Doctorat en Sciences Psychologiques et de l'éducation / info:eu-repo/semantics/nonPublished

Doctorat en sciences psychologiques / info:eu-repo/semantics/nonPublished

Les altérations mnésiques associées au trouble de stress post-traumatique (TSPT) constituent un aspect fondamental de la symptomatologie de cette pathologie. Cette altération qualitative de la mémoire inclut à la fois une hypermnésie, c’est-à-dire une intensification de la mémoire vis-à-vis du coeur de l’événement traumatique, et une amnésie de type déclaratif pour les éléments contextuels péri-traumatiques. Les données chez l’Homme suggèrent que ces altérations mnésiques pourraient être sous-tendues par une hyper-activation amygdalienne et un dysfonctionnement hippocampique, respectivement. Cependant, les bases neurobiologiques, et en particulier moléculaires, du TSPT restent largement méconnues. Un modèle comportemental développé chez la souris au laboratoire et basé sur un conditionnement aversif permet précisément de comparer une mémoire de peur normale, c’est-à-dire « contextualisée » et adaptée, à une mémoire pathologique de type TSPT, c’est-à-dire « décontextualisée » et focalisée sur un élément saillant du trauma. Dans la mesure où il a été montré que le développement d’une mémoire de peur contextuelle implique certaines modifications épigénétiques spécifiques, nos travaux ont eu pour objectif de déterminer les altérations des modifications post-traductionnelles d’histones qui sous-tendent le développement d’une mémoire traumatique au lieu d’une mémoire de peur normale. Nos résultats révèlent (1) que des profils spécifiques différents des états d’acétylation/méthylation de l’histone H3 dans le réseau hippocampo-amygdalien sont associés à une mémoire de peur normale et à une mémoire traumatique de type TSPT. Spécifiquement, une mémoire de peur normale est associée à une forte acétylation de H3K9 hippocampique, tandis qu’une mémoire traumatique de type TSPT s’accompagne d’une hyperméthylation de H3K9 dans l’hippocampe, traduisant une répression transcriptionnelle, ainsi que d’une diminution de la tri-méthylation de H3K27 dans l’amygdale latérale, caractéristique d’une activation transcriptionnelle. De plus, nos travaux montrent (2) qu’une modulation pharmacologique de la balance des états d’acétylation/méthylation de H3K9 dans l’hippocampe permet de promouvoir ou de prévenir le développement d’une mémoire traumatique. Enfin, (3) une dernière série d’expériences révèle (i) qu’un stress prénatal est un facteur de risque au développement d’une mémoire traumatique, (ii) que cette dernière est associée à des profils épigénétiques spécifiques, et (iii) qu’une telle vulnérabilité peut se transmettre de manière intergénérationnelle. / Memory alterations associated with post-traumatic stress disorder (PTSD) are a fundamental feature of this pathology. PTSD is characterized both by hypermnesia for simple salient trauma-related stimuli and amnesia for peri-traumatic contextual cues. In humans, this disorder is associated with hippocampal hypofunction and amygdalar hyperfunction, which may underlie such paradoxical memory pattern. However, neurobiological bases of PTSD, particularly at the molecular level, remain largely unknown. A behavioral model based on aversive conditioning was developed in mice by our team. This model allows the comparison between a normal, i.e. “contextualized” and adaptive, fear memory, and a PTSD-like pathological fear memory, i.e. “decontextualized” and focused on a salient cue of the trauma. Since specific epigenetic alterations have been involved in the development of contextual fear memory, our aim was the identification of the alterations in post-translational histone modifications underlying the development of traumatic memory instead of normal fear memory. Our results first reveal that normal and PTSD-like fear memory are associated with distinct acetylation/methylation profiles of histone H3 in the hippocampal-amygdalar network. Specifically, we show that, compared to normal fear memory, PTSD-like memory is associated with a switch from H3K9 hyperacetylation (marker of transcriptional activation) to H3K9 hypermethylation (marker of transcriptional repression) in hippocampal CA1, as well as a significant reduction of H3K27 trimethylation, which results in an increased transcription, in the lateral amygdala. Second, we show that the pharmacological manipulation of the acetylation/methylation balance of H3K9 in the hippocampus can prevent or promote the development of PTSD-like memory. Finally, a last series of experiments shows that (i) prenatal stress is a risk factor for the development of PTSD-like memory, (ii) which is associated with specific epigenetic alterations and (iii) that such vulnerability to stress can be transmitted to subsequent generations.

