M.A. (Psychology) / Please refer to full text to view abstract

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D.Litt. et Phil. / This research focuses on the development of a short-term cognitive behavioural intervention treatment programme for adult victims of hijackings who developed Post-Traumatic Stress Disorder (PTSD) as a result. A programme was developed incorporating previously tested cognitive behavioural techniques and was tailored to the South African context. The need for the study arose out of the serious crime problem facing the South African population.Crime is rampant and has spread to all avenues of people's lives. There is no place that can be presumed to be safe. Being a victim of a car hijacking is a traumatic experience, and the effects thereof are often far-reaching in a person's life. It has been found that many people develop PTSD as a result of an experience, which is out of the range of 'normal' human experience (a trauma).

The aim of this research study was achieved by providing support for the effectiveness and the transportability of the Ehlers and Clark (2000) cognitive therapy model for the assessment and treatment of PTSD. Furthermore, the contextual factors which were important in this case were investigated and documented. However, research within the social sciences will inevitably produce various limitations due to the unique individuals and dynamic phenomena that are studied.

Thesis (PhD (Psychiatry))--University of Stellenbosch, 2005. / Many gaps remain in our current state of knowledge about the epidemiology, phenomenology, neurobiology, and psychopharmacology of posttraumatic stress disorder (PTSD) in children and adolescents. Empirical evidence, particularly in non-Western settings, is sparse and there is little convergent understanding of the interrelationship of epidemiological factors, PTSD symptom expression, full and partial syndromes, disorders comorbid with PTSD, and pharmacotherapeutic interventions. Clinicians are faced with the difficult task of treating this often complicated and debilitating disorder in youth in the absence of data from well-controlled clinical trials. The studies detailed here are a point of departure for understanding the confluence that exists between epidemiological, phenomenological, and pharmacotherapeutic aspects of adolescent PTSD. Two studies were conducted to investigate the prevalence and effects of violence exposure and PTSD, clinical and functional correlates of full and partial syndromes, and associated gender differences in school and clinic samples, respectively. Two preliminary open-label trials assessed the efficacy and safety of a selective serotonin reuptake inhibitor (SSRI) in adolescents with at least moderate severity PTSD. The results indicate that (i) partial PTSD is a common nosological entity in adolescents, (ii) gender-related differences in PTSD, even if not manifest in differences in prevalence (i.e., in the rates of trauma exposure and full and partial PTSD), may well manifest in symptom expression (i.e., higher symptom burden in girls), associated morbidity, and functional impairment, and (iii) SSRIs may be effective in treating core PTSD symptoms in this age group. While not yet demonstrated, the partial subtype may have similar biological underpinnings to full PTSD in adolescents and may benefit from similar pharmacotherapeutic interventions. This is an area deserving of further investigation. Controlled SSRI data are needed to establish if these should be agents of choice for paediatric PTSD.

There is currently a crisis in military veteran mental health care. At 5-30% of veterans receive a PTSD diagnosis. Veterans face a large gap that exists in accessing and receiving high quality care. One intervention that is becoming more popular is equine assisted counseling (EAC). The purpose of the present study was to examine the effectiveness of Relational Equine-Partnered Counseling (REPC) in reducing symptoms of PTSD in military veterans. I also examined specific PTSD symptom clusters including intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The present study utilized a single-case design consisting of a baseline phase, intervention phase, and post-intervention phase. Participants included four military veterans presenting for war zone-related PTSD: four males and one female, aged 32-67 years, two White/European non-Hispanic, one African American non-Hispanic, and one mixed ethnicity. Symptoms were assessed weekly using the Clinician-Administered PTSD Scale and the PTSD Checklist (PCL-5). The data were analyzed by visual analysis and statistical effect size. The results were mixed across the participants. All participants experienced decreased means between the baseline and intervention phases. However, interpretation of the results indicated that the intervention was effective in some areas for some of the participants. All participants reported that the intervention was beneficial in targeting specific symptoms. Overall, the results indicated that REPC may have some benefit in reducing distress related to PTSD. More research is needed to further explore the effectiveness of REPC on the reduction of PTSD-related distress.

Clinicians’ attitudes and behaviors toward patients with borderline personality disorder (BPD) are affected by the label’s stigma. Complex posttraumatic stress disorder (CPTSD) was proposed as a comprehensive and less stigmatizing diagnostic category for clients with BPD and a history of complex trauma. Given considerable similarities across both disorders’ diagnostic criteria, the CPTSD framework holds promise as a means to improve therapists’ attitudes towards clients with BPD and a history of complex trauma. However, this quality of CPTSD had not yet been examined empirically. Using vignettes in a between-subjects experimental design, this study investigated whether CPTSD is a less stigmatizing label than BPD for trauma survivors. Participants were 322 practicing psychotherapists. Evidence of BPD stigma was found, as was an affinity for CPTSD. Results generally supported CPTSD as a less stigmatizing label than BPD; therapists presented with a CPTSD-labeled vignette were somewhat less likely to blame the client for her symptomatic behavior and expected slightly stronger working alliance with the client than therapists presented with the BPD-labeled vignette. However, therapists’ agreement with the BPD diagnosis and theoretical orientation were found to be more salient than diagnostic label in affecting concepts related to the stigmatization of BPD clients. Additionally, familiarity with CPTSD was related to more favorable attitudes toward the client and her course of treatment. Regardless of CPTSD’s recognition as a formal diagnosis, education about the construct is widely recommended for therapists.

The purpose of this study was to examine and compare individuals that had survived a single incidence trauma, the Luby's massacre in Killeen, Texas. Participants answered questions regarding various facets of social support following the trauma, and were also screened for a diagnosis of PTSD. Participants' level of symptoms, specifically depression, anxiety, and phobic anxiety was measured over time with the SCL-90-R. The results of this study indicate that, while women initially experience a higher level of depression and phobic anxiety, there is no gender difference in rate of symptom change over time. This study also found that women were significantly higher than men on desirability, utilization and usefulness of social support. Of the target symptoms, however, only depression correlated with any facet of social support, specifically, desirability. Finally, this study questioned whether individuals would share more similarities with others based on gender or diagnosis. It is suggested by the current data that diagnosis is the better indicator of similarity.