Coping with War through God: Religion and the Promotion of Mental Health and Prosociality Among Refugees

Last registered on October 08, 2023


Trial Information

General Information

Coping with War through God: Religion and the Promotion of Mental Health and Prosociality Among Refugees
Initial registration date
May 18, 2023

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
May 24, 2023, 1:15 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
October 08, 2023, 11:43 AM EDT

Last updated is the most recent time when changes to the trial's registration were published.


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Primary Investigator

Princeton University

Other Primary Investigator(s)

Additional Trial Information

On going
Start date
End date
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Armed conflicts cause tremendous human suffering, particularly for displaced populations who lose their homes and sources of livelihood. Armed conflicts have resulted in 48 million people being displaced, either as refugees or Internally Displace People (IDP). Displaced populations are particularly vulnerable to psychological disorders because of war-related traumas before departure and adverse experiences during the transition and after arrival in a new community. Despite their dire need, displaced populations have limited access to mental health services. For this pilot study, around 600 Afghan refugees will be recruited in Istanbul, Turkey, and randomly assigned to (1) a manualized Cognitive Behavioral Therapy (CBT) training that teaches coping and emotion regulation skills, (2) Islamic-based CBT delivered by religious clerics, (3) sermons delivered by religious clerics without CBT structure, or (4) a waiting control condition. We will study the impact of the intervention on refugees' psychological well-being and prosociality.
External Link(s)

Registration Citation

Isaqzadeh, Mohammad. 2023. "Coping with War through God: Religion and the Promotion of Mental Health and Prosociality Among Refugees." AEA RCT Registry. October 08.
Sponsors & Partners



Experimental Details


For this pilot study, around 600 Afghan refugees will be recruited in Istanbul, Turkey, through advertisements on social media and posters distributed in neighborhoods with large populations of Afghan refugees. Those interested in the program will be randomly
assigned to (1) a manualized Cognitive Behavioral Therapy (CBT) training that teaches coping and emotion regulation skills, (2) an Islamically integrated version of CBT, (3) traditional Islamic sermons on spiritual coping and healing without CBT structure, or (4) a waiting control condition. The sample will include male and female participants. However, due to cultural issues, there will be separate sessions for men and women. As a result, the assignment will through block randomization based on gender.

The CBT condition combines elements from the WHO Self-Help Plus program and START NOW, both psychoeducation programs designed for refugees. START NOW is a cognitive behavioral therapy that integrates building blocks from dialectical-behavioral therapy and acceptance commitment therapy. Originally developed for correctional environments, by Professor Robert Trestman at the University of Connecticut, it has been adapted for use in other settings that face similar resource constraints and an extensive need for effective, reliable, and manual-guided treatment for teaching emotion regulation and coping skills. The program is offered as a group-based training and includes four units: (1) dealing with stressors, (2) understanding and coping with emotions and feelings, (3) building relationships, and (4) setting and reaching goals. The self-Plus program, designed by WHO, focuses on relaxation and emotion regulation skills. In addition, the CBT condition will also include two units on compassion training (Germer and Neff 2019), focusing on skills to mitigate self-blame and promote positive emotions toward others.

The Islamically integrated CBT is modeled after the standard CBT intervention and follows the same structure but incorporates Islamic traditions for coping and healing. It includes the same elements of START NOW, Self-Help Plus, and compassion training. The standard START NOW program teaches relaxation techniques (such as breathing and muscle relaxation) and focuses on cognitive restructuring and positive thinking to help participants evaluate and correct negative cognitions and thoughts that lead to negative emotions. The Islamically integrated CBT teaches relaxation through religious meditation and prayer. For cognitive restructuring and positive thinking, the Islamically integrated version relies on Islamic teachings such as trust in God, patience, and appraising adverse events as opportunities for spiritual growth. In addition, examples of Prophet Mohammad and other Prophets, mentioned in the Quran, who experienced involuntary migration will be used as role models for reinterpretation of adverse conditions and cultivating compassion toward others.

The third group will receive traditional Islamic sermons that discuss Islamic teachings for dealing with adverse conditions. The themes include patience, trust in divine providence, prayer, and seeking divine support and compassion toward others. This treatment arm is delivered as sermons--the same format as Muslim clerics deliver a speech in religious ceremonies--and will lack the CBT structure. The sermons do not include the discussion and exercise of coping skills.

