The researchers used a psychoeducation intervention program, The Field Guide for Barefoot Psychology with Syrian refugees in the Za’atri Refugee Camp in Jordan and found that the subjects’ average mental health stigma and trauma decreased and emotional regulation improved, according to a Beyond Conflict research brief.

In the randomized controlled trial, the researchers divided 160 adult Syrians living in the camp into three groups that would use The Field Guide. (The final number of study participants was 128 as 19 officially withdrew and 13 who attended less than 50% of the activities were not counted in the final sample.) Forty-three subjects (46.5% female) used The Field Guide as a self-directed tool, 36 subjects (52.8% female) participated in guided reading of The Field Guide in a workshop structure, and 49 subjects (49% female) formed a waitlist that received the intervention as a workshop 8 weeks later than the other treatment groups.

The researcher assessed each subject before the intervention, immediately after the intervention, and 3 months after the intervention. Undergraduate and graduate school psychology students collected participants’ demographic information and measured mental health stigma, emotional regulation, and trauma-related symptoms.

The study authors found that the intervention led to improvement for the self-directed group from baseline to the first post-intervention assessment (Mdiff = 1.07, P =.03, d = 0.32), for the workshop group from baseline to the follow-up (Mdiff = 1.14, P =.034, d = 0.39), as well as a replication of intervention findings for the waitlist group (F [1, 80.7] = 9.76, P =.002) and lack of condition effect (F [1, 0.46] = 0.30, P = .743). The researchers noted that the change seen increased (Mdiff = -1.9, P < .001, d = 0.86) when they honed in on the findings regarding subjects who had “relatively high stigma” at baseline.

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Emotional regulation also increased, the researchers said. All groups experienced increases between baseline and the first post-assessment (reading: Mdiff = – .387, P = .049, d = .4; workshop: Mdiff = -1.026, P <.001, d = .91; waitlist: F [1, 81.71] = 24.8, P <.001), but the reading group’s score dropped slightly (3.54 to 3.49) between the baseline and the follow-up while the workshop group retained emotional regulation scores at the time of the follow-up (3.92) that were higher than baseline (3.26).

The workshop structure group experienced short- and long-term improvement in incidence of complex post-traumatic stress disorder (C-PTSD) between the baseline and the first post-intervention assessment (Mdiff = 3.44, P =.014, d = 0.33) and between the post-intervention assessment and the follow-up (Mdiff = 4.96, P =.002, d = 0.47). The reading group did not experience a significant change in C-PTSD (Mdiff = .44; -.06) or PTSD (Mdiff, baseline to post-assessment: = -1.11; Mdiff, baseline to follow-up = -1.03). The waitlist group had long-term, not short-term improvements in C-PTSD (F [1, 7.06] = 0.351, P = .572) and PTSD (F [1, 60.65] = 0.140, P =.710).

Limitations of the study included insufficient data regarding engagement with the materials, limited length of follow-up, lack of assessment of individual impact on outcomes and lack of knowledge as to whether participants used specialized mental health care resources after the study.

“The present findings suggest that while the impacts were greater in the workshop condition, the intervention and not group proximity itself led to the observed gains,” the researchers wrote. “This is evidenced by the fact that while the group had some effect, we saw no increases in closeness or decreases in loneliness in the workshop groups even after participation.”

The study authors wrote that the lesser impact of the program on the self-directed group may have been due to intervention dosage effects and members of the group may not have wanted to report their actual level of engagement in the intervention.


DePierro VK. Story, science, and self-care in a refugee community: Initial impact of the field guide for barefoot psychology. Beyond Conflict. October 2020. Accessed on October 16, 2020.