“It’s like uprooting trees”: responsive treatment for a case of complex post-traumatic stress disorder following multiple rapes
- Van der Linde, Francois, Edwards, David J A
- Authors: Van der Linde, Francois , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6238 , http://hdl.handle.net/10962/d1007788
- Description: This systematic case study documents 27 sessions of assessment and treatment with cognitive therapy of Bongi (23)who presented with major depression, posttraumatic stress disorder and borderline traits. Bongi had been raised in a punitive environment, had been raped three times, the first time at age 9, and had been in a series of abusive relationships. The treatment illustrates the importance of therapist responsiveness in addressing this kind of complex presentation, the importance of drawing on case formulation to guide the course of treatment and the range of different interventions that need to be incorporated into an integrative treatment of a complex case. Self-report measures of depression, anxiety and posttraumatic stress indicators provided evidence that the therapy contributed to positive changes and the qualitative therapy narrative gives details of the nature of some of those changes. Although treatment was not complete when Bongi moved away, Bongi herself judged that the therapy had been a valuable experience which had resulted in her feeling more alive, more confident, and better able to take care of herself.
- Full Text:
- Date Issued: 2013
- Authors: Van der Linde, Francois , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6238 , http://hdl.handle.net/10962/d1007788
- Description: This systematic case study documents 27 sessions of assessment and treatment with cognitive therapy of Bongi (23)who presented with major depression, posttraumatic stress disorder and borderline traits. Bongi had been raised in a punitive environment, had been raped three times, the first time at age 9, and had been in a series of abusive relationships. The treatment illustrates the importance of therapist responsiveness in addressing this kind of complex presentation, the importance of drawing on case formulation to guide the course of treatment and the range of different interventions that need to be incorporated into an integrative treatment of a complex case. Self-report measures of depression, anxiety and posttraumatic stress indicators provided evidence that the therapy contributed to positive changes and the qualitative therapy narrative gives details of the nature of some of those changes. Although treatment was not complete when Bongi moved away, Bongi herself judged that the therapy had been a valuable experience which had resulted in her feeling more alive, more confident, and better able to take care of herself.
- Full Text:
- Date Issued: 2013
Treatment of post traumatic stress disorder following an armed robbery : a case study testing the transportability of trauma-focused cognitive-behavioural therapy to urban Africans
- Drake, B, Edwards, David J A
- Authors: Drake, B , Edwards, David J A
- Date: 2012
- Language: English
- Type: Article
- Identifier: vital:6225 , http://hdl.handle.net/10962/d1007775
- Description: John, an urban African male who developed post traumatic stress disorder (PTSD) following an armed robbery at the petrol station where he worked, was treated with 12 sessions of Trauma-focused cognitive behaviour therapy. Intervention involved a combination of psycho-education, prolonged imaginal exposure, cognitive restructuring and behavioural assignments. This article is a systematic case study of his treatment which included a comprehensive narrative and tracking of progress by means of the Post traumatic Diagnostic Scale. John responded well to the treatment, finding it acceptable and credible and remained free of PTSD symptoms at 15 months follow up. It is argued, based on the principles of Elliott’s Hermeneutic Single Case Efficacy Design, that there is evidence from within the narrative that it was the treatment that led to remission of symptoms. This case study demonstrates the cognitive, emotional and behavioural processes underlying John’s PTSD, which fits with those extensively described in the research literature, and that this evidence-based treatment developed in a westernised context is transportable to work with urban Africans.
