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PSYCHOLOGICAL SCIENCES / «<g@[L[L@@U[IUM=J0UPMaiL» 2024
psychological sciences
Anastasiia Khotimska Master's degree in psychology, Private psychological practice, m. Dnipro, Ukraine https://orcid.ors/0009-0005-8806-7713 Inna Makarova Psychiatrist of the highest category, Municipal Enterprise "Dnipropetrovs 'k Multidisciplinary Clinical Hospitalfor Psychiatric Care " DOR ",
m. Dnipro, Ukraine DOI: 10.24412/2520-6990-2024-2195-68-71 THE IMPACT OF SHORT-TERM GROUP PSYCHOTHERAPY FOR IDP WOMEN ON THEIR INTEGRATION INTO SOCIETY, REDUCTION OF PTSD SYMPTOMS, SELF-DEVELOPMENT
AND MENTAL STABILIZATION
Abstract:
The article presents the impact of short-term group psychotherapy for IDP women on their integration into society, reduction of PTSD symptoms, self-development and mental stabilisation. The impact of short-term psychotherapy is measured both in quantitative terms by scales and in qualitative terms in terms of changes in PTSD symptoms. The article presents 3 cases of group psychotherapy of IDP women with psychiatrists and psychotherapists worked and their results before, immediately after and 3 months after short-term group psychotherapy.
Keywords: psychology, group psychotherapy, PTSD, stress psychology, IDP psychological groups.
Background: The war in Ukraine is in its tenth year. From 2014 to 2022, the war was localised and limited to a much smaller area, so the impact of PTSD was much smaller. However, with the beginning of the full-scale invasion in February 2022, the number of people affected by the war increased hundreds of thousands of times. Many studies have shown that direct exposure to conflict-related traumatic events is widespread among displaced persons (DPs) compared to a significant minority among urban residents (URs) [1]. According to a 2016 nationwide survey, the prevalence of PTSD among internally displaced persons (IDPs) was 32%, with 74% not receiving adequate mental health care[2]. After the full-scale invasion, the incidence of PTSD symptoms among civilians displaced inside and outside Ukraine is estimated to be 30.8% [3]. A review of the literature on refugee mental health revealed significant heterogeneity in the prevalence of depression, post-traumatic stress disorder (PTSD) and anxiety disorders, with prevalence estimates typically ranging from 20% and above, with some estimates as high as 88% (for anxiety disorder)[4]. These mental health disorders were most often associated with greater exposure to traumatic experiences prior to migration and post-migration stress, with poor socioeconomic status after migration being particularly associated with depression.
Currently, in many regions of Ukraine (Kyiv, Dnipro, Poltava, Ternopil, etc.), psychological groups for IDPs of different age and gender categories are operating. This is essential for the integration of people in new cities and towns of the country and the provision of primary psychological assistance. This study is not the result of long-term and in-depth psychotherapy and does not aim to completely separate from the trauma. However, it was necessary to conduct it because many IDPs, when migrating to another city, feel lost in life, they do not have the opportunity and resources to adapt
in a new city, it is difficult for them to start communicating with the locals and find the strength to start employment. Another important aspect is the factor of hostility and rejection of everything around them in the first stages of life in another city due to forced relocation.
The purpose of the study is to determine the impact of short-term psychotherapeutic group therapy for IDP women on their integration into society, reduction of PTSD symptoms, self-development and mental stabilisation.
Materials and Methods: This study was conducted by psychiatrists, psychologists, and psychotherapists at the Charitable Foundation "Resolute Hearts" in Dnipro, Ukraine. The study had a gender distribution - only women. The groups were formed by age category, with the main sample being 35-55 years old. The groups worked on the principle of small groups, up to 10 people in a group. Each group was designed for 3 months, i.e. 12 psychotherapeutic sessions, 1 session per week.
