Global Institute for Mental Health Innovations, Networking and Development

 

Mental Health Open              ISSN 3122-1181                                                           Vol. 2 (2026). Issue 1.             

DOI: https://doi.org/10.64257/cpjmy543

 

(c) Authors

 

“We Stayed, But We Were Not the Same": Post-Trauma Adjustment Among Adolescent Survivors of the 2014 Army Public School Peshawar Attack — A Phenomenological Study with Implications for Global School Violence Policy {under peer review}

 

research article

 

Sumbal Gilani, School of Health and Wellbeing, College of Medical Veterinary & Life Sciences, University of Glasgow, United Kingdom (UK); https://orcid.org/0009-0008-0623-3258

Salma Siddiqui, Department of Behavioural Sciences, School of Social Sciences & Humanities, National University of Sciences and Technology, Islamabad (Pakistan); https://orcid.org/0000-0003-1110-6188

 

Abstract

 

Background: Mass casualty school violence produces profound psychological consequences for adolescent survivors, yet lived experiences of survivors in conflict-affected, Muslim-majority, low-to-middle income country settings remain largely absent from the qualitative trauma literature. The December 2014 terrorist attack on Army Public School (APS) Peshawar, Pakistan, in which 132 students and 9 staff members were killed, represents one of the deadliest school massacres in recorded history and most under-researched in terms of survivor psychology.

Objectives: This study explored the lived experience of post-trauma adjustment among male adolescent survivors, in the absence of formal psychological support in a conflict-affected, resource-limited setting.

Methods: An exploratory phenomenological design following Moustakas' transcendental phenomenological methodology was employed. Five male survivors participated in in-depth semi-structured Urdu-language interviews six months post-attack at the school. Data were analysed using phenomenological reduction, horizontalization, and thematic synthesis, with verification through reflexivity journalling, member checks, peer debriefing, and dual supervision. A retrospective COREQ assessment found 28 of 32 items fully met.

Results: Three domains emerged. Participants experienced pervasive multi-dimensional distress including anger, grief, physiological hyperarousal, intrusive re-experiencing, social withdrawal, and academic deterioration. Participants engaged in active, culturally grounded coping through family, peers, community solidarity, and Islamic meaning-making frameworks including qadr (divine decree), shahdat (martyrdom), and sabr (patient endurance). Post-traumatic growth was evident, encompassing deepened relationships, increased confidence, and civic-national identity reconstruction, with survivors articulating education as an explicit counter-terrorism mission.

Conclusion: Findings are situated within the global school violence literature to argue that the psychological toll on school massacre survivors in the Global South remains systematically under-researched and under-resourced. Collected in 2015, the data represents a historically significant baseline; survivors demonstrated significant distress and endogenous resilience without any formal professional support. Evidence-based recommendations address school-embedded psychosocial frameworks, culturally informed trauma protocols, and mental health policy reform in Pakistan, with direct implications for Pakistan's National Mental Health Policy.

 

Keywords: post-traumatic stress, adolescent survivors, school massacre, phenomenology, post-traumatic growth, Pakistan, school violence policy, mental health systems, Global South.

 

 

Introduction

 

School massacres are among the most psychologically catastrophic events a society can endure. The targeted killing of children in the one space universally understood as safe, the school, ruptures not only individual psyches but the foundational social contract between a state and its citizens. Since the 1999 Columbine High School shooting in the United States, the global literature on school-based violence has grown substantially, with quantitative studies documenting high rates of post-traumatic stress disorder (PTSD), depression, grief, and functional impairment among survivors, including evidence that over half of mass shooting survivors meet criteria for PSTD and depression years after the event (Lowe & Galea, 2017; Abba-Aji et al., 2024a; Abba-Aji et. al., 2024b). Yet most of this literature is anchored in Western, high-income contexts, leaving a critical gap in our understanding of how adolescent survivors in conflict-affected, low-to-middle-income countries (LMICs) with distinct cultural, religious, and structural circumstances experience and process mass trauma.

The December 16, 2014, attack on the Army Public School (APS) & College for Boys in Peshawar, Pakistan offers one of the most acute cases through which to examine this gap. Seven-armed militants affiliated with Tehrik-i-Taliban Pakistan entered the school during a first-aid lecture, systematically shooting students and staff over approximately six hours. A total of 141 lives were lost, 132 of them children. At the time, it was the deadliest terrorist attack in Pakistan's history. The attack provoked global outrage, altered Pakistani counter-terrorism policy, and prompted a national conversation about resilience, grief, and recovery. When the school reopened on January 12, 2015, students returned; an act of collective defiance widely interpreted as resilience, though the question of what was happening inside these children remained largely unanswered.

This paper addresses that question. It presents findings from a qualitative phenomenological study conducted in mid-2015, six months after the attack, with five male adolescent survivors who were inside the school auditorium during the assault. The data, drawn from a master's thesis in clinical psychology (Gilani & Siddiqui, 2015) at the National University of Sciences and Technology (NUST), Islamabad, has not previously been published in a peer-reviewed forum.

We publish this work now, a decade later, for three interconnected reasons. First, primary qualitative data from adolescent survivors of mass school violence in Muslim-majority, conflict-affected settings is exceptionally rare in the global trauma literature and this rarity is itself a policy failure. Second, Pakistan has experienced escalating cycles of mass violence since 2014, including the January 2016 Bacha Khan University attack, repeated threats against educational institutions, and the catastrophic 2022 floods, making this 2015 dataset a historically significant baseline that speaks to patterns of chronic and compounding trauma in a population that has received virtually no longitudinal psychological attention. Third, Pakistan enacted its first National Mental Health Policy in 2021 and a revised framework in 2023, creating an unprecedented policy window within which evidence from studies like this one can meaningfully inform the design of school-based mental health infrastructure.

We therefore position this paper at the intersection of two urgent conversations: the global school violence literature's need for non-Western, qualitatively grounded data; and Pakistan's emerging mental health policy landscape's need for empirical evidence on what adolescent trauma and culturally embedded coping genuinely look like in this specific context.

 

Literature Review

 

The APS massacre did not occur in a vacuum. Peshawar, the capital of Khyber Pakhtunkhwa province, had by 2014 endured more than a decade of spillover violence from the Afghanistan-Pakistan border conflict. In the years leading up to the school attack, Peshawar had experienced bombings of markets, mosques, and public spaces with such regularity that residents had developed what local observers described as a kind of traumatic numbness, a flattening of the acute fear response in the face of chronic threat (Gilani & Siddiqui, 2015). This context is critical: the students who survived the APS massacre were not trauma-naive. Many had grown up in a city under siege, attended funerals of relatives killed in prior attacks, and experienced school lockdowns as a matter of routine. The December 2014 attack was thus not merely a single catastrophic event; it was the most extreme data point in a continuous spectrum of adversity. Miller and Rasmussen (2010) have argued persuasively that in conflict-affected settings, direct trauma exposure and the cumulative burden of chronic daily stressors interact to produce mental health outcomes that trauma-focused frameworks, designed primarily for populations encountering acute violence for the first time, systematically underestimate. Unlike Western school shooting survivors, these boys carried the weight of compounding, community-wide, chronic trauma alongside the acute shock of the massacre itself, a distinction that has profound implications for the interpretation of their responses and the design of appropriate interventions.

