M.Fam.Med., Faculty of Health Sciences, University of the Witwatersrand, 2011 / Purpose: To determine the prevalence of post-traumatic stress disorder (PTSD), and the extent of resilience among former national servicemen who had matriculated from a Johannesburg high school from 1975 to 1988. Design & Methods: A quantitative design which utilised an anonymous, internet-based questionnaire accessed a sample of former national servicemen. Demographic data such as year of intake to national service, current occupation, the type of service unit, combat exposure, drug and alcohol use, exposure to other traumatic events, and recourse to medication and counselling were obtained. The Impact of Event Scale –Revised (IES-R) was used to measure prevalence of PTSD and the Connor Davidson Resilience Scale (CDRISC) was chosen to provide a measure of coping. A sample of 109 men was traced out of a possible population of 1527. They were contacted via email and invited to participate in the anonymous web-based questionnaire. Data was processed from the Wits Health Sciences website via a Microsoft Excel worksheet to the STATA version 11 statistical software package and were subjected to regression analysis using the chi square test and Spearman’s rho. Results: The response rate was 49.5% of the sample of 109. The PTSD level in this sample was 33% and was statistically significantly associated with combat exposure. There was no association between the IES-R and the CD-RISC. Only 5.6% of respondents scored in the range for PTSD on the CD-RISC suggesting high levels of resilience in this sample. Current cannabis use was significantly linked with PTSD. Conclusions. The PTSD prevalence in this population of former national servicemen is higher than in comparable international studies. The primary care practitioner needs to consider prior exposure to national service or combat in routine history-taking and to consider PTSD when former national servicemen present with anxiety symptoms, depression, somatisation disorder, irritable bowel syndrome, chronic pain or substance abuse disorder.

Thesis (M MSc (Clinical Psychology))--University of Limpopo,2010. / The phenomenon of trauma from violent crime is deeply rooted within the South African community (Human Rights Watch, 2008). Various studies has researched the resulting post-traumatic stress reaction (PTSR) of the trauma victim, with far-reaching implications for an understanding of the emotional, cognitive, physiological, and social level of functioning of the victim (Edwards, 2005). Punctuating from the general systems theory, however, it is clear that the trauma victim does not function in isolation, but forms part of certain circular patterns of interaction within a family system. Change in one part of this system will induce change in the system as a whole (Becvar & Becvar, 2006). The aim of this research project was to move away from exclusively focusing on the trauma victim and to investigate the effects, if any, on the whole family system if one of its members experienced a PTSR. Data was collected from qualitative interviews with a family member of each trauma victim, someone who had not directly experienced the traumatic incident. The data was transcribed verbatim and analysed, in accordance with qualitative methodology by three independent, systemically trained clinicians. The findings indicate that there is a significant effect on the whole family system, and that all the members of this system experience some form of PTSR as a secondary traumatic experience. The ability of the system to cope effectively with this environmental demand is based largely on the effectiveness of its patterns of communication. These findings have important implications for our understanding of the phenomenon of trauma, trauma prevention and intervention strategies.

