D.Litt. et Phil. / A plethora of research has been conducted on victims of township violence, detention and political unrest, but there is no research on car hijack victims or the prevalence of Post-Traumatic Stress Disorder (PTSD), which could result from this crime. The implications of this lack of research are important because people are confronted by trauma on a daily basis but there are few guidelines for providing treatment. Hijackings are a somewhat recent phenomenon unlike other traumas such as wars and natural disasters, but the effects of hijacking are no less severe. Post-Traumatic Stress Disorder (PTSD) always requires an initiating event which is assumed to be traumatic. The context in which car hijackings occur in South Africa can be considered to meet the criteria for what constitutes a traumatic event, which could possibly lead to the development of PTSD (Myerson, 1995). Not all crime victims who need professional assistance will enter therapy. This is often due to the victim's self-perception of weakness, feelings of embarrassment, or the perception that others will not understand their experience. A group-based intervention offers the advantages of reducing isolation, providing comfort and support, and eliminating feelings of stigma. For this reason it was important to analyse the nature of PTSD and how to intervene to aid the recovery from PTSD, in the South African context. The literature points to the recovery from PTSD as being contingent upon the psychotherapeutic input that the traumatised individual receives. This research focused on the development of a group-based cognitive behaviour intervention programme for victims who developed Post-Traumatic Stress Disorder as a result of car hijackings. Cognitive behavioural therapy is the only treatment modality that is supported by objective measures of success (Peterson, Prout & Schwartz, 1991) and has been found to be one of the most effective treatments (Kaplan & Sadock, 1993). In order to test the hypotheses, the Beck's Depression Inventory was used to measure the level of depression, the Spielburger's Stai Anxiety scale was used to measure the level of anxiety, and the CAPS and PCL were used to determine whether Post-Traumatic Stress Disorder existed in the individuals who participated in the study and the intensity and frequency of the symptoms.

This research report documents the therapeutic intervention undertaken with a 23-year-old Swazi rape victim. The format of this research report takes the form of a case study that follows the principles proposed by Fishman (2005). Its aim is to document the treatment process of an individual of African decent in order to establish whether the treatment model can be effective in clinical settings and in contexts and cultural settings different from that in which it was developed. The Ehlers and Clark (2000) cognitive therapy model for post-traumatic stress disorder (PTSD) was utilised to assess, conceptualise, and treat the case. The client entered therapy three years after being raped for a third time. The case formulation identified factors maintaining the disorder as well as how other traumatic and abusive events earlier in her life influenced her response to the rapes. Data consisted off audio-tape recordings and detailed written synopses of each assessment and therapy session, psychometric measurement instruments and self-report scales completed throughout the intervention, material written by the client, and a research interview conducted by an independent party. She was treated for PTSD and comorbid depression over a period of five months in accordance with the principles described by Ehlers and Clark and a narrative of the treatment process was written. The case narrative in conjunction with quantitative data suggested that this model assisted the client in initiating a healing process. As such the model was found to be both effective and transportable to an African context. Various points of discussion are highlighted, including the challenges of working with PTSD and comorbid major depression, the client-therapist relationship, and that a client and therapist from different cultures, backgrounds, and with different home languages can work together effectively using the Ehlers and Clark model.

This study employed a case-based research design to document the psychological assessment and treatment of Zanele, a 15-year-old black Xhosa speaking female who was raped twice in 2006 by the same perpetrator. The aim of the study was to explore whether, the model for assessment and intervention for posttraumatic stress disorder (PTSD) developed by Ehlers and Clark (2000) was effective and transportable to the South African context. Zanele had a sufficient understanding of English for assessment to proceed without use of an interpreter. She reported a number of PTSD symptoms which were causing her significant distress and had impacted on her social and educational functioning. These included flashbacks of the perpetrator's face when she looked at the faces of black men, nightmares about the traumas she had endured and feeling isolated from others. A number of cognitive techniques were utilised in this study, however the central interventions included working with triggers, imagery rehearsal techniques with a focus on nightmares, and reliving with cognitive restructuring within and outside reliving. Psychoeducation and increasing her social support were also important components of the intervention. Her progress was monitored by means of several self-report measures which were displayed in graphic and tabular form. In addition, a thematically selective narrative of the assessment and first 23 sessions of the intervention was written which documents some of the central processes set in motion by the interventions. These results provide evidence that this model was both effective and transportable to the South African population. In addition, the study demonstrated that it is possible for a white English speaking clinician to work with a black Xhosa speaking individual and make substantial therapeutic gains.

