INTERNATIONAL JOURNAL FOR PSYCHOTHERAPY IN ...

INTERNATIONAL

JOURNAL

FOR

PSYCHOTHERAPY

IN AFRICA

ISSN: 2550-7257 (Print)

ISSN: 2550-7249 (Online)

Fifth Edition, Number 1

July, 2020

Published by the

School of Psychotherapy and Health Sciences (SPHS),

Okija Campus, Nigeria.

Affiliated to Sigmund Freud University, Vienna, Austria

International Journal for Psychotherapy in Africa (5:1)

ii

EDITORIAL BOARD

Prof. S.N. Madu

Chukwuemeka Odumegwu Ojukwu University, Nigeria - Editor-in-Chief

Prof. P. A. Agashua

Nigerian Defense Academy, Kaduna, Nigeria - Associate Editor

Prof. H. Osinowo

University of Ibadan, Nigeria - Member

Prof. Z. Knight

University of Johannesburg, South Africa - Member

Dr. G. Madubuike

School of Psychotherapy & Health Sciences, Nigeria - Member

Dr. Alh. M. Tafida

Nasarawa State University, Nigeria - Member

Mr. P. Egwu

School of Psychotherapy & Health Sciences, Nigeria - Editorial Secretary

EDITORIAL ADDRESS

Editorial Secretary

International Journal for Psychotherapy in Africa (IJPA)

School of Psychotherapy and Health Sciences (SPHS),

Okija Campus,

P. O. Box 33, Okija, Anambra State, Nigeria.

Mobile: 09063927862

Email: [email protected]; [email protected]

Web Address: www.sphs.com.ng

© School of Psychotherapy and Health Sciences (SPHS), Okija Campus, Nigeria

mailto:[email protected]

http://www.sphs.com.ng/


iii

Editorial Brief

nternational Journal for Psychotherapy in Africa is published by the School of

Psychotherapy and Health Sciences, Okija, Nigeria, with the editorial policy to address

issues that border on people’s psychological health and psychotherapy in African. The

journal publishes contributions that advance the frontier of knowledge in psychotherapy

in Africa, submitted by trained psychotherapists, psychologists, and other scholars from

related disciplines, whose research works and practical experience unraveled new knowledge

in the area of psychotherapy. The emphasis for the journal is on empirical papers; however, it

also accepts theoretical papers, review articles, short communications and interactions

containing fair commentary. Priority is given to articles that are relevant to Africa, and that

address psychotherapeutic issues and methods for the enhancement of psychological wellness

of Africans.

The need for psychotherapeutic intervention is very vital in many countries of Africa.

In these days of corona virus (COVID-19) pandemic which locked down the whole world,

the countries of Africa are least prepared to face the psychological effects of the pandemic.

They are least prepared for the needed psychotherapeutic intervention during and post

COVID-19. The trauma, stigma, depression and other forms of psychological ill-health are

likely to take many African countries unaware. In addition to that, many of the countries are

being challenged by various forms of conflict and insecurity problems like terrorism, and

insurgency, the aftermath of which many innocent individuals, families and communities are

displaced of their natural residences; and are physically and mentally tormented. In the face

of this condition, the International Journal for Psychotherapy in African holds it as a

responsibility to invite scholars to contribute their knowledge of Psychotherapeutic

intervention models that will be of great help in assisting victims of this pandemic and

menace.

This fifth edition of the International Journal for Psychotherapy in African contains many

scholarly and vibrant research articles in areas of Psychotherapeutic Implications of COVID-

19 Pandemic, Psychotherapy Training in Africa, Acceptance and Commitment Therapy,

Suicidal Ideation, Post-traumatic Stress, Insurgencies, Internal Displacement of Persons,

Spirituality and Psychotherapy, and Traditional Healing, among others. The scholars cross-

pollinated knowledge on their psychotherapy models and expressed the need for

psychotherapy for mental wellness in African.

The editorial board wishes to thank all the authors of the articles and all those who helped in

one way or the other to make this publication a reality.

Prof. Sylvester Ntomchukwu Madu

Editor-in-Chief

I


iv

Editorial Mission and Policies

nternational Journal for Psychotherapy in Africa (IJPA) is published by the School of

Psychotherapy and Health Sciences (SPHS), Okija Campus, Nigeria. The institution is

affiliated to Sigmund Freud University, Vienna, Austria.

The journal is geared to dissemination of research out-put and cross-pollination of ideas

among psychotherapists world-wide about psychotherapy in Africa. It is a peer-reviewed

indexed journal and the articles can be accessed online through Google Scholar. It accepts

original articles, empirical investigations, position papers, as well as short book reviews of

not more than 1500 words.

Authors interested in publishing articles in IJPA are encouraged to submit their manuscripts

electronically by email attachment to the Editorial Secretary. Manuscripts should not exceed

20 typed pages, and should be accompanied by an abstract of not more than 150 words. Five

key words for identifying the paper on web search should be supplied immediately below the

abstract. Manuscripts should be typed in MS Word, Times New Romans, 12 font size and

should be on double spaced A4 size paper. The author’s named, institutional affiliation, and

address should appear on the title page separated from the manuscript, to ensure anonymity in

the review process. The title of the paper should appear on all the pages of the manuscript.

The journal adopts the latest edition of American Psychological Association (APA) format.

Acknowledgement should normally come at the end of references. Contributors should

ensure that papers submitted are not under consideration for publication in any other research

outlet. An editorial decision on the manuscripts will be taken as soon as possible and

communicated on the contributors. One complimentary copy of the journal in which the

author’s article appears will be forwarded to the first author immediately on publication. The

journal appears once a year, but articles are welcome throughout the year. All articles for

publication, requests for advertisement, and other enquiries should be forwarded to the

Editorial Secretary. The assessment fee per article is N5,000.00. Authors of accepted papers

are required to pay a publication fee of N25, 000.00. After payment, a scanned copy of

payment evidence should be forwarded to the journal’s email addresses. All payments should

be made to the bank account as stated below:

Account Name: School of Psychotherapy and Health Sciences.

Bank Name: Access Bank.

Account Number: 0084829949.

For Additional information, contact:

Prof. S.N. Madu

Mobile: +234(0)7062883630

Email: [email protected]; [email protected]

I



v

Contents

1 – 10 Challenges Facing Psychotherapists In Africa

In The Hit Of The Novel Coronavirus 2019

(Covid-19) Global Pandemic By: Sylvester Ntomchukwu Madu;

Valentine Ucheagwu

11 – 21 Psychological Intervention To Break

The Cycle Of Violence And Accelerate Public Safety,

Security And Development (With Special Reference To Africa) By: Chioma Ihuoma Igboegwu

22 – 34 The Relevance Of Acceptance And Commitment Therapy (ACT)

In The Treatment Of Emotional Numbing Among The

Adolescents: A Narrative Review By: Uchenna E. Enem

Bahago Samaila

35 – 43 Diagnosis And Treatment Of Mental Illness By Vhavenda

Traditional Healers In Vhembe District, South Africa By: Salome Thilivhali Sigida;

Nare Judy Masola

44 – 53 Psychotherapy Training In Africa South Of Sahara By: Sylvester Ntomchukwu Madu

54 – 69 Post-Traumatic Stress Disorder And Depression In

Personnel Of Nigeria Police Force: Implications For Psychotherapy

By: Chioma Ihuoma Igboegwu


vi

70 – 83 Personality Trait, Drug use and Abuse as Predictors of

Suicidal Intention Among Youths: A Focus for Psychotherapy

By: Charity Justin Takyun

Okwoli Matthew James

Maryam Abubakar

84 – 97 Posttraumatic Stress Disorder Among Trafficked Victims,

Role Of Self-Esteem, Demographic Factors And Relevance

Of Psychotherapy By: Ezeakor Adolphus I.

Okpala Michael O.

98 – 107 Integration Of Spirituality Into Psychotherapy –

A Potential Model For Nigeria B: Richard Uwakwe

108 – 115 English Language Students And Their Coping Styles

During Lockdown As A Result Of The Novel Coronavirus 2019

(Covid-19) Global Pandemic By: Bridget Ngozi Madu

116 – 121 Genuineness In Client Centered Psychotherapy:

It’s Relevance To The Nigerian Society During

The Convid-19 Global Pandemic

By: Promise Chinedu Uwakwe

122 – 135 Gender Differences In Attitude To The

Skin Disease-Atopic Dermatitis Among Adolescents:

The Role Of Cognitive Behavioral Therapy

By: Charity Justin Takyun

Aleksandra Surenovich Kocharyan

Madu, S.N. & Ucheagwu, V. (2020). Challenges Facing Psychotherapists in Africa in the Hit of The Novel

Coronavirus 2019 (Covid-19) Global Pandemic, International Journal for Psychotherapy in Africa 5(1):1-10

1

Challenges Facing Psychotherapists In Africa

In The Hit Of The Novel Coronavirus 2019

(Covid-19) Global Pandemic

Sylvester Ntomchukwu Madu Department of Psychology, Chukwuemeka Odumegwu Ojukwu University,

Igbariam Campus, Nigeria.

[email protected]

Valentine Ucheagwu Department of Psychology, Madonna University,

Okija Campus, Nigeria.

[email protected]

Abstract To fully understand the challenges facing psychotherapists in Africa in the hit of the

Novel Coronavirus 2019 (COVID-19) global pandemic, the paper visited/reflected the

origin and transmission of the virus, the global epidemiology, and the resultant adoption

of international and national lockdown limiting heavily movements of people and goods

to prevent further spread of the virus. The lockdown, however, has seriously affected the

interpersonal relationships and freedom of gathering. It is also expected that it will have

adverse mental and psychological effects leading to behavioural, emotional, social/family

problems. Increased incidence of stress reactivity and anxiety, reality denial, depression,

isolation, loneliness and lack of social support, undesirable marital adjustment and

irritability, trauma, self-injurious behaviours like suicidal ideation and drug addiction,

unhealthy eating behaviours and resultant increase in weight, and Obsessive Compulsive

Disorder, increased neuropsychological symptoms, are some of the expected adverse

effects of the lockdown. The ability to adequately address all these anticipated problems

pose a big challenge to the few qualified psychotherapists in Africa. There are also very

few institutions for the training of psychotherapist in Africa south of Sahara. The speed

with which the virus is spreading also calls for short-term acquisition of hands-on

psychotherapeutic skills. African governments are therefore called upon to address the

above-mentioned shortage as a matter of urgency. The few psychotherapists available in

Africa are also called upon to look into the above psychologically unhealthy situation

from the point of view of crisis intervention.

Key words: Corona virus (COVID-19), Pandemic, Challenges, Psychotherapists, Africa.

Introduction

Origin and Transmission of COVID -19

In December 2019, a cluster of pneumonia

cases, caused by a newly identified β-

coronavirus, occurred in Wuhan, China.

This coronavirus was initially named as

the 2019-novel coronavirus (2019-nCoV)

on 12 January 2020 by World Health

Organization (WHO) and was officially



2

named corona virus disease 2019

(COVID-19) (Yan-Rong and Colleagues,

2020). The Coronavirus Study Group

(CSG) of the International Committee had

proposed to name the new coronavirus as

severe acute respiratory syndrome (SARS-

CoV-2). COVID-19 belongs to a β-

coronavirus, which is enveloped non-

segmented positive-sense RNA virus

(subgenus sarbecovirus,

Orthocoronavirinae subfamily) (Zhu et.

al., 2020). Coronaviruses (CoV) are

divided into four genera, including α−/

β−/γ−/δ-CoV. Yan-Rong and colleagues

(2020) argued that α- and β-CoV are able

to infect mammals, while γ- and δ-CoV

tend to infect birds. Previously, six CoVs

have been identified as human-susceptible

virus, among which α-CoVs HCoV-229E

and HCoV-NL63, and β-CoVs HCoV-

HKU1 and HCoV-OC43 with low

pathogenicity, causing mild respiratory

symptoms similar to a common cold,

respectively (Yang-Rong, et. al., 2020).

Above all, the other two known β-CoVs:

SARS-CoV and MERS-CoV lead to

severe and potentially fatal respiratory

tract infections. It was found that the

genome sequence of SARS-CoV-2 is

96.2% identical to a bat CoV RaTG13,

whereas it shares 79.5% identity to SARS-

CoV (Yan-Rong et. al., 2020). Based on

virus genome sequencing results and

evolutionary analysis, bat has been

suspected as natural host of virus origin,

and SARSCoV-2 might be transmitted

from bats via unknown intermediate hosts

to infect humans (Yan-Rong et. al., 2020).

It is clear now that SARS-CoV-2 could

use angiotensin-converting enzyme 2

(ACE2), the same receptor as SARS-CoV

to infect humans.

COVID-19 pandemic which started

first in Wuhan, China, since 12 December

2019, is possibly related to a seafood

market. Several studies suggested that bat

may be the potential reservoir of SARS-

CoV-2 (Giovanetti et. al., 2020;

Paraskevis et. al., 2020). On virus genome

sequencing, the COVID-19 was analyzed

throughout the genome to Bat CoV

RaTG13 and showed 96.2% overall

genome sequence identity (Zhou et. al.,

2020) suggesting that bat CoV and human

SARS-CoV-2 might share the same

ancestor, although bats are not available

for sale in this seafood market (Wu and

Colleagues, 2020). Protein sequences

alignment and phylogenetic analysis

showed that similar residues of receptors

were observed in many species, which

provided more possibility of alternative

intermediate hosts, such as turtles,

pangolin and snacks (Li and Co-workers,

2020). In other words, there is potential

transmission from animals to humans that

may not be limited to bats alone. There is

possibility of intermediate hosts by some

domestic animals. At present, the mode of

transmission is through human to human

transmission via respiratory droplets.

Guan and co-workers (2020) stated

that sampled 1099 laboratory-confirmed

cases in China, reported that common

clinical manifestations of COVID-19

included fever (88.7%), cough (67.8%),

fatigue (38.1%), sputum production

(33.4%), shortness of breath (18.6%), sore

throat (13.9%), and headache (13.6%).

Their reports are similar to those of the

Centre for Disease Control (US) and other

clinical symptom reports from other parts

of the world. Liang and colleagues (2020)

showed different clinical characteristics of

corona virus disease cases between

children and their families in China.

COVID-19 in children is mainly caused

by family transmission, and their



3

symptoms are mild, and prognosis is better

than adults. However, their PCR result in

stool showed longer time than their

families. Because of the mild or

asymptomatic clinical process, it is

difficult for pediatricians and public health

staff to recognize early the presence of

COVID in children.

Global Epidemiology of COVID-19

The COVID-19 outbreak has quickly

turned into a pandemic, with hundreds of

thousands of cases reported globally.

Centre for Disease Control estimated the

prevalence of COVID-19 in the US as at

April 5, 2020 to be at 304,826 cases with

total deaths of 7,616. Italy has been

viewed as the worst hit in the global

pandemic. Italian civil protection

authorities as at March, 13 said the

number of infections has soared by more

than 2,500 in 24 hours while virus-related

deaths make the largest single-day jump of

250 taking the total number of infected in

Italy to 17,660 and the number of related

deaths to 1,266. With Italy at the epicentre

of Europe’s outbreak, the virus is now

present in all 27 EU countries with more

than 22,000 cases of COVID-19 having

been confirmed across Europe. Africa is

gradually witnessing a surge in COVID-19

with North Africa having the highest cases

of 6400 infections (603 deaths/1100

recoveries) as at April 13, 2020 followed

by West Africa with 3400 cases (84

deaths/664 recoveries), Southern Africa

2300 cases (35 deaths/452 recoveries),

then Central and East Africa with 1200

cases (38 and 28 deaths/ 129 and 187

recoveries) of infection respectively

(Africa CDC, April 13, 2020). On country

basis, South Africa has the highest number

of infection with 2,173 cases followed by

Egypt with 2,065 cases and then Algeria

and Morocco with 1,914 and 1,661 cases

respectively (Africa CDC, April 13,

2020). Nigeria with largest African

economy has recorded the infection cases

of 627 (21 deaths and 170 recoveries) on

19th April 2020 (Nigerian Centre for

Disease Control/NCDC, 2020). As there is

currently no known vaccine or treatment

for COVID-19, most African countries

have adopted precautions as directed by

WHO to contain the wide spread of the

virus. Among the precautions were

observing personal hygiene practices

particularly washing hands with soap

under running water, maintaining social

distancing, wearing of face masks,

sneezing in your inner flexed arm/elbow

or with disposable tissue paper. Africa

Center for Disease Control has also

advised that people should get influenza

vaccines if such is available in their

community.

At the wake of the pandemic, some

countries have adopted international and

national lockdowns limiting heavily

movements of people and goods to

prevent further spread of the virus. The

lockdown has seriously affected the

interpersonal relationships and freedom of

gathering. For example, in Nigeria, all

churches, mosques, schools at all levels,

and markets were closed to forestall

further spread of the virus.

Psychological Consequences of COVID-

19 Pandemic in Developing African

Nations

COVID-19 pandemic undoubtedly comes

with lots of social and psychological

distress particularly in resource poor

settings. People are worried about their

health and possibility of being infected

with the virus. The poor health care

facilities and corrupt nature of many


4

African countries leave many people

anxious and in doubt about their health

and over all protection. Psychologists and

mental health professionals have been

speculating the likely psychological

consequences that may follow COVID-19

pandemic and the subsequent measures

taken by countries to contain it. The

following sections discuss the possible

psychological consequences of the

pandemic.

COVID-19 Outbreak and Mental

Health in Africa

COVID-19 and Defense Mechanisms

To maintain psychological homeostasis,

Freud (1949) proposed the concept of

defense mechanism. Defense mechanisms

are psychological shock absorbers that

make individuals withstand stress and

pressures of life. They are mental

operations that enable the mind to reach

compromise solutions to conflicts that are

unable to resolve. These mental operations

can relieve the individual of the anxieties

following conflicts. But when defense

mechanisms are not well controlled by the

individual, it may subsequently lead to

psychological disturbances. The COVID-

19 outbreak in Africa may likely lead to

denial of reality as a form of defense

mechanism or true reality testing as a

positive adjustment.

When reality denial is a form of

defense mechanism, individuals are most

likely to underplay the pandemic and its

consequences. Denial of reality is seen in

some forms of mild psychological

disturbances where individuals deny the

existence of a known diagnosed illness

even at the expense of their lives. Low

level of education, health awareness and

ignorance about health in Africa may help

increase the possibility of denial of

COVID-19. A general observation by the

authors as to the way people respond to

lockdown instructions in some areas in

Nigeria show that many citizens are even

not aware of the consequences of the virus

or are in total denial about the virus

infection in the country. For example, we

hear the common man in Nigeria saying

that COVID-19 is ‘not real’; some say ‘it

is all about politics’; and others say it is ‘a

Whiteman’s/rich man’s disease’. In such

situations, necessary precautions that

should help prevent the spread of the virus

are undermined. At present, there are no

known research evidences from Africa on

denial of reality to COVID-19. Our

presentations are only experiential as we

await the outcome of researches on mental

health during the COVID-19 outbreak in

Africa.

Reality testing in the face of

COVID-19 leads the nation to a better

understanding of the disease progression

and possible ways to reduce spread of the

virus. However, there are failures to

reality testing and denial. When

individuals over exaggerates the realities

of situation, there is tendency of anxiety

and panic. The present situation in Nigeria

shows some signs of over exaggeration of

situation in many elite locations. Many

posts from social media particularly the

WhatsApp show extreme exaggeration of

the situation. WhatsApp social media is

full of posts on different remedies that

cure COVID-19. Anxious and uniformed

public are likely to key into these remedies

and possibly use them. Such unguarded

use may create more harm and complicate

the already heated polity. Over

exaggeration of reality can further lead to

anxiety, depression, panic and somatic

symptoms. When people over perceive the



5

consequences of COVID-19 outbreak,

they are more likely to become anxious

and apprehensive about their health and

those of their loved ones. Implications of

such anxieties and poor mindfulness on

mental and physical health have been

studied by Branstrom, Duncan and

Moskowitz (2011).

COVID-19 and Social Psychology of

Mental Health

Major precautions against the spread of

COVID-19 is social distance and

appropriate hygiene behaviours. It is well

known that humans are social animal and

live day to day in social interactions with

others. Among the ways humans maintain

social interactions include activities in

work places, religious and social

gatherings and schools. Human social

interactions are known to play

fundamental roles in mental health.

Abbasa and Co-workers (2019) showed

the moderating role of social support for

marital adjustment and mental health.

Their study emphasized positive

contributions of social support to marital

adjustment and significant negative

association between social support and

major mental health index including

anxiety, depression and stress reactivity.

In the hit of COVID-19 outbreak, people

are heavily advised to maintain social

isolation and avoid public gatherings

which may undermine social support.

Some studies in mental health show

negative consequences of social isolation

on physical and mental health particularly

in the elderlies. Leigh-Hunt and

colleagues (2017) in their meta-analysis of

public health consequences of social

isolation and loneliness identified a

significant association between social

isolation and loneliness with increased all-

cause mortality and social isolation with

cardiovascular disease. Narrative

systematic reviews suggest associations

with poorer mental health outcomes, with

less strong evidence for behavioural and

other physical health outcomes. Courtin

and Knapp (2017) reviewed studies on

social isolation, loneliness and health in

old age. Their finding showed that social

isolation and loneliness are significant

predictors of depression and

cardiovascular health in the population

reviewed. Tanand Colleagues (2017)

examined the relations between loneliness

and health related quality of life (HR-

QoL) among community dwelling older

citizens. Their findings showed that

participants who were lonely experienced

a lower HR-QoL than participants who

were not lonely. Emotional loneliness and

social loneliness were both associated with

a lower physical and mental HR-QoL.

Although social isolation is not the same

as loneliness, strong relationship exists

between the two factors. Interestingly,

COVID-19 has been shown to affect more

the elderly population and people with co-

existing chronic illnesses. Social isolation

is known to affect more the elderly group

although the mechanisms of action are not

yet understood. The ageing population is

at greater risk for social isolation

prescription for containing the spread of

the virus and may be more at risk with the

mental consequences of the COVID-19

pandemic.

Aside from the direct mental health

consequences of social isolation, the

indirect consequences are also important

to sustaining mental health. The present

lockdown in many countries of Africa is

likely to affect the economic development

and living standards of the people. Such

lockdown for many citizens came


6

unprepared and many African

governments have no plans prior to the

outbreak. This creates many psychological

imbalances for the public including

uncertainty about future, anxiety over

survival, depression over closure of works

and businesses and irritability following

continuous lockdown.

COVID -19 and Infected Patients

Patients with COVID-19 infection are

faced with some psychological

disturbances. The individual is worried

over possible survival and trauma

associated with social isolation. The sick

person is not only battling with Cov-2 but

is also battling with psychological

consequences following isolation. The

psychological consequences are necessary

factors to be managed alongside the

symptoms of Cov-2 so as to quicken the

recovery of the patients. It is known that

social isolation comes with loneliness,

anxiety and depression. These

psychological symptoms particularly

depression have been shown to

compromise immunity through their

endocrine systems mechanisms like the

pro-inflammatory cytokines and

corticosteroids stimulations (Coe, 2010;

Kiecolt-Glaser, Derry & Fagundes, 2015)

and is known to influence health and

recovery. Equally, the families of the

patients are not also immune to the

psychological consequences of the

diagnoses. The family members are

shocked and traumatized over the situation

and may be disposed to depression and

stigmatization. The psychological

strengths to look after the affected family

member and to bear the transient loss of

the quarantined family member are

important.

COVID-19: Depression, Trauma, and

Illness Anxiety in the Public

COVID-19 pandemic has also

psychological consequences in the

uninfected public. Illness anxiety is a

concept that describes apprehension

following illness people have no control

over. Because there is no cure for the

disease now, a lot of people are anxious

over their health and what they can do to

contain the virus. Such apprehension

could lead to survival behaviour where

people do things to keep safe. Such

survival acts could lead to self-injurious

behaviours like the cases of chloroquine

toxicity and increased cases of drug

addiction we hear from the social media.

Illness anxiety can as well co-exist with

depression even then complicating the

situation.

COVID-19 and Nuclear Family

Relations

Social isolation in the hit of corona virus

pandemic has created some changes in

nuclear family relations. Because people

are most likely to stay indoors, extensive

time is shared between couples and among

siblings. There are much time for parents

to interact with themselves and their

children. Because we live in a world

preoccupied with work, many families

have little time to share with their

children. The way the relationship

between couples are managed this time

determines to a significant extent how the

social isolation could impact on their

health. Couples with good understanding

can enjoy the quarantine period, take time

to discuss and rebuild their relationships.

However, couple with poor marital

relations can have their marital discord

escalated and consequently create more

problems for themselves. Because many



7

couple are more likely to stay at home,

increased sexual relations may be

encountered in sexually active couples.

Some people in Nigeria have even

reported in the social media of achieving

long expected pregnancies, while others

have talked about having unexpected and

unwanted pregnancies, as a result of the

lockdown. The extent to which these bring

psychological health or distress is to be

studied. Unwanted pregnancies and

consequent psychological consequences

may further be a problem for couples not

observing family planning during this

period.

Because people are compelled to

stay at home, there are tendencies of poor

regulation of eating behaviour, sedentary

life styles and consequent increase in

weight and other metabolic syndromes.

Some children are terribly bored,

especially those living in township

flats/condominiums with little space for

playing. Some parents who are not used to

staying at home with their children are

irritated by the children’s boredom. Many

workers are facing joblessness, and others

are losing job-identity. Increased drug

abuse and addiction among adolescents

and adults are expected. Physical,

emotional, psychological and sexual abuse

of children and women would be on the

increase. Some of these are possible

outcome that the public may face as a

result of social change following COVID-

19 pandemic. These issues are worth

deliberating by psychotherapists and

further provide people with possible

adaptive behaviours

Neuropsychological consequences

following COVID-19 Infection

Neurological symptoms have been

reported in some patients with SARS-2

infection. Among the symptoms were

headache, dizziness, and loss of

consciousness. Mao and co-workers

(2020) examined retrospectively

symptoms presented by COVID-19

patients for neurological symptoms.

Compared to 214 patients studied, 78

(36.4%) had neurologic manifestations.

Patients with more severe infection had

neurologic manifestations, such as acute

cerebrovascular diseases, impaired

consciousness and skeletal muscle injury.

There is every possibility that Cov-2

crosses blood brain barriers as evidence

has shown the detection of SARS corona

virus RNA in cerebrospinal fluids of

patients (Hung et. al., 2003; Lau and

colleagues, 2004). There is need to study

the neuropsychological consequences

following COVID-19 infection since there

are mounting evidence of neurological

symptoms. Neuropsychological

assessment post SARS recovery will be

helpful to ascertain future brain-behaviour

issues arising from the SARS infection.

Challenges for Psychotherapists in

Africa

The need for increase opportunities for

psychotherapy training in Africa

Due to the scarcity of properly trained

psychotherapists in Africa in general on

the one hand, and the increasing incidence

of emotional problems resulting from

poverty and underdevelopment, child

abuse and neglect, trauma resulting from

different forms of crime and abuse of

human dignity, insecurity problems like

terrorism, insurgency, kidnapping and

hijacking, increasing stress-provoking

lifestyles, tribal and national wars and

conflicts, westernization and globalisation,

and the HIV/AIDS pandemic, different


8

forms of cancer, and all sorts of abuse of

human dignity, on the other hand, Madu

(2016) called for urgent need for

establishment of institutions for formal

psychotherapy training in Africa. Now,

with the COVID-19 global pandemic, with

its expected effects on mental health,

behavioural, emotional, social/family

problems, and neurological consequences

(as described above), the need for training

opportunities for psychotherapists in

Africa has become more urgent than ever.

There is an urgent need for increased

number of psychotherapists to address the

problems as mentioned above. The School

of Psychotherapy and Health Sciences in

Okija, Nigeria, (www.sphs.com.ng)

(which is the first of its kind in Africa

South of Sahara) can only do as much as it

can cope with. More of such efforts are

therefore urgently needed.

Short-term psychotherapy skills-

acquisition

Normally, full-term psychotherapy

training lasts for years. For example,

based on the personal training experience

of the authors, in most parts of Europe

and America, full formal training in

psychoanalysis last for a minimum of

seven years, five years for any form of

Behaviour therapy/Behaviour

modification, four years for Client-

Centred Psychotherapy, and the same for

Gestalt therapy, etc. The speed with which

COVID-19 is spreading in Africa, with its

resultant mental, emotional and social

adverse effects, one cannot wait for such a

long-term training, before addressing them

psychotherapeutically. No African nation

was prepared for the pandemic. Therefore,

short-term training programmes on hands-

on psychotherapeutic skills are needed for

crisis and trauma intervention among

survivors of the corona virus, as well as

for the families and relatives of victims

and survivors of the virus. The issue of

stigmatisation of survivors as well as

relatives of survivors and victims’

families, need to be addressed by

psychotherapists now and after the

pandemic.

Conclusion and Recommendation

Many mental health, emotional,

behavioural and neuropsychological

problems are being envisaged to come

now as a result of the COVID-19 spread

and pandemic in Africa and thereafter.

These demand for urgent

psychotherapeutic training opportunities

which are rare to find in Africa, since

there are only a handsfull of fully trained

psychotherapists in Africa south of

Sahara. Therefore, short-term

psychotherapy skills-acquisition is a sine

qua non if Africa is to outlive the Corona

virus pandemic and maintain

psychological balance thereafter.

It is therefore recommended that

governments in Africa should have

political goodwill and offer financial

support to institutions of higher learning

that have the capacity to train

psychotherapists. This should be

considered as equally important as the

palliatives being given to cushion the

adverse effects of the lockdown as a result

of the COVID-19 pandemic. While the

governments are playing their own role,

the few psychotherapists available in

Africa should look into the above

psychologically unhealthy situation from

the point of view of crisis intervention.




9

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Igboegwu, C.I. (2020). Psychological Intervention to Break the Cycle of Violence and Accelerate

Public Safety, Security and Development (With Special Reference to Africa),

International Journal for Psychotherapy in Africa 5(1):11-21

11

Psychological Intervention To Break The Cycle Of

Violence And Accelerate Public Safety, Security And

Development (With Special Reference To Africa)

Chioma Ihuoma Igboegwu 18011 Pomelo Lane, Pflugerville, Texas 78660, USA

[email protected]

Abstract Pervasive and unrelenting violence threatens the safety and security of women and

children, present day survival and collective future of the people in various communities

and nations, across the globe. This tragic crisis has become one of the most serious

issues compelling the increasing attention of governments, at all levels, scholars in

traumatic stress studies, psychology, psychiatry, contemporary medicine, human

development, military and police administrators. Countries and communities are being

destroyed by violence. Images and accounts of violence pervade the media; it is on the

streets, homes, schools, workplaces and institutions. It has become a universal scourge

that tears at the fabric of society. In a world desperate to comprehend, address and

arrest the seemingly ever-enlarging explosion of violence and its psychological

aftermath, the Three-Dimensional Psychological Intervention Strategy (3-DPIS) Model

has been developed to explain the underlying factors that perpetuate violence in society

and the 3-DPIS Model to holistically address these factors and break the vicious circle

(Igboegwu, 2016).

Key words: Violence, post-traumatic stress, psychological intervention model.

Introduction

Research study on prisoners suggests that

there is a link between traumatic incident

exposure and violence perpetration

(Neller, Denney, Robert, Pietz&

Thomlinson, 2006). Foa, Ehlers, Clark,

Tolin and Orsillo (1999) explains that

chronic and prolonged exposure to

violence may develop into a

dysfunctional routine creating a link

between experiences of violence as

victims and later experiences of violence

as a perpetrator (Garbarino, 2002). While

Muller (2015) revealed that police

personnel with (vs. without) post-

traumatic stress disorder (PTSD) are at

great risk for police brutality. Research

evidence further shows that individuals

with (vs. without) PTSD have more

violent marriages and are at a higher risk

of violence towards and by their partners

(Jordan, Marmar, Fairbank, Sclenger,

Kulka, Hough & Weiss, 1992).

Despite a proliferation of research

and a large and growing evidence base to

effectively meet the needs of those


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402156/#CIT0017



12

exposed to trauma, there are gaps in

knowledge, policies, institutional

capacities, due to neglect of the

psychological dimension of social and

criminal justice, public safety and

development policy agenda (Igboegwu,

2006, 2013, 2018 & 2019). These gaps

produce diverse categories of

psychologically disoriented, destabilized

and disillusioned populations and weak

institutions within which violence and its

psychological consequences thrive (Foa,

Ehlers, Clark, Tolin & Orsillo, 1999).

This cycle of violence in society can

have severe psychological consequences

in the lives of children. Deficits in the

socio-cultural environment can exacerbate

traumatic memories of children with a

history of child abuse, neglect and/or

survival of armed conflict. The adverse

mental health impact of childhood trauma

can predispose them to violence

perpetration later in life. Child abuse can

lead to suicidal ideation and attempts, as

well as the abuse of others and violent

arrests (Lansford, Miller-Johnson, Berlin,

Dodge, Bates & Pettit, 2007). Violent

conflicts and wars not only adversely

affect military and police personnel, but

hold adverse implications for the

psychological development of children in

cities, towns, villages, and private spaces.

It has adverse mental health impact on

civilians in the armed conflict

environment and creates vulnerabilities

that can lead to the problem of

intergenerational transmission of trauma

and violence among military, police and

civilian armed conflict survivors.

Attitudes and beliefs about violence

also cause direct harm as well as

determine the social and cultural use of

violence and destruction to discharge the

hopelessness, despair, and the frustration

and shame of lacking education and

employment (Igboegwu, 2013; Brandy,

2018). This can be observed in the rise in

violent conflicts and crime, including

widespread schoolyard bullying, shooting,

militancy, terrorism and escalating gun

murders.

Igboegwu (2009) explains that gaps

in the knowledge, policies, institutional

capacities and consequent deficits in the

social and criminal justice administration;

as well as internal security and

development strategies of stakeholders at

the local community, national, regional

and international levels have produced

diverse categories of psychologically

destabilized, disoriented and disillusioned

populations. These populations include

prisoners, ex-prisoners, street children,

militants, ex-militants, survivors of armed

conflict trauma, childhood trauma, gender-

based and domestic violence (GBDV), as

well as criminal, terrorist, drugs, human

and arms trafficking groups, as well as

women, children, youths and elderly, at

risk, world -wide. She further explains that

it is within these highlighted gaps in the

various sectors that violence thrives. Thus,

police and military personnel are deployed

to combat seemingly endless violence in

the society.

