AnxietyNT-ADNCT07691021
Narrative Therapy for Anxiety and Depression in Palestinian Refugee Adolescents
A study testing Culturally Adapted Narrative Therapy in people with Anxiety and Depression - Major Depressive Disorder, run by Nablus University for Vocational and Technical Education at 1 site in Palestinian Territories.
Trial summary
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. Read more about this study
- Who is it for?
- Ages 12 to 15 years
- Conditions the study is for
- Anxiety, Depression - Major Depressive Disorder
- What is being tested?
- Culturally Adapted Narrative Therapy
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 120 participants
- Where
- 1 sitePalestinian Territories
- Study dates
- 16 Jun 2024to 14 Dec 2024
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 12 to 15 years
- All sexes
- No healthy volunteers
- Child
Who may be able to join
- 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)
Who cannot join
- 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
Trial locations and contacts
1 site in 1 country.
Palestinian Territories1 site
Nablus University for Vocational and Technical Education, Ibn Sina College for Health Professions
Nablus, West Bank, P401
About this study
Official title: Effectiveness of Narrative Therapy in Reducing Anxiety and Depression Among Middle School Students in Refugee Camps in Northern Palestine: A Quasi-Experimental Study
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.
Read the detailed description
This quasi-experimental study evaluated the effectiveness of a culturally adapted, school-based narrative therapy program for reducing anxiety and depression among Palestinian refugee adolescents. The study was conducted in UNRWA-operated middle schools across three refugee camps in Northern Palestine (Jenin, Balata, and Askar) from June to December 2024.
The 10-week manualized intervention integrated Palestinian cultural metaphors including sumud (steadfastness), olive tree symbolism, and traditional storytelling practices. The program consisted of weekly 60-minute group sessions delivered by trained school counselors and psychologists, with sessions progressively guiding participants from psychological safety building toward problem externalization, agency restoration, collective resilience, mindfulness practice, and future-oriented narrative reconstruction. Facilitator training included 20 hours of instruction in session protocols, cultural competence, and trauma-informed care.
Outcome measures were administered at baseline, immediately post-intervention, and at 3-month follow-up. Statistical analyses employed mixed-effects repeated-measures ANCOVA to test the Group × Time interaction. The study received ethical approval from the Research Ethics Committee of Nablus University for Vocational and Technical Education, Ibn Sina College for Health Professions (Approval Ref: Nrs. May, 2024/1).
- Conditions
- Anxiety, Depression - Major Depressive Disorder
- Being tested
- Culturally Adapted Narrative Therapy
- Keywords
- Narrative Therapy, Refugee Adolescents, Palestine, School-Based Intervention, Cultural Adaptation, Mental Health, Quasi-Experimental, UNRWA
- Medical subject headings
- Anxiety Disorders, Psychological Well-Being
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Culturally Adapted Narrative TherapyBehavioural
A 10-week manualized narrative therapy program delivered in weekly 60-minute group sessions. The program integrates Palestinian cultural metaphors including sumud (steadfastness) and olive tree symbolism. Key components include problem externalization (using shadow and cloud metaphors), agency restoration (identifying personal strengths and resilience stories), collective resilience (community narratives), mindfulness practices, and future-oriented narrative reconstruction. Each session follows a structured format including check-in, main activity, discussion, and closing reflection. The program was delivered by trained school counselors and psychologists in UNRWA-operated middle schools.
| Study group | Role | What they receive |
|---|---|---|
| Arm 1 (Intervention) Narrative Therapy Program | Experimental | Participants received a 10-week culturally adapted narrative therapy program delivered in weekly 60-minute group sessions. The program incorporated Palestinian cultural metaphors including sumud (steadfastness) and olive tree symbolism, and focused on problem externalization, agency restoration, and collective resilience. Receives: Behavioral: Culturally Adapted Narrative Therapy |
| Arm 2 (Control) Standard School Services | No intervention | Participants received standard school-based services including regular educational activities, social skills activities, music/art therapy, and sports activities as typically provided in UNRWA-operated schools. Individual counseling was available but limited. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in Anxiety and Depression Symptoms
Change in total score on the Revised Children's Anxiety and Depression Scale (RCADS) from baseline to post-intervention and from baseline to 3-month follow-up. The RCADS is a 47-item self-report questionnaire measuring anxiety and depression symptoms across six subscales: separation anxiety (7 items), social phobia (9 items), generalized anxiety (6 items), panic disorder (9 items), obsessive-compulsive disorder (6 items), and major depression (10 items). Items are rated on a 4-point scale (0 = never, 1 = sometimes, 2 = often, 3 = always), with higher scores indicating greater symptom severity.
Measured: Baseline (pre-intervention), immediately post-intervention (Week 10), and 3-month follow-up
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Jul 2026
- Study start16 Jun 2024
- Primary completion14 Sep 2024
- Study completion14 Dec 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for AnxietyStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Model description
- Participants were assigned to either a 10-week narrative therapy intervention or standard school services (control) in a parallel design.
