Includes bibliographical references / Objective: The main aim of this thesis is to analyze data from the South African Stress and Health (SASH) study and , for the first time, generate information on the epidemiology of traumatic event s (TEs) and posttraumatic stress disorder (PTSD), and on the association of TEs with other psychopathological and physical health outcomes. Methods: A literature review was done to provide information current knowledge in the field. Cross - tabulations, Chi - squared tests and logistic regression analyses were then conducted SASH data to determine the prevalence of the different types of trauma and PTSD and the associations between the sociodemographic variables and TEs and PTSD on the one hand, and TEs and PTSD, other psychopathology and chronic physical conditions on the other . Results: The most common traumatic events were the unexpected death of a loved one and witnessing trauma. Lifetime prevalence of PTSD was 2.3%, and the conditional prevalence of PTSD after trauma exposure was 3.5%. PTSD conditional risk and burden were both highest for witnessing trauma. Witnessing trauma was commonest among males and those with low - average education. There was statistically significant association between witnessing and PTSD, mood, and anxiety disorders. Exposure to any TE significantly increased the odds of all the physical conditions, and the odds of having a physical condition were directly related to the number of lifetime traumatic events. Sexual violence and unexpected death of a loved one significantly increased the odds of all the e physical conditions assessed, while war events were only associated with respiratory conditions. Apart from war events, accidents and witnessing trauma were associated with the fewest physical conditions. Conclusions: Consistent with the literature, trauma and PTSD in South Africa are not distributed according to the socio - demographic factors or trauma types observed in other countries. Witnessing trauma is common in South Africa and increases the risk of mood and anxiety disorders. Finally, TE exposure is associated with chronic physical conditions in a dose - response manner. Trauma interventions must therefore focus also on those not directly affected, and routine evaluation for chronic physical conditions is recommended for survivors of all trauma.

Indiana University-Purdue University Indianapolis (IUPUI) / Posttraumatic stress disorder involves a constellation of neural and behavioral alterations in response to trauma exposure. Aside from symptoms involved in posttraumatic stress disorder diagnosis, patients frequently present with working memory impairments. Working memory training has been established as an effective intervention to reduce posttraumatic stress symptoms. Working memory is associated with posttraumatic stress disorder in that it is commonly impaired in patients and that training can reduce the severity of posttraumatic stress symptoms. Taken together, these points suggest the possibility of a shared mechanism between working memory and posttraumatic stress disorder but working memory has not been studied thoroughly in rodent models of posttraumatic stress disorder. The present study utilizes footshock trauma to induce a posttraumatic stress state in rats and evaluates the effect of trauma and trauma-paired cues on working memory performance. Results demonstrate the emergence of chronic deficits in working memory among traumatized animals three weeks post-trauma. Presentation of trauma-paired cues caused further decrement in working memory performance. Regression analysis indicates that the degree of working memory impairment in response to a trauma-paired cue can be significantly predicted by behavioral phenotypes typic of diagnostic symptoms for posttraumatic stress disorder. This study enhances existing animal models by replicating the clinical observations of working memory deficits associated with posttraumatic stress disorder. This will pave the way for future work to probe underlying mechanistic dysregulation of working memory following trauma exposure and for future development of novel treatment strategies.

The purpose of the current study was to provide both additional evidence of the psychometric properties of the TIPSA by examining reliability and validity coefficients, and to add to the empirical evidence for the application of betrayal trauma theory outside the context of complex and/or historical trauma. It was hypothesized that internal-consistency coefficients for the TIPSA would exceed 0.70; the TIPSA and the PTSD Checklist for DSM 5 (PCL-5) would be significantly positively correlated; the TIPSA and the Composite Codependency Scale (CCS) would not be significantly correlated; and that neither Adverse Childhood Experiences (ACE) nor Benevolent Childhood Experiences (BCE) scores would be significantly correlated with, or have a significant effect on TIPSA or PCL-5 scores. This study was conducted using anonymous survey data from192 female participants who self-identified as partners of sex addicts. Participants completed the TIPSA, PCL-5, CCS, ACE, and BCE measures. All reliability estimates for the TIPSA were above 0.70, as were all total-scale reliability estimates for the additional measures. Correlation between the TIPSA and PCL-5 produced a Pearson's r of 0.851 (p = 5.541 E-55), which indicated a large effect size. Correlations with additional measures produced statistically significant, yet small to weak, effect sizes (CCS: r = 0.292; ACE: r = -0.173; BCE: r = 0.244). Based on study results, there appears to be sufficient evidence to establish convergent validity of the TIPSA as a measure of trauma symptoms. Moreover, statistical evidence indicates only a weak relationship between the TIPSA and the CCS, thus establishing divergent validity of the TIPSA. Finally, neither the BCE nor the ACE was strongly correlated with the TIPSA, which adds to the empirical evidence for utilizing betrayal trauma theory outside the context of complex trauma, and also serves to provide additional evidence for divergent validity of the TIPSA.