Globally, the APS attack belongs to a distinct and growing category of events that researchers have termed "mass casualty school violence", defined by its targeting of a protected space, its perpetration against minors, and its deliberate use of terror to produce collective psychological damage (Moghaddam & Marsella, 2004). The table below situates the APS attack within the modern global timeline of school massacres to underscore both its magnitude and its under-representation in the literature:

 

Table 1. Selected global school massacres, prior trauma context of survivors, and status of qualitative survivor research

 

Event

Location

Deaths

Prior Trauma Context

Qual. Survivor Research

Columbine (1999)

Colorado, USA

15

Isolated incident; no prior context of systemic community-level violence

Substantial — peer-reviewed literature available

Sandy Hook (2012)

Connecticut, USA

28

Isolated incident; safe suburban community

Substantial — longitudinal studies conducted

APS Peshawar (2014)

Peshawar, Pakistan

141

Decade of chronic urban terrorism; survivors not trauma-naive

Minimal — this paper represents primary phenomenological data

Bacha Khan Univ. (2016)

Peshawar, Pakistan

21

Direct aftermath of APS attack; ongoing militant threat

Negligible in peer-reviewed literature

Parkland (2018)

Florida, USA

17

Isolated incident; no prior community conflict context

Growing — survivor testimonies and policy studies

Uvalde (2022)

Texas, USA

21

Isolated incident; marginalised community, limited services

Emerging — policy-focused literature developing

 

As Table 1 illustrates, the disproportion in survivor research is stark: the APS attack killed nearly five times as many people as Columbine yet attracted a fraction of the psychological research attention. This asymmetry is not incidental. Keynejad et al. (2023), in a survey of international researchers across 24 low- and middle-income countries, identified the intersection of violence and mental health in LMICs as systematically under-studied, attributing this to structural barriers including the absence of institutional research infrastructure, limited research capacity, and the persistent prioritisation of Western contexts in leading journals. The Prior Trauma Context column in Table 1 makes visible what the existing literature systematically ignores, that APS survivors were processing a catastrophic acute trauma on top of an already fractured baseline. This layering fundamentally shapes the phenomenology of their distress and recovery, and it is a dimension that no Western school violence framework is currently equipped to address.

 

Methodology

 

Research Design

 

A phenomenological design was selected to explore the lived experience of post-trauma adjustment among APS survivors. Phenomenology does not measure or predict; it develops an interpretive understanding of human experience as it is consciously lived (Merleau-Ponty, 1962; van Manen, 1997). The use of phenomenology was especially appropriate here because the research goal was not to establish the prevalence of symptoms, quantitative studies on Pakistani earthquake survivors had already done that (Ahmad et al., 2010), but to understand the texture of experience: how distress presented itself in the daily lives of these specific adolescents in this specific cultural and political context, and what meaning-making processes they were actively engaging in.

Moustakas' (1994) approach to phenomenological analysis was adopted, which emphasizes epoché (bracketing of researcher bias), horizontalization of significant statements, identification of invariant horizons, and synthesis into a holistic account. The active management of the researcher's positionality is discussed in the dedicated Researcher Positionality and Reflexivity section below.

 

Participants

 

Five male students of APS Boys, aged 14–15 years at the time of data collection, were recruited via purposive sampling. Inclusion criteria required that participants: (1) were present in the school on December 16, 2014; (2) were in the auditorium during the attack; (3) had returned to APS following the attack; (4) had not lost a blood relative in the attack (to reduce compounded bereavement confounds); and (5) had not received any formal psychological counselling or therapy following the event, to maintain the naturalistic quality of adjustment data. Theoretical saturation was reached by the fifth interview, with no substantially new themes emerging. Confidentiality and anonymity are preserved; participants are referred to as S1 through S5.

Verbal consent was obtained from parents by telephone prior to interviews. Prior to formal data collection, the researcher’s dual role was explicitly explained to each participant: her ongoing function as school counsellor at APS was clearly distinguished from her role as a research interviewer, and the research purpose, procedures, and confidentiality were explained separately as part of the consent process. All participants were fully informed of their right to withdraw at any point, and oral process consent was renegotiated throughout each interview in recognition of the sensitive and emergent nature of phenomenological dialogue. No monetary compensation was offered.

 

Data Collection

 

In-depth semi-structured interviews were conducted at the school's counsellor's office, a space familiar and comfortable to participants. Interviews lasted 30–45 minutes. A grand tour opening question, "How has life in general been for you since the school attack?" invited participants to narrate their experiences broadly, followed by clarifying questions ("When did that start?", "Can you tell me more?", "What helped?") and a closing reflective question. Four participants consented to audio recording; one declined, and verbatim notes were taken for that session. All interviews were conducted in Urdu; excerpts in this paper are presented with original Urdu text and English translation.

 

Data Analysis

 

Interviews were transcribed verbatim. Analysis followed Moustakas' (1994) five-step procedure: (1) horizontalization, all significant statements were listed; (2) invariant horizons, repetitive or overlapping statements were removed; (3) theme clustering, remaining statements were clustered into emerging themes; (4) textural description, themes were developed with verbatim illustration; and (5) structural description and holistic synthesis; contextual, theoretical, and reflexive dimensions were integrated. Data analysis was conducted manually without software, using a physical post it note method over a two-month period in which significant statements were written, arranged, grouped, and iteratively refined across multiple sessions. Coding was carried out by three coders: the primary researcher, the institutional supervisor (Dr. Salma Siddiqui, NUST) and a qualitative expert Dr. Najma, NUST. The supervisors independently reviewed and validated the coding structure and emergent themes, with disagreements resolved through discussion until consensus was reached. Member checks were conducted; participants reviewed both their interview transcripts and the emergent themes and findings, confirming their accuracy and offering additions where relevant. Peer debriefing and dual supervision provided additional verification throughout.

 

Researcher Positionality and Reflexivity

 

In phenomenological research, the researcher is not a neutral instrument. She is the primary tool of inquiry, and transparency about her positionality is not merely a methodological formality, it is the evidence that bracketing was genuinely attempted. The first author (S.G.) is a female clinical psychologist. I offer the following account not as a disclaimer but as an integral part of the epistemological record of this study.

Insider identity and its productive tensions. I am from Peshawar. The "chronic collective adversity" I describe in the Background section is not an abstraction; it is the city of my own upbringing. I had attended funerals that these boys' parents had attended. When participants described the quality of Peshawar's traumatic numbness, I did not need it explained. This shared geographic and cultural identity produced two methodological consequences that pulled in opposite directions: it opened doors and created risks. The doors: participants spoke with an ease and an assumption of shared comprehension that might not have emerged with an outside researcher. When S2 described seeing his friends performing tawaf in Mecca, he did not feel the need to justify the experience or brace for scepticism. The risks: the same familiarity created a constant pull toward premature understanding toward hearing what I expected rather than what was said. The reflexivity journal I maintained throughout data collection was, above all, a discipline against this. After each interview I recorded what had surprised me, what had confirmed my assumptions, and which of my interpretations rested on shared cultural knowledge rather than explicit participant statement. Re-reading these entries during analysis repeatedly corrected my course.

