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Exploring the associations between social support and symptoms of posttraumatic stress disorder among Malaysian and Australian trauma survivors

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Social support is an important feature in understanding posttraumatic stress disorder (PTSD) and its treatment. Non-clinical research has identified distinct profiles of culturally appropriate social support. Laura Jobson discusses cultural differences in the associations between social support and symptoms of PTSD.

Image courtesy of interviewee. August 12, 2024

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The discussion revolves around the associations between social support and post-traumatic stress disorder (PTSD) among trauma survivors in Malaysia and Australia. Laura, the speaker, highlights that PTSD is a widely recognized and debilitating psychological disorder resulting from trauma and underscores the significant role social support plays in its development and maintenance.

Key points discussed include:

1. **Definition of Social Support**: Social support refers to an individual's perception of the availability and quality of social relationships during times of need. Research indicates that lower social support correlates with higher PTSD symptomatology, while higher social support can help mitigate these symptoms.

2. **Cultural Differences**: Most existing research on PTSD has focused on Western trauma survivors, leaving a gap regarding its applicability across diverse cultural contexts. Laura argues that culture influences how social support is perceived, sought, and how effective it is in aiding recovery.

3. **Explicit vs. Implicit Support**: The study differentiates between implicit support (emotional comfort without explicit communication of needs) and explicit support (openly discussing stress and seeking help). Cultural differences are observed, with Malaysian participants preferring implicit support, while Australian participants showed no distinction in preference.

4. **Mutual vs. Non-Mutual Support**: The study investigates support from individuals who the survivor has helped versus those they have not. Findings suggest that Malaysian participants benefit more from seeking support from those they have previously helped, while Australian participants do not experience this influence.

5. **Professional Help Seeking**: The study examines attitudes towards seeking professional help, noting cultural nuances in willingness to seek treatment and how trauma is discussed within various social networks.

Key findings reveal that cultural context significantly moderates the effectiveness of different types of social support in relation to PTSD symptoms. The study calls for further research to better understand these dynamics, ensuring that interventions are culturally sensitive and tailored to effectively support trauma survivors.

Laura concludes with an emphasis on the need for more extensive research in the area of culturally informed clinical practices as it relates to PTSD and social support, highlighting the importance of understanding diverse cultural experiences in recovery processes.

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It seems like you intended to provide a specific video for me to analyze, but it appears as "..". Could you please provide the video you'd like me to summarize into key points?

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Here are some key quotes from the video regarding PTSD and the role of social support across different cultures:

1. **Definition of PTSD**: "PTSD is a significantly disabling psychological disorder that can develop following trauma."

2. **Impact of Social Support**: "Social support is basically how someone perceives the availability and also the quality of their social relationships and social networks around them, particularly in times of need."

3. **Research Findings on Social Support**: "Those with lower levels of social support... tend to have higher levels of PTSD symptomatology. Whereas those who feel like they have strong social networks around them... tend to have lower levels of PTSD symptomatology."

4. **Bi-Directional Relationship**: "Not only is social support influenced by PTSD, but PTSD can also influence social support."

5. **Cultural Considerations**: "Almost all of the research in this area has been conducted using Western trauma survivors... there’s a really, really big gap in the literature."

6. **Individual vs. Collective Perspectives**: "In Western individualistic cultures... the self is seen as very independent, separate and unique. In Asian collectivistic cultures... the view that the self is much more interdependent."

7. **Implicit vs. Explicit Support**: "Implicit support is where I might be with other people to try and get emotional support and comfort without having to disclose what happened to me... Explicit support... is talking about the stressful things that are happening in my life."

8. **Cultural Preferences for Support**: "Those from Asian cultural backgrounds tend to use explicit social support less frequently. They often perceive it as burdening others."

9. **Importance of Mutual Support**: "In Asian collectivistic cultures, participating in mutual support... is seen as potentially more beneficial."

10. **Need for Cultural Sensitivity in Treatment**: "We know social support is important... but how does culture influence that?"

11. **Research Limitations**: "This is just an initial study... We can't do any causal inferences. We obviously need longitudinal studies to look into this."

12. **Future Directions**: "This is an initial study and it suggests mainly that we need to take into account culture when we are considering how people are recovering following trauma."

These quotes capture the essence of the discussion on PTSD, the vital role of social support, and the cultural dimensions affecting these relationships.

X-TIMESTAMP-MAP:LOCAL=00:00:00.000,MPEGTS=900000

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Post-Traumatic Stress Disorder

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or PTSD is a significantly disabling psychological disorder

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that can develop following trauma.

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Uh, PTSD has now been observed in many societies

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and cultures,

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and given its negative impact on people, on families,

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on communities, and actually on society more broadly,

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a great deal of research has gone into trying to understand,

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well, why does someone develop PTSD?

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What are some of the factors that are associated

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with the maintenance of the symptoms?

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And as clinicians,

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what should we be targeting in the interventions

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to help people recover from PTSD?

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And one factor that's been given a great deal

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of attention is social support.

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And social support is basically how someone

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perceives the availability

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and also the quality of their social relationships

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and social networks around them,

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particularly in times of need.

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And there's a great deal of research trying to understand,

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well, what does the role social support plays in PTSD?

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And the research tends to suggest that those

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with lower levels of social support, so those

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who feel they don't have social networks around them,

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there aren't strong relationships supporting them, tend

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to have higher levels of PTSD symptomatology.

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Whereas those who feel like they have strong social networks

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around them, strong social support tend to have lower levels

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of PTSD symptomatology.

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So social support tends

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to play a role in PTSD symptomatology,

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but this also seems to be this sort

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of bi-directional relationship.

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So not only is social support influence PTSD,

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but PTSD can also influence social support.

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So what's been found is that over time those

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with high levels of PTSD tend

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to have lower levels of social support.

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As the PTSD tends to erode

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or deteriorate relationships, people get sick

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of hearing about the trauma,

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people find it hard looking after others.

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And so it ends up being this cycle where sort

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of social support can influence PTSD

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and PTSD influence Social support in this cycle sets up.

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Additionally, a lot of research at the beginning

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of PTSD really looked at the individual

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and trying to understand what happens

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to the individual in regards to PTSD

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and post-trauma recovery.

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Um, since then, it's obviously not surprising

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that trauma very rarely happens just to an individual.

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It's rare that PTSD just impacts on an individual.

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So over the last few years, there's much more sort

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of focus on trying to understand, well,

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how does the individual interact with their social world

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and their relationships, interactions

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and more about that interplay and those complexities.