- Full Text:
- Date Issued: 2012
- Authors: Drake, B , Edwards, David J A
- Date: 2012
- Language: English
- Type: Article
- Identifier: vital:6225 , http://hdl.handle.net/10962/d1007775
- Description: John, an urban African male who developed post traumatic stress disorder (PTSD) following an armed robbery at the petrol station where he worked, was treated with 12 sessions of Trauma-focused cognitive behaviour therapy. Intervention involved a combination of psycho-education, prolonged imaginal exposure, cognitive restructuring and behavioural assignments. This article is a systematic case study of his treatment which included a comprehensive narrative and tracking of progress by means of the Post traumatic Diagnostic Scale. John responded well to the treatment, finding it acceptable and credible and remained free of PTSD symptoms at 15 months follow up. It is argued, based on the principles of Elliott’s Hermeneutic Single Case Efficacy Design, that there is evidence from within the narrative that it was the treatment that led to remission of symptoms. This case study demonstrates the cognitive, emotional and behavioural processes underlying John’s PTSD, which fits with those extensively described in the research literature, and that this evidence-based treatment developed in a westernised context is transportable to work with urban Africans.
- Full Text:
- Date Issued: 2012
Treating posttraumatic stress disorder in South Africa : an integrative model grounded in case-based research
- Authors: Edwards, David J A
- Date: 2009
- Language: English
- Type: Article
- Identifier: vital:6232 , http://hdl.handle.net/10962/d1007782
- Description: The article presents a model for formulating and planning treatment for post-traumatic stress disorder (PTSD) in South Africa derived from the existing literature and in conjunction with a review of a series of studies of cases treated using the guidelines of Ehlers and Clark's cognitive therapy. It is argued that the construction of psychotherapies (or even components of psychotherapy) for PTSD in terms of traditional categories ("psychodynamic", "cognitive-behavioural", "narrative" etc.) is misleading and unhelpful. Instead, superordinate concepts derived from thinking about evidence-based practice provide a more grounded focus on the practical issues faced by therapists treating PTSD. These concepts, which include competences and metcacompetences, therapist responsiveness, stages of therapy and case formulation, provide a basis for a genuinely integrative approach. The proposed model suggests seven broad areas of clinical focus for work with PTSD which can be arranged at three levels of priority: level 1 crisis intervention and stabilization; level 2 promoting engagement with treatment, and level 3 selection, sequencing and timing of active treatment interventions. Material from the case series is used to illustrate the application of the model.
- Full Text:
- Date Issued: 2009
- Authors: Edwards, David J A
- Date: 2009
- Language: English
- Type: Article
- Identifier: vital:6232 , http://hdl.handle.net/10962/d1007782
- Description: The article presents a model for formulating and planning treatment for post-traumatic stress disorder (PTSD) in South Africa derived from the existing literature and in conjunction with a review of a series of studies of cases treated using the guidelines of Ehlers and Clark's cognitive therapy. It is argued that the construction of psychotherapies (or even components of psychotherapy) for PTSD in terms of traditional categories ("psychodynamic", "cognitive-behavioural", "narrative" etc.) is misleading and unhelpful. Instead, superordinate concepts derived from thinking about evidence-based practice provide a more grounded focus on the practical issues faced by therapists treating PTSD. These concepts, which include competences and metcacompetences, therapist responsiveness, stages of therapy and case formulation, provide a basis for a genuinely integrative approach. The proposed model suggests seven broad areas of clinical focus for work with PTSD which can be arranged at three levels of priority: level 1 crisis intervention and stabilization; level 2 promoting engagement with treatment, and level 3 selection, sequencing and timing of active treatment interventions. Material from the case series is used to illustrate the application of the model.
- Full Text:
- Date Issued: 2009
Development and validation of the Xhosa translations of the Beck Inventories: 1. Challenges of the translation process
- Steele, Gary I, Edwards, David J A
- Authors: Steele, Gary I , Edwards, David J A
- Date: 2008
- Language: English
- Type: Article
- Identifier: vital:6248 , http://hdl.handle.net/10962/d1007866
- Description: This article describes the translation of the Beck Depression Inventory-II, the Beck Hopeless Scale, and the Beck Anxiety Inventory, into Xhosa the language spoken in the Eastern Cape of South Africa. The processes of translation, back-translation and committee discussion failed to yield trustworthy translations because of practical difficulties in working with translators. Critical words and phrases were identified which gave rise to lack of agreement. For each, a range of options was generated and the advantages and disadvantages evaluated in terms of criteria such as conceptual and idiomatic equivalence, and extensiveness of usage. Examples are given of the problems encountered and the way in which final decisions were made. A pilot clinical trial demonstrated the acceptability of the translated Instruments. Two further articles report the psychometric evaluation of the translated scales.
