Posttraumatiskt stressyndrom (PTSD) är en sjukdom som är traumarelaterad och svår att få en övergripande bild av då statistiken för antalet drabbade är bristfällig framför allt av ett stort mörkertal. Symtombilden vid denna sjukdom är mycket individuell och de upplevda symtomen är många, vilket skapar en svårighet i att diagnostisera sjukdomen. Vem som helst kan drabbas när som helst under sin livstid och att få en behandling som fungerar är problematisk då ingen exakt bot finns. Under ett trauma påverkas vårt alarmsystem i kroppen för att varna om fara och då har hjärnstrukturen amygdala en övergripande roll. Eftersom amygdala har stor betydelse för vår uppfattning om faror har därför denna studie valt att se om dessa traumatiska händelser orsakar symtomen vid PTSD. Mer specifikt var syftet med denna litteraturstudie att se om förändringar i amygdala och närliggande regioner kan vara bidragande till symtomen som upplevs av individer med PTSD samt vilka neurologiska förändringar som skett/finns i dessa hjärnregioner som kan ha en bidragande faktor till uppkomsten av sjukdomen. Av sex utvalda orginalartiklar kunde det sammantaget konstateras att vissa neurologiska förändringar som amygdala aktivitet och kortikal volym möjligtvis kan ha en koppling till vissa upplevda symtom som bland annat förhöjd vaksamhet och känsloregleringsförmåga. Artikel 1 visade på minskad volym av grå substans i premotorcortex och i främre cingulate cortex (p<0.05)samt att de med PTSD hade svårare att hantera vardagliga utmaningar, var mindre positiva och mer negativa (p<0.0001).Artikel 2 visade på att volymen av grå substans hade korrelationer med svårighetsgraden av PTSD samt symtombilden. Artikel 3 visade att individer med PTSD hade en minskad aktivitet i högra och vänstra amygdala och ventrala striatum (p<0.005). Där emotionellt avtrubbande hade korrelationer med högra ventrala striatum(p<0.05).Artikel 4 såg att de med PTSD hade förändrad cortex, i högra hemisfären var det åttaregioner och i den vänstra sex regionersom antagligen hade samband med totala CAPS poäng. Artikel 5visade att PTSD gruppen hade en ökad respons i högra amygdala vid syn av skrämmande ansikten (p<0.05) samt att högra amygdala aktiviteten hade samband med symtomet förhöjd vaksamhet. Artikel 6 visade att förmågan att reglera känslor var förändrad hos individer med PTSD. Både vid intensifiering av en känsla (amygdala (p<0.04), bakre cingulate cortex (p<0.01), främre cingulate cortex (p<0.04), middle cingulate cortex (p<0.02), vänstra inferior frontal cortex (p<0.04), vänstra putamen (p<0.04), bilaterala inferior parietal loben (p<0.03)) samt vid minskning av känsla (inferior frontal cortex (p<0.01), vänstra putamen (p<0.02), bilaterala inferior parietal loben (p<0.01), insula (p<0.03)).Denna studie kunde alltså inte påvisa tydliga hjärnområden, kopplade till amygdala, vilka hade förändringar som kan ha orsakat uppkomsten av ångestrelaterade besvär vid PTSD. Eftersom hjärnan är mycket komplex och kan bearbeta intryck på väldigt olika sätt kan dessa resultat kanske förklaras med hjälp av att de olika typer av trauman som individerna utsattes för i stor utsträckning påverkade skilda hjärnregioner. Det är alltså därför viktigt att fler studier, med större deltagarantal och likartade traumatiska händelser, fortsätter belysa PTSD symtom och deras koppling mot amygdala och närliggande hjärnregioner för att öka förståelsen för uppkomsten av PTSD. Eftersom kunskapen idag är begränsad vid behandling av PTSD-relaterad symtom behövs dessa frågeställningar klarläggas för att snabbare kunna ställa diagnos och kunna ge tidigbehandling till individer med PTSD. / Post-traumatic stress disorder (PTSD) is a trauma-related disorder that is difficult to get an overall picture of because of lack of statistics regarding affected individuals, most likely due to a large number of unrecorded cases. The symptoms of this disease are very individual and the perceived symptoms are many, which create a difficulty in diagnosing the disease. Anyone can be affected at any time during his or her lifetime, where effective treatment still needs to be developed. During a trauma our alarm systems in the body warns us of danger and then the brain structure amygdala has a central role. Because the amygdala is of great importance for our understanding of dangers, this study set out to examineif these traumatic events cause the symptoms of PTSD. More specifically, the purpose of this study was to examine if changes in the amygdala and nearby regions may contribute to the symptoms experienced by individuals with PTSD, as well as if the neurological changes that occurred in these brain regions may be a contributing factor to the onset of the disease. Of the six selected original articles it could be noted that certain neurological changes, including amygdala activity and cortical volume, could be linked to certain perceived symptoms together with heightened alertness and emotional regulation skills. Article 1 showed reduced volume of gray matter in the premotor cortex and the anterior cingulate cortex (p <0.05), and those individuals with PTSD had more difficulties handling everyday challenges together with less positive attitudes (p <0.0001). Article 2 showed that the volume of gray matter had correlations with the severity of PTSD and symptoms. Article 3 showed that individuals with PTSD had a decreased activity in the right and left amygdala and ventral striatum (p <0.005). There, emotional numbing had correlations with right ventral striatum (p <0.05). Article 4 showed that those with PTSD had altered cortex in the right hemisphere was the eight regions and in the left six regions that probably was associated with total CAPS score. Article 5 indicated that PTSD group had a higher response in the right amygdala at sight of the faces daunting (p <0.05) and the right amygdala activity was associated with elevated symptom vigilance. Article 6 showed that the ability to regulate emotions was altered in individuals with PTSD. Both the intensification of a sense (amygdala (p <0:04), the posterior cingulate cortex (p <0:01), anterior cingulate cortex (p <0:04), middle cingulate cortex (p <0:02), left inferior frontal cortex (p <0:04) left putamen (p <0.04), bilateral inferior parietal lobe (p <0.03)) and the reduction of sensation (the inferior frontal cortex (p <0.01), the left putamen (p<0.02), bilateral inferior parietal lobe (p <0.01 ), insula (p <0:03)). This study could thus not demonstrate distinct brain areas, linked to amygdala, which had changes that may have caused the onset of anxiety-related disorders in PTSD. Since the brain is very complex and can process impressions in very different ways, these results may be explained by the different types of trauma that the individuals were exposed to,which in turn could affect different brain regions. It is thus important that more studies with larger number of participants, and similar traumatic events, continues highlighting PTSD symptoms and their relationship to amygdala and related brain regions to increase understanding of the onset of PTSD. As knowledge today is limited in the treatment of PTSD-related symptoms, these issues must be continuously examined to develop earlier diagnosecriterias and finally propose proper treatments for individuals with PTSD.