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There's a great deal of research looking at the role

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of social support in PTSD

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and this, this research

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is actually really, really impressive.

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There's a significant limitation

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and there's a concerning gap in the literature.

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And that is that almost all

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of the research in this area has been conducted using

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Western trauma survivors.

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And it's therefore based on western cultural norms,

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values, and belief systems.

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And this is obviously problematic.

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'cause actually globally most trauma survivors don't come

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from western cultural backgrounds.

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And even in countries such as Australia, US,

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we celebrate cultural diversity.

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So this raises really, really

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Important questions

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regarding all this impressive literature.

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We know about social support and PTSD.

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Does it pertain globally across lots

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of different cultural groups in regards to

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how people recover following trauma?

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Or is it actually just specific to some trauma survivors?

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So there's a really, really big gap in the literature

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and making this even worse is

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that if we leave the clinical literature aside

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for the moment and look at the cross-cultural literature,

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what the research shows is that,

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culture really influences on social support.

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It influences whether someone gets support, it influences

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how someone might go about getting support.

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It influences who someone might go and ask for support from.

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And it also influences whether someone perceives a support

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to be helpful and beneficial

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or whether it's actually detrimental and costly to them.

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So culture actually influences how and who and where,

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and why we actually get support

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and whether it's seen as beneficial.

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One cultural factor that's been really studied in the

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literature to try and understand cultural differences in

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social support is

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how individuals perceive the self in relation to others.

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And what's been found in western individualistic cultures

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such as Australia, such as the us, such as Europe, is

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that the self is seen as very independent,

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separate and unique.

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So it's seen as separate from other people

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and there's a real valuing of people's individual sort

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of values, their experiences,

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their emotions, and their goals.

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Yet this is no by no means universal in other cultures is

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different perceptions of self.

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And for instance, in Asian collectivistic cultures such

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as Malaysia or China, there's a view

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that the self is much more interdependent.

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It's much more about how the self is linked to other people,

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much more about social connection.

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And there's valuing of maintaining group harmony

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and maintaining this group harmony is often seen

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as more valuable than someone's own personal experiences,

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their own personal emotions, values, goals, et cetera.

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And this has been found to impact on

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how people seek out social interactions

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and how social networks sort of are formed.

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Now, social support is obviously quite a complex,

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and quite a vast sort of construct.

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So in the study we did, that I'm talking about today,

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we looked at four aspects of social support

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that have been found to be influenced by culture.

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The first is implicit versus explicit support.

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So implicit support is where I might be with other people

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to try and get emotional support

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and comfort without having to disclose what happened

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to me without having to talk about my stresses

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or my experiences.

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And I'm not gonna actually ask anyone for help.

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So I might be hanging out and having a coffee with someone

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or going to have dinner with someone

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or just being with someone without having

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to talk about my stresses

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and without having to ask someone to help me with them.

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So that's implicit, it's support,

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explicit support on the other side is the opposite of that.

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It is talking about the

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stressful things that are happening in my life.

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It is talking about my experiences

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and it is asking other people for help.

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And this is the area in PTSD that most

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of the researchers focused on.

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Yeah, if we gain leave the cross, sorry,

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the clinical literature side,

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look at the cross-cultural literature.

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What the research strongly shows us is

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that there's cultural differences in whether people value

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explicit or implicit social support

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and whether they find it beneficial or not.

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So what's been found is

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that those from Asian cultural backgrounds tend

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to use explicit social support less frequently.

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So they're less likely to go out and ask for help

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and to actually disclose their stresses

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to their friends and communities.

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Additionally, when they are asked to do this,

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it is often not as beneficial.

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And there's some really nice neat experiments that have done

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that be that show

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that actually asking those from Asian cultural backgrounds

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to go out and seek explicit social support

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actually can increase stress and distress.

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Yet within European cultural context, these sort of asking

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for help and this explicit,

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explicit social support is saying as beneficial

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and as positive impacts on wellbeing.

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In contrast, in Asian co collectivistic cultures tends

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to be more focused on implicit social support

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that is perceived as being more

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positive and more beneficial.

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And the reason why this is thought to occur is

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because that explicit social support seems

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to be burdening on others.

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It negatively potentially impacts on relationships.

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It's put pressure on other people, burdens other people,

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and hence those from Asian collectivistic cultures

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may be less likely to engage in this

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and see it as more detrimental.

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Whereas in European cultural contexts,

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Western European cultural context, it's much more about

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negative feelings and negative emotions

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and much more seen as something that can be examined in are

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to be discussed in these interpersonal sort of interactions.

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Yet despite this research is

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how she hasn't been investigated in the context of PTSD.

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So that's implicit explicit social support.

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The second one is a form of explicit support,

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which is mutual versus non-mutual support.

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So when we actually delve deeper into explicit support,

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there's different types of social support

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and it depends who we're asking the help from.

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And it can be that we're asking it from a mutual person.

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So that is somebody that I have helped in the past.

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So I'm asking help from someone that I've provided help

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and assistance to in the past, or there's also a non-mutual,

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or I'm asking help

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and assistance from someone

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that I've never helped in the past.

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So it's sort of a out of balance sort of relationship.

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And what's been found in research is

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that in Asian collectivistic cultures

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participating in mutual support has been perceived

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as potentially nurturing that relationship

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and actually diminishing that burden

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of put putting on of other people.

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And it's seen as potentially more beneficial.

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Again, there's been some really lovely experiments done

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where they've looked at, Asian Americans

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and European Americans

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and actually looked at how they went about seeking

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explicit support and looked at whether it was from a mutual

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or a non-mutual provider.

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So remember that mutual provider is someone

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that you've helped in the past, Non-Mutual is not.

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And what they found is

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that Asian Americans experience the support

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as less stressful

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and more helpful when they could ask it from someone

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where it was perceived as mutual.

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Whereas European Americans, it didn't matter

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who they were asking for support from.

09:21.305 --> 09:24.165
So it seems that if you're asking explicit social support,

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if it is coming from someone that you've helped in the past,

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is maybe less distressing

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for those from Asian collectivistic cultures.

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But for those from European, Western sort of cultures,

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it doesn't seem to matter.

09:35.185 --> 09:37.405
Um, but again, this hasn't been investigated in

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regards to PTSD.

09:40.075 --> 09:42.335
The third area that we looked at was the support provider.

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So it's also worth considering who is offering this support.

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So social support can come from many different places.

