Post-Conflict Trauma Recovery Models in the Middle East: A Comparative Analysis
DOI:
https://doi.org/10.55606/termometer.v3i4.5617Keywords:
CBT, EMDR, Middle East, NET, Therapeutic EffectivenessAbstract
This meta-analysis comprehensively examines the effectiveness of various post-conflict trauma recovery models in the Middle East by analyzing 78 studies involving a total of N=12,467 participants published between 2000 and 2024. The synthesis results indicate three dominant approaches occupying primary positions in intervention frameworks, namely Cognitive Behavioral Therapy (CBT) with an effect size of d=0.82 (95% CI: 0.76–0.88), Eye Movement Desensitization and Reprocessing (EMDR) with d=0.77 (95% CI: 0.71–0.83), and Narrative Exposure Therapy (NET) with d=0.69 (95% CI: 0.63–0.75). Moderator analysis reveals that the variables of intervention duration (β=0.31, p<0.001) and therapist qualification (β=0.28, p<0.001) play significant roles in determining therapeutic success. CBT demonstrates the highest effectiveness in addressing PTSD (r=0.73, p<0.001), whereas NET proves superior in managing collective trauma (r=0.68, p<0.001). Compared to the findings of Knaevelsrud et al. (2015) and Alzaghoul et al. (2022), which previously reported only moderate effectiveness within the range of d=0.45–0.60, this study shows a substantial improvement in trauma intervention outcomes. Furthermore, the latest findings indicate that integrating cultural-spiritual elements into CBT produces a 27% increase in effectiveness (p<0.001), representing a previously undocumented result in earlier meta-analyses and marking an original contribution of this study. Overall, the findings provide a robust empirical foundation for developing trauma intervention protocols that are more contextual, adaptive, and effective in conflict-affected regions.
Downloads
References
Abdul-Hamid, W. K., & Hughes, J. H. (2015). Integration of religion and spirituality into trauma psychotherapy: An example in Sufism? Journal of EMDR Practice and Research, 9(3), 150–156. https://doi.org/10.1891/1933-3196.9.3.150
Abi Ramia, J., Abi Hana, R., Noun, P., Cuijpers, P., Carswell, K., Van't Hof, E., ... & El Chammay, R. (2024). Feasibility and uptake of a digital mental health intervention for depression among Lebanese and Syrian displaced people in Lebanon: A qualitative study. Frontiers in Public Health, 11, 1293187. https://doi.org/10.3389/fpubh.2024.1293187
Acarturk, C., Konuk, E., Cetinkaya, M., Senay, I., Sijbrandij, M., Gulen, B., & Cuijpers, P. (2016). The efficacy of eye movement desensitization and reprocessing for post-traumatic stress disorder and depression among Syrian refugees: Results of a randomized controlled trial. Psychological Medicine, 46(12), 2583–2593. https://doi.org/10.1017/S0033291716001070
Acarturk, C., Konuk, E., Cetinkaya, M., Senay, I., Sijbrandij, M., Cuijpers, P., & Aker, T. (2016). EMDR for Syrian refugees with posttraumatic stress disorder symptoms: Results of a pilot randomized controlled trial. European Journal of Psychotraumatology, 6(1), 27414. https://doi.org/10.3402/ejpt.v6.27414
Afana, A. H., Pedersen, D., Rønsbo, H., & Kirmayer, L. J. (2010). Endurance is to be shown at the first blow: Social representations and reactions to traumatic experiences in the Gaza Strip. Traumatology, 16(4), 73–84. https://doi.org/10.1177/1534765610395663
Ali, A. S. A. S. A. (2020). Efficiency of intervention counseling program on the enhanced psychological well-being and reduced post-traumatic stress disorder symptoms among Syrian women refugee survivors. Clinical Practice and Epidemiology in Mental Health: CP & EMH, 16(Suppl 1), 134–142. https://doi.org/10.2174/1745017902016010134
Ali, R., Brown, F. L., Stevenson, K., Jordans, M., Taha, K., Amine, M. E., ... & STRENGTHS Consortium. (2024). Implementing a non-specialist delivered psychological intervention for young adolescents in a protracted refugee setting: A qualitative process evaluation in Lebanon. The Journal of Behavioral Health Services & Research, 51(3), 377–394. https://doi.org/10.1007/s11414-023-09884-8
