Effects of a Trauma-Informed Mindfulness-Based Stress Reduction Program on Social Anxiety and Sleep Quality Among War-Exposed Secondary-School Students

Nahid Yousefpour; Marjan  Jowkar; Zahra Heydari; Afarin Aghamohammadsadegh

Authors

Nahid Yousefpour Assistant Professor, Department of Educational Sciences and Psychology, Payame Noor University, Tehran, Iran. Author https://orcid.org/0000-0002-6069-9277
Marjan Jowkar M.A. Student in Psychology, Department of Psychology, Shi.C., Islamic Azad University, Shiraz, Iran. Author https://orcid.org/0009-0004-1995-2199
Zahra Heydari PhD, Department of Psychology, Marv.C., Islamic Azad University, Marvdasht, Iran. Author https://orcid.org/0009-0000-3805-7035
Afarin Aghamohammadsadegh Department of Health Psychology, University of Tehran, Kish International Campus, Kish Island, Iran. Corresponding Author https://orcid.org/0009-0007-6786-4902

Keywords:

war, related trauma, adolescents, school, based mental health, mindfulness, based stress reduction, social anxiety

Abstract

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.

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