This work documents the treatment of a 20-year-old male suffering from Post Traumatic Stress Disorder as a result of his experience during two years of national service as an Operations "Ops" Medic in the South African Defence Force. The literature review is drawn largely from the body of work emerging from the Vietnam War, and in particular the work of Robert Lifton and Erwin Parson is considered. The case study consists of a detailed synopsis of the treatment based upon material from the therapy sessions. This section hopes to accurately convey the experience of working with someone suffering from Post Traumatic Stress Disorder and provide insight into the dynamics of such a therapeutic relationship. Finally the discussion examines the links between the theory and the treatment and attempts to understand the various factors which shaped and influenced the final outcome of the therapy. Special consideration is given to showing how essentially cognitive restructuring techniques are successfully utilised within a more existential, psychodynamic framework. Furthermore, there is a paucity of literature on the subject of combat-related Post Traumatic Stress Disorder in South Africa and it is hoped that this work will both point to a need for further research in this field whilst simultaneously provide guidance for those who wish to become involved in working with individuals suffering from Post Traumatic Stress Disorder.

This study discusses the assessment and treatment of a 21-year old male who had suffered multiple traumas, which had culminated in the death of his younger brother. He presented with Acute Stress Disorder. The literature review examines a diverse range of theorists and discourses, that have addressed the psychological consequences of trauma and highlights the complexity of the phenomena involved. The case study, located in the South African context, aims to sensitise the reader to the unique dilemmas facing each trauma survivor, and serves to highlight specifically those areas, which are pertinent and further more contribute significantly to the recovery process. The case narrative consists of a detailed synopsis of the therapy process, extracted from the session record notes documented at the time. Several other sources of information, including contributions from the participant, were used to verify and validate the accuracy of the data included. The narrative is written in a style that conveys the intensity of the nature of trauma work and the manner in which both patient and clinician are frequently confronted with very difficult emotional work. Finally the discussion examines the case narrative through the use of a set of carefully selected hermeneutic questions. These focused on (I) key concepts from the work of Robert Lifton who highlights the existential dimensions of the impact of trauma; (2) the role of the image in encapsulating the complex traumatic and post-traumatic experience of the survivor as well as facilitating the emotional processing of the trauma is examined; (3) the contribution to the process of therapy of aspects of the therapeutic relationship; and (4) the concept of recovery in relation to the question of what constitutes 'trauma work'. In conclusion, several meta-theoretical issues related to trauma, the strengths and weaknesses inherent to the research and relevant future areas of research are highlighted.

Thesis (MA)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: Posttraumatic stress Disorder (PTSD) has been researched and written about since its recognition as a disorder in the DSM-III in 1980. This study reviews the literature on PTSD and cognitive behavioural therapies, designed for its treatment. It covers the historical aspects of how the syndrome came to be identified, defined and recognized as a discrete disorder. The neurobiological features of the disorder, its cognitive processes, particularly those of dissociation and traumatic memory are dealt with. Cognitive behavioural therapies are reviewed, these include: relaxation; hypnosis; exposure; eye movement desensitization reprocessing; anxiety management training; cognitive therapy and combination therapies. Further areas for research are suggested based on the lacunae that have yet to be explored with regard to cognitive behavioral therapy treatments. / AFRIKAANSE OPSOMMING: Posttraumatiesestressversteuring is nagevors en bespreek vandat dit in 1980 in die DSM-III as 'n versteuring herken is. Hierdie studie gee 'n oorsig van die literatuur oor PTSVen kognitiewe gedragsterapeutiese, ontwerp om dit te behandel. Dit gee 'n historiese oorsig van hoe dit geïdentifiseer, beskryf en gedefinieër is as 'n spesifieke gedragsversteuring. Die neurobiologiese implikasies van die versteuring, die kognitiewe kenmerke, veral die van dissosiasie en traumatiese geheue word ondersoek. Kognitiewe gedragsterapieword beskryf en sluit die volgende in: ontspanning; blootstelling, oogbewegingdesensiteringherprosering; angsbeheeropleiding; kognitiewe terapie en kombinasie terapie. Verdere areas vir navorsing word voorgestel en is gebasseer op die gebrekke wat bestaan in kognitiewebedragsterapie.

