Effectiveness of the Maeum Program in a Stabilization-Focused Psychological Intervention for Trauma Survivors

Article information

Psychiatry Investig. 2025;22(7):741-747

Publication date (electronic) : 2025 July 16

doi : https://doi.org/10.30773/pi.2024.0324

In Mok Oh ¹

, Jeongmi Yoon ²

, Euihyun Kwak ³

, Kyungae Kim ³

, Minyoung Sim^,³

¹Armed Forces Guri Hospital, Armed Forces Medical Command, Guri, Republic of Korea

²Seoul Women’s University Child-Adolescents Psychology Research Center, Seoul, Republic of Korea

³National Center for Disaster and Trauma, National Center for Mental Health, Seoul, Republic of Korea

Correspondence: Minyoung Sim, MD, PhD National Center for Disaster and Trauma, National Center for Mental Health, 127 Yongmasan-ro, Gwangjin-gu, Seoul 04933, Republic of Korea Tel: +82-2-2204-0115, Fax: +82-2-2204-0389, E-mail: mdsim@hanmail.net

Received 2024 November 24; Revised 2025 January 25; Accepted 2025 March 18.

Abstract

Objective

Although stabilization-centered interventions alleviating posttraumatic symptoms are well known, scant scientific evidence exists examining interventions on individuals who have experienced various traumatic events in South Korea. This study examined the effectiveness of a Maeum Program, developed by the National Center for Disaster and Trauma, based on the principles of stabilization and psychoeducation for trauma survivors.

Methods

The Maeum Program for trauma survivors consists of psychoeducation and stabilization and imagery techniques conducted in a modular manner. From April 2018 to August 2023, 45 trauma survivors participated in the program. Trained mental health professionals conducted the program over 4–10 sessions. The Posttraumatic Diagnostic Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Patient Health Questionnaire-15, Insomnia Severity Index, and Posttraumatic Growth Inventory were used at pre- and post-intervention. Paired t-tests were performed to test the effectiveness of the Maeum Program. Repeated-measures analysis of variance was conducted to identify differences in psychiatric symptoms before and after the Maeum Program, after controlling for demographic factors.

Results

After the Maeum Program, psychiatric symptoms showed significant reductions in the post-intervention test, while post-traumatic growth increased. Compared with personal trauma, participants who experienced natural and man-made disasters showed a sharp decrease in somatic symptoms after the program.

Conclusion

This study examined the effectiveness of a stabilization-centered intervention program for individuals who had experienced both disasters and personal trauma, for the first time in South Korea. We suggest that this evidence-based program should be delivered across the country and contribute to reducing mental suffering from trauma.

Keywords: Trauma; Disaster; Trauma survivor; Maeum Program; Stabilization program; Post-traumatic stress disorder

INTRODUCTION

Many people experience potentially traumatic events, such as disasters or accidents, at some point in their lives [1]. A recent World Mental Health Survey found that approximately 29%–85% of the participants across 24 countries had experienced at least one traumatic event in their lifetime [2]. One survey showed that people in South Korea experienced an average of 4.8 traumatic events, and 89.9% experienced at least one trauma during their lifetime [3]. Trauma and posttraumatic stress disorder (PTSD) are becoming increasingly important issues in South Korea as the incidence and awareness of psychiatric sequelae among survivors increases [4,5].

When individuals experience trauma, including natural or man-made disasters, they often develop various psychiatric symptoms [6,7]. These symptoms may present as depressive symptoms, anxiety symptoms, sleep disturbances, substance use problems, and trauma symptoms and can even influence suicidal behavior. 8-11 Consequently, evidence-based approaches and interventions are necessary for those who have undergone trauma.

Various treatments for trauma and PTSD have been developed and applied. Generally, psychosocial interventions for trauma include three phases: stabilization, trauma treatment, and reconnection [12]. Trauma stabilization is particularly effective in preventing mental disorders, including PTSD, in individuals who have experienced trauma [13]. According to Ogden and Minton [14], the purpose of stabilization is to place trauma survivors in a stable and safe state, thereby preparing them to proceed to the next stage of treatment [15]. This is especially important because trauma treatment often has a high dropout rate and a significant risk of symptom deterioration [16,17]. Therefore, initial stabilization is critical in trauma survivors. Recent randomized controlled trials have shown that stabilization techniques are effective for treating PTSD symptoms [18,19].

