Abstract
Ukraine's war-exposed youth face a myriad of barriers to receiving mental health services, perhaps most notably a dearth of mental health professionals. Experts recommend evaluating digital mental health interventions (DMHIs), which require minimal clinician support. Based on the content of empirically supported treatments for war-exposed youth (e.g., Teaching Recovery Techniques), one strategy that might be useful is self-calming (e.g., paced breathing, progressive muscle relaxation). In this pre-registered randomized controlled trial (ClinicalTrials.gov Record: NCT06217705 ; first submitted January 12, 2024), we assessed the acceptability, utility, and clinical efficacy of one such DMHI (Project Calm) relative to a usual schoolwork control among a sample of Ukrainian students in grades 4-11. We analyzed outcomes for the full sample and subsamples with elevated symptoms at baseline. Although Calm was perceived favorably, there were no significant between-group differences in the full sample (N = 626); differences in subsample analyses demonstrated that while internalizing, externalizing, and trauma symptoms held steady for the Calm group, control participants' symptoms reduced. We generated potential explanations for these results (e.g., interference with youths' natural coping skills or fear extinction) through a focus group with school staff. Given that we found no evidence that calming skills taught via DMHI are effective for Ukrainian youth, we suggest that researchers test other strategies delivered by DMHI and that calming skills continue to be taught in provider-guided formats.