Thesis (Ph.D.)--York University, 2005. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 102-140). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pNR11564

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This research portfolio examines the impact of trauma exposure in the emergency services. Emergency services represent a unique population in that they are frequently and repeatedly exposed to distressing and potentially traumatic situations. Firstly, a systematic review was conducted looking at factors that may potentially predict positive outcomes following trauma exposure in firefighters, namely the concept of posttraumatic growth (PTG). A review of the existing evidence was conducted across five databases. Studies were assessed against inclusion criteria and 12 studies were included. Results suggested that PTG was generally either not significantly or weakly related to other factors. Variables that were associated with PTG were aspects of the trauma exposure, post-traumatic stress severity and organisational and operational factors; however results were limited by methodological quality. Overall, the current evidence base has not identified strong predictors of PTG and associations appear multifactorial. Results indicate that PTG appears to have limited clinical utility in firefighters and that future research should improve upon the methodological limitations of the existing evidence base. The second part of the portfolio consists of an empirical study exploring the levels of post-traumatic stress symptom (PTSS) severity in ambulance clinicians and a cross-sectional analysis of factors relating to PTSS severity and psychological wellbeing in this population. A total of 508 ambulance clinicians (Paramedics and Ambulance Technicians) were recruited across Scotland. The relationships between PTSS severity, psychological wellbeing, self-compassion and psychological inflexibility were analysed using structural equation modelling. Results showed approximately 50% demonstrate clinically concerning levels of PTSS in the ambulance service and a strong positive relationship between psychological inflexibility and PTSS severity as well as with psychological wellbeing. Self-compassion had a small association with psychological wellbeing but was not significantly associated with PTSS severity. The potential impact of relying on post-traumatic stress disorder criteria of symptoms lasting for four weeks or more may mask the extent of PTSS experienced in this population. Findings indicate concerning levels of trauma symptomology within a representative ambulance service sample, and suggest the need for further investigation into potential causal relationships between psychological flexibility and PTSS in order to deliver effective interventions to reduce PTSS severity in this population.

M.A. / The current social and political situation in South Africa has resulted in an extremely violent climate in which the incidence of highly stressful events experienced by people on the whole is extremely high. The severe and pathological negative symptoms that often follow the experience of highly stressful events are defined as Post-traumatic Stress Disorder (PTSD) in the Diagnostic and Statistical Manual for Mental Disorders - IV (DSM-IV)(APA, 1994). An improved understanding of the factors involved in the development, treatment and prevention of PTSD is important considering the potentially debilitating effects of this disorder. With the increasing emphasis being placed on 'positive' psychology, the salutogenic orientation was given focus in this study. Antonovsky (1979, 1987) defines salutogenesis as 'the origins of health', and the emphasis is on identifying those factors in which health originates and is promoted. This study aimed to investigate two specific variables, sense of coherence (Antonovsky, 1979, 1987) and self-efficacy (Bandura, 1977, 1986) as two potential psychological resilience factors that may positively contribute to effective functioning after the experience of a highly traumatic event. The research tested a postulated model which suggested that the two resilience variables influence the presentation of PTSD symptoms after exposure to a traumatic event. The research was conducted in a police and banking environment with 50 participants, all of whom had experienced a traumatic event as defined by the criteria in the DSM-IV. Three measuring instruments were used to measure the constructs of interest. PTSD symptomatology was measured by means of Horowitz's "Impact of Events Scale - Revised" (Weiss & Marmar, 1997), self-efficacy in the face of a traumatic event was measured by means of a specific questionnaire constructed by the researcher for this study (SEFTE), and sense of coherence was measured by means of Antonovsky's "Orientation to Life" questionnaire, or Sense of Coherence Scale (1983). The results of the study indicated that a relationship does exist between the three constructs of interest. A higher sense of coherence. contributes to higher selfefficacy expectations in the face of a traumatic event, and both these variables reduce the level of PTSD symptomatology after exposure to a traumatic event. In conclusion, the importance of understanding some of the psychological resilience factors which may help to prevent PTSD after exposure to a traumatic event, or at least reduce the severity of the symptoms, was highlighted. By doing so, emphasis can be moved from the treatment of PTSD after the event, to the prevention of the disorder, by strengthening the resilience of those people at risk of exposure to a highly traumatic event, before the event occurs.

