Acute myocardial infarction (AMI), caused by ischaemic heart disease (IHD), is a leading cause of death in both men and women in the western society. Hypertension, diabetes, and smoking are examples of well-known risk factors of IHD, but also there are psychosocial factors, such as stress, vital exhaustion (unusual fatigue, irritability, and demoralization) and depression that have been associated with an increased risk in both genders. After an AMI, however, women are more likely than men to be psychosocially impaired resulting in suffering and a presumed increase in the risk of recurrent cardiac events. Psychosocial factors may be targeted in secondary prevention, complementary to drug treatment and conventional lifestyle advice. There is some evidence of beneficial effects on both psychosocial well-being and cardiac outcomes by psychosocial interventions in men. Far fewer women have been studied and the results have been inconsistent. It is not clear how psychosocial factors convey the increased risk of cardiac events, but many possible psychopathological mechanisms, including biochemical and physiological links, have been suggested. In the Women’s Hearts study we have, in a randomised controlled trial, evaluated a one-year cognitive-behavioural stress management programme designed specifically for women with IHD. We included 198 women with IHD, with a mean age of 61 years and from the county of Västerbotten in Northern Sweden, who were randomised to either conventional treatment and follow-up, or to stress management in addition to conventional care. Extensive questionnaires, blood samplings, and biomedical and physiologic data were obtained before randomisation, as well as at follow-ups approximately one and two years after randomisation. Two groups of healthy controls were included for comparisons with women with IHD. Compared to women without IHD, women with IHD reported more stress behaviour and vital exhaustion. Women with IHD also had a lower heart rate variability (HRV) than the healthy controls, possibly reflecting a dysfunctional autonomic nervous regulation of the heart. Reduced HRV has been shown to increase the risk of cardiac arrhythmias and sudden death. At the first follow-up, performed at the end of the one-year stress management programme, women who had participated in the programme had reduced the stress behaviour and vital exhaustion, compared to the women in the conventional care group. We could not find any evidence of a direct cause-effect relationship between stress management and biological cardiovascular risk indicators, or HRV; the intervention and control groups did not differ in insulin resistance, inflammatory, haemostatic and fibrinolytic factors, or HRV. At second follow-up one year later, several additional psychosocial domains were studied. The stress management programme had accelerated psychosocial recovery at the first follow-up over and above that observed in the control group. At the second follow-up, there was further marked improvement in the control group, so the differences in psychosocial variables between the intervention and control groups were no longer significant. In conclusion, a cognitive-behavioural stress management programme could accelerate psychosocial improvement in women with IHD, and thus reduce the amount of psychological and psychosocial suffering. We could not find any evidence that the stress management programme was associated with a concomitant improvement in biological cardiovascular risk indicators, or HRV. Our results suggest that the women with the greatest psychosocial burden should be identified and targeted in new clinical trials of cognitive-behavioural interventions in women with IHD. Future studies within the Women’s Hearts project will evaluate the psychosocial effects at a five-year follow-up, as well as investigations of other possible pathways by which psychosocial interventions might mediate beneficial effects on cardiac events.

