Mental contamination (i.e., feelings of dirtiness in the absence of contact with a contaminant) is a potentially important yet understudied factor in posttraumatic psychopathology, particularly for survivors of sexual trauma. Mental contamination has been linked to PTSD symptom severity, negative affect, and coping cross-sectionally and in lab-based paradigms, but research has yet to assess these relationships in ecological contexts. The present study extends previous cross-sectional findings by modelling relationships between mental contamination and posttraumatic psychopathology, emotions, and coping both within-day and from one day to the next. Forty-two female sexual trauma survivors completed twice-daily assessments of mental contamination, PTSD symptoms, negative emotions, and avoidant/approach coping via a smartphone app. Daily averages and intraindividual changes in mental contamination scores were linked with PTSD symptoms at the same timepoint. Mental contamination also significantly predicted several specific avoidant coping strategies at later timepoints in addition to concurrent links. Unexpectedly, several negative emotions exhibited positive links with concurrent mental contamination but were negatively linked to later mental contamination. Exploratory analyses identified a significant interaction whereby elevated morning negative affect predicted evening reductions in mental contamination, but only for individuals also high in morning PTSD symptoms. Lastly, prevalence of reported baseline mental contamination was much higher in the present study compared to prior research. Clinical relevance and future recommendations for ecological research in trauma-related mental contamination is discussed.

A manualised trauma-focused cognitive behavioural therapy (TF-CBT) programme was developed for multiply-abused children diagnosed with posttraumatic stress disorder (PTSD; Feather & Ronan, 2004) referred to the specialist clinic of the statutory child protection agency in New Zealand. The TF-CBT protocol was based on: (1) a review of the history of child abuse (CA) and child protection in New Zealand and internationally, with particular reference to professional developments and the role of psychologists in ameliorating CA; (2) a conceptualisation of the clinical presentation of CA in children; (3) a review of the field of psychotraumatology and theoretical models, including locally developed, relevant to the development of a treatment programme for traumatised abused children in a child protection setting in New Zealand; and (4) a review of evidence-based practice, treatment outcome models, and current empirical research related to developing an effective treatment model in this area. The locally developed TF-CBT programme built on efficacious treatments for child anxiety and PTSD as a result of sexual abuse. It encompasses psychosocial strengthening, coping skills training, gradual exposure using expressive modalities, and special issues relevant to trauma and abuse. A “scientist-practitioner” approach to local clinical research was used to evaluate the programme. A single-case multiple-baseline design demonstrated the controlling effects of the treatment across four studies; each comprising four typically-referred multiply-abused children aged 9-15 years who met diagnostic criteria for PTSD. Parent/caregivers were involved in treatment sessions. Study 1 was a pilot with four Pakeha/New Zealand European children; Study 2 trialled the protocol with two Maori and two Samoan children; Study 3 was an evaluation of the developed protocol with a multicultural group of typically-referred children; and Study 4 was an evaluation with other therapists delivering the manualised programme. Despite some methodological difficulties related to conducting research in a setting of this nature, the overall results indicate a good deal of promise. Across the four studies, for the majority of children treated, PTSD symptoms decreased and child coping increased. Where follow-up data was available, gains generally maintained or improved over 3-, 6-, and 12-month intervals. Recommendations are made about further applications of this TF-CBT programme, including the interweaving of cultural models with TF-CBT, and development and evaluation of the protocol in other settings. Implications of the current research are discussed in terms of recognition of the crucial importance of evidence-based practice in CA/child protection settings, and the contribution psychologists and therapists can make to ensure quality outcomes for this most vulnerable population of children and families.

