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| ID | Type | Description | Link |
|---|---|---|---|
| 122/RNEC/2023 | Other Identifier | Rwanda National Ethics Committee approval number |
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| Name | Class |
|---|---|
| Centre for Sustainable Peace and Democratic Development | OTHER |
| University of Rwanda | OTHER |
| Interpeace | UNKNOWN |
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This pragmatic, pathway-stratified, cluster-randomized waitlist-controlled trial evaluated Resilience-Oriented Therapy (RoT), a culturally adapted group-based psychosocial intervention for post-genocide Rwanda. Community screening assigned eligible adults to one of three RoT variant pathways based on presenting profile: emotion regulation, identity development, or behavioural self-management. Within each pathway, local clusters were randomized to immediate RoT or waitlist control. The baseline cohort included 427 participants across 52 clusters in five Rwandan districts. Outcomes were assessed at baseline and immediate post-intervention endline from April to September 2023.
Resilience-Oriented Therapy (RoT) is a structured, trauma-informed, resilience-oriented group intervention developed for psychosocial recovery in post-genocide Rwanda. The intervention is organized around six broad phases: engagement and hope-building; psychoeducation about trauma, distress, and resilience; strengthening self-care and resilience practices; socioemotional skills acquisition; relational, socio-economic, and civic reintegration work; and follow-up or maintenance. Sessions were delivered by trained facilitators or mental-health practitioners.
The study used a pragmatic, pathway-stratified, cluster-randomized waitlist-controlled design. Participants were identified through a wider societal-healing screening process across five districts in Rwanda. Individuals with acute clinical risk were referred for appropriate clinical or hospital support. Remaining eligible adults were screened for intervention fit and routed to one of three RoT variants. The emotion-regulation variant (RoT-ER) targeted internalizing distress, including depression, anxiety, rumination, emotion dysregulation, and social withdrawal. The identity-development variant (RoT-ID) targeted alienation, shame, emptiness, identity disturbance, and belonging-related difficulties. The behavioural self-management variant (RoT-BSM) targeted aggression, alcohol or substance misuse, impulse regulation, and interpersonal responsibility.
Within each variant pathway, clusters were randomized to immediate RoT or waitlist control. Waitlist-control participants did not receive the assigned RoT variant during the baseline-to-endline evaluation period and were to be invited to participate after the evaluation exercise where feasible. The baseline cohort included 427 participants across 52 clusters: 173 in the RoT-ER pathway, 120 in the RoT-ID pathway, and 134 in the RoT-BSM pathway. Endline data were observed for 394 participants; missing endline records were handled in the manuscript analysis using multiple imputation.
The trial evaluated whether pathway-matched RoT improved clinical and psychosocial outcomes from baseline to immediate post-intervention endline. General outcomes included post-traumatic stress symptoms and resilience across all pathways. Variant-specific outcomes included depression and anxiety/cross-diagnostic symptoms in RoT-ER, borderline/identity disturbance symptoms in RoT-ID, and aggression, alcohol abuse/dependence, and drug abuse/dependence in RoT-BSM. Secondary outcomes included socioemotional difficulties, hopefulness/agency, forgiveness of others, stigma, social cohesion, perceived community threat, economic security, food insecurity, and food security.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Resilience-Oriented Therapy for Emotion Regulation Immediate | Experimental | Participants in clusters randomized to receive the emotion-regulation variant of Resilience-Oriented Therapy during the evaluation period. |
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| Resilience-Oriented Therapy for Emotion Regulation Waitlist Control | No Intervention | Participants in emotion-regulation pathway clusters randomized to waitlist control during the evaluation period; offered RoT after endline where feasible. | |
| Resilience-Oriented Therapy for Identity Development Immediate | Experimental | Participants in clusters randomized to receive the identity-development variant of Resilience-Oriented Therapy during the evaluation period. |
