From panic disorder to complex traumatic stress disorder : retrospective reflections on the case of Tariq
- Authors: Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6234 , http://hdl.handle.net/10962/d1007784
- Description: This is a phenomenological-hermeneutic case study of Tariq who initially presented with panic disorder. It documents how, as therapy proceeded, the underlying meaning of his initial panic deepened as its roots in traumatic memories of childhood emerged. There were four spaced phases of treatment over four years. The first focused on anxiety management; the second was conceptualized within schema-focused therapy, and evoked and worked with childhood memories using inner child guided imagery; in the third and fourth phases insights gained led to an authentic re-engagement with family members in relationships that had been problematic. The panic attacks resolved and there were two dreams representing a reconfiguring of his relationship with his deceased father. The first two phases were the focus of an unpublished case study presented at a conference in 1995. This article incorporates material from that study and looks back at the case both in light of developments in phases two and three and also in light of theoretical developments in our understanding of complex trauma since the initial presentation.
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- Date Issued: 2013
Responsive integrative treatment of PTSD and trauma related disorders : an expanded evidence-based model
- Authors: Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6223 , http://hdl.handle.net/10962/d1007679
- Description: In this article a practitioner oriented review of the literature on the treatment of post-traumatic stress disorder is used to construct a phase-based model that can serve as a basis for case formulation and treatment planning. Treatments shown to be efficacious in randomized controlled trials are listed and two discourses about them are contrasted. One calls for therapists to implement treatments scrupulously according to the manual, the other calls for flexibility and responsiveness to contextual understanding of the situation and personality of individual clients. Evidence for the centrality of the principles of this latter discourse for professional practice is summarized from work on case formulation, standards for therapist competence, and the concept of evidence-based practice. This provides the foundation for a model for treatment of PTSD, both simple and complex, that has five levels which represent increasing degrees of depth of clinical work. In accordance with the phased approach, conditions at one level need to be satisfied before proceeding to work on a deeper level. At each level specific areas of clinical focus are highlighted including risk management (at level 1), building the therapeutic alliance (at level 2) and trauma-focused work (at level 3). The model serves as a broad structured summary of accumulated clinical knowledge about PTSD and its treatment that provides an evidence-based foundation for assessment and treatment planning.
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- Date Issued: 2013
Treating the psychological sequelae of proactive drug-facilitated sexual assault : knowledge building through systematic case based research
- Authors: Padmanabhanunni, Anita , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6235 , http://hdl.handle.net/10962/d1007785
- Description: Background: Drug-facilitated sexual assault (DFSA) has emerged as a distinct category of sexual victimization and precipitates posttraumatic stress disorder (PTSD). Few studies have examined the distinct psychological aspects of PTSD caused by DFSA. Gauntlett-Gilbert, Keegan and Petrak (2004) represent a notable exception and draw on cases, from their clinical experience, treated using Ehlers and Clarks’ (2000) cognitive therapy (CT). Aims: This paper aims to further develop and refine clinical knowledge on CT for PTSD arising from DFSA and advance the findings of Gauntlett-Gilbert et al. (2004). Method: Systematic case based research was used to investigate the applicability of CT for PTSD related to DFSA. Three survivors were treated with CT within the South African context. Results: The case series corroborated existing findings but also documented the presence of somatic and visual intrusions among survivors with partial or complete amnesia for rape and illustrated the utility of imagery interventions in targeting intrusions. The study highlighted the role of physical paralysis in DFSA in compounding helplessness/powerlessness and the necessity of enhancing physical agency and building social support. Conclusion: Distinctive aspects of PTSD related to DFSA can be effectively treated by adapting CT to suit this population group.
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- Date Issued: 2013
Treating the psychological sequelae of proactive drug-facilitated sexual assault : knowledge building through systematic case based research : extended version of the article that was published as a brief report
- Authors: Padmanabhanunni, Anita , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6236 , http://hdl.handle.net/10962/d1007786
- Description: From Introduction: Drug facilitated sexual assault (DFSA) -- on victims who are too intoxicated to be aware of their surroundings or exercise any control of the situation -- has emerged as a distinct category of sexual victimisation. DFSA has been identified as a significant public health concern, particularly among college students, with the majority of victims being women (McCauley, Ruggiero, Resnick, & Kilpatrick, 2010; Zinzow, Resnick, McCauley, Amstadter, Ruggiero, & Kilpatrick, 2010). Exact rates remain uncertain due to significant under-reporting (Du Mont, Macdonald, Rotbard, Asslanni, & Bainbridge, 2010; Lawyer, Resnick, Bakanic, Burkett, & Kilpatrick, 2010). Opportunistic DFSA, also called incapacitated rape (Lawyer et al., 2010; Zinzow at al., 2010), is the most common form and refers to assaults on women who have voluntarily consumed an excessive amount of alcohol (Lovett & Horvath, 2009). In proactive DFSA (called drug facilitated rape by Lawyer et al., 2010 and drug-alcohol facilitated rape by Zinzow et al., 2010), perpetrators deliberately incapacitate victims by plying them with alcohol or covertly administering an incapacitating drug such as Flunitrazepam (Rohypnol) or Gamma-hydroxybutyrate (GHB) to victims with the intention of sexually assaulting them (Hall & Moore, 2008).
