The Efficacy of Cognitive Behavioral Therapy on Sense of Coherence, Social Support, and Spiritual Well-being in Students with Post-Traumatic Stress Disorder

Document Type : Original Research

Authors
Farzin Bagheri Sheykhangafshe 1
Nazanin Haghighat Bayan 2
Mona Baheri 3
Vahid Savabi Niri 4
Forough Esrafilian 5
1 PhD of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran.
2 PhD of Clinical Psychology, Islamic Azad University, Roudehen Branch, Roudehen, Iran
3 MA of Clinical Psychology, Islamic Azad University, Behshahr Branch, Behshahr, Iran.
4 MA of Clinical Psychology, Islamic Azad University, Ardabil Branch, Ardabil, Iran
5 Assistant Professor of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
10.48311/eijh.31.4.70
Abstract
Post-traumatic stress disorder (PTSD) is a devastating mental health condition that can arise following exposure to traumatic events. This study aims to investigate the effects of cognitive behavioral therapy (CBT) on the sense of coherence, social support, and spiritual well-being among students diagnosed with PTSD. The research employed a semi-experimental, pre-, post-test design with a control group. The statistical population included students diagnosed with PTSD at the University of Tehran during the 2023-2024 academic year. A total of 36 students with PTSD were selected using purposive sampling and were divided into experimental (n=18) and control (n=18) groups. The experimental group attended eight 90-minute CBT sessions, while the control group received no intervention. Data collection involved administering the Post-Traumatic Stress Disorder Scale (Keane et al., 1998), the Sense of Coherence Scale (Antonovsky, 1993), the Social Support Questionnaire (Sherbourne & Stewart, 1991), and the Spiritual WellBeing Scale (Paloutzian & Ellison, 2012). The data were analyzed using multivariate covariance (MANCOVA) analysis in SPSS-24. The results indicated that CBT significantly increased the sense of coherence (F=40.69, p=0.001, η²=0.58), social support (F=60.50, p=0.001, η²=0.67), religious well-being (F=52.16, p=0.001, η²=0.64), and existential well-being (F=54.50, p=0.001, η²=0.65) in students with PTSD. These results support the incorporation of CBT into therapeutic programs for students with PTSD to foster resilience and holistic well-being. Future research could explore the long-term effects of CBT and its impact on other psychological and behavioral outcomes in diverse student populations.

Keywords

Subjects

Adelufosi, A., Edet, B., Arikpo, D., Aquaisua, E., & Meremikwu, M. M. (2017). Cognitive behavioral therapy for post‐traumatic stress disorder, depression, or anxiety disorders in women and girls living with female genital mutilation: A systematic review. International Journal of Gynecology & Obstetrics, 136, 56-59.
Allen, L., Jones, C., Fox, A., Copello, A., Jones, N., & Meiser-Stedman, R. (2021). The correlation between social support and post-traumatic stress disorder in children and adolescents: A meta-analysis. Journal of Affective Disorders, 294, 543-557.
Antonovsky, A. (1993). The structure and properties of the sense of coherence scale. Social science & medicine, 36(6), 725-733.
Bagheri Sheykhangafshe F, Shabahang R. (2020). Prediction of Psychological Wellbeing of Elderly People based on Spirituality, Social Support, and Optimism. JRH, 7(2), 22-32.
Bashir, N., ul Ain, Q., Niazi, H., Khan, M. I., & Asghar, A. K. (2024). Assessment of Post-Traumatic Stress Disorder and Role of Spirituality Amongst Caregivers of Pediatric Cancer Patients in Pakistan. Life and Science, 5(1), 08-08.
Bisson, J. I., Ariti, C., Cullen, K., Kitchiner, N., Lewis, C., Roberts, N. P., ... & Williams-Thomas, R. (2022). Guided, internet based, cognitive behavioural therapy for post-traumatic stress disorder: pragmatic, multicentre, randomised controlled non-inferiority trial (RAPID). bmj, 377.
Bryant, R. A., Kenny, L., Rawson, N., Cahill, C., Joscelyne, A., Garber, B., ... & Nickerson, A. (2019). Efficacy of exposure-based cognitive behaviour therapy for post-traumatic stress disorder in emergency service personnel: a randomised clinical trial. Psychological medicine, 49(9), 1565-1573.
Cui, X., & Chi, X. (2021). The relationship between social support and internet addiction among Chinese adolescents during the COVID-19 pandemic: a multiple mediation model of resilience and post-traumatic stress disorder symptoms. Psychology Research and Behavior Management, 1665-1674.
