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

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.

Background: Recent Canadian Armed Forces operations involved multiple deployments and exposure to traumatic events that are associated with post-traumatic stress disorder, depression and substance abuse. Despite efforts to facilitate mental health care, some soldiers do not get the help they need. Objective: To understand soldiers’ experiences and explore barriers and facilitators they encountered accessing mental health care. Results: Qualitative descriptive interviews with 11 Canadian Armed Forces members revealed six major categories that provide insights into their experiences accessing mental health care. Participants’ revealed significant barriers to care including fear of damaging their career or being released, stigma beliefs and actions from peers and leaders, and physical and organizational barriers to care. Social support from family, military co-workers, and unit leaders facilitated care. Conclusions: Notwithstanding efforts to facilitate access to mental health care, some soldiers still perceive significant barriers to care.

Considerable research has demonstrated a link between thoughts of revenge, or vengeful rumination, and the development of posttraumatic stress disorder (PTSD) symptoms, particularly in situations involving interpersonal trauma. Personality factors have been related to both vengefulness and PTSD. No study to date has simultaneously examined the unique contributions of vengefulness and personality factors in the development of PTSD symptoms. Therefore, the present study addressed these questions in an inpatient sample by comparing contributions of the Big Five personality factors and vengeful rumination to the development of PTSD symptoms through correlation, hierarchical regression, and omnibus regression analyses. Results showed that Neuroticism predicted PTSD symptoms better than other personality factors, that Neuroticism and Agreeableness predicted vengeful rumination in opposite directions, and that personality factors and vengeful rumination each added unique variance in the prediction of PTSD symptoms. Future directions and implications are discussed.

The purpose of this study was to develop a manualized therapy group for wives or significant others of veterans with posttraumatic stress disorder and to evaluate its effectiveness in reducing wives' psychological symptoms. A second aim of the study was to determine if women's involvement in the wives group resulted in decreases in their husbands' PTSD symptoms. Women recruited for the study were administered pre-test measures during a screening session. They then participated in a 9-session manualized therapy group designed by the researcher that included psychoeducational, process, and support components. Examples of group topics included psychoeducation regarding PTSD, assertiveness and communication, intimacy, self-care, and stress management. After completing the group sessions, participants were asked to complete post-test measures. Other factors explored in this study included marital satisfaction, perceived social support, general satisfaction with the group, and demographic variables. Results indicated that wives who participated in the group treatment exhibited significant decreases in secondary stress symptoms and increases in marital satisfaction from pre-test to post-test. The majority of participants also reported high levels of satisfaction with the group process. Therefore, it appears that the group protocol presented in this study could be a useful tool in the treatment of wives of veterans with PTSD. The results of this study have potential implications regarding the clinical treatment of families of veterans with PTSD and the development of future programs within the VA system.

Abstract BACKGROUND: The PTSD Checklist-civilian (PCL-C) is one of the most commonly used self-report measures of PTSD symptoms, however, little is known about its validity when used in pregnancy. This study aims to evaluate the reliability and validity of the PCL-C as a screen for detecting PTSD symptoms among pregnant women. METHODS: A total of 3372 pregnant women who attended their first prenatal care visit in Lima, Peru participated in the study. We assessed the reliability of the PCL-C items using Cronbach's alpha. Criterion validity and performance characteristics of PCL-C were assessed against an independent, blinded Clinician-Administered PTSD Scale (CAPS) interview using measures of sensitivity, specificity and receiver operating characteristics (ROC) curves. We tested construct validity using exploratory and confirmatory factor analytic approaches. RESULTS: The reliability of the PCL-C was excellent (Cronbach's alpha =0.90). ROC analysis showed that a cut-off score of 26 offered optimal discriminatory power, with a sensitivity of 0.86 (95% CI: 0.78-0.92) and a specificity of 0.63 (95% CI: 0.62-0.65). The area under the ROC curve was 0.75 (95% CI: 0.71-0.78). A three-factor solution was extracted using exploratory factor analysis and was further complemented with three other models using confirmatory factor analysis (CFA). In a CFA, a three-factor model based on DSM-IV symptom structure had reasonable fit statistics with comparative fit index of 0.86 and root mean square error of approximation of 0.09. CONCLUSION: The Spanish-language version of the PCL-C may be used as a screening tool for pregnant women. The PCL-C has good reliability, criterion validity and factorial validity. The optimal cut-off score obtained by maximizing the sensitivity and specificity should be considered cautiously; women who screened positive may require further investigation to confirm PTSD diagnosis. / Revisión por pares

