The purpose of this study is to provide an inclusive portrait of the experience of female spouses living with traumatized male Canadian soldiers healing from Post-Traumatic Stress Disorder (PTSD). By facilitating the articulation of the spouses' stories this research gives a voice to and fosters appreciation for this neglected population. As well, this study helps clarify the needs and possible therapeutic interventions for spouses of soldiers in psychotherapy for PTSD. Although recently there has been an increased focus on addressing PTSD in soldiers, there has been comparatively little research and clinical attention given to the soldiers' families. For this study, in-depth interviews were conducted with six spouses of former peacekeeping Canadian soldiers who received group therapy for PTSD. Using the Life Story interview method, a spontaneous picture of the spouses' experiences was elicited as part of a comprehensive relationship narrative. This provided the opportunity for understanding the experience of living with a soldier in treatment for PTSD within a couple relationship and larger social context. Narrative summaries were created from the interviews and follow-up was conducted with each participant to gain feedback on these narratives. Participants were also given the opportunity to read each other's narratives and discuss their impressions. The narrative summaries are presented along with thematic results. The participants' stories revealed instances of aggression, primary trauma and problems related to their husbands' periods of alcohol abuse, so Figley's model of Secondary Traumatic Stress was not the best conceptual fit to explain the experiences of these women. Limited support was found, however, for Hobfoll's (1998)model of a loss spiral to help describe the descent into chronic disability associated with combat-related PTSD as well as the difficulties soldiers experience in their transition from military service. This study's implications for practice include recommendations for groups for military spouses; the need to address the iatrogenic suffering of soldiers and their spouses; treatment recommendations for soldiers with PTSD. Future research also needs to include delivery and evaluation of a group-based counselling intervention for the spouses of traumatized soldiers. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

South Africa as a country is known for its high crime rate which produces an ongoing traumatising environment for its multicultural nation. Posttraumatic stress disorder in the general South African population is thought to be more prevalent than most international norms which make this topic both relevant and important. Cultural diversity is seen to play a role in the experience of PTSD which means that it has become important to gain an understanding of the potential effect of the individual’s cultural background on the processing of a traumatic experience and the symptoms related to the experience. The proposed research focused on appraisals of the traumatic event and symptoms (in schematic and cultural terms). An interpretive (with current cognitive conceptions of the disorder as guiding theory) phenomenological approach was used. The sample consisted of eight isiXhosa-speaking adults that qualified for a diagnosis of PTSD with no prior psychiatric diagnosis. Data was gathered using a semi-structured interview and analysed using the Interpretive Phenomenological Analysis. Results indicated that participants understood their PTSD symptoms in a functional manner but struggled to make sense of their traumatic event. Not understanding their traumatic event was the variable that maintained their PTSD diagnosis. Most of the interpretations made by these participants were fairly universal and there were very few links to content that can directly be attributed to a traditional African worldview. Practitioners may not need to completely reinvent the wheel as far as treatment strategies for PTSD for isiXhosa-speaking individuals in an urban setting go.

Background: This study identified, addressed and validated risk factors that can be measured in the peri-traumatic period which may eventually be used in predicting the development of traumatic stress. Many people in South Africa possibly suffer from Posttraumatic Stress Disorder (PTSD) if we consider the extent of trauma exposures that is apparent within the South African population. Traumatised individuals are at risk but may remain undiagnosed and untreated. It makes sense for first line and primary health care practitioners (i.e., not highly qualified psychological practitioners) to screen for risk since they have the initial contact with trauma individuals. A relatively easy screening instrument that can be administered time efficiently would be useful in this regard. The principles of this instrument are that it needs to be objectively measurable, quick and easy to administer. No consistent measure geared towards identifying risk factors in such a manner immediately post trauma currently exists in South Africa. Objectives: The overall aim was to start a process of designing a psychometric instrument that is valid in predicting the development of traumatic stress. Since this is the initial stage of constructing a new measure, content validity was of utmost importance. It became imperative to ensure that items were not only relevant and appropriate, but also accurate and capable in identifying at-risk individuals. The proposed end goal is to develop effective identification strategies in South Africa geared towards helping victims of traumatic events. Method: A pilot psychometric questionnaire was compiled using three major international reviews, South African research on known risk factors, and literature on PTSD risk assessment considerations. This preliminary assembled item pool was used as a departure point and evaluated quantitatively as well as qualitatively by expert reviewers who have research and/or clinical experience with PTSD in a South African context. Their feedback resulted in either the omission or the modification of certain items; for some items, further exploration was recommended. The questionnaire was further scrutinised and modified accordingly after qualitative interviews with and critical feedback from the intended administrators or primary health care professionals, namely Registered Counsellors (RCs) and/or nursing staff from a participating general government hospital and a non-government organisation. Findings: Expert reviewers did not agree consistently across all the items. At times they rated certain items as relevant according to the necessity of the information rather than with regards to the relevance of the content of the item – in terms of prediction of PTSD. It was also observed that intended administrators did not always agree with expert reviewers.

