Changes in symptoms severity dynamics using IES scale are also presented in Diagram 4:
Diagram 4. Changes in PTSD symptoms severity dynamics using IES scale in the Group 1.0 during the 2-4 training modules
Student’s t-test analysis of the changes in PTSD symptoms severity by IES scale (total score) in the group during the 2-4 training modules revealed statistically significant decrease between the second and the fourth levels: t=2,42 > tкр (tкр=2,056 with p<0.05). The greatest positive dynamic (even though statistically insignificant) is seen between the third and the fourth levels (t=1,79) in comparison to the period between the second the third levels (t=0,68). The occurred changes most likely due to the processing of the experiences that happens during the third level.
Individual symptoms criteria dynamic for the Group 1.0 participants for the duration of the training is represented in Diagram 5, where 1-15 is the number of each group participant.
Data Processing PCL-5
The increase in the PTSD symptoms criteria average by 4,4 points according to the PCL-5 test was observed for the group during the period between the 4th level and 4 month after the end of the course. This was due to the increase of the symptoms manifestation for the 53% of the participants (7 people). At the same time 41% (6 people) demonstrated the decreased of the symptoms. The limit of 38 points (diagnostically significant number) was exceeded by 2 people during the 4th levels, and by 3 people after 4 month. At the same time we observed decreased in symptoms by 9 points for one of the participants and for two participants there was an increase by 27 and 9 points respectively. Diagram 6 represents PTSD symptoms manifestation during the 4th level and in 4 month after the course.
Statistical analysis of the PTSD symptoms change significance by the PCL-5 scale (total points) between the period of the 4th level and 4 month after the training did not reveal any significant changes: t=0,71 < tкр (tкр=2,06 with p<0.05).
As can be seen from Diagram 7, 23.1% of the participants do not estimate their symptoms as clinically significant (PCL-5 test accepts the estimate 2 (“Moderate”) or higher as the symptom confirmation). 76.9% demonstrated at least one (or more) groups of symptoms, 38.5% – four groups of symptoms. Based on these preliminary results further psychometric measurements could be suggested in order to further clarify PTSD diagnosis.
Diagram 8 presents the most and the least experienced symptoms in 4 months after the end of the training course. The most common symptom among the respondents is “Are you very upset when something reminds you of the stressful event?” – 69.2% of participants, “Memories of the stressful event that are reoccurring and disturbing are undesirable?” – 61.5%, “Were you in the state of “excessive alertness”, vigilance, caution?” – 46.2% participant. Consequently the symptoms that are revealed by the questions ## 2, 8, 14, 15 by the PCL-5 scale are the least prominent.
As seen from the Diagram 9, the most prominent group of symptoms (according to PCL-5 test) is “Memory Intrusion” (B), the least prominent is “Avoidance” (C). “Alienation, inability to experience positive emotions” (D) and “Overexcitement” (E) occupy an intermediate position.
Data processing DES
70% (9 people) demonstrated decrease in the individual DES criteria. The number of participants with clinically diagnosed dissociation symptom criteria decreased by 7% (1 person).
DES criteria average did not change significantly between the second module and after 4 month of the training.
Statistical analysis of the changes in dissociation disorder symptoms significance by DES scale did not reveal verifiable changes between the second module and after 4 month of the training: t=0,13 < tкр (tкр=2,06 with p<0.05).
Data processing MS
Data comparison by the MS methodology revealed a decrease in the level of the symptoms manifestation: 15% of the participants demonstrated his level of the dysfunctions at the 2nd level while by the end of the 4th level there were 7% such participants. Symptoms increase during the 3rd level up to 23% could be related to activation of the defense mechanisms at the stage of the traumatic experiences processing.
Statistical analysis of the changes in dissociation disorder symptoms significance by MS scale did not reveal verifiable changes between the second module and after 4 month of the training: t=1,19 < tкр (tкр=2,06 with p<0.05). Statistically significant changes are also absent between the 2nd and the 3rd modules (t=0,29) and between the 3rd and 4th levels (t=1,57 < tкр, при tкр=2,06, p<0.05).
Data Processing PTSS-10
Estimation of the post traumatic condition probability criteria changes according to PTSS-10 demonstrated its decrease from 2nd to 4th training level while maintaining the effect in 4 month (see Diagram 11).
