The feasibility of disseminating and implementing prolonged exposure therapy for survivors of trauma in South Africa: a mixed method pilot and feasibility study
| dc.contributor.advisor | Ashraf, Kagee | en_ZA |
| dc.contributor.author | Booysen, Duane Danny-Coe | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology. | en_ZA |
| dc.date.accessioned | 2021-01-19T19:23:13Z | |
| dc.date.accessioned | 2021-04-21T14:26:46Z | |
| dc.date.available | 2021-01-19T19:23:13Z | |
| dc.date.available | 2021-04-21T14:26:46Z | |
| dc.date.issued | 2021-03 | |
| dc.description | Thesis (MA)--Stellenbosch University, 2021. | en_ZA |
| dc.description.abstract | ENGLISH ABSTRACT: The study investigated the feasibility of disseminating and implementing brief prolonged exposure therapy (PE) for post-traumatic stress disorder (PTSD) in South Africa. I used a mixed method design to investigate and explore the broad aim, which was to implement PE in a South African context, and to explore whether PE is feasible and acceptable in a South African context. The study had three aims. The first aim was to explore the experiences and perspectives of trauma counsellors treating PTSD in low resource communities and to explore their attitudes toward the use of PE in South Africa. Using Thematic Analysis (TA), eighteen counsellors (n = 18) participated in semi-structured individual interviews across four community counselling centres located in the Western Cape (WC) and Eastern Cape (EC) of South Africa. The first aim produced eight themes that were grouped under three superordinate themes. The superordinate themes were working as a counsellor, which consisted of the following themes: encountering trauma narratives, social support and resilience, treatments for trauma, and a collective approach. The second superordinate theme was trauma in the social context, which consisted of: helplessness and social factors. The final superordinate theme was experiences of growth, which included: helping others heal and empowerment. The second aim of the study investigated the effectiveness of brief PE therapy for treatment of PTSD at two community counselling centres in the WC and EC of South Africa. Using a single case experimental design (SCED), a total sample of 12 participants started a 6-session intervention and only nine completed the intervention. The phase had four data time points, namely, baseline, intervention, post-intervention, and three-month follow-up. The clinical assessments used were the Post-traumatic Symptom Scale Interview for DSM-5 (PSSI-5), the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5), the Beck Depression Inventory second edition (BDI-II), and the Beck Anxiety Inventory (BAI). Considering the results of the brief PE intervention, I reject the null hypothesis, and the research hypothesis has not been falsified, which is that trauma survivors who complete six sessions of brief PE had statistically significant reduced PTSD symptoms (p < 0.001) and maintained their symptom reductions at three-month follow-up. The third aim of the study was to explore the acceptability of PE in a South African context, which was to explore how trauma clients (n = 7) who present with symptoms of traumatic stress experience a brief prolonged exposure treatment for PTSD. Using TA, phase 3 produced a total of six themes grouped under two superordinate themes that highlighted the experiences of persons receiving PE as a trauma therapy at a community counselling centre. The superordinate theme implementation of PE consisted of the following: room for improvement: “it’s nice to hear that it’s not your fault”, obstacles: “cure my problem”, and gender: “talking about my experiences with a man”. The second superordinate theme, adapting to PE, consisted of the following themes: PE structure: “all my issues”; exposure: “are we really going to deal with my issues here”, and noticing change: “I’m actually dealing with things”. Overall, the study found that brief PE is a feasible treatment to disseminate and implement in a South African context for the treatment of PTSD among adults at a primary care level but need to consider the social context factors. