A dissertation submitted in partial fulfilment of requirements for the degree of Master of Arts At the University of Witwatersrand Johannesburg 2016 / This study explored the subjective experiences of a population who appear to be at relatively high risk of potential violence and harm, specifically female university students who are compelled to commute by taxi on a daily basis. The study aimed to explore and document the psychological experiences of these female university students including their anxieties, levels of traumatic stress related responses, cognitions and fantasies, and conscious and unconscious adaptations to their circumstances. It was hoped that information gleaned would contribute to, and possibly expand the understanding of what the lived experience of Continuous Traumatic Stress (CTS) might entail. In order to investigate the research questions, ten students who were identified as being compelled to use minibus taxis as their primary mode of transport to and from university participated in semi-structured interviews on the topic of their experiences in this space and how they adapt to and survive in their circumstances. The study was located in the qualitative research tradition and the interview transcripts were analysed using critical thematic analysis. The main themes were identified and presented under four sections; exposure to traumatic events, the effects and impacts of these events, managing and coping, and gender related experiences in the taxi commuting space. Exposure to traumatic events included taxi driver aggression, motor vehicle accidents, crime and violence, xenophobic attacks and gender related trauma. The most prominent effects or impacts that were identified were firstly, anxiety, fear and preoccupation with danger and secondly, numbing, resignation and hopelessness. The tactics which were employed by participants in managing and coping with their circumstances included, prayer and observation and management of their commuting environment. It was through observation and self-management that participants practiced strategies that allowed them some measure of control in terms of how they conducted themselves in the taxi commuting space. Under the final section, participants revealed their gender related experiences reporting a sense of being exploited, being subject to sexual harassment, and the constant fear of rape or sexual violation. The links between these participants’ experience and the concept of CTS are presented and it is argued that many aspects of their experience appear consistent with CTS. / GR2017

Early life adversity (ELA) produces long lasting developmental changes to the postnatal brain, increasing predisposition to a number of physical and psychiatric disorders. The mechanisms through which ELA is able to create lasting detrimental changes to neuronal development remains unclear. This thesis tested the hypothesis that increases in fear generalization, a common symptom in psychiatric disorders, follows ELA exposure in age dependent and sexually dimorphic ways in alignment with the findings of clinical studies. The effects of ELA often impact fear circuitry and we confirmed, using electrophysiology and tissue imaging, that 5-HT circuitry from the median raphe nucleus (MRN), integral to fear response, was impaired following ELA. Using a transgenic mouse model that allows for modulation of serotonergic release, we showed that circumventing serotonergic pathways disrupted by ELA and increasing whole brain 5-HT release was enough to rescue hippocampal dependent fear responses and fear generalization. Involvement of the hippocampus in ELA effects, particularly the ventral dentate gyrus (vDG), in fear overgeneralization was confirmed as hyperactivity in thevDG following exposure to novel contexts was rescued by increased 5-HT release. In addition to ELA-induced hyperactivity of the vDG, known to potentiate stress susceptibility, I demonstrated that ELA resulted in an increase in passive coping strategies, HPA axis dysfunction and elevated stress hormone release. These effects were seen predominantly in adult females and rescued in those with increased 5-HT release. Together these data suggest that increased predisposition to psychiatric disorders following ELA exposure involves the disruption of fear circuitry regulated by 5-HT activity. Identifying the underlying circuits altered by ELA not only provides insight about disrupted postnatal brain development, but also increases our knowledge of the timeline, trajectory and factors affecting healthy postnatal brain development.

