Pioneering work under wartime conditions: Trauma therapy for children and young people in Ukraine

The large-scale Russian war of aggression against Ukraine since 2022 has marked a sharp turning point in the lives of Ukrainians: Bombs, missiles and attacks by Russian soldiers also affect the civilian population. Death and fear are part of everyday life. Many people, especially children and adolescents, have been and still are confronted with traumatic events that can lead to long-term psychosocial impairments if left untreated. Prof. Dr. Elisa Pfeiffer recognized the urgent need for psychotherapeutic care early on: "There has been no evidence-based trauma therapy in Ukraine to date, and public funding for mental health was cut shortly before the Russian invasion." 

As a senior psychologist at Ulm University Hospital, she and her colleague Prof. Dr. Cedric Sachser therefore launched a further training program for Ukrainian therapists in trauma-focused cognitive behavioral therapy (TF-CBT) in March 2022. They were supported by certified TF-KVT trainers from all over the world. By May 2024, the team had trained more than 240 people in evidence-based trauma therapy. 63 of them are now fully certified. 

The training program and the therapy itself were specifically adapted to the ongoing war situation. The training took place online with simultaneous interpretation into Ukrainian. Situation-specific aspects were newly integrated into the training, such as traumatic grief or dealing with trauma in military families. For the international trainers, the war context was also a personal challenge: "In this sector, you are used to hearing the worst stories. But human rights violations like those happening in Ukraine shocked even our experienced trainers", reports Elisa Pfeiffer.

Scientifically proven effectiveness

In the course of the program, more than 300 children and adolescents with TF-CBT were treated and their data collected as part of the scientific evaluation of the training program and therapy. “This is only a small part of those actually affected—we estimate there are hundreds more”, says project leader Pfeiffer. Many therapists had treated significantly more than the minimum number stipulated in their training. The great success of the therapy is clear from the approx. 300 cases evaluated: The psychological stress of the young patients demonstrably decreased, and many no longer even met clinical diagnostic standards for post-traumatic stress disorder after completing the therapy. "In some cases, we even have better effects than in comparative studies in Germany or Norway. The children have benefited greatly in any case", states Pfeiffer.

This is also an important result for research, as it shows that the treatment is successful in children who continue to experience trauma. In Ukraine, the TF-CBT was used for the first time in an ongoing war. "It is actually a credo that trauma therapy only takes place when the child is already safe", explains psychology professor Elisa Pfeiffer. "However, we wanted to specifically help the children who continue to experience trauma, as their symptoms could otherwise become chronic." This is an important message for other war and crisis regions: "It's worth starting early." 

The circumstances are extraordinary not only for the patients, but also for the therapists, emphasizes Pfeiffer: "They themselves lived through war, experienced loss or had to flee, so they are just as burdened as the patients." Despite this – or precisely because of this – they show "impressive resilience". An accompanying study confirms that they have low levels of burnout and secondary traumatization. To support these positive results in the long term, the project included an eight-week self-care program for the therapists.

Sustainable development of a therapy network

As Elisa Pfeiffer emphasizes, the long-term orientation of the project also included an exchange at eye level right from the start: "The project was only possible thanks to close cooperation between international TF-CBT experts and local partners in the region, such as the Ukrainian Psychological Society." The second part of the project, which aims to establish a permanent trauma therapy network in Ukraine, has been running since the beginning of the year. Among other things, three Ukrainian therapists were certified as TF-CBT trainers who will be able to offer independent training and supervision in the future. One of them is Natalia Mossul from the University of Zaporizhzhya, who has already trained over 200 other therapists with her team. Pfeiffer and her team are now handing over the project to the national partners step by step. 

But one bottleneck remains: financing. A TF-CBT training course with supervision and translation/interpreting costs around 10,000 euros per cohort (approx. 30 therapists). "Without numerous individual grants, such as from the Porticus Foundation or the Ukrainian Ministry of Health, the project would not have been possible", emphasizes Pfeiffer. She hopes for further support in the future, as the high social benefit is now evident. "We see how strong the Ukrainian people are and help them to help themselves – the children we treat today are the adults who will be able to help shape their country tomorrow."