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SHATTERED ASSUMPTIONS AND COPING STYLES AS PREDICTORS OF POST TRAUMATIC STRESS DISORDER FOLLOWING A TRAUMATIC EVENT
ABSTRACT
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.
CHAPTER ONE
INTRODUCTION
Background to the Study
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)
- 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.
Statement of the Problem
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:
- no appropriate health care policy
- no nationwide orientation on PTSD
- no research on the peculiarity of PTSD in Nigeria (if any)
- 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.
Research Questions
Therefore this study intends to find answers to the following questions:
- Would shattered assumptions significantly predict post traumatic stress disorder (PTSD) among individuals who experienced trauma?
- Would coping styles significantly predict post traumatic stress disorder (PTSD) among individuals who experienced trauma?
Purpose of Study
The major purpose of this study is to determine whether:
- To determine if shattered assumptions will predict post traumatic stress disorder (PTSD) among individuals who experienced trauma.
- Coping styles will predict post traumatic stress disorder (PTSD) among individuals who experienced trauma.
Operational Definition of Terms
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).