Al-Krenawi, A., & Graham, J. R. (2011). Mental health help-seeking among Arab university students in Israel, differentiated by religion. Mental Health, Religion & Culture, 14(2), 157–167. https://doi.org/10.1080/13674670903443432
Al-Krenawi, A., Graham, J. R., & Sehwail, M. A. (2007). Mental health and violence/trauma in Palestine: Implications for helping practice. Journal of Comparative Family Studies, 38(2), 181–201. https://doi.org/10.3138/jcfs.38.2.181
Al-Smadi, A. M., Tawalbeh, L. I., Gammoh, O. S., Ashour, A. F., & Alshraifeen, A. (2022). Post-traumatic stress disorder and coping strategies among Syrian refugees in Jordan. BMC Psychiatry, 22, 189. https://doi.org/10.1186/s12888-022-03823-y
Al-Tamimi, S. A. G., & Leavey, G. (2022). Community-based interventions for the treatment and management of conflict-related trauma in low-middle income, conflict-affected countries: A realist review. Journal of Child & Adolescent Trauma, 15(2), 441–450. https://doi.org/10.1007/s40653-021-00384-3
Alzaghoul, A. F., McKinlay, A. R., & Archer, M. (2022). Post-traumatic stress disorder interventions for children and adolescents affected by war in low- and middle-income countries in the Middle East: Systematic review. BJPsych Open, 8(5), e153. https://doi.org/10.1192/bjo.2022.552
Alzoubi, F. A., Al-Sheyab, N., Kanaan, S. F., Alrimawi, I., & Hamdan-Mansour, A. (2021). The impact of trauma exposure on the mental health of Syrian refugees in Jordan: The moderating role of resilience. Issues in Mental Health Nursing, 42(10), 917–924. https://doi.org/10.1080/01612840.2021.1922232
Araya, M., Chotai, J., Komproe, I. H., & de Jong, J. T. V. M. (2007). Effect of trauma on quality of life as mediated by mental distress and moderated by coping and social support among postconflict displaced Ethiopians. Quality of Life Research, 16(6), 915–927. https://doi.org/10.1007/s11136-007-9201-9
Atallah, D. G. (2017). A community-based qualitative study of intergenerational resilience with Palestinian refugee families facing structural violence and historical trauma. Transcultural Psychiatry, 54(3), 357–383. https://doi.org/10.1177/1363461517706287
Başoğlu, M., Livanou, M., Crnobarić, C., Frančišković, T., Suljić, E., Đurić, D., & Vranešić, M. (2005). Psychiatric and cognitive effects of war in former Yugoslavia: Association of lack of redress for trauma and posttraumatic stress reactions. JAMA, 294(5), 580–590. https://doi.org/10.1001/jama.294.5.580
Bass, J., Murray, S. M., Mohammed, T. A., Bunn, M., Gorman, W., Ahmed, A. M. A., ... & Bolton, P. (2016). A randomized controlled trial of a trauma-informed support, skills, and psychoeducation intervention for survivors of torture and related trauma in Kurdistan, Northern Iraq. Global Health: Science and Practice, 4(3), 452–466. https://doi.org/10.9745/GHSP-D-16-00063
Benjamin, L., Gillard, S., Jones Nielsen, J., Costa E. Silva, M., & Sin, J. (2025). Cultural adaptations to the assessment and treatment of trauma experiences among racial and ethnic minority groups: A mixed-methods systematic review and meta-analysis. Trauma, Violence, & Abuse, 26(1), 1–27. https://doi.org/10.1177/15248380251320982
Berhe, K. T., Gesesew, H. A., & Ward, P. R. (2024). Traditional healing practices, factors influencing access to the practices, and their complementary effect on mental health in sub-Saharan Africa: A systematic review. BMJ Open, 14(9), e083004. https://doi.org/10.1136/bmjopen-2023-083004
Betancourt, T. S., Borisova, I., Williams, T. P., Meyers-Ohki, S., Rubin-Smith, J., Annan, J., & Kohrt, B. A. (2013). Psychosocial adjustment and mental health in former child soldiers–systematic review of the literature and recommendations for future research. Journal of Child Psychology and Psychiatry, 54(1), 17–36. https://doi.org/10.1111/j.1469-7610.2012.02620.x
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2021). Introduction to meta-analysis (2nd ed.). Wiley. https://doi.org/10.1002/9781119558370
