D. Litt. et Phil. / This research focuses on the development of a short term action centered clinical personological treatment programme for adult emergency rescue workers who developed secondary traumatic stress disorder (STSD)/compassion fatigue and co-morbid symptoms of burnout as a result of exposure to critical incidents. A programme, comprising three sessions, was developed incorporating previously tested cognitive behavioural techniques with clinical personological theory as well as newly developed behavioural techniques tailored to the cross cultural South African context. The need for the study arose out of the lack of scientific validated data regarding the treatment of STSD/compassion fatigue among emergency rescue workers as well as the need for a cost-effective treatment programme that would address the serious need of emergency rescue workers in South Africa who for the most part need to make do without any employee wellbeing programmes. The effects of STSD/compassion fatigue are often as debilitating as that of PTSD. It hampers the sufferer unable to operate as well as they previously did. As a result they may present with lower productivity at work as well as various psycho-social problems and be at risk of substance abuse. This ultimately has a negative impact on the victims of trauma they are responsible for rescuing. Various theoretical models are discussed on the etiology of STSD/compassion fatigue, including the constructivist development al theory by McCann and Pearlman (1990) as well as Valent’s (2003) bio-social theory on survival strategies. Treatment approaches are investigated and critiqued, including, the accelerated recovery program (ARP) as developed by Gentry, Baranowsky and Dunning (2003) under the direction of Figley (2003) for the treatment and prevention of compassion fatigue, critical incident stress debriefing as first formally described by Mitchell in 1983 for the treatment of acute traumatic stress reactions, as well as Saakvitne and Pearlman’s (1992) constructivist self-developmental treatment program for vicarious traumatization, based on the constructivist self development al theory developed by McCann and Pearlman (1990). The theories and therapies underlying the intervention programme include various cognitive behavioural and personological principles to offer a person specific practical solutions for their personality type and psychological needs. The hypotheses were formulated with regard to significant improvement of symptoms of STSD/compassion fatigue as result of the intervention programme. The co-morbid symptoms of burnout are also evaluated for a decrease, without significantly reducing their capacity for compassion satisfaction. A test re- test quasi-experimental analysis with two independent groups was required, in order to determine whether there will be a statistically meaning full reduction in the prevalence of symptoms of secondary traumatic stress disorder (STSD)/compassion fatigue and the co-morbid symptoms of burnout amongst emergency rescue staff who had been instructed in an Action Centred Personological Treatment Plan. In an effort to attain spatial and temporal control a sample population was selected with a cluster sampling method from the greater Gauteng emergency rescue staff. They included paramedics, fire fighters and ambulance staff. The specific municipality had been incorporated into a greater Gauteng metropolis in the past two years. Potential subjects for both the experimental and control group were obtained through drawing personnel files, using random sampling. A sample of 17 participants was included in the intervention group and 17 participants were included in a non-intervention group. This was representative of 80% of the total population group of emergency rescue staff in this particular municipality. Existing psychometric assessment instruments were utilised to generate data for the experimental analysis. The measurement instruments included, the Millon inventory of personality styles (MIPS) to customise a cognitive behavioural treatment programme, the Compassion fatigue and satisfaction questionnaire to verify symptoms of STSD/compassion fatigue and burnout, and the British Columbia burnout questionnaire to confirm symptoms of burnout. The quantitative data was supported by information gathered from a clinical social history questionnaire. This information was used as part of the discussion of the results as a means to enhance the former descriptive results. The action centred personological treatment programme proved to be effective in the treatment of symptoms of STSD/compassion fatigue and burnout without significantly reducing the candidates’ potential for compassion satisfaction.

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

No description available.

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.