The clinical gaze and its deliberate suspension. I came to these interviews with clinical training. I had been working at the CMH Peshawar Psychosocial Support Centre and had clinical exposure to APS survivors before the formal data collection began. This created a specific reflexive challenge: phenomenology demands that I remain in the mode of understanding, not diagnosis. In practice, this was harder than it sounds. When Participant S4 described punching walls until his knuckles swelled and driving recklessly until the adrenaline subsided, every clinical instinct I had named what I was hearing, trauma-linked self-harm, unprocessed grief, dysregulated affect. The phenomenological discipline required that I hear it first as his account of his own experience, in his own terms. My supervision sessions became the space where clinical interpretation was consciously separated from phenomenological description. I documented in my journal a specific moment after the S4 interview where I wrote: "I want to fix this. That is not my role today." The clinical observation is recorded in the Discussion and Policy sections of this paper but it enters there as an analytical observation, not as something I carried into the interview room. The fact that his self-directed aggression went entirely unidentified by any clinical system for six months is itself the policy argument; my job in the interview was to understand it, not to label it.

Linguistic and interpretive reflexivity. Conducting interviews in Urdu and then producing an English-language academic text is not a neutral translation exercise. It is an interpretive act at every step. When S5 used the word sabr, the English word "patience" is technically correct and entirely inadequate. Sabr carries a Quranic weight, a practice of spiritual endurance in the face of divine test, that "patience" as used in a Western psychological context simply does not contain. Similarly, when S2 spoke of qadr, "divine decree" is an accurate gloss but strips away the lived quality of the concept, the felt sense that events unfold within a cosmological order that one trusts rather than resists. Throughout the translation process I returned repeatedly to participants' surrounding speech to ensure that the English rendering preserved, as far as possible, the affective and cosmological texture of the original. Where a term carries irreducible specificity, I have retained the Urdu alongside the English translation.

Temporal reflexivity: the decade gap. This data is being published in 2025, a decade after its collection. My perspective on it has changed. In 2015, I was a master's student in my own city, six months after the worst day that city had ever experienced, interviewing boys who had survived it. The data felt enormous and urgent and almost too raw to hold analytically. Returning to these transcripts now, after Pakistan's 2021 and 2023 mental health policy frameworks, after Bacha Khan University, after the 2022 floods, after watching an entire generation of Pakistani children grow up in the shadow of compounding mass trauma; I read the students' purposeful identity reconstruction and their religious coping not only as fascinating findings but as evidence of something that was never supported, never followed up, and never built upon. The temporal distance has sharpened, rather than diminished, the urgency of the policy argument this paper makes. I have tried throughout to make clear where retrospective interpretation has enriched the analysis and where I have been careful to remain anchored in the 2015 data as it was collected.

 

Results

 

Three major thematic domains emerged from the phenomenological analysis: (I) the impact of trauma as manifested through multi-dimensional distress; (II) active coping strategies, both self-initiated and relationally and spiritually facilitated; and (III) post-traumatic growth and reconstruction of life perspective. Together, these domains map what the students themselves described as an ongoing, effortful, and by no means complete process of adjustment.

 

Domain I: The Weight of Distress — A Multi-Dimensional Experience

 

Six months after the attack, all five participants were living with significant and multi-dimensional distress. This was not merely an abstract clinical observation; it saturated every aspect of their daily lives and was described with striking specificity and self-awareness.

Emotional disturbances. The most uniformly reported emotional experience was a dramatic increase in anger and irritability. Students described a low threshold for provocation, reacting sharply to ordinary domestic interactions, such as siblings asking them to play or parents suggesting a course of action. Strikingly, several participants demonstrated metacognitive awareness: they knew their anger was disproportionate, they knew its source, and yet they felt unable to contain it.

"Ghussa bohut jaldi ata hai, pehlay nahi ata tha itna." / "Anger comes very quickly now, it didn't use to be like this." (S1)

"Kabhi lagta hai intezar mein hota hun k koi kuch kahe aur mein apni frustration nikaaloun." / "Sometimes it feels like I am waiting for someone to say something so I can release my frustration." (S1)

Grief was the other dominant emotional presence. The loss of close friends, killed in the auditorium where these boys sat beside them, produced a form of sorrow that intertwined with identity and daily functioning. The basketball team was gone. Study groups had dissolved. The texture of school life had permanently changed:

"Dost bohut yaad aatay hain, kal wo hamaray saath the, aj nahi hain. Ab kuch bi karnay ko dil nai krta, puri basketball ki team hamari khatam ho gai hai." / "I miss my friends so much, yesterday they were with us, today they are not. Now I don't feel like doing anything; our entire basketball team is gone." (S2)

 

Physiological disturbances. Participants reported a constellation of somatic symptoms consistent with chronic autonomic hyperarousal: loss of appetite, disturbed sleep, recurrent nightmares, fatigue, palpitations, and headaches. For several students, palpitations occurred specifically in moments of solitude when cognitive intrusions were most likely to surface.

"Jab akaila hota hun... kaafi deep sochon mein jata hun... heartbeat kaafi tez ho jaat hai." / "When I'm alone... I go very deep into thoughts... my heartbeat becomes very fast." (S2)

 

Behavioural disturbances. Social withdrawal was pervasive. Students described actively distancing themselves from peers, extended family, and social gatherings; particularly situations where the attack might be discussed. Avoidance had become a primary coping strategy, though one with significant secondary costs, reinforcing isolation and disrupting pre-trauma social bonds.

"Is attack kay baad aisa hai na kay sab se dur hun. Kiunkay mera dil nahi krta." / "Since the attack I have become distant from everyone, because I just don't feel like it." (S3)

Participant S4's account merits particular attention here, as it carries direct policy significance. Six months after the attack, with no access to any clinical support, he had developed a pattern of self-directed aggression to manage emotional flooding:

"Mein apnay aap ko nuqsaan aur takleef pohuncha kr apni frustration nikalta hun... jaisay kay dewaar pe mukay marna shuru ho jata hun... ya itna tez chalata hun [car] kay mein kehta hun kay yr abhi accident ho ga." / "I cause myself pain and harm to release my frustration... like I start punching the wall... or I drive so fast that I think an accident is about to happen." (S4)

He connected this behaviour explicitly and repeatedly to the loss of his friends and his inability to process grief through other channels. This pattern, trauma-linked self-harm, entirely invisible to any clinical or school system, is the primary empirical evidence for the first policy recommendation in this paper. It illustrates with precision what the absence of mandatory post-trauma screening means in human terms: a fourteen-year-old boy causing himself physical harm for six months, alone, because no professional ever asked.

 

Cognitive disturbances and re-experiencing. All five participants reported intrusive, recurrent thoughts about the attack, thoughts that arrived without invitation and were remarkably resistant to voluntary suppression, accompanied by sensory memories that made suppression feel physiologically impossible.

"Sochtay hain kay haan is khayal ko chor den, lekin phir kuch eik haftay baad phir wohi soch aati hai." / "We try to let the thought go, but then about a week later, the same thought comes back again." (S2)

Several students had also developed anticipatory cognitions, persistent mental rehearsal of future attacks. One student described his class cutting window bars in preparation for evacuation:

"Hum sochtay rehtay hain kay wo dobara ayengay tou hum khud ko aur doston ko kaisay bachaengay, hum tayar rehtay hain har waqt." / "We keep thinking about how we will protect ourselves and our friends if they come back. We are always prepared." (S2)

This anticipatory hypervigilance and the practical preparations it generated, reflects the compounding context described earlier. These were not students imagining a hypothetical threat; they were students whose lived experience had demonstrated that such attacks were real and recurring. Their "preparation" is simultaneously a PTSD symptom and a rational response to an environment in which they had no reason to believe they were safe.

