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In a resource-rich environment, WS of CSA, wanting to enter therapy in order to deal with their early life trauma, can choose from an array of potential treatment modalities. One such intervention is called wilderness therapy. Although a number of studies have investigated various facets ofthis fairly new therapeutic modality, this is not the case for WS as potential clients. This study with its focus on how WS ofCSA experience and perceive therapeutic change as a result of participating in wilderness therapy, intended to explore how this intervention facilitates change. The research aimed to elicit phenomenological insights that could assist in the development and refinement of the therapeutic approach and its intricate constituents. The sample included twelve WS ofCSA (21 years and older) ofwhom four took part in a fourday therapeutic wilderness experience in the Drakensberg Mountains, a World Heritage Site, while another four joined a traditional time-limited therapy group. Four participants opted to withdraw from the study. Factors that influenced the decision to withdraw were explored. Ethical considerations necessitated a pre-interview with each participant. It allowed the researcher to screen each WS for her suitability, but also to identify her unique therapeutic needs, while also providing an opportunity to acquaint her with the research project as a whole, and more specifically with the respective therapeutic intervention. The researcher gathered interview data after each intervention, which after transcription was analysed using an experience-near, phenomenological research model (Colaizzi, 1978; Giorgi, 1994; Polkinghorne, 1989) that included validation through the participants. The themes that the participants of each group described were analysed and then presented in diagrammatical form. A comparison of the results elicited elements common to both therapeutic interventions, but more importantly the unique features ofwilderness therapy. These included (a) the reality of therapeutic change in terms of CSA-related issues, (b) nature as a significant therapeutically containing space, and (c) silence as a tool for facilitating catharsis. The reality of post-hike depression and the change-inducing quality ofanticipatory anxiety evolved as other significant elements of therapy within a nature setting. The themes were examined in greater depth leading to the conclusions that wilderness therapy is a valuable therapeutic modality for WS of CSA, possibly best used as an adjunct, and offers unique therapeutic change mechanisms to these trauma survivors. Because of its exploratory nature, the study was unable to outline these mechanisms in more detail and hence suggestions for further in-depth research were made. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.

The purpose of this thesis was to investigate the prevalence of mental illness in a nonrandom sample of undergraduate female Emirati students in the United Arab Emirates. In addition, students’ views and attitudes towards counselling were solicited. One hundred and twenty-three women completed Golberg and Hillier’s (1979) 28-item scaled version of the General Health Questionnaire (GHQ-28). The GHQ-28 revealed a high prevalence of mental illness (51%) among the students surveyed, using a GHQ-28 threshold of eight. Furthermore, students reported they held favourable views towards counselling despite never having sought counselling services. The differences between American/European and Arab views of mental illness are explored as one of several limitations to this study. Recommendations for future research are noted. / xii, 117 leaves ; 29 cm

Depression is a major mental health problem for women. Several lines of evidence suggest that fluctuating levels of estrogen associated with various reproductive events are related to changes in mood. It has been hypothesized that estrogen may exert its influence on mood via its effect on the serotonergic system---a system frequently implicated in the regulation of mood. The major goal of the following study was to elucidate further the role of estrogen in mood regulation. To this end, we examined the role of estrogen in the mood-lowering effect of Acute Tryptohpan Deption (ATD), a technique designed to cause a marked lowering of plasma and brain tryptophan, and therefore brain serotonin levels, so that the effects of decreased serotonin on mood can be studied directly. We hypothesized that (1) exogenous estrogen may protect against the mood-lowering effects of ATD in postmenopausal women and that (2) a history of affective disturbance, particularly reproduction-related affective disturbance, would be associated with greater vulnerability to ATD as predicted by the kindling model of depression. Fifty-eight postmenopausal women were randomly assigned to treatment with estrogen (0.625 mg Premarin) or placebo in the context of prospective, double-blind, cross-over design. During the final two week sof the 12-week treatment phase, all participants completed one ATD test session and one nutritionally balanced amino acid control session. We found that: (1) treatment with exogenous estrogen significantly improved mood and menopausal symptoms as compared to placebo treatment, (2) ATD was associated with a significant lowering of mood in both groups, (3) treatment with estrogen did not protect women from ATD effects unless they responded to 11 weeks of treatment with exogenous estrogen with enhanced mood, and (4) a history of reproduction-related affective disturbance was associated with more dysphoric mood in response to ATD. In conclusion, these data provide further evi

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Observation of the frequency with which major decisions on issues affecting psychiatric patients were decided on material elicited from techniques like the Rorschach stimulated the investigation of the applicability of this technique to African patients. The nosological group chosen for this study was the schizophrenic group. Scrutiny into the literature revealed great diversity in conceptions of the etiology of the schizophrenic condition. To handle this material it was necessary to adopt a modification of the framework used in Friedman and Kaplan (1974). Having gone into the models on etiology it was evident that consistency was only possible in the realm of symptoms and diagnosis and the definition of schizophrenia as a group of psychotic disorders characterised by gross distortions of reality : the disorganisation and fragmentation of perception, thought and emotion and withdrawal from social interaction, was adopted. With this preconceived idea of schizophrenia three hypotheses were formulated to test the diagnostic utility of the Rorschach with Nguni schizophrenic female subjects. Summary, p. 104.

