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The purpose of this study was to examine people's experiences of self-medication with cannabis in relation to post-traumatic stress disorder and professions’ opinions of cannabis for medical use. The study focuses on norms and values as well as its impact on individuals. A qualitative approach was used with thematically open interview questions, in order to gain an insight into the interviewees’ reality and their experiences. Selected theories emphasize on norms, social control and gateway. The study has chosen to point out Sweden's drug policy attitudes to cannabis, research on cannabis as a complement to post-traumatic stress disorder, resources and therapies in the section earlier research. The results showed patterns of how the social control and norms affect the individual who chooses to deviate from the prevailing norm. The informants who have chosen to self-medicate cannabis in relation to post-traumatic stress disorder describes itself countered in their experiences with emotions such as contempt, exclusion and being misunderstood. It also emerged that there is transparency in the professions to the possibilities of cannabis as medicine, at present, it is a lack of evidence and research. It was also found that the informants who self-medicated strives cannabis as medicine in the market, controlled dosage.

Total institutions' (which include prisons) unique context prescribes "confinement" of inmates. Coping mechanisms applied "outside" (especially the ability to create distance from stressful events) is thus ineffective. Another common feature is lack of privacy, which may result in "forced intimacy" - individuals being forced into a situation of physical and psychological "invasion" (beyond the norm) of their person/personal space. Victims lose control over intimate decisions, including who may and may not be intimate with them. Within prisons, gangs "force intimacy" by sexually victimizing inmates, taking advantage of the context to heighten their power, and to control inmates "under" them. Four (subjects) victims' experiences and means of adaptation/ empowerment were investigated phenomenologically. Results indicated that inadequately empowered victims suffer prolonged and repeated victimization - a continued "posttraumatic stress disorder" - which is more traumatizing and draining than one circumscribed traumatic event (due to its intensity, immobilization and resulting drastic change of "personality"). / Psychology / M.A. (Clinical Psychology)

Objectifs : Étudier l’incidence de la dépendance à l’alcool ou aux drogues chez les étudiants exposés à la fusillade du Collège Dawson dans les 18 mois suivant celle-ci. Identifier les précurseurs au développement d’une dépendance à une substance psychoactive en tenant compte de la sévérité d’exposition à l’événement. Examiner si la consommation d’alcool 18 mois après les événements est en lien avec les différents groupes de symptômes d’état de stress post-traumatique. Méthode : La population à l’étude est composée de l’ensemble des étudiants du Collège Dawson au moment de l’événement. Les analyses ont été faites auprès de 854 étudiants inscrits au Collège au moment de la fusillade. Résultats : Cinq pourcent des femmes et 7 % des hommes présentent pour la première fois de leur vie un problème de dépendance à une substance suite à la fusillade. Pour les hommes, leur jeune âge, la présence de pensées suicidaires au cours de leur vie, ainsi que le fait d’avoir vu le tireur au moment de la fusillade sont les principaux précurseurs de cas incidents de dépendance. Aucun des précurseurs étudiés n’est significatif pour les femmes. Les hommes et les femmes se distinguent également quant aux symptômes d’état de stress post-traumatique qui prédisent la consommation d’alcool 18 mois après la fusillade. Conclusion : La principale retombée de l’étude est de souligner l’importance de considérer le sexe des individus pour étudier leur consommation de substances psychoactives suite à un traumatisme. / Objectives: To determine the incidence of a drug or alcohol addiction among the students who witnessed the Dawson shooting, in the 18 months that followed the event. Identify predictors of development of an addiction to a psychoactive substance, taking into account the severity of the exposure to the event. Consider whether alcohol consumption, 18 months after the event, is connected to the different categories of symptoms of post-traumatic stress. Method: The population under study includes the students at Dawson College at the time of the event. Analyses were conducted with data from 854 students enrolled at the College when the shooting took place. Results: In the 18 months following the shooting, 5 % of women and 7 % of men developed an addiction to a substance for the first time in their lives. For men, younger age (< 20 years old), the prevalence of suicidal thoughts throughout their lives, as well as having seen the perpetrator at the time of the shooting, were key predictors. No predictors were significant for women. Men and women also differed with regards to post-traumatic stress symptoms that predict alcohol consumption, 18 months after the shooting. Conclusion: The main outcome of this study stresses the importance of considering the gender of individuals, when evaluating their consumption of psychotropic drugs or alcohol after a trauma.

