Chapter2: Literature ReviewThe chapterwill represent the theoretical stance of this study and literature review ofrelated studies.
This study is primarily rooted in core concepts of psychologyof terrorism and its effect on psychological and emotional health andwellbeing. An internal dislocation has been around different parts of the worldsince its creation. Much has been focus on the issues but literature findslittle for the communities affected directly form a man-made disaster or theeffects on survivors of a particular incident regarding their physical orpsychological health, who found it unavoidable rethinking or relieving of aprevious havocs incident and the circumstances of that incident on theirpresent life. Traumatic experiences often top to psychiatric circumstances mostlyin the form of Post-Traumatic Stress Disorder and other mood disorders such asEmotion Deregulation. 2.1 Context, Trauma and Types”Trauma”usually means an extremely shocking and disturbing event. For example, tounderstand the traumatic events the basic key is that it states the extremestress after a violent or heartbreaking event and it effect individual’sability to survive.
Trauma, stress, and adaptation are not dived clearly,whereas, stress responses are noticeably physiological in nature. Psychologicaltrauma is defined differently by various experts. It is basically the effect ofsome traumatic experience encountered by an individual that proves howtraumatic the incident is. It is the kind of experience that makes victimincapable of integrating his/her emotions or is a long-term condition which canbe life threatening, sanity or bodily honesty (Pearlman & Saakvitne, 1995).
Trauma has awide range of meanings containing the aftereffects of shocking incidents likenatural or accidental deaths, severe crimes, encountering violence, naturaldisasters, etc. Chronic or repetitive experiences are also part of it such asneglect, struggle, domestic or urban violence, fight, abusive relationship,child abuse, concentration camps and long term deprivation. The survivor’sexperience and aftereffects on his/her life determines whether a specific eventis more or less traumatic. Traumatic incident is described in two componentssubjective and objective. The personal experience of objective incident constitutesthe trauma. Traumatization will be high if a person is highly endangered. Psychologicallytraumas mean feeling of complete helplessness and devastating emotion.
It mayor may not include body injuries but psychological traumas are involved inphysiological disruptions that play a role in long lasting effects and later ontrauma become an experience of the survivor. The harmful event may affect twopeople at the same time; one person may not even get a scratch and other may begetting affected badly and get traumatized. The specific traumatic aspect of anevent can be different from one person to other. The details or meaning of theevents can’t be assumed, such as terrorist or violent attack; if it is distressingfor one individual it isn’t necessary to be as or at all distressing for otherindividual and its aftereffects may vary from one another.
2.2 Single Blow vs. Repeated TraumaLenore Terr describedand differentiated about single blow and repeated traumas in traumatizedchildren studies. In some people single shocking event may create traumareactions for example natural disaster which may include hurricanes, volcanoes,floods, earthquakes etc. whereas, technological disasters such as chemicalspills, nuclear failures, plane and auto crashes are closely related and aresocially troublesome because of finding faults and blaming others. Criminalviolence is also part of single blow traumas which may include rape homicideand robbery that leaves great impact on victim’s life and their loved ones.
Thesetraumatic event develop their effects on victim’s life day by day. The mostserious and common mental health problems of victims of trauma exposure arethat they are repeated, sustained and sometimes develop over years.2.3 Natural vs.
Human MadeThere is a differencein natural and human prepared stressors that are arranged consciously onindividual and its effect also vary. Mostly, victims of violence and injurygiven by any person or a group of people seek mental health treatment; if it’s doneto stop any cause, the problem may increase. Man-made violence is immense inscale they are repeated, prolonged, severe or unpredictable; it is also threateningfor witnesses’ lives but also treating others violently. It embraces theidentity of a killer; human rights are being violated and abused by torture,kidnapping, terrorist massive killing without any reason. Criminal violencehas been done by killing the innocent people of a community, speciallytargeting one group, adding up exposure of war and political violence.Including the U.S. incidents Oklahoma City bombing, the 9/11 attacks, or the Peshawarattack on 12 December at APS School; apart from continuous violence in Syria,Palestine, Burma and Afghanistan, Exterior U.
