ARTICLE INFO

Article Type

Original Research

Authors

Abolmaali   Kh. (* )
Aghaeepour Gavasaraee   M. (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: Psychology Department, Imam Ali Building, Islamic Azad University, Roudehen, Iran
Phone: +982176505018
Fax: +982188577520
sama.abolmaali@gmail.com

Article History

Received:  December  21, 2014
Accepted:  February 18, 2015
ePublished:  April 20, 2015

BRIEF TEXT


…[1, 2]. About 9 to 45% of veterans returning from war are affected by posttraumatic stress disorder (PTSD) [3-11]. Secondary trauma is considered as psychological outcome and an emotional and natural repercussion caused by close, direct and long-term contacts with patients with posttraumatic stress disorder and its symptoms appear suddenly and without warning [6, 12-15]. … [16, 17]

Spouses of veterans with posttraumatic stress disorder are among the groups that suffer the negative consequences of psychological traumatic events [6, 13, 14, 18].... [19-40]

This study aimed to evaluate the effect of teaching cognitive-behavioral techniques to reduce symptoms of secondary trauma and its components (interference, avoidance and arousal) in the spouses of veterans with posttraumatic stress disorder through controlling the effects of anxiety, stress and depression.

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

The study sample consisted of spouses of veterans with posttraumatic stress disorder who were living in Tehran in 2013.

The veterans had referred to Sadr Psychiatric Hospital in the Tehran between 2003 and 2013 and they were diagnosed of having PTSD (due to their psychiatric records). 24 spouses of veterans with posttraumatic stress disorder after the screening were placed randomly into two groups.

The groups were experimental and control. It should be noted that in the course of implementation, the total number of cases due to the loss was reduced to 22 persons and there were 11persons per each group. Inclusion criteria included obtaining required score in the Secondary Traumatic Stress Scale (with a cut-off score of 38), having no history of hospitalization due to psychiatric illness, lacking psychiatric drugs and psychological therapy in the past 4 months, at least 10 years marriage, 35-55 years old and at least fifth grade of primary school. An exclusion criterion was lack of willingness to participate in the research. Data was gathered using a researcher-made questionnaire for demographic information, Secondary Traumatic Stress Scale (STSS) and Depression, Anxiety, Stress Scales (DASS). The demographic questionnaire contained information related to age, marriage length, education, history of hospitalization due to psychiatric disease and so on. ... [41-50]. Each training session was hold on a weekly basis, in two 1-hour parts, and the whole time of the session was 135 minutes for experimental group considering the time for rest and reception (Table 1) [31, 38, 45, 51]. After completion of the training sessions and at the end of the thirteenth session, participants, again, took a secondary traumatic stress scale (as a post-test) and the results were compared with the results of the pretest. T-test was used in independent groups to compare the mean of pre-test of Secondary Traumatic Stress Scale and their components in the control and experimental groups. To investigate the effects of independent variables (training of cognitive- behavioral techniques) on secondary trauma and its components, ANCOVA and MANCOVA tests were used with pretest and anxiety, depression and stress (DASS) effects control.

The mean age of participants was 43.5 ± 6.2years between 32 and 54 years. Mean years of education was 10.5 ± 3.4years, between 5 and 16 years. In addition, the mean years of married life of participants was 22.5 ± 6.7years, between 10 and 34 years. The mean scores of secondary trauma test and the components of interference, avoidance, and arousal in the all cases in the posttest of experimental group was lower than those in the control group (Table 2). Based on the results of T-test, there was no significant difference between the mean of total score of pre-test of the secondary trauma and its components in the two groups. Pre-test, depression, anxiety, and stress (DASS) scores having been controlled, , the independent variable (cognitive-behavioral training method) could make a significant difference between experimental and control groups. Therefore, application of cognitive-behavioral training method resulted in a reduction in the total score of secondary trauma in the experimental group. In addition, 68.4% (0.648) of the variance of the total score of secondary trauma was explained by the independent variable (teaching the cognitive behavioral techniques). In general, the teaching the cognitive-behavioral techniques could reduce symptoms of secondary trauma. There was a significant difference between experimental and control groups in the symptoms of interference, avoidance, and arousal with controlling the effects of the variables of depression, anxiety, and stress (DASS) and controlling the effects of pretest. Moreover, Eta-square values indicated a moderate connection between cognitive-behavioral techniques and disturbing symptoms of interference, avoidance, and arousal, 0.530, 0.350 and 0.475 respectively.