Syftet med denna studie var att undersöka hur terapeuter inom den offentliga sjukvården resonerar kring svårigheter i att arbeta med trauma. Frågeställningarna var: hur resonerar terapeuter kring svårigheter att arbeta med trauma; vilka känslomässiga reaktioner har de; vad säger de om handledning, kollegialt stöd och organisationen inom vilket de arbetar; samt hur de resonerar kring kultur, språk och tolkanvändning. Semistrukturerade intervjuer genomfördes med fem terapeuter som arbetar inom primärvården respektive psykiatriska öppenvården. Intervjuerna spelades in, transkriberades och analyserades genom Tematisk Analys. Resultaten visar att traumatiserade personer upplevdes som en tung patientgrupp och att de önskade sig mer handledning och utbildning för att klara av arbetet. Det var även svårt för dem att se hur patienterna skickades runt mellan olika vårdinstanser. Resultaten visar också att man upplevde svårigheter kring kulturella skillnader och att arbeta med tolk. Tidsbrist i behandlingarna och underbemanning upplevdes också som försvårande omständigheter i arbetet med trauma. Avslutningsvis diskuteras om den svåra symtomatologin och traumats inbyggda dialektik är bidragande orsaker till att traumatiserade patienter skickas mellan vårdinstanser och upplevs som en tung grupp att arbeta med. Också terapeuternas beskrivningar av underbemanning och tidsbrist diskuterades utifrån de behandlingsrekommendationer som finns och riskerna om dessa inte följs. / The purpose of this study was to investigate how psychotherapists within the Swedish health service perceive difficulties in working with trauma. The research questions were how do therapists perceive difficulties in working with trauma; what are their emotional reactions; what are their views concerning supervision, peer support and the organisation within which they work; what thoughts do the therapists have concerning culture, language and the use of interpreters. Semi structured interviews were conducted with five psychotherapists who work in municipal health centers and psychiatric outpatient clinics. The interviews were recorded, transcribed and analysed using thematic analyses. The results show that in general the therapists experienced traumatised people as a difficult group of patients and they felt a need for increased levels of supervision and training. They also experienced difficulties arising from the fact that patients were often moved frequently between different health services. The results also showed that they experienced difficulties due to cultural differences and working with interpreters. Limits on treatment duration and under staffing also contributed to difficulties. The relationships between symptoms and the dialectics of trauma and the fact that patient group are often passed between health services and experienced as a difficult were discussed.

