Abstract

This research aimed at investigating the impact of terrorism trauma on post-traumatic growth in victims of terrorism trauma in Swat (Pakistan). Moreover, gender differences across study variables were also explored. The cross-sectional survey design was used in the present study. The instruments used in the present study included Terrorism Trauma Questionnaire (Javaid, 2007) and Post Traumatic Growth Inventory Short Form (Aziz, 2012). 

The sample of the study comprised 441 participants from the district swat of Khyber Pakhtunkhwa (Pakistan). The purposive sampling technique was used for data collection. Results showed that avoidance is the strongest predictor of post-traumatic growth, depicting 47% variance.  Independent sample t-test results revealed significant differences in gender i.e., male’s scores are higher on terrorism trauma, whereas on two domains of post-traumatic growth (relating to others and spiritual change), significant differences were observed between females and males. Where female victims of trauma scored high on both domains (relating to others and spiritual change) as compared to male victims.   Intervention related to post-traumatic care, especially for male victims, is required in backward areas like Swat (Pakistan) So that people can recover from their trauma and take a new start.

Taliban, where television was forbidden, public executions were common, educational institutes were banned (Khan & Khan 2019). The valley of Swat is located on a small drive of (153.5 miles) from the capital of Pakistan. From year 2007 to 2010, the Taliban imposed a rough form of Shariah law in the district and started a battle against female education in the area.

Approximately 640 educational institutes of Swat were ruined, and Taliban activists had banned girls' education and forbid female instructors from institutes. Swat valley is also the birthplace of Nobel prize winner Malala Yousafzai, who was shot in the head by the Taliban in 2012 for her courageous voice for girls' education; it was a shameless attack on Yousafzai, at that time, her age was just 15 years.  The terrorism trauma faced by the people of Swat resulted in dangerous as well as uncommon traumatic experiences. This leads to prolonged, impulsive, and intense experiences, which effected their routine life cycle, the value of lifespan, and the prosperity of the person (Anwer, 2019). 

Terrorism is a kind of physical and psychological conflict that badly affected the people living in Swat. Terrorists used different methods to provoke terror and fear in people, but their tenacity behind these schemes stayed similar. Bomb blast, suicide bombing, bio-psychological bombing, and even economic warfare can be formed to create destruction in society (Crenshaw, 2007). Terrorism is a faux and man-made trauma that can be an outcome of an abortive, intent, or failed system (Riaz, Malik, Nawaz, Batool & Shujaat, 2015).    

 The term ‘‘trauma’’ mainly labels the harm or damage that is produced by experiencing or perceiving frightening events such as mistreating or abuse (sexual, physical, and emotional), conflict, war, disorder, drug addiction, loss of a close one, tragedy, and disaster (natural disasters, man-made disasters terrorism). Traumas are frequently related to negative consequences (Posttraumatic Stress Disorder or PTSD) (Grenon, Consigny, Lemey, Simson, & Coulon, 2019),   but can also be escorted by positive features, that is, Post Traumatic Growth (PTG), where an individual experiences a variation in their mental development that covers beyond their earlier functional level (Zalta et al., 2017).

Post-traumatic growth (PTG) has been defined as a capacity to persist in the face of difficulty and is assisted by the use of constructive psychosocial incomes, such as beliefs that life is understandable, controllable, and significant (Antonovsky, 1987; McKee-Ryan et al., 2005). In the field of psychology, the concept of a traumatic event is changing as researchers identified that difficulty not only leads to defective life but can lead to positive changes and suitable life. Voluminous literature demonstrates that trauma survivors often experience negative outcomes, including disruption in a relationship, post-traumatic stress, etc. However, the adversity likewise evokes new coping skills and a sense of personal strength, more specifically post-traumatic growth. Terrorism is a major threat to Pakistan’s sovereignty, safety and security. Acts of terrorism have taken place in every nook and corner of the country, and the beautiful Switzerland of Pakistan is considered the most affected area. Keeping in view the lack of studies in this area present study was focused on investigating the impact of terrorism trauma on the post-traumatic growth of people living and Swat (Pakistan) and studying the gender differences with reference to terrorism trauma and post-traumatic growth.

Method

Sample

The study's sample size was composed of 441 males and females of District swat Tehsil: Kabal and Tehsil: Matta, which was the more affected region of Swat (Khan, 2015). to report of Khpalkor foundation, DIG, DPO, And DC of Swat from the total population of 2.31 million, the affected population was 2 million people. Approximately all villages of this district were affected fully or partially and had severe economic and human losses. The statistic showed that in 2007 and 2008, there were deaths of around 5,000 people and injuries to around 10,000 people (Khan, 2015). There is no independent confirmation of the number of casualties. 