Igboegwu (2019) also revealed a

high prevalence of psychological

consequences of trauma, such as post-

traumatic stress disorder and depression,

in active duty Nigeria police personnel.

According to the study, Nigeria Police

personnel aged 25-34 years had the

highest occurrence of PTSD (49.2%)

followed by Nigeria Police personnel aged

35-44 years (39.3%), while Nigeria Police

personnel aged 45-54 years had the lowest

occurrence of PTSD (31.2%). In addition,

Nigeria Police personnel aged 35-44 years





13

had the highest occurrence of depression

(33.7%) followed by Nigeria Police

personnel aged 25-34 years (28.8%), while


had the lowest occurrence of depression

(12.5%). Comparatively, the highest

PTSD occurrence was among Nigeria

Police personnel aged 25-34 years, while

the highest depression occurrence was

among the police personnel aged 35-44

years. The least PTSD and depression

occurrences were however, among the

police personnel aged 45-54 years.

It is important to note that combat-

related psychological disorders, such as

PTSD and depression, among police

personnel do not only affect the personnel,

but their families, communities and the

general public. Combat-related

psychological disorders, such as PTSD

and depression, can lead to poor decision-

making, disciplinary problems, excessive

use of sick leave, severe difficulty in

regulating affect, which can impact

negatively on the quality of life as well as

the relationships of the security personnel.

There are also attention difficulties that

can undermine learning and employment

and thus complicate the reintegration of

the military and police returnee from

combat duty deployment with his/her

family and community. In addition, there

can be negligent accidental bullet

discharge, alcohol/drug dependence,

explosive anger, interpersonal violence,

including gender-based and domestic

violence (GBDV), murder and suicide.

Thus, deficits in the social and

criminal justice system, public safety,

security and development sectors as well

as adverse socio-cultural environment

created by these sectors produce diverse

categories of psychologically disoriented,

destabilized, disillusioned civilian trauma

survivors, who are unable to find the

means to actualize their potential. They

therefore become frustrated, resentful and

vulnerable to violent conflicts and crime,

militancy and terrorism, while the police

and military personnel deployed to quell

the unrelenting violence also sustain

psychological injuries due to critical

incident exposure associated with combat

operations and missions (Igboegwu, 2013,

2019).

The adverse mental health impact of

armed conflict, such as PTSD, and co-

morbidities, such as depression, are

predictive of violence, human rights

violations, gender-based and domestic

violence (GBDV), breeches of

international humanitarian laws (IHL) and

breeches of national and local laws and

norms that constitute what is acceptable

use of force by active duty military and

police personnel as well as intervention

forces.

Who, then, will build the city if the

people are not first built? This is a

common axiom that points to the

undisputable fact that the builders of a city

build in vain, if the people are not first

built! It is upon this premise that the

author of this article developed the Three-

Dimensional Psychological Intervention

Strategy (3-DPIS) Model for the bridging

of gaps in knowledge, policies and

institutional capacities, in order to

mobilize the cooperation of stakeholders

at the community level, national, regional

and international levels for mainstreaming

of the psychological dimension of social

and criminal justice, public safety, health,

security and development sectors, in order

to transform and empower institutions and

communities to break the cycle of

violence in the society.


14

The Three-Dimensional Psychological

Intervention Strategy (3-DPIS) Model:

In a world desperate to comprehend,

address and arrest the seemingly ever-

enlarging explosion of violence and its

psychological aftermath, the Three-


Strategy (3-DPIS) Model has been

developed to explain underlying factors

that perpetuate violence in society and the

3-DPIS Model to address these factors and

break the vicious circle (Igboegwu, 2016).

The diagram presented, below, illustrates

fundamental gaps in the social and

criminal justice system, public safety,

security and development sectors that

perpetuate violence.

DIAGRAM ILLUSTRATION OF

GAPS IN SOCIAL AND CRIMINAL

JUSTICE SYSTEM, SECURITY AND

DEVELOPMENT SECTORS THAT

PERPETUATE VIOLENCE IN

AFRICA AND SIMILAR REGIONS,

AND THE 3-DIMENSIONAL

PSYCHOLOGICAL INTERVENTION

STRATEGY TO BREAK THE

VICIOUS CYCLE

PSYCHOLOGICAL INTERVENTION

STRATEGY TO BREAK THE

VICIOUS CYCLE




15

The 3-DPIS Theory was inspired and

developed through 32 years of observing

and working with prisoners in the Nigeria

Prisons Service, pioneering psychological

services for prisoners in Nigeria, research

study on military and police populations,

in addition to being a survivor of the

Nigerian/Biafran bitter civil war as a child

(Igboegwu, 2006; 2018, 2019 ).

The Equation.

The problem of violence in the society can

be represented in an equation as follows:

PVO + LD →SED → PD →Violence and

its psychological aftermath.

The 3-DPIS Theory states that in any

environment, community, nation or region

of the world, where there is perverse value

orientation (PVO) and leadership deficits

(LD), there will, certainly, be socio-

economic distress (SED), a wide range of

psychological disorder (PD), including

emotional and personality disorders, as

well as behavior deficits, anti-social, anti-

security, anti-development behavior

patterns (Igboegwu, 2006). The adverse

socio-cultural environment created by this

problem will lead to weak institutions and

vulnerabilities that rekindle and

exacerbate traumatic memories of trauma

survivors, thereby leading to the insidious

mental health crisis that perpetuates

violence in society (Igboegwu, 2006;

2019). This is the root of violent conflicts

and crime, proliferation of small arms and

illicit weapons, prison over-population,

proliferation of criminal, militant, terrorist

networks, high populations of internally

displaced people and refugees, vulnerable

women, children and youths, at risk,

diverse categories of disillusioned,

disoriented and destabilized populations,

including civilians, police and military

populations. The diverse categories of

psychologically disoriented, destabilized

and disillusioned populations and weak

constitute the weak social capital that

perpetuates the vicious circle in such a

society. These crises diminish society and

make it vulnerable to disintegration.

The Problem: PVO + LD = SED + PD

• Perverse value orientation (PVO),

distorted values, ignoring the things

that matter to development and the

values that promote the unfolding or

development of the potentials of

human beings; Leadership deficits,

failure of leaders, at all levels, due to

the one-sided striving for material

gains and goals, earthly power and

domination, in line with the principle

of manipulation and exploitation of

the weak by the strong, which has

triggered social and economic distress

(SED) and psychological disorder(PD)

leading to the backlash effect of a

global security and development crisis.

• Africa and other similar regions of the

world have a tragic history of socio-

economic distress, psychological

trauma and the consequent emotional,

personality and behavioural disorders,

including anti-security and anti-

development behaviour patterns of the

people.

• The backlash effect of this problem

triggers violent conflicts, violent

crimes, militancy, extremism,

terrorism and illegal hazardous

migration. Millions of psychologically


16

traumatized women, children and

youths, including refugees, the

internally displaced, ex-child soldiers,

victims of human trafficking, human

rights abuses in various nations in

Africa and other distressed regions,

are stranded.

• Heavy casualties, decimation of huge

populations, unacceptable waste of

human and material resources being

recorded constitute an emergency that

calls for the bridging of gaps in the

social and criminal justice, public

safety, internal security and

development strategies of the affected

nations, including Nigeria and the

entire Africa region.

The Backlash Effects

The backlash effect of the tragedy

includes: socio-economic and political

conflicts; Persistent migration of people

from their homeland; Infiltration of

criminals, including armed and terrorist

groups across national and regional

borders; prison over-population; Human,

arms and drug trafficking; Drug addiction,

violent crimes, kidnappings, political

assassinations, etc; Illegal oil bunkering

and oil pipe line vandalism; Destruction of

national and foreign investments; General

insecurity of foreigners and nationals,

alike; arms proliferation; Youth militancy,

terrorism, extremism and wars; and

pandemics, including the COVID-19.

Governments of African nations ,

and other conflict-torn regions of the

world are relentlessly making the effort to

reinforce security, peace, and development

through the enactment and enforcement

of laws, as well as the establishment of

structures, such as the following: The

Sustainable Development Goals (SDGs);

The New Partnership for Africa’s

Development (NEPAD); Reinforcement of

Military and Paramilitary institutions;

Prison Reforms, Security Sector Reform;

Human Rights Laws; The mobilization of

Military and Police Forces; Global

Terrorism Strategy; and Disarmament,

Demobilization and Rehabilitation

Programs.

Important as the highlighted efforts

are, by themselves, alone, the cycle of

violence cannot be broken, unless, the

underlying psychological issues that

perpetuate violence in the communities,

nations and regions of the world are

addressed through the mainstreaming of a

holistic psychological intervention

strategy, as a priority agenda of

governments, at all levels.

During and after COVID-19

pandemic, the adverse psychological

consequences of neglect of the


criminal justice, public safety, internal

security and development, including

health, education, women, children and

youth development, as a priority agenda,

at the community level, national, regional

and international levels, will be

exacerbated in various families,

communities and nations across the globe.

COVID-19 pandemic will heighten the

level of mental health crisis and violence

being perpetuated across the globe as a

result of this neglect of the psychological

dimension of these critical sectors, at all

levels, across the globe. Thus, the urgent

the need for collective action through the

mobilization of communities, national,

regional and international cooperation for

mainstreaming of the psychological




17

dimension, as a priority agenda, in the

highlighted sectors through the Three-


Strategy (3-DPIS) Model.

Through this intervention, the

vicious circle of violence will be broken,

public safety, internal security and

development, including health, education,

women, children and youth development,

will be accelerated at the family level,

community, national, regional and

international levels. The 3-DPIS is also

crucial in dealing with the corona virus

(COVID-19) pandemic prevention,

recovery and restoration of health.

Three Pillars of 3-DPIS

The 3-Dimensional Psychological

Intervention Strategy (3-DPIS) Model to

break the cycle of violence in the society

is comprised of the following three Pillars: 1. Advocacy, including legislative

advocacy;

women/children/youths/public re-

education, reorientation,

sensitization and mobilization

campaign for peace, security and

development, including the

mobilization and sensitization of

women and girls, especially, since

women and children are most

vulnerable when their communities

are torn apart by violence; and

integrating the use of psychological

science, art and culture, in

facilitation of the 3-DPIS

implementation.

2i. Psychological assessment and

intervention services for

psychologically traumatized

populations, including military,

police personnel and veterans and

their families, civilian counterparts;

civilian armed conflict survivors and

COVID-19 pandemic survivors,

including women, children, youths,

elderly, at risk, health/rescue

workers and journalists and

paramilitary personnel; preventive,

promotive, curative, reformative and

rehabilitative psychological

intervention services, including

creative/vocational skill

development and post amnesty

psychological rehabilitation.

2ii. Psychological assessment,

correctional diagnoses, promotive,

preventive, curative, reformative and

rehabilitative psychological services

for offender reformation,

rehabilitation and mental health of

prisoners, including


development and economic

empowerment in order to integrate

them into the development and

democratic agenda of their

communities.

2iii. Psychological assessment and

promotive, preventive, curative,

reformative and rehabilitative

psychological services, including


development and economic

empowerment/skill development for

psychologically traumatized women,

children and youths, including

displaced people, ex-street children,

ex-child soldiers, ex-combatants and

victims of human trafficking.


18

3. Institutional capacity building,

psychological research and

partnership to ensure project

sustainability

A special component of the 3-DPIS

Model is the women sensitization,

mobilization campaign. Women and

children are most vulnerable when their

families and communities are torn apart by

violence. There is prevalent, pervasive

violence against women and girls,

including gender-based and domestic

violence, the killing of women by

members of their families; abductions,

forced marriages and torture of women

and girls in conflict and humanitarian

crises in various nations in Europe, Asia

and Africa; United States, Canada and

others nations across the globe. In spite of

increasing deployment of military and

police personnel to combat violence and

dismantle human trafficking/ drug/arms/

terrorist/militant/criminal networks and

infrastructure, violence persists in various

countries across the globe. Gross human

rights abuses and breeches of International

Humanitarian Laws (IHL) by security and

intervention forces, including violation of

national and local laws and norms that

regulate what is acceptable use of force,

are also being recorded by national and

international human rights monitoring

groups (Igboegwu, 2019; Muller, 2015).

Research evidence also shows that

individuals with (vs. without) PTSD have

more violent marriages and are at a higher

risk of violence towards and by their

partners (Jordan, Marmar, Fairbank,

Sclenger, Kulka, Hough & Weiss, 1992).

These highlighted issues expose the

vulnerability of women in times of

conflict and humanitarian crises. Women’s

safety, emotions, bodily health and bodily

integrity are threatened and jeopardized by

the violent treatment they receive around

the world and during times of conflict. In

or out of war, women are handicapped in

society and subjected to sexual assault at a

larger rate than men partially due to their

lack of autonomy in society and power

within their families. Much of women’s

rights in society depends on the place they

are given within the family as they are the

basis for society’s structure. The power a

woman holds in society affects everything

from the family’s social class to whether

the children are sent to school or pressured

into work. The immense potentials that lie

in woman have not yet been fully

recognized, developed and utilized in the

development and general upliftment of

society, just as the immense powers that

lie in the environment have not been fully

appreciated and utilized in development of

the world.

Violence against women and girls is

perpetuated by gaps in knowledge,

policies, institutional capacities and

consequent neglect of the psychological

dimension of social and criminal justice,

public safety, security and development,

including education, health, women,

children and youth development sectors,

in the policy agenda, at all levels. An

important component of the 3-DPIS

Model is therefore the “Women Go On!”

mobilization campaign. It is aimed to

inspire and sensitize women and girls to

recognize their fundamental mission in

society, as guardians of the flame of

longing and enthusiasm in the hearts of

their people for uplifting, enduring values

that serve as building blocks of peace and

nation building. It is aimed to empower

women and girls through psychological




19

science, art and culture to know their role

and enhance their skills in politics,

leadership and general upliftment of the

society, in order to facilitate the 3-DPIS

transformation project to break the cycle

of violence in the society.

Women and girls are most

vulnerable when their families and

communities are torn apart by violence.

Thus, the Women Go On! campaign

component of the 3-DPIS is aimed to

inspire, sensitize and mobilize women and

girls, world-wide, as the bedrock of their

communities and nations, and instruments

for social change, to facilitate


dimension of the highlighted sectors, as a

priority agenda, in order to transform and

empower their communities and

institutions to break the cycle of violence

and lay a firm foundation for the reign of

peace in our hitherto troubled world.

Conclusion

Countries and communities are destroyed

by violence. Images and accounts of

violence pervade the media; it is on the

streets, homes, schools, workplaces and

institutions. It has become a universal

scourge that tears at the fabric of society,

threatening the lives of women and

children, present day survival and

collective future of the people, world-

wide.

The 3-DPIS theory shows how

violence is perpetuated in society. It also

explains how gaps in knowledge, policies

and institutional capacities of

stakeholders, due to neglect of the


criminal justice, internal security, public

safety and development, including health,

education, women, children and youth

development, as a priority agenda,

produce weak institutions and diverse

categories of psychologically disoriented,

destabilized and disillusioned populations

that perpetuate violence in society. The 3-

DPIS aims to mobilize national, regional

and international cooperation to bridge the

highlighted gaps, transform and empower

communities and institutions at all levels,

to break the cycle of violence and

accelerate public safety, security and

development in the society. This

intervention has become a most

compelling need, in view of COVID-19

pandemic, which is bound to exacerbate

the mental health crisis and cycle of

violence being perpetuated by the

highlighted neglect. In facilitation of the

agenda to break this vicious circle,

women and girls are to play a key role in

inspiring and uplifting their land and

people, recognizing their fundamental,

natural role and inherent abilities as the

guardians of the flame of longing and

enthusiasm for the values that serve as

building blocks of peace and nation

building.

Women and children are most

vulnerable, when their families and

communities are torn apart by violence.

How the mother hen weaves her

protective, loving wings over her chicks to

protect them from the evil eye of

predatory hawks, is how a truly conscious,

genuine woman envelops and shields her

children, community and nation through

her inspiring, protective, caring, loving

thoughts, words and actions, so that they

survive the harsh, evil, challenging, visible

and invisible influences of the world and

actualize their potential. Thus, the woman

creates a bridge to the life-giving,

sustaining power of God in creation, thus,


20

laying the hitherto neglected firm

foundation for a sustainable, global

civilization. When peaceful, safe, secure

communities and nations are created

through the bridging of gaps in

knowledge, policies and institutional

capacities of stakeholders, mainstreaming

of the psychological dimension as a

priority agenda in the social and criminal

justice, public safety, security and

development, including health, education,

women, children and youth development,

communities and institutions, at all levels,

will be transformed and empowered to

break the cycle of violence. Women,

children, youths, the elderly, all categories

of the people in all their diversities will,

then, be able to live, work, flourish and

actualize their potentials in peaceful, safe,

secure, developed communities and

nations.

The 3-DPIS Model will guide the


dimension, as a priority agenda, in the

social and criminal justice, public safety,

internal security and development sectors

in Nigeria, other nations in Africa and

world-wide. It should be integrated into

the agenda for conflict prevention,

management and post conflict

reconstruction, as well as COVID-19

pandemic prevention, recovery and

restoration of health. It will address the

vulnerabilities that perpetuate violence, as

well as restore, heal and rehabilitate

psychological consequences of trauma,

including the adverse mental health impact

of armed conflict and COVID-19

pandemic Africa and other regions of the

world. The 3-DPIS, also, provides the

guiding light for teachers, in researchers,

clinicians in the traumatic stress field and,

indeed, all stakeholders to make more

effective and sustainable impact through

their services in the society for the

enthronement of peace in our hitherto

troubled world.

The 3-DPIS Model integrates

psychological science, art and culture in

psychotherapy and provides a holistic

intervention to address the mental health

crisis of PTSD and co-morbidities, such as

depression, which perpetuate violence in

the society. It will facilitate pro-social

engagement with all diverse categories of

the population, mobilizing their

cooperation at the community level,

national, regional and international levels,

including the dissemination of evidence-

based data, to bridge the gaps in


capacities in the highlighted sectors within

which violence thrives. It will transform

and empower communities and

institutions, at all levels, to mainstream the


criminal justice, public safety, security and

development sectors, including health,


development, as a priority agenda, in order

to break the cycle of violence, accelerate

public safety, security, and development

for the reign of peace in our hitherto

troubled world.

References

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Delinquency: A Prospective

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Today. New York City

Neller, D. J.; Denney, R. L.; Pietz, C. A.

& Thomlinson, R. Paul (2006). The

Relationship between Trauma and

Violence in a Jail Inmate Sample.

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21: 9, 1234-1241.

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https://journals.sagepub.com/doi/abs/10.1177/1077559507301841




22

The Relevance Of Acceptance And Commitment

Therapy (ACT) In The Treatment Of Emotional

Numbing Among The Adolescents:

A Narrative Review

Uchenna E. Enem

Educational Foundations, Veritas University, Abuja

[email protected]

Bahago Samaila

Educational Foundations, Veritas University, Abuja

[email protected]

Abstract The issue of emotional numbing is a serious emotional challenge among the adolescents

and which is greatly impacting on them negatively and sometimes goes unnoticed until

the damage is done. The study explored the concept of emotional numbing, its symptoms

and the causes for a clear understanding of the phenomenon. It also examined the

Acceptance and Commitment therapy (ACT), its core processes as a suitable therapeutic

property to resolve the emotional problem of the adolescents who go through such pain.

The ACT is a process and mindfulness model which promotes psychological flexibility

through fostering openness, awareness and engagement as illustrated in its six core

processes. It was observed that the ACT promotes emotional awareness through the

functions of the six core processes of the ACT model and as a result, could be adopted to

manage the challenges of emotional numbing among the adolescents. The researchers

therefore recommend that the therapists identify such adolescents in the schools and

address their issues with the ACT model.

Key words: Adolescents, Emotional Numbing, Psychological flexibility/inflexibility and

Acceptance and Commitment Therapy (ACT).

Introduction

Emotion is a very important aspect of

human life which determines how we

function in life. Emotions manifest in

cognitive, behavioural and physiological

properties of man and as a result

influences human behaviour. Daniel

(2011) has observed that emotions are

state of feelings that result in physical and

psychological changes that influence our

behaviour. Emotions are multifaceted

phenomenon that involves changes in

subjective experience, behaviour and

physiology (Gross, 2014).This explains

that emotion is behaviourial, we behave in

a certain way due to our emotions; people

who can readily express their emotions

behave differently from people who

conceal their emotions. Emotions are also

instrumental to our motivation in life, be it



Enem, U.E. & Samaila, B. (2020). The Relevance of Acceptance and Commitment Therapy (ACT)

in the Treatment of Emotional Numbing among the Adolescents: A Narrative Review,


23

positive or negative (Gaulin et al, 2003).

Though emotion is not a causal force but

comprises of components such as anger,

mood, motivation, temperament,

disposition etc.

The study of emotion is a necessary

outcome in the life of the adolescents

because they spend quite amount of time

learning in the classroom and interacting

actively which involves a lot of emotions.

Emotions also predict important learning

outcome as well as future career choices

(Valiente et al., 2012). These researchers

have juxtaposed students’ emotion with

their academic achievement, asserting that

the former influences the latter.

Studying emotions within a group of

adolescents lends support to Emotional

Contagion which is a situation of one

person’s emotions and related behavior

reflecting a similar emotions and

behaviour on other people. Emotional

contagion was observed to influence

significantly the individual level attitude

and group processes (Barsade, 2002). In

his study on group emotional contagion,

positive emotional contagion members

experienced improved co-operation,

decreased conflict, and increased

perceived task performance. Evidently,

maintaining positive emotions or

emotional stability among our adolescents

is a way of improving the quality of their

achievement; be it academics, social life,

and their future career choices. Albeit, it is

a fact that emotions generally are not well

addressed in researches, in the words of

Zembylas (2003), he pointed out that

emotion was an elusive construct that

could not easily be measured and regarded

a feminine issue and not a worthwhile

research topic.

The adolescence is a formative

period in the life of the adolescents, during

which they experience emotional changes

as well as other changes. Heller et al

(2016) defined adolescence as a time of

transition from childhood to adulthood

when individuals experience significant

changes in cognitive capabilities, physical

maturity, biological functioning, social

environment and family and peer

relationships. Though some of them may

go through these challenges successfully,

there is need to understand and maintain

their emotional development and habit, to

promote their well-being, improve their

interpersonal relationships, adopt effective

academic standard which could foster their

career development and assist them to

integrate properly in the society.

Researchers like Rojas et al (2015) have

related the adolescents’ poor

psychological outcome such as anxiety,

suicidal thought etc to a range of

emotional intensity. They described the

emotions as; high frequency and intensity

of positive emotions, low frequency and

intensity of negative emotions, instability

of positive and negative emotions, and low

emotional clarity.

Maintaining emotional stability

requires training, counselling and

psychotherapy depending on the intensity

and the trigger of the emotional instability.

Emotional numbing is a type of emotion

that one may have without being aware of

it and may exacerbate the adolescents’

activities, development and productivity if

it prolongs.

Emotional Numbing

Emotional numbing is an aspect of

emotion that has not received much

attention probably because it is overtly a

situation of shutting off negative feelings.

Litz and Gray (2002) posited that

emotional numbing entails a deficit in


24

responsiveness to positive emotional

stimuli but not to negative emotional

stimuli. A person may decide to shut out

feelings and certainly not feel anything.

Shutting out feelings may make one feel

he/she is in control but it comes with

underlying effect on the individual

especially when the numbness lasts for a

long time. It manifests as feelings of

emptiness, confusion, exhaustion and in

diminished responsiveness to emotional

stimuli. Mendez (2019) described

emotional numbing as a mental and

emotional process of shutting out feelings

and may be experienced as deficits of

emotional response or reactivity. She also

explained that “while emotional numbing

blocks or shuts down negative feelings

and experiences, it also shuts down the

ability to experience pleasure, engage in

positive interactions and social activities,

and interferes with openness of intimacy,

social interests, and problem-solving.

Emotional numbing obviously affects

one’s feelings, his/her actions and social

relationship.

Emotional numbing is a diminished

interest or pleasure in important activities:

feelings of detachment or estrangement

from people: and a restricted range of

emotion (APA, 2000). Emotional numbing

makes one feel;

isolated from and superficial to

reality,

invisible to and detached from other

people and activities,

numb to people’s reactions and

opinions,

loss of interest in important

activities one used to enjoy,

flat in both physical and emotional

situations

inability to participate in life,

difficulty in expressing positive

feelings like joy, happiness, and love

confusion and lack of

communication

sleep walking through the day time

altered sense of sight, feelings and

sounds,

The foregoing explains why

Diagnostic and Statistical Manual–v

(DSM-5) (2013) classified emotional

numbing as Depersonalization-de-

realization disorder (DD) (Huizen, 2017).

Researchers have stressed the

semblance between emotional numbing

and posttraumatic stress disorder saying

that the people who suffer PTSD

experience emotional numbing- a deficit

to express or experience emotion (Tull,

2003). According to Kerig et al (2016),

emotional numbing has implications for

maladaptive outcomes in adolescence such

as delinquent behaviour. Delinquent

behaviors may include the addiction to,

use and abuse of substances, sexual related

offences, truancy, stealing, pilfering,

aggressions, violence and the like. He

drew attention to the symptom of

emotional numbing in posttraumatic stress

disorder (PTSD) in his study by

investigating whether numbing of positive

emotions was associated with PTSD

symptoms above and beyond numbing of

negative emotions, general emotional

numbing or depressive symptoms among

at-risk adolescents. The result in

hierarchical multiple regression evinced

that general emotional numbing and

numbing of anger accounted for

significant variance with PTSD symptoms

while numbing of sadness and positive

emotions were correlates of depressive

symptoms.




25

In an attempt to underpin the

emotional numbing symptoms associated

with PTSD, Tull et al. (2003) discovered

that hyperarousal symptoms predicted

emotional numbing above and beyond

experiential avoidance and other

symptoms of PTSD. Foa et al (1992)

expressed that emotional numbing

symptoms are the distinctive feature of

PTSD from other anxiety disorder.

Researchers for example Huizen

(2017) identified some causes of

emotional numbing to include:

1. Trauma and Stress: Individuals who

are exposed to continual stress may

develop emotional numbness as a

coping mechanism to avoid the

experience. Huizen (2017) listed

some examples of stress as; loss of

close one, traumatic experiences like

car crash, bombing, physical abuse,

exposure to violence, emotional

abuse or neglect, impairment,

interpersonal conflict and financial

crisis.

2. Medications: The anti-anxiety drugs

and Anti-depressant medications

have been found to have side effect

of emotional numbing on the young

children who took them.

3. Other common causes of temporary

emotional numbness include:

seizure, drug abuse, panic attacks,

severe depression, severe anxiety

and posttraumatic stress disorder.

Clients in this category, experience a

lot of pain which include psychological

and physical pain. HeShuchang et al

(2011) found in their study that scores of

emotional distressed pain patients

(Chronic backache) were higher than the

control group, explaining that emotional

distress could lead to chronic pain. The

professionals who treat emotional

distressed pain find it difficult to provide a

soothing solution to their problems.

Medical intervention, in most cases may

cause further problems in terms of chronic

pain, though might be helpful with acute

pain (Van Tulder et al (2000).

Based on the researchers’

experience, emotional numbing is a

serious problem which the adolescents

experience all the time. The temporary

emotional numbing might not be

dangerous but its persistence impacts on

their academic achievement. An

adolescent who is experiencing emotional

numbing as a result of trauma, shock or

other forms of stressors may feel alienated

or act in alienation to things around him

for instance he/she may forget

examination time or to write his or her

name and matriculation number on the

answer script and when confronted may

look aloof to the situation. Sometimes they

are encountered wandering hopelessly in

the compound, at times talking to

themselves, appearing tattered, not placing

value and committed to their goals,

playing truancy to class work and dwell

much on the pain and seeking for

immediate relieve from it. Such search for

relieve from emotional discomfort is

destructive, a situation known as

psychological inflexibility. Therapists

need to identify the cause of the numbing

and help resolve the pain clinically.

Given the situation, emotional

numbing among the adolescents could be

treated with Acceptance and commitment

therapy for its efficacy in chronic pain.

ACT has also adapted an assessment

measure for the pain adolescence, Chronic

Pain Acceptance Questionnaire,

Adolescent Version (CPAQ-A)


26

Description of Acceptance and

Commitment Therapy (ACT)

Acceptance and Commitment Therapy

(ACT) is a psychotherapy of learning to

accept change in circumstance but try as

much as possible to make the best of the

situation without trying to change your

perception of the outcome (Chalk, 2019).

This therapy is essential to coping with

chronic pain from long-term conditions.

Emotional numbing if lasts longer can

trigger a condition of chronic pain as

reported above. As a result, the processes

and methods incorporated in the ACT will

have a far reaching effect in treating

emotional numbing.

ACT according to Eccleston et al

(2009) emanated as a call to improve the

standard of psychotherapy by focusing

adequate attention on therapeutic

processes through selection of processes

and methods known to produce

improvement. In line with the

consideration, ACT was one of the

approaches within Cognitive Behaviour

therapy (CBT) that met the challenge.

ACT is an acceptance and mindfulness

based-approach that can be applied to

many emotional problems and disorders. It

is also a process-based, third wave,

cognitive behavioural therapy (CBT). It

has been reported to solve a broad set of

psychological problems (Ruiz, 2010&

Bach and Hayes, 2002). ACT approaches

psychological problem in a dynamic

manner manifesting in verbal, social,

emotional and direct sensory influences on

behaviour with emphasis on how suffering

emerges with human abilities in language

and thought. People who are in pain

exhibit psychological inflexibility or

destructive experiential avoidance, a

constant behaviour pattern geared towards

searching for immediate relieve of

minimizing physical and emotional

discomfort (Hayes, 1999). They spend

great effort in fighting against their

experiences of pain; which includes

physical sensations, emotions, memories,

images and thoughts about the pain. They

normally indulge in reducing their

physical activities, avoiding thoughts of

pain or by engaging in excessive thoughts

of pain, avoiding people, ruminating about

the causes of their pain, asking

overwhelming questions about their pain

or seeking a second opinion to their

medications. ACT emphasizes observing

thoughts and feelings as they are, without

trying to change them and behaving in

ways consistent with valued goals and life

direction. Its goal mainly, is to reduce the

dominance of pains in someone’s life and

improve daily functioning (McCracken,

2011) through increased psychological

flexibility rather than increased

psychological inflexibility or destructive

experiential avoidance. Psychological

inflexibility or experiential avoidance can

only reduce pain tolerance and increase

the enormity of the pain (Gilbert et al,

2004).Psychological flexibility on the

other hand is the ability to persist or to

change behaviour, being conscious in the

midst of discomfort and other

discouraging experiences guided by goals

and values (Hayes, 2000). This implies

having the ability to accept pain, or any

form of discomfort in manner to reduce

the dominance of such pains in ones’ life.

A patient who is experiencing emotional

numbing as a result of trauma, one has to

develop the capability to accept the pain

and other devastating experiences through

reduction of dominance of the pain. The

basic understanding of ACT in respect to

chronic pain is that in as much as the pain

hurts, it is the struggle with the pain that




27

causes suffering or more pain. In the case

of the chronic pain, the causal and the

maintaining factors may be uncertain and

the struggle to reduce or remove the pain

may not be successful. Be it the case,

McCracken et al (2004) posited that the

continuing attempts to control the pain (a

situation Hayes, 2000 termed

psychological inflexibility) may be

maladaptive especially if the pain control

measures cause unwanted side effects or

lack of involvement in valued activities

like family relationships, dedication to

work, community roles.

ACT emphases is on seeing that

patients’ responses toward the symptom of

pain is more successful in relation to their

own goal through the increase of

psychological flexibility. Patients

experiencing emotional numbing in ACT

will realize that turning away from pain

and distress simultaneously result to

turning away from their values and goals.

Psychological flexibility comprises of six

therapeutic processes which are organized

into a structure known as hexaflex, which

are; Acceptance, Cognitive defusion,

Flexible present-focused attention, Self-as

context, Values and Committed action

(Hayes, 1999). Taking a look at the

processes, Feliu-Soler et al (2018)

described them thus: Acceptance is

described as the ability to embrace or

accept the unwanted experiences (pain,

thoughts, feelings, memories etc) in

connection to one’s goals. Cognitive

defusion is the ability to differentiate

between the thoughts and the experiences

which the thoughts relate. It means

experiencing thoughts as thoughts without

getting entangled in the literal meaning of

thoughts. Therefore it is the process of

learning to notice the process of thought

rather than getting caught up in the

content. They described flexible present-

focused attention as being able to connect

with the present moment and track

moment to moment experiences. Self-as a

context is the distinction between the

observed thoughts /feelings and the person

who observes. They saw values as freely

chosen directions connected with desired

aims and goals that guide actions. Lastly,

committed action is related with choosing

a course of action guided by value, and

then persisting in this choice, or changing

one’s direction if need be.

The hexaflex is the key model of


(ACT) framework encompassing the

structure of the six core processes (as

mentioned above) and the treatment guide.

When the clients work through the key

areas, they identify areas of entanglement

and are able to remove themselves from

such entanglement. The psychological

flexibility is at the centre of the ACT

model. The six core processes relate to

one another as well foster psychological

flexibility. The six core processes are in

three components; Open (acceptance and

cognitive defusion), Aware (Contact with

the present and self-as a context) and

Engaged (values and committed action) as

illustrated below

Figure 1: The hexaflex model of ACT for

psychological flexibility and

inflexibility


28

Source: Feliu-Soler et al (2014)




29

Measuring the six core processes of

ACT in relation to Emotional Numbing

(1). Acceptance: The most widely

used assessment measures in pain context

for acceptance is a 20-item Chronic Pain

Acceptance Questionnaire (CPAQ)

developed by McCracken et al (2004).

The scale has emphasized on two major

aspects of pain assessment:

(a) Achieving acceptance is the

willingness to experience pain, it reflects

the absence of attempts to control or

reduce pain. Ones’ thoughts and feelings

about pain must change before one can

take important steps in my life. Achieving

acceptance for the emotional numbing

adolescents depends on their being able to

open up fully to the reality of the pain or

discomfort they are experiencing and

accepting both the positive and negative of

the new situation. Focusing only on the

negative side will lead to self-defeatism,

and depression while a focus on the reality

and the worst possible outcome will assist

them achieve genuine acceptance and gain

productive life while experiencing

discomfort.