The level of crime in South Africa as reflected by crime statistics affects a high number of adolescents. Trauma and stress associated with interpersonal violence can adversely affect the neurobiology of the individual, since social, emotional and cognitive influences interact in multifaceted ways with neurobiological systems to affect every-day adaptive functioning. This study was embarked upon to determine the difference in the expression of personality between adolescents exposed to community related interpersonal violence and those not exposed to such violence. The 183 research participants were selected from a group of 335 grade 12 learners from a single secondary school in a middle class community. The participants were placed into two sample groups by means of purposive sampling as follows: Sample 1 consisted of all the research participants that reported exposure to community related interpersonal violence during the past 5 years on the self-reporting questionnaire (n = 93). The research participants that did not report exposure to such violence formed Sample 2 (n = 90). Reflecting on the adolescent’s emotional, adaptive functioning and referring to high levels of anxiety and feelings of worthlessness, certain factors of the 16PF questionnaire were predicted to show a statistical significant difference after exposure to community related interpersonal violence after a period of 3 to 5 years. To assess the differences in personality profiles of adolescents exposed to community related interpersonal violence and those not exposed to violence, a MANOVA was used in analysing 16PF results. There were statistically significant differences between the two groups on Factor G (rule consciousness), Factor I (emotional sensitivity) and Factor Q4 (anxiety). This indicated that adolescents exposed to incidents of community related interpersonal violence are inclined to experience more tension, are emotional volatile, depressed and anxious. They tend to be more sensitive to environmental stressors and are likely to give up easily. The group exposed to interpersonal violence (Sample 1) experienced higher levels of PTSD as assessed with the PSD Questionnaire than the group that was not exposed to interpersonal violence (sample 2). The personality profiles of three groups (Sample 1 with high PTSD, Sample 1 with low PTSD and Sample 2) were compared by means of a MANOVA to test whether adolescents who experience high levels of PTSD express their personality different from others. The results identify differences in the expression of personality between adolescents of Sample 1 experiencing higher levels of PTSD and the adolescents who did not experience community related interpersonal violence (sample 2) on Factors G- (Selfindulgent and disregards obligations to people), I + ( Perception might be emotionally influenced) and Q4 + (Elevated levels of anxiety). The coping style (positive or negative coping) of adolescents exposed to community related interpersonal violence was assessed using the Kidcope. This was done to examine the possible influence of coping on the development of posttraumatic stress and differences in the expression of personality. There were no correlations between positive and negative coping and the level of PTSD symptoms and the 16PF. The research could therefore not identify coping as a medicating variable in the development of PTSD and differences in the expression of personality. However, research is required to evaluate coping closer to the time of the actual event. The results of this research are a clear indication that the experience of community-related violence has serious implications for the well-being and development of the personality of adolescents. Violence-exposed adolescents may experience symptoms characteristic of PTSD, including significant difficulty regulating one’s emotions and behaviour impacting on their social, cognitive, physiological and emotional functioning. The original target group for this study was the middle class income population and suburb with relatively good security. The sample was drawn from a typical middleclass environment and adolescents from communities with less protection may present different results if sampled for similar research. / Thesis (PhD)--University of Pretoria, 2014. / tm2015 / Psychology / PhD / Unrestricted