Data Processing BDI
Decrease in depression symptoms level is observed during the course of 2-3 modules (according to BDI scale) and also after 4 months (according to PHG-9 scale). Diagram 12 demonstrates the symptoms levels for the training levels and in 4 month (in percentages). 85% of the participants demonstrated decrease in depression criteria, 15% – demonstrate insignificant increase.
It should be noted that increase in symptoms according to several tests observed for participant #14 during the 3rd training module could be related to coping with a sudden death of his son.
Data Processing PTGI
Post Traumatic Growth Inventory (PTGI) (Tedeschi & Calhoun, 1996)) during the period “level 4 – in 4 month after the end of the training” revealed that 33% of the participants demonstrate increase in criteria, which attests to delayed positive dynamic. 58% demonstrate decrease in the post traumatic growth level, 1 participant (8%) did not show any changes. This may indicate the need for additional support during the first period after the end of the training. Diagram 13 shows the distribution of the individual post traumatic growth criteria.
Statistical analysis results of the criteria changes reliability for several tests during training and in 4 months after the training is shown in Table 1. (for comparison).
Correlation analysis of the significance in the test criteria changes for the group 1.0 during the training stages (according to the Student coefficient).
Statistically significant changes:
* – p<0.05
** – p<0.01
As seen from Table 1, significantly reliable changes for Group 1.0 occurred in the decrease of PTSD symptoms during the period of 2-4 levels (according to IES, t=2,42, p<0.05; PTSS-10 t=2,31, p<0.01), maintaining therapeutic effect in 4 months after the end of the training (PTSS-10, t=2,1, p<0.05). The absence of data is not always due to the absence of change in the symptoms but is rather due to the fact that comparison was carried out only for the tests technically administered at the certain training levels.
Participant #9 stands out among the others due to high dysfunctional criteria for different symptoms at the beginning and positive dynamics demonstrations during the training.
Correlation analysis of the test criteria relationship for Group 1.0 was carried out using SPSS 17.0 statistical package. The results are shown in Table 2.
Correlation analysis of the test criteria relationship for Group 1.0 (according to Pearson coefficient)
As seen from Table 2, PCL-5, PTSD screening and PTSS-10 tests correlate with each other, which could be an evidence of their mutual compatibility.
PTSS-10 was the most sensitive to post traumatic growth dynamic – increase in PTGI criteria is related to decrease in PTSS-10 (-0,558*, p<0.05).
PCL-5, PTSS-10 and PHQ-9 were sensitive to the changes in dissociation disorders. Depression is related to the PTSD symptoms and dissociation disorders (0,825**, p<0.01).
Bodynamic training is aimed to direct the participant to overcome their traumatic feelings and to promote post traumatic growth. Therefore we estimated possible connection between the components of the post traumatic growth (according to PTGI test) and other methods. Correlation analysis demonstrated that strengthening of faith and awareness of the fact that the participant is able to overcome present difficulties is the most important factor in PTSD symptoms decrease (-0,766, p<0.01 according to PCL-5; -0,8, p<0.01 according to PTSD screening; -0,671, p<0.05 according to PTSS-10), depression (-0,579, p<0.05) and dissociation disorders (-0,603, p<0.05) (see Table 3). An effective factor in reducing the symptoms of PTSD is the ability to turn to others for help and support (this is one of the structural and organizational conditions of the training among the anti-terrorist operation participants), the ability to see their strength, to believe in themselves and their abilities. This is also achieved due to the content of the training aimed at development of reflective thinking, a better self-understanding, restoring a sense of control over their conditions, skills training, mutual support.
Additionally it can be concluded that PTGI survey is in good correlation with the PTSD symptoms test and to the lesser extent with comorbid disorder tests.
Correlation criteria between PTIG survey scale and other tests (according to Pearson coefficient)
The hypothesis that the group participants involved in teaching the groups based on the equal to equal principle would demonstrate higher post traumatic growth criteria in 4 month after the end of their own training (level 4) was not confirmed. PCL-5, PTSS-10 and PHQ-9 tests showed that these trainers do not significantly differ from those not involved in such teaching (Table 6).
Comparison of PCL-5, PTSS-10, PHQ-9 tests for the trainers, who were teaching based on the equal to equal principle and those who were not involved in teaching (after level 4)