MEmory Training for Recovery- Adolescent Plus (METRA+): A brief intervention targeting psychosocial distress among Afghan adolescents living in Pakistan

METRA+: Module 1: Memory specificity training is a manualized training delivered over five 60-minute face-to-face sessions (3-5 times per week based on local security situations) to groups of 6-8 adolescents. It is delivered by a group facilitator. Session 1 provides psycho-education about mental health and memory. Participants practice recalling memories in response to positive and neutral cues, with support from the group facilitator. Session 2 follows the same format with further practice focusing on recalling memories in response to positive and neutral cues. In Session 3, practice in response to negative cues is introduced. Session 4 involves further exercises. Session 5 includes further practice and a summary. Module 1 focuses on everyday remembering. Module 2: Writing for Recovery is a written exposure training that involves 5 face-to-face sessions (delivered 3-5 times per week based on local security situations). It is delivered by the same group facilitator that delivered Module 1 and is delivered immediately following Module 1 (i.e., week following last session of Module 1). In the first session, the purpose of Module 2 is outlined. Then the facilitator simply reads the instructions and the participant completes the writing task; writing about their trauma including thoughts and feelings. After 30 minutes, the facilitator instructs the participants to stop writing. This writing task is repeated in the following four sessions. Each session takes 45-60 minutes. Module 3: Social skills training. Will include three social skills training sessions. This is based on "Nonviolent Communication" training to address trauma. This program has been previously implemented this program for students and faculty at Kabul University. We would use this three-session protocol for Afghan adolescents in Pakistan. The goal of these sessions is to foster appropriate communication through compassion and empathy for oneself and others. Module 3 will focus on four components – observations, feelings, needs, and requests – though empathic connection. With a focus on peer and family/parent relationships METRA+ will be delivered consecutively - the three modules will be delivered over a 2-3 week period (with no breaks between the modules, with the exception of weekends) METRA+ will be delivered daily, with each session being 60 minutes, over a 2-3 week period. Module 1 is five sessions delivered in Week 1. Module 2 is five sessions and will be delivered in Week 2, Module 3 will be delivered for the beginning of Week 3. There will be weekend breaks between Modules. The total duration of METRA+ will be about 2.5 weeks. We will assess monitor adherence to the intervention by monitoring session attendance and drop out.