<p>The present thesis explored the neurobiological basis of three aspects of defense behaviors in humans. Positron emission tomography methodology was used, and changes in regional cerebral blood flow (rCBF) were measured as an index of neural activity. Firstly, brain function was studied in a group of patients suffering from combat-related posttraumatic stress disorder, using a symptom provocation paradigm with combat sounds in order to elicit fear. Exposure to auditory trauma reminders relative to neutral sounds was associated with increased rCBF in sensorimotor areas, the cerebellar vermis, the periaqueductal gray matter, and the right amygdala, whereas decreased activity was observed in the retrosplenial area of the posterior cingulate cortex. Secondly, the neural circuitry mediating the acoustic startle response and its habituation was studied in a group of healthy subjects. During acoustic startle stimulation as compared to a resting condition, increased rCBF was found in a medial posterior area of the pons corresponding to the nucleus reticularis pontis caudalis. As a result of startle repetition, altered activity was found in the cerebellum, pointing to its involvement in startle habituation. Thirdly, neural activity associated with startle modulation by phobic fear was studied in a group of subjects with specific animal phobias during exposure to pictures of their feared and non-feared objects, paired and unpaired with acoustic startle stimuli. As a result of startle potentiation, increased rCBF was found in the left amygdaloid-hippocampal region, and medially in the affective division of the anterior cingulate cortex. In conclusion, these results provide evidence for the involvement of limbic and paralimbic brain areas during fear provocation and fear-potentiated startle and for a similar neurocircuitry underlying startle in humans and animals.</p>

Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2006.

Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2007.

Disasters and major accidents are a significant cause of distress worldwide. High levels of posttraumatic stress can become chronic after severe and prolonged psychological trauma, raising concerns about the extent of adverse long-term consequences after single events. The present thesis aimed to describe the course and burden of posttraumatic stress in survivors from a ferry disaster in the Baltic Sea, an airliner crash-landing in Gottröra, Sweden, and a bus accident involving Swedish 6th grade schoolchildren in Måbødalen, Norway. The participants were surveyed 1 month to 4 years after the events and again after 14 to 20 years. The follow-up surveys included 33 ferry disaster survivors, 70 airline survivors, and 7 surviving schoolchildren with a comparison group from the same school (n = 33). Short- and long-term changes in posttraumatic stress were estimated separately in generalised regression models refined by linear splines. In-depth interviews were conducted with 22 ferry survivors 15 years after the disaster, including structured clinical interviews and thematic analysis of survivors’ descriptions of consequences of the event and social support. Approximately half of all survivors experienced significant posttraumatic stress at the initial assessments. Significant long-term distress was noted in one fourth of the ferry survivors and one sixth of the airline survivors. The bus crash was not associated with significant long-term posttraumatic stress. A poorer long-term outcome was noted in women and in bereaved survivors. The thematic analysis revealed that long-term consequences not only included negative aspects but also positive ones, including personal growth and existential awareness. There was ample availability of social support, although the need for support extended over a period of several years. Barriers to support from significant others were described in detail by the survivors. The results extend previous research by providing a comprehensive account of long-term consequences of disasters and major accidents in light of early reactions. The interviews provide some new insights into features of social support that warrant further study. Important future challenges include evaluating whether timely attention to survivors at risk for chronic distress and significant others can facilitate recovery. / Allvarliga händelser som katastrofer eller stora olyckor kan leda till svår psykisk belastning på kort sikt. Svåra posttraumatiska stressreaktioner kan bli beständiga efter svår traumatisering som omsorgssvikt eller övergrepp. Det är därför angeläget att undersöka omfattningen av psykologiska konsekvenser efter enskilda händelser som katastrofer och stora olyckor. Denna avhandling syftade till att beskriva utvecklingen av posttraumatisk stress på lång sikt hos överlevande efter förlisningen av MS Estonia 1994, nödlandingen av ett passagerarflygplan i Gottröra 1991 och efter en olycka med en skolbuss medförande en skolklass från årskurs sex. De överlevande tillskickades enkäter 1 månad till 4 år efter händelsen, samt efter 14 till 20 år. Långtidsenkäterna besvarades av 33 överlevande från färjekatastrofen, 70 från flygolyckan samt 7 överlevande från bussolyckan och 33 personer från parallellklasserna. Intervjuer genomfördes med 22 överlevande 15 år efter färjekatastrofen. Ungefär hälften av alla överlevande upplevde betydande posttraumatiska stressreaktioner vid tidpunkten för den första enkäten. Frekventa stressreaktioner fanns kvar hos 27 % fjorton år efter färjekatastrofen, medan andelen var 16 % nitton år efter flygolyckan. Tjugo år efter bussolyckan upplevde de nu drygt trettioåriga svarande låga nivåer av posttraumatisk stress. Förlustdrabbade överlevande upplevde i genomsnitt en mindre återhämtning under det första året och hade också svårare reaktioner efter många år. Kvinnor upplevde i genomsnitt svårare reaktioner än män såväl på kort sikt som på lång sikt, medan återhämtningen inte skiljde sig åt mellan män och kvinnor. Konsekvenser på lång sikt innefattade enligt de överlevande negativa men också positiva aspekter som personlig mognad och existentiell medvetenhet. De flesta intervjuade hade upplevt gott om stöd från närstående, dock kunde ett visst behov av stöd kvarstå i flera år efter händelsen. Många berättade om hinder för att söka stöd, t.ex. att den närstående var känslomässigt belastad.  Avhandlingen utvidgar det som hittills varit känt om posttraumatisk stress hos överlevande efter katastrofer och stora olyckor. Intervjuerna pekar på viktiga aspekter av socialt stöd att utforska vidare. Resultaten visar att dessa händelser är förknippade med övergående stressreaktioner hos majoriteten av de överlevande. Vidare forskning behövs för att bättre förstå den naturliga återhämtningen och närmare vilka insatser till överlevande och anhöriga som kan underlätta återhämtning. / Long-term posttraumatic stress in survivors from disasters and major accidents

