Post-traumatic stress disorder resilience and treatment

PTSD Resilience & Treatment

In this section, two objectives are addressed: the methodology that has been used in this work is explained and secondly, the reasons for choosing this particular methodology are offered. To aid explanation of the premises, eight headings have been identified as under:

Research philosophy;

Time horizons and research type;

Sample Description;

Data Quality issues; and The eight headings will make it easier to understand the logic behind the study itself as well as the aims of the subject chosen easier and hence to carry through the course of the methods adopted. Segmentation also aids the process of looking at percepts and pragmatic considerations (Cohen, Manion and Morrison, 2007).

Research Philosophy

The three mainline thoughts followed in research processes are those of Analytical, Positive, and Pragmatic. (Saunders et al., 2012).

PTSD is a very complex phenomenon and unique to each individual, though groups can be formed based on universal occurrences across demography's and situations. The right approach hence would be interpretive or Analytical rather than Positive or Pragmatic. Different types of situations can manifest in the trauma that people face as a result of the differences in situations that they actually face or even perceive. PTSD patients have also been known to carry hereditary, sociological, or circumstantial experiences and characteristics that result in the traumatic conditions that they find themselves in. It is not only important to the analyze the specific cause that created stress in the individual, but also to the factors leading to development of the personality that succumbed mentally or psychologically to the situation. That explanation, looked at from all possible angles, may offer a clue to the behavioral shifts that the individual exhibits, and which are generally socially unacceptable causing negative aspersions on character of the individual (Saunders et al., 2012), face a very difficult time in adjusting to even the most mundane tasks at times and as such it is a better strategy to allow time and non-intrusive therapies to bring back the patients as close to the mainstream as possible. Saunders (2012) emphasizes that certain situations cannot be anticipated and situations that were in the background, causing the ultimate breakdown may continue to persist. This may well be in most cases out of the control of the individual. As a result, the methodology in this work chooses to combine the virtues of analytical and well as realist approach.

Research Approach

In the present work two lines of approaches will be encountered, those of Inductive ( wherein an assumed hypothesis is weighed against the data obtained for substantiating or negating the theoretical premise and the Deductive approach, that interprets the data collected to arrive at a hypothesis to address the situation, problem, or phenomenon. Both the approaches can be followed in a variety of ways and the approaches followed can vary for different situations being studied or outcomes sought. Generalizations of outcomes from data garnered is not always a feasible outcome according to one school of thought which is in direct disagreement to the notion of many scholars that hold the exactly opposing view that such generalizations are always possible if data supports the theory (Saunders et al., 2012).

As discussed, the object of this work is to use ascertain precepts and constructs that would address the PTSD patients and their afflictions in behavioral attributes of various classes arising out of exposure to different situations and enable them to acclimatize to normative behavior and hence enjoy a socially healthy life. This theoretical and practical framework is sought to be built by the deductive approach that configure data collected to arrive at a theoretical premise. The whole idea of deductive theory is to assess the agreement of the theory proposed to the statistical data collected by way of responses in actual life cases. In present times, we are living in a strife-ridden era. The strife's are not well defined nor are they constricted to a particular cause or origin. They are also much different in nature and reach to what may have existed only a few generations ago. In as much as the trauma that people face have been thought to be hereditary, those causes that initially caused trauma have all but disappeared, but the effects can be seen generations after the transformation in societal construct. This causes the introduction of inductive theory towards finding a solution for the PTSD patients. The other reason why inductive approach is being sought is that the older philosophies that effectively took on PTSD patients are rapidly proving inadequate in countering the present day violence, which is not only physical imminent danger, but also mental and psychological with the proliferation of information and communicational strides in the last 50 years. The surveys that will hence be carried out will have a two-fold objective. The first one will be that it will accept or reject the deductive philosophy and the second one will be that of inductive approach. The inductive premises will be applied to the data accumulated and tested for the best-fit response. Thus, in this work, both approaches will be used to arrive at the solutions for PTSD patients help align with socially acceptable behavioral attributes.

This work, which aims to add the results of this work to the existing literature on methods and ways to offer corrective rehabilitation procedures for PTSD patients, will hence make use of both the approaches, deductive as well as inductive.

