ARTICLE INFO

Article Type

Original Research

Authors

Aghayousefi   A. (1 )
Amirpour   B. (* )






(* ) Psychology Department, Psychology Faculty, Tehran Branch, Payame- Noor University, Tehran, Iran
(1 ) Psychology Department, Psychology Faculty, Tehran Branch, Payame- Noor University, Tehran, Iran

Correspondence

Address: Graduate Education Center of Payam-e-Noor University, Safa Alley, Shahnaz Alley, Haj Mahmoud Noorian Street, North Dibaji Street, Tehran, Iran. Postal Code: 19536335
Phone: +98 8348233449
Fax: +98 8348227173
borzooamirpour@gmail.com

Article History

Received:  November  10, 2014
Accepted:  December 24, 2014
ePublished:  February 19, 2015

BRIEF TEXT


Alongside other symptoms such as re-experiencing the events and psychological numbness, physiologic reactions evoking the trauma are of the main symptoms in the post-traumatic stress disorders (PTSD) [1]. Many evidences show sever and chronic changes of the autonomic nervous system following psychiatric trauma experiences in the patients with post-traumatic stress disorder [2, 5-7]. … [8-17] PTSD can change the persons’ attitudes about the world, themselves, and others, negatively [18].

Veterans with PTSD have systolic and diastolic blood pressure and higher heart rate. In addition, they have higher mean body temperature, cardiovascular disorders, and abnormal electrocardiographic patterns, compared to normal persons and veterans without PTSD [5, 6, 8, 13-17]. … [19-21] The effectiveness of cognitive processing treatment on healing PTSD and its associated symptoms has been shown in the general population and the veterans [22-27]. The previous studies have been mainly about physiologic indicators of cardiovascular risks in the veterans with PTSD. There is a need for studies about psychological interventions in the consequences of PTSD such as variables related to the cardio-vascular situation.

The aim of this study was to investigate the effects of cognitive processing treatment on cardiovascular biomarkers (systolic and diastolic blood pressure, heart rate, and body temperature) in veterans with PTSD.

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

All the male veterans of Iran-Iraq war living in Kermanshah province, Iran, were studied in 2014. The veterans had post-traumatic stress disorder, diagnosed by the medical commission of Kermanshah.

24 persons were selected using convenience sampling method. They were divided into “experiment” and “control” groups. 2 persons from experiment group could not continue the study and their pretests analyses were ignored. The inclusion criteria were PTSD, male sex, being married, at least five elementary education levels, aged less than 70years, score more than the cutoff point of the military version of PTSD (PTSD-M) checklist, and willingness and consent to participate in the treatment course. Persons with psychiatric disorder and active bi-polar, sever dependency to the drugs, serious damaging behaviors such as suicide and sever violence, and more than 70% injury level were not included in the study.

PTSD-M was used. The tool has seventeen 5-choice questions and it is used as the diagnostic aid to diagnose PTSD, based on DSM-IV criteria. Its consistency coefficient for the veterans of Vietnam War is 0.97 [28]. Twelve 60-minute sessions of cognitive processing treatment were performed weekly for the experiment group. Treatment sessions were done after pretest. In the 1st to 4th sessions, after introducing PTSD and stating the rules, the participants were educated to learn about the theoretical bases of cognitive processing treatment and to discuss about the causes of traumatic event and the way through which it affected the person’s beliefs about themselves, others, and the world. The participants were advised to note security, reliance, power-control, self-esteem, and intimacy domains. Then, the participants were trained to make correlations between events, thoughts, and feelings via ABC worksheet and to identify the matters on which thought stopped or to identify thoughts based on the trauma by which every person evaluated himself and the world. Finally, the participants wrote the details of the most traumatic event such as sensory details (smell, light, voice, and the images). In the 5th to 7th sessions, the main cognitive therapy skills, such as using challenging questions worksheet (CQW), were trained. In the 6th session, problematic thinking patterns worksheets were introduced. Veterans considered each stuck points to know they are associated with which faulty thinking patterns. In the 8th to 12th sessions, challenge beliefs worksheet was used. The worksheet made the participants concentrate on security, reliance, power-control, self-esteem, and intimacy domains. In the 12th session, the veterans recorded the event report for 2 times and compared it with the 1st written report they had written in the primary sessions. Aneroid sphygmomanometer and digital thermometer (Beure; Germany) were used by a nurse in the pretest and posttest stages to compute systolic blood pressure, diastolic blood pressure, heart rate, and body temperature and to consider the error possibility. Data was analyzed using SPSS software. Univariate Covariance Analysis was done to investigate the difference between the mean values of dependent variables after controlling the pretests of experiment and control groups.

Mean ages of the experiment and control groups were 52.70±4.47 and 53.83±5.92years, respectively. Mean lengths of participation in the war for experiment and control groups were 4.40±1.64 and 3.52±1.21yeas, respectively. Mean injury percentage values of experiment and control groups were 46.00±10.48% and 47.08±13.22%, respectively. There was no significant difference in the pretest scores between the groups, according to the results of the regression slope. Increase in the mean systolic blood pressure of the control group in posttest (120.16±6.68mmHg) was not significant, compared to pretest (119.16±9.03mmHg). The mean systolic blood pressure of the experiment group in the pretest stage was 118.00±6.32mmHg, which decreased to 114.00±6.99mmHg in the posttest stage. 56% of the systolic blood pressure decrease in the experiment group in posttest stage were explained by cognitive processing treatment. Increase in the mean diastolic blood pressure of control group in posttest (81.66±7.18mmHg) was not significant, compared to pretest (80.83±6.68mmHg). The mean diastolic blood pressure of experiment group in the pretest stage was 86.00±5.16mmHg, which decreased to 74.00±8.43mmHg in the posttest. 62% of the decrease in the experiment group were explained by cognitive processing treatment. Decrease in the mean heart rate of control group in posttest (78.75±2.73) was not significant, compared to pretest (78.91±1.88). The mean heart rate of experiment group in the pretest was 78.80±2.90, which decreased to 74.60±4.76 in the posttest. 80% of heart rate decrease in the experiment group in posttest were explained by cognitive processing treatment. Decrease in the mean body temperature of control group in posttest (36.77± 0.16°C) was not significant, compared to pretest (36.86± 0.08°C). The mean body temperature of experiment group in pretest stage was 36.23±0.70°C, which decreased to 35.03±0.98°C in the posttest stge. 97% of body temperature decrease of experiment group in posttest was explained by cognitive processing treatment.

Due to the weakness of the literature, there was no possibility to compare the results with other studies. Hypothalamic-pituitary-adrenal axis disorder is a factor leading to more disorders in the cardiopulmonary system of the veterans with PTSD and increase in the blood pressure and heart rate [1, 6]. … [30, 31]

Hypothalamic-pituitary-adrenal axis function in persons with PTSD ought to be studied via non-invasive methods such as interleukins status and cortisol secretion.

Lack of control of the correlated variables with the changes in the cardiovascular biomarkers, such as sex, age, life style, smoking, history of coronary artery, and secretion of hormones associated with stress, was one of the limitations of the study. Any generalization of the results to non-veteran patients with PTSD should be done cautiously.

As a treatment approach based on the cognitive-behavioral treatments and via mere focus on the trauma disorders using efficient technics, cognitive processing treatment can be used as an effective method in the treatment of the symptoms associated with PTSD such as biological and vascular symptoms.

The researcher feels grateful to the participants and Elmi-Karbordi Center of Kermansah Martyrs Foundation.

Non-declared

Non-declared

The study was funded by Kermanshah Martyrs and Veterans Foundation.


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