The present study involves an exploration of the phenomenological expenence of posttraumatic growth in the context of a traumatic bereavement. An idiographic case study of a student who had witnessed her mother's death twelve years previously was conducted. Semi-structured interviews elicited data which was analysed using interpretative phenomenological analysis (IP A). Posttraumatic growth was found to have developed with regards to self-perception, relationships, and also in a broader spiritual and existential domain. The findings of this study shed light on the extant posttraumatic growth literature. In particular, findings were discussed in relation to the posttraumatic growth model as proposed by Calhoun and Tedeschi (2006). As posttraumatic growth is a relatively young concept, further research is needed in order to understand the meaning of reported growth more fully. While posttraumatic growth has been investigated in the context of bereavement, future research should distinguish more clearly between growth following traumatic and non-traumatic bereavement. Posttraumatic growth has received minimal empirical attention in South Africa, and therefore exploration of this area is suggested in the future. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

Purpose: The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for post-traumatic stress disorder (PTSD), acknowledged repeated or extreme indirect exposure to aversive details of traumatic event(s) in the course of professional duties, can lead to symptoms of PTSD. This has led to discussions around impact and prevalence of vicarious trauma in psychological therapists treating trauma clients. This study considers how therapists delivering trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) make sense of their experiences and protect themselves from any negative effects of the work. Furthermore, it considers if there is a distinction in therapist experience between the two modalities. Methodology/Method: An Interpretative Phenomenological Analysis (IPA) was conducted to explore how trauma-focused CBT and EMDR therapists engaged in trauma work, interpreted and made sense of their experiences; with a view to identifying any protective practice that informed clinical practice and helped ameliorate vicarious trauma. Recorded, semi-structured interviews were conducted with CBT and EMDR therapists (N=11). Before analysis, interviews were transcribed verbatim and sent to individual participants for validation of their authenticity. Data was analysed using descriptive, linguistic and conceptual comments to identify an initial seventy nine emergent themes. When refined, four master themes of ‘Nature of Trauma’, ‘Participant sense of self and managing the process of hearing trauma narrative’, ‘Participant experience of delivering the trauma models’ and ‘Protecting and sustaining the participant sense of self’ were identified to answer the research question and are discussed herein. Findings: This study forms part of the growing body of evidence towards understanding therapist vicarious traumatisation. It both supports and challenges findings of previous studies. It also introduces new concepts in relation to the vicarious trauma phenomenon. Whilst there are clear limitations associated with making generalisations from an IPA study, the findings from the study suggest EMDR may be a protective factor against the negative effects of hearing repeated trauma narrative. Furthermore, certain strategies such as time management, comprehensive trauma training and specific trauma supervision, may also reduce the negative effects of hearing trauma narrative. Finally, regardless of the difficulties faced, therapists enjoy their trauma work and feel a great sense of professional satisfaction. Implications/Recommendations: Indications from the findings of the study are that therapists working within primary care in particular, are becoming increasingly pressurised by cuts to funding within mental health services. Recommendations are that those components of trauma work which promote therapist wellbeing should be supported. In particular, realistic timeframes within which to work, good quality training and supervisors, ideally external to the workplace, who can provide trauma-specific supervision.

Traumatic incidences happen all around the globe. Some of the people who experience trauma develop post-traumatic stress disorder (PTSD), while some do not. Even more interesting is that some also experience growth afterwards (post-traumatic growth; PTG). The purpose of this paper is to look at neural aspects of why some people develop PTSD and others PTG after a traumatic event. To fulfill the aim, both PTSD and PTG will be reviewed to create an image of the existing research in behavioral and neurological terms. In addition to looking at the constructs separately, a chapter will also look at studies where both PTSD and PTG are acknowledged collaterally in participants. When looking deeper into the theories of PTSD divisions occur, and more research is needed to establish the most prominent explanation of PTSD. PTG on the other hand has only been studied for a short period of time but yields important insights into trauma-related outcomes. These fields need to be submerged and new multidisciplinary definitions are needed for future research. The key to PTSD is suggested to emerge within the new field.

