Effects of a Trauma-Informed Mindfulness-Based Stress Reduction Program on Social Anxiety and Sleep Quality Among War-Exposed Secondary-School Students
This study aimed to evaluate the effects of an eight-week trauma-informed Mindfulness-Based Stress Reduction program on social anxiety and sleep quality among war-exposed secondary-school students. This individually randomized, parallel-group, superiority trial was conducted in 2026 across six secondary schools and affiliated counseling services in Tehran, Iran. A total of 120 students aged 14–18 years with documented war-related exposure and clinically meaningful social-anxiety symptoms and/or poor subjective sleep were randomly allocated in a 1:1 ratio to trauma-informed MBSR or an active health-education control condition. The intervention consisted of eight weekly 75-minute group sessions emphasizing safety, present-moment awareness, flexible attention, emotional regulation, social-threat management, sleep-related arousal reduction, and trauma-informed opt-out procedures. Social anxiety was assessed using the Social Phobia Inventory, and sleep quality was assessed using the Pittsburgh Sleep Quality Index at baseline, postintervention, and eight-week follow-up. Data were analyzed using intention-to-treat linear mixed-effects models with group, time, group-by-time interaction, age, and baseline trauma burden as predictors, with Holm adjustment for co-primary outcomes. Significant group-by-time interactions favored trauma-informed MBSR for social anxiety at postintervention, B = -11.20, SE = 1.58, 95% CI [-14.32, -8.08], p < .001, and at follow-up, B = -9.74, SE = 1.64, 95% CI [-12.98, -6.50], p < .001. Significant effects were also observed for sleep quality at postintervention, B = -3.87, SE = 0.55, 95% CI [-4.96, -2.78], p < .001, and follow-up, B = -3.31, SE = 0.57, 95% CI [-4.44, -2.18], p < .001. Holm-adjusted between-group contrasts remained significant for both outcomes, with large standardized effects. Trauma-informed MBSR produced significant and sustained reductions in social anxiety and sleep disturbance among war-exposed secondary-school students, supporting its potential as a safe, school-based intervention for adolescents affected by armed conflict.