Thesis (PhD (Psychiatry))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Pregnancy is often accompanied by distressing psychological symptoms such as anxiety. These symptoms may result from changes in cognitive-affective processing, which in turn reflect hormonal changes during this time. However, findings on associations between psychological distress, cognitive-affective changes and hormones have been inconsistent. Furthermore, few studies have investigated the neural circuitry underlying distress and cognitive-affective processing in pregnancy. The prefrontal cortex (PFC) plays a specific role in regulating emotion. Determining the relationship between these changes in cognitive-affective processing and in prefrontal circuitry is important, given the high prevalence of depressive and anxiety disorders in pregnancy. The overall objective of this study was to investigate distressing psychological symptoms and their association with cognitive-affective processes and neurobiological changes over the course of pregnancy. Pregnant women with low risk singleton pregnancies were recruited from Midwife Obstetric Units in the Western Cape. Non-pregnant healthy controls were also recruited from the same demographic area. Distress levels were assessed using the K-10, Spielberger State -Trait Inventory, and Perceived Stress Scale. Subjectively experienced cognitive ability was asked about. Objective cognitive ability was assessed using standardized neuropsychological tests. Selective attention to threat such as fear and anger was assessed using a Facial Stroop Task. Neural circuitry was assessed using Near-Infrared Spectroscopy while viewing dynamic emotional facial expressions of threat (Emotion Recognition Task). Glucocorticoid (cortisol) and gonadal hormonal levels (estrogen, progesterone, and testosterone) were also determined at each trimester of pregnancy. Associations between distressing psychological symptoms, cognitive-affective processes and neurobiology were assessed using standard statistical methods. The main findings to emerge from this research were that, 1. pregnant women had significantly higher trait anxiety at trimester 2, compared to trimester 1 of pregnancy; 2. compared to non-pregnant women, pregnant women paid significantly more attention to fearful faces across trimesters, suggesting altered cognitive-affective processing in pregnancy compared to non-pregnancy; 3. pregnant women demonstrated significantly increased PFC activation in response to fearful and angry faces (all trimesters) that was particularly evident at trimester 2; 4. the PFC activation was, across trimesters, significantly correlated with distress and selective attention to threat; and 5. the PFC activation was, across trimesters, also significantly associated with increased glucocorticoid and gonadal hormone levels. The main findings of this study are consistent with previous literature insofar as distress has previously been associated with altered cognitive-affective processing and prefrontal cortex activation, but extend it by showing that emotional regulation is altered in pregnancy compared to the non-pregnant state. These data provide an important insight into distressing psychological symptoms and their associations with cognitive-affective processes, and changes in neural circuitry and in hormone levels in pregnancy. These findings are also the first to show that structures involved in emotional processing (e.g. the PFC) also play a role in the regulation of affect in pregnancy. Future research should explore the causal mechanisms underlying altered emotional regulation in pregnancy, and include pregnant women that are clinically depressed or anxious as comparison subjects. / AFRIKAANSE OPSOMMING: Swangerskap word dikwels geassosieër met stres-veroorsakende sielkundige simptome soos angstigheid. Hierdie simptome mag die gevolg wees van veranderinge in kognitief-affektiewe prosessering, wat op sy beurt mag dui op hormonale veranderinge. Bevindinge oor assosiasies tussen sielkundige stres, kognitief-affektiewe prosessering en hormone is tot dusver onbeslis. Voorts was min studies gerig op die neurologiese meganika onderliggend aan stres en kognitief-affektiewe prosessering tydens swangerskap. Die prefrontale korteks (PFK) het 'n spesifieke rol in die regulering van emosie. Die bepaling van spesifieke assosiasies tussen veranderinge in kognitief-affektiewe prosessering en in prefrontale regulering is belangrik, gegewe die hoë voorkoms van toestande soos depressie en angssteurings tydens swangerskap. Die doel met hierdie studie was 'n ondersoek na assosiasies tussen stres-veroorsakende sielkundige simptome, kognitief-affektiewe prosesse en neurobiologie tydens swangerskap. Swanger vroue met lae risiko enkel-swangerskappe is gewerf by klinieke in Wes-Kaapland. Gesonde nie-swanger vroue is uit dieselfde omgewing gewerf as kontroles. Angs-vlakke is geevalueer met behulp van die K-10; die Spielberger State-Trait Inventory en die Perceived Stress Scale. Vrae is tydens ondersoeke gevra oor subjektief-ervaarde kognitiewe vermoë. Voorts is kognitiewe vermoë geëvalueer met behulp van gestandardiseerde neurosielkundige toetse. Hierbenewens is selektiewe aandag aan bedreigende gesigte wat vrees en woede toon, geëvalueer met behulp van 'n Facial Stroop Task. Neurologiese funksie is geëvalueer met gebruik van Na-Infrarooi Spektroskopie terwyl dinamiese bedreigende emosionele gesigsuitdrukkings vertoon is (Emotion Recognition Task). Gluko-kortikoïed (kortisol) en geslagshormoonvlakke (estrogeen, progesteroon, en testosteroon) is gemeet tydens elke trimester. Verwantskappe tussen stresvolle simptome, kognitief-affektiewe prosessering en neurobiologie is geëvalueer met standaard statistiese metodes. Die hoofbevindinge het op die volgende gedui: 1. swanger vroue het betekenisvolle hoër trait angs-vlakke getoon in trimester 2, vergeleke met trimester 1; 2. vergeleke met nie-swanger vroue, het swanger vroue beduidend meer aandag geskenk aan angstige gesigsuitdrukkings tydens elke trimester wat mag dui op veranderde kognitief-affektiewe prosessering tydens swangerskap vergeleke met nie-swangerskap; 3. swanger vroue het beduidend hoër PFK aktivering getoon teenoor angstige en kwaai gesigte in alle trimesters, maar veral in trimester 2; 4. swanger vroue se PFK aktivering het, in alle trimesters, beduidend gekorreleer het met stres-vlakke en selektiewe aandag teenoor bedreigende stimuli; en 5. swanger vroue se PFK aktivering het, in alle trimesters, ook 'n beduidende verwantskap getoon met verhoogde gluko-kortikoïed en geslagshormoonvlakke. Die hoofbevindinge in hierdie studie stem ooreen met vorige literatuur wat aangedui het dat daar 'n verband is tussen stres en veranderinge in kognitief-affektiewe prosessering en in prefrontale korteks aktivering, maar dui verder op veranderinge in emosionele regulering tydens swangerskap vergeleke met nie-swangerskap. Die data bied 'n belangrike insig in stres-veroorsakende sielkundige simptome; hul verwantskap met kognitief-affektiewe prosesse; veranderinge in neurologiese netwerke; en veranderinge in hormoonvlakke tydens swangerskap. Sover bekend is dit ook die eerste keer bevind dat strukture wat betrokke is by emosionele prosessering (bv. die PFK), ook betrokke is in die regulering van emosie tydens swangerskap. Dit is belangrik dat toekomstige navorsing die onderliggende meganismes wat veranderinge in emosionele regulering teweeg bring, ondersoek. Verdere ondersoek om hierdie veranderinge in swanger depressie-lyers of diegene met angssteurings te vergelyk is ook van belang.