- Full Text:
- Date Issued: 2008
- Authors: Steele, Gary I , Edwards, David J A
- Date: 2008
- Language: English
- Type: Article
- Identifier: vital:6248 , http://hdl.handle.net/10962/d1007866
- Description: This article describes the translation of the Beck Depression Inventory-II, the Beck Hopeless Scale, and the Beck Anxiety Inventory, into Xhosa the language spoken in the Eastern Cape of South Africa. The processes of translation, back-translation and committee discussion failed to yield trustworthy translations because of practical difficulties in working with translators. Critical words and phrases were identified which gave rise to lack of agreement. For each, a range of options was generated and the advantages and disadvantages evaluated in terms of criteria such as conceptual and idiomatic equivalence, and extensiveness of usage. Examples are given of the problems encountered and the way in which final decisions were made. A pilot clinical trial demonstrated the acceptability of the translated Instruments. Two further articles report the psychometric evaluation of the translated scales.
- Full Text:
- Date Issued: 2008
A successful cognitive-behavioural intervention that failed : a case study of adolescent conduct disorder at a school for the disadvantaged
- Mashalaba, Eugenia D, Edwards, David J A
- Authors: Mashalaba, Eugenia D , Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6273 , http://hdl.handle.net/10962/d1008273
- Description: Conduct Disorder (CD) is a widespread problem in southern Africa. The aim of the study was to design, implement and evaluate a multi-modal cognitive-behavioural intervention based on treatments developed overseas, in order to investigate whether this approach can be transported to a South African school for deprived children. The target adolescent had a history of severely disruptive behaviour and was facing expulsion from a shelter for homeless children and his school. A thorough assessment served as the basis for a case formulation and treatment plan. Intervention included 23 individual sessions focussing on bereavement and the learning of self-control skills and prosocial behaviours, as well as contingency management training for school and shelter staff. Progress was tracked with a behaviour checklist completed daily by the teacher and regular interviews with school and shelter staff. After four months, the disruptive behaviour was eliminated. However, he was involved in stealing with some other learners and expelled anyway. Nevertheless the case study provides evidence for the transportability of the cognitive-behavioural approach to this kind of setting and documents the way in which a comprehensive intervention can be tailored to the needs of a child with a severely deprived background and little social support.
- Full Text:
- Date Issued: 2005
- Authors: Mashalaba, Eugenia D , Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6273 , http://hdl.handle.net/10962/d1008273
- Description: Conduct Disorder (CD) is a widespread problem in southern Africa. The aim of the study was to design, implement and evaluate a multi-modal cognitive-behavioural intervention based on treatments developed overseas, in order to investigate whether this approach can be transported to a South African school for deprived children. The target adolescent had a history of severely disruptive behaviour and was facing expulsion from a shelter for homeless children and his school. A thorough assessment served as the basis for a case formulation and treatment plan. Intervention included 23 individual sessions focussing on bereavement and the learning of self-control skills and prosocial behaviours, as well as contingency management training for school and shelter staff. Progress was tracked with a behaviour checklist completed daily by the teacher and regular interviews with school and shelter staff. After four months, the disruptive behaviour was eliminated. However, he was involved in stealing with some other learners and expelled anyway. Nevertheless the case study provides evidence for the transportability of the cognitive-behavioural approach to this kind of setting and documents the way in which a comprehensive intervention can be tailored to the needs of a child with a severely deprived background and little social support.