Bryant, R. A., Edwards, B., Creamer, M., O’Donnell, M., Forbes, D., Felmingham, K. L., ... & Silove, D. (2018). The effect of post-traumatic stress disorder on refugees’ parenting and their children’s mental health: A cohort study. The Lancet Public Health, 3(5), e249–e258. https://doi.org/10.1016/S2468-2667(18)30051-3
Burchert, S., Alkneme, M. S., Bird, M., Carswell, K., Cuijpers, P., Hansen, P., ... & Knaevelsrud, C. (2019). User-centered app adaptation of a low-intensity e-mental health intervention for Syrian refugees. Frontiers in Psychiatry, 9, 663. https://doi.org/10.3389/fpsyt.2018.00663
Burgund Isakov, A., & Markovic, V. (2024). Systematic review of trauma-informed approaches and trauma-informed care for forced migrant families: Concepts and contexts. Trauma, Violence, & Abuse, 25(5), 3999–4015. https://doi.org/10.1177/15248380231151220
Carswell, K., Harper Shehadeh, M., Watts, S., van’t Hof, E., Abi Ramia, J., Heim, E., ... & Cuijpers, P. (2018). Step-by-Step: A new WHO digital mental health intervention for depression. mHealth, 4, 34. https://doi.org/10.21037/mhealth.2018.08.01
Charlson, F., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. (2019). New WHO prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis. The Lancet, 394(10194), 240–248. https://doi.org/10.1016/S0140-6736(19)30934-1
Charlson, F., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. (2019). New WHO prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis. The Lancet, 394(10194), 240–248. https://doi.org/10.1016/S0140-6736(19)30934-1
Chu, Y. C., Wang, H. H., Chou, F. H., Hsu, Y. F., & Liao, K. L. (2024). Outcomes of trauma‐informed care on the psychological health of women experiencing intimate partner violence: A systematic review and meta‐analysis. Journal of Psychiatric and Mental Health Nursing, 31(2), 203–214. https://doi.org/10.1111/jpm.12993
Crombach, A., Wilker, S., Hermenau, K., Wieling, E., & Hecker, T. (2025). Treating and preventing psychological trauma of children and adolescents in post-conflict settings. In Evidence-based treatments for trauma-related disorders in children and adolescents (pp. 699–723). Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-40224-1_28
Cuijpers, P., Karyotaki, E., de Wit, L., & Ebert, D. D. (2020). The effects of fifteen evidence-supported therapies for adult depression: A meta-analytic review. Psychotherapy Research, 30(3), 279–293. https://doi.org/10.1080/10503307.2019.1649732
Damra, J. K. M., Nassar, Y. H., & Ghabri, T. M. F. (2014). Trauma-focused cognitive behavioral therapy: Cultural adaptations for application in Jordanian culture. Counselling Psychology Quarterly, 27(3), 308–323. https://doi.org/10.1080/09515070.2013.875887
de Jong, J. T. V. M., Komproe, I. H., & van Ommeren, M. (2003). Common mental disorders in postconflict settings. The Lancet, 361(9375), 2128–2130. https://doi.org/10.1016/S0140-6736(03)13692-6
Dragayeva, S., Bodner, E., Mann, S., & Stone, J. (2025). The Virtual Ukraine Project: Trauma therapy in warzones with virtual reality. In Mental health virtual reality: The power of immersive worlds (p. 159). Springer. https://doi.org/10.1007/978-3-031-51522-4_9
Eagle, G. T. (1998). Promoting peace by integrating Western and indigenous healing in treating trauma. Peace and Conflict: Journal of Peace Psychology, 4(3), 271–282. https://doi.org/10.1207/s15327949pac0403_6
Egger, M., Davey Smith, G., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315(7109), 629–634. https://doi.org/10.1136/bmj.315.7109.629
Elayah, M., Al-Sameai, N., Khodr, H., & Gamar, S. (2024). Community-based initiatives and public services delivery in a fragile context: The case of Yemen. Nonprofit and Voluntary Sector Quarterly, 53(1), 5–28. https://doi.org/10.1177/08997640221145182
Epping-Jordan, J. E., Harris, R., Brown, F. L., Carswell, K., Foley, C., García-Moreno, C., ... & van Ommeren, M. (2015). Self-Help Plus (SH+): A new WHO stress management package. World Psychiatry, 15(3), 295–296. https://doi.org/10.1002/wps.20355
Epping-Jordan, J. E., Harris, R., Brown, F. L., Carswell, K., Foley, C., García-Moreno, C., ... & van Ommeren, M. (2015). Self-Help Plus (SH+): A new WHO stress management package. World Psychiatry, 15(3), 295–296. https://doi.org/10.1002/wps.20355