Inledning: Trauma påverkar drömmar och dess bearbetningsförmåga av innehåll. En viktig punkt är att etiologin av PTSD anses vara en traumatisk upplevelse som kan leda till återkommande mardrömmar. Idag finns det många personer i samhället som lider av trauma och traumarelaterade problem vilket gör att utveckling av traumateorin får en central betydelse för att erbjuda bra behandlingsmetoder. Syftet med studien är att bidra med kunskap om hur traumatiska upplevelser bearbetas i drömmarna med fokus på affekter och interaktioner med andra människor som kan leda till vidareutveckling av psykodynamisk traumateori. Frågeställningar:  Vad finns det för skillnader i drömmarna mellan grupperna i avseende på affekter?  Vilka centrala teman förekommer i båda gruppernas drömmar och hur ser det ut i jämförelse mellan grupperna? Metod: Den metod som använts är en kombinerad kvantitativ och kvalitativ ansats där 60 drömmar från tidigare krigsveteraner studeras och jämförs i två grupper. Resultat: Studiens resultat visar traumats negativa effekter på affektregleringsförmåga och relationer. Det lyfter också fram drömmens betydelse som en ingång till det psykiska livet för att få inblick i hur traumatiska händelser och affekter hanteras, samt drömmandets funktion i affektreglering som är en viktig bearbetande faktor för trauma. Diskussion: Studiens resultat är i många avseenden i linje med tidigare forskning och teoribildning, men särskilt två aspekter av resultatet förtjänar att lyftas fram: Drömmen som en scen för det psykiska livet: 1. hur traumatiska händelser och affekter hanteras; 2. vilka faktorer kan tänkas vara bearbetande för trauma. / Introduction: Trauma affects dreams and its processing skills of content. An important point is that the etiology of PTSD is considered to be a traumatic experience that can lead to recurrent nightmares. Today there are many people in the community who suffer from trauma and trauma-related problems making the development of trauma theory be of central importance for providing good treatment. The aim of this study is to contribute knowledge about how traumatic experiences are processed in dreams with a focus on affects and interactions with other people that can lead to further development of psychodynamic trauma theory. Research questions:  What are the differencesindreamsbetween thegroupsin terms of emotions ?  What are thekey themespresent inboth groupsdreams andhowdoes it lookincomparisonbetween the groups? Method: The used method is a combined quantitative and qualitative approach where 60 dreams from former war veterans studied and compared in two groups. Results: Results of the study demonstrate traumas negative effects on affect regulation skills and relationships. It also highlights both the dream's meaning as an entrance to the psychic life to gain insight into how traumatic events and affects handled, and the function of dreaming in affect regulation as an important processing factor for trauma. Discussion: The study results are in many aspects in line with previous research and theory, but in particular, two aspects of the results deserve to be highlighted: The dream as an entrance for the psychic life: 1. how traumatic events and affects handled; 2. Which factors could be of importance in the processing of trauma.

Syftet med studien var att synliggöra hur bildterapeuter arbetar med vuxna med PTSD, och eventuella skillnader och likheter i arbetssätt. Ett annat syfte var att få ökad kunskap om hur bildterapi bedrivs vid PTSD och vilka delar i behandlingen bildterapeuterna ser som verksamma. Frågeställningarna var: a) Arbetar bildterapeuter annorlunda vid PTSD än vid annan problematik? b)Vilka beståndsdelar i det bildterapeutiska arbetet ser bildterapeuten som särskilt verksamma vid PTSD? Metod för studien var semistrukturerade intervjuer med 6 bildterapeuter med erfarenhet av att arbeta med PTSD. Fem intervjuer gjordes via personliga möten och en via Skype. Intervjuerna spelades in digitalt, transkriberades och bearbetades därefter genom Tematisk Analys. Resultaten visar att bildterapeuterna håller fast vid sin terapeutiska metod oavsett problematik hos patienten de möter men att förhållningssättet förändras när diagnosen PTSD finns från terapistart. Vid bildterapi med PTSD-patienter ser bildterapeuterna flera avgörande faktorer, där bl.a. den skapade bilden utgör en viktig del, liksom att kreativiteten engagerar kroppsminnen och underlättar bearbetningen. I diskussionen presenteras tankar kring undersökningens utformning, bildterapins position som traumabehandlande metod och den brist på forskning som gör att bildterapin saknar erkännande. / The purpose of this study was to visualize how arttherapists work with adults suffering from PTSD, and how differences and similarities in the approaches are expressed. The aim was also to find out more about how arttherapy in PTSD is conducted as well as what aspects the therapists themselves consider to be active parts of the treatment. The issues were: a) Do arttherapists operate differently in PTSD than with other problems? b) What elements in the therapeutic work are especially effective with PTSD, according to the arttherapists? The method consists of semi-structured interviews with six artherapists, all with experience in meeting patients with PTSD. Five interviews were made through personal meetings and one via Skype. The interviews were recorded digitally, transcribed and then processed through Thematic Analysis. The results of the survey shows that arttherapists maintain their therapeutic method regardless of the patient’s problems but that their approaches change when PTSD is known from the start of the therapy. In arttherapy with PTSD arttherapists notice several crucial factors, e.g. the created image as an important part, as well as creativity that involves embodied memories and facilitate processing. The discussion presents thoughts on the survey design, arttherapy's position as treatment in PTSD and the lack of research that makes art therapy failing to receive recognition.

