@2024 Afarand., IRAN
ISSN: 2008-2630 Iranian Journal of War & Public Health 2015;7(1):21-28
ISSN: 2008-2630 Iranian Journal of War & Public Health 2015;7(1):21-28
Effect of Schema-Based Learning on Reducing the Symptoms of Secondary Traumatic Stress in Wives of Post-Traumatic Stress Disorder Veterans
ARTICLE INFO
Article Type
Descriptive & Survey StudyAuthors
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, IranPhone: +98 2176505018
Fax: +98 2188519082
sama.abolmaali@gmail.com
Article History
Received: October 10, 2014Accepted: December 2, 2014
ePublished: February 19, 2015
ABSTRACT
Aims
Secondary trauma is considered as a similar syndrome to post-traumatic stress
disorder that is caused indirectly and through close contact with victims. This study aimed to
examine the effects of schemes-based model training in reducing the symptoms of secondary
traumatic stress and its dimensions (re-experiencing of the event, avoidance, and arousal) in
the spouses of veterans with post-traumatic stress disorder.
Materials & Methods In this quasi-experimental study with pretest-posttest and control group, 24 spouses of veterans with post-traumatic stress disorder from 2006 to 2013 had been admitted to the Sadr Psychiatric Hospital of Tehran were studied. The subjects were randomly assigned to two experimental (n=12) and control (n=12) groups. Data collected using demographic questionnaire, depression, anxiety and stress scale and Secondary Traumatic Stress Scale. Schema-based approach learning was done in 12 sessions with 2h. Data were analyzed by univariate and multivariate covariance.
Findings In the posttest phase, the mean score of secondary trauma symptoms in experimental group was significantly lower than control group. There was a significant difference between mean scores of two groups regarding disturbing, avoidance and arousal symptoms (p<0.01).
Conclusion Schema-based instruction is an effective method for reducing of the symptoms of secondary trauma and its components (disturbing, avoidance and arousal) in the spouse of veterans with post-traumatic stress disorder.
Materials & Methods In this quasi-experimental study with pretest-posttest and control group, 24 spouses of veterans with post-traumatic stress disorder from 2006 to 2013 had been admitted to the Sadr Psychiatric Hospital of Tehran were studied. The subjects were randomly assigned to two experimental (n=12) and control (n=12) groups. Data collected using demographic questionnaire, depression, anxiety and stress scale and Secondary Traumatic Stress Scale. Schema-based approach learning was done in 12 sessions with 2h. Data were analyzed by univariate and multivariate covariance.
Findings In the posttest phase, the mean score of secondary trauma symptoms in experimental group was significantly lower than control group. There was a significant difference between mean scores of two groups regarding disturbing, avoidance and arousal symptoms (p<0.01).
Conclusion Schema-based instruction is an effective method for reducing of the symptoms of secondary trauma and its components (disturbing, avoidance and arousal) in the spouse of veterans with post-traumatic stress disorder.
CITATION LINKS
[1]Bani Fatemi S, Hosseini SS, Hekmatpour A, Jamal Livani MR, Hossein SM, Haghighi H, et al. Fatigue caused by PTSD and war. Qoam: Razban; 2001. [Persian]
[2]Davidson J. New strategies for the treatment of posttraumatic stress. J Clin Psychiatry. 2000;61(7):3-51.
[3]Cash A. Posttraumatic stress disorders. Wiley: New Jersey; 2006.
[4]Yoder EA. Compassion fatigue in nurses. Appl Nurs Res. 2010;23(4):191-7.
[5]Figley CR. Treating compassion fatigue (Routledge psychosocial stress series). 1st ed. New York: Brunner-Rutledge; 2002.
[6]Klaric M, Franciskovic T, Obrdalj EC, Petric D, Britvic D, Zovko N. Psychiatric & health impact of primary & secondary traumatization in wives of veterans with posttraumatic stress disorder. Psychiatr Danub. 2012;24(3):280-6.
[7]Solomon Z, Dekel R. Posttraumatic stress disorder among Israeli ex-prisoners of war 18 and 30 years after release. J Clin Psychiatry. 2005;66(8):1031-7.
