Effectiveness of a 10-Day Residential Murray Method Trauma Regulation Programme for Civilians with War-Related Psychological Trauma in Ukraine: A Prospective Cohort Study

Armed conflict is widely recognized as a major determinant of population mental health. Civilian exposure to war is consistently associated with increased rates of Post-Traumatic Stress Disorder (PTSD), depression, anxiety disorders and long-term functional impairment. A recent systematic review and meta-analysis reported pooled PTSD prevalence estimates ranging between 20 and 30% in conflict-affected settings [1], with substantial psychiatric comorbidity across trauma-exposed groups. Civilians exposed to hostilities, regardless of diagnostic categories, tend to report persistent sleep problems, hypervigilance, emotional instability, difficulty concentrating and reduced social functioning. These patterns suggest that both exposure to acute trauma and prolonged psychological stress related to uncertainty and insecurity are contributing factors.

Trauma is rarely an isolated event for populations in war situations. People may experience situations such as forced displacement, repeated bombings, the loss of family members, the destruction of their homes and economic collapse. Studies examining migrants previously exposed to this type of armed conflict reveal that psychological distress tends to persist even after relocation, especially when displacement is exacerbated by social instability and limited support networks [2]. These findings indicate that war-related trauma is often cumulative and embedded within ongoing stressors that complicate recovery.

Since February 2022, Ukraine has experienced armed hostilities resulting in mass displacement and disruption of essential services. According to UNHCR global reports, the scale of forced displacement from Ukraine has reached historic levels [3]. Epidemiological data collected during the first months of the invasion documented high levels of anxiety, trauma-related symptoms and stress reactions among the civilian population in multiple regions [4]. Other parallel analyses have also demonstrated significant associations between disruption of daily life and anxiety among Ukrainians following the invasion [5]. Surveys conducted at the beginning of the war similarly documented high levels of psychological distress and maladaptive coping strategies among civilians [6]. Increased rates of acute stress reactions have also been documented among Ukrainian war refugees during the initial phase of displacement [7]. Recent assessments have also confirmed a significant mental health burden among Ukrainians both within the country and abroad [8]. A separate study comparing internally displaced persons with non-displaced urban residents identified a significantly higher prevalence of PTSD among displaced persons [9].

Most validated protocols are trauma-centered and were developed within outpatient treatment models. These require weekly sessions for several months. Randomized trials have evaluated narrative exposure therapy delivered by trained providers for war-affected Ukrainian populations [10]. These approaches assume environmental stability, predictable access to care and sustained therapeutic engagement. However, in contexts characterized by displacement, transportation barriers and ongoing insecurity, prolonged outpatient participation is often not feasible. In contexts for the Ukrainian population characterized by displacement, transportation barriers and ongoing insecurity, prolonged outpatient participation is often not feasible. Refugees from Ukraine have reported substantial barriers to accessing healthcare and social services during integration processes [11]. The health effects of war have recently highlighted the critical importance of strengthening rehabilitation systems in the country [12]. International guidelines on mental health and psychosocial support emphasize the importance of context-specific, scalable interventions that include the restoration of functional and social stability along with psychological care [13]. Emerging rehabilitation approaches, including technology-assisted and nature-based interventions, have shown promise in diverse clinical populations [14,15]. Despite these recommendations, few prospective evaluations have analyzed intensive multimodal or residential rehabilitation models in active conflict settings. The primary hypothesis of this study was that participation in the MM-TRP would be associated with significant reductions in PTSD, depression and anxiety symptoms from baseline to post-intervention, with improvements sustained at three-month follow-up.

The Murray Method Trauma Regulation Program (MM-TRP), a ten-day residential program, was implemented to address the needs of people affected by the war in Ukraine. The program is based on the Murray Method, an integrative psychosocial rehabilitation framework that combines trauma-focused psychotherapy with psychoeducation, emotion regulation strategies, interpersonal boundary work and body-oriented practices [16,17]. The Way Out rehabilitation center adapted its services following the escalation of hostilities to offer structured residential intervention to civilians affected by war-related trauma.

The present study employed a single-group prospective cohort design to assess changes in PTSD symptoms, depressive symptoms, anxiety symptoms, functional disability, quality of life and post-traumatic growth. Given the humanitarian context, a controlled design was not feasible; therefore, this study provides preliminary observational evidence.

Study Design

This study used a prospective, non-randomized observational cohort design, with repeated measurements at three established time points. Baseline (T1), Post-Intervention (T2) and three-month follow-up (T3). The study did not include a control or comparator group. Due to emergency implementation in a humanitarian context, prospective trial registration was not performed- a limitation noted in accordance with reporting standards. Reporting followed TREND guidelines for nonrandomized evaluations [18]. The role of clinical research methodology in improving medical practice in humanitarian settings has been increasingly recognized [19].