Research Strategy

The construct of this work seeks to present the theory used for the objective of the problem sought to be addressed through dissemination of the data collected and theologies visited in the literature review. Thus authenticating the direction adopted for reaching the objective of the research work. As such, the data collection strategies will be verified, based on the theories visited and complement them (Saunders et al., 2012). Inductive and deductive approaches, when used in tandem are best served by survey methods of data and theoretical response collection. The main advantage of this method is that most reliable, objective and subjective information can be obtained from the patients and first-line affected persons directly. The method or approach of surveys can be actualized in two ways primarily: the First being a well designed yet flexible Interview framework keeping in mind the information to be sought along with certain other unforeseen parameters that may arise, and Secondly the Questionnaire that may also serve the purpose of data and statistical analysis for any further work that may be sought (Trochim, 2006). In keeping with the vista of the problem sought for this work, following the observations of Trochim, (2006), Interview is a better approach as it encompasses all unknown dimensions that may provide deeper insight into the apparent problems and hence offer a better background for arriving at solutions to the malady. In this work hence, the approach of conducting face-to-face interviews has been adopted for collecting information on which the theories will be applied.

Time Horizons and Research Type

In trying to arrive at a solution for those in traumatic condition and impaired social and normative personal behavior, the chief concern is that of the effect such behavior has on the societal and familial construct. The stressors can present themselves in a variety of forms even after the causal happening has ceased. It has been observed that avoidance of problem/threat is one of the ways used by the patients and maintain a sort of decorum in their social connect. The societal role in helping the affected gain stability and overcome behavioral anomalies or adapt to recurrence hence needs to be investigated. An interview based along the lines of situational effects is known as cross -- sectional study and the interview pattern attempted in this research is hence a cross-sectional study (Saunders et al., 2012).

The basic nature of this study in inquisitive and enquiry based that seeks as much subject matter and response in explanatory or causative form as possible and instance-based liberty is availed by the interviewer to get the most comprehensive information that can then be subjected to the inductive and deductive theories and arrive at the most applicable and suitable solutions of the concern of this research work. This form of open ended interviewing is not only suitable for this study, it is also important, as many dimensions of this problem, being mental and psychological in nature basically, may not have been uncovered as yet (Saunders et al., 2012). Since no strict rules are set in these types of interviews, they have often been alleged to be directionless and unrestricted unlike the strict codes of discipline that research work needs to adhere to conventionally. However, the elaborate interviews serve the purpose of seeing the problems in a new and often better light and make arriving at solutions easier (Saunders, 2012).

Data Collection Methods

In the qualitative approach pursued by researchers, all aspects of the social construct; its tenets, traditional values, and practices are encompassed. (Bouma, 2010).

A researcher delving into qualitative aspects of a work presumes the effect of various parameters on the individual under investigation to seek the real cause and effect relationships exhibited by the elemental respondent (Saunders et al., 2012). Another important virtue that qualitative analysis bestows on the interviewer is that it allows for flexibility to set norms and process of investigation and afford adaptability taking cognizance of the emerging data and adapting to accommodate for diversion of presumed precepts. The rapport that an investigator builds with the interviewee connects him with the respondent on a platonic level to experience and hence appreciate the full impact of the behavioral stresses faced (Bouma, 2010). The contemporary society with its many complexities makes quantitative assessment an inadequate measure to understand the actions and reactions of an individual owing to societal limitations, liberties, and characteristics. Numbers alone cannot fully explain behavioral aspects (Yin, 2013).

In this work all the previous work done on finding ways and means to address the problems faced by PTSD patients are visited and analyzed in the light of data collected through the interview process adopted to try and find more acceptable ways to pursue the cause. The theories visited in the literature will be presented to the data collected through the interview. A thorough analysis of the results obtained will then be dissected to choose the best method to be followed to collect, disseminate and pursuable policies needed for the object of this study. Most of the data will be obtained through the interview process, which promises better comprehension of the subject. The questions will seek subjective as well as quantitative responses and a studied mix of the two will sought through the interview and a questionnaire. In many instances of earlier research work, face-to-face interviews have been found to provide better responses for analysis. Quantitative questionnaires are prone to being replied with reservations and even manipulations that can go unchecked in absence of human touch and anonymity it offers. There are three types of interviews: a) individuality is protected and projected in certain interviews, b) a process where questions are set without any presumptions, and c) the third kind is a very comprehensive array of questions (Saunders et al., 2012). The interviews may thus be structures or non-structured.

