An-Najah National University 

Faculty of Graduate Studies 
 

 

CONTINUOUS TRAUMATIC STRESS RESPONSE AND 

COPING STRATEGIES AMONG ADULTS EXPOSED 

TO POLITICAL VIOLENCE IN THE NORTH OF THE 

PALESTINIAN TERRITORIES:  

A MIXED METHOD STUDY 

 

By 
Maram Ghannam 

 

Supervisor 
Dr. Jamal Qaddumi 

 

This Thesis is Submitted in Partial Fulfillment of the Requirements for the Degree of  
Master of Community Mental Health Nursing, Faculty of Graduate Studies,  An-Najah 

National University, Nablus, Palestine. 
2024 



II 

 
CONTINUOUS TRAUMATIC STRESS RESPONSE AND 

COPING STRATEGIES AMONG ADULTS EXPOSED 

TO POLITICAL VIOLENCE IN THE NORTH OF THE 

PALESTINIAN TERRITORIES:  
A MIXED METHOD STUDY 

 
 

By 

Maram Ghannam 

 

 This Thesis was Defended Successfully on 02/10/2024 and it was approved. 

Dr. Jamal Qaddumi  

Supervisor 

 

 
 

Signature 

Dr. Salam khateeb 

External Examiner 

 
 

Signature 

Dr. Adnan Sarhan 

Internal Examiner 

 
 
 

Signature 



III 

Dedication 

ي ولنجاحي كالذي ينظر الى  ، الحمد هلل الذي بفضله ادركت اسمى الغايات انظر لنفسالحمد هلل حبًا وشكرًا وإمتناناً 

 بفضل هللا وأصبح واقعًا افتخر به. ، تحقق معجزته، الى الحلم الذي طال إنتظاره

الى من كانت الداعمة األولى واألبدية ، مالكي الطاهر ، من كان وجودها يمدني بالسعي دون ملل ، الى التي ظلت  

دعواتها تضم اسمي دائمًا ، معلمتي األولى ، دكتورتي األولى ، أمي ومحبوبتي وملهمتي( ، أهديك هذا اإلنجاز الذي  

ضل والثناء للمولى ثم لكفاحك ألجلي ، وعطائك الذي يضمد تعبي لوالك لم يكن ، اهديك مراحلي وإنجازاتي كلها فالف

، كنت لي األم واألب اكتفيت بك عن العالم أجمع يا خير عوض وأعظم سند ، ُكنِت لي النور في دربي الشاق مضينا 

وتعليمي ، ممتنه   معًا طريقًا لم يكن محفوفًا بالسهوله ها أنا اليوم أهديك علمًا وشهادًة تخليتي عنها في سبيل رعايتي

 ألن هللا اصطفاك من البشر أما لي . 

)أخي    ، الى ضلعي الثابت وأمان أياميأياديهم وقت ضعفي وأمنوا بقدرتي  ، الى من مدت لي االى خيرة أيامي وصفوته

 (. وأختي

زوجي الغالي الذي أشرقت شمسه في سماء حياتي، وأصبحت نورًا تمدني بالحب والدعم، سندي ورفيق دربي من  

 أخذت عنه حب التحدي وتخطي الصعاب. 

 الفاضلين.  اهل زوجي –حنانهم دون مقابل بمثابة أهل وأغدقوني بحبهم و  عطفهم وكانواالى من غمرتوني بحبهم و 

بالمعلومات   لهم الدور األكبر في ُمساندتي ومدِ ي  أنسى دكاترتي ممن كان  لكم بحث وال ينبغي أن  أُهدي  القيِ مة، 

 أن ُيطيل في أعماركم، ويرزقكم بالخيرات. -عزَّ وجلَّ -تخرُّجي، داعًيا المولى 

، ألصدقاء ورفقاء السنين وأصحاب الشدائد  كان عونًا وسندًا في هذا الطريق  ، ولكل منذين يبهجهم نجاحيالى ال

 واألزمات.

، ها أنا اختم كل ما مررت فسي على الصبر والعزيمة واإلصرار، والتي كانت اهاًل للمصاعبأخيرًا الشكر موصول لن

، راجية من هللا تعالى أن ينفعني بما علمني وان يعلمني ما أجهل ويجعله  ونجاح الحمد هللا من قبل ومن بعدبه بفخر  

 حجة لي ال علي. 



IV 

Acknowledgement 

نطالقا من العرفان بالجميل فانه يسرني ويثلج صدري أن أعبر عن امتناني وشكري لجامعة النجاح الوطنية وخاصة  ا

الرئيسي على   المشرف  بالشكر والعرفان  علمهم، وأخص  يبخلوا علي بعطائهم من  لم  الذين  التدريس  أعضاء هيئة 

ر من المساندة والمساعدة، وأنار دربي بتسلق درجات رسالتي الدكتور جمال القدومي الذي مدني من منابع علمه بالكثي

التقدم في البحث العلمي منذ دخولي الجامعة دون كلل أو ملل، وأحمد هللا بأن يسره في دربي ويسر به أمري وعسى  

 أن يطيل هللا بعمره ليبقى نبراسا متأللئًا في نور العلم والعلماء. 

التوجيه  كما أنني أمتن بجزيل العرفان والشكر للدكتورعدنان سرحان الذي قدم لي الدعم النفسي والتشجيع باإلضافة إلى  

 واإلرشاد العلمي بشكل مستمر.

كما اتقدم بجزيل شكري وتقديري لمنسقة برنامج الصحة النفسية العميدة الدكتورة عايدة القيسي التي منحتني وقتها  

 الثمين لنصحي وارشادي.

 وأيضا أتقدم بجزيل الشكر والعرفان للدكتور القدير محمد مرعي ، والذي كان سخي العطاء بوقته وعلمه. 

وكل الشكر للدكتور محمود خريشة وكل زمالئي في رحلة ماجستير التمريض بكافة التخصصات الذين أصبحوانعم 

 األخوة والسند. 

كما أتقدم بجزيل الشكر لكافة أعضاء لجنة المناقشة الموقرين الذين تكبدوا الكثير من العناء في قراءة رسالتي المتواضعة  

 القيمة.واغنائها بمقترحاتهم 

وأتقدم بجزيل الشكر والتقدير لكافة المؤسسات الشعبية والمراكز الشبابية ولجان أمهات الشهداء الالتي ساعدنني على  

االستمارات خاصة   المعلومات وتوزيع  الجليل  جمع  استقبالي    ….. مؤسسة كي ال ننسى ومؤسسة  أحسنوا  اللواتي 

بالدراسة الذين منحوني ثقتهن ووقتهن وشاركوا    وعملوا على توفير البيئة المناسبة لجمع البيانات وأشكر كافة المشاركين

 بدراستي. 

يضيء درب الحرية، ُكل    س الصمود والتضحية، النبراس الذي، األرض التي ُتعل منا درو واخيرًا اقدم تحياتي لفلسطين

 ركٍن في فلسطين يروي قصة مقاومة. تحيًة لكل شهيد يكتب بدمه فصاًل جديًدا في سجل التاريخ.



V 

Decaration 

I, the undersigned, declare that I have submitted the thesis entitled: 

CONTINUOUS TRAUMATIC STRESS RESPONSE AND COPING 

STRATEGIES AMONG ADULTS EXPOSED TO POLITICAL 

VIOLENCE IN THE NORTH OF THE PALESTINIAN 

TERRITORIES: A MIXED METHOD STUDY 

 
I further declare that the work presented in this thesis, unless otherwise referenced, is the 

researcher's own work and has not been submitted elsewhere for any other degree or 

qualification. 

Maram Ghannam  Student's Name:  

Maram Ghannam Signature: 

02/10/2024 Date: 

 

 

  



VI 

Table of Contents 

Dedication ....................................................................................................................... III 

Acknowledgement .......................................................................................................... IV 

Decaration ........................................................................................................................ V 

Table of Contents ............................................................................................................ VI 

List of Tables ............................................................................................................... VIII 

List of Figures ................................................................................................................. IX 

List of Appendices ........................................................................................................... X 

Abstract ........................................................................................................................... XI 

Chapter One: Introduction ................................................................................................ 1 

1.1 Overview ................................................................................................................... 1 

1.1.1 Palestine's political status ........................................................................................ 1 

1.1.2 CTS and PTSD ........................................................................................................ 3 

1.2 Conceptual definitions ............................................................................................... 8 

1.3 Operational definitions .............................................................................................. 8 

1.4 Aim of the study ........................................................................................................ 9 

1.4.1 Objectives ................................................................................................................ 9 

1.5 Problem statement ..................................................................................................... 9 

1.6 Significant ................................................................................................................ 10 

1.7 Research Questions ................................................................................................. 10 

1.8 Hypotheses .............................................................................................................. 11 

1.9 Literature review (LR) ............................................................................................. 12 

1.9.1 Introduction to literature review ............................................................................ 12 

1.9.2 Review of literature ............................................................................................... 12 

1.9.3 Summary of the L.R .............................................................................................. 18 

Chapter two: Method and procedures ............................................................................. 19 

2.1 Introduction ............................................................................................................. 19 

2.2 Study design ............................................................................................................ 19 

2.3 Study Population ..................................................................................................... 20 

2.4 Site and setting ........................................................................................................ 20 

2.5 Study time ................................................................................................................ 20 

2.6 Sample size and sampling methods ......................................................................... 21 

2.6.1 Sample size ............................................................................................................ 21 



VII 

2.6.2 Sampling method................................................................................................... 21 

2.7 Inclusion and Exclusion Criteria ............................................................................. 21 

2.8 Data collections ....................................................................................................... 22 

2.8.1 Data Collection tools and process: ........................................................................ 22 

2.9 Pilot study ................................................................................................................ 24 

2.10 Variables .................................................................................................................. 24 

2.11 Data analysis ............................................................................................................ 25 