[8]Figley CR. Burnout as systematic traumatic stress: A model for helping traumatized family members. In: Figley CR. (Editor). Burnout in Families: The Systematic Costs of Caring. Boca Raton, FL: CRC Press; 1998. Pp. 15-28.
[9]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(5):477-501.
[10]Henry SB, Smith DB, Archuleta KL, Sanders-Hahs E, Goff BS, Reisbig AM, et al. Trauma and couples: Mechanisms in dyadic functioning. J Marital Fam Ther. 2011;37(3):319-32.
[11]Bale R. Secondary Traumatic Stress and Related Concepts. London: Medical Foundation. Available from: http://www.freedomfromtorture.org/document/publication/5667.
[12]Baird K, Kracen AC. Vicarious traumatization and secondary traumatic stress: A research synthesis. Counsell Psychol Q. 2006;19(2):181-8.
[13]Sabin-Farrell R, Turpin G. Vicarious traumatization: Implications for the mental health of Health workers?. Clin Psychol Rev. 2003;23(3):449-80.
[14]Figley CR, Nash WP. Combat stress injury: Theory, research, and management. New York: Routledge; 2006.
[15]Ray SL, Vanstone M. The impact of PTSD on veterans’ family relationships: An interpretative phenomenological inquiry. Int J Nurs Stud. 2009;46(6):838-47.
[16]Mason JW, Wang S, Yehuda R, Riney S, Charney DS, Southwick SM. Psychogenic lowering of urinary cortisol levels linked to increased emotional numbing and a shame-depressive syndrome in combat-related posttraumatic stress disorder. Psychosom Med. 2001;63(3):387-401.
[17]McCormack L. Civilian women at war: Psychological impact decades after the Vietnam war. J LossTrauma. 2009;14(6):447-58.
[18]Franciskovic T, Stevanovic A, Jelusic I, Roganovic B, Klaric M, Grkovic J. Secondary traumatization of wives of war veterans with posttraumatic stress disorder. Croat Med J. 2007;48(2):177-84.
[19]http://www.ncbi.nlm.nih.gov/pubmed/17299302
[20]Nateghian S, Mollazadeh J, Goudarzi MA, Rahimi Ch. Forgiveness and marital satisfaction in combat veterans with post traumatic stress disorder and their wives. Q J Fundament Ment Health. 2008;10(37):33-46. [Persian]
[21]Najafi M, Mohammadifar M, Dabiri S, Erfani N, Kamary A. The comparison of the quality of life war veteran's families with/without PTSD. Iran J War Public Health. 2011;3(11):27-35. [Persian]
[22]Lee DA, Scragg P, Turner, S. The role of shame and guilt in traumatic events: A clinical model of shame-based and guilt-based PTSD. Br J Med Psychol. 2001;74(4):451-66.
[23]Renshaw KD, Rodrigues CS, Jones DH. Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom Veterans: Relationships with spouses' perceptions of veterans' experiences and symptoms. J Fam Psychol. 2008;22(4):586-94.
[24]Franciskovic T, Tovilovic Z, Sukovic Z, Stevanovic A, Ajduković D, Kraljević R, Bogić M, et al. Health care and community-based intervention for war-traumatized people in Coratina: Community-based study of service use and mental health. Corat Med J. 2008;49(4):483-90.
[25]Yousefi R, Abedin AR, Tirgari A, Fath Abadi J. The effectectiveness of intervention based on Schemas model on marital satisfaction enhancement. J Clin Psychol. 2009;2(7):25-37. [Persian]
[26]Cockram D. Role and treatment of early maladaptive schemas in Vietnam veterans with PTSD [Dissertation]. Perth: Murdoch University; 2009.
[27]Klaric M, Kvesic A, Mandic V, Petrov B, Franciskovic T. Secondary traumatizaition and systemic traumatic stress. Medicina Academica Mostariensia. 2013;1(1):29-36.
[28]Bamber MR. CBT for occupational stress in health professionals: Introducing a schema focused approach. London: Routledge; 2006.
[29]O'Donohue WT, Fisher JE, Hayes S. Cognitive behavior therapy. New York: Wiley; 2012.
[30]Young JE, Klosko JS, Weishaar ME. Schema therapy a practitioner's guide. New York: The Guilford Press; 2006.