Experiencing early life adversity (ELA) increases the risk of anxiety disorders, such as generalized anxiety disorder and post-traumatic stress disorder, with disproportionally higher risk in women compared to men. Neurodevelopmental and behavioral outcomes following ELA are multifaceted and are influenced heavily by the type of adversity experienced and sex of the individual. A major contributor to emotional dysfunction and anxiety disorders resulting from ELA are changes in fear and threat circuitry. Children who experienced ELA have been reported to show an accelerated development of the amygdala, a region involved in processing threat, and greater cerebrospinal levels of corticotrophin releasing hormone (Crh), an orchestrator of neuroendocrine and behavioral responses to stress. Work in rodents have linked Crh signaling within the lateral central amygdala (CeAL) with processing and responding to threat, core features disrupted in anxiety-related disorders. Further, sex biases in risk and symptom presentation have been proposed to be related to sexual dimorphic signaling of Crh across the brain that differentially influence a variety of Crh-dependent behaviors. However, it remains unclear what properties of ELA portend differential neurobiological risk, what is the basis of sex-differences for negative outcomes, and how specific mechanistic changes give rise to certain endophenotypes. In this work, I use genetic, cellular, and behavioral approaches to explore the impact of ELA and sex on perinatal development in mice and the functional consequences of altered Crh neuron activity in the CeAL on threat responding in adulthood. In Chapter 1, I review how factors such as sex and type of ELA influence amygdala development and Crh. In Chapter 2, I assess the impact of two forms of ELA, maternal separation (MS) and limited bedding and nesting (LBN) on perinatal development and anxiety-like behavior. Both forms of ELA shifted the timing of somatic maturation and basal CORT levels and led to increased anxiety-like behaviors, but the degree of the impact depended on the sex and type of adversity experienced. In Chapter 3, I demonstrate that a distinguishing feature between types of ELA was the predictability of maternal care. The type of ELA also contributed to sex-differences in Crh related gene expression in the perinatal amygdala. Increased expression was primarily observed in males following MS and in females following LBN. In Chapter 4, I investigate the functional consequences of ELA in the form of LBN on the activity of CeALCrh+ neurons in vivo and their causal role in threat reactivity indexed by the startle response. LBN rearing led to sustained activity of CeALCrh+ in female mice but diminished in male mice. Persistent activity of this population was necessary for and predicted the magnitude of startle responding. In Chapter 5, I discuss important considerations when integrating new advancements in the study of ELA and the use of sex as a biological variable. Collectively, this work deepens our understanding of the neurobiological mechanisms impacted by sex and ELA and holds promise for future strategies that may consider the sex and specific experiences of the individual to target specific endophenotypes and address the underlying root causes of anxiety disorders.

Traumatic events are a common part of the human experience. Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are common sequelae of trauma that are both associated with poor physical health and mortality. The objective of this dissertation is to identify common and unique risk factors for each disorder in order to identify at-risk groups for PTSD and/or depression following trauma. his dissertation is organized into five parts: 1) an introduction, 2) a simulation study exploring the use of test equating methods to standardize the Hospital Anxiety and Depression Scale (HADS) to the Beck Depression Inventory II (BDI) in order to create common depression scale across studies in a pooled analysis, 3) an individual participant data meta-analysis on risk factors for PTSD and depression following incident trauma, 4) a Mendelian Randomization analysis of childhood abuse victimization and neuroticism on PTSD and depression, 5) a discussion of the findings and avenues for future research. The simulation study found that an Equated BDI diagnosis had higher specificity (range: 0.86 to 0.91) compared to using the HADS diagnosis (range: 0.80 to 0.82) when the correlation between the BDI and HADS was greater than 0.7, but had lower sensitivity (Equated BDI range: 0.67 to 0.72; HADS range: 0.84 to 0.92). The Equated BDI diagnosis was found to improve statistical power when the prevalence of depression was 20% or higher with greater improvements when the proportion of studies assessing the depression with the HADS was less than 50%. In the individual participant data meta-analysis, common risk factors for acute and persistent MDD and PTSD were found including increased risk for female sex and reduced risk for those who experienced an accident versus an assault or other traumatic event as the index trauma. Acute MDD symptom severity was associated with persistent PTSD and remained significant after inclusion of acute PTSD symptom severity. In an analysis of PTSD symptom clusters, only reexperiencing symptoms were associated with persistent PTSD along with MDD symptom severity. In models of persistent MDD, acute PTSD symptom severity was associated with persistence, but neither overall symptom severity nor cluster symptom severities were associated with persistence after inclusion of acute MDD symptom severity. In the Mendelian Randomization analysis, childhood abuse victimization was found to be associated with PTSD symptom severity but was not associated with an increased odds of a MDD diagnosis, while neuroticism was associated with an increased odds of a diagnosis of MDD, but was not associated with an increase in PTSD symptom severity. Findings from the meta-analysis that leveraged the use of item-response theory imply that while PTSD and MDD share many risk factors for onset of symptoms following the experience of a traumatic event, persistence of symptoms depends most strongly on initial symptoms. However, PTSD and MDD were also found to have different relationships with childhood abuse victimization and neuroticism, indicating that some risk factors are unique to each disorder. Future studies can build upon these results, especially when pooling data from different studies, to further explicate the associations between PTSD, MDD, and their causes.

