International Society for Traumatic Stress Studies

Teaching Trauma With JOTS

Posted 20 January 2014 in StressPoints by Kathryn Becker-Blease, PhD

Many of us educators teach both scientific literacy and the science of traumatic stress. In this article, I describe ways to accomplish both of these goals using articles from the Journal of Traumatic Stress (JOTS).
 

The Association of American Medical Colleges shares this goal. Beginning in 2015, the medical admissions exam (MCAT) will add a new section on the “psychological, social, and biological foundations of behavior” that will include most topics commonly covered in Introductory Psychology, including trauma, and some novel types of multiple choice test questions. These questions present students with a brief, simplified synopsis of a research study and a graph depicting a result from the study, then asks students a series of questions that require them to integrate knowledge they have learned, information presented in the passage, and information displayed in the graph. More information and sample questions are available in the MCAT 2015 Student Preview Guide.  

Well-designed multiple-choice tests can be a powerful and efficient way to teach material in college classes (Glass & Sinha, 2013a) A few factors are key. First, working hard to try to recall information is better than re-reading information, so go with a closed book test (Glass & Sinha, 2013b; Karpicke, 2012). Second, write distractors that cause students consider why the correct answer is right and the incorrect answer is incorrect (Little, Bjork, Bjork, & Angello, 2012). This way, students learn not only to recognize the correct answer, but information related to the wrong answers. Third, provide prompt feedback so that students can correct their errors and do not accidently encode incorrect information.

Together, the new research on learning and the MCAT change is an opportunity for us to teach and assess scientific literacy at a high level, and to introduce students to the science of traumatic stress specifically. Here are some ideas about how to do this, and one specific example of using a recent JOTS article. Note that I have included a few tips on how I might discuss both the correct and incorrect answers, but I have not provided the full answer key to keep the answers secure.

Use these questions as an in-class activity to reinforce lecture material.
Hand out hard copies and then go over the right and wrong answers for students. Students might be able to discuss their answers together productively. Or, use clickers to have students record their answers and respond immediately to common errors.

Put these questions on a practice test.
I have started allotting class time to practice tests. In a 50 minute Introductory Psychology class, we spend 20 minutes to take the practice test, 20 minutes with me going over each right answer and distractor, and 10 minutes for me to answer any remaining individual questions. While you can give students the practice test to complete at home, there is the risk that they simply try to memorize the questions or look up the answers without ever really trying to retrieve the information. This can cause them to learn incorrect information and gain a false sense of confidence about their ability to take the test under real test conditions. Because I have found this to be a problem, I do not give students practice tests to take outside of class.

Put these questions on the exam.
I have been putting these questions on Introductory Psychology exams without any student complaints. I tell them they are challenging, and allot plenty of time. The test can be a powerful learning activity.

Assign questions like this as homework.
Use your course management system to present the questions and give students feedback on the right and wrong questions. Have students turn in hard copies and grade them by hand. Or, have students bring the completed questions to class and go over the answers together without grading.

Read and discuss the journal article itself.
Students in my large lecture classes typically read a journal article and write a summary for extra credit as an alternative to participating in research through the human subjects pool. Links to these articles through the library are available in the course management system. Students typically write a summary of the article and upload that for a TA to grade. In the future, I may try assigning a JOTS article this way. In smaller, upper division classes, such as Psychology of Trauma, I do not usually use multiple choice questions at all. Rather, we discuss and write essays. Given the potential benefits of multiple choice testing, I may experiment with using these questions in my smaller classes as well.

Below is an example of an MCAT2015-style question I wrote based on a recent JOTS article. If I were teaching about this study in class, I might want students to understand how self-compassion and depression were measured, what the DSM-5 symptoms of depression and PTSD are, and what lovingkindness meditation entails. Here are a few relevant links:

Lovingkindness Mediation - Many examples are available online, including some nice audio and visual versions. The authors based their intervention on work by Susan Salzberg, who has a 7-minute version online. One caveat: Lovingkindness meditation involves developing compassion for self and others, including others we feel neutral about, and eventually those who we find challenging. It is not appropriate to start lovingkindness meditation with a focus on compassion for people who evoke strong emotions. Particularly in a trauma-focused class, it would be appropriate to stop with considering neutral others, and being particularly careful around the question of perpetrators of abuse and violence.

Self-Compassion Scale - Copies of the short and long forms are available. 

Depression Scale - The PROMIS depression scale is unusual in that it is delivered online and is adaptive. That is, later questions depend on answers to earlier questions. You can demonstrate how it works using the demonstration version.

PTSD Symptoms - DSM-5 PTSD criteria are posted on the National Center for PTSD’s website

The MCAT-style question below is based on the following article: Kearney, D. J., Malte, C. A., McManus, C., Martinez, M. E., Felleman, B., & Simpson, T. L. (2013). Loving-Kindness Meditation for Posttraumatic Stress Disorder: A Pilot Study. Journal of Traumatic Stress, 26(4), 426-434.