Ertl, V., & Neuner, F. (2014). Are school-based mental health interventions for war-affected children effective and harmless? BMC Medicine, 12(1), 84. https://doi.org/10.1186/1741-7015-12-84
Eytan, A., Munyandamutsa, N., Mahoro Nkubamugisha, P., & Gex-Fabry, M. (2015). Long-term mental health outcome in post-conflict settings: Similarities and differences between Kosovo and Rwanda. International Journal of Social Psychiatry, 61(4), 363–372. https://doi.org/10.1177/0020764014553004
Farhood, L. F., Dimassi, H., & Lehtinen, T. (2006). Exposure to war-related traumatic events, prevalence of PTSD, and general psychiatric morbidity in a civilian population from Southern Lebanon. Journal of Transcultural Nursing, 17(4), 333–340. https://doi.org/10.1177/1043659606291549
Feldman, R., Vengrober, A., & Ebstein, R. P. (2014). Affiliation buffers stress: Cumulative genetic risk in oxytocin–vasopressin genes combines with early caregiving to predict PTSD in war-exposed young children. Translational Psychiatry, 4(3), e370. https://doi.org/10.1038/tp.2014.8
Harper Shehadeh, M., Heim, E., Chowdhary, N., Maercker, A., & Albanese, E. (2016). Cultural adaptation of minimally guided interventions for common mental disorders: A systematic review and meta-analysis. JMIR Mental Health, 3(3), e44. https://doi.org/10.2196/mental.5776
Hassan, G., Ventevogel, P., Jefee-Bahloul, H., Barkil-Oteo, A., & Kirmayer, L. J. (2016). Mental health and psychosocial wellbeing of Syrians affected by armed conflict. Epidemiology and Psychiatric Sciences, 25(2), 129–141. https://doi.org/10.1017/S2045796016000044
Hijazi, Z., Weissbecker, I., & Chammay, R. E. (2011). The integration of mental health into primary health care in Lebanon. Intervention, 9(3), 265–278. https://doi.org/10.1097/WTF.0b013e32834d8e59
Ibrahim, H., & Hassan, C. Q. (2017). Post-traumatic stress disorder symptoms resulting from torture and other traumatic events among Syrian Kurdish refugees in Kurdistan Region, Iraq. Frontiers in Psychology, 8, 241. https://doi.org/10.3389/fpsyg.2017.00241
Jefee-Bahloul, H., Moustafa, M. K., Shebl, F. M., & Barkil-Oteo, A. (2014). Pilot assessment and survey of Syrian refugee mental health needs in Lebanon. Community Mental Health Journal, 50(4), 477–482. https://doi.org/10.1007/s10597-013-9612-5
Karam, E. G., Fayyad, J., Karam, A. N., Melhem, N., & Mneimneh, Z. (2014). War and mental disorders among the Lebanese population: A national study. World Psychiatry, 13(3), 266–272. https://doi.org/10.1002/wps.20157
Kazour, F., Zahreddine, N. R., Maragel, M. G., Almustafa, M. A., Soufia, M., Haddad, R., & Richa, S. (2017). Post-traumatic stress disorder in a sample of Syrian refugees in Lebanon. Comprehensive Psychiatry, 72, 41–47. https://doi.org/10.1016/j.comppsych.2016.09.006
Kira, I. A., Ashby, J. S., Lewandowski, L., Al-Huwailah, A. H., & Mohanesh, J. (2013). Advances in continuous traumatic stress theory: Traumatogenic dynamics and consequences of intergroup conflict: The Palestinian adolescents case. Psychology, 4(4), 396–409. https://doi.org/10.4236/psych.2013.44057
Knaevelsrud, C., Brand, J., Lange, A., Ruwaard, J., & Wagner, B. (2015). Web-based psychotherapy for posttraumatic stress disorder in war-traumatized Arab patients: Randomized controlled trial. Journal of Medical Internet Research, 17(3), e71. https://doi.org/10.2196/jmir.3582
Langer, A. I., Díaz, M., Villegas, P., Rojas, G., & Krause, M. (2019). Web-based mindfulness interventions for people with mental disorders: Systematic review and meta-analysis. JMIR Mental Health, 6(8), e10278. https://doi.org/10.2196/10278
Mahfoud, Z. R., Afifi, R. A., Haddad, P., & DeJong, J. (2011). Prevalence and determinants of mental disorders among Syrian refugee children in Lebanon. Child and Adolescent Psychiatry and Mental Health, 5(1), 30. https://doi.org/10.1186/1753-2000-5-30
Miller, K. E., & Rasmussen, A. (2017). The mental health of civilians displaced by armed conflict: An ecological model of refugee distress. Epidemiology and Psychiatric Sciences, 26(2), 129–138. https://doi.org/10.1017/S2045796016000172
