Since the fall of man, God in His grace has called specific persons and set them apart for a specific purpose. This calling can only be realised through the powerful working of the Spirit of God. However, this calling does not indemnify the called person against the stressful dispensation, where Satan still has influence and where people are still in a struggle with their own sin as well as the sin of others. The high stress levels which some ministers experience because of their calling can result in chronic stress, depression, bum-out and even early death. Research in this study made it clear that most ministers of the GKSA probably experience high levels of negative stress and show signs of burnout and depression. Ministers of the GKSA find themselves in a world where secularism reigns, among others because humanism, rationalism, individualism, pluralism and even relativism are emphasised and are gaining ground, as a result of the current popularity of the postmodem spiritual trend. The result is that people are inclined to elevate themselves and to question absolute spiritual truths, at the expense of the honest teachings of the gospels. An empirical study was conducted involving nine ministers of the GKSA in an in-depth study of stress by means of a qualitative research topic. A grounded phenomenological qualitative study method was chosen, since the study concerned people who were not a homogenous group and who could not be quantified. It is their perceptions of the world they are living in which are important here and which can give rise to high stress levels. The results indicate that ministers experience tremendous inner conflict to maintain a focus on God only in their ministry and not to succumb to the temptations and pressure of present-day worldly standards. In addition, they are in a constant conflict with secularism in their congregations, especially with regard to the tendency to compare, measure and manipulate the minister and his congregation according to worldly standards. Based upon the basis theory and the meta-theory, a practice theory was developed by outlining the contours of a model for pastoral guidance for ministers with high stress levels. On the one hand, factors giving rise to high stress levels among the ministers of the GKSA may be addressed by introspection regarding their relationship with their Creator, their own spiritual growth and the example they set for their congregations. On the other hand, they are also tasked with guiding the congregation in which God placed them to break away from their own sinful worldly nature and to direct them towards God and His promises. The ministers are important instruments in God's divine plan in which all of the chosen will be allowed to share in His salvation, when Christ will return and glorify God. / Thesis (Ph.D. (Pastoral))--North-West University, Potchefstroom Campus, 2007

Background: Attachment literature indicates attachment status is related to trauma with associations between early trauma and insecure attachment. Links between psychosis and trauma have been established within the literature; however the precise nature of this relationship is still not fully understood. A systematic review was carried out to assess the state of the evidence pertaining to psychosis and attachment. Associations between insecure attachment and psychotic symptoms were identified. Other psychological correlates such as perceived parental care, attachment to services and interpersonal problems were found to relate to insecure attachment status. However due to the early stage of this area of research, small clinical sample sizes and heterogeneity of correlates investigated, firm conclusions cannot currently be drawn. Aim: The aim of this study was to investigate the relationship between trauma, attachment, reflective functioning (RF) and distress for people with psychosis with a view to further understanding these links and the clinical implications. Method: Participants with a diagnosis of psychosis were recruited and measures were completed with the principle investigator pertaining to trauma, attachment and distress in psychosis. Results: The majority of the sample reported insecure attachment and low RF and there were high levels of general, and more specifically, interpersonal trauma within the sample. Results indicated that early interpersonal trauma was associated with higher levels of emotional distress. Exploratory mediation analyses implicated anxious attachment in mediating the relationship between interpersonal trauma and distress. Discussion: The results indicate the need to consider early trauma histories and specifically interpersonal trauma and attachment in the context of emotional distress for people experiencing psychosis. Incorporating trauma and attachment based therapeutic approaches for people with psychosis is as relevant as it is for other trauma populations, where these approaches may be more routinely drawn on for formulation and treatment. Limitations of the methodological approach are considered along with suggestions for future research.

With the corporatization of healthcare, combined with rapid advances in medical technology, frontline health care workers, especially nurses, are facing an increase in daily ethical dilemmas, with potential increases in moral distress. The contributing factors and negative effects of moral distress are well researched, in particular as they impact nurses in specialty areas. However, understanding how nurses navigate moral distress, specifically in general medical and surgical units, is not as well understood. The purpose of this study was to understand and articulate the processes that nurses carry out when navigating moral distress, by exploring their interactions with the health care environment. Using grounded theory methodology, a substantive theory was developed to explain the process. The participants in this study were all registered nurses from an acute care academic hospital, who worked on non-specialty medical and/or surgical units. Data collection consisted of audio-recorded face-to-face interviews that were transcribed post interview. All the events and situations that resulted in the experience of moral distress were primarily rooted in organizational structures, which often blindsided the nurses in this study, and led to a sense of feeling ill-equipped and unsupported to respond in the moment. Furthermore, the participants expressed their inability to be agents of change due to the established organizational expectations. The basic social process for navigating moral distress was “Just getting through the shift”. This theory is comprised of the categories of Experiencing Moral Distress, Making Sense of the Situation, and Finding the Way. In working through these processes, the participants engaged in navigating moral distress. Making sense of the situation was an ongoing process that nurses engaged in whereby they sought out knowledge in various ways, such as exploring internal resources, and building relationships with their peers, their patients, and patients’ families. Throughout this iterative process of making sense of the situation, the nurses were then able to find their way. Participants discussed positive outcomes such as reflecting and learning from the experience. However, despite this response, there was a feeling of powerlessness to make a difference. Therefore, they focused on providing the best care they could and getting on with their shift without experiencing closure. / Graduate