When forming the groups, they were not divided by the fact of the traumatic event (except for victims of sexual violence, they are distributed to other foundations and groups that deal with this specificity). The main facts of traumatic events that people in the groups encounter are: mother of a military man, wife of a military man, loss of home due to the total destruction of the city, torture (sitting in basements), moral and physical violence by the military occupiers, being under occupation. Psychiatrists, psychotherapists and psychologists used the psychoanamnestic method to collect medical history based on the Istanbul International Protocol [5], as well as the psychodiagnostic method using psychiatric scales for assessing PTSD symptoms. In short-term group therapy, methods such as cognitive
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behavioural group psychotherapy (CBT), psychody-namic, psychoanalytic psychotherapy, and art therapy were used to work with trauma[6].
Main part / empirical part:
We chose 3 random groups to demonstrate the impact of short-term group psychotherapy for IDP women on their integration into society, reduction of PTSD symptoms, self-development and mental stabilisation. All 3 groups underwent group psychotherapy using the above methods with different psychologists and psychotherapists to ensure the reliability of the results demonstrated in the 3 cases. If there were women in the group who had a history of torture, their group trainer was always a woman.
A list of symptoms of post-traumatic stress disorder was used to assess the impact of short-term psychotherapeutic group therapy on the psycho-emotional state ofwomen. The PTSD symptom checklist was validated and adapted by V. Bezsheiko for use in the Ukrainian population and is recommended for psychological population studies [7]. All women were interviewed according to the PTSD symptom checklist for the Ukrainian population before group therapy, immediately after completion and 3 months after completion of short-term group psychotherapy [7]. The qualitative assessment of the impact of short-term group therapy included: finding a job, the possibility of studying or interest in society, establishing communication with citizens, moving and creating their own comfort in a new home, even a rented one, actions to integrate children in a new city (attending local schools, clubs, creative events).
Interpretation of PCL-5 results acct
Case 1. This group was formed and functioned for 12 weeks and consisted of 8 women aged 40 to 55. They were IDP women from Donetsk, Luhansk and Za-porizhzhia regions. All these women had spent some time in the occupation, having left for different periods of time. All of their hometowns are either still under occupation or completely destroyed (Donetsk region).
The following data was obtained when determining the checklist of traumatic life events (LEC-5).
Happened directly to them: staying in the military conflict zone as a civilian, being held captive, hostage (military captivity), severe human suffering, torture, destruction of home.
Witnessed: the sudden violent death of an acquaintance or loved one, an armed attack (shooting, threats with a knife, pistol, bomb).
At the beginning of the short-term group therapy, only 2 people were working, 1 was a volunteer, all other women were unemployed and had not received any training.
The most common symptoms of PTSD in this group were unexpected feelings as if the stressful event was happening again, physical reactions (heartbeat, difficulty breathing, sweating), when something reminded them of the stressful experience, irritability, outbursts of anger, aggression, feeling very upset, had strong negative beliefs about themselves, other people, or the world, blamed someone else for the stressful event or its consequences, felt very ashamed and uncomfortable when recalling the traumatic event, and were unable to recall important moments of the stressful event (table. 1).
Table 1
Bng to the PTSD symptom inventory
Group of IDP women from case 1 Study results before the start of short-term group psychotherapy Study results after short-term group psychotherapy Study results 3 months after the end of short-term group psychotherapy
The patient 1.1 45 points 37 points 38 points
The patient 1.2 39 points 32 points 31 points
The patient 1.3 33 points 25 points 22 points
The patient 1.4 31 points 26 points 25 points
The patient 1.5 42 points 35 points 33 points
The patient 1.6 40 points 35 points 35 points
The patient 1.7 31 points 22 points 20 points
The patient 1.8 43 points 31 points 30 points
According to the data, the changes in scores range from 5 to 12 points, which indicates a real and present therapeutic effect that persists after the completion of the short-term group therapy course.
After completing the course, 3 women found jobs, 2 started studying to change their job profile, 1 of the women continues to volunteer, and 1 woman started volunteering. Most ofthe women moved to new homes, began to set up their lives and make short-term plans for their lives. Each of the women had a different degree of integration into society, but it was significant: for some, it was a job, or the opportunity to spend more time with their children in society and the desire to socialise them
Case 2. The 2nd group was formed and functioned for 12 weeks and consisted of 9 women aged 40 to 50. These were IDP women from Donetsk and Luhansk regions. All of these women had spent some time in the occupation, leaving for different periods of time. All of their hometowns are either still under occupation or have been completely destroyed.