2.12 Ethical Consideration: ............................................................................................. 26 

2.13 Risk-benefits assessment ......................................................................................... 26 

Chapter three: Results ..................................................................................................... 27 

3.1 Introduction ............................................................................................................. 27 

3.2 Qualitative part findings .......................................................................................... 36 

3.2.1 Military occupation as a source of  danger, terror, sabotage and deprivation of 

freedom and rights .......................................................................................................... 37 

3.2.2 3.2.2. Occupation as a source of psychological and physical diseases ................. 40 

3.2.3 The occupation is a source of loss of loved ones. ................................................. 41 

3.2.4 Talking about the martyr as a source of conflict feelings (happiness  and sadness)

 ........................................................................................................................................ 44 

3.2.5 Challenging the occupation as a source of hope ................................................... 46 

3.2.6 Ways to cope and adapt ......................................................................................... 47 

Chapter four: Discussion ................................................................................................ 52 

4.1 Discussion ................................................................................................................ 52 

4.2 Conclusions ............................................................................................................. 59 

4.3 Recommendations ................................................................................................... 60 

4.4 Strength and Limitations ......................................................................................... 61 

List of abbreviations ....................................................................................................... 63 

Reference ........................................................................................................................ 64 

Appendices ..................................................................................................................... 72 

 ب ............................................................................................................................... الملخص 

  



VIII 

List of Tables  

Table 3.1: Demographic characteristics of study participants whom exposed to political 

events exposure (N=407) ................................................................................. 27 

Table 3.4: Political events exposure scale of study participants whom exposed to political 

events (N=407) ................................................................................................ 28 

Table 3.5: Frequency of CTSR items: extent of the study participants feeling over the past 

month ............................................................................................................... 30 

Table 3.6: Participants’ responses frequency distribution of their avoidance Coping scale 

items ................................................................................................................ 31 

Table 3.7: Participants’ responses frequency distribution of their approach coping scale 

items ................................................................................................................ 31 

Table 3.8: Correlations between the severity of political events exposure and their 

psychological responses to stress .................................................................... 32 

Table  3.19: the relationship between total political events and CTSR with coping 

strategies .......................................................................................................... 36 

Table 3.20: Reliability Statistics ..................................................................................... 36 

 

  



IX 

List of Figures 

Figure 3.1: percentage distribution of political events exposed by ................................ 29 

Figure 3.2: Frequency distribution of CTSR subscales .................................................. 29 

Figure 3.3: Participants’ responses frequency distribution of their avoidant Coping scale 

items ............................................................................................................... 31 

Figure 3.4: Participants’ responses frequency distribution of their approach coping scale 

items ............................................................................................................... 32 

Figure 3.5: Frequency distribution of Coping scale items .............................................. 35 

 

  



X 

List of Appendices  

  

Appendix A: Tables ........................................................................................................ 72 

Table 3.2: Work and income of Palestinian people exposed to political events study 

(N=407) participants ........................................................................................ 72 

Table 3.3: Frequency of disability and psychological support among Palestinian people 

exposed to political events study participants (N=407) .................................. 72 

Table 3.9: Gender and study variables (political event, CTSR, & coping style) ........... 72 

Table 3.10: Disability and study variables (political event, CTSR, & coping style) ..... 73 

Table 3.11: Psychological support and study variables (political event, CTSR, & coping 

style) .............................................................................................................. 73 

Table 3.12: residency and study variables (political event, CTSR, & coping style) ...... 74 

Table 3.13: Correlations between age and family number with study variables (political 

event, CTSR, & coping style) ........................................................................ 75 

Table 3.14: Education level and study variables (political event, CTSR, & coping style)

 ....................................................................................................................... 75 

Table 3.15: marital status and study variables (political event, CTSR, & coping style) 76 

Table 3.16: Employment and study variables (political event, CTSR, & coping style). 76 

Table 3.17: Income and study variables (political event, CTSR, & coping style) ......... 77 

Table 3.18: house and study variables (political event, CTSR, & coping style) ............ 78 

Appendix B: Data Collection Tool ................................................................................. 79 

Appendix C: The questionnaire is in English ................................................................. 85 

Appendix D:  IRB Approval Letter ................................................................................ 89 

 

  



XI 

Continuous Traumatic Stress Response and Coping Strategies Among 

Adults Exposed to Political Violence in Palestinian Territories A Mixed 

Method Study 

By  

Maram Ghannam 

Supervisor 

Dr. Jamal Qaddumi 

Abstract 

Background: Prolonged exposure to political violence, such that which occurred during 

the Israeli-Palestinian occupation, has caused serious physical and mental distress for 

Palestinian civilians. It is crucial to examine that people experience anxiety, dread, and 

sense of perceived threat during continuous traumatic stress are directly affect coping 

strategies.  

The aim of the study: To assess the level of Continuous Traumatic Stress Response and 

coping strategies among Palestinian adults exposed to political violence. 

Method: A mixed method of quantitative and qualitative research study design was 

adopted in this study. A purposive sampling method of adults who are from Jenin and 

Nablus camps and Nablus Old City. Out of 407 participants were included in this study. 

The Politically Violent Events Scale, continues traumatic stress response scale and the 

Jalowiec Coping Scale were used.Ten participants were included in this study in 

qualitative study for in depth interviews 

Results: The findings indicated that the participants' greatest exposure (76.7%) was to 

their home being searched by the military. In terms of the event's severe impact, curfews 

or being prohibited from leaving one's home or city was ranked as the most severe 

influences. Participants feels fear and helplessness (63.6%), followed by feeling of 

exhausted and detachment (62.61%), and finally feeling of rage and betrayed (59.35%). 

the focus on concentrating their efforts on doing something about the situation was the 

highest among the approach coping method and their trying to find comfort in religion 

was the highest among the avoidant coping method among the study participants. In the 

qualitative findings, Six themes were emerged: Military occupation as a source of danger, 

terror, sabotage, deprivation of freedom and rights. a source of psychological and physical 



XII 

diseases, loss of loved ones. And the “Challenging the occupation as a source of hope” 

theme. 

Conclusion: Enhanced comprehension of the psychological ramifications of possibly 

traumatic incidents can eventually result in better CTSR prevention and treatment 

strategies. The promotion of mental health and well-being among people impacted by 

stress and trauma connected to conflict requires standardized instruments, family support, 

and cultural sensitivity. 

Keywords: Continuous traumatic stress response, Political violence, Palestinian adults, 

Coping strategies. 



1 

Chapter One  

Introduction 

1.1 Overview 

1.1.1 Palestine's political status 

In order to subdue the Palestinians in the occupied West Bank and Gaza Strip, Israel has 

put in place an oppressive regime that depends heavily on the use of force—a level that 

is completely out of proportion to the threat the population's lack of weapons poses to its 

security. As a result, the Palestinians have adopted a range of resistance tactics in an effort 

to halt Israel's unlawful occupation of their territory and win their independence and 

sovereignty. The Palestinians began a national revolt (now called the intifada) in 

December 1987; it was a costly endeavor for them in terms of human casualties and severe 

suffering. 962 Palestinians had been slain by Israeli forces as of the second quarter of 

1991; 252 of them had been 16 years of age or younger. Since many of the young people 

who were shot to death had upper body or head wounds, there was conjecture that the 

Israeli authorities might have been using snipers to position themselves during patrols. 

There have been an estimated 115,118 injuries. The Israeli authorities imposed a curfew 

on various portions of the territories for 10,212 days, excluding the period during which 

the entire area was under curfew. More than 100,000 trees have been removed, and 

375,753 dunums—roughly equivalent to.25 acres—of land have been taken. The 

occupation forces have blocked off or destroyed 1,971 homes in total. There is still 

unrelenting Palestinian resistance to the Israeli occupation, either in spite of or perhaps 

because of this litany of tragedy (50). 

The Palestinian communities have been plagued by daily tensions for decades, and the 

bloodshed still occurs today. Since the Second Intifada began in 2000, Israeli security 

forces have murdered 6,489 Palestinians, while 1,096 Israelis have been killed by 

Palestinians in various terrorist attacks (1). 

Since September 2000, With total impunity, the Israeli army has slaughtered more 

unarmed Palestinian citizens than were killed on September 11, 2001.. The army has 

executed 238 people extrajudicially while also killing 186 bystanders, including 26 

women and 39 children. Small weapons fire, directed in more than half of the cases to the 

head, neck, and chest—the sniper's wound—killed 621 children, including 2/3 of those 

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under the age of 15, who were killed at checkpoints, in the street, on their way to school, 

and in their homes. It is obvious that Israeli soldiers are regularly permitted to fire and 

kill children in circumstances where there is little to no threat (2). 

Between December 27, 2008, and January 19, 2009, Israel attacked the Gaza Strip, 

committing egregious, unparalleled human rights abuses that were the result of a political 

choice to ignore the deaths of civilians in favor of saving Israeli soldiers. These violations 

included assaults on medical staff and civilians, obstruction of emergency medical 

evacuations, limitations on civilian access to health care, impediments to referrals for care 

outside the Gaza Strip, and threats to the transfer of food and medical supplies (3). 

The people in the Jenin refugee camp, as well as those in all other Occupied Territories, 

are deprived of their independence and have their sense of humiliation increased by living 

in cramped quarters that are surrounded by impenetrable borders that keep them cut off 

from the outside world. The house is purposefully made into a battlefield. Destroying and 

undermining houses turns becomes a tactical tool for attacking the community as a whole 

(52).  

the manner in which sixty years of continuous fighting and forty years of Israeli military 

occupation have changed them. While standards of health, literacy, and education are 

currently higher in the Israeli compared to the occupied Palestinian territory than in 

several Arab countries, in 2007 (52%) of families (40% in the West Bank and 74% in the 

Gaza Strip) were living below the US$3·15 per person per day poverty threshold (53).  