Il est possible qu’une personne qui consulte pour un problème d’utilisation de substances souffre également d’un problème associé à un état de stress post-traumatique ( ESPT ). Plusieurs auteurs croient qu’il existe un lien expliquant cette co-morbidité. Voilà pourquoi plusieurs hypothèses ont été formulées pour expliquer le lien entre un trouble tel que celui lié à l’utilisation de substance (TUS) pouvant exister avant l’ESPT, la vulnérabilité suite au TUS, ainsi que l’automédication. Plusieurs recherches proposent deux types d’interventions afin d’aider les personnes aux prises avec cette double problématique. La première consiste à traiter les deux problèmes séparément alors que la seconde, préconise une approche intégrée et simultanée. Puisque les écrits conseillent davantage un traitement intégré, il y aura une présentation d’une de ces formes de traitement nommé « À la recherche de la sécurité ». Le volet académique visait à comprendre le lien existant entre le TUS, les traumas psychologiques et l’ESPT ainsi que les différentes formes d’interventions pour aider les personnes ayant cette co-morbidité. Nous avons utilisé un module du programme « À la recherche de la sécurité » récemment traduit en français afin de vérifier sa mise en application et l’appréciation qu’en ont fait cinq usagers du Centre Dollar-Cormier-Institut universitaire sur les dépendances (CDC-IUD) ayant vécu un traumatisme au cours de leur vie. En conclusion, il sera démontré dans nos résultats que les hypothèses quant au lien de comorbidité sont effectivement présentes dans la réalité des personnes ayant un ESPT et un TUS, et qu’une intervention intégrée offre des points positifs autant pour l’usager que pour l’intervenant. / It is possible that the substance abuse disorder for which a person consults is associated with Posttraumatic Stress Disorder (PTSD). Several authors believe that there is a link explaining this co-morbidity. For this reason, several hypotheses have been formulated to explain this link as the substance abuse disorder (SUD) prior to PTSD, vulnerability following the SUD and selfmedication. Moreover, research shows the various interventions to help people struggling with these twin problems. The first is to separate the two issues while the second includes PTSD and the SUD. Research advice a more integrated treatment, there will be a presentation of one of these forms of treatment called "Seeking Safety". The academic component of our apprenticeship was to understand the link between the SUD, psychological trauma and PTSD and the various forms of interventions to help people with this co-morbidity. We used a module of "Seeking Safety" recently translated in French to ensure its implementation and its assessment from five users of the Centre Dollar-Cormier-Institut universitaire sur les dépendances who experienced trauma in their lives. In conclusion of the study, it is clearly shown that different assumptions are present in the reality of people with PTSD and SUD and an integrated response has positives for both the user and for the speaker.

Les mauvais traitements représentent un facteur de risque pouvant entraver le développement normal des enfants qui en sont victimes. L’objectif général de cette thèse est de mieux comprendre le concept d’état de stress post-traumatique-complexe (ÉSPT-C) et ce, en permettant l’évaluation rigoureuse de ses symptômes et en documentant sa relation avec d’autres variables. La présente thèse est composée de deux articles empiriques. L’objectif du premier article est d’obtenir une mesure de l’ÉSPT-C pour une population francophone. Pour ce faire, les qualités psychométriques de la traduction francophone du Structured Interview of Disorders of Extreme Stress-Self-Report (SIDES-SR) ont été testées par le biais d’analyses préliminaires auprès de 438 adultes canadiens-français provenant de la population générale et de l’Université de Montréal. Les résultats démontrent que l’instrument possède une structure factorielle de 5 facteurs comparable à celle obtenue pour l’instrument en anglais dans sa version originale. Les facteurs obtenus sont : 1) les croyances pessimistes par rapport aux autres et au futur, 2) la gestion des affects, 3) l’évitement des contacts physiques et sexuels, 4) la somatisation et 5) la prise de risques. La cohérence interne de 4 facteurs sur 5 varie d’acceptable à très satisfaisante alors que leur stabilité temporelle et leur validité convergente, divergente et concurrente ressortent comme étant assez satisfaisantes. Le but du deuxième article de cette thèse est d’examiner l’apport des symptômes d’ÉSPT-C retrouvés chez les mères et de leurs pratiques parentales (supervision et utilisation abusive de la punition) pour expliquer les symptômes d’ordre psychologique chez leurs enfants victimes d’agression sexuelle (AS). Les symptômes d’ÉSPT-C des mères et leurs pratiques éducatives ont été évalués auprès de 96 mères à l’aide de mesures auto-rapportées alors que les symptômes de leur enfant ont été mesurés à partir d’un instrument qui leur était destiné. Les résultats suggèrent qu’en contrôlant les variables sociodémographiques et les caractéristiques de l’AS de l’enfant, les symptômes d’ÉSPT-C des mères sont liés à plusieurs symptômes retrouvés chez les enfants après le dévoilement de l’AS qu’ils ont subie. Le rôle modérateur de la supervision maternelle dans la relation entre l’ÉSPT-C des mères et les symptômes de dépression et d’opposition des enfants a également été démontré. Les implications théoriques et cliniques concernant les résultats obtenus dans le cadre de ce projet doctoral sont finalement abordées. / Maltreatment is a risk factor that may hinder the normal development of children. The principal objective of