M.A., Faculty of Humanities, University of the Witwatwersrand, 2011 / Posttraumatic growth has been an ongoing area of interest in the field of positive psychology. In recent years posttraumatic growth has been linked with the presence of posttraumatic stress symptomatology. The existence of posttraumatic growth has been validated in a number of cultures. There are certain domains that have been implicated in the construction of the phenomenon which taps into different aspects of people’s lives like relating to others, personal strength, new possibilities and appreciation of life. Particular interest has risen with regard to whether this phenomenon develops as a function of ethnic and cultural influences. This study aimed to investigate whether there are differences in posttraumatic growth and posttraumatic stress symptoms as a function of ethnocultural identity. This was investigated by the use of self-report measures of MEIM (Phinney, 1992), Traumatic Stress Schedule (Norris, 1990), Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996) and the Impact of Events Scale Revised (Weiss & Marmar, 1997). The sample consisted of 80 students from the Faculty of Humanities and the Faculty of Commerce, Law and Management, at the University of Witwatersrand. Results of the multivariate analysis showed that ethnocultural identity interacts with ethnicity to moderate posttraumatic stress symptoms. Specifically, findings suggested that Black South African and Indian students who identified with their ethnocultural heritage, reported fewer PTSD symptoms. Whereas the converse was true for White South Africans and Black Africans from other countries. The more they adopted ethnoculturally informed beliefs, the more likely they were to report symptoms of PTSD. There were no significant findings regarding ethnocultural identity in relation to posttraumatic growth. Implications for further research and clinical intervention are discussed.

Somatic complaints of children in primary care settings often go unexplained despite attempts to determine a cause. Recent research has linked violence exposure to stress symptomatology and associated somatic problems. Unknown, however, is whether specific physical symptom complaints can be attributed, at least in part, to violence exposure. Urban African-American 6- and 7-year-old children (N = 268), residing with their biological mothers, recruited before birth, and without prenatal exposure to hard illicit drugs participated. Children and mothers were evaluated in our hospital-based research laboratory, with teacher data collected by mail. Community violence exposure (Things I Have Seen and Heard), stress symptomatology (Levonn), and somatic complaints (teacher-and self-report items) were assessed. Additional data collected included prenatal alcohol exposure, socioeconomic status, domestic violence, maternal age, stress, somatic complaints and psychopathology, and child depression, abuse, and gender. Community violence witnessing and victimization were associated with stress symptoms (r= .26 and .25, respectively, p < .001); violence victimization was related to decreased appetite (r = .16, p < .01), difficulty sleeping (r = .21, p < .001), and stomachache complaints (r = .13, p < .05); witnessed violence was associated with difficulty sleeping (r = .13, p < .05) and headaches (r = .12, p < .05). All associations remained significant after control for confounding. Community violence exposure accounted for 10% of the variance in child stress symptoms, and children who had experienced community violence victimization had a 28% increased risk of appetite problems, a 94% increased risk of sleeping problems, a 57% increased risk of headaches, and a 174% increased risk of stomachaches. Results provide yet another possibility for clinicians to explore when treating these physical symptoms in children.