The purpose of this study is to tell the story of lay trauma counsellors - how the work they do affects them, what helps them to cope and what hinders their coping. The epistemological framework of this study is constructivism. This study involved in-depth interviews with three lay trauma counsellors from different cultural backgrounds who counselled for a minimum of one year. Hermeneutics was the method used to analyse the data. The stories of participants were recounted through the researcher’s lens in the form of specific themes that emerged for individual participants. Recurring themes evident in the stories of all three participants were discussed and compared with the literature. The information gleaned could be valuable to organisations considering setting up lay trauma programmes, to those with established programmes, as well as to prospective and experienced lay counsellors. / Psychology / M.A. (Psychology)

This study explores the possible use of digital media as an effective psychotherapeutic aid in art psychotherapy, specifically in addressing the effects of trauma experienced by adolescents. A literature review provides evidence on what exactly can be understood under the concepts 'art psychotherapy' and 'digital media'. The literature study further investigates trauma, its treatment and how art psychotherapy can be used as a psychotherapeutic tool with adolescents who have been exposed to trauma. An empirical study including six participants, chosen through a specific sampling process, and whose background information regulates the appropriate methods of intervention demonstrates the practicality of digital media in art psychotherapy. Data gathered from pre-assessment activities, art psychotherapy sessions and post-assessment activities are analysed, interpreted, and reduced through a systematic process. The empirical findings are then presented in a detailed, concise manner From the empirical investigation, it is determined that digital media can be used as a successful tool in art psychotherapy, specifically with adolescents who have experienced trauma. The researcher gained experience in the implementation of digital media in art psychotherapy and was able to provide valuable information about this practice, specifically for professionals interested in the field of art psychotherapy. The researcher was also able to identify limitations and further areas for research in this field. / Psychology of Education / M. A. (Guidance and Counselling)--University of South Africa --2013

Despite the growing recognition of the prevalence of domestic violence worldwide, there is an increasing number of women reporting abuse, and there are those who have died at the hands of their abusers. Many of these domestic violence situations involve children who grow up carrying the physical and/or emotional scars of abuse into adulthood, which also has negative implications for their social well-being. This study adopts a qualitative approach to analysing emerging themes relating to the experiences of eight adult participants (four men and four women) who have lived in domestically violent homes during their childhood. The study deals with definitions of abuse, the social, physical, emotional, cognitive, behavioural and psychological effects of abuse and identifies the social consequences of growing up in a violent home. With reference to the research interviews, it is the researcher’s finding that if there is violence in the home, children’s socialisation will be impaired. The results of the study support the hypothesis that the socialisation of adults and their ability to form healthy relationships are hindered by being exposed to domestic violence during childhood. In terms of the goals of intervention, the basic principle is that children need to be provided with a safe environment, appropriate discipline and a secure relationship with an attentive caregiver. The ultimate goal of intervention is to prevent further harm and promote recovery. Socio-educational goals include being taught to communicate and settle differences without the use of violence, to promote the development of well-adjusted social beings. / Educational Foundations / M. Ed. (Socio-Education)