The following data was obtained when determining the checklist of traumatic life events (LEC-5).
Happened directly to them: staying in a military conflict zone as a civilian, severe human suffering, destruction of their home.
Witnessed: the sudden violent death of an acquaintance or loved one, the capture of a loved one (son), an armed attack (shooting, threats with a knife,
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gun, bomb), the presence of loved ones at the frontline, military injuries of a loved one.
At the beginning of the short-term group therapy, 5 women worked remotely, while the rest of the women did not have jobs, did not undergo any training, did not try to build a life in a new city and had no desire to communicate with the townspeople.
The most common symptoms of PTSD in this group were having strong negative beliefs about themselves, other people or the world, blaming themselves or someone else for the stressful event or its conse-
fear, terror, anger, guilt or shame, being overly vigilant or cautious, being on guard all the time, being nervous, easily frightened, having difficulty concentrating, had difficulty falling asleep or had restless sleep, suddenly felt as if the stressful event was happening all over again (as if you were reliving it), avoided doing things or being in situations that reminded you of the stressful experience, had strong negative feelings such as fear, terror, anger, guilt or shame, lost interest in things you used to enjoy (table 2).
quences, experiencing strong negative feelings such as
Table 2
Interpretation of PCL-5 results according to the PTSD symptom inventory
Group of IDP women Study results before the start Study results after short- Study results 3 months
from case 2 of short-term group psycho- term group psychother- after the end of short-
therapy apy term group psycho-
therapy
The patient 2.1 35 points 30 points 28 points
The patient 2.2 36 points 28 points 27 points
The patient 2.3 34 points 28 points 29 points
The patient 2.4 40 points 31 points 27 points
The patient 2.5 38 points 32 points 31 points
The patient 2.6 35 points 29 points 27 points
The patient 2.7 31 points 25 points 24 points
The patient 2.8 31 points 23 points 21 points
The patient 2.9 34 points 25 points 22 points
According to the data, the changes in scores range from 5 to 9 points, which indicates a real and present therapeutic effect that persists after the completion of the short-term group therapy course.
After completing the course, 3 more women found jobs and 1 started her own business. All the women started to equip their "new, temporary homes" to create their own comfort here and now. All the women started attending social events and communicating more with people, not separating other IDPs from the townspeople s o much.
Case 3. The 3rd group was formed and functioned for 12 weeks, consisting of 8 women aged 45 to 55. They were IDP women from Donetsk, Zaporizhzhia, Dnipro and Luhansk regions. Some of the women had been under occupation for some time and left for different periods of time. Their hometowns are either still under occupation or are in a liberated but dangerous area. Some women have moved from dangerous regions that are located near the contact line and are subject to constant rocket attacks.
The following data was obtained when determining the checklist of traumatic life events (LEC-5).
Happened directly with them: staying in a military conflict zone as a civilian, severe human suffering, destruction of their home.
Witnessed: the sudden violent death of an acquaintance or loved one, the capture of a loved one (friends, relatives), an armed attack (shooting, threats with a knife, gun, bomb), the presence of loved ones at the front, military injuries of a loved one.
At the beginning of the short-term group therapy, none of the women were working, had undergone any training, were not trying to build a life in the new city and had no desire to communicate with the townspeople.
The most common symptoms of PTSD in this group were had physical reactions (heart beating fast, difficulty breathing, sweating) when something reminded them of the stressful experience, felt very upset when something reminded them of the stressful experience, avoided memories and thoughts of the stressful events or avoided feeling about those events, avoided doing or being in certain situations if they reminded them of the stressful experience, lost interest in things they used to enjoy, felt distant or disconnected from other people, felt emotionally numb, unable to feel joy, love for loved ones, or other positive feelings, had strong negative beliefs about themselves, other people, or the world, blamed themselves or someone else for the stressful event or its consequences (table 3).