- Full Text:
- Date Issued: 2005
Post-traumatic stress disorder as a public health concern in South Africa
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6229 , http://hdl.handle.net/10962/d1007779
- Description: This article briefly surveys the extent to which traumatic events are a feature of life all over Africa and provides a comprehensive review of research that documents the pervasiveness of traumatic events in South Africa and the prevalence of PTSD symptoms. The material reviewed includes statistics on crime, violence and accidents, research from clinical settings, and surveys. Several provide evidence for the causal link between traumatic events and the development of PTSD. These studies show that PTSD has been and continues to be a significant problem for public health in South Africa, affecting individuals in all sectors of society and as much a concern with respect to children as to adults.
- Full Text:
- Date Issued: 2005
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6229 , http://hdl.handle.net/10962/d1007779
- Description: This article briefly surveys the extent to which traumatic events are a feature of life all over Africa and provides a comprehensive review of research that documents the pervasiveness of traumatic events in South Africa and the prevalence of PTSD symptoms. The material reviewed includes statistics on crime, violence and accidents, research from clinical settings, and surveys. Several provide evidence for the causal link between traumatic events and the development of PTSD. These studies show that PTSD has been and continues to be a significant problem for public health in South Africa, affecting individuals in all sectors of society and as much a concern with respect to children as to adults.
- Full Text:
- Date Issued: 2005
The experiences and needs of HIV/AIDS counsellors at a South African hospital
- Nulty, Maria, Edwards, David J A
- Authors: Nulty, Maria , Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6269 , http://hdl.handle.net/10962/d1008268
- Description: To increase the availability of HIV/AIDS counselling in South Africa, nurses have been trained to serve as counsellors within hospital services. The aim of the study was to document the experiences and needs of nurse HIV/AIDS counsellors at a small South African hospital (with 279 beds and 10 medical doctors on the staff). The design was a qualitative, multiple-case study. The sample consisted of four nurse counsellors and the co-ordinator of HIV/AIDS services at the hospital. Three semi-structured interviews with the counsellors were used as the basis for case narratives of their experiences. These narratives were in turn subjected to content analysis to determine the range and nature of the concerns identified by the counsellors. The counsellors found their HIV/AIDS counselling work to be emotionally demanding and identified several significant problems. These were related to confidentiality, stigmatisation, motional responses to informing clients of their HIV-positive status, cultural and contextual factors and situational stressors related to the organisation of the work environment. They did not feel sufficiently supported by their work infrastructure. It is recommended that in setting up counselling services of this sort, managers need to be aware of the need for ongoing support in the form of facilitated groups, professional supervision, managerial attention to problems in the working environment, and regular in-service training.
- Full Text:
- Date Issued: 2005
- Authors: Nulty, Maria , Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6269 , http://hdl.handle.net/10962/d1008268
- Description: To increase the availability of HIV/AIDS counselling in South Africa, nurses have been trained to serve as counsellors within hospital services. The aim of the study was to document the experiences and needs of nurse HIV/AIDS counsellors at a small South African hospital (with 279 beds and 10 medical doctors on the staff). The design was a qualitative, multiple-case study. The sample consisted of four nurse counsellors and the co-ordinator of HIV/AIDS services at the hospital. Three semi-structured interviews with the counsellors were used as the basis for case narratives of their experiences. These narratives were in turn subjected to content analysis to determine the range and nature of the concerns identified by the counsellors. The counsellors found their HIV/AIDS counselling work to be emotionally demanding and identified several significant problems. These were related to confidentiality, stigmatisation, motional responses to informing clients of their HIV-positive status, cultural and contextual factors and situational stressors related to the organisation of the work environment. They did not feel sufficiently supported by their work infrastructure. It is recommended that in setting up counselling services of this sort, managers need to be aware of the need for ongoing support in the form of facilitated groups, professional supervision, managerial attention to problems in the working environment, and regular in-service training.
- Full Text:
- Date Issued: 2005
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