ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Atadokht   A. (1)
Einy   S. (*)
Tagavy   R. (2)






(*) Psychology Department, Educational Sciences & Psychology Faculty, Mohaghegh Ardabili University, Ardabil, Iran
(1) Psychology Department, Educational Sciences & Psychology Faculty, Mohaghegh Ardabili University, Ardabil, Iran
(2) Psychology Department, Psychology Faculty, Ardabil Branch, Islamic Azad University, Ardabil, Iran

Correspondence

Address: Psychology & Educational Sciences Faculty, University of Mohaghegh Ardabili, Daneshgah Street, Ardabil, Iran
Phone: +98 (45) 33262678
Fax: +98 (45) 33511508

Article History

Received:  September  27, 2017
Accepted:  January 11, 2017
ePublished:  April 10, 2018

BRIEF TEXT


Post-Traumatic Stress Disorder (PTSD) is one of the most common, chronic and disabling psychiatric disorders that is based on the fifth statistics and diagnostic manual for Mental Disorders (DSM-5), which is part of the diagnostic series of stress-related disorders, which can happen after facing with a traumatic event [1, 2].

… [3]. Studies have shown that veterans with PTSD have a higher degree of experiential avoidance than veterans who have recovered and veterans who are not suffering from PTSD at all, which play a pivotal role in the continuation of PTSD [4]. Experiential avoidance is defined as inflexible attempts to avoid emotional or psychological experiences, suppression or containment of emotional or psychological experiences [5]. ... [6-13]. Research findings have also shown that veterans with PTSD have a strong tendency to involve in impulsive behaviors in negative emotional states [14]. In general, impulsiveness is defined by the lack of ability to postpone gratification [15]. ... [16]. Cognitive and behavioral inhibition in PTSD sufferers is defective, which is the cause of arousal, aggression, re-experience of harmful events and the appearance of intrusive and unwanted thoughts, which are considered as essential signs of PTSD disorder [17]. ... [18-22]. One of the theories that can be considered for describing and explaining individual differences and psychopathology in war veterans with PTSD is the Gary's theory of Reinforcement Sensitivity Theory (RST). In RST theory, Gray proposed three Behavioral Activation System (BAS), Behavioral Inhibition System (BIS), and Fight/Flight and Freeze System (FFFS) [23]. ... [24-27]. A review of literature and research history suggests that the system of activation and inhibition of behavior may be related to the impulsivity and experiential avoidance of PTSD veterans. On the other hand, since experiential avoidance and impulsivity [13] and impulsivity [22] are accompanied with the exacerbation of PTSD symptoms, the study of relationship between activation and behavioral inhibition systems with impulsivity and experiential avoidance of veterans with PTSD can be important.

The purpose of this study was to predict the impulsivity and experiential avoidance of veterans with PTSD based on activation and behavioral inhibition systems.

This research is descriptive-correlational.

This research was conducted among all veterans with posttraumatic stress disorder in Ardabil Isar Psychiatric Hospital in 2017.

According to the law of minimum sample size in correlation research which is 100 participants [28], 120 veterans with PTSD were selected using convenience sampling method. The diagnosis of post-traumatic stress disorder was also based on the psychiatrist's point of view. Activation and behavioral inhibition systems were considered as predictive variables and impulsivity and experiential avoidance of war veterans with PTSD were considered as criterion variables. The criteria for entering the study included the absence of psychotic symptoms, hallucinations and delusions, and other diagnoses associated with post-traumatic stress disorder, such as mood disorders, the absence of substance abuse disorders, the minimum level of education and the patient's consent to participate in the research process.

The scale of Inhibition / Behavioral Activation Systems [29-32], Impulsivity Questionnaire (BIS-11) [33-35] and Acceptance and Action Questionnaire (AAQ) [10, 36, 37] were used as a research tool. The samples were first interviewed by the psychiatrist at the hospital and diagnosis of PTSD was done by him. After that, the research objectives were explained for the sample and after receiving the patients' satisfaction, they were asked to respond to the research questionnaires. Data analysis was performed by SPSS 21 software. Kolmogorov-Smirnov test to examine the natural data distribution, Pearson correlation coefficient to examine the existence of significant correlation between variables and multiple regression analysis to explain the experimental avoidance and impulsivity of veterans with PTSD based on the system of behavioral activation and inhibition systems were applied.