Literature investigating trauma exposure, Posttraumatic stress disorder (PTSD) and cortisol secretion has produced conflicting results with regard to whether cortisol is increased or decreased. With trauma there is also a pro- inflammatory response which is intimately linked with the hypothalamic pituitary axis (HPA). The police population can offer useful information in this regard as they represent a sample that will undergo exposure to traumatic events as part of their normal duties. In South Africa few studies have examined biological correlates of the traumatic stress response in the police population. This study sought to determine whether correlations exist between cortisol and the inflammatory response in terms of the cytokines Interleukin 6 (IL6) and Tumour Necrosis Factor (TNF) in response to trauma exposure in a cohort of newly enrolled metro police officers, previously naïve to the duty related trauma exposure. Personality styles were assessed, as coping skills and personality have been suggested as factors determining responses to trauma. The study participants were followed up for one year with repeated measures analysis of urine, blood, and saliva cortisol as well as blood cytokine determination every 3 months. Measures for PTSD [the Clinician Administered Scale for Posttraumatic stress disorder (CAPS) and the revised version of the Impact of Event Scale (IES-R)] as well as for depression [the Hamilton Depression Rating Scale (HAM-D)] were undertaken. 145 new recruits volunteered for the study, of which 120 completed all 5 visits. There were slightly more females than males in the sample and almost 50% of the sample admitted to alcohol abuse. Trauma exposure on entry into the police force was remarkably high with 99% having been exposed to at least one traumatic event in their lives. The majority (61.1 %) had been exposed to more than one traumatic event. There was evidence for the influence of prior trauma on responses to current traumatic events. MVA’s were very common, both duty and non duty related. Certain traumas were associated with greater changes in scores for PTSD and depression in relation to baseline. Over the 5 visits, only a third submitted valid 24 hour urine samples. Of these, the profile of the entire group indicated that 24 hour urine cortisol tended to initially decrease, and then increase with time. Saliva and blood cortisol, which were more reliably measured, tended to decrease with time. Scores for depression and post traumatic stress disorder were generally low in response to duty related traumatic events, and tended to decrease over time. However, the prevalence of lifetime PTSD as measured by the CAPS was high. There was a strong linear correlation between TNF and IL6. Results indicate a proinflammatory response, particularly with regard to IL6. There were no significant correlations between blood cortisol and HAM-D and between blood cortisol and CAPS (lifetime). There was an inverse relationship between CAPS (current scores) and blood cortisol. Cortisol and IES-R scores were significant at visit 3 (inverse relationship). For saliva, there were no significant associations with any of the variables for PTSD and depression. For personality styles, aggressive and antisocial clinical patterns were associated with lower current CAPS scores, while schizoid clinical pattern and the severe syndrome scale of thought disorder showed an association with lower lifetime CAPS score. For the IES-R, only narcissistic clinical pattern was associated with lower scores. A further analysis of those with low (less than 25% of the median) and high (greater than 25% of the median) cortisol responses was undertaken. The results indicate a similar trend to some studies showing lowered cortisol levels with chronic trauma exposure, but this did not correlate with sufficiently high scores for PTSD as measured by the CAPS. Similarly, proinflammatory cytokine increases are evident with trauma exposure, but not with scores for PTSD and depression. There were more variables significantly associated with the low cortisol responders than the high cortisol responders; with a suggestion of cumulative trauma exposure correlating with low cortisol response and a corresponding pro inflammatory response in terms of IL6. The results are discussed with a view to assisting the metro police force with recruitment and counseling strategies and important future research is recommended.

by Chan Won Shing, Raymond. / "May 2000." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (p. 177-191). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

54 225: crimes against children reported in 2010/2011  28 128: sexual offences  30% of the sexual offences occurred in children younger than ten years. These figures are a stark reminder of the growing number of children who experience deprivation, abuse and maltreatment in South Africa (Unicef, 2013). Although controversy exists with the reporting methods and the accuracy of recall in adult patients, it remains evident that a significant number of female children are sexually abused. Associations between early life stress and later life dysregulation of the hypothalamic-pituitary-adrenal axis hormone, cortisol, and the immune system cytokine, interleukin 6, have been found in adult patients and in animal studies. Importantly, although there is also evidence that early life stress results in later life neurobiological changes, we have to date, no identifiable biological markers to assist with diagnosis or to inform treatment strategies in young children who present with early life stress such as sexual abuse or maternal neglect. Thus, there is a growing imperative to establish whether the potential precursor biomarkers are evident in early in development following adverse life conditions. Therefore the research focus of the thesis was to investigate (1) whether dysregulation of the HPA axis is evident in young children who are exposed to the traumatic stress of abuse, (2) whether there is evidence that inadequate maternal care, during the neonatal stage of development, has an impact of HPA and immune function and consequently on

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 6 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 4 uppsatser.