D.Litt. et Phil. / The negative psychological effect of rape on survivors has been extensively researched, with most studies emphasising rape-related Post Traumatic Stress Disorder (PTSD) its symptoms, diagnosis and treatment. Interventions described in the current literature mainly aim at measuring and reducing symptoms, and restoring functioning in rape survivors. Group art therapy has been used with adult and adolescent survivors of incest with encouraging results, but little research has been published regarding its use with rape survivors. My intention in the current study is to examine the utility of a group art therapy intervention with adult female rape survivors in a South African context. I selected a postmodern feminist theoretical basis for the study, and examined the societal discourses that promote women’s disadvantaged status and high levels of rape in South Africa. I used qualitative methods to analyse the art works, journals and transcripts produced by three participants during seven weekly group art therapy sessions. I used postmodern feminist research methods, such as participant observation, reflexivity, and concepts such as situatedness, bodiliness, relatedness and plurality of explanations to assess the women’s lived experience of rape, their recovery from it, and the intervention itself. The current study proposes that analysing the data reveals metaphors, symbols and meanings that represent the lived experience of the women participants in the group art therapy intervention. I used a grounded theory approach to data analysis, as well as methods from content analysis, visual anthropology, iconography, social semiotics and visual cultural studies in order to assist with triangulation of the visual and verbal data. The data was voluminous and rich, and fourteen strands of meaning emerged from the data, consisting of vivid metaphors, visual and verbal symbolic language, and insights into the challenges and victories of each of the participants. I gathered these strands under two overarching themes: one of themes related to the rape, and the other related to the group art therapy experience. I conclude that group art therapy was useful to the participants, and that the data analysis gave considerable insight into the individual nature of recovery from rape, such as coping mechanisms, influence of personality on recovery, the dialectical nature of recovery and the difficulty of recovering from a trauma that affects every area of functioning. The current study provides a structured format for clinicians interested in group art therapy, and I have provided suggestions for those who wish to replicate the intervention. My findings propose that the intervention was a powerful therapeutic tool for the participants, and that it provides a structured short-term group outline for use with the vast numbers of rape survivors in South Africa.

Introduction: Posttraumatic stress disorder (PTSD) is a disabling psychological disorder that affects about 7% of adults in the United States. PTSD and its symptoms have consistently been shown to have an inverse relationship with exercise participation. The strongest reported associations have been between high intensity exercise, and the hyperarousal and avoidance symptom clusters. Importantly, resistance training (i.e., weight lifting) is thought to have beneficial effects for several conditions that commonly co-occur with PTSD, such as anxiety, depression, and poor sleep quality. However, no studies have examined the effects of high intensity resistance training on PTSD symptoms. Purpose: This study sought to examine the effects of a 3-week high intensity resistance training program on the PTSD hyperarousal and avoidance symptom clusters, sleep quality, anxiety, and depression symptoms in anxious adults who screened positive for PTSD. Additionally, this study explored potential mechanisms of action (e.g., cognitive appraisal, perceived exertion, acute changes in affect, arousal, and distress) between exercise and PTSD. Methods: Thirty trait anxious individuals who screened positive for PTSD were randomly assigned to either a 3-week high intensity resistance training intervention, or a 3-week time-matched attention control group, while blocking for gender. Both groups were required to attend 3 on-site sessions per week, for 3 weeks (i.e., 9 total sessions). Each resistance training session consisted of a 5-minute warm-up, 20 minutes of high intensity resistance training, and a 5-minute cool-down. Each control session consisted of a brief 30-minute educational video on topics not relating to exercise or PTSD. Changes in PTSD symptoms, sleep quality, anxiety and depression were analyzed using repeated measures ANOVA, and potential mechanisms of action were explored with a series of longitudinal mixed-effects regression models. Results: Participants were 73.3% female, with a mean age of 29.1 years (SD = 7.4), and 63.3% identified as a racial minority. Groups did not significantly differ at baseline. There was a Time*Group interaction for hyperarousal symptoms (F = 4.7, p = .04, η2 .18), demonstrating a significantly larger reduction in hyperarousal symptoms for the resistance training group (d = -1.84) relative to the control (d = -1.13). The Time*Group interaction for avoidance symptoms was not significant (F = 1.7, p = .20, η2 = .08); however, the effect size of resistance training was larger (d = -2.71) than the control (d = -1.16). There was a significant Time*Group interaction for sleep quality (F = 4.7, p = .04, η2 = .19), demonstrating greater improvements in global sleep quality for resistance training (d = -1.06) relative to the control (d = -.15). However, there was no significant effect of Time on PTSD-related sleep disturbances (F = 3.0, p = .1, η2 = .13) nor was there a significant Time*Group interaction (F = .09, p = .80, η2 < .01). Similarly, Time*Group interactions for anxiety (F = 3.5, p = .08, η2 = .14) and depressive symptoms (F = 2.7, p = .12, η2 = .11) were not significant. However, resistance training had a large effect on anxiety (d = -.81), and small effect on depression symptoms (¬d = -.41). Regarding the potential mechanisms of action, changes in cognitive appraisal significantly predicted changes in PTSD symptoms during the resistance training intervention (b = 7.1, SE = 2.9, p = .02). Similarly, changes in perceived exertion during exercise was a significant predictor of PTSD symptoms over the 3-week intervention period (b = -3.1, SE = 1.2, p = .01). However, changes in affect, arousal, and distress did not significantly predict changes in PTSD (p’s >.05). Conclusion: This is the first randomized attention-controlled trial testing the effects of high intensity resistance training on PTSD symptoms. The overall results support the hypothesis that resistance training can beneficially affect PTSD symptoms and its commonly co-occurring conditions, such as poor sleep quality. Future adequately powered studies are warranted.