Dai, W., Chen, L., Tan, H., Wang, J., Lai, Z., Kaminga, A. C., ... & Liu, A. (2016). Association between social support and recovery from post-traumatic stress disorder after flood: a 13–14 year follow-up study in Hunan, China. BMC public health, 16, 1-9.
Danielsson, F. B., Schultz Larsen, M., Nørgaard, B., & Lauritsen, J. M. (2018). Quality of life and level of post-traumatic stress disorder among trauma patients: A comparative study between a regional and a university hospital. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26, 1-9.
Dehshiri. A, Sohrabi. F, Jaafari. A & Najafi. M. (2008). Investigating the Psychometric Properties of Spiritual Scale among Students. Journal of Psychological Studies, 4 (3): 129-144.
Eames, C., & O’Connor, D. (2022). The role of repetitive thinking and spirituality in the development of posttraumatic growth and symptoms of posttraumatic stress disorder. PloS one, 17(8), e0272036.
El-Solh, A. A., O’Brien, N., Akinnusi, M., Patel, S., Vanguru, L., & Wijewardena, C. (2019). Predictors of cognitive behavioral therapy outcomes for insomnia in veterans with post-traumatic stress disorder. Sleep and Breathing, 23, 635-643.
Ennis, N., Sijercic, I., & Monson, C. M. (2021). Trauma-focused cognitive-behavioral therapies for posttraumatic stress disorder under ongoing threat: A systematic review. Clinical Psychology Review, 88, 102049.
Feng, Y., Liu, X., Zhang, S., Lin, T., Guo, X., & Chen, J. (2024). Relationship among post-traumatic growth, spiritual well-being, and perceived social support in Chinese women with gynecological cancer. Scientific Reports, 14(1), 4847.
Ferrajão, P. C., & Oliveira, R. A. (2016). The effects of combat exposure, abusive violence, and sense of coherence on PTSD and depression in Portuguese colonial war veterans. Psychological trauma: theory, research, practice, and policy, 8(1), 1.
Florez, I. A., Allbaugh, L. J., Harris, C. E., Schwartz, A. C., & Kaslow, N. J. (2018). Suicidal ideation and hopelessness in PTSD: Spiritual well-being mediates outcomes over time. Anxiety, Stress, & Coping, 31(1), 46-58.
González-Siles, P., Martí-Vilar, M., González-Sala, F., Merino-Soto, C., & Toledano-Toledano, F. (2022). Sense of coherence and work stress or well-being in Care professionals: a systematic review. In Healthcare (Vol. 10, No. 7, p. 1347). MDPI.
Goodarzi, M. A. (2003). Evaluating reliability and validity of the Mississippi scale for post-traumatic stress disorder in Shiraz. Journal of Psychology, 7(3), 153-78.
Gottvall, M., Vaez, M., & Saboonchi, F. (2019). Social support attenuates the link between torture exposure and post-traumatic stress disorder among male and female Syrian refugees in Sweden. BMC international health and human rights, 19, 1-11.
Grupp, F., Skandrani, S., Moro, M. R., & Mewes, R. (2021). Relational spirituality and transgenerational obligations: the role of family in lay explanatory models of post-traumatic stress disorder in male Cameroonian asylum seekers and undocumented migrants in Europe. Frontiers in Psychiatry, 12, 621918.
Gündüz, E. S., Avci, D., & Kiraz, N. (2023). The Relationship Between Spiritual Well-Being and Post-Traumatic Growth in Turkish Patients Undergoing Solid Organ Transplantation. Journal of religion and health, 62(6), 4436-4450.
Haller, H., Mitzinger, D., & Cramer, H. (2023). The integration of yoga breathing techniques in cognitive behavioral therapy for post-traumatic stress disorder: A pragmatic randomized controlled trial. Frontiers in psychiatry, 14, 1101046.
Hébert, M., & Amédée, L. M. (2020). Latent class analysis of post-traumatic stress symptoms and complex PTSD in child victims of sexual abuse and their response to Trauma-Focused Cognitive Behavioural Therapy. European journal of psychotraumatology, 11(1), 1807171.
Hu, B., Yang, X., & Tuo, X. (2023). The prevalence of post-traumatic stress disorder in college students by continents and national income during the COVID-19 pandemic: A meta-analysis. Frontiers in Psychology, 14, 1129782.
Idoiaga, N., Legorburu, I., Ozamiz-Etxebarria, N., Lipnicki, D. M., Villagrasa, B., & Santabárbara, J. (2022). Prevalence of post-traumatic stress disorder (PTSD) in university students during the COVID-19 pandemic: A meta-analysis attending SDG 3 and 4 of the 2030 agenda. Sustainability, 14(13), 7914.