Bakgrund: Posttraumatiskt stressyndrom (PTSD) är en av de vanligaste psykiatriska följdsjukdomarna efter en traumatisk upplevelse. Många av de individer som har diagnostiserats med PTSD har samtidiga kroppsliga besvär och det finns forskning som tyder på att fysioterapeutiska interventioner skulle kunna vara betydelsefulla i behandlingen av PTSD. Trots att forskning på området fysioterapi vid PTSD har ökat i omfattning under de senaste åren är fysioterapeutprofessionen inte självklar i PTSD-teamet. En kvalitativ studie om hur fysioterapeuter upplever sin roll i behandlingen av patienter med PTSD skulle kunna bidra med värdefull information. Syfte: Syftet med studien var att beskriva fysioterapeuters upplevelser och erfarenheter av att arbeta med vuxna personer som har diagnostiserats med posttraumatiskt stressyndrom. Metod: Studien var en kvalitativ intervjustudie som baserades på fem semistrukturerade intervjuer med fysioterapeuter från Röda Korsets behandlingscenter i Sverige. Ett ändamålsenligt urval tillämpades i studien och datan analyserades utifrån en kvalitativ innehållsanalys. Resultat: Analysprocessen resulterade i 14 underkategorier och fyra kategorier. De fyra kategorierna var; Ett varierat och individanpassat fysioterapeutiskt arbetssätt vid PTSD, Fysioterapeutens betydelse och unika roll i PTSD-teamet, Variationsrika framgångsfaktorer inom vården av PTSD och Utmaningar som komplicerar vården vid PTSD. Konklusion: Fysioterapeuter har, i och med sin unika kompetens, en betydelsefull roll i PTSD-teamet och kan genom kroppsliga behandlingsmetoder göra en stor skillnad för patienter med PTSD. Utmaningarna för fysioterapeuter inom vården av PTSD var många och det fanns en önskan om mer forskning och utbildning. Vidare forskning på området fysioterapi vid PTSD behövs för att fylla de kunskapsluckor som finns inom området. / Background: Posttraumatic stress disorder (PTSD) is one of the most common psychiatric disorders following a traumatic event. Many of those who have been diagnosed with PTSD have bodily symptoms and research suggests that physiotherapeutic interventions may be meaningful in the treatment of PTSD. Even though research regarding physiotherapy and PTSD has grown over the last couple of years physiotherapists are not a natural part of the PTSD-team. A qualitative study regarding physiotherapists views on their role in the treatment of PTSD could provide valuable information. Purpose: The purpose of this study was to describe physiotherapists' views and experiences of working with adults who have been diagnosed with posttraumatic stress disorder.  Method: The study was a qualitative interview study which was based upon five semi-structured interviews with physiotherapists from the Red Cross treatment centers in Sweden. A purposive sampling was used and the data was analyzed using qualitative content analysis.   Results: The analysis resulted in 14 subcategories and four categories. The four categories were; A varied and personalized physiotherapeutic way of working with PTSD, The physiotherapists importance and unique role in the PTSD-team, Variating successful factors in the healthcare of PTSD and Challenges that complicates the healthcare of PTSD. Conclusion: Physiotherapists have, because of their unique competence, an important role in the PTSD-team and can make a big difference for their patients through physiotherapeutic interventions. There are many challenges in the healthcare of PTSD for physiotherapists and more research and education was requested. Further research regarding physiotherapy and PTSD is needed.

There is growing evidence to suggest an inverse association between physical activity and symptoms of posttraumatic stress disorder (PTSD). However, the mechanisms are not well understood and much of the research in this area stems from cross-sectional studies, thereby limiting what is known about these relationships at the intra-individual level. Chapter 1 of this dissertation is a systematic review examining the literature on the association between physical activity and PTSD in a variety of study designs (i.e., cross-sectional, longitudinal, and intervention). Chapters 2 and 3 used data from a 7-day diary study of 15 participants with a diagnosis of PTSD. In this study, participants completed twice daily surveys on mobile phones and wore Fitbit accelerometers measuring physical activity and sleep. Chapter 2 used multilevel modeling to examine the within-person and between-person associations between physical activity and symptoms of PTSD, sleep, positive and negative affect, and coping. Multiple operationalizations of physical activity were used (i.e., self-report and accelerometer-measured) in order to explore and better understand which metrics are most strongly related to psychosocial factors. Results from Chapter 2 add to the literature by providing evidence of within-person associations between physical activity and PTSD symptoms over the course of the day, such that on days when participants are more physically active than usual, they also report fewer symptoms of PTSD that evening. Chapter 3 discusses the utility of using N-of-1 study designs with an emphasis on the benefits of using frequent repeated measurements in clinical practice. Three case examples are presented to illustrate the intra-individual variability that is observed in symptoms of PTSD, affect, and health behaviours. These examples provide rationale for the use of intensive measurement designs in order to fully capture and understand how and when variables fluctuate over time. / Graduate

The COVID-19 pandemic has negatively affected everyone in the world, however the phenomenon of growth following intense suffering has been well-documented over the past few decades (e.g., Tedeschi et al., 2018). Less research has been able to explain why some experience growth from trauma while others do not. Drawing from Joseph and Linley’s (2005) Organismic Valuing Theory model of posttraumatic growth, we examined the role of the basic psychological needs of autonomy, competence, and relatedness (during the onset of the pandemic and currently) in fostering posttraumatic growth. Participants (N = 289) completed an online survey assessing the impact of the pandemic, basic psychological needs, and posttraumatic growth. We hypothesized that participants with greater satisfaction of basic psychological needs during the onset of the pandemic and currently would report greater posttraumatic growth. We found that current satisfaction of psychological needs significantly predicted posttraumatic growth (β = .42, p < .001) whereas satisfaction of psychological needs at onset did not. Secondary analyses of the impact of each need (current and at onset) on posttraumatic growth revealed that current autonomy support significantly predicted posttraumatic growth above and beyond the other needs across both time points (β = .29, p < .001). Interpretations of these results are discussed, and implications and limitations of the study are addressed. / Graduate / 2023-12-31

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