The efficacy of cognitive-behavioral strategies to reduce the symptoms of secondary traumatic has been confirmed in other studies [23, 25- 28]. Each method which is effective in alleviating the symptoms of posttraumatic stress disorder could be useful in alleviating the symptoms of secondary trauma, as well as the protection and empowerment of veterans’ wives in the way to deal with the secondary trauma [14]. In line with this assumption, the results of this research are consistent with the results of other studies in terms of the efficiency of cognitive-behavioral techniques in reduction of primary stress disorder and other psychological problems [48, 49, 52- 57]. In addition, the results of the present study are consistent with the studies showing that cognitive-behavioral techniques reduce psychological problems. … [58]

In the present research, there was no possibility to study the continued effects of teaching the cognitive-behavioral techniques. Therefore, the persistence of the effect of education on cognitive behavioral symptoms of secondary trauma symptoms should be studied and the variables such as the economic conditions, the situation of employment, and the level of education of veterans’ wives affected by posttraumatic stress disorder should also be controlled.

Non-declared

The method of teaching the cognitive-behavioral techniques is an effective strategy to reduce the symptoms of secondary trauma and its three components, namely interference, avoidance, and arousal in wives of veterans with posttraumatic stress disorder.

All spouses of veterans with posttraumatic stress disorder, officials of Tehran Foundation of Martyrs and Veterans’ Affairs, and the chief of Sadr Psychiatric Hospital are appreciated.

No conflict of interest was reported by researchers, participants and Sadr Hospital Officials.

After obtaining informed consent from participants, they were insured that the information contained in the questionnaires would remain confidential and the participation in this study did not cause any losses for them. In addition, they were assured that the findings from this study were reported as a whole and without citing individual cases.

The study was funded by the authors.