this thesis is to better understand complex posttraumatic stress disorder, by evaluating it and documenting its relationship with other variables. This thesis includes two empirical articles. The objective of the first article is to develop a measure of complex posttraumatic stress disorder for French-speaking adults. The psychometric properties of the translated version of the Structured Interview for Disorders of Extreme Stress-Self-Report (SIDES-SR) were tested through preliminary analyses with 438 French-speaking adults from the general population and the University of Montreal. Results demonstrate that the instrument has a factor structure of five factors similar to the English version of the instrument. The factors obtained are: 1) pessimistic beliefs about others and future, 2) managing emotions, 3) avoidance of physical and sexual contact, 4) somatization, and 5) risk-taking behaviours. The internal consistency of 4 of the 5 factors varies from acceptable to very satisfactory, while their temporal stability and convergent, divergent and concurrent validity are acceptable. The purpose of the second article is to examine the contribution of complex posttraumatic stress disorder found in mothers and parenting practices (monitoring and abusive punishment) on psychological symptoms reported by children victims of sexual abuse. Symptoms of 96 mothers and their rearing practices were assessed using self-report measures, while children’s symptoms were measured with an instrument designed for children. Results demonstrate that, after controlling for sociodemographic variables and characteristics of the child sexual abuse, complex posttraumatic stress disorder is associated with several symptoms in children. The moderating role of maternal monitoring in the relationship between complex posttraumatic stress disorder of mothers and symptoms of depression and opposition of children is also demonstrated. Theoretical and clinical implications are discussed concerning the results obtained in this doctoral project.

Recurrent and intrusive distressing recollections of trauma are a hallmark symptom of Posttraumatic Stress Disorder (PTSD). The term ‘flashback’ is used in this thesis to refer to vivid, sensory perceptual (predominantly visual images), emotional memories from a traumatic event that intrude involuntarily into consciousness. Furthermore, intrusive image based memories occur in a number of other psychological disorders, for example, bipolar disorder and depression. Clinically, the presence and occurrence of flashbacks and flashback type memories are well documented. However, in terms of the neural underpinnings there is limited understanding of how such flashback memories are formed or later involuntarily recalled. An experimental psychopathology approach is taken whereby flashbacks are viewed on a continuum with other involuntary autobiographical memories and are studied using analogue emotional events in the laboratory. An initial review develops a heuristic clinical neuroscience framework for understanding flashback memories. It is proposed that flashbacks consistent of five component parts – mental imagery, autobiographical memory, involuntary recall, attention hijacking and negative emotion. Combining knowledge of the component parts helped provide a guiding framework, at both a neural and behavioural level, into how flashback memories may be formed and how they return to mind unbidden. Four studies (1 neuroimaging, 3 behavioural) using emotional film paradigms were conducted. In the first study, the trauma film paradigm was combined with neuroimaging (n = 35) to investigate the neural basis of both the encoding and the involuntary recall of flashback memories. Results provided a first replication of a specific pattern of brain activation at the encoding of memories that later returned as flashbacks. This included elevation in the rostral anterior cingulate cortex, insula, thalamus, ventral occipital cortex and left inferior frontal gyrus (during just the encoding of scenes that returned as flashbacks) alongside suppressed activation in the left inferior frontal gyrus (during the encoding of scenes that returned as flashbacks in other participants, but not that individual). Critically, this is also the first study to show the brain activation at the moment of flashback involuntary recall in the scanner. Activation in the middle and superior frontal gyri and the left inferior frontal gyrus was found to be associated with flashback involuntary recall. In the second study, control conditions from 16 behavioural trauma film paradigm experiments were combined (n = 458) to investigate commonly studied factors that may be protective against flashback development. Results indicated that low emotional response to the traumatic film footage was associated with an absence of flashbacks over the following week. The third study used a positive film to consider the emotional valence of the emotion component of the framework. Positive emotional response at the time of viewing the footage was associated with positive involuntary memories over the following week. The fourth study aimed to replicate and extend this finding, comparing the impact of engaging in two cognitive tasks after film viewing (equated for general load). Predictions were not supported and methodological considerations are discussed. Results may have implications for understanding flashbacks and involuntary autobiographical memories occurring in everyday life and across psychological disorders. Further understanding of the proposed components of the clinical neuroscience framework may even help inform targeted treatments to prevent, or lessen, the formation and frequency of distressing involuntary memories.