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING: Die studie het die uitvoerbaarheid van die gebruik van langdurige blootstellingsterapie (PE) vir Posttraumatiese stresversteuring (PTSD) in Suid-Afrika ondersoek. Ek het ’n gemengde-metode-studie gebruik om die breë doel – om PE binne ’n Suid-Afrikaanse konteks te implementeer – na te vors en vas te stel of dit beide uitvoerbaar en aanvaarbaar binne ’n Suid-Afrikaanse konteks sou wees. Die studie het drie doelstellings gehad. Die eerste doelstelling was om die ondervindings en perspektiewe van traumaberaders wat PSTV in gemeenskappe met min hulpbronne behandel, asook hul houding teenoor die gebruik van PE binne ’n Suid-Afrikaanse konteks, te ondersoek. Met die gebruik van Tematiese Analise (TA), het 18 beraders in semi-gestruktureerde individuele onderhoude wat oor vier gemeenskapsberadingsentrums in die Wes- en Oos-Kaap in Suid-Afrika strek, deelgeneem. Die eerste doelstelling het agt temas, wat verder onder drie oorkoepelende temas gegroepeer is, geweler. Dié oorkoepelende temas was om as ’n berader te werk en het uit die volgende temas bestaan: trauma-vertellings wat teëgekom word, maatskaplike ondersteuning en veerkragtigheid, traumabehandeling, en ’n kollektiewe benadering. Die tweede oorkoepelende tema was trauma binne die maatskaplike konteks, wat uit die temas: hulpeloosheid en maatskaplike faktore, bestaan het. Die finale oorkoepelende tema was ondervindinge van groei wat die temas: om andere te help genees en bemagtiging, ingesluit het. Die tweede doelstelling van die ondersoek het die effektiwiteit van kort PE terapie vir die behandeling van PTSD by twee gemeenskapsberadingsentrums in die Wes- en Oos-Kaap in Suid-Afrika nagevors. Met die gebruik van ’n enkelvoudige eksperimentele ontwerp (SCED), het ’n totale steekproef van 12 deelnemers 6 intervensiesessies begin en slegs 9 het die sessies voltooi. Die fase het vier datatydpunte gehad, naamlik basislyn, intervensie, post-intervensie en drie maande opvolg. Die kliniese assesserings wat gebruik was, is die Post-traumatiese simptoom-onderhoud vir DSM-5 (PSSI-5), die Kontrolelys vir post-traumatiese stresversteurings vir DSM-5 (PCL-5), die tweede uitgawe van die Beck Depressie inventaris (BDI-II) en die Beck Angstigheidsinventaris (BAI). Die resultate van die kort PE-intervensie in ag geneem, verwerp ek die nul-hipotese – en die navorsingshipotese is nie vervals nie – wat aandui dat diegene wat trauma oorleef het en ses sessies van kort PE voltooi, statisties beduidend verminderde PTSD-simptome gehad het (p < 0.001) en hul simptoomvermindering teen drie maande opvolg, handhaaf het. Die derde doelstelling was om die aanvaarbaarheid van PE binne ’n Suid-Afrikaanse konteks te ondersoek, naamlik hoe traumakliënte met simptome van PTSD kort langdurige blootstellingsterapie vir PTSD ervaar. Met die gebruik van IFA, het fase drie ’n totaal van ses temas onder twee oorkoepelende temas – wat die ervaringe van diegene wat PE as traumaterapie by ’n gemeenskapsberadingsentrum uitgelig het – gegroepeer is, gelewer. Die implementering van die oorkoepelende tema van PE bestaan uit die volgende: ruimte vir verbetering: “dit is goed om te hoor dat dit nie jou skuld is nie”, struikelblokke: “genees my van my probleem”, en geslag: “om my ervaringe met ’n man te deel”. Die tweede oorkoepelende tema, met die aanpassing tot PE, het die volgende temas ingesluit: die struktuur van PE: “al my probleme; blootstelling: “gaan ons werklik hier my probleme hanteer”, en verandering of vordering wat oplet is: “ek is werklik besig om werk te maak van my probleme.” In geheel het die studie bevind dat die gebruik van kort langdurige blootstellingsterapie (PE) vir Posttraumatiese stresversteuring (PTSD) binne ’n Suid-Afrikaanse konteks uitvoerbaar is vir die behandeling van PTSD in volwassenes op ’n primêre sorgvlak, maar dat die maatskaplike konteksfaktore in ag geneem moet word. | af_ZA |
| dc.description.version | Doctoral | en_ZA |
| dc.format.extent | xxv, 289 pages : illustrations, maps | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/10019.1/109802 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | en_ZA |
| dc.rights.holder | Stellenbosch University | en_ZA |
| dc.subject | Post-traumatic stress disorder -- Treatment | en_ZA |
| dc.subject | Exposure therapy | en_ZA |
| dc.subject | Post-traumatic stress disorder -- Care -- South Africa | en_ZA |
| dc.subject | Mixed methods research | en_ZA |
| dc.subject | Single subject research | en_ZA |
| dc.subject | UCTD | |
| dc.title | The feasibility of disseminating and implementing prolonged exposure therapy for survivors of trauma in South Africa: a mixed method pilot and feasibility study | en_ZA |
| dc.type | Thesis | en_ZA |