Setting

The study was conducted at “The Way Out” rehabilitation facility located in Poltava, Ukraine. In response to the armed conflict in February 2022, the center implemented the MM-TRP a structured 10-day residential programme designed specifically for civilians affected by war-related psychological trauma. Parallel telemedicine initiatives have been implemented to expand mental health access during the ongoing conflict [20]. Knowledge-exchange platforms have also been developed to support trauma-focused clinical training during the war [21].

Participants

Eligibility Criteria: Participants were civilians aged 18 to 65 years who had experienced war-related traumatic exposure as a direct or indirect consequence of hostilities in Ukraine. Eligible trauma exposures included forced displacement, exposure to shelling or bombardment, loss of family members, destruction of property, sexual violence, or repeated exposure to life-threatening events. To ensure clinical relevance of the intervention, participants were required to demonstrate probable PTSD symptomatology at baseline, operationalized as a score of ≥33 on the PTSD Checklist for DSM-5 (PCL-5), a commonly used screening threshold for clinically significant PTSD symptoms [22].

Exclusion criteria were established to ensure participant safety and the feasibility of the program. Individuals were excluded if they had an active psychotic disorder; acute suicidal behavior with a specific plan requiring immediate crisis intervention; a serious somatic illness that prevented participation in structured daily activities; an active substance dependence requiring medical detoxification; or cognitive impairment that prevented informed consent or meaningful participation in group therapy.

Recruitment and Screening Procedure

Participants were self-selected through community outreach initiatives, referrals from local humanitarian organizations and direct contact with the rehabilitation center. This voluntary enrollment introduces potential selection bias, as participants may have differed from the broader war-affected population. Those who met the prerequisites were invited for a face-to-face psychological evaluation approximately one week before the program began. During this evaluation, clinicians reviewed trauma exposure history, implemented tools for early symptom detection, assessed clinical stability and confirmed the absence of exclusion criteria. Over the course of the study, 192 eligible civilians enrolled in the program. A total of 186 participants successfully completed the ten-day intervention. Outcome data were available for 168 individuals at the three-month follow-up assessment, representing 90.3% of all participants who completed the program.

Intervention: MM-TRP Programme

The MM-TRP is a 10-day residential program with a defined structure. It is based on a manual and combines psychosocial and somatic elements with trauma-focused psychotherapy. Participants lived at the rehabilitation center for the duration of the treatment and the intervention was conducted in a closed residential setting.

Therapeutic Framework

The program is based on a multidisciplinary model. This model draws on the psychological, social, physiological and existential spheres as they relate to trauma recovery. The intervention was designed to promote emotion regulation, restore functionality and facilitate social reintegration beyond symptom reduction alone.

Daily group therapy sessions included psychoeducation about trauma reactions, emotion regulation strategies, cognitive restructuring, narrative processing of traumatic experiences and work on interpersonal boundaries. When clinically necessary, individual psychiatric treatment was provided. Table S1 (Supplementary Material) provides a detailed session-by-session schedule of the 10-day program, including therapeutic content, duration and provider discipline for each component. Physical activities incorporated breathing exercises, Nordic walking, mindfulness techniques and yoga-inspired movements to support autonomic regulation and somatic awareness. Guided meditation and group reflection sessions promoted cognitive integration of traumatic experiences. Structured physical rehabilitation programs have demonstrated benefits for trauma-affected populations [23]. To enhance reproducibility and fidelity, all sessions followed a standardized treatment manual. Weekly supervision meetings were conducted and session checklists were completed by group facilitators. Treatment fidelity was assessed as 94% adherence to protocol across the study period.

Daily Structure

Intervention Reporting (TIDieR Framework): The intervention was conducted by licensed psychiatrists and clinical psychologists with specialized training in trauma-focused psychotherapy and at least five years of clinical experience. Prior to the program’s implementation, staff received in-house training on the specific protocol of the MM-TRP model. Treatment fidelity was ensured through structured session guidelines and weekly supervision meetings. The core components of the intervention consisted of standardized psychoeducational modules, trauma processing frameworks and structured group activities. No significant changes were made to the intervention protocol throughout the study period.

A structured daily program included psychotherapy sessions, group discussions, physical exercises, community activities and time for individual reflection.

Outcome Measures

Primary Outcomes: The PTSD Checklist for DSM-5 (PCL-5) [24] is used to assess the severity of PTSD symptoms. This instrument consists of 20 items rated on a five-point Likert scale (0–4), with total scores ranging from 0 to 80. A score of 33 or higher was used as a sign that PTSD is likely.