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Table 3
Interpretation of PCL-5 results according to the PTSD symptom inventory
Group of IDP women from case 3 Study results before the start of short-term group psychotherapy Study results after short- term group psychotherapy Study results 3 months after the end of short- term group psychotherapy
The patient 3.1 36 points 29 points 26 points
The patient 3.2 33 points 27 points 24 points
The patient 3.3 34 points 24 points 25 points
The patient 3.4 31 points 23 points 22 points
The patient 3.5 31 points 25 points 25 points
The patient 3.6 30 points 20 points 20 points
The patient 3.7 28 points 20 points 20 points
The patient 3.8 34 points 25 points 23 points
According to the data, the changes in scores range from 6 to 10 points, which indicates a real and present therapeutic effect that persists after the completion of the short-term group therapy course.
After completing the course, 3 women got a job, 3 women went to study (either in one of the professions offered by the state or in courses they had long wanted to attend). The other 2 women wanted to start their own psychotherapy in order to continue working on themselves and to understand some aspects of their own trauma.
Conclusions: Based on the data from 3 random group cases, the following conclusions were drawn regarding the impact of short-term group psychotherapy for IDP women on their integration into society, reduction of PTSD symptoms, self-development and mental stabilisation:
1. Participants of all groups adapt to life here and now, even during the war. The main criteria are the ability to make at least short-term plans, to function in a family and team, to get used to the presence of sirens and shelling, taking care of their safety.
2. Qualitative and quantitative reduction of PTSD symptoms: in all groups, there is a decrease in scores from 5 to at least 9, which indicates a real and present therapeutic effect that persists after the completion of the short-term group therapy course. The women showed an improvement in sleep quality, a decrease in depersonalisation and derealisation, restoration of emotional state (results of work with alexi-thymia), and restoration of the idea of their own identity after dissociation.
3. Some women made a decision to change their place of residence and implemented it. Women learned new information and began to understand themselves better through psychoeducation.
4. 4. Women got a job after completing the course. This is the main type of integration, as work is currently a priority for IDPs. Women were able to improve communication with their families and start communicating with local residents (colleagues, friends).
Some of the women transferred their children to schools in the city.
References:
1. Johnson R.J., Antonaccio O., Botchkovar E. et al.War trauma and PTSD in Ukraine's civilian population: comparing urban-dwelling to internally displaced persons. Soc Psychiatry Psychiatr Epidemiol, 2022; 57:1807-1816 https://doi.org/10.1007/s00127-021-02176-9
2. Roberts B, Makhashvili N, Javakhishvili J, Karachevskyy A, Kharchenko N, Shpiker M, Richardson E. Mental health care utilisation among internally displaced persons in Ukraine: results from a nation-wide survey. Epidemiol Psychiatr Sci. 2019 Feb;28(1):100-111. doi: 10.1017/S2045796017000385
3. Ben-Ezra M, Goodwin R, Leshem E, Hamama-Raz Y. PTSD symptoms among civilians being displaced inside and outside the Ukraine during the 2022 Russian invasion. Psychiatry Res. 2023 Feb;320:115011. doi: 10.1016/j.psychres.2022.115011.
4. Kelly B D. Trauma and displacement in Ukraine: the challenge to medicine and politics. QJM: An International Journal of Medicine. 2022. V. 115, Issue 5, P. 269-270, https://doi.org/10.1093/qjmed/hcac090
5. Istanbul Protocol : Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment New York ; Geneva : UN, 2004.
6. Плетка О., Чаплинская Ю. Интенсивная работа с травмой: психотерапевтические методы: пособие. — К. : Тал ком, 2017. — 232 с.
7. Bezsheiko V. Адаптацiя Шкали для клшчно! дагностики ПТСР та опитувальника "Перелж сим-птомгв ПТСР" для украшсько! популяци. PMGP [гн-тернет]. 19, Вересень 2016 [цит. за 19, Березень 2023];1(1):e010108. доступний у: https://uk.e-medjournal.com/indexphp/psp/article/view/8