(b) Activity engagement entails

engaging in valuable activities in the

presence of pain, living a good life

irrespective of pain or discomfort. Pain

acceptance in ACT was correlated with

lower self-rated pain intensity, less self-

rated depression and pain-related anxiety,

greater physical and social ability, less

pain avoidance and better work status.

This scale will afford the therapist the

level of acceptance of pain by the

adolescents. An adolescent suffering

emotional numbing, the cause of the pain,

be it stress or trauma, should be accepted

and they should not struggle with attempts

to remove the pain. The therapists should

provide activities that the adolescents

could engage in as to move on with their

life endeavours rather than focus on the

pain which could generate more

devastating issues.

The CPAQ was validated by Wicksell et

al (2009) among other researchers, they

compared CPAQ with the Tampa scale of

Kinesiophobia in the treatment of pain in

an empirical study. The study investigated

the psychometric properties of the

instrument and compared its relation to

another pain assessment scale-Tampa

Scale of kinesiophobia. The result

indicated that CPAQ explained more

variance than Tampa Scale of

kinesiophobia in pain intensity, disability,

life satisfaction, and depression.

(2). Cognitive Defusion. The widely

used measure for cognitive defusion is the

Cognitive Fusion Questionnaire (CFQ). It

is a seven item scale with all the items

keyed towards cognitive fusion. In ACT,

cognitive defusion intervention tries to

detach thoughts from actions and create

psychological distance between the person

and their thoughts, memories, beliefs and

self-stories. This suggests that how we

react to mental occurrences is basically

essential. For instance, ones’ thought

should not cause one emotional pain or

distress. The adolescents should be

thought decentering, to step outside of

their mental events towards objective

stance in life. Evidence has lend support

on the reliability and validity of the CFQ

for use among people with chronic pain

(Gillanders et al, 2014)

(3). Flexible present-focused

attention: This aspect of the process is

mostly measured by questionnaires that


30

measure mindfulness. According to Feliu-

soler et al (2018), the most commonly

used is the Mindful Attention Awareness

Scale (MAAS). The scale is a 15-item one

that measures the general tendency to be

attentive to one’s experiences in daily life

ie. The level of one’s mindfulness or

mindlessness to moment-to-moment

activities. Abilities in trait mindfulness

improves psychological and physical well-

being, manifesting in autonomy, vitality

and satisfaction. The authors of this scale

have ascertained its validity and reliability

across cultures and ages in patients with

chronic pain. The adolescent of emotional

numbing should be discouraged against

dwelling in the past. They should pre-

occupy themselves with the present issues

instead of the past or even future events or

occurrences. Some of them may not be

aware of what they doing until they fall

into great problems. For instance, an

adolescent in a counselling session who

was recovering from a shock in an

accident has maintained that he did know

how his car got into the gutter. He was

neither hit by another car nor did his car

developed a fault. The scale will help

determine how the adolescents are focused

in what they are doing.

(4). Self-as a context: The Self-

Experience Questionnaire (SEQ) is the

mostly widely used assessment measure

for self in people with chronic pain. SEQ’s

validity and reliability was ascertained for

measure of self as defined within the

psychological flexibility model Yul et al

(2017). It is a 15-item questionnaire for

investigating “Self” in chronic pain. The

adolescents through the response to the

items, elucidate their level of self -

separateness from thoughts, emotions and

sensations. Self-as a context entails an

experience of taking a perspective from

which to observe one’s psychological

experience, a sense of separation from of

containing one’s psychological

experiences. Be it the case, the adolescents

should learn to a distinction between their

experiences and Self through which they

could improve their psychological

flexibility.

(5). Value: The ACT model

emphasizes on values-based action for the

treatment of chronic pain. It developed a

measure for value known as Chronic Pain

Value Inventory (CPVI), a 12-item

measure. The respondents rate the

importance of the value they hold for in

six domains of live functionalities: family,

friends, work, intimate/close interpersonal

relationships, health, and growth or

learning and their success in at living

according to them on a 5point scale.

Evidently, the greater success scores are

associated with better future functioning

(McCracken et al, 2014). The adolescents

based on their rating are expected to rate

high on the domains for vitality and

productivity irrespective of pain. If reverse

is the case they need to be drilled to place

values on the things that matter in their

lives.

(6). Committed Action: Finally the

measure for committed action. The most

widely measure on this aspect is the

Committed Action Questionnaire (CAQ).

Its reliability and validity for the treatment

of chronic pain was ascertained. It has a

version of 18 items and a version of 8-

items (CAQ-8). It assesses the construct of

committed action drawn from the

psychological flexibility model of ACT.




31

The 8-item questionnaire is rated on a

scale of 0 to 6 of how true the statements

are in commitment to one’s goal. The

items are positively keyed and the higher

the scores, the indication of being

committed to one’s goals. An adolescent

who remains committed to his/her goal

and who makes effort to reach his goals

amidst pain will function well.

The ACT as well has a specific

assessment measure for the adolescence.

Though it is not detailed as the main

CPAQ, its assessment is based only on

acceptance, the other five core processes

of ACT were not considered. The Chronic

Pain Assessment Questionnaire for

Adolescents (CPAQ-A) is a 20-item

questionnaire developed for acceptance of

pain in adolescents. It is associated with

quality of life and functional disability in

adolescents with chronic pain and

validated as having internal consistency,

convergent and predictive validity

(Connolly et al, (2019) The scale was used

by some researchers, Gauntlett-Gilbert et

al (2018), the objective of the study being:

Acceptance of pain is a predictor of pain-

related disability and treatment outcome in

adolescents with pain. They used simple

item reduction to select eight (8) (CPAQ-

A8) items from the 20-item measure to

ensure brevity and to reduce clinician and

patients’ workload in the clinical setting.

The items 1-4 elicited response on

Activity management while items 5-8 was

on Pain Willingness. The responses are

rated on a scale of 5. Where Never True

(NT) = 0, Rarely True (RT) = 1,

Sometimes True (ST) = 2, Often True

(OT) = 3 and Always True (NT) = 4

The result of their study

demonstrated sensitivity to treatment and

they found that the CPAQ-A8 produced a

suitable result to the overall model of the

20-item with four items fitting well to

each factor (activity engagement and pain

willingness).

Table1: The 8-item questionnaire for

adolescence Chronic pain

assessment (CPAQ-A8).

S/N Items NT RT ST OT AT

1 I am getting

on with my

life no matter

what the level

of my pain is.

2 My life is

going well

even though I

have chronic

pain

3 I am living a

normal life

with my

chronic pain

4 I don’t need to

concentrate on

getting rid of

my pain

5 I do things that

are important

and things that

are fun even

though I have

chronic pain

6 Keeping my

pain under

control is the

most

important

whenever am

doing

something

7 Before I can

make my real

plans, I have

to get some

control over

my pain

8 I avoid

situations

where pain

might

increase.


32

The scale will assist identify the chronic

pain adolescents who are engaging

actively in other activities irrespective of

the pains because activity engagement will

improve and foster their psychological

flexibility which aids their functionality in

life. On the other the adolescents who are

not engaging well in activities would get

some professional help to enable them

adjust. The last four items will indicate the

chronic pain adolescents who have

accepted and who have not accepted the

pain situation willingly. The latter will get

help to improve their psychological

flexibility.

Discussions

ACT is a mindfulness- process based

approach to treating emotional pain and it

has showcased that pain is unavoidable in

humans but can be accepted. Accepting

pain and engaging in activities that will

help one establish sense of self. A sense of

self that is greater than one’s thoughts and

feelings. The ACT teaches the individual

to develop observed-self which facilitates

cognitive defusion, a situation where the

clients learn neither to believe nor be

controlled by thoughts. For instance, Dahl

et al (2014) expressed that any pain-

related thoughts that tell the client to avoid

particular situation or activities can be

seen for what they are (thoughts), rather

than what they say they are (truth or

reality).ACT helps clients to create and

maintain awareness of the present

moment, identify personal and deeply

important valued life direction that will

provide natural positive reinforcement.

In ACT, struggling to avoid pain causes

more suffering to the client because it

indicates non-acceptance to what is

already there, the intensity of (the

suffering) which depends on the extent of

the clients’ fusion with thoughts and

feelings associated with the pain (Feliu-

Soler et al, (2014)).

Efficacy of ACT in the treatment of

emotional pain of adolescents which

manifests in form of emotional numbing is

not in doubt because emotional numbing

is evidence of poor emotional awareness.

Most of the sufferers use destructive

experiential avoidance and psychological

inflexibility for discomforting experiences

which worsens the situation. Teaching

them processes that promote

psychological flexibility will enhance their

well-being.

Conclusion

Emotional numbing is a serious emotional

problem that has been in the cog of the

adolescents’ development and has not

received much attention in the area of

research. Its manifestations may result

from exposure to trauma, shock, attack or

exposure to violent situations. Kerig et al

(2016) noted that emotional numbing has

implication for maladaptive outcomes in

adolescence such as delinquent behaviour.

Emotional numbing (avoidance,

detachment) blocks the adolescents’

capacity from confronting, processing and

managing emotions and experiences. The


(ACT) as a psychotherapy creates positive

awareness in them through the exposure to

core processes of ACT and which will

predispose them to psychological

flexibility and in turn aids them to

function properly in the society and

improve their interpersonal relationships.




33

Recommendations

The researchers make the following

recommendations based on the study

1. That therapists should identify

emotional numbing among the

adolescents and use the ACT model

to resolve their problems

2. That psychologists should make

further researches on emotional

numbing

3. That the in-school adolescents

should be constantly educated on

emotional awareness

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Sigida, S.T. & Masola, N.J. (2020). Diagnosis And Treatment Of Mental Illness By Vhavenda Traditional

Healers In Vhembe District, South Africa, International Journal for Psychotherapy in Africa 5(1):35-43

35

Diagnosis And Treatment Of Mental Illness By

Vhavenda Traditional Healers In Vhembe District,

South Africa

Salome Thilivhali Sigida

[email protected]

Nare Judy Masola

Department of Psychology, University of Limpopo,

South Africa

Abstract In rural African communities, traditional healers hold an esteemed and powerful position

in the diagnosis and treatment of various illnesses. They assume a significant role in

addressing the mental health care needs of individuals by offering cultural appropriate

treatment and they are easily accessible. This was a qualitative study, and specifically,

the case study method was utilised. Ten traditional healers were chosen through

purposive and snowball sampling to participate in the study. Data was collected through

semi-structured interviews and analysed using the thematic analysis method. The findings

revealed that several procedures (like throwing of bones and direct observation of

patient’s behaviours) are used to diagnose mental illness. The findings also revealed that

mental illness can be treated through the use of traditional remedies and practices (like

rituals). From the findings of the study, it can be suggested that both traditional medical

interventions and some culturally relevant psychological procedures are used to treat

mental illness. Increased cooperation between western oriented psychotherapists and

African traditional healers is therefore highly recommended.

Key words: South African traditional healers, traditional remedies, treatment, diagnosis,

mental illness.

Introduction

In different societies around the world,

culture plays an important role in

understanding how different groups

construct health and illness (Zungu, 2013).

In addition to this, every society develops

its cultural way of managing illness

(Mokgobi, 2014). In this regard, it has

been indicated by Brandt and Rozin (2013,

p.148) that, how society responds to

disease reveals its deepest cultural, social

and morals. It is, therefore worth noting

that because the attainment of good health

is intrinsically desirable; people in

different parts of the world, more

specifically people living in sub-Saharan


36

Africa utilise traditional healers for their

healthcare needs, including mental health

(James, Wardle, Steel, & Adams, 2018;

Madu, Baguma & Pritz, 1997). Moreover,

literature has shown that traditional

healers play an important role in health

care for the majority of South Africans.

Interestingly, efforts towards achieving

optimum health are as diverse as the

social, cultural, economic, mental,

spiritual, physical, and even political

circumstances of the particular individual

at any point in time (Zuma, Wight, Rochat

& Moshabela, 2016).

In South Africa, especially in

indigenous societies, it is estimated that

between 60% and 80% of South African

consult traditional healers and that these

healers are frequently consulted for mental

illness when compared to western-trained

counterparts (Puckree, Mkhize, Mgobhozi

& Lin, 2002; Truter, 2007). Thus

traditional healer’s beliefs and medicine

play an important role in the treatment of

illness, this also includes the treatment of

mental illness (Tomita, Burns, King,

Baumgartner, Davis, Mtshemla, & Susser,

2015). Interestingly, traditional healers are

geographically accessible and offer

treatment that is similar to the culture of

their patients (Burns, 2011; Tomita et al,

2015). They are the entry point for care in

many African communities (Richter,

2003; Zungu, 2013). Ross (2010), also

pointed out that the treatment of

traditional healers is also used along with

western treatment.

The various ways in which

individuals conceptualize social

circumstances reflect their fundamental

belief and perspective on the world that

gives their lives direction and motivation.

In an unforeseen manner, perception is the

source of reason for the way things are on

the planet, including speculations about

mental illness, death, misery, how human

suffering is (Nwoye, 2011). Taking into

account the assorted varieties in the

human direction across social orders and

societies, musings, thinking and methods

for knowing about individuals inside these

social orders likewise contrast from

various perspectives, particularly from the

predominant Western idea and thinking

(Yidana, 2014). It is important to note that

decisions about mental health and

wellbeing and the possible interventions

during illness episodes are often managed

by the people's belief structures (Berger &

Luckmann, 1967). In this regard,

individual and collective response to

mental illness varies and reflects pertinent

information, culture, and knowledge of

aetiology, including the accessibility of

treatment alternatives.

In some of the indigenous societies,

knowledge and thoughts on issues relating

to psychological wellbeing are supported,

taking into account mending professionals'

capacity to develop and reproduce culture

with the progression of time (Wuthnow,

James, Albert, & Edith, 1984). As

indicated by Thomas (1999), since illness

is socio-culturally constructed, the ways

people express their mental sicknesses

gives knowledge into how they see the

world just as sourcing potential

mediations. As the training proceeds, the

perspective stays genuine in abstract

credibility as it is affirmed and

reconfirmed without anyone else

comparable to the social others (Berger &

Luckmann, 1967).

Even though literature shows the

popularity of traditional healers, their roles

and competencies are often criticized and

belittle (Zuma et al., 2016). There is

abundant evidence showing that in Africa,



37

"illness representations are commonly

constructed to emphasize external and

uncontrollable supernatural factors"

(Bogart, Wagner, Galvan & Banks et al.,

2010, p.182). The importance of

recognising cultural belief systems and

practices in dealing with mental health has

been highlighted (Kubeka, 2016). In most

African cultures a core belief is that

diseases are due to a violation of cultural

taboos or witchcraft (Mufamadi & Sodi,

2010). Whilst there is evidence to suggest

that most people in rural communities

consult with traditional healers for illness,

including mental illness, there appears to

be very little research that has been done

to understand how traditional healers

diagnose and treat mental illness. Based

on the relatively fewer studies that have

been conducted on this particular subject,

the current study seeks to understand how

traditional healers diagnose and treat

mental illness at Vhembe District in

Limpopo Province, South Africa.

Traditional healers as Spiritual and

healing Specialists

An African traditional healer is

characterized by the World Health

Organization as an "individual who is perceived by

the community in which he or

she lives as competent to provide

health care by using vegetable,

animal and mineral substances

and other methods based on the

social, cultural and religious

background, as well as on the

knowledge, attitude and beliefs

that are prevalent in the

community regarding physical,

mental and social well-being and

the causation of disease and

disability" (WHO, 2002).

Thus, traditional healing is an effort to

increase comprehension or vision into an

inquiry or circumstance in a given

network of sick individuals. It is a

methodical procedure of sorting out what

gives off an impression of being

disengaged aspects of presence with the

end goal that they give understanding into

an issue close by and an answer thereof

(Sambe, Abanyam, & Lorkyaa, 2013).

Besides, this recuperating alludes to a lot

of methodologies including the specialty

of utilising custom or service to procure

data from the soul world to anticipate the

future and mend the psychological sick

person. In some indigenous networks, this

training is the principle methods for

spotting purportedly profound issues and

endorsing cures (Azongo & Abdulai,

2014). Customary healers who are thought

to have otherworldly powers can

recognize the ills influencing individuals

and society and recommend cures from

the gods and imperceptible world.

In situations where afflictions manifest

individually, useful separation gets

worrying because of the arrangement of

causal spirits as per the external

manifestation of afflictions. In this

manner, depending on the society and the

current community, different meanings

may be added to the same condition. As a

result, diagnosis and course of action in

such situations are often decided through

divination. Subsequently, finding and

strategy in such circumstances are

frequently chosen through divination.

While clinical specialists use machines to

decide the reason for sickness, traditional

healers utilize divination to decide the

reason for tribulations and decide the

treatment. In the cosmology of the nearby

individuals, divination assumes a focal job

in lay meetings to decide the correct


38

treatment or referral for therapy (Azongo

& Abdulai, 2014).

Overseeing mental illnesses of this

nature concerning healers and the

tormented exposes two significant

perceptions drawn from the recuperating

rehearses. The primary issue includes

dependence on soothsayers to figure out

which soul is liable for a specific issue.

Under this condition, an assortment of

otherworldly elements might be tended to

thus use the profound lab to decide the

soul liable for the pain (Sambe, Abanyam,

& Lorkyaa, 2013). Per the cosmological

set up of the individuals, this is the main

way they can give the correct antitoxin.

The subsequent perception includes the

demonstration of distinguishing proof of

the reason for the sickness and the

mediations to be attempted. Although

individuals would frequently contend that

the training establishes a post hoc

appraisal in that it is simply after an

improvement in the state of the patient that

a connection between what was at first

hypothesized can be certified, one needs to

endure at the top of the priority list that the

training is a piece of their believability

structure and its proceeded with training

makes it genuine.

Research Methods

Study design: A qualitative research

approach was best suited for this study as

the focus was on understanding the

diagnosis and treatment of mental illness

by Vhavenda traditional healers.

Setting: The sample was recruited from

Vhembe District in Limpopo Province

South Africa.

Study population and sampling

strategy: In total 10 participants (8 males

and 2 females), aged between 35 years and

60 years were selected through purposive

and snowball sampling to participate in

the study

Data collection: Data for this study was

collected through the use of in-depth semi-

structured one-to-one interviews. The

interviews were conducted in Tshivenda a

predominant language used by the

participants. An interview guide was used

to guide the discussions.

Data analysis: Data was analysed through

thematic data analysis.

Ethical considerations: Before

conducting the study, ethical clearance

was requested from The University of

Limpopo's Research Ethics Committee

and also from the Vhembe Traditional

Healers Association. After obtaining

ethical approval and permission, the

researchers commenced with data

collection. The participants were assured

of privacy and confidentiality.

Results and Discussion

From the findings of the study two themes

emerged from data analysis; those are, (a)

the diagnosis of mental illness and (b) the

treatment of mental illness. The two

themes are presented and discussed below

in line with the previous findings.

Diagnosis of mental illness

Traditional healers use several procedures

to diagnose mental illness. For example,

the use of mufuvha or ṱhangu (divination

bones) are common procedures that the

traditional healers use to diagnose mental

illness.

"…when we talk about mental illness to us

as ṅanga (traditional healers), it is when



39

we observe in this manner, firstly we

throw bones and determine if it is related

to mental illness" [Participant 3]

"As ṅanga (traditional healers), we see

through our bones that a person has a

mental illness and what caused that

mental illness."[Participant 6]

These findings are consistent with the

findings of Buhrmann (1984) and

Ngubane (1977), they reported that

divination bones are used in other parts of

Africa to diagnose illnesses. It was further

pointed out by traditional healers in this

study that mufuvha and thangu (divination

bones) not only help to diagnose mental

illness, they also help to inform traditional

healers what caused the mental illness and

the type of mental illness the patient might

have.

"So we take mufuvha or ṱhangu

[divination bones] and throw them down

and see what kind of mental illness the

person has."[Participant 9]

Participants also mentioned that they can

see that the person has mental illness

through their behaviour, they further

pointed out that the behaviour of the

person with mental illness is different

from the behaviour of other people. The

following extracts express this notion:

"We can also see that a person has mental

illness by his/her behaviour"[Participant

6] "Ehh…that is why I mentioned that why I

mentioned that sometimes you will see by

action…."[Participant 8]

"Mental illness is when a person is

behaving unusually. These things

that…ehh…things that a normal person

cannot do". [Participant 6]

"Maybe when we know that a person must

live or think or his behaviour is different

from other people"[Participant 7]

It could be suggested that mental illness is

understood by participants as a condition

that has some behavioural manifestations

that are not considered normal within their

social context. In other words, mental

illness is understood and described in the

context of the socio-cultural context of the

individual affected. The participants went

further and reported some of the

behaviours that are not considered to be

normal. These findings are supported by

Mufamadi (2001), Mzimkulu and Simbayi

(2006), Robertson (2006), who indicated

that in many parts of Africa, mental illness

is understood to be present when an

individual shows behavioural signs and

symptoms that are perceived to deviate

from social norms. The participants also

described some of the behaviours that are

not considered normal:

“mental illness is…eh...like when you see

a person playing with their fingers,

pointing here and there, laughing alone,

and also collecting dirty

things"[Participant 8]

"From there the person will start talking

alone or calling someone's name, or

saying "I'm coming now", or "I didn't take

everything" or "I will come tomorrow"

then you will know that that person has a

mental illness"[Participant 7]

The description of mental illness

according to traditional healers

interviewed in the study can be said to be

linked to how mental illness is

conceptualised in the academic literature.

The American Psychiatric Association

(2013) in particular, conceptualises mental

illness as being a manifestation of a


40

behavioural, psychological or biological

dysfunction in the individual.

Treatment of mental illness

Participants considered mental illness to

be a condition that can be treated through

traditional remedies and practices. The

following extracts further express this

understanding:

"Yes, they can be cured by u aravhedziwa

dzi tsemo (steaming) and those things will

come out and they will live a normal life

just like everyone."[Participant 1]

"That person will be given some remedy to

inhale and will be given some soft

porridge and he will eat and be

healed"[Participant 6]

Previous studies reported that traditional

healers use different herbs to treat illness

(Dlamini, 2006). It is estimated that there

are over 300 medicinal plants that are used

by traditional healers to treat illness

(Rankoana, 2016; Truter, 2007). These

findings are similar to Hadebe (1986) who

reported that some traditional healers'

intervention strategies include the use of

namesis, anema, steaming, taking

medicine nasally and vaccination. Dlamini

(2006) also reported that herbal medicine

is the most commonly used treatment

method by traditional healers. Besides

giving herbs to patients for the treatment

of mental illness, it was also reported by

the participants that certain curative rituals

are performed to treat mental illness.

"So when a person has been done such

things…it means that we must make some

herbs and a wristlet and some water and

he will go and call his ancestors under a

big tree. And tell them to stay with him

and those things that were cast to him to

remain there. After that, he must bath his

body and that means those things are

gone." [Participant 4]

The above extract indicates that traditional

healing not only aims at achieving

physical treatment purposes but also the

psycho-spiritual treatment (United Nations

Joint Programme on HIV/AIDS, 2006).

One participant reported that traditional

healers acknowledge and recognise the

role that can be played by other role

players in mental health promotion as

reflected in the extract below:

"But if such a person seeks help from

people who can counsel him, people like

pastors and fellow Christians such person

can improve without any need for

medicine."[Participant 3]

This means when traditional healers can

see that they are unable to assist the

patient in seeking the treatment they then

refer or advise their patients to go

religious healers such as pastors.

Therefore, there is a need for closer

cooperation between indigenous healers

and other role players such as western

trained health care practitioners and

spiritual/faith healers.

Conclusion

In conclusion, the results of the study

show that traditional healers occupy

multiple roles, that is the role they play

goes beyond healing using herbs. They

also perform other healing practice such as

the performance of curative rituals. Both

traditional medical interventions and some

culturally relevant psychological

procedures are used to treat mental illness

by traditional healers. This suggests that

traditional healers play an important role



41

in medicine and psychotherapy at the

same time in their communities. The

authors therefore recommend increased

cooperation between western oriented

psychotherapists and African traditional

healers.

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44

Psychotherapy Training In Africa South Of Sahara

Prof. Sylvester Ntomchukwu Madu (D.Sc. Psych., Innsbruck)


Chukwuemeka Odumegwu Ojukwu University, Nigeria.

[email protected].

Abstract The scarcity of properly trained psychotherapists in Africa south of Sahara on the one

hand, and the increasing incidence of emotional problems resulting from poverty and

underdevelopment, child abuse and neglect, trauma resulting from different forms of

crime and abuse of human dignity, insecurity problems like terrorism, insurgency,

kidnapping and hijacking, increasing stress-provoking lifestyles, tribal and national wars

and conflicts, westernization and globalisation, and the HIV/AIDS pandemic, different

forms of cancer, and all sorts of abuse of human dignity on the other hand, call for

urgent need for establishment of institutions for formal psychotherapy training in Africa.

This paper highlights not only the above lacuna but also describes the important aspects

of psychotherapy training in the Western world. It went further to describe current efforts

being made (with Nigeria as an example) to establish a world-class tertiary institution,

the School of Psychotherapy and Health Sciences (SPHS), which takes it lead from

modern psychotherapy training programmes in Austria. The SPHS in Nigeria is affiliated

to Sigmund Freud University, Vienna, Austria. Students from SPHS are trained by

qualified staff from Nigeria and from Austria, and they are properly equipped with

psychotherapeutic skills that will enable them to address the emotional problems of

Africans, in which ever work-setting they find themselves. They are also registerable with

the World Council for Psychotherapy and with other psychotherapy organisations world-

wide.

Key words: Psychotherapy Training, Africa, South of Sahara

Introduction

The World Council for Psychotherapy

African Chapter (WCP-AC) was

inaugurated at its first Conference in

Kampala, Uganda in 1997. The second

WCP-AC Conference took place in

Polokwane, South /Africa, in 1998. The

third, fourth, and fifth Conferences also

took place in Polokwane (RSA) in 2000,

2004, and 2008 respectively. The sixth

one took place in Kampala, Uganda in

2010. In 2014, we hosted the seventh

World Congress in Durban, South Africa.

The seventh WCP-AC Conference is now

taking place in 2020 in Johannesburg,

South Africa.

Our focus during the conferences were:

1. To make Awareness campaign about

psychotherapy.

Madu, S.N. (2020). Psychotherapy Training in Africa South of Sahara,


45

2. To sensitize African on the need for

Psychotherapy.

3. To establish a platform for

discussion among African

Psychotherapists, including national

associations.

4. To publish books in the area of

psychotherapy in Africa; and so far,

we published 8 books in the area of

Psychotherapy in Africa.

As successful as the conferences and

publications were, there is still a vacuum

we need to fill, and they are:

• Formal Training of Professional

Psychotherapists in Africa.

• Formal Training in Psychotherapy

Science.

• Establishment of Scientific Journals

for Psychotherapy in Africa.

In most black African countries south of

Sahara, the challenges posed by poverty

and underdevelopment, child abuse and

neglect, trauma resulting from different

forms of crime and abuse of human

dignity, insecurity problems like terrorism,

insurgency, militancy, kidnapping and





forms of cancer, are enormous (Madu,

2009; Madu, Baguma & Pritz, 1996;

Madu, 2003). The emotional aspects of

those problems need to be addressed by

well-trained psychotherapists, using

appropriate psychotherapeutic methods

that would appeal to the African clients.

One may consider psychotherapy to be

that process that enables people to express

their feelings in a protected environment,

to a person well-trained to listen with

understanding and compassion. The

process helps people reconnect with – and

honour – their roots, affirm their identity,

and develop healthy ways of being in the

world (Pritz, Kuriansky, Nemeth,

Mulcahy, Walsh & Madu, 2005). By

restoring an individual's human dignity,

and personal and cultural identity through

psychotherapy, the person can regain

emotional resilience and achieve

sustainable mental health to overcome fear

and deal effectively with personal

suffering and trauma in the world.

Surely, we have the likes of Sigmund

Freud and Carl Rogers in Africa, but often

we run short of African-originated and

integrated forms of psychotherapy to be

used to address our emotional problems. It

is a challenge for us to know exactly how

to adapt the different western forms of

psychotherapy to our African situations.

Some African traditional and religious

faith healers, have been said to be

managing many of the physical as well as

emotional problems of our people (Ebigbo

& Tyodzua, 1982; Madu, 1989; Madu &

Adebayo, 1996; Madu et al. 1997; Madu

& Ohaeri, 1989; Peltzer, 1995). In spite of

that, how we (the western-oriented

African psychotherapists) should relate to

them professionally, is still a matter of

debate (Madu, Baguma & Pritz, 1998,

1999, 2000; Madu & Govender, 2005).

The above are some of the challenges that

have generated intensive dialogue among

African psychologists and

psychotherapists.

Types of African psychotherapy clients:

According to Ebigbo and Ihezue (1981),

there are three types of clients (in black

Africa) - the traditional, the mixed, and


46

the western oriented types. The

traditional type grew up and spent most

of his or her formative years in rural areas.

Some of them move to the townships at a

later stage in their lives. Their world

image is analogical, magical and pictorial.

They always go to traditional healers

when they have health problems

(including emotional problems).

The intermediate mixed type was either

born and bred in the rural areas but moved

to a city to work and live as an adult or

grew up in a city but continued to have a

very strong tie to the rural areas and their

customs. This type is a compendium of

two cultural systems (the traditional and

the western-oriented), because he or she

has the tendency of making use of the two

methods of healing (traditional and

western) at the same time (concurrently).

Some of them also consult the religious

faith healers. It is worth noting here that

the majority (about 80%) of the black

African population today would fall

(within either the traditional or) the mixed

types (compare also with Peltzer, 1991;

Pennymon, 2004). African well-trained

psychotherapists would be particularly

relevant to this group of clients (the mixed

type).

Most of the western-oriented type of

clients were born and bred in the

townships. They are educated, mostly

Christians or Moslems, they come from

monogamous families and their parents

are also educated. From childhood, they

have always been treated in hospitals and

have never thought of going to a

traditional healer for treatment. The

western forms of psychotherapy would

appeal to this group of clients.

The above complexity in types of clients

found in Africa makes it imperative that

special training programmes need to be

organised for psychotherapists in Africa.

The psychotherapists trained in Africa

should be well-equipped to attend to any

of the types of clients found in Africa.

Some African-Originated Forms of

Psychotherapy

The problems psychotherapists are

encountering in trying to apply western

oriented psychotherapy in an African

culture have also been extensively

reported (Madu, 1991; Hanneke, 1989;

Oladimeji, 1988). Happily, some of the

western trained psychotherapists have

gone a step further in trying to develop

some Africa-based forms of

psychotherapy. Three examples of such

forms of psychotherapy are the Ubuntu

therapy (Nefale& van Dyk, 2003; Louw &

Madu, 2004), the "Meseron” Therapy

(Awaritefe, 1995, 1997, 2004; Ofovwe,

2005), the "Harmony Restoration

Therapy" (Ebigbo, Oluka, Ezenwa,

Obidigbo, Okwaraji, 1995) and the

Culture-Centred Psychotherapy (CCP)

(Madu, 2013). Each of these forms of

therapy has some aspects of the African

cultures, values, and belief systems as its

take-off-base.

It is however an unfortunate reality that no

full training programme has been

developed for any of the African-

originated forms of psychotherapy. Also,

no formal full training programme for any

form of psychotherapy (whether western

or African) is available in most countries

of Africa South of Sahara. The few

psychotherapists who were trained

overseas who came back and settle in

Africa, are overwhelmed with work as



47

lecturers teaching clinical, counselling, or

other branches of psychology in

institutions of higher learning. Those

psychology post-graduate programmes

offer students only a few modules in

psychotherapy. Clinical psychology

students, for example, therefore graduate

being experts in psychopathology and

psycho-diagnostics; but become

handicapped when it comes to

psychotherapy. When it comes to

treatment, cure or management of

psychological problems, they become

helpless-helpers. The enormous need for

fully trained psychotherapists who would

be at the grass-root addressing the

emotional problems associated with

poverty and underdevelopment, child

abuse and neglect, trauma resulting from

different forms of crime and abuse of

human dignity, insecurity problems like

terrorism, insurgency, kidnapping and





forms of cancer, remains far-fetched. This

paper therefore throws some light on a

way forward from this dilemma by

highlighting some efforts being made, in

collaboration with some of our colleagues

overseas, to set up a training institution for

psychotherapy, using Nigeria as an

example.

Psychotherapy training in the Western

world

In Europe and America, psychotherapy

training is a rigorous training that lasts for

many years. It is often organised by the

respective professional bodies in charge of

licensing the graduants from the different

schools of psychotherapy (Psychoanalysis,

Behaviour therapy, Client-Centred

Psychotherapy, Gestalt therapy, Logo

therapy, to mention but only a few). To

qualify to be admitted into any of the

schools of thought, in most cases, one

must have acquired a master’s degree in a

relevant field of study (e.g., clinical

psychology, counselling psychology).

Each psychotherapy training is often

divided into three segments/phases: 1.

Theoretical phase. 2. Phase of Self-

experience of psychotherapy

(Eigentherapie Phase). 3. Practical phase.

During the theoretical part, the trainee is

exposed to many theories and publications

in the specific psychotherapy school of

thought. Thus, the trainee acquaints

him/herself with the thoughts of the

father-founders of the school of thought as

well as with the research findings of

modern psychotherapists in the same

school of thought. Series of seminars and

workshops are organised for the trainees

to ensure proper internalisation of the

school of thought. During the second stage

of the training, the trainees are meant to

experience themselves psychotherapy

sessions as clients. They are to go to an

approved renowned psychotherapist of the

same school of thought as clients for

psychotherapy. The reason behind this

(compulsory) experience of psychotherapy

as clients is to ensure that they do not later

become helpless helpers. This self-

experience of psychotherapy offers the

trainees the opportunity to deal with and

properly address shackles of

psychopathology in them which may later

be a hindrance, an intervening variable, or

a source of counter-transference, when

they start to practice as therapists. Even,

not having a problem can be a problem.

Until the candidate is certified by the

psychotherapist that he/she has successful


48

gone through this phase, he/she may not

move on to the next phase which is real

practical training phase. The therapy

period may last for between 6 months and

many years. During the third phase, the

candidate is then allowed under close

mentoring and supervision to handle real

clients. The sessions conducted are tape-

recorded or video-taped and supervised by

his/her trainers. Many hours of successful

sessions of psychotherapy must be

demonstrated before the candidate is

certified as a psychotherapist of the

respective school of thought.