Due to differences in psychometric validation among language adaptations, particular attention was paid to translation aspects. Although previous efforts have been made to adapt PTSD assessment tools for people in Ukraine [25], large-scale validation studies remain scarce. The cultural and linguistic challenges of assessing PTSD in the Ukrainian population have also been highlighted by recent research [26]. In the present study, the version reflecting local clinical practice was used; however, a limitation related to its measurement is its limited formal validation.

The Generalized Anxiety Disorder Scale (GAD-7) [27] was used to measure anxiety symptoms and the Beck Depression Inventory-II (BDI-II) [28] was used to assess depressive symptoms. Both instruments are widely used and show robust psychometric properties in various population groups.

Secondary Outcomes

Secondary outcomes were chosen to cover broader areas of adaptation and functioning. Quality of life (assessed using the World Health Organization Quality of Life Questionnaire [WHOQOL-BREF] [29]), post-traumatic growth (measured using the Post-Traumatic Growth Inventory [PTGI] ​​[30]) and functional disability (assessed using the World Health Organization Disability Assessment Scale 2.0 [WHODAS 2.0] [31]) were among the items included.

Data Collection Procedures

Outcome data were collected at three time points: baseline (T1); days 1–2 of the intervention (T2); days 11-12; post-intervention; and at three months (T3). Initial and post-intervention assessments were conducted in person, under the supervision of trained research staff to ensure their comprehensiveness and accuracy. For participants without internet access, follow-up assessments were conducted via structured telephone interviews or secure online questionnaires. Reminder contacts were made when necessary to maximize retention at follow-up.

Statistical Analysis

Descriptive statistics were computed for demographic and clinical variables. Continuous variables are presented as means with standard deviations and categorical variables as frequencies and percentages.

Within-subject changes across time were examined using repeated-measures ANOVA with Greenhouse–Geisser correction when sphericity assumptions were violated. To adjust for potential confounding variables, multivariable linear regression analyses were conducted including age, gender, baseline trauma severity (PCL-5 score), displacement status (internally displaced vs. non-displaced) and social support as covariates.

All statistical analyses were conducted using SPSS version 28.0. Statistical significance was set at a two-tailed alpha level of 0.05. Post-hoc power analysis indicated that the achieved sample size provided >0.99 power to detect a medium effect size (f = 0.25) in repeated-measures ANOVA. A sensitivity analysis was conducted using a Last Observation Carried Forward (LOCF) approach for participants lost to follow-up (n = 24). The overall pattern and statistical significance of results remained materially unchanged.

Ethical Considerations

The study protocol was reviewed and approved by the Ethics Committee of Poltava V. G. Korolenko National Pedagogical University (Protocol No. 2022-03-15/A). All participants provided written informed consent prior to participation. Participants were explicitly informed that the program was voluntary and that non-participation or withdrawal would not affect access to other services. The study was conducted in accordance with the Declaration of Helsinki.

Participant Flow and Baseline Characteristics

A total of 192 participants enrolled, 186 (96.9%) completed the full 10-day intervention and 168 (87.5% of enrolled) provided three-month follow-up data. The cohort was predominantly female (64.5%), with a mean age of 42.8±11.3 years. Baseline clinical burden was substantial: probable PTSD in 73.1%, moderate-to-severe depressive symptoms in 68.3% and moderate-to-severe anxiety in 61.8% (Table 1).

Table 1: Sociodemographic and Clinical Characteristics (N = 192)

Changes in PTSD Symptoms

Post-intervention mean score declined to 32.7±10.8 (95% CI: 31.1–34.3). At three-month follow-up, the mean score was 35.4±11.2 (95% CI: 33.7–37.1) (Figure 1).

Figure 1: PTSD Symptoms (PCL-5) Across Time Points (Mean±SD)

Repeated-measures analyses demonstrated a statistically significant effect of time (p<0.001). The repeated-measures ANOVA showed a significant main effect of time (F(2, 334) = 215.73, p<0.001, η² = 0.62). In multivariable analyses adjusting for age, gender, displacement status, baseline trauma severity and social support, the effect of time remained significant (p<0.001), suggesting that improvements were not fully explained by these covariates. Bonferroni-adjusted post-hoc pairwise comparisons confirmed significant reductions between T1–T2 (p<0.001) and T1–T3 (p<0.001). The difference between T2–T3 was smaller but remained statistically significant (p = 0.04). The within-group effect size for PTSD symptom reduction from Baseline (T1) to Post-Intervention (T2) was large (Cohen’s d = 2.05). The effect size from baseline to three-month follow-up (T3) was also large (Cohen’s d = 1.89). Clinically meaningful improvement (≥30% reduction from baseline PCL-5 score) occurred in 78.6% of participants at discharge (Table 2).

