The Effect of Psychodrama and Virtual Reality-Supported Psychoeducation on Emotion Recognition Skills in Earthquake Survivors

Post-traumatic stress disorder (PTSD) and depression are among the most common psychiatric conditions observed in individuals who experience major traumatic events such as earthquakes. Post-earthquake traumatic reactions and the recovery process result from the complex interaction of biological, personal, cultural, and environmental factors, and the overall treatment goal is to restore an individual's daily functioning. The importance of early and systematic psychological interventions to prevent symptoms from becoming chronic is increasingly recognized. Indeed, according to the findings of a systematic review and meta-analysis conducted on victims of the Kahramanmaraş earthquakes, trauma-focused cognitive-behavioral therapy, psychoeducation, and virtual reality-based programs have yielded significant improvements in PTSD and depression, with large effect sizes .

Trauma profoundly affects not only mental health but also an individual's social-cognitive functioning. In particular, the ability to recognize emotions from facial expressions is central to these processes. Trauma can alter how individuals interpret emotional and social cues, weakening their capacity to successfully maintain social relationships. Individuals diagnosed with PTSD are affected by three main symptom clusters: avoidance/numbing, increased emotional arousal, and intrusive memories. The emotional distress at the core of this condition negatively impacts the ability to recognize emotions in facial expressions. Research shows that veterans diagnosed with PTSD experience difficulties recognizing facial expressions across all basic emotion types compared to controls without the diagnosis. Moreover, this impairment exhibits intergenerational transmission, negatively affecting the emotion recognition skills of these individuals' children. In light of these findings, systematic assessment and support of emotion recognition skills during the post-traumatic period should be integral components of psychosocial intervention programs.

It is well established that verbal approaches alone are insufficient to alleviate trauma symptoms. The effects of trauma are often experienced as difficult or impossible to put into words; psychodrama's action-based interventions offer trauma survivors nonverbal and symbolic channels of expression. The psychodramatic experience can transform the internalized and physical traces of trauma by creating a space in which individuals can safely access the traumatic neural network and restructure it while resolving the fight-or-flight-or-freezing response. Research shows that trauma-focused psychodrama models result in measurable reductions in PTSD symptoms; the vast majority of participants reported a strong sense of emotional safety and connection, increased hope, improved capacity to express emotions, and progress in managing trauma-related symptoms.

Technological advancements are paving the way for new forms of intervention that complement traditional psychotherapeutic approaches to mental health. Virtual reality (VR) technology is an emerging and increasingly prominent tool in this field. VR can provide multisensory stimuli tailored to the patient's individual trauma and create a highly interactive virtual environment with high ecological validity that reenacts the traumatic event for therapeutic purposes through computer-generated visual, auditory, olfactory, and tactile experiences. Systematic reviews and meta-analyses have shown that virtual reality exposure therapy (VRET) yields significantly better results for PTSD symptoms than control groups and demonstrates efficacy equivalent to other trauma-focused psychotherapies. In contrast, integrating VR with psychoeducation gives individuals the opportunity to experience both psychoeducational content and emotion regulation skills in a safe, structured environment. Studies conducted in this context indicate that SG-supported interventions can increase post-traumatic growth, reduce trauma symptoms, and strengthen the pursuit of social support and problem-focused coping skills among individuals who have experienced trauma.

However, no randomized quasi-experimental study has directly examined the relationship between psychodrama, virtual reality-supported psychoeducation, and emotion recognition skills among earthquake survivors. To address this gap, the planned study aims to investigate the effect of psychodrama and virtual reality-supported psychoeducation on facial emotion recognition skills among earthquake survivors living in a container city in a province that experienced a severe earthquake, using a pre-test-post-test randomized quasi-experimental design and an artificial intelligence-based Facial Emotion Recognition System. The findings of this study are expected to make significant contributions to the development of intervention programs in disaster psychology and to the wider adoption of technology-supported psychosocial interventions in the future.

Inclusion criteria

• The study included individuals aged 25 to 60 who possessed computeror technology skills,
• were open to communication and collaboration,
• had not previously participated in psychoeducation or psychodrama training, and whose homes sustained severe or moderate damage.

Exclusion criteria

• Individuals who were uncommunicative, had a psychiatric diagnosis according to hospital records,
• had vision or hearing problems, had epilepsy,
• had cancer, or were illiterate were excluded from the study.