This study investigated Shattered
Assumptions and Coping Styles as predictors of Post Traumatic Stress Disorder
(PTSD) following a Traumatic Event. One hundred and twenty one (121) participants comprising 70
males and 51 females participated in the study. Participants were randomly
selected Nkwagu military barracks, Abakaliki, Ebonyi State, and indigenes of
Ezzilo Community, Ebonyi State. Their ages ranged between 23 to 71 years with a
mean age of 39.68 years (SD = 10.94). Cross sectional design was adopted.
Regression result indicated that Shattered assumption (β = .20, t = 2.15, p< .05)
significantly predicted PTSD. Among the dimensions of shattered assumption,
only controllability of event (β = -.51, t = -3.43, p< .001) significantly predicted PTSD among
individuals who experienced trauma; but comprehensibility and predictability of
people (CPP), trustworthiness and goodness of people (TGP), and safety and
vulnerability (SV) were not significant predictors of PTSD. Coping style (β = .08, t = .69) did not
significantly predict PTSD among individuals who experienced trauma. Among the
dimensions of coping style only rational coping (β = .60, t = 2.40, p< .01), and
detached coping (β = -.56, t = -3.84, p< .01) significantly predicted PTSD among
individuals who experienced trauma; but emotional coping, and avoidance coping
were not significant predictors of PTSD among individuals who experienced
trauma. Implications of the study were stated, and suggestions made for further
studies.
Post-Traumatic Stress Disorder
(PTSD) is a trauma and stress related disorder that may develop after
exposure to an event or ordeal in which death, severe physical harm or
violence occurred or was threatened (Lodrick, 2007.
Traumatic events that may trigger PTSD include violent personal assaults,
natural or unnatural disasters, accidents, or military combat (Brewin
& Lennard, 1999).
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV:
APA, 2000) outlines PTSD as the development of characteristic symptoms of
distress or impairment that are present for over one month after exposure
to a traumatic event. Banyard (1999) described its cyclical nature,
outlining three main clusters of symptoms: re-experiencing
phenomena, avoidance/numbing and increased arousal. In
the immediate aftermath of a traumatic event, many individuals experience
physiological reactivity in response to reminders of the traumatic event that
typically lessens over time(Foa, 1992). However, an overreliance on avoidant
coping strategies may interfere with the natural recovery process, particularly
for those who are highly reactive to trauma reminders (Riggs,1992).
In the
weeks following a traumatic event, most individuals experience at least some
symptoms characteristic of posttraumatic stress disorder (PTSD). Many, but not
all, trauma survivors experience a profound reduction or complete remittance of
these symptoms over the course of the first several months (Rothbaum, Foa,
Riggs, Murdock, & Walsh, 1992). Identifying the subset of
traumatized individuals who do not recover but instead maintain PTSD symptoms
over time is a critical research question. Physiological reactivity and coping
style are two potential risk factors with promising empirical support. For
example, increased heart rate measured shortly after a traumatic event is
associated with increased risk for PTSD (Yehuda,
McFarlane, & Shalev, 1998). Further, increased heart rate
reactivity to trauma reminders is associated with greater maintenance of PTSD
symptoms over time (Blanchard, 1996).
Post traumatic stress disorder occurs in approximately eight percent of the general
population in African-Nigeria and seven
percent in Europe, with higher rates in women than in men (de Vries
& Olff, 2009; Glynn, Marshall, Schell, & Shetty, 2006; Kessler,
Chiu, Demler, & Walters, 2005; Kessler &
Üstün, 2008 for international prevalence estimates). PTSD results in
significant social and economic burden and puts individuals at increased risk for physical and mental
health difficulties including depression and suicide (e.g., Hidalgo & Davidson, 2000).
Although
epidemiological investigations indicate that as many as 74% of women and 81% of
men will experience a stressful event that qualifies as a traumatic stressor
according to the APA diagnostic criteria (Kessler et al., 2005; Stein, Walker, & Hazen, 1997), only a relative minority of
trauma-exposed individuals goes on to develop PTSD (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; McNally, Bryant & Ehlers, 2003). This suggests that
individual differences present before, during, or after trauma may be important
in understanding why some individuals go on to develop PTSD while others
recover naturally. Researchers evaluating risk factors for psychopathology
propose that examination of vulnerability
diathesis factors is especially critical (e.g., Ingram & Price, 200).