This study deals with the pastoral counselling of people who became ill as a result of unresolved trauma. Some of the important questions raised in this study, included: Why are certain traumatic events physically harmful to people? 0 What is the relationship between unresolved trauma and the development of disease in the human body? Which additional factors play a role in the development of disease? The basis theoretical research clearly showed that a wounded person can be healed and restored by God; even if the wounding took place a long time ago. The traumatized person can bring his/her pain to God, uninhibitedly, with the expectation that God's healing power can heal. Negative thoughts and emotions, which are harmful to a person, must be brought under the truth of the Word, through the guidance of the Holy Spirit; with the intention to correct these thoughts and emotions. The meta-theoretical research has clearly shown a relationship between unresolved trauma and the development of disease in humans. Unresolved emotions can create certain emotions that work in negatively on a person's body. Unresolved trauma can also lead to Post-Traumatic Stress Disorder. For the purpose of the empirical study, four cases, of people who experienced trauma, were selected and studied. These people all struggled with new diseases after their traumatic experiences. The results highlighted the importance of considering the unique personal history of each individual; especially with reference to unresolved traumatic experiences in a person's past. The co-operation between the researcher and the medical profession regarding the results of the case studies should be noted. Chapter 6 clearly points out that the point of departure in pastoral counselling is God, the Holy Trinity. Vital dimensions of the Biblical counselling process are the following: Establishing involvement with counselees. Inspiring in them Biblical hope. 0 A thorough inventory and Biblical interpretation of counselees and their problems. Instructing counselees in an accurate and appropriately Biblical way to inspire in them decisive commitment to Biblical obedience and the implementation of Biblical instructions. / Thesis (M.A. (Pastoral))--North-West University, Potchefstroom Campus, 2006.

Teens around the world manifest with dysfunctional behaviour and according to statistics there was an increase of 75% in addictions, suicidal attempts and promiscuity among the youth in the past ten years. This study attempts to establish whether unresolved hurt and damaged emotions of the parents and even grandparents contribute to this affect amongst teens. The basic-theoretical chapter shows that dysfunctional families had already existed in the Bible. An example of this is the family of Abraham, Isaac and Jacob. Through the history of these Biblical families it is shown that certain patterns repeat themselves in generation after generation. The exegetical analysis of suitable Scriptures give Biblical guidelines with which damaged emotions, caused by intergenerational trauma, can be healed when assisted with the guidance of pastoral caregivers. The next chapter deals with contributions by various pastoral authors in connection with the theme of intergenerational trauma. According to their view there is a definite connection between the unresolved trauma of previous generations and the wounds of some of the current generation of teens. God based family structure on perfect harmony, but this relationship was broken because of the fall. It subsequently led to the inheritance of fractured relationships by mankind and the only way to repair this relationship is for man to repair his relationship with God. Only thereafter man would be able to repair his earthly relationships. According to empirical theory the research done on the children of Holocaust survivors was the first of its kind to be undertaken on secondary traumatization, which by its nature is connected to intergenerational distress. Although current literature gives some recognition to the problem of intergenerational distress, the total impact of secondary trauma on the next generation is still being ignored. Empirical researchers came to the overwhelming conclusion that trauma is "contagious". They furthermore concluded that there is a hiatus with regard to theological reflection in connection with the spiritual as well as the pastoral implications of this theme. Empirical research concluded that intergenerational distress can have a devastating and traumatic effect on the next generation. Unresolved trauma experienced by previous generations have the ability to wound the next generation, particularly the teenagers, on the physical, psychological, emotional and most of all on the spiritual level. Empirical research found that these wounds need a multidimensional approach and that Pastoral input is of utmost importance. The practical-theoretical theory reconciles the conclusions drawn from the auxiliary science as well as the results from the empirical research with Biblical principals drawn from the basic-theoretical chapter. This guidelines together with pastoral care, can guide the teenager suffering from the negative affects of intergenerational trauma towards emotional healing. / Thesis (M.A. (Pastoral))--North-West University, Potchefstroom Campus, 2008.