Table 2: Changes in PTSD Symptoms and Diagnostic Status (PCL-5)

PTSD Symptom Clusters

All four DSM-5 PTSD symptom clusters demonstrated statistically significant reductions over time (p<0.001 for overall time effects) (Table 3).

Table 3: PTSD Symptom Clusters (PCL-5 Domains)

Depression and Anxiety Outcomes

Depression (BDI-II)

Mean depressive symptom severity decreased from 28.6±10.2 (95% CI: 27.1–30.1) at baseline to 14.3±8.6 (95% CI: 13.0-15.6) post-intervention. At follow-up, the mean score was 16.8±9.1 (95% CI: 15.4-18.2) (Table 4).

Table 4: Changes in Depressive and Anxiety Symptoms

The within-group effect size for depressive symptom reduction from T1 to T2 was large (Cohen’s d = 1.57) and from T1 to T3 remained large (Cohen’s d = 1.23). Mean anxiety scores decreased from 13.2±4.8 (95% CI: 12.5-13.9) at baseline to 6.4±3.9 (95% CI: 5.8-7.0) post-intervention and 7.3±4.2 (95% CI: 6.6-8.0) at follow-up (p<0.001). The effect size for anxiety reduction from T1 to T2 was large (Cohen’s d = 1.58) and from T1 to T3 remained large (Cohen’s d = 1.30) (Table 5).

Table 5: Post-Traumatic Growth (PTGI)

Secondary Outcomes

Post-Traumatic Growth (PTGI): Mean PTGI scores increased from 42.3±18.6 at baseline to 63.7±19.2 post-intervention and 68.4±20.1 at follow-up (p<0.001).

Quality of Life (WHOQOL-BREF)

All domains demonstrated statistically significant improvement from baseline to post-intervention (p<0.001), with sustained gains at follow-up (Table 6).

Table 6: WHOQOL-BREF Domain Scores

Functional Disability (WHODAS 2.0)

Functional impairment decreased significantly over time (p<0.001) (Table 7).

Table 7: Functional Disability (WHODAS 2.0)

Overall Pattern of Change

Across PTSD, depression, anxiety, quality of life, post-traumatic growth and functional disability, a consistent pattern of improvement was observed between baseline and post-intervention assessments. During the three months, most gains were maintained, although modest attenuation in symptom severity was observed relative to immediate discharge.

In this prospective cohort study of war-affected civilians, participation in a 10-day residential, multimodal MM-TRP program was associated with marked reductions in PTSD, depressive and anxiety symptoms, accompanied by improvements in disability, quality of life and post-traumatic growth. Symptom reductions were observed immediately after program completion and were largely sustained at three-month follow-up, although modest attenuation was evident across several domains.