Objetivo: Avaliar a eficácia da Terapia Cognitiva Processual na melhora de pacientes com Transtorno de Estresse Pós-traumático. Desenho do estudo - Estudo randomizado, com dois grupos paralelos. Intervenções - Dois modelos de Terapia Comportamental Cognitiva - Terapia Cognitiva Processual e Exposição (os pacientes receberam tratamento farmacológico). Duração e frequência: Após a avaliação inicial (semana 00), as sessões de psicoterapia tiveram frequência semanal, durante onze semanas, e quinzenais nas quatro últimas semanas, totalizando 13 (treze) sessões. As sessões de psicoterapia duraram 1 (uma) hora. Os pacientes foram reavaliados após três meses. Número de participantes: Amostra de conveniência envolvendo 86 pacientes; 42 no grupo de Exposição e 44 no grupo de Terapia Cognitiva Processual. Resultados e Conclusão: Os dois grupos melhoraram, porém melhoras nos sintomas de TEPT não foram estatisticamente significantes entre os grupos (p > 0,1), assim como para sintomas depressivos e ansiosos (p > 0,2). Estes resultados sugerem que a Terapia Cognitiva Processual é tão eficaz quanto a Terapia de Exposição padrão-ouro / Objective: To evaluate the efficacy of Trial-Based Cognitive Therapy in the improvement of patients with posttraumatic stress disorder. Study design - Randomized study with two parallel groups. Interventions - Two Models of Cognitive Behavioral Therapy - Trial-Based Cognitive Therapy (TBCT) and Exposure (patients received pharmacological treatment). Duration and frequency: After the initial assessment (week 0), psychotherapy sessions were held weekly for eleven weeks and twice a week for four weeks, a total of thirteen (13) sessions. Psychotherapy sessions were one (1) hour long. Patients were reassessed after three months. Total Duration: 13 sessions of treatment and three months follow-up. Number of Participants: Convenience sample involveing 86 patients, 42 in the exposure group and 44 in the TrialBased Therapy group. Results and Conclusion: Both groups improved, but improvements in the symptoms of PTSD depression and anxiety were not statistically significant among the two treatment groups (p > 0.1; p > 0.2). These results suggest that Trial-Based Cognitive Therapy is as effective as the gold standard Exposure

Objetivo: Avaliar a eficácia da Terapia Cognitiva Processual na melhora de pacientes com Transtorno de Estresse Pós-traumático. Desenho do estudo - Estudo randomizado, com dois grupos paralelos. Intervenções - Dois modelos de Terapia Comportamental Cognitiva - Terapia Cognitiva Processual e Exposição (os pacientes receberam tratamento farmacológico). Duração e frequência: Após a avaliação inicial (semana 00), as sessões de psicoterapia tiveram frequência semanal, durante onze semanas, e quinzenais nas quatro últimas semanas, totalizando 13 (treze) sessões. As sessões de psicoterapia duraram 1 (uma) hora. Os pacientes foram reavaliados após três meses. Número de participantes: Amostra de conveniência envolvendo 86 pacientes; 42 no grupo de Exposição e 44 no grupo de Terapia Cognitiva Processual. Resultados e Conclusão: Os dois grupos melhoraram, porém melhoras nos sintomas de TEPT não foram estatisticamente significantes entre os grupos (p > 0,1), assim como para sintomas depressivos e ansiosos (p > 0,2). Estes resultados sugerem que a Terapia Cognitiva Processual é tão eficaz quanto a Terapia de Exposição padrão-ouro / Objective: To evaluate the efficacy of Trial-Based Cognitive Therapy in the improvement of patients with posttraumatic stress disorder. Study design - Randomized study with two parallel groups. Interventions - Two Models of Cognitive Behavioral Therapy - Trial-Based Cognitive Therapy (TBCT) and Exposure (patients received pharmacological treatment). Duration and frequency: After the initial assessment (week 0), psychotherapy sessions were held weekly for eleven weeks and twice a week for four weeks, a total of thirteen (13) sessions. Psychotherapy sessions were one (1) hour long. Patients were reassessed after three months. Total Duration: 13 sessions of treatment and three months follow-up. Number of Participants: Convenience sample involveing 86 patients, 42 in the exposure group and 44 in the TrialBased Therapy group. Results and Conclusion: Both groups improved, but improvements in the symptoms of PTSD depression and anxiety were not statistically significant among the two treatment groups (p > 0.1; p > 0.2). These results suggest that Trial-Based Cognitive Therapy is as effective as the gold standard Exposure

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.