In Korea, various stabilization techniques are currently used for individuals who have experienced trauma [20,21]. However, evidence-based, manualized, and stabilization-centered intervention programs are lacking. This study aimed to apply an evidence-based stabilization program for trauma survivors and investigate its effects.

METHODS

Study design and procedure

This study employed a one-group pre-post design to evaluate the effectiveness of the Maeum Program. Participants’ sociodemographic information including gender, age, region, religion, and educational level was collected. In addition, pre- and post-assessments were conducted to measure depressive symptoms, anxiety symptoms, somatic symptoms, insomnia, PTSD symptoms, and posttraumatic growth. The assessments aimed to analyze changes in mental health and recovery outcomes following participation in the program.

The study protocol was approved by the Institutional Review Board of the National Center for Mental Health (approval number: 116271-2023-29). The study protocol included clauses regarding participants’ rights, safety, confidentiality, recruitment, and other guidelines.

Participants and data collection

Participants who experienced significant suffering following a traumatic event (either a natural, man-made disaster or personal trauma) and sought treatment were referred to the National Center for Disaster and Trauma or the Stress Clinic at the National Mental Health Center. Participants were recruited based on their voluntary choice to participate in the Maeum Program, which focuses on trauma recovery. All participants provided informed consent to undergo mental health assessments before and after the intervention. They were registered with the Disaster Mental Health Information System (D-MHIS) as clients of the program. Confidentiality was strictly maintained, with personal information such as age, gender, name, and assessment dates anonymized. Each participant was assigned a unique identification number to ensure privacy throughout data collection and analysis.

Among the 44 individuals who participated in the Maeum Program from April 2018 to May 2023, two who did not respond to the mental health assessment were excluded, and 42 participants were analyzed. All participants agreed to data collection and use of personal and sensitive information before participating in the program. No new data collection was conducted for this study; only previously collected data were used.

The sample size was determined using G*Power 3.1.9.7. (Heinrich Heine University) to confirm the minimum sample size required for the paired-sample t-tests [22].

The Maeum Program

The National Center for Disaster and Trauma has developed a stabilization-centered “Maeum Program” for trauma survivors, supported by the Ministry of Health and Welfare. The Maeum Program is a trauma recovery program designed to alleviate psychological distress among trauma survivors and promote mental stability. It consists of psychoeducation, stabilization techniques, and additional imagery techniques (Table 1). The participants undergo psychoeducation and learn to apply stabilization techniques such as abdominal breathing, relaxation techniques, grounding, and resource enhancement. Additionally, optimal modules are available to address pain and somatic symptoms as well as trauma re-experience responses. The program is structured to have at least four sessions, once a week, following mental health assessment and initial consultation, and is applied in a modular manner based on the symptoms, compliance, motivation, and proficiency in stabilization techniques of trauma survivors. The average number of sessions were 6.49. Certified mental health professionals, including mental health social workers, clinical psychologists, and mental health nurses, all of whom are staff members at the National Center for Disaster and Trauma, conducted the program under the weekly supervision of a senior psychiatrist. A mental health questionnaire was administered before and after the program to evaluate the severity of reported psychiatric symptoms.

Table 1.

Maeum Program modules

Measures

The Patient Health Questionnaire-9 (PHQ-9) is a 4-point Likert scale consisting of nine items developed to evaluate depressive symptoms over the past 2 weeks [23]. A score of 0–4 is classified as normal, 5–9 as mild, 10–14 as moderate, and 15 or more as severe. In a domestic standardization study, the internal consistency of the PHQ-9 was reported to be 0.88, and the test-retest reliability was 0.91. In this study, the PHQ-9 scores were compared and analyzed [24].

The Generalized Anxiety Disorder-7 (GAD-7) is a 4-point Likert scale consisting of seven items concerning anxiety symptoms over the past 2 weeks [25]. The cut-off score for screening for generalized anxiety disorder is 10. A total score of 0–4 is classified as normal, 5–9 as mild, 10–14 as moderate, and 15 or more as severe. In a study of migraine patients in Korea, the internal consistency was 0.915, and the test-retest reliability was 0.895 [26].