[31]Dalgleish T, Power M. Handbook of Cognition and Emotion. New York: John Wiley & Sons; 2000.
[32]Jitendra AK. The effects of schema-based instruction on the mathematical word-problem-solving performance of students with learning disabilities. J Learn Disabil. 1996;29(4):422-31.
[33]Jitendra AK, Star JR, Starosta K, Leh JM, Sood S, Caskie G, Hughes CL, Mack TR. Improving seventh grade students' learning of ratio and proportion: The role of schema-based instruction. Contemp Educ Psychol. 2009;34(3);250-64.
[34]Blissett S, Cavalcanti RB, Sibbald M. Should we teach using schemas? Evidence from a randomized trial. Med Educ. 2012;46(8):815-22.
[35]Paunovic N, Ost LG. Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees. Behav Res Ther. 2001;39(10):1183-97.
[36]Zoellner LA, Feeny NC, Fitzgibbons, Foa EN. Response of African American and Caucasian woman to cognitive behavior therapy for PTSD. Behav Ther. 1999;30(4):581-95.
[37]Cockram DM, Drummond PD, Lee CW. Role of treatment of early maladaptive schemas in Vietnam veterans with PTSD. Clin Psychol Psychother. 2010;17(3):165-82.
[38]Kazemi AS, Banijamali SS, Ahadi H. 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. J Med Sci. 2012;22(2):122-9. [Persian]
[39]Crumpton NM. Secondary traumatic stress and mindfulness training. J Emerg Nurs. 2010;36(1):3-4.
[40]Kazemi AS. The effectiveness of mindfulness-based cognitive strategies to reduce the symptoms of secondary traumatic stress disorder and chronic psychological problems. Thought Behav Clin Psycol. 2011;6(23):129-2. [Persian]
[41]Cristofolini L. The importance of sample size and statistical power in experimental research: A comparative study. Acta Bioengin Biomechanics. 2000;2(1).
[42]Samani S, Joukar B. Validity and reliability of the short form of depression, anxiety and stress. J Soc Sci Human Shiraz Univ. 2007;26(3):65-77. [Persian]
[43]Asghari Moghaddam, M. A, Saed, F, Dibajnia, P, Zangane, J. A preliminary validation of the Depression, Anxiety and Stress Scales (DASS) in non-clinical sample. Daneshvar Raftar. 2010;11(31):23-38. [Persian]
[44]Resick PA, Schnicke MK. Cognitive processing therapy for sexual assault victims. J Consult Clin Psychol. 1992;60(5):748-56.
[45]Moradi Msanesh 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]
[46]Sahebi A, Asghari J, Salari RS. Validation of Depression Anxiety Stress Scale (DASS) for Iranian population. J Dev Psychol. 2005;4:299-312. [Persian]
[47]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.
[48]Ahmadi Kh, Rezapour MS, Davoodi F, Saberi M. Reliability and validity of the secondary traumatic stress scale (STSS) to further assess PTSD symptoms in a sample of veterans' wives. Veteran Med J Magazine. 2012;5(19):47-57. [Persian]
[49]Ben Arzi N, Solomon Z, Dekel R. Secondary traumatization among wives of PTSD and post-concussion casualties: distress, caregiver burden and psychological separation. Brain Injury. 2000;14(8):725-736.
[50]Kopp, RR, Craw, MJ. Metaphoric language, metaphoric cognition, and cognitive therapy. Psychother Theory Res Pract Train. 1998;35(3):306-311.
[51]Ahmadian AL, Smaeeli Far N, Hatami M, Hasan Abadi HR. Schema therapy based on metaphorical-allegorical narrative training in therapeutic data retrieval of dysthymic patients. Int J Psychol Behav Res. 2013;2(3):132-46.
[2]Davidson J. New strategies for the treatment of posttraumatic stress. J Clin Psychiatry. 2000;61(7):3-51.
[3]Cash A. Posttraumatic stress disorders. Wiley: New Jersey; 2006.
[4]Yoder EA. Compassion fatigue in nurses. Appl Nurs Res. 2010;23(4):191-7.
[5]Figley CR. Treating compassion fatigue (Routledge psychosocial stress series). 1st ed. New York: Brunner-Rutledge; 2002.