D. Litt. et Phil. / This report presents the findings of a study conducted in February-March 1995, involving 109 members of different emergency services from three regions: Pretoria, Durban and Cape Town. The emergency services included in the study were three units of the South African Police Service (Visible Policing, the Internal Stability Unit and the Flying Squad), provincial fire and ambulance services, and municipal traffic services. The aims of the study were to: (1) describe the underlying causes of stress in the emergency services; (2) establish how stress is currently being dealt with by members and identify the structures and support systems available to assist members with stress-related problems; (3) identify constructive and destructive, effective and ineffective mechanisms used by members to cope with their stress, and (4) suggest solutions to problems experienced in managing stress in the emergency services. The study investigated stressors of SAPS members under the following themes: (1) public image of the SAPS, (2) management style in the SAPS, (3) communication in the SAPS, (4) working environment in the SAPS, (5) working conditions and remuneration packages, (6) distinct characteristics of the work of SAPS members, and (7) the priorities set by SAPS members that need to be addressed in order to reduce their level of stress. The stressors of members of the fire and ambulance services were dealt with under the following themes: (1) utilisation of manpower in the organisation, (2) training provided to members, (3) management style in the fire and ambulance services, (4) distinct characteristics of the work of members of the fire and ambulance services, (5) remuneration packages, and (6) the priorities set by members that need to be addressed in order to reduce their level of stress. The stressors of members of the traffic services were dealt with under the following themes: (1) the public image of the traffic services, (2) distinct characteristics of the work of traffic officials, (3) communication in the traffic services, (4) working conditions and remuneration packages and (5) the priorities set by members that need to be addressed in order to reduce their level of stress. Regarding the support members of the emergency services receive within their organisations for managing stress, a number of sources of support were mentioned, such as social workers, psychologists and chaplains in the SAPS, support by supervisors, debriefing after traumatic events, stress management training, nursing sisters at ambulance stations, drinking and socialising, with the biggest form of support being "buddies". Regarding the co-operation between members of the different emergency services, the perception was that there was a very good relationship and good co-operation. Number of problems experienced in their day-to-day contact with each other were however mentioned.

These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve as a source of information for patients and their carers. The recommendations are presented together with a more detailed review of the available evidence. A consensus meeting involving experts in anxiety disorders reviewed the main subject areas and considered the strength of evidence and its clinical implications. The guidelines were constructed after extensive feedback from participants and interested parties. The strength of supporting evidence for recommendations was rated. The guidelines cover the diagnosis of anxiety disorders and key steps in clinical management, including acute treatment, relapse prevention and approaches for patients who do not respond to first-line treatments.

Indiana University-Purdue University Indianapolis (IUPUI) / Epidemiologic studies suggest that depression is an independent risk factor for cardiovascular disease (CVD). Although several possible mediators of this association have been proposed, few studies have examined the role of moderators. Accordingly, I examined adverse childhood experiences (ACE) as a potential moderator of the depression-CVD association, given that individuals with a history of ACE show a greater inflammatory response to depression, and inflammation plays a role in the development of CVD. Data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analyzed. Participants were 29,282 adults (58% female, 42% non–white) aged 18–97 years, free of CVD diagnoses at baseline. Lifetime depressive disorder (LDD) was assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule–IV (AUDADIS–IV), and adverse childhood experiences (abuse, neglect, and household dysfunction), and CVD were assessed during separate interviews. The primary outcome was incident CVD (n = 1,255), defined as nonfatal arteriosclerosis, angina pectoris, myocardial infarction, and/or stroke reported during the Wave 2 interviews. All analyses were adjusted for demographic and traditional CVD risk factors. Logistic regression models revealed that both LDD (OR = 1.44, 95% CI: 1.28–1.62, p < .001) and any ACE (OR = 1.25, 95% CI: 1.16–1.35, p < .001) were independent predictors of incident CVD. Interactions between LDD x any ACE (p = .024), LDD x neglect (p = .003), and LDD x household dysfunction (p < .001), but not LDD x abuse (p = 0.16), were detected. Analyses stratified by the ACE variables revealed that LDD was a predictor of incident CVD among adults with a history of (1) any ACE (OR = 1.51, 95% CI: 1.32–1.73, p < .001), but not among those without a history (OR = 1.15, 95% CI: 0.87–1.50, p = .332); (2) neglect (OR = 1.59, 95% CI: 1.36–1.87, p < .001) and among those without a history (OR = 1.25, 95% CI: 1.07–1.62, p = .005); (3) household dysfunction (OR = 1.73, 95% CI: 1.46–2.04, p < .001), but not among those without a history (OR = 1.18, 95% CI: 0.96–1.43, p = .11). Overall, the present findings suggest that depression may be a stronger risk factor for CVD among adults with a history of ACE, especially neglect and household dysfunction, than among adults who did not have these experiences.