In an interview, the interviewee responds to specific questions asked by the researcher and by way of answers furnishes more knowledge about social, psychological, and other factors pertinent with the line of questioning. During the conversation, the respondent reveals insights into the working of and making of the character of the patient, thereby enabling the interviewer gain a better insight and hence draw better and more accurate conclusions. At the same time, it should also be remembered that the interview is supposed to answer within a framework of questions and hence may not be able to express his views freely. All he has to do is answer specific questions. There is a possibility of certain information lost during such interviews. It is suggested that such interviews should be recorded for further analysis. (Yin, 2013).

Requiring the respondent to answer to a questionnaire is the other favored method used by researchers. The main utility of the questionnaire lies in the statistical data that can be had from it. The questionnaire hence has to be decided very carefully with proper emphasis laid on the salient points. Such a questionnaire is usually arrived at through iterations of trials or test runs. This methodology is a targeted one, results in lesser but focused data, and is favored choice of the researchers (Wilson and McLean (1994).

Primary data collection

The Questionnaire

The principles of are followed in preparing the questionnaire. This data will be helpful in statistically determining the prevalence, effect, and outcomes of the various factors and effects of medications and therapies. It will also clearly state the role of societal help and its importance in the mental set up of the patient. As this is a largely socio-psychological problem that we are investigating in this work, the results shown are restricted to a particular region and area but are mostly accurate to relevant conditions and demography. For applicability in other areas, specific relevant questionnaire is advised. This questionnaire has however solved the purpose of providing the most relevant figures from which work can be carried forth.

It similarly needs to be understood that PTSD is a very sensitive issue and the trigger points and reactions of the patients to certain questions are largely unknown. Care has to be taken that the sensitivities' limits are never transgressed with inquisitive and probing questions. Full information and confidentiality clause of the questionnaire has to be maintained at all costs in such cases. Personal liberty to profess information cannot be overstepped and ethical consideration has to be maintained very strictly. The patients are at liberty to answer wholly or in part depending on the individual's comfort and ease or sense of social security.

The researcher needs to clear the issues of authenticity of purpose, ethicality, and confidentiality to the respondent. In addition, all queries that arise while answering questions need to be satisfied by the investigator. The investigator should address to all concerns of the respondent. The respondent should be given full liberty to raise any sensitive concerns that may affect him during the course of the replies to the questionnaire. The respondent has the right to stop answering questions at any point without having to furnish a specific reason (Sudman and Bradburn, 2010). These are some of the basic conditions and observations laid down by Sudman and Bradburn (2010) while forming the questionnaire and have been used with success by many researchers in the past (Cohen, Manion and Morrison, 2007).

A flow charted course will be followed in this questionnaire that will not only allow the flexibility needed to adapt to the different types of answers that may be received, but also to predict the possible answers that may arise to the interview questions (Cohen, Manion and Morrison, 2007).

Towards forming the right set of questions, the primary objective should be to crystallize the aim and goal of the research work. The next logical step is to form the questions that will help elucidate the right data. As a result, defining the purpose of the research helps in forming the right framework to get the most relevant data most efficiently (Cohen, Manion and Morrison, 2007).

Once the objectives and outcomes expected are crystallized, all the points that need to be attained are then categorized under different headings so that specific attention could be given to each sub-section that proves vital in the final analysis (Cohen, Manion and Morrison, 2007). In this work, the categorization will be done after perusal of the literature as earlier work could provide the best guideline towards newer research.

After arriving at the broad classification and drawn up the format, it then becomes important to populate the sections with sub-sections and topics that would best serve the purpose of the research objective and seek the best data efficiently. Like the selection of sections, the selection of sub-sections will also be gathered from the literature in this work as past work is the best premise to build a new work (Cohen, Manion and Morrison, 2007).

As in many other research works, this method of qualitative research is an additional one to the widely used quantitative work and follows the precedent laid down Wilson and McLean (1994) in their own study. Wilson and McLean (1994) explain that this research work is done by analyzing the data provided, followed by appreciating the data for all its various parameters and finer thoughts exhibited thereto, to align the results of qualitative research with the quantitative conclusions and inferences wherever relevant. (Cohen, Manion and Morrison, 2007).