Those conversant with happenings in
Nigeria in the past three decades would agree that the country witnessed all
sorts of violence (Agbu, 2003). This may not be unconnected to heterogeneity
nature of the country that is constantly manipulated by its political elites in
their race for control of the state resources (Akeem, 2008). A few example of
trauma in the nation include, but not limited to, electoral malfeasance and
electoral fraud and political assassinations, massive corruption in high and
low places with selective judicial dispositions, reign of terror and
suppression of opposition and thought process, HIV epidemic with death and
morbidities, unemployment, Niger Delta war–execution and death, bomb explosion
and imprisonments (Agbu, 2003). Psychosocial trauma and physically induced
trauma include the following: Childhood emotional and physically induced trauma
include the following: Childhood emotional or sexual abuse, including prolonged
or extreme neglect; hostage taking, illegal oil bunkering, environment
degradation, internet pedophilla e. t. c (Akeem, 2008)
Indeed, PTSD is increasingly
being recognised not as a specialised area, but a fundamental aspect of
human experience (Gold, 2000). Reactions to traumatic events
vary considerably, ranging from relatively mild responses, creating minor
disruptions in the person’s life, to severe and debilitating reactions. It
is common for those who are exposed to traumatic events to experience
intrusive thoughts and images, accompanied by attempts at avoidance,
emotional numbing, and increased arousal (Joseph, 2010).
Researcher Van der Kolk as cited in
lodrick (2007) is of the view that ‘traumatised people lead traumatic and
traumatising lives’ (Lodrick, 2007). Themes of repetition are indeed
central in which the individual may be subjected to intrusive replays of
the original trauma (Lodrick, 2007). Totton (2005) writes that traumatic
experiences in childhood can have enduring profound effects on traumatic
experiences as an adult, influencing the traumatised person’s
responses and creating patterns of hyperarousal or dissociation together
with a tendency to re-enact traumatic experiences (Perry, 1995; Schore,
2000). Wainrib (2006) argues that traumatic events can generate severe
psychological reactions that can manifest anytime. For some, the effects
last throughout their remaining lifetimes and traumatized individuals
have been found to have elevated rates of psychiatric diagnosis including
major depression and alcohol or drug dependence (Wainrib, 2006). High
co-morbidity rates of trauma and psychosis are also evident in the
literature. Bebbington, (2004) identified associations between psychotic
disorders and early victimisation experiences, Janssen, (2004) reported a significant cumulative relationship
between trauma and psychosis, while Shevlin (2007) observed a positive
relationship between occurrences of childhood trauma and self-reported experiences
of hallucinations.
People facing the same
circumstances around a trauma vary greatly in their risk for PTSD (Ingram &
price, 2000). At least two psychological factors have been identified to
explain differences between people in response to trauma. First, some people
are already distressed before a trauma occurs and they appear at greater risk
for PTSD. Secondly, certain coping styles seem to increase people’s chance of
developing PTSD (Ingram & price, 2000).
The
cause of PTSD seems obvious, trauma; it seems perfectly understandable for PTSD
to develop in assault or feature victims, people who have lost a loved one in a
car accident, people who have lost their homes in a hurricane, and so on.
However, just what is it about traumatic events that can cause long-term severe
psychological impairment in some people. And do some people develop PTSD in the
wake of a trauma, where as others do not. Researcher have, identified a number
of factors that seem to contribute to PTSD.
The assumptive
world concept refers to the assumptions or beliefs that ground, secure,
stabilize, and orient people. In the face of death and trauma, these beliefs
are shattered and disorientation and even panic can enter the lives of those
affected. In essence, the security of their beliefs has been aborted (Farley
& Shaver, 1999) The assumptive world is an organized schema reflecting all
that a person assumes to be true about the world and the self on the basis of
previous experiences. As first articulated by Parkes (1988) and built upon by
others (Janoff-Bulman, 1992; Kauffman, 2002), assumptions helps those who deal
with traumatic loss, the bereaved and those who work with the bereaved, to
understand the intensity and complexity of responses. Our assumptions are guides for our day-to-day thoughts and
behaviors” (Janoff-Bulman, 1992)
C. M. Parkes (1975) first used the
term “assumptive world” to refer to people’s view of reality. It was a “. . .
strongly held set of assumptions about the world and the self which is
confidently maintained and used as a means of recognizing, planning, and
acting. Assumptions such as these are learned and confirmed by the experience
of many years” (Kauffman, 2002). In essence, the assumptive world refers to a
conceptual system, developed over time that provides us with expectations about
the world and us.
Janoff-Bulman (1992) identifies three
core assumptions that shape our worldview: the world is benevolent; the world is meaningful; the self is worthy. The
benevolence of the world according to Janoff-Bulman (1992) refers to the belief that the world is a good
place, that the people in it are kind and well intentioned, and that events
usually have positive outcomes. The world being meaningful means that things
make sense, that there is a cause and effect relationship between events and
outcomes. The notion of the self as worthy means that we perceive ourselves as
good, capable, and moral individuals. In essence, our assumptive world leads us
to believe we are good people who live in a benevolent world where things make sense,
more or less.
