Traumatic experiences are relatively common for individuals, particularly Military members, and can have long-term negative impacts such as posttraumatic stress, comorbid mental health symptoms, and functional impairment. However, a growing body of research suggests that some civilians and service members who experience traumas also report beneficial personal growth from the experience; this phenomenon has been termed Posttraumatic Growth (PTG). Understanding PTG and how it occurs has important implications for civilian and Military individuals who have experienced trauma as well as the helping professionals who serve them. This literature review provides an overview of trauma, definitions and conceptual frameworks of PTG mechanisms, static and dynamic factors related to PTG, and examples of interventions used to promote growth. Relevant and application-focused implications for helping professionals are provided.

In the U.S., Black mothers experience fetal and infant mortality at alarming rates when compared to White and Latina mothers (Gregory, Drake, & Martin, 2018). The intent of this study was to examine perinatal loss among Black American women and to expand understanding of how the Strong Black Woman (SBW) ideology influences bereavement. Data were gathered from (N=109) Black American bereaved mothers. It was predicted that endorsement of differing aspects of the SBW would moderate the relationship between perinatal grief and psychosocial outcomes (i.e., depression and post-traumatic growth). Regression analyses, alongside a bootstrapping procedure via PROCESS (Hayes, 2017), were used to evaluate the moderation models. Results yielded a model of perinatal bereavement among Black American mothers. In particular, reliance on spirituality moderated the relationship between perinatal grief and depression, while the obligation to manifest strength moderated the relation between perinatal grief and posttraumatic growth (PTG). Neither moderated moderation model was significant. The model provided significant implications for clinical practice and intervention.

In many conflict regions, women and girls continue to be at high risk of becoming victims of rape by armed combatants, whether local or foreign militaries, rebel groups or peace keeping forces. The physical and psychological repercussions of CRSV against women and their families can be long-lasting and far-reaching (Bosmans, 2007); and it is by no accident that sexual violence is now widely referred to as a ‘weapon of war’ (Clifford, 2008) or an ‘act of terrorism’ (United Nations, 2017). Very often, social taboos dictate that victims of sexual violence be seen as unclean, spoiled or unfaithful, which can lead to social isolation and stigmatisation (Albutt, Kelly, Kabanga, & VanRooyen, 2016). Injuries and trauma from sexual violence may also raise the concern that women are not be able to work, perform household chores or care for children; effectively diminishing their perceived ‘worth’ (Glass, Ramazani, Tosha, Mpanano, & Cinyabuguma, 2012). Depression and other mental illnesses may create further barriers with family and friends and diminish participation in wider community life (Betancourt, Agnew-Blais, Gilman, Williams, & Eliis, 2010). Raising a child born from CRSV can add to this burden, and these dyads may face further barriers to secure attachments. This may arise as a result of a mother’s own emotion dysregulation following the trauma of sexual violence or indeed ambivalence towards their child as a result of his/her conception. Such dyadic victimhood may also be compounded by migration and assimilation into a new culture. And yet, women do not (always) see themselves as victims, many women seem themselves as brave and courageous (Medica Zenica & medica mondiale, 2014). Many are able to achieve growth in spite of their experiences. The overarching aim of this dissertation is to contribute to the discourse on the myriad psychosocial outcomes of conflict-related sexual violence for survivors, by systematically exploring areas of difficulty and areas of perceived strength and combining mixed methodologies. It is built on the foundation of multiple intertwining areas of global mental health and explored several of these within two different contexts: being a mother, being a survivor. Using the evidence generated through this dissertation, recommendations for addressing their needs have been provided.:Foreword 4 Introduction 5 Background & Context 6 Outcomes of CRSV Against Women: Being a Mother, Being a Survivor 8 Aims & Objectives 12 Research Questions 12 Core Publications of this Dissertation 13 Chapter I: Being a Mother 14 Methodology 15 Publication I 21 Publication II 36 Chapter II: Being a Survivor 57 Methodology 58 Publication III 63 A Dual Model of Posttraumatic Stress and Posttraumatic Growth in Survivors of Sexual Violence 76 Publication IV 77 Discussion 103 Summary of Findings 104 Strengths and Limitations 107 Conclusion 108 Future directions 111 Recommendations 113 Thesis References 134 Appendices 141 1. Abbreviations 142 2. Zusammenfassung 143 3. This dissertation is based on the following publications 145 4. Presentation of own contribution 146 6. Curriculum Vitae 148 7. Publication List 149 8. Certificate of Good Scientific Practice 151 9. Acknowledgements 152