Kalmakis, K. A., Chiodo, L. M., Kent, N., & Meyer, J. S. (2020). Adverse childhood experiences, post-traumatic stress disorder symptoms, and self-reported stress among traditional and nontraditional college students. Journal of American college health, 68(4), 411-418.
Kaźmierczak, I., Strelau, J., & Zawadzki, B. (2016). Post-traumatic cognitions as a mediator of the relationship between sense of coherence and post-traumatic stress disorder after motor vehicle accidents. Transportation research part F: traffic psychology and behaviour, 41, 38-44.
Keane, T. M., Caddell, J. M., & Taylor, K. L. (1988). Mississippi Scale for Combat-Related Posttraumatic Stress Disorder: three studies in reliability and validity. Journal of consulting and clinical psychology, 56(1), 85.
Khaleel, R. I., & Al-Doori, N. M. (2019). Post-traumatic stress disorder in relation to social support among adolescents in Mosul City. Indian Journal of Public Health, 10(10), 3949.
Lampe, A., Riedl, D., Kampling, H., Nolte, T., Kirchhoff, C., Grote, V., ... & Kruse, J. (2024). Improvements of complex post-traumatic stress disorder symptoms during a multimodal psychodynamic inpatient rehabilitation treatment–results of an observational single-centre pilot study. European Journal of Psychotraumatology, 15(1), 2333221.
Lewis, C., Roberts, N. P., Simon, N., Bethell, A., & Bisson, J. I. (2019). Internet‐delivered cognitive behavioural therapy for post‐traumatic stress disorder: Systematic review and meta‐analysis. Acta Psychiatrica Scandinavica, 140(6), 508-521.
Mahammadzadeh A, Poursharifi H, Alipour A. (2010). Validation of Sense of Coherence (SOC) 13-item scale in Iranian sample. Procedia-Social and Behavioral Sciences, 5(1), 1451-1455.
Mavranezouli, I., Megnin-Viggars, O., Daly, C., Dias, S., Welton, N. J., Stockton, S., ... & Pilling, S. (2020). Psychological treatments for post-traumatic stress disorder in adults: A network meta-analysis. Psychological medicine, 50(4), 542-555.
Mousa Thabet, A. A., & Vostanis, P. (2017). Relationships between traumatic events, religious coping style, and post-traumatic stress disorder among Palestinians in the Gaza Strip. J Nurs Health Stud, 2(1).
Murray, H., Grey, N., Wild, J., Warnock-Parkes, E., Kerr, A., Clark, D. M., & Ehlers, A. (2020). Cognitive therapy for post-traumatic stress disorder following critical illness and intensive care unit admission. The Cognitive Behaviour Therapist, 13, e13.
Nickerson, A., Creamer, M., Forbes, D., McFarlane, A. C., O'donnell, M. L., Silove, D., ... & Bryant, R. A. (2017). The longitudinal relationship between post-traumatic stress disorder and perceived social support in survivors of traumatic injury. Psychological Medicine, 47(1), 115-126.
Paloutzian, R. F., Bufford, R. K., & Wildman, A. J. (2012). Spiritual well-being scale: Mental and physical health relationships. Oxford textbook of spirituality in healthcare, 4, 353-8.
Ragger, K., Hiebler-Ragger, M., Herzog, G., Kapfhammer, H. P., & Unterrainer, H. F. (2019). Sense of coherence is linked to post-traumatic growth after critical incidents in Austrian ambulance personnel. BMC psychiatry, 19, 1-11.
Ramadan, M., Kheirallah, K., Saleh, T., Bellizzi, S., & Shorman, E. (2022). The relationship between spirituality and post-traumatic stress symptoms in Syrian adolescents in Jordan. Journal of Child & Adolescent Trauma, 15(3), 585-593.
Schäfer, S. K., Becker, N., King, L., Horsch, A., & Michael, T. (2019). The relationship between sense of coherence and post-traumatic stress: a meta-analysis. European Journal of Psychotraumatology, 10(1), 1562839.
Seo, E. Y., & Kwon, S. (2018). The influence of spiritual well-being, self-esteem, and perceived social support on post-traumatic growth among breast cancer survivors. Asian Oncology Nursing, 18(4), 232-240.
Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social science & medicine, 32(6), 705-714.
Simon, N., McGillivray, L., Roberts, N. P., Barawi, K., Lewis, C. E., & Bisson, J. I. (2019). Acceptability of internet-based cognitive behavioural therapy (i-CBT) for post-traumatic stress disorder (PTSD): a systematic review. European Journal of Psychotraumatology, 10(1), 1646092.