Understanding the neuronal basis of learning and memory is a fundamental problem in neuroscience. A leading theory, the origins of which date back to the beginning of the twentieth century, is that the neural basis for memory resides in engrams (also called memory traces), ensembles of cells that are activated during learning and reactivated during memory retrieval. Recent genetic tools have allowed researchers to visualize and manipulate memory traces in small brain regions; however, the ultimate goal is to analyze memory traces across the entire brain in order to better understand how memories are stored in neural networks and how multiple memories may coexist. In order to do so, methods and technologies need to be developed that allow labeling of engram cells throughout the brain, visualization of these cells, and automated quantification of cells in an anatomically precise manner. The first of these challenges has been addressed through the development over the past several years of different mouse models that permit the labeling of active cells throughout the brain at multiple time points. One of the most powerful models, the ArcCreERT2 mouse line, uses drug-induced genetic recombination to indelibly label cells throughout the brain in an activity-dependent manner. In this thesis, I present our work utilizing this model to solve the second and third challenges: imaging of brain-wide memory traces and automated quantification of labeled cells, as well as the application of these novel methods to understanding the engram network changes following fear extinction. Intact tissue clearing and imaging is a new and rapidly growing area of focus that holds great promise for enabling the brain-wide visualization of memory traces. We utilized the leading protocols for whole-brain clearing and applied them to the ArcCreERT2 mice. We found that CLARITY and passive clarity technique (PACT) greatly distorted the tissue, and immunolabeling-enabled three-dimensional imaging of solvent-cleared organs (iDISCO) quenched enhanced yellow fluorescent protein (eYFP) fluorescence and hindered immunolabeling. Alternative clearing solutions, such as tert-Butanol, circumvented these harmful effects, but still did not permit whole-brain immunolabeling. Clear unobstructed brain imaging cocktails and computational analysis (CUBIC) and CUBIC with Reagent 1A produced improved antibody penetration and preserved eYFP fluorescence, but also did not allow for whole-brain memory trace visualization. We developed CUBIC with Reagent-1A*, a modified CUBIC protocol that resulted in eYFP fluorescence preservation and immunolabeling of the immediate early gene (IEG) Arc in deep brain areas; however, optimized memory trace labeling still required tissue slicing into mm-thick tissue sections. Nonetheless, our data show that CUBIC with Reagent-1A* is the ideal method for reproducible clearing and immunolabeling for the visualization of memory traces in mm-thick tissue sections from ArcCreERT2 brains. Recent developments in brain-wide engram tagging strategies, primarily through the use of transgenic mouse models such as the ArcCreERT2 line, and whole brain imaging strategies, such as CLARITY, CUBIC, and iDISCO, have created the circumstances to, for the first time, be able to visualize throughout the brain neuronal activity that is directly linked to behavior. However, as noted above, quantifying and analyzing these brain-wide memory traces presents its own challenge, and widely applicable, readily accessible solutions to this problem have thus far been limited. Although a handful of freely available programs and suites do exist, such as CellProfiler and ClearMap, these are generally tailored to specific approaches, and in particular, no currently available solution exists for quantifying multi-labeled engram cells imaged in three dimensions along the coronal plane, a relatively common scenario that is sure to become even more prominent as greater adoption of the underlying technologies progresses. Using ImageJ and R, we developed an image analysis pipeline to solve precisely this problem. Our strategy allows for the segmentation of both the encoding and retrieval populations, including identification of the reactivated cells, and registration of segmented cells to an anatomical atlas in order to analyze cell activity in a region- and layer-specific manner. Post-traumatic stress disorder (PTSD) can develop following a traumatic event and results in heightened, inappropriate fear and anxiety. Approximately 8% of the US population suffers from PTSD, the main treatment for which is repeated exposure to triggering stimuli under controlled conditions. A better understanding of the neural circuits modified during this process would help advance therapeutic treatment for PTSD. We sought to determine the brain-wide neuronal activity changes underlying fear extinction, the best laboratory model of exposure therapy, by using the ArcCreERT2 x eYFP mice and our newly developed brain-wide segmentation and registration pipeline. ArcCreERT2 x eYFP mice were administered a 4-shock contextual fear conditioning (CFC) paradigm followed by either a 10-day extinction protocol or re-exposure to the aversive context without extinction. Following the final exposure session, mice were euthanized, and active cells were quantified throughout the brain using the pipeline. We found that fear learning leads to increased functional connectivity of amygdalar and hypothalamic regions, and extinction leads to a decentralization of the fear memory network and disengages the thalamus and striatal amygdala. Additionally, coordinated reactivation of the basomedial amygdala and secondary somatosensory cortex with frontal association regions are differentially modulated following extinction, and we identified the temporal association area and medial habenula as novel brain regions involved in modulating freezing behavior. In summary, in this thesis, we have developed a novel engram analysis pipeline and shown its potential for quantifying brain-wide memory traces. This is the first study to analyze brain-wide functional connectivity following fear learning and extinction of a recent fear memory, as well as the first study to analyze fear memory trace reactivation patterns across the brain and relate all three measures to behavioral output. This work both greatly enhances our understanding of the neural underpinnings of fear extinction and provides a toolset for readily exploring the neural underpinnings of other behaviors and types of associative memory.