@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2019;11(1):1-6

Background
Posttraumatic stress disorder (PTSD) is one of the psychological consequences of the war survivors. ... [1].
Previous Studies
... [2-4]. Rumination is one of the factors leading to an increase and persistence of the PTSD symptoms in veterans [5]. ... [6-8]. Meiser-Stedman et al. [9] concluded that PTSD symptoms are associated with social support and rumination and that rumination is contributed to the persistence of PTSD symptoms. Basharpoor et al. [10] showed that the rumination level in people with PTSD is significantly higher than those without PTSD; and the people with PTSD are greatly concerned with predicting the causes and consequences of a traumatic event. ... [11, 12]. Veterans suffering from PTSD have a higher degree of experiential avoidance than the veterans who have improved or do not have PTSD, which plays a pivotal role in the persistence of PTSD [13]. ... [14-18]. Shenk et al. [19] showed that experiential avoidance has a significant role in the symptoms of PTSD. ... [20-22]. Behavioral Activation Therapy (BAT) is one of the therapeutic methods to reduce the rumination and experiential avoidance of the veterans which has so far not been taken into consideration by the researchers. ... [23-28]. Moshier et al. [29] showed that BAT method via focus on activity scheduling can encourage patients to do activities that are avoided and also to analyze the performance of cognitive processes such as rumination.
Aim(s)
The purpose of the present study was to investigate the effectiveness of the brief BAT on the rumination and experiential avoidance of veterans with PTSD.
Research type
This research is a semi-experimental study with pretest-posttest design using control group.
Research society, place and time
This study was done on veterans with PTSD who referred to Isar Ardabil psychiatric hospital in 2017.
Sampling method and number
40 veterans were selected through purposive sampling method and were randomly assigned to the experimental (20 samples) and control groups (20 samples). Inclusion criteria included at least guidance school education, age range of 40-70 years, no participation in other psychotherapy interventions, no psychiatric symptoms, including hallucinations and delusions, no other disorders in addition to PTSD, and no disorders caused by drug abuse.
Used devices&materials
Data was collected using Ruminative Response Scale (RRS) [30-32] and Acceptance and Practice-Editing Questionnaire (AAQ-II). [20, 33, 34]. The essential permission was obtained from the research department of the Isar Hospital to visit the hospitalized veterans and the research was introduced to the Medical Ethics Committee of the Hospital and was approved. The samples were interviewed using the structured clinical interview (SCID) by a psychiatrist to investigate some of the inclusion criteria. Some of the inclusion criteria were also reviewed using the psychiatric records of the patients. Veterans who met the inclusion criteria were selected as the samples. The consent of the samples was obtained and they were assigned into the experimental and control groups, and they were individually also informed about the research objectives and details and they were communicated. The written consent was obtained from the veterans and the AAQ-II and RRS questionnaires were presented to subjects to answer. The questionnaires were individually completed and the subjects were guided about the possible questions while answering. The experimental group received the brief BAT based on the practical guide developed by Lejuez et al. [24] through 10 one-hour sessions (Table 1). The control group also visited the researcher, however they did not receive any active and specific treatment. Following the interventions, the post-test data was collected using the questionnaires used in the pre-test through two-week interval. Ethical considerations were observed, including the confidentiality of information and psychologically preparation of samples.For moderating the effects of pre-test, data was analyzed using the multivariate covariance analysis using SPSS 23. Homogeneity of covariance matrices was also checked through the box test. In addition, the linear relationship between the covariate variables (pre-test scores) was approved, according to the correlation coefficients between the pre-test and the post-test variables. No correlation above 0.7 was obtained for covariate variables, so multiple linear was refused. Multivariate analysis of covariance was used to investigate the effectiveness of brief BAT (independent variable) on rumination and experiential avoidance (dependent variables) of veterans with PTSD.
Findings by Text
The mean age of the experimental group and control group was 51.51±1.19 and 52.25±1.30 years, respectively. In the experimental group, 5 and 15 subjects and in the control group, 6 and 14 subjects were singles and married, respectively. In the experimental group, 9 and 11 subjects and in the control group, 8 and 12 subjects had below diploma and diploma and above. The mean scores of rumination and experiential avoidance were significantly different between the experimental and control groups in the post-test with control of pre-test (p<0.05), the interventional significantly reduced the mean scores of rumination (P=0.035, F=4.843) and experiential avoidance (P=0.030; F=5.123) (Table 2).
Main comparison to the similar studies
The brief BAT was effective in reducing rumination of veterans with PTSD, which is consistent with previous studies [29, 35]. Zemestani et al. [35] showed that brief BAT has a significant effect on depression, anxiety, and decreased rumination in students. In the present study, brief BAT was effective on the experiential avoidance of veterans with PTSD. No consistent research was found, however there are other studies with similar results [26, 36]. Myers et al. [26] showed that behavioral inhibition as a positive and significant relationship with behavioral avoidance in PTSD veterans. Contractor et al. [36] also suggested that there is a significant stronger relationship between Behavioral Inhibition System (BIS) with dysphoria, avoidance, and re-experience of an accident in PTSD.
Suggestions
It is suggested that a similar study be carried out on veterans with PTSD in other cities and their findings be compared with the findings of this study.
Limitations
The study population was limited to the veterans with PTSD from Isar Psychiatric Hospital of Ardabil, so the results should be generalized to other cities cautiously.
Conclusions
Training BAT can reduce rumination and experiential avoidance of veterans with PTSD.
Acknowledgments
The authors are grateful to the veterans of the Isar Psychiatric Hospital of Ardabil for their cooperation and also to the officials of the Foundation of Martyrs and Veterans Affairs of Ardabil for their support.
Conflict of interest
None declared.
Ethical Permissions
The research was introduced to the Medical Ethics Committee of the Hospital and the essential permission was obtained.
Funding Sources
None declared.

TABLES and CHARTS

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