Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2009. / Includes bibliographical references (p. 39-40).

D.Litt. et Phil. / A plethora of research has been conducted on victims of township violence, detention and political unrest, but there is no research on car hijack victims or the prevalence of Post-Traumatic Stress Disorder (PTSD), which could result from this crime. The implications of this lack of research are important because people are confronted by trauma on a daily basis but there are few guidelines for providing treatment. Hijackings are a somewhat recent phenomenon unlike other traumas such as wars and natural disasters, but the effects of hijacking are no less severe. Post-Traumatic Stress Disorder (PTSD) always requires an initiating event which is assumed to be traumatic. The context in which car hijackings occur in South Africa can be considered to meet the criteria for what constitutes a traumatic event, which could possibly lead to the development of PTSD (Myerson, 1995). Not all crime victims who need professional assistance will enter therapy. This is often due to the victim's self-perception of weakness, feelings of embarrassment, or the perception that others will not understand their experience. A group-based intervention offers the advantages of reducing isolation, providing comfort and support, and eliminating feelings of stigma. For this reason it was important to analyse the nature of PTSD and how to intervene to aid the recovery from PTSD, in the South African context. The literature points to the recovery from PTSD as being contingent upon the psychotherapeutic input that the traumatised individual receives. This research focused on the development of a group-based cognitive behaviour intervention programme for victims who developed Post-Traumatic Stress Disorder as a result of car hijackings. Cognitive behavioural therapy is the only treatment modality that is supported by objective measures of success (Peterson, Prout & Schwartz, 1991) and has been found to be one of the most effective treatments (Kaplan & Sadock, 1993). In order to test the hypotheses, the Beck's Depression Inventory was used to measure the level of depression, the Spielburger's Stai Anxiety scale was used to measure the level of anxiety, and the CAPS and PCL were used to determine whether Post-Traumatic Stress Disorder existed in the individuals who participated in the study and the intensity and frequency of the symptoms.

This research report documents the therapeutic intervention undertaken with a 23-year-old Swazi rape victim. The format of this research report takes the form of a case study that follows the principles proposed by Fishman (2005). Its aim is to document the treatment process of an individual of African decent in order to establish whether the treatment model can be effective in clinical settings and in contexts and cultural settings different from that in which it was developed. The Ehlers and Clark (2000) cognitive therapy model for post-traumatic stress disorder (PTSD) was utilised to assess, conceptualise, and treat the case. The client entered therapy three years after being raped for a third time. The case formulation identified factors maintaining the disorder as well as how other traumatic and abusive events earlier in her life influenced her response to the rapes. Data consisted off audio-tape recordings and detailed written synopses of each assessment and therapy session, psychometric measurement instruments and self-report scales completed throughout the intervention, material written by the client, and a research interview conducted by an independent party. She was treated for PTSD and comorbid depression over a period of five months in accordance with the principles described by Ehlers and Clark and a narrative of the treatment process was written. The case narrative in conjunction with quantitative data suggested that this model assisted the client in initiating a healing process. As such the model was found to be both effective and transportable to an African context. Various points of discussion are highlighted, including the challenges of working with PTSD and comorbid major depression, the client-therapist relationship, and that a client and therapist from different cultures, backgrounds, and with different home languages can work together effectively using the Ehlers and Clark model.

This study employed a case-based research design to document the psychological assessment and treatment of Zanele, a 15-year-old black Xhosa speaking female who was raped twice in 2006 by the same perpetrator. The aim of the study was to explore whether, the model for assessment and intervention for posttraumatic stress disorder (PTSD) developed by Ehlers and Clark (2000) was effective and transportable to the South African context. Zanele had a sufficient understanding of English for assessment to proceed without use of an interpreter. She reported a number of PTSD symptoms which were causing her significant distress and had impacted on her social and educational functioning. These included flashbacks of the perpetrator's face when she looked at the faces of black men, nightmares about the traumas she had endured and feeling isolated from others. A number of cognitive techniques were utilised in this study, however the central interventions included working with triggers, imagery rehearsal techniques with a focus on nightmares, and reliving with cognitive restructuring within and outside reliving. Psychoeducation and increasing her social support were also important components of the intervention. Her progress was monitored by means of several self-report measures which were displayed in graphic and tabular form. In addition, a thematically selective narrative of the assessment and first 23 sessions of the intervention was written which documents some of the central processes set in motion by the interventions. These results provide evidence that this model was both effective and transportable to the South African population. In addition, the study demonstrated that it is possible for a white English speaking clinician to work with a black Xhosa speaking individual and make substantial therapeutic gains.