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| Resilience-Oriented Therapy for Identity Development Waitlist Control | No Intervention | Participants in identity-development pathway clusters randomized to waitlist control during the evaluation period; offered RoT after endline where feasible. | |
| Resilience-Oriented Therapy for Behavioral Self-Management Immediate | Experimental | Participants in clusters randomized to receive the behavioural self-management variant of Resilience-Oriented Therapy during the evaluation period. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Resilience-Oriented Therapy - Emotion-Regulation Variant | Behavioral | RoT-ER is a culturally adapted, group-based psychosocial intervention variant focused on internalizing distress. Sessions emphasize psychoeducation, emotion regulation, distress tolerance, self-care and resilience practices, hope and agency, and group-based social support. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in post-traumatic stress symptoms across Resilience-Oriented Therapy pathways | Post-traumatic stress symptoms were measured with a genocide-adapted four-item mean score from the Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Items were rated from 0 to 4; the mean score ranges from 0 to 4, with higher scores indicating worse post-traumatic stress symptoms. | Baseline to immediate post-intervention endline, up to 5 months |
| Change in resilience across Resilience-Oriented Therapy pathways | Resilience was measured with the 10-item Connor-Davidson Resilience Scale. Items were summed to a total score ranging from 0 to 40, with higher scores indicating greater resilience. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in depression symptoms in the Resilience-Oriented Therapy emotional-regulation pathway | Depression symptoms were measured with the Beck Depression Inventory-Short Form cognitive-affective subscale. The 13 items are summed to a total score ranging from 0 to 39, with higher scores indicating worse depression symptoms. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in anxiety and related symptoms in the Resilience-Oriented Therapy emotional-regulation pathway | Anxiety and related cross-diagnostic symptoms were measured with a 10-item cross-diagnostic symptom severity scale. Scores range from 0 to 40, with higher scores indicating worse anxiety and related internalizing symptoms. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in borderline and identity-disturbance symptoms in the Resilience-Oriented Therapy identity-development pathway | Borderline and identity-disturbance symptoms were measured with the McLean Screening Instrument for Borderline Personality Disorder. The 10 yes/no items are summed to a total score ranging from 0 to 10, with higher scores indicating more borderline and identity-disturbance symptoms. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in emotional wellbeing difficulties | Emotional wellbeing difficulties were measured with the emotional-wellbeing subscale from the locally developed socioemotional-skills measure. Items were averaged to a mean score ranging from 1 to 4, with higher scores indicating greater emotional-wellbeing difficulties. | Baseline to immediate post-intervention endline, up to 5 months. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Alexandros Lordos, PhD | University of Cyprus | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Community and Health-Centre Settings, Ngoma District | Ngoma | Eastern Province | Rwanda | |||
| Community and Health-Centre Settings, Nyagatare District |
De-identified participant-level data underlying the manuscript analyses.
Available after publication, with no predetermined end date.
Researchers must submit a methodologically sound proposal to the corresponding author. Access is subject to ethics, data-protection, and partner-organization approvals.
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This was a pragmatic, pathway-stratified cluster-randomized waitlist-controlled study. Screening assigned participants to one of three Resilience-Oriented Therapy variant pathways based on clinical profile: emotion regulation, identity development, or behavioural self-management. Within each pathway, local clusters were randomized to immediate RoT or waitlist control. Primary comparisons were pathway-specific.
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Participants and implementers necessarily knew whether RoT was delivered during the evaluation period. Baseline and endline assessors were not involved in intervention delivery; however, endline masking could not be fully maintained because participants could disclose whether they had received the intervention.
