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SHATTERED ASSUMPTIONS AND COPING STYLES AS PREDICTORS OF POST TRAUMATIC STRESS DISORDER FOLLOWING A TRAUMATIC EVENT
Post-Traumatic Stress Disorder (PTSD) is a trauma and stress related disorder that may develop after exposure to an event or ordeal in which death, severe physical harm or violence occurred or was threatened (Lodrick, 2007. Traumatic events that may trigger PTSD include violent personal assaults, natural or unnatural disasters, accidents, or military combat (Brewin & Lennard, 1999).
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV: APA, 2000) outlines PTSD as the development of characteristic symptoms of distress or impairment that are present for over one month after exposure to a traumatic event. Banyard (1999) described its cyclical nature, outlining three main clusters of symptoms: re-experiencing phenomena, avoidance/numbing and increased arousal. In the immediate aftermath of a traumatic event, many individuals experience physiological reactivity in response to reminders of the traumatic event that typically lessens over time(Foa, 1992). However, an overreliance on avoidant coping strategies may interfere with the natural recovery process, particularly for those who are highly reactive to trauma reminders (Riggs,1992).
In the weeks following a traumatic event, most individuals experience at least some symptoms characteristic of posttraumatic stress disorder (PTSD). Many, but not all, trauma survivors experience a profound reduction or complete remittance of these symptoms over the course of the first several months (Rothbaum, Foa, Riggs, Murdock, & Walsh, 1992). Identifying the subset of traumatized individuals who do not recover but instead maintain PTSD symptoms over time is a critical research question. Physiological reactivity and coping style are two potential risk factors with promising empirical support. For example, increased heart rate measured shortly after a traumatic event is associated with increased risk for PTSD (Yehuda, McFarlane, & Shalev, 1998). Further, increased heart rate reactivity to trauma reminders is associated with greater maintenance of PTSD symptoms over time (Blanchard, 1996).
Post traumatic stress disorder occurs in approximately eight percent of the general population in African-Nigeria and seven percent in Europe, with higher rates in women than in men (de Vries & Olff, 2009; Glynn, Marshall, Schell, & Shetty, 2006; Kessler, Chiu, Demler, & Walters, 2005; Kessler & Üstün, 2008 for international prevalence estimates). PTSD results in significant social and economic burden and puts individuals at increased risk for physical and mental health difficulties including depression and suicide (e.g., Hidalgo & Davidson, 2000).
Although epidemiological investigations indicate that as many as 74% of women and 81% of men will experience a stressful event that qualifies as a traumatic stressor according to the APA diagnostic criteria (Kessler et al., 2005; Stein, Walker, & Hazen, 1997), only a relative minority of trauma-exposed individuals goes on to develop PTSD (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; McNally, Bryant & Ehlers, 2003). This suggests that individual differences present before, during, or after trauma may be important in understanding why some individuals go on to develop PTSD while others recover naturally. Researchers evaluating risk factors for psychopathology propose that examination of vulnerability diathesis factors is especially critical (e.g., Ingram & Price, 200).
Those conversant with happenings in Nigeria in the past three decades would agree that the country witnessed all sorts of violence (Agbu, 2003). This may not be unconnected to heterogeneity nature of the country that is constantly manipulated by its political elites in their race for control of the state resources (Akeem, 2008). A few example of trauma in the nation include, but not limited to, electoral malfeasance and electoral fraud and political assassinations, massive corruption in high and low places with selective judicial dispositions, reign of terror and suppression of opposition and thought process, HIV epidemic with death and morbidities, unemployment, Niger Delta war–execution and death, bomb explosion and imprisonments (Agbu, 2003). Psychosocial trauma and physically induced trauma include the following: Childhood emotional and physically induced trauma include the following: Childhood emotional or sexual abuse, including prolonged or extreme neglect; hostage taking, illegal oil bunkering, environment degradation, internet pedophilla e. t. c (Akeem, 2008)
Indeed, PTSD is increasingly being recognised not as a specialised area, but a fundamental aspect of human experience (Gold, 2000). Reactions to traumatic events vary considerably, ranging from relatively mild responses, creating minor disruptions in the person’s life, to severe and debilitating reactions. It is common for those who are exposed to traumatic events to experience intrusive thoughts and images, accompanied by attempts at avoidance, emotional numbing, and increased arousal (Joseph, 2010).
Researcher Van der Kolk as cited in lodrick (2007) is of the view that ‘traumatised people lead traumatic and traumatising lives’ (Lodrick, 2007). Themes of repetition are indeed central in which the individual may be subjected to intrusive replays of the original trauma (Lodrick, 2007). Totton (2005) writes that traumatic experiences in childhood can have enduring profound effects on traumatic experiences as an adult, influencing the traumatised person’s responses and creating patterns of hyperarousal or dissociation together with a tendency to re-enact traumatic experiences (Perry, 1995; Schore, 2000). Wainrib (2006) argues that traumatic events can generate severe psychological reactions that can manifest anytime. For some, the effects last throughout their remaining lifetimes and traumatized individuals have been found to have elevated rates of psychiatric diagnosis including major depression and alcohol or drug dependence (Wainrib, 2006). High co-morbidity rates of trauma and psychosis are also evident in the literature. Bebbington, (2004) identified associations between psychotic disorders and early victimisation experiences, Janssen, (2004) reported a significant cumulative relationship between trauma and psychosis, while Shevlin (2007) observed a positive relationship between occurrences of childhood trauma and self-reported experiences of hallucinations.