Experts in traumatology have postulated traumatized children play differently than non-traumatized children. These differences are called posttraumatic play and include the behaviors of intense play, repetitive play, play disruption, avoidant play and negative affect. The purpose of this study is the continued development of the Trauma Play Scale through the addition of a normative sample. The Trauma Play Scale is an observation-based instrument designed to distinguish the play behaviors of children in play therapy with a history of interpersonal trauma when compared to non-traumatized children. The present study compares two samples of children. One group (n=6) currently in play therapy with a history of interpersonal trauma and another group (n=7) considered normally developing (cognitively, emotionally, socially, and physically) by their parents with no known history of interpersonal trauma. Trained raters blind to the trauma history of the children rated a series of eight consecutive video-recorded play therapy sessions for each participant. One-way analysis of variance statistics, including effect sizes were compute to determine the discriminant validity of the Trauma Play Scale. Traumatized children scored significantly higher on the Trauma Play Scale than non-traumatized children on all domains of the scale as well as the overall Average Trauma Play Scale score. Large effect sizes indicated strong relationships between group membership (trauma history versus normally developing) and scores on the Trauma Play Scale.

Researchers have found an overlap of psychological symptoms in victims of Post-Traumatic Stress Disorder and Continuous Traumatic Stress. Although the circumstances inducing the psychological reactions are different, the symptoms mimic one another without a clear cut demarcation, calling for practitioners to be cautious of contexts inducing psychopathology that is triggered through re-experiencing of past trauma when they are assessing and intervening with ongoing trauma-exposed communities. This study explored the subjective experiences of 15 local Non-Governmental Organization (NGO) administrators in Nigeria across 5 states, including the federal capital Abuja, about the intersectionality of their clients' persistent trauma experiences and their program planning and intervention strategies. The study leveraged complexity and organizational change models, using qualitative inquiry with open ended interview questions and purposive sampling. Questions probed administrators' modalities, orientations, and perceptions that inform organizational planning and interventions. Open-ended interviews of top local NGO administrators provided contrasting insights on current interventions. Data were collected and analyzed using constant comparative content analysis. Findings suggest that local NGO administrators currently lack the awareness and capacity to address their clients' psychosocial, behavioral, and mental health issues that are related to continuous, direct, and indirect violence. The study impacts social change by identifying gaps in current NGO administrators' efforts to reduce effects of violence and support peace in affected communities.

The subject of Attention Deficit Hyperactivity Disorder (ADHD), and Ritalin as a method of treatment, has received a lot of media attention in recent years as it appears to be the most “popular” diagnosis for children who are difficult, who struggle to pay attention and who are impulsive and hyperactive. Some medical professionals are of the opinion that incidences of the disorder are increasing, while others believe that the disorder is being misdiagnosed. There is a significant overlap in the symptoms of ADHD and those of Post-traumatic Stress Disorder (PTSD). In South Africa, where many children are exposed to traumatic stimuli on a regular and ongoing basis, health care professionals cannot afford to overlook the possibility that children exhibiting symptoms of ADHD may, in fact, be traumatised. However, when examining the criteria for PTSD we find that the DSM-IV (Diagnostic and Statistical Manual IV) does not adequately describe the differences between adult and childhood PTSD and also does not adequately account for children who may be in an almost continuous state of traumatic stress. Since there is increasing evidence of the interaction between mind/emotions and body, it is plausible that the emotions of children with ADHD play an important role in their condition, particularly if the child has suffered traumatic stress. The researcher believes that children who experience continuous traumatic stress may develop maladaptive responses which may eventually become traits, and that ADHD may be one such response. The goal of this exploratory study was to gain insight into the thoughts and feelings of a few children (case studies) who have been diagnosed with ADHD and who are in the middle childhood phase of development. The first objective was to gather knowledge regarding ADHD, traumatic stress, biological responses to trauma and to describe middle childhood and gestalt play therapy. In the empirical study, gestalt play therapy techniques were used to assess whether children with ADHD had suffered traumatic stress (particularly the loss of safety and security) prior to the diagnosis and whether they are able to express their thoughts and emotions appropriately. Since the study was qualitative, the researcher made use of observation and unstructured interviews (including play therapy sessions) to obtain background information from the parents and to explore the thoughts, feelings and behaviours of children with ADHD from their perspective. This study falls under applied research, undertaken with a view to creating preventative measures and improving interventions for children with ADHD and children who have suffered traumatic stress. The final objective of the study was to draw conclusions and make recommendations in order to promote awareness of the likelihood of traumatic stress in children with ADHD in South Africa. The researcher concluded that the respondents in this study have indeed suffered traumatic stress in the form of loss of safety and security, related to an inadequate bond with a responsive, nurturing caregiver. In addition, they have difficulty expressing their thoughts and emotions. / Dissertation (Magister Socialis Diligentiae (Play Therapy))--University of Pretoria, 2007. / Social Work and Criminology / unrestricted