In January 2009, the military said 142 soldiers and paramilitary troops had died since August 2008. In 2007, the military confirmed the deaths of 230 civilians and 90 military personnel. At the end of 2007, the Human Rights Commission of Pakistan (HRCP) in Swat said at least 400 civilians had died, and 1,000 houses were destroyed. According to human rights groups and the media, approximately 800,000 of Swat’s 1.8 million individuals have escaped (A profile of the internal displacement situation, 2 December 2009). The age ranged between 18 to 60 years (M=25.62, SD=7.57). The sample included both males (N=271) and females (N=170). The participants were chosen through purposive and convenient sample techniques. A non-probability purposive sample is used to select the sample. Inclusive sampling criteria were individuals above age 18 from district Swat, who directly experienced terrorist trauma in Swat. Only those individuals were included as a participant of the study who has the ability to read and write and can be able to comprehend the questionnaires.

Procedure 

First, permission was taken from the respective concerned authorities for the purpose of collecting the data. The people of District Swat who were victims of terrorism trauma were approached after permission, and only those people who met the criterion for inclusion in the study were included.

The nature, purpose, and scope of the study were clearly instructed to participants, and informed consent was obtained from the participants, and it was ensured that information provided by them would be kept anonymous, confidential, and solely used for research purposes. 

The contributors were then given the questionnaire booklet, which also contained informed consent along with a demographic sheet with complete instructions. The participants were also informed that they could ask if any query was there about the study, and their queries were answered inefficiently polite and professional manner. They were also given verbal instruction about how to respond to the research questionnaire items as the items were neither in true false nor yes-no format. Participants were also told that they had the right to withdraw themselves during the study if they needed. In the end, participants were thanked for their cordial cooperation and best wishes for their bright future.

 Instrument 

The following measures were used to collect data for research. The detail of each scale is given below.

Traumatic Appraisal Questionnaire. An indigenous scale for measuring post-traumatic stress symptoms based on DSM 5 criteria, developed by Javaid and Hanif (2017), was used in the present study. This scale consists of items indicating four major domains i.e., “Intrusion (items:1,6,11,16,22), Avoidance (items:2,7,12,23,26), Change in mood and cognition (items:3,4,8,9,13,15,18,19,24,27), Change in arousal and reactivity level (items:5,10,14,17,20,21,25)”. This is 27 items scale in which participants rated the degree of change they experienced after any trauma on a 5-point Likert scale ranging from 1(I did not experience this change as a result of this trauma) to 5 (I experienced this change to a very great degree as a result of this trauma). The alpha reliability of the traumatic appraisal questionnaire for the present study was .93.

Post-traumatic growth inventory (PTGI-SF). The post-traumatic growth inventory short form (PTGI-SF), developed by Cann et al. (2010) and translated in Urdu by Aziz (2012), is a 10-item measure of post-traumatic growth. The participant will rate the degree of change they experienced after any trauma on a six-point Likert scale ranging from 0(I did not experience this change due to my crisis) to 5(I experienced this change to a very great degree as a result of my crisis). The measure yields a total score in addition to five subscale scores: New possibilities (items:3,6); Relating to others (items:5,10); Personal strength (item:7,9); Spiritual change(items:4,8); appreciation of life(items:1,2). A higher score on this scale indicates more post-trauma growth. The alpha reliability of the scale for the present study was .70.

The purpose of this study was to investigate post-traumatic growth in victims of terrorist trauma in Swat (Pakistan); it is a land of breath-taking beauty, but unfortunately, this beauty was destroyed.

Results

Pearson correlation depicted a positive correlation between two subscales of terrorism trauma: Intrusion, Avoidance with post-traumatic growth, where a negative relation was observed between two other sub-scales of terrorism trauma, i.e. (alteration and Hyperarousal) Post-traumatic growth.  In order to see the impact of terrorism trauma on post-trauma growth, multiple linear regression was done, which is given below

Gender-wise comparison for study variables

For comparison of gender on terrorism trauma and post-traumatic growth and their sub-scales independent sample t-test was run.

Discussion

The purpose of this study was to investigate post-traumatic growth in victims of terrorist trauma in Swat (Pakistan); it is a land of breath-taking beauty, but unfortunately, this beauty was destroyed, and people were traumatized because of a wave of terrorism in 2009. It is the land of a daughter like Malala and a son like Etazaz. In a time of trauma, the people of Swat (Pakistan) bounce back with remarkable strength and hope. The present study was conducted on the victims of Swat terrorism trauma to investigate the impact of terrorism trauma on post-traumatic growth and also to study the gender differences across study variables.