Aims There is a growing body of evidence that some individuals are at risk of developing post-traumatic stress disorder (PTSD) after life-threatening cardiac events, such as myocardial infarction (MI) or cardiac arrest, which can result in distress, dysfunction and increased risk of mortality. In relation to this population, this thesis had two aims: to review the evidence regarding whether pain during MI predicts post-traumatic stress symptoms; and to explore the characteristics and impact of traumatic imagery experienced by individuals who develop symptoms of post-traumatic stress subsequent to MI or cardiac arrest. Methods A review of the evidence relating to pain as a potential risk factor for PTSD subsequent to MI is presented in the systematic review. The findings from a qualitative study investigating the characteristics of traumatic imagery and associated behaviours experienced by individuals who have symptoms of post-traumatic stress subsequent to MI or cardiac arrest, are presented in the journal article. Interpretative Phenomenological Analysis (IPA) was used to identify themes in the data. Results The systematic review indicated that there are mixed findings for pain as a risk factor for PTSD subsequent to MI. The limited number of studies in this area and significant methodological limitations within the existing evidence make it difficult to draw any firm conclusions with regard to the relationship between pain and PTSD post-MI. With regard to the qualitative study, the majority of imagery related to flashbacks of the event and were focused mainly on external experiences. Themes arising from the distressing flashback imagery included: loss of control; realisation of threat; negative impact on others; physical sensations; and actions of others. Imaginary elements and distortions were a feature of some traumatic imagery experienced, and non-flashback imagery connected with mortality was also experienced. Imagery was associated with avoidance behaviour and affected behaviour within relationships. Conclusions Findings from the systematic review indicate that further studies are warranted in this area to establish the link between pain and PTSD post-MI. These studies should seek to address methodological limitations of the current evidence by using a standardised pain measurement tool; adopting a prospective design; using a diagnostic tool to measure PTSD; ensuring PTSD is measured at least one month after the MI; assessing prior PTSD of non-cardiac origin; including a sufficient sample size and using an appropriate method of recruitment to improve generalisability. External experiences during a cardiac event are the main focus of traumatic visual imagery experienced by people with intrusive post-traumatic stress symptoms post cardiac event. Specific aspects of the cardiac event may be particularly distressing and these may be represented in post-traumatic visual imagery. Both gradual exposure and imagery rescripting techniques may be useful for reducing distress associated with the imagery, depending on the type of imagery experienced.

Contexte – Cette recherche analyse les liens entre la pathologie démentielle de type maladie d’Alzheimer (MA) et le Trouble Stress Post Traumatique (TSPT) et vérifie si un traitement du TSPT chez les sujets souffrant de MA peut améliorer l’efficience de la mémoire épisodique, des fonctions cognitives globales et de la qualité de vie des patients. Méthode – Après avoir passé en revue la littérature sur les liens existants entre TSPT et pathologies de type MA, nous proposons l’hypothèse que la détection et le traitement d’un TSPT chez les sujets souffrant de MA pourrait améliorer la mémoire épisodique verbale et la mémoire autobiographique épisodique avec des effets positifs sur l’évolution de la pathologie démentielle. Nous présentons une recherche longitudinale, analysant les données recueillies auprès de 20 sujets cibles (TSPT et MA) et de 20 sujets témoins (MA sans TSPT). Durant trois sessions successives (T0, T1 et T2) séparées par des intervalles de six mois, les différentes composantes de la mémoire épisodique ont été suivies à l’aide de tests spécifiques. L’évolution d’une MA a été vérifiée avec le Mini-Mental State Examination (MMSE). Pour le groupe cible, la présence du TSPT et la qualité de vie ont été testées et un traitement du TSPT a eu lieu entre T0 et T1.Résultats – La littérature scientifique souligne des similitudes entre le TSPT et la MA, avec un rôle clé de la mémoire épisodique. Nos résultats confirment que le traitement d’un TSPT chez les sujets souffrant de MA améliore significativement tous les indicateurs testés : rappel et reconnaissance de mots, rappel immédiat et différé, rappel d’événements de vie, fonctionnement cognitif global et qualité de vie.Discussion/Conclusion – Des données solides existent en faveur de la proposition d’une détection systématique et d’un traitement du TSPT chez les patients avec MA. Cette recherche suggère une voie prometteuse pour les soins de patients atteints de MA et souffrant d’un traumatisme psychique non résolu. / Purpose – This research aims to analyze the links between Alzheimer’s disease (AD) and Post-Traumatic Stress Disorder (PTSD) and to verify if a PTSD treatment can improve episodic memory, global cognitive functioning and quality of life in AD patients.Methods – We review the literature about the links between PTSD and AD, building on several theoretical models. We propose the hypothesis that the treatment of PTSD in AD can improve verbal episodic memory and autobiographical episodic memory with some positive effects on AD evolution. We present a longitudinal study in order to confirm the likely benefits of such an approach. There were 20 participants in the target group (AD and PTSD) and 20 participants in the control group (AD without PTSD). During three sessions (T0, T1 and T2) separated by an interval of six months, different components of episodic memory were assessed with specific tests. AD evolution was assessed with the Mini-Mental State Examination (MMSE). For the target group, PTSD presence and quality of life were also assessed, and treatment for PTSD was undertaken between T0 and T1 for the target group.Results/Findings – The analysis of scientific literature highlighted some clinical, cognitive and neurobiological similarities between AD and PTSD with a key-role of episodic memory. The results of the research indicate that PTSD treatment in AD participants improves significatively all assessed indicators: word recall, word recognition, immediate recall, delayed recall, personal recent events recall, personal lifetime events recall, global cognitive abilities (MMSE) and quality of life.Discussion/Conclusion – There are strong theoretical and practical reasons to search for an effective intervention for PTSD in AD patients. This study indicate a promising avenue for therapeutic care of AD patients with involved trauma.