Terapeuter ingår i riskgruppen för utvecklandet av psykisk ohälsa. Det finns både risk- och skyddsfaktorer som påverkar compassion fatigue (CF) - empatitrötthet - och sekundär traumatisk stress (STS) hos terapeuter. Forskningen visar att traumaarbete upplevs såväl positivt som negativt. Syftet i föreliggande studie var att beskriva terapeuters upplevelser om CF och STS. Därtill att ta reda på om detta kunde relateras till terapeuten själv och arbetsvillkoren samt vad som tycktes ha betydelse för att undvika CF och STS. En litteraturstudie gjordes där artiklarna analyserades genom kvalitativ innehållsanalys. Resultatet innehåller ett huvudtema; Att arbeta med människors trauma är ett privilegium, samtidigt har det sitt pris och sju subteman. I studien diskuteras CF och STS utifrån att det som terapeut i traumaarbete är oundvikligt att drabbas samt att dessa fenomen behöver vara pratbara. Dessutom framkom källor till resiliens. / Therapists are at risk of developing mental illness. Research shows that working with traumatreatment gives both positive and negative experiences. There are both risk and protective factors that affect Compassion Fatigue (CF) and Secondary Traumatic Stress (STS). The aim of this study was to describe therapists' experiences of CS and STS. Furthermore finding out if they could be related to the therapist in person and working conditions as well as if certain elements were important to avoid CF and STS. A literature study was carried out where articles were analyzed using a qualitative content approach. The result includes a main theme; “Working with people ́s trauma is a privilege, at the same time it has its price” and seven subthemes. CF and STS are thereafter discussed based on the idea of the importance that these phenomena are known and that as a traumatherapist it is inevitable to be affected. In addition sources of resilience emerged.

American children growing up in poor urban communities experience a disproportionate amount of direct and indirect violence in addition to the challenges of growing up with limited resources. Due to high amounts of physical and structural violence in these communities, urban youth are at increased risk for complex post-traumatic stress disorder (C-PTSD) and its associated sequelae, such as asthma, obesity, diabetes, and behavioral problems. Evidence demonstrates that sexual abuse and repeated interpersonal trauma leads to more intense symptomatology than traditional post-traumatic stress disorder (PTSD), and traumatic events in early childhood predisposes one to a C-PTSD reaction. This literature review of complex trauma serves to further validate the need for modern psychiatry to recognize C-PTSD as a diagnosis and to identify treatment interventions for this vulnerable population. / Urban Bioethics

The relation between dissociative symptoms and posttraumatic stress disorder (PTSD) was investigated in women who had experienced trauma or sexual assault. Subjects were administered the Dissociative Experiences Scale (DES), the Sexual Experiences Scale (SES), and the PTSD Interview (PTSD-I). Subjects were grouped according to their scores on the SES and the PTSD-I. Analysis of variance revealed a relation between DES scores and PTSD symptom severity scores. Correlational analyses showed a relation between dissociative symptoms and PTSD symptom severity but not recency of trauma. Three factors from a previously published factor analysis of the DES were found to contribute to the DES scores of PTSD subjects.

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.