Background: Recent Canadian Armed Forces operations involved multiple deployments and exposure to traumatic events that are associated with post-traumatic stress disorder, depression and substance abuse. Despite efforts to facilitate mental health care, some soldiers do not get the help they need. Objective: To understand soldiers’ experiences and explore barriers and facilitators they encountered accessing mental health care. Results: Qualitative descriptive interviews with 11 Canadian Armed Forces members revealed six major categories that provide insights into their experiences accessing mental health care. Participants’ revealed significant barriers to care including fear of damaging their career or being released, stigma beliefs and actions from peers and leaders, and physical and organizational barriers to care. Social support from family, military co-workers, and unit leaders facilitated care. Conclusions: Notwithstanding efforts to facilitate access to mental health care, some soldiers still perceive significant barriers to care.

Considerable research has demonstrated a link between thoughts of revenge, or vengeful rumination, and the development of posttraumatic stress disorder (PTSD) symptoms, particularly in situations involving interpersonal trauma. Personality factors have been related to both vengefulness and PTSD. No study to date has simultaneously examined the unique contributions of vengefulness and personality factors in the development of PTSD symptoms. Therefore, the present study addressed these questions in an inpatient sample by comparing contributions of the Big Five personality factors and vengeful rumination to the development of PTSD symptoms through correlation, hierarchical regression, and omnibus regression analyses. Results showed that Neuroticism predicted PTSD symptoms better than other personality factors, that Neuroticism and Agreeableness predicted vengeful rumination in opposite directions, and that personality factors and vengeful rumination each added unique variance in the prediction of PTSD symptoms. Future directions and implications are discussed.

The purpose of this study was to develop a manualized therapy group for wives or significant others of veterans with posttraumatic stress disorder and to evaluate its effectiveness in reducing wives' psychological symptoms. A second aim of the study was to determine if women's involvement in the wives group resulted in decreases in their husbands' PTSD symptoms. Women recruited for the study were administered pre-test measures during a screening session. They then participated in a 9-session manualized therapy group designed by the researcher that included psychoeducational, process, and support components. Examples of group topics included psychoeducation regarding PTSD, assertiveness and communication, intimacy, self-care, and stress management. After completing the group sessions, participants were asked to complete post-test measures. Other factors explored in this study included marital satisfaction, perceived social support, general satisfaction with the group, and demographic variables. Results indicated that wives who participated in the group treatment exhibited significant decreases in secondary stress symptoms and increases in marital satisfaction from pre-test to post-test. The majority of participants also reported high levels of satisfaction with the group process. Therefore, it appears that the group protocol presented in this study could be a useful tool in the treatment of wives of veterans with PTSD. The results of this study have potential implications regarding the clinical treatment of families of veterans with PTSD and the development of future programs within the VA system.

The success of mental health counseling partially depends on the professionals who are providing these services, also on the quality of services they provide. To maximize their efficacy, counselors must achieve and maintain their own personal wellness. However, for counselors who work with people who have experienced trauma, there is an increased chance that these counselors will experience adverse effects from this work. In fact, the impact of trauma on counseling professionals is similar to actually experiencing the traumatic event themselves. Native Americans are more likely than any other racial group in the United States to experience chronic traumatization and victimization. As a result of this, Native Americans suffer disproportionate health disparities, including mental health conditions like depression, anxiety, and addiction. The research question of this phenomenological study is, “What are the lived experiences of Native American counselors working in the trauma-intense environment of a Native American reservation?”. In this study, three participants took part in a semi-structured, open-ended, individual interview. Through data analysis, four themes were identified about the participants’ shared experiences: the worth and weight of working on a reservation, the impact of culture and community on counseling, four forms of trauma impacting the counselor and their work, and the effects of personal and professional wellness on counselors. The discussion of these findings are presented, along with implications for future research and policy change. In short, the goal of this study is to assist Native American counselors in maintaining their wellness, so they may continue providing counseling services to a population of people who experience significant trauma.