Thesis (PhD (Biomedical Sciences. Medical Physiology))--University of Stellenbosch, 2006. / Early life trauma leads to behavioural abnormalities later in life. These include mood and anxiety disorders such as depression and posttraumatic stress disorder (PTSD). This association may be due in part to the effects of trauma on brain development. Data from basic and clinical experiments suggest that alterations in the hippocampus may be fundamental to the development of these disorders. Here we used an animal model of early life trauma to investigate its effects on the behaviour and neurochemistry of the adult rat. Adolescent rats were subjected to time-dependent sensitization stress consisting of a triple stressor (2 hours restraint, 20 min swim stress and exposure to ether vapour) on post-natal day (PND) 28, a single re-stress on PND 35 (20 min swim stress), and a second re-stress in adulthood (PND 60, 20 min swim stress). The rationale was that the frequency of exposure to situational reminders contributes to the maintenance over time of fear-related behavioural disturbances. The effects of trauma on the hypothalamus-pituitary-adrenal-axis, hippocampal and plasma neurotrophin levels, behaviour and phosphoinositide-3 kinase (PI-3 kinase) signaling proteins were initially investigated. In addition, proteomic technologies such as protein arrays and 2D-SDS PAGE combined with liquid chromatography tandem mass spectrometry (LC-MS/MS) were employed to study trauma-induced effects on the hippocampus. Traumatized animals showed a decrease in glucocorticoid receptors in the dentate gyrus of the hippocampus and an increase in basal corticosterone levels 24 hours after adulthood re-stress. These effects were reversed by pretreatment with the serotonin selective reuptake inhibitor, escitalopram. A decrease in the neurotrophins, BDNF and NT-3 were evident 8 days, but not 24 hours after adulthood re-stress. This decrease was not accompanied by decreases in plasma neurotrophin or PI-3 kinase, protein kinase B (PKB), phosphatase and tensin homologue (PTEN), phospho-forkhead and phospho-AFX protein levels. In addition, traumatized animals showed increased rearing in both the elevated plus maze and open field. Proteomic analysis of trauma-induced changes in the hippocampus show increases in Ca2+ homeostasis / signaling proteins such as S-100B, phospho-JNK and calcineurin. Apoptotic initiator proteins, including caspase 9, -10 and -12 were increased and there was evidence of cytoskeletal protein dysregulation. Furthermore, cell cycle regulators and energy metabolism proteins were decreased. These effects indicate to a cellular state of cell cycle arrest after increased calcium influx to avoid apoptosis. Our data suggest that adolescent trauma with adulthood re-stress may affect numerous systems at different levels. These include neuroendocrine-, protein systems and behaviour, and confirmed that a systems biology approach is needed for a better understanding of the neurobiology of mental disorders.

Previous research indicates that those with a history of abuse have an increased risk to experience subsequent traumatic events. This study utilized a convenience sample of undergraduate students to examine the reaction of those with a history of abuse to subsequent traumatic experiences. In addition, the study assessed the level of posttraumatic growth an individual experiences following childhood abuse. The level of posttraumatic growth was examined to determine if the growth allowed for participants to better handle successive traumas. Those with a history of abuse experienced higher levels of symptomology following a successive traumatic event. Results did not support the hypothesis that among those with a history of abuse, lower levels of posttraumatic growth would predict higher levels of symptoms following a later trauma. Implications and limitations of the study, as well as directions for future research are discussed.