Despite evidence to suggest that pathways from adverse childhood experiences (ACEs) to psychological distress and offending are gender-specific, theory-driven research examining intervening factors in such pathways is rare. Utilising a mixed-method design, the research presented in this thesis aimed to a) provide further insight into gender-specific trajectories from ACEs to negative outcomes and b) to identify a theoretically viable framework within which to conduct such research. It was anticipated that comparing and contrasting the quantitative (Study 1 and Study 2) with the qualitative (Study 3) findings would help to inform interventions to reduce female offending. The literature review identified an attachment framework as appropriate for the research and highlighted a range of factors that warranted investigation. The findings from an internet survey (Study 1) in a mixed-gender community sample provided some support for the notion of genderspecific pathways to offending. Moreover, several variables were identified (e.g. emotional intelligence, empathy and anger) that warranted further examination in a second survey (Study 2) with a sample of women with a history of ACEs (ex- and non-offenders). The findings from the two studies suggested that emotion coping and management (EI) skills may foster resilience to negative experiences and also provided support for the use of an attachment framework in research that examines the negative sequelae of ACEs. The qualitative study (Study 3) utilised interpretative phenomenological analysis in order to gain a deeper insight into women’s trajectories from ACEs to psychological distress and offending. The findings strongly suggested that interventions may need to target deficits in emotion regulation in order to ameliorate the potential negative outcomes of chronic childhood adversity. The importance of context was also highlighted. Additionally, EI and an emotional approach to coping were identified as factors that were beneficial in terms of the women’s psychological well-being. The findings from the research highlighted emotion coping and management skills as useful targets for intervention in women ex-offender populations with a history of ACEs and associated psychological distress. Based on the findings reported in this thesis, recommendations were made with regard to future research in the field of ACEs, psychological distress and offending.

