Predictive Factors of Posttraumatic Stress and Posttraumatic Growth Among the Survivors of Van, 2011, Earthquakes’ Trauma
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PREDICTIVE FACTORS OF POSTTRAUMATIC STRESS AND POSTTRAUMATIC GROWTH AMONG THE SURVIVORS OF VAN, 2011, EARTHQUAKES’ TRAUMA A THESIS SUBMITTED TO THE GRADUATE SCHOOL OF SOCIAL SCIENCES OF MIDDLE EAST TECHNICAL UNIVERSITY BY ÖZCAN ELÇİ IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR PHILOSOPHY IN THE DEPARTMENT OF PSYCHOLOGY JANUARY 2021 Approval of the thesis: PREDICTIVE FACTORS OF POSTTRAUMATIC STRESS AND POSTTRAUMATIC GROWTH AMONG THE SURVIVORS OF VAN, 2011, EARTHQUAKES’ TRAUMA submitted by ÖZCAN ELÇİ in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Psychology, the Graduate School of Social Sciences of Middle East Technical University by, Prof. Dr. Yaşar KONDAKÇI Dean Graduate School of Social Sciences Prof. Dr. Sibel KAZAK BERUMENT Head of Department Department of Psychology Prof. Dr. Özlem BOZO ÖZEN Supervisor Department of Psychology Examining Committee Members: Assoc. Prof. Dr. Deniz CANEL ÇINARBAŞ (Head of the Examining Committee) Middle East Technical University Department of Psychology Prof. Dr. Özlem BOZO ÖZEN (Supervisor) Middle East Technical University Department of Psychology Prof. Dr. Ayşegül DURAK BATIGÜN Ankara University Department of Psychology Assoc. Prof. Dr. Sedat IŞIKLI Hacettepe University Department of Psychology Assoc. Prof. Dr. Ilgın GÖKLER DANIŞMAN TED University Department of Psychology PLAGIARISM I hereby declare that all information in this document has been obtained and presented in accordance with academic rules and ethical conduct. I also declare that, as required by these rules and conduct, I have fully cited and referenced all material and results that are not original to this work. Name, Last Name: Özcan ELÇİ Signature: iii ABSTRACT PREDICTIVE FACTORS OF POSTTRAUMATIC STRESS AND POSTTRAUMATIC GROWTH AMONG THE SURVIVORS OF VAN, 2011, EARTHQUAKES’ TRAUMA ELÇİ, Özcan Ph.D., The Department of Psychology Supervisor: Prof. Dr. Özlem BOZO ÖZEN January 2021, 130 pages Earthquakes, like other natural major disasters involves trauma resulting from exposure and/or witnessing to deaths and injuries, extreme fear of threatening situations, loss of a significant one, monetary loss and need of extreme physical power. On the other hand, the survivors may have also present positive changes in face of adversity. In present study, both negative and positive impacts of Van earthquakes which happened in 23rd of October and 9th of November 2011 are examined. 630 volunteer teachers from Erciş and Van districts participated in the study who experienced at least one of the earthquake in the disaster area. The data was collected four months after the second earthquake. Female gender, degree of exposure (proximity to the epicenter), loss of life, helpless coping, negative cognitions about self and world are found to be the risk factors for Posttraumatic Stress (PTS). In addition to the same variables, problem focused coping also significantly predicted the level of Hyperarousal and Intrusion factors. Avoidance factor was predicted by ego- resilience, helplessness coping, and negative cognitions about self. The predictors of iv Posttraumatic Growth (PTG) were found to be female gender, ego-resilience, perceived social support, problem focused coping, fatalistic coping, and seeking support coping. The mediator role of Posttraumatic Cognitions and Coping Styles in developing PTS and PTG were investigated. The results were discussed within the previous literature and posttraumatic stress and growth theories. Furthermore, limitations of the study, implications of the findings for clinical practice and community interventions, and future research were discussed. Keywords: Posttraumatic stress, posttraumatic growth, earthquake, natural disasters, coping v ÖZ 2011 VAN DEPREMLERİNİ YAŞAYANLARDA TRAVMA SONRASI STRES VE TRAVMA SONRASI BÜYÜMEYİ YORDAYAN FAKTÖRLER ELÇİ, Özcan Doktora, Psikoloji Bölümü Tez Yöneticisi: Prof. Dr. Özlem BOZO ÖZEN Ocak 2021, 130 sayfa Depremler, diğer doğal afetler gibi kayıp, ölüm ve yaralanmaya maruz kalma veya tanık olma, tehdit edici durumların yarattığı aşırı korku, önemli kişilerin kaybı, mali kayıplar ve aşırı düzeyde bedensel güce ihtiyaç duyma gibi sebeplerden dolayı travmatik bir süreci içerir. Öte yandan, böyle zor durumlarla karşılaşan hayatta kalan kişiler olumlu değişimler de gösterebilirler. Bu çalışmada, 23 Ekim ve 9 Kasım 2011 tarihlerinde meydana gelen Van depremlerinin hem olumsuz hem de olumlu etkileri araştırılmaktadır. Araştırmaya iki depremden en az birini afet bölgesinde yaşamış olan 630 gönüllü öğretmen katılmıştır. Araştırma verisi ikinci depremden 4 ay sonra toplanmıştır. Travma sonrası stresi (TSS) yordayan faktörler olarak, kadın cinsiyeti, can