TABLES and CHARTS

Show attach file


CITIATION LINKS

[1]Rezaee M, Yonesi J, Ahmadi Kh, Asgari A, Mirzaee J. The impact of emotionally focused couple therapy on improving communication patterns in combat-related PTSD veterans & their wives. J Fam Res. 2010;6(1):43-58. [Persian]
[2]Milliken CS, Auchterlonie JL, Hoge CW. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA. 2007;298(18):2141-8.
[3]Dohrenwend BP, Turner JB, Turse NA, Adams BG, Koenen KC, Marshall R. The psychological risks of Vietnam for U.S. veterans: A revisit with new data and methods. Sci. 2006;313(5789):979-82.
[4]Kotler M, Cohen H, Aizenberg D, Matar M, Loewenthal U, Kaplan Z, et al. Sexual dysfunction in male posttraumatic stress disorder patients. Psychother Psychosom. 2000;69(6):309–15.
[5]Solomon Z, Shklar R, Mikulincer M. Frontline treatment of combat stress reaction: A 20-year longitudinal evaluation study. Am J Psychiatry. 2005;162(12):2309-14.
[6]Galovski T, Lyons JA. Psychological sequelae of combat violence: A review of the impact of PTSD on the veteran’s family and possible interventions. Aggress Violent Behav. 2004;9:477-501.
[7]Boscarino JA, Figley CR, Adams RE. Compassion fatigue following the September 11 terrorist attacks: A study of secondary trauma among New York City social workers. Int J Emerg Ment Health. 2004;6(2):57-66.
[8]Zimering R, Gulliver SB, Knight J, Munroe J, Keane TM. Posttraumatic stress disorder in disaster relief workers following direct and indirect trauma exposure to Ground Zero. J Trauma Stress. 2006;19(4):553-7.
[9]Sodeke-Gregson EA, Holttum S, & Billings J. Compassion satisfaction, burnout, and secondary traumatic stress in UK therapists who work with adult trauma clients. Eur J Psychotraumatol. 2013;4:10.
[10]Pines A, Aronson E. Career burnout: Causes and cures. New York: Free Press; 1998.
[11]Pearlman LA. Self-care for trauma therapists: Ameliorating vicarious traumatization. In: Stamm BH, editor. Secondary traumatic stress: Self-care issues for clinicians, researchers & educators. 2nd edition. Baltimore: Sidran Press; 1999. pp. 51-64.
[12]Klarić M, Kvesić A, Mandić V, Petrov B, Frančišković T. Secondary traumatisation and systemic traumatic stress. Psychiatr Danub. 2013;25(Suppl1):29-36.
[13]Figley CR. The family as victim: Mental health implication. Psychiatry. 1985;6:283-91.
[14]Francisković T, Stevanović A, Jelusić I, Roganović B, Klarić M, Grković J. Secondary traumatization of wives of war veterans with posttraumatic stress disorder. Croat Med J. 2007;48(2):177–84.
[15]Collins J. Addressing secondary traumatic stress: Emerging approaches in child welfare. Children’s Voice. 2009;2:10-4.
[16]Adams RE, Boscarino JA, Figley CR. Compassion fatigue and psychological distress among social workers: A validation study. Am J Orthopsychiatry. 2006;76(1):103-8.
[17]Ben Arzi N, Solomon Z, Dekel R. Secondary traumatization among wives of PTSD and post-concussion casualties: Distress, caregiver burden and psychological separation. Brain Inj. 2000;14(8):725-36.
[18]Klarić M, Frančišković T, Obrdalj EC, Petrić D, Britvić D, Zovko N. Psychiatric and health impact of primary and secondary traumatization in wives of veterans with posttraumatic stress disorder. Psychiatr Danub. 2012;24(3), 280-6.
[19]Koić E, Frančišković T, Mužinić-Masle L, Đorđević V, Vondraček S, Prpić J. Chronic pain and secondary traumatization in wives of Croatian war veterans treated for post-traumatic stress disorder. Acta Clinica Croatica. 2002;41(4):295-306.
[20]Porafshar S, Ahmadi Noudeh Kh, Elias MH. Evaluation of secondary PTSD and marital satisfaction in spouses of veterans with PTSD. Milit Psychol Q. 2008;1(1):67-76. [Persian]
[21]Cockram DM, Drummond PD, Lee CW. Role and treatment of early maladaptive schemas in Vietnam Veterans with PTSD. Clin Psychol Psychother. 2010;17(3):165-82.
[22]Yousefi R, Abedin A, Tirgari A, Fathabadi J. The effect of schema-based instruction on improving marital satisfaction. J Clin Psychol. 2009;2(3):25-37. [Persian]
[23]Kazemi AS, Banijamali SS, Ahadi H, Farrokhi NA. Effectiveness of cognitive-behavioral strategies in reducing the symptoms of secondary traumatic stress disorder (STSD) spouses of veterans with chronic PTSD and psychological problems caused by the war. Islamic Azad Univ J Med Sci. 2012;22(2):122-9. [Persian]
[24]Ortlepp k, Friedman M. Prevalence and correlates of secondary traumatic stress in workplace lay trauma counselors. J Trauma Stress. 2002;15(3):213-22.
[25]Follette V, Palm KM, Pearson AN. Mindfulness and trauma: Implications for treatment. J Ration-Emot Cogn-Behav Ther. 2006:24(1):45-61.
[26]Kazemi AS. The effectiveness of mindfulness-based cognitive strategies to reduce the symptoms of secondary traumatic stress disorder and chronic psychological problems. J Think Behav. 2011;6(23):122-9. [Persian]
[27]Robertson CS, Valadka AB, Hannay HJ, Contant CF, Gopinath SP, Cormio M, et al. Prevention of secondary ischemic insults after severe head injury. Crit Care Med. 1999; 27(10):2086-95.
[28]Pietrzak RH, Johnson DC, Goldstein MB, Malley JC, Southwick SM. Psychological resilience and post deployment social support protect against traumatic stress and depressive symptoms in soldiers returning from Operations Enduring Freedom and Iraqi Freedom. Depress Anxiet. 2009;26(8):745-51.
[29]LaMontagne, LL, Hepworth JT, Cohen F, Salisbury MH. Cognitive-behavioral intervention effects on adolescents’ anxiety and pain following spinal fusion surgery. Nurs Res. 2003;52(3):183-90.
