Caldwell, Frances
(2017)
An investigation into the impact of conflict and non-conflict related traumas in the north of Ireland on PTSD and aggression.
DForenPsy thesis, University of Nottingham.
Abstract
Background: The impact of trauma on mental health is well established, but the specific effects of trauma relating to war or conflict and how this manifests behaviourally is less well understood. This research sought to investigate the impact of conflict and non-conflict related experiences on mental health outcomes and intra-familial aggression in the context of the north of Ireland following the thirty year Troubles conflict. This research is of value as previous research in this area suggests that traumatic symptoms and disproportionately high suicide rates are a current trans-generational issue in the north of Ireland. A better understanding of the impact of particular traumas is important in developing effective treatment facilities for addressing these widespread issues which could improve quality of life across those directly and indirectly affected by conflict.
Aims and Objectives: The main purpose of this thesis was to investigate the impact of conflict and non-conflict related experiences on mental health and behaviour in the north of Ireland. Civilians were the focus of the quantitative section of this research, and ex-political prisoners and internees were the focus of the qualitative component. The main research questions were:
• Are trauma measures which are widely utilised in assessing for PTSD suitable for assessing conflict related trauma in the north of Ireland (chapter 2)
• Do conflict related trauma or non-conflict related traumas predict increased aggression within families and other difficulties in a civilian sample from the north of Ireland? (chapter 3)
• What are the main themes of experience reported by ex-prisoners or internees, are these similar or different and how have these experiences impacted on individuals? (chapter 4)
• Does psychologically based therapy reduce traumatic symptoms in people affected by conflict? (chapter 5)
• An exploration of a CBT based treatment for an individual with mental illness and history of conflict and non-conflict related trauma; what complexities remain in the area of treatment for conflict related trauma? (chapter 6)
Methods: A critique of trauma measures and methods was undertaken in chapter 2 in order to investigate the utility of particular tools in culturally specific regions and where traumas are specifically conflict related. In chapter 3, an empirical research study investigating the experiences of a community sample from the north of Ireland who lived through the Troubles conflict was undertaken using a quantitative approach. In chapter 4, qualitative analysis of semi-structure interviews with ex-political prisoners and internees of the conflict in the north of Ireland was carried out. In chapter 5 a meta-analysis explored the effectiveness of therapeutic interventions for conflict related trauma. Finally a case study was completed to explore the effectiveness of a CBT treatment programme on an individual with mental illness and conflict and non-conflict related trauma.
Overall findings:
• In chapter 2, it was found that several measures used to assess for PTSD relating to other experiences which are not conflict specific may be of limited value in assessing for conflict related trauma, as they often require an individual to focus on a particular incident and don’t consider the pervasive nature of living through conflict. Culturally specific factors were found to be important in designing measures for particular regions. The Troubles Related Experiences Questionnaire (TREQ - Dorahy et al., 2007) was found to be effective in gathering a picture of Troubles related experiences specifically, but an additional PTSD measure may be required to relate these experiences to mental health outcomes.
• In chapter 3, 93% of respondents reported at least one Troubles related experience and half suggested the impact on their communities were 'significant.' Only 10% reported the Troubles had no impact on them personally. 17% of participants met the threshold for provisional PTSD diagnosis using a cut-off estimate validated for civilians on the Post-traumatic stress disorder checklist (PCL-C). Various traumatic experiences including being beaten by a partner or caregiver, and various Troubles related experiences predicted the development of PTSD. PTSD in turn was associated with increased aggression towards partners and children and suicidality. Older people were less likely to acknowledge adverse pathology than younger people, despite experiencing more traumas.
• In chapter 4, themes including positive and negative coping, camaraderie, loss and Troubles related stressors and experiences were shared by all interviewees. Ex-prisoners appeared to report greater experiences of loss and a greater impact of their experiences than internees. Internees were troubled by not having a release date which they found particularly stressful.
• In chapter 5, meta-analysis results suggest that a broad range of therapeutic approaches including cognitive behavioural therapy, narrative exposure therapy and psychotherapy significantly reduced symptoms of post-traumatic stress disorder in people affected by conflict compared to untreated controls.
• In chapter 6, an individual CBT approach was effective in reducing anxiety and increasing self-esteem in an individual with complex PTSD, both conflict and non-conflict related. The complexities in identifying treatment targets and addressing symptoms in those with complex backgrounds and multiple traumas are discussed.
Conclusion: PTSD appears to predict aggression within families and mental health problems in a sample from the north of Ireland. Both conflict related and non-conflict related traumas were predictive of PTSD. Therapy appears to be effective in reducing trauma symptoms where the primary trauma is conflict related. It is difficult to disentangle the contribution of one type of trauma from another in treatment where there is complex PTSD. There is no one-size-fits-all treatment pathway for trauma, particularly in a post-conflict society and therefore in any future treatment facilities consideration should be given to individual needs.
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