CC BY
4ИСПОЛЬЗОВАННАЯ ЛИТЕРАТУРА:
1. Мухаметзянова Ф. Ш., Ибрагимов Г. И. Развитие фундаментальных исследований в области профессионального образования (результаты исследований ИПП ПО РАО в 2013 году) / Ф. Ш. Мухаметзянова, Г. И.
2. Ибрагимов // Казанский педагогический журнал. 2014. № 1 (102). С. 9-27.
3. Мухаметзянова Ф. Ш., Левина Е. Ю. Типология управления развитием образовательных систем и структур / Ф. Ш. Мухаметзянова, Е. Ю. Левина // Теория и практика общественного развития. 2015. № 19. С. 201-203.
4. Мухаметзянова Г. В. Приоритетные задачи профессионального образования в современной теории и практике / Г. В. Мухаметзянова // Среднее профессиональное образование. 2010. №2 10. С.2-7.
5. Ф. Ш. Мухаметзянова, Г. И. Ибрагимов // Вестник НЦБЖД. 2014. № 1 (19). С. 45-51.
PSYCHOLOGICAL REHABILITATION OF WAR PARTICIPANTS
Hakan Seyhan
Baku State University Social Sciences and psychology faculty Clinical psychology, Azerbaijan, Baku
Ab&ract: Mental trauma is observed when there is a vital imbalance between a tiressful event faced by a person and the ability to cope psychologically. Despite this definition, it is also a fact that, taking into account subjective factors, traumatic situations usually occur after serious events that can objectively injure anyone. In the events that occurred during the war, both direct physical injuryacute and chronic mental effects are observed in people who live as well as those who hear/ see what happened to their relatives and acquaintances, fellow soldiers, that is, who witness the tragic aspects of the war. For these reasons, overcoming the effects of psychological trauma is important not only for alleviating pati suffering, but also for improving future personal and social life.
Keywords: War participant, social support, psychotherapy, rehabilitation, adaptation period, traumatic experiences.
Wars are large-scale events that affect a large part of the society in which they occur. The type of trauma an individual experiences during wartime depends on the type of trauma and how closely the individual experienced the event. The losses of the soldiers during the war and the events they saw have a permanent place in their minds. Emotional thoughts that are formed in the subconscious become aggravated over time and cause trauma. During the battle, soldiers suffer from emotional thoughts. One of these emotional thoughts is fear, fear is an emotion that develops a person, as a result of this feeling we provide many reflexes and intellectual development, but a high degree of
fear causes psychological disorders. If the fear is repeated and the level &arts to increase, it will cause an anxiety problem. Putting a burden on the soldier and the military, in other words, it turns out that it will create problems in terms of operativeness and tactics while performing their duty and duty. The vital imbalance between the threat from the outside world and the person's ability to cope with this threat causes psychological trauma. War and terrorism increase the risk of psychological trauma (e.g. physical injury and other negative factors) due to the large number of severe &ressful events that exceed ordinary daily life. Such conditions can lead to long-term consequences, from sudden rare events, resulting chronic or cumulative trauma-based diseases, to increasing events with massive negative impacts on society. Such events can result in traumas in the following order:
- Type I traumatic experiences.
- Type II traumatic experiences.
- Type III traumatic experiences [11, 114].
The frequency of postraumatic &ress disorder in the fir& months of those who witnessed terrori& bombings is about 10%. For those who have been in a war environment and refugees fleeing from war, this rate is about 50% [11, 116].
In order to eliminate these situations, fir& of all, taking advantage of natural and social coping mechanisms, avoiding evaluating the emerging reactions as pathological, providing support in a suitable environment for the person to be able to accept and ma&er his emotions are among the measures that are taking place. Although the support of government agencies, media, healthcare and legal sy&ems is important in traumatic experiences that affect many people at the same time, in the case of an increase in relatively maladaptive reactions, the individual's life hi&ory and &ory should be brought to the fore.