The whole process of going through the

three phases of training takes years (e.g.

minimum of 4 years for Client-centred

therapy, minimum of 5 years for

Behaviour therapy, and minimum of 6

years for Psychoanalysis). Moreover, it is

very cost-intensive. In addition to the

training, one may still have to undergo

certain forms of application and scrutiny

before he/she is given the license to

practice as a “Psychotherapist” in the

country/continent/world. For example, the

World Council for Psychotherapy which is

based in Vienna, Austria, demands such

before one is given a certificate as a

“World Psychotherapist”.

Some of the founders of the World

Council for Psychotherapy (WCP) have

taken the training of psychotherapists a

new direction. Before the 1990s, most of

the training of psychotherapists were

organised by the different professional

bodies and outside the university system.

All forms of psychotherapy training had

three phases: the theoretical phase, the

self-experience phase, and the practical

phase. But in the mid-1990s, motivated by

the need to make psychotherapy more

scientific, and thereby also research based,

a university was established in Austria,

with a mandate to train students in

Psychotherapy Science and related

disciplines. Since then, one could study

psychotherapy science at Diploma, B.Sc.,

M.Sc., and PhD levels in Austria. These

training programmes brought a 4th

component to the training of

psychotherapist: the Research Component.

Following this model, a trainee in

Psychotherapy Science must now go

through relevant theories, self-experience

of psychotherapy, practicals, and research,

thereby also widening their score for

future profession.

Psychotherapy training in Africa South

of Sahara, using Nigeria as an example

As already indicated above, to date, no full

formal psychotherapy training programme

exist in most part of Africa South of

Sahara (including Nigeria) (to the

knowledge of the author) (see also Peltzer

et al, 1989). Therefore, in collaboration

with the founders of the World Council for

Psychotherapy and the Sigmund Freud

University, Vienna, Austria, efforts are

being made to establish a training

institution in Nigeria which will have

Psychotherapy Science as a niche area.



49

SCHOOL OF PSYCHOTHERAPY AND HEALTH SCIENCES, OKIJA, NIGERIA

Web address: www.sphs.com.ng; Email: [email protected];

[email protected]. Mobil: +234-9063927862.

The School for Psychotherapy and Health

Sciences (SPHS) started with Internship,

Certificate, Diploma, and post-graduate

programmes in the area of psychotherapy

Science. These programmes took to the

model that ensures well-grounding in

relevant theories, self-experience of

psychotherapy, practicals, and research.

The school also gives the trainees the

opportunity of choosing to be trained with

emphasis on any of the major western

psychotherapy schools of thought (e.g.

Client-Centred therapy, Psychoanalysis,

Behaviour therapy, Logo therapy, etc.), or

on any of the afore-mentioned African

originated forms of psychotherapy (e.g.,

Harmony Restoration therapy, Meseron

Therapy, Ubuntu Therapy, or Culture-

Centred Psychotherapy).

The Brand of Psychotherapy

The School for Psychotherapy and Health

Sciences (SPHS) started in 2016 with

Internship and Certificate programmes for

post-graduate students. These programmes

took to the model that ensures well-

grounding in relevant theories, self-





50

experience of psychotherapy, practicals,

and research.

The school gives the trainees the

opportunity of being trained in in a form

of Technical Eclectic Psychotherapy with

Client-Centred therapy as its bedrock, and

then Rational Behaviour Emotive therapy,

Solution Focused Therapy, and one of the

afore-mentioned African originated forms

of psychotherapy (e.g., Harmony

Restoration therapy, Meseron Therapy).

Figure 1: Technical Eclecticism with Client-Centred Psychotherapy Theoretical

Framework

Graduants from the school have the

opportunity to continue their postgraduate

studies in Austria. They can also register

with the World Council for Psychotherapy

(nationally, Africa-wide, and globally).

They will be well-equipped to address the



51

emotional problems of our people, no

matter the type of client that comes for

psychotherapy, and no matter whether the

clients are in hospitals/clinics, refugee

camps, rehabilitation centres, or in a

setting of private practice.

So far, the School of Psychotherapy and

Health Sciences, Nigeria has:

– Trained about 33 students in

different programmes of

psychotherapy.

– Organised 4 National Conferences in

the area of Psychotherapy.

– Published 4 volumes of the

International Journal for


Conclusion

Haven shown that there is scarcity of

properly trained psychotherapists in Africa

South of Sahara on the one hand, and that

there is increasing incidence of emotional

problems resulting from insurgency,

terrorism, westernisation, urbanisation,

stress-provoking life-styles, criminality

and all sorts of abuse of human dignity on

the other hand, we hereby call for call for

urgent need to establishment of

institutions for formal psychotherapy

training in Africa. The establishment of

the School of Psychotherapy and Health

Sciences (SPHS), which takes it lead from

modern psychotherapy training

programmes in Austria, is a move in the

right direction. Students from the

institutions should be properly equipped

with psychotherapeutic skills that will

enable them to address the emotional

problems of Africans, in whichever work-

setting they find themselves. After

completing a stage of study, they should

also have the opportunity of continuing

their training in Austria.

Recommendations

Based on the success experience at SPHS,

I recommend the following:

1. Establishment of more institutions

that focus on training Africans in

the area of psychotherapy is key to

development of psychotherapy in

Africa.

2. Organisation of Psychotherapy

Conferences is also crucial. We

need to tell our own story by

ourselves.

3. Publishing of more journals that

focus on psychotherapy in Arica

would give us for cross-pollination

of ideas in the area of

psychotherapy in Africa.

References

Awaritefe A. (1995). Meseron therapy. A

paper presented at the first national

conference on the practice of

psychotherapy in Nigeria held at the

Nigerian Institute for International

Affairs, Victoria island, Lagos, 6th –

9th November.

Awaritefe A. (1997). Meseron therapy in

the treatment of depression. A paper

presented at the National

Conference/Workshop of the

Nigerian Society for psychotherapy,

University of Calabar teaching

Hospital, Calabar, Nigeria.

Awaritefe A. (2004): Meseron therapy in

the management of Anorexia

Nervosa. Nigeria Journal of

Clinical and Counseling Psychology,

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54

Post-Traumatic Stress Disorder And Depression In

Personnel Of Nigeria Police Force:

Implications For Psychotherapy

Chioma Ihuoma Igboegwu

18011 Pomelo Lane, Pflugerville, Texas 78660, USA.

[email protected]

Abstract Psychological disorders associated with combat operations among active duty military

and police personnel have become one of the most serious issues compelling the

increasing attention of scholars in traumatic stress studies, psychology, psychiatry,

contemporary medicine, human development, military and police administrators. Most of

the research investigation on this insidious mental health crisis has, however, been

reported in military populations more than in police personnel. In addition, very few

studies have examined the prevalence of post-traumatic stress disorder and depression in

Nigeria and the role of combat deployment on the manifestation of PTSD symptoms

among personnel of the Nigeria Police Force. The purpose of the current article is to

summarize and discuss the current empirical research on the prevalence of PTSD and

depression in personnel of Nigeria Police Force, using cohorts from Federal Capital

Territory, Abuja (FCT-Abuja); Abia, Benue and Lagos states, Nigeria, who returned

from counter terrorism, insurgency operations and other combat duties, and the impact

of combat deployment on PTSD symptoms manifestation in the cohort. The article, also,

highlights implications of the research findings for psychotherapy as well as recommends

a holistic psychological model, the Three-Dimensional Psychological Intervention

Strategy (3-DPIS) Model, integrating psychological science, art and culture in

psychotherapy, to address the identified mental health crisis.

Key words: Post-traumatic stress disorder, depression, police, psychotherapy, Nigeria.

Introduction Pervasive and unrelenting violence,

including terrorism, insurgency and

banditry, threatens the safety and security

of the people of Nigeria, their present-day

survival and collective future. This tragic

crisis has become one of the most serious

issues compelling the increasing attention

of scholars in traumatic stress studies,

psychology, psychiatry, contemporary

medicine, human development, military

and police administrators. The unrelenting

violence and multiple critical incident

stressors are being unleashed in various

communities, farms and forests in Nigeria

by armed herds men, and Boko Haram, a

jihadist militant organization and Islamic

State’s West Africa Province affiliated to

Igboegwu, C.I. (2020). Post-Traumatic Stress Disorder and Depression in Personnel of Nigeria Police

Force: Implications for Psychotherapy, International Journal for Psychotherapy in Africa 5(1):54-69

55

Islamic State of Iraq and the Levant (ISIL)

and ALQEIDA in the Middle East. Their

atrocities include the beheading of

Christians and security agents, abduction

and forced recruitment of under-age boys;

large-scale murders, conquests of territory,

bombing of churches, and mosques they

consider deficient in their type of Islamic

ideology; unexpected violet attacks of

villages, military, prison and police

facilities during the day and at night, mass

execution of villagers, abduction, rape and

enslavement of women and girls.

This has led to the increasing

deployment of personnel of Nigeria Police

Force to arrest the crisis being unleashed

in the various locations by the terrorists,

insurgents and criminal groups. Policing is

associated with exposure to traumatic,

violent and horrific events with an

increased risk for an insidious mental

health crisis, such as post-traumatic stress

disorder (PTSD) and co-morbidity of

depression (Marchard, Boyer, Nadeau &

Martin, 2013). McCafferty, Godofredo,

Domingo, and McCafferety (1990) also

explained that police personnel experience

similar levels of stress as people engaged

in military combat and therefore suffer the

adverse mental health impact of armed

conflict. Exposure to traumatic events in

combat operations may account for as

many as 50 percent of the casualties in

armed conflict-torn environment and

subsequent lead to the development of

PTSD (Mareth & Brooker, 1985). There

are multiple critical incident stressors

associated with policing present-day

Nigeria.

Overwhelming research evidence

shows that the prevalence rate for PTSD

and co-occurring disorders, such as

depression, among trauma survivors is

higher among those “at risk” due to their

history of traumatic incident exposure

(Ameh, Kazeem, Abdulkarim & Olasupo

(2014 ). The level of traumatic stress

connected with defeating criminal and

terrorist networks, and being involved in

war and violent conflicts can be alarming,

socially, morally destructive and

damaging to physical and mental

wellbeing (Dietz, 2004).

The psychological burden associated

with combat exposure is therefore a major

concern to military and police authorities

because of the considerable disability and

co-morbidity of depression associated

with PTSD (Kessler, 2000). The insidious

mental health crisis has adverse

implications both for the police personnel

affected, for the employer, and for society

in general. PTSD and depression in police

and military populations predispose them

to excessive use of force, alcoholism,

substance abuse, divorce, domestic

violence, violations of human rights and

international humanitarian laws, including

mass executions and torture (Amnesty

international, 2008; Marchard, Boyer,

Nadeau & Martin, 2013). It also has

adverse implications for public safety and

the security for police personnel,

communities into which they are

deployed, their families and the

psychological development of their

children (Igboegwu, 2019; Marchard,

Boyer, Nadeau & Martin, 2013; Van der

Kolk, Spinazzola & Pelcovitz, 2005;).

Chae and Boyle (2013) also linked the

increasing incidents of suicidal behavior in

the police population to those who suffer

from PTSD. While O’Hara, Violanti,

Levenson, and Clark (2013) points out that

suicide in the police population is not

openly discussed in police culture because

police officers perceive police suicide as

dishonorable to the profession. Patients

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3785135/#R34


56

with diagnosed PTSD may also have co-

morbid psychological disorders, such as

depression (MDD), substance abuse and

addictions (Javidi & Yadollahie, 2012).

Koenen, Harley, Lyons, Wolfe, Simpson

and Goldberg (2002) explained that MDD

increases the vulnerability for the later

development of PTSD. While Breslau,

Davis, Peterson and Schultz, (2000)

revealed that PTSD was a risk factor for

later depression.

According to World Bank (2018), 22

per cent of Nigerians suffer from chronic

depression. Duckers, Alisic and Brewin

(2016) however observed the dearth of

information on PTSD in Nigeria, due to

the wide spread stigma and discrimination

associated with mental illness in the

country. Ohaeri and Jegede (1991) also

revealed that depression tends to mask

itself in somatic symptoms among

Africans, which may explain why it is also

under-diagnosed or under- recognized in

Nigeria. Depression has been found to be

the strongest single risk factor for

attempted or completed suicides (WHO,

2017). Depression and PTSD are

predictive of violence and suicides (WHO,

2017).

Despite adverse health and

security impact (Pacella, Hruska, &

Delahanty, 2013; WHO, 2017), very few

studies have examined co-morbidity of

PTSD and depression, especially in

Nigeria (Alisic & Brewin (2016). Only

prevalence rates of the disorders have

been reported with little information on

their predictors in police population. Thus,

the urgent need for theoretical models for

the understanding of PTSD and depression

in active duty personnel of Nigeria Police

Force in order to bridge the research gap

and respond to their mental health needs.

The present study therefore examined the

prevalence of PTSD and depression

among Nigeria police personnel in Federal

Capital Territory, Abuja (FCT-Abuja);

Abia, Benue and Lagos states, Nigeria,

who returned from counter terrorism,

insurgency operations and other combat

duties, and the impact of combat

deployment on PTSD symptoms

manifestation in the cohort, and its

implications for psychotherapy in Nigeria.

Research Questions

The following research questions were

raised:

1. What are the patterns of

Posttraumatic Stress Disorder

(PTSD) and Depression symptoms

among personnel of the Nigeria

Police Force?

2. How would combat deployment

bring about PTSD symptoms among

personnel of the Nigeria Police

Force?

Specific Objectives of the Study

1. To assess the prevalence of PTSD

and Depression among personnel of

the Nigeria Police Force

2. To examine the role of combat

deployment in the manifestation of

PTSD symptoms among personnel

of the Nigeria Police Force.

Relevance of the Study

It is anticipated that the outcomes of the

study will:

1. Provide information on the

prevalence of PTSD and Depression

among personnel of the Nigeria

Police Force

2. Enable authorities of the Nigeria

Police Force to identify the mental

health needs of its personnel who are

exposed to combat operations

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734407/#R10



57

3. Provide indicators for policy

formulation on psychological and

mental health services for personnel

of Nigeria Police Force.

4. Throw light on the implications of

the findings on psychotherapy in

Nigeria.

In the research study, the following

hypotheses were stated

1. There will be a higher prevalence of

PTSD and Depression symptoms

among junior than senior rank

personnel of the Nigeria Police

Force

2. There will be a relationship between

duration of combat duty deployment

and the prevalence of Post-traumatic

Stress Disorder

Scope of the Study The study was restricted to the Counter

Terrorism Unit, K9 (Dog) Unit, Special

Protection Unit (SPU), and Mobile Police

Force (MPF) at the Nigeria Police Force

Headquarters, Abuja; Benue, Abia and

Lagos states, Nigeria. The locations were

selected because pre deployment briefing

and training of police personnel for

combat assignment duties are held at the

Police Headquarters, Abuja, Nigeria. The

selection of research participants was

specific to returnees from counter

insurgency, terrorism, militancy

operations and mediation in election

violence in trouble spots across the

country.

Method

The research was a prospective study of

180 police personnel with age range 25-59

years from the Counter Terrorism, Police

Mobile Force, Special Protection and Dog

Units of the Nigeria Police Force. 70.7%

of the research participants had Senior

Secondary Eduction (SSCE) level, while

28.3% of them had tertiary level of

education; 73.9% of the cohort were junior

rank, while 26.1% of them were senior

rank; 30.6% of them had Boko Haram

violent attacks, while 22.8% of them had

militants violent attacks, among other

forms of critical incident exposure. Their

period of combat deployment ranged from

1-3 months, 4-6 months, and 7 months and

above.

Prior to the research study, the

validation of the Posttraumatic Stress

Disorder Checklist-Military Version

(PCL-M) was undertaken. The Beck

Depression Inventory (BDI) is already

being used in research in Nigeria. I chose

to validate the PCL-M to enable me screen

for PTSD in the Nigeria Police population.

The PCL-M was found reliable with

Cronbach’s Alpha reliability Coefficient

of .833. Once validated the PCL-M was

adapted for use in the Nigeria police

personnel with a new name, Post-

traumatic Stress Disorder Checklist,

Military and Police Version (PCL-MP).

Ethical approval was given by

Nigerian Psychological Association

(NPA) to justify seeking permission from

the Inspector-General of Police, Nigeria.

When approval was granted, I commenced

the selection of research participants in the

various police formations, namely, the

Nigeria Police Headquarters (NPQ),

Abuja, Benue, Abia and Lagos States to

select participants. Voluntary informed

consent was sought and given.


58

Result

Table 1: Prevalence of PTSD and Depression among Personnel of Nigeria Police

Force

Independent Variables

PTSD Depression

PTSD - PTSD + Depression - Depression +

N % N % N % N %

Age: a. 25-34 years 30 50.8 29 49.2 42 71.2 17 28.8

b. 35-44 years 54 60.7 35 39.3 59 66.3 30 33.7

c. 45-54 years 22 68.8 10 31.2 28 87.5 4 12.5

Total 106 58.9 74 41.1 129 71.7 51 28.3

Critical Incidents

a. None

33

18.3

9

5.0

33

18.3

9

5.0

b. Boko Haram Violence 29 16.1 26 14.4 38 21.1 17 9.4

c Death of Colleagues 12 6.7 13 7.2 16 8.9 9 5.0

d. Militant Attacks 23 12.8 18 10.0 29 16.1 12 6.7

e. Election Violence 6 3.3 1 0.6 6 3.3 1 0.6

f. Robbery Attacks 1 0.6 7 3.9 5 2.8 3 1.7

g. Accident 2 1.1 0 0.0 2 1.1 0 0.0

Total 106 58.9 74 41.1 129 71.7 51 28.3

Duration of Combat Deployment:

No combat

8

47.1

9

52.9

11

64.7

6

35.3

b. 1-3 Months 40 69.0 18 31.0 41 70.7 17 29.3

c. 4-6 Months 39 31.0 12 28.6 52 82.5 11 17.5

d. 7 Months + 19 45.2 23 54.8 25 59.5 17 40.5

Total 106 58.9 74 41.1 129 71.7 51 28.3

Table 1 shows the prevalence of PTSD

and Depression according to age groups,

life event and duration of combat

deployment among the Nigeria Police

personnel aged 25-34 years (n= 29), 35-44

years (n=35) and 45-54 years (n=10) and

revealed the PTSD prevalence rate to be

49.2%, 39.3% and 31.2%, respectively.

Also, among the Nigeria police personnel

aged 25-34 years (n= 17), 35 - 44 years

(n=30) and 45-54 years (n=4) the

prevalence rate for depression prevalence

rate was 28.8%, 33.7% and 12.5%,

respectively.



59

Hypothesis 1:

Hypothesis 1 states that “There will be a higher prevalence of PTSD and Depression

symptoms among junior rank than senior rank Nigeria Police Personnel.

Table 2: Prevalence of PTSD and Depression among Personnel of the Nigeria Police

Force by Rank.

Variables

Rank

Sig. Junior Senior Total

X2

N % N % N

%

PTSD

NPTSD 80 44.4 26 14.4 106 58.9 0.335 0.563

PTSD 53 29.4 21 11.7 74 41.1

Depression

No Depression 90 50 39 21.7 129 71.7 4.009 0.045*

Depression 43 23.9 8 4.4 51 28.3

*Significant level 0.05

Table 2 shows that the difference in the

rate of PTSD symptoms between junior

rank (53, 29.47%) and senior rank (21,

11.7%) Nigeria Police personnel showed

no significant difference X2 (1) =0.335, P

> 0.05, but there was a significant

difference in the prevalence rate of

Depression between junior rank (43,

23.9%) and senior rank Nigeria Police

personnel (8, 4.4%) with the junior rank

personnel having higher rates of

Depression than their senior counterparts

X2 (1)= 4.009, P< 0.05.. Hypothesis 1 was

therefore rejected for PTSD and accepted

for Depression.

Hypothesis 2 states that “There will be a

significant relationship between duration

of combat duty deployment and Post

traumatic Stress Disorder”.

It was tested with Pearson Product

Moment Correlation, which yielded a

significant result, r= 0.178; P<0.05. Thus,

there is a significant relationship between

the duration of combat deployment and

Post traumatic Stress Disorder in the study

cohort. The hypothesis was therefore

accepted. Meanwhile, it can be observed

that next to long term exposure to critical

life events, short term exposure to critical

life events had higher rates of PTSD and

Depression than medium term exposure

(see Table 3 below).


60

Table 3: Relationship between Duration of Combat Deployment and PTSD Among

Personnel of Nigeria Police Force

Variables N M SD Df R Sig.

Duration of

Deployment 180 6.63 10.65

178 0.178 .018

PTSD 180 43.58 18.55

*Significant level 0.05

Discussion


had the highest occurrence of PTSD

(49.2%) followed by those aged 35- 44

years (39.3%), while their counterparts

aged 45-54 years had the lowest

occurrence of PTSD (31.2%). Nigeria

Police personnel aged 35-44 years had the

highest occurrence of depression (33.7%)

followed by their counterparts’ agenda 25-

34 years (28.8%), while those aged 45-54

years had the lowest occurrence of

depression (12.5%). Comparatively, the

highest PTSD occurrence was among

participants aged 25-34 years, followed by

their counterparts aged 35-44 years. The

least PTSD and depression occurrences

were, however, among the police

personnel aged 45-54 years. These

findings posit the following possible

explanations. First, Nigeria Police

Personnel aged 25-34 years are young

adults in their prime; secondly, they had

the highest tendency to be deployed to

combat duties that exposed them to such

traumatic incidents like bombing,

slaughtering, witnessing atrocities and

being victims of roadside bombs,

landmines and suicide bombers more than

their older counterparts.

Nigeria Police personnel with 7

months and above duration of combat

deployment had the highest rate of PTSD

(54.8%), followed by those with no

combat deployment (52.9%); while those

with 1-3 months duration of combat

deployment had a higher prevalence of

PTSD (31%) than their counterparts with

4-6 months duration of combat

deployment with a PTSD prevalence rate

of 26.6%. Those with 7 months and above

duration of combat deployment also had

the highest rate of depression (40.5%) and

were curiously followed by the Nigeria

Police personnel with no combat

deployment (35.3%). Those Police

personnel with 1-3 months duration of

combat deployment had a 29.3%

prevalence rate of depression, which is

higher than the 17.5% rate of depression

among those with 4-6 months duration of

combat deployment.

Similarly, Foa and Kozak (1986)

explains that associative mnemonic

reminders, such as sights and sounds,

mental images or anything that serves as

memory aid, representation of stimuli

constituting traumatic events in the war

theater are well-established etiological

factors for PTSD. Thus, the way these

reminders are perceived trigger specific

emotional states and consequently prime

either approaching or avoiding behavior

patterns that result in combat-related

PTSD or depression (Elbert, Weierstall &

Schaue, 2010).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285743/#B12



61

Police personnel and members of the

Armed Forces, who are often deployed to

combat zones are of younger age group,

except for those who joined at the officer

cadre. This means that police personnel of

younger age group, who are deployed to

combat zones, are at the receiving end of

the command chain which limits their

choices to avoid or escape traumatic

incidents. One notes, also, that the highest

depression prevalence was among the

police personnel aged 35-44 years. The

least PTSD and depression prevalence was

among the police personnel aged 45-54

years. This suggests that the rate of

depression in the cohort was differential.

This is indicated by the 33.7% prevalence

of depression among Nigeria Police

personnel aged 33-44 years, which is

followed by the 28.8% rate of depression

among the Nigeria Police personnel aged

25-34 years. Those aged 45-54 years had

the lowest prevalence of depression and

PTSD, implying that in the face of

adversity, people respond differently.

While some people experience PTSD,

others experience depression. These

findings therefore suggest that more

elderly Nigeria Police personnel may be at

command positions. Accordingly, the

trauma they experience might be vicarious

and not as manifest as those of the

younger age groups because they identify

with the predicament of the “rank and

file”.

The discovery that Nigeria Police

personnel that experienced Boko Haram

and militancy related violence have the

highest occurrence of PTSD corroborates

the findings of Hoge (2004) and Gao

(2006) that PTSD and depression are

significantly linked to combat trauma

exposure. PTSD and depression are not

only linked to combat exposure, but also

to participating in or witnessing atrocities.

It is interesting to note that violence

related to elections, robbery, accidents and

the bereavement of colleagues did not

generate high rates of PTSD and

depression. This outcome confirms that

violent extremism, such as terrorism,

militancy and insurgency, which trigger

high levels of stress, have adverse mental

health consequences, such as heightened

rates of PTSD and depression.

Another outcome of the study was

that Nigeria Police personnel with 7

months and above duration of combat

deployment had the highest occurrence of

PTSD (54.8%), followed by Nigeria

Police personnel with no combat

deployment (52.9%). While the Nigeria

Police personnel with 1-3 months duration

of combat deployment had a higher

prevalence of PTSD (31.0%) than the

Nigeria Police personnel with 4-6 months

duration of combat deployment, with a

PTSD prevalence rate of 28.6%. The

Nigeria Police personnel with 7 months

and above duration of combat deployment

had the highest rate of depression (40.5%)

and were curiously followed by the

Nigeria Police personnel with no combat

deployment (35.3%).In addition, the

Nigeria Police personnel with 1-3 months

duration of combat deployment had a

29.3% prevalence of depression, which is

higher than the 17.5% rate of depression

among Nigeria Police personnel with 4-6

months duration of combat deployment. A

possible explanation for these is that

cumulative stressful impact of combat

exposure and exhaustion of coping

resources of the Nigeria Police personnel

are responsible.

But the unusual result of high rates

of PTSD and depression among personnel

of the Nigeria Police Force, who were


62

never deployed to combat operation,

suggests that combat operations are not

the only stressors capable of inducing

PTSD and depression among human

populations. The contribution of other life

events that were not anticipated by the

study could have been significant. For

example, Heim and Nemeroff (2008)

revealed that exposure to traumatic

incidents in childhood increases the risk of

adult psychopathology, because of the

same processes of sensitization of

traumatic memories. Cannabis and alcohol

abuse/dependence can also induce PTSD

and Depression (Raimo & Schuckit,

1998). Therefore, genetic predisposition,

exposure to adverse life events, such as

gender-based and domestic violence

(GBDV) tends to place any victim at risk

to PTSD and depression (Jessor & Jessor,

1977).

One observes, also, that Nigeria

Police personnel with 1-3 months duration

of combat exposure had a higher

prevalence of depression and PTSD than

the personnel with 4-6 months duration of

combat exposure. This could be due to

“shock” at the onset of combat after which

coping efforts led to “adaptation”. While

the least rate of PTSD and depression

associated with 4-6 months duration of

combat deployment may be indicative of

the positive use of coping efforts by

personnel of the Nigeria Police Force.

This outcome conforms with Selye’s

proposition of the Generalised Adaptation

Syndrome (GAS), whereby the initial

response to stress is accompanied by vivid

physiological arousal followed by a period

of resilience characterized by the fight or

flee response the failure, which leads to

learned helplessness, frustration and

exhaustion (Selye, 1975.)

The study revealed that PTSD and

depression symptoms increase as duration

of combat deployment increases, which is

consistent with Hoge (2004) and Gao

(2006). The discovery that Nigeria Police

personnel that experienced Boko Haram

and militancy related violence have the

highest occurrence of PTSD also

corroborates the findings of Hoge (2004)

and Gao (2006) that PTSD and depression

are significantly linked to trauma

exposure. PTSD and depression are not

only linked to combat exposure, but also

to participating in or witnessing atrocities.

A major part of the symptomatology

of PTSD is the remembering of the painful

recollection in the mind which has both

features of psycho-physiological

reactivation and psychological pain. A

distinctive part of this condition is the

continuous reactivation of the traumatic

memory and the associated stress response

related to the persistent aggravation

rekindling of the reactivity of the

individual (McFarlane, Yehuda & Clark,

2002). Thus, PTSD symptoms have been

explained as the failure of the retention

and extinction of conditioned fear (Milad,

Orr, Lasko, Chang, Rauch & Pitman,

2008). Another important point to note is

that the recollection of painful, distressful

incidents in the mind are a key component

of man’s phenomenological reaction to

distressing life events. Freud emphasized

the importance of recollection of painful

incidents in the mind in his first lecture

with Breuer, signifying that that these

were the prime causes or forces that

mainly bring about symptom onset and

maintenance (Freud, 2001). Wessa and

Flor (2007) explained that these

recollection of painful, distressful

incidents in the mind are activated by a

fear conditioning mechanisms, which



63

maintain and ignite the increased arousal

that is central to the symptoms of PTSD,

in the presence of adverse environmental

conditions. Scholars, who specialize in

PTSD and depression research, also

believe that the predisposition to develop

both PTSD and depression most likely

indicates a joint vulnerability with regard

to trauma exposure (McFarlane, Yehuda

& Clark, 2002).

It is important to note that combat-

related psychological disorders, such as

PTSD and depression among personnel of

the Nigeria Police Force do not only affect

the Police personnel, but their families,

Nigerian communities and the general

public. PTSD and depression can also lead

to poor decision-making, disciplinary

problems, excessive use of sick leave,

severe difficulty in regulating affect,

which can impact negatively on the

quality of life as well as the relationships

of the police personnel. There are also

attention difficulties that can undermine

learning and employment and thus

complicate reintegration of police

returnees with their families and

communities. There can also be negligent,

accidental bullet discharge, alcohol/drug

dependence, explosive anger,

interpersonal violence, including gender-

based and domestic violence (GBDV),

murder and suicide.

Implications for Psychotherapy

Psychotherapists in Nigeria should take

the above findings into consideration

when treating clients from the Nigeria

Police Force. The preponderance of

available scientific evidence has

established that psychological

interventions, particularly cognitive-

behavioral therapies (CBTs), are usually

as effective or more effective than

medications in the treatment of

depression, even if severe, for both

vegetative and social adjustment

symptoms, especially when patient-rate

measures and long-term follow-up are

examined (Antonuccio, 1995). A meta-

analysis by Wexler and Cicchetti, (1992)

also stated that pharmacotherapy alone is

substantially worse than psychotherapy,

alone. The relapse rate is higher among

depressives treated with combined

treatment than with, just psychotherapy.

Psychotherapy is more effective than

medication in the long-term and is more

enduring than medication. While Grohol,

(2019) also asserts that psychotherapy is

more cost-effective, and leads to fewer

relapses of anxiety and mild to moderate

depression than medication use alone.

Depression can be effectively treated with

six to eight sessions of psychotherapy,

particularly cognitive behavioral therapy

and problem-solving therapy.

Psychotherapy is provided in active

collaboration between therapist and client.

Increased interdisciplinary collaboration

between psychotherapists in Nigeria, other

mental health disciplines and public health

is recommended to develop, enact, and

evaluate multi-level preventive

interventions aimed at decreasing the

population health burden of major

depression.

According to APA (2013), the main

treatments for people with PTSD are

psychotherapy, medications, or both.

Psychological treatments are however

considered first-line treatment for PTSD.

They have been confirmed to have larger

effect sizes in Randomised Clinical Trials

(RCTs) than pharmacotherapy. Cognitive

behaviour therapy (CBT), prolonged

exposure, and eye movement

desensitization and reprocessing therapy


64

have had multiple RCTs that showed large

reductions in PTSD symptoms (Foa,

Rothbaum, & Furr, 2003). Therapy

involves an active collaboration between

therapist and client.

To monitor progress in treatment,

brief self-report measures of symptoms of

PTSD should be routinely used. The 17-

item PTSD Checklist, such as the

Posttraumatic Stress Disorder Checklist,

Military and Police Version (PCL-MP),

Posttraumatic Stress Disorder Checklist,

Civilian Version (PCL-C) and Beck

Depression Inventory (BDI) should be

commonly used scales for monitoring

PTSD symptoms and Depression among

personnel of Nigeria Police Force.

Conclusion

In the present study, prevalence of PTSD

and depression among personnel of the

Nigeria Police Force were examined;

study result analysis revealed highest

PTSD occurrence among Nigeria Police

personnel aged 25-34 years, while the

highest depression occurrence was among

the police personnel aged 35-44 years. The

least PTSD and depression occurrences

were however, among the police personnel

aged 45-54 years; age, critical incident

exposure and duration of combat

deployment were predictors of PTSD in

the Nigeria police personnel. More

attention should be given to these factors

in guiding policy and procedures for both

pre and post deployment psychological

evaluation and psychotherapeutic

intervention services for active duty police

personnel of the Nigeria Police Force.

Recommendations

Most active duty Nigeria Police personnel

are in their prime age range placing them

at risk for the onset of PTSD and

depression. There is therefore the need for

psychotherapeutic services programme

development, implementation, evaluation

and monitoring for young Police personnel

and their family members. This will be of

great benefit to the Nigeria Police Force

and the Nigerian society and will help

Nigeria Police personnel to recognize

signs and symptoms of stress, PTSD and

depression symptoms in themselves and

others as well as decrease the stigma of

seeking assistance.

Findings from the study also call for

the bridging of gaps in knowledge,

policies and institutional capacities of

stakeholders, in order to mainstream the





development, in the policy agenda, at the

community level, national, regional and

international levels, using the Three-


Strategy (3-DPIS) Model, which has been

developed by Igboegwu (Igboegwu,

2006). This will empower the Police and

Armed Forces with evidence-based data,

including relevant information, for

decision making for the balancing of

priorities of changing combat mission

requirements with preservation of long-

term mental health and psychological

well-being of active duty Military and

Police Forces.

The 3-DPIS Model, integrating

psychological science, art and culture in

psychotherapy, will provide a holistic

intervention to address the identified

mental health crisis. It will facilitate pro-

social engagement with all diverse

categories of the population, mobilization

of their cooperation at the community

level, national, regional and international



65

levels, including the dissemination of

evidence-based data, to bridge the gaps in


capacities in the highlighted sectors within

which violence thrives. It will transform

and empower communities and

institutions, at all levels, to mainstream the





development, as a priority agenda, in order

to break the cycle of violence, accelerate

public safety, security and development in

the society.

