Effect of Mindfulness-Based Trauma Recovery for Refugees on Shame and Guilt in Trauma Recovery Among African Asylum-Seekers

We sought to, first, better understand the role of emotional responding, and specifically shame and guilt, in trauma recovery among asylum-seekers following forced displacement; and, second, to explore whether therapeutic effects of a mindfulness and compassion-based intervention on trauma recovery among asylum-seekers are mediated by therapeutic effects of the intervention on shame and guilt. Study aims were tested through a randomized waitlist-controlled trial of a 9-week Mindfulness-Based Trauma Recovery for Refugees program among a community sample of 158 Eritrean asylum-seekers (55.7% female) residing in an unstable high-risk urban postdisplacement setting in the Middle East (Israel). First, in a cross-product test of parallel mediation, we found that shame, but not guilt, mediated the preintervention associations between traumatic stress exposure history, as well as current postmigration living difficulties, and current posttraumatic stress (ab_Shame =.035, 95% CI [.024,.048], ab_Shame =.183, 95% CI [.122,.249]) and depression (ab_Shame =.384, 95% CI [.234,.55], ab_Shame =.405, 95% CI [1.117, 2.693]) symptom severity. Second, in a linear mixed effects model of mediation, we found that reduced shame from pre to postintervention, mediated the effect of MBTR-R, relative to waitlist control, on improved posttraumatic stress (ACME_Shame = -.18, BCa 95% CI [-.34, -.04]) and depression (ACMEShame = -1.78, BCa 95% CI [-3.29, -.29]) symptom severity outcomes. Findings provide insight into the potential role of shame in trauma and stress-related recovery among FDPs (forcibly displaced people). Findings indicate that mindfulness and compassion-based training promotes trauma recovery, in part, through reducing feelings of shame postdisplacement.