At the individual level, the degree of PTSD symptom reduction was clinically significant. At discharge, mean PCL-5 scores dropped by around 44% and at follow-up, they were still about 40% below baseline. Clinically significant improvement was defined as a 30% or greater reduction in symptom intensity, which occurred for a large proportion of participants. Significant reductions were observed in all four DSM-5 PTSD symptom clusters. However, without a comparison group, these improvements cannot be definitively attributed to the intervention itself. Natural recovery, regression to the mean, temporary environmental stabilization within the residential setting and expectancy effects may have contributed to the observed outcomes. Without a comparison group, causal inference is not possible. The residential setting may contribute to symptom recovery by temporarily reducing environmental stressors, increasing the perception of safety and providing structured daily routines. Regional health authorities report a sustained increase in demand for trauma-related mental health and rehabilitation treatments across Ukraine [22]. Global mental health policy frameworks emphasize the importance of transforming mental health systems to address widespread trauma in the population [32]. Consequently, although the level of improvement demonstrated in this cohort is clinically promising, it should not be considered definitive proof of its efficacy or superiority over well-established trauma-focused treatments. PTSD management in various treatment settings can be carried out through systematic procedures, according to VA/DoD guidelines and other international standards of clinical practice [33,34]. One of the distinctive features of the MM-TRP program is its rigorous residential approach. The MM-TRP program is an intensive residential rehabilitation method that was created for humanitarian situations in which long-term psychotherapy is not always accessible. This differs from most evidence-based treatments for PTSD, which are provided on an outpatient basis over extended periods. In humanitarian and war situations, when long-term outpatient treatment is sometimes challenging to maintain, the residential format may be a particularly pertinent approach. Intensive rehabilitation programs may help with stabilization and recovery processes that are challenging to accomplish in fragmented care environments by temporarily lowering environmental stresses and offering a structured psychosocial environment. Empirical evaluations of such residential rehabilitation models in active conflict environments remain limited in the current literature. Most evidence-based PTSD treatments were developed for outpatient delivery, typically involving weekly sessions over several months. Among established trauma-focused therapies, Eye Movement Desensitization and Reprocessing (EMDR) has demonstrated clinically meaningful symptom reductions in randomized trials [35]. Similarly, meta-analytic evidence supports the efficacy of narrative exposure therapy for reducing PTSD and depression symptoms in trauma-exposed populations [36]. Economic and comparative effectiveness analyses have further evaluated the clinical and cost-effectiveness of EMDR in adult PTSD populations [37]. Systematic reviews of psychological therapies for adult PTSD consistently report moderate to large treatment effects under controlled conditions [38]. Recent umbrella reviews of published meta-analyses similarly confirm consistent effectiveness of trauma-focused interventions for adult PTSD [39]. Network meta-analytic evidence further supports the comparative efficacy of established psychological treatments for PTSD [40]. Meta-analytic evidence indicates that trauma-focused psychological interventions are generally effective across diverse trauma exposures, including repeated and complex trauma contexts [41]. Exposure-based approaches remain among the most empirically supported treatment modalities for PTSD [42]. The MM-TRP program's rigorous residential style is one of its unique features. The MM-TRP program is an intense residential rehabilitation approach intended for humanitarian circumstances where sustained access to long-term psychotherapy may be limited, in contrast to the majority of evidence-based PTSD therapies that are provided in outpatient formats over lengthy periods of time. In humanitarian and war situations, when long-term outpatient treatment is sometimes challenging to maintain, the residential format may be a particularly pertinent approach. Intensive rehabilitation programs may help with stabilization and recovery processes that are challenging to accomplish in fragmented care environments by temporarily lowering environmental stresses and offering a structured psychosocial environment. The Murray Method supports the applicability of organized multimodal therapies in complicated trauma contexts by conceptualizing trauma as a multidimensional disturbance requiring integrated cognitive, emotional and somatic regulation methods [16,17]. Phase-oriented and multimodal treatment frameworks are increasingly recommended in clinical guidelines for complicated PTSD [43,44]. Improvements in the quality-of-life (WHOQOL-BREF) and disability (WHODAS 2.0) domains, in addition to symptom severity, may be explained by this wider therapeutic scope. These findings align with previous research on quality of life among persons with disabilities in rehabilitation settings [45,46]. In addition to symptom reduction, evaluating functional disability, quality of life and post-traumatic growth represents a more comprehensive rehabilitation-oriented viewpoint that is becoming more and more important in international mental health and trauma recovery research. From baseline to follow-up, post-traumatic growth scores rose, indicating progressive processes of emotional and cognitive integration. Media influences and social factors have been shown to affect psychological outcomes in vulnerable populations [47,48]. The clinical significance of functional and disability-related outcomes in trauma rehabilitation studies is further supported by the common correlation between higher comorbid psychopathology across various dimensions and PTSD symptom patterns [49]. Recovery from trauma can be hampered by comorbid illnesses and substance abuse disorders, requiring comprehensive treatment [50]. Growth may signal an adaptive reconstruction of meaning following intensive rehabilitation, but should not be confused with symptom remission. The concept of post-traumatic growth in conflict settings has been previously explored in relation to meaning-making processes [39,17]. To verify durability, longer-term monitoring is necessary.

Several methodological limitations must be acknowledged. First, the absence of a control or comparator group substantially limits internal validity. Causal inference is not possible and the observed improvements may reflect natural recovery, regression to the mean, or non-specific effects of residential care and expectancy. Second, selection bias is likely, as participants voluntarily enrolled in the program and may have differed from the broader war-affected population in motivation, resources, or symptom profile. Third, all outcomes were self-reported, introducing potential social desirability and recall biases. Future studies should include clinician-administered diagnostic interviews (e.g., CAPS-5) and objective physiological markers. Fourth, the follow-up period was only three months; longer-term durability (6-12 months) remains unknown. Fifth, the psychometric validation of Ukrainian versions of PCL-5, BDI-II and GAD-7 remains limited, potentially affecting score interpretation and cross-study comparability [26]. Sixth, prospective trial registration was not performed due to the emergency humanitarian context, limiting transparency relative to contemporary standards. Seventh, expectancy effects and social desirability bias-participants who invested significant time and effort in a residential program may have been motivated to report improvement-cannot be ruled out.

Despite these limitations, the study has notable strengths: a relatively large sample for a conflict-zone rehabilitation study, acceptable follow-up retention (87.5%), comprehensive outcome assessment and reporting according to TREND guidelines.

Participation in the MM-TRP residential programme was associated with substantial short-term reductions in PTSD, depressive and anxiety symptoms, alongside improvements in disability, quality of life and post-traumatic growth. However, given the observational, single-arm design, these findings should be considered preliminary. Definitive conclusions regarding efficacy require randomized controlled trials with active comparators, longer follow-up and clinician-administered assessments. The results support the feasibility and potential utility of intensive multimodal rehabilitation models in conflict-affected areas, but causality cannot be established.