Text in English / Against the background of high prevalence of substance abuse in the globe generally and South Africa in particular, research has shown an association between substance abuse and other mental disorders or vice-versa. With most rehabilitation centres offering separate diagnosis and treatment for the two disorders, the problem of relapse has been significant. The purpose of this study is to explore the perceived effectiveness of CBT as a treatment model for substance use disorders with co-occurring disorders. Subsequently, the research will add to the already existing research evidence. The study was conducted in five rehabilitation centres in Gauteng Province. The qualitative descriptive research approach was used to conduct the study. Both purposive and snowball sampling were used to recruit participants in this study. The sample consisted of CBT specialist participants from diverse race, gender, ethnicity, and age ranging from 30 to 65 years, with at least a minimum of five years’ experience. A pilot study with two specialist participants was conducted, and this enhanced trustworthiness and authenticity of the study. The primary method of qualitative data collection employed in this study was semi-structured individual interviews for specialist participants. Grounded theory analysis was employed to analyse data. The findings of the study emphasised a need to not separate treatment of substance use disorders and psychiatric pathologies. More importantly, the effectiveness of CBT in treating both disorders was established by the study. The study further encourages more time in therapy as the way to increase effective results accompanied by less relapse rate. Accordingly, the findings of this study encourage more research and use of CBT treatment for substance use disorders with co-occurring disorders in South Africa. This study found that the most used substances are both legal and illegal, and they are further classified as depressants, stimulants, opioids, and new psychoactive substances. A vulnerable population to abuse substances includes adolescent and young adults, individuals with co-occurring disorders, and low socio-economic status. The disorders that normally co-exist with substance use disorder ranges from depression, bipolar disorder, schizophrenia, sleeping disorder, impulsivity, antisocial behaviour, borderline disorder, paranoia, panic disorder, and suicide behaviour. The study found that genetic predisposition, depression, parental neglect and financial problems, experimentation with substances for relaxation, peer group pressure, and co-occurring disorders are high risk causes for substance abuse. The experience of participants in treating substance use disorder with co-occurring disorders involves which disorders get treated first, and the mental state of patients for effective treatment. The various substance abuse treatment models includes person centred approach, bio-psychosocial approach, holistic approach, eclectic therapy, integrated approach, resilient approach, rational emotive behavioural therapy, family therapy, motivational interviewing, 12-step programme, and cognitive behavioural therapy. The participants’ experience with CBT entails its usability in both individual and group therapy, the use of CBT skills after therapy, and CBT effectiveness in relapse prevention. Accessibility and affordability of CBT treatment is influenced by access to rehabilitation centres and cost of rehabilitation centres. Lastly, individual factors, family factors, and environmental factors are part of the contributing factors towards high relapse rates. / Psychology / M.A. (Psychology)

The prevalence of dieting is alarmingly high amongst adolescents in South Africa. Dieting behaviour, influenced by the promotion of the thin ideal, poses one of the main risks for eating disorders, which have serious physical, psychological and social consequences, including death. Treatment of eating disorders is a costly, difficult and long-term process, therefore preventative measures have been advocated. One of the shortcomings of existing school-based primary intervention programmes has been the failure to bring about significant changes in body image, a key defining feature of eating disorders. This study evaluates the effectiveness of a modified version of Rosen's body image programme with adolescents, with the view to exploring the idea of adding a body image component to existing preventative programmes. The modified version of Rosen's programme proved to be effective in improving the body image of mid-adolescents. / Educational Studies / M. Ed. (Psychology of Education, with specialisation in Guidance and Counselling)

This research was executed as three separate studies. Study 1 focused on the perception of pain and the semantic aspects of pain. Study 2 focused on the measurement of acute pain and mood states. Study 3 focused on the psychological treatment of cancer pain. In Study 1 a group of 66 Setswana-speaking adults were required to describe what they saw, what happened, and what would be the outcome with respect to three visually presented pain scenes using The Pain Apperception Test (PAT) A qualitative analysis of their responses shows that pain is experienced as an all encompassing experience affecting all aspects of their lives, such as the physical, emotional, social, and economic. This was found to be true, irrespective of gender and age with the exception of economic issues. A qualitative analysis of their responses to the Pain Eliciting Incidents Questionnaire (PEIQ) reveals that the Setswana pain descriptors are classifiable according to the three dimensions of pain namely, the sensory-discriminative, affective-motivational, and cognitive-evaluative. Sludy 2 applied