As mentioned before, adversity often leads to growth and strength.  To see the predictive role of terrorism trauma, multiple linear regression revealed that effects of the traumatic event (avoidance) strongly predict post-traumatic growth variables. A study was conducted in New York following the attacks of 11 September 2001 and in Israel during tumultuous periods of violence and terrorism. Post-traumatic growth is related to greater psychological distress, more right-wing political attitudes, and support for retaliatory violence (Hobfoll et al., 2007). Moreover, people in the trauma group reported more PTG (Kastenmüller, Greitemeyer, Epp, Frey & Fischer, 2011). Trauma symptoms were positively associated with growth in this study (Butler et al., 2005). Several other studies have also found this association (Cadell et al., 2003; Park & Ai, 2006). 

Mean differences were analyzed on a sample of terrorism victims based on gender. The result of the t-test showed that male victims of terrorism showed more symptoms related to stress as compared to female victims. Results revealed that male victims of terrorism trauma in swat (KPK) showed more stress-related symptoms to trauma as compared to female victims. Similarly, they are more prone to avoid distressing memories, thoughts, feelings related to trauma as compared to their female counterparts. Again, they (male victims) are generally more pessimistic, and they have a persistent and distorted sense of self-blaming and inability to remember key aspects of the trauma-related events. Moreover, male trauma victims showed more physiological symptoms related to stress (hyperarousal) than female victims. Their behaviors are marked by aggressive, reckless, or self-destructive behavior along with sleep disturbance and hyper-vigilance. According to previous studies, male participants were inclined to have relatively low levels of post-traumatic growth and more trauma-related stress (Carmassi et al., 2014; Zhou, Wu, Yuan, et al., 2015). Barrett and Bliss-Moreau (2009) showed that male participants were less likely to engage in repetitive thoughts about traumatic cues than female participants. Repetitive thoughts can expose people to trauma-related memories or the materials to elicit Post Traumatic Stress Disorder (Janoff-Bulman, 2010). This can also increase the propensity to form positive cognitive reappraisals to produce Post Traumatic Growth (Calhoun & Tedeschi, 2006) and increase post-traumatic stress in males. In addition, in collective cultures, male individuals of the family are usually less expressive. They usually hide their extreme emotional expression just to show that they are a man of the family and are brave. In such circumstances, avoidance, pessimism, and distraction might lead to more stress-related symptoms of trauma.   

Gender differences also depicted no significant difference between male and female victims of trauma on post-traumatic growth, and this shows that both genders experience emotional and psychological changes as a result of their struggle with a highly traumatic life event, but the difference is not significant.  On two subscales of post-traumatic growth that are “relating to others” and “spiritual change,” significant differences are observed in female victims scoring high compared to male trauma victims. They show an increased faith in religious or spiritual beliefs after personally experiencing a traumatic event. Harper and Pargament (2015) mentioned that religiosity facilitated growth and exacerbated distress related to the crisis. The current study results also support this, as female victims of trauma showed less stress-related symptoms than male victims.

Limitations and suggestions  

Like every other study, the current study also has its limitations. The first limitation of the study lies in its quantitative research design.  While this study has its benefits, it lacks a detailed inquiry of the phenomenon under study in this research method.

The study’s second limitation is based on a targeted sample of half area and not all the population, so results cannot be generalized to a community sample. Although this research has a relatively large sample and fulfills the normal distribution condition, it is limited to only some severe district areas. To achieve more generalizable outcomes in future, this study requires a sample from some non-severe areas of the district too. 

Future research should use a qualitative study method with in-depth interviews to get detailed information. Respondents may be reluctant to give their actual responses because of the fear of being judged. Although they were previously assured of their anonymity right and privacy, their responses were still affected by their social desirability.

Implications 

Research may suggest points to add to existing interventions to produce Post Traumatic Growth associated with other aspects. This study may help to improve their coping and resilience. It may also help to reduce the prevalence or intensity of traumatic symptoms. This research also reinforces that Post Traumatic Growth is a possible post‐trauma outcome for terrorist-affected areas. Given the ongoing difficult work circumstances and repeated exposure to potentially terrorism trauma, efforts to promote Post Traumatic Growth may help individuals perceive positive benefits, which in turn may aid in keeping people well. This research is an addition to the limited research done with the terrorist-affected people of Swat and their Rehabilitation.