[6]Klaric M, Franciskovic T, Obrdalj EC, Petric D, Britvic D, Zovko N. Psychiatric & health impact of primary & secondary traumatization in wives of veterans with posttraumatic stress disorder. Psychiatr Danub. 2012;24(3):280-6.
[7]Solomon Z, Dekel R. Posttraumatic stress disorder among Israeli ex-prisoners of war 18 and 30 years after release. J Clin Psychiatry. 2005;66(8):1031-7.
[8]Figley CR. Burnout as systematic traumatic stress: A model for helping traumatized family members. In: Figley CR. (Editor). Burnout in Families: The Systematic Costs of Caring. Boca Raton, FL: CRC Press; 1998. Pp. 15-28.
[9]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(5):477-501.
[10]Henry SB, Smith DB, Archuleta KL, Sanders-Hahs E, Goff BS, Reisbig AM, et al. Trauma and couples: Mechanisms in dyadic functioning. J Marital Fam Ther. 2011;37(3):319-32.
[11]Bale R. Secondary Traumatic Stress and Related Concepts. London: Medical Foundation. Available from: http://www.freedomfromtorture.org/document/publication/5667.
[12]Baird K, Kracen AC. Vicarious traumatization and secondary traumatic stress: A research synthesis. Counsell Psychol Q. 2006;19(2):181-8.
[13]Sabin-Farrell R, Turpin G. Vicarious traumatization: Implications for the mental health of Health workers?. Clin Psychol Rev. 2003;23(3):449-80.
[14]Figley CR, Nash WP. Combat stress injury: Theory, research, and management. New York: Routledge; 2006.
[15]Ray SL, Vanstone M. The impact of PTSD on veterans’ family relationships: An interpretative phenomenological inquiry. Int J Nurs Stud. 2009;46(6):838-47.
[16]Mason JW, Wang S, Yehuda R, Riney S, Charney DS, Southwick SM. Psychogenic lowering of urinary cortisol levels linked to increased emotional numbing and a shame-depressive syndrome in combat-related posttraumatic stress disorder. Psychosom Med. 2001;63(3):387-401.
[17]McCormack L. Civilian women at war: Psychological impact decades after the Vietnam war. J LossTrauma. 2009;14(6):447-58.
[18]Franciskovic T, Stevanovic A, Jelusic I, Roganovic B, Klaric M, Grkovic J. Secondary traumatization of wives of war veterans with posttraumatic stress disorder. Croat Med J. 2007;48(2):177-84.
[19]http://www.ncbi.nlm.nih.gov/pubmed/17299302
[20]Nateghian S, Mollazadeh J, Goudarzi MA, Rahimi Ch. Forgiveness and marital satisfaction in combat veterans with post traumatic stress disorder and their wives. Q J Fundament Ment Health. 2008;10(37):33-46. [Persian]
[21]Najafi M, Mohammadifar M, Dabiri S, Erfani N, Kamary A. The comparison of the quality of life war veteran's families with/without PTSD. Iran J War Public Health. 2011;3(11):27-35. [Persian]
[22]Lee DA, Scragg P, Turner, S. The role of shame and guilt in traumatic events: A clinical model of shame-based and guilt-based PTSD. Br J Med Psychol. 2001;74(4):451-66.
[23]Renshaw KD, Rodrigues CS, Jones DH. Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom Veterans: Relationships with spouses' perceptions of veterans' experiences and symptoms. J Fam Psychol. 2008;22(4):586-94.
[24]Franciskovic T, Tovilovic Z, Sukovic Z, Stevanovic A, Ajduković D, Kraljević R, Bogić M, et al. Health care and community-based intervention for war-traumatized people in Coratina: Community-based study of service use and mental health. Corat Med J. 2008;49(4):483-90.
[25]Yousefi R, Abedin AR, Tirgari A, Fath Abadi J. The effectectiveness of intervention based on Schemas model on marital satisfaction enhancement. J Clin Psychol. 2009;2(7):25-37. [Persian]
[26]Cockram D. Role and treatment of early maladaptive schemas in Vietnam veterans with PTSD [Dissertation]. Perth: Murdoch University; 2009.
[27]Klaric M, Kvesic A, Mandic V, Petrov B, Franciskovic T. Secondary traumatizaition and systemic traumatic stress. Medicina Academica Mostariensia. 2013;1(1):29-36.