Simon, N., Robertson, L., Lewis, C., Roberts, N. P., Bethell, A., Dawson, S., & Bisson, J. I. (2021). Internet‐based cognitive and behavioural therapies for post‐traumatic stress disorder (PTSD) in adults. Cochrane database of systematic reviews, (5).
Sölva, K., Haselgruber, A., & Lueger-Schuster, B. (2020). The relationship between cumulative traumatic experiences and ICD-11 post-traumatic symptoms in children and adolescents in foster care: The mediating effect of sense of coherence. Child Abuse & Neglect, 101, 104388.
Umucu, E., Rumrill, P., Chiu, C. Y., & Ghosh, A. (2022). Functional Limitations, Post-Traumatic Stress Disorder, and College Adjustment in Student Veterans: A Mediation Analysis Study. Rehabilitation Research, Policy & Education, 36(1).
Valsø, Å., Rustøen, T., Skogstad, L., Schou‐Bredal, I., Ekeberg, Ø., Småstuen, M. C., ... & Tøien, K. (2020). Post‐traumatic stress symptoms and sense of coherence in proximity to intensive care unit discharge. Nursing in critical care, 25(2), 117-125.
Veronese, G., & Pepe, A. (2017). Sense of coherence as a determinant of psychological well-being across professional groups of aid workers exposed to war trauma. Journal of interpersonal violence, 32(13), 1899-1920.
Veronese, G., Mahamid, F. A., & Bdier, D. (2022). Subjective well-being, sense of coherence, and posttraumatic growth mediate the association between COVID-19 stress, trauma, and burnout among Palestinian health-care providers. American Journal of Orthopsychiatry, 92(3), 291.
Wathelet, M., Fovet, T., Jousset, A., Duhem, S., Habran, E., Horn, M., ... & D’hondt, F. (2021). Prevalence of and factors associated with post-traumatic stress disorder among French university students 1 month after the COVID-19 lockdown. Translational Psychiatry, 11(1), 327.
Wilkinson, C., Von Linden, M., Wacha-Montes, A., Bryan, C., & O'Leary, K. (2017). Cognitive processing therapy for post-traumatic stress disorder in a University Counselling Center: an outcome study. The Cognitive Behaviour Therapist, 10, e20.
Wood, J. D., Ware, C. M., Correll, T., Heaton, J. E., McBride, T., & Haynes, J. T. (2018). Relationship between spiritual well-being and post-traumatic stress disorder symptoms in United States Air Force remotely piloted aircraft and intelligence personnel. Military Medicine, 183(9-10), e489-e493.
Wright, J. H., Brown, G. K., Thase, M. E., & Basco, M. R. (2017). Learning cognitive-behavior therapy: An illustrated guide. American Psychiatric Pub.
Xi, Y., Yu, H., Yao, Y., Peng, K., Wang, Y., & Chen, R. (2020). Post-traumatic stress disorder and the role of resilience, social support, anxiety and depression after the Jiuzhaigou earthquake: A structural equation model. Asian journal of psychiatry, 49, 101958.
Xian-Yu, C. Y., Deng, N. J., Zhang, J., Li, H. Y., Gao, T. Y., Zhang, C., & Gong, Q. Q. (2022). Cognitive behavioral therapy for children and adolescents with post-traumatic stress disorder: meta-analysis. Journal of affective disorders, 308, 502-511.
Yang, X., Xu, Y., Tan, R., & Zhou, X. (2022). Event centrality and post-traumatic stress symptoms among college students during the COVID-19 pandemic: the roles of attention to negative information, catastrophizing, and rumination. European Journal of Psychotraumatology, 13(1), 2078563.
Zhang, D., Qin, L., Huang, A., Wang, C., Yuan, T., Li, X., ... & Zhang, L. (2023). Mediating effect of resilience and fear of COVID-19 on the relationship between social support and post-traumatic stress disorder among campus-quarantined nursing students: a cross-sectional study. BMC nursing, 22(1), 164.
Zhao, Y., An, Y., Sun, X., & Liu, J. (2020). Self-acceptance, post-traumatic stress disorder, post-traumatic growth, and the role of social support in Chinese rescue workers. Journal of loss and trauma, 25(3), 264-277.
Zhou, X., Wu, X., & Zhen, R. (2018). Self-esteem and hope mediate the relations between social support and post-traumatic stress disorder and growth in adolescents following the Ya’an earthquake. Anxiety, Stress, & Coping, 31(1), 32-45.
The International Journal of Humanities
Volume 31, Issue 4
Autumn 2024
Pages 70-91