Conclusion 

The conclusions derived from the study demonstrated that post-traumatic growth is a valuable concept in trauma psychology and suggests that difficult situations inspire ingenious solutions. The research findings highlighted the concept that resources available to the survivors and available in the environment are essential for understanding growth rather than the mere passage of time. Therefore, the results suggested that Terrorism Trauma (avoidance) positively predicts Post Traumatic Growth in trauma victims. Male victims of terrorism trauma showed more stress related to trauma, and they need more help and intervention.

References

Altmaier, E. M. (2019). An introduction to trauma. Promoting Positive Processes After Trauma, 1–15.  10.1016/b978-0-12-811975-4.00001-0

Amin, R., & Iqbal, K. (2018). Psychological Consequences of Television Coverage of Terrorism among Youth. Pakistan Journal of Social Sciences (PJSS), 38(2).

Anwar, S. (2019). Religious Extremism and the Rise of Talibanization in Swat.Journal of Politics and International Studies 5 (2), 45– 62

Aziz, S. (2012). Psychiatric Morbidity, Post Traumatic Growth, Work and Social Adjustment among Earthquake Survivors Extricated from Under the Rubble (Unpublished MSc. Research Report). National Institute of Psychology, Quaid-i-Azam University, Islamabad.

Barrett, L. F., & Bliss‐Moreau, E. (2009). Affect as a psychological primitive. Advances in experimental social psychology, 41, 167-218.

Bhushan, B. (2018). Perspectives on Posttraumatic Growth. In Psychosocial Interventions for Health and Well-Being (pp. 83-107). Springer, New Delhi.

Butler, L. D., Blasey, C. M., Garlan, R. W., McCaslin, S. E., Azarow, J., Chen, X. H., ... & Kraemer, H. C. (2005). Posttraumatic growth following the terrorist attacks of September 11, 2001: Cognitive, coping, and trauma symptom predictors in an internet convenience sample. Traumatology, 11(4), 247-267.

Butler, L. D., Blasey, C. M., Garlan, R. W., McCaslin, S. E., Azarow, J., Chen, X. H.,  & Kraemer, H. C. (2005). Posttraumatic growth following the terrorist attacks of September 11, 2001: Cognitive, coping, and trauma symptom predictors in an internet convenience sample. Traumatology, 11(4), 247-267.

Cadell, S., Regehr, C., &Hemsworth, D. (2003). Factors contributing to posttraumatic growth: A proposed structural equation model. American Journal of Orthopsychiatry, 73(3), 279-287.

Calhoun, L. G., & Tedeschi, R. G. (2006). The foundations of posttraumatic growth: An expanded framework. Handbook of posttraumatic growth: Research and practice, 3-23.

Cann, A., Calhoun, L. G., Tedeschi, R. G., Taku, K., Vishnevsky, T., Triplett, K. N., &Danhauer, S. C. (2010). A short form of the Posttraumatic Growth Inventory. Anxiety, Stress, & Coping, 23(2), 127-137.

Carmassi, C., Dell'Osso, L., Manni, C., Candini, V., Dagani, J., Iozzino, L., & De Girolamo, G. (2014). Frequency of trauma exposure and post-traumatic stress disorder in Italy: analysis from the World Mental Health Survey Initiative. Journal of psychiatric research, 59, 77-84.

Chaudhry, M. A. H. A. (2016). Mental illness in Pakistan: the impacts of terrorism. Public Health Review.

Cohen-Louck,K.(2016). Perception of the Threat of Terrorism. Journal of Interpersonal Violence 1 –25 10.1177.

Crenshaw, M. (2007). The logic of terrorism. Terrorism in perspective, 24, 24-33.

Eze, J. E., Ifeagwazi, C. M., &Chukwuorji, J. C. (2019). Core Beliefs Challenge and Posttraumatic Growth: Mediating Role of Rumination Among Internally Displaced Survivors of Terror Attacks. Journal of Happiness Studies, 1-18.

Eze, J. E., Ifeagwazi, C. M., &Chukwuorji, J. C. (2019). Core Beliefs Challenge and Posttraumatic Growth: Mediating Role of Rumination among Internally Displaced Survivors of Terror Attacks. Journal of Happiness Studies, 1-18.

Fleischner, J. (2011). Governance and militancy in Pakistan's Swat valley. Center  for Strategic and International Studies.

Grenon, M., Consigny, M., Lemey, C., Simson, J. P., & Coulon, N. (2019). Impact of a Terrorist Attack on the Mental Health of Directly Exposed French Adolescents: Study Protocol for the First Step of the AVAL (Adolescents Victimes de l’Attentat de Londres) Cohort Study. Frontiers in psychiatry, 10, 744.