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70

Personality Trait, Drug use and Abuse as Predictors

of Suicidal Intention Among Youths:

A Focus for Psychotherapy

Charity Justin Takyun,

Department of Psychology, Faculty of Social Sciences,

Federal University of Lafia, Nasarawa State, Nigeria

[email protected]

Okwoli Matthew James


Federal University of Lafia, Nasarawa State, Nigeria

Maryam Abubakar

Benue State University, Makurdi, Nigeria

Abstract The rate at which youths commit suicide and the number who attempt suicide is on the

increase every day. Every suicide is a tragedy that affects families, communities and

entire countries and has long-lasting effects on the people left behind. This study

investigates Personality Trait and Drug use and Abuse as predictors of suicidal ideation

among adolescents in Makurdi Metropolis in Benue State, Nigeria, and makes

suggestions for effective psychotherapeutic treatment of suicidal ideation among the

youth. The study employed survey research design where 325 participants were

randomly drawn from Makurdi Metropolis in Benue State through Stratified,

Convenience and Simple Random Sampling Methods. Personality Trait Scale, Drug use

and Abuse Scale, Bio data and Suicidal Ideation Scale were used for data collection.

Three hypotheses were tested using multiple regression and simple regression analyses.

The result revealed a positive relationship between Personality Trait and suicidal

intention among adolescents. Drug use and Abuse also shows significant influence on

suicidal intention among the youths. There was a significant interactive influence of

Personality Trait and Drug use and Abuse on suicide ideations among the adolescents.

Based on these findings, it was concluded that Personality Trait and Drug use and Abuse

are predictors of suicidal ideation among youths in Makurdi Metropolis in Benue State,

Nigeria. It is recommended that understanding personality traits of youths, type of

substance used and abused can further help Clinicians during psychotherapeutic

sessions with youths in solving problems of suicidal ideation. Parents and caregivers

should be enlightened on the behavioral and attitudinal signs to watch out for when their

wards are abusing drugs and also the danger of the use and abuse of drugs.

Key words: Personality Traits, Substance Use and Abuse, Suicidal Ideation, and

psychotherapy.

Takyun, C.J.; Okwoli, M.J. & Abubakar, M. (2020). Personality Trait, Drug use and Abuse as

Predictors of Suicidal Intention Among Youths: A Focus for Psychotherapy,


71

Introduction The rate at which youths commit suicide

and the numbers who attempt suicide

increase daily. Every suicide is a tragedy

that affects families, communities and

entire countries and has long-lasting

effects on the people left behind. The

major tragedy of suicide is not the victim

but the people left behind. Many families

have been forced into single parenting and

poverty as result of suicide.

Youth is the period in life

characterized by movement, changes and

transitions from one state into another in

several domains at the same time. Youths

sometimes address new challenges with

regard to building their own identity,

developing self-esteem, acquiring

increasing independence and

responsibility and building new intimate

relationships, etc. In the meantime, they

are subject to ongoing, changing

psychological and physical processes

themselves. Youths are often confronted

with high expectations; sometimes too

high from significant relatives and peers.

Such situations inevitably provoke a

certain degree of helplessness, insecurity,

stress and a sense of losing control which

may lead to suicidal ideation (Patton,

Sawyer, Santelli, Ross, Afifi&Allen,

2016). To address these challenges and to

reduce the rates of suicide in the country,

the risk factors of this disorder need to be

identified for proper solution.

Suicide is a fatal self-injurious act

with some evidence of intent to die.

Suicidal thoughts are thinking about,

considering, or planning suicide

(Shneidman, 1985). The range of suicidal

ideation varies from fleeting thoughts, to

extensive thoughts, to detailed planning.

Most people who have suicidal thoughts

do not go on to make suicide attempts, but

suicidal thoughts are considered a risk

factor. Suicidal ideation does not just

occur, but comes as a result of some

factors; life events and family events, all

of which may increase the risk (Crosby,

Alex; Beth & Han 2011).

Suicide is the act of taking one's

own life (Uddin; Burton; Maple; Khan;

Khan, 2019). Suicide is different from

attempted suicide or non-fatal suicidal

behavior which is self-injury with at least

some desire to end one's life that does not

result in death (Turecki& Brent, 2016).

Assisted suicide is when one individual

helps another bring about their own death

indirectly via providing either advice or

the means to the end. This is in contrast to

euthanasia, where another person takes a

more active role in bringing about a

person's death (Lester & David, 2009).

Suicidal ideation is thoughts of ending

one's life but not taking any active efforts

to do so.It may or may not involve exact

planning or intent (Lester & David, 2009).

Those who have previously

attempted suicide may be at a higher risk

for future attempts (Ajdacic-Gross, Weiss,

Ring, Hepp, Bopp, Gutzwiller&Rössler,

2008).The most commonly used method

of suicide is partly related to the

availability of effective means. Common

methods of suicide include hanging,

pesticide poisoning, and firearms (Nock,

Borges, Bromet, Alonso &Angermeyer,

2008). For a successful therapeutic

sessions with youths, Clinicians must

understand that a number of factors may

increase the risk of suicide among youths.

These factors include among others

personality traits and substance use and

abuse.


72

Suicidal ideation may depend on the

individual personality traits. This

difference is as a result of individual

unique characteristic. The Big Five

personality traits also known as the five-

factor model (FFM) and the OCEAN

model, is taxonomy for personality traits.

It is the unique characteristic that

differentiates people. The OCEAN is an

acrimony for; openness, consciousness,

Extraversion, Agreeableness and

Neuroticism.

Individuals with openness

experience are generally very active, have

a tremendous inclination towards

creativity and aesthetics and listen to their

heart i.e. follow their inner feelings. Such

individuals are generally open to new

learning, skill sets and experiences.

(Poropat, 2009).The Conscientiousness

personality trait listens to their conscience

and act accordingly. Such individuals are

extremely cautious and self disciplined.

They never perform any task in haste but

think twice before acting. (Marshall &

Georgiades, 2005).

Extraversion refers to a state where

individuals show more concern towards

what is happening outside. Such

individuals love interacting with people

around and are generally talkative. They

do not like spending time alone but love

being the centre of attraction of parties and

social gatherings. Such individuals love

going out, partying, meeting people and

often get bored when they are all by

themselves (Ambridge, 2014).

Agreeableness is a personality trait which

teaches individuals to be adjusting in

almost all situations. Such individuals do

not crib and face changes with a smile.

They accommodate themselves to all

situations and are friendly and kind

hearted. People (Marshall & Georgiades,

2005). Neuroticism is a trait where

individuals are prone to negative thoughts

such as anxiety, anger, envy, guilt and so

on. Such individuals are often in a state of

depression and do not how to enjoy life.

Substance misuse may also be a risk

factor for suicide. The use of psychoactive

substances constitutes one of most

important public health problems among

youth worldwide (Oshodi, Aina&Onajole,

2010). Recent studies in African countries

have shown that the phenomenon of drug

use is also common in the continent and is

becoming one of the most disturbing

health-related problems among youths

(Olawole-saac, Ogundipe, Amoo &

Adeloye, 2015) needing a quick

intervention of clinicians and other health

workers for psychotherapy.

Psychotherapy is the use of

psychological methods to help an

individual change his or her behavior in

order to overcome problems in a desired

way. In order to have successful

therapeutic sessions with clients and

restore their well being and mental health,

therapists must understand client’s

personality profile, the use and misuse of

psychoactive drugs among other things.

Statement of the Problem Suicidal ideation can lead to suicide itself.

Experiencing the suicide of a relative can

have a significant impact on family

members' emotional health. Youths’

suicide may have negative implication on

physical health of family members. People

bereaved by suicide may be at increased

risk of negative physical outcomes,

including hypertension, diabetes and

pancreatic cancer. This avoidance of grief-

related emotions may prevent relatives

from engaging in meaningful life task

whereby they assimilate the death of their




73

loved one into their new reality making

recovery difficult. There is need therefore

for a therapist to have in-depth

understanding of other predisposing

factors to suicide such as personality traits

and substance use and abuse. Therefore

this study intends to fill this gap in

literature.

Aim and Objectives of the Study

The aim of this study is to determine the

role of personality traits and substance use

and abuse as predictors of suicidal

ideation among youths in Makurdi

Metropolis. The specific objectives of the

study are to; i. Investigate the relationship between

personality traits and suicidal


Metropolis.

ii. Investigate the relationship between

substance use and abuse and

suicidal ideation among youths in

Makurdi Metropolis.

iii. Investigate the joint influence of

personality traits and substance use

and abuse on suicidal ideation

among youths in Makurdi

Metropolis.

iv. Make recommendations for

effective treatment of suicidal

ideation among youth.

Research Questions

The following research questions were

raised to guide the study:

i. What is the relationship between

personality traits and suicidal


Metropolis?

ii. What is the relationship between

substance use and abuse and


Makurdi Metropolis?

iii. To what extend will personality

traits and substance use and abuse

jointly predict suicidal ideation

among youths in Makurdi

Metropolis?

Conceptual Review

Personality Traits Gordon (1937) described two major ways

to study personality: the nomothetic and

the idiographic. Nomothetic psychology

seeks general laws that can be applied to

many different people, such as the

principle of self-actualization or the trait

of extraversion. Idiographic psychology is

an attempt to understand the unique

aspects of a particular individual.

Psychoactive Drugs

Bronstein, Spyker, Cantilena, Green,

Rumack and Dart (2010) defines “misuse”

as a use of the substance that does not

follow medical indications or prescribed

dosing which bears similarity to certain

abuse definitions. In some, although not

all definitions, misuse is specifically

restricted to prescription or over-the-

counter medications. Two definitions

propose that misuse occurs only when a

drug is taken with a therapeutic intent (ie,

the use does not involve seeking

psychotropic or euphoric effects) in a

manner other than as prescribed.

National Center on Addiction and

Substance Abuse at Columbia University

(2012) defines drug abuse as an

Intentional improper or incorrect use of a


74

substance where the victim was likely

attempting to achieve a euphoric or

psychotropic effect. All recreational use of

substances for any reason is included. It

also means the use of drug to get high; use

in combination with other drugs to get

high; use as a substitute for other drugs of

abuse.

Suicide

Vocabulary.com (2019) views the word

suicide to have breaks down into the Latin

words sui and caedere, which together

translate to “kill oneself.” However, not

all suicides are about the final end of life.

For example, a righteous politician can

commit political suicide by speaking

publicly about an unpopular topic. We call

a person who has killed himself a suicide,

and a police report might tell how many

suicides happen in a city each year.

Theoretical Review

Interpersonal Theory of Suicide

The interpersonal theory of suicide

attempts to explain why individuals

engage in suicidal behaviour and to

identify individuals who are at risk. It was

developed by Joiner (2005) and focuses

on why people commit suicide. The theory

consists of three components that together

lead to suicide attempts. According to this

theory, the simultaneous presence of

thwarted belongingness and perceived

burdensomeness produce suicidal ideation.

While the desire for suicide is necessary, it

alone cannot result to suicide. Rather,

Joiner (2005) asserts that one must also

have acquired capability (that is, the

acquired ability to overcome one's natural

fear of death). They must have wiped

away all possible fear and consequences

of death.

Belongingness which is the feeling

of acceptance is believed to be a

fundamental need, something that is

essential for an individual's psychological

health and well-being. Increased social

connectedness is a construct related to

belongingness that has been shown to

lower risk for suicide. More specifically,

being married, having children, and

having more friends are associated with a

lower risk of suicidal behavior (Joiner,

Hollar& Van Orden, 2007). Additionally,

working together with others has been

shown to have a preventive effect (Joiner,

Hollar& Van Orden, 2007. According to

this theory, personality traits may also

contribute to this phenomenal. This is

because some of the personality traits like

introversion that prefers to be only

concerned with their own life and nothing

else. Such individuals do not bother about

others and are seldom interested in what is

happening around. They prefer staying

back at home rather than going out and

spending time with friends. Such

individuals speak less and enjoy their own

company. Such person would never be

fine in meetings, clubs, parties or social

get-togethers. They generally do not have

many friends and tend to rely on few

trusted ones (Marshall & Georgiades,

2005).

Interpersonal theory of suicide also

tries to explain the importance of

perceived burdensomeness. Perceived

burdensomeness is the belief that one is a

burden on others or society. Joiner (2005)

describes perceived burdensomeness as

the belief that "my death is worth more

than my life". Unemployment, medical or

health problems and incarceration are

examples of situations in which a person

may feel like they are a burden to others

(Joiner, 2005). It is important to note that




75

the burdensomeness is "perceived", and is

often a false belief. According to the

theory, thwarted belongingness and

perceived burdensomeness together

constitute the desire for suicide.

Sometimes, these people may decide to

use drugs as the way out of their problems,

which may in turn open ways of taking

their own lives since they will feel little

fear about death due to drugs influence.

Interpersonal theory of suicide tries to

explain the importance of acquired

capability in suicidal ideation. Joiner

(2005) terms this "acquired" capability

because it is not an ability with which

humans are born with. Rather, this ability

to engage in suicidal behaviors is only

acquired through life experiences. Fear of

death is a natural and powerful instinct.

According to the theory, one's fear of

death is weakened when one is exposed to

physical pain or provocative life

experiences as these experiences often

lead to fearlessness and pain insensitivity.

These experiences could include

childhood trauma, witnessing a traumatic

event, suffering from a severe illness, or

engaging in self-harm behaviors such as

drugs.

These behaviors are thought to result

in the desensitization to painful stimuli

and to increase one's ability to engage in

suicidal behaviors. This component is

important in identifying individuals who

are likely to attempt or die by suicide. For

example, youths are exposed to physical

pain or provocative experiences in the

process of making it in life. More

specifically, youths with a history of

unemployment have likely been exposed

to grave poverty, witnessing the death of

others trying to make it in life, and are

habituated to fear of painful experiences

(Joiner, 2010). This is consistent with data

indicating an increased rate of suicide in

youths.

Empirical Review

Personality Traits and Suicidal Ideation

Marc, Alessandra, Alessandra and Kerstin

(2018) investigated the function of

personality traits on suicidal ideation. The

Interpersonal-Psychological Theory of

Suicide (IPTS) has been increasingly

studied over the last years, responding to

the demand for a valid framework

addressing suicide. Yet, only a few studies

have explored the function of personality

in the IPTS and none with clinical

patients. They aimed to contribute to fill

this gap in investigating the relationship

between personality as conceptualized by

the Five-Factor Model, the IPTS

constructs, and a dimensional measure of

current suicidal ideation correlation,

multiple linear regression, and path

analyses based on a trait-interpersonal

framework in a sample of 201 individuals

visiting the psychiatric emergency room of

a general hospital with current suicidal

ideation. Neuroticism (positively) and

openness (negatively) predicted perceived

burdensomeness, while neuroticism

(positively) and extraversion (negatively)

predicted thwarted belongingness. Higher

conscientiousness and lower extraversion

were both predictors of the acquired

capability for suicide. However, none of

the models involving path analyses with

IPTS variables as mediators of the

relationship between personality traits and

suicidal ideation was adequately adjusted

to the data. Thus, it appears that

personality plays a significant albeit

modest role in suicide when considered

from an IPTS perspective. As personality

is frequently assessed in the clinical

https://www.ncbi.nlm.nih.gov/pubmed/?term=Costanza%20A%5BAuthor%5D&cauthor=true&cauthor_uid=29601506

https://www.ncbi.nlm.nih.gov/pubmed/?term=Canuto%20A%5BAuthor%5D&cauthor=true&cauthor_uid=29601506

https://www.ncbi.nlm.nih.gov/pubmed/?term=Weber%20K%5BAuthor%5D&cauthor=true&cauthor_uid=29601506



76

routine, health professionals should

consider it as complementary to detect

individuals at risk of or presenting suicidal

ideation.

Substance Use and Abuse and Suicidal

Ideation

Pompili, Serafini, Innamorati (2010)

conducted research on substance use and

suicide and concluded that substance use

independently increases the risk of

suicidal behavior. According to their

result, acute and chronic drug abuse

impairs judgment, weaken impulse

control, and interrupt neurotransmitter

pathways, leading to suicidal tendencies

through disinhibition. Additionally,

physiological and metabolic stress

resulting from drug abuse can lead to

neurotoxic damage and other severe

medical complications.

Bohnert, Ilgen and Louzon (2017)

conducted a research and concluded that

almost all substance use disorders are

associated with an increase in suicide risk.

Their result shows that the suicide hazard

ratio is 1.35 for cocaine use, 2.10 for

psychostimulant use, 3.83 for

benzodiazepine use, 3.89 for cannabis use,

and 11.36 for sedative use. Additionally,

marijuana use, cocaine use, alcohol use

and cigarette smoking were all found to be

independently related to suicide, even

after controls for socio-demographic

factors. Tobacco use and smoking appear

to contribute to deaths by suicide. Current

smokers are at the highest risk of suicidal

ideation, plans, and attempts, followed by

past smokers, with nonsmokers carrying

the lowest risk. Genetic vulnerabilities in

the serotonergic system may predispose a

smoker to suicide, although the exact

mechanisms have yet to be elucidated.

Hypotheses i. Personality traits will significantly

predict suicidal ideation among

youths in Makurdi Metropolis.

ii. Substance use and abuse will

significantly predict suicidal


Metropolis.

iii. Personality traits and substance will

significantly and jointly predict


Makurdi Metropolis

METHOD

Design

Survey design was used for the study. This

design enabled the researcher to find the


suicidal ideation and psychoactive drugs

used and suicidal ideation among youths

in Makurdi metropolis in Benue state. This

is a survey study that tried to seek the

opinion of youths with the use of

questionnaires on suicidal ideation.

Participants

The populations for this study were

strictly youths in Makurdi Metropolis in

Benue State. The study involved 300

youths, 142 male which is 71 % and

female 57 which is 29 % randomly

selected to participate in the study. The

participants were asked to fill their bio-

data and to respond to the option that best

fit them.

Instruments

Three set of instruments were used for the

study. The instruments are (1) personality

traits (lBS) Scale, (2) Alcohol, Smoking




77

and Substance Involvement Scale

(ASSIST) and (3) suicidal ideation scale.

The Big five inventory: the big five

inventory (BFI) by John and Srivastava

(1999) is a 44-iteminstrument that assesses

the big five personality factors

(neuroticism, extraversion, openness,

agreeableness, and conscientiousness).

Items are scored using a 5- point, Likert

scale that ranges from disagree strongly to

agree strongly. BFI scales include 8–10

items each, and have demonstrated

moderate to high internal consistency

reliability (alpha range = .79 to .88;

median = .82) as well as substantial

convergent/ discriminant relations with

other big five instruments,

Alcohol, Smoking and Substance

Involvement Scale (ASSIST) is a

standardize scale that measure drug

involvement and the rate of use. The

strong overall results in the reliability and

validity studies suggest that the ASSIST is

a valid screening test for international use.

ASSIST is score ranging from Never=0

Once Twice=2, Monthly= 3, Weekly=4,

Daily=6 or Almost Daily=7

Suicide ideation was assessed with

the Geriatric Suicide Ideation Scale

(GSIS), a 31-item measure of suicide

ideation designed for use with older

adults. This multidimensional measure

assesses Suicide Ideation (e.g., “I want to

end my life”), Death Ideation (e.g., “I long

for the peaceful slumber of death”), Loss

of Personal and Social Worth (e.g., “I

generally feel pretty worthless”), and

Perceived Meaning in Life (e.g., “I feel

that my life is meaningful”; reverse-

scored). GSIS items are rated on a 5-point

Likert format scale (1 = strongly disagree,

5 = strongly agree) and yield total scores

ranging from 31 to 155, with higher scores

indicating greater intensity of suicide

ideation. Acceptable internal consistency

has been demonstrated for GSIS total

scores (Cronbach’s α = 0.90) and the four

subscales (Cronbach’s α = 0.74 – 0.86).59

In the present study, Cronbach’s α = .91

and .94 for GSIS total scores at time 3 and

4, respectively.

Procedures

The procedure for the study involved

moving from street to street engaging the

youths. The participants were asked to fill

the bio-data and to respond to the option

that best fit them. 320 questionnaires were

distributed. It was only the 300

questionnaires that were filled completely

that were used for the study. The

researcher waited and collected the

questionnaires after they were filled. Some

of the illiterate participants that may find it

difficult to read were assisted by the

researcher and assistant that helped to read

and interpret for the illiterate participants.

Method of Data Analysis The statistical methods for this study were

Simple and Multiple Regressions

Analysis. The simple regression tested the


suicidal ideation, psychoactive drug used

abuse on suicidal ideation. Multiple

regression was used to determine a

statistically significance joint relationship

as well as personality traits and

psychoactive drug use and abuse on

suicidal ideation.

RESULTS

Hypotheses Testing

Hypotheses 1

This hypothesis states that personality

traits will significantly predict suicide

ideations among adolescents.


78

This hypothesis was tested using Multiple

Regression Analysis and the results are

tabulated and interpreted as shown below.

Table 1: Multiple Regression

Analysis showing the

influence of Personality

on Suicide Ideation

among Adolescents Variables R R2 F ß t p

Constant .770 .593 96.551

.022

.178

.369

-.079

.325

2.727

0.591

2.260

4.558

0.876

3.270

.007

.555

.024

.000

.382

.001

Agreeableness

Conscientiousness

Openness to Exp.

Extroversion

Neuroticism

Dependent Variable: Suicide Ideation

The results presented in Table 1 showed

that personality traits have significantly

and jointly predicted suicide ideations

among adolescents (R = .591 = R2 = .593

(F (5, 331) = 96.551, t = 2.720, p< .05).

This means that all the five dimensions of

personality traits had jointly contributed to

59.3% changes observed in the level of

suicide ideations among adolescents. In

considering the individual personality

traits, the results clearly showed that

agreeableness has no significant influence

on suicide ideations (ß = .022, p>.05),

when the variance explained by the other

four factors are controlled. This means

that adolescents who are predominantly

agreeable are less likely to contemplate

suicide. This implies that adolescents who

are dominant on agreeableness have only

2.2% chances for suicide ideation. Thus,

they are insulated from suicide ideations.

On the contrary, conscientiousness has

significantly made the unique positive

contribution to suicide ideations (ß = .178,

p<.05). This means that adolescents who

are dominant on conscientiousness have

17.8% chances of contemplating suicide.

Similarly, openness to experience has a

significant positive influence on suicide

ideations (ß = -.369, p<.05). This means

that adolescents who are predominant on

openness to experience are highly (36.9%)

preoccupied with suicide ideations.

Furthermore, neuroticism has a significant

positive influence on suicide ideations (ß

= .325, p<.05). This means that

adolescents who are predominant on

neurotic personality trait are highly

(32.5%) preoccupied with suicide

ideations. Lastly, the results showed that

extroversion has no significant influence

on suicide ideations (ß = -.079, p>.05),

when the variance explained by the other

four factors are controlled. This means

that adolescents who are extroverts are

7.9% less likely to contemplate suicide.

Therefore, the hypothesis that personality

traits will significantly predict suicide

ideations among adolescents has been

confirmed for conscientiousness, openness

to experience and neuroticism but not for

agreeableness and extroversion.

Hypotheses II

This hypothesis states that drug use/abuse

will significantly predict suicide ideations

among adolescents.

This hypothesis was tested using Simple



Table 2: Regression analysis showing

the influence of drug use/abuse on

suicide ideations Variables R R2 F ß t Sig

Constant .756 .571 99.746

.756

3.512

21.160

.001

.000 Drug

Use/Abuse

Criterion variable: Suicide Ideations




79


that there was a significant influence of

drug use/abuse on suicide intentions

among adolescents (R= .756 = R2 =

.571(F (1,336) = 99.746, t = 3.512, p >

.05). This means that drug use/abuse is

likely to predict 57.1% of suicide ideations

among adolescents. This finding implies

that higher level of drug use/abuse leads to

higher tendencies for suicide. Therefore,

this hypothesis has been accepted.

Hypotheses III

This hypothesis states that personality

traits and drug use/abuse will significantly

jointly predict suicide ideations among

adolescents.

This hypothesis was tested using Multiple



Table 3: Multiple Regression

Analysis showing the

joint influence of

Personality Traits and

Drug Abuse on Suicide

Ideation among

Adolescents Variables R R2 F ß t P

Constant .780 .606 84.675

.018

.088

.259

-.150

.285

.320

2.114

0.500

1.075

2.924

-1.642

2.883

3.429

.035

.618

.283

.004

.102

.004

.001

Agreeableness

Conscientiousness

Openness to Exp.

Extroversion

Neuroticism

Drug abuse

Dependent Variable: Suicide Ideation


that personality traits and drug have

significantly and jointly predicted suicide

ideations among adolescents (R = .780 =

R2 = .606 (F (6, 326) = 84.475, t = 2.114,

p< .05). This means that all the five

dimensions of personality traits and drug

use/abuse had jointly contributed to 60.6%

changes observed in the level of suicide

ideations among adolescents. In a

controlled joint equation agreeableness,

conscientiousness and openness to

experience contributed 1.8%, 8.8% and

25.9% respectively. Just like extroversion,

neuroticism and drug use/abuse

contributed 15.0%, 28.5% and 32.0%

respectively.

Discussion of Findings

The study has implication for therapeutic

processes among youths. The discussions

of the findings were done according to the

tested hypotheses. Hypothesis one was

tested to find if personality traits will

predict suicidal ideation among youths in

Makurdi Metropolis in Benue State. The

finding showed that personality traits have


ideations among adolescents. The five

dimensions of personality traits jointly

contributed to changes observed in the

level of suicide ideations among

adolescents. In considering the individual

personality traits, the results clearly

showed that agreeableness has no

significant influence on suicide ideations

when the variances explained by the other

four factors are controlled. From this

result, agreeable adolescents are less likely

to contemplate suicide. This implies that

during psychotherapy, clinicians must note

that youths who are dominant on

agreeableness have little chances for

suicide ideation. Thus, they are insulated

from suicide ideations. On the contrary,

conscientiousness has significantly made

the unique positive contribution to suicide

ideations. This means that youths who are


80

dominant on conscientiousness have

higher chances of contemplating suicide.

Similarly, openness has a significant

positive influence on suicide ideations.

This means that youths who are

predominant on openness are highly

preoccupied with suicide ideations.

Furthermore, neuroticism has a significant

positive influence on suicide ideations.

The youths that are predominant on

neurotic personality trait are highly

preoccupied with suicide ideations. Lastly,

the results showed that extroversion has

no significant influence on suicide

ideations when the variances explained by

the other four factors are controlled. That

is to say that, youths that are extroverts are

less likely to contemplate suicide.

Therefore, the hypothesis that stated that

personality traits will significantly predict

suicide ideations among adolescents has

been confirmed for conscientiousness,

openness to experience and neuroticism

but not for agreeableness and

extroversion.

These findings are in line with those

of Winnie, Jan, Adrian, Thomas and Peter

(2018) that assessed associations between

suicide ideation and personality

characteristics in a sample of community-

residing adults 65 years of age and older.

Within the sample of older adults, more

severe suicide ideations was significantly

associated with lower Extraversion and

greater Neuroticism and Socially

Prescribed Perfectionism, controlling for

age, sex, and depression symptom

severity. Although findings concerning

Neuroticism were not consistent across

measures, Extraversion and Socially

Prescribed Perfectionism appear to have

particularly robust associations with

suicide ideation.

Hypothesis two stated that drug use/abuse

will significantly predict suicidal ideation.

The result showed that there was a

significant influence of drug use/abuse on

suicide intentions among adolescents.

This means that drug use and abuse is a

strong predictor of suicide ideations

among adolescents. This finding implies

that higher level of drug use/abuse among

youths leads to higher tendencies for

suicide. Therefore, this hypothesis has

been accepted.

This finding is also in line with a

survey conducted by the Substance Abuse

and Mental Health Services

Administration in (2015) which showed

those 9.8 million people ≥18 years old

seriously considered suicide in the past 12

months, with 1.4 million making nonfatal

suicide attempts. Young adults aged 18–

25 were also more likely to have serious

thoughts of suicide or suicide attempts due

to drug abuse.

This finding is also in line with Wilcox,

Conner and Caine, et al. (2004) conducted

research on substance abuse and suicide

and concluded that the rates increased to

72.2% for synthetic opioids and were

20.6% for heroin. A meta-analysis the

researchers showed that heroin use

increased the risk of suicide by 13.5 times

compared with the 10-fold increase with

alcohol use disorder. Another study

investigating the association between

prescription opioid use and suicide among

patients with chronic non-cancer pain

revealed that an increased opioid dose was

related to an increased risk of suicide,

even after controlling for demographic and

clinical factors.

The hypothesis three states that

personality traits and drug abuse will

significantly and jointly predict suicidal


https://www.ncbi.nlm.nih.gov/pubmed/?term=Loerbroks%20A%5BAuthor%5D&cauthor=true&cauthor_uid=29997316

https://www.ncbi.nlm.nih.gov/pubmed/?term=Muth%20T%5BAuthor%5D&cauthor=true&cauthor_uid=29997316

https://www.ncbi.nlm.nih.gov/pubmed/?term=Angerer%20P%5BAuthor%5D&cauthor=true&cauthor_uid=29997316





81

metropolis. The result showed that

personality traits and drug have


ideations among youths. This means that

all the five dimensions of personality traits

and drug use/abuse had jointly contributed

to changes observed in the level of suicide

ideations among adolescents. In a

controlled joint equation agreeableness,

conscientiousness and openness to

contributed to suicidal ideation

respectively. Just like extroversion,

neuroticism and drug use/abuse

contributed also contributed respectively.

Conclusion/Recommendations

In a bid to conclude that personality traits

and drug use/abuse as predictors of

suicidal ideation among youths in Makurdi

metropolis in Benue State, theories were

reviewed, data were collected and the

hypotheses were tested. Based on the

result, it was concluded that:

i. Personality traits predicted suicidal


metropolis in Benue State. ii. Drug use/abuse predicted suicidal


mertopolis in Benue State.

iii. There is an interactive influence of

personality traits and drug use/abuse

on suicidal ideation among

adolescents in Makurdi metopolis in

Benue State.

We therefore recommend that: i. Communication skills, listening

exercises, emotional expression,

and conflict resolution are also

important parts of treatment which

therapists must not neglect during

the psychotherapeutic sessions

i. Therapists should encouraged

patients through creating of rapport

to communicate their feelings, their

fears and desires during therapy.

ii. Therapist should help patients to

examine and change any beliefs

about suicide. Some of these

mistaken beliefs are widely shared

in the society and can result from

past traumatic events, family

attitudes, or cultural ideas.

iii. Government should discourage the

use of drugs in the society if there is

a true need to control the high level

of suicide in the country.

iv. Parents and care givers should

educate, monitor their children cum

wards to know their mood and

recommend psychotherapy, as this

can help in suicide prevention

among youths

Limitations of the Study

Having contributed immensely to

knowledge; however, the study is limited

in some aspects:

Youths demonstrated some level of fear

and shame when filling the questionnaires

since it involves their private life. They

felt that the information given might be

used in discussing them. So the researcher

could not guarantee the degree of their

responses.

The study was only limited to two

independent variables; personality traits

and drug use and abuse. The study was

only limited to adolescents in the study

area.


82

The study was limited to specific

population group which is Markudi

Metropolis.

References

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84

Posttraumatic Stress Disorder Among Trafficked

Victims, Role Of Self-Esteem, Demographic Factors

And Relevance Of Psychotherapy

Ezeakor Adolphus I.

Psychology Department,

Chukwuemeka Odumegwu Ojukwu University, Igbariam

[email protected]

Okpala Michael O.

Psychology Department,

Nnamdi Azikiwe University, Awka

[email protected]

Abstract Objective: Experiences of traumatic exposure of trafficked victims keep tormenting them

after they are rescued. Trafficked victims at rehabilitation centers of National Agency for

Prohibition of Trafficking in Persons and Other Related Matters (NAPTIP) at Southern

Zones have been found to present with posttraumatic stress disorder. This finding made it

necessary that improving their mental health should include efforts to identify factors

likely to predispose, maintain, or perpetuate PTSD presentation among trafficked

victims. Current study thereby examined posttraumatic stress disorder among trafficked

victims: the role of self-esteem and demographic factors. Method: 55 participants

selected through total population sampling technique from the rehabilitation centers of

NAPTIP in their South-East, South-South, and South-West zonal offices, participated.

Their age ranged between 14 to 25 years, with a mean age of 19.89 and a standard

deviation of 2.87. The instruments administered on them were Posttraumatic Stress

Disorder Keane Scale (PKS) (Keane, Malloy & Fairbanks, 1984) and Index of Self –

Esteem (ISE) (Hudson, 1982). Mental State Examination of some of the clients was also

done. The study used ex-post-facto design and Independent t-test was used to test the

hypotheses. Result: This revealed that hypotheses two to seven on demographic factors

were rejected. It also showed that only hypothesis one on self-esteem was accepted,

t(53)=-3.26, p <.05. Conclusion: The relevance of psychotherapy will establish the

linkage through trafficked victims at rehabilitation centers of NAPTIP in her zonal

offices in the southern parts of Nigeria, and determine self-esteem factor likely to

influence PTSD presentation.

Key words: Demographic Factors, Posttraumatic Stress Disorder, Self-esteem,

Trafficked Victims and Psychotherapy

Ezeakor, A.I & Okpala, M.O. (2020). Posttraumatic Stress Disorder among Trafficked Victims,

Role of Self-Esteem, Demographic Factors and Relevance of Psychotherapy,


85

Introduction Traumatic event is an unpleasant or

disturbing experience that causes physical,

emotional, psychological distress or harm

and is perceived and experienced as a

threat to one’s safety or to the stability of

one’s world (Medline Plus, 2004). World

Health Organization (WHO), International

Classification of Diseases, Tenth Edition

(ICD-10), (1992), defines traumatic

stressor as events or situations that are

exceptionally threatening or catastrophic

in nature, which are likely to cause

pervasive distress in almost anyone.

American Psychiatry association (APA),

Diagnostic and Statistical Manual of

Mental Disorders, Fifth Edition (DSM –

V) (2013), on the other hand, defines

traumatic stressors as events that involve

life endangerment, death, or serious injury

or threat and are accompanied by feelings

of intense fear, horror or helplessness.

Human trafficking or trafficking in

persons (TIP) is a traumatic event

(Carling, 2005) and experiences of

Nigerian trafficked victims could best be

referred to as traumatic. International

Organization for Migration (2001)

estimates that trafficking in human beings

is a huge billion industry worldwide.

