Evaluating a Group Intervention Addressing Wellbeing Among Syrian Women in Türkiye

Background and purpose: Group interventions demonstrate promise in promoting wellbeing among refugees in diverse contexts globally. When the Assad regime in Syria ended in late 2024, the largest number of Syrians outside their country resided in Turkiye. Research with Syrian refugees residing in Turkiye identifies high rates of distress and trauma. This study evaluates a 5-week culturally-adapted cognitive behavioral therapy group intervention, “Coping with Stress – Self-Care and Empowerment,” conducted with Syrian women across five sites in Turkiye (Istanbul, Ankara, Izmir, Gaziantep, and Adana). This randomized controlled trial tested an intervention group and a waitlist control group within each of the five sites. We hypothesize that the intervention is feasible and acceptable to implement and that participation promotes wellbeing among young adult Syrian women.

Methods: As a part of this experimental study, Syrian women aged 18 – 30 were recruited through the non-government organization ASAM (Association for Social Development and Aid Mobilization). ASAM provides services to people in need including refugees andasylum seekers. After approximately 30 participants were enrolled in each of five sites, randomization divided participants into two groups. The key study outcome included emotional distress, assessed using the Refugee Health Screening (RHS)-15. Investigators in the U.S. and Turkiye worked collaboratively to develop and pilot-test the intervention. The 5-week group model emphasized mindfulness, emotion regulation, and psychological flexibility, with a focus on breathing, stretching, and visualization. Cohen’s d effect sizes were used to compare differences between the intervention group and the waitlist conrol group after the intervention group was completed. Change scores were used to minimize the effect of baseline differences. Analysis also examined qualitative feedback from participants.

Results: 148 participants were randomized to either the initial intervention group or the waitlist control group. Group interventionswere conduced in 2024, and attendance averaged 72%. Distress scores were high at the baseline assessment, with 94% experiencing distress and an average RHS-15 score of 29. At the post-test follow-up assessment, distress scores dropped significantly for those in the intervention group, but not for those in the waitlist control group. Comparing the treatment group to the waitlist control group revealed a moderate to large effect size of .69 for emotional distress. In qualitative feedback, participants indicated they appreciated opportunities to learn valuable skills and share experiences with other women.

Conclusions and implications: Globally, nations are becoming increasingly hostile towards refugees and asylum seekers. While policy solutions are needed, organizations and communities play a valuable role in promoting wellbeing among displaced communities in countries such as Turkiye. Efforts to support women and other vulnerable groups through programs that build coping strategies, awareness, and connections, are critical. Community organizations and advocates can seek to expand such resources in creative ways, while also working for increased opportunities for safety, integration, and legal permanence.