Objective: This study aims to explore the traumatic experiences and to estimate prevalence and predictor factors for PTSD, depression and general psychiatric morbidity amongst Palestinian adults living in the Gaza Strip. Method: A total of 500 Palestinian adults were recruited from four areas of the Gaza Strip using a snowball sampling. The same sample was used for both quantitative studies. Four scales were employed to identify predictors for trauma, PTSD, depression and general mental health. Participants were divided into three age groups: young adults (18 to 25 years), adults (26 to 49 years) and older adults (50 to 65 years). The third qualitative study was aimed at exploring the traumatic experiences of adults living in the Gaza Strip to expand upon the outcomes from the quantitative studies. Results: For Studies 1 and 2, the prevalence rate of PTSD symptoms was 90% and 36.7% met the criteria of DSM-IV for PTSD. Study 2 found depression was 38.4%, and general mental health comorbidity was 67.1%. Study 2 revealed significant differences in PTSD between age groups. Novel results were found amongst adults and older adults on the re-experiencing subscale for PTSD. Participants who lived in Gaza City scored significantly higher on the PTSD subscale for hyperarousal compared to those living in the middle Gaza region. Study 3 expanded on the psychometric data through interviewing members of the Gaza community. When analysed five main themes were identified: Siege related stressors; war related trauma; psychological negative effects; re-experiencing initial event and coping strategies. Conclusions: The findings indicated that blockade was the predominant cause of the increased prevalence rate of PTSD. These studies found that the Palestinian adult participants in Gaza had been exposed to a variety of traumatic events on an ongoing basis that was having a detrimental impact on their mental health.

abstract: The brain is a fundamental target of the stress response that promotes adaptation and survival but the repeated activation of the stress response has the potential alter cognition, emotion, and motivation, key functions of the limbic system. Three structures of the limbic system in particular, the hippocampus, medial prefrontal cortex (mPFC), and amygdala, are of special interest due to documented structural changes and their implication in post-traumatic stress disorder (PTSD). One of many notable chronic stress-induced changes include dendritic arbor restructuring, which reflect plasticity patterns in parallel with the direction of alterations observed in functional imaging studies in PTSD patients. For instance, chronic stress produces dendritic retraction in the hippocampus and mPFC, but dendritic hypertrophy in the amygdala, consistent with functional imaging in patients with PTSD. Some have hypothesized that these limbic region's modifications contribute to one's susceptibility to develop PTSD following a traumatic event. Consequently, we used a familiar chronic stress procedure in a rat model to create a vulnerable brain that might develop traits consistent with PTSD when presented with a challenge. In adult male rats, chronic stress by wire mesh restraint (6h/d/21d) was followed by a variety of behavioral tasks including radial arm water maze (RAWM), fear conditioning and extinction, and fear memory reconsolidation to determine chronic stress effects on behaviors mediated by these limbic structures. In chapter 2, we corroborated past findings that chronic stress caused hippocampal CA3 dendritic retraction. Importantly, we present new findings that CA3 dendritic retraction corresponded with poor spatial memory in the RAWM and that these outcomes reversed after a recovery period. In chapter 3, we also showed that chronic stress impaired mPFC-mediated extinction memory, findings that others have reported. Using carefully assessed behavior, we present new findings that chronic stress impacted nonassociative fear by enhancing contextual fear during extinction that generalized to a new context. Moreover, the generalization behavior corresponded with enhanced functional activation in the hippocampus and amygdala during fear extinction memory retrieval. In chapter 5, we showed for the first time that chronic stress enhanced amygdala functional activation during fear memory retrieval, i.e., reactivation. Moreover, these enhanced fear memories were resistant to protein synthesis interference to disrupt a previously formed memory, called reconsolidation in a novel attempt to weaken chronic stress enhanced traumatic memory. Collectively, these studies demonstrated the plastic and dynamic effects of chronic stress on limbic neurocircuitry implicated in PTSD. We showed that chronic stress created a structural and functional imbalance across the hippocampus, mPFC, and amygdala, which lead to a PTSD-like phenotype with persistent and exaggerated fear following fear conditioning. These behavioral disruptions in conjunction with morphological and functional imaging data reflect a chronic stress-induced imbalance between hippocampal and mPFC regulation in favor of amygdala function overdrive, and supports a novel approach for traumatic memory processing in PTSD. / Dissertation/Thesis / Ph.D. Psychology 2013