Understanding the potential promotive effects of cultural values is particularly relevant for studies on Mexican-origin fathers who are at risk for exposure to multiple sociocultural contextual stressors. Studies, however, have yet to account for specific sociocultural contextual stressors that are particularly pertinent to Mexican-origin groups, such as immigrant- and ethnic-based discrimination and acculturative stress. According to the Family Stress Model, stressors undermine parenting through psychological dysfunction. Using a community sample of Mexican-origin biological fathers (N = 85) of 3 to 6 year-old children, this study aimed to: first, test the linkages between sociocultural contextual stressors and psychological distress; second, test the linkages between psychological distress and parenting practices; and lastly, consider whether cultural values, namely, familismo, respeto, and caballerismo, moderate these associations. Findings from hierarchical linear regression analyses indicated that immigrant-based discrimination stress was positively related to psychological distress only when fathers strongly endorsed familismo and respeto. In addition, a positive relationship between economic hardship and psychological distress existed only when fathers endorsed high levels of familismo. Findings also showed that the inverse relationship between psychological distress and supportive coparenting quality was substantiated when fathers endorsed low levels of familismo. An inverse link between psychological distress and father accessibility was also observed when fathers reported low levels of respeto. Examining how culturally specific risks and strengths inform future responsible fatherhood intervention work among Mexican-origin families is discussed.

Prostate cancer (PCa) has been the leading cause of cancer death in men since1930. While studies pertaining to PCa have primarily focused on the disease and the subsequent side effects of treatment, psychological distress in this group has yet to be adequately addressed. The purpose of this dissertation was to: 1) conceptualize health related quality of life (HRQL) and health seeking behavior of men by describing lifestyle, cultural and health risks associated with being male, 2) evaluate the psychometric properties of the SF-12 Health Survey (SF-12) combined with the urinary and sexual portions of the UCLA PCa Index (UCLA-PCI), 3) investigate the psychological impact, coping styles and informational needs of a group of men diagnosed with PCa who have not yet undergone treatment. Men have been observed to underutilize health care services despite the fact that they are in poorer health, have higher mortality rates and lower life expectancies than women. Restricting emotions, being oriented toward success, having limited social networks and taking health risks are often associated with being male. Because incontinence and sexual dysfunction, the two most common side effects of PCa treatments impact men's quality of life, portions of the UCLA-PCI and the SF12 were analyzed. The psychometric analysis of the SF-12/UCLA-PCI and its three subcomponents confirmed the validity of the instrument. The SF-12 component had a Cronbach's alpha of 0.87, while the urinary and sexual subscales had a Cronbach's alpha of .86 and .91 respectively. All three scales were found to have good internal consistency. KEYWORDS: prostate cancer, health related quality of life, coping styles, psychological distress.