This master thesis follows up the topic of posttraumatic growth of paramedics. The first part clarifies the concept of posttraumatic growth and factors which influence the process of growth that is following the trauma. The most substantial models of posttraumatic growth are also included. A paramedic as a profession is described, too. In this part, requirements for paramedics and possible intervences often used to handle with the stressful event. The empiric part deals with the relationship between posttraumatic growth and coping strategies among paramedics. A use of positive coping strategies is a possible way how to reach a higher level of post traumatic growth. The questionnaires PTGI and SVF 78 are used in the research to detect the level of posttraumatic growth achieved and the coping strategy that is used by the participants. The questionnaire PTGI detects the change in five areas: relationships with other people, stregths, new opportunities, change in spiritual areas and understanding of life. The research shows positive corelation between the level of posttraumatic growth and following coping strategies: control of situation, control of reactions and positive self- instruction. It was also found that women reach significantly better in the subscales relationships with other people and...

This study explored the social construction of black male Zimbabwean refugees’ identities as they experienced becoming refugees living in South Africa. A review of refugee literature revealed that Zimbabwean refugees demonstrate an exceptional nature that sets them apart from what most definitions of refugees assume. Refugee theory focusing on deficits and disorder promoted a view of refugees as helpless victims. As a result, refugees have come to be viewed as state burdens. Immigration practices characterized by the herding of refugees into spatially segregated areas, deportation and neglect continue to endanger the livelihoods of refugees. The manner in which government and media conceptualise the identity of a refugee has significant consequences for foreigners and locals. It is therefore important to explore the social construction of black male Zimbabwean refugees’ identities by investigating their own experiences through the telling of life stories. A process of in-depth qualitative interviews were conducted with four black male Zimbabwean refugees between the ages of 18 and 50, all currently living in South Africa. A self told life story outlined a narrative of their past migration, present circumstances and future deliberations. Results showed that participants bore great suffering in search of a stable existence. They were subjected to political abuse and an immense economic downfall in Zimbabwe, and experienced a great shock of self-confidence upon leaving their home. They came to bear a painful sense of ‘otherness’ living as a foreigner, and had to develop new understandings of themselves. Race and religion became important signifiers of identity, and participants were said to undergo a posttraumatic growth in the aftermath of their turbulent experiences. A study such as this offers valuable insights into the aspects of a Zimbabwean refugee’s existence and needs. Research may also inform bureaucratic practices as to conceptualising more appropriate refugee relations in the future, as well as media campaigns capable of rehabilitating the image of the refugee. / Dissertation (MA)--University of Pretoria, 2012. / Psychology / unrestricted

The #MeToo movement was established as a grassroots initiative in Brooklyn by Tarana Burke, as a way to bring awareness to the commonality of sexual violence towards African American women. Despite the awareness brought by the movement, it was virtually not inclusive of men who have experienced sexual violence. This study intends to provide educators an understanding of this phenomenon, as well as provide practitioners, scholars, and organizations supporting gay male rape survivors a qualitative perspective beneficial to enhance support systems in order to foster post-traumatic growth. This study answered questions of how participants described their experience of having been raped; how learning revealed itself during the participants’ journey towards post-traumatic growth; and what factors participants described that helped and/or hindered their ability to manage the experience, learn, and develop towards post-traumatic growth. Six individual in-depth cases are presented; each participating in a two-hour interview. Using Lifelines and Nohl’s (2015) five phase analysis of the unfolding of deep learning over time, this study demonstrated that Transformative Learning revealed itself throughout each of these cases. As described by O’Sullivan et al. (2002), Transformative learning is “[an] experiencing [of] a deep, structural shift in the basic premises of thought, feeling, and actions. It is a shift of consciousness that dramatically and permanently alters our way of being in the world. Such a shift involves our understanding of ourselves and our self-locations; our relationships with other humans and with the natural world; our understanding of relations of power in interlocking structures of class, race, and gender; our body-awareness; our visions of alternative approaches to living; and our sense of the possibilities for social justice and peace and personal joy.” The study provides insight into the various systems and social relationships that help and/or hinder the interviewees’ learning experience, as well as how they managed their lives along the way. Moreover, this study demonstrates that Transformative Learning can take over 20-years, as well as that the process requires recalibration after encountering obstacles as learners journeyed towards post-traumatic growth.