Objectif : Il s'agit de comparer les professionnels du risque à une population tout-venant, dans les modes de réaction et d'adaptation au stress à travers l'évaluation de plusieurs dimensions (stress perçu, intensité du névrosisme, stratégie de coping, lieu du contrôle et degré de sévérité de l'ESPT) afin de mettre en évidence les différences, les similitudes et les relations entre ces variables. L'hypothèse selon laquelle les deux groupes (Sauveteurs et Pôle Emploi) se distinguent par le niveau de stress perçu, l'intensité du névrosisme, le niveau de contrôle, le type de coping et le degré de sévérité de l'ESPT a été formulée. Méthode : Population : 42 individus de sexe masculin, âgés de 24 à 55 ans (groupe étude : sauveteurs pompiers mer et montagne, gendarmes du PGHM, démineurs, pilotes hélico et mécaniciens navigants) et 42 individus (33 femmes et 9 hommes) âgés de 24 à 59 ans (groupe contrôle : conseillers du Pôle Emploi). Outils : 5 échelles ont été utilisées : la PSS (stress perçu), l'EPI (névrosisme-extraversion/introversion), l'échelle de Levenson (locus of control), la WCC (coping) et le QSPT (état de stress post-traumatique). Résultats : les résultats montrent que les sauveteurs présentent un faible niveau de stress perçu, un bas niveau de névrosisme, de LOC externe (P et C) et interne, un faible recours au coping émotionnel et à la recherche de soutien social ainsi qu'un degré de sévérité de l'ESPT plus bas que ceux retrouvés chez les conseillers du Pôle Emploi. En revanche, ces deux groupes ne se différencient pas significativement dans l'emploi du coping centré sur le problème. / Purpose: This study aims at comparing professional rescuers and ordinary people, the way they react and they adjust to stress on different levels (perceived stress, neuroticism intensity, coping strategies, locus of control and posttraumatic stress disorder severity level ) in order to highlight the differences, the similarities and the links between the variables. The following hypothesis has been expressed: both groups (rescuers and job councellors) are different regarding perceived stress, neuroticism intensity, locus of control, the type of coping and the postttraumatic stress disorder severity level. Method: Population: 42 male individuals aged 24 to 55 (survey group: sea and moutain firefighters, High Mountain Squad gendarmes, bomb disposal experts, helicopter pilots and mechanics) and 42 individuals (33 women and 9 men) aged 24 to 59 (control group: job councellors) Tools: 5 scales have been filled in : PSS (perceived stress), EPI (neuroticism – extraversion / introversion), the Levenson scale (locus of control), WCC (coping) and QSPT (posttraumatic stress disorder). Results: the results bring to light that the rescuers show a lower level of perceived stress, of neuroticism, of external (P and C) and internal LOC, of emotional coping, of social support searching and of PTSD severity level than the job councellors. However, both groups do not differ significantly regarding the problem-focused coping. Conclusion: the harmful influence of environmental factors on the personality seems to determine the adjustment to stress and its traumatic consequences.

