The present study presents three individual cases; all three clients had endured a traumatic event, namely rape, and all three met the criteria for PTSD. Despite the fact that each of the clients was initially assessed as being a suitable candidate for psychological treatment, none of the cases proceeded to the therapy phase of treatment. A number of obstacles, both personal and contextual, were encountered during treatment implementation, preventing or limiting a successful outcome of psychological treatment in each case. An examination of these cases highlights a few of the many obstacles frequently faced when delivering psychological treatment to the South African context. In so doing, this research provides an opportunity to consider the possible reasons for the limited documentation of treatment efficacy within the South African context, as well as to enhance our understanding of and sensitivity towards the cultural and contextual factors playing a role in psychological treatment.

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Das überwiegend männliche Einsatz- und Rettungspersonal (Polizei, Feuerwehr, Sanitäter, Justizvollzugsbedienstete) zeigt nach berufsbedingten Traumata häufig Schwierigkeiten bei der Akzeptanz von psychotherapeutischen Hilfsangeboten. Im vorliegenden Beitrag wird diese Problematik anhand von Fallbeispielen sowie konzeptuellen Überlegungen des Zusammenhangs zwischen Männlichkeit und Therapiemotivation diskutiert. Klinische Erfahrungen zu männerspezifischen Komplikationen der Posttraumatischen Belastungsstörung (PTBS) und das Modell eines Risikoprofils männlicher Traumaopfer in Einsatzberufen («Alpha-Männer») werden dargestellt, sowie theoretische Einordnungen in sozialkognitive Theorien der Männlichkeit und Entstehungsmodelle von Traumafolgen vorgenommen. Der Beitrag schließt mit der Skizzierung eines Interventionsvorschlags für berufsbedingte Traumata in den männertypischen Berufsbereichen. / Persons in the predominately male domains of high-risk occupational groups (police, fire department, rescue teams, prison guards) often show difficulties in accepting psychological help after traumatization. The paper presents case reports and conceptual discussion of the relationship between masculinity and treatment motivation. Clinical experiences on male-specific complications of posttraumatic stress disorder (PTSD) and a high risk profile of male work-related trauma victims (‘alphaman’) are discussed. Theoretical discussion furthermore includes social cognitive theories of masculinity and of development of PTSD. The paper concludes with suggestions for interventions relevant to the outlined problems. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

The purpose of this study was to investigate whether a psycho-educational intervention program could support traumatised people to increase their mental toughness. Mental toughness is a well proven phenomenon in sports psychology as well as in leadership in the corporate world. I wanted to apply the use of mental toughness in trauma. Literature was consulted to understand the phenomena of mental toughness and trauma respectively. The corresponding aspects of mental toughness and trauma were selected for the literature review and many similarities between mental toughness and trauma were discovered. The corresponding aspects included action taking, the importance of the “self”, facing negativity and adversity, the importance of support systems, flexibility and adjustment, dealing with guilt and self-blame, the role of self-talk, people’s perceptions, goal-setting, commitment, helplessness / learned helplessness and dealing with stress. I used the corresponding aspects to compile a psycho-educational intervention programme to support traumatised persons to develop increased mental toughness that will support them to better deal with trauma. A valid and reliable psychometric instrument, the MTQ48 (Mental Toughness Questionnaire 48), has been successfully used to determine people’s mental toughness in sports psychology and in corporate management, but has never been tested before in supporting traumatised people. An action research design was employed, where both qualitative as well as quantitative methods were used. This is also known as a mixed research design. Eight traumatised people took part in the research which was presented weekly, as individual sessions, over eight weeks. Data collection methods included questionnaires, observation and individual therapy. The results of the study indicated that seven of the eight participants’ overall mental toughness increased after the intervention program, and four of the eight participants’ mental toughness components increased. As an additional benefit, all respondents indicated that they could better deal and cope with their trauma after the intervention program. The conclusion could be drawn that the psycho-educational intervention program was successful in supporting the traumatised participants to increase their mental toughness. / Psychology of Education / D. Ed. (Psychology of Education)