This study examined the effects of two 8-week stress-management interventions (aerobic exercise and progressive relaxation) on reductions in trait anxiety, increases in self-efficacy, and enhancement of coping strategies for sedentary working women. It was expected that aerobic exercise, a relatively new treatment, would be as effective or more effective than progressive relaxation, a well researched treatment, as a stress-management intervention. The subjects were 72 females aged 24-59, (M = 39.8) solicited from the Vancouver community via newspaper advertisement asking for stressed volunteers to participate in two stress-management programs. They were interviewed and randomly assigned to an aerobic exercise or progressive relaxation treatment. The treatment sessions were conducted over an 8-week period with subjects meeting in groups for 1 1/2 hours per week. Prior to the first session subjects were administered: STAI-T (Spielberger, Gorsuch, & Lushene, 1970), the General Self-Efficacy Scale (Sherer et al., 1982), Ways of Coping Checklist (Lazarus 6 Folkman, 1984), and a 7-Day Exercise Recall Inventory (Blair, 1984). Subjects were assessed again at post treatment and at 8-week follow-up. Repeated measures, multivariate analysis of variance with preplanned contrasts, indicated that both treatment groups were effective in decreasing trait anxiety and increasing self-efficacy from pre- to post-treatment. These changes were maintained at 8-week follow-up. In addition, a one-way multivariate analysis of variance with repeated measures indicated that the total number of coping strategies, as well as the difference between the number of problem-focused and emotion-focused coping strategies, did not change significantly from pre- to post-treatment. Additionally, there was a negative relationship between low scores in self-efficacy and high scores in emotion-focused coping. In response to ancillary post-treatment and follow-up questionnaires, aerobic exercise was perceived by the participants as a more satisfactory stress-management treatment. Implications of these results and suggestions for future studies are discussed. / Education, Faculty of / Curriculum and Pedagogy (EDCP), Department of / Graduate

Although there has been a great deal of research in the areas of social networks, social support and well-being over the past two decades, little of that research has been cross-cultural, and virtually none has been carried out in countries outside the West. The present study attempted to describe the structure and functioning of the social networks of a group of relatively modern urban Moroccan women, and the associations among their social networks, social support, physical health and psychological well-being. Extensive interviews were conducted with 108 married or previously-married women who were living in a middle-class neighborhood in Rabat, Morocco. Subjects were asked to identify social network members, defined as friends, family or others who provided various types of support in typically encountered life situations, or with whom the subject had negative interactions. Standardized self-report instruments were used to assess physical and psychological well-being, and to assess the occurrence of stressful life events. Additional observational data were collected on respondents' neighborhoods and immediate physical surroundings. A model describing the interactions between well-being, network structure and network function was tested using factor-analytic and set-regression techniques. Stressful life events predicted reduced physical well-being. Enhanced psychological functioning was predicted by reciprocity in relationships, marital satisfaction, and to a lesser degree, practical and emotional support. Contrary to predictions, patronage support was associated with both enhanced physical and psychological well-being. Results were generally consistent with Conservation of Resources (COR) theory, which predicts that the uniformly large and well-functioning networks found in this study would produce effect sizes that were small, but consistent with Western research findings.