EMDR incorporates various aspects of commonly used psychotherapy approaches. It is a &ep-by-&ep protocol-based integrative treatment approach. Norman Doidge: «This therapy method discovered by Shapiro is one of the moS successful cases in the field of psychotherapy». he realizes that it no longer bothers him. Then he notices that his eyes move quickly and diagonally up and down when the di&urbing thoughts come to his mind. Conscious cross-eye movements after his discovery. Having begun to do this in some way, Shapiro decided to inve&igate this situation and included 70 people and began to te& it by trial and error. The articles he wrote with the positive data he obtained were fir& published in the Journal of Traumatic Stress. EMDR therapy was fir& introduced in the 1990s. many scientific &udies have been conducted.
Psychological support approaches such as eye movement desensitization and reprocessing (EMDR) along with the principles of psychotraumatology developed in the la& few decades can have a positive effect in a relatively short time [11,114]. Utilizing this method is believed to be beneficial in preventing the psychological processes that cause a person to experience detachment from life and, in general, society's despair about the future caused by trauma.
A number of mental problems emerge as a result of events that involve major traumatic experiences, such as war. Some of them can be li&ed as follows:
• Chronic diseases related to &ress
• Depression
• Anxiety disorders
• Memory violations
• Postraumatic &ress disorder
• Character change, etc. [11].
There are many psychological approaches and different types of intervention used in psychological trauma. Eliminating the negative effects of trauma is the main goal of the healing process. Herman divides the healing process into three Sages. Therefore, at the firS Sage, the safety of the person muS be ensured and the sense of confidence muS be re&ored. Factors such as the severity level and duration of trauma experienced early affect the process of rebuilding a person's traumatized confidence.
At the second Sage, it should be noted at what age the trauma occurred. Then it is necessary to eliminate that problem as soon as possible, if this process continues for a long time, it will negatively affect the healing process.
In the third Sage, the person's relationship with people and the world should be re&ored and returned to normal life, and social life should be ensured [2,7]. Psychological trauma damages a person's sense of self, relationships with other people and the world, and causes feelings of helplessness. For this reason, Srengthening a person spiritually and helping to rebuild broken bonds is an indispensable part of the treatment process [4, 3].
Emotional and social support reduces the severity of postraumatic Sress disorder and depression [2,17]. Thus, Herman noted the support from the person's loved ones as a «vaccination» againS the negative emotions caused by the trauma.
There are a number of factors that influence postraumatic development. These are illu&rated in the graph below.
Figure 1. Description of factors influencing postraumatic development.
Factors influencing to po&raumatic progress Stress Peculiar characteri&ics Struggling characteri&ics
Social support
World vision and rumination form
A number of changes caused by postraumatic development have been identified during research. These changes are connected to each other in a chain, and are described in the following graph[5,12]. Graph 2. Description of changes caused by postraumatic development in an individual.
Chnages causing to po&raumatic progress in individual Development in interpersonal relations Exi&ential development
Discovery of new possibilities Development of thought
Personal Srength and acknowledgment of potential Value of life
Postraumatic &ress disorder caused by exposure to war and events affecting the psychology of war (learning about the martyrdom of a colleague, witnessing the martyrdom of a colleague, fear of death, exposure to loud explosives, etc.) causes insomnia and depression. All this can lead to a decrease in people's activities in daily life.
People who have experienced psychological trauma can receive psychiatric intervention, short, medium and long term. Collective or if necessary, psychotherapy is conducted. In principle, it is necessary to maximize and take advantage of a person's natural coping abilities, especially in the period immediately after encountering a traumatic experience. For example, social support, appropriate therapies to increase natural coping skills in depressed adolescents in terrori& and military operations environments have a positive effect on symptom reduction.
In this regard, resilience can consi& of personal, social or cultural components. Unnecessary attempts at intervention should be avoided and the person should be supported in the therapy process in a solution-oriented role that aims to continue living by overcoming difficulties («survivor») rather than a helpless victim. It should not be forgotten that a significant part of people in communities affected by mass trauma show high psychological resilience, and this rate does not fall below 1/3 [11,115]. In order to be effective in this direction, it is very important to create conditions for the expression of emotions felt during the peak of depression, to keep it in the environment of a possible tolerance window («window of tolerance»), and to remove it from the cycle of thoughts.