the Profile of Mood States (POMS) preoperatively to a group of 58 female laparotomy (gynaecological) patients. These patients were also tested post-operatively with the Visual Analogue Scale (VAS) and the Wisconsin Brief Pain Questionnaire (WBPQ) as pain measures. The pain measures were taken at no medication and at the peak of medication. Factor analysis could not confirm the validity of the six POMS scales. These scales also did not show correlations with post-operative pain. Correlations between the pain measures showed acceptable reliability and validity of the VAS and the WBPQ. In Study 3 three groups of 15 cancer patients each, suffering from chronic pain, were treated over a period of two weeks with either cognitive behavioural therapy plus medication, reassurance therapy plus medication, or medication only. Comparison of before and after treatment pain measures showed that both cognitive behavioural therapy and reassurance therapy had a beneficial effect. Follow-up results three months later showed that the beneficial effect of reassurance therapy did not persist. Patients treated with cognitive behavioral therapy still showed the beneficial effects thereof. / Psychology / D. Litt. et Phil. (Psychology)

This research concentrates on the development of an intervention model for the sexually abused latency aged child. The focus is on short term, structured individual therapy. The importance of this model is linked to the underlying theoretical basis that it provides as well as the guidelines suggested for therapy. Intervention research was used as research methodology. This methodology implies a combined quantitative and qualitative approach. The first part (Chapters 2, 3&4) addresses the problem analysis and information gathering linked to the development of a theoretical basis for the intervention model. The latency years as developmental stage is discussed and suggestions are made as to which this information can be used during the planning and conducting of intervention. The reasons for the child’s vulnerability to become a sexual abuse victim are explained. The different forms of sexual abuse are indicated and it is argued that one child can be abused by another. The social environments where sexual abuse might occur are described as well as the possible consequences that sexual abuse holds for the victim. The second part of this research (Chapters 5&6) is related to the design of the intervention model, the conducting of a pilot test and the refining of the intervention. The key elements of abused focused therapy, cognitive behavioural therapy and movement therapy is outlined. These approaches serve as theoretical background for the formulation of the principles of the intervention model. The areas of focus during intervention are described. In Chapter 7 an outline of the intervention program is described. This programme can be viewed as a practical application of the intervention model. A detailed description of every therapy session is provided. The intervention program was tested on three children from the Jakaranda Children’s Home in Pretoria. Chapter 8 indicates the results of the empirical research as well as the interpretation thereof. The focus of this chapter is on the results as referring to the changes in the respondent’s experience of compliance, relationships, security and anxiety. The research results clearly shows that the three respondents were helped by the intervention and that they were no longer overwhelmed by their experience of the sexual abuse. The study is concluded in Chapter 8 with some remarks in summary and proposals for further research. / Thesis (DPhil (Social Work))--University of Pretoria, 2005. / Social Work and Criminology / unrestricted

Pain during sexual intercourse, now classified under the single term of genito-pelvic pain/penetration disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), would affect up to 34% of young women and 45% of older women. Provoked vestibulodynia, a chronic pain elicited via pressure to the vulvar vestibule or attempted vaginal penetration, is the most common form of pain during intercourse. Controlled studies have shown that provoked vestibulodynia has multiple deleterious physical, psychological, sexual and relational impacts and thus greatly affects women’s quality of life, as well as their partners’. Provoked vestibulodynia occurs in the very intimate context of sexual intercourse. In that context, women’s self-concept could be negatively affected. Moreover, research among couples with provoked vestibulodynia has demonstrated the role of interpersonal factors in the modulation of women’s pain and associated consequences for both partners. Considering the documented efficacy of cognitive-behavioural therapy for chronic pain, including provoked vestibulodynia, and the importance of the relational context for this condition, a new cognitive-behavioural couple therapy has been developed by our team. It is the first treatment to take into account the interpersonal context of provoked vestibulodynia. Furthermore, we lack empirical evidence on mediators of change of cognitive-behavioural therapy for provoked vestibulodynia and on positive psychological factors that could foster better adjustment for women and their partners. The objective of this thesis was to use a dyadic perspective to examine the role of self-compassion in the adjustment of couples coping with provoked vestibulodynia, as well as the roles of both partners’ pain self-efficacy and pain catastrophizing as mediators of change in cognitive-behavioural couple therapy. The first study examined the associations between self-compassion of women with provoked vestibulodynia and their partners and their depression, anxiety, sexual distress and relational