The Patient Health Questionnaire-15 (PHQ-15) is a 3-point scale consisting of 15 items that assess somatic symptoms over the past 4 weeks [27]. A cutoff score of 15 points is recommended. A total score of 0–4 is classified as normal, 5–9 as mild, 10–14 as moderate, and 15 or more as severe. In a domestic standardization and validity study, the internal consistency was 0.87, and test-retest reliability was 0.65 [28].

The Posttraumatic Diagnostic Scale-5 (PDS-5) is a 24-item self-report questionnaire that assesses trauma exposure and functioning, and the severity of PTSD symptoms in the last month according to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria [29]. The 24 items are rated on a 5-point scale and scored from 0–4. A cutoff score of 28 is used to identify a probable PTSD diagnosis. In a standardization and validity study, the internal consistency was 0.95, and test-retest reliability was 0.74 [30].

The Insomnia Severity Index (ISI) is a 7-item self-report instrument that measures a patient’s perception of insomnia severity and assesses the presence of insomnia [31]. The 7 items are rated on a 5-point scale and scored between 0 and 28. A cutoff score of 10 is optimal for the screening of insomnia. In a standardization and validity study, the internal consistency was 0.92, and test-retest reliability was 0.86 [32].

The Posttraumatic Growth Inventory-Short Form (PTGI-SF) was developed to assess posttraumatic growth and self-improvement [33]. A 10-item and 6-point Likert scale is used based on a five-factor model: relating to others, new possibilities, personal strength, spiritual change, and appreciation of life. In a standardization and validity study, internal consistency was 0.92 [34].

Statistical analysis

Sociodemographic and traumatic event characteristics were analyzed using descriptive statistics. The primary analysis focused on psychiatric symptoms, such as PTSD, depression, anxiety, insomnia, and somatic symptoms, using an intent-to-treat approach. The primary hypothesis (i.e., change in psychiatric symptoms’ severity) was tested using paired t-tests. Repeated measures analysis of variance was conducted to examine whether there were differences in pre- and post-program changes after controlling for demographic variables such as age, gender, and type of disaster. Associations between the independent variables and covariates were quantified using 95% confidence intervals. Statistical significance was set at p<0.05. All data analyses were performed using R version 4.3.0 (R Foundation for Statistical Computing).

RESULTS

Of the 44 participants, 42 were analyzed, and 2 non-respondents were excluded. The gender distribution was 23 women (53.5%) and 20 men (46.5%). The numbers of participants in their 20s, 30s, 40s, and over 50s were 13 (30.2%), 10 (23.3%), 6 (14.0%), and 14 (32.6%), respectively. There were no significant differences in demographic characteristics, such as marital status, region, religion, education, and job (Table 2). Traumatic events were identified as 20 man-made disasters (46.5%), 6 natural disasters (14.0%), and 17 personal traumas (39.5%) (e.g., sexual abuse, motor vehicle accidents, and adverse childhood experiences). In all, 32 (74.4%) were trauma survivors and 11 (25.6%) were in other categories (traumatic event witnesses, bereaved family members, etc.); 14 (32.6%) were in the acute/subacute phase, and 29 (67.4%) were in the chronic phase (Table 3).

Table 2.

Demographic characteristics of Maeum Program participants

Table 3.

Type and characteristics of traumatic events

At pre-treatment, 45 participants’ PTSD (mean [M]=44.71, standard deviation [SD]=20.51), depression (M=13.71, SD=5.82), anxiety (M=10.72, SD=5.89), somatic symptom (M=13.08, SD=5.93), and insomnia (M=16.20, SD=6.67) scores were clinically significant. The mean PTGI-SF total score of 22.12 (SD=12.08) was evaluated and compared with the score of trauma survivors in another study, which was 22.6 (SD=10.10) [35]. After implementing the Maeum Program, trauma survivors reported a statistically significant decline in the scores of PDS-5 (M=44.71, SD=20.51 vs. M=34.22, SD=19.24; t(33)=4.200, p<0.001), PHQ-9 (M=13.71, SD=5.82 vs. M=8.94, SD=5.09; t(41)=4.558, p<0.001), GAD-7 (M=10.72, SD=5.89 vs. M=6.49, SD=5.36; t(42)=4.838, p<0.001), PHQ-15 (M=13.08, SD=5.93 vs. M=9.51, SD=6.32; t(42)=4.271, p<0.001), and ISI (M=16.20, SD=6.67 vs. M=11.81, SD=7.42; t(34)=4.857, p<0.001) (Table 4 and Figure 1).