Limitations

The main limitations are:

• Lack of a control group
• Potential selection bias
• Self-report measures without clinician-administered validation
• Short follow-up (3 months)
• Limited psychometric validation of Ukrainian instrument versions
• Absence of prospective trial registration
• Possible expectancy and social desirability effects.

Consent for Publication

Not applicable. The manuscript does not contain identifiable individual data, images, or personal information requiring additional consent for publication.

Availability of Data and Materials

The datasets generated and analysed during the current study are not publicly available due to the sensitive nature of trauma-related data and ongoing security considerations in a conflict-affected setting. De-identified data may be made available from the corresponding author upon reasonable request and subject to institutional approval.

Competing Interests

The authors declare that they have no competing interests, financial or non-financial, that could have influenced the design, conduct, or reporting of this study.

This research received no external funding. The MM-TRP programme operates as part of the rehabilitation services provided by “The Way Out” centre. No commercial entity had any role in study design, data collection, analysis, interpretation, or manuscript preparation.

Financial Disclosure/Funding

No funding was received for this study. The authors confirm the absence of any financial interests, sponsorships, or monetary relationships that could have influenced the study design, methodology, interpretation of findings, or final conclusions. The authors had no affiliations with commercial entities or specific products related to the subject of this research.

Artificial Intelligence Statement

Artificial intelligence tools were used exclusively for linguistic editing and language refinement. No AI tools were used for data analysis, interpretation, or generation of scientific content.

Ethical Statement

The study protocol was reviewed and approved by the Bioethics Committee of Poltava V. G. Korolenko National Pedagogical University (Protocol No. 2022-03-15/A). All participants provided written informed consent prior to participation. Participants were informed about the voluntary nature of the programme, confidentiality safeguards, and their right to withdraw at any time without consequences for access to care. Data were anonymized and stored in secure, encrypted databases accessible only to authorized research personnel. The study was conducted in accordance with the principles of the Declaration of Helsinki.