Experiencing early life adversity (ELA) increases the risk of anxiety disorders, such as generalized anxiety disorder and post-traumatic stress disorder, with disproportionally higher risk in women compared to men. Neurodevelopmental and behavioral outcomes following ELA are multifaceted and are influenced heavily by the type of adversity experienced and sex of the individual. A major contributor to emotional dysfunction and anxiety disorders resulting from ELA are changes in fear and threat circuitry. Children who experienced ELA have been reported to show an accelerated development of the amygdala, a region involved in processing threat, and greater cerebrospinal levels of corticotrophin releasing hormone (Crh), an orchestrator of neuroendocrine and behavioral responses to stress. Work in rodents have linked Crh signaling within the lateral central amygdala (CeAL) with processing and responding to threat, core features disrupted in anxiety-related disorders. Further, sex biases in risk and symptom presentation have been proposed to be related to sexual dimorphic signaling of Crh across the brain that differentially influence a variety of Crh-dependent behaviors. However, it remains unclear what properties of ELA portend differential neurobiological risk, what is the basis of sex-differences for negative outcomes, and how specific mechanistic changes give rise to certain endophenotypes. In this work, I use genetic, cellular, and behavioral approaches to explore the impact of ELA and sex on perinatal development in mice and the functional consequences of altered Crh neuron activity in the CeAL on threat responding in adulthood. In Chapter 1, I review how factors such as sex and type of ELA influence amygdala development and Crh. In Chapter 2, I assess the impact of two forms of ELA, maternal separation (MS) and limited bedding and nesting (LBN) on perinatal development and anxiety-like behavior. Both forms of ELA shifted the timing of somatic maturation and basal CORT levels and led to increased anxiety-like behaviors, but the degree of the impact depended on the sex and type of adversity experienced. In Chapter 3, I demonstrate that a distinguishing feature between types of ELA was the predictability of maternal care. The type of ELA also contributed to sex-differences in Crh related gene expression in the perinatal amygdala. Increased expression was primarily observed in males following MS and in females following LBN. In Chapter 4, I investigate the functional consequences of ELA in the form of LBN on the activity of CeALCrh+ neurons in vivo and their causal role in threat reactivity indexed by the startle response. LBN rearing led to sustained activity of CeALCrh+ in female mice but diminished in male mice. Persistent activity of this population was necessary for and predicted the magnitude of startle responding. In Chapter 5, I discuss important considerations when integrating new advancements in the study of ELA and the use of sex as a biological variable. Collectively, this work deepens our understanding of the neurobiological mechanisms impacted by sex and ELA and holds promise for future strategies that may consider the sex and specific experiences of the individual to target specific endophenotypes and address the underlying root causes of anxiety disorders.

Uganda has experienced substantive shifts in HIV prevention and treatment resulting in marked declines in HIV incidence and mortality rates across the country despite being among the top 5 highest new prevalence rates for HIV transmission and infection among women (Uganda Ministry of Health, 2019). Prior research has revealed that fear of stigma and discrimination, disclosure of HIV status, and quality of services are key factors in women’s healthcare decisions and care-seeking behaviors (Akatukwasa et al. 2021; Lancaster et al., 2016; Grossman & Stangl, 2013). Yet, there continue to be significant knowledge gaps regarding the mechanisms through which intersectional stigma exacerbates health outcomes for people living with HIV. This dissertation draws on baseline data, from the Kyaterekera project an efficacy trial testing the effects of a structural intervention on the HIV-health outcomes of women engaged in sex work within the Masaka region, Uganda. Using an explanatory sequential mixed method design, this study utilized Structural Equation Modeling (SEM) to test the direct and indirect effects of intersectional stigma on mental health, while also evaluating mechanisms (i.e., social support and quality of care) through which stigma impacts mental health, treatment adherence and subsequent viral load. There were no direct or indirect effects of intersectional stigma on mental health, but intersectional stigma was positively associated with social support. Additionally, depression and adherence were negatively associated with viral load. Next, in-depth interviews (n=52) explored personal and community-level factors that may influence women’s care-seeking attitudes and overall health decisions. The following themes were most salient for women: 1) disclosure risk, 2) Intersectional community stigma permeates marginalized women’s health decisions, 3) adaptive behaviors and coping strategies are essential to maximizing care experiences, and 4) the Care Seeking Cost-Benefit Tradeoff. Through an integrative framework, quantitative and qualitative findings were then juxtaposed through a joint display and found to be predominantly complementary (McCrudden, M. T., Marchand, G., & Schutz, P. A., 2021). Findings suggest that a positive association between intersectional stigma and social support may underscore the significant long-term effects of living with HIV. Moreso, holding other stigmatized social statuses. Moreso, this link between intersectional stigma and social support may be due to women anticipating the likelihood of experiencing community-level/interpersonal stigma with HIV disclosure and extensive contact with their social support network. Also, more contact with social networks, particularly those in which stigma norms and discriminatory attitudes are pervasive on the community/ interpersonal level (or perceived to be so) may account for the positive associations between HIV stigma and social support. Sex work had a higher degree of concealability than HIV. As such, sex work was disclosed less frequently than HIV to healthcare providers, family, and friends due to anticipatory community stigma. Despite the finding that the explanatory sequential design produced no direct or indirect effects of intersectional stigma on mental health or viral load via SEM, the exploratory analysis provides substantive insights into the negative impact of HIV-related intersectional stigma on women’s care-seeking experiences and broader health decisions. Women’s care-seeking attitudes and behaviors reveal the intrinsic adaptive skills, strength, and resilience they possess to address individual health needs despite known barriers to care. Overall, this study provides further support for holistic interventions that can enhance and build resilience and successful adaptive strategies to mitigate the effects of HIV-related intersectional stigma.