The aims of this thesis were to increase the knowledge about the long-term psychological consequences in parents of children diagnosed with cancer, including parents of childhood cancer survivors (CCSs) and bereaved parents, and to take the first steps towards developing a psychological treatment for parents of CCSs. Study I was a systematic review synthesizing the literature on psychological long-term consequences in parents of CCSs. Study II had a longitudinal design assessing posttraumatic stress symptoms (PTSS) from shortly after the child’s diagnosis (T1, N=259) up to five years after end of the child’s treatment or death (T7, n=169). Study I and II concluded that while most parents show resilience in the long-term, a subgroup report high levels of general distress and/or PTSS. In Study III, interview data from the last assessment in the longitudinal project (T7, n=168) was used. Participants described particularly negative and/or positive experiences in relation to their child’s cancer, and results pointed to the wide range of such experiences involved in parenting a child with cancer. In Study IV and V, parents of CCSs reporting cancer-related psychological distress were included (N=15). In Study IV, a conceptualization of this distress was generated by aggregation of individual behavioral case formulations. The conceptualization consisted of two separate but overlapping paths describing development and maintenance of symptoms of traumatic stress and depressive symptoms. In Study V, cognitive behavior therapy (CBT) based on the individual case formulations were preliminarily evaluated in an open trial. The CBT appeared feasible, and at post-assessment participants reported significant decreases in PTSS (p&lt;.001), depression (p&lt;.001), and anxiety (p&lt;.01) with medium to large effect sizes (Cohen’s d=0.65-0.92). Findings indicate that psychological long-term consequences in parents of children with cancer consist of a broad range of negative as well as positive experiences, and that while most parents show resilience in the long-term, a subgroup report high levels of psychological distress. For parents of CCSs this distress is suggested to primarily consist of symptoms of traumatic stress and depression, and a preliminary evaluation of CBT targeting hypothesized maintaining mechanisms showed promise in terms of feasibility and treatment effect. / Behandling av traumatisk stress hos föräldrar till cancerdrabbade barn med kognitiv beteendeterapi via internet / Förekomst, utveckling och behandling av posttraumatiskt stressymptom hos föräldrar till barn med cancer / Utveckling och utvärdering av ett webbaserat psykologiskt självhjälpsprogram för föräldrar till barn som tidigare behandlats mot cancer

Hurricane exposure places youth at risk for psychological distress such as symptoms of Posttraumatic Stress Disorder (PTSD), anxiety, and depression, while social support may contribute to resilience following disasters. This study examined associations among family and peer social support, level of hurricane exposure, and psychological distress using both a large single-time assessment sample (N = 1098) and a longitudinal sample followed over a six-month period (n = 192). Higher levels of hurricane exposure were related to lower levels of social support from family and peers as well as to higher levels of psychological distress. Higher levels of family and peer social support demonstrated both concurrent and longitudinal associations with lower levels of psychological distress, with associations varying by social support source and psychological distress outcome. Findings suggested that the protective effects of high peer social support against the development of PTSD symptoms may be diminished by high hurricane exposure.

The objective of this study is to undertake research regarding Posttraumatic Growth and its relationship with Sense of Coherence, within the South African context. In addition, the associations between the three domains of SOC, in particular Meaningfulness, and the five domains of PTG, will be investigated. A further aim of this study is to explore whether the relationship between posttraumatic stress symptoms and Posttraumatic Growth is moderated by Meaningfulness. Sample: The sample consisted of tertiary education students, 18 years and older, and who have experienced a traumatic event as defined by the Traumatic Stress Schedule (N=79). Measures: In addition to a demographic questionnaire, the following measures were administered: the Sense of Coherence Scale (SOC), the Posttraumatic Growth Inventory (PTGI), the Impact of Event Scale - Revised (IES-R), and the Traumatic Stress Schedule (TSS). Results: Participants reported moderate scores on overall PTG with lower SOC scores relative to similar samples in the literature. Age was found to be associated with PTG, and PTG was associated with subjective distress as measured by the IES-R. In addition, those reporting PTG, particularly in the areas of Relating to Others, New Possibilities and Appreciation of Life, evidenced lower levels of Comprehensibility, and those low on Comprehensibility tended to report higher levels of subjective distress. High levels of subjective distress also appeared to be associated with lower levels of Manageability. Findings further suggested that participants who had been exposed to multiple traumas, as well as those who reported higher subjective distress, generally evidenced lower SOC. Multiple trauma exposures were strongly associated with increased subjective distress. Implications of the findings and recommendations for future research are discussed.