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| Resilience-Oriented Therapy for Behavioral Self-Management Waitlist Control | No Intervention | Participants in behavioural self-management pathway clusters randomized to waitlist control during the evaluation period; offered RoT after endline where feasible. |
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| Resilience-Oriented Therapy - Identity-Development Variant | Behavioral | RoT-ID is a culturally adapted, group-based psychosocial intervention variant focused on alienation, shame, emptiness, identity disturbance, and belonging-related difficulties. Sessions emphasize coherent self-understanding, constructive social identity, relational repair, and resilience practices. |
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| Resilience-Oriented Therapy - Behavioural Self-Management Variant | Behavioral | RoT-BSM is a culturally adapted, group-based psychosocial intervention variant focused on aggression, alcohol or substance misuse, impulse regulation, accountability, and interpersonal responsibility. Sessions emphasize self-management, responsible relationships, and reintegration into family and community life. |
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| Baseline to immediate post-intervention endline, up to 5 months. |
| Change in aggression in the Resilience-Oriented Therapy behavioural self-management pathway | Aggression was measured with 13 retained items from the Aggression Questionnaire. Items were averaged to a mean score ranging from 1 to 5, with higher scores indicating greater aggression. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in alcohol abuse or dependence risk in the Resilience-Oriented Therapy behavioural self-management pathway | Alcohol abuse or dependence risk was measured with the six alcohol-use items from the Psychiatric Diagnostic Screening Questionnaire. Yes/no items are summed to a total score ranging from 0 to 6, with higher scores indicating greater alcohol abuse or dependence risk. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in drug abuse or dependence risk in the Resilience-Oriented Therapy behavioural self-management pathway | Drug abuse or dependence risk was measured with the six drug-use items from the Psychiatric Diagnostic Screening Questionnaire. Yes/no items are summed to a total score ranging from 0 to 6, with higher scores indicating greater drug abuse or dependence risk. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in collaboration difficulties | Collaboration difficulties were measured with the collaboration subscale from the locally developed socioemotional-skills measure. Items were averaged to a mean score ranging from 1 to 4, with higher scores indicating greater collaboration difficulties. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in self-management difficulties | Self-management difficulties were measured with the self-management subscale from the locally developed socioemotional-skills measure. Items were averaged to a mean score ranging from 1 to 4, with higher scores indicating greater self-management difficulties. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in hopefulness/agency | Hopefulness and agency were measured with four agency-oriented hope items. Items were averaged to a mean score ranging from 1 to 4, with higher scores indicating greater hopefulness and agency. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in forgiveness of others | Forgiveness of others was measured with a retained two-item mean score derived from the Heartland Forgiveness Scale after reliability review. Items were averaged to a mean score ranging from 1 to 4, with higher scores indicating greater forgiveness of others. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in perceived stigma of mental illness | Perceived stigma was measured with a five-item perceived stigma of mental illness scale adapted for the programme. Items were averaged to a mean score ranging from 1 to 4, with higher scores indicating greater perceived stigma. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in social cohesion | Social cohesion was measured with seven retained items from the Social Cohesion Scale used in the Rwanda societal-healing programme. Items were averaged to a mean score ranging from 1 to 4, with higher scores indicating greater social cohesion. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in perceived community threat | Perceived community threat was measured with four items from the Social Cohesion Scale. Items were averaged to a mean score ranging from 1 to 4, with higher scores indicating greater perceived community threat. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in economic security | Economic security was measured with programme items assessing whether the household had enough money for basic needs. Items were averaged to a mean score ranging from 0 to 3, with higher scores indicating greater economic security. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in short-term food insecurity | Short-term food insecurity was measured with Food Security Consumption Coping Strategy Index items covering the previous seven days. Scores range from 0 to 84, with higher scores indicating worse short-term food insecurity. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in long-term food insecurity | Long-term food insecurity was measured with Food Security Consumption Coping Strategy Index items covering the previous 12 months. Scores range from 0 to 12, with higher scores indicating worse long-term food insecurity. | Baseline to immediate post-intervention endline, up to 5 months. |
| Change in food security | Food security was measured with programme food-security items derived from the food-consumption coping strategy indicators. Scores range from 0 to 84, with higher scores indicating greater food security. | Baseline to immediate post-intervention endline, up to 5 months. |
| Nyagatare |
| Eastern Province |
| Rwanda |
| Community and Health-Centre Settings, Musanze District | Ruhengeri | Northern Province | Rwanda |
| Community and Health-Centre Settings, Nyamagabe District | Nyamagabe | Southern Province | Rwanda |
| Community and Health-Centre Settings, Nyabihu District | Nyabihu | Western Province | Rwanda |
| ID | Term |
|---|---|
| D000092862 | Psychological Well-Being |
| D000067073 | Psychological Trauma |
| D013313 | Stress Disorders, Post-Traumatic |
| D003863 | Depression |
| D001008 | Anxiety Disorders |
| D000374 | Aggression |
| D019966 | Substance-Related Disorders |
| ID | Term |
|---|---|
| D010549 | Personal Satisfaction |
| D001519 | Behavior |
| D040921 | Stress Disorders, Traumatic |
| D000068099 | Trauma and Stressor Related Disorders |
| D001523 | Mental Disorders |
| D001526 | Behavioral Symptoms |
| D000096762 | Aberrant Motor Behavior in Dementia |
| D012919 | Social Behavior |
| D064419 | Chemically-Induced Disorders |
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