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It could come from family,

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it could come from friends, significant others.

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And so it really raises questions on who is the best people

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to seek support from in the context of post-trauma recovery.

09:57.455 --> 09:59.175
And this hasn't really been looked at either.

10:00.155 --> 10:02.815
And what tends to be suggested in the cross-cultural

10:03.055 --> 10:05.655
literature is that potentially those from Asian cultural

10:05.655 --> 10:09.295
backgrounds may find it less helpful asking help from those

10:09.455 --> 10:11.455
who are relationally close to them and family.

10:12.055 --> 10:13.735
'cause again, it's putting burden on other people

10:13.755 --> 10:14.975
and putting other people out.

10:15.795 --> 10:17.615
Yet there is also other research that shows

10:17.615 --> 10:19.815
that asking family and family plays a really,

10:19.815 --> 10:22.055
really important role in regards to support,

10:22.515 --> 10:23.575
following stress.

10:23.575 --> 10:25.335
So this area is a little bit less clear.

10:26.355 --> 10:28.775
And the final area is professional support.

10:29.395 --> 10:32.815
So we know in PTSD, if people don't get treatment

10:32.815 --> 10:35.055
for their symptoms, they tend not to recover.

10:35.475 --> 10:37.215
People who don't get treatment tend

10:37.215 --> 10:38.815
to then have symptoms for decades.

10:39.035 --> 10:40.295
So it really is important

10:40.295 --> 10:42.615
that people actually seek out professional help if

10:42.615 --> 10:43.895
people develop PTSD.

10:45.315 --> 10:47.015
And yet there's a lot of research shows

10:47.015 --> 10:49.615
that culture actually systematically influences

10:49.755 --> 10:51.695
how people seek out professional help.

10:52.595 --> 10:55.095
And again, the research suggests that it's quite,

10:55.095 --> 10:57.255
there's not that much research in this space

10:57.685 --> 11:00.215
that those from Asian collectivistic cultures may be less

11:00.215 --> 11:01.295
likely to seek out.

11:01.555 --> 11:04.335
Um, professional help because of stigma and also

11:04.335 --> 11:07.055
because of seeking it out may indicate

11:07.055 --> 11:08.135
that something's ruptured

11:08.135 --> 11:10.175
or not going right in social networks

11:10.175 --> 11:11.415
because we're going outside

11:11.415 --> 11:13.455
of those social networks to get assistance.

11:13.955 --> 11:16.895
But again, this hasn't been looked at really of PTSD

11:16.895 --> 11:18.695
and there's still a lot of work that needs

11:18.695 --> 11:19.935
to be done sort of in this space.

11:21.275 --> 11:23.775
So the study that I'm talking about today pulled all this

11:23.935 --> 11:25.575
together and what it really wanted

11:25.575 --> 11:28.935
to look at was cultural differences in social support in the

11:28.935 --> 11:31.895
four types I've just spoken about in regards to explicit

11:31.995 --> 11:35.895
and implicit mutual versus non-mutual support provider

11:36.155 --> 11:38.535
and whether people are willing to get professional support.

11:39.075 --> 11:42.295
And we looked at this in, this was in the context of PTSD

11:43.035 --> 11:44.055
and we looked at this aim.

11:44.055 --> 11:47.175
We invested this game using those from an Asian

11:47.175 --> 11:49.975
collectivistic culture, which in this instance was Malaysia

11:50.555 --> 11:52.815
and from a western individualistic culture, which

11:52.815 --> 11:54.085
In this case was Australia.

11:54.545 --> 11:57.285
And we used trauma survivors to sort of explore some

11:57.285 --> 11:59.725
of these, constructs that I've been explaining,

11:59.825 --> 12:00.925
be able to address this aim.

12:00.945 --> 12:03.645
We used a cross-sectional cross country design.

12:04.265 --> 12:07.325
Um, we also had a quasi experimental paradigm,

12:07.325 --> 12:09.045
which was sort of built into it looking at the

12:09.045 --> 12:10.285
mutual and non-mutual distress.

12:10.285 --> 12:11.565
But I'll get to that in a moment.

12:12.145 --> 12:13.725
Uh, we had both Australian

12:13.785 --> 12:17.205
and Malaysian trauma, researchers co-designing the study

12:17.265 --> 12:19.245
to ensure that it was culturally appropriate

12:19.745 --> 12:22.765
and the study was available both in English and Malay.

12:23.465 --> 12:25.325
Um, in terms of participants,

12:25.385 --> 12:28.805
we had 91 Australian trauma survivors in the study.

12:29.305 --> 12:32.085
Uh, the mean age of that group was about 34

12:32.345 --> 12:35.245
and it comprised 45 men, 43 women,

12:35.385 --> 12:37.925
and three non-binary gender diverse participants.

12:38.505 --> 12:39.925
In regards to the Malaysian group,

12:39.925 --> 12:41.765
we also had 91 trauma survivors,

12:41.765 --> 12:43.685
and their mean age was about 27.

12:44.145 --> 12:46.965
And in this group we had 27 men, 60 women,

12:47.105 --> 12:50.285
and four, non-binary gender diverse participants.

12:51.025 --> 12:53.685
All participants were trauma survivors, so they all had

12:53.685 --> 12:56.605
to have experienced a criterion, a trauma experience.

12:57.185 --> 12:59.685
Um, and in regards to the eligibility

12:59.705 --> 13:02.325
for cultural background for the Australian participants,

13:02.795 --> 13:06.125
they had to be residing in Australia, born in Australia,

13:06.665 --> 13:09.485
and have been of western European cultural descent

13:09.715 --> 13:12.405
with all four grandparents of western cultural descent

13:12.405 --> 13:14.085
of the same descent as the participant

13:14.705 --> 13:16.125
for the Malaysian participants.

13:16.675 --> 13:20.045
They all had to be born in Malaysia, residing in Malaysia,

13:20.385 --> 13:21.885
and had to be of Chinese, Indian

13:21.885 --> 13:23.645
or Malaysia descent with all four grandparents

13:23.755 --> 13:25.005
also of the same descent.

13:25.585 --> 13:27.245
The two groups didn't differ in regards

13:27.245 --> 13:28.885
to PTSD symptomatology

13:29.465 --> 13:32.165
and all participants were recruited just from the general

13:32.165 --> 13:34.645
community in Australia and Malaysia.

13:35.785 --> 13:38.245
So participants were asked to complete measures

13:38.245 --> 13:39.365
that were done online

13:39.545 --> 13:41.725
and they were asked to complete measures relating

13:41.725 --> 13:42.725
to their trauma exposure.