O abuso sexual é uma forma de violência interpessoal que acomete milhões de pessoas em todo o mundo, 20% das mulheres e 2% dos homens relatam passar por algum tipo de abuso sexual durante a vida. O Transtorno de Estresse Pós-Traumático (TEPT) é um dos possíveis resultados do abuso sexual e compromete a qualidade de vida do indivíduo e também suas relações interpessoais, com sintomas de reexperiência, hiperexcitação, esquiva e alterações em cognição e humor. As principais terapias baseadas em evidências para o tratamento de TEPT: Cognitive Processing Therapy e Prolonged Exposure, ambos com base na exposição, apesar de apresentarem dados empíricos e significativos de mudança, apontam até 50% de evasão a terapia, dificuldade de implementação pelo terapeuta e aumento de sintomas pela exposição. Os estudos em Psicoterapia Analítica Funcional (FAP) têm mostrado resultados satisfatórios na compreensão e aprimoramento dos processos de mudanças clínicas com foco na relação terapêutica. Levando em consideração que pessoas com TEPT tendem a apresentar comportamentos de esquivas emocionais, esquivas de relações de intimidade e de confiança e que a FAP tem por objetivo proporcionar mudanças por meio da relação terapêutica, os objetivos do presente estudo foram: 1) investigar os efeitos da FAP como tratamento para pessoas com TEPT por abuso sexual, e 2) os processos de mudança clínica envolvidos na utilização da FAP. Os participantes foram uma terapeuta/pesquisadora, três aferidores de concordância e três clientes adultos. A intervenção ocorreu com delineamento experimental de caso único, com introdução da variável independente (FAP) em diferentes momentos para cada participante, na seguinte disposição: Linha de Base - A - B (delineamento em linha de base múltipla - DLBM). As sessões foram transcritas e categorizadas com uso do Sistema de Categorização da Psicoterapia Analítica Funcional (FAPRS), a fim de encontrar os processos envolvidos nas mudanças clínicas, com foco na relação terapêutica. Já as melhoras do cliente foram analisadas por meio dos instrumentos: Escala de Sintomas de Transtorno de Estresse Pós-Traumático (PCL-C) e Outcome Questionnaire (OQ-45). O padrão comportamental de esquivas de situações que sinalizavam intimidade e vulnerabilidade foi encontrado em todas as participantes por meio da conceituação do caso. Os resultados apontaram que, após a introdução da variável independente (FAP) os comportamentos clinicamente relevantes do tipo problema (CRB1) diminuíram drasticamente e os comportamentos clinicamente relevantes de melhora (CRB2) aumentaram. Ademais, o instrumento FAPRS apontou a potência da Regra 3 (consequenciar diferencialmente) e da Regra 2 (evocar) como os principais processos de mudanças clínicas na FAP. Os efeitos da FAP foram observados também no instrumento PCL-C, com queda dos escores para as clientes que tiveram maior tempo de intervenção FAP, dado corroborado pelos resultados do OQ-45 que também tiveram queda após a introdução da FAP, com exceção da participante exposta à menos sessões com a variável independente (FAP). Dessa forma, esse estudo pontua a eficácia da FAP para o tratamento de vítimas de abuso sexual e o primeiro caso de sucesso na utilização do DLBM em pesquisas de prática clínica / Sexual abuse is a type of interpersonal violence that happens among millions of people worldwide, 20% of women and 2% of men states being a victim of sexual abuse during their lives. Posttraumatic Stress Disorder (PTSD) is one of the possible outcomes of sexual abuse that compromises the life quality of the victim and interpersonal relationships, experiencing symptoms as re-experience, hyperexcitation, avoidance and negative changes in thinking and mood. The main evidence based practice for treatment of PTSD: Cognitive Processing Therapy and Prolonged Exposure, both based on exposure, although they show data of meaningful changes, they point up to 50% of drop-out rates, difficult implementation by therapists and increase of re-experience symptoms. Researches on Functional Analytic Psychotherapy (FAP) have shown satisfactory results related to the knowledge and improvement in the mechanism of change mainly occurring in the therapeutic relationship. Considering that people with PTSD tend to show emotional avoidance, avoidance of intimacy and trust and that FAP has as main goal to provide changes through therapeutic relationship, the current study aimed to investigate: 1) the effects of FAP, as treatment for victims of sexual abuse with PTSD and 2) the FAP mechanism of change. The participants were a therapist-researcher, three agreement coders and three clients. The study had a single-case experimental design, introducing the independent variable (FAP) in different time for each client, following: baseline - A - B (multiple baseline design MBLD). The sessions were transcribed and coded with Functional Analytic Psychotherapy Rating Scale (FAPRS) aimed to study the therapeutic relationship and to find the mechanism of change. The clients improvements were analyzed through the assessments: Posttraumatic Stress Disorder Checklist (PCL-C) and Outcome Questionnaire (OQ-45). The avoidance patterns that indicated intimacy and vulnerability were found in all clients through the case conceptualization. Results indicated that after the introduction of FAP the clinical relevant problems behaviors (CRBs1) considerably decreased and the clinical relevant improvements behaviors (CRBs2) increased. In addition, the FAPRS assessment indicated that Rule 3 and Rule 2 were the main mechanism of change in FAP. The FAP effects were also analyzed by the OQ-45 and PCL-C assessments that showed decreased scores by the clients who had the longest period of FAP intervention. In conclusion, the current study demonstrated the efficacy of FAP in the treatment of sexual abuse victims and is the first successful study using MBLD in clinical researches