This dissertation is about how the concept of harm, damage or wound is applied as a metaphor to a site often called the self or the soul. This is the social space of the individual subject, which is, paradoxically, placed by our language and culture in a person’s interior – a place where we are all said to be vulnerable and endangered by a potentially hostile environment. The thesis consists of a series of studies which are designed to show how the concept of harm to an inner life emerges from different discursive contexts, and how it does so in distinctly variable versions: psychological, emotional, neurological or social, in more or less stable hybrid forms. Using primary sources which are mostly documentary, supported by some interviews, the studies range from a look at the psychiatric history of post traumatic stress disorder (PTSD) and at the story of its rewriting in English tort law; the recent reprised popularity of attachment theory and its marriage to neurology and a look at the career of the concept of the emotional abuse of children as a social problem category in the legal/administrative processes of Child Protection. These are introduced by a first chapter which concentrates on the metaphoric content of invisible wounds or psychic trauma and the way it produces particular forms of the self. The studies which follow this are clustered around the literature and practices of the psychiatric, psychological, psycho-analytic, social work and legal professions, in order to show how the work of these professionals makes the concept of a psychic injury visible, discussible, treatable, administrable and justiciable. Through their efforts, it is argued, the concept moves from being a metaphor, hooked onto the palpable reality of a physical wound, to acquire a ‘facticity’ of its own; it becomes a reality through its achieved status as a social problem category and an ever present risk to self and self regulation at the turn of the 21st century.

In this PhD thesis, the lives and experiences of a group of combat veterans who began surfing following their return from war are explored. Having encountered life changing traumatic events and experienced much suffering (with many becoming diagnosed with post-traumatic stress disorder), these veterans joined an ex-services charity called Surf Action where they were introduced to surfing alongside other veterans who shared their suffering. The purpose of this research is to explore the effects of surfing and, more broadly, of participation in the charity Surf Action in the veterans lives and on their well-being. It is the first in-depth qualitative investigation of surfing in the lives of combat veterans. Using a combination of life history interviews and participant observation, I collected and analysed stories from the veterans about their lived experiences. Through rigorously applying the innovative analytical approach of dialogical narrative analysis (Frank, 2010, 2012), also inspired by phenomenology, the effects of the veterans stories both on and for their lives and well-being are examined. The analysis first demonstrates that stories of surfing were focused on the veterans physical and sensory interactions with the ocean environment, and helped to cultivate the notion of embodied respite from suffering. It is then suggested that by telling and enacting a collective story, the veterans at Surf Action (the Combat Surfers ) created a therapeutic community through which they accessed mutual support, recreated positive military identities associated with camaraderie, and legitimised their struggles with PTSD. Next, the masculine performances which shaped the veterans actions and narratives around help-seeking and dealing with PTSD are highlighted. Furthermore, the analysis reveals the meanings associated with moving beyond the chaotic influence of trauma in the veterans lives and suggests ways of keeping well following trauma and PTSD. The thesis also incorporates an ethnographic creative non-fiction as a way of enhancing knowledge translation and facilitating wider impact and dissemination of the findings. Finally, the thesis concludes with empirical, theoretical, methodological, and practical implications of the research, with an emphasis throughout on what to the study adds to knowledge. The potential of surfing to contribute to veterans healthcare is discussed alongside recommendations for the charity Surf Action and future possibilities for expanding this research.

published_or_final_version / abstract / Social Work and Social Administration / Doctoral / Doctor of Philosophy

Intrusive images are a common phenomenon in post-traumatic stress disorder (PTSD; American Psychological Society, 2013). Imagery-Rescripting (ImRs; Arntz & Weertman, 1999) is an experiential technique for targeting intrusive images and is gaining popularity as a treatment for PTSD (Arntz, 2012). Although there is evidence to suggest that ImRs is an effective treatment of PTSD (see Arntz, 2012), it is currently unclear how ImRs works. The aims of the present study were 1) to develop a coding scheme that captured important factors of ImRs session, and 2) to apply this coding scheme prospectively to investigate how certain factors might relate to treatment outcome. The study used thematic analysis (Braun & Clarke, 2006) to develop an ImRs coding scheme. Next, a single case experimental design was employed to track six participants over the course of their ImRs therapy for PTSD. Session content captured by the coding scheme was compared to changes in weekly outcome measures to investigate whether the presence of certain codes related to a reduction in PTSD symptoms. Results suggested a number of factors might be important for determining treatment outcome. Specifically, Attitude towards ImRs, Activation of the image, Ability to follow ImRs, Activation of original internal processes and internal processes during the re-script, Believability and Attitude towards the outcome are suggested as potentially important factors for determining ImRs efficacy. Study strengths, limitations and clinical implications are discussed. Recommendations for future research, including in-depth investigation of individual factors are suggested.