13:42.825 --> 13:44.765
So what traumas they'd been exposed to,

13:44.915 --> 13:46.885
what was the worst trauma they'd been exposed to?

13:46.885 --> 13:48.365
And how long ago had it occurred?

13:48.915 --> 13:51.485
They completed measures about PTSD symptoms.

13:52.235 --> 13:56.605
They were completed measures about how, frequently

13:56.605 --> 13:58.205
and how perceived beneficial it would be

13:58.205 --> 14:01.085
to seek out explicit versus implicit social support.

14:01.795 --> 14:04.525
They were asked questions about support provider who they go

14:04.525 --> 14:06.645
to in regards to seeking social support

14:07.145 --> 14:10.045
and also attitudes towards seeking mental health services

14:11.325 --> 14:13.985
to examine the mutual versus non-mutual support provider.

14:14.005 --> 14:15.825
We actually had a quasi experimental sort

14:15.825 --> 14:17.025
of design built into it.

14:17.565 --> 14:20.425
And here everyone had to focus on the index trauma

14:20.965 --> 14:24.105
and participants in both cultural groups were randomly

14:24.105 --> 14:27.105
allocated to a mutual or a non-mutual condition.

14:27.845 --> 14:30.585
And in both conditions, participants had to,

14:31.145 --> 14:32.705
complete a writing task and they were had

14:32.705 --> 14:34.785
to do a a, a writing class.

14:34.785 --> 14:37.225
They had to, spend three minutes writing a letter

14:37.285 --> 14:39.425
to a close other person seeking

14:39.605 --> 14:41.865
and asking for help to deal with their trauma.

14:43.045 --> 14:45.865
And for in the non-Mutual group, they had to write

14:45.865 --> 14:47.985
to someone that they had never helped in the past.

14:48.205 --> 14:50.865
So they had to write this letter asking for help, and it had

14:50.865 --> 14:53.285
To be be written to someone that they'd never asked.

14:53.425 --> 14:54.725
Uh, they'd never helped in the past

14:55.745 --> 14:57.805
in the mutual support condition, they were asked

14:57.805 --> 14:59.525
to write the letter in the same way,

14:59.865 --> 15:01.605
but they were to write the letter to someone

15:01.605 --> 15:03.125
that they had helped in the past.

15:04.055 --> 15:06.565
After both writing, exercises had finished,

15:06.565 --> 15:08.525
participants were then asked to write about

15:08.545 --> 15:10.525
or think about their trauma for five minutes.

15:10.945 --> 15:12.605
And then they were to ask to write their,

15:12.745 --> 15:14.445
to rate this objective distress.

15:14.475 --> 15:17.725
Following this experience, we had, sort of five,

15:17.925 --> 15:19.085
I guess, key findings.

15:19.665 --> 15:21.205
The first was when we looked at

15:21.405 --> 15:22.645
implicit and explicit support.

15:22.645 --> 15:25.325
The Malaysian group actually reported significantly greater

15:25.845 --> 15:27.365
implicit support than the Australian group.

15:27.425 --> 15:28.725
So they reported using

15:28.825 --> 15:32.605
and finding preferring implicit support significantly more

15:32.605 --> 15:34.205
than the Australian group as we predicted.

15:34.465 --> 15:37.205
But interestingly, the two groups didn't differ in regards

15:37.205 --> 15:39.845
to explicit support in regards

15:39.865 --> 15:42.245
to explicit support being associated with PTSD.

15:42.405 --> 15:45.085
Interestingly though, we found that explicit social support,

15:45.185 --> 15:47.685
higher levels of it were associated with lower levels

15:47.685 --> 15:50.365
of PTSD, what's always found in the PTSD literature.

15:50.715 --> 15:52.925
However, what was interesting though was

15:52.925 --> 15:55.165
that cultural group moderated this association.

15:55.865 --> 15:57.525
And what we found was that yes,

15:57.805 --> 15:59.485
explicit social support was associated

15:59.485 --> 16:00.845
with PTSD symptomatology,

16:01.105 --> 16:03.205
but this was only found for the Australian group.

16:03.255 --> 16:06.285
There was no evidence of this association being significant

16:06.585 --> 16:07.645
for the Malaysian group.

16:09.205 --> 16:12.505
Uh, in regards to family, we found

16:12.505 --> 16:15.505
that support from family was associated with PTSD.

16:15.525 --> 16:17.465
So more support from family was associated

16:17.465 --> 16:18.985
with lower levels of PTSD.

16:19.685 --> 16:21.505
Um, but again, cultural group moderated this,

16:21.505 --> 16:24.025
this association was only significant

16:24.085 --> 16:26.065
for the Malaysian group and it wasn't

16:26.065 --> 16:27.385
significant for the Australian group.

16:27.405 --> 16:28.625
So again, we're getting this pattern

16:28.625 --> 16:29.985
that these associations are there,

16:29.985 --> 16:31.745
but cultural group seems to moderate it

16:31.745 --> 16:34.025
with the associations being different depending on

16:34.215 --> 16:38.175
what cultural group trauma survivors are from in terms

16:38.175 --> 16:41.295
of the experimental findings, just starting

16:41.295 --> 16:42.655
with the non-mutual conditions.

16:42.775 --> 16:44.415
So that was when someone wrote to someone

16:44.525 --> 16:46.215
that they hadn't helped in the past.

16:46.765 --> 16:49.055
What we found was that the Malaysian group expressed

16:49.055 --> 16:51.735
significantly more distress than the Australian group,

16:52.405 --> 16:54.335
however, in the mutual condition.

16:54.475 --> 16:56.135
So this is when what you were writing to someone

16:56.135 --> 16:57.335
that you had helped in the past,

16:57.875 --> 17:01.175
the Malaysian group experienced significantly less distress

17:01.485 --> 17:02.655
than the Australian group.

17:03.815 --> 17:05.415
Additionally, when we looked at the two Malaysian groups,

17:05.565 --> 17:07.295
when they were asked to write to someone

17:07.295 --> 17:08.695
that they had helped in the past,

17:09.165 --> 17:11.775
they experienced less distress when they were a,

17:11.775 --> 17:13.575
rather than when they were asked to write to someone

17:13.575 --> 17:14.695
that they'd never helped in the past.

17:15.245 --> 17:17.455
Whereas for the Australian group, it didn't seem to matter

17:17.455 --> 17:18.735
who they were asking help from.