Using Meditation to Treat PTSD Among Veterans

People who have been diagnosed with PTSD are often critical of themselves and have symptoms of depression. Even people who have completed evidence-based treatment for PTSD frequently still experience shame, guilt, and trouble relating to other people. A group of researchers hypothesized that adding a meditation practice to usual PTSD treatment could help veterans experience less self-criticism, depression, and post-traumatic stress symptoms. The researchers enrolled 42 veterans with PTSD in a 12-week loving kindness meditation course and measured self-criticism, depression, and PTSD symptoms before the class, at the end of the class, and 3 months after the class. Loving kindness meditation involves focusing on thoughts of well-being for the self and for others. Self-criticism was operationalized as low scores on the Self-Compassion Scale. The results are shown in Figures 1 - 3. For each variable (depression, self-compassion, and PTSD), the means between pretreatment and postreatment, and between pretreatment and 3 month follow up, were significant (p < .05).


Question Set 1

1. Which of the following is a symptom of Post-Traumatic Stress Disorder as it is defined in the DSM-5?

a. Hallucinations
b. Frequent crying
c. Self-compassion
d. Hypervigilance

This question requires prior knowledge not presented in the passage. New MCAT questions require students to synthesize course material with information presented in the passage. Going over this question in class, I would say, “A can’t be right, because hallucinations are a symptom of psychosis and is seen in schizophrenia. People diagnosed with PTSD may have intense memories, but these are not hallucinations.” And continue through until I had explained why each distractor was incorrect and the correct answer was right.

2. The results of the study showed that

a. the veterans became less self-critical after completing the meditation course
b. the veterans became more self-critical after completing the meditation course
c. the veterans became more depressed after completing the meditation course
d. all of the veterans who completed the meditation course improved.

Correctly interpreting graphs is an important skill. I try to write distractors that allow me to assess for common errors. In this case, it is crucial that students understand that self-criticism is operationalized as the opposite of self-compassion. Also, it is important to realize that while the mean scores improved, not every veteran improved.

3. This study is an example of

a. a true experiment
b. a randomized control trial
c. a case study
d. none of these

This was a pilot study to determine, in part, if veterans would tolerate the intervention. It is important that students understand while the results are promising, it was a not a randomized control trial or true experiment.

Question Set 2

1. As defined in the DSM-5, PTSD symptoms include

a. intrusive memories, avoiding reminders of the trauma, and hyperarousal
b. substance abuse, suicidal thinking, and violent behavior
c. a lack of energy, low mood, and inability to concentrate
d. hallucinations, delusions, and paranoia

2. Three months after the end of the study,

a. participants were less depressed than at the end of the study.
b. participants had the same level of PTSD symptoms as at the end of the study.
c. participants were more self-critical than before the study began.
d. no participants still had symptoms of PTSD.

3. If the researchers wanted to be confident that meditation caused a decrease in depression symptoms, they would need to

a. test the differences between groups to be sure they are statistically significant.
b. repeat the study and add a placebo control condition.
c. randomly assign some participants to take the Self-Compassion Scale and some to take the depression test.
d. repeat the study using the same design with a larger sample.

JOTS is provided to ISTSS members at no charge as part of their ISTSS member benefits package.

About the Author
Kathy Becker-Blease earned a PhD in developmental psychology from the University of Oregon, completed a post-doctoral fellowship at the Family Research Lab/Crimes Against Children Center at the University of New Hampshire, and is an assistant professor in the School of Psychological Science at Oregon State University. She studies developmental traumatology and the science of teaching and learning.

References

Glass, A. L., & Sinha, N. (2013a). Multiple-Choice Questioning Is an Efficient Instructional Methodology That May Be Widely Implemented in Academic Courses to Improve Exam Performance. Current Directions in Psychological Science, 22(6), 471-477.

Glass, A. L., & Sinha, N. (2013b). Providing the answers does not improve performance on a college final exam. Educational Psychology, 33(1), 87-118.

Karpicke, J. D. (2012). Retrieval-Based Learning: Active Retrieval Promotes Meaningful Learning. Current Directions in Psychological Science, 21(3), 157-163. doi: 10.1177/0963721412443552

Kearney, D. J., Malte, C. A., McManus, C., Martinez, M. E., Felleman, B., & Simpson, T. L. (2013). Loving?Kindness Meditation for Posttraumatic Stress Disorder: A Pilot Study. Journal of Traumatic Stress, 26(4), 426-434.

Little, J. L., Bjork, E. L., Bjork, R. A., & Angello, G. (2012). Multiple-Choice Tests Exonerated, at Least of Some Charges: Fostering Test-Induced Learning and Avoiding Test-Induced Forgetting. Psychological Science. doi: 10.1177/0956797612443370