During the second intifada, UNRWA's restoration of the Jenin refugee camp after Israel's 

catastrophic destruction in April 2002 was the largest humanitarian initiative. The author 

emphasizes the conflict between the needs and desires of the refugees and UNRWA's 

politically “neutral” technical vision by reviewing the interactions between planners and 

local refugee committees. Although acknowledging UNRWA's critical role, the author 

laments that the organization chose a more conventional (liberal) community-based 

development framework rather than a rights-based approach when expanding its 

operations beyond relief provision, which depoliticized the community's fight for its 

rights. Given this experience, it is even more imperative that UNRWA recognize the 

overlapping rights of Palestinian refugees and include them in its definition of 

humanitarianism (54).  

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The quality and accessibility of mental health services must be improved. To better serve 

the requirements of professionals and service consumers, Palestine's mental health 

policies and services need to be developed. Increasing the integration of mental health 

services with other health care domains and increasing awareness of mental health are 

critical. Basic human requirements, such as freedom of movement and the cessation of 

the occupation, must be satisfied for civilians. The ability and resilience of community 

mental health teams must be improved. greater funding is required, along with greater 

assistance, modern training, and oversight for mental health teams (5). 

Civilians have experienced severe physical and mental suffering as a result of prolonged 

exposure to political violence (EPV), such as that experienced during the Israeli-

Palestinian conflict (10).  

1.1.2 CTS and PTSD 

Israeli occupation and mental illness 

Natural and man-made calamities frequently result in trauma and Post-Traumatic Stress 

Disorders (PTSD), with refugees being one such tragedy, some of which were brought on 

by political disputes. Since the 1948 Nakba, Palestinians have the greatest refugee 

population in the world, PTSD and other psychological issues are constantly a major 

concern for Palestinian children, teens, adults, and their families in the Gaza Strip(4). 

Worldwide, a large number of people are subjected to continuous traumatic stress (CTS). 

It is yet unknown, though, what psychological effects CTS may have had or whether  

the diagnostic criteria for posttraumatic stress disorder (PTSD) apply in this particular 

case. Responses to CTS turned out to go beyond the current PTSD symptomatology. 

PTSD, anxiety, somatization, and depression were among the psychological responses to 

CTS (7). 

A continuous or ongoing exposure to traumatic stress does not meet the current diagnostic 

criteria for posttraumatic stress disorder (PTSD). Therefore, stress symptoms linked  

to exposure to risks that last for months or years are not adequately captured by  

existing evaluation techniques. To fill this gap, we included the symptoms linked to 

persistent stress exposure, including those that are different from the diagnostic criteria 

for PTSD (8). 

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4 

Existing conceptualizations of traumatic stress continue to assume that traumatic 

experiences have already happened, despite significant theoretical and empirical 

advancements in the field since the diagnosis of posttraumatic stress disorder (PTSD) was 

added to the mental health nomenclature. In order to characterize the experience and 

effects of living in situations of real-world present and continuing risk, such as prolonged 

political or civil unrest or widespread community violence, we suggest the term 

continuous traumatic stress (CTS) as an addition to the lexicon of traumatic stress(11). 

Many young adult Palestinians were involved directly or indirectly in the actual fighting 

while others witnessed the events (12). Numerous studies conducted during the past ten 

years have documented high levels of psychosocial issues among women, children and 

adolescents, refugees, and prisoners in Palestine. (13). 

The three hallmark criteria for post-traumatic stress disorder (14) (Diagnostic and 

Statistical Manual of Mental Disorders; American Psychiatric Association, 2000) are re-

experiencing the event (e.g., intrusive memories, dreams), avoiding stimuli connected to 

the events and emotional numbing, and symptoms of increased arousal. Exposure to 

extreme ethnic-political violence appears to interfere with the child's cognitive and 

emotional processing of those experiences (15). Additionally, it has been discovered that 

teenagers exposed to PV are susceptible to psychological distress and post-traumatic 

stress reactions (16). A wide range of psychological disorders, including as aggressive 

behaviors, sadness, anxiety, learning difficulties, and post-traumatic stress disorder 

(PTSD), can affect children and adolescents exposed to PV (17). Eleven out of twenty 

five questions that measured three different factors—exhaustion/detachment, 

rage/betrayal, and fear/helplessness—were kept by the writers. We discovered a moderate 

degree of agreement between the scales, suggesting that the CTSR assesses a concept that 

is connected to PTSD but separate from it (8) The evidence supporting the existence of a 

complicated kind of post-traumatic disorder in victims of protracted, repetitive trauma is 

reviewed in this essay. Disorders of Extreme Stress Not Otherwise Specified, or 

DESNOS, is the name being considered for this syndrome's inclusion in the DSM-IV. The 

majority of the existing diagnostic standards for PTSD come from the observations of 

people who have survived quite narrowly scoped traumatic situations (6). 

The substantial significance of trauma and the severe burden for mental health in this 

population are indicated by the PTSD prevalence of (36%) revealed in Palestine in 2021 

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(19). While about one-third of PTSD sufferers recover after a year, those with war-related 

PTSD appear to have the lowest likelihood of doing so (21). The two groups' levels of 

intrusion symptoms did not differ, according to our findings. The only factor that might 

account for the difference in intrusion severity between the PTS and CTS groups was the 

reported lifetime exposure to traumatic experiences (22). 

Regardless of the severity of the youth's past PTS symptoms, cumulative exposure to 

violence in more contexts over the course of the initial two years was linked to an 

increased risk of acquiring PTS symptoms later on than exposed to fewer instances of 

violence (24). PTSD is substantially more common in women than in men (25).  

Participants with low and moderate incomes are thought to be the group most susceptible 

to PTSD. These findings highlight the need for quick action to assist the affected 

population in regaining their mental health so they may participate fully in society and 

meet the demands of the post-conflict era (26). 

A review of Posttraumatic stress disorder symptoms were positively linked with both 

lifetime and the previous 30-day assessments of political violence (27). A study found 

that children directly exposed to the trauma developed more severe PTSD, while those 

who had been indirectly exposed to house demolitions developed more anxiety and 

mild/moderate PTSD. They give two interpretations for this finding: One is that those 

directly exposed develop emotions and a physical reaction to the bombing, while others 

only worry about what may happen. The second interpretation is that the PTSD in those 

directly exposed masked their anxiety (28). 

The fear of bombardment puts civilians at risk for developing PTSD. Even if communities 

that are frequently threatened have high levels of resilience, it is wise to create and put 

into practice public health strategies to protect individuals who are most traumatized 

during and after assaults from getting PTSD. Interventions should take into account 

building on citizens' prior effective coping strategies because, to a small extent, prior 

trauma exposure buffers the response to bombardment (24). In contrast, a child who has 

experienced a terrible incident firsthand has had the chance to put his skills to the test and 

develop his strength on his own. In this instance, he might have been able to internalize 

the threat in order to feel less worried or fearful, allowing him to face it and overcome it 

peacefully. The other possibility is that the occurrence was much bigger than he could 

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have imagined and that his mind was unable to give the overpowering experience any 

significance (29). But It is advisable to exercise caution when applying current post 

traumatic stress models to those who have experienced ongoing trauma (30).  

The threat of political violence to people's health is quite real. However, protective 

elements might enable individuals to develop resilience in the face of political violence 

(27).  

The first difference between  CTS and PTSD is that there is no discernible beginning or 

end to CTS. The criteria for PTSD, on the other hand, require that symptoms be indicative 

of a protracted stress reaction that lasts for at least a month following prior events.PTSD 

stressor circumstances arise in the context of particular people, relationships, and events, 

whereas CTS emerges in families and is made worse by communities and cultures. 

Second, rather than past traumatic experiences, the temporal location of stressor 

conditions in CTS is concentrated on the present and future. This leads to an adaptive 

fixation on safety, as opposed to the pathological kind of hypervigilance observed in 

concurrent PTSD. Third, it can be difficult to distinguish between perceived and actual 

threats. Consequently, anticipatory anxiety is a component of CTS. Fourth, the lack or 

malfunction of external defense mechanisms that sustain persistent stressors characterizes 

CTS. Traditional PTSD paradigms do not specifically address the lack of these protective 

systems, despite the fact that systemic causes probably shape PTSD (32). It is crucial to 

remember that people's coping mechanisms from past experiences contribute to their 

feelings of perceived threat, dread, and anxiety when they experience CTS. PTS and CTS 

may also exhibit different avoidant behavior symptoms: PTS sufferers would attempt to 

avoid symptom triggers, while CTS sufferers would attempt to avoid true danger.(31). 

Additionally, the multivariate analysis showed that the likelihood of getting PTSD 

symptoms is increased if you have a history of trauma and feel unable of handling your 

patients amid the current Gaza war and Israeli-Palestinian political violence. Furthermore, 

utilizing behavioral disengagement, self-blame, and venting as coping mechanisms raises 

the risk of PTSD symptoms. Additionally, utilizing substance abuse and acceptance as 

coping mechanisms lowers the likelihood of experiencing symptoms of PTSD. (20). On 

the other hand the clinical picture for some individuals supports the diagnosis of post-

traumatic stress disorder (PTSD). The onset and constellation of symptoms are, however, 

less typical of PTSD in other people. Instead of being caused by a single, prior traumatic 

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event, anxiety symptoms in these situations appear to develop gradually and are linked to 

persistent, daily tension over impending assaults. Their avoidance tactics are mostly 

grounded in fact. They describe experiencing hyperarousal, extreme distress, and lack of 

control both during and right after genuine missile attacks. They are less prone to display 

symptoms of reliving events, nevertheless. Additionally, in contrast to how PTSD often 

manifests, their symptoms frequently drastically lessen or disappear altogether once they 

are no longer in danger (9). 