Scholars (Sita, 2003; Morka, 2009) noted

that this trend has degenerated to a level to

warrant its description as becoming the

order of the day in Nigeria, being an

organized crime, which has lawyers,

herbalists, corrupt immigration and police

officers and relatives or friends “as

participants”. Certainly, as these

unscrupulous persons pursue their

business interest, they perpetuate the

traumatic exposure of the trafficked

victims. European Race Audit Bulletin

(1997) revealed that after being recruited,

the victims are conveyed through long and

tortuous land routes mainly through the

Sahara Desert to European counties. Once

they arrive the victims are forced to work

as sex hawkers (especially the girls). The

victims often undergo a process of

initiation or ritual, which involves

collection of underwear, pubic hair and

other personal items deemed fit by the

baronesses. This is aimed at instilling fear

in the victims in order to prevent them

from revealing anything that could lead to

the arrest of the baronesses. These ugly

exposures made victims to directly have

traumatic experiences, witness traumatic

events as they happen to other victims, or

leant of one that had happened to the

person they know. It is these negative

experiences that make them vulnerable to

posttraumatic stress disorder (PTSD).

According to ICD-10, traumatic

experiences are characterized as being

outside the range of usual human

experience and have been implicated in

the aetiology of certain specified

psychiatric disorders, like PTSD. PTSD is

the most common psychological disorder

following traumatic experiences (Caffo &

Belaise, 2003). Gelder, Harrison and

Cowen, (2006) noted that the clinical

features of PTSD can be divided into three

groups. The symptoms of the first group

are related to hyperarousal and include

persistent anxiety, irritability, insomnia,

and poor concentration. The second group

of symptoms centers on intrusion,

involving intense intrusive imagery of the

events, sudden flashback, and recurrent

distressing dreams. The third group of

symptoms is concerned with avoidance

and includes difficulty in recalling

stressful events at will, avoidance of

reminders to the events, a feeling of

detachment, inability to feel emotion

(‘numbing’), and diminished interest in


86

activities. Gelder et al., (2006) noted that

the most characteristic symptoms are

flashbacks, night mares, and intrusive

images, sometimes known collectively as

re-experiencing symptoms.

While not all trafficked victims die

as a result of terror unleashed on them in

the course of their trafficking, it is

perceived that the traumatic experiences

trafficked victims had could precipitate

PTSD. After some traumatic events,

survivors feel forced into a painful

reconsideration of their beliefs about the

meaning and purpose of life (Janoff-

Bulman, 1985). However, not all survivors

of traumatic events develop posttraumatic

stress reactions (Sadruddin, Walter &

Hidalgo, 2005). Certainly, some are more

susceptible. Self-esteem and demographic

factors may stand the chance to influence

the presentation of PTSD among

trafficked victims.

Self-esteem refers to a person’s

overall evaluation or appraisal of his or

her own worth. Baumeister (2008) defined

self-esteem as how favourably someone

evaluates himself or herself. Human

trafficking experiences can cause major

change in a victim’s life leading to grave

change in self-concept as the victim

experiences difficulty in adjusting to the

new image he/she has of himself/herself

(Carson & Arnold, 1996). This could

predispose trafficked victims to PTSD.

Similarly, a wide range of factors,

ranging from demographic characteristics

to personal psychological factors have

been associated with PTSD onset after

disasters. Gender (female) has consistently

been shown to be at risk factor for the

onset of PTSD after disasters (Grieger,

Fullerton & Ursano, 2003; Pulcino, Galea

& Alern, 2003). Moreso, Fitzpatrick and

Boldizar (1993) stated that whereas boys

were reported to experience more

traumatic events, girls have a higher rate

of PTSD.

Personal psychological factors such

as guilt and anger (Hull, Alexander &

Klein, 2002), external locus of control

(North, Spitznagel, & Smith, 2001),

weaker coping ability (Stewart, Mitchell

& Wright, 2004) and low social support

(Johnson, North & Smith, 2002), have

been associated with PTSD onset after

traumatic events. Accordingly, the general

objective of this study is to examine the

influence of self-esteem and demographic

factors on PTSD among trafficked

victims. It is from this general purpose

that the following specific purposes arose:

1. To know if there will be a

significant difference between

victims with low self-esteem and

victims with high self-esteem on

PTSD.


significant difference between minor

and adult victims of human

trafficking on PTSD.


significant difference between the

victims from monogamous family

setting and those from polygamous

family setting on PTSD.



victims who attended school and

those who do not on PTSD.



victims trafficked outside Nigeria

and those trafficked within Nigeria

on PTSD.



victims trafficked for sexual




87

exploitation and those trafficked for

non-sexual exploitation on PTSD.

Literature Review

Literature review for this article is carried

out under the following sub-headings: a)

Psychological theories of PTSD; b) Self-

esteem and PTSD; and c) Demographic

Factors and PTSD

a. Psychological Theories of PTSD

Learning theorists assume that PTSD

arises from a classical conditioning of fear

(Fairbank & Brown, 1987; Keane,

Zimerine, & Caddell, 1985). A trafficked

victim who has been raped may fear

walking in a certain place (conditioned

stimulus (CS) because of memories of

having been raped in a similar

environment (UCS). Based on this

classically conditioned fear, avoidance is

built up, and victims are negatively

reinforced by the reduction of fear that

comes from not being in the presence of

the CS. PTSD is a prime example of the

two-factor theory of avoidance learning,

proposed years ago by Mowrer (1947).

Psychodynamic theories emphasize

the role of emotional development in

determining individual variations in the

response to severely stressful events

(Gelder et al., 2006). A psychodynamic

theory proposed by Horowitz (1986,1990)

posits that memories of the traumatic

event occur constantly in the person’s

mind and are so painful that they are either

consciously suppressed (by distraction, for

example) or repressed. The person is

believed according to Davison and Neale

(2001) to engage in a kind of internal

struggle to integrate the trauma into his or

her existing beliefs about himself and the

world to make some sense out of it.

Cognitive theories suggest that

PTSD arises when the normal processing

of emotionally charged information is

overwhelmed, so that memories persist in

an unprocessed form in which they can

intrude into conscious awareness (Gelder

et al., 2006). In support of this idea,

patients with PTSD tend to have

incomplete and disorganized recall of the

traumatic events (Ehlers, Mayou, &

Bryant, 1998). Individual differences in

response to the same traumatic events are

explained as due to differences in the

appraisal of the trauma and of its effects

(Ehlers et al., 1998). Similarly, difference

in the appraisal of the early symptoms

may explain why these symptoms persist

longer in some people. Negative

interpretations of intrusive thoughts (for

example, “I am going mad”) after road

accidents predict the continuing presence

of PTSD after one year (Ehlers et al.,

1998).

In an international study of

trafficked prostituted children and adults,

including male prostitutes in five

countries, it was found that almost three-

fourths of the victims met the diagnostic

criteria for PTSD (Farley, Barel, Kiremire,

& Sezquin, 1998; Silbert & Pines, 1981).

Again, a multi-country report published in

2003 found that nearly 70% of women

trafficked for prostitution that was studied

met the criteria for PTSD (Farley &

Melissa, 2003). In a study of female

survivors of human trafficking in Nepal,

PSTD was found to be higher in sex

workers group (29.6%) than in the non-sex

workers group (7.5%) (Tsutsumi, Izutsu,

Poudyal, Kato, & Marui, 2008). Also, in

Israel, about 17% of trafficked women

(the majority of which were from

Moldevia, Ukraine, Russia, and Central

Asian Republics of Soviet Union), who


88

had worked as sex workers scored over the

cut-off point of measurement for PTSD

(Tsutsumi et al., 2008).

b. Self-esteem and PTSD

Self-discrepancy theory developed by

Higgins (1989) posits that self-

discrepancy serves to introduce

accessibility of the various ways people

construe the world. According to Higgins

(1989), one’s self-esteem is defined by the

match between how one sees oneself and

how one want to be seen by others, and he

argues that any likely discrepancy will

occur between these three dimensions of

self: one’s actual self, one’s ought self and

one’s ideal self. If the discrepancy is

between one’s actual self and ought

selves, he/she may feel guilty, ashamed

and resentful; if there is discrepancy

between one’s actual and ideal selves, one

will feel disappointed, frustrated, sad and

unfulfilled (Strauman, 1992).

According to Higgins (1989), one’s

self-esteem level based on these three

dimensions depends on a number of

factors, that included the amount of

discrepancy, the importance of the

discrepancy to the self and the extent to

which one focuses on one’s self

discrepancies. The most focused, the

greater the harm. From this perspective,

the major source of low self-esteem is the

guilt and shame that some victims feel

when they do not experience idealized

emotions that follow with returning home

with money made abroad through

prostitution and becoming role model to

the vulnerable ones in the society.

Study by Hershberger and D’Augelli

(1995) found self-esteem to be negatively

correlated with mental health variables

such as measure of psychiatric symptoms;

suicidal ideation and suicide attempts,

among victimized youths. Bradley,

Schwartz and Kaslow, (2005) reported a

finding showing that low self- esteem was

related to high mental health difficulties.

Salami (2010) reported that the

relationship between exposure to violence

and PTSD was moderated by resilience,

self-esteem and social support.

Consequently, self-esteem is suspected to

be a variable likely to influence PTSD

presentation among trafficked victims.

c. Demographic Factors and PTSD

Population of developing countries

appears to create favourable market for

victims to be trafficked. Such population

creates avenues for criminal activities like

human trafficking to be thriving, perhaps,

due to poverty. The study by Inocencio

(2011) carried out at the University of

Roehampton in London using quantitative

analyses of secondary data to identify risk

factors associated with trafficking hotspots

in Nigeria and Indonesia, used content

analysis to identify ‘hotspot’ areas for

human trafficking. The hotspot refers to

locations that were more developed, had

higher populations, and a record of more

crime. Such could engender clandestine

operation of trafficking business.

Good number of epidemiological

studies on gender and PTSD revealed that

PTSD is twice as common in women as in

men. According to Yehuda (2007), some

of these differences are clearly societal

and non-biologically based. Findings from

some studies suggest that whether

traumatic experience will lead to PTSD is

dependent on the type of trauma and the

gender involved. According to Spitzberg

(1999), rape in both men and women,

carries one of the highest risks for

producing PTSD that approximately 0.7%

of men in the United States reported being




89

raped as compared with 9.2% of women

who develop PTSD.

Hypotheses

1. There would be a significant

difference between victims with low

self-esteem and victims with high

self-esteem on PTSD.


difference between minor and adult

victims of human trafficking on

PTSD.


difference between victims from

monogamous family setting and

those from polygamous family

setting on PTSD.


difference between victims who

attended school and those who do

not on PTSD.


difference between victims

trafficked outside Nigeria and those

trafficked within Nigeria on PTSD.


difference between victims

trafficked for sexual exploitation and

those trafficked for non-sexual

exploitation on PTSD.

Method

A sample of 55 participants selected

through total population sampling

technique, participated. They were

employed from the rehabilitation centers

of National Agency for Prohibition of

Trafficking in Persons and Other Related

Matters (NAPTIP) in their South-East,

South-South, and South-West zonal

offices. Their age ranged between 14 to 25

years, with a mean age of 19.89 and a

standard deviation of 2.87.

Instruments

Two standardized instruments used for

data collection were Posttraumatic Stress

Disorder Keane Scale (PKS) (Keane,

Malloy & Fairbanks, 1984) and Index of

Self-Esteem (ISE) (Hudson, 1982). The

demographic factors of the participants

were collected using the section for

demographic factors added to the

instruments by the researchers. The

instruments were pilot tested using

twenty-three (23) trafficked victims

elicited from these zones. A Cronbach co-

efficient alpha reliability method was used

to determine the reliability estimates for

the instruments and .90 and .88 were

obtained for PKS and ISE, respectively.

The trafficked victims involved in the

pilot test were however, not used in the

main study. Moreover, mental state

examination of each participant from

South-South zone (where access to victims

was granted) was undertaken to generate

qualitative data peculiar to trafficked

victims, the nature of which the

instruments used did not capture.

Procedure

A letter seeking for permission to embark

on this study was sent to each Zonal

Director of the three zones used. On

obtaining their oral approval through the

Head of Research Unit of the concerned

zones, different dates were chosen for the

administration of the instruments on the

participants. With the assistance of a

NAPTIP staff in Counseling and

Rehabilitation Unit in the zone, the

instruments were administered on the

participants. Importantly, only trafficked

victims who have been in the

rehabilitation center for a month and

above, can read and understand English

Language, and willing to participate


90

voluntarily, took part. It is important to

note that the baseline to be an eligible

participant is that the trafficked victim

must have obtained on PKS instrument a

score equal or above the norm for being

classified as having PTSD.

Design and Statistic

This is a survey study that adopted ex-

post-facto design. Independent t-test was

the statistic used to analyze the postulated

hypotheses.

Result

Table 1: Summary Table of Mean, Standard Deviation and t-test on Self-Esteem

Hypothesis one stated that there would be a significant difference between victims with

low self-esteem and victims with high self-esteem on PTSD. Table 1 above showed that

victims with low self–esteem scored mean higher than those with high self–esteem (low

self–esteem (M = 26.14); high self–esteem (M = 20.44). The observed difference in the

mean reached significant level at t(53)=-3.26, p <.05. Therefore, hypothesis one is

accepted.

Table 2: Summary Table of Mean, Standard Deviation and t-test on age. Source Age Mean Std deviation N T Df Sig

Age on PTSD Below 18

18 & above

24.73

21.83

5.32

7.22

15

40

1.42 53 .16

The hypothesis two stated that there would be a significant difference between minor and

adult victims of human trafficking on PTSD. Table 2 above showed that minors scored

mean higher than the adults (Minors (M = 24.73); Adults (M = 21.83), but the difference

observed in the mean failed to reach significant level at t(53)=1.42, p >.05. Therefore,

hypothesis two is rejected.

Table 3: Summary Table of Mean, Standard Deviation and t-test on Family type Source Family type Mean Std deviation N T Df Sig

Family type

on PTSD

Monogamous

Polygamous

23.20

22.13

7.41

6.40

25

30

.57 53 .57

The hypothesis three stated that there would be a significant difference between victims

from monogamous family setting and those from polygamous family setting on PTSD.

Table 3 above showed that victims from a monogamous family setting scored mean

higher than those from a polygamous family setting, (Monogamous (M = 23.20);

Polygamous (M = 22.13). However, the observed difference in the mean failed to reach

significant level at t(53)=.57, p >.05. Therefore, hypothesis three is rejected.

Source Self-esteem Mean Std deviation N T Dt Sig

Self-esteem

On PTSD

High self-esteem

Low self-esteem

20.44

26.14

7.33

4.04

34

21

-3.26 53 .00




91

Table 4: Summary Table of Mean, Standard Deviation and t-test on School Attempt Source Scholl attempt Mean Std deviation N T Df Sig

School attempt

On PTSD

Attended school

No school attempt

22.93

21.36

6.81

7.10

44

11

.68 53 .50

The hypothesis four stated that there would be a significant difference between victims

who attended school and those who do not on PTSD. Table 4 above showed that victims

who attended school scored mean higher than those who do not (attended school (M = 22.

93); no school attempt (M = 21.36). However, the observed difference in the mean failed

to reach significant level at t(53)=.68, p>.05. Therefore, hypothesis four is rejected.

Table 5: Summary Table of Mean, Standard Deviation and t-test on Trafficked

Destination

The hypothesis five stated that there would be a significant difference between victims

trafficked outside Nigeria and those trafficked within Nigeria on PTSD. Table 5 above

showed that victims trafficked outside Nigeria scored mean higher than those trafficked

within Nigeria (within Nigeria (M = 22.48); outside Nigeria (M = 22.75). However, the

observed difference in the mean failed to reach significant level at t(53)=-.14, p >.05.

Therefore hypothesis five is rejected.

Table 6: Summary Table of Mean, Standard Deviation and t-test on sexual

exploitation Source Reason for trafficking Mean Std deviation N T df Sig

Reason for

trafficking

On PTSD

Sexual exploitation

Non sexual exploitation

21.44

23.19

8.85

5.67

18

37

-.89 53 .38

The hypothesis six stated that there would be a significant difference between victims

trafficked for sexual exploitation and those trafficked for non-sexual exploitation on

PTSD. Table 6 above showed that victims trafficked for non–sexual exploitation scored

mean higher than those trafficked for sexual exploitation (non –sexual exploitation (M =

23.19); sexual exploitation (M = 21.44). However, the observed difference in the mean

failed to reach significant level at t(53)=-.89, p >.05. Therefore, hypothesis six is

rejected.

Source Sexual exploitation Mean Std deviation N T Df Sig

Trafficked

Destination

on PTSD

Within Nigeria

Outside Nigeria

22.48

22.75

7.30

6.49

27

28

-.14 53 .89


92

Information from Mental State

Examination

Appearance and Behaviour: This

involves the appropriateness of observable

behaviour and victims’ appearance. All

the victims were appropriately dressed and

appeared neat. Some victims were easily

irritated, while others behaved normal.

Some victims corroborated the irritability

of those one that were easily irritated as

observed by the researchers.

Speech: Most victims’ speech was

spontaneous, coherent and relevant, and

only few victims showed speech delay,

though was still coherent and relevant.

Mood: Some victims reported their mood

to be normal while some others reported

depressed mood which they said is

strongly pointed at their negative

exposures via trafficking experiences to be

the major cause.

Affect: The affect of those that reported

normal mood was congruent, as was the

same with those that reported depressed

mood.

Thought process: All the victims thought

stream, thought form and thought

possession were reported normal.

Perception: There is absence of

hallucination of any sensory modality for

all the victims.

Cognition:

Sensorium: They were aware of their

environment and oriented in time, place

and person.

Attention: The attention span and

concentration of some of victims were

poor, while that of others were normal.

Memory: Their immediate, short term and

long term memories were intact; with

some of the victims showing avoidance of

reminders to their trafficking experience.

Insight and Judgement: The victims had

good insight, and while the judgment of

some was impaired, others had good

judgment.

It is also important to note that some of the

victims reported intensive imagery of their

trafficking experience, sudden flashback

and fearful nightmares.

Discussion

By looking at the role played by self-

esteem and demographic factors on PTSD

among the participants, findings revealed

that only self-esteem was found

significant. This suggests that victim’s

age, family setting, educational status,

trafficked destination, and reason for

trafficking, were not yardstick to

determine which participant will present

PTSD. Based on this, every participant has

equal chance of presenting with PTSD

after traumatic exposure associated with

trafficking. Findings as these disagree

with Green et al., (1991) that reported that

age of traumatization tend to predispose

older victims to PTSD onset than their

younger counterparts after a disaster. The

findings further disagree with Maercker,

Michael, Fehm, Becker, and Margraf,

(2004) who noted that the development of

PTSD requires certain maturation of

memory organization and arousal

modulation. Equally, the findings fail to

agree with Tsutsumi et al., (2008), who in




93

a study of female survivors of human

trafficking in Nepal, reported that PTSD

was found to be higher in sex workers

group than in the non sex workers group.

Findings as this did not support the view

of Anaeto (2008) that those trafficked for

sexual exploitation are at greater risk of

developing psychological disorders

following their being at greater risk of

violence and abuse.

Besides, obtaining a significant

difference between low and high self-

esteem level among trafficked victims on

PTSD indicates that the two variables can

associate. It could be that the victims with

low self-esteem had low self-esteem

before being trafficked and their traumatic

exposure exacerbated it or that the

trafficking experiences lowered their self-

esteem. It could as well be that those with

high self-esteem before being trafficked

had the exploits (e.g. income) they made

from the trafficking increase their self-

esteem or that their self-esteem increased

for the first time following the gains they

recorded from the trafficking. It is

suspected that trafficked victims that

consciously made themselves available to

be trafficked could have such goal

attainment increase their self-esteem.

Current study finding agrees with Bradley

et al., (2005) who reported that low self-

esteem was related to high mental health

difficulties, as well as with Salami (2010)

who reported that self-esteem moderated

presentation of PTSD.

Relevance of Psychotherapy Psychotherapy is an activity that enables

people to develop understanding about

themselves and make changes in their

lives. Grand (1997) cites that

psychotherapy takes into account the

socio-cultural and socio-political context

in which the client lives and how these

factors affect the client’s present problem.

The relevance of psychotherapy to the

handling of PTSD in Trafficked victims at

rehabilitation centers at NAPTIP’s

southern zonal offices cannot be

overemphasized. Psychotherapy may

involve working with current problems,

immediate crisis, and long-term

difficulties that Trafficked victims

experience in presentations of their

problems. It also involves maintaining the

PTSD that underlies:

1. Overwhelming feelings of sadness

or helplessness

2. An inability to cope with everyday

problems

3. Drinking problems, being

aggressive to an extent that is

harming themselves or others

4. Feeling constantly on edge or

worrying unnecessarily

In addition, one cannot treat a

persons’ illnesses unless one knows why

they are ill and how it happened. This

statement illustrates how psychotherapy

helps people gain insight in dealing with

their PTSD cases. Psychotherapy targets

to improve therapeutic support to

influence people’s behavior with the

myriads of the available therapies such as

Cognitive Behavioural Therapy (CBT),

Behavioural Therapy (BT), Rational

Emotive Behavioural Therapy (REBT),

Aversion Therapy, to mention but few.

Madu (2003) supports this view that

psychotherapy is a basic need for the

human, irrespective of gender, colour, or

race. He explains that psychotherapy in

the past, present and future targets

people’s health and wellness.

Psychotherapy refers to a sum total of

knowledge, representing generation of


94

experiences, careful observations and try-

and-error experiments which

psychotherapists in a particular ethnic

group possess, and which enable them to

handle both social and health problems

affecting people in their respective

communities. As a clinicians, one of the

authors realized the illustration of Madu

here while working with Trauma Network

United Kingdom. Based on author’s

(Ezeakor) scientific knowledge and

research, he observed that psychotherapy

improves a lot with PTSD trauma victims

to regain their self-esteem in the society.

With PTSD Trafficked victims, the

authors have seen things that stay quite a

long time with them while working with

people that are shattered with emotional

difficulties. In the presentations of their

stories, we observed that prolonged

trauma is a targeted lesson for us to see

what people pass through in their lives and

also the possible behavioural indicators

such as:

1. Reluctant to disclosure of trauma

due to shame and guilt

2. The stigma associated with abuse,

torture and power relations

3. Inability to seek help as a result of

low self-esteem

4. Hyper arousal or symptoms of

anger, fearfulness, irritability,

temper tantrums and regressive or

clinging behaviour

Remarkable presentations of

peoples’ PTSD with multiple experiences

of abuses and despair challenged our

practice to look at how psychotherapy is

structured to improve support for PTSD

Trafficked victims to regain their self-

esteem with the instrument of the modern

technology.

Conclusion Of the factors examined in the present

study, only victims’ self-esteem level was

found to be a factor likely to determine

who is to present PTSD. Inferring from

this, one can assert that victims’

evaluation of their worth is an important

aspect of their mental health and ability to

cope with associated negative experiences

of trafficking. Psychotherapy facilitates

improved mental state of individual(s)

who are unable to successfully process

and handle the inundating psycho-

emotional presentations.

Psychotherapy on treatment

modalities with PTSD Trafficked victims

explains the basic need for the human

interventions. The intensifying efforts in

psychotherapy need promotion of co-

operation and a favourable atmosphere for

cross-pollination of ideas between the

western-oriented psychotherapists and

their African colleagues. It will create

opportunities for training, especially in the

School of Psychotherapy and Health

Sciences Okija Nigeria, where

psychotherapy knowledge facilitates

professional development on PTSD

related crisis and trauma. Enriching in

more information services and problem-

solving strategies, the relevance of

psychotherapy will continue to be a basic

human need for PTSD Trafficked victims

to regain their self-esteem in Africa.

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98

Integration Of Spirituality Into Psychotherapy –

A Potential Model For Nigeria

Richard Uwakwe

Department of Mental Health, Faculty of Medicine

Nnamdi Azikiwe University, Awka, Nigeria.

[email protected]; [email protected]

Abstract Although Sigmund Freud, reputed to be the father of psychoanalysis was not favourably

disposed to religion, recent developments indicate that interest in religion and mental

health and psychotherapy has grown. Most clients that come to psychotherapy are likely

to have a religious orientation and will benefit from integrating spirituality into therapy.

Psychotherapists need to learn the techniques and skills of how this integration can best

be achieved especially in Nigeria where religion is a very sensitive issue.

Key words: Religion, psychotherapy, Nigeria.

Introduction

Long before the development of modern

psychological treatments, it has been

known that giving psychological and

social assistance to people in distress was

helpful. The psychosocial assistance may

sometimes involve religious approaches

such as prayers. Traditionally, Sigmund

Freud is often credited as the father of

formal psychoanalysis. Freud’s views

about religion have been a matter of

academic debate. Freud is said to have

regarded religion as an illusion on one

hand and as having originated from the

father figure in the Oedipus complex

(Ahmed 2012; Okon 2012). Freud saw

belief in God as an attempt to reconcile

humankind with its embeddedness into

nature that is mostly experienced as

traumatic. He interpreted the formation of

religions in terms of their function in this

conflict between nature and culture, or

between the ego and the drive.

In recent times, although skepticism

remains, there seems to have been a flood

of interest in spirituality, in respect of

people’s health, mental health and

psychotherapy. A myriad of issues

surround this subject.

In this paper, the author will attempt

to briefly examine the potential

opportunities for integrating spirituality

into psychotherapy in Nigeria.

Religion and Spirituality

Susanto and Idris (2017) in reviewing

Freudian view of religion, opined that

Freud theorized that religion was a tool to

make people believe in the existence of

God or Gods and that the gods function as

a medium to overcome the threat of

nature, to make people accept the cruelty

of their fate and promise rewards for the

suffering and the frustration demanded of

human beings. In other words, through

religion, men merely attempt to protect


Uwakwe, R. (2020). Integration of Spirituality into Psychotherapy –

A Potential Model For Nigeria, International Journal for Psychotherapy in Africa 5(1):98-107

99

themselves against all kinds of threats and

suffering. This protection is said to be

only an illusion: gods do not really

protect human beings, but are only

imagined to have protected them.

This line of thought thus dismisses

religion more or less as a psychological

defence mechanism.

While many Christian writers

present Carl Jung as being non-religious,

or in fact anti-religious, especially with

respect to Christianity, those who ascribe

the initial thoughts or ideas leading to the

formation of alcoholic anonymous regard

Jung as deeply religious (James, 2016).

In fact the tones of the steps of the

alcoholic anonymous look very spiritual.

The first of the twelve steps is particularly

remarkable, indicating that the client has

reached the point of human limit and

requires a Higher Power, which is a very

spiritual laden position.

The famed Psychiatrist, Jerome

Frank is often generally quoted to have

averred that psychotherapy is not

primarily an applied science but rather that

in some ways it more resembles a religion

(Dow 1986; James 2016).

In themselves, the two concepts of

religion and spirituality have been difficult

to define universally.

According to Dew et al (2008),

religion is an “organized system of beliefs,

rituals, practices, and community, oriented

toward the sacred”. It is said that religion

tends to focus on formal organizations

with specifically defined and widely

accepted beliefs, practices, and traditions.

Spirituality, in contrast, can be thought of

as a “search for the sacred, a process

through which people seek to discover,

hold on to, and, when necessary, transform

whatever they hold sacred in their lives”

(Hill & Pargament, 2008). Unlike religion

which is practiced in communities of

individuals, spirituality can be a very

private experience and need not be part of

experiences in organized religion.

Authorities in the field have argued that it

is possible for someone to be religious but

not spiritual, spiritual but not religious,

neither religious nor spiritual, or both

spiritual and religious (Worthington et al

1996). Different people from all walks of

life fall into these various groups of

religious orientations. In most parts of the

world there is no doubt that quite a

number of people are religious.

Although the distinction has been

made between religion and spirituality yet

at the same time, the concepts may be

seen as just terms and words. Some, [for

example Nolan and Crawford (1997)]

argue that spirituality is subsumed by

religion while others see religion as one

dimension of spirituality (Hill et al.,

2000). People who are spiritual may be

involved in establishing religion

organizations. Therefore spirituality and

religion may be interchangeable. In this

paper, any expression of personal or

communal belief or practice about God

will be taken as spirituality or religion.

Therefore throughout this paper, the two

terms will be used interchangeably.

Psychotherapy and Religion

Psychotherapy has many definitions but

Meltzoff and Kornreich (1970) provided

a classical conceptualization. They defined

Psychotherapy as the informed and

planned application of techniques derived

from established psychological principles,

by persons qualified through training and

experience to understand these principles

and to apply these techniques with the

intention of assisting individuals to modify

such personal characteristics as feelings,


100

values, attitudes, and behaviors which are

judged by the therapist to be maladaptive

or maladjustive. (p. 6). This is the

definition adopted in this paper. The

psychotherapy may involve simple talk

between the therapist and the client or any

other technique used to produce a change

in the feeling, thinking or behaviour of the

client.

Perhaps for political and other

reasons, there does not seem to be an

official documentation of the religious

orientation of Nigerians, distributed across

the main stream faiths of Christianity and

Islam. There is no official documentation

by the National Population Commission as

to how many Nigerians belong to which

religion. However, in general, most

people believe that Nigeria is a very

religious country and that most of its

citizens belong to one or another religious

faith. In many western and non-western

countries many people are to a large extent

religious.

Pew Research (2008) reported that

more than nine-in-ten Americans (92%)

believe in the existence of God or a

universal spirit, sixty three percent of

American women and 44% of American

men say that religion is very important to

their lives and Americans are nearly

unanimous in accepting a belief in God

and religion (92%), and large majorities

believe in life after death (74%) and

believe that the Scripture is the word of

God (63%).

According to the same report, more

than half of the studied American

population (54%) claim that they attend

religious services fairly regularly (at least

once or twice per month), with about four-

in-ten (39%) saying they attend worship

services every week. The report indicates

that Americans also engage in a wide

variety of private devotional activities.

Nearly six-in-ten (58%), for instance,

profess that they pray every day. The

report states that some people who are not

affiliated with a particular religious

tradition do not necessarily lack religious

beliefs or practices. In fact, a large portion

(41%) of the unaffiliated population

admits that religion is at least somewhat

important in their lives, seven-in-ten

accept that they believe in God, and more

than a quarter (27%) claim that they

attend religious services at least a few

times a year (Pew Research, 2008).

From these findings, the authors

think that it is safe to assume that religion

and spirituality are of relevance to the

lives of a large portion of American clients

every psychotherapist will come in contact

with. This is most likely the case in

Nigeria and perhaps a huge number of

countries throughout the world.

While religious and spiritual issues

may not be a primary focus of treatment,

they are likely to be relevant aspects of

each client’s life, helping to define their

values, beliefs, lifestyle choices, and

decision making. The authors of the

American religious survey hitherto

referred to; contend that many people find

spirituality and religiosity extremely

comforting. Some people may consult

psychotherapists when there is something

wrong in their lives that their faith does

not help them with. Feelings of

depression, existentiality, anxiety, etc

affect people of all faiths.

Most religious faiths have rules,

regulations and prohibitions against such

things as masturbation, pre-marital sex,

extra marital sex, or, sex during a

woman’s menstrual cycle, stealing,

forgiveness, generosity, etc. These may



101

become areas of conflict for some people

for which psychotherapy may be needed.

There are other areas of life where

religious faith can become a complicating

problem for many people. These problems

include such things as homosexuality,

divorce, abortion, inter faith marriage,

depression and many heterosexual

practices. Religious and spiritual issues

may be relevant to the underlying issues

that prompt clients to seek treatment.

These can include conflicts over religious

values, crises of faith, feelings of

alienation from one’s religion, and

distortion of religious beliefs and

practices, among others.

On the other hand, the client’s

religious and spiritual beliefs and faith

community may be sources of strength

and support that may be accessed in the

course of psychotherapy to assist clients to

achieve their treatment goals. Yet it has

been reported that many psychotherapists

do not enquire about the religious and

spiritual aspects of their clients (Frazer &

Hansen, 2009; Hathaway, Scott & Garver,

2004).

Post and Wade (2009) contend that

the recent resurgence of interest within

the mental health professions to

understand and address the sacred is

probably attributed to the following

developments: research showing a positive

relationship between religion and health;

the majority of the general public in the

United States identifying as religious or

spiritual; and the ascendancy of

multicultural counseling encouraging

sensitivity to cultural diversity, which

includes the religious and spiritual (Hage,

Hopson, Siefel, Payton, & DeFanti, 2006).

The authors cited the study by Delaney,

Miller, and Bisono (2007) who surveyed

the religiosity and spirituality of some

members of the American Psychological

Association (APA) to make comparisons

to both a sample of psychologists

surveyed in 1985 and reported that the

psychologists remain much less religious

than the population they serve.

Post and Wade (2009) were of the

view that psychologists as a group tend to

embrace spirituality more commonly

today than they did in the mid-1980s.

Psychologists today, they argue, are more

likely to describe themselves as ‘‘spiritual

but not religious’’ than the population they

serve (Delaney et al., 2007).

Still, it seems that most

psychologists view the religiosity of their

clients positively.

The widespread nature of religious

orientation among a great number of

people in the world implies that the

majority of people who come for

psychotherapy are likely to belong to one

or another religion. The question is

whether these clients can be treated

without any reference to their spirituality

or if it is possible to integrate their religion

with their psychotherapeutic treatment.

Integration of Spirituality in

Psychotherapy

Some have advocated the integration of

spirituality in psychotherapy when

appropriate and if the therapists have the

competence to do so. According to Plante

(2016) mindfulness, a method that

originated from Buddhist tradition has

been found to be commonly used in

psychotherapy in recent times. This is also

true of yoga, prayer, meditation from other

traditions etc. Hodge (2006) in a review

of the then extant literature demonstrated

that incorporating spirituality into

cognitive therapy for depressive disorders

was effective.


102

More recently, Pearce et al (2015) have

developed a manualized psychotherapeutic

approach, Religiously Integrated

Cognitive Behavioral Therapy (RCBT)

which is designed to assist persons with

depressive disorders to develop

depression-reducing thoughts and

behaviors informed by their own religious

beliefs, practices, and resources. The

treatment approach has been developed for

five major world religions (Christianity,

Judaism, Islam, Buddhism, and

Hinduism), making it useful for ill

individuals from a variety of religious

backgrounds. Kennedy, Macnab and Ross

(2015) reviewed published literature from

2010, and reported that spirituality has

been found useful in psychotherapy when

dealing with a number of psychosocial

conditions including anxiety, depression,

schizophrenia and coping with physical

illness.

Peres, Smao and Nasello (2007)

regard religious beliefs and practices as

constituting an important part of culture

and principles which clients use to shape

judgments and process information.