The present thesis explored the neurobiological basis of three aspects of defense behaviors in humans. Positron emission tomography methodology was used, and changes in regional cerebral blood flow (rCBF) were measured as an index of neural activity. Firstly, brain function was studied in a group of patients suffering from combat-related posttraumatic stress disorder, using a symptom provocation paradigm with combat sounds in order to elicit fear. Exposure to auditory trauma reminders relative to neutral sounds was associated with increased rCBF in sensorimotor areas, the cerebellar vermis, the periaqueductal gray matter, and the right amygdala, whereas decreased activity was observed in the retrosplenial area of the posterior cingulate cortex. Secondly, the neural circuitry mediating the acoustic startle response and its habituation was studied in a group of healthy subjects. During acoustic startle stimulation as compared to a resting condition, increased rCBF was found in a medial posterior area of the pons corresponding to the nucleus reticularis pontis caudalis. As a result of startle repetition, altered activity was found in the cerebellum, pointing to its involvement in startle habituation. Thirdly, neural activity associated with startle modulation by phobic fear was studied in a group of subjects with specific animal phobias during exposure to pictures of their feared and non-feared objects, paired and unpaired with acoustic startle stimuli. As a result of startle potentiation, increased rCBF was found in the left amygdaloid-hippocampal region, and medially in the affective division of the anterior cingulate cortex. In conclusion, these results provide evidence for the involvement of limbic and paralimbic brain areas during fear provocation and fear-potentiated startle and for a similar neurocircuitry underlying startle in humans and animals.

Survival after severe burns has improved in recent decades, but there is limited information on the course of recovery after surviving a burn and on factors that can affect recovery. The aims of this thesis were to investigate the occurrence of physical and psychological problems after burns, and to examine the consequences of psychological problems for the clinical management of burn patients. Three groups of consecutive patients who were treated at the Burn Unit at Uppsala University Hospital between 1980 and 2005 were included in the studies. The Burn Specific Health Scale (BSHS) was used for self-report of burn-specific aspects of health. Personality traits and coping strategies as psychological factors during recovery were examined with the Swedish universities Scales of Personality (SSP) and the Coping with Burns Questionnaire (CBQ). Presence of symptoms of posttraumatic stress were assessed with the Impact of Event Scale-Revised (IES-R), and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was used to determine the concurrent validity of the IES-R as a measure of Posttraumatic Stress Disorder (PTSD). Furthermore, the effect of pre-injury psychiatric morbidity on perceived health one year after injury was assessed. Both pruritus and nightmares were common problems after burns; 59% of the individuals in the study reported pruritus and 43% reported nightmares. Neuroticism-related personality traits and avoidant coping strategies were associated with an increased risk of having pruritus or nightmares. The presence of nightmares could be used as a screening tool for high scores in the IES-R. The IES-R was in turn shown to be a good, although overly inclusive, test for the diagnosis of PTSD. Pre-injury psychiatric morbidity predicted perceived outcome in six out of nine burn-specific health domains. These studies show that psychological factors and psychiatric morbidity affect outcome after burns.

