Quick Response Report #87
COPING SELF-EFFICACY AND PSYCHOLOGICAL DISTRESS FOLLOWING THE OKLAHOMA
CITY BOMBING
Charles C. Benight
Assistant Professor of Clinical Psychology
University of Colorado at Colorado Springs
1996
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This material is based upon work supported by the National Science
Foundation under Grant No. CMS-9632458.
Any opinions, findings, and conclusions or recommendations expressed in
this material are those of the author(s) and do not necessarily reflect
the views of the National Science Foundation.
COPING SELF-EFFICACY AND PSYCHOLOGICAL DISTRESS FOLLOWING THE OKLAHOMA
CITY BOMBING
Approximately 2 million people in the U.S. alone will be
significantly effected by a disaster this year (Solomon, l989). At 9:02
A.M. on April l9, l995, the world was suddenly shocked by the worst
terrorist act on U.S. soil in recent U.S. history. One hundred and sixty
eight people were killed and hundreds more were injured as a terrorist
bomb ripped through the Alfred P. Murrah Federal building in Oklahoma
City. Since this tragic day in April, citizens have been attempting to
recover and to put the pieces of their lives back together. Research on the
mental health impact of disasters has rapidly proliferated in the last
several decades, and has demonstrated that serious psychological
ramifications occur following a disaster (Adams & Adams, l984; Rubonis
& Bickman, l99l). The primary aim of this research was to evaluate
the predictive power of subjective appraisals of coping self-efficacy
for psychological distress after the Oklahoma City bombing tragedy.
Coping self-efficacy is defined as a person's subjective
appraisal of his/her ability to cope with the environmental demands of
the stressful situation. High coping self-efficacy has been related
to improved psychological adjustment to abortion (Meuller & Major,
l989), improved coping with physical assault (Ozer & Bandura, l990),
improved immune function (Wiedenfeld, et al. l990), lower
catecholamine responsivity (Bandura, Taylor, Williams, Mefford, &
Barchas, l985), and reduced blood pressure response (Bandura, Reese, &
Adams, l982). Coping self-efficacy has also been correlated with
better psychological adjustment following severe environmental
stressors such as volcanic eruptions (Murphy, l987), hurricanes
(Benight, et al., in press; Benight, et al., under review), and military
combat (Solomon, et al., l988).
Based on this research, we hypothesized that coping efficacy in
dealing with the coping demands following the bombing would explain a
significant proportion of the variance in PTSD symptomology and
general psychological distress over and above several control
variables (e.g., social support, threat of death).
Methods
A total of 27 victims were recruited two months after the
bombing. These participants were found through local businesses
within a 5-mile radius around the bombing site. The mean age of this
sample was 41 years old. Of these individuals, 48% were men and 52%
were women. The mean income range reported for sample one was between
$40,000 and $45,000 per year. Educationally, 7% reported a high school
education, 26% some college, 37% college graduate, and 30% graduate
education. Ethnically, almost the entire sample was Caucasian, with
only 3% African-American and 3% Native American. Approximately one
year after the bombing 17 of these victims were assessed again. In
addition, 10 new participants were added at the one year follow-up.
This second sample consisted of 63% women and 37% men. The mean age
of this group was 43 years of age. The mean range of income for this
second sample was basically the same, between $35,000 and $40,000 annual
income. This sample reported slightly more education experience with
4% high school, 19% some college, 33% college graduate, and 44%
graduate education. This sample was entirely Caucasian. Thus, this
study is reporting results from the initial 27 participants and how
the one-year sample reacted to the bombing. Time one participants
completed a psychosocial questionnaire and an interview. The one-year
follow-up participants filled out the questionnaire packet and
returned it in the mail. Hierarchical multiple regression was
utilized to test the importance of the coping self-efficacy measure.
The control variables utilized were threat of death, income, social
support, and loss of resources.
Measures
Coping Self-Efficacy
Coping self-efficacy was measured using a
43-item scale designed to assess the main situational demands of
coping with a bombing. Items are divided into four main areas of
coping demands: Behaviors, Thoughts, Images, and Emotions. Under
each of these areas specific demands that participants were facing
were assessed. The items were all answered on a 7-point Likert-type
scale with 1="not at all capable" and 7="totally capable." The items
related to issues such as "doing my job well," "managing thoughts of
people dying," "thoughts of personal injury," "distressing dreams,"
"feelings of helplessness," etc. The internal reliability of this
measure was acceptable, alpha>.85.
Life Threat
Subjects were asked whether they thought they were
going to die during the bombing, with answers ranging from (1) "not at
all" to (7) "absolutely."
Loss of Resources
Loss of resources was assessed in line with
Hobfoll's (Hobfoll, l989) model of stress. The list of resources
utilized for this study relates to material resources (e.g., car,
furniture, etc.) and experiential resources such as time for sleep,
daily routine, etc.
Social Support
The Interpersonal Support Evaluation List (ISEL)
was utilized to measure social support (Cohen, Mermelstein, Kamarck, &
Hoberman, l985). The ISEL is a 40-item assessment that measures four
main areas of social support. These include: tangible support,
belonging support, appraisal support, and self-esteem support.