To standardize the format of the three treatment arms and only vary the contents, all three groups will receive seven sessions. The PI has developed manuals for all three treatment arms and has pre-recorded a 30-minute video for each session. For CBT and Islamically integrated CBT, Each video discusses the main coping techniques and exercises discussed in the manuals. Videos will be played by trained facilitators who will help participants practices the exercises discussed in each video. Each session is expected to last between 45 to 60 minutes. Each video for the traditional sermon is also around 40 minutes, but there will be no discussion or practice of coping skills in this treatment arm. Since the contents in all three treatment arms are presented by the same individual (PI) and only the contents vary, the three treatment arms are relatively comparable.

The fourth group will not receive any treatment initially in order to provide comparable control groups. To avoid withholding treatment from those in need of counseling, however, those assigned to the control condition will also be provided the standardized CBT training within 12 to 18 months after the treatment groups complete their sessions and the second wave of the survey has been completed. Nonetheless, to control for the impact of financial compensation on the outcomes of interest, the control group will receive the same financial compensation at the same time as the three treatment arms.

There was a modification to the intervention after the baseline survey and registering the participants. Our final sample included 350 women and 250 men. Because of the smaller sample size of male participants, we removed the traditional sermons condition for men. Please see the document titled "Pre-Analysis Plan Modification 1" for details.
Intervention Start Date
Intervention End Date

Primary Outcomes

Primary Outcomes (end points)
The primary outcomes are psychological well-being, coping skills, and prosociality. Please see the pre-analysis plan for details.
Because Afghan refugees have faced a heightened risk of being arrested and deported from Turkey since we launched the intervention, we are removing the cloth donation exercise (for measuring prosociality). Instead, we are conducting a phone survey in October 2023 (three months after the end of the intervention) to measure the medium-term impact of the program on mental health and prosociality. We use HSCL-25 questionnaire to measure mental health. To measure prosociality toward outgroups, we invite participants during the phone survey to take part in another survey that collects information and guidance for a website that is to serve members of outgroups. The website is to be in the language of the rival ethnic group: for Uzbek and Dari speakers, the language of the website is told to be Pashtu while for Pashtu speakers the language is told to be Dari.
Primary Outcomes (explanation)
We will use indices for measuring psychological well-being, coping skills, and prosociality. Please see the pre-analysis plan for details.

There is a change to measuring prosociality. Please see Modification 2, dated July 4th, 2023.

Secondary Outcomes

Secondary Outcomes (end points)
Please see the pre-analysis plan for details.
There were two changes to the secondary outcomes. Please see the document titled "Pre-Analysis Plan Modification 1" for details.
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Please see the pre-analysis plan for the details of the experimental design.
We are adding qualitative interviews and new questions to the follow-up survey for exploring mechanisms. We also modified how we measure compliance and effect size. Please see the attached Modification 2, dated July 4th, 2023.
Experimental Design Details
Not available
Randomization Method
Randomization will be done in an office by a computer.
Randomization Unit
Block randomization based on gender. Male and female participants will be separately randomized and assigned to the control condition or one of the three treatment arms.
After the baseline survey, we modified the randomization procedure and used block randomization based on time and Availability Group. Please see "Pre-Analysis Plan Modification 1" for details.
Was the treatment clustered?

Experiment Characteristics

Sample size: planned number of clusters
600 individuals
Sample size: planned number of observations
600 individuals
Sample size (or number of clusters) by treatment arms
150 individuals control, 150 individuals CBT, 150 individuals Islamically integrated CBT, and 150 individuals traditional Islamic sermons.

After the baseline survey, we removed the traditional Islamic sermons condition for men. The size of those assigned to traditional sermons was reduced to 68. Please see "Pre-Analysis Plan Modification 1" for details.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)

Institutional Review Boards (IRBs)

IRB Name
Princeton University
IRB Approval Date
IRB Approval Number
IRB Name
Istanbul Gelisim University
IRB Approval Date
IRB Approval Number
Analysis Plan

Analysis Plan Documents

Pre-Analysis Plan_MI_18MAY2023

MD5: 876f4352d2a80ee5cf2450ebcca0084b

SHA1: feab754eafec9fc9b0db6326005ba2bd270c1a02

Uploaded At: May 18, 2023

PAP_Modification 1_13JUNE2023

MD5: 54f647dff846754006e1c478a4067842

SHA1: ac3c713bd36f0e4a50591a39fbe1779416853bdc

Uploaded At: June 13, 2023

PAP_Modification 2_04JULY2023

MD5: 127fc44db0856b454bc85d71595d29a0

SHA1: e68bcdb0d57f6c0e01ff87d2bb3f894cf354ba0a

Uploaded At: July 04, 2023