S. such as bombardment, violence, raiding,or any accidents that results in terrorist activities and persons acting inisolation if they are considered political in nature.Disruption resultsin more severe exploitation which includes long duration, forced perceptionfear of injury or death and helplessness. Viewing physical abuse can bestressful and as much the victim is attached the stress will be. Particularly, watchingviolence directed towards a close relative or friend is sadistic. Interpersonalviolence is considered as a passionate eruption, whereas, the most horribleform of it is consciously inflicted.
Insettings such as prostitution, pornography rings, concentration camps, and insome families powerful control is used.In the field oftrauma the greatest predictable research findings are dose response, it dependson dose, the more the dose trauma it will produce more damaging effects. Alsoit is noticed that in greater stress, PTSD is more likely to be develop. Psychological effect will understated greatlyif trauma is prompted, unpredictable, sadistic, repeated and complex by humanor is bad childhood experience given by any human.2.
4 Terrorism and TraumaThere is harshchange in the world since September 11, 2001. First incident occur in 1993which was bombardment over world trade center which was almost a wakeup callbut only few people took that seriously alarming situation related to peace inworld. The impending attack focused against the innocent children and commonpeople of society just to create the element of fear in a society. Impact ofterrorism on children and communities dispirit, terrify and traumatize the public(Vasquez et al. (2008). These horrifying terroristic attacks incidents havebecome common and are increasing day by day.
The terrorists started to provokewar state by targeting the school children, such as the incident in 2006 inAfghanistan, another group of 20 children were attacked while playing soccerand a suicidal attack Baghdad college; both incidences took place in February2007. In March 2007 32 children and teachers were taken as prisoner in Manila forcedat gun point. Terroristic bombardment attacks also took place on 7thof July, 2005 in London subway, another attack on Paris on 13th ofNovember 2015.
Pakistan is amongst the sufferers of being a target of terroristactivities. Within six days just after Malala Yousafzai was honored the Nobelpeace prize the terrorist attack was faced on 16th December 2014 in Peshawar targetingschool children. An estimated 145 innocent lives along with teachers waskilled; however, the exact numbers of lives lost are still unknown.
Childrenwere shooting in their classrooms. The so called Tehreek-i-Taliban Pakistan(TTP) took the responsibility of this attack and claimed it to be a revengefrom Pakistan Army for attacking the North Waziristan tribal areas in June2014. It was deadly attacks ever on a school in any country.
However, accordingto GCPEA report Colombia, Pakistan, Afghanistan, Syria, Sudan and Somalia wereworst affected. These places had experienced more than a 1,000 attacks onuniversities, schools, staff and students. The emphasis is to discuss impactsof terrorism on Pakistani youth amongst the countries affected by complicatedterrorism. The reason behind terroristic attacks on educational institutions isdifficult to understand because there are varying reasons.
Violence produceslong-term effects than any natural disaster or accidents (Schenlger et al.,2002). Maximum experience of the traumatic incident and threat to life or anyconstant violence causes damaging effect to the psychological health ofindividual and mostly in Pakistani society (Khalily et al., 2010; Galea et al.,2003). In Pakistani society psychological trauma is on the rise and isprevailing in whole country (Medicines Sans Frontiers, 2008), due to whichpeople are effected badly and they are helpless, powerless and paralyzed (Herman,1992; Abdel-hamid et al.
, 2004). It is documented that severe exposure topsychological traumas outcome in physical health problems and psychologicalproblems (Boscarino, 1997). According to Alexander and Klein (2005) the purposebehind terrorist activities is to build anxiety, fear and panic and developinga sense of helplessness and hopelessness to destroy the sense of security andsafety and representing the ineffectiveness of the authorities.Alexander andKlein (2005) stated that reaction of terrorist events have not documentedproperly therefore there is large literature and research work on reaction ofcommunities and individuals to major traumas. General reaction to terroristattacks often include emotional trauma, lack of sensation, denial, terror, nervousness,helplessness and hopelessness, cognitive disorientation, confusion, disturbingthoughts, images, high alert, impaired concentration and memory, socialwithdrawal, irritability, loss of trust and faith, avoidant behavior, insomnia,and loss of energy.Universally theeffects of carelessness and violence are intense and extensive.