According to the transactional framework of stress, resilience may be thought of as a 

dynamic process in which people use both internal and external coping mechanisms in 

the face of hardship. This essay examines the functions of two resources—social support 

and self-efficacy—in the setting of forced migration, terrorism, and conflict. These 

resources are thought to be protective elements that might lessen the effects of hardship 

and facilitate healing from traumatic events. As essential elements of the coping process, 

they help people reframe their viewpoints and engage in cognitive restructuring, which 

eventually results in a recovery from hardship or even the formation of higher levels of 

functioning after trauma (23) Unsurprisingly, the results indicate a negative correlation 

between anxiety, despair, and intolerance for uncertainty and well-being. Overall, it was 

discovered that mental anguish mediated both the relationship between maladaptive 

coping and wellbeing as well as the relationship between uncertainty and wellbeing. (18).  

Depending on the stage of recovery, certain coping mechanisms may or may not be time-

dependent in their ability to promote recovery. Avoidance (such as fleeing) at the 

beginning of trauma exposure, for instance, may help to lessen the cognitive and 

biological "wear and tear" that a person might otherwise experience if they decide to stay 

close to the trauma and/or associated stressors. When confronted with an urgent and 

uncontrollable trauma, approach-oriented coping may jeopardize safety and 

psychobiological function that would have been maintained with more avoidant flight-

oriented tactics (34). 

  

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1.2 Conceptual definitions 

Continuous Traumatic stress(CTS) can show itself as emotions, actions, and perceptions 

in people as well as in families, societies, and communities. The suggested CTS model 

incorporates a cyclical element that unites perceptions from the past and present with 

emotional reactions resulting from ongoing, repetitive traumatic experiences over an 

extended duration (31) . 

Political violence: The WHO defines political violence as acts of injury or intimidation 

against people that are physical, psychological, or sexual in nature. Examples include the 

use of rape, psychological torture, and assassinations as weapons of war and political 

repression (35) . 

Coping strategies: According to Webster's Dictionary, the word "cope" is derived from 

the Latin word "colpus," which means "to alter," and is typically used in the psychological 

paradigm to imply "dealing with and attempting to overcome problems and difficulties.", 

the transactional model classifies coping into two major groups. The first is known as the 

problem-focused coping technique, while the emotion-focused coping approach is the 

second. The ability to think and change the environmental event or scenario is more 

important when it comes to problem-focused coping (36). 

1.3 Operational definitions 

Continuous Traumatic stress Response scale (CTSR): a scale allows you understanding 

and effective measurement of the effects of persistent or ongoing trauma is necessary to 

identify and treat those affected. However, a scale assess the broader effects of exposure 

to ongoing traumatic stress aside from PTSD measures. 

Political violence: adults who exposed to physical or verbal abuse at a military 

checkpoint, the arrest of themselves or a family member, being subject to long curfew 

periods, injury by soldiers, death of a relative, or property damage or loss during military 

house searching. 

Coping strategies: specific coping behaviours which adolescents may use to manage and 

adapt to stressful situations as ventilating feelings, seeking diversion, developing self-

reliance, developing social support, avoiding problems, seeking spiritual support, solving 

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family problems, investing in close friend, engaging in demanding activity, seeking 

professionals support, being humorous and relaxing . 

1.4 Aim of the study 

To assess the level of continuous Traumatic Stress response and coping strategies among 

Palestinian adults exposed to political violence . 

1.4.1 Objectives 

• To assess the frequency and severity of exposure of political violence among 

Palestinian adults who exposed to political violence. 

• To assess the correlation between these characteristics ( physical disability and 

psychological support receive services) with CTSR and coping strategies among 

Palestinian adults exposed to political violence. 

• To assess the correlation between CTSR and coping strategies among Palestinian 

adults exposed to political violence. 

• To assess the correlation between demographic characteristics ( age, gender, 

educational level, income level, marital status, working status , family members 

number and housing status) with CTSR and coping strategies among Palestinian 

adults exposed to political violence. 

• To explore Palestinian adults’ experiences with political violence, continuous 

traumatic stress, and ways of coping with Palestinian-Israeli conflict. 

1.5 Problem statement 

A constant threat to their lives is the prolonged socio-political conflict or communal 

violence that millions of people and families face today and in the future. The concept of 

continuous traumatic stress (CTS) was proposed as an additional viewpoint to help 

comprehend the unique effects of being under both real-world threats and potential threats 

in the future (37). Political violence significantly interacted with proactive coping, 

reliance on oneself, and political or civic engagement to affect health in a counterintuitive 

way; those who scored higher on these more internalized and individualistic coping 

strategies showed worse health as political violence increased (27). 

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In the West Bank, an area affected by the political conflicts between Palestinian and the 

Israel’s occupation. The conflict left many psychological illnesses undiscovered among 

civilians in Palestine. Therefore, not discovering these illnesses means not finding a 

solution or treatment for them. 

1.6 Significant 

The war leaves physical and psychological effects on the Palestinian people and all care 

providers are concerned with the physical effects of war victims and political violence 

and neglect the psychological aspect of fear and terror and the feeling that their lives are 

in danger and that their lives are not important. There is no article matching the same title 

in Palestine and published on approved sites. If we know the percentage of people 

exposed to political violence and those with a high level of continuous traumatic stress , 

we can create a support and psychological relief program and help them build healthy 

coping methods. 

Assessing the level of CTSR helps you comprehend how to quantify the consequences of 

continuous or persistent trauma effectively, which is important for identifying and treating 

persons who are impacted. In addition to PTSD measurements, we evaluates the more 

general consequences of ongoing exposure to high levels of stress (8). The temporal 

directionality of the relationship between trauma exposure and coping has not yet been 

investigated in any research, which is a crucial therapeutic concern. Our results could 

contribute to intervention studies that aim to support adaptive coping strategies. 

1.7 Research Questions 

• What’s the frequency and severity of exposure of political violence among Palestinian 

adults exposed to it? 

• Is there a significant association between demographic characteristics (age, gender, 

educational level, income level, marital status, working status, family members 

number and housing status) and CTSR, coping strategies among Palestinian adults 

exposed to political violence? 

• Is there a significant association between CTSR and coping strategies among 

Palestinian adults exposed to political violence. 

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• Is there a differences in coping strategies related to exposure to political violence 

among Palestinian adults. 

• Is there a differences in the level of CTSR related to exposure to political violence 

among Palestinian adults. 

• Is there a significant association between these characteristics (physical disability and 

psychological support receive services) and CTSR and coping strategies among 

Palestinian adults exposed to political violence. 

1.8 Hypotheses 

(H1) Research Hypothesis  

Palestinian adults who exposed to political violence have higher level of CTSR. 

(H0) Null Hypothesis  

There is no relationship between level of exposure to political violence and coping 

strategies among Palestinian adults exposed to political violence. 

  



12 

1.9 Literature review (LR) 

1.9.1 Introduction to literature review 

The introduction to the literature review provides an overview of the Similarities and 

differences in terms and symptoms between CTS and PTSD and shows the prevalence of 

PTSD as a mental disorder. 

In general, the literature review section of the study presents a detailed summary of the 

previous research that has been conducted on people who exposed to any type of political 

violence and the authors also discuss the impact of these violence on their mental health 

and coping strategies. 

Search Engines: PubMed, Google scholar, Cochrane, Science Direct and CINAHL. 

Key words: CTSR, PTSD, trauma, violence, political violence, coping strategies, mental 

illness, Palestinian war  

Search strategy: 

I used the keyword in the search sources, then I began to read the abstract. Any article 

that was in one way or another related to the idea of my topic, I would attach the link to 

a Word file, where I would appraise the article in terms of how to benefit from it in my 

research. 

1.9.2 Review of literature  

CTSR and PTSD: 

A study Investigated the Continuous Traumatic Stress (CTS) concept and whether it can 

be distinguished from PTS based on structured clinical interviews with Congolese 

refugees (N = 226). The CTS group's fears about violence's return positively linked with 

their current exposure to it, whereas the greater intrusive symptom severity in the PTS 

group (no symptom reduction under safe conditions) was shown to be explained by higher 

lifetime trauma exposure. Symptom-like reactions may be considered appropriate 

reactions to real risk in situations where trauma exposure is ongoing. To prevent 

overestimating the prevalence of PTSD in these situations, it is important to take into 

account the chance that symptom changes are a reaction to actual dangers (22). 

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In another study conducted investigation of the network was done on the International 

Trauma Questionnaire's classification of Complex Post-Traumatic Stress Disorder 

(CPTSD) symptoms based on information from a nationally representative sample of 

2000 Ukrainians. The findings support the ICD-11 classification system for PTSD, but 

they also imply that ongoing traumatic stress shows up as more compacted correlations 

between symptoms of the disorder, and that emotional control may be essential for 

triggering the CPTSD network. Scalable, concise self-help resources aimed at promoting 

emotion regulation and a sense of threat could be made available to people affected by 

war (38). 

Another study aimed to ascertain the prevalence of moral injury and PTSD symptoms in 

the civilian population that experiences prolonged and continuous warfare, as well as the 

protective and risk factors that either exacerbate or lessen the negative psychological 

states in this population, a rich demographic surveys to around 1,300 civilians in Ukraine 

while the Russian invasion is still going on. Analyses showed that, in comparison to both 

previously published clinical cut-offs and assessments from a comparable sample, there 

was an exceptionally high prevalence of moral harm and severe PTSD symptoms. 

Additional regression analysis revealed protective and risk variables. The severity of 

PTSD symptoms was shown to be higher in women, older adults who were forced to flee 

their homes, and people from areas that were occupied by the Russians. Milder PTSD 

symptoms were connected with higher education. Younger people showed a particularly 

profound moral injury (39). 