Abstract BACKGROUND: The PTSD Checklist-civilian (PCL-C) is one of the most commonly used self-report measures of PTSD symptoms, however, little is known about its validity when used in pregnancy. This study aims to evaluate the reliability and validity of the PCL-C as a screen for detecting PTSD symptoms among pregnant women. METHODS: A total of 3372 pregnant women who attended their first prenatal care visit in Lima, Peru participated in the study. We assessed the reliability of the PCL-C items using Cronbach's alpha. Criterion validity and performance characteristics of PCL-C were assessed against an independent, blinded Clinician-Administered PTSD Scale (CAPS) interview using measures of sensitivity, specificity and receiver operating characteristics (ROC) curves. We tested construct validity using exploratory and confirmatory factor analytic approaches. RESULTS: The reliability of the PCL-C was excellent (Cronbach's alpha =0.90). ROC analysis showed that a cut-off score of 26 offered optimal discriminatory power, with a sensitivity of 0.86 (95% CI: 0.78-0.92) and a specificity of 0.63 (95% CI: 0.62-0.65). The area under the ROC curve was 0.75 (95% CI: 0.71-0.78). A three-factor solution was extracted using exploratory factor analysis and was further complemented with three other models using confirmatory factor analysis (CFA). In a CFA, a three-factor model based on DSM-IV symptom structure had reasonable fit statistics with comparative fit index of 0.86 and root mean square error of approximation of 0.09. CONCLUSION: The Spanish-language version of the PCL-C may be used as a screening tool for pregnant women. The PCL-C has good reliability, criterion validity and factorial validity. The optimal cut-off score obtained by maximizing the sensitivity and specificity should be considered cautiously; women who screened positive may require further investigation to confirm PTSD diagnosis. / Revisión por pares

Abstract Background There is limited research and guidelines regarding physiotherapy as a treatment approach      for post-traumatic stress (PTS). Refugee experience of physiotherapy interventions is hoped                      to contribute to awareness of the subject and to give insight into this developing field of the         profession. Purpose The purpose of the study was to investigate and describe refugees experience of post-             traumatic stress physiotherapy. The study was interested in both refugee experience of          treatment itself and of possible effects. Design and Method Qualitative explorative design. The study was based on five semi-structured interviews. A        qualitative, content analysis was used to process the data. Results          The analysis showed that the refugees faced many physical and psychological barriers to         treatment, especially relating to pain and somatisation, however they were able to                    experience increased bodily comfort during treatment itself. The relationship to         physiotherapist, the psychological impact of the treatment environment and other social      factors were also described as important to experience. Physiotherapy was described as positively affecting patient outcomes both in physical and mental health, despite certain uncontrollable/unmanageable symptoms making this difficult. The refugees were able to achieve generalisation of physiotherapy into their day-to-                     day life enabling them to self-manage to some extent and feel liberated from PTS symptoms. Conclusion The study agrees with the available literature on the effectiveness of treating refugee              patients suffering from post-traumatic stress with physiotherapy, not just to improve            physical health outcomes but even to give holistic improvements.  Keywords Post-traumatic stress, refugee, physiotherapy, experiences / Abstrakt Bakgrund Det finns begränsad forskning och riktlinjer gällande fysioterapeutisk behandling mot post-traumatisk stress (PTS). Flyktingars upplevelse av fysioterapeutisk behandling förväntas sprida kunskap och bidra till insikt i denna del av det fysioterapeutiska området som fortfarande är under utveckling. Syfte Syftet av studien var att utforska och beskriva flyktingars upplevelse av posttraumatisk stress-fysioterapi. Studiens intresse var av flyktingars upplevelse och effekt av den fysioterapeutiska behandlingen. Design och Metod Studien är av kvalitativ utforskande design baserat på användandet av 5 semi-strukturerade intervjuer. En kvalitativ innehållsanalys användes för att bearbeta informationen. Resultat Analysen visade att flyktingar möter många fysiska och psykiska hinder i behandlingen, mest gällande smärta och somatisering men att de kunde uppleva en viss grad av bekvämlighet under behandlingen ändå. Förhållandet till fysioterapeuten, den psykologiska effekten av behandlingsmiljön och andra sociala faktorer var också viktiga. Fysioterapi beskrevs ge positiv påverkan i resultatet av patienternas fysiska och mentala hälsa efter behandling trots utmaning från icke-hanterbara symptom. Flyktingarna kunde uppnå generalisering av deras fysioterapi till det dagliga livet som gjorde att de kunde hantera situationen själva till en viss grad och känna frihet från sina PTS symptom. Konklusion Studiens resultat går i samma linje som den tillgängliga litteraturen på effekten av att behandla flyktingar som lider av posttraumatisk stress med fysioterapi, inte bara för att öka den fysiska hälsan utan även för att ge mer vidgående holistiska förbättringar och livskvalitet. Nyckelord Post-traumatic stress, refugee, physiotherapy, experiences