Having a secure attachment to God may act as a buffer against stress. Secure attachment to God has been positively associated with adaptive outcomes following stress, such as higher levels of stress-related growth and fewer maladaptive symptoms including depression, prolonged grief, and traumatic distress. However, relatively few studies have empirically tested the relationship between attachment to God and resilience and posttraumatic growth. Thus, the current study explored the potential associations and pathways through which attachment to God is associated with resilience and posttraumatic growth in a sample of 303 suddenly and/or traumatically bereaved individuals. The current study found that (a) God attachment avoidance is a unique negative predictor of resilience and posttraumatic growth even when controlling for adult attachment, (b) self-compassion and meaning-making mediate the association between God attachment anxiety and resilience/posttraumatic growth, (c) secure attachment to God is associated with higher levels of resilience than insecure attachment styles, but not with posttraumatic growth, and (d) an increased number of secondary losses is associated with lower levels of resilience. I conclude by discussing my findings in light of the extant literature on attachment to God, resilience, and posttraumatic growth. By better understanding attachment to God and how it may relate to resilience and posttraumatic growth, clinicians will be better equipped to interact with clients of diverse religious/spiritual (R/S) identities, potentially utilizing R/S as a strength or addressing maladaptive aspects of R/S in the wake of life stressors.

PTSD is a mental health condition that affects many people over the course of their life (National Comorbidity Survey, 2005), including veterans (Litz & Schlenger, 2009). However, many do not experience clinical levels of distress and some experience posttraumatic growth (PTG) resulting from such an event (Tedeschi, Park, & Calhoun, 1998). The Psychological Flexibility Model, of which Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) is based, may help explain these phenomena. The purpose of this study was to examine these relationships utilizing a measure simultaneously assessing psychological flexibility and inflexibility. It was hypothesized that psychologically inflexible behaviors would predict PTSD symptom severity, while flexible behaviors would predict PTG. Furthermore, each of psychological inflexibility and flexibility would account for unique variance in PTSD symptom severity and PTG, respectively. Finally, the domains of ACT were examined to assess the strength each component has in the maintenance of these experiences. Results indicated that both psychological inflexibility and flexibility predicted PTSD symptoms and PTG, respectively, and each predicted unique variance in these experiences. Of the individual components, cognitive fusion, experiential avoidance, inaction, and lack of contact with the present moment all contributed to PTSD symptom severity, while values clarity, lack of contact with the present moment, and present moment awareness contributed to PTG. These results suggest the psychological flexibility model overall is consistent with the experience of PTSD symptoms and the posttraumatic growth. Though further experimental methods are needed, the application of psychological flexibility through ACT could enhance PTSD treatments.

Research has been accumulating on the positive outcomes that people may experience following trauma. However, scholarly literature is deficient in the area of investigating the association among centrality of event (CE), posttraumatic growth (PTG), and health behaviors of women with histories of sexual trauma. The purpose of this quantitative cross-sectional study was to (a) determine the extent of the relationship between CE and PTG, (b) explore the relationship between PTG and health behaviors (i.e., drug, alcohol, and tobacco use, and physical activity), and (c) to determine whether general self-efficacy (SE) mediated these relationships. The theoretical frameworks used to inform this study were the theories of PTG and SE. A sample of 123 women with histories of sexual violence completed the Posttraumatic Growth Inventory, the Centrality of Events Scale-SF, the New General Self-Efficacy Scale, the Drug Abuse Screening Test-10, and health behavior questions from the Behavioral Risk Factor Surveillance System. The majority of participants reported that their experiences were highly central. Simple regression analysis indicated a marginal relationship between CE and PTG as well as a significant relationship between PTG and SE. PTG was not directly related to the health behaviors in this study. However, a bootstrap mediation analysis indicated that SE significantly mediated the relationship between PTG and physical activity. This study contributes to positive social change by helping women understand how their cognitions influence their SE and behaviors. Likewise, this study can inform practitioners on developing interventions through a lens of positive psychology to promote beneficial health behaviors.

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