Therefore, it is said that Psychotherapists

may use knowledge of these belief

systems and appreciation of their potential

to leverage client adherence and achieve

better outcomes. The humanistic

psychotherapies believe that humans have

the innate tendency to grow and self-

actualize. These potentialities can be

harnessed in clients when their religious

beliefs and practices are taken into

account in therapy. In doing this, a key

issue is the maintenance of neutrality and

ethical standard.

Challenges and Suggestions

Integration of spirituality into

psychotherapy poses a number of

challenges, not only because most

therapists have neither the training nor the

experience in the area but also because

religion and spirituality can be highly

personal and it can be an exceedingly

great challenge for professionals to

separate their personal beliefs (or lack of

beliefs) and practices from their

professional ones (Plante, 2006).

In Nigeria the challenge can be quite

huge and more complicated, not only

because of the likely nature of the training

and experience of therapists but because

of the sensitive nature of religion in the

country. In both Islam and Christendom,

the beliefs are not homogenous and

denominational/ sectarian conflicts are not

uncommon. How can religion be

integrated into psychotherapy with an

acceptable coherent marriage that does not

evoke bias, prejudice, and unwitting overt

or covert conflict?

Plante (2016) provided some

suggestions on the principles that should

guide the integration of spirituality into

psychotherapy. The author argues that

spirituality and religion should be treated

as a multicultural and diversity issue

demonstrating respect for and attention to

multiculturalism that includes religion and

spirituality on par with race, ethnicity,

gender, sexual orientation, and so forth

(American Psychological Association,

2002).

In the helping professions such as

education, medicine, social works etc,

clients and therapists come from mixed

different backgrounds –both cultural and

religious. Once there is mutual respect

and understanding, Jews, Shintoists,

Buddhists, Muslims, Jainists, Animists etc

could be attended to by Christians,

Confuciusnists, vice versa.Plante (2006)

states that other principles to consider in



103

integration of religion into psychotherapy

include keeping biases in check, staying

within one’s own area of expertise,

referring to experts including clerics,

being aware of best practices and evidence

based assessments and interventions, and

using resources where available. A

psychotherapist must be ethical and

mature and avoid imposing his or her

religious disposition on the client while

attempting to integrate religion into

psychotherapy. The overriding issue will

be what the client believes in. There is

need for extra caution in cases where the

client and the therapist do not share the

same beliefs. Barnett and Johnson (2011)

recommend that in taking such an

integrative decision, the therapist must

carefully consider and do the following:

i. Respectfully assess the client’s

religious or spiritual beliefs and

preferences.

ii. ii. Carefully assess any connection

between the presenting problem and

religious or spiritual beliefs and

commitments:

iii. Weave results of assessment into

the informed consent process.

iv. Honestly consider the therapist’s

counter- transference to the client’s

religiousness.

v. Honestly evaluate the therapist’s

competence in any given case.

vi. Consult with experts in the area of

religion and psychotherapy.

vi. If appropriate, clinically indicated,

and client gives consent, consult

with client’s own clergy or other

religious professional.

vii. Take a decision about treating the

client or making a referral.

viii. Assess outcomes and adjust plan

accordingly.

In the same vein, the American Psychiatric

Association, 2006 (as cited by Peres Smao

and Nasello, 2007) recommend that

psychotherapists working with the

question of spirituality and religiousness

should do the following:

i. Determine whether religious and

spiritual variables are clinical

characteristics relevant to the

complaints and symptoms

presented.

ii. Examine the role of religion and

spirituality in the belief system.

iii. See whether religious idealizations

and representations of God are

relevant and approach this

idealization clinically.

iv. Demonstrate the use of religious and

spiritual resources in psychological

treatment.

v. Use interview procedures to access

history and involvement of religion

and spirituality.

vi. Get trained in appropriate

interventions for religious and

spiritual subjects and update

knowledge of ethics in relation to

religious and spiritual themes in

clinical practice.

It has been suggested that psychotherapists

can learn how to integrate spirituality in

their session by learning from the

experience of those who already know

how to do it and also by becoming more

self-aware to enhance their work with

religious/spiritual clients (Bartoli, 2007).

Being aware of one’s own beliefs and

biases regarding religion/spirituality for

example by exploring one’s own spiritual

ideas and values through writing a

spiritual autobiography is thought to help

therapists avoid imposing their own values

on their clients. (Wiggins, 2008). Peres,


104

Smao and Nasello (2007) opine that

religious belief is an important part of

culture, principles and values used by

clients to shape judgments and process

information. The authors argue that

confirming clients’ beliefs and perceptive

leanings may boost the ability to organize

or comprehend painful, chaotic, or

unexpected events. The authors further

state that to be successful in integrating

spirituality into psychotherapy, it will be

helpful for therapists to be versed in some

of the basic tenets of their clients’

religions but not necessarily for therapists

to be experts in comparative religion.

Instead, approaching religious/spiritual

clients with an openness and willingness

to engage the religious/ spiritual

conversation will help clients to feel

comfortable expressing their needs.

Post and Wade (2009) gave the

following summary:

Psychotherapists can

routinely assess clients’

treatment preferences for

including or not including

spirituality. Therapists should

routinely assess for religious/

spiritual history and

concerns. Empirical evidence

suggests that

religious/spiritual

interventions are often

effective.

Consequently, integrated psychoreligious

interventions can be delivered effectively

by therapists of all religious/spiritual

beliefs.

In one study in south western

Nigeria, Adegoke (2007) concluded that

many Nigerians use spiritual healing

homes to solve their various problems,

with great influence of education and

economic factors associated with such

religious use. Before they reach formal

psychiatric care, up to 80% of Nigerians

would have contacted a spiritual guide

(Toftegaard et al 2015). More recent

studies indicate that for both physical and

psychological illnesses, Nigerians

copiously use religious therapeutic

approach (Amadi et al 2016; Busari &

Muftau M. A. 2017).

Therefore Nigerians are already used

to religiously delivered therapy.

The questions to consider are: to what

extent is psychotherapy taught and

practised in Nigeria? In view of the

multicultural and multi-religious nature of

Nigeria, with a very sensitive

ethnoreligious characteristic, what

practical steps are necessary in integrating

spirituality into formal psychotherapy in

Nigeria? How can the only school of

psychotherapy in Nigeria (School of

Psychotherapy and Health Sciences;

www.sphs.com.ng), especially at its early

phase, establish the culture of integrating

spirituality in psychotherapy training?

There are no available records to

show the level of psychotherapy practice

in Nigeria. It is also not clear to what

extent Nigerian practising

psychotherapists and clinical

psychologists weave spirituality into

psychotherapy in their local practice.

These issues need to be properly studied to

permit an assessment of what may already

be in place.

Conclusion

It is likely, given the very religious nature

of Nigerians, that bringing spirituality into

psychotherapy would be a potentially

useful model. It has been reported that

therapy seems more effective when the

therapist and the client have common

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105

cultural heritage ((Hayes, McAleavey,

Castonguay, & Locke 2016). Religion in

itself is a culture (Cohen and Hill 2007).

It can therefore be speculated that the

results of treatment may be more effective

if religious Nigerian clients and therapists

adopt spirituality in therapy.

Although there are no available

research reports to show how religious

Nigerian clinical psychologists and

psychotherapists are, nevertheless, one can

speculate that the majority of these

Nigerian professionals are doubtless

religious in view of the religiocultural

milieu of the country. Given that many

Nigerians are already religiously inclined

with respect to their mental health,

Psychotherapists in this environment will

need to seriously consider and attune

themselves to incorporate religion into

psychotherapy. Religious healers should

not be seen as competitors but

complementers and psychotherapists

should be ready and willing to synergize

with them in resolving clients

psychosocial problems (Uwakwe &

Otakpor 2014). In other words, while

adopting religion integration into

psychotherapy, therapists should feel free

to refer clients to religious guides when

and if necessary. Taking into account the

suggestions and experiences of therapists

in other climes, there is need for home

grown local studies to guide the way to

proceed in integrating religion into

psychotherapy in Nigeria.

Religion is part and parcel of the

psychological fabric of human beings and

cannot be separated from their mental

health. Research evidence shows that

religiousness has been associated with

positive outcomes in many investigated

psychosocial and physical problems. If

psychotherapists maintain good ethical

and professional standards and learn the

art and skill of integrating religion into

psychotherapy, the process can be

successful. This will be useful in Nigeria

where religion matters much to most

people.

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108

English Language Students And Their Coping Styles

During Lockdown As A Result Of The Novel

Coronavirus 2019 (Covid-19) Global Pandemic

Bridget Ngozi Madu

Department of English,

Chukwuemeka Odumegwu Ojukwu University,

P.M.B 6059 Igbariam Campus, Nigeria.

[email protected]

Abstract The author examined the effective and ineffective coping mechanisms of English

language undergraduate students during the total lockdown in Nigeria as a result of the

Corona Virus (COVID-19) global pandemic. The participants in the study were twenty

undergraduate students of English language in a state university. The students were

interviewed on telephone on their coping styles during lockdown as a result of the

COVID-19 global pandemic. Their responses were recorded on the phone, transcribed,

and thematically analysed using qualitative methods. Results show that they used such

effective coping mechanisms as having a positive attitude towards the lockdown, and

therefore used the opportunity for reading novels, writing poems, playing and dancing

music at home, and painting/drawing. Other effective coping activities reported were:

Having quiet moments for meditation and prayers, home physical exercises and aerobic,

sleeping/resting, watching television and movies, gardening/farming, family

bonding/reunion, and expected/desired pregnancy. Some of them also reported some

ineffective ways of coping, such as denial of reality of COVID-19, feeling anxious,

boredom/loneliness, weight gained, substance abuse/use, domestic violence, unwanted

pregnancy, longing for intimate sexual partner, being angry with the governments

because of food-shortage/starvation, and obsessive-compulsive behaviour. The author

concludes that the effective coping mechanisms would enhance their proficiency in

English language, and should be encouraged; while the ineffective ways of coping would

definitely be detrimental to their future professions and life in general, and should be

discouraged.

Key words: English language students, Lockdown, COVID-19, Coping strategies,

Nigeria.

Introduction

The corona virus (COVID-19) which

started in China in December 2019

quickly spread over the whole world

within a few months, infecting and killing

thousands of people in many parts of the

world (Africa CDC, April 13, 2020;

Nigerian Centre for Disease

Control/NCDC, 2020). In order to control

the spread of the deadly virus, most

countries of the world embarked on total

lockdown. In Nigeria, the total lockdown


Madu, B.N. (2020). English Language Students and their Coping Styles During Lockdown as a

Result of the Novel Coronavirus 2019 (Covid-19) Global Pandemic,


109

was enforced on 30th March 2020. Like in

most countries of the world, all schools,

churches, mosques, airlines, businesses

(except for food and vegetable sellers)

were closed. There were no inter-country,

inter-state, or inter-town movements. In

many cases, people were not even allowed

to come out of their homes or flats (except

for those on essential duties like nurses,

medical doctors, and police). People were

compelled to stay at home for months,

depending on when the country declared

its own total lockdown. This unexpected

lockdown was never experienced before

by most living citizens of the world.

Students in secondary and tertiary

institutions, who were mostly teenagers or

young adults, must have experienced the

lockdown in a special way. For young

people who are full of life and energy, and

some with mood swings, all of a sudden to

sit at home without knowing when the

lockdown will end, can be devastating.

This made the author to investigate the

coping strategies of English language

students during the lockdown. The author,

being a lecturer of English language in a

university, had telephone contacts of some

of her students; thus she decided to limit

her investigation to English language

students.

The aim of the study therefore was

to investigate the experiences of English

language students during the COVID-19

total lockdown in Nigeria and their coping

mechanisms.

Lahey (2009: 456-459) grouped

coping with stress into two: Effective

coping and Ineffective coping. Under

effective coping are removing or reducing

the source of stress, cognitive or attitude

change, and managing stress reactions.

While ineffective coping strategies are

withdrawal from the society or

environment (social isolation), aggression

(like domestic violence), self-medication

(like using drugs to forget the stressful

situation), and defense mechanisms like

denial of reality (as suggested by Freud,

1949). Lahey’s view on coping with stress

is the theoretical framework adopted for

this work.

Literature review shows that many

authors from different parts of the world

have reported the experiences of

university students and the general public

during lockdown as a result of the

COVID-19 pandemic. Some of the authors

reported that their respondents felt more

worried, depressed, were preoccupied with

the idea of contracting the virus, had sleep

disturbances, and felt their existence was

being threatened (Chakraborty &

Chatterjee, 2020). Spanish Arts,

Humanities, and Social Science students

also expressed higher levels of anxiety,

depression, and stress more than

Engineering and Architecture students

(Odriozola-Gonzalez, Plachuelo-Gomez,

Irurtia, & de Luis-Garcia (2020). See also

similar report about Veterinary students in

England Yiannouli, 2020). In the U.S.,

Schildkraut, Nickerson and Ristoff (2020)

reported of fear and anxiety among

students. Similar to reports from other

authors, Mucci, Mucci, Diolaiuti (2020)

reported feeling of uncertainty, fear,

despair, stress, sleep disturbances,

depressive symptoms and suicidal ideation

among their participants in Italy. Also, in

Italy, Galle, Sabella, Da Molin, De Giglio,

et al. (2020) reported complaints of

decreased physical activities among Life

Science Degree Students; and Cellini,

Canale, and Mioni (2020) reported of

sleep difficulties (lower sleep quality),

depression, anxiety, and stress symptoms


110

among their participants. None of the

above studies were conducted in Nigeria,

and none of them focused on English

language students.

The author therefore set out for the

study with the following two objectives: 1. To find out the effective ways the

English language students are using

to cope with the unusual mandatory

lockdown.

2. To find out the ineffective ways the

English language students are using

to cope with the unusual mandatory

lockdown.

Method

This study used the qualitative research

method where 20 key informants (English

language students) are interviewed

through telephone call and their responses

analysed using thematic method of data

analysis (De Vos, Strydom, Fouche, &

Delport, 2002).

The participants (key informants)

interviewed were 20 English language

students of a State University in Nigeria.

There was no distance learning or online

education system in the university.

Because of the lockdown as a result of the

COVID-19 pandemic, the students had to

be interviewed on telephone. The

interview took place between 29th and 30th

April 2020 (that is, one month after the

total lockdown was enforced in Nigeria).

The author, using the Departmental record

selected 5 students at each undergraduate

level (100-400 levels) and contacted them.

The method of selection was simple

random sampling.

The researcher first of all called each

student using a cell-phone (handset),

explained the nature and purpose of the

research to him/her, assured him/her of

confidentiality and anonymity, and sought

oral consent from him/her to participate in

the study. Any student who did not agree

to participate in the study would have been

left out, but all of them agreed to

participate.

A topic guide which has the

following question was used for the

interview: “How are you coping with the

total lockdown due to the corona virus

pandemic?” Their responses were

recorded on the phone. The recorded

responses were transcribed and

thematically analysed, to find out their

effective, as well as, ineffective ways of

coping with the situation.

Result

The following themes emerged as a result

of the thematic analysis of the transcribed

interviews responses: a) Effective coping mechanisms:

1. Change of perception and

attitude towards the lockdown.

Many of the students saw the

lockdown as a necessity to

save their lives and that of

others. One of the students

said “Doc, it is better for us to

sit at home and be alive than to

go to school and die”.

2. Opportunity for reading

novels: Some of the students

used the period to read novels

which they did not have time

to read before because the

hectic nature of their

university activities. One

student said “I have even




111

finished reading one novel I

have been wishing to read”.

3. Writing poems: One boy said

“I am good in writing poems,

so I have written some during

this lockdown”.

4. Playing and dancing music at

home. One student said “I

have been playing and dancing

rock music everyday”.

5. Painting/drawing: Two

students said they are good in

painting and drawing; so they

are keeping themselves busy

with paintings and drawings.

6. Having quiet moments for

meditation and prayers. One

girl said “It has been a good

opportunity for me to have

quiet moments and pray to my

God”.

7. Home physical exercises and

aerobic. Another girl said “I

am enjoying having time for

my physical exercises at home

and aerobic. I also at times

walk around our compound”.

8. Sleeping and resting: One girl

said: “I sleep, sleep and sleep.

I have not had such a rest in a

long time. The last time I had

siesta was in my boarding

(secondary) school”.

9. Watching Television and

movies: Many students said

they often watch TV and

movies. One student said, “I

am enjoying my African

Magic day and night”.

10. Gardening/farming: Some

students said that this is

farming season, so they are

helping their parents in

farming/gardening. “We

cultivate cassava” a student

said.

11. Family bonding/reunion: One

girl said “This is the first time

all my brothers and sisters are

staying at home chatting and

playing with each other. We

get to know each other better”.

12. Expected/desired pregnancy:

One lady said “I have been

married and living in the same

house with my husband for

four years and I am a day-

student, but I could not

conceive a child. Now, during

this lockdown, I don’t know

how it happened. I am

pregnant”.

b) Ineffective coping mechanisms:

Some students however reported the

following ineffective ways of coping with

the lockdown:

1. Denial of reality: Some boys

do not believe that the corona

virus is a reality. One boy said:

“It is all about politics! They

(the government) are all

deceiving us! They want to

make money with this issue. It

is not real”.


112

2. Feeling anxious: One girl said,

“I am always feeling anxious

and suspicious of everybody

because I do not know who is

carrying this virus and who is

not. I can’t even sleep well

again”.

3. Boredom: Some students

experienced the period as very

boring. One student said “The

thing (lockdown) is just boring

me”.

4. Weight gained: One girl said

“I eat and eat and eat. I have

even gained a lot of weight”.

5. Substance abuse/use: One boy

said “I am now smoking and

drinking (alcohol) more than

before”.

6. Domestic violence: Some

ladies said: “It is like we are

quarrelling everyday at home.

I want this thing (lockdown) to

end so that we go our different

ways again”.

7. Unwanted pregnancy: One

lady said “I already have three

children and I did not want

more. But now the lockdown

has made me to be pregnant

again”.

8. Longing for intimate sexual

partner: One boy said, “My

girlfriend is living in another

State and I cannot meet her

(for sex) due to the lockdown.

This thing (lockdown) should

stop so that I go and meet her.”

9. Angry with the governments

because of food shortage/

starvation: Some students are

angry with the governments

for forcing their parents who

are business men/women to sit

at home and do nothing; while

they (the governments) did not

provide enough palliatives to

cushion the effect of the

lockdown. One student said:

“Look at America and other

countries; they provide enough

food and drinks to people

every day. They bring them to

their door-steps. Watch your

TV and see what I am saying.”

10. Obsessive-compulsive

behaviour: One girl said, “I am

always washing my hands for

fear of contacting the virus. I

wash my hands almost every

five minutes, even though I am

at home. I cannot stop doing it.

It’s too bad.”

Discussion

As English language students, it is a

desired finding to see that the participants

in this study used such effective coping

mechanisms (Lahey, 2009) as having a

positive attitude towards the lockdown,

and therefore used the opportunity for

reading novels, writing poems, playing

and dancing music at home, and

painting/drawing. These activities would

enhance their proficiency in English

language. None of the literature reviewed

reported of any effective coping activity

among students.




113

Other effective coping activities

engaged by participants in this study are:

having quiet moments for meditation and

prayers, home physical exercises and

aerobic, sleeping/resting, watching

Television and movies, gardening/

farming, family bonding/reunion, and

expected/desired pregnancy. These are

desirable coping style which may not be

unique to English language students.

Again, none of the literature reviewed

mentioned any of the coping mechanisms.

Besides the above-mentioned

effective coping mechanisms used by the

English language students who

participated in this study, some of them

also reported some ineffective ways of

coping (Lahey, 2009), such as denial of

reality of COVID-19, feeling anxious,

boredom/loneliness, weight gained,

substance use/abuse, domestic violence,

unwanted pregnancy, longing for intimate

sexual partner, being angry with the

governments because of food shortage/

starvation, and obsessive-compulsive

behaviour. Freud (1949) referred to denial

of reality as a form of defense mechanism

with which the Ego protects itself from a

form perceived threat. Current literature

search also shows that many authors have

also reported similar ineffective coping

mechanisms among their participants.

Some of them reported that their

respondents felt more worried, depressed,

were preoccupied with the idea of

contracting the virus, had sleep

disturbances, and felt their existence was

being threatened (Chakraborty &

Chatterjee, 2020). Spanish Arts,

Humanities, and Social Science students

also expressed higher levels of anxiety,

depression, and stress more than

Engineering and Architecture students

(Odriozola-Gonzalez, Plachuelo-Gomez,

Irurtia, & de Luis-Garcia, 2020;

Yiannouli, 2020). In the U.S., Schildkraut,

Nickerson and Ristoff (2020) also reported

of fear and anxiety among students.

Mucci, Mucci, and Diolaiuti (2020)

reported feeling of uncertainty, fear,

despair, stress, sleep disturbances,

depressive symptoms and suicidal ideation

among their participants in Italy; Galle,

Sabella, Da Molin, De Giglio, et al. (2020)

reported complaints of decreased physical

activities among Life Science Degree

Students; and Cellini, Canale, and Mioni

(2020) reported of sleep difficulties (lower

sleep quality), depression, anxiety, and

stress symptoms among their participants.

The above ineffective ways of coping with

the lockdown are not good for anybody,

not to talk of students who are still young

and growing. The ineffective ways of

coping will definitely be a setback in their

future profession and life in general.

Conclusion

It is concluded that English language

students who participated in this study

used such effective ways of coping with

COVID-19 pandemic such as having a

positive attitude towards the lockdown,

and therefore read novels, wrote poems,

played and danced music at home, and

painted/drew pictures. These activities

must have enhanced their proficiency in

English language. The students also

reported some ineffective ways of coping

such as denial of reality of COVID-19,

feeling anxious, boredom/loneliness,

weight gained, substance abuse/use,

domestic violence, unwanted pregnancy,

longing for intimate sexual partner, being

angry with the governments because of

food shortage/starvation, and obsessive-

compulsive behaviour. The ineffective

ways of coping will definitely be a setback


114

in their future profession and life in

general.

Recommendation

While we wish that such a total lockdown

due to COVID-19 pandemic would not

repeat itself in our lifetime, it is

recommended that English language

students (in Nigeria) are made aware of

the desired effective ways of coping with

such lockdowns in the future. They should

also be discouraged from using the

ineffective ways as reported by many

authors.

Future studies should use English

language students from many other

universities as participants. That would

increase the external validity of the

findings. A comparison of the coping

styles of English language students and

that of other students would be interesting.

Also, a study design that triangulates both

quantitative and qualitative methods is to

be encouraged.

References

Africa Centre for Disease Control and

Prevention (Africa CDC) (2020).

COVID-19 case update, 13th April

2020. Addis Ababa, Ethiopia: Africa

CDC.

Cellini, N., Canale, N. & Mioni, G.

(2020). Changes in sleep pattern,

sense of time and digital media use

duringCOVID-19 lockdown in Italy.

Journal of Sleep Research.

Electronic publication, May15,

2020, e13074.

Chakraborty, K. & Chatterjee, M (2020).

Psychological impact of COVID-19

pandemic on general population in

West Bengal: A Cross-sectional

study. Indian Journal of Psychiatry,

62, 3, 266-272.

De Vos, A.S., Strydom, H., Fouche, C.B.

& Delport, C.S.L. (2002). Research

at grass roots: For social science

and human service professions.

Pretoria: Van Schaik.

Freud, S. (1949). A general introduction to

psychoanalysis. New York: Garden

City Publishing.

Galle, F., Sabella, E.A., Da Molin, G., De

Giglio, O., Caggiano, G., Di

Onofrio, V., Ferracuti, S.,

Montagna, M. T., Liguori, G. Orsi,

G. B. & Napoli, C. (2020).


Environmental Research and Public

Health, 17(10), Electronic

publication, May 16, 2020.

Lahey, B. B. (2009). Psychology: An

introduction. Boston: Mc Graw Hill.

Mucci, F., Mucci, N. & Diolaiuti, F.

(2020). Lockdown and isolation:

Psychological aspects of COVID-19

pandemic in the general population.

Clinical Neuropsychiatry, 17(2), 63-

64.

Nigerian Centre for Disease Control

(NCDC) (2020). COVID-19 case

update (11.50pm, 19/04/20).

Twitter/Facebook:@NCDCgov/Covi

d19.NCDC.gov.ng. Accessed

19/04/20.

Odriozola-Gonzalez, P., Plachuelo-

Gomez, A., Irurtia, M.J. & de Luis-

Garcia, R. (2020). Psychological

effects of COVID-19 outbreak and

lockdown among students and

workers of a Spanish university.

Psychiatry Research, 290, 113-128.

Schildkraut, J., Nickerson, A.B. &

Ristoff, T. (2020). Locks, lights, out

of sight: Assessing students’

perceptions of emergency

preparedness across multiple




115

lockdown drills. Journal of School

Violence, 19(1), 93-106.

Yiannouli, A. (2020). How is the

lockdown affecting Vet students?

The Veterinary Record, 186(16), e5.


116

Genuineness In Client Centered Psychotherapy:

It’s Relevance To The Nigerian Society During

The Convid-19 Global Pandemic

Promise Chinedu Uwakwe


Imo State University, Owerri, Nigeria.

[email protected]

Abstract In this paper, the concept of genuineness, as expressed by Carl Rogers in Client-

Centered Psychotherapy, is the platform on which efforts of some Nigerian citizens and

governments to curb the spread of corona virus (COVID-19) is discussed. The

genuineness in seeing COVID-19 as real, the political goodwill, the sincerity in

administering the COVID-19 funds, in carrying out the internationally mapped out

measures to contain the virus, and in the distribution of the palliatives to cushion the

adverse effects of the lockdown, are questioned. A call for attitudinal change on the part

of the concerned citizenry and the governments are therefore made.

Key words: Genuineness, Client-Centered Psychotherapy, Corona Virus (COVID-19),

Nigeria.

Introduction

Genuineness remains an important

condition for a good insight into the

authenticity of life variability, especially

regarding psychological well-being.

Changeability is one oblivious reality of

life and most times fundamental to the

incongruence faced by many (Crowell,

2016). As humans grow and develop in

the biological and psychological domain,

lots of challenges are experienced

consequent to the inherent changes

accompanying these developments.

Genuineness is a vital ingredient applied

in creating an enabling atmosphere for

individuals to gain superior insights into

their challenges in a psychotherapeutic

engagement. In problem solving, it can be

said that clear insights into the indices of

human challenges are essential to the

effective management and/or helpful in

sorting life predicaments or changes

successfully. Genuineness is perceived as

the unadulterated and congruent external

display of an individual’s actual internally

recognized values, beliefs, emotions, and

other perceptions of themselves including

the world they exist in (Crowell, 2016).

In psychotherapy, assiduous efforts

are made through the application of

psychological methods that helps a person

change behavior and overcome problems

in desired ways (APA, 2016).When

individuals enter therapy, they are in a

state of incongruence, meaning there is a

difference between how they see

Uwakwe, P.C. (2020). Genuineness In Client Centered Psychotherapy:

It’s Relevance To The Nigerian Society During The Convid-19 Global Pandemic,


117

themselves and reality (Lietaer, 2001). But

through the reflection of genuineness by

the therapist, the individual tends to find

reasons to be genuine to his or herself and

by extension other persons around.

Psychotherapy aims to improve an

individual's well-being and mental health,

to resolve or mitigate troublesome

behaviors, beliefs, compulsions, thoughts,

or emotions, and to improve relationships

and social skills (Grafanaki, & McLeod,

2002).

As a behavioral healing principle or

condition, genuineness should be prized

highly, cultured and promoted at all cost

and by any well-meaning government or

institution with the goal of behavioral

harmony. This highlights the necessity of

creating enabling environment for such

social services as psychotherapy to thrive,

since it is bound to eliciting genuineness

from individuals and society.

It is therefore unarguable that

genuineness is a useful tool for survival in

the face of the current Corona Virus

(Covid-19) pandemic, where many

persons have become confused,

traumatized, anxious, fearful, and many

other emotionally disturbing conditions

experienced by many in the Nigerian

society. Thus, psychotherapy, principled

in genuineness, has been shown to be

helpful in reaching the etiology of the

individual’s emotional and behavioral

challenges and key to positive thinking

(Karlsson, 2011).

In Nigeria, the imposition of total

lockdown across the country, as measure

to inhibit the spread of the Corona virus

(Covid-19) pandemichas forced millions

of people to stay at home, restricting their

mobility and pushing them to increase

screen time (Adebajo, 2020).

Corona virus is a spherical or

pleomorphic, single stranded, enveloped

RNA and covered with club shaped

glycoprotein. Corona viruses are of four

sub- types such as Alpha, Beta, Gamma

and Delta Corona virus. Each of the sub-

types of Corona viruses have many

serotypes. Some of them affect human

while others affect animals such as pigs,

birds, cats, mice and dogs (ICTV, 2020).

The adverse situation created by

Covid-19 has led many to call on Nigerian

and African leaders to adapt their Corona

virus response measures to the realities on

the ground (Adebajo, 2020). But the

measures applied by the Nigerian

government seem to lack sensitivity and

sincerity and seem not to be truly survival

oriented. As these measures such as:

shutdown of economy without proven

palliatives, sensitization of the masses,

payment of wages/salaries in some part of

the country, establishment of Covid-19

intervention team/committee without strict

follow-up on their actions and activities,

setting up of Covid-19 quarantine centers

with no sensitization program involving

mental health workers to work against

phobia and stigmatization (BBC News,

2020), tend to reflect the proven survival

narrative of a typical Nigerian society in

the face of outbreaks. This situation can be

described as lacking genuineness in

content and intent.

However, this work expresses the

need for the Nigerian society to adopt and

domesticate her own model for the fight

against Corona virus to the unique

Nigerian personality, culture, social

construct, belief system etc, as it attempts

to reflect the relevance of genuineness in

the Nigeria society in the ongoing global

covid-19 pandemic.

https://en.wikipedia.org/wiki/Well-being

https://en.wikipedia.org/wiki/Mental_health

https://en.wikipedia.org/wiki/Social_skills


118

Since the first index confirmed case

relating to the COVID-19

pandemic in Nigeria on 27 February 2020

when an Italian citizen in Lagos tested

positive for the virus, caused by SARS-

CoV-2 (Olurounbi, 2020 ), the Nigeria

society has continued to be in panic and

confusion as the pandemic expresses itself

in bereavement for those who have lost

their dear ones to the virus and phobia for

socialization as the government tries to

clamp down on social gathering in other to

foster social distancing as prescribed by

World Health Organization. As

precautionary measures adopted against

the spread of the virus are being

implemented, there has been increase in

assaults and molestations by Covid-19 law

enforcement agents across many

settlements in Nigeria. According to

health ministry data, Covid-19 law

enforcers have killed 18 people in Nigeria

since lockdowns began on 30 March 2020

(BBC News, 2020). Another overt impact

of the Covid-19 pandemic in Nigeria is

hunger and starvation. Unlike many other

countries going through the shock of

Covid-19 pandemic, the Nigerian society

seems not to have an accurate data of

palliatives intervention to help masses

cushion the terrible effects of the

pandemic (Adebajo, 2020). Consequently,

many persons have become financially

bankrupt, since meeting survival needs

like food, health care, accommodation

bills (house rent, water supply bill,

electricity bill has become a problem. This

asks the question of sincerity and

genuineness in the attitude of the Nigerian

government towards properly addressing

the problem of Covid-19 pandemic.

Background to the concept of

Genuineness

The person-centered approach was

developed from the concepts of

humanistic psychology. The humanistic

approach “views people as capable and

autonomous, with the ability to resolve

their difficulties, realize their potential,

and change their lives in positive ways”

(Seligman, 2006). Rogers (1942),

advanced an approach to psychotherapy

and counseling that, at the time (1940s–

1960s), was considered extremely radical

if not revolutionary. Carl Rogers

emphasized the humanistic perspective as

well as ensuring therapeutic relationships

with clients promote self-esteem, and

actualization in their life, and help them to

use their strengths (Seligman, 2006).

The theory is described as non-

directive. This concept moved away from

the idea that the therapist was the expert

and towards a theory that trusted the

innate tendency of human beings to find

fulfillment of their personal potentials. An

important part of this theory is that, in a

particular psychological environment, the

fulfillment of personal potentials includes

sociability, the need to be with other

human beings and a desire to know and be

known by other people. It also includes

being open to experience, being trusting

and trustworthy, being curious about the

world, being creative and compassionate.

The psychological environment described

by Rogers was one where a person felt

free from threat, both physically and

psychologically. This environment could

be achieved when being in a relationship

with a person who was deeply

understanding (empathic), accepting

(having unconditional positive regard) and

genuine (congruent) (Wendera, et al

2008).

https://en.wikipedia.org/wiki/COVID-19_pandemic

https://en.wikipedia.org/wiki/COVID-19_pandemic

https://en.wikipedia.org/wiki/Nigeria

https://en.wikipedia.org/wiki/Lagos

https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome_coronavirus_2

https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome_coronavirus_2




119

The psychotherapists in this approach

works to understand an individual’s

experience from their point of view. The

psychotherapist must positively value the

client as a person in all aspects of their

humanity, while aiming to be open and

genuine as another human being. This is

vital to helping an individual feel accepted

and better understands their own feelings,

essentially helping them to reconnect with

their inner values and sense of self-worth.

This connection with their inner resources

enables them to find their own way to

move forward. The work of the therapist,

therefore, is to facilitate this by creating an

enabling environment for client to find the

solution to his or her problems. The

therapist does not try directing the client

or offering solutions. Roger’s proposition

was that, any relationship possessing the

conditions, would produce psychological

change within the client, irrespective of

whichever psychological approach was

employed.

Genuineness or Congruence requires

the therapist to be transparent about his or

her feelings and thoughts. He or she does

not present an aloof professional facade,

but is present and transparent to the client

in the sense that, he or she expresses

feelings and thoughts that he or she

actually experiences rather than those he

or she thinks. This will help the client

open up. In this regard, the therapist may,

sometimes, share his or her personal

experiences with the client. The aim of

this is to make the client comfortable

enough to become genuine and fully

express him or herself (Rogers, 1959).

Genuineness and its relevance to the

Nigerian society amidst the Covid-19

global pandemic

Many people in some Nigerian societies

are said not to be genuine. They are

fraudulent, untruthful, deceitful,

untrustworthy and unreliable. What of the

so called “419” people, the scammers,

fraudsters etc. Even in this period of

Covid-19 pandemic, the Nigerian society

can be said to witnessing manifold levels

and forms of insincerity.

