This study evaluated whether a culturally adapted 10-week narrative therapy program could reduce anxiety and depression symptoms among middle school students living in refugee camps in Northern Palestine. Adolescents aged 12-15 years from UNRWA-operated schools with moderate-to-severe anxiety and depression symptoms participated. The study used a quasi-experimental design with 120 students assigned to either the narrative therapy program (n=60) or standard school services (n=60). The 10-week program included weekly 60-minute group sessions that incorporated Palestinian cultural metaphors such as sumud (steadfastness) and olive tree symbolism. Participants completed the Revised Children's Anxiety and Depression Scale (RCADS) at three time points: before the program, immediately after the 10-week intervention, and three months later. The study measured changes in anxiety and depression symptoms, clinical improvement, and feasibility outcomes including retention, fidelity, and acceptability. Results showed that participants in the narrative therapy program experienced greater reductions in anxiety and depression symptoms compared to those receiving standard school services. The effects were maintained at the three-month follow-up. Seventy-two percent of intervention participants achieved clinically significant improvement compared to 21% of controls. The program demonstrated high retention (95%), good implementation fidelity (87.3%), and strong acceptability (85% of participants found the cultural metaphors helpful). The findings suggest that culturally adapted school-based narrative therapy may be a feasible and promising approach for addressing mental health needs among refugee adolescents in humanitarian settings. However, because this was not a randomized controlled trial, the results should be interpreted as associations rather than definitive causal effects.
Who can participate
Age range
12 Years – 15 Years
Sex
ALL
See this in plain English?
AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.
Inclusion Criteria:
* Middle school students in grades 6-9
* Aged 12-15 years
* Moderate-to-severe symptoms of anxiety and depression as measured by the Revised Children's Anxiety and Depression Scale (RCADS T-scores ≥ 65)
* Written informed consent from parent or legal guardian
* Written assent from the student
* Enrolled in a UNRWA-operated middle school in one of the participating refugee camps (Jenin, Balata, or Askar)
Exclusion Criteria:
* Current involvement in other mental health interventions or psychotherapy
* Severe psychiatric disorders requiring specialist care (e.g., psychosis, bipolar disorder, severe eating disorders)
* Inability to complete study assessments due to language or cognitive barriers
* Severe emotional or behavioral difficulties that would prevent participation in group sessions
Questions worth asking your doctor
Bring these to your next appointment. They're a starting point for a shared conversation — not a sign you qualify or a recommendation to enrol.
1This trial used narrative therapy specifically with Palestinian refugee adolescents — if my situation or background is different, is there evidence that this same approach would work for someone like me or my child?
2Since this study is already completed, have the results been published yet, and what did they actually find about whether narrative therapy reduced anxiety and depression symptoms in the adolescents who took part?
3Narrative therapy is a talking-based approach — how does it compare to other treatments my doctor might already recommend, like cognitive behavioral therapy or medication, for anxiety and major depressive disorder?
4This trial was listed as Phase NA, meaning it wasn't a standard drug trial — does that affect how confident we should be in the safety and effectiveness of narrative therapy based on what this study found?
5If the results from this trial look promising, are there any therapists or programs near us that are already trained in narrative therapy, or would we need to find another way to access this kind of treatment?
Generated to help you prepare — always confirm anything about your own eligibility and care with the study team and your doctor.
Questions for the trial coordinator
The trial coordinator is the person who runs the study day to day. These cover the practical side — logistics, costs, and what taking part would actually mean for your life. The study team confirms whether you meet the criteria; these are questions to ask, not a sign you qualify.
1What does taking part actually involve week to week — how many visits, where, and how long does each one take?
2What costs are covered by the study, and what might I have to pay for myself, including travel, parking, or time off work?
3What happens during screening, and what happens if the study team confirms I don't meet the criteria after those tests?
4Who pays for the scans, blood work, and other tests the trial requires — the study, my insurance, or me?
5How will being in the trial affect my regular care, and will my own doctor stay informed and involved?
6Can I leave the trial at any point if I change my mind, and what would happen to my care if I do?
A starting point for the conversation — always confirm anything about your own eligibility, costs, and care with the study team and your doctor.
What they're measuring
1
Change in Anxiety and Depression Symptoms
Timeframe: Baseline (pre-intervention), immediately post-intervention (Week 10), and 3-month follow-up
Trial details
NCT IDNCT07691021
SponsorNablus University for Vocational and Technical Education