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- Date Issued: 2013
Victimisation in the lives of lesbian-identified women in South Africa : implications for clinical assessment and treatment
- Authors: Padmanabhanunni, Anita , Edwards, David J A
- Date: 2013
- Language: English
- Type: Article
- Identifier: vital:6237 , http://hdl.handle.net/10962/d1007787
- Description: Few clinical studies have examined victimisation in the lives of lesbian women in South Africa and whether there are distinct implications for psychological treatment. This paper presents the assessment and treatment of a lesbian-identified South African survivor of childhood sexual abuse who, as an adult, was raped and later gang raped. Her victimisation in adulthood represented ‘corrective rape’ motivated by the prejudiced assumption that the sexuality of lesbian women is pathological and should be ‘corrected’ through rape. This paper lends insights into the role of heterosexism in shaping vulnerability to victimisation and the process of recovery. It provides recommendations for work with sexual minority clients and highlights the implications when there is an absence of safety and support in the external environment.
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- Date Issued: 2013
“It’s like uprooting trees”: responsive treatment for a case of complex post-traumatic stress disorder following multiple rapes
- 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.
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- Date Issued: 2013
Treating complex post-traumatic stress disorder following childhood neglect, sexual abuse and revictimisation : interpretative reflections on the case of Khuselwa
- Authors: Padmanabhanunni, Anita , Edwards, David J A
- Date: 2012
- Language: English
- Type: Article
- Identifier: vital:6233 , http://hdl.handle.net/10962/d1007783
- Description: This paper describes the psychological assessment and treatment process with Khuselwa, a South African adolescent survivor of multiple sexual traumas presenting with complex post-traumatic stress disorder (PTSD). The paper identifies some of the common barriers encountered by practitioners in delivering treatments in local contexts and highlights the role of external safety and stability and social support in providing a vehicle for change and a basis for overcoming the psychological handicaps reinforced by repeated and multiple traumas and chronic neglect.
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- Date Issued: 2012
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
- 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.
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- Date Issued: 2012
Using systematic case studies to investigate therapist responsiveness : examples from a case series of PTSD treatments
- Authors: Edwards, David J A
- Date: 2010
- Language: English
- Type: Article
- Identifier: vital:6224 , http://hdl.handle.net/10962/d1007774
- Description: This article highlights the emerging literature on therapist responsiveness in psychotherapy and examines several concepts used to identify dimensions of responsiveness. Some methodological obstacles are identified to studying responsiveness in a systematic manner, and several examples of existing responsiveness research are reviewed. It is argued that meaningful theory on responsiveness has emerged from research methods that are qualitative and interpretive and that the writing of systematic case studies can be of particular importance since only the presentation of a case unfolding over time can disclose some of the more complex aspects of therapist responsiveness. Examination of a series of systematic case studies of the treatment of post traumatic case disorder in South Africa was used to derive a model for guiding therapist responsiveness with respect with what to focus on at a particular phase of the therapy within a particular session. Material from the cases is used to illustrate aspects of the model related to building social support for the client and promoting emotional processing of trauma memories. , Acknowledgements: This research was supported by grants from the National Research Foundation and the Joint Research Committee of Rhodes University. An earlier version of this paper was presented at the Conference of the Society for Psychotherapy Research in Barcelona in 2008 (Edwards, 2008).
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- Date Issued: 2010
A case of effective single-session treatment for attention deficit and learning problems in a routine clinical practice : the value of a transdiagnostic approach to case formulation
- Authors: Whitefield-Alexander, V , Edwards, David J A
- Date: 2009
- Language: English
- Type: Article
- Identifier: vital:6274 , http://hdl.handle.net/10962/d1008274
- Description: This article reports a systematic clinical case study of the psychological assessment and treatment of Daniel (9), a coloured South African boy with a diagnosis of attention deficit hyperactivity disorder (ADHD) (inattentive type). The case is of scientific interest because: (1) there was only a single treatment session, in which contingency management training was delivered to Daniel’s parents and teacher; (2) there was evidence for the effectiveness of the intervention immediately and at two-year follow-up; (3) it documents the transportability to a South African context of an intervention developed by overseas research; (4) it documents the central role of case formulation in the delivery of effective psychological interventions; and (5) although Daniel met the criteria for ADHD, he also displayed symptoms of depression and social anxiety and the case supports the use of a transdiagnostic approach to case formulation. The conscientiousness with which his parents and teachers applied the programme was a major factor in the effectiveness of the intervention, and such rapid impact would not be possible where parents and teachers are unavailable or not co-operative. The publication of systematic case studies such as this one is important for the development of a local evidence-based practice in South Africa.