M.A. / Hijacking has become so prevalent that the South African Police Service created a separate division to attend to these priority crimes, The Crime Information Analysis Centre. This division coordinates statistics and information and analyse factors leading to crime in order to plan a strategy to prevent it. The reasons for the multiplication of hijacking can be found in economic benefits, urbanization, dehumanization, inefficiency of law enforcement, the role of syndicates, security mechanisms in cars, and the ready availability of weapons. Few subjects are as relevant as trauma counseling, with few South Africans who have not experienced at some stage a crisis, shock or trauma due to crime, violent deaths, hijackings, rape, molesting and abuse, murder of farmers, and HIV and Aids. Trauma counseling is the professional treatment of a person experiencing problems, through constructive growth in faith and renewal, based on the atonement with God through Christ. It is important that the Bible be utilised in Christian counseling as the Spirit of God speaks through it. The counselor can help the traumatized patient by giving them the 12 opportunity to communicate their pain, anguish, fright, terror and anger in an honest way to God. Healing occurs when the traumatized find a (new) reason to live, through faith in the goodness of God. The counselor does not teach positive thinking but rather the truth of the Word of God instead of wrong thought processes and perceptions. In the end the client is taught to find meaning in their lives in the midst of tragic events and crises. With the help of God they are enabled top look back at what happened in the trauma and to realize that it makes sense. Even though Christians do not always understand God’s meaning with what He allows in their lives, they learn to trust Him. When they learn to look at their lives through God’s eyes, they realize the limitations of their own vision. Even pain has a purpose and can be the cause of growth and a sharper focus. It reminds us of the need to trust in God so that hijacking is not the end of life but the beginning of a new life.

M.A. / It is now well known that HIV/AIDS-sufferers face profound psychological, psychiatric and neurological sequelae as the disease progresses. However, studies indicate that women diagnosed with HIV-infection are twice more likely to be depressed, to suffer from PTSD and other psychiatric morbidity than men. Yet very few studies have attempted to investigate the role that gender plays in reacting to the illness. Finding out that one is HIV-infected is one of the most significant discoveries. This is due to the fact that in receiving an HIV-positive diagnosis individuals are exposed to news of prodigious personal consequence. And yet very few studies have focused on how the impact of finding out that one is HIV-positive may affect their adjustment to the illness. Moreover, how men and women are likely to react to such news. It is against this background that the current study was conducted. The aim of the current study was to compare post traumatic symptoms in men and women upon hearing news of their HIV-positive status and to investigate to what extent such reactions may be similar or different and to further assess how their reactions are likely to affect disease progression and adjustment. A total of one hundred participants (38 Male, 63 female) diagnosed with HIV/AIDS participated in the study. These men and women were obtained from support groups in the Gauteng region. The Impact of Event Scale-Revised and Mental Adjustment to HIV-Scale questionnaires were used to collect data over a period of a month. A large majority of 60.2% of the total sample (n = 87) reported experiencing feelings of shock upon hearing about their HIV-positive status, 66.0% of the total sample (n = 94) of those who responded to this item reported trying to remove the issue from their mind. A further 59.6% of the total sample of (n = 94) indicated feeling as though news about their HIV-positive status were not real suggesting that the incident was traumatic. There were no significant gender differences in how both men and women reacted to news of their HIV-positive diagnosis. However, significant differences were found in relation to adjustment. Men were found to be more likely to have more Fighting Spirit which is indicative of adaptive adjustment as compared to women. Women on the other hand were found to be more likely to be Hopeless which is indicative of maladaptive coping.

Magister Psychologiae - MPsych / This study focused on trauma and seeked to demonstrate that the application of a Buberian understanding to the experience of trauma can help shed light on the impact of trauma on a sufferer's life. The aim of the study was to gain an understanding of the impact of trauma on interpersonal relationships as well as to determine components of psychotherapy found most helpful in the recovering process. / South Africa

