Memory Training for Recovery-Adolescent: An intervention for adolescent refugees

Research Snapshot: Supporting Trauma Recovery in Adolescents Through Memory Training

This mixed-methods trial examined METRA (Memory Training for Recovery Adolescents) and found that it shows promise as a feasible and effective mental health intervention for adolescents who have experienced conflict, violence, or displacement.

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What did the study set out to achieve?

Many adolescents living through war, violence, or other traumatic events in crisis-affected areas struggle with serious emotional distress. However, they have little access to mental health support. Both Afghanistan and Northern Iraq have large adolescent populations. Young people in these regions have been affected by conflict and insecurity, leading to high levels of trauma exposure and heightened psychological distress. Access to specialised care is often limited or unavailable

The study aimed to:

1. Investigate the efficacy of METRA in improving psychological symptoms (posttraumatic stress disorder, depression, and well-being) in adolescent refugees.
2. Investigate the feasibility and appropriateness of METRA for refugee adolescents delivered by local NGOs in low- and middle-income country (LMIC) humanitarian contexts.
3. Examine the mechanisms mediating treatment effects.
4. Include a cost-analysis of METRA in LMIC humanitarian contexts.

To achieve these aims, METRA was compared to treatment as usual (TAU; i.e. study skills group, puberty health group, and trauma-informed interventions) across four studies with young people aged 10–19 years in Kabul, Afghanistan (three studies, 303 participants) and Kirkuk, Iraq (one study, 132 participants). Local health workers were trained to deliver METRA in small group sessions (ten sessions over a fortnight). Qualitative research explored feasibility and acceptability with facilitators and adolescents, and cost-effectiveness was also evaluated.

What were the key findings?

• When compared to control groups (puberty health, study skills), adolescents offered METRA had significant improvements in symptoms of post-traumatic stress, depression, and anxiety.
• When compared to TAU (trauma-informed interventions), while those in the METRA group had symptom improvements, these improvements were not superior to those observed in TAU.
• Adolescents and facilitators reported high satisfaction with METRA, and most adolescents attended all METRA sessions. METRA was associated with low drop-out rates (15-23%), with the exception of the clinical trial with boys (46%) due to METRA interfering with class time.
• METRA was less costly than TAU, with implementation costing USD3340 (USD33 per group session) versus TAU (USD6974). The cost per point reduction in PTSD symptoms was USD305 for METRA vs. USD575 for TAU, and USD1022 vs. USD1900 for depression

What does this mean for policymakers and practitioners?

METRA has shown promise as a feasible and effective mental health intervention for adolescents in humanitarian settings. METRA was less costly than standard care while delivering comparable benefits for adolescent mental health, with implementation costing USD3340 (USD33 per group session) versus TAU (USD6974).

Delivered by trained community health workers, it can be integrated into existing health services at low cost. Facilitators noted improvements in the mental health of youth, METRA could be readily delivered, and METRA helped youth develop new skills and learn from the past in the present and plan for the future.

Findings suggest that METRA can reduce posttraumatic stress symptoms and improve mood and cognitive functioning among youth affected by conflict and is placement. For humanitarian practitioners and policymakers, METRA offers a scalable, evidence-based approach to addressing the urgent mental health needs of adolescents in crisis settings—helping to fill a critical gap in provision.

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