17:19.835 --> 17:22.375
And so that again, supports past previous research.

17:22.375 --> 17:23.615
And this is the first time it's sort

17:23.615 --> 17:24.775
of been suggested in the context

17:24.875 --> 17:26.655
of trauma survivors and PTSD.

17:27.915 --> 17:31.055
And finally opposite to sort of what we predicted, actually,

17:31.055 --> 17:33.135
the Malaysian group was significantly more open

17:33.135 --> 17:35.175
to psychological problems than the Australian group.

17:35.555 --> 17:36.775
And there was no differences,

17:37.415 --> 17:39.695
cultural differences in tendency to seek out help

17:39.795 --> 17:42.215
or professional help for their psychological problems.

17:42.515 --> 17:44.855
And there's also sort of no difference in regards

17:44.955 --> 17:46.535
to perceptions of stigma

17:46.555 --> 17:48.495
and how this may impact on seeking

17:48.595 --> 17:49.805
out, professional help.

17:50.215 --> 17:52.605
First thing is that we often assume universality

17:52.625 --> 17:53.845
and PTSD research.

17:53.905 --> 17:57.245
We assume that universally people are gonna recover in a

17:57.245 --> 17:58.485
similar way following trauma.

17:58.945 --> 18:01.005
And I guess our research across the broad,

18:01.025 --> 18:02.965
across the board is starting to challenge that

18:02.965 --> 18:05.325
and to actually think we actually need to consider culture

18:05.985 --> 18:08.085
and how that influences some of the factors

18:08.235 --> 18:10.045
that are involved in post-trauma recovery.

18:10.425 --> 18:13.005
And in this instance, we looked at, social support.

18:13.545 --> 18:16.645
So again, we found what always found in the PTSD literature

18:16.645 --> 18:19.125
that explicit social support tends to be associated

18:19.125 --> 18:21.445
with social support, with PTSD symptomatology.

18:22.025 --> 18:23.485
Yet what's interesting though is

18:23.485 --> 18:25.445
that this doesn't potentially seem to be universal

18:25.565 --> 18:27.005
'cause we found it for the Australian group,

18:27.225 --> 18:28.365
but there was no evidence

18:28.395 --> 18:29.965
that it was there for the Malaysian group.

18:31.215 --> 18:33.205
Again, we found that family seems

18:33.205 --> 18:35.565
to be really important in the notion of PTSD,

18:35.565 --> 18:38.205
but this seems to be particularly important potentially

18:38.205 --> 18:39.685
for Malaysian trauma survivors.

18:41.345 --> 18:42.585
Additionally, it may be important,

18:42.865 --> 18:45.305
although for Australians it may not matter who people go

18:45.305 --> 18:46.305
and ask for help from.

18:46.765 --> 18:49.025
Our finding suggests that it may be really important

18:49.025 --> 18:51.905
for Malaysian trauma survivors if people are gonna have

18:51.905 --> 18:52.945
to go out and ask for help.

18:53.055 --> 18:54.945
It's potentially quite important that they ask

18:54.945 --> 18:57.745
for help from people who they have helped in the past.

18:58.285 --> 19:00.985
So again, this findings starting to come together to suggest

19:00.985 --> 19:04.625
that culture may be impacting on some of the,

19:04.625 --> 19:07.065
factors known to play a role in PTSD.

19:08.565 --> 19:11.065
And finally against what we sort of, hypothesized,

19:11.065 --> 19:12.345
the Malaysian group did report

19:12.345 --> 19:14.745
that there was potentially more psychologically minor

19:14.745 --> 19:15.905
or as psychologically minor

19:15.905 --> 19:17.065
as the Australian groups are further

19:17.345 --> 19:18.585
researchers needed in that space.

19:19.855 --> 19:22.715
In terms of clinical implications, a lot of our guidelines,

19:22.715 --> 19:24.475
our clinical guidelines tell us

19:24.475 --> 19:25.635
to be culturally appropriate,

19:26.035 --> 19:27.755
culturally responsive, culturally adaptive.

19:28.335 --> 19:31.475
But in the instance of PTSD, there's just so little evidence

19:31.475 --> 19:33.155
to guide, well, what does that actually mean?

19:34.195 --> 19:36.875
Additionally, we know that if we don't culturally tailor our

19:37.115 --> 19:39.115
interventions, effect sizes can be quite small,

19:39.735 --> 19:42.915
but if we can culturally tailor them, effect sizes improve.

19:43.615 --> 19:46.235
Yet in the instance of PTSD, there's just so little research

19:46.255 --> 19:47.515
to guide what does this mean?

19:47.695 --> 19:49.435
We know social support is important.

19:49.455 --> 19:51.475
We know telling people to get social support

19:51.475 --> 19:53.275
around them following trauma is important,

19:53.775 --> 19:55.435
but what, how does culture influence that?

19:55.815 --> 19:57.355
How does it influence who should people

19:57.355 --> 19:58.555
should be asking for help?

19:59.015 --> 20:00.395
How they should be asking for help,

20:00.395 --> 20:01.795
whether it's beneficial or not?

20:02.695 --> 20:05.435
And these just initial findings are starting to suggest

20:05.435 --> 20:07.835
that maybe explicit social support isn't

20:07.835 --> 20:08.915
beneficial for everyone.

20:09.565 --> 20:12.835
Maybe it has limits as we found for Malaysian participants.

20:13.515 --> 20:15.355
Secondly, it seems to be very important

20:15.375 --> 20:16.595
to consider those family

20:16.615 --> 20:18.835
and those broader networks, particularly when working

20:18.835 --> 20:20.435
with Malaysian trauma survivors.

20:21.295 --> 20:23.915
And thirdly, while for Australians it may not matter whether

20:23.915 --> 20:26.235
people seek support from someone they've helped before

20:26.235 --> 20:27.755
or whether they haven't, it doesn't really matter.

20:27.815 --> 20:30.075
For Malaysians, it may be particularly important when

20:30.205 --> 20:32.595
clinicians suggest that people go out and seek support

20:32.595 --> 20:33.995
or tell people about their trauma,

20:34.305 --> 20:36.675
that they may be take into account that they do this

20:36.675 --> 20:38.275
with someone that they've helped in the past.

20:39.605 --> 20:41.675
There are worth noting some of the limitations

20:41.675 --> 20:43.475
and obviously this is just an initial study.

20:43.575 --> 20:45.755
So much more work in this area needs to be done.