Thesis (Ph.D.)--Bowling Green State University, 2009. / Document formatted into pages; contains ix, 87 p. Includes bibliographical references.

Thesis. / Includes vita. Includes bibliographical references (leaves 110-125)

xvii, 103 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / The purpose of this study was to investigate intergenerational relationships between trauma, dissociation, and emotion. Short and long term consequences of betrayal trauma on cognitive and emotion coping strategies in a sample of 67 mother-child dyads were explored. Group comparison, correlation, and regression strategies were used to examine relationships between the following variables: maternal and child trauma histories, maternal and child dissociation, maternal alexithymia, and child emotion coping strategies in response to distressful events. Experiences of high betrayal trauma were found to be related to higher levels of dissociation in both children and mothers. Furthermore, mothers who experienced high betrayal trauma in childhood and were subsequently interpersonally revictimized in adulthood were shown to have higher levels of dissociation than a group of mothers who had experienced high betrayal trauma in childhood but were not revictimized in adulthood. This may indicate that dissociation from a history of childhood betrayal trauma involves a persistent unawareness of future threats in the environment. Additional evidence consistent with this hypothesis was found. Maternal revictimization status was related to child interpersonal trauma history, suggesting that a dissociative unawareness for threats may extend to children. More generally, an association was found between maternal interpersonal trauma history and child interpersonal trauma history. Maternal dissociation was also predictive of maternal alexithymia. This relationship was examined because mothers high in alexithymia were hypothesized to display deficits in emotion socialization that could put their children at greater risk for dissociation. Evidence consistent with a relationship between maternal alexithymia and child dissociation was found. Furthermore, a significant association between maternal alexithymia level and child emotion coping strategy was revealed. Children with highly alexithymic mothers displayed higher levels of passive emotion coping strategies on a task assessing their reactions to a distressful parent-child event. This study provides evidence that the experience of parental trauma has intergenerational effects on children. It is an important first step towards longitudinal studies that can provide additional clarification of the nature of the relationships between these variables, as well as parent-child intervention studies that may help to prevent child trauma exposure and reduce symptomatology. / Committee in charge: Jennifer Freyd, Chairperson, Psychology; Jennifer Ablow, Member, Psychology; Philip Fisher, Member, Psychology; Debra Eisert, Outside Member, Special Education and Clinical Sciences

Betrayal trauma theory posits that victims of abuse perpetrated by someone close are more likely to dissociate from awareness of the abuse in order to protect the needed relationship. Shame may likewise protect the relationship by turning the victim's attention inward, thereby increasing the likelihood that the abusive environment will be overlooked. In this dissertation, the associations between shame, dissociation, and betrayal trauma were examined in two experimental studies. A third study examined the consequences of chronic shame. Aims were to determine whether shame and dissociation have a unique link with high betrayal traumas (HiBT), to understand the nature of the relationship between shame and dissociation, and to investigate the consequences of chronic shame. In study 1, 124 female trauma survivors were randomly assigned to a high or low betrayal threat condition. Greater exposure to HiBT but not low betrayal traumas (LoBT) predicted increased shame and dissociation following high betrayal threat. Greater exposure to LoBT but not HiBT predicted increased fear following non-betrayal threat. Compared to non-dissociators, dissociators from threat endorsed more negative psychological consequences. In study 2, 127 female trauma survivors completed a dissociation induction and battery of questionnaires. The bypassed shame theory, which proposes that dissociation serves to disconnect from the pain of shame, was examined. Results partially supported bypassed shame theory. Although feelings of shame led to a larger dissociation response to the induction, dissociation did not interrupt shame but rather led to even higher shame. Implications are discussed for a possible contributing role of shame to betrayal blindness. In study 3, 247 trauma survivors completed online questionnaires addressing chronic shame hypotheses. Regression results revealed that all forms of chronic shame, especially trauma-focused shame, predicted negative health consequences. Correlation results revealed that HiBT was associated with more types of negative outcomes compared to LoBT and that HiBT but not LoBT was associated with chronic shame. Taken together, results indicate that, like dissociation, shame may be both an adaptive and detrimental response following betrayal trauma and that emotional and cognitive responses other than fear warrant attention in trauma research and practice.