This proposed study will determine the effectiveness of PTSD treatments on selected samples. In studying the effectiveness of selected PTSD treatments on trait- and trauma-related anger and guilt, the research will investigate whether or not the effect of the interventions differed from pre-treatment severity of anger or guilt. Research Questions The study is designed to ascertain the effectiveness of PTSD treatments. In order to do this, the following will be the specific objectives.
What is the psychosocial profile of the survivors in terms of age, civil status, highest educational attainment, employment, and history of violence? 2. What are the pre- and post-treatment trait- and trauma-related anger and guilt among the rape survivors? 3. Is there a significant difference in both trait and trauma-related anger and guilt after undergoing PTSD treatments? Hypothesis The null hypothesis will be tested at alpha of 0. 05 posits that there is no significant difference in the levels of trait- and trauma-related anger and guilt of Native American rape survivors before and after the interventions.
Rationale and significance of the study It is hoped that this study will contribute in generating data on the subject of PTSD among Native American rape survivors and possible treatments that could be recommended. Moreover, the findings, if well disseminated, will be helpful in policy formulation which is aimed at improving the victims’ well-being and recovery. Furthermore it has important implications in theory and practice for researchers and practitioners in psychology and counseling. Limitations
Participants for this study will be Native American women who can voluntarily report their rape experience. These subjects may not be representative of all recorded rape cases involving Native American women. Due to stigma, lack of awareness, or nature of the crime, many cases are unreported. In truth, the difficulty the researcher is anticipating is uncertainty on the survivor’s ability to describe and label what is happening to her. Even if they can describe the experience to themselves, their willingness to accept what is happening differs from each other.
With this, the researcher will ask the aid of therapists to make the survivors feel at ease. The demographic factors to be described will include age, civil status, highest educational attainment, employment, and history of violence. The independent variable will be the treatments namely prolonged exposure, eye movement sensitization, and relaxation training. The dependent variable will be trait- and trauma-related anger and guilt. II. Literature Review Theoretical Framework The Cognitive-Behavioral Theory will be the theoretical basis of this study.
The theory implies that cognition has an important role in modifying behavior. Specifically, cognitions or thought processes impact behaviors thus having negative thoughts or beliefs would be difficult in creating a positive behavioral change. Interventions patterned after this theory combine both cognitive and behavioral approaches in solving a variety of behavioral and psychological problems. Through education and enforcement of positive experiences, the client’s irrationality will be changed dramatically enabling the person to actively cope.
Thus, by altering or shifting the way of thinking of clients, they are able to more clearly think about their choices as well as their behaviors. Another significant theory is the emotional processing theory proposed by Foa and Kozak (1986). According to this theory, encounter of pathological fear structures evokes feelings of trepidation. These fear structures are harmless stimuli associated with the conceptualization that the world is a dangerous and inhospitable place. Treatment is successful when these fear structures become emotionally processed in such a way that exposure to stimuli will not elicit fear.
Anger and guilt in rape victims Taylor (2006) mentioned two types of beliefs that are associated with anger. The first points out that the survivor is wronged by others. Survivors might be heard saying: “They had no right to do this to me” or “Others should be punished for what they’ve done”. These are associated with or predict severity of experienced PTSD symptoms. The second however are referred to as metacognitions which by definition are beliefs about the value of dwelling on angry thoughts.
These enable survivors to understand, prepare for, and cope with distressful and threatening instances and justify aggression towards their attackers (“Others are not likely to take advantage of me if I have been dwelling on my angry thoughts”, “Dwelling on what happened prevents me from blaming myself”). There are occasions when survivors entertain negative metacognitive beliefs which are concerned with the detrimental emotional impact of anger on the overall functioning of the individual socially and occupationally (“My anger builds up, last longer, and gets me into trouble when I dwell on my angry thoughts”).
Steyn (2005) maintained that guilt and shame are closely associated to each other in response to sexual abuse and trauma. When a victim has self-guilt, there is the tendency for the individual to feel responsible for the event accompanied by embarrassment or disgrace. However these feelings are not only limited to sexually abused victims to be trauma survivors in general. It should be emphasized that guilt is the attempt of the survivor to learn valuable life lessons from and establish a sense of power and control over oneself.
Self-blame has been considered as an influential factor on how the victim may respond to her being sexually abused. Both guilt and self-blame are closely linked because behind the guilt is blaming oneself for experiencing the trauma. The response of the victim after the rape depends on self-blame and is noted to greatly affect the victim psychologically. Meyer and Taylor (as cited in Steyn, 2005) also found that self-blame is associated with adjustment and depression after rape and increased anxiety, hostility, and greater confusion of core beliefs about one’s existence and the world.
Use of prolonged exposure, eye movement sensitization, and relaxation training In exposure therapy, the rape survivor is subjected to imaginal exposure which allows her to revisit the traumatic event in a safe environment. In practice, the therapist guides and encourages the client in imagining, narrating, and emotionally processing the traumatic experience within the safe and supportive confines of the clinician’s office. It has a low threat to the client and de-conditions the disorder through the habituation/extinction process (Rizzo et al.
2009). EMDR is a PTSD treatment method utilizing exposure and cognitive restructuring in a relatively short time without having to subject patients to prolonged anxiety and with the aid of the therapist the patient makes saccadic bilateral eye movements. The action of EMDR could be attributed to the conditioning process brought about by the accelerating function of the eye movements and the activation of a neurobiological substrate modulating the emotional responses, thereby leading to homeostasis (Well Care Health Plans Inc, 2008).