Survivors cansuffer from any psychiatric diagnosis or individual with frequent traumaexposure carry many diagnoses on other end they may have grown and achievedPTG. Due to cultural domains it has been difficult for men to get help forpsychological counseling which is also due to cultural gender bias. There isdifference between boys and girls exposure to terror and posttraumatic symptomswhich was explored by Solomon (2009) in a sample of 2,999 Israeli adolescents.His study concluded that the female have more posttraumatic symptoms than malesand male reported very few symptoms. Huddy et al.(2008) explored the public reactions to terrorism and his results showed thatwomen responded higher on the personal helplessness, threat and anxiety in reactionto terrorist events.
According to Farooqi (1981) male students have orexperience less anxiety as compare to female. Pridemore et al. (2008) pointedout that there is major suggestion that disastrous events which also includeterrorist attacks and it is indications of posttraumatic stress and especially forthe communities that are directly exposed to the incident. Frommeta-analytic (e. g., DiMaggio & Galea, 2006; DiMaggio, Galea, & Li,2009) also narrative reviews (e.
g., Bills et al., 2008; García-Vera &Sanz,2008) happening the psychopathological consequences of terrorist attacks, itderives that, after terrorist attacks, an important percentage of direct victims(around 20-30%) will develop a posttraumatic stress disorder (PTSD) as well asother mental disorders, mainly, major depression disorder, panic disorder,generalized anxiety disorder, agoraphobia, and alcohol and other substancedependence/abuse disorders as compared to indirect victims.Trauma isdifferent from normal stress experience in childhood. Trauma usually occurssuddenly and it is unpredictable, unusual and out of the range of anyexperience and child or any victim feels inability and helplessness to copewith traumas. Moreover unpredictability, overwhelming and suddenness nature ofthe event form a terror response in survivors. Most common reaction to anydanger has labeled as fight or flight reaction (Monahon 1993).
According toMonahon (1997) early studies those experiences which involve emotions leaveimpact on individual life for forever and trauma is outcome of any experiencesrelated to violence. Traumatic events influences relationships with others,self, environments and communities and often lead to the feeling of guilt,self-blame, panic, rage and disconnection from everyone (SAMSHA, 2011). Symptomsof trauma includes terror and fear, crying, spontaneous behavior, regression,insecurity and unable to regulate any emotions or feelings. Several things thateffect the impact of any trauma is victim’s age, relation with perpetrator,trauma type, exposure duration, severity and trauma chronicity most importantaspect for healing from traumatic event is self-care.
According toSAMHSA, (2010), for the journey of healing it is important that oneparticipates in the activities of that process so individual can feel the needsof survivor of traumatic event. Healing is the process in whichcognitive-behavioral components should be effective. According to SAMHSA it isimportant to involve in positive self-talk, make accomplishment and one shouldbe confident and pro-active for preventing to stay healthy and to heal.Negative impact or after effects of trauma may include depression, posttraumaticstress disorder, hopelessness (Bostock, Sheikh, & Barton, 2009; Calhoun& Tedeschi, 2001; Linley, Joseph, , 2008).
2.5 Post-Traumatic stress disorder andTerrorismAfterthe experience of any traumatic event the survivor may suffer from the disorderthat is PTSD (DiMaggio , 2006; García-Vera , 2008; Norris,Friedman, Watson, Byrne, Diaz, , 2002). Mostly people are exposingto violent or threating events once in a lifetime (Ozer, Best, Lipsey, , 2003).
Victims who have experience traumatic events reported PTSDsymptoms while few survivors show severe symptoms and they develop chronic PTSD(Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). According to NCTC 2010report 2670 innocent people were killed by terrorist attacks on Pakistan in2009, in Afghanistan 2778 were killed and in Iraq 3654 were killed. It ispossible that severe PTSD may be caused due to terrorist attacks due tomultiple reasons.