kaybı, afete maruz kalma düzeyi, çaresiz başa çıkma, kendisi ve dünya hakkında olumsuz travma sonrası bilişler değişkenleri bulunmuştur. TSS’in alt boyutları olan aşırı uyarılmışlık halini ve giricilik düzeyini aynı değişkenlere ek olarak problem odaklı başa çıkma değişkeni de yordamıştır. Travma sonrası büyümeyi (TSB) ise kadın cinsiyeti, ego-resilience, algılanmış sosyal destek, problem odaklı başa çıkma, kaderci başa çıkma ve son olarak sosyal destek arama değişkenleri yordamıştır. Travma vi sonrası bilişlerin ve başa çıkma biçimlerinin aracı değişken olarak etkileri de araştırılmıştır. Bulgular, önceki yazın ve TSS ve TSB kuramlarıyla birlikte tartışılmıştır. Ayrıca, araştırmanın sınırlılıkları, elde edilen bulguların klinik uygulama ve toplumsal müdahalelerdeki olası yansımaları, gelecekte yapılabilecek araştırmalarla ilgili öneriler sunulmuştur. Anahtar Kelimeler: Travma sonrası stres, travma sonrası büyüme, deprem, doğal afet, başa çıkma vii DEDICATION To my wife and our beloved cat Pişo viii ACKNOWLEDGMENTS I would like to express my heartfelt gratitude to my previous advisor, lifelong friend and guide Prof. Dr. A. Nuray Karancı, for her endless patience, support, and encouragement. During this study, I may have fall down hundred times, but she was not tired of picking me up hundred times. I am deeply honored that I know her since 1999. I would like to express my appreciation to my supervisor, Prof. Dr. Özlem Bozo Özen for her ongoing support and patience. I also want to extend my appreciation to Prof. Dr. Ayşegül Durak Batıgün, for her helpful feedbacks and contributions over the years. I am thankful to my committee members Assoc. Prof. Dr. Deniz Canel Çınarbaş, Assoc. Prof. Dr. Sedat Işıklı, and Assoc. Prof. Dr. Ilgın Gökler Danışman for their valuable critiques and comments. Special thanks to my wife. She always supported me with love and tolerance. I am indebted to Eylem. I would like to thank to Evindar Karabulut, Berivan Aydın, Cengiz Beyde, Bayram Eren, and Adil for their sincere help during data collection in Van and Erciş. ix TABLE OF CONTENTS PLAGIARISM ............................................................................................................ iii ABSTRACT ................................................................................................................ iv ÖZ ................................................................................................................................ vi DEDICATION .......................................................................................................... viii ACKNOWLEDGMENTS ........................................................................................... ix TABLE OF CONTENTS ............................................................................................. x LIST OF TABLES .................................................................................................... xiii LIST OF FIGURES .................................................................................................... xv CHAPTERS 1. INTRODUCTION .................................................................................................... 1 1.1. "Natural" Disasters ................................................................................................ 1 1.2. Earthquakes in Turkey .......................................................................................... 2 1.2.1. Van Earthquakes ............................................................................................ 3 1.3. Psychological Effects of Disasters ........................................................................ 5 1.3.1. Trauma Terminology and Posttraumatic Distress Following Disasters ......... 6 1.3.2. Epidemiology of PTSD .................................................................................. 8 1.3.3. Models of PTSD ............................................................................................. 9 1.3.3.1. Conditioning Model ................................................................................ 9 1.3.3.2. Horowitz’s Stress Response Syndromes ............................................... 10 1.3.3.3. Cognitive Model of the Maintenance of PTSD (Ehlers & Clark, 2000) ................................................................................................................... 11 1.3.4. Predictors Associated with PTSD After Disasters ....................................... 12 1.4. Posttraumatic Growth .......................................................................................... 16 x 1.4.1. Models of PTG ............................................................................................. 17 1.4.1.1. Schaefer and Moose’s Life Crises and Growth Model ......................... 17 1.4.1.2. Tedeschi and Calhoun’s Functional