- Masking
- None (open label)
- Enrolment
- 120 participants (actual)
Sponsor and investigators
- Lead sponsor
- Nablus University for Vocational and Technical Education
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Dr. Ibrahim Aqtam, Nablus University for Vocational and Technical Education
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07691021
- Sponsor's protocol ID
- Ref: Nrs. May, 2024/1
- Other IDs
- Nrs. May 2024/1
- Acronym
- NT-AD
- Status last verified
- Jul 2026
- First submitted
- 30 Jun 2026
- Last updated
- 8 Jul 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Study at a glance
From the registry record, last updated by the sponsor on 8 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effectiveness of Narrative Therapy in Reducing Anxiety and Depression Among Middle School Students in Refugee Camps in Northern Palestine: A Quasi-Experimental Study
- ClinicalTrials.gov ID
- NCT07691021
- Acronym / sponsor ID
- NT-AD / Ref: Nrs. May, 2024/1
- Conditions
- Anxiety, Depression - Major Depressive Disorder
- Keywords
- Narrative Therapy, Refugee Adolescents, Palestine, School-Based Intervention, Cultural Adaptation, Mental Health, Quasi-Experimental, UNRWA
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 120 participants (actual)
- Lead sponsor
- Nablus University for Vocational and Technical EducationUniversity, hospital or other
- Study start
- 16 Jun 2024 (actual)
- Primary completion
- 14 Sep 2024 (actual)
- Study completion
- 14 Dec 2024 (actual)
- First posted
- 8 Jul 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
This quasi-experimental study evaluated the effectiveness of a culturally adapted, school-based narrative therapy program for reducing anxiety and depression among Palestinian refugee adolescents. The study was conducted in UNRWA-operated middle schools across three refugee camps in Northern Palestine (Jenin, Balata, and Askar) from June to December 2024.
The 10-week manualized intervention integrated Palestinian cultural metaphors including sumud (steadfastness), olive tree symbolism, and traditional storytelling practices. The program consisted of weekly 60-minute group sessions delivered by trained school counselors and psychologists, with sessions progressively guiding participants from psychological safety building toward problem externalization, agency restoration, collective resilience, mindfulness practice, and future-oriented narrative reconstruction. Facilitator training included 20 hours of instruction in session protocols, cultural competence, and trauma-informed care.
Outcome measures were administered at baseline, immediately post-intervention, and at 3-month follow-up. Statistical analyses employed mixed-effects repeated-measures ANCOVA to test the Group × Time interaction. The study received ethical approval from the Research Ethics Committee of Nablus University for Vocational and Technical Education, Ibn Sina College for Health Professions (Approval Ref: Nrs. May, 2024/1).
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Participants were assigned to either a 10-week narrative therapy intervention or standard school services (control) in a parallel design.
| Arm | Type | Receives |
|---|---|---|
| Arm 1 (Intervention) Narrative Therapy Program | Experimental | Behavioral: Culturally Adapted Narrative TherapyParticipants received a 10-week culturally adapted narrative therapy program delivered in weekly 60-minute group sessions. The program incorporated Palestinian cultural metaphors including sumud (steadfastness) and olive tree symbolism, and focused on problem externalization, agency restoration, and collective resilience. |
| Arm 2 (Control) Standard School Services | No intervention | –Participants received standard school-based services including regular educational activities, social skills activities, music/art therapy, and sports activities as typically provided in UNRWA-operated schools. Individual counseling was available but limited. |
Who may qualify
- Ages
- 12 to 15 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child
Key inclusion criteria (6 listed)
- 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
Key exclusion criteria (4 listed)
- 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
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Culturally Adapted Narrative TherapyA 10-week manualized narrative therapy program delivered in weekly 60-minute group sessions. The program integrates Palestinian cultural metaphors including sumud (steadfastness) and olive tree symbolism. Key components include problem externalization (using shadow and cloud metaphors), agency restoration (identifying personal strengths and resilience stories), collective resilience (community narratives), mindfulness practices, and future-oriented narrative reconstruction. Each session follows a structured format including check-in, main activity, discussion, and closing reflection. The program was delivered by trained school counselors and psychologists in UNRWA-operated middle schools. | Behavioural | Arm 1 (Intervention) Narrative Therapy Program |
Primary outcome
Change in Anxiety and Depression Symptoms
Time frame: Baseline (pre-intervention), immediately post-intervention (Week 10), and 3-month follow-up
Change in total score on the Revised Children's Anxiety and Depression Scale (RCADS) from baseline to post-intervention and from baseline to 3-month follow-up. The RCADS is a 47-item self-report questionnaire measuring anxiety and depression symptoms across six subscales: separation anxiety (7 items), social phobia (9 items), generalized anxiety (6 items), panic disorder (9 items), obsessive-compulsive disorder (6 items), and major depression (10 items). Items are rated on a 4-point scale (0 = never, 1 = sometimes, 2 = often, 3 = always), with higher scores indicating greater symptom severity.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 8 Jul 2026.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Culturally Adapted Narrative Therapy in people with Anxiety and Depression - Major Depressive Disorder, run by Nablus University for Vocational and Technical Education at 1 site in Palestinian Territories.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 8 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Palestinian Territories. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in Anxiety and Depression Symptoms (time frame: Baseline (pre-intervention), immediately post-intervention (Week 10), and 3-month follow-up). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Jul 2026.