These attacks can lead to high level of PTSD than othertraumas. Whereas, these terroristic attacks result in large number of lifelosses andengage exposure to extreme scenes for emergency workforce. The workforce works nonstop for hours risking their lives fortheir loved ones during and after the attacks.The factorsinclude family background and family history of psychopathology (Inslichtet al., 2010), childhood emotional abuse (McCaslin et al., 2006), and highlevel of anxiety (Asmundson and Stapleton, 2008), and alexithymia (McCaslin etal., 2006) including anger as personality trait (Meffert et al., 2008).
The responseto a traumatic event has been found to be predictive such as high levels ofperi-traumatic distress (Marmar et al., 2006; Lilly et al., 2009; Inslicht etal., 2010) and dissociation (Marmar et al., 2006; McCaslin et al., 2008; Lillyet al., 2009; Martin et al.
, 2009). Other factors include repetitive workstress (Marmar et al., 2006; Maguen et al.
, 2009) and less social support(Marmar et al., 2006; Martin et al., 2009), are related to the severity of PTSDsymptoms. The aftereffects of terroristic attacks arelong-term among young children and youngsters. Some researchers found out thatbefore the age of 18 children suffer from trauma events.The terror attacks resulted in feelingof hopelessness and uncertainty among the mass in Pakistan. These feelings comeup with psychological problem including anxiety, depression and PTSD. Thetrauma not only is being faced in person but can be experienced through mediaexposure.
The rate of experiencing trauma through media is high around 91%. Thetrauma exposure effects psychological as well as physical health of youth (Boscarino,1997). Other psychological disorders include depression, anxiety, obsessivecompulsive disorder, posttraumatic disorder (PTSD) and substance abuse disordercommon in Pakistan (Khalily 2010) including the negative impacts life have become common in Pakistan (Khalily,2011). Another study found out that around 65% of youth in Pakistan has mild tomoderate stress. 2.
6 Post-TraumaticStress Disorder and Emotion RegulationEmotionregulation (ER) is seen to be a perilous factor in the development andpreservation of posttraumatic stress symptoms PTS (Bardeen, Kumpula, & Orcutt,2013; Marx & Sloan, 2005; Nightingale & Williams, 2000). It is also themain factor in the development of PTSD symptoms following trauma exposure inemotion regulation ER (Bardeen, Kumpula, & Orcutt, 2013; Marx & Sloan,2005; Nightingale & Williams 2000). ER is the conscious or unconscious attemptto affect the probability, intensity, or duration of an emotion (Gross, 1998).Traumatic event exposure provokes a variety of strong, emotional responses (Resick& Gerrol, 1988). Moreover, intrusive re-experiencing symptoms, and supplementarydistress, are common following trauma exposure (Rothbaum et al.
, 1992).As a result,this delicate emotional distress following trauma exposure places increaseddemands on efforts to regulate emotion. Individuals with PTSD often experiencea state of emotional freezing; so it is comparatively difficult for them toexperience both positive and negative emotions e.g.
, fear, horror, anger (APA,2013). Likewise, individuals with PTSD often experience marked, chronicemotions, such as guilt and shame (Resick & Schnicke, 1992). Collectively,these PTSD characters indicate a disturbance in efforts to modulate emotionalresponding.
One of the aspects of ER is avoidance. Emotion regulation is theconcept which is highly complex to study about; nonetheless, in this studybased on integrative conceptualization of the term ER and how it can be synchronizedor to study its regulating strategies after a traumatic incident and its effecton the individual’s well-being. Early studies suggest that after a traumaticincident, emotional and psychological problems may arise but the insight oftheir emotion and how to control it personally is not yet studied.
2.7 School Terrorism and its Effect onMental HealthAfterthe error attacks or natural disasters, many survivors go through symptoms of suffering,sorrow, and anxiety, which may resolve on their own (Norris, Friedman,Watson,& Byrne, 2002).September 11, 2001, terror attacks, Galea and colleagues(2002) found that 7.5% reported symptoms consistent with a diagnosis ofposttraumatic stress disorder (PTSD) is related to the attacks. Schools may ormay not be the targets of terrorism, but they are certain to be affected byterrorism, directly or indirectly.