Table 4.

Mean differences in psychiatric symptoms between pre- and post-intervention

Figure 1.

Mean differences in psychiatric symptoms between pre- and post-intervention. PTSD, posttraumatic stress disorder.

Although the PTGI-SF score did not show statistical significance, an increasing trend in posttraumatic growth was observed, which contrasted with the decline in psychiatric symptoms (M=22.12, SD=12.08 vs. M=24.67, SD=11.21; t(42)=-1.426, p=0.150). The study showed that women tended to show a statistically significant increase in PTGI-SF scores compared to men after controlling for gender (mean square [MS]=370.896, df=1, F=5.768, p<0.05). Depending on the type of trauma (natural, man-made disaster, personal trauma), a difference in the level of change in somatic symptoms was observed. Compared to personal trauma, participants who experienced natural or man-made disasters showed a sharp decrease in somatic symptoms after the Maeum Program (MS=88.880, df=1, F=6.727, p<0.05) (Figure 2).

Figure 2.

Interaction effect of trauma type on the intervention effects (somatic symptoms). The Maeum Program, as analyzed using repeated measures analysis of variance, led to a significantly greater reduction in somatic symptoms for participants with natural disaster or social accidents-related trauma compared to personal trauma (F=6.727, p<0.05).

DISCUSSION

In this study, the Maeum Program, which focuses on stabilization techniques, was found to significantly reduce not only PTSD symptoms, but also depression, anxiety, somatic symptoms, and sleep disturbances among trauma survivors. Additionally, PTGI scores improved following the program. Excluding the two participants who were not included in the data analysis, there were no dropouts.

This is the first study to confirm the effectiveness of a stabilization-focused intervention program for trauma survivors in South Korea. Previous studies have shown that the use of stabilization techniques in trauma survivors can alleviate comorbid symptoms and have a positive impact [36,37]. The Maeum Program is based on patient-therapist rapport and includes various psychiatric techniques. Previous studies have indicated that stabilization aids in emotional regulation, management, and interpersonal relationships, elements that are also incorporated into the Maeum Program [38,39]. The success of trauma treatment depends on the patient-therapist relationship [40]. Psychoeducation plays a pivotal role in trauma recovery by helping trauma survivors understand their trauma-related symptoms, which fosters a sense of empowerment [41-43]. Specifically, the experience of feeling understood by the therapist contributes to rebuilding the damaged trust system and facilitates the formation of a positive therapeutic rapport, enhancing treatment outcomes. The observed increase in PTGI scores among participants aligns with reports that such increases can occur through engagement with social support systems, motivation, and post-adversity engagement based on patient-therapist rapport [44].

Regarding the effects related to natural, man-made disasters, and personal trauma, this program was effective in all types, alleviating various psychiatric symptoms. Notably, compared to personal trauma, physical symptoms significantly improved in those who experienced natural or man-made disasters. Other studies have reported that physical symptoms are significant among the primary symptoms of survivors of natural or manmade disasters, suggesting that initial symptom relief may be more effective for the physical symptoms of disaster trauma [45,46].

This study has several limitations. First is the absence of a control group, without which, it was difficult to definitively establish the relationship between the Maeum Program and the reduction in psychiatric symptoms, as natural recovery over time and placebo effects cannot be excluded. Additionally, the lack of a control group makes it challenging to account for confounding variables and biases that may have influenced the outcomes. Second, the sample size was insufficient to allow for detailed analyses of factors such as the type of trauma or timing of the event. This highlights the need for follow-up studies to clarify the observed correlations between the reductions in physical symptoms among disaster trauma survivors. Third, limitation was the lack of formal psychiatric diagnoses. However, the main focus of this study was to determine the program’s effectiveness in alleviating the subjective suffering of trauma survivors in real-world settings, regardless of their specific diagnoses. Fourth, although the program was manualized and focused on stabilization techniques, the total number of sessions varied depending on client preferences and motivation. All participants completed the basic modules, but elective modules or additional counseling sessions were also conducted. Varying number of sessions can result in different outcomes. Consequently, it may be difficult to reproduce the results of the study, which may introduce bias into the results. Furthermore, it can complicate comparisons with follow-up studies or other research. Future research should address these issues.

