The effectiveness of therapeutic interventions on psychological distress in refugee children: A systematic review

Misha M. Cowling and Joel R. Anderson

Clinical Psychology, Volume 79, Issue 8 (2023) 


This paper systematically reviews existing research on the effectiveness of psychological interventions in reducing symptoms of distress amongst refugee and asylum-seeker children. 

The systematic reviews cover studies in English presenting original empirical quantitative data (published before September 2022) testing the efficacy of psychological interventions for children from refugee and asylum-seeking backgrounds. 71 eligible articles (out of over 10,000 articles extracted from six academic databases) met the following criteria: (a) present original empirical quantitative data; (b) utilize a sample of refugee/asylum-seeking children; (c) include at least one standardized, validated measure of psychological distress; and (d) evaluate a psychological intervention intended to reduce symptoms of distress.  

Participants across the studies included refugees or asylum-seekers who had been born in Africa (Sierra Leone, Somalia, Uganda), Europe (Kosovo, Turkey), the Middle East (Syria, Iraq, Afghanistan), and Asia (Vietnam). Interventions occurred in various countries (Germany, America, Australia, Sri Lanka, Uganda) and settings (schools, clinics, home-based, refugee camp).  

Main findings: 

  • Cognitive behavior therapy (CBT) seems effective in targeting a range of psychopathology including PTSD, anxiety, depression, and social and emotional difficulties. CBT is a short-term and problem-orientated approach focused on changing unhelpful patterns in cognitions, behaviors and emotion regulation through psychoeducation and the development of personal coping strategies. Ten studies (out of 11 studies) reported significant reductions in PTSD symptom severity (medium-to-large effects). Eight studies (out of 10) reported significant reductions in depressive symptom severity (small-to-large effects) and five (out of seven) reported significant reductions in anxiety symptom severity. The origin of the participants and mode of delivery did not appear to impact effectiveness. 
  • Narrative exposure therapy (NET) appears to be effective in targeting PTSD symptoms. NET is a short-term manualized intervention program for the treatment of trauma. Six studies found NET reduced PTSD symptom severity. geographic location, origin of the participants and mode of delivery did not appear to impact on the effectiveness. 
  • While findings were mixed, there were some promising results to support the use of expressive art therapies (EAT) to target symptoms of psychological distress in refugee and asylum-seeker children. EAT is a form of psychotherapy that aims to provide individuals with outlets to explore feelings, process emotions associated with traumatic experiences, as well as to facilitate growth through emotional expressions such as art, music, and drama. Interventions that utilized multiple modalities appeared to produce particularly positive results. Geographic location, origin of the participants, and mode of delivery did not appear to impact on the effectiveness. 
  • Multimodal interventions appear to reduce the severity of PTSD and depression symptoms and reduce anxiety. Multimodal interventions bring together principles from various interventions, usually including individual therapy (e.g., CBT), family therapy (e.g., parent psychoeducation), as well as group-based interventions (e.g., social skills groups). All studies identified were implemented across various high-income countries (e.g., America, England, Germany), but were implemented across various settings, such as within schools, clinics, and homes.  
  • Psychosocial interventions were not usually associated with significant improvements in psychological outcomes, with some promising exceptions. Psychosocial interventions do not employ specific approaches to therapy (e.g., CBT, NET) but incorporate principles from various therapeutic approaches (e.g., psychoeducation) alongside interpersonal activities/techniques (e.g., role-play, drawing) with the aim of improving overall wellbeing. Somatic Soothing and Emotional Regulation Skill Development Intervention (i.e., a trauma focused intervention that aims to target traumatic stress, as well as equip participants with self-regulation skills) led to significant reductions in symptoms of depression, anxiety, and PTSD in one study. 
  • Family-based interventions led to significant reductions in psychopathology, including traumatic stress, emotional and behavioral difficulties, and depressive symptoms. Parent-based interventions had mixed results and most studies reported high rates of dropout during the intervention. 
  • EMDR (Eye Movement Desensitization and Reprocessing) reduced symptoms of PTSD across all studies. EMDR is a psychotherapeutic approach that aims to alleviate distress associated with traumatic memories using bilateral stimulation. While participants across these studies originated from various countries (in Asia, Africa, Europe, the Middle East), all interventions were implemented in middle-high income countries, including Turkey, Germany, and Sweden. 
  • Play Therapy appears to be a promising intervention, particularly when targeting symptoms of PTSD in samples of young children. Play therapy is a psychotherapeutic approach that aims to help children explore and express their repressed thoughts/emotions through play. 
  • A study on Trauma Systems Therapy (TST) indicated nonsignificant reductions in symptoms of both depression and PTSD, and a significant reduction in symptoms of avoidance. TST refers to a treatment program designed to address the emotional needs of children exposed to traumatic experiences. 
  • One positive psychology intervention led to significant improvements in their overall levels of wellbeing, optimism, and self-esteem, and reductions in symptoms of depression. 

Overall, most interventions included in this systematic review were associated with some improvement in child psychopathology, with certain methods of intervention attracting more research than others.