This thesis focuses on the development of Gestalt guidelines for alternative caregivers to enhance attachment with the traumatised child. The researcher made use of the intervention research process, consisting of six phases. For the purpose of this study of limited scope, the intervention research process was completed up to step one of the fourth phase. The target group in this study was alternative caregivers of traumatised children where attachment difficulties existed. `Alternative caregivers' refers to people who provide care to these children, either on a voluntary basis or professionally. Focus groups, field notes and observation were used as data collection method, and Creswell's spiral was used to analyse data. Not all aspects regarding attachment were covered in this study and only relevant Gestalt principles were discussed. Gestalt guidelines with an observational system were finally developed. The views of the respondents, those of experts and a literature review were incorporated into the guidelines, as well as some functional elements of existing treatments. / Practical Theology / M. Diac. (Play Therapy)

This thesis focuses on the development of Gestalt guidelines for alternative caregivers to enhance attachment with the traumatised child. The researcher made use of the intervention research process, consisting of six phases. For the purpose of this study of limited scope, the intervention research process was completed up to step one of the fourth phase. The target group in this study was alternative caregivers of traumatised children where attachment difficulties existed. `Alternative caregivers' refers to people who provide care to these children, either on a voluntary basis or professionally. Focus groups, field notes and observation were used as data collection method, and Creswell's spiral was used to analyse data. Not all aspects regarding attachment were covered in this study and only relevant Gestalt principles were discussed. Gestalt guidelines with an observational system were finally developed. The views of the respondents, those of experts and a literature review were incorporated into the guidelines, as well as some functional elements of existing treatments. / Philosophy, Practical and Systematic Theology / M. Diac. (Play Therapy)

This thesis includes four studies investigating the experiences of abused women. According to ecological approaches different systems should be considered when conducting research into abused women and their experiences. The first study involved women who successfully left an abusive relationship. An ecological approach was used to investigate the experiences of the women in the different phases of their relationship, including the initial attraction to the partner, the development and sustaining of the abuse and her attempts to leave until her final decision to leave permanently. An important finding was the importance of considering and investigating all systems and levels when dealing with abused women, including those who have left and those who are contemplating leaving this relationship. The second study found that women who experienced physical abuse were often hurt in anatomical locations that were indicative of impulsive violence. The abuser used any object in the heat of the moment to attack the victim and no premeditated planning was evident in the type of injuries sustained. The women further reported that medical practitioners did not investigate the causes of injuries and that they were not referred to social services or organisations dealing with abused women, although they were recognised as suffering from abuse. The intersection of abuse of women and HIV was the topic of focus of the third study. A review of the records of abused women revealed that many abused women were subjected to risk factors for contracting HIV, with counsellors focussing only on abuse issues. Longitudinal case studies, of women exposed to both conditions, revealed that they lacked social support and were often secondarily victimised by the social welfare systems. An environmental scan found that social and health care services were not accessible to these women. The final study investigated intervention strategies to combat burnout in workers at an organisation dealing with abused women. The importance and effectiveness of creative exercises and art sessions were determined in combination with debriefing and supervision sessions. The studies all considered systems that are important in service delivery to abused women. A holistic and systemic investigation and treatment of abused women is shown to be essential, as is the importance of grass roots research. / Psychology / D. Phil. (Psychology)