In another systematic review and meta-analysis of 2786 studies, 28 publications covering 

32 samples and a total of 15,121 participants from the West Bank and Gaza Strip were 

selected because they either met the DSM-4 or DSM-5 inclusion criteria. The prevalence 

of PTSD, which ranged from (6%) to (70%), was (36%) overall. After only included 

studies utilizing a representative sample, sub-group analysis revealed that the prevalence 

of PTSD did not differ by geography (West Bank, Gaza Strip), and actually tended to 

decline (19). 

An epidemiological study was conducted in the Gaza Strip to examine the prevalence of 

mental health issues among patients at primary care clinics. The study's goals were to find 

out how common post-traumatic stress disorder (PTSD) is among patients who visit 

primary care clinics in the Gaza Strip and whether certain sociodemographic factors are 

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linked to PTSD. Except for those who came for referrals, immunizations, insurance or 

driver's license exams, prenatal care, reports, pregnancy issues, or emergencies, Every 

other patient in each clinic, aged 16 to 55, was contacted and invited to take part. After 

contacting their medical practitioner, a total of 670 people were requested to participate 

in the study, and 661 of them said they would. The prevalence of PTSD symptoms was 

found to be (29%) overall and to be substantially greater in females than in males 

(P=0.001) among patients in primary care. (36%) of people who had been exposed to 

stressful experiences had PTSD. Patients with higher levels of education were more likely 

to experience stressful experiences, although PTSD was less common than it was among 

patients with lower levels of education. In comparison to traumatized females, guys 

reported a reduced prevalence of PTSD (25).  

On a sample of Al-Furat university students in Deir ez Zor, a descriptive cross-sectional 

study design was utilized. 833 students in all were enrolled in the study. We looked into 

trauma and assessed PTSD prevalence. The estimated PTSD prevalence was (28.2%), and 

the students who were forced into sexual acts had the highest PTSD rates (46.3%). 

Internal displacement (p =.032), academic year (p =.002), and social economic position 

(p =.000) were all found to be significantly correlated with PTSD (26). 

Mental Disorders related to political violence: 

According to a review of the research, political violence and national security concerns 

can cause recurrent traumatic experiences over an extended period of time, which can 

lead to protracted exposure to threat in CTS. In these circumstances, symptomatology 

and/or reduced functioning are manifestations of the cumulative impact of these 

experiences. The capacity to go about daily life in these conditions begs the question of 

how people adjust or cope when exposed to ongoing risks for an extended period of time. 

It is crucial to remember that adapting to and thriving in these circumstances does not 

lessen the prevalence or severity of symptomatology in the impacted communities (31). 

A cross-sectional study reveals a strong correlation between a history of trauma and 

anxiety disorders, such as post-traumatic stress disorder and other disorders. Furthermore, 

those who had experienced personal attack were more likely than those who had 

experienced other forms of trauma to seek treatment during the previous year. These 

exposures are probably a contributing factor in the presentation of PTSD or persistent 

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stressors. The fact that a chronic illness was linked to a seven-fold increase in the 

likelihood of seeking treatment for mental health issues in the previous year is also 

noteworthy. This suggests that medical illness, or somatic complaints, may be a 

significant presentation, whether or not anxiety or other psychiatric symptoms are 

expressly reported (40). 

2006–2021: A long-term research conducted in Palestine seeks to understand how 

prolonged combat trauma affects PTSD diagnoses and symptoms. The main findings of 

the current study, which is a follow-up of 607 adolescents and adults aged 10 to 30 years, 

including those children who took part in the study in 2006, show that at least (97.2%) of 

participants had at least six traumatic experiences by the year 2006 and that (100%) of 

participants were exposed to traumas by the year 2021. Four categories of responses to 

persistent war stress were discovered in this study: (a) The acute group (n = 321, 52.9%) 

exhibits high PTSD symptoms both in 2006 and in 2021; (b) The Remitters group (n = 

54, 8.9%) has substantial PTSD symptoms in 2006 but not in 2021; (c) Delayed group (n 

= 204, 33.6%) exhibits no major PTSD symptoms in 2006 but does so in 2021; (d) The 

resilient group (n = 28, 4.6%), which did not exhibit PTSD symptoms in 2021 as well as 

in 2006, was resilient (4). 

According to a survey of Palestinian teenagers enrolled in school, both collective and 

individual exposure to violence will negatively affect the mental health of youngsters. 

Additionally, we thought that group exposures would not be as harmful to mental health 

as individual exposures.These theories were put to the test by our analysis. The survey 

was completed by 3415 students in the 10th and 11th grades from the Ramallah District 

of the West Bank. Scales of individual and collective exposures to trauma/violence 

(ETV). ETV and teenage mental health are strongly correlated, with both individual and 

group exposures having distinct impacts, according to logistic and multiple regression 

models. The prevalence of depressive-like conditions was greater among girls compared 

with boys, and in adolescents living in Palestinian refugee camps compared with those 

living in cities, towns and villages (23). 

Three separate exposure periods—pre-Intifada, Intifada peak, and Intifada recession—

were used to sample 3667 adolescents between the ages of 10 and 18 into two age groups, 

early and late adolescents. This study looked at potential differences in effects based on 

age and gender, as well as relationships between exposure to political violence among 

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Israeli adolescents and mental impacts throughout a seven-year period around the second 

Intifada. All of the Brief Symptom Index scales supported the initial hypothesis, which 

predicted that exposure to political violence would have a major impact on mental indices. 

Higher psychopathological indices during the Intifada peak than at the pre-Intifada and 

retreating Intifada periods supported the second hypothesis, which predicted a main 

influence of exposure duration, higher levels of exposure to political violence were linked 

to higher rates of symptomatology for both younger and older adolescents, according to 

research on potential moderating effects in the relationship between exposure to 

psychiatric indices and political life events. There was a general direct correlation 

between the intensity of political violence exposure and the severity of the mental 

outcome for both genders, however the relationship varied depending on the Intifada 

exposure period (41). 

A study evaluates the reported stress, insecurity, and health-related quality of life 

(HRQoL) among Palestinian young adults in the West Bank. We conducted a survey of 

398 university students in Nablus (mean age: 20.1; SF-36 HRQoL measure; PSS-4 stress 

measure; context-specific insecurity instrument). The results showed better outcomes for 

these people in several outcomes, with the notable exception of insecurity, among the 

participants who made up one-third of those who reported having Israeli citizenship. One 

of the first studies to consider Palestinian citizenship in the West Bank as a potential 

covariate to forecast well-being metrics. This study reveals that there are complicated 

dynamics outside of traditional political systems because citizenship is such a significant 

issue for Palestinians and is connected to personal freedom and access to resources (6). 

An investigation examined the relationship between pre-schoolers in the Gaza Strip and 

war trauma, anxiety, and post-traumatic stress disorder (PTSD). N=399 mothers with 

preschoolers enrolled in kindergartens in the Gaza Strip. Ages of the kids ranged from 3-

6 years. Mothers most frequently described hearing artillery shelling in the region 

(95.5%), hearing loud noises from drones (89.2%), and seeing dismembered bodies on 

TV (81.2%) as unpleasant experiences for their children. Preschoolers experienced 8.3 

traumas on average, with (6%) of children five years old and above having higher 

prevalence scores for PTSD. Generalized anxiety was 10.7, social anxiety was 8.4, 

particular phobia was 21.1, and separation anxiety was 9.65. The mean for overall anxiety 

was 49.84. Significant correlations were found between PTSD and anxiety as well as 

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between PTSD and trauma, PTSD, and anxiety. No discernible statistical differences 

between reported traumatic occurrences by gender were found in the study (20). 

Coping strategies after political violence:  

A 2005 survey of 2,328 youth (aged 12 to 18) in the West Bank, Palestine, found a link 

between psychological symptomatology and exposure to spousal violence, school 

violence, and politically violent events. Additionally, connections were discovered 

between psychological symptomatology, family economic position, and family violence. 

The respondents described poor family functioning. Data showed some regional variation 

in the occurrence of violent political events, violent home situations, violent school 

situations, and psychiatric symptomatology (42). 

A study looked into the connections between trauma, mental health, and coping 

mechanisms in kids living in the southern Gaza Strip 317 children and their parents made 

up the sample. Traumatic incidents were reported  9.34 on average by Palestinian children 

due to political violence. Boys than girls reported experiencing more distressing 

situations. According to the findings, (25.2%) of kids developed PTSD. For self-reported, 

parent, and teacher forms, the current study demonstrated the prevalence of general 

mental health disorders (19.4%, 24.3%, and 28.4%). A total anxiety score of 41.15 was 

reported. Compared to boys, girls reported having more panic/agoraphobia and separation 

anxiety. The association between total trauma and PTSD, PTSD and overall coping 

mechanisms, venting emotions and PTSD, social support and PTSD, and avoiding 

difficulties was significant (34).  

In this study, adult Palestinian women from the West Bank (N = 122) had their mental 

and physical health investigated in relation to their lifetime and recent 30-day experiences 

of political violence. Two theories were looked at: Political or civic engagement would 

serve as moderators of the effects of political violence, buffering or reducing its effects 

on physical and mental health outcomes. (A) Reports of exposure to political violence 

would be associated with reports of poorer physical and mental health; and (B) several 

coping variables (proactive coping, self-reliance, reliance on political, family, and 

religious support, and political or civic engagement) would serve as moderators of the 

effects of political violence. . Posttraumatic stress disorder symptoms were positively 

linked with both lifetime and the previous 30-day assessments of political violence. 

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Political violence significantly interacted with proactive coping, reliance on oneself, and 

political or civic engagement to affect health in a counterintuitive way; those who scored 

higher on these more internalized and individualistic coping strategies showed worse 

health as political violence increased. Relying on religious support, especially in 

particular receiving it from and taking part in religious institutions' activities, has been 

found to be a key protective factor. The findings highlight the significance of examining 

not only whether political violence has an impact on health but also how those 

associations might arise, including the possible protective role of resources in people's 

social context  (27) . 