20:46.395 --> 20:47.685
A few of the limitations are

20:47.685 --> 20:49.605
that this is a cross-sectional study, so we,

20:49.635 --> 20:51.245
it's only based on associations.

20:51.265 --> 20:53.085
We can't do any causal inferences.

20:53.265 --> 20:55.965
We obviously need longitudinal studies to look into this

20:56.105 --> 20:58.165
and potentially more experimental work as well.

20:59.715 --> 21:01.875
Additionally, there's a culture is a very complex,

21:02.425 --> 21:04.075
dynamic sort of construct.

21:04.295 --> 21:06.475
And we only looked at sort of this idea

21:06.475 --> 21:09.675
of the self in relation to others, which is self construal.

21:09.745 --> 21:11.955
There's obviously a lot more cultural factors such

21:11.955 --> 21:13.115
as religion and other factors

21:13.115 --> 21:14.595
that could be taken into account too,

21:14.595 --> 21:17.395
which may be playing a role in our sort of findings.

21:18.055 --> 21:20.715
The final thing is we did control for trauma type

21:20.935 --> 21:22.435
and also time since trauma.

21:22.455 --> 21:25.275
But it is important to think that the kinds of trauma

21:25.305 --> 21:27.195
that people have been through, whether it's childhood,

21:27.385 --> 21:28.755
whether it's interpersonal

21:28.775 --> 21:30.315
or whether it's more like an accident

21:30.495 --> 21:33.955
or a, a disaster, is potentially gonna impact on

21:33.975 --> 21:35.435
how someone talks about their trauma

21:35.535 --> 21:37.195
and who they go and tell about their trauma.

21:37.575 --> 21:38.635
And then cultures obviously

21:38.635 --> 21:40.035
potentially gonna play a role on that too.

21:40.095 --> 21:41.915
So future studies should also think about

21:42.725 --> 21:44.755
maybe thinking about the triumph trauma,

21:44.755 --> 21:45.795
that people have been through.

21:46.575 --> 21:49.155
So pulling it all together though, this is an initial study

21:49.375 --> 21:51.515
and it suggests mainly that we need

21:51.515 --> 21:53.875
to take into account culture when we are considering

21:54.015 --> 21:55.835
how people are recovering following trauma.

21:56.135 --> 21:58.155
And this, in this instance, looking at social support.

21:58.775 --> 22:01.955
And I guess the main, implication from these sort

22:01.955 --> 22:04.355
of findings is to highlight the need for much,

22:04.355 --> 22:06.035
much more research in this space.

The Role of Social Support in PTSD: Cultural Considerations and Gaps in Research

00:00:00 - Post-Traumatic Stress Disorder or PTSD is a significantly disabling psychological disorder that can develop following trauma. PTSD has now been observed in many societies and cultures, and given its negative impact on people, on families, on communities, and actually on society more broadly, a great deal of research has gone into trying to understand, well, why does someone develop PTSD? What are some of the factors that are associated with the maintenance of the symptoms? And as clinicians, what should we be targeting in the interventions to help people recover from PTSD? And one factor that's been given a great deal of attention is social support. And social support is basically how someone
00:00:44 - and also the quality of their social relationships and social networks around them, particularly in times of need. And there's a great deal of research trying to understand, well, what does the role social support plays in PTSD? And the research tends to suggest that those with lower levels of social support, so those who feel they don't have social networks around them, there aren't strong relationships supporting them, tend to have higher levels of PTSD symptomatology. Whereas those who feel like they have strong social networks around them, strong social support tend to have lower levels of PTSD symptomatology. So social support tends to play a role in PTSD symptomatology,
00:01:25 - of bi-directional relationship. So not only is social support influence PTSD, but PTSD can also influence social support. So what's been found is that over time those with high levels of PTSD tend to have lower levels of social support. As the PTSD tends to erode or deteriorate relationships, people get sick of hearing about the trauma, people find it hard looking after others. And so it ends up being this cycle where sort of social support can influence PTSD and PTSD influence Social support in this cycle sets up. Additionally, a lot of research at the beginning of PTSD really looked at the individual and trying to understand what happens to the individual in regards to PTSD and post-trauma recovery.
00:02:06 - that trauma very rarely happens just to an individual. It's rare that PTSD just impacts on an individual. So over the last few years, there's much more sort of focus on trying to understand, well, how does the individual interact with their social world and their relationships, interactions and more about that interplay and those complexities. There's a great deal of research looking at the role of social support in PTSD and this, this research is actually really, really impressive. There's a significant limitation and there's a concerning gap in the literature. And that is that almost all of the research in this area has been conducted using Western trauma survivors. And it's therefore based on western cultural norms, values, and belief systems.
00:02:47 - 'cause actually globally most trauma survivors don't come from western cultural backgrounds. And even in countries such as Australia, US, we celebrate cultural diversity. So this raises really, really Important questions regarding all this impressive literature. We know about social support and PTSD. Does it pertain globally across lots of different cultural groups in regards to how people recover following trauma? Or is it actually just specific to some trauma survivors? So there's a really, really big gap in the literature and making this even worse is that if we leave the clinical literature aside for the moment and look at the cross-cultural literature, what the research shows is that,
00:03:29 - It influences whether someone gets support, it influences how someone might go about getting support. It influences who someone might go and ask for support from. And it also influences whether someone perceives a support to be helpful and beneficial or whether it's actually detrimental and costly to them. So culture actually influences how and who and where, and why we actually get support and whether it's seen as beneficial. One cultural factor that's been really studied in the literature to try and understand cultural differences in social support is how individuals perceive the self in relation to others. And what's been found in western individualistic cultures

Cultural Perspectives on Self and Social Support: Implicit vs. Explicit Support Dynamics