 

Functional disturbances. Academic functioning had deteriorated markedly for all participants. Pre-attack students who described themselves as diligent reported complete inability to study, lost examination cycles, and in one case (S3) having to repeat a school year due to missed board examinations while recovering from surgery.

"Parhai pehlay bohut krta tha aur ab bilkul nahi krta. Pehlay bohut acha tha parhai mein aur ab bilkul chor di hai." / "I used to study a lot before, now I don't at all. I used to be very good at it, now I have completely stopped." (S3)

The presence of one school counsellor serving five branches of the school with over 8000 students meant there was limited professional support to identify this collapse as a trauma symptom rather than an attitudinal failure, no one to intervene before the academic consequences became structural. S3 lost a school year. In a system with school-embedded mental health support, this might have been prevented.

 

Domain II: Coping — Active, Relational, and Spiritually Grounded

 

Despite the severity of distress described above, none of the participants was passive in response to it. All five were actively engaged in developing strategies to manage their experience, strategies that were notably congruent with the cultural, relational, and religious resources of their context.

 

Self-initiated coping. Students described a range of self-directed strategies for managing intrusions and emotional arousal: staying physically busy, using mobile phones and books as attentional distractors, going outdoors, and deliberately seeking social interaction when alone. The logic was consistent: intrusive thoughts emerged in solitude; movement and engagement interrupted them.

"Is mobile ne... jab mein akaila hota hun... mein sochnay lag jata hun, mobile ata hai tou mein us mein busy ho jata hun, nai sochta." / "The phone helped me... when I'm alone... I start thinking, but with the phone I keep busy and don't think." (S1)

 

Family as a coping resource. All participants described their families as central to their adjustment. Parental and sibling responsiveness, particularly the shift from strict authority to warm tolerance — was experienced as profoundly containing.

"Ghar walon ko ab samajh aati hai meray mood ki, unhon ne bohut help ki hai manage karnay mein." / "My family now understands my moods; they have helped a lot in managing things." (S5)

 

Peer relationships and community solidarity. The act of returning to school and finding peers who shared the same experience was described as one of the most significant sources of support. Being among others who understood without needing explanation reduced the emotional labour of social interaction. One participant described the moment he regained consciousness after surgery on December 16 and saw his friends alive as the most immediate source of relief and motivation to continue.

“Jab mein hosh mein aya tha tou apnay doston ko dekh kr bohut Khushi howi na us time. Kay chalen ye dost tou hamaray zinda hain yahan pe” / “When I regained consciousness and saw my friends, I felt such joy at the moment, at least these friends of mine are alive here.”

Community solidarity, including hospital visits, public expressions of support, and messages of solidarity from across Pakistan, provided meaningful early care, though well-meaning enquiries about the attack could also function as involuntary triggers.

 

Religious and spiritual coping. Perhaps the most culturally distinctive finding of this study was the profound role of Islamic faith in structuring survivors' meaning-making. Students drew on concepts of qadr (divine decree), shahdat (martyrdom), and sabr (patient endurance) to develop a framework within which the deaths of their friends were not random or meaningless but spiritually ordered, a framework that both acknowledged loss and provided a cosmological container for it.

"Jis ka time pura na ho wo nahi ja sakta is duniya se. Matlab hai kay sab ka koi na koi maqsad hota hai." / "One who has not completed their destined time cannot leave this world. Everyone has some purpose." (S5)

Participant S2, who had performed Umrah after the attack, described seeing his deceased friends in a vision during tawaf, dressed in ihram and performing the circumambulation of the Kaaba:

"Wahan pe dur nazar aatay the humien... ihram bandhay howay, tawaaf kartay howay. Us waqt bohut zyada khushi hoti thi kay Allah Tallah ne inko itna barra martaba diya hai." / "We could see them there in the distance... wearing ihram, performing tawaf. At that moment there was immense joy that Allah had given them such a great station." (S2)

It is worth pausing on what a Western clinical framework would do with this account. A clinician oriented toward DSM-5-TR criteria might note "perceptual disturbances," flag for complicated grief, or probe for psychotic features. What the phenomenological and cultural record shows is something categorically different: a young man, in one of the most spiritually charged locations in the Islamic world, experiencing a felt sense of his friends' elevation and safety within a cosmological order he trusted. The experience provided genuine peace, reduced the torment of unanswered questions about his friends' fate, and facilitated grief processing rather than impeding it. The capacity to hold this distinction, between a Western clinical frame and a culturally valid inner event, is precisely why cultural adaptation of trauma protocols is not an optional refinement but a clinical necessity in this context.

Across all three coping dimensions, self-initiated, relational, and spiritual, a consistent logic was visible; these students were not waiting for support that never came; they were constructing their own architecture of survival from the materials their culture, faith, and relationships made available.

 

Domain III: Post-Traumatic Growth and Transformation of Life Perspective

 

The third domain to emerge from the data was post-traumatic growth (PTG), the experience of positive psychological change in the aftermath of a traumatic event (Tedeschi et. al., 2018). This was not denial of distress; students described both dimensions simultaneously. It was an emergent and authentic reorientation of life meaning, identity, and relationship.

 

Deepened appreciation of relationships and life. Across all five interviews, participants described a striking shift in how they valued the people around them. Friends who survived had become irreplaceable. Parents and teachers, previously experienced through the lens of authority, were now seen as sources of warmth, sacrifice, and love.

"Dosti ki importance bohut zyada howi hai meray dil mein. Itnay doston ko kho diya hai tou ab jo hain un pe bohut zyada khayal krta hun." / "The importance of friendship has grown greatly in my heart. Having lost so many friends, I now take great care of those who remain." (S5)

 

Increased confidence and personal strength. Several students described a paradoxical increase in social confidence following the attack. Having survived a near-death experience and returned to the same school produced a felt sense of having already faced the worst.

"Confidence zyada ho gaya hai. Tabhi straight-forwardly baat krta hun; usko samajh bi pata hun auron ko bi convince kr pata hun." / "My confidence has increased. I speak straight-forwardly now; I can understand people and convince them." (S2)

 

Purposeful identity reconstruction, the civic-national dimension. Perhaps the most remarkable PTG finding was the emergence of a distinctly purposeful identity among several survivors. The attack had not diminished their aspirations; it had redirected and deepened them and given them a specifically civic and national dimension that was absent before December 16.

"Pehlay hum apnay tak mehdood the, khud apnay tak. Lekin abhi parhna hai apnay lie nahi, apni qaom kay lie kuch krna hai... qalam kay zariye hum ne is dehshatgardi ko khatam krna hai." / "Before, we were limited to ourselves alone. But now we must study not for ourselves but to do something for our nation... through the pen, we must end this terrorism." (S2)

This finding extends the PTG literature in an important direction. The scholarship on PTG typically describes positive changes as primarily personal, enhanced relationships, increased personal strength, changed life philosophy. What S2 demonstrates is PTG that has been transmuted into a collective, political, and historical mission. His identity has not merely been reconstructed; it has been consciously positioned in relation to the historical forces that tried to destroy it. Ending terrorism through the pen is not merely a life goal, it is an act of meaning-making that directly confronts and inverts the perpetrators stated objective of disrupting education. This is PTG as counter-narrative, a dimension of post-trauma growth in politically targeted populations that deserves its own theoretical attention.