M.A. / Violence being a prominent and invasive factor in South Africa has left many people feeling powerless, hopeless and incapable of dealing and coping with the effects that exposure to trauma has produced. This idea appears even more disturbing if one considers that military personnel will inevitably be exposed to some form of trauma in their employment history. As a result of this traumatic exposure, many people develop post traumatic stress disorder or symptoms thereof. The literature ind icates that certain variables may increase vulnerability for the development of this disorder. The purpose of this research was to evaluate whether or not there is a relationship between Post Traumatic Stress (PTS) symptoms and axis II personality traits using Millon’s Clinical Multiaxial Inventory (MCMI - III) as a measure. The results of which will have major implications for our understanding of PTS, as well as aid in the deployment of military personnel. The sample comprised 5853 military personnel who completed the MCMI III as part of a yearly project to determine their mental health status. Inferential and descriptive statistical analyses were used on the data. It was found, in accordance with previous literature findings, that narcissistic, antisocial and borderline personality styles are the best predictors of PTS. In addition, the study found that there is a significant relationship between PTS and various personality styles, namely depressive, schizotypal, borderline, passive -aggressive, compulsive, antisocial and narcissistic personality styles. It is recommended that if the MCMI-III is used to scan military personnel prior to combat, those with high scores on borderline, narcissistic and antisocial personality scales, should be subjected to a more in-depth evaluation.

In the pathophysiology of traumatic brain injury (TBI), the amygdala remains understudied, despite involvement in processing emotional and stressful stimuli associated with anxiety disorders, such as post-traumatic stress disorder (PTSD). Because the basolateral amygdala (BLA) integrates inputs from sensory and other limbic structures coordinating emotional learning and memory, injury-induced changes in circuitry may contribute to psychiatric sequelae of TBI. This study quantified temporal changes in dendritic complexity of BLA neurons after experimental diffuse TBI, modeled by midline fluid percussion injury. At post-injury days (PIDs) 1, 7, and 28, brain tissue from sham and brain-injured adult, male rats was processed for Golgi, glial fibrillary acidic protein (GFAP), or silver stain and analyzed to quantify BLA dendritic branch intersections, activated astrocytes, and regional neuropathology, respectively. Compared to sham, brain-injured rats at all PIDs showed enhanced dendritic branch intersections in both pyramidal and stellate BLA neuronal types, as evidenced by Sholl analysis. GFAP staining in the BLA was significantly increased at PID1 and 7 in comparison to sham. However, the BLA was relatively spared from neuropathology, demonstrated by an absence of argyrophilic accumulation over time, in contrast to other brain regions. These data suggest an early and persistent enhancement of dendritic complexity within the BLA after a single diffuse TBI. Increased dendritic complexity would alter information processing into and through the amygdala, contributing to emotional symptoms post-TBI, including PTSD.

There is a growing body of research in support of the relationship between self-compassion and psychological health (Neff, Kirkpatrick & Rude, 2007). However, studies are limited on the malleability of self-compassion specifically within clinical populations, and its influence on psychiatric symptom reduction (Raes, 2011). This study therefore aimed to explore self-compassion, through examination of the underlying components (self-kindness, common humanity and mindfulness), and their impact on maladaptive functioning, specifically for participants diagnosed with PTSD. The study used an exploratory mixed methods design, with eight participants recruited by their attendance at two PTSD CBT/IPT (with self-compassion) group treatment interventions. Participants were adults, with a diagnosis of PTSD and a history of recurrent or current depression. Participants attended a group interview and two therapists who facilitated each treatment group were also interviewed. Participants completed quantitative measures pre and post intervention; Self-Compassion Scale (Neff, 2003a) and Clinician-Administered PTSD Scale (Blake et al., 1995), and session data was recorded using the PTSD checklist (PCL-C; Weathers, Litz, Huska & Keane, 1994) and the Session Feedback Form (AccEPT Primary Care Psychological Therapies Service). The findings demonstrate the importance that individuals place on self-compassion in their PTSD recovery, particularly in relation to self-kindness and the generation of positive self-belief and a compassionate inner-voice. The study also indicates that a clinically significant change in self-compassion is possible for individuals with PTSD, supporting the malleability of self-compassion within clinical populations.