Experts in traumatology have postulated traumatized children play differently than non-traumatized children. These differences are called posttraumatic play and include the behaviors of intense play, repetitive play, play disruption, avoidant play and negative affect. The purpose of this study is the continued development of the Trauma Play Scale through the addition of a normative sample. The Trauma Play Scale is an observation-based instrument designed to distinguish the play behaviors of children in play therapy with a history of interpersonal trauma when compared to non-traumatized children. The present study compares two samples of children. One group (n=6) currently in play therapy with a history of interpersonal trauma and another group (n=7) considered normally developing (cognitively, emotionally, socially, and physically) by their parents with no known history of interpersonal trauma. Trained raters blind to the trauma history of the children rated a series of eight consecutive video-recorded play therapy sessions for each participant. One-way analysis of variance statistics, including effect sizes were compute to determine the discriminant validity of the Trauma Play Scale. Traumatized children scored significantly higher on the Trauma Play Scale than non-traumatized children on all domains of the scale as well as the overall Average Trauma Play Scale score. Large effect sizes indicated strong relationships between group membership (trauma history versus normally developing) and scores on the Trauma Play Scale.

The relation between dissociative symptoms and posttraumatic stress disorder (PTSD) was investigated in women who had experienced trauma or sexual assault. Subjects were administered the Dissociative Experiences Scale (DES), the Sexual Experiences Scale (SES), and the PTSD Interview (PTSD-I). Subjects were grouped according to their scores on the SES and the PTSD-I. Analysis of variance revealed a relation between DES scores and PTSD symptom severity scores. Correlational analyses showed a relation between dissociative symptoms and PTSD symptom severity but not recency of trauma. Three factors from a previously published factor analysis of the DES were found to contribute to the DES scores of PTSD subjects.

American children growing up in poor urban communities experience a disproportionate amount of direct and indirect violence in addition to the challenges of growing up with limited resources. Due to high amounts of physical and structural violence in these communities, urban youth are at increased risk for complex post-traumatic stress disorder (C-PTSD) and its associated sequelae, such as asthma, obesity, diabetes, and behavioral problems. Evidence demonstrates that sexual abuse and repeated interpersonal trauma leads to more intense symptomatology than traditional post-traumatic stress disorder (PTSD), and traumatic events in early childhood predisposes one to a C-PTSD reaction. This literature review of complex trauma serves to further validate the need for modern psychiatry to recognize C-PTSD as a diagnosis and to identify treatment interventions for this vulnerable population. / Urban Bioethics

Thesis (MA)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: Treatment outcome research strives towards objective estimates of disorder-specific treatment efficacy and has been applied to most psychiatric disorders. However, due to shortcomings in outcome research designs, problems still remain regarding the interpretation and generalisability of treatment outcomes. This is despite the development of research methodology criteria such as the Gold Standards, currently viewed as essential criteria for well-controlled cognitive-behavioural outcome research. The objectives of this assignment are (a) to assess the Gold Standards as criteria for treatment outcome research by means of a qualitative overview and evaluation of exposure treatment studies for PTSD, and (b) to make recommendations for the expansion and/or modification of these criteria. An assessment of five selected treatment outcome trials, based on the Gold Standards, showed significant limitations in the scope of the Gold Standards regarding (a) the inclusion of target symptoms in the research hypotheses, (b) estimates of treatment adherence, (c) guidelines for statistical analyses of attrition points, (d) the ethical implementation of exposure treatment, and (e) estimates of significant clinical change. It is concluded that the Gold Standards are not sufficient to ensure valid and reliable treatment outcomes. Recommendations are made for the expansion of four of the existing Gold Standards parameters and three additional criteria are proposed. Key words: treatment outcome research, Gold Standards, post-traumatic stress disorder, exposure therapy. / AFRIKAANSE OPSOMMING: Navorsing oor behandelingsuitkoms streef na objektiewe resultate oor die uitkoms van behandeling vir spesifieke psigiatriese versteurings. Nogtans, weens tekortkominge in die ontwerp van uitkomsstudies, word talle probleme steeds ervaar met die interpretasie en veralgemeenbaarheid van die resultate van die studies. Dit is die geval ten spyte van die ontwikkeling van navorsingskriteria soos die "Gold Standards" wat huidig as die belangrikste kriteria vir uitkomsstudies op die gebied van die kognitiewe gedragsterapie aanvaar word. Hierdie projek het ten doelom (a) die Gold Standards as kriteria vir uitkomsnavorsing te assesseer deur middel van 'n kwalitatiewe oorsig en evaluering van vyf geselekteerde uitkomsstudies van blootstellingsterapie vir post-traumatiese stresversteuring, en (b) om aanbevelings te maak ter aanvulling enJofwysiging van die Gold Standards. Evaluasie van die studies het betekenisvolle beperkings in die Gold Standards se omvattenheid uitgelig in terme van (a) die insluiting van teikensimptome in die navorsingshipoteses, (b) die skatting van behandelingvoitrekking ("treatment adherence"), (c) riglyne vir die statistiese analise van data oor attrisie, (d) die etiese implementering van blootstellingsterapie, en (e) skattings van betekenisvolle kliniese verandering. Dit blyk dat die Gold Standards nie voldoende is om geldige en betroubare resultate oor behandelingsuitkomste te verseker nie. Aanbevelings word gemaak vir die hersiening van vier van die Gold Standards kriteria en drie addisionele kriteria word voorgestel. Sleutelwoorde: behandelingsuitkomsnavorsing. Gold Standards, post-traumatiese stresversteuring, blootstellingsterapie.