The level of crime in South Africa as reflected by crime statistics affects a high number of adolescents. Trauma and stress associated with interpersonal violence can adversely affect the neurobiology of the individual, since social, emotional and cognitive influences interact in multifaceted ways with neurobiological systems to affect every-day adaptive functioning. This study was embarked upon to determine the difference in the expression of personality between adolescents exposed to community related interpersonal violence and those not exposed to such violence. The 183 research participants were selected from a group of 335 grade 12 learners from a single secondary school in a middle class community. The participants were placed into two sample groups by means of purposive sampling as follows: Sample 1 consisted of all the research participants that reported exposure to community related interpersonal violence during the past 5 years on the self-reporting questionnaire (n = 93). The research participants that did not report exposure to such violence formed Sample 2 (n = 90). Reflecting on the adolescent’s emotional, adaptive functioning and referring to high levels of anxiety and feelings of worthlessness, certain factors of the 16PF questionnaire were predicted to show a statistical significant difference after exposure to community related interpersonal violence after a period of 3 to 5 years. To assess the differences in personality profiles of adolescents exposed to community related interpersonal violence and those not exposed to violence, a MANOVA was used in analysing 16PF results. There were statistically significant differences between the two groups on Factor G (rule consciousness), Factor I (emotional sensitivity) and Factor Q4 (anxiety). This indicated that adolescents exposed to incidents of community related interpersonal violence are inclined to experience more tension, are emotional volatile, depressed and anxious. They tend to be more sensitive to environmental stressors and are likely to give up easily. The group exposed to interpersonal violence (Sample 1) experienced higher levels of PTSD as assessed with the PSD Questionnaire than the group that was not exposed to interpersonal violence (sample 2). The personality profiles of three groups (Sample 1 with high PTSD, Sample 1 with low PTSD and Sample 2) were compared by means of a MANOVA to test whether adolescents who experience high levels of PTSD express their personality different from others. The results identify differences in the expression of personality between adolescents of Sample 1 experiencing higher levels of PTSD and the adolescents who did not experience community related interpersonal violence (sample 2) on Factors G- (Selfindulgent and disregards obligations to people), I + ( Perception might be emotionally influenced) and Q4 + (Elevated levels of anxiety). The coping style (positive or negative coping) of adolescents exposed to community related interpersonal violence was assessed using the Kidcope. This was done to examine the possible influence of coping on the development of posttraumatic stress and differences in the expression of personality. There were no correlations between positive and negative coping and the level of PTSD symptoms and the 16PF. The research could therefore not identify coping as a medicating variable in the development of PTSD and differences in the expression of personality. However, research is required to evaluate coping closer to the time of the actual event. The results of this research are a clear indication that the experience of community-related violence has serious implications for the well-being and development of the personality of adolescents. Violence-exposed adolescents may experience symptoms characteristic of PTSD, including significant difficulty regulating one’s emotions and behaviour impacting on their social, cognitive, physiological and emotional functioning. The original target group for this study was the middle class income population and suburb with relatively good security. The sample was drawn from a typical middleclass environment and adolescents from communities with less protection may present different results if sampled for similar research. / Thesis (PhD)--University of Pretoria, 2014. / tm2015 / Psychology / PhD / Unrestricted