Many individuals and even some

church leaders are denying the reality of

Covid-19 (Adebayo, 2020; Jideonuo,

2020). They are not genuinely spreading

the news that putting on face mask,

washing/sanitizing hands often, and

maintaining social/physical distancing

would assist in curing the spread of the

virus.

However, with all these opposing

trait to genuineness, it can be said that

many religious leaders in Nigeria have

need to review their value system by

adopting the principle of genuineness in

modifying their cognition and personality

so as to front more sincere and helpful

paradigm that can enable the government

and masses survive the Covid-19

pandemic or any other pandemic in later

times.

Similarly, some Nigerian political

activities point to traces of insensitivity,

insincerity, manipulations,

unaccountability, dishonesty, greed, fraud

and other manner of spurious behavioral

tendencies to lack in genuineness and fair

play for everyone. Some evidence to lack

of genuineness in the political

activities/system during the pandemic

includes: 1. Non-transparent records on the of

Covid-19 funds.


120

2. Insincerity in the disbursement of

Covid-19 funds by the Federal and

state governments.

3. Inconsistent/conflicting information

on the causes (etiology and

precursor) of Convid-19 pandemic.

4. Inconsistent/conflicting information

on the outbreak statistic/update.

5. Compromises on the mapped out

measures to curb the spread of

Covid-19.

6. Dissatisfaction of the masses in

quantity, quality, and manner of

palliatives distributed to cushion the

adverse effects of the lockdown on

poor people.

7. Disbelieves in figures of infected

individuals as posited by Nigeria

Centre for Diseases Control

(NCDC).

Finally, an observation on attitude of

masses to the covid-19 pandemic in the

Nigerian, especial with regards to

commitment and adherence to

precautionary measures setup by the

governments, reveals huge dishonesty and

lack of corporation. In as much as the

governments make some efforts to

orientate and enlighten the masses on the

alarming dangers implicated with the

pandemic, it is noticed that many persons

seem to show little or no commitment to

the directives of the governments against

the spread of the virus. This is made

visible by the large scale of poor

commitment by many individuals in

adherence to wearing of face mask, the

stay at home bill, regular washing of

hands, and social distancing. This

predisposition can be classified as

dishonest in the sense that many of these

individuals who decline government

directives, do so merely to frustrate the

efforts of the government; and not

necessarily because they doubt the

information projected by the government

about the pandemic.

However, it has been established

with all these traits of insincerity,

selfishness, dishonesty, fraud /scamming

found in some Nigerians during the

pandemic, that there is huge lack of

genuineness found many Nigerians with

respect to curbing the spread of Cov0d-19

pandemic. When genuineness is a seldom

character within the government of a

given society, the citizens see that as a

model. When one is not genuine to

him/herself, he/she cannot be genuine to

the environment. Not being genuine leads

to many psychological problems. Durđa

(2017) posits that genuineness

(authenticity) is closely connected to

mental health and significantly contributes

to it. Therefore, genuineness in Client

Centered Therapy has vital a role to play

among such societies that are said to be

fraudulent, corrupt, inconsiderate

especially, during a pandemic situation

like the Covid-19.

Conclusion

Genuineness, as used in Client Centered

Psychotherapy, provided a platform on

which to question and discuss genuineness

of the part of some Nigerian citizens and

governments with respect to controlling

the spread of Covid-19 global pandemic.

The genuineness and sincerity in seeing

the virus as real; the genuine goodwill in

political, in social and financial efforts in

controlling the virus are questioned.

Attitudinal change in the entire populace

both on the part of some citizenry and




121

some government in Nigeria are therefore

called for.

References

Adebajo K. (2020). COVID-19: Infodemic

Challenges the War Against The

Pandemic in Nigeria. Newsletters of

humble angle.online news feed.

APA (American Psychological

Association) (2016). Client centered

therapy. Retrieved from http://

apa.com, May 10, 2020.

BBC News (2020). BbcNews May 2020.

Retrieved from http:// bbcnews

.com.

Crowell, S. (2016). Existentialism. In E.

N. Zalta, (Ed.), The Stanford

encyclopedia of philosophy.

Retrieved from

http://plato.stanford.edu/archives/sp

r2016/entries/existentialism.

Durđa G. (2017). Authenticity as a

predictor of mental health. Research

Gate Journal 10.21465/2017-kp-1-

2-0002.

Grafanaki, S., & McLeod, J. (2002).

Experiential congruence: A

qualitative analysis of client and

counsellor narrative accounts of

significant events in time-

limited person-centred therapy.

Counselling and Psychotherapy

Research, 2(1), 20-33.

International Committee on Taxonomy of

Viruses (ICTV 2020).Taxonomy

history: Orthocoronavirinae.

Retrieved 24 January 2020.

Jideonwo C. Covid-19: There’s One Thing

Nigeria’s Religious Rockstars Can

Do To Help. Publication of African

Arguments.

Karlsson, H. How Psychotherapy changes

the Brain. Psychiatric Times. 2011

Lietaer, G. (2001). Being genuine as a

therapist: Congruence and

transparency. In G. Wyatt (ed.),

Rogers’ therapeutic conditions:

Evolution, theory and practice. Vol.

1.Congruence (pp. 36-54). Ross-on-

Wye, UK: PCCS Books.

Olurounbi R. (2020), Coronavirus: Nigeria

goes home for funds out of fear on

COVID-19 Impact. The Africa

Report Newsletter.

Rogers, C. (1959). A Theory of Therapy,

Personality and Interpersonal

Relationships as Developed in the

Client-centered Framework. In (ed.)

S. Koch, Psychology: A Study of a

Science. Vol. 3: Formulations of the

Person and the Social Context. New

York: McGraw Hill.

Rogers, Carl R. (1942). Counseling and

psychotherapy. Cambridge, MA:

Riverside Press. ISBN 978-

1406760873.

Wandera, J. (2008). Persons centered

therapy. Oxford University Press.

East Africa Ltd.


122

Gender Differences In Attitude To The Skin Disease-

Atopic Dermatitis Among Adolescents:

The Role Of Cognitive Behavioral Therapy

Charity Justin Takyun


Federal University of Lafia, Nasarawa State, Nigeria.

[email protected]

Aleksandra Surenovich Kocharyan

Department of Counseling and Psychotherapy

Faculty of Psychology,

V.N. Karazin Kharkiv National University, Ukraine

Abstract This paper examines gender differences in attitude to the skin disease-atopic dermatitis

among adolescents: The role of Cognitive- Behavioural Therapy. 83 adolescents aged

between 13 and 15 and diagnosed with moderate (43) to grave (40) atopic dermatitis

took part in the study. The groups were divided according to gender; group 1 was made

up of 38 adolescent boys, and group 2 was made up of 45 adolescent girls. The control

group included 80 adolescents (40 girls and 40 boys) matched for age. The

psychodiagnostic complex used in the study were: Method for establishing the disease

attitude type (DAT) and Male and Female Painting projective test. Data were analyzed

using correlation and student’s t-test. The comparison of data yielded results that

indicate gender-specific types of attitude to the disease among adolescents diagnosed

with atopic dermatitis. A statistically significant difference between the groups was found

in the anosognosic disease attitude type that is more typical of adolescent boys. This

disease attitude type is characterized by active rejection of thoughts about the disease

and its consequences which is explained by boy’s bravado, by their wish to demonstrate

invulnerability and confidence, which is in effect an attempt to compensate for low self-

appraisal.

Key words: Atopic dermatitis among Adolescents, Gender differences, attitude to

Disease, CBT.

Introduction

The skin has many functions among which

are protection, thermoregulation, water-

salt exchange, excretion, blood pooling, as

well as endocrine, metabolic, receptor, and

immune functions. In addition to the

above physiological skin functions, it also

plays a psychological role – the skin is an

expression and self-presentation organ.

Skin diseases are therefore characterized

by their external noticeability and

concomitant skin itch. This characteristic


Takyun, C.J. & Kockaryan, A.S. (2020). Gender Differences in Attitude to the Skin Disease-Atopic

Dermatitis among Adolescents: The Role of Cognitive Behavioral Therapy,


123

of skin diseases arises as a result of

psychic problems which in turn adversely

impact on the mental state of the patient,

thus leading to a vicious circle. Atopic

dermatitis is one of the most wide-spread

skin diseases occurring in different age

groups in both males and females in all

countries. According to the WHO, the

prevalence rate of atopic dermatitis is

constantly rising and is 6% to 25% in

different countries. It occurs significantly

more frequently in women. Atopic

dermatitis is more prevalent among the

citizens of large cities than amongrural

population. Usually manifesting itself at

an early age, atopic dermatitis soon

acquires a chronic recurrent course. The

discomfort related to severe itching leads

to the disruption of sleep, every-day life

and social activity which in turn requires

the application of psychological

intervention in order to change negative

and unrealistic faulty emotional

disturbances.

The adolescent stage of atopic

dermatitis is diagnosed in children above

13 years of age. It affects the face and

upper body parts and has a chronic

recurrent course (Smirnova, 2006).

Adolescence is usually characterized as a

critical and transitional age. It is regarded

as the most important and the most

difficult period of life characterized by

abrupt, rapid and critical events.

Adolescence is perceived as the second

birth, resulting in the emergence of a new

“self” (Averin, 2003; Cle, 1997;

Obukhova, 2003, & Polivanova, 1996).

Adolescence is accounted for by the

presence of a major need to be “satisfied

with one’s own appearance. (Mendelevich

& Solovyeva, 2002). Accordingly, the

adolescent thinks that other people are

equally concerned with their appearance

and behavior. This very belief was termed

in Reana (2003) as "imaginary audience",

and it is viewed as one of the main

manifestations of egocentricity in

adolescence. Adolescents persistently

attempt to predict others’ reactions to

themselves. However, these predictions

depend on adolescents’ self-attitude. In

their view, other people will treat them the

same way they treat themselves. Due to

these reasons, adolescents constantly

construct the "imaginary audience" with

themselves in the spotlight of attention.

The affect often experienced by

adolescents is “shame” as a reaction to

constant attention on the part of the

"imaginary audience". He or she view

acceptance by others as very important.

The acceptance of one’s own body

acquires a major interest. In the

adolescent’s view, “being attractive”

means having successful personal

relationships. Thus, the body becomes a

hostage of romantic relationships rather

than a value in itself. Sexual maturation

increases inner tension. Bodily appearance

and feelings become even more important

enhancing the possibility of intimate

relationship with a partner. Therefore,

when an adolescent evaluates his or her

body and detects physical defect, a

conclusion is drawn about his/her own

social inferiority. A desire may also arise

to compensate drawbacks in another field

or to try and improve them. Discomfort or

insults by people around regarding the

peculiarity of appearance can cause

violent affect and pervert the behavior of

the adolescent thereby causing traumatic

experiences.


124

The Role of Cognitive- Behavioral

Therapy (CBT) In Changing Thought

Pattern

As opined in Takyun, (2009), the major

challenge for mental health community is

to learn how best to help people who are

suffering from all forms of traumatic

experiences including emotional trauma.

Foa et al (1995), developed Brief

Cognitive-Behavioural Treatments which

include various forms of relaxation

therapy and education. Cognitive

restructuring is applied in CBT which

involves techniques for replacing

catastrophic, self-defeating thought

patterns with more adaptive, self-

reassuring statements. What sustains an

individual through the disease process is

the therapeutic alliance. Therapeutic

interventions attempts to restore not only

an individuals somatic and social balance

but also the sense of coherence. The use of

Cognitive Behavioral Therapy (CBT) is

aimed at changing negative and unrealistic

faulty reasoning because thinking

determines feelings, emotions and

behaviors.

Attitude to disease The reflection of a disease in a person’s

emotion is commonly called the internal

disease pattern (IDP). This term

encompasses everything “a patient feels

and experiences, all the multitude of

his/her feelings, the general sense of well-

being, self-observation, ideas about the

disease and its causes – the patient’s entire

huge world consisting of complex

combinations of perceptions and feelings,

emotions, affects, conflicts, psychic

experiences and traumas”. (Yeresko,

Isurina, & Koydanovskaya 1994; Amon,

2000). The term was first introduced by

the physician- Luria (1977) and is now

broadly used in medical psychology. As a

complex structural unit, the internal

disease pattern consists of several levels:

sensitive, emotional, intellectual,

volitional, and rational.

The IDP is determined not only by

the nosology, but also by the patient’s

personality, it is as individual and dynamic

as our internal world. There are a number

of studies describing how the patient

experiences his/her condition (Nikolaeva,

1987).

Mendelevich, (2005) states that the

type of reaction to a particular disease is

determined by two characteristics:

objective gravity of the disease (defined

by the mortality rate and disability

likelihood) and its subjective gravity (the

patient’s assessment of his/her condition).

Subjective gravity depends on social

and constitutional features including the

individual’s sex, age, and profession. Each

age group has a distinct disease gravity

register – a classification of diseases by

their socio-psychological significance and

gravity (Karvasarsky, 2002; Mendelevich,

2005). Thus, the most serious

psychological reaction in adolescence may

be caused by diseases that change the

adolescent’s appearance making him/her

unattractive. It is accounted for by the

presence of a major need to be “satisfied

with their own appearance” in

adolescents’ consciousness (Mendelevich,

2005).

The typology of disease reactions

includes 13 types of psychological disease

reactions distinguished based on three

factors: the nature of somatic condition,

the type of personality with the character

accentuation type being of major

importance, and disease attitude in the

referent (significant) group (Lichko, &

Ivanov, 1980):




125

1. Harmonic type: This reaction type

is characterized by sober evaluation

of one’s condition without the

inclination to overstate one’s

burden, but also without

underestimating the disease gravity.

The patient is willing to actively

contribute to the treatment. He or

she does not want to burden others

with the need for care. In case of an

unfavorable disability forecast the

individual shifts to the domains of

life that remain available. In case of

an unfavorable prognosis, attention,

care and interests are centered on

close relatives’ life and the patient’s

own business.

2. Ergopathic type. This reaction type

is characterized by “withdrawal

from “disease to work”. Excessively

responsible, sometimes obsessive,

volitional attitude to work is typical,

which is sometimes more

pronounced than attitude to the

disease. Selective attitude to

treatment caused by the desire to

continue work in spite of the disease

gravity. The desire to maintain

professional status and to continue

work in the current position by any

means.

3. Anosognosic type. This type is

characterized by active rejection of

thoughts about the disease, its

potential consequences, denial of

obvious disease signs, attributing

them to random events or other

transient conditions. Refusal of

medical examinations and

treatment, desire to do with one’s

own means.

4. Anxious type. This reaction type is

characterized by constant

nervousness and distrust to

unfavorable disease outcome,

possible complication treatment

inefficiency .The search for new

treatment methods, craving for

additional information about the

disease, possible complications and

treatment methods.

5. Hypochondriac type. This type is

characterized by an excessive focus

on subjective disease-related and

other negative feelings. An

inclination to always share them

with doctors, medical staff and

people around. Exaggeration of the

existing disease and the search for

non-existent diseases and sufferings.

Exaggeration of unpleasant

sensations associated with side

effects and diagnostic procedures.

The combination of willingness to

be treated and the disbelief in

treatment success. Constant demand

for thorough examination by

superior specialists. Fear of the pain

of procedures and possible harmful

effects,

6. Neurasthenic type. This type is

characterized by an “irritable

weakness” behavior. Outbursts of

irritation, especially when in pain

orin case of painful sensations,

treatment failures or unfavorable

examination findings. Irritation

often hits the nearest person and

often ends in remorse and tears.

Intolerance of pain sensations. Lack

of general tolerance. Inability to

wait for relief. Later, the feeling of


126

remorse for inconveniences and lack

of restraint.

7. Melancholic type. This type is

characterized by the feeling of

depression because of the disease,

disbelief in recovery, possible

improvement, or treatment effect.

Active depressive statements to

suicidal thoughts. Pessimistic view

of everything around, disbelief in

the therapeutic success even in spite

of positive evidence.

8. Apathetic type. This type is

characterized by complete

indifference to one’s fate, disease

outcome, and treatment results.

Passive compliance with procedures

and treatment when insistently

induced from outside. Loss of

interest to life and everything that

arouse interest before. Inertness and

apathy in behavior, activities and

interpersonal relationships.

9. Sensitive type. This type is

characterized by excessive concern

with possible ‘negative impression

and information about the disease.

Concerns that people around will

start avoiding and considering

inferior the person, treat with

contempt or apprehension, spread

gossip or unfavorable information

about the causes and nature of the

disease. Fear of becoming

burdensome to relatives and

resulting unfriendly relationships.

10. Egocentric type. This type is

characterized by "withdrawal into

disease", demonstration of the

feeling of suffering to relatives and

people around in order to capture

their attention. The demand for

exclusive care: everybody must

forget and leave everything just to

take care of the patient. Other

people’s conversations are quickly

turned to oneself. They require care

and attention from others, they only

see competitors and treat them in a

hostile manner. Constant desire to

show their particular condition and

uniqueness of the disease.

11. Paranoid type. This type is

characterized by the confidence that

the disease is a result of somebody’s

evil intention. Extreme

suspiciousness towards drugs and

procedures. Propensity to attribute

possible complications and side

effects of treatment to incompetence

or evil intention of doctors and

medical staff. Accusations and

demand of punishment in this

respect.

12. Dysphoric type. This attitude type is

dominated by angry, dismal, and

sullen mood and constantly gloomy

and dissatisfied appearance. Envy

and hatred towards the healthy,

including friends and relatives. Fits

of anger with an inclination to blame

the disease on others. Demand for

particular attention and

suspiciousness against procedures

and the therapy. Aggressive,

sometimes despotic attitude to

relatives, demand that everybody

should please them.

13. Obsessive-phobic type. This type is

characterized by fears that concern

unreal, unlikely disease




127

complications, treatment failures,

disease-related difficulties in life,

work or family; objects (talismans)

and rituals become protection from

phobias.

Dubrovina, (2008) investigated

disease attitude types in adolescents with

neurodermatitis. The disease duration was

between 10 and 17 years. The harmonic

type of disease attitude was absent in this

population, the euphoric type was

observed in 40.7% of cases, sensitive type

in 26.9%, anosognosic type also in 26.9%,

and mixed psychological reaction was

found in 51,9% of cases. Severe atopic

dermatitis characterized by deteriorated of

general condition, activity and mood,

increased personal anxiety and

intrapsychic behavioral patterns of mainly

anxious type, in authors’ opinion, this

demonstrate “withdrawal into disease”

among adolescents with atopic dermatitis.

Gender Differences in adolescents

It is at early school age that children start

interpreting contacts between girls and

boys as romantic and sexual (Isaev &

Kagan, 1979; Kagan, 1990, 1991). The

emergence of sexuality in relationships

between girls and boys is manifested

under conditions of sexual segregation.

Children of different genders have

different attitudes to sex and related

issues. Bendas, (2007) opined that, as a

result of conversations with children of

different sexes, it revealed gender

differences in attitudes to sex. Girls talked

willingly, used verbal constructions with

multiple details, demonstrated serious

reflection, whereas boys used short

phrases, jargons, and sexual slangs. Girls

draw information about sexual life from

the family, while the source of sexual

information for boys is their friends and

the mass media. Girls were more

interested in sexual relations between

people; they are afraid of psychic pain

from potential loss of a child and fear

early pregnancy. Boys were more

interested in the issues of contraception,

abortions, sexual intercourses, and

childbirth. Girls were more realistic

concerning career and family, they were

aware of the risks of alcohol consumption,

drug abuse and violence, whereas boys

demonstrated fearlessness and a humorous

attitude to sex and violence.

When sexual maturation begins in

adolescence, sexual segregation is ruined,

and the same happens to gender

confrontation. Boys and girls start

building new relations (Ilyin 2002). Man’s

role is traditionally instrumental and

action-oriented, and the woman’s role is

expressive and communicative. This is

evidenced by experimental data showing

that the masculine style is solution-

oriented, whereas women have either

expressive or mixed style. Mendelevich

(2005) and Kocharyan (2010) point to

women’s better tolerance of pain, long-

lasting movement limitation or

immobilization. In contrast to Bendas,

(2007) with data on better pain tolerance

in men and higher pain sensitivity in

women. Studies dealing with individual

diseases often contrast gender differences

in the mental course of the disease.

However, there is no comprehensive

systematization or classification of gender

differences in psychic reaction to a disease

as of present. At the same time, there is a

great amount of research dealing with

gender differences and its analysis

provides a solid foundation for studying

and analyzing gender differences in

disease reaction among adolescents


128

diagnosed with atopic dermatitis

(Golovneval, 2006; Kleitsina, 2004;

Vorontsov, 2008). Thus, literature

provides data on gender differences in

visual system development registered in

school age and adolescence. Males

outperform females in spatial perception

and chronometric indicators; females

develop earlier visual acuity and visual

estimation with the right eye. Attention

studies also demonstrate gender

differences. Thus, females outperform

males in voluntary attention. Females

focus more on the speed and males more

on the precision of the task, Males are

better at working with novel tasks and

females with patterns; females also outdo

males in communicative attention. Male’s

general intelligence has a clear structure

with predominant non-verbal component,

whereas female’s intelligence is poorly

integrated.

Females are more emotional than

males. It is evidenced by the following

empirical facts: Females are more anxious;

the link of emotions to interpersonal

relations is more significant for girls and

women than for boys and men; females

more often talk about negative emotions,

and positive emotions are experienced

more vividly; females are more prone to

depression; females are more sensitive to

negative events experienced by their

friends or relatives than male; females are

not a shame of demonstrating their

emotional reactions; females are more

precise about the non-verbal expression of

emotions; females are better at

recognizing emotional signals from other

people (Bendas, 2007; Heibrun, 1976;

Ilyin, 2002).

Greater emotionality in females is

evident by data about lower emotionality

in males: males do not like to show their

emotions, especially negative ones. They

are emotionally reserved even with same-

sex friends and are subject to strict social

regulations with regard to emotionality

demonstration. There are also male and

female emotions. It is anger for males and

sorrow and fear for females (Bendas,

2007)

Males show an advantage in terms

of the masculine aspect of self-evaluation,

whereas females in terms of the feminine

aspect. The shift of self-evaluation

towards narcissism in female is associated

with keenness on their appearance, and

with physical conditions and social status

in male. Females have less stable self-

evaluation than males. These differences

are influenced by the level of openness in

relations, reaction to the feedback, stress

caused by relations with relatives, and

protective mechanisms (Ilyin, 2002). Boys

and men outdo girls and women in open

physical aggression, whereas girls and

women are more prone to often resort to

hidden verbal aggression (Bendas, 2007).

The aim of this article is therefore to

assess gender differences in attitude to

disease among adolescents diagnosed with

the skin disease -Atopic Dermatitis and to

explore the role of Cognitive Behavioral

Therapy in changing thought pattern of

individuals experiencing emotional

disturbances.

METHOD

Participant’s characteristics

Participant’s characteristics include 83

adolescents aged between 13 and 15 and

diagnosed with moderate (43) to grave

(40) atopic dermatitis took part in the

study. The groups were divided according

to gender – group one (1) included 45

adolescent girls, and 38 adolescent boys




129

were in group two (2). The control group

included 80 adolescents (40 girls and 40

boys) matched for age. The participants

did not have complaints about the

psychological condition. However, the

patients showed irritability,

aggressiveness, tearfulness, low mood,

sub-depressive conditions, increased

anxiety, feeling of inferiority, disbelief in

treatment success, suspiciousness, sleep

disorders, asthenic conditions,

unwillingness to meet with peers; on the

contrary, they prefer to retreat into

themselves or a close circle of people.

These conditions did not reach a clinical

level so adolescent patients were not

examined by a psychiatrist.

Instruments & Procedure

The psychodiagnostic complex used

include the following methods:

Method for establishing the disease

attitude type (DAT) Male and Female

Painting projective test.

Method for establishing the disease

attitude type (DAT) (Wassermann L.I. et al

(2003) was developed at the Laboratory of

Clinical Psychology at V.M. Bekhterev

Institute. The method distinguishes

between 12 types of disease attitudes

grouped into 3 blocks. There were two

blocking criteria: “adaptivity-

disadaptation” (influence of disease

attitude on personality adaptation) and

“intrapsychic orientation” of disadaptation

(in case of disadaptive relationships). This

technique took the form of a questionnaire

consisting of 12 tables with sets of

statements each containing from 10 to 16

statements. The patient is asked to select

two most suitable statements. In addition

to “Yes” and “No” answers, each table

with statements also had the “Not

applicable” option, which allows for more

precise classification of disease attitudes.

Male and Female Painting projective test

by Romanova N.M. (2004).The Male and

Female Painting (MFP) studies personal

gender attitudes. The author of the method

defines gender attitudes as a certain

gestalt, a figure against the background of

a person’s individual gender concept.

Gender attitudes point to the person’s

main socio-sexual dominance.

The participant is supposed to paint male

and female figures. The analysis of the

painting (size of the figure, their mutual

positioning, graphic features of same-sex

and opposite-sex figures, completeness of

the painting) help determine the nature of

relationship between man and woman,

single out gender attitudes reflecting the

main aspects of gender identity.

The author of the method

distinguishes between the following types

of gender: - mindsets: support, isolation,

cooperation, independence,

attraction, indifference;

- attitudes: super valuable object,

blame object, romantic object,

functional object, object of

contempt, sexual object, dangerous

object, incomprehensible object,

low-value object.


130

Results

Table 1: Prevalence of subclinical psychopathological symptoms in adolescent

patients with atopic dermatitis

Subclinical Psychopathological Symptoms Prevalence (%)

Irritability 48.12

Aggressiveness 38.55

Tearfulness 40.96

Subdepressive conditions 36.14

Increased anxiety 69.88

Feeling of inferiority 54.22

Disbelief in treatment success 46.99

Suspiciousness 34.94

Sleep disorders 61.44

Asthenic conditions 57.83

Unwillingness to meet with peers 43.94

Table 2: Prevalence (abs. values and %) and reliability of variance (φ- criterion)

of disease attitude types between groups

Disease attitude types Group 1

(n=45)

Group 2

(n=38)

Anosognosic 2 (4.4%) 10 (26.3%)

φ =2.97**

Ergopathic 3 (6.7%) 8 (21.1%)

φ =1.96**

Anxious 5 (11.1%) 3 (7.9%)

φ =0.49

Sensitive 10 (22.2%) 2 (5.3%)

φ =2.34**

Mixed 14 (31.2%) 14 (36.8%)

φ =0.55

Diffuse 21 (24.4%) 1 (2.6%)

φ =3.22**

Note: ** – p<0.01




131

Discussion of findings

Table 1 shows the prevalence of the

conditions in the group of adolescent

patients suffering from atopic dermatitis.

The fact that more than 60% of

adolescents with atopic dermatitis reported

sleep disorders caused by itching and

unpleasant thoughts is the basis for

asthenic manifestations.

Table 2 shows comparison of data

obtained in two samples yielded results

that indicate gender-specific types of

disease attitudes in adolescents diagnosed

with atopic dermatitis.

A statistically significant difference

between the groups was found in the

anosognosic disease attitude type that is

more typical of adolescent boys. This

disease attitude type is characterized by

active rejection of thoughts about the

disease and its consequences.

Male adolescents have unreasonably

uplifted spirits, are light-minded about the

disease, they try to ignore the disease and

tend to break the regime and not to abide

by recommendations. Lack of this disease

attitude type among females can be

explained by boys’ bravado, by their wish

to demonstrate their invulnerability and

confidence, which is in effect an attempt

to compensate for low self-appraisal.

Boys tend to maintain the existing

gender stereotypes attributed to males,

such as power and stamina, whereas they

think that the recognition of problems,

fears and anxiety is a sign of weakness.

It was noted by Bendas, (2007) that

boys and men have to resort to a more

powerful protection of their self-esteem

than women, i.e. this disease attitude type

works as a falsifier and amplifier of self-

esteem. Besides, it should be noted that

boys are more reserved than girls: the

latter more readily share their experiences

and trust adults. This gender difference

may also mean that, when giving answers,

boys are more inclined to stay reserved

and to demonstrate their invulnerability.

Girls, who are “allowed” to be weak,

uncertain, and expressive, do not resort to

this self-description of the disease because

they do not have to employ such self-

protection methods.

Boys also differ from girls in terms

of the ergopathic disease attitude type,

which is characterized by a “retreat into

studies”, preoccupation with their

activities, over-responsibility, and

volitional attitude; despite the disease,

boys try to maintain their status at school

and remain active. This gender difference

may be explained by the fact that boys

have more pronounced motivation to be a

success in the fields that suggest activity,

encouragement or discouragement (Ilyin,

2002). Purposefulness and result-

orientedness, which is characteristic of

males, make boys determined and firm in

their hard work and the desire to overcome

obstacles posed by the disease. The

achievement of goals is very important for

males because it is in this way that they

can prove their success and not fall in their

own eyes. Many authors Averin (2003)

emphasize that females prioritize

interpersonal relations which is evidenced

by greater significance of communication

for women. Males are more task-oriented

so the men’s style is described as

analytical and manipulative.

The sensitive disease attitude type is

typical of teenage girls. This type is

characterized by interpsychic personal

reactions, which explains girls’ social

maladaptation. Girls’ major concern in


132

relation to the disease is the unfavorable

impression that the disease symptoms may

produce on people around, and this makes

girls overly vulnerable and shy. It leads to

a restricted behavior and the narrowing of

the range of interpersonal contacts. Mood

fluctuations are influenced by

interpersonal contacts that are more

significant for girls than for boys. Girls are

more oriented towards relationships that

are disrupted as a result of the disease,

whereas boys are more task-oriented.

Boys and girls are motivated by different

needs: the need for affiliation is more

important for girls than the need for

achievements, which is more important for

males. In addition to the affiliative vector

of females’ motivation accounting for the

sensitive disease attitude, another factor is

the females’ attitude to their appearance.

Attractive appearance is one of the central

life values; it is females that tend to be

highly dissatisfied with their appearance

(Rumsey, 2009). Attractive appearance is

of great social value, it raises female’s

self-appraisal and value for people around.

The symptoms of atopic dermatitis

negatively affect the appearance of a

teenage girl, which is a reason for the

sensitive disease attitude. Females are

under a greater social and cultural

influence related to the appearance, and

the teenagers’ environment is a “merciless

appearance judge”, which is evidenced by

the phenomenon of lookism –

discrimination by looks.

The diffuse disease attitude type is

also characteristic of adolescent girls with

atopic dermatitis. Non-differentiation

indicates the vagueness of the disease

pattern, which apparently seizes the whole

personality leaving no zones free from

conflict. It should be noted that an

indispensable part of the undifferentiated

disease attitude type in girls is its

sensitized component (100%). Lower

pronouncedness of the diffuse disease

attitude in boys may be explained by

lower vulnerability of males to this disease

and greater vulnerability and involvement

of females.

Irrespective of gender, the mixed

disease attitude of intra- and inter-psychic

type is the most common disease attitude

type. Thus, ergopathic disease attitude

type is more common among boys. It is

characterized by absorption into an

activity, ethnicity, and general activity.

Sensitive and diffuse disease attitude types

are more common among girls. Their

major concern in relation to the disease is

the unfavorable impression that the

disease symptoms may produce on people

around, and this makes girls overly

vulnerable and shy. It leads to a restricted

behavior and the narrowing of the range of

interpersonal contacts. Mood fluctuations

are influenced by interpersonal contacts

that are more significant for girls than for

boys. Girls are more oriented towards

relationships that are disrupted as a result

of the disease. The symptoms of atopic

dermatitis negatively affect the appearance

of a teenage girl, which is a reason for the

sensitive disease attitude. People around

are treated as condemning and

discriminating based on appearance.

Diffuse disease attitude type is a

combination of types into two blocks:

1) intrapsychic, including anxious,

hypochondriac, neurasthenic, melancholic,

and apathetic types; 2) interpsychic,

including sensitive, dysphoric, and

paranoid types. The diffuseness means

that the disease pattern is unshaped,

underarticulated and vague.




133

Male-specific disease attitude types

among adolescents with atopic dermatitis

are the types that do not considerable

disrupt social adaptation (ergopathic,

anosognosic). Female-specific disease

attitude types among adolescents with

atopic dermatitis are the types (sensitive,

diffuse) that disrupt psychic adaptation,

mainly of interpsychic orientation. The

adaptivity-disadaptivity poles are set by

gender mechanisms: in boys, it is “false

self-evaluation” and task-orientedness

(adaptation pole), while in girls it is

motivation of affiliation and high

significance of appearance for females

(disadaptivity pole).Irrespective of gender

the most common disease attitude type is

the mixed disease attitude of intra- and

inter-psychic type. Harmonic disease

attitude type was not diagnosed. The study

has serious implication for youths In

Africa most especially where families

have been undermined, truncated and

displaced due to multi-faceted and

complex issues exposing them to all kinds

of skin diseases. Youths who are most

passionate about their look are often the

most vulnerable;emotionally, physically

and psychological. As stated earlier, the

most serious psychological reaction in

adolescence may be caused by diseases

that change the adolescent’s appearance,

making him or her feel unattractive

thereby the need for Cognitive Behavioral

treatment that changes the adolescents

thought pattern from maladaptive to

adaptive.

Conclusion & Suggestions

The quality of life in girls with atopic

dermatitis is significantly decreased – the

disease influences all spheres of their life

and does not leave any “lucid windows”.

The most significant component disrupted

among the girls is the sphere of personal

relationships. The decrease in the life

quality of males with atopic dermatitis is

due to two factors: 1) disturbance of the

general sense of well-being, which affects

adolescents’ day-to-day activity and

learning; 2) “disrupted leisure”, which is

related to the limitation of personal

relationships and the need to follow the

therapeutic regimen.

Adolescents with atopic dermatitis

have decreased self-esteem. Boys have

higher self-esteem than girls. In the

subjective world image of the girls with

AD, “attractive appearance ensures

success and is the basis for self-

confidence”; girls with atopic dermatitis

demonstrate the “phenomenon of scissors”

– a large gap between the system of actual

self-evaluation and demands (ideal images

of the self), which creates inner tension

and incongruence which inform the need

for behavioral treatment.

Suggestions for further studies

include the investigation of adolescent’s

personal traits that account for the

predisposition to certain disease attitude

types and to determine how the

adolescence crisis affects the shaping of

the disease attitude type.

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