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- Date Issued: 2009
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.
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- Date Issued: 2009
What services and supports are needed to enable trauma survivors to rebuild their lives? Implications of a systematic case study of cognitive therapy with a township adolescent girl with PTSD following rape
- Authors: Payne, Charmaine , Edwards, David J A
- Date: 2009
- Language: English
- Type: Article
- Identifier: vital:6278 , http://hdl.handle.net/10962/d1008279
- Description: This systematic clinical case study describes the psychological assessment and treatment with cognitive therapy of Zanele, a Xhosa-speaking adolescent rape survivor with major depressive disorder and posttraumatic stress disorder (PTSD). A case narrative was developed to document the main features of the therapy process and progress was monitored using scales measuring symptoms of depression and PTSD. The narrative documents the operation in a local context of factors that maintain PTSD that have been identified in the international literature and, with the self-report scales, provides evidence for Zanele’s recovery from PTSD and the transportability to this context of an evidence-based psychological treatment. The narrative also documents the lack of safety for young women and girls in a South African township as well as significant limitations in the professional services available: in this case, Zanele was infected with HIV and other sexually transmitted diseases but medical management had not been followed through, and criminal charges against the rapist were dropped, and dropped again even after he had committed another rape on a six-year-old girl. This provides a basis for examining the complementary roles that can be played by psychologists and other professionals in empowering trauma survivors to regain a sense of dignity and control over their lives.
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- Date Issued: 2009
Development and validation of the Xhosa translations of the Beck Inventories: 1. Challenges of the translation process
- 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.
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- Date Issued: 2008
Handling multiple levels of data and multiple research questions in an embedded case study : methodological challenges
- Authors: Edwards, David J A
- Date: 2008
- Language: English
- Type: Article
- Identifier: vital:6247 , http://hdl.handle.net/10962/d1007865
- Description: Hougaard et al. report an embedded case study in which nine socially phobic clients were treated as part of a therapy program, which incorporated individual and group therapy and which was largely delivered by trainee clinicians. An important focus of the report is on the effectiveness of their treatment model. This commentary draws attention to the size and complexity of the available data, and it suggests ways in which the use of a more explicitly interpretative methodology can draw out additional dimensions of the data and allow a more systematic contribution to be made to the development of clinical theory.
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- Date Issued: 2008
The assessment and treatment of post-abortion syndrome : a systematic case study from Southern Africa
- Authors: Boulind, Melissa , Edwards, David J A
- Date: 2008
- Language: English
- Type: Article
- Identifier: vital:6270 , http://hdl.handle.net/10962/d1008270
- Description: This article reports a clinical case study of "Grace", a black Zimbabwean woman with post-abortion syndrome (PAS), a form of post-traumatic stress disorder precipitated by aborting an unwanted pregnancy. She was treated by a middle class white South African trainee Clinical Psychologist. The case narrative documents the assessment and the course of treatment which was guided by ongoing case formulation based on current evidence-based models. Factors that made her vulnerable to developing PTSD included active suppression of the memory of the event and lack of social support. An understanding of these factors was used to guide an effective intervention. In spite of the differences in culture and background between client and therapist, there was considerable commonality in their experience as young women and students who each had to balance personal and occupational priorities. The narrative also highlights the commonalities of Grace's experiences with those reported in the literature on post-abortion syndrome, which is mostly from the U. S. A. and Europe.
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- Date Issued: 2008
Collaborative versus adversarial stances in scientific discourse : implications for the role of systematic case studies in the development of evidence-based practice in psychotherapy
- Authors: Edwards, David J A
- Date: 2007
- Language: English
- Type: Article
- Identifier: vital:6245 , http://hdl.handle.net/10962/d1007861
- Description: There is still a need for advocacy in the promotion of case study research because there has been insufficient appreciation of its role as a source of evidence relevant to the development and evaluation of practice in psychotherapy. Distorted use of terms like "gold standard", "anecdotal",and "empirical" in the discourse in which research methodology is typically presented has disempowered the practitioner's perspective and discredited the role of case-based knowledge building. The framework of evidence-based practice (EBP) recognizes the complementarity