1. Ahmed, S.H. et al. "Prevalence of post-traumatic stress disorder and depressive symptoms among civilians residing in armed conflict-affected regions: A systematic review and meta-analysis." General Psychiatry, vol. 37, no. 3, 2024, article e101438. https://doi.org/10.1136/gpsych-2023-101438
2. Mesa-Vieira, C. et al. "Mental health of migrants with pre-migration exposure to armed conflict: A systematic review and meta-analysis." The Lancet Public Health, vol. 7, no. 5, 2022, pp. e469–e481. https://doi.org/10.1016/S2468-2667(22)00061-5
3. United Nations High Commissioner for Refugees. Global Trends: Forced Displacement in 2023. UNHCR, 2023.
4. Mavranezouli, I. et al. "A systematic review and network meta-analysis of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris." British Journal of Dermatology, vol. 187, no. 5, 2022, pp. 639–649. https://doi.org/10.1111/bjd.21739
5. Levin, Y. et al. "The association between daily life changes and anxiety among Ukrainians following the Russian invasion." Psychiatry Research, vol. 329, 2023, article 115530. https://doi.org/10.1016/j.psychres.2023.115530
6. Xu, W. et al. "Mental health symptoms and coping strategies among Ukrainians during the Russia–Ukraine war in March 2022." International Journal of Social Psychiatry, vol. 69, no. 4, 2023, pp. 957–966. https://doi.org/10.1177/0020 7640221143919
7. Kordel, P. et al. "Acute Stress Disorder among 2022 Ukrainian war refugees: A cross-sectional study." Frontiers in Public Health, vol. 12, 2024, article 1280236. https://doi.org/10.3389/fpubh.2024.1280236
8. Yasenok, V. et al. "Mental health burden of persons living in Ukraine and Ukrainians displaced to Switzerland: The mental health assessment of the Ukrainian population (MAP) studies." BMJ Global Health, vol. 10, no. 8, 2025. https://doi.org/10.1136/bmjgh-2025-019557
9. Johnson, R.J. et al. "War trauma and PTSD in Ukraine's civilian population: Comparing urban-dwelling to internally displaced persons." Social Psychiatry and Psychiatric Epidemiology, vol. 57, no. 9, 2022, pp. 1807–1816. https://doi.org/10.1007/s00127-021-02176-9
10. Ferreira, V.N. et al. "Empowering narratives: Aid to self-help for Ukrainian refugees: A randomized controlled trial of Narrative Exposure Therapy (NET) delivered by supervised Ukrainian health workers in Norway." European Journal of Psychotraumatology, vol. 16, no. 1, 2025, article 2567094. https://doi.org/10.1080/20008066.2025.2567094
11. Urbanavičė, R. et al. "Experiences and challenges of refugees from Ukraine in accessing healthcare and social services during their integration in Lithuania." Frontiers in Public Health, vol. 12, 2024, article 1411738. https://doi.org/ 10.3389/fpubh.2024.1411738
12. Armitage, R.C. "War in Ukraine: Public health, rehabilitation and assistive technologies." Disability and Rehabilitation: Assistive Technology, vol. 17, no. 8, 2022, pp. 989–990. https://doi.org/10.1080/17483107.2022.2110950
13. Inter-Agency Standing Committee. Guidelines on Mental Health and Psychosocial Support in Emergency Settings. IASC, 2007.
14. Sarancha, I. et al. "Horticultural Therapy course as an educational-therapeutic tool of rehabilitation for individuals with MSDs." Revista Romaneasca Pentru Educatie Multidimensionala, vol. 14, no. 3, 2022, pp. 180–200. https://doi.org/10.18662/rrem/14.3/604
15. Tsekhmister, Y. et al. "Virtual reality in EU healthcare: Empowering patients and enhancing rehabilitation." Journal of Biochemical Technology, vol. 14, no. 3, 2023, pp. 23–29.
16. Murray, M. Prisoner of another War: A Remarkable Journey of Healing from Childhood Trauma. PageMill Press, 1991.
17. Murray, M.L. et al. "Overcoming the consequences of psychological trauma with the help of 'The Murray Method' and becoming a healthy balanced personality." Polski Merkuriusz Lekarski, vol. 53, no. 2, 2025, pp. 267–272. https://doi.org/10.36740/Merkur202502116
18. Des Jarlais, D.C. et al. "Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: The TREND statement." American Journal of Public Health, vol. 94, no. 3, 2004, pp. 361–366. https://doi.org/10.2105/AJPH.94.3.361
19. Bati, V. et al. "The role of clinical research in improving medical practice: From theory to practice." Salud Ciencia y Tecnologia-Serie de Conferencias, vol. 3, 2024. https://doi.org/10.56294/sctconf2024.1132
20. Narayan, A. et al. "TeleHelp Ukraine: A distributed international telemedicine response to the ongoing war." Journal of Global Health, vol. 14, 2024, article 04158. https://doi.org/10.7189/jogh.14.04158eference One
21. Rovati, L. et al. "Implementation of a multimodal knowledge-exchange platform to provide trauma critical care education during the ongoing conflict in Ukraine." JAMA Network Open, vol. 6, no. 2, 2023, article e230050. https://doi.org/10.1001/jamanetworkopen.2023.0050
22. World Health Organization Regional Office for Europe. Three Years of War: Rising Demand for Mental Health Support, Trauma Care and Rehabilitation. WHO Regional Office for Europe, 2025.
23. Honcharuk, N. et al. "New physical and neurophysiological rehabilitation programmes for women of childbearing age." Brain: Broad Research in Artificial Intelligence and Neuroscience, vol. 14, no. 1, 2023, pp. 346–369. https://doi.org/10.18662/brain/14.1/424
24. Weathers, F. W. et al. The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD, 2013.
25. Bezsheiko, V. "Adaptation of the Clinician-Administered PTSD Scale and PTSD Checklist for Ukrainian population." Psychosomatic Medicine and General Practice, vol. 1, no. 1, 2016, article e010108.
