Psychological Assistance Tool Model for Foreign Students
senior lecturer in psychology, philosophy department,
University of Radio Electronics, Ukraine
Melnichuk M. (2017) Psychological Assistance Tool Model for Foreign Students
with PTSD. International Journal of Psychosocial Rehabilitation. Vol 21 (1) 116-122
Abstract: The present article represents an instrumental model
for providing psychological support to foreign students with posttraumatic
stress disorders caused by acquired traumatic experience and a trauma of
migration. It shows the review of psycho-diagnostic tools that are applied in
the proposed instrumental model, describes its characteristics and explains our
psychosocial adaptation, mental health,
post-traumatic stress disorder, psychological support, instrumental model.
adaptation of foreign students to new country and education system is
still an open question, even been widely discussed. Many students who
come to Ukrainian universities are temporary migrants from countries
with economic or political problems, ethnic conflicts, high level of
crime, unemployment, inflation, displays of civil disobedience, etc.
Successful mastering of curriculum is largely determined by the level
of students’ psychosocial adaptation in education process. Here we show
the importance of considering special features of psychological support
provided to foreign students who have previous home traumatic
experience and psychotrauma of migration.
Current research review:
The present study represents structural and dynamic approach to
psychosocial adaptation of temporary migrants. Structural component is
determined by the complex and systematic understanding of such mental
phenomenon as personal adaptive behavior (conscious or unconscious) and
its analysis in the personal regulation system (B.F. Lomov, A.V.
Petrovskiy, A.A. Rean et al.). Dynamic component appears due to the
fact that the adaptation process has its stages and phases, dynamic
characteristics (F.B. Berezin, V.I. Medvedev, A.A. Nalchadzhyan, M.V.
Romm et al.).
The choice of specific psycho-diagnostic tools for
our study was based on the level of psychosocial adaptation of
personality, diagnosis of posttraumatic stress disorders (PTSD) and
personal psychological characteristics which are presumably related to
the adaptation process. It is important to note that in the specific
literature we can find subjective and objective criteria for effective
adaptation. Thus, the degree of conscious or unconscious satisfaction
of himself/herself and different aspect of person’s life is a
subjective criterion, while the performance of his/her activities (some
level of effectiveness) is an objective criterion. We are also
interested in the level of psychosocial adaptation of migrants in
education process as well as in coping strategies used by them.
most important criterion in our study was subjective adaptation, that’s
why to explore these options we selected two groups of
psycho-diagnostic techniques based on self-reports of respondents. We
considered mandatory tools’ requirements such as: techniques should
match aim and object of study; clear set of actions and its
quantification; sufficient representativeness, reliability, validity
and objectivity of the test; clear and unambiguous instructions to the
Theoretical analysis of psycho-diagnostic tools, that we
can see in the references suggests existence of a small selection of
valid methods used to study psychosocial adaptation of personality.
That’s why the purpose of the article was to develop a tool model of
the psychological support to foreign student with PTSD caused by
traumatic experiences and psychotrauma of migration.
bases: Structure of psychological assistance tool model for foreign
students consists of three components: diagnosis of PTSD, diagnosis of
psychosocial maladjustment (PSM) and training program for acquisition
of new adaptive mechanisms in the education process (Fig. 1).
order to identify PTSD symptoms and determine the effect of their
presence/absence to psychosocial adaptation of foreign students in the
process of education we used original version of the questionnaires:
The PTSD Checklist (PCL), The Life Events Checklist (LEC), Satisfaction
with Life Scale (SWLS), General Health Questionnaire (GHQ), Rosenberg
Self-Esteem Scale (SES), Multidimensional Scale of Perceived Social
The psychosocial maladjustment of foreigners as
well as coping strategies used by them were tested by original version
of the survey “Ways of Coping Questionnaire” (WCQ), the author's survey
“Migrants Psychosocial Maladjustment Scale” (MPMS), and author’s
questionnaire “Foreign Students Psychosocial Maladjustment
Fig. 1. Tool model for diagnosis
and psychological assistance of people with PTSD caused by traumatic
experiences and psychotrauma of migration
training program for the development of new adaptive mechanisms in
education was developed on the basis of methodological materials and
scientific developments carried out under the patronage of state
institutions and research institutions of the United States, The U.S.