00:04:12 - that the self is seen as very independent, separate and unique. So it's seen as separate from other people and there's a real valuing of people's individual sort of values, their experiences, their emotions, and their goals. Yet this is no by no means universal in other cultures is different perceptions of self. And for instance, in Asian collectivistic cultures such as Malaysia or China, there's a view that the self is much more interdependent. It's much more about how the self is linked to other people, much more about social connection. And there's valuing of maintaining group harmony and maintaining this group harmony is often seen
00:04:54 - their own personal emotions, values, goals, et cetera. And this has been found to impact on how people seek out social interactions and how social networks sort of are formed. Now, social support is obviously quite a complex, and quite a vast sort of construct. So in the study we did, that I'm talking about today, we looked at four aspects of social support that have been found to be influenced by culture. The first is implicit versus explicit support. So implicit support is where I might be with other people to try and get emotional support and comfort without having to disclose what happened
00:05:34 - or my experiences. And I'm not gonna actually ask anyone for help. So I might be hanging out and having a coffee with someone or going to have dinner with someone or just being with someone without having to talk about my stresses and without having to ask someone to help me with them. So that's implicit, it's support, explicit support on the other side is the opposite of that. It is talking about the stressful things that are happening in my life. It is talking about my experiences and it is asking other people for help. And this is the area in PTSD that most of the researchers focused on. Yeah, if we gain leave the cross, sorry, the clinical literature side,
00:06:14 - What the research strongly shows us is that there's cultural differences in whether people value explicit or implicit social support and whether they find it beneficial or not. So what's been found is that those from Asian cultural backgrounds tend to use explicit social support less frequently. So they're less likely to go out and ask for help and to actually disclose their stresses to their friends and communities. Additionally, when they are asked to do this, it is often not as beneficial. And there's some really nice neat experiments that have done that be that show that actually asking those from Asian cultural backgrounds to go out and seek explicit social support
00:06:57 - Yet within European cultural context, these sort of asking for help and this explicit, explicit social support is saying as beneficial and as positive impacts on wellbeing. In contrast, in Asian co collectivistic cultures tends to be more focused on implicit social support that is perceived as being more positive and more beneficial. And the reason why this is thought to occur is because that explicit social support seems to be burdening on others. It negatively potentially impacts on relationships. It's put pressure on other people, burdens other people, and hence those from Asian collectivistic cultures may be less likely to engage in this
00:07:37 - Whereas in European cultural contexts, Western European cultural context, it's much more about negative feelings and negative emotions and much more seen as something that can be examined in are to be discussed in these interpersonal sort of interactions. Yet despite this research is how she hasn't been investigated in the context of PTSD. So that's implicit explicit social support. The second one is a form of explicit support, which is mutual versus non-mutual support. So when we actually delve deeper into explicit support, there's different types of social support and it depends who we're asking the help from. And it can be that we're asking it from a mutual person. So that is somebody that I have helped in the past.

The Dynamics of Mutual and Non-Mutual Support in Cultural Contexts of PTSD Recovery

00:08:18 - and assistance to in the past, or there's also a non-mutual, or I'm asking help and assistance from someone that I've never helped in the past. So it's sort of a out of balance sort of relationship. And what's been found in research is that in Asian collectivistic cultures participating in mutual support has been perceived as potentially nurturing that relationship and actually diminishing that burden of put putting on of other people. And it's seen as potentially more beneficial. Again, there's been some really lovely experiments done where they've looked at, Asian Americans and European Americans and actually looked at how they went about seeking explicit support and looked at whether it was from a mutual
00:09:00 - So remember that mutual provider is someone that you've helped in the past, Non-Mutual is not. And what they found is that Asian Americans experience the support as less stressful and more helpful when they could ask it from someone where it was perceived as mutual. Whereas European Americans, it didn't matter who they were asking for support from. So it seems that if you're asking explicit social support, if it is coming from someone that you've helped in the past, is maybe less distressing for those from Asian collectivistic cultures. But for those from European, Western sort of cultures, it doesn't seem to matter. but again, this hasn't been investigated in regards to PTSD.
00:09:42 - So it's also worth considering who is offering this support. So social support can come from many different places. It could come from family, it could come from friends, significant others. And so it really raises questions on who is the best people to seek support from in the context of post-trauma recovery. And this hasn't really been looked at either. And what tends to be suggested in the cross-cultural literature is that potentially those from Asian cultural backgrounds may find it less helpful asking help from those who are relationally close to them and family. 'cause again, it's putting burden on other people and putting other people out. Yet there is also other research that shows that asking family and family plays a really, really important role in regards to support,
00:10:23 - So this area is a little bit less clear. And the final area is professional support. So we know in PTSD, if people don't get treatment for their symptoms, they tend not to recover. People who don't get treatment tend to then have symptoms for decades. So it really is important that people actually seek out professional help if people develop PTSD. And yet there's a lot of research shows that culture actually systematically influences how people seek out professional help. And again, the research suggests that it's quite, there's not that much research in this space that those from Asian collectivistic cultures may be less likely to seek out. professional help because of stigma and also
00:11:07 - that something's ruptured or not going right in social networks because we're going outside of those social networks to get assistance. But again, this hasn't been looked at really of PTSD and there's still a lot of work that needs to be done sort of in this space. So the study that I'm talking about today pulled all this together and what it really wanted to look at was cultural differences in social support in the four types I've just spoken about in regards to explicit and implicit mutual versus non-mutual support provider and whether people are willing to get professional support. And we looked at this in, this was in the context of PTSD and we looked at this aim. We invested this game using those from an Asian
00:11:50 - and from a western individualistic culture, which In this case was Australia. And we used trauma survivors to sort of explore some of these, constructs that I've been explaining, be able to address this aim. We used a cross-sectional cross country design. we also had a quasi experimental paradigm, which was sort of built into it looking at the mutual and non-mutual distress. But I'll get to that in a moment. we had both Australian and Malaysian trauma, researchers co-designing the study to ensure that it was culturally appropriate and the study was available both in English and Malay. in terms of participants, we had 91 Australian trauma survivors in the study.

"Exploring Cultural Differences in Trauma Survivor Support: A Comparative Study of Australian and Malaysian Participants"