Men's adherence to restrictive emotionality, a traditional masculine norm, has frequently been linked to higher rates of psychological distress and other negative mental health outcomes. Masculinity researchers have recently begun to study how the effects associated with restrictive emotionality might be related to how men regulate their emotions. Limited findings suggest that restrictive emotionality may be related to non-acceptance of emotion. However, these studies have not examined how acceptance affects the relationship between restrictive emotionality and distress. Further, no published studies have attempted to manipulate levels of men's emotional acceptance in service of reducing restrictive emotionality and distress. The current study tested whether a brief psychoeducational intervention could promote acceptance in men and thus reduce their restrictive emotionality and distress. Participants were randomly assigned to an experimental condition teaching emotional acceptance, or a control condition teaching time management skills. Both conditions consisted of audio recordings that described how these approaches benefit coping with stressful situations, as well as prompts asking participants to write about how this information could relate to their lives. The study also investigated baseline interrelationships between restrictive emotionality, fear of emotion, emotional acceptance, and distress using pretest self-report data. Moderation analyses were conducted to determine whether emotional acceptance might serve as a buffer against the effects of restrictive emotionality on psychological distress. Self-report measures at pretest and at one-week follow-up assessed acceptance, fear of emotion, restrictive emotionality, emotional non-acceptance, and distress. Performance-based measures, including a semantic decision task and a scrambled sentences test, were also used to assess for differences by condition. Contrary to hypotheses, no effect of condition was evident in analyses of self-report or performance-based measures. Self-report data demonstrated a main effect of time, such that distress, emotional non-acceptance, and fear of emotion decreased across conditions from pretest to follow up, while acceptance increased. Restrictive emotionality scores remained unchanged. As predicted, significant intercorrelations were found among fear of emotion, emotional non-acceptance, distress, and emotional acceptance with the exception of restrictive emotionality, which was associated only with greater distress. Finally, the hypothesis that emotional acceptance would moderate the relationship between restrictive emotionality and psychological distress was not supported. / text

The current study examined psychological distress in couples coping with a cancer diagnosis. Although it is widely recognised that spouses coping with a cancer diagnosis are at risk of psychological distress, debate exists within the literature regarding the amount of distress experienced by individuals, and about who is most at risk. Fifty-five couples coping with a cancer diagnosis completed questionnaires assessing psychological distress, social support and attachment style characteristics. Results indicated that partners psychological distress levels were more influenced by social support and attachment characteristics than patients were. Partners of those with cancer, who were higher on the insecure attachment dimensions, perceived providing and receiving less support and were less satisfied with support overall compared to less insecure partners. In addition to this, partner social support was significantly related to psychological distress, and attachment style was found to moderate this relationship. Specifically, partners were more vulnerable to psychological distress when they were higher on the insecure attachment dimensions and when support satisfaction was low or when they had a perception of low support receipt. Contrary to expectations, there were no significant findings for the patient group. Explanations and implications are discussed.

It is widely accepted in the literature that adverse experiences in childhood, such as abuse and emotional invalidation, pose a major risk factor for the development of psychopathology later in life. What is less known, however, is what processes mediate these associations. This study investigated whether psychological inflexibility – that is, cognitive fusion and experiential avoidance - play a role in mediating these relationships. Although abuse and experiential avoidance have featured prominently in the literature, emotional invalidation and cognitive fusion have been comparatively neglected. 518 adults currently experiencing self-reported psychological distress were recruited from online mental health support forums. They completed questionnaires measuring experiences of abuse and maternal/paternal emotional invalidation in childhood and current levels of cognitive fusion, experiential avoidance and psychopathology in an online survey. Given the interpersonal nature of the childhood experiences, and the impact these may have on attachment relationships, participants were also asked to complete a measure of adult attachment. Regression and path analyses indicated that whilst childhood abuse had a direct impact on adult psychopathology, experiences of maternal and paternal emotional invalidation had indirect relationships with psychopathology via cognitive fusion and experiential avoidance. In terms of predicting current levels of psychopathology, cognitive fusion made the most significant contribution, both directly, and indirectly via experiential avoidance. No reliable predictive relationships were observed between adult attachment and any other variable. The results add novel findings to the literature regarding the role of childhood emotional invalidation and cognitive fusion in the development and/or maintenance of distress. They suggest that clinical interventions aimed at cognitive defusion may be of particular benefit to people currently experiencing psychological distress and, perhaps, those with a history of emotional invalidation. However, the cross-sectional nature of this study limits the causal conclusions that can be made and future research should consider the use of longitudinal designs to extend these findings.