People facing the same circumstances around a trauma vary greatly in their risk for PTSD (Ingram & price, 2000). At least two psychological factors have been identified to explain differences between people in response to trauma. First, some people are already distressed before a trauma occurs and they appear at greater risk for PTSD. Secondly, certain coping styles seem to increase people’s chance of developing PTSD (Ingram & price, 2000).
The cause of PTSD seems obvious, trauma; it seems perfectly understandable for PTSD to develop in assault or feature victims, people who have lost a loved one in a car accident, people who have lost their homes in a hurricane, and so on. However, just what is it about traumatic events that can cause long-term severe psychological impairment in some people. And do some people develop PTSD in the wake of a trauma, where as others do not. Researcher have, identified a number of factors that seem to contribute to PTSD.
The assumptive world concept refers to the assumptions or beliefs that ground, secure, stabilize, and orient people. In the face of death and trauma, these beliefs are shattered and disorientation and even panic can enter the lives of those affected. In essence, the security of their beliefs has been aborted (Farley & Shaver, 1999) The assumptive world is an organized schema reflecting all that a person assumes to be true about the world and the self on the basis of previous experiences. As first articulated by Parkes (1988) and built upon by others (Janoff-Bulman, 1992; Kauffman, 2002), assumptions helps those who deal with traumatic loss, the bereaved and those who work with the bereaved, to understand the intensity and complexity of responses. Our assumptions are guides for our day-to-day thoughts and behaviors” (Janoff-Bulman, 1992)
- M. Parkes (1975) first used the term “assumptive world” to refer to people’s view of reality. It was a “. . . strongly held set of assumptions about the world and the self which is confidently maintained and used as a means of recognizing, planning, and acting. Assumptions such as these are learned and confirmed by the experience of many years” (Kauffman, 2002). In essence, the assumptive world refers to a conceptual system, developed over time that provides us with expectations about the world and us.
Janoff-Bulman (1992) identifies three core assumptions that shape our worldview: the world is benevolent; the world is meaningful; the self is worthy. The benevolence of the world according to Janoff-Bulman (1992) refers to the belief that the world is a good place, that the people in it are kind and well intentioned, and that events usually have positive outcomes. The world being meaningful means that things make sense, that there is a cause and effect relationship between events and outcomes. The notion of the self as worthy means that we perceive ourselves as good, capable, and moral individuals. In essence, our assumptive world leads us to believe we are good people who live in a benevolent world where things make sense, more or less.
In the event of trauma—violent tragedy and death—each of these assumptions is challenged and the loss of the assumptive world can occur (Kaufmann, 2002b).
Those assumptions which have kept us steady and have given coherence to our lives are soon discovered to be illusions and an abrupt, terrifying disillusionment occurs (Fleming & Robinson, 2001).
When the assumptive world is shattered through loss, the guidelines with which the self navigates the world are overturned. The world is no longer a safe, benevolent place, peopled with good caring individuals who have a modicum of control and impact over what happens to them. “Traumatic loss overwhelms and floods the self with negative assumptions deviant from the protective norm of the good. . . . The terror that shatters the assumptive world is a violent deprivation of safety. . . . What is lost in the traumatic loss of the assumptive world? All is lost. Hope is lost . . .” (Kauffman, 2002). For the bereft, there are no answers, safety, logic, clarity, power, or control. There is a low level of panic as the self is in danger. Healing from this type of loss may be especially painful and more protracted, as new assumptions have to be created in the worldview of the griever.
Depending on the depth and nature of the attachments we have formed in our lives (Bowlby, 1980), the violations of the assumptive world can be even more wrenching. We tend to go through life with a number of assumptions about ourselves and how the world works that help us feel good most of the time but can be shattered by a trauma (Bowlby, 1980; Raphael, 1983). Most people believe that bad things happen to other people, and that they are relatively invulnerable to traumas, such as being in a severe car accident when such events happen, people lose that illusion of invulnerable chronically feeling vulnerable, they are hyper viigilant for signs of new traumas and may showings of chronic anxiety (Kastenbaum, 2001; Shaver & Tancredy, 2001).
The second basic assumption is the assumption that the world is meaningful and just and hat things happen for a good reason (Kastenbaum, 2001). This assumption can be shattered by events that seem senseless unjust or perhaps evil such as turnouts bombing of a children’s day-care center. The third assumption is the assumption that people who are good “play by the rules” do not experience bad things: Trauma victims often will say that they have lived a god life, have been a good person, and thus can’t understand how the trauma happen to them.