[28]Bamber MR. CBT for occupational stress in health professionals: Introducing a schema focused approach. London: Routledge; 2006.
[29]O'Donohue WT, Fisher JE, Hayes S. Cognitive behavior therapy. New York: Wiley; 2012.
[30]Young JE, Klosko JS, Weishaar ME. Schema therapy a practitioner's guide. New York: The Guilford Press; 2006.
[31]Dalgleish T, Power M. Handbook of Cognition and Emotion. New York: John Wiley & Sons; 2000.
[32]Jitendra AK. The effects of schema-based instruction on the mathematical word-problem-solving performance of students with learning disabilities. J Learn Disabil. 1996;29(4):422-31.
[33]Jitendra AK, Star JR, Starosta K, Leh JM, Sood S, Caskie G, Hughes CL, Mack TR. Improving seventh grade students' learning of ratio and proportion: The role of schema-based instruction. Contemp Educ Psychol. 2009;34(3);250-64.
[34]Blissett S, Cavalcanti RB, Sibbald M. Should we teach using schemas? Evidence from a randomized trial. Med Educ. 2012;46(8):815-22.
[35]Paunovic N, Ost LG. Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees. Behav Res Ther. 2001;39(10):1183-97.
[36]Zoellner LA, Feeny NC, Fitzgibbons, Foa EN. Response of African American and Caucasian woman to cognitive behavior therapy for PTSD. Behav Ther. 1999;30(4):581-95.
[37]Cockram DM, Drummond PD, Lee CW. Role of treatment of early maladaptive schemas in Vietnam veterans with PTSD. Clin Psychol Psychother. 2010;17(3):165-82.
[38]Kazemi AS, Banijamali SS, Ahadi H. 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. J Med Sci. 2012;22(2):122-9. [Persian]
[39]Crumpton NM. Secondary traumatic stress and mindfulness training. J Emerg Nurs. 2010;36(1):3-4.
[40]Kazemi AS. The effectiveness of mindfulness-based cognitive strategies to reduce the symptoms of secondary traumatic stress disorder and chronic psychological problems. Thought Behav Clin Psycol. 2011;6(23):129-2. [Persian]
[41]Cristofolini L. The importance of sample size and statistical power in experimental research: A comparative study. Acta Bioengin Biomechanics. 2000;2(1).
[42]Samani S, Joukar B. Validity and reliability of the short form of depression, anxiety and stress. J Soc Sci Human Shiraz Univ. 2007;26(3):65-77. [Persian]
[43]Asghari Moghaddam, M. A, Saed, F, Dibajnia, P, Zangane, J. A preliminary validation of the Depression, Anxiety and Stress Scales (DASS) in non-clinical sample. Daneshvar Raftar. 2010;11(31):23-38. [Persian]
[44]Resick PA, Schnicke MK. Cognitive processing therapy for sexual assault victims. J Consult Clin Psychol. 1992;60(5):748-56.
[45]Moradi Msanesh 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]
[46]Sahebi A, Asghari J, Salari RS. Validation of Depression Anxiety Stress Scale (DASS) for Iranian population. J Dev Psychol. 2005;4:299-312. [Persian]
[47]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.
[48]Ahmadi Kh, Rezapour MS, Davoodi F, Saberi M. Reliability and validity of the secondary traumatic stress scale (STSS) to further assess PTSD symptoms in a sample of veterans' wives. Veteran Med J Magazine. 2012;5(19):47-57. [Persian]
[49]Ben Arzi N, Solomon Z, Dekel R. Secondary traumatization among wives of PTSD and post-concussion casualties: distress, caregiver burden and psychological separation. Brain Injury. 2000;14(8):725-736.
[50]Kopp, RR, Craw, MJ. Metaphoric language, metaphoric cognition, and cognitive therapy. Psychother Theory Res Pract Train. 1998;35(3):306-311.
[51]Ahmadian AL, Smaeeli Far N, Hatami M, Hasan Abadi HR. Schema therapy based on metaphorical-allegorical narrative training in therapeutic data retrieval of dysthymic patients. Int J Psychol Behav Res. 2013;2(3):132-46.