This thesis explores the psychological trauma of the survivors of the Chernobyl nuclear disaster, which occurred on April 26, 1986. I argue for the emergence from the disaster of three Chernobyl traumas, each of which will be analysed individually – one per chapter. In reading these three traumas of Chernobyl, the thesis draws upon and situates itself at the interface between two primary theoretical perspectives: Freudian psychoanalysis and the deconstructive approach of Jacques Derrida. The first Chernobyl trauma is engendered by the panicked local response to the consequences of the explosion at Chernobyl Reactor Four by the power plant’s staff, the fire fighters whose job it was to extinguish the initial blaze caused by the blast, the inhabitants of nearby towns and villages, and the soldiers involved in the region’s evacuation and radiation decontamination. Most of these people died from radiation poisoning in the days, weeks, months or years after the disaster’s occurrence. The first chapter explores the usefulness and limits of Freudian psychoanalytic readings of local survivors’ testimonies of the disaster, examining in relation to the Chernobyl event Freud’s practice of locating the authentic primal scene or originary traumatic witnessing experience in his subjects’ pasts, as exemplified by his Wolf Man analysis, detailed in his psychoanalytic study ‘On the History of an Infantile Neurosis’ (1918). The testimonies read through this Freudian psychoanalytic lens are constituted by Igor Kostin’s personal account of the disaster’s aftermath, detailed in his book Chernobyl: Confessions of a Reporter (2006), and by Svetlana Alexievich’s interviews with Chernobyl disaster survivors in her book Voices from Chernobyl: The Oral History of a Nuclear Disaster (2006). The second chapter argues that Freudian psychoanalysis only provides a provisional, ultimately fictional origin of Chernobyl trauma. Situating itself in relation to trauma studies, this thesis, progressing from its first to its second chapter, charts the geographical and temporal shift between these first and second traumas, from trauma-as-sudden-event to trauma-as-gradual-process. In the weeks following the initial Chernobyl explosion, which released into the atmosphere a radioactive cloud that blew in a north-westerly direction across Northern Ukraine, Belarus, Latvia, Estonia, Finland and Sweden, symptoms of radiation poisoning slowly emerged in the populations of the abovementioned countries. To analyse the psychological impact of confronting this gradual, international unfolding of trauma – the second trauma of Chernobyl – the second chapter of this thesis explores the critique of the global attempt to archivise, elegise and ultimately understand the Chernobyl disaster in Mario Petrucci’s elegies, compiled in his poetry collection Heavy Water: A Poem for Chernobyl (2006), the horror film Chernobyl Diaries (2012, dir. Bradley Parker), and Adam Roberts’ Science Fiction novel, Yellow Blue Tibia (2009). Analysing the deconstructive approach of Jacques Derrida in these texts – his notions of archive fever, impossible mourning and ethical mourning – this chapter argues that the attempt to interiorise, memorialise and mourn the survivors of the Chernobyl disaster is narcissistic, hubristic and violent in the extreme. It then proposes that Derrida’s notion of ethical mourning, outlined most clearly in his lecture ‘Mnemosyne’ (1984), enables us to situate our emotional sympathy for survivors – who, following Derrida’s lecture, are maintained as permanently exterior and inaccessible to us – in our very inability or failure to comprehend or locate the origin of their Chernobyl traumas. The third and final chapter analyses the third trauma of Chernobyl: the psychological and physiological effects of the disaster on second-generation inhabitants living near the Exclusion Zone erected around the evacuated, cordoned-off and still-radioactive Chernobyl region. These second-generation experiences of living near a sealed-away source of intense radiation are reconstructed in literature and videogaming: in Darragh McKeon’s novel All That Is Solid Melts Into Air (2014), Hamid Ismailov’s novel The Dead Lake (2014) and the videogame S.T.A.L.K.E.R: Shadow of Chernobyl (2007), developed by the company GSC Game World. The analysis of these texts is informed by Nicolas Abraham and Maria Torok’s psychoanalytic theory of the intergenerational phantom: the muteness of a generation’s history which returns to haunt the succeeding generations. This chapter will explore the psychological effects upon second-generation Chernobyl survivors, which result from these survivors’ incorporation or unconscious interiorisation of their parents’ psychologically repressed traumatic Chernobyl experiences, by analysing reconstructions of this process in the abovementioned texts. These parental experiences, echoing the Exclusion Zone as a denied physical space, have been interred in inaccessible psychic crypts. By way of conclusion, the thesis then offers an alternative theory of reading survivors’ Chernobyl trauma. Survivors’ restaging of their Chernobyl witnessing experiences as jokes enables them to cathartically, temporarily abreact their trauma through the laughter that these jokes engender.