Bakgrund: Ambulanspersonal är en yrkesgrupp som i sitt yrkesutövanden riskerar att utsättas för traumatiska händelser som kan vara mycket påfrestande och stressfulla. Trots erfarenhet och träning blir vissa trauman stundtals övermäktiga och kan ge reaktioner som posttraumatiskt stressyndrom. Risken att utveckla PTSD ökar med antalet upplevda trauman och prevalensen i yrkesgruppen är hög. Syfte: Syftet var att beskriva vilka traumatiska händelser ambulanspersonalen upplevde som mest stressfulla. Syftet var även att beskriva ambulanspersonalens upplevelser och hantering av posttraumatiskt stressyndrom i relation till traumatiska händelser i sitt yrkesutövande. Syftet var dessutom att granska artiklarnas kvalitet utifrån den metodologiska aspekten undersökningsgrupp. Metod: Beskrivande litteraturstudie innefattande elva vetenskapliga artiklar av både kvalitativ och kvantitativ ansats sökta i medicinsk och omvårdnadsorienterade databas. Huvudresultat: Traumatiska händelser som upplevdes mest stressfulla innefattade händelser som involverade akut sjuka och allvarligt skadade barn, vilka väckte en emotionell respons och där ambulanspersonalen identifierade sig med nödställda. Upplevelser av PTSD kännetecknades av överspändhet, sämre prestation, mental avstängning och återupplevande av minnesbilder. Hantering av PTSD utmärktes av copingstrategier som känslomässig distans, fokusering, stöd, återhämtning, kontroll och förberedelse. Slutsats: Ambulanspersonal upplever i sitt yrkesutövande traumatiska händelser som kan vara mycket stressfulla och som kan leda till posttraumatiskt stressyndrom. Upplevelserna kan ge psykiska och fysiska symtom som påverkar hälsa och funktionsförmåga. Ambulanspersonalen behöver utbildning i copingstrategier för att hantera kritiska incidenter på ett gynnsamt sätt, speciellt händelser som involverar barn. Strategier behövs för att stärka känslan av kontroll och förmågan till fokusering, där förberedelse, socialt stöd och återhämtningstid är betydelsefullt.

Thesis (MA) -- University of Stellenbosch, 2000. / ENGLISH ABSTRACT: Judgement of risk for negative events in certain situations was investigated in a group of emergency medical service (EMS) personnel with a diagnosis of posttraumatic stress disorder (PTSD; n = 27) and a group without PTSD (n = 74). Participants completed the PTSD Symptom Scale: Self-Report version (Faa, Riggs, Dancu, & Rothbaum, 1993), an EMS work experiences questionnaire, the Beck Depression Inventory (Beck, Rush, Shaw, & Emery, 1979), and an event probability questionnaire designed to assess judgement of risk. Participants with PTSD overestimated amount of risk involved in comparison to participants without PTSD, thereby demonstrating a judgement bias for risk related events. The present study found that the judgement bias in PTSD participants extended to include not just external harm related events but also general negative events (without potential threatening/harmful consequences), negative social events, and negative workrelated events. Of the posttraumatic symptomatology assessed, avoidance symptomatology was found to be the best predictor of judgement bias. The results of the present study are discussed in terms of the cognitive clinical psychology theories of PTSD, which predict the manifestation of judgement bias in PTSD, and cognitive experimental psychology explanations of the effect of negative emotional states on judgement processes. / AFRIKAANSE OPSOMMING: Oordeeloor risiko vir negatiewe gebeurtenisse in sekere situasies is ondersoek by "n groep mediese nooddienspersoneel met "n diagnose van posttraumatiese stresversteuring (PTSV; n = 27) en "n groep sonder PTSV (n = 74). Deelnemers het die PTSD Symptom Scale: Self-Report version (Foa, Riggs, Dancu, & Rothbaum, 1993), "n mediese nooddiens werkservaringe-vraelys, die Beck Depression Inventory (Beck, Rush, Shaw, & Emery, 1979), en "n gebeurtenis-waarskynlikheidsvraelys wat opgestel is om oordeeloor risiko te meet, voltooi. Deelnemers met PTSV het die mate van risiko betrokke oorskat in vergelyking met deelnemers sonder PTSVen sodoende "n beoordelingsydigheid vir risiko-verbandhoudende situasies gedemonstreer. In die huidige studie is gevind dat beoordelingsydigheid by PTSV deelnemers nie beperk was tot eksterne skade-verbandhoudende gebeurtenisse nie, maar dat dit ook veralgemeen het na algemene negatiewe gebeurtenisse (sonder potensieel skadelike gevolge), negatiewe sosiale gebeurtenisse, en negatiewe werksverwante gebeurtenisse. Daar is gevind dat, wat PTSV-simptomatologie betref, vermyding die beste voorspeller van beoordelingsydigheid was. Die resultate van die huidige studie word bespreek in terme van kognitiewe klinies-sielkundige teorieë van PTSV, wat die aanwesigheid van beoordelingsydigheid voorspel, en kognitiewe eksperimentele-sielkunde verklarings van die effek van negatiewe emosionele toestande op beoordelingsprosesse.