Besides, a survey of 332 adult Israeli residents who reside in the southern portion of the 

country was conducted to gather information about their exposure to political violence, 

coping mechanisms, level of post-traumatic stress disorder (PTS), and preference for 

experiential and rational processing styles. The results showed that, through the mediation 

of strong emotion-focused coping, there was a direct and indirect link between low 

rational thinking and elevated PTS. According to the research, a tendency toward 

irrationality may put one at risk, while rational cognition may protect against the stress 

caused by frequent exposure to political violence (43). 

1.9.3 Summary of the L.R 

Overall, the studies provide valuable evidence to the effect of political violence and 

traumatic events on occurrence of mental illness and used coping strategies that are 

deviant from safe strategies, many articles assessing the prevalence of PTSD in many 

areas and other studies Link two terms CTS and PTSD, The remaining studies connecting 

these variables. 

  

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Chapter two 

Method and procedures 

2.1 Introduction 

This chapter describes the methodology adopted by the study in carrying out research, 

and the design used to achieve the study results. It also entails processes of population 

determination, sampling for suitable population, and data management. 

2.2 Study design 

 Mixed methods research: A cross sectional, descriptive quantitative study design will be 

used to assess the score of CTSR and coping strategies among Palestinian adults exposed 

to political violence. Researchers in a variety of social science fields employ in-depth 

interviews as a flexible method of gathering qualitative data. They enable people to 

express how they perceive and understand the world in their own terms. People 

communicate through asking and responding questions during interviews, which are a 

deceptively common social interaction. Nonetheless, they are a very specific kind of 

discussion, directed by the researcher and employed for particular purposes. For 

inexperienced researchers in particular, this dynamic presents a number of 

methodological, analytical, and ethical difficulties. The phases and difficulties of 

planning, carrying out, and analyzing an interview project, as well as methods for 

overcoming these difficulties, are the main topics of this primer (45). In this study in-

depth interviews can provide qualitative data on adults’ experiences and opinions  with 

political violence and continuous stress reaction and coping strategies related to it. 

As long as the skill sets of collaborators are viewed as equally beneficial to the project, 

there can be genuine advantages to such mixed-methods collaboration, such as reaching 

different and more diverse audiences or testing assumptions and theories between 

research components in the same project (e.g., testing insights from prior quantitative 

research via interviews, or vice versa). As a starting point, Cheek offers a series of 

questions that can help direct collaboration, whether it be through mixed approaches or 

another approach. 

  



20 

2.3 Study Population 

In this study target population, Palestinian adults(18 years or older) in north West Bank 

who exposed to political violence. The selected sample in qualitative part was adults who 

are from ( jenin camp >Askar Camp >Balata Camp> Ein Beit Almaa> Nablus Old City) 

and exposed to political violence. In qualitative part the sample was adults who are from 

( jenin camp > Nablus Old City) and exposed to political violence. 

2.4 Site and setting 

 The first step is to select sample from North West Bank( Jenin, Nablus), I chose this city 

because that is easy to access to some of them and I focus on camps that is located in 

areas where there are political confrontations and there are daily confrontations, arrests 

and killings of Palestinians in these areas and others. Second step I chose five regions ( 

jenin camp >Askar Camp >Balata Camp> Ein Beit Almaa> Nablus Old City). From the 

community, I asked anyone in front of me if he or she is s from the camp and ask him or 

her to fill out the questionnaire. 

Collective sessions and interviews took place in the homes of the mothers of the martyrs 

from two regions ( jenin camp and Nablus Old City). All participants had signed assent 

forms immediately prior to participating. 

2.5 Study time 

 After receiving IRB (Institutional Review Board) approval from An-Najah National 

University (NNU) and approval from the Palestinian Ministry of Health's Research Ethics 

Committee Department, the study will begin in November 2023. The pilot study 

conducted in December 2023 as well. After the pilot sample, we made several 

modifications to suit the level of the participants. Among the modifications we made, 

first, we changed the age from continuous periods to state your age specifically. We also 

changed the marital status and added a widower item. We also added to the work item 

that he works as a worker in the occupied territories and added the variable of physical 

disability. 

From December to February 2024, data collected and entered. In addition, by the end of 

February 2024, data analysis, literature reviewing, and writing study results were 

completed. 



21 

2.6 Sample size and sampling methods 

2.6.1 Sample size 

Related to quantitative part: we need at least sample size equal to 379. It calculated by 

sample size calculator called ROASOFT, With this value (confidence level = 95%, margin 

of error = 5%, population size =27700, response of distribution=50, attrition rate about 

10%), actual sample size equal to 407 participants who engaged to the study. 

 Regarding to qualitative part ten participants, along with an academic supervisor and a 

note-taker, make up the optimal participants size regarding to Numerical standards state 

that saturation happens once a specific number of interviews are conducted. This is 

frequently troublesome, though, because it is impossible to predict in advance how many 

themes would surface from an iterative process of data collecting and analysis. It's a 

common misconception that "themes" are unaffected by the social background, 

experience, understanding, etc. of the participants and that additional informants wouldn't 

provide fresh insights  (44). small sample (n=10, Age Range = 20 to 60 years), including 

principals. The participants (70%) identified as female and (30%) identified as males 

2.6.2 Sampling method 

Purposive sampling a sampling technique where the goal is to find the most pertinent 

individuals for the study issue in terms of their deep knowledge or insights. (45). 

Purposive samples of Palestinian adults (18 years or older) in north West Bank who 

exposed to political violence were recruited to participate in this study. 

2.7 Inclusion and Exclusion Criteria 

Inclusion criteria: 

• Palestinian adults (18 years or older) in north West Bank camps who exposed to 

political violence. 

• Adults who have the ability to speak fluently about the subject of political violence 

and its effects. 

• Adults who are able to read and write. 

Exclusion criteria: 

• those with severe intellectual or mental impairment. 

• People who are unable to speak. 

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2.8 Data collections 

Data collection took place in January 2024. 

2.8.1 Data Collection tools and process: 

In quantitative part: 

The data collected in January, 2024, by a self-reported questionnaire, it designed to 

capture the demographic and socioeconomic status of the respondents, including their 

exposure to trauma, selection of coping strategies and a scale of CTSR on adults who 

exposed to political violence. First and second scales translated into Arabic, and back 

translated by a professional translator, fluent in both Arabic and English, and then it was 

independently translated back into English to ensure the accuracy of translation. The 

needed time to fill out the questionnaire and scales is 15 to 20 minutes. 

2.8.1.1 The Politically Violent Events Scale 

The scale assessed the level of subjective severity of experiencing different political 

events activated by the Israeli army. Respondents were asked first to indicate (Yes or No) 

whether they experienced any of the following events: physical or verbal abuse at a 

military checkpoint, the arrest of themselves or a family member, being subject to long 

curfew periods, injury by soldiers, death of a relative, or property damage or loss during 

military house searching. If the answer was yes, they were asked to rate the level of 

severity, using a scale ranging from 1 (no impact) to 5 (serious impact). Sample question: 

“Has the Israeli army ever made a search in your house?”; Cronbach’s alpha = .92. 

Political Violent Events Scale (this measure was prepared by the research teams based on 

focus groups adapted to cultural norms and specific situations ), it was prepared in 

Palestine in arabic version (42). 

2.8.1.2 CTSR SCALE 

The scale include 1.exhaustion / emotional detachment (5 items; e.g., I feel mentally 

exhausted); 2. Rage / betrayal, (3 items; e.g., I feel betrayed); and 3. Fear / helplessness 

(3 items; e.g., I feel I cannot protect those who depend on me). The internal consistency 

was α = .90 for the total scale, α = 0.86 for Exhaustion / emotional detachment, α = .82 

for Rage / betrayal, and α = .74 for Fear / helplessness. Mild to moderate correlations 

were found between the three factors. Correlation coefficient values ranged between  

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r=.511 (exhaustion/detachment and fear/ helplessness) and r=.649 

(exhaustion/detachment and rage/betrayal; p < .001 for all). Concurrent and construct 

validity was assessed. The questionnaire was taken directly from the author via email in 

English and was translated into Arabic, and back translated by a professional translator, 

fluent in both Arabic and English, and then it was independently translated back into 

English to ensure the accuracy of translation.  

2.8.1.3 The Jalowiec Coping Scale 

The scale consists of it 40 coping behaviors culled from a comprehensive literature 

review, which are rated on a 1- to 5-point scale to indicate degree of use. Twenty judges 

classified the items to permit analysis of the coping behaviors according to a problem-

oriented/affective-oriented dichotomy; 15 problem and 25 affective items resulted. 

Overall agreement by the judges was (85%), with greater consensus on problem items. 

Evaluation of stability using a two-week retest interval (N = 28) yielded significant rhos 

of .79 for total coping scores, .85 for problem, and .86 for affective. With a one-month 

interval (N = 30) coefficients were .78, .84, and .83, respectively. Alpha reliability 

coefficients of .86 (N = 141) and .85 (N = 150) supported instrument homogeneity. 

Content validity is substantiated by the systematic manner of tool development, by the 

large number of items used, and by the inclusion of diverse coping behaviours (46). 

Cope scale—28 questions used in Palestine in arabic version, it was statistically tested 

using the Cronbach Alpha test, resulting value: 0.919. face and content validity were 

assessed (47). The original study using the Brief COPE was conducted on a community 

sample of adult survivors of Hurricane Andrew; and it indicated acceptable psychometric 

properties, including an internal reliability of a =0.68. We adapted the scale to include the 

11 items that performed best with the Sierra Leonean sample in the pilot phase. Each item 

represents a different dimension of coping, including self-distraction, behavioral 

disengagement, denial, substance use, positive reframing, planning, use of emotional 

support, religious coping, use of instrumental support, acceptance, and self-blame. We 

asked participants to think about stressful war experiences, and provide responses 

retrospectively about the coping strategies they used after experiencing a particular 

stressor. Response options ranged from not at all to a lot. The Cronbach a value for the 

overall scale in this sample was 0.60 (48). 