Afrikaans text / Kreatiwiteit is die sentrale tema van hierdie navorsing. Die doel van die navorsing was om die relevansie en waarde van kreatiwiteit in spelterapie met seksueel-misbruikte kinders in die multi-kulturele konteks van Suid-Afrika, te ondersoek en te beskryf. Die navorsing is vanuit „n konstruktivistiese epistemologiese fundering en „n eksistensieel-fenomologiese paradigma gedoen, deur uitgebreide teoretiese en empiriese navorsing. Die teoretiese navorsingproses het eerstens op die holistiese impak van seksuele misbruik op kinders, te midde van hul spesifieke verhoudings- en omgewingskonteks gefokus. Dit het duidelik geword dat seksuele misbruik ernstige trauma by kinders veroorsaak, wat alle modaliteite van die kinders affekteer. Die voorkoms van komplekse posttraumtiese stresversteuring, vanweë langdurige seksuele misbruik, is teoreties beskryf en ook empiries bevestig. „n Sintese van gestalt-, persoonsgesentreerde en logoterapeutiese teorieë, is deur die navorser ontwikkel om die traumatiese nagevolge van die seksuele misbruik kreatief aan te spreek in spelterapie. Die verband tussen en vervlegting van kreatiwiteit en spelterapie is ondersoek en beskryf. Ook die bemagtigende waarde van kreatiwiteit om die kompleksiteit van hierdie kinders se trauma te hanteer is teoreties én empiries nagevors. Die oënskynlik teenstrydige prosesse van kreatiwiteit as „n intuïtiewe, artisitieke, én logiese, kognitiewe proses is ondersoek, om die waarde daarvan vir die navorsingsdoel te bepaal. Die aard en waarde van kreatiewe aktiwiteite en die uitdagings wat gestel word aan die terapeute om kreatief te werk te gaan om die komplekse proses van seksueel-misbruikte kinders aan te spreek, is verder teoreties en empiries nagevors en beskryf. Die noodsaaklikheid van die ondersteunende sisteme vir die kind en terapeut, in belang van „n suksesvolle afloop van terapie, is ook ondersoek, beskryf en beklemtoon.In die empiriese navorsingsproses is veelvuldige gevallestudies, met behulp van vyf deelnemende veldnavorsers gedoen, waar elkeen „n terapeutiese proses gevolg het, volgens riglyne en onder leiding van die navorser, met „n seksueel-misbruikte kind. Die benutting en waarde van kreatiwiteit is ondersoek, beskryf en geëvalueer in die samelopende proses van die navorser met elke deelnemende navorser en kind binne die diverse kulturele konteks in Suid-Afrika. Die teoretiese raamwerk van die navorser en die riglyn vir kreatiewe spelterapie met seksueel-misbruikte kinders is sodoende getoets, verfyn en afgerond as hulpmiddel in die breër Suid-Afrikaanse konteks. Die navorsingsbevinding was dat kreatiwiteit onontbeerlik is in spelterapie met kinders wat seksueel misbruik is in „n multi-kulturele konteks soos Suid-Afrika. / Creativity is the central concept of this research. The goal of the research was to explore the value of creativity in play therapy with sexually abused children in the multi-cultural South-African context. The research was done from a constructivistic epistemological foundation and existential-phenomological paradigms. Extensive theoretical research was supported and substantiated by empirical research. The theoretical research process focused on the holistic impact of sexual abuse on children in and as part of their specific context (field). It became clear that sexual abuse implies severe trauma for the child, and affects all of their modalities, and their functioning in their field. The impact of severe and ongoing sexual abuse on children, as complex post-traumatic stress disorder, was described to clarify their therapeutic needs. A synthesis of gestalt-, person-centred- and logotherapy to address the traumatic after-effects of sexually abused children creatively in play therapy, was developed and described and motivated in the research paper. The concept of creativity was defined and extensively explored an applied in the context of therapy with sexually abused children. Creativity as a cognitive process, a problem solving process, and an artistic process is explored and applied in this context. The value of creative activities, the challenges of being a creative therapist, the supportive role of the supervisor and the systems in society, was explored and described. The empirical research process was done in a participatory way in the form of a multiple case study. Five therapists followed a therapeutic process, according to the guideline, guidance and supervision of the researcher, with a child who had been severely sexually abused. The results from the research confirmed the value and necessity of creativity in dealing with the severe trauma of sexually abused children and bridging gaps in a multi-cultural setting. The theoretical framework of the researcher and a guideline for creative therapy with sexually abused children was tested in the empirical research process, and could be refined and finalised. It was concluded that the use of creativity is crucial in play therapy with sexually abused children in a multi-cultural context, such as South Africa. / Social Work / D. Diac. (Spelterapie)