satisfaction as well as women’s pain intensity during intercourse. Forty-eight couples with provoked vestibulodynia completed self-report questionnaires. For both women and their partners, higher levels of self-compassion were associated with their own lower anxiety and depression. When partners reported higher levels of self-compassion, they were more satisfied with their relationship, and both partners and women reported lower sexual distress. No significant association was found for pain during intercourse. The second article examined pain self-efficacy and catastrophizing as mediators of therapeutic change regarding pain, sexual distress and sexual function in cognitive-behavioural couple therapy for provoked vestibulodynia. Because cognitive-behavioural couple therapy did not improve significantly more pain self-efficacy relative to lidocaine treatment, this variable was not included in subsequent mediation models. In women with provoked vestibulodynia, greater decreases in pain catastrophizing in cognitive-behavioural couple therapy, as compared to the lidocaine control condition, mediated reductions in pain intensity and sexual distress as well as improvement of sexual function. In partners, greater decreases in pain catastrophizing in cognitive-behavioural couple therapy, as compared to the lidocaine control condition, mediated reductions in sexual distress and improvement of sexual function. Partners’ pain catastrophizing reductions also mediated women’s decrease in sexual distress. Implications of results, as well as theoretical, methodological and clinical contributions of the thesis are discussed. / Les problèmes de douleur durant les relations sexuelles, maintenant désignés par le terme « douleur génito-pelvienne » dans le Manuel diagnostique et statistique des troubles mentaux (DSM-5), toucheraient jusqu’à 34% des jeunes femmes et 45% des femmes plus âgées. La cause la plus fréquente de douleur génito-pelvienne serait la vestibulodynie provoquée (VP). Les études contrôlées indiquent que la VP a des conséquences négatives multiples, physiques, psychologiques, sexuelles et relationnelles, et hypothèque donc grandement la qualité de vie des femmes qui en souffrent, ainsi que celle de leurs partenaires. Une particularité de ce problème de douleur chronique est le contexte dans lequel il survient, soit celui des relations intimes. Dans ce contexte, l'image que les femmes souffrant de VP ont d'elles-mêmes en tant que partenaires sexuelles serait affectée. De plus, la recherche a démontré l’influence des facteurs interpersonnels sur l’intensité de la douleur et les conséquences psychologiques et sexuelles associées. Considérant l’efficacité documentée des thérapies cognitivo-comportementales (TCC) pour la douleur chronique, incluant la VP et l’importance du contexte relationnel de cette problématique, une nouvelle TCC de gestion de la douleur a été développée pour les couples. Ce traitement vient combler une lacune importante du domaine puisqu’aucun autre traitement à ce jour ne tient compte de l’influence des facteurs interpersonnels. Par ailleurs, le manque de connaissance des mécanismes de changement sous-tendant l’efficacité des traitements psychologiques pour la VP ainsi que le peu d’études sur les facteurs psychologiques qui joueraient un rôle protecteur chez les femmes souffrant de VP sont d’autres limites du domaine. Afin de pallier ces lacunes, l’objectif de la thèse était d’examiner dans une perspective dyadique le rôle de l’auto-compassion dans l’ajustement de couples faisant face à la VP, de même que le rôle du catastrophisme et l’auto-efficacité comme médiateurs de changement dans le cadre d’un essai clinique randomisé évaluant l’efficacité de la thérapie cognitive-comportementale de couple (TCCC). Le premier article de la thèse visait à examiner les liens entre l’auto-compassion et l’ajustement psychologique et sexuel des femmes souffrant de VP et de leurs partenaires. Quarante-huit couples ont complété des questionnaires auto-rapportés. Les analyses ont montré que plus d’auto-compassion chez les femmes souffrant de VP était associée à moins de symptômes dépressifs et anxieux chez celles-ci. Plus d’auto-compassion chez les partenaires était aussi associée à moins de symptômes dépressifs et anxieux de même que plus de satisfaction relationnelle chez ceux-ci. De plus, des niveaux plus élevés d’auto-compassion chez les partenaires étaient aussi associés à moins de détresse sexuelle pour eux et pour l’autre membre du couple, soit la femme souffrant de VP. Aucune association avec l’intensité de la douleur n’était significative. Dans le deuxième article de la thèse, l’auto-efficacité et le catastrophisme ont été examinés en tant que médiateurs de changement thérapeutique au cours de la TCCC, comparée à un traitement médical, la lidocaïne topique. Puisque la TCCC n’améliorait pas l’auto-efficacité significativement plus que le traitement de lidocaïne, cette variable n’a pas été incluse dans les modèles de médiation. La TCCC, en comparaison avec le groupe contrôle de lidocaïne, diminuait significativement la douleur, la détresse sexuelle et la fonction sexuelle des femmes via la plus grande diminution de leurs propres niveaux de catastrophisme, en comparaison au groupe contrôle de lidocaïne. La plus grande diminution du catastrophisme chez les partenaires, en comparaison au groupe contrôle, expliquait également les améliorations quant à leur propre détresse et fonction sexuelle. Enfin, la plus grande diminution du catastrophisme chez les partenaires expliquait la diminution de la détresse sexuelle des femmes dans le groupe TCCC, en comparaison au groupe contrôle. Les implications de ces résultats et les contributions théoriques, cliniques et méthodologiques de la thèse sont discutées.