Whether this PTG was sustained, whether S2 went on to Oxford or to the army or to disillusionment, we do not know. This is one of the most significant limitations of the study, and one of the strongest arguments for the longitudinal research recommended in the policy section.

 

Discussion

 

The Texture of Adolescent Trauma in a Conflict-Affected Setting

 

The central analytical contribution of this study is not the documentation of trauma symptoms per se, though the symptom profile is broadly consistent with DMS-5-TR criteria for PTSD (APA, 2022), encompassing re-experiencing, avoidance, hyperarousal, and negative cognitions and mood. Rather what the phenomenological approach reveals that symptom enumeration cannot: the lived texture of distress in a specific cultural, political and relational context, and the active meaning-making processes that were already reshaping that distress from within.

The Shattered Assumptions Model (Janoff-Bulman, 1989, 1992, 1997) provides the most analytically productive lens for understanding what these findings reveal. The APS attack violated each of the three core assumptions Janoff-Bulman identifies: that the world is benevolent, that events are meaningful, and that the self is worthy of protection. For these students, the violation was not merely physical, it occurred in their school, the institution whose symbolic safety had been absolute, beside friends whose futures were distinguished while these boys survived. Their subsequent anger, hypervigilance, metacognitive awareness of emotional dysregulation, and anticipatory rehearsal of future attacks all reflect the ongoing cognitive labour of rebuilding a functional model of the world. This is the philosophical labour of adolescent survival, a process that DSM-5-TR criteria can name but cannot describe.

The self-directed aggression described by Participant S4; wall-punching to exhaustion, reckless driving as a frustration-release mechanism, went entirely unidentified for six months in the absence of any formal follow-up. His co-existence of profound distress and the most expansive vision of post-traumatic growth of any participant speaks to a critical clinical principle: surface resilience is not evidence of resolved distress. Systems that read the returning-to-school narrative as evidence of recovery, without conducting any structured assessment, risk missing exactly the kind of internalised, self-directed harm that S4 was experiencing.

 

PTG as Counter-Narrative: Expanding the Theoretical Framework

 

The PTG observed in this study demands theoretical engagement beyond Tedeschi and Calhoun's (1996) original framework, not because that framework is wrong, but because it does not fully account for what happened here. The standard PTG domains (personal strength, relating to others, new possibilities, appreciation of life, spiritual change) are all present in this data. But the most striking finding, S2's civic-national identity reconstruction, his articulation of education as a weapon against terrorism, represents something the individual-focused PTG literature has not systematically theorised. Emerging scholarship on collective violence and PTG is beginning to gesture toward this territory: Brooks et al. (2025), in a scoping review of PTG following collective violence, found that religious community and social connection were associated with perceived PTG in politically victimised populations, and Sanaullah (2025) documented PTG strategies among Pashtun civilians in the Swat conflict, a geographically and culturally proximate population to APS survivors. However, neither study captures the specifically political and counter-insurgent dimension of growth that S2 articulates not merely surviving or finding meaning but consciously redirecting the self against the very forces that caused the trauma.

This finding points toward what we might term collective PTG: the transmutation of individual post-traumatic growth into a mission consciously located in the political and historical forces that caused the trauma, a construct that Muldoon et al. (2026) have begun to theorise in relation to political violence, examining how positive changes in the collective self arise from personal response to organised harm. This is not merely "finding new meaning" in the abstract, it is the active redirection of the self toward the undoing of what was done. In populations that have been targeted by political violence for specific reasons (destroying a community's relationship with education, as the Taliban explicitly stated), PTG can take the form of radical re-commitment to the thing the attack tried to destroy. This dimension of PTG deserves its own theoretical attention, and future research in politically victimised populations should actively look for it.

The resilience discourse that dominated media coverage of APS, the school reopening as national triumph, is categorically distinct from what PTG theory describes. Resilience implies returning to baseline; PTG implies emerging changed in the direction of growth. Several students in this study explicitly contested the "just move on and forget" narrative. Their insistence that December 16 must be held, understood, and integrated, ‘not suppressed’, is itself a form of psychological sophistication that the resilience framing cannot accommodate. Any school or community mental health framework that encourages forgetting over integration is, on this evidence, working against the very PTG processes that are naturally occurring.

 

Coping in Context: What Western Frameworks Miss

 

The coping strategies documented in this study are notably congruent with the students' cultural and religious context, and they challenge frameworks that privilege individual psychotherapeutic modalities as the primary or ideal response to mass trauma. The concepts of qadr, shahdat, and sabr are not passive fatalistic acceptance; they are active cognitive reappraisal mechanisms, fully consistent with the theorized function of meaning-making in trauma adjustment (Park, 2010) and the finding that positive religious coping predicts post-traumatic growth specifically in Muslim displaced populations (Alsubaie et al., 2021). The Umrah experience of S2 is the most vivid illustration: within its cosmological context, it was a moment of genuine grief integration that would likely be misread by a clinician without cultural grounding.

Fredrickson's (2004) Broaden-and-Build Theory of Positive Emotions illuminates the relational coping dimension: positive social relationships expand the cognitive and behavioural resources available to individuals under stress, facilitating upward spirals of emotional resilience. The students' instinct to seek social connection in moments of distress is not merely informal coping, it is the enactment of a culturally and neurobiologically sound principle. Post-trauma interventions in this context should work with this relational architecture, not replace it.

 

Situating APS within the Global School Violence Literature

 

The hypervigilance, social withdrawal, academic deterioration, and intrusive re-experiencing reported by APS students echo findings from studies of survivors of other school massacres (Haravuori et al., 2011; Schwarz et al., 1993). The academic deterioration documented here, including lost examination cycles and one student repeating a school year, is particularly consistent with Strøm et al. (2016), whose longitudinal study of Utøya shooting survivors found marked and sustained declines in school performance and absenteeism among adolescents exposed to mass political violence. The anticipatory preparation for future attacks parallels vigilance responses documented in other survivor populations. However, three dimensions of the APS students' experience are either absent from or peripheral to the Western literature.

First, the context of chronic prior trauma is without parallel in the existing school violence literature. These adolescents were processing a catastrophic acute event on top of a decade of community-wide collective adversity. The theoretical frameworks currently dominant in the literature, drawn almost entirely from populations encountering mass violence for the first time, are simply not designed for this. Second, the role of religious coping is substantially more prominent here than in any Western school massacre literature, consistent with the broader finding that religious coping is a more central resource in Muslim-majority and developing-world contexts (Paragament et al., 1990; Alsubaie et. al., 2021). Third, the entirely endogenous nature of the coping and growth documented here; no clinical facilitation, no school counsellors, no formal follow-up, is not an advertisement for the adequacy of no support. It is an argument for how much more was possible, and how much more of this kind of organic resilience was left unsupported, scaffolded, and in some cases (S4) at significant personal cost.

 

Policy Implications: What This Study Demands of Pakistan's Mental Health Infrastructure

 

Pakistan's 2021 National Mental Health Policy and its 2023 revision represent the first formal acknowledgment at the national level that mental health is a public health priority. Yet implementation remains nascent, child and adolescent mental health services are almost entirely absent from the public system, and no mandatory post-disaster psychological support protocol for schools exists. This study's findings generate six specific, actionable policy recommendations, each grounded in direct participant evidence.