Psychological Distress
Symptom Checklist-90 Revised (SCL-90R)
The SCL-90R (Derogotis, l983) was used to assess psychological distress
following the bombing. The SCL-90R is a 90-item self-report measure
designed to assess general psychological distress in psychiatric and
medical patients. The questions relate to the past week and the
checklist sums to an overall psychological distress measure called the
Global Severity Index (GSI90). The SCL-90R has been extensively used in
studies investigating emotional fallout from traumatic stress (Baum, Gatchel,
& Schaeffer, l983)
Post-Traumatic Stress Disorder (PTSD)
PTSD was assessed utilizing the frequency of experiencing 17 PTSD
symptoms derived from the Diagnostic and Statistical Manual Third
Edition-Revised (APA, l987). Participants were asked to assess how often
over the past week they have experienced the series of symptoms
associated with PTSD diagnosis (e.g., intrusive thoughts, avoidant
response, and hyperarousal). Participants indicated how often they had
experienced the symptom with 0=
"Not at all" to 4="Everyday" and the
severity of those symptoms on a 4 point scale with 0="Not at all
Distressing" and 4="Extremely Distressing."
Impact of Event Scale
The Impact of Event Scale (Horowitz,
Weiner, & Alvarez, l979) is a 15-item scale that assesses the
emotional impact of an event on a person by looking at intrusive
thoughts, emotional numbing, and avoidance. This scale has shown
adequate reliability and validity and is extensively used in trauma
research.
Results
Results supported the importance of coping self-efficacy (CSE)
perceptions in helping to explain psychological distress following
this type of disaster. At two months following the bombing, CSE
accounted for an additional 24% of the variance over and above the
control variables of threat of death, income, social support, and loss
of resources in predicting general psychological distress
[(F(1,21)=29.35, p<.000]. CSE also added 30% of the variance over and
above control variables for PTSD symptomology at this time. For the
Impact of Event Scale Total Score, CSE added 23% of the variance, which
was significant [F(1,21)=12.33, p<.002]. The one-year data are
consistent with these findings. Coping self-efficacy added a
significant portion of the variance over and above control variables
for general psychological distress [F(1,22)=24.09, p<.000].
Interestingly, CSE did not significantly add to the prediction of
frequency of experiencing PTSD symptomology but did add to the
prediction of reported severity of these symptoms [F(1,20)=40.48,
p<.000]. Finally, CSE added significantly to the explanation of the
Impact of Event Scale Total Score adding 22% additional variance
[F(1,22)=12.12, p<.002].
Discussion and Implications
The present findings supporting the value of assessing CSE
appraisals following a disaster are consistent with data from other
severe environmental stressors (Benight et al., in press; Benight et
al., under review; Murphy, l987; and Solomon et al., l988). These
findings suggest that individual's appraisals of his/her perceived
ability to cope with environmental demands are highly associated with
reported psychological distress. Implications of these findings are
important in relationship to postdisaster mental health
interventions. However, before addressing these implications it is
important to mention the limitations of this study.
This study is correlational, and causation cannot be inferred from
these findings. Thus, it is unclear if those with higher distress
report lower CSE perceptions or the other way around. However,
studies experimentally manipulating CSE levels have shown that varying
levels of CSE are accompanied by differences in psychological outcome
(Ozer & Bandura, l990) and cardiovascular and endocrine reactivity
(Bandura, et al., l985; Bandura, et al., l982) Thus, it is
conceivable that perceived CSE levels, at least in part, are
contributing to psychological and physiological reactions in this
study. This study is also limited based on its small sample size and
homogeneity of the sample. Generalization of these findings to other
terrorism actions or to other samples is not warranted.
The implications of these findings are important for developing
psychosocial interventions facing the aftermath of domestic terrorism.
The CSE measure designed for this study focused heavily on the
psychological demands facing individuals following this type of
horrific experience, whereas the hurricane CSE measure focused on
both psychological recovery and physical recovery (e.g., "managing the
rebuilding of my home," etc.). Specialized interventions for post-
terrorism recovery might be designed that focus on specific emotional
demands where a person feels inefficacious (e.g., dealing with
intrusive thoughts about the bombing), rather than Critical Incident
Stress Debriefing interventions currently done (see Kenardy, Webster &
Carter, l996). It is conceivable that CSE perceptions may interact
with the CISD intervention with some individuals who are having
greater difficulty (i.e., feeling highly inefficacious in dealing with
memories from the bomb, or thoughts from the bomb) feeling more
distressed when asked to discuss in detail his/her experience with the
tragedy. Indeed, due to the emotional reactivity linked with poor CSE
perceptions, recounting the experience may only further exacerbate
self-appraisals of inability to cope. With recent evidence that
Critical Incident Stress Debriefing Interventions may not always be
helpful (Kenardy et al., l996), future research is needed to look at
individual difference variables that may interact with our current
front-line interventions. Interventions designed to help affected
persons deal with the variety of emotional reactions that emerge from
this type of event might benefit from incorporating components such as
realistic goal setting and self-appraisals of success that enhance
perceptions of emotional mastery. In the context of terrorism
recovery, it is possible that interventions might help individuals
normalize their emotional reactions and provide specific coping skills
(e.g., relaxation training, social support, etc.) that would enhance
efficacy perception. The utilization of alternative treatments that
may help the individual process this traumatic material more quickly
(e.g., Eye Movement Desensitization and Reprocessing Therapy) may also
prove beneficial in increasing individuals perceptions of CSE.
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July 26, 1996
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