Mutations in BRCA1 and BRCA2, the first two breast cancer susceptibility genes identified, carry as much as an 85% lifetime risk of developing breast, ovarian or other cancers. Genetic testing for mutations in these two genes has recently become commercially available. There have been varying amounts of psychological distress noted among women with a family history of breast cancer. Distress has been observed to impact psychological functioning, activities of daily living, and the practice of breast cancer surveillance behaviors. Within the genetic screening process, psychological distress has been shown to impact the decision to undergo genetic screening, the comprehension and retention of risk assessment information, as well as affecting the subject following the receipt of the genetic test results. Little work has been done to examine predictors of distress within at risk subjects. This study examines psychological distress among 52 community women presenting for BRCA1 and BRCA2 genetic mutation testing. Predictors of distress included family cancer history, education, age, Ashkenazi ethnicity, and Internality and Powerful Others Health Locus of Control. Vulnerable sub-groups of patients include younger women, women with higher levels of education and women of Ashkenazi ethnicity.

Background: Self-compassion which may be shaped by early attachment experiences involves being kind to oneself at times of difficulty and is consistently linked to psychological well-being. Self-compassion may be particularly useful in adolescence during which, difficulties associated with physiological and psychosocial transitions can lead to psychological distress. Aims: The aims of this thesis were twofold. First: to review the literature exploring the relationship between self-compassion and psychological distress in adolescents. Second: a research study to investigate the emerging theory that self-compassion may offer a healthier self-relating construct than self-esteem. The study examined whether self-compassion or self-esteem mediated the relationship between attachment and depression and anxiety in adolescents attending child and adolescent mental health services (CAMHS). Method: A systematic search of articles related to the relationship between self-compassion and psychological distress in adolescents was conducted. The quality of included papers was assessed. In the research study, 53 adolescents (mean age 15.52 years; 75% female) attending CAMHS presenting with symptoms of anxiety and/or depression were asked to complete five self-report questionnaires measuring: self-compassion, self-esteem, quality of life, satisfaction with attachment relationship and current symptoms of depression and anxiety. Results: The systematic review revealed 25 studies for inclusion. Studies reported an inverse relationship between self-compassion and psychological distress in adolescents. Quality ratings illustrated variation in methodological quality of included studies. In the research study self-compassion and self-esteem were both negatively correlated with depression and anxiety. The mediating impact of self-compassion was only apparent in the relationship between attachment availability and depression, but not anxiety. Contrary to the hypothesis, self-esteem mediated the relationship between attachment security and depression and anxiety to a greater extent than self-compassion. Conclusions: Self-compassion may have clinical implications in improving psychological well-being among adolescents. Future studies with different measures of self-compassion; varying study designs and consideration of contextual factors would increase understanding of the relationship between self-compassion and psychological distress in adolescents.

A certain community within the southern region of Texas has consistently been linked to escalating poverty, high crime rates, low educational achievement, and poor physical and mental health. For the purpose of this research, this community will be referred to as Community X. Although some researchers have found that sense of community and supportive social networks are associated with healthy mental and physical functioning, others have suggested that in a debilitated community social networks can facilitate psychological distress and a strong sense of community is difficult to develop. Guided by Bronfenbrenner's ecological model, the purpose of this quantitative correlational study was to examine the combination of 3 Social Network Index (SNI) scores and 4 Sense of Community Index 2 (SCI-2) scores that affect Kessler Psychological Distress Scale (K10) scores. For the 106 Community X resident participants, as the SNI number of embedded networks increased, K10 scores tended to increase, indicating higher levels of psychological distress (consistent with the negative effect research). In a cluster analysis, two clusters emerged in which one cluster (n = 67) had positive z-score means on all SNI indices and all SCI-2 subscales, while the other cluster (n = 39) had all negative z-score means. The cluster with all positive scores had lower K10 psychological distress scores (consistent with the positive effect research), but the difference was not statistically significant. The mixed results indicated that comparative research is needed to control for communities of varying ecological distress to better relate psychological distress to sense of community and the valence of social networks to facilitate positive social change health policies and interventions that are ecological-distress sensitive.