A randomized controlled trial of an online dialectical behavior therapy skills intervention for war-related distress

Abstract: Objective: Living in war-afflicted regions involves long-term detrimental consequences for emotional well-being. Given the prevalence of ongoing conflicts worldwide, there is a pressing need to evaluate brief interventions that can be disseminated quickly and broadly to improve coping with war-related stress. This study examined the efficacy of an online dialectical behavior therapy (DBT) distress tolerance skills intervention for improving emotional well-being among women experiencing elevated distress amid war. Method: The study was conducted during the Israel-Hamas war and recruited 149 women whose first-degree relatives or spouses were deployed. Participants were randomly assigned to one of three conditions: (a) radical acceptance-training in a DBT skill promoting acceptance of reality, (b) relaxation-training in DBT skills fostering body relaxation, and (c) active control-monitoring distressing events without implementing DBT skills. The intervention included an online workshop to learn the skills and three home training sessions over 1 week to practice the skills for coping with personal distressing events. Measures of emotional distress were assessed at baseline, postintervention, 3-week follow-up, and during the home training sessions. Results: During the home training, practicing radical acceptance and relaxation skills led to improvements in negative and positive affect. However, only radical acceptance produced significant pre-to-post intervention reductions in stress, depression, and emotion regulation difficulties, with benefits persisting at follow-up. Conclusions: A brief online radical acceptance intervention is a cost-effective and accessible tool for coping with acute war-related stress. It may offer rapid emotional support in high-stress situations like war.

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