In the event of trauma—violent tragedy
and death—each of these assumptions is challenged and the loss of the
assumptive world can occur (Kaufmann, 2002b).
Those
assumptions which have kept us steady and have given coherence to our lives are
soon discovered to be illusions and an abrupt, terrifying disillusionment occurs
(Fleming & Robinson, 2001).
When the assumptive world is shattered
through loss, the guidelines with which the self navigates the world are
overturned. The world is no longer a safe, benevolent place, peopled with good
caring individuals who have a modicum of control and impact over what happens
to them. “Traumatic loss overwhelms and floods the self with negative
assumptions deviant from the protective norm of the good. . . . The terror that
shatters the assumptive world is a violent deprivation of safety. . . . What is
lost in the traumatic loss of the assumptive world? All is lost. Hope is lost .
. .” (Kauffman, 2002). For the bereft, there are no answers, safety, logic,
clarity, power, or control. There is a low level of panic as the self is in
danger. Healing from this type of loss may be especially painful and more protracted,
as new assumptions have to be created in the worldview of the griever.
Depending on the depth and nature of
the attachments we have formed in our lives (Bowlby, 1980), the violations of
the assumptive world can be even more wrenching. We tend to go through life
with a number of assumptions about ourselves and how the world works that help
us feel good most of the time but can be shattered by a trauma (Bowlby, 1980;
Raphael, 1983). Most people believe that
bad things happen to other people, and
that they are relatively invulnerable to traumas, such as being in a
severe car accident when such events happen, people lose that illusion of
invulnerable chronically feeling vulnerable, they are hyper viigilant for signs
of new traumas and may showings of chronic anxiety (Kastenbaum, 2001; Shaver
& Tancredy, 2001).
The
second basic assumption is the assumption that the world is meaningful and just
and hat things happen for a good reason (Kastenbaum, 2001). This assumption can
be shattered by events that seem senseless unjust or perhaps evil such as
turnouts bombing of a children’s day-care center. The third assumption is the
assumption that people who are good “play by the rules” do not experience bad things: Trauma victims often will say
that they have lived a god life, have been a good person, and thus can’t
understand how the trauma happen to them.
Coping
is defined as “ Constantly changing cognitive and behavioural efforts to manage special
external and internal demands that are appraised as taxing or exceeding the resources of the person
(lazarus & Folkman, 1984). Coping
is not considered a personality trait that remains stable across
situations. Instead caring is considered
as a set of strategies that are available to be implemented to match
specific situations. Coping may take one
of two general forms; emotion focused or problem focused (lazarus &
Folkman, 1984).
Emotion-focused
coping strategies are focused on internal emotional states, rather them on
external situations that trigger emotional responses. Emotional focused coping is most likely to occur when on
appraisal has been made that nothing environmental conduction (lazarus &
Folkman, 1984) .
Problem
focused strategies alter the stressor by direct action. It includes learning
new skills, finding alternative channels of gratification, or developing new
standards of behavior. Some coping strategies, such as seeking social support
may serve both emotion and problem focused functions simultaneously (Vitaliano,
Maiuro, Russo, & Becker, 1987). Both
emotion and problem focused forms of coping are used by most individual in
response to stressful events (Folkman & Lazarus, 1980).
Coping
is an entical factor in competency/vulnerability models of child adolescent and
youth psychopathology (Rutter, 1979; 1990). In these models, coping serves as a
protective factor that helps to buffer individuals responses to stressful life
events. Thus, exposure to crime and violence challenges the victim witness’
capacity to generate adaptive coping responses, and promotes the use of
maladaptive coping responses. These might include self-blame, anger,
withdrawal, blaming others, etc, (Schepple and Bart, 1983). These maladaptive
coping responses, moreover, if sufficiently intense, may facilitate the
intrusive memories and avoidance reactions associated with posttraumatic stress
(Resick and Schnicke, 1992), and interfere with successful emotional processing
during the exposure-based exercise
People styles of coping with stressful events and
with their own symptoms of distress may also influence their vulnerability to
PTSD following a trauma. Several studies have shown that people who use self
destructive or avoidant coping strategies, such as drinking and self-isolation,
are more likely to experience PTSD. (Fairbank, Hansa & fitterling, 1991);
marriu, 2001, sutker; 1995).