<p>Kompleksnost visokoenergetskih preloma platoa i pilona tibije i njihova udruženost sa značajnim povredama mekog tkiva oko pripadajućeg zgloba veoma je dobro opisana. Lečenje ima za cilj da multifragmentarni prelomi platoa i pilona tibije postanu stabilni, artikularno poravnani, bezbolni, da koleno i skočni zglob budu pokretni i da se minimizira rizik do nastanka posttraumatskog osteoartritisa. Aparat po Ilizarovu sa nategnutim iglama, koristi opterećenje da stvori jedinstvenu podr&scaron;ku za zglob i stabilnu imobilizacju preloma da se postigne njegovo srastanje. Ovo omogućuje ranu pokretljivost zgloba bez rizika od gubitka redukcije. Cilj istraživanja je procena i poređenje rezultata lečenja unutarzglobnih vi&scaron;ekomadnih preloma kostiju proksimalnog i distalnog okrajka potkolenice tretiranih spoljnjim unilateralnim rigidnim fiksatorom i aparatom po Ilizarovu primenom ASAMI ko&scaron;tanog skoring sistema i funkcionalnog skoring sistema po Karlstrom &ndash; Olerudu.Takođe je jedan od ciljeva istraživanja bio da se uoče faktori koji utiču na različite rezultate lečenja unutarzglobnih vi&scaron;ekomadnih preloma kostiju gornjeg i donjeg okrajka potkolenice tretiranih spoljnim unilateralnim rigidnim fiksatorom i aparatom po Ilizarovu. Istraživanje je dizajnirano kao kontrolisana komparativna klinička studija a podaci su se prikupljali retrospektivno i delom prospektivno na osnovu medicinske dokumentacije od 2008. do 2013. godine. Studija je u potpunosti izvedena na Klinici za ortopediju i traumatologiju Kliničkog centra Vojvodina u Novom Sadu. Studija je obuhvatila ukupno 103 ispitanika kod kojih je u toku 2008 do 2013. godine postavljena dijagnoza unutarzglobnog vi&scaron;ekomadnog preloma gornjeg ili donjeg okrajka tibije. Ispitanici koji su obuhvaćeni ovim kliničkim istraživanjem razvrstani su u tri grupe: Prvu grupu od 53 ispitanika činili su oni sa vi&scaron;ekomadnim unutarzglobnim otvorenim ili zatvorenim prelomima gornjeg ili donjeg okrajka kostiju potkolenice lečenih isključivo spoljnjim unilateralnim rigidnim fiksatorom. Drugu grupu ispitanika, njih 31, činili su oni sa vi&scaron;ekomadnim unutarzglobnim otvorenim ili zatvorenim prelomima gornjeg ili donjeg okrajka kostiju potkolenice lečenih isključivo aparatom po Ilizarovu. Treću grupu činila su 19 ispitanika sa vi&scaron;ekomadnim unutarzglobnim otvorenim ili zatvorenim prelomima gornjeg ili donjeg okrajka kostiju potkolenice koji su lečenje započeli spoljnjim unilateralnim rigidnim fiksatorom, a u kasnijem periodu zbog nastalih komplikacija (lo&scaron;e srastanje, produženo srastanje, nesrastanje, infekcija, pseudoartroza) lečenje nastavili konverzijom spoljnjeg unilateralnog rigidnog fiksatora u aparat po Ilizarovu. Osnovni izvor podataka za prikazano istraživanje bio je protokol formiran za svakog bolesnika pojedinačno, istorije bolesti i poliklinička evidencija. Za potrebe istraživanja dizajniran je protokol istraživanja gde su se prikupljeni podaci analizirali hronolo&scaron;ki : podaci o pacijentu, klinički nalaz na prijemu, postoperativni tok, monitoring aparata, klinički nalaz na otpustu i klinički nalaz na kontrolama od 6, 12 i 18 meseci. Kliničke nalaze na kontrolama na 6, 12 i 18 meseci beležili smo upotrebom skoring sistema ASAMI ( Udruženja za istraživanje i primenu metoda po Ilizarovu) &ndash; za ko&scaron;tane rezultate, i Karlstrom &ndash; Oleruda za procenu funkcionalnih rezultata. Neki do najvažnih rezultata dobijenih prilikom ovog istraživanja jesu da je najbrže vreme srastanja imala grupa Ilizarov, nakon 16&plusmn;2 nedelja. Grupa konverzija zabeležila je prosečno vreme srastanja u 17&plusmn;2 nedelji, dok je kod ispitanika u grupi fiksator zabeženo srastanje u 21&plusmn;4 nedelji. Pojava povr&scaron;nih i dubokih infekcija značajno je veća kod grupe tretiranih spoljnim unilateralnim fiksatorom nego kod grupa tretiranih aparatom po Ilizarovu. Vreme postizanje ranog, punog oslonca na operisani ekstremitet je značajno kraće kod grupe Ilizarov i konverzija nego kod grupe fiksator. Procena ko&scaron;tanih rezultata kori&scaron;ćenjem ASAMI bodovnog sistema ko&scaron;tanog srastanja ukazuje na statistički značajno bolje rezultate kod grupa Ilizarov i konverzija u odnosu na grupu spoljnji fiksator u periodu praćenja i analize na 6,12 i 18 meseci. Funkcionalni rezultati primenom sistema funkcionalne evaluacije po Karlstrom &ndash; Olerudu govore u prilog značajno statistički boljim rezultatima kod grupe Ilizarov i konverzija u odnosu na grupu spoljni fiksator u periodima praćenja i analize na 6,12 i 18 meseci. Na osnovu dobijenih rezultata dolazimo do zaključka da je tretman ispitanika sa multifragmentarnim, intraarikularnim prelomima gornjeg i donjeg okrajka kostiju potkolenice znatno efikasniji aparatom po Ilizarovu &scaron;to sveukupno daje smernice za brži i kvalitetniji oporavak ispitanika i njihov povratak svakodnevnim aktivnostima sa &scaron;to manjim posttraumatskim sekvelama.