Intervention
The Empowerment group intervention is a manualized group therapy written in German, designed to be carried out with the help of linguistic and cultural mediators. The manual is based on well-established cognitive behavioral therapy (CBT) principles and consists of four central components: psychoeducation, behavioral activation, stress management, and emotion regulation. The 16 Empowerment sessions were conducted over a period of 3 months. Participants attended two sessions per week in the first 4 weeks of treatment and one session per week in the last 8 weeks of treatment. The session length was 90 minutes. Group assignment was based on the same native language of the participants. In some groups, participants spoke the same language but came from different countries of origin (e.g., Arabic-speaking participants from Syria and Iraq). The translations were in Arabic or in Dari/Farsi. All groups except for one were implemented with the assistance of linguistic and cultural mediators. In this one group, the therapist herself was a native speaker of Arabic. The duration of therapy in this group was adjusted accordingly and reduced to 60 minutes per session. Groups were held with only female, only male, or mixed-gender participants. Group size was intended to be between 4 and 10 participants.All study therapists had completed a master’s degree and were in advanced practical post-graduate training. In addition, all therapists had prior experience in therapeutic work with refugees and culturally sensitive psychotherapy. All psychologists were trained for 1 day in using the manual and working with linguistic and cultural mediators. Regular supervision sessions in-person and via phone were conducted to ensure adherence to the treatment protocol and therapy manual. Participants in the control condition received the available routine care with no stipulations made regarding the treatment received (TAU).