Department of Health and Human Services (HHS), Substance Abuse &
Mental Health Services Administration (SAMHSA), National Center for
Posttraumatic Stress Disorders (NCPTSD) and The National Child
Traumatic Stress Network (NCTSN).
The research base of the study
is represented by the first year foreign students of the Kharkiv
National University of Radio Electronics, who came to study in Ukraine
for five years (240 males, 42 females; average age M = 20.8; SD =
1.83). The study involved temporary migrants from Afghanistan – 3.6%,
Egypt – 2.8%, Iraq – 19.5%, Iran – 12.1%, Cameroon – 17.0%, Libya –
5.0%, Nigeria – 28.0%, Sudan – 9.9%, Tunisia – 2.1%.
diagnosis was carried out with help of two psycho-diagnostic tools: LEC
and PCL. We used the questionnaire “The Life Events Checklist for
DSM-V” (LEC-5), developed with the support of the US Government
Department of Veterans Affairs, to identify traumatic events that
occurred in students’ life. The questionnaire provides a list of 16
items – specific traumatic events (plus one more item – “Another
traumatic experience”) that can cause PTSD or distress. Traumatic
events include: natural disasters, fires, traffic accidents, physical
violence, illnesses or injuries, life threatening, participation in
armed conflict, etc. Opposite to each item, the respondent should mark
on a 6-point scale: “Happened to me”, “Witnessed it”, “Learned about
it”, “Part of my job”, “Not Sure”, “Doesn’t Apply”.
questionnaire includes: a standard self-report (traumatic event
identification), an extended self-report (the worst event, if there are
several), an interview (establishing the severity of the event). In our
study, we first used the standard LEC self-report (D. Blake et al.,
1995), and then LEC-5 (F. Weathers et al., 2013). The differences of
the last version from the previous one are minimal: section “This is a
part of my job” was added to the category of answers, and item 15
“Sudden, violent death (for example, homicide, suicide)” was changed to
“Sudden accidental death”. It is believed that the psychometric
characteristics of the questionnaire, given the minor adjustments made,
should not differ from the original LEC version [The Life Events
Checklist …, 2013].
The PTSD Checklist for DSM-V (PCL-5)
questionnaire was used to screen PTSD and assess the quantitative
severity of its symptoms. It is recommended to be used together with
LEC-5 and it is also developed at the National Center for PTSD (F.
Weathers et al., 2013). The questionnaire consists of 20 statements
that reflect mental condition of a person who has a traumatic
experience. They include such points as: trauma-related obsessive
anxious and undesirable feelings, actions, memories and dreams;
self-accusations or accusation of others in a traumatic event or its
consequences; loss of interest in familiar activities; irritability,
aggressive or risky behavior; sleep troubles, etc. [The PTSD Checklist
The PCL-5 questionnaire is based on the previous
version of PCL for DSM-IV (F. Weathers et al., 1993), with psychometric
characteristics indicating good retest reliability (correlation
coefficient 0.96), internal consistency (Cronbach alpha from 0.89 to
0.92), as well as convergent and discriminant validity. In addition,
confirmatory factor analysis has shown that the 6-factor model best
suits the structure of PCL-5, which in turn conforms with the
clustering of PTSD symptoms in DSM-V. This makes it possible to use
PCL-5 for various clinical and scientific purposes, in particular for
quantifying the severity of PTSD symptoms according to the new
diagnostic criteria revised in DSM-V, establishing a preliminary
diagnosis, and estimating the prevalence of PTSD [Diagnostic and
statistical …, 2013]. In our study, we used standard PCL questionnaire
followed by PCL-5.