</p> / <p>The complexity of high-energy fractures of the tibia plateau and pilons and their association with significant violations of the soft tissue around the corresponding joint is well described in the literature. Main aim of the treatment is to multiple fractures of the tibia plateau and pilon become stable, articularly aligned, without pain, and with full motion in the knee and ankle joint with minimum risk for post-traumatic osteoarthritis. Ilizarov apparatus with taut needles is used to create a unique load support for the ankle and create conditions for good healing. This strong stability allows early joint movement, without risk of loss position of fracture parts. The aim of this research is assessment and comparation of the results of treatment, for intraarticular multiple fractures of the proximal and distal part of lower leg tretaed with unilateral external rigid fixator and Ilizarov apparatus, with ASAMI bone scoring system and functional scoring sistem by Karlstrom &ndash; Olerud. One of the goals of the study was to detect factors which affecting different treatment results of the intraarticular multiple fractures of the proximal and distal part of lower leg, tretaed with unilateral external rigid fixator and Ilizarov apparatus. The study was designed as a controlled comparative clinical study and data were collected retrospectively and prospectively form medical records from 2008 to 2013. The study has been fully implemented at the Department for orthopedic surgery and traumatology in the Clinical Center of Vojvodina in Novi Sad and included 103 patients who had intraarticular multiple fractures of the proximal and distal part of tibia. Subjects covered in this clinical study were classified into three groups: The first group of 53 patients were with intraartiulary multifragmentary open or closed fractures of the upper or distal part of lower leg, treated exclusively with unilateral external rigid fixator. The second group included 31 patients with intraarticular open or closed fractures of the upper or distal lower leg, treated exclusively with Ilizarov apparatus. 19 patients made the third group with intraarticulary open or closed fractures of the upper or distal lower leg, which were treated at the begining with unilateral external rigid fixator and later because of the complications (poor or prolonged healing, nonunion, infection and pseudoarthrosis) tretment was continued by Ilizarov apparatus. The main source of data for this study was protocol wich was established for each patient individually. In this protocol collected data analyzed by date: patient data, clinical findings at admission, postoperative course, monitoring apparatus, clinical findings at discharge and clinical findings at the controls which were at 6, 12 and 18 months after surgery. Clinical findings at control examinations (6, 12 and 18 months after surgery), we recorded by scoring system ASAMI (Association for the Study and Application of the Methods of Ilizarov) - that represent the results of the bone healing, and Karlstrom - Olerud for assessment functional outcomes. The most important results were: the fastest time of bone union was in the group of Ilizarov, and it was after 16 &plusmn; 2 weeks and the third group (conversion group) recorded an average time after 17 &plusmn; 2 weeks, while the patients in the first group (external fixator) had average time of union after 21 &plusmn; 4 week. The appearance of superficial and deep infection was significantly higher in the group treated with unilateral external fixator than in the group treated by the Ilizarov apparatus. Fastest full weight bearing on the injured leg, had patients in the group treated with Ilizarov apparatus. Evaluation of results using bone ASAMI fusion scoring system indicating a statistically significantly better results in the conversion and Ilizarov group compared to the group of external fixator in the period of monitoring at 6,12 and 18 months after surgery. Functional results by Karlstrom - Olerud scoring system show statistically significantly better results in the Ilizarov and conversion group contrary to the external fixator group in periods of monitoring at 6,12 and 18 months. Based on these results we conclude that the treatment of subjects with intraarticulary, multifragmentary fractures of the upper and lower part of the lower leg are more efficient after Ilizarov apparatus which provides overall guidance for faster and better recovery of patients and their return to their daily activities with minimal post-traumatic sequelae.</p>