One form
of copying styles that may increase the likelihood of PTSD is the use of
dissociation (Foa & HenrsHkeda, 1996; Seiege, 1990. Dissociation involves a
range of psychological processes that indicate a detachment from the trauma and
from ongoing events people who dissociate following a trauma may feel they are
in another place, or in someone else’s body watching the trauma and its after
math unfold. Studies have shown that people who dissociate shortly after a
trauma are at after a trauma are at increased risk to develop PTSD (Ehlers ,
1998; Fau & Bach; Koopman; Classen,
& Spiegel, 1996; Mayou, 2001, Shalev, 1996).
Finally,
many studies have found that, following a trauma, most people try to make sense
of the trauma somehow as a way of coping ( lehman, 1987; silver Boon, &
stones, 1983). They try to find a reason or purpose for the trauma or to
understand what the trauma means in their lives psychodynamic and existential
theorists have argued that searching
for meaning in a trauma is a health process, which can lead people to gain a
sense of mastery over their traumas, and to integrate their traumas into their
understanding of themselves (franki, 1963; freud, 1920; Horbwitz, 1976). They suggest that people who are able to make
sense of their traumas are less likely to develop PTSD or other chronic
emotional problem and may recover more quickly from their traumas than do
people who cannot make sense of their trauma (Bulman & wortman, 1977;
silver l; 1983). How do people make sense of traumas? Some people have religious or philosophical beliefs that
assist then for example many recently bereaved
people who are religious say that
God needed their loved ones in Heaven or had a special purpose for taking their
loved ones and their seems to help them
understand their losses (Mclntosh,
silver, &Wortman, 1993; Nolen- Hoeksema & Lason, 1999). Other people
say that the deaths of loved ones made them reevaluate their lives and their
relationships with others and make positive changes, and this helped them deal
with the loss (Steven, 2010).
Some
people are never able to make sense of their losses or other traumas and these
people are more likely to experience chronic and serve symptoms of PTSD and
depression. For example, researchers in the study by (Silver, 1983) questioned
77 women who were the survivors of incest, an average of 20 years after the incest
had ended. They found that 50 percent of the women over still actively searching
for meaning in their incest. These women said things such as “always ask myself why, over and over, but there is no answer”
and u There is no sense to be
made. This should not have happened to me or any child” (Silver, 1983). The
more actively a women was still searching for meaning in her incest, the more
likely she was to be experiencing
recurrent and intrusive ruminations about the incest experience, the more distress she was
experiencing, and the lower her level of social functioning was. Finding
meaning may be particularly difficult in traumas such as sexual assault or
genocide, in which the nature of the event violates basic moral codes and
distress people basic trust in others.
In view of the day-to-day
occurrence of traumatic events (such as listed above) in Nigeria, and the
exposure of both the military and civil populace to such traumas, the
management of people presenting with PTSD may become a vital concern in our
national health care practice. However, considering the effect of functional
impairment associated with PTSD presentation to individual life and national
progress, it is alarming to observe that as regards prevention or proper
management of PTSD in Nigeria, there are:
Ø
no appropriate health care policy
Ø
no nationwide orientation on PTSD
Ø
no research on the peculiarity of PTSD in
Nigeria (if any)
Ø no
update or adaptation of applicable PTSD psychotherapies.
It
is against this background, that this exploratory research is designed to elicit
data on present PTSD prevalence, risk factors, demographic correlates and functional
impairments that may be associated with PTSD presentation in
Nigeria, as an empirical facilitation of
professional psychological practice and national health care.
All these and many
propelled the researcher to the study.
Therefore this study intends to find answers
to the following questions:
1. Would
shattered assumptions significantly predict post traumatic stress disorder (PTSD)
among individuals who experienced trauma?
2. Would
coping styles significantly predict post traumatic stress disorder (PTSD) among
individuals who experienced trauma?
The
major purpose of this study is to determine whether:
1. To
determine if shattered assumptions will predict post traumatic stress disorder
(PTSD) among individuals who experienced trauma.
2. Coping
styles will predict post traumatic stress disorder (PTSD) among individuals who
experienced trauma.
Shattered
assumptions: refers to the assumptions, or beliefs,
that ground, secure, and orient people, that give a sense of reality, meaning,
or purpose to life
and in
the face of death and trauma, these beliefs are shattered and disorientation
and even panic can enter the lives of those affected as measured by World Assumptions
Scale(WAS) developed by Janoff Bulman (1989) .
Coping styles: is the cognitive, affective, or
behavioral response of a person to problematic or traumatic life events as
measured by Coping Styles Questionnaire developed by Rogers (1993).
Post-Traumatic
Stress Disorder (PTSD): is a trauma and stress related
disorder that may develop after exposure to an event or ordeal in which
death, severe physical harm or violence occurred or was threatened as measured
by Post-traumatic stress diagnostic scale(PDS) developed by Foa (2015).
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