Preliminary Results from the Sane Ukraine Program, a Trauma-Informed Intervention on the Frontlines

Living under the stress, anxiety, and precarity of war takes a psychological toll. The Sane Ukraine program provides trauma-informed interventions for teachers, soldiers, and medical professionals, and training in administering these mental health interventions to non-mental health professionals. Thus, Sane Ukraine offers one model of preventative psychological care and psychoeducation, representing the first layer of a multi-tier model of psychosocial, community-based support. Initial data suggests that this model is feasible, tolerable, and cost-effective despite the ongoing stressors of acute conflict. 

Intervention Content

Sane Ukraine trainings deliver “psychological first aid,” touching on topics including:

• Mental health literacy, allowing for naming and rating emotional responses
• Polyvagal theory, a physiological explanation for trauma responses
• Self-assessment of protective factors and personal resources
• Coping skills, such as grounding practices to manage traumatic stress
• Community resources for additional support as needed 

Online hour-long presentations of body-mind integration techniques, including mindful breathing techniques and components of Emotion Focused Therapy (EFT) such as verbal affirmations and tapping and breathing practices, were offered daily every evening from approximately March 2022 to January 2023.

These training were expanded to include mental health support instruction for teachers in June 2022. As first responders, teachers were often working with children and adolescents who were deeply affected by acute and chronic exposures to traumatic stress–even while they themselves were not receiving adequate mental health support. Teachers reported and demonstrated signs of burnout as they struggled to guide their students toward emotional regulation. Along with education about empathically managing dysregulated students, teachers were provided strategies for regulating their own emotions as well as additional coping skills. Despite the clear need, some initially resisted these interventions, on either the grounds that they were too emotionally overwhelmed to consider new responsibilities or that their mastery of student and classroom management strategies meant there would be little benefit from a new skill set. Over the course of the training, some teachers relented and reported benefits despite their initial reluctance. A 2022 preliminary evaluation of teachers’ well-being performed by Olesya Vepryk and Oksana Senyk of Ukrainian Catholic University showed that for teachers who demonstrated initial higher anxiety, the training resulted in significant decreases in anxiety and increases in subjective well-being.

Intervention Assessment Results

Preliminary findings of a pilot evaluation of the Sane Ukraine intervention collected in the fall of 2022 show significant benefits. In pre-and post-assessments of subjective well-being, as measured on the World Health Organization’s Well-Being Index (WHO-5) in 148 teachers participating in training, those with high and moderate anxiety—indicated by the Generalized Anxiety Disorder Screener (GAD-7) and the State-Trait Anxiety Inventory (STAI)—demonstrated a significant reduction in anxiety and a 9% increase in self-reported subjective well-being. Those with lower anxiety did not show a significant change in their anxiety or well-being. 

Subjective, qualitative assessments of intervention effectiveness suggested that the response to the intervention was overwhelmingly positive. Participants reported improvement, some of which they suggested was not completely captured by the subjective well-being and anxiety measures. These results suggest it is feasible and tolerable for in-country trainees to complete assessments with these interventions, to inform future work and establish an evidence base. 

Limitations and the Need for Additional Research

Additional research is needed to assess the longitudinal effects of these interventions. As of March 2023, this research is now underway, including program evaluation of the interventions’ effects on anxiety using the GAD-7, as well as charting the impact of emotional distress on professional, recreational, familial, and social functioning using the Work and Social Adjustment Scale. The population being assessed includes helping professionals such as medical professionals, social workers, and teachers in the front-line regions of Kyiv, Zaporizhzhia, Mykolaiv, Dnipro, Sumy, and Chernihiv. The study aims to assess 2,500 participants and is anticipated to be complete by fall 2023. 

The efforts of Sane Ukraine are limited by Ukrainians’ extensive psychological and physical fatigue after one year of acute stress exposure and ongoing existential threats; after all, the effects of mindfulness practices are short-term and do not erase the significant danger that Ukrainians face. Further research is needed to determine how much Sane Ukraine and related programs have affected Ukrainians’ longitudinal well-being and resilience, destigmatized mental health concerns, and increased individual and collective understanding of and access to mental health services. 

A Promising Start

Sane Ukraine shows promise as a model for providing front-line mental health support and resources as well as destigmatization and education about mental health amid ongoing existential threats. Further research is needed to explore scaling this model as well as its longer-term ramifications for individual and collective well-being, resilience, and recovery.