The purpose of this study was to investigate whether a psycho-educational intervention program could support traumatised people to increase their mental toughness. Mental toughness is a well proven phenomenon in sports psychology as well as in leadership in the corporate world. I wanted to apply the use of mental toughness in trauma. Literature was consulted to understand the phenomena of mental toughness and trauma respectively. The corresponding aspects of mental toughness and trauma were selected for the literature review and many similarities between mental toughness and trauma were discovered. The corresponding aspects included action taking, the importance of the “self”, facing negativity and adversity, the importance of support systems, flexibility and adjustment, dealing with guilt and self-blame, the role of self-talk, people’s perceptions, goal-setting, commitment, helplessness / learned helplessness and dealing with stress. I used the corresponding aspects to compile a psycho-educational intervention programme to support traumatised persons to develop increased mental toughness that will support them to better deal with trauma. A valid and reliable psychometric instrument, the MTQ48 (Mental Toughness Questionnaire 48), has been successfully used to determine people’s mental toughness in sports psychology and in corporate management, but has never been tested before in supporting traumatised people. An action research design was employed, where both qualitative as well as quantitative methods were used. This is also known as a mixed research design. Eight traumatised people took part in the research which was presented weekly, as individual sessions, over eight weeks. Data collection methods included questionnaires, observation and individual therapy. The results of the study indicated that seven of the eight participants’ overall mental toughness increased after the intervention program, and four of the eight participants’ mental toughness components increased. As an additional benefit, all respondents indicated that they could better deal and cope with their trauma after the intervention program. The conclusion could be drawn that the psycho-educational intervention program was successful in supporting the traumatised participants to increase their mental toughness. / Psychology of Education / D. Ed. (Psychology of Education)

In 2009, South African police statistics revealed that more than 68 332 women were raped in the country. The evidence from independent researchers has shown that SAPS statistics are highly susceptible to under-reporting and the actual figure is more than double this amount. One pervasive feature of the phenomenology of rape is post-traumatic stress disorder (PTSD). PTSD is a highly debilitating condition with severe individual and societal costs. The condition takes a critical toll on occupational functioning, schooling and personal relationships and is associated with depression, suicide risk, self-harming behaviours and alcohol-abuse problems. The Ehlers and Clark (2000) cognitive model represents the most efficacious treatment for PTSD but the approach is severely under-utilised by South African practitioners working with sexual trauma. The reasons for such under-utilisation relate to a lack of exposure and training surrounding the model and concerns about the transportability of the treatment to a multi-cultural context. One method of addressing these barriers to treatment delivery is through systematic case-based research. Systematic case-based research offers a complementary means of refining theory and developing evidence-based practice in the context of a developing country. The method offers an intensive analysis and description of the particular phenomena under study within its real-life context. It allows the researcher to intensively examine and identify the specific aspects of the therapist’s responses and client’s reactions that contributed to significant change. Unlike efficacy studies, generalisability in case-study research is based on replication on a case-by-case basis and the creation of case law. This research study uses a systematic-case study approach to investigate the applicability of the Ehlers and Clark (2000) model in the treatment of rape-related PTSD in South Africa. The study aims to demonstrate the transportability of the model and develop a needed evidence base for service providers in the country. Seven women participated in the project and lent their treatment process to the research. The participants varied in terms of age, race, culture, socio-economic status and the nature of their sexual trauma. Through synoptic thematic analysis of their therapy process specific client-related personal aspects, client-related contextual factors and state-level factors were found to impede treatment delivery and implementation. The implications of these aspects for clinical practice and social policy are comprehensively discussed.