The basic features adapted in this work and the procedure suggested by Wilson and McLean (1994) are as under:

i) The queries in the questionnaire examine clearly the perception and concerns that seek elucidation.

ii) Prior to including or excluding elements all the precepts that are plausible are examined thoroughly.

iii) The basic premise of the research work is clearly stated and understood in layman terms.

iv) The queries are so formed that factual and actual verification of facts is easily achieved.

v) Every query in the questionnaire is direct and ethical obliterating any prejudice or presumed assumption.

vi) The main content of the questionnaire incorporates the unbiased and most relevant information obtained from other studies (Cohen, Manion and Morrison, 2007).

Thought the questionnaire can be formulated in various ways, they can be categorized as strictly structured, or semi-structured or totally unstructured. The main factor that decides such categorization is the magnitude and volume of information sought to address the research fully. In case the respondents and parameters are relatively a small sample, then the queries tend to be rather unstructured or semi-structured allowing for the most elaborative response and more amount of data collection. The questionnaire is then generally open-ended and can be adaptive in its repertoire to adapt to the additional information coming in from the respondents in variation to the questions fielded in the questionnaire. A structured questionnaire is generally adopted when the sample size sought is very large. Specific questions are asked in a fashion so as to elicit focused answers that do not require elaboration. This helps the researcher to put the data through statistical tools for envisioning the deductions and inferences. (Cohen, Manion and Morrison, 2007).

If the targeted audience is constricted by its own definitions or by intelligent choice an open-ended questionnaire posts the possibility of knowing more variables by way of elaborative answers that the interviewee engages in. The disadvantage of this method is presented by the time that the researcher has on hands to reach to a conclusion. Since the answers can be circuitous and at times not relevant to the purpose of the study, the researcher has to filter out the irrelevant data and information after accumulating the data. This can take time. Hence such open-ended and semi-or totally unstructured is generally not advisable when faster work is required. (Cohen, Manion and Morrison, 2007).

The statistical data could be presented to the investigator only by the way of close-ended and structured questionnaire. They researcher can then appreciate numerical data for inferences by obtaining answers in binary or graded format (yes or no, agree or partially agree or disagree, etc.). It thus becomes easier for the researcher as he arrives at conclusions, by segregating the similar answers of respondents in categories that compare and contrast the elicited answers and present a critical analytics also (Oppenheim, 2000). The researcher thus has the tools and data that enable him to arrive at calculations and proffer numerical values of response received. That is the advantage of a quantitative questionnaire. It should be anticipated, however that the process of framing the questionnaire would seek deliberation, inquisitiveness and certain amount of iteration before arriving at the most appropriate set of questions. That would consume time. However, past this initial investment of time and checks and balances, the next process of fielding the queries is rather fast and the following evaluation is easier to progress through. Thus, anticipation of the framework of the questionnaire is crucial to this method of quantitative investigation. (Cohen, Manion and Morrison, 2007). With minimal time at disposal, this type of investigation has been adopted by the researcher and the questionnaire is a structured, closed-ended format.

The interviews

An interview method of getting information from respondent is a rather direct one. It accumulates data through a face-to-face interview. In such interviewing pattern, the researcher has the chance to observe the mannerisms, feelings, analysis, relevant details (other than asked for), cognition, knowledge, and general awareness that the respondent displays when faced with the questionnaire (Tuckman, 2012). This interview process helps the researcher to evaluate the theories, past and present that afford the best solution in a particular situation. Another important benefit that this kind of interview provides is that of being used in conjunction with other results and data collection methods to add depth to findings or provide another facet to understood inferences (Kerlinger, 2000). The most important outcome of interview process is that individuality of a problem presents itself very clearly and the best available option can hence be made available to the respondent. It only by understanding all the aspects of a problem that a holistic solution can be attempted and the interview process provides the interviewer with these opportunities.

The variation in the behavioral inconsistencies and tendencies of the stressed persons varies greatly owing to the different causative factors that have manifested these symptoms. Add to that the hereditary factor and the socio-economical lineage during formative years and we have a whole gamut of forces that result in a particular behavior seen apparently when under duress. As such no single, structured, semi-structured or even open-ended analysis can prove to fully be adequate to categories the target audience. The interviews, hence seek a mix of at least two procedures that may then be complementary to assess various categories of patients. The strategy devised will hence be that of an open-ended interview forming the qualitative part and adequately supported by properly formed quantitative questionnaire eliciting data, which has to be analyzed for theoretical categorization with corresponding qualitative inferences.