M.A. (Psychology) / This study regarding the long-term effects of the Westdene bus-disaster which was undertaken after a period of seven years, had the following objectives: (1) A literature survey regarding the theory of disaster psychology; (2) An investigation of the long-term effects of traumatic events in the primary victims of the Westdene bus-disaster; (3) A survey to establish the long-term effects of therapeutic inputs in the primary victims. The first part of this study is devoted to a theoretical investigation which gives an overview of the Post Traumatic Stress Syndrome. Since the concept of stress is essential to the understanding of this syndrome, it is also closely examined. The conclusion was reached that the concept of stress and how stress is measured should be reconsidered. Stress should be seen as a contextual phenomenon and not just physioloqical and intra-psychological one. The specific types of disasters are also examined in the literature survey. The way in which children and adolescents experience stress differently to adults is also discussed. This is largely due to the dynamic processes involved during development which allows them (within the context of supportive systems) to absorb elements of healing faster and more effectively. The processes involved in development are also discussed in the literature survey. Research was done mainly in a qualitative way. The results of the research suggest that the experiencing of serious trauma by adolescents negatively influence the process of becoming independent and forming of an identity. This appears to be a function of the adolescent's in ability to separate from his/her family of origin and/or the inability of the family of origin to allow the adolescent to become independent. It further appears that the presence of PTSS in victims of a traumatic event is not a linear matter which follows automatically after exposure to a certain amount of stressful events. There appear to be other factors that play a causal role in the extent to which the victim experiences " events as stressful or not. These factors operate as "mediating factors" with regards to the victim's experience of an event as stressful or not. Such factors include social networks and whether vicitim's experience events as ideologically meaningful or not. With regards to psychological help/therapy and the long-term effects of such interventions, the researcher came to the conclusion that developmental processes in interaction with a supportive psychological climate can be a powerful antidote for the experiencing of PTSS symptoms in the long-term. Criticism against this study is that due to the long lapse of time between the taking place of the disaster and the of the study factors other than the disaster maybe responsible for the current functioning of the primary victims,as well as the fact that the group used for research purposes was to a degree self-selective.

D.Litt. et Phil. / The objective of this study was to describe, apply and evaluate the effect of an integrated Ericksonian and ego state therapy intervention approach for the treatment of adult survivors of childhood sexual abuse. Sexual abuse rips away an invaluable inner resource from the victim and this needs to be restored during the healing process. Every adult survivor presents a unique pattern of symptoms and effects of having experienced childhood sexual abuse. Therefore, it was necessary to plan an intervention strategy individualised according to each sexually abused person's unique experience. Therapeutic models and approaches developed to assist in the treatment of adult survivors of childhood sexual abuse are available but not always comprehensive and often not evaluated. Thus, evaluated studies that determine the effectiveness of distinct strategies and procedures for treating sexual abuse, are required. Psychological research regarding sexual abuse has tended to focus on aspects related to pathology. This study aimed to explore the possibilities for treatment plans for sexually abused individuals from the salutogenic/fortigenic perspective. This focus emphasises the promotion of strengths, well-being and wholeness. Accordingly, both the Ericksonian and ego state therapy approaches acknowledge the existence of resources within an individual, and therefore focus on the utilisation and mobilisation of strengths and resources during psychotherapy. In 2002, Hartman integrated these two approaches and proposed the Utilisation Model of Ego State Therapy, which included principles of the SARI Model (Frederick & McNeal, 1999; Phillips & Frederick, 11 1995), which was primarily developed for the treatment of trauma and dissociative disorders. Therefore, this study described, applied and evaluated the application of the Utilisation Model of Ego State Therapy as a broad and integrated approach for intervention with adult survivors of childhood sexual abuse.

M.A. (Psychology) / Youth and children constitute seventy percent of the population in South Africa. It is these children who carry the potential for the future of our nation. They may be precluded from reaching their potential jf we do not urgently address the problems brought about by violence. Highly evident is the increased incidence of PTSD within the violence stricken communities in South Africa. PTSD among black youths is so high that it can be described as an epidemic. Due to the limited therapeutic resources available, it is imperative that a programme ofaction aimed atreducing the negative impact which PTSD has and continues to have on children is designed. Thus, following adiligent study of the literature, it was decided to train lay counsellors I volunteers in terms of a previously devised Cognitive Behavioural Group intervention formulated by Cowley, Hetz and Rosin (1994) in order to reach out to these children who have been so aversively affected by violence. Utilising the services of lay counsellors rather than professionals is cost effective and time effective. A large sample of PTSD positive subjects were selected from three different schools on the basis that they satisfied the DSM IV criteria for PTSD. The subjects participated in a six week intervention programme. A large number of lay counsellors were trained and selected to facilitate the intervention programme. The administration of the intervention by the lay counsellors did not alter the effectiveness of the Cognitive Behavioural intervention. The results obtained were in accordance with those obtained by Cowley et al.,(1994) in the paired sample tests which were deemed appropriate for this kind of research.