Harper, A. R., & Pargament, K. I. (2015). Trauma, religion, and spirituality: Pathways to healing. In Traumatic stress and long-term recovery (pp. 349-367). Springer, Cham.

Hobfoll, S. E., Hall, B. J., Canetti‐Nisim, D., Galea, S., Johnson, R. J., & Palmieri, P. A. (2007). Refining our understanding of traumatic growth in the face of terrorism: Moving from meaning cognitions to doing what is meaningful. Applied Psychology, 56(3), 345-366.

Hobfoll, S. E., Hall, B. J., Canetti‐Nisim, D., Galea, S., Johnson, R. J., & Palmieri, P. A. (2007). Refining our understanding of traumatic growth in the face of terrorism: Moving from meaning cognitions to doing what is meaningful. Applied Psychology, 56(3), 345-366.

Janoff-Bulman, R. (2010). Shattered assumptions. Simon and Schuster. New York: Free press.

Javaid, D, & Hanif, R, (2017). Impact of Traumatic Event on Quality of Life: Exploring the Role of Rumination, Posttraumatic Growth and Perceived Social support (Unpublished MPhil dissertation). National Institute of Psychology, QAU.

Kastenmüller, A., Greitemeyer, T., Epp, D., Frey, D., & Fischer, P. (2012). Posttraumatic growth: why do people grow from their trauma? Anxiety, Stress & Coping, 25(5), 477-489.

Kastenmüller, A., Greitemeyer, T., Epp, D., Frey, D., & Fischer, P. (2012). Posttraumatic growth: why do people grow from their trauma? Anxiety, Stress & Coping, 25(5), 477-489.

Khalid, I., & Roy, M. I. (2016). Pakistan's military operations: the counter-terrorism strategy (2001-2013) prospects and implications. Journal of the Research Society of Pakistan, 53(2).

Khan, A. Z., & Khan, M. I. (2019). Teachers’ Perception about Terrorism in Swat: A Qualitative Study.  Pakistan Journal of Professional Psychology: Research and Practice Vol, 10(1).

Khan, S. (2015). Impact of Armed Conflict on Female Education in Tehsil Matta, Kabal and KhawazaKhela of District Swat, Pakistan. International Journal of Humanities and Social Science Invention, 4(12), 19-31.

Park, C. L., & Ai, A. L. (2006). Meaning making and growth: New directions for research on survivors of trauma. Journal of Loss and Trauma, 11(5), 389-407. Retrieved from: 

www.internal-displacement.org.

Riaz, M. N., Malik, S., Nawaz, S., Riaz, M. A., Batool, N., & Shujaat, J. M. (2015). Well-being and post-traumatic stress disorder due to natural and man-made disasters on adults. Pakistan Journal of Medical Research, 54(1), 25.

Saeed, L., Syed, S. H., & Martin, R. P. (2014). Historical patterns of terrorism in Pakistan. Defense & Security Analysis, 30(3), 209-229.

Sajid, I.(2019).Pakistan’s swat valley: From terrorism to tourism, Anadolu agency.

Wahab, A., & Ahmad, M. (1996). Biosocial perspective of consanguineous marriages in rural and urban Swat, Pakistan. Journal of biosocial science, 28(3), 305-313

Zalta, A. K., Gerhart, J., Hall, B. J., Rajan, K. B., Vechiu, C., Canetti, D., &Hobfoll, S. E. (2017). Self-reported posttraumatic growth predicts greater subsequent posttraumatic stress amidst war and terrorism. Anxiety, Stress, & Coping, 30(2), 176-187.

Zhang, Y., Xu, W., Yuan, G., & An, Y. (2018). The relationship between posttraumatic cognitive change, posttraumatic stress disorder, and posttraumatic growth among Chinese adolescents after the Yancheng tornado: the mediating effect of rumination. Frontiers in psychology, 9, 474.

Zhou, X., Wu, X., Fu, F., & An, Y. (2015). Core belief challenge and rumination as predictors of PTSD and PTG among adolescent survivors of the Wenchuan earthquake. Psychological Trauma: Theory, Research, Practice, and Policy, 7(4), 391.

Zhou, X., Wu, X., Fu, F., & An, Y. (2015). Core belief challenge and rumination as predictors of PTSD and PTG among adolescent survivors of the Wenchuan earthquake. Psychological Trauma: Theory, Research, Practice, and Policy, 7(4), 391

‍

‍