ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Abolmaali   Kh. (* )
Kamal   A. (1 )






(* ) Psychology Department, Psychology Faculty, Roudehen Branch, Islamic Azad University, Roudehen, Iran
(1 ) Psychology Department, Psychology Faculty, Roudehen Branch, Islamic Azad University, Roudehen, Iran

Correspondence

Address: 6th Floor, Unit 21, Block 42, Kooye Noor 4, Noor Street, Phase 3, Mahallati Town, Minicity, Tehran, Iran
Phone: +98 2176505018
Fax: +98 2188519082
sama.abolmaali@gmail.com

Article History

Received:  October  10, 2014
Accepted:  December 2, 2014
ePublished:  February 19, 2015

BRIEF TEXT


… [1-7] The secondary trauma is indirectly created due to close relationships with the main victims [8]. … [9-11] In the secondary traumatic stress (STS), the patient imitates the psychological symptoms of posttraumatic stress disorder (PTSD). The components of STS are similar to the components of the primary post-traumatic stress. Therefore, the concepts of the primary post-traumatic stress have been used to explain the concepts of the secondary trauma [5, 12, 13]. … [14-19] Stressful factors might lead to decrease health and mood [20]. There is a significant difference between the quality of life of the wives of the veterans with PTSD and the quality of life of the wives of other veterans [21]. … [22-25] Susceptibility to the secondary trauma has been related to the cognitive schemas [5]. The trauma symptoms in the persons have been related to their schemas and fundamental beliefs [26]. … [27-31]

The effects of schema-based education on reduction in marital dissatisfaction [25], problem solving in children with learning disabilities [32], learning ratio and proportion in children [33], and improving knowledge organizing and the diagnostic reasoning strategies [34] have been evaluated positive. Methods such as information processing-based treatment [35], cognitive-behavioral [36], and schema therapy [37] were used to reduce the PTSD symptoms. The effects of cognitive-behavioral education [38, 39] and mindfulness education [39, 40] on reduction in the secondary trauma symptoms and adaption with the trauma have been investigated. The effects of the schema-based education on reduction in STS have not been studied.

The aim of this study was to assess the effects of schema-based education model on reducing STS symptoms and its dimensions (re-experiencing the traumatic event or disturbing thoughts, avoidance responses, and arousal syndrome) in the wives of the veterans with PTSD.

This is a quasi-experimental study with pretest-posttest and control group.

All veterans’ wives with PTSD, referred to Sadr Psychiatric Hospital (Tehran, Iran) from 2006 to 2013, were studied.

Sample size estimated 12 persons for experiment and control groups, based on Cohen’s Table [41]. The inclusion criteria were scores more than 38 in the secondary trauma stress scale (STSS), education level at five-grade education and more, no history of psychiatric diseases, a wife of a veteran with post-traumatic stress disorder (PTSD), residence in Tehran, and age between 30 and 55years. The exclusion criteria were major psychiatric disorders, less than five-grade education level, psychotherapy and consumption of administrated psychiatric medications simultaneously with the group meetings, a history of hospitalization in a psychiatric hospital, and scores less than 38 in STSS.