Measurement of life satisfaction degree on
the basis of global cognitive judgments was carried out with help of
the “Satisfaction with Life Scale” (SWLS, W. Pavot and E. Diener,
1993), which due to its simplicity has spread all over the world since
its appearance in 1985 [Pavot, 1993]. SWLS respondents note whether
they agree or disagree with each of the 5 statements of the
The SWLS scale is usually used as a measure of
life satisfaction, which is an integral part of subjective
psychological balance assessment. The results obtained with help of
SWLS correlate with the indicators of mental health and allow
predicting future inadequate human behavior, for example, suicide
attempts. Being a valid and reliable indicator of life satisfaction,
SWLS is suitable for use in a wide range of ages and under different
conditions, which makes it possible to save resources and time for
interviews. The scale is recommended as an addition to psychometric
tests focused on the mental or emotional state, as it evaluates a
person's conscious judgment about his/her life using his/her own
In order to assess general state of mental
health of respondents, we used the “General Health Questionnaire” (GHQ,
D.P. Goldberg and P. Williams, 1988) designed to quantify the risk of
developing mental disorders, diagnose psychological resistance and
emotional stability [Goldberg, 1988].
The questionnaire has 5
variants, which differ in volume and consist respectively of 60, 30,
28, 20 and 12 points (statements). Our study uses GHQ-12 version, which
is convenient for testing and processing its results. It has comparable
psychometric properties of “long” versions, although it takes very
little time to conduct it.
The validity and reliability of this
one-dimensional indicator of the level of psychological morbidity is
confirmed by the results of numerous tests: the alpha Cronbach for
GHQ-12 is noted in the range from 0.78 to 0.95. Correlation analysis of
GHQ-12 with the scale of “Global Quality of Life” showed a negative
correlation. This shows an inverse relationship – with an increase in
the level of distress, the quality of life decreases. In the
literature, there is ample evidence that GHQ-12 is an effective tool if
used in general population samples (health, medicine, psychology) for
the purpose of screening mental disorders.
The level of
respondents' self-esteem, as a measure of positive or negative
self-image, also called self-esteem or global self-esteem, was
diagnosed with help of the Rosenberg Self-Esteem Scale (SES, M.
Rosenberg, 1989). The sense of self-worth, which the author of this
scale calls the totality of the individual's thoughts and feelings with
reference to himself as an object is one of the key components of the
“I” concept, along with self-efficacy and self-identity. Self-esteem
affects social behavior and is closely related to anxiety and
depression [Rosenberg, 1989].
The questionnaire has high
reliability, internal consistency and construct validity (the retest
correlation coefficient for various tests is ranged from 0.82 to 0.88,
the Cronbach alpha from 0.77 to 0.88). Indicators are associated with
psychosomatic symptoms, anxiety, depressed state, activity in
communication, leadership, sense of interpersonal security and
interpersonal relationships. For its half-century history (the
presentation of the first version of SES was held in 1965), the
Rosenberg scale was translated into 53 foreign languages and adapted in
many countries. It is widely used for sociological, psychological and
cross-cultural studies of all categories of respondents, starting from
the age of 15.
In order to assess the respondents' relations
with others we used the “Multidimensional Scale of Perceived Social
Support” (MSPSS, G. Zimet et al., 1988) which is widely used in
practice as a tool for express diagnostics of environmental coping
resources. Social support serves as a buffer for psychological
distress, and therefore its absence can lead, for example, to a relapse
of depression, emotional stress and other adverse consequences for
mental health [Zimet et al., 1988].
