Posttraumatic functioning in a Muslim setting following mass trauma

The overwhelming majority of posttraumatic stress research has been conducted in western settings. The aim of this thesis is to extend this literature by examining the extent to which western-derived conceptions of posttraumatic stress and grief can be applied to an Islamic, non-western context, namely, Aceh, Indonesia. This research aimed to investigate culture-specific manifestations of distress in Aceh among adults who were exposed to the Southeast Asian tsunami in 2004, and to civil conflict, which occurred over the preceding three decades. A particular focus was on cognitive mechanisms that have been identified in the west as key processes underlying adaptation to trauma.Initial ethnographic investigations revealed a great deal of overlap between western constructs, such as posttraumatic stress disorder (PTSD), and the reactions that were reported by the Acehnese sample. Culture-bound appraisals and coping responses were also identified, which highlighted the role of religion in this setting. The project revealed that PTSD, grief, and depression were prevalent among the community sample at rates of 24%, 14%, and 47%, respectively, although it should be noted these estimates were not derived from a representative sample. Confirmatory factor analyses demonstrated that these disorders are readily distinguishable from each other. Subsequent experimental studies delineated the roles of key cognitive mechanisms, such as autobiographical memory, rumination, and attachment, in posttraumatic adjustment. Collectively, these studies demonstrated that adopting an acceptance style of thinking had ameliorative effects in a bereaved sample, whereas thinking in a more self-efficacious manner resulted in improved problem-solving ability. The findings alsovdemonstrated that an insecure attachment style was linked to higher levels of yearning for a deceased loved one.This thesis represents a novel attempt at investigating the cross-cultural applicability of cognitive models of PTSD and grief by combining qualitative, quantitative, and experimental methods. The findings extend current models, however, by noting the importance of religion and gender in a non-western context. The findings have implications for cross-cultural research and treatment implementation in the aftermath of trauma in a non-western setting