[30]Prochaska JO. Decision making in the trans-theoretical model of behavior change. Med Decis Making. 2008;17;11-9.
[31]Beck AT. The current state of cognitive therapy: A 40-year retrospective. Arch Gen Psychiatry. 2005;62(9):953-59.
[32]Roiser JP, Elliott R, Sahakian BJ. Mood disorders: Cognitive mechanisms of treatment in depression. Neuropsychopharmacol Rev. 2012;37:117-36.
[33]Burns DD, Spangler DL. Does psychotherapy homework lead to improvements in depression in cognitive-behavioral therapy or does improvement lead to increased homework compliance? J Consult and Clin Psychol. 2000;68(1):46 –56.
[34]Gould RA, Buckminster S, Pollack MH, Otto MW, Yap L. Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis. Clin Psychol: Sci Pract. 1997;4(4):291-306.
[35]Scascighini L, Toma V, Dober-Spielmann S, Sprott H. Multidisciplinary treatment for chronic pain: A systematic review of interventions and outcomes s. Rheumatol. 2008;47(5):670-8.
[36]Hilbert A, Tuschen-Caffier B. Body image interventions in cognitive-behavioral therapy of binge-eating disorder: A component analysis . Behav Res Ther. 2004;42(11):1325–39.
[37]Narimani M, Rajabi S. Comparison of the effect of eye movement desensitization and reprocessing and cognitive-behavioral therapy in the treatment of posttraumatic stress disorder. Islamic Azad Univ J Med Sci. 2009; 19(4):236-45. [Persian]
[38]Zoellner, L A, Feeny NC, Fitzgibbons LA, Foa EB. Response of African American and Caucasian women to cognitive behavior therapy for PTSD. Behav Ther. 1999;30(4):581–95.
[39]Paunovic, N, Ost LG. Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees. Behavior research and therapy. 2001;39(10):1183-97.
[40]Devilly GJ, Spence SH. The relative efficacy and treatment distress of EMDR and a cognitive-behavior trauma treatment protocol in the amelioration of posttraumatic stress disorder. J Anxiety Disord. 1999;13(1-2):131-57.
[41]Cristofolini L. The important of sample size and statistical power in experimental research: A comparative study. Acta Bioengin Biomechanics. 2000;2(1):3-16.
[42]Ahmadi Kh, Rezapour Y, Davoudi F, Saberi M. Investigate of validity and reliability of secondary trauma stress scale for evaluation of ptsd symptoms in samples of warfare victims’ wives. Iran J War Public Health. 2013;5(3):47-57. [Persian]
[43]Bride BE, Robinson MM, Yegidis B, Figley CR. Development and validation of the secondary traumatic stress scale. Res Soc Work Pract. 2004;14(1):27-35.
[44]Zoladz PR, Diamond DM. Current status on behavioral and biological markers of PTSD: A search for clarity in a conflicting literature. Neurosci Biobehav Rev. 2013;37(5):860-95.
[45]Abolmaali Kh, Kamal A. Effect of schema-based learning on reducing the symptoms of secondary traumatic stress in wives of post-traumatic stress disorder veterans. Iran J War Public Health. 2015;7(1):21-8. [Persian]
[46]Ahmadi Kh, Rezapour Mirsalah R. Standardization test of vicarious PTSD in veterans' families [Research Report]. Institute of Behavioral & Neuroscience and Behavioral Sciences Research Center: Baqiyatallah University of Medical Sciences, Tehran, Iran; 2011. [Persian]
[47]Samani S, Jokar B. A study on the reliability and validity of the short form of depression, anxiety and stress scale. J Soc Sci Humanities Shiraz Univ. 2007;26(3):65-77. [Persian]
[48]Ahmadzadeh Aghdam E, Ahmadi Kh, Nooranipoor R, Akhavi Z. The effect of stress inoculation on decrease of PTSD symptoms in veterans. Iran J War Public Health. 2013;5(3):32-40. [Persian]
[49]Zayfart C, DeViva JC. Residual insomnia following cognitive behavioral therapy for PTSD. J Trauma Stress. 2004;17(1):69-73.
[50]Moradi Manesh F, Ahadi H, Jomehri F, Rahgozar M. Relationship between psychological distress and quality of life in women with breast cancer. J Zabol Univ Med Sci Health Serv. 2012;4(2):51-9. [Persian]
[51]Leahy RL, Trich D, Napolintano LA. Emotion Regulation in Psychotherapy: A Practitioner guide. New York- London: The Guilford Press; 2011.
[52]Aslani M, Hashemian K, Lotfi Kashani F, Mirzaei J. The effectiveness of cognitive behavioral therapy (CBT) in patients with chronic posttraumatic stress disorder as a result of the war. J Appl Psychol. 2005;1(3):16-7. [Persian]
[53]Zoghi Paidar M, Sohrabi F, Borjali A, Delavar A. Effectiveness of instruction of coping skills based on cognitive-behavioral approach on post-traumatic stress disorder and depression caused by the war veterans. Milit Psychol. 2011;2(5):1-16. [Persian]
[54]Foa EB, Rothbaum BO, Riggs D, Murdock T. Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling. J Consult Clin Psychol. 1991;59(5):715-23.
[55]Monson CM, Fredman SJ, Macdonald A, Pukay-Martin ND, Resick PA, Schnurr PP. Effect of cognitive-behavioral couple therapy for PTSD: A randomized controlled trial. J Am Med Assoc. 2012;308(7):700-9.
[56]Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang, A. The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognit Ther Res. 2012;36(5):427–40.
[57]Otte C. Cognitive behavioral therapy in anxiety disorders: Current state of the evidence. Dialogues Clin Neurosci. 2011;13(4): 413-21.
[58]McGuire J. The think first program. In: McMurran M, McGuire J, editors. Social problem solving and offending: Evidence, evaluation and evolution. Hoboken: John Wiley & Sons; 2005. pp. 183-206.