In trauma-focused psychotherapies accompanied by eye movements desensitization and reprocessing (EMDR) and (cognitive-behavioral) therapy come to the fore [9]. In some cases, drug treatment can also be used. Caution should be exercised in psychotherapeutic interventions for children and adolescents, as other mental problems may be similar to reactions to events [3, 21].
In medical centers, at the same time as other treatments, the weak points of the person should be determined and the recognition of the conditions should be facilitated by psychological examinations that can be carried out [1, 31].
Cognitive Behavioral Social Rhythm Therapy -This is a 12-week manual cognitive behavioral participation behavioral therapy admini&ered in a group format to overcome the lack of daily routine [9].
In accordance with traditional group therapy, each session la&s approximately 2 hours, with a short break in the middle of each session. The therapi& gives individual tasks and during the fir& hour the task is reviewed, and in the second hour new material is presented. In the fir& 4 sessions, the participants of the war tend to the cognitive behavioral model, trying to monitor their moods, thoughts and daily habits in the context of time and space [9].
Thought tracking and thought challenge sessions are introduced in sessions 3 and 4, respectively, where participants are equipped with cognitive therapy audio-visual aids to challenge any thoughts or images that may be getting in the way of daily, behavioral change[9].
These changes begin in session 5, where participants e&ablish a reali&ic social rhythm and are in&ructed to perform activities at recommended times in their daily schedules. Participants in therapy focus on carrying out their routines in 6 to 8 sessions, and participants are given examples of daytime behaviors related to light exposure, exercise, and eating [9].
Cognitive Behavioral Social Rhythm Therapy directly promotes the elimination of behaviors (such as excessive control over latches) that interfere with maintaining a regular sleep or wake time, i.e., their sleep performance, as well as postraumatic &ress disorder and increases focus on participation in activities of daily living (e.g., eating breakfa&) that are hindered by depressive symptoms. Studies have concluded that cognitive behavioral social rhythm therapy optimizes sleep functioning and activities of daily living hindered by other symptoms.
References
In Turkish
1. Qirakoglu OC. Uzun suren bir sava§: Travma sonrasi &ress bozuklugu. Pivolka Sava§ ozel sayisi 2003; 21: 20-21.
2. Herman, J. L. (2007). Travma ve iyile§me: §iddetin sonu?lari: Ev i?i i&ismardan siyasi terore. I&anbul: LiteraturYayincilik.
3. Sava§ K., Travmatik Beyin Hasari Rehabilitasyonu,1 Fiziksel Tip ve Rehabilitasyon Klinigi, Karapinar Devlet Ha&anesi, Karapinar, Konya/Turkiye, Aegean J Med Sci 2019;3:161-167
4. §ahin D. (31.03.2003). Sava§in yol a5tigi psikolojik yikimlar. http:// www. savaskarsitlari.org/arsiv.asp. Eri§im tarihi: 14.04.2011.
5. Volkan A. Gazilerde Travma Sonrasi Geli§im ve Etkileyen Faktorlerin Belirlenmesi, Yeditepe Universitesi Saglik Bilimler En&itusu, 16.07.2019, 77 s.
In English
1. Byrne L (December 12, 2009). New ways of addressing the psychological traumas of war: Supplementing traditional social supports to prevent homelessness among mentally ill veterans. http://digitalcommons.providence.edu/socialwrk_&udents/30. Eri§imtarihi: 9 Nisan 2011.
2. Schnyder, U., Ehlers, A., Elbert, T., Foa, E. B., Gersons, B. P., Resick, P. A., ... &Cloitre, M. (2015). Psychotherapies for PTSD: what do they have in common?. European journal of psychotraumatology, 6(1), 28186.
3. Zhai, J., Liu, X., Wu, J., & Jiang, H. What does postraumatic growth mean to Chinese burn patients: a phenomenological &udy. Journal of Burn Care & Research. 2010; 31(3): 433-440.
Internet resources
https://ergoterapi.biz/gazilerde-olusan-travma-sonrasi-^res-bozuklugu-depresyon-uyku-bozukluguna-ergoterapi-yaklasimi/
https://dergipark.org.tr/tr/download/article-file/1136730
https://jag.journalagent.com/eamr/pdfs/QTD_33_SUP_1_114_120.pdf