Nickerson, A., Bryant, R. A., Steel, Z., Silove, D., & Brooks, R. (2010). The impact of fear for family on mental health in a resettled Iraqi refugee community. Journal of Psychiatric Research, 44(4), 229–235. https://doi.org/10.1016/j.jpsychires.2009.08.006
Rahman, A., Hamdani, S. U., Awan, N. R., Bryant, R. A., Dawson, K. S., Khan, M. F., ... & van Ommeren, M. (2016). Problem Management Plus (PM+): A WHO transdiagnostic psychological intervention for common mental health problems. World Psychiatry, 15(2), 190–191. https://doi.org/10.1002/wps.20315
Sijbrandij, M., Acarturk, C., Bird, M., Bryant, R. A., Burchert, S., Carswell, K., ... & van Ommeren, M. (2017). Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: Integrating scalable psychological interventions in eight countries. European Journal of Psychotraumatology, 8(sup2), 1388102. https://doi.org/10.1080/20008198.2017.1388102
Sijbrandij, M., Bryant, R. A., Schafer, A., Dawson, K. S., Anjuri, D., Ndogoni, L., ... & van Ommeren, M. (2017). Problem Management Plus (PM+): A WHO transdiagnostic psychological intervention for common mental health problems in communities affected by adversity. World Psychiatry, 16(3), 294–295. https://doi.org/10.1002/wps.20405
Tol, W. A., Barbui, C., & van Ommeren, M. (2021). Mental health and psychosocial support in humanitarian settings: A public mental health perspective. Epidemiology and Psychiatric Sciences, 30, e67. https://doi.org/10.1017/S2045796021000567
Tol, W. A., Leku, M. R., Lakin, D. P., Carswell, K., Augustinavicius, J., Adaku, A., ... & Ventevogel, P. (2020). Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: A cluster randomized trial. World Psychiatry, 19(2), 185–193. https://doi.org/10.1002/wps.20712
van Ommeren, M., Hanna, F., Weissbecker, I., Ventevogel, P., & Saxena, S. (2015). Mental health in primary care: Enhancing treatment and promoting mental health in countries exposed to adversity. Eastern Mediterranean Health Journal, 21(7), 535–537. https://doi.org/10.26719/2015.21.7.535
van’t Hof, E., Heim, E., Abi Ramia, J., Burchert, S., Cuijpers, P., Sijbrandij, M., & Knaevelsrud, C. (2022). Cultural adaptation of digital mental health interventions for refugees and conflict-affected populations: A systematic review. Journal of Medical Internet Research, 24(5), e37300. https://doi.org/10.2196/37300
Ventevogel, P., Ryan, G. K., Kahi, V., & Kane, J. C. (2019). Improving mental health care in humanitarian emergencies. Bulletin of the World Health Organization, 97(10), 722–722A. https://doi.org/10.2471/BLT.19.239244
Watts, S., van Ommeren, M., Cuijpers, P., & Burchert, S. (2022). Digital mental health interventions for people affected by humanitarian crises: Review and policy recommendations. World Psychiatry, 21(3), 437–438. https://doi.org/10.1002/wps.21046
Weissbecker, I., Hanna, F., El Shazly, M., Gao, J., & Ventevogel, P. (2018). Integrative mental health and psychosocial support interventions for refugees in humanitarian crisis settings. In V. Patel, D. Chisholm, T. Dua, R. Laxminarayan, & M. E. Medina-Mora (Eds.), Disease Control Priorities: Mental, Neurological, and Substance Use Disorders (3rd ed., Vol. 4, pp. 325–342). World Bank. https://doi.org/10.1596/978-1-4648-0426-7_ch19
Whaibeh, E., Mahmoud, H., & Naal, H. (2020). Telemental health in the context of a pandemic: The COVID-19 experience. Current Treatment Options in Psychiatry, 7(2), 198–202. https://doi.org/10.1007/s40501-020-00210-2
Yaser, A., Slewa-Younan, S., Mond, J., Melkonian, M., Mohammad, Y., Dover, H., ... & Jorm, A. F. (2016). Psychosocial status and mental health among Syrian refugees in Jordan: A cross-sectional study. Social Psychiatry and Psychiatric Epidemiology, 51(9), 1349–1359. https://doi.org/10.1007/s00127-016-1259-0
Zhou, X., Snoswell, C. L., Harding, L. E., Bambling, M., Edirippulige, S., Bai, X., & Smith, A. C. (2020). The role of telehealth in reducing the mental health burden from COVID-19. Telemedicine and e-Health, 26(4), 377–379. https://doi.org/10.1089/tmj.2020.0068
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.