Background: Childhood maltreatment is associated with the development and maintenance of mental disorders. The purpose of this naturalistic study was (a) to identify different patterns of childhood maltreatment, (b) to examine how these patterns are linked to the severity of mental disorders and (c) whether they are predictive of treatment outcome. Methods: 742 adult patients of a university hospital for psychotherapy and psychosomatics were assessed at intake and discharge by standardized questionnaires assessing depression (Beck Depression Inventory, BDI) and general mental distress (Symptom Check List-90-R, SCL-90-R). Traumatic childhood experience (using the Childhood Trauma Questionnaire, CTQ) and ICD-10 diagnoses were assessed at intake. Results: The patients could be allocated to three different patterns of early childhood trauma experience: mild traumatization, multiple traumatization without sexual abuse and multiple traumatization with sexual abuse. The three patterns showed highly significant differences in BDI, General Severity Index (GSI) and in the number of comorbidity at intake. For both BDI and GSI a general decrease in depression and general mental distress from intake to discharge could be shown. The three patterns differed in BDI and GSI at intake and discharge, indicating lowest values for mild traumatization and highest values for multiple traumatization with sexual abuse. Patients with multiple traumatization with sexual abuse showed the least favourable outcome. Conclusion: The results provide evidence that the severity of childhood traumatization is linked to the severity of mental disorders and also to the treatment outcome in inpatient psychotherapy. In the study, three different patterns of childhood traumatization (mild traumatization, multiple traumatization without sexual abuse, multiple traumatization with sexual abuse) showed differences in the severity of mental disorder and in the course of treatment within the same therapy setting.

In the United States, approximately 7.7 million individuals are affected by posttraumatic stress disorder (PTSD) at any given time. Though women are likelier to develop PTSD symptoms, men are exposed to more traumatic events in their lifetimes. Empirically- supported PTSD options exist, however clinical application of these treatments may not consistently culminate in beneficial outcomes. Dance Movement Therapy (DMT) has demonstrated positive treatment outcomes for a variety of mental and physical disorders. Nonetheless, there is a lack of robust research related to the treatment experiences of men who have participated in DMT for trauma-related symptoms. The purpose of this phenomenological study was to explore this research gap. Focusing on adult male trauma survivors, the research question addressed the lived experiences of participating in DMT and the meaning ascribed to this involvement. Eleven adult male participants were interviewed via audio-recorded telephone interviews consisting of semistructured interview questions. Through a constructivist lens, the modified Van Kaam method of analysis was implemented revealing 4 emergent themes. The findings of this explorative study suggested positive PTSD symptom outcomes for all 11 participants including improvements in social belongingness, social acceptance, quality of life, and a reduction in symptoms of anxiety and depression. Accordingly, the findings of this research may help to advance social change through broadening clinical awareness of the beneficial neurogenic treatment advantages of somatic and creative interventions such as DMT for PTSD. Moreover, these findings may augment existing research related to movement- based treatment options for individuals coping with PTSD and trauma-related symptoms.