26. Figueiredo, S. and D. Hefter. "PTSD assessment in Ukrainian refugees using the PCL-5: Linguistic and cultural challenges." Frontiers in Psychology, vol. 16, 2025, article 1659301. https://doi.org/10.3389/fpsyg.2025.1659301
27. Spitzer, R.L. et al. "A brief measure for assessing generalized anxiety disorder: The GAD-7." Archives of Internal Medicine, vol. 166, no. 10, 2006, pp. 1092–1097. https://doi.org/10.1001/ archinte.166.10.1092
28. Beck, A.T. et al. Manual for the Beck Depression Inventory-II. Psychological Corporation, 1996.
29. The WHOQOL Group. "Development of the World Health Organization WHOQOL-BREF quality of life assessment." Psychological Medicine, vol. 28, no. 3, 1998, pp. 551–558. https://doi.org/10.1017/S0033291798006667
30. Tedeschi, R.G. and L.G. Calhoun. "The posttraumatic growth inventory: Measuring the positive legacy of trauma." Journal of Traumatic Stress, vol. 9, no. 3, 1996, pp. 455-471. https://doi.org/10.1002/jts.2490090305
31. Üstün, T.B. et al. Measuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0). World Health Organization, 2010.
32. World Health Organization. World Mental Health Report: Transforming Mental Health for All. WHO, 2022.
33. Department of Veterans Affairs and Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. VA/DoD, 2023.
34. Krüger-Gottschalk, A. et al. "Effectiveness in routine care: Trauma-focused treatment for PTSD." European Journal of Psychotraumatology, vol. 16, no. 1, 2025, article 2452680. https://doi.org/10.1080/20008066.2025.2452680
35. Villegas-Ortega, J. et al. "Effects of EMDR vs. waiting list for adults with post-traumatic stress disorder: A systematic review and meta-analysis of randomized controlled trials." Journal of Affective Disorders, vol. 392, 2026, article 120134. https://doi.org/10.1016/j.jad.2025.120134
36. Raghuraman, S. et al. "Evaluating narrative exposure therapy for post-traumatic stress disorder and depression symptoms: A meta-analysis of the evidence base." Clinical Psychology & Psychotherapy, vol. 28, no. 1, 2021, pp. 1–23. https://doi.org/10.1002/cpp.2486
37. Simpson, E. et al. "Clinical and cost-effectiveness of eye movement desensitization and reprocessing for treatment and prevention of post-traumatic stress disorder in adults: A systematic review and meta-analysis." British Journal of Psychology, vol. 116, no. 4, 2025, pp. 1128–1149. https://doi.org/10.1111/bjop.70005
38. Lewis, C. et al. "Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis." European Journal of Psychotraumatology, vol. 11, no. 1, 2020, article 1729633. https://doi.org/10.1080/ 20008198.2020.1729633
39. Kip, A. et al. "Psychological interventions for adult posttraumatic stress disorder: A systematic review of published meta-analyses." Journal of Anxiety Disorders, vol. 112, 2025, article 103017. https://doi.org/10.1016/j. janxdis.2025.103017
40. Mavranezouli, I. et al. "A systematic review and network meta-analysis of psychological, psychosocial, pharmacological, physical and combined treatments for adults with a new episode of depression." EClinicalMedicine, vol. 75, 2024. https://doi.org/10.1016/j.eclinm.2024.102780
41. Hoppen, T.H. et al. "The efficacy of psychological interventions for adult post-traumatic stress disorder following exposure to single versus multiple traumatic events: A meta-analysis of randomised controlled trials." The Lancet Psychiatry, vol. 11, no. 2, 2024, pp. 112–122. https://doi.org/10.1016/S2215-0366(23)00373-5
42. McLean, C.P. et al. "Exposure therapy for PTSD: A meta-analysis." Clinical Psychology Review, vol. 91, 2022, article 102115. https://doi.org/10.1016/j.cpr.2021.102115
43. Filonenko, L. et al. "Developing a values-based attitude towards people in adolescent rehabilitation centres: Neurophysiological patterns." Brain: Broad Research in Artificial Intelligence and Neuroscience, vol. 13, no. 2, 2022, pp. 76–96. https://doi.org/10.18662/brain/13.2/333
44. Schaug, J.P. et al. "Psychotherapies for adults with complex presentations of PTSD: A clinical guideline and five systematic reviews with meta-analyses." BMJ Mental Health, vol. 28, no. 1, 2025, article e301158. https://doi.org/10.1136/ bmjment-2024-301158
45. Demchenko, I. et al. "The psychological and pedagogical aspect of the life quality of citizens with disabilities." Revista Amazonia Investiga, vol. 11, no. 54, 2022, pp. 339–348. https://doi.org/10.34069/ai/2022.54.06.32
46. Sarancha, I. et al. "The influence of parents' mutual support on the socialization of children with special needs in rehabilitation centres: Neuropsychological aspects." Brain: Broad Research in Artificial Intelligence and Neuroscience, vol. 13, no. 4, 2022, pp. 362–382. https://doi.org/10.18662/ brain/13.4/393
47. Shirokova, O. et al. "The influence of the media on the body perception and the risk of developing eating disorders in youth." Revista Amazonia Investiga, vol. 12, no. 72, 2023, pp. 135–144. https://doi.org/10.34069/ai/2023.72.12.12
48. Slipetska, V. et al. "Structure and semantics of verbal means of expressing states of emotional tension in English publicistic texts." Revista Amazonia Investiga, vol. 12, no. 67, 2023, pp. 212–222. https://doi.org/10.34069/ai/2023.67.07.19
49. Lushchak, O. et al. "Prevalence of stress, anxiety and symptoms of post-traumatic stress disorder among Ukrainians after the first year of Russian invasion: A nationwide cross-sectional study." The Lancet Regional Health-Europe, vol. 36, 2024, article 100773. https://doi.org/10.1016/j.lanepe. 2023.100773
50. Roberts, N.P. et al. "Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: A systematic review and meta-analysis." Clinical Psychology Review, vol. 38, 2015, pp. 25–38. https://doi.org/10.1016/j. cpr.2015.02.007