The mean age of veterans with PTSD was 58.03 ± 7.76 years, ranging from 41 to 78 years old. 25 (20.8%) of these veterans were single and 95 (79.2%) were married. 33 (27.5%) had under-diploma education and 87 (72.5%) had diploma or higher education. Also 53 (44.2%), 27 (22.5%) and 40 (33.3%) were employed, self-employed and unemployed or retired respectively. There was a significant and positive relationship between experiential avoidance and behavioral inhibition, motion impulsivity and sensitivity to rewards, cognitive impulsivity and sensitivity to reward and behavioral inhibition as well as disorganization and sensitivity to reward in veterans with PTSD. Therefore, with the increase in sensitivity of the behavioral inhibition system, experiential avoidance and impulsivity increase, and increase in susceptibility to rewards, leads to increase in impulsivity of veterans with PTSD (Table 1). The behavioral inhibition and activation system was a good predictor of empirical avoidance, so that 65.4% of the variance in experiential avoidance of veterans with PTSD was explained by inhibition and behavioral activation systems (p = 0.001). The behavioral inhibition system (β = .167) and reward sensitivity (β = 0.66) predicted the experiential avoidance of veterans with PTSD significantly (p <0.001). Also, the inhibition and behavioral activation system was a good predictor of impulsivity and 79.1% of the impulsivity variance of war veterans with PTSD was explained by inhibition and behavioral activation systems (p = 0.001). Sensitivity to rewards (β = 0.366) directly and significantly, and behavioral inhibition (β = -0.132) inversely and significantly predicted impulsivity of war veterans with PTSD (p <0.001).

Regarding the results of this study, there was a significant positive correlation between behavioral inhibition system and experimental avoidance of veterans with PTSD, which was consistent with the results of previous studies [4, 24-27]. Based on the findings of the present study, the higher are the sensitivity of the behavioral inhibition system and the sensitivity to reward, the greater is the amount of experiential avoidance in veterans with PTSD. ... [38]. Concerning the relationship between the activation and inhibition systems and the impulsivity of veterans with PTSD, the results showed that motor and cognitive impulsivity and lack of planning of veterans with PTSD had positive and significant relationship with reward sensitivity. Also, there was a significant and positive relationship between cognitive impulsivity and behavioral inhibition in veterans with PTSD. These findings are consistent with other research results [14, 25-27]. ... [39].

It is suggested that a research similar to this study be carried out in other cities and its findings be compared with the findings of the present study. It is also suggested that other information collection methods such as interview (both personal and family) and observation be used to obtain more complete and accurate information.

The present study also encountered some restrictions. For instance, it was conducted only on veterans with PTSD in Ardabil, which makes generalization of the results difficult for other cities. The use of self-report scales is another limitation of this research. The inability to control some of the intrusive variables and severity of PTSD symptoms and the use of a descriptive research design that would not provide causal inference were another limitations of this study.

The sensitivity of inhibition and behavioral activation systems can increase the experiential avoidance and impulsivity in veterans with PTSD. Thus, by reducing the activity of brain / behavioral systems, it is possible to modulate experiential avoidance, impulsivity, and PTSD symptoms in veterans.

The authors of this study are grateful to the sincere veterans of the Isar Psychiatric Hospital in Ardabil, as well as to the support of the officials of the Foundation of Martyrs and Veterans Affairs of the city of Ardabil.

Non-declared

Prior to the implementation of the study, coordination was carried out with the Foundation of the Martyrs and Veterans Affairs in Ardabil Province and the ethical permission was obtained from Medical Ethics Committee of Isar Psychiatric Hospital in the Ardabil. In the meantime, the consent of all veterans participating in the study was obtained and they were assured of confidentiality of information and the use of code instead of the names.

This research is based on research work and no financial support has been taken from any institution or organization.

TABLES and CHARTS

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