The purpose of this study was to functionally define and empirically test a model of psychological distress for mothers of children diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD). This model delineates characteristics of the child, the parent, and the environment that may affect mothers' psychological symptomatology.

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder and is associated with impairment in multiple domains. Research on the development of PTSD symptoms is often limited by the use of cross-sectional designs and retrospective reports of pre-trauma factors. The trauma film paradigm allows for the measurement of pre-trauma factors to determine which variables serve as prospective predictors of posttraumatic stress symptom development. Two factors which may predict posttraumatic stress symptom development are distress intolerance and attentional control. Research suggests distress intolerance is related to posttraumatic stress symptoms, but this relationship has only been shown cross-sectionally. Research has further shown attention control prospectively predicts posttraumatic stress symptoms. Cross-sectional research also suggests attentional control moderates the relationship between distress intolerance and posttraumatic stress symptoms. The current study used the trauma film paradigm to investigate whether attentional control moderates the relationship between distress intolerance and posttraumatic stress symptoms. The current study findings were mixed, but suggest that attentional control does not moderate the association between distress intolerance and posttraumatic stress symptoms. These results suggest distress intolerance and attentional control may not be important variables in the development of posttraumatic stress symptoms.

After the Second World War mothering became an object of social, political, medical and psychiatric investigation. These investigations would in turn serve as the bases for new campaigns around the practice, meaning and significance of maternity. This brought attention to mothers' emotional repertoires, and particularly their experiences of distress. In this thesis I interrogate the use of maternal distress, asking how and why maternal distress was made visible by professions, institutions and social movements in postwar Britain. To address this I investigate how maternal mental health was constituted both as an object of clinical interrogation and used as evidence of the need for reform. Social and medical studies were used to develop and circulate ideas about the causes and prevalence of distress, making possible a new series of interventions: the need for more information about users of the health care service, an enhanced interest in disorders at the milder end of the psychiatric 'spectrum', and raised expectations of health. I argue that the approaches of those studying maternal distress were shaped by their particular agendas. General practitioners, psychiatrists, activists in the Women's Liberation Movement, clinicians interested in child abuse and social scientists, sought to understand and explain mothers' emotions. These involvements were shaped by the foundation of the National Health Service in 1948 and the crystallization of support for alternative forms of care into self-help groups by 1979. The story of maternal distress is one of competing and complementary professional and political interests, set against the backdrop of increasing pessimism about the family. I argue that the figure of the distressed mother has exerted considerable influence in British society. As such, this research has important implications for our understanding of how mental distress developed into a mode of social and political critique across the late twentieth century.

Magister Artium - MA (Psychology) / Psychological distress during pregnancy has been a fairly neglected phenomenon and has only recently started emerging as an area of research interest. The existing body of scholarship on distress during pregnancy has largely been conducted from a positivist paradigm, emphasising the identification, incidences and risks. There is thus a dearth of qualitative inquiry into pregnant women's experiences and accounts of distress. In an attempt to address these gaps within the literature, my study explored psychological distress among a group of pregnant women from socio-economically disadvantaged contexts. The specific objectives of my study was to explore how pregnant women conceptualised psychological distress within the context of pregnancy; the feelings or symptoms of psychological distress; what pregnant women perceived as its causes; and the psychosocial needs of pregnant women in relation to antenatal distress. This study was guided by a feminist approach and a feminist standpoint epistemology in particular. This lent itself to exploring the phenomenon while departing from a clinical, decontextualised position which translated into an investigation with pregnant women who subjectively perceived themselves to be distressed.