This study explored the relationship between perceived racism and stress symptoms in a sample of Latina/o women and men. One hundred and fifty-one female and male Latina/o college students participated in this study. Resting blood pressure, weight, and height measurements were taken after which participants completed 6 questionnaires measuring experience of perceived racism, coping strategies, neuroticism, negative affectivity, symptoms of distress, and perceived stress. Questionnaires employed included the Perceived Racism Scale for Latinos (PRSL), the Coping Inventory for Stressful Situations (CISS), the Neuroticism subscale of the NEO PI-R, the Positive and Negative Affect Schedule (PANAS), the Hopkins Symptoms Checklist-21 (HSCL-21), and the Perceived Stress Scale (PSS). It was hypothesized that neuroticism, negative affectivity, and emotion-focused coping would be positively correlated with self-reports of perceived racism while avoidance coping would be negatively correlated with perceived racism. Perceived racism was hypothesized to predict increased blood pressure, symptoms of distress, and perceived stress. Other predictors included in these regression models included, task-focused, emotion-focused, and avoidant coping strategies, neuroticism, negative affectivity, Body Mass Index, age, and gender. Emotion-focused coping, task-focused coping, and BMI were positively correlated with increased self-reports of perceived racism. Hypotheses that perceived racism would significantly predict increased blood pressure, symptoms of distress, and perceived stress were not supported. Notably, perceived racism significantly predicted frequency of visits to a physician over the past two months after controlling for variance associated with neuroticism, negative affectivity, coping strategies, BMI, age, and gender. Avoidant coping negatively predicted both systolic and diastolic blood pressure, while neuroticism negatively predicted diastolic blood pressure. Argument is presented to suggest that items measuring social support rather than maladaptive avoidant coping are responsible for the significant prediction of blood pressure from avoidance coping. BMI also predicted higher systolic and diastolic blood pressure. Male gender was predictive of higher systolic blood pressure while age predicted higher diastolic blood pressure. Neuroticism and negative affectivity were predictive of symptoms of distress. Perceived stress was predicted by emotion-focused coping, neuroticism, negative affectivity, and BMI. Potential explanations for these results are offered as well as implications and suggestions for future research. / text

Having a child diagnosed with cancer is stressful and many parents of children on treatment for cancer report symptoms of posttraumatic stress (PTSS). The overall purpose was to, among parents of children on treatment for cancer, investigate the factor structure of PTSS; investigate the relationships between experiential avoidance (EA), rumination, PTSS and depression; and to develop, test, and evaluate a guided self-help intervention provided via the internet. In a longitudinal study with three assessments (n = 249-203) results indicated that a four-factor solution of PTSS including the factors re-experiencing, avoidance, dysphoria, and hyper-arousal provided best fit and that the pattern and size of factor loadings were equivalent across the three assessments (Study I). In a case study with pre-, post-, and follow-up assessments a guided self-intervention was well received with clinical significant and reliable improvements in PTSS, depression, and quality of life (Study II). Furthermore, in cross-sectional analyses (n = 79) EA and rumination were positively associated with PTSS and depression and provided incremental explanation in depression while controlling for demographic characteristics, anxiety, and PTSS. In longitudinal analyses (n = 20), EA but not rumination predicted PTSS and depression while controlling for initial levels (Study III). Finally, in a randomized controlled trial with parents fulfilling the modified symptom criteria on the PTSD-Checklist allocated to guided self-help via the internet (n = 31) or to a wait-list control condition (n = 27) there was a significant intervention effect with a large effect size for the primary outcome PTSS. Similar results were observed for the secondary outcomes depression and anxiety, but not for EA and rumination. Exploratory analyses suggested that the relationships between EA and PTSS and between EA and depression were weakened in the intervention group (Study IV). The studies included in the current thesis suggest that a four-factor solution should be used when assessing PTSS in parents of children on cancer treatment. Furthermore, rumination and EA in particular seem to be important constructs to consider when understanding PTSS and depression in this population. Finally, guided self-help via the internet shows promise in reducing PTSS and depression among parents of children on cancer treatment who report a high level of PTSS.

The present investigation evaluated whether dispositional use of emotional approach coping partially accounts for the association between parental response to emotional expression and posttraumatic stress symptoms (PTSS) in a sample of 252 trauma-exposed individuals drawn from a pool of college students and college-age members of the community at-large. An online survey assessed parental reactions to participants' negative emotions during childhood (i.e., offspring retrospective report), as well as participant trauma history, PTSS, and use of emotional approach coping. Findings complement literature illustrating the long-lasting implications of the parent-child relationship, such that both supportive and unsupportive parenting were related to PTSS. Supportive parental reactions also were related to emotional expression, but not emotional processing, and unsupportive reactions did not significantly relate to either aspect of emotional approach coping. Notably, emotional approach coping strategies were unrelated to PTSS in the full sample, and thus the indirect effects models were not supported. Post hoc analyses indicated preliminary support for the indirect effect of emotional expression on the relation between supportive parenting and PTSS in the local college student sample (n = 117). Limitations and implications for future research are discussed.

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