Over the past five decades, universities across the globe have been subjected to powerful forces of change that have impacted their definition, governance and funding structures, and managerial practices. In South Africa, the reform process was amplified by the country’s apartheid legacy and the political and socio-economic realities. Consequently, the transformation has resulted in the corporatisation of universities and the re-engineering of the academic profession into a managed profession that brought about a changed work environment with less secure conditions of employment, more expectations and increased work pressure, with diminished autonomy. The changed and changing South African higher education environment has had and continues to have its effects on academic employees’ well-being, health and morale. Limited research has investigated the sense of purpose and meaning and psychological health of academic employees. Moreover, there is an absence of empirical studies that have reported on the development and evaluation of a brief group-based meaning-centred intervention that focuses on both the sense of purpose and meaning, and psychological health of academic employees. The primary aim of the study was to first explore the meaning and/or meaning frustration embedded in the academic employee experience, in order to develop and empirically assess a brief group-based meaning-centred intervention in a higher education setting. The intervention was articulated from a logotherapy perspective of Viktor Frankl’s system of psychotherapy. An intervention mixed methods design, consisting of four interdependent phases, was used to pursue the aim of the study. The phase one qualitative single case study was used to explore and describe the sense of meaning and/or meaning frustration embedded in academic employees’ experiences. This was used as a means of developing and supporting the intervention that was implemented in the phase three quantitative quasi- experimental single-group pre/post test study. Phase two was thus an applied phase where the intentional mixing of the qualitative and quantitative phases took place. Likewise, phase four was an applied phase since it was used to draw conclusions based on the integration of the phase one findings and the phase three results. The results of the quantitative study indicated that the majority of academic employees who participated in the study had a sense of definite purpose and meaning (MPIL-post = 114.59, SDPIL-post = 18.04) and psychological health, despite the changed and changing HE landscape. The main finding suggests that a logotherapy brief group-based intervention, with a strong cognitive restructuring component, may have a positive impact on the sense of purpose and meaning of academic employees, whilst reducing the presence of symptoms of depression, post traumatic stress, binge eating and panic. The experience of purpose and meaning in work, and adaptive psychological coping, was related to academic employees’ sense of making a difference in students’ development, the appreciation they have received from students, their freedom of choice, their view of work as a calling, the unique benefits of working in HE, meaning beyond the meaning in the moment (ultimate meaning) and making a difference in colleagues’ (staffs’) lives. Llimitations in the study are noted and recommendations are made to formalise existential analysis as a research method of meaning informed organisational assessment. / Psychology / Ph. D. (Counselling Psychology)

This research aimed to investigate how life coaching influenced five female high school learners (aged 16 and 17 years old) at an independent school in Gauteng province. The learners attended four life-coaching sessions with an experienced and accredited life coach over a period of eight weeks. Data was collected from a literature review of previous research on life coaching and coaching in general, interviews with the learners both before and after the life coaching experience and from journal entries kept by the learners during the process. All learners learnt through the process and experienced positive changes in their lives. This included improved balance in their lives; improved time management, reduced stress and more positive mind-sets. They were able to set goals and achieve some success during the process. They expressed increased confidence in themselves and their abilities to overcome challenges in their lives and recommended life coaching for other learners. / Educational Management and Leadership / M. Ed. (Educational Management)