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.

M.A. (Psychology) / Youth and children constitute seventy percent of the population in South Africa. It is these children who carry the potential for the future of our nation. They may be precluded from reaching their potential jf we do not urgently address the problems brought about by violence. Highly evident is the increased incidence of PTSD within the violence stricken communities in South Africa. PTSD among black youths is so high that it can be described as an epidemic. Due to the limited therapeutic resources available, it is imperative that a programme ofaction aimed atreducing the negative impact which PTSD has and continues to have on children is designed. Thus, following adiligent study of the literature, it was decided to train lay counsellors I volunteers in terms of a previously devised Cognitive Behavioural Group intervention formulated by Cowley, Hetz and Rosin (1994) in order to reach out to these children who have been so aversively affected by violence. Utilising the services of lay counsellors rather than professionals is cost effective and time effective. A large sample of PTSD positive subjects were selected from three different schools on the basis that they satisfied the DSM IV criteria for PTSD. The subjects participated in a six week intervention programme. A large number of lay counsellors were trained and selected to facilitate the intervention programme. The administration of the intervention by the lay counsellors did not alter the effectiveness of the Cognitive Behavioural intervention. The results obtained were in accordance with those obtained by Cowley et al.,(1994) in the paired sample tests which were deemed appropriate for this kind of research.

M.A. / The purpose of this research study is to explore and identify a knowledge contents base needed for the development of a competency-based stress-coping program for traumatized adolescents. The aim of a competency-based stress-coping program is to address the inadequacy of the traumatized adolescent to cope with stress, and the need to channel their inability to cope with stress, thus enabling them to channel stress adequately. To accomplish this aim, an in-depth study is made into the competency-based approach, as well as the exploration of stress and traumatized adolescents. The research process of Mouton and Marais (1991) is followed and four data collection methods are utilized in the study. The research process is initiated by a literature study and is supplemented by (a) semi-structured interviews with experts in the field of Competency Based Training; (b) the use of a focusgroup with social workers in practice with traumatized adolescents and (c) group-administered questionnaires completed by traumatized adolescents receiving social work services. The study is not conducted and tested on a large scale due to the qualitative research undertaken. Data collected is analyzed by inductive reasoning and the processing of data through the utilization of the SPPC computer program which is used for the questionnaires completed in this study. Results show that a prerequisite for the utilization of the Competency-Based Approach entails the preliminary training of presenters of programs based upon this approach. Furthermore adolescents need to have certain intellectual and emotional abilities at their disposal which enables them to participate in a program based upon the Competency Based approach. Results show that traumatized adolescents who participated in this study have been exposed to a number of stress factors, mainly related to the relationships they are involved in, and indicate a need to participate in a stress-coping program. In a competency based stress coping program for adolescents it is necessary to identify between the cognitive outcomes and the behaviour or social outcomes that are intended.

M.A. (Psychology) / The aim of the research conducted was to analyze and evaluate the prevalence of Posttraumatic Stress Disorder (PTSD) in emergency workers. A literature study was formulated in which PTSD, and comorbid symptoms of Anxiety, Depression, Stress and Burnout were defined. These are seen as secondary symptoms to the overall effect of PTSD. Data was collected through the use of psychometric tests. These were administered to two main groups. The experimental group reflected the results of the emergency medical worker, while the control group reflected thescores attained by the emergency worker. Both groups were made up of a sample of 30 individuals (n= 30) making the full total of persons studied 60 (n=60). To evaluate for any level of significant difference t-tests for independent groups were administered. Scores found to be significant were trait anxiety scores and burnout scores. All other scores were found to be nonsignificant in a comparison of the two' groups.