00:12:32 - and it comprised 45 men, 43 women, and three non-binary gender diverse participants. In regards to the Malaysian group, we also had 91 trauma survivors, and their mean age was about 27. And in this group we had 27 men, 60 women, and four, non-binary gender diverse participants. All participants were trauma survivors, so they all had to have experienced a criterion, a trauma experience. and in regards to the eligibility for cultural background for the Australian participants, they had to be residing in Australia, born in Australia, and have been of western European cultural descent
00:13:12 - of the same descent as the participant for the Malaysian participants. They all had to be born in Malaysia, residing in Malaysia, and had to be of Chinese, Indian or Malaysia descent with all four grandparents also of the same descent. The two groups didn't differ in regards to PTSD symptomatology and all participants were recruited just from the general community in Australia and Malaysia. So participants were asked to complete measures that were done online and they were asked to complete measures relating to their trauma exposure. So what traumas they'd been exposed to, what was the worst trauma they'd been exposed to? And how long ago had it occurred? They completed measures about PTSD symptoms.
00:13:56 - and how perceived beneficial it would be to seek out explicit versus implicit social support. They were asked questions about support provider who they go to in regards to seeking social support and also attitudes towards seeking mental health services to examine the mutual versus non-mutual support provider. We actually had a quasi experimental sort of design built into it. And here everyone had to focus on the index trauma and participants in both cultural groups were randomly allocated to a mutual or a non-mutual condition. And in both conditions, participants had to, complete a writing task and they were had
00:14:34 - They had to, spend three minutes writing a letter to a close other person seeking and asking for help to deal with their trauma. And for in the non-Mutual group, they had to write to someone that they had never helped in the past. So they had to write this letter asking for help, and it had To be be written to someone that they'd never asked. they'd never helped in the past in the mutual support condition, they were asked to write the letter in the same way, but they were to write the letter to someone that they had helped in the past. After both writing, exercises had finished, participants were then asked to write about or think about their trauma for five minutes. And then they were to ask to write their,
00:15:14 - Following this experience, we had, sort of five, I guess, key findings. The first was when we looked at implicit and explicit support. The Malaysian group actually reported significantly greater implicit support than the Australian group. So they reported using and finding preferring implicit support significantly more than the Australian group as we predicted. But interestingly, the two groups didn't differ in regards to explicit support in regards to explicit support being associated with PTSD. Interestingly though, we found that explicit social support, higher levels of it were associated with lower levels of PTSD, what's always found in the PTSD literature. However, what was interesting though was
00:15:55 - And what we found was that yes, explicit social support was associated with PTSD symptomatology, but this was only found for the Australian group. There was no evidence of this association being significant for the Malaysian group. in regards to family, we found that support from family was associated with PTSD. So more support from family was associated with lower levels of PTSD. but again, cultural group moderated this, this association was only significant for the Malaysian group and it wasn't significant for the Australian group. So again, we're getting this pattern that these associations are there, but cultural group seems to moderate it with the associations being different depending on

"Exploring Cultural Differences in Social Support Dynamics Among Trauma Survivors: Insights from Malaysian and Australian Perspectives"

00:16:38 - of the experimental findings, just starting with the non-mutual conditions. So that was when someone wrote to someone that they hadn't helped in the past. What we found was that the Malaysian group expressed significantly more distress than the Australian group, however, in the mutual condition. So this is when what you were writing to someone that you had helped in the past, the Malaysian group experienced significantly less distress than the Australian group. Additionally, when we looked at the two Malaysian groups, when they were asked to write to someone that they had helped in the past, they experienced less distress when they were a, rather than when they were asked to write to someone that they'd never helped in the past.
00:17:17 - who they were asking help from. And so that again, supports past previous research. And this is the first time it's sort of been suggested in the context of trauma survivors and PTSD. And finally opposite to sort of what we predicted, actually, the Malaysian group was significantly more open to psychological problems than the Australian group. And there was no differences, cultural differences in tendency to seek out help or professional help for their psychological problems. And there's also sort of no difference in regards to perceptions of stigma and how this may impact on seeking out, professional help. First thing is that we often assume universality and PTSD research. We assume that universally people are gonna recover in a
00:17:58 - And I guess our research across the broad, across the board is starting to challenge that and to actually think we actually need to consider culture and how that influences some of the factors that are involved in post-trauma recovery. And in this instance, we looked at, social support. So again, we found what always found in the PTSD literature that explicit social support tends to be associated with social support, with PTSD symptomatology. Yet what's interesting though is that this doesn't potentially seem to be universal 'cause we found it for the Australian group, but there was no evidence that it was there for the Malaysian group. Again, we found that family seems to be really important in the notion of PTSD, but this seems to be particularly important potentially
00:18:41 - Additionally, it may be important, although for Australians it may not matter who people go and ask for help from. Our finding suggests that it may be really important for Malaysian trauma survivors if people are gonna have to go out and ask for help. It's potentially quite important that they ask for help from people who they have helped in the past. So again, this findings starting to come together to suggest that culture may be impacting on some of the, factors known to play a role in PTSD. And finally against what we sort of, hypothesized, the Malaysian group did report that there was potentially more psychologically minor or as psychologically minor as the Australian groups are further researchers needed in that space.
00:19:22 - our clinical guidelines tell us to be culturally appropriate, culturally responsive, culturally adaptive. But in the instance of PTSD, there's just so little evidence to guide, well, what does that actually mean? Additionally, we know that if we don't culturally tailor our interventions, effect sizes can be quite small, but if we can culturally tailor them, effect sizes improve. Yet in the instance of PTSD, there's just so little research to guide what does this mean? We know social support is important. We know telling people to get social support around them following trauma is important, but what, how does culture influence that? How does it influence who should people should be asking for help? How they should be asking for help,
00:20:02 - And these just initial findings are starting to suggest that maybe explicit social support isn't beneficial for everyone. Maybe it has limits as we found for Malaysian participants. Secondly, it seems to be very important to consider those family and those broader networks, particularly when working with Malaysian trauma survivors. And thirdly, while for Australians it may not matter whether people seek support from someone they've helped before or whether they haven't, it doesn't really matter. For Malaysians, it may be particularly important when clinicians suggest that people go out and seek support or tell people about their trauma, that they may be take into account that they do this with someone that they've helped in the past. There are worth noting some of the limitations

"Exploring Limitations and Future Directions in the Study of Cultural Influences on Trauma Recovery"

00:20:43 - So much more work in this area needs to be done. A few of the limitations are that this is a cross-sectional study, so we, it's only based on associations. We can't do any causal inferences. We obviously need longitudinal studies to look into this and potentially more experimental work as well. Additionally, there's a culture is a very complex, dynamic sort of construct. And we only looked at sort of this idea of the self in relation to others, which is self construal. There's obviously a lot more cultural factors such as religion and other factors that could be taken into account too, which may be playing a role in our sort of findings. The final thing is we did control for trauma type and also time since trauma.
00:21:25 - that people have been through, whether it's childhood, whether it's interpersonal or whether it's more like an accident or a, a disaster, is potentially gonna impact on how someone talks about their trauma and who they go and tell about their trauma. And then cultures obviously potentially gonna play a role on that too. So future studies should also think about maybe thinking about the triumph trauma, that people have been through. So pulling it all together though, this is an initial study and it suggests mainly that we need to take into account culture when we are considering how people are recovering following trauma. And this, in this instance, looking at social support. And I guess the main, implication from these sort of findings is to highlight the need for much,
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