Since the first publication
of the methodology, it has been translated into 23 foreign languages
and tested on respondents of different age groups and cultural
traditions. MSPSS studies confirm its good internal consistency
(Cronbach alpha from 0.85 to 0.91), retest reliability (Cronbach alpha
from 0.72 to 0.85), construct validity (significant correlations
between subscales MSPSS and The Hopkins Symptoms Checklist), as well as
a fairly stable factor structure. The original 3-factor model of MSPSS
was confirmed, including a sample of inpatient adolescent with such
diagnoses as behavioral disorders and maladjustment.
differentiated assessment of foreign students’ coping behavior was
conducted using the well-known questionnaire “Ways of Coping
Questionnaire” (WCQ, S. Folkman and R. Lazarus, 1986) [Folkman et al.,
1986]. In one of the latest editions, the methodology contains 66
statements summarized in 8 sub-skills that were obtained using factor
analysis. The respondent should answer how often the offered behavioral
options manifest in a difficult or problematic life situation on a
The WCQ method can be used to investigate the
behavior of respondents in difficult situations, to identify specific
ways to overcome stress or risk factors for mental maladjustment. WCQ
in conjunction with other methods can be used to assess the
effectiveness of psycho-corrective measures and psychotherapy.
listed psycho-diagnostic tools are reliable, valid and relevant to the
tasks of our study. But, despite their high effectiveness, these
methods do not take into account the specifics of psychosocial
adaptation of migrants in new conditions of life. In this regard, there
was a need to develop a separate methodology to analyze problems of
psychosocial adaptation of students-visitors from distant foreign
We developed the “Migrants Psychosocial Maladjustment
Scale” (MPMS) to assess the degree of psychosocial adjustment disorder
of foreign students and to carry out screening for maladjustment. It
updates socio-biographical information of respondents, information
about being on psychiatric records, presence of psychotraumatic
situations, shocks, accidents and/or disasters. The MPMS is designed to
work with migrants of both sexes, starting from the age of 18. It
consists of 25 statements describing the state and behavior of each
person in a particular situation, which he/she had to face in the
country of arrival [Melnichuk, 2016].
In order to assess the
adequacy of the new psycho-diagnostic tool, we investigated its
psychometric characteristics. To determine the reliability of the MPMS,
it was checked for its stability and internal consistency. Pearson's
correlation coefficient between the first and the second tests’ results
was 0.87 for p < 0.05, and the Cronbach alpha coefficient was 0.91,
which indicates high retest reliability and internal consistency of the
scale. The content validity of the MPMS was ensured by achieving
maximum compliance of the test material content with the modern
understanding of the individual's maladjustment concept.
with MPMS, the author's questionnaire “Foreign Students Psychosocial
Maladjustment Questionnaire” (FSPMQ) was applied to reveal the level of
psychosocial maladjustment of temporary migrants as well as their
attitude to reality, the degree of awareness of their semantic
attitudes that mediate relationships with others in new conditions of
Then we introduced a training program of psychosocial
adaptation to foreign students. The purpose of the training was to
provide conditions and opportunities for effective psychosocial
adaptation for foreign students giving them prolonged psychological and
social assistance, organizing systematic psychological and corrective
measures. Training, which was offered for implementation, consists of
six sessions of 90 minutes each and is designed to work in group of up
to 15 people. In the model for diagnosing and providing psychological
assistance to foreign students with PTSD (Fig. 1), the training program
shows the interaction of a Database of respondents with six work sheets
(Screening Form, Problem-Solving Worksheet, Helpful Thinking Worksheet,
Positive Activity Worksheet , Managing Reactions Worksheet and Social
Connections List), which are consistently used in the corresponding
order to identify the dynamics of psychosocial adaptation, we carried
out a control survey of foreign students, which comprised the
experimental and control groups. The test was carried out twice: 5
weeks after the program and 3 months later. The following comparison of
the data ensured the reliability of the obtained results.
of the model of psychological support for foreigners required analysis
of actual stressful situations and appropriate coping strategies, as
well as identification of adequate psychological and diagnostic tools
to investigate this problem.
Analysis of consistent
implementation of established empirical procedures’ results provided an
opportunity to determine the level of psychosocial adaptation of
foreign students, taking into account the presence (absence) of PTSD
symptoms. It also made possible offering an adequate psychological
support system and suggesting an adaptation-oriented training program.
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