1.      Mandatory post-disaster mental health screening in schools. The primary evidence: Participant S4 was causing himself physical harm; punching walls to the point of finger swelling, driving recklessly until the adrenaline subsided, for six months after the attack. This went entirely unidentified because no clinical system ever reached him. This is not a failure of individual resilience; it is a failure of institutional infrastructure. Pakistan must establish and resource a Rapid Psychological Response Protocol for schools that mandates formal screening of all students present at a mass casualty event within 30, 90, and 180 days post-incident. The 30-day screen catches acute presentations; the 90- and 180-day screens catch exactly the kind of delayed, internalised distress that S4's case exemplifies.

2.     School-embedded counsellor infrastructure. The primary evidence: S3's academic collapse; "I used to be very good at it, now I have completely stopped", went unaddressed because there was no professional in the school system to identify it as a trauma symptom rather than an attitudinal failure. S1's uncontrollable irritability went unaddressed for the same reason. Trained school counsellors are the first line of identification and early intervention for post-trauma distress in adolescents. Pakistan currently has no national policy mandating counsellors in government schools. The evidence from this study makes the case for such a policy unambiguously.

3.     Culturally adapted trauma protocols. The primary evidence: S2's Umrah vision and the consistent use of qadr, shahdat, and sabr as meaning-making resources across all five participants demonstrate that Islamic frameworks of meaning are not supplementary to coping. they are central to it. International trauma frameworks (including EMDR, TF-CBT, and IASC guidelines) require formal cultural adaptation before use in Pakistani and Pashtun contexts. Specifically, protocols should integrate religious coping resources, community-level healing practices, and family-inclusive models of intervention, rather than exclusively individual therapeutic approaches. A clinician who pathologises S2's Umrah vision as a grief-related hallucination is not merely missing a therapeutic opportunity, they are actively undermining the very mechanism that provided him peace.

4.    Teacher training in psychological first aid. The primary evidence: Multiple participants described teachers' post-attack shift toward warmth and reduced strictness as meaningfully protective. S5 described his family's (and by extension, teachers') increased understanding of his moods as one of the most significant sources of support. These informal behavioural changes represent an instinctive enactment of psychological first aid principles. Formalizing this through structured PFA training for all school staff; particularly in conflict-affected regions, would systematize an organic resource that was already present and demonstrably helpful. This is a low-cost, high-impact intervention: it does not require a clinical workforce, it requires training the workforce already in schools.

5.     Longitudinal survivor research. The primary evidence: S2's articulation of a civic-national mission, "through the pen, we must end this terrorism", represents the most expansive PTG finding in this dataset. Whether this identity was sustained, whether it enabled flourishing or eventually collapsed under the weight of ongoing adversity, we do not know. The study captured one time-point, six months post-attack. A prospective longitudinal cohort study following APS survivors would generate the evidence base needed to understand developmental trajectories of post-trauma adjustment in Pakistani adolescents, evaluate the long-term sustainability of informal coping, and track whether the policy changes since 2021 have made any measurable difference to the lives of people like these five boys.

6.     Inclusion in global school violence policy frameworks. The primary evidence: S2's account of anticipatory hypervigilance; his class cutting window bars in preparation for evacuation, his constant mental rehearsal of what he would do if they came back, reflects a level of chronic hypervigilance that is structurally incomprehensible within frameworks developed for populations encountering mass school violence for the first time. Pakistan's APS attack must be explicitly incorporated into WHO, UNICEF, and IASC frameworks on school safety and student mental health. The systematic exclusion of Global South data from these frameworks produces guidelines that are empirically inadequate for the populations most affected by school-based violence. The APS attack killed more children than Sandy Hook, Parkland, and Uvalde combined. Its absence from the international literature is not an oversight, it is a pattern of exclusion with real consequences.

 

Limitations

 

This study has several limitations that must be acknowledged. First, the sample is small (n=5) and exclusively male, drawn from a single school in Peshawar; findings cannot be generalised to female survivors, students at other schools, or survivors of other attack typologies. The exclusion of female students is a particularly significant gap given that girls’ education was a specific target of Taliban violence in this period. Second, data was collected at a single time-point six months post-attack; longitudinal follow-up was not conducted, and the trajectories of these individuals’ adjustment remain unknown.

Third, the researcher’s dual role; as a Peshawari herself with prior clinical contact with APS survivors, while reflexively managed through journaling, peer debriefing, dual supervision, and member checks, introduces the possibility of interpretive bias. Fourth, the exclusion of students who had received counselling means that findings do not capture the experience of those who had access to formal psychological support, a group that may have had importantly different adjustment profiles. Fifth, the exclusion of students who had lost blood relatives, while methodologically justified for sample homogeneity, removes the experience of bereavement-complicated trauma from these findings.

Sixth, two potential sources of bias warrant explicit acknowledgment that were not discussed in the original thesis. Recall bias is a meaningful concern: participants were asked to reconstruct their experiences six months after a profoundly disruptive event, during which time intrusive memories, social discourse about the attack, and media coverage may all have shaped what was accessible and how it was narrated. Social desirability bias is also relevant, particularly given that interviews were conducted in the school counsellor’s office; a space associated with institutional authority and “correct” responses, and by a researcher who had prior clinical exposure to the school community. The renegotiation of oral process consent throughout the interview was one mitigation; the use of open-ended, non-leading questions was another. However, these measures cannot fully eliminate the possibility that participants shaped their accounts toward what they believed was expected or appropriate. Finally, this work was originally conducted in 2015–2016; the theoretical framing has been updated to reflect contemporary scholarship, and this temporal gap between data collection and publication is itself a limitation on the currency of the analysis.

 

Conclusion

 

A decade after one of the most devastating school massacres in history, the inner lives of its adolescent survivors have remained largely unvoiced in the scientific literature. This paper has offered five of those voices; fragmented, honest, complex, and ultimately irreducible to any diagnostic category or symptom checklist. These young men were angry, exhausted, isolated, and grieving. They were also resourceful, purposeful, devout, and growing. They were doing what human beings do in the aftermath of catastrophic rupture: making meaning, reconstructing identity, reaching toward purpose, holding pain and possibility simultaneously.

What they did not have; and what the children who will inevitably survive the next attack also will not have, unless policy changes, is any professional support in doing so. The absence of school counsellors, the absence of post-trauma screening, the absence of culturally adapted mental health protocols, and the absence of longitudinal research are not merely gaps in the academic literature. They are failures of the state's duty of care to its most vulnerable citizens.

The APS attack produced, among other things, a national conversation about resilience. But resilience without support is just endurance with better public relations. These students endured. They also grew. Both facts deserve documentation, clinical attention, and a policy response worthy of what they lived through.

 

Ethical Statement

This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical review and approval were obtained from the Ethics Committee of the Department of Behavioral Sciences, School of Social Sciences and Humanities, National University of Sciences and Technology (NUST), Islamabad, Pakistan, prior to data collection. The committee reviewed the study protocol and established the ethical safeguards governing participant recruitment, consent procedures, data handling, and researcher conduct.