Background: A recent epidemiological analysis on premenstrual dysphoric disorder (PMDD) in the community revealed increased rates of DSM-IV posttraumatic stress disorder (PTSD) among women suffering from PMDD. Aims: To explore whether this association is artifactual or might have important pathogenic implications. Methods: Data come from a prospective, longitudinal community survey of an original sample of N¼1488 women aged 14–24, who were followed-up over a period of 40 to 52 months. Diagnostic assessments are based on the Composite International Diagnostic Interview (CIDI) using the 12-month PMDD diagnostic module. Data were analyzed using logistic regressions (odds ratios) and a case-by-case review. Results: The age adjusted odds ratio between PTSD and threshold PMDD was 11.7 (3.0–46.2) at baseline. 10 women with full PTSD and at least subthreshold PMDD were identified at follow-up. Most reported an experience of abuse in childhood before the onset of PMDD. Some had experienced a life-threatening experience caused by physical attacks, or had witnessed traumatic events experienced by others. 3 women reported more than one traumatic event. Conclusions: A case-by-case review and logistic regression analyses suggest that women with traumatic events and PTSD have an increased risk for secondary PMDD. These observations call for more in-depth analyses in future research.

Sammanfattning Stressrelaterad psykisk ohälsa såsom utmattningssyndrom, är en komplex problematik som varit mycket omdebatterad. Åtskilligt är publicerat i ämnet, men bara ett fåtal studier finns där personer med utmattningssyndrom själva fått möjligheten att beskriva orsakssambanden. Olika förklaringsmodeller och perspektiv beskrivs i litteraturen, men den rådande uppfattningen om varför människor drabbas utgår ofta från ett arbetsrelaterat perspektiv. Vi ville utforska om den rådande föreställning i ämnet stämmer överens med den uppfattning människor som drabbats av utmattningssyndrom har om orsakerna till symtomen. Vår ansats var även att undersöka om det kan finnas fler eller andra orsakssamband till utmattningsprocessen.   Vårt syfte med studien är; dels undersöka hur individer med utmattningssyndrom upplever vilka orsaker som är av betydelse för utmattningsprocessen, dels försöka beskriva och analysera dessa utsagor i ett vidare perspektiv.   Till studien valdes en kvalitativ metod och data samlades in med hjälp av intervjuer utifrån specifika forskarfrågor. Sju respondenter med utmattningssyndrom och närbesläktade stressrelaterade diagnoser deltog.   Resultatet visar att utlösande faktorer kopplade till bland annat arbetet är en orsak i utmatt-ningsprocessen, Studiens resultat visar också att bakomliggande faktorer är om möjligt ännu viktigare och som presenteras i Bohlin-Hogen-Henner modellen. Bakomliggande orsaker menar vi kan vara påfrestande och belastande livshändelser i uppväxten, vilka kan bidra till oförmåga att tillgodose egna behov och en prestationsbaserad självkänsla. Genomgående mönster har visat sig vara problematik med gränssättningen, det vill säga, dysfunktionell gränssättning som är en konsekvens av de olika bakomliggande faktorerna och har en avgörande betydelse för utmattningsprocessen. / Abstract Stress related psychological health-problems such as burn-out syndrome are complex issues which have been much debated. Much have been published on this topic but only a handful of studies have been conducted where individuals diagnosed with burn-out syndrome have been given the opportunity to describe the cause-effect of their condition. Different explanations and perspectives are described in the literature concerning this topic but the current view as to why people are afflicted by burn-out syndrome is based on a work-related perspective. We wanted to explore if the current view on the topic is in accordance with the diagnosed individuals view on the causes of their symptoms. Our intention was also to investigate into the possibility that there could be more or other causality behind the burn-out process.     The purpose of this study is twofold. First, to investigate how individuals with burn-out syndrome rate different causes in terms of importance to their process of burning out. Second, to try to describe and analyze these statements in a wider context.   For this study, we chose to use a qualitative methodology. Data were collected from interviews where adapted research questions were asked. Seven respondents diagnosed with burn-out syndrome or other stress related disorders participated.   The results show that work-related factors often are the triggers for the process of burning out, but hidden factors, such as conditions in the childhood and traumatic life events which can contribute to performance-based self-esteem, are even more significant. Overall patterns for burn-out syndrome show an inability to create personal boundaries, “dysfunctional personal boundaries”. This dysfunction is, in our opinion, the consequence of the hidden factors and in itself plays a crucial role in the burn-out process.