Improving access to psychological intervention in low-middle income settings: Results from a waitlist-controlled, proof-of-concept trial of the MemFlex intervention for trauma-exposed Afghan youth.

BACKGROUND: Low-intensity interventions targeting a range of mental health issues offer a scalable approach for young trauma survivors in low-middle income countries. AIMS: Here, we present results from a proof-of-concept, randomized, waitlist-controlled trial evaluating MemFlex, an autobiographical memory-based intervention, for trauma-exposed Afghan youth residing in Iran. MemFlex seeks to reduce the negative and overgeneral memory biases which maintain and predict poor mental health. MATERIALS AND METHODS: Young people aged 12-18 years (N = 40) with parents who had experienced forced migration from Afghanistan were recruited from high schools in Karaj City in Iran. All had experienced a traumatic event in the last year. Participants were randomized to receive four weeks of a group-based delivery of MemFlex or Waitlist. Our primary cognitive outcome was autobiographical memory flexibility, that is, the ability to deliberately retrieve any memory type on demand. Primary clinical outcome was emotional distress, measured on the Farsi version of the Hopkins Symptom Checklist. RESULTS: Results indicated that MemFlex participants demonstrated large effect sizes for pre-to-post improvement in memory flexibility (d = 2.04) and emotional distress (d = 1.23). These improvements were significantly larger than Waitlist (ds < .49), and were maintained at three-month follow-up. DISCUSSION: Positive benefits were observed for completion of MemFlex, and future comparison against an active intervention appears warranted. CONCLUSION: Further evaluation of MemFlex in this context may offer a low-cost, and low-resource intervention to improve access to psychological intervention for young migrants in low-middle income countries.

Affective working memory capacity in refugee adolescents.

OBJECTIVE: High numbers of adolescents today are exposed to conflict-related trauma, with trauma-exposure being associated with adverse biopsychosocial outcomes. Here we investigated the influence of trauma-exposure and high levels of posttraumatic stress disorder (PTSD) symptoms on cognitive functioning in trauma-related compared to neutral contexts. METHOD: Afghan adolescent refugees with high levels of PTSD symptomatology and non-trauma-exposed Afghan adolescent refugee controls (N = 47; 43% female; aged 13-19 years, M = 15.49, SD = 1.40) completed a visual working memory task including affective (trauma-related) and neutral distractors. RESULTS: Working memory capacity in the context of trauma-related distractors (and not neutral distractors) was significantly poorer in trauma-exposed refugees with high levels of PTSD when compared to non-trauma-exposed controls. CONCLUSIONS: The findings highlight the importance of investigating posttraumatic cognitive functioning within affective contexts and suggest that affective working memory capacity may constitute a promising target for intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Impact of COVID-19 Outbreak on Emotional and Cognitive Vulnerability in Iranian Women With Breast Cancer.

The psychological cost on emotional well-being due to the collateral damage brought about by COVID-19 in accessing oncological services for breast cancer diagnosis and treatment has been documented by recent studies in the United Kingdom. The current study set out to examine the effect of delays to scheduled oncology services on emotional and cognitive vulnerability in women with a breast cancer diagnosis in Iran, one of the very first countries to be heavily impacted by COVID-19. One hundred thirty-nine women with a diagnosis of primary breast cancer answered a series of online questionnaires to assess the current state of rumination, worry, and cognitive vulnerability as well as the emotional impact of COVID-19 on their mental health. Results indicated that delays in accessing oncology services significantly increased COVID related emotional vulnerability. Regression analyses revealed that after controlling for the effects of sociodemographic and clinical variables, women's COVID related emotional vulnerability explained higher levels of ruminative response and chronic worry as well as poorer cognitive function. This study is the first in Iran to demonstrate that the effects of COVID-19 on emotional health amongst women affected by breast cancer can exaggerate anxiety and depressive related symptoms increasing risks for clinical levels of these disorders. Our findings call for an urgent need to address these risks using targeted interventions exercising resilience.

Investigating Emotion in Malay, Australian and Iranian Individuals with and without Depression.

This study investigated the influence of culture and depression on (1) emotion priming reactions, (2) the recall of subjective experience of emotion, and (3) emotion meaning. Members of individualistic culture (Australia, n = 42) and collectivistic culture (Iran, n = 32, Malaysia, n = 74) with and without depression completed a biological motion task, subjective experience questionnaire and emotion meaning questionnaire. Those with depression, regardless of cultural group, provided significantly fewer correct responses on the biological motion task than the control group. Second, the collectivistic control groups reported greater social engaging emotion than the Australian control group. However, the three depressed groups did not differ culturally. The Australian depressed group reported significantly greater interpersonally engaging emotion than the Australian control group. Third, the collectivistic groups reported significantly greater social worth, belief changes and sharing of emotion than the individualistic group. Depression did not influence these cultural effects. Instead we found that those with depression, when compared to controls, considered emotions as subjective phenomena, that were qualifying for relationships with others, and associated with greater agency appraisals. The applicability of the biocultural framework of emotion in depression was considered.

A preliminary study investigating time perception in adolescents with posttraumatic stress disorder and major depressive disorder.

OBJECTIVE: The aim of the current study was to conduct a preliminary investigation into time perception in adolescents with posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and healthy controls. METHOD: Iranian adolescents with PTSD (n = 15) or MDD (n = 15) and healthy, non-trauma-exposed control participants (n = 15) completed 3 measures of time perception: a verbal time estimation task, a production task, and a reproduction task. RESULTS: The PTSD group was found to have significantly poorer overall time perception accuracy compared to the control group (d = 1.38). Group differences were dependent on the type of time perception task; the groups did not differ significantly on the time reproduction task but did differ significantly on the verbal time estimation task and production task. The PTSD group had significantly poorer time estimate accuracy (i.e., underestimates) on the verbal estimation task than did the MDD group (d = 1.10), and the control group performed at the intermediate level. The PTSD and MDD groups did not differ significantly on the production task, but both clinical groups had significantly poorer performance than did the control group (ds> .76). Finally, working memory mediated the relationship between group and time perception accuracy (95% confidence interval [2.10, 38.69]). CONCLUSIONS: These findings highlight the need for further research examining time perception in PTSD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).