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After constructing the questionnaire, it will be presented to a group of experts in the field 

of scientific research and hold PhDs in nursing, to judge face and content validity, and to 

get feedback and comments. 

In qualitative part: 

In December 2023, the interview  cofacilitated by the first author and the academic 

supervisor who used semi-structured protocols. Immediately prior to the in depth 

interviews, demographic information (age, gender, educational level and income level) 

were collected from all participants. Semi-structured interview analysis could be viewed 

as a generating process as opposed to an extractive one. The data from the interviews does 

not already contain any findings (45). 

Questions that were asked to participants about their experience with the occupation and 

the violent situations they have been subjected to, and what do they know about political 

violence and what impact it has on them. Questions included “Please tell us how your life 

is in the camp with the occupation, what do you know about political violence? ,” “Does 

political violence pose a psychological threat to you?,” “What does it mean to you to be 

‘traumatized by political events’?,”  and “What are the coping methods you follow to 

continue in life?”. 

 The interview was audio-recorded and transcribed by trained researchers. This study was 

approved by the University’s Institutional Review Board and all participants provided 

informed consent. 

2.9 Pilot study 

In quantitative part the survey was tested and allow participants to give input on the items, 

the translation, the time required for completion, and ethical or emotional issues regarding 

the survey. pilot study was conducted 39 participants who make up (10%) of the study 

sample in which they filled out the questionnaire as a way to assess the questionnaire 

before starting data collection on a larger scale.  

2.10  Variables 

 Dependent variables: Continuous Traumatic Stress Response and Coping Strategies 

Independent Variables: political violence, we considered multiple geographic and 

demographic factors as independent variables of potential influence. These included 

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gender (with male, female), age, marital status (married or not married), and education 

(with secondary, college/vocational secondary, bachelor’s degree, and higher university 

degree as levels). 

2.11  Data analysis 

Quantitative data was analysed using descriptive statistics in Statistical Package for 

Social Sciences called SPSS version 23, to describe the distribution of variables. 

Descriptive statistics: used to summarize the characteristics of the study sample , 

including age, gender, educational level and income level. Descriptive statistics can also 

be used to calculate measures of central tendency (such as mean or median) and measures 

of variability (such as CTSR, PTSD, coping strategies and political violence). 

In regard to the qualitative data, the first author was conducted thematic analysis (49) of 

participants’ responses to continuous stress. This method is appropriate for identifying 

and describing patterns or themes that emerge in qualitative data and for exploring an 

array of questions using inductive or deductive approaches (49). First, the author and 

academic supervisor were fully immerse themselves in the data by independently reading 

and re-reading each transcript and making notes of themes that they observed. Next, they 

were discussed their findings and transform the themes into an initial set of codes that 

they were summarized codebooks for participant group. Using the codebooks, they were 

independently code the transcripts and met to resolve any discrepancies in their coding 

decisions.  

Initial coding was done line by line. A coding matrix described codes and their 

relationships to each other, to data from the larger project (e.g. photographs, field notes, 

interview transcripts), and to theories, grey literature and other scholarly research on 

political violence (particularly within the West Bank).Braun & Clarke (2006) provide a 

six-phase guide which is a very useful framework for conducting this kind of analysis, 

The codes had been arranged into more general themes by the end of this step, which 

appeared to address this study issue in a particular way. The majority of our themes were 

descriptive; they explained data patterns that were pertinent to the study topic(49). Data 

were analyzed with a theoretically informed thematic analysis, supported by Nvivo® 

software. 

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2.12  Ethical Consideration 

1. Ethical approval was obtained from the institution review board (IRB) at An-Najah 

university, also the permissions from the Medical Research and Ethics Committee of 

the Ministry of Health in Palestine.  

2. The confidentiality of all study participants were assured by giving a number to each 

one of them for the purpose of data analysis only & by no form of identification was 

required from participants or any markers to identify participants indicated on any 

questionnaires. 

3. The participation in the study was voluntary (no corrosion, right to self-

determination). 

4. No rewards was given to the participants 

5. A written consent form was taken from all participants or their legal representatives 

that explained the study in language that was easy to understand. 

6. Participants’ protection rights: Participants were assured that no harm or risks were 

encountered as they participate in the study. This was included monitoring 

participants for adverse events or psychological complications related to the study 

procedures and taking steps to ensure that any adverse events were promptly 

addressed. 

7. The identity of the participants will be protected if the research is published. 

8. Harm minimization, informed consent, anonymity and confidentiality, and reflexivity 

and positionality were assured in the qualitative part. 

2.13  Risk-benefits assessment 

 There will be no risk throughout the implementation of the research.  When people felt 

stressed and anxious while collecting data from them, I gave them the freedom to choose 

to complete the information collection process or withdraw from the study. If they wanted 

to continue, I gave them a period of time with stress-relieving exercises such as deep 

breathing exercises before completing the study. 

  



27 

Chapter three 

Results 

3.1 Introduction 

This thesis used mixed method (qualitative & quantitative) to get a whole view of the 

Palestinian people exposed to political violence events. By qualitatively explore and 

quantitatively assess the type and severity of political violence events effect on the 

Palestinian people exposed to political violent events. Then, figure out the feelings of 

Palestinian people exposed to political violent events. Furthermore, type and frequency 

of coping mechanism which were used by those Palestinian whom exposed to political 

events.  

Part one: Results of the quantitative part 

Demographic characteristics of study participants whom exposed to political events 

exposure:  

Out of 407 participants, 179 (44.4%) were male compare to 223(55.3%) were female. 

The majority were from Jenin camp (62.3%). Nearly half of them participants had school 

level of education (61.3%), married (57.3%), and their mean age was 36 ± 13.7 years old. 

See table 3.1. 

Table 3.1  

Demographic characteristics of study participants whom exposed to political events exposure 

(N=407)     

  Frequency Percent 

Residence 

Jenin Camp 251 62.3 

Askar Camp 63 15.6 

Balata Camp 45 11.2 

Ein Beit Almaa 26 6.5 

Nablus Old City 16 4.0 

Gender 
Male 179 44.4 

Female 223 55.3 

Education 

School 143 35.5 

Tawjihi 104 25.8 

Diploma 43 10.7 

Bachelor 96 23.8 

Higher 16 4.0 

Marital Status 

Married 231 57.3 

Single 139 34.5 

Divorce 19 4.7 

Widowed 14 3.5 

Age 
M (SD) MIN MAX 

36.27 (13.73) 15 80 



28 

The results showed that (50.1%) of the participants in study who were Palestinian exposed 

to political events were unemployed. Adding (7.9%) were partially employed and only 

(21.1%) of the participants were working full time.  

As for monthly income, unfortunately, (84.1%) had a monthly income of less than 1,500 

shekels, while (22%) were the percentage of those whose income exceeded 1,500 shekels 

per month. On the other hand, the number of family members and household, the largest 

percentage (41.7%) of families participating in the study was containing 6 or more 

members, and 64.9% owned a private house. See table 3.2 in Appendix A. 

Despite the participants’ EVP events and (12.7%) of them having disabilities, 

unfortunately, most of them (63%) did not receive any type of psychological support, in 

addition see table 3.3 in Appendix A. 

Regarding political violence events in terms of frequency and severity of exposure, the 

results showed that the exposure of their home was searched by the soldiers was the 

highest percentage (76.7%) of exposure among the participants, followed by under 

curfew or forbidden to leave your house or city (73.7%), and house or property was 

damaged by the Israeli military forces (71.0%). On the other side, as for the severity of 

the impact of the political violence event, under curfew or forbidden to leave your house 

or city and home was searched by the soldiers were rated as the highest sever impact 

political violence events, as is shown in Table 3.4 and Figure 3.1. 

Table 3.4 

Political events exposure scale of study participants whom exposed to political events (N=407) 

 Political events 

 Exposed Severity out of 5 

 None Yes Mean SD 

You or one of your family members have been 

arrested 
203 (50.4) 49.6 1.45 1.76 

You were abused in a military checkpoint 214 (53.1) 46.9 1.32 1.70 

You have been injured or shot by the Israeli army 272 (67.5) 32.5 0.91 1.55 

A relative of yours died or was injured by the Israeli 

army 
163 (40.4) 59.6 1.88 1.89 

Your house or property was damaged by the Israeli 

military forces 
117 (29.0) 71.0 2.28 1.82 

You were under curfew or forbidden to leave your 

house or city 
106 (26.3) 73.7 3.10 2.13 

Your home was searched by the soldiers 94 (23.3) 76.7 2.99 2.08 



29 

Figure 3.1 

percentage distribution of political events exposed by  

 

CSTR scale was used in the present thesis for measuring the feeling of continuous 

traumatic stress response by Palestinian people who exposed to political violence events, 

the study showed that the highest response of participants who were exposed to political 

violent events was the feeling of fear and helplessness (63.6%), followed by feeling of 

exhausted and detachment (62.61%), and finally feeling of rage and betrayer (59.35%). 