Klein (2007) mentioned that relaxation techniques are helpful in treating DSM-IV diagnosis most particularly trauma, depression, and anxiety. In the treatment session, patients are provided tools which do not only sooth themselves but also help develop healing positive self-talk statements. Hogberg et al. (2007) observed that EMDR has a short-term effect on PTSD based on the Global Assessment of Function (GAF) and Hamilton Depression (HAM-D) scores. Then in 2008, the same authors found that the symptom-reduction effects of EMDR on 20 subjects presenting chronic PTSD remained stable 35 months after the therapy.
In their study, the participants underwent five sessions of EMDR. Rothbaum, Astin and Marsteller (2005) noted improvement in PTSD especially among the PE and EMDR groups compared to the control group. However, no significant difference in depression, dissociation, and state anxiety were found in PE and EMDR from baseline to either post treatment or 6-month follow-up. Stapleton, Taylor and Asmundon (2006) investigated anger and guilt before and after prolonged exposure, eye movement sensitization and reprocessing and relaxation training.
The study also showed that the treatments had significantly reduced anger and guilt, even among patients who had high levels of these emotions. III. Methodology Research Design The proposed study will use a pre-test post-test experimental design because the purpose is to compare groups resulting from experimental treatments which in the context of this study are the cognitive-behavioral strategies in treating PTSD among Native American rape survivors. Participants and Sampling Participants will be Native American rape survivors who experienced most severe PTSD based on physician referrals.
Only those that presented severe PTSD using the DSM-IV diagnosis, more than 18 years of age, signed the written informed consent, and willing to suspend any psychological treatment and keep doses of any psychotropic medication constant throughout the duration of the study. Rape survivors with mental retardation or psychotic disorder and has changed medication within the last three months will be excluded. Respondents will be assigned randomly to each of the treatments in the study. Measures
The respondents will be asked to fill out information regarding trait- and trauma-related anger and guilt aside from the psychosocial profile based on age, civil status, highest educational attainment, employment, and history of violence. To measure trait anger, the State Trait Anger Expression Inventory will be used. It has 44 items and divided into five subscales namely state anger, trait anger, anger-in, anger-out, and anger control. The statements will be rated using a four-point frequency scale (0-almost never to 3-almost always).
Trait guilt levels of rape survivors will be assessed using the Guilt Inventory. This tool is a 45-item self-report indicative of state guilt, trait guilt, and moral standards where subjects will be asked to respond using a five-point Likert scale from strongly disagree (1) to strongly agree (5). For both trauma-related anger and guilt, evaluation was made by an item that asked the frequency of anger and guilt for the past week. The item will be rated on a four-point frequency scale from 0 (not at all) to 3 (almost always). Procedure
Before conduct of study is commenced, permission will first be obtained from Institutional Review Board (IRB) of the University. Permission will also be secured from the Dean of the Graduate School after Oral Examination. Afterwards, another letter will be sent to the president of a local organization of Native Americans or local clinics stating the intent of the researcher to seek their participation and coordination. Prospective participants referred to by local organizations and physicians will be invited for screening for the inclusion/exclusion criteria.
Those who passed will be asked to carefully read the written informed consent before baseline evaluation. The researcher will then randomize assign the subjects to any of the following interventions: prolonged exposure, eye movement sensitization, or relaxation training. There will also be a control group. The structured questionnaires will be administered during the pre-treatment, post-treatment (one month after end of intervention), and follow-up (three months after the post-treatment). Several ethical considerations will be taken into account.
The answers to the structured questionnaires will be kept confidential and PTSD records will only examined by the researcher. Furthermore, permission to use information will be requested and secured prior to data analysis. Lastly, no monetary incentives will be offered to participate in the study. Data Analysis After questionnaire administration, tabulation and data analysis will follow. The first problem will be addressed by computing for frequency and percentage. Means and standard deviations in anger and guilt in the pre-treatment, post-treatment, and follow-up periods will be obtained to answer the second problem.
Statistical inferences will be based on the results of the t-test for Dependent Sample Means at 5% level of significance. Comparison will be between pre- and post-treatment and pre- and follow up phases of the study. Internal Validity It is expected that this study will test the null hypothesis that no significant difference exists in the anger and guilt of the Native American rape survivors before and after treatment with cognitive-behavioral strategies at 95% level of confidence. Therefore there is a high degree of certainty that the result is attributed to the treatment. External Validity
There will be a high external validity since the participants will be randomly assigned to a treatment or intervention. Thus, there are no sampling discrepancies which will introduce error and bias into the results. The selection of respondents also guarantees the same. References Amnesty International. (2008). Maze of Injustice. Retrieved from http://www. amnestyusa. org/pdf/maze_1yr. pdf. Bryant-Davis, T & Ocampo, C. (2005). Racist incident-based trauma. The Counseling Psychologist, 33, 479-500. Dauer, S. (2006). The Global Advancement of Women: Barriers and Best Practices.
University of Maryland School of Law. Heckman, CJ. , Cropsey, KL. , & Olds-Davis, T. (2007). Posttraumatic stress disorder treatment in correctional settings: a brief review of the empirical literature and suggestions for future research. Psychotherapy: Theory, Research, Practice, and Training, 44, 46-53. Hogberg G, Pagani M, Sundin O, Soares J, Aberg-Wistedt A, Tarnell B, & Hallstrom T. (2007). On treatment with eye movement desensitization and reprocessing of chronic post-traumatic stress disorder in public transportation workers- a randomized control trial. Nord J Psychiatry, 61, 54-61.