Demographic questionnaire, depression, anxiety, and stress scale (DASS), and secondary trauma stress scale (STSS) were the study tools. Data, including age, marital length, education level, injury percentage of the husband, and children’s number, were collected by the demographic questionnaire. 21-sentence DASS form, adapted from 42-question long form, was used. In the scale, any psychological structure or factor (depression, anxiety, and stress) is measured by every seven sentences and every response to each question is graded by 4-point Likert (never=zero, to some degree=1, to a considerable degree=2, very much=3) [37]. Validity of the scale has been investigated, using factor analysis and criterion validity [42, 43]. Using test-retest method, reliabilities of the questionnaire for depression, anxiety, and stress scales has been evaluated 0.80, 0.76, and 0.77, respectively [41]. STSS includes 3 sub-scales to evaluate disturbing thoughts and images, avoidance responses, and arousal symptoms in persons who are in a close relationship with patients with PTSD. Every question is scored by 5-point Likert (never=1, rarely=2, occasionally=3, often=4, very often=5). 38 scores and more show the secondary traumatic stress indices. … [44-46] Using test-retest method, reliability of the questionnaire has been reported between 0.71 and 0.91 [47, 48]. At first, about 300 documents of veterans with PTSD referred to Sadr Psychiatric Hospital from 2006 to 2013 were evaluated. Then, 40 wives of the veterans with PTSD were asked to participate in the classes. Training method (titles and aims of the courses) was explained to the wives, who were willing to participate. At the first session, the secondary stress symptoms scale was taken from them and 24 persons with 38 scores and more were selected. The persons divided randomly into “control” (12persons) and “experiment” (12persons) groups. Then, experiment group was informed by kind of participation and number of the sessions of the courses (twelve 2-hour sessions and one session per week). In case of effectiveness of schema-based education, control group was promised to take part in the courses. Experimental intervention was conducted in 12 sessions. A review of previous sessions, logic of technic presentation, educating the determined foundations in each session, a review of the determined tasks, determining the tasks for the next session, and finally, abstracting and taking feedbacks were done in every session. STSS test was done at the end of the 12th session and the results were compared with the pretest. Schema-based group education intervention box was compiled by the researcher, based on Young’s Early Maladaptive Schema theory. … [49] To accelerate the learning, metaphor therapy was used in every session [50, 51]. Data were analyzed, using univariate and multivariate covariance statistical methods. Standard deviation and average descriptive indices were used to describe the data of STSS. The distribution indices and Kolmogorov–Smirnov test were used to investigate data distribution. In case of fulfillment the hypotheses of the test, univariate covariance analysis test was used to compare the total numbers of STSS in both groups. Multivariate covariance analysis was used to compare the components of STSS (disturbance, avoidance, and arousal) in both groups.

At the post-test stage, the mean score of secondary trauma in experiment group was significantly lesser than control group did. Therefore, schema-based education with controlling the effects of the pretest and depression, anxiety, and stress variables was able to decrease the secondary trauma symptom. 67.1% of variance of the symptoms of the secondary trauma were explained via schema-based education variable. There was a significant difference between mean scores of both groups at the post-test stage in symptoms, including disturbance, avoidance, and arousal with controlling the effects of pretest, and depression, anxiety, and stress variables. Schema-based education was able to reduce the dependent variable mean scores of participants in experimental group. Schema-based education explained 65.6, 32.2, and 38% of variance of disturbance, avoidance, and arousal components, respectively (Table 1).

Schema-based education was effective in reducing the symptoms of secondary trauma and its components (disturbance, avoidance, and arousal). The result is consistent with some other studies [35-40]. Schema-based experimental technics are effective factors in overcoming avoidance, reducing the disturbance behaviors, and facilitating the conditions of emotional improvement [30].

Effectiveness of schema-based education on other psychiatric problems of the wives of veterans with PTSD ought to be investigated. The education method should be considered in preventive programs and education policies for the veterans’ wives.

Due to operational constraints, there was no pursuit of the effectiveness of schema-based education on the secondary trauma symptoms. Lack of control on personal characteristics, educational levels, and economic and social situation of the veteran’s wives was of the limitations for the study.

Schema-based education model is an effective and efficient intervention to reduce the symptoms of the secondary trauma and its dimensions (re-experiencing the traumatic event or disturbing thoughts, avoidance responses, and arousal syndrome) in wives of veterans with PTSD. Through schema-based education, it is possible to help persons to change their general beliefs after experiencing the traumatic event (including beliefs about self, others, and the world), which reduces disturbing thoughts and other symptoms.

The researchers feel grateful to all the veterans’ wives, who participated in the study.

Non-declared

Non-declared

The study was funded by the researchers.

TABLES and CHARTS

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