In conclusion, a growing body of research on trauma and PTSD suggests that stabilization interventions for trauma survivors are quite effective and important. This is the first study to examine the effectiveness of the Korean Version of a stabilization intervention for trauma. This study showed that the Maeum Program is effective not only for disaster trauma but also for personal trauma. Additionally, the Maeum Program led to significant reductions in PTSD symptoms as well as depression, anxiety, somatic symptoms, and insomnia. Therefore, we expect that mental health professionals will be able to conduct such evidence-based program for various types of trauma survivors. Follow-up studies are needed to reproduce the effectiveness of the program and to develop it by reflecting sociocultural environmental changes.

Notes

Availability of Data and Material

The datasets generated or analyzed during the current study are not publicly available due to the inclusion of sensitive personal information and ethical considerations regarding participant confidentiality.

Conflicts of Interest

The authors have no potential conflicts of interest to disclose

Author Contributions

Conceptualization: Minyoung Sim. Data curation: Kyungae Kim. Formal analysis: Jeongmi Yoon. Investigation: In Mok Oh, Kyungae Kim. Methodology: In Mok Oh, Jeongmi Yoon, Minyoung Sim. Project administration: Kyungae Kim. Resources: Minyoung Sim. Supervision: Minyoung Sim. Validation: Kyungae Kim. Writing—original draft: In Mok Oh. Writing—review & editing: Euihyun Kwak, Minyoung Sim.

Funding Statement

None

Acknowledgments

This study was conducted as part of the national project supported by the National Center for Disaster and Trauma. We sincerely thank the dedicated staff members of the Center who implemented the Maeum Program and contributed to data collection and participant care.

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	Module	Techniques
Module 1	Psychoeducation	Psychoeducation, abdominal breathing
Module 2	Basic stabilization: relaxation	Muscle relaxation, safe-zone practice
Module 3	Basic stabilization: grounding	Mindfulness meditation, finding triggers, grounding practice
Module 4	Promoting positivity	Resource reinforcement, discovering me
Optional module 1	Body relaxation	Light beam technique, body scanning
Optional module 2	Dealing with re-experience reaction	Sealing practice, distancing

Demographics	N (%)
Sex
Male	20 (46.5)
Female	23 (53.5)
Age (yr)
20s	13 (30.2)
30s	10 (23.3)
40s	6 (14.0)
≥50s	14 (32.6)
Marital status
Single	21 (48.8)
Married	18 (41.9)
Other	3 (7.0)
Region
Capital	26 (60.5)
Gyeonggi-do	11 (25.6)
Other	6 (14.0)
Religion
Yes	20 (46.5)
No	21 (48.8)
Education
Middle school	3 (7.0)
High school	11 (25.6)
College	23 (53.5)
Graduate school	5 (11.6)
Job
Employee	10 (23.3)
Self-employed	5 (11.6)
Professional	5 (11.6)
Student	6 (14.0)
Homemaker	2 (4.7)
Unemployed	4 (9.3)
Other^*	8 (18.6)

Characteristics	N (%)
Type of trauma
Man-made disasters	20 (46.5)
Natural disasters	6 (14.0)
Personal traumas	17 (39.5)
Type of trauma experience
Survivors	32 (74.4)
Other^*	11 (25.6)
Phase
Acute/subacute	14 (32.6)
Chronic	29 (67.4)

Scale	N	Pre	Post	t(df)	p
Scale	N	Mean±SD	Mean±SD	t(df)	p
PTSD (PDS)	34	44.71±20.51	34.22±19.24	4.200(33)	<0.001^***
Depression (PHQ-9)	42	13.71±5.82	8.94±5.09	4.558(41)	<0.001^***
Anxiety (GAD-7)	43	10.72±5.89	6.49±5.36	4.838(42)	<0.001^***
Somatic symptoms (PHQ-15)	43	13.08±5.93	9.51±6.32	4.271(42)	<0.001^***
Insomnia (ISI)	35	16.20±6.67	11.81±7.42	4.857(34)	<0.001^***
Posttraumatic growth (PTGI)	43	22.12±12.08	24.67±11.21	-1.426(42)	0.150