Given that all participants were minors (aged 14–15 years) at the time of data collection, a two-stage consent process was followed. Parental assent was obtained first, via telephone, from the parent or guardian of each prospective participant. Only following explicit parental agreement were the young people themselves contacted. Verbal consent was then obtained directly from each participant prior to interview commencement. All participants and their parents were fully informed of the study's purpose, procedures, voluntary nature, and their right to withdraw at any point without consequence. Given the sensitive and emergent nature of phenomenological inquiry with trauma-exposed adolescents, oral process consent was renegotiated with each participant throughout the course of their interview.

Participant confidentiality and anonymity have been maintained throughout all stages of the research and publication process. Participants are identified solely by alphanumeric codes (S1–S5); no identifying information appears in the manuscript or associated materials. Audio recordings made during data collection have been permanently destroyed following transcription. The study was conducted six months after the Army Public School Peshawar attack of December 2014, in a conflict-affected setting. Particular care was taken throughout data collection to minimise the risk of re-traumatisation, including the selection of a familiar and comfortable interview setting, the renegotiation of consent throughout each session, and the maintenance of close supervisory oversight by the institutional and on-site supervisors.

This research received no external funding. It was conducted as part of the first author's Master of Science in Clinical Psychology programme at NUST Islamabad and was entirely self-funded. The authors declare no conflicts of interest.

 

Data Availability Statement

The data that support the findings of this study consist of verbatim transcripts of in-depth interviews conducted with minor survivors of a mass casualty terrorist attack. These data are not publicly available due to the sensitive and potentially identifying nature of the material, the age and vulnerability of the participants at the time of data collection, and the ethical obligations of confidentiality and anonymity made to participants and their families as part of the consent process. Public sharing of these data would be inconsistent with the ethical approvals granted by the Ethics Committee of the Department of Behavioral Sciences, School of Social Sciences and Humanities, National University of Sciences and Technology (NUST), Islamabad, Pakistan.

Requests for access to anonymised excerpts of the data for legitimate academic purposes may be considered on a case-by-case basis, subject to the approval of both authors and in compliance with the ethical framework governing the original study. Such requests should be directed to the corresponding author at the contact details provided.

 

Funding

This research received no external funding. The study was conducted entirely as part of the first author's (S.G.) Master of Science in Clinical Psychology programme at the National University of Sciences and Technology (NUST), Islamabad, Pakistan, and was self-funded throughout all stages of data collection, analysis, and write-up. The preparation of this manuscript for publication was similarly undertaken without financial support from any funding body, commercial entity, or institution.

 

Competing Interests

The authors declare no competing interests.

 

Authors’ Contribution

The following roles are attributed to each author in accordance with the CRediT (Contributor Roles Taxonomy) framework:

Sumbal Gilani (S.G.): Conceptualisation; Methodology; Investigation; Formal Analysis; Data Curation; Writing — Original Draft Preparation; Writing — Review and Editing; Project Administration; Funding Acquisition.

Dr Salma Siddiqui (S.S.): Conceptualisation; Methodology; Validation; Supervision; Writing — Review and Editing.

 

Use of AI Technologies

A pre-written manuscript was updated to the current global context using new articles found through the AI platform Consensus. Later, Claude (Anthropic) was used to assist in improving the final manuscript draft. The corresponding author reviewed, substantially revised, and takes full intellectual and academic responsibility for the final text. Conceptualisation, theoretical framing, empirical grounding, and all scholarly claims are entirely the authors' own. AI-generated content was reviewed and validated by the authors prior to submission, and Claude has not been listed as an author.

 

Acknowledgements

The authors wish to express their sincere gratitude to Brigadier Rashid Qayyum and the team at the Combined Military Hospital (CMH) Peshawar Psychosocial Support Centre for their on-site supervision, institutional support, and facilitation of data collection. Their guidance and commitment to the psychological wellbeing of those affected by the Army Public School attack made this research possible.

The authors also wish to acknowledge the Army Public School Peshawar administration for permitting access to the school and supporting the research process during an extraordinarily difficult period in the institution's history.

The first author wishes to offer a personal note. Shortly after completing this study, her father was diagnosed with cancer. As she walked alongside him through his illness and ultimately lost him, it was the memory of these five young men, their honesty, their resilience, and their refusal to be diminished by what had been done to them, that stayed with her. They taught her, before she fully understood the lesson, that human beings can carry grief and growth simultaneously. This paper is dedicated, with love, to her father.

Above all, the authors wish to express their profound gratitude to the five young men who agreed to share their experiences for this study. Their openness, courage, and trust; offered six months after one of the most traumatic events in Pakistan's recent history, are the foundation upon which this entire paper rests. This work is, in every meaningful sense, theirs.

 

 

 

References

 

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Alsubaie, M. K., Dolezal, M., Sheikh, I. S., Rosencrans, P., Walker, R. S., Zoellner, L. A., & Bentley, J. (2021). Religious coping, perceived discrimination, and posttraumatic growth in an international sample of forcibly displaced Muslims. Mental Health, Religion & Culture, 24(9), 976–992. https://doi.org/10.1080/13674676.2021.1973978

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"We Stayed, But We Were Not the Same"

COREQ Reporting Checklist (Tong et al., 2007)

 

Consolidated Criteria for Reporting Qualitative Research — 32-Item Checklist
Retrospective assessment conducted during manuscript preparation (2025).
Original study conducted 2015 following Moustakas (1994) phenomenological methodology.

 

Summary: 28 items Fully Met | 2 items Partially Met | 2 items Not Met | Total: 32 items

 

Item
No.

Item

Guide Question

Response / Manuscript Reference

Status

DOMAIN 1: RESEARCH TEAM AND REFLEXIVITY

Personal Characteristics

1

Interviewer / facilitator

Which author(s) conducted the interview or focus group?

All interviews were conducted by the first author (S.G.), a female clinical psychologist and MS Clinical Psychology candidate at NUST Islamabad, who was also serving as school counsellor at APS Peshawar at the time of data collection.

MET

2

Credentials

What were the researcher's credentials, e.g. PhD, MD?

MS Clinical Psychology (NUST Islamabad); trained counsellor; clinical practitioner at CMH Peshawar Psychosocial Support Centre. Supervised by Dr Salma Siddiqui (Head of Department, Behavioural Sciences, NUST).

MET

3

Occupation

What was the researcher's occupation at the time of the study?

School counsellor at Army Public School Peshawar; clinical psychology practitioner at CMH Peshawar Psychosocial Support Centre.

MET

4

Gender

Was the researcher's gender specified?

Yes. The first author (S.G.) is a female clinical psychologist, as stated in the Researcher Positionality and Reflexivity section of the manuscript.

MET

5

Experience and training

What experience or training did the researcher have?

Clinical psychology training at NUST; counselling practice; prior clinical exposure to APS survivors through the CMH Peshawar Psychosocial Support Centre before formal data collection commenced.

MET

Relationship with participants

6

Relationship established

Was a relationship established prior to study commencement?

Yes. The researcher had an established professional relationship with students through her role as school counsellor at APS, providing rapport prior to formal data collection.

MET

7

Participant knowledge of the interviewer

What did participants know about the researcher, e.g. personal goals, reasons for doing the research?

Prior to formal data collection, the researcher's dual role was explicitly explained to each participant: her ongoing function as school counsellor was clearly distinguished from her role as research interviewer. Research purpose, procedures, and confidentiality were explained separately in the consent process.