Moral distress is a negative emotional and somatic response to external constraints on moral action. The constraints are typically identified as a component of the work environment, called the ethical climate. Moral distress is identified as a primary reason for job attrition by up to one-quarter of registered nurses who leave their jobs. One strategy suggested to staff nurses who experience moral distress is to consult their Nurse Manager (NM). However, the moral distress of NMs who are employed in acute care hospitals is poorly understood. The purpose of this qualitative study was to examine NMs' perceptions of the external constraints on moral agency, specifically the hospital ethical climate, which leads to their experience of moral distress and how attributes of the ethical climate facilitated or impeded resolution of their moral distress. Semi-structured, audio-recorded telephone interviews were conducted with 17 NMs from across United States. An interpretive description design using an iterative process between data collection and data analysis was used. Data were analyzed through descriptive coding and thematic analysis. The participants in this study were 15 women and 2 men with a mean age of 46.4 years. The mean length of time in their current positions was slightly less than 5 years. Of the 17 hospitals represented, 6 were affiliated with a university and 4 had a religious affiliation. Fifteen of 17 NMs described situations in which the implicit and explicit values of the hospital were incongruent with their personal moral values and professional ethics. Common themes describing factors contributing to moral distress were administrative policies, negative communication patterns and relationships with physicians, issues related to staff nurses, issues related to patients and families, and multiple competing job obligations. Respondents described strategies to navigate through their moral distress. The strategies included taking a positive perspective, seeking the advice of NM colleagues, reliance on a positive relationship with a supervisor, and talking it through with family members. For 5 of the 15 NMs who experienced moral distress, their final strategy included plans to resign from their positions. Issues within the ethical climate of the hospital that were perceived to contribute to the development of moral distress among this cohort of NMs differed from those reported for staff nurses. Further examination of strategies used by NMs to improve the ethical climate may yield insights into effective ways to address moral distress for this population.

Maternal responsiveness to infant needs is critical to child development. Few studies have attempted to identify basic processes that underlie responsiveness. Parenting theory suggests that distress tolerance (DT) may be important to understanding dysfunctional parenting. Distress tolerance refers to an individual’s ability to withstand subjective internal distress (e.g., uncomfortable thoughts, feelings). Despite its significance in the study of psychopathology, DT is not a well validated construct. Thus, the primary objectives of the present study were 1) to validate the construct of DT in a sample of perinatal women, and 2) to examine the concurrent and longitudinal associations between perinatal DT and maternal responsiveness. Eighty-six pregnant women in their third trimester and their respective informants completed an online survey of DT. At 4-months postpartum, a research team collected observational assessments of maternal responsiveness and a second assessment of self-reported DT. Factorial validity of DT was demonstrated through confirmatory factor analysis and suggested that DT is best represented as a multidimensional construct. Convergent validity of DT was demonstrated by small to moderate correlations (r’s = .16-.53) between self- and informant ratings of DT. Results of path analyses demonstrated a small association (r=.19) between prenatal DT and responsiveness; however, no association was found between postpartum DT and responsiveness. These findings suggest that targeting DT during pregnancy may improve outcomes for women and their infants. Distress tolerance skills are used in a number of empirically supported psychotherapies. Similarly, these skills could be incorporated into existing prenatal programs and parenting interventions to increase responsiveness and, ultimately, improve child outcomes.

Cancer is an illness that knows no international boundaries. There are more than eight million global cancer deaths each year. A life-threatening diagnosis generates significant emotional problems for many patients across cultures. Death distress—consisting of death depression, death anxiety and death obsession—often results in poorer treatment adherence and lower overall health and quality of life. The purpose of this study was to determine whether religiosity has a moderating effect on the relationship between death distress and quality of life among patients facing a life-threatening cancer diagnosis. The study sample consisted of 118 cancer patients: 82 cancer patients from a National Guard hospital in Saudi Arabia and 36 cancer patients from H. Lee Moffitt Cancer Center, Tampa, Florida. Three validated scales were used to obtain data from study participants: the Death Distress Scale, the Belief into Action Scale; and the Functional Assessment of Cancer Therapy Scale. After a Pearson correlation were conducted and results indicated a moderately strong inverse relationship between death distress and quality of life among both the Christian (r=-.45, p <.001) and Muslim (r=-.39, p <.001) patient samples. The degree of religiosity among study participants did not alter the effect of death distress on quality of life. Results reveal that the interaction term was not statistically significant (b=.005, p=.32). However, quality of life correlated with degree of religiosity in both the Christian(r=.39, p=.018) and Muslim patient groups ( r=.24, p=0.034)). This finding reinforces the importance of religious involvement among cancer patients found in earlier research. The current study highlights the importance of a holistic treatment approach that includes a spiritual component for these vulnerable individuals and their loved ones. This holistic emphasis is particularly important for nurses, who often spend more time with cancer patients than other health care professionals. By proactively discussing common issues surrounding death distress with patients and families, nurses can provide much needed education and emotional support and make appropriate referral. Given that death distress appears to be a nearly universal experience among cancer patients regardless of religious affiliation, future research should develop evidence-based nursing protocols to address this vital topic.