The purpose of this study is to provide an inclusive portrait of the experience of female spouses living with traumatized male Canadian soldiers healing from Post-Traumatic Stress Disorder (PTSD). By facilitating the articulation of the spouses' stories this research gives a voice to and fosters appreciation for this neglected population. As well, this study helps clarify the needs and possible therapeutic interventions for spouses of soldiers in psychotherapy for PTSD. Although recently there has been an increased focus on addressing PTSD in soldiers, there has been comparatively little research and clinical attention given to the soldiers' families. For this study, in-depth interviews were conducted with six spouses of former peacekeeping Canadian soldiers who received group therapy for PTSD. Using the Life Story interview method, a spontaneous picture of the spouses' experiences was elicited as part of a comprehensive relationship narrative. This provided the opportunity for understanding the experience of living with a soldier in treatment for PTSD within a couple relationship and larger social context. Narrative summaries were created from the interviews and follow-up was conducted with each participant to gain feedback on these narratives. Participants were also given the opportunity to read each other's narratives and discuss their impressions. The narrative summaries are presented along with thematic results. The participants' stories revealed instances of aggression, primary trauma and problems related to their husbands' periods of alcohol abuse, so Figley's model of Secondary Traumatic Stress was not the best conceptual fit to explain the experiences of these women. Limited support was found, however, for Hobfoll's (1998)model of a loss spiral to help describe the descent into chronic disability associated with combat-related PTSD as well as the difficulties soldiers experience in their transition from military service. This study's implications for practice include recommendations for groups for military spouses; the need to address the iatrogenic suffering of soldiers and their spouses; treatment recommendations for soldiers with PTSD. Future research also needs to include delivery and evaluation of a group-based counselling intervention for the spouses of traumatized soldiers. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

South Africa as a country is known for its high crime rate which produces an ongoing traumatising environment for its multicultural nation. Posttraumatic stress disorder in the general South African population is thought to be more prevalent than most international norms which make this topic both relevant and important. Cultural diversity is seen to play a role in the experience of PTSD which means that it has become important to gain an understanding of the potential effect of the individual’s cultural background on the processing of a traumatic experience and the symptoms related to the experience. The proposed research focused on appraisals of the traumatic event and symptoms (in schematic and cultural terms). An interpretive (with current cognitive conceptions of the disorder as guiding theory) phenomenological approach was used. The sample consisted of eight isiXhosa-speaking adults that qualified for a diagnosis of PTSD with no prior psychiatric diagnosis. Data was gathered using a semi-structured interview and analysed using the Interpretive Phenomenological Analysis. Results indicated that participants understood their PTSD symptoms in a functional manner but struggled to make sense of their traumatic event. Not understanding their traumatic event was the variable that maintained their PTSD diagnosis. Most of the interpretations made by these participants were fairly universal and there were very few links to content that can directly be attributed to a traditional African worldview. Practitioners may not need to completely reinvent the wheel as far as treatment strategies for PTSD for isiXhosa-speaking individuals in an urban setting go.

Background: This study identified, addressed and validated risk factors that can be measured in the peri-traumatic period which may eventually be used in predicting the development of traumatic stress. Many people in South Africa possibly suffer from Posttraumatic Stress Disorder (PTSD) if we consider the extent of trauma exposures that is apparent within the South African population. Traumatised individuals are at risk but may remain undiagnosed and untreated. It makes sense for first line and primary health care practitioners (i.e., not highly qualified psychological practitioners) to screen for risk since they have the initial contact with trauma individuals. A relatively easy screening instrument that can be administered time efficiently would be useful in this regard. The principles of this instrument are that it needs to be objectively measurable, quick and easy to administer. No consistent measure geared towards identifying risk factors in such a manner immediately post trauma currently exists in South Africa. Objectives: The overall aim was to start a process of designing a psychometric instrument that is valid in predicting the development of traumatic stress. Since this is the initial stage of constructing a new measure, content validity was of utmost importance. It became imperative to ensure that items were not only relevant and appropriate, but also accurate and capable in identifying at-risk individuals. The proposed end goal is to develop effective identification strategies in South Africa geared towards helping victims of traumatic events. Method: A pilot psychometric questionnaire was compiled using three major international reviews, South African research on known risk factors, and literature on PTSD risk assessment considerations. This preliminary assembled item pool was used as a departure point and evaluated quantitatively as well as qualitatively by expert reviewers who have research and/or clinical experience with PTSD in a South African context. Their feedback resulted in either the omission or the modification of certain items; for some items, further exploration was recommended. The questionnaire was further scrutinised and modified accordingly after qualitative interviews with and critical feedback from the intended administrators or primary health care professionals, namely Registered Counsellors (RCs) and/or nursing staff from a participating general government hospital and a non-government organisation. Findings: Expert reviewers did not agree consistently across all the items. At times they rated certain items as relevant according to the necessity of the information rather than with regards to the relevance of the content of the item – in terms of prediction of PTSD. It was also observed that intended administrators did not always agree with expert reviewers.