The research shall Endeavour to define a semi-structured interview and explain the underlying concepts clearly to the respondent. Semi-structured interviews are those queries on which the response and suggestions of the interviewee are sought. The investigator presents many scenarios to the respondent and seeks the opinion of the patient/respondent on those possibilities presented to the subject (Saunders et al., 2012). Riley (1996), explains that steering the course of an interview by choosing questions that lead ultimately to the specific questions seeking response of the final objective is a semi-structured interview. He goes on to explain that the main aim not to gather only statistical data in such an interview (Riley, 1996). Yin (2013), points outs that the investigator can ask troubling questions and seek the opinion and judgment of the respondent in a semi-structured interview setup as well as in open-ended constructs (Yin, 2013). Semi-structures interviews have hence been accepted widely in research analysis of late. In this setup both of those in dialogue can be informal and express unbridled opinions and judgments, thereby making it a qualitatively significant contributor to the whole philosophy of the research subject. (Saunders et al., 2012).

By engaging in this kind of interview, it would be logical and easier to bracket cases under different heads following the instructions expounded in the literature visited. Once the sub-categories have been defined fully, the literature review will have served its purpose of giving direction to this work in the real sense.

To make the respondents comfortable with the research aims and processes, an intimation of the interview and its format will be conveyed to the interviewee well in advance. In order to gain better insight, the interview will be flexible enough to allow for the free flowing expressions of the patient in question. The response and opinions can be used to form further questions in continuum, and because there will apparently be a large diversity in the questions asked from person to person and even in the answers obtained, the interview will be allowed to be taped and recorded for analysis and retrospective work, of course with the express approval of the respondent. However, if the interviewee negates the proposition of recording the dialogue, then it becomes unwieldy for the interviewer to assimilate and reproduce all the answers of the patient (Saunders et al., 2012).

Recorded interviews would seem mandatory in such setups and played back when work further to data collection is to be carried out. That is essential to misread, miss or get confused on certain issues that may prove to be of much value in the research process. As a bonus, the interviewee may reveal information that was hitherto unknown in the entire construct. In all such interviews, absolute confidentiality and must be safeguarded about the interview itself as well as the privacy of the respondent. (Saunders et al., 2012).

Sample Description

The sample size of respondents chosen in present work is small and hence chooses to go for smaller questionnaires that supplement the smaller interviews as well. Saunders et al. (2012) unravels that choosing a smaller sample size may be seen to be more effective in cases where studies survey the background and contextual parameters of a specific phenomenon. According to Bouma (2010), the qualitative research method lays emphasis on the assumption and anticipation of occurrences in a target setting, and hence, the study is always constricted and restricted by sampling procedure adopted. Majority of the literature, in reference to social domain research, is based on the concepts of non-profitability (Saunders et al. .2012). The main premise is subjective evaluation of the research topic and prescribes many different methods to arrive at the analytics. A sample size is evaluated subjectively and then the result is extrapolated to the corresponding domain.

Consequently, the questionnaire framework presupposes certain precepts and subjects that are logically aligned to meet the purposes of the target aim of the work. The choice of subjects presented in the questionnaire will be aimed at meeting the larger objectives of the purpose of the research work (Saunders et al., 2012). In order to gain insightful inferences, it is important for the investigator to keep his questionnaire open to alterations even as he enters the fielding stage of the queries. The variety that he counters by way of answers may require incorporation of or deletion of certain queries based on the elicited response. At the same time, it must be fully comprehended that this sample size may not represent the larger relevant populace in entirety (Saunders et al., 2012).

In addition to this, both, the interviewee and interviewer on one hand and questionnaire form the primary source of the response that will comment on societal role; as such, they will be approached in the best possible approach and respondents who have experience can provide with meaningful insights of the phenomenon will aid the study immensely. Over and above this, both the forms of investigations; the interview and the questionnaire, will offer important depictions of common data, specific to PTSD patients and the hurdles faced in aligning along normative behavior in the society.

Since, the best result is ought using a mix of the two strategies explained, the respondents will be selected from different cases of traumatic patients like the soldiers, home violence, sexual violence, and the like, so that the investigator can reach out to the best representatives.

Since the target is much diversified but all are prone to similar disorders, the samples that are chosen as representatives will have to belong to each of the identified sectors and thus an assorted sample may be desirable and represented in the study to present an authentic and closer to home depiction of the objective at hand. The samples will be reached through associations like VA and other social enclaves that would be able to pledge anonymity or a social media like platform may be chosen that would be a totally an unofficial exercise requiring no permissions and assured anonymity