MET

8

Interviewer characteristics

What characteristics were reported about the interviewer/facilitator, e.g. bias, assumptions, reasons and interests in the research topic?

Addressed in the dedicated Researcher Positionality and Reflexivity section. Four reflexive dimensions documented: (1) insider identity and productive tensions as a Peshawari; (2) deliberate suspension of the clinical gaze; (3) linguistic and interpretive reflexivity in Urdu-to-English translation; (4) temporal reflexivity across the decade gap between data collection and publication.

MET

DOMAIN 2: STUDY DESIGN

Theoretical framework

9

Methodological orientation and theory

What methodological orientation was stated to underpin the study, e.g. grounded theory, discourse analysis, ethnography, phenomenology?

Transcendental phenomenology following Moustakas (1994). Epistemological justification provided in the Research Design sub-section. Phenomenological methodology selected to explore lived experience and texture of post-trauma adjustment, not to measure or predict outcomes.

MET

Participant selection

10

Sampling

How were participants selected, e.g. purposive, convenience, consecutive, snowball?

Purposive sampling. Five detailed inclusion criteria documented in the Participants sub-section: presence in school on 16 December 2014; presence in auditorium during attack; continued attendance at APS post-attack; no blood relative lost in attack; no formal counselling or therapy received post-attack.

MET

11

Method of approach

How were participants approached, e.g. face-to-face, telephone, mail?

Participants were identified through the researcher's existing role at APS. Interviews scheduled according to participant convenience and availability. Verbal consent obtained from parents by telephone prior to interviews.

MET

12

Sample size

How many participants were in the study?

Five participants. Sample size determined by theoretical saturation rather than a predetermined number; saturation reached at the fifth interview with no substantially new themes emerging.

MET

13

Non-participation

How many people refused to participate or dropped out? Reasons?

All eligible participants who were approached agreed to take part. No participant declined or withdrew. Stated in the Participants sub-section of the manuscript.

MET

Setting

14

Setting of data collection

Where was the data collected, e.g. home, clinic, workplace?

School counsellor's office at Army Public School Peshawar — a space familiar and comfortable to participants. Prior permissions obtained from the Head of Department of Mental Health at CMH Peshawar.

MET

15

Presence of non-participants

Was anyone else present besides the researcher and participants?

No other persons were present during interviews. The one-to-one interview format is clearly described throughout the Data Collection sub-section.

MET

16

Description of sample

What are the important characteristics of the sample, e.g. demographic data, date?

Detailed individual vignettes provided for all five participants in the Findings section, including class year, physical injuries sustained, family structure, academic standing, and personality characteristics. All participants aged 14–15 at data collection, male, of Pashtun origin, middle-class socio-economic background.

MET

Data collection

17

Interview guide

Were questions, prompts, guides provided? Was it pilot tested?

Semi-structured interview guide documented in the Data Collection sub-section. Grand tour opening question stated verbatim; clarification question types described; closing reflective question provided. Interview guide was not formally pilot tested — noted as a limitation of the original study context.

PARTIAL

18

Repeat interviews

Were repeat interviews carried out? If yes, how many?

Single-session interviews were conducted with each participant. No repeat interviews were carried out. This reflects the methodological decision to capture the lived experience at one time-point (six months post-attack) and is acknowledged in the Limitations section.

NOT MET

19

Audio/visual recording

Did the research use audio or visual recording to collect the data?

Four of five interviews were audio-recorded with participant consent. For the one participant who declined audio recording, verbatim handwritten notes were taken during the interview. Documented in the Data Collection sub-section.

MET

20

Field notes

Were field notes made during and/or after the interview?

Yes. The researcher maintained a reflexivity journal throughout data collection and analysis, recording personal responses, emerging biases, contextual observations, and moments of interpretive challenge after each interview. Documented in the Researcher Positionality and Reflexivity section.

MET

21

Duration

What was the duration of the interviews or focus group?

Interviews lasted 30–45 minutes. Stated in the Data Collection sub-section.

MET

22

Data saturation

Was data saturation discussed?

Yes. Theoretical saturation was reached by the fifth interview, with no substantially new themes emerging. Documented in the Participants sub-section.

MET

23

Transcripts returned

Were transcripts returned to participants for comment and/or correction?

Yes. Member checks were conducted; participants reviewed both their interview transcripts and the emergent themes and findings, confirming accuracy and offering additions where relevant. Documented in the Data Analysis sub-section.

MET

DOMAIN 3: ANALYSIS AND FINDINGS

Data analysis

24

Number of data coders

How many data coders coded the data?

Three coders: the primary researcher (S.G.); the institutional supervisor (Dr Salma Siddiqui, NUST); and a qualitative data coding expert from faculty checked the final codes (Dr. Najma Akhtar, NUST). Supervisors independently reviewed and validated the coding structure and emergent themes; disagreements resolved through discussion until consensus reached. Documented in the Data Analysis sub-section.

MET

25

Description of the coding tree

Did authors provide a description of the coding tree?

Full thematic structure documented in the Findings section: three overarching domains, each with multiple sub-themes, supported by a flowchart of the analysis process (Annex 2 of original thesis). All themes illustrated with verbatim participant quotations.

MET

26

Derivation of themes

Were themes identified in advance or derived from the data?

Themes were derived inductively from the data through the Moustakas (1994) phenomenological process, not identified in advance from theory. Explicitly stated in the Research Design and Data Analysis sub-sections.

MET

27

Software

What software, if applicable, was used to manage the data?

No software was used. Data analysis was conducted manually using a physical post-it note method over a two-month period, in which significant statements were written, arranged, grouped, and iteratively refined across multiple sessions. Documented in the Data Analysis sub-section.

NOT MET

28

Participant checking

Did participants provide feedback on the findings?

Yes. Member checks confirmed both transcript accuracy and the emergent themes and findings — not transcripts only. Participants offered additions where relevant. Documented in the Data Analysis sub-section.

MET

Reporting

29

Quotations presented

Were participant quotations presented to illustrate the themes/findings?

Yes, extensively and consistently throughout the Findings section. All quotations presented bilingually — original Urdu text followed by English translation — with participant identifier (S1–S5).

MET

30

Data and findings consistent

Was there consistency between the data presented and the findings?

Yes. All findings are directly and transparently grounded in verbatim participant quotations. Analytical claims in the Findings section are illustrated with specific quotes; claims without participant data are reserved for the Discussion.

MET

31

Clarity of major themes

Were major themes clearly presented in the findings?

Yes. Three major domains presented with distinct sub-themes, each with a descriptive heading, analytical commentary, and supporting verbatim quotations. Domain structure summarised at the opening of the Findings section.

MET

32

Clarity of minor themes

Is there a description of diverse cases or discussion of minor themes?

Sub-themes systematically presented within each domain. Limited discussion of negative or divergent cases — where participant experiences differed significantly from the emerging pattern — is acknowledged as a limitation in the Limitations section.

PARTIAL

 

Reference: Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042

Note: Items 17 (interview guide not pilot tested) and 32 (limited negative case analysis) are partially met. These gaps are acknowledged in the Limitations section of the manuscript and reflect the constraints of conducting sensitive trauma research in a conflict-affected, resource-limited setting in 2015–2016 without formal COREQ guidance at the time of original data collection.