(PS8-84) Psychological Support for War-Exposed Children in Ukraine: Randomized Controlled Trial of a Brief, Self-Guided Digital Mental Health Intervention Teaching Calming Skills

Abstract Text: Ukraine’s war-exposed youth face a myriad of barriers to receiving mental health services, perhaps most notably a dearth of mental health professionals. Experts recommend evaluating digital mental health interventions (DMHIs), which require minimal clinician support, to begin to close the treatment gap. Based on the content of empirically supported treatments for war-exposed youth (e.g., Teaching Recovery Techniques), one therapeutic strategy that might be useful in a DMHI format is self-calming (e.g., paced breathing, progressive muscle relaxation). We tested Project Calm, a DMHI that teaches self-calming skills, via randomized controlled trial. Recruiting 4th-11th grade students from schools in a region of Ukraine frequently targeted by Russian attacks, we assessed intervention acceptability and utility, as well as effects on youth mental health symptoms relative to a usual schoolwork control. We analyzed outcomes for the full sample and subsamples with elevated symptoms at baseline. Although Calm was perceived favorably by youths, there were no significant between-group differences in the full sample of participants (N=626) or in most subsamples—differences in subsample analyses demonstrated that while internalizing, externalizing, and trauma symptoms held relatively steady for the Calm group, control participants’ symptoms reduced. To inform future efforts to develop DMHIs for war-exposed youths, we generated potential explanations for these results (e.g., intervention interference with youths’ naturally developed coping skills; interference with fear extinction) through focus group discussions with Ukrainian school staff. Given that we found no evidence that calming skills taught via DMHI are effective for Ukrainian youth, we suggest that researchers transition to testing the effects of other therapeutic strategies delivered by DMHI, and that calming skills continue to be taught only in clinician- and lay-provider-led formats.