See figure 3.2 

Figure 3.2 

Frequency distribution of CTSR subscales 

 

32.5

46.9

49.6

59.6

71

73.7

76.7

0 10 20 30 40 50 60 70 80 90

You have been injured or shot by the Israeli army

You were abused in a military checkpoint

You or one of your family members have been
arrested

A relative of yours died or was injured by the Israeli
army

Your house or property was damaged by the Israeli
military forces

You were under curfew or forbidden to leave your
house or city

Your home was searched by the soldiers

Political event

Exhaustion & 
Detachment

Rage & Betraya Fear & Helplessness Total CTSR

1سلسلة 62.61 59.35 63.60 62.10

62.61

59.35

63.60

62.10

57.00

58.00

59.00

60.00

61.00

62.00

63.00

64.00

CTSR



30 

The feeling of the participants to their exposure to political violence events were varied 

between their feelings of mental exhaustion, the feeling of hard to trust the people around 

them and feeling that their lives are in danger as being their highest reactions, while their 

feelings of betrayer and the lack of meaning of life as their lowest response feelings to 

the political violence events exposure. See table 5 

Table 3.5 

Frequency of CTSR items: extent of the study participants feeling over the past month 

 Statement None Little Often Always 

1. ED I feel unmotivated 113 (28.0) 118(29.3) 54(13.4) 111(27.5) 

2. ED I feel mentally exhausted 51(12.7) 103(25.6) 65(16.1) 180(44.7) 

3.FH I feel that my life is in danger 90(22.3) 65(16.1) 61(15.1) 181(44.9) 

4.ED I feel that my life has no meaning 151(37.5) 89(22.1) 40(9.9) 107(26.6) 

5.RB 
I have difficulty controlling my 

emotions 
97(24.1) 100(24.8) 86(21.3) 113(28.0) 

6.ED I find it hard to trust the people around me 90(22.3) 118(29.3) 78(19.4) 112(27.8) 

7.ED I feel that no one understands me 125(31.0) 106(26.3) 72(17.9) 92(22.8) 

8.FH I have intense feelings of fear or horror 102(25.3) 115(28.5) 70(17.4) 108(26.8) 

9.RB I have episodes of rage 110(27.3) 98(24.3) 89(22.1) 98(24.3) 

10. RB I feel betrayed 192(47.6) 61(15.1) 54(13.4) 89(22.1) 

11. FH 
I feel that I cannot protect those who 

depend on me 
146(36.2) 80(19.9) 66(16.4) 107(26.6) 

Note. ED = exhaustion and detachment; RB= rage and betrayal; FH= fear and 

helplessness. 

As for the coping style adapted by the study participants who were exposed to political 

violence events, it was generally slightly higher through avoid coping compare to 

approach coping.  

The results showed that the highest methods of coping through avoid type among the 

study participants were their trying to find comfort in religion (3.14 out of 5), trying to 

distract their thoughts through work or Other activities (2.61/5), and their claim that what 

happened was not real (2.59/5).  

While, the focus on concentrating their efforts on doing something about the situation 

was the highest among the methods of coping with the confrontation (2.8/5), as well as 

taking action in an attempt to improve the situation (2.5/5). For more information, you 

can refer to Tables 3.6, 3.7 and Figures 3.3, 3.4. 

  



31 

Table 3.6 

Participants’ responses frequency distribution of their avoidance Coping scale items  

avoidance Coping scale items None Little Fair Often RM 

I've been turning to work or other 

activities to take my mind off things 

98(24.3) 93(23.1) 73(18.1) 134(33.3) 2.61 

I've been saying to myself "this isn't 

real. 

82(20.3) 93(23.1) 117(29.0) 96(23.8) 2.59 

I've been using addictive behaviors or 

substances to make myself feel better 

169(41.9) 101(25.1) 71(17.6) 52(12.9) 2.02 

I've been giving up trying to deal with 

it. 

316(78.4) 30(7.4) 31(7.7) 15(3.7) 1.35 

I've been refusing to believe that it has 

happened. 

97(24.1) 114(28.3) 87(21.6) 99(24.6) 2.47 

I've been saying things to let my 

unpleasant feelings escape. 

99(24.6) 100(24.8) 110(27.3) 83(20.6) 2.45 

I’ve been trying to find comfort in 

religion 

53(13.2) 60(14.9) 62(15.4) 223(55.3) 3.14 

Figure 3.3 

Participants’ responses frequency distribution of their avoidant Coping scale items 

 

Table 3.7 

Participants’ responses frequency distribution of their approach coping scale items 

Approach coping None Little Fair Often RM 

I've been getting emotional support 

from others. 
130(32.3) 99(24.6) 83(20.6) 71(17.6) 2.25 

I've been concentrating my efforts on 

doing something about the situation 

I'm in. 

66(16.4) 86(21.3) 100(24.8) 141(35.0) 2.80 

I've been taking action to try to make 

the situation better. 
109(27.0) 89(22.1) 86(21.3) 110(27.3) 2.50 

I’ve been getting help and advice from 

other people. 
175(43.4) 102()25.3 59(14.6) 58(14.4) 2.00 

 

  

2.61

2.59

2.02

1.35

2.47

2.45

3.14

0 0.5 1 1.5 2 2.5 3 3.5

I've been turning to work or other activities to take…

I've been saying to myself "this isn't real.

I've been using addictive behaviors or substances…

I've been giving up trying to deal with it.

I've been refusing to believe that it has happened.

I've been saying things to let my unpleasant…

I ‘ve been trying to find comfort in religion 

Avoidant coping



32 

Figure 3.4 

Participants’ responses frequency distribution of their approach coping scale items 

 

Regarding the relationship between the intensity of exposure to political violence events 

and the type of feelings (CTSR) among the Palestinian participants who were exposed to 

political violence events, Table 3.8 shows that there is a statistically significant positively 

relationship between exposure to events of political violence and the feelings of the 

participants in the study of total CTSR (r=0.369, p< 0.001), and its subscales; Exhaustion 

& Detachment (r=0.301, p< 0.001), Rage & Betrayal (r=0.310, p< 0.001), and Fear & 

Helplessness(r=0.344, p< 0.001). 

Table 3.8 

Correlations between the severity of political events exposure and their psychological responses 

to stress     

  
Exhaustion    &
Detachment 

Rage & 

Betrayal 

Fear & 

Helplessness 
CTSR 

Total Events Pearson (r) .301** .310** .344** .369** 

 Sig. < 0.001 < 0.001 < 0.001 < 0.001 

 N 351 366 369 339 
** Correlation is significant at the 0.01 level (2-tailed). 

Table No. 3.9 in Appendix A shows that the means of the variables, the severity of the 

political violence event (Z=-4.47, P< 0.001), participants’ feeling of exhaustion and 

detachment (Z=-2.59, P= 0.010), feeling of rage & betrayal (Z=-2.03, P<= 0.043), and 

total feeling response via CTSR (Z=-2.03, P< 0.042)), were higher in males compare to 

females, and this difference were statistically significant. However, the other variables, 

especially coping style, avoid, or approach, did not have any statistically significant 

difference between males and females (P> 0.05). 

2.25

2.8

2.5

2

0 0.5 1 1.5 2 2.5 3

I've been getting emotional support from others.

I've been concentrating my efforts on doing
something about the situation I'm in.

I've been taking action to try to make the situation
better.

I’ve been getting help and advice from other people.

Approach Coping



33 

The variables that had a statistically significant difference with presence of physical 

disabilities were exposure to political violence (Z=-3.25, P=0.001), total feeling CTSR 

(Z=-4.44, P<0.001), exhaustion & detachment (Z=-4.52, P<0.001), rage & betrayal (Z=-

3.36, P=0.001), fear & helplessness (Z=-2.93, P=0.003), as well the coping style (Z=-

2.08, P=0.037), see table 3.10 in Appendix A. 

As for the study variables that had a statistically significant difference between the 

participants who received psychological support compared to those who did not receive 

psychological support, most of the thesis variables were slightly higher among those 

participants who did not received any type of psychological support but did not have any 

statistically significant difference (p values > 0.05) except for the intensity of exposure to 

events of political violence (Z=-4.43, P<0.001) and participants feeling of exhaustion & 

detachment (Z=-1.96, P=0.05), as the rate of exposure to political violence was higher 

among the participants who did not receive any type of psychological support (15.17 & 

59.47 respectively) compared to their counterparts who did receive psychological support 

(11.4 & 46.15 respectively). For more information, you can refer to table. 3.11 in 

Appendix A. 

As for the place of residence of the study participants, the study showed that the place of 

residence had a statistically significant difference with the intensity of exposure to 

political violence (K-WH=123.70, P<0.001), as the residents of Jenin camp and residents 

of Ain Beit Al-maa camp had the highest score (17.22 & 14.62 respectively) for the 

intensity of exposure to political violence events. Likewise, the participants’ feelings of 

total feeling CTSR (K-WH=55.113, P<0.001), exhaustion & detachment (K-

WH=28.466, P<0.001), rage & betrayal (K-WH=39.486, P<0.001), fear & helplessness 

(K-WH=53.695, P<0.001) were statistically significant difference according to 

participants’ place of residence. 

Finally, although the place of residence had a statistically significant difference with the 

coping style (K-WH=12.514, P=0.014), but there was no difference between avoid versus 

approach way of coping see table 3.12 .in Appendix A. 

Table 3.13: Regarding age and family members, and their relationship with the thesis 

variables, the results showed that the age of the participants had a statistically significant 

positive relationship with the feeling of fear & helplessness (r=0.172, p=0.001), as well 



34 

as the total feelings CTSR (r=0.110, p=0.038) and the avoid method of coping style 

(r=0.193, p<0.001), while others had no significance statistic relation (p > 0.05). 

On the other hand, the number of family members did not have any statistically significant 

relationship with the variables. See table 3.13 in Appendix A. 

Regarding the educational level, the results showed that it had a statistically significant 

difference with the intensity of exposure to political violence events (K-WH= 11.969, P 

=0.081), and higher in tawjihi educational level. Feeling of exhaustion & detachment (K-

WH= 26.070, P <0.001), feeling rage & betrayal (K-WH= 13.120, P =0.011), feeling fear 

& helplessness (K-WH= 26.337, P <0.001), and CTSR (K-WH= 30.170, P <0.001) and 

higher in Postgraduate studies or higher educational level. 

The coping style, avoid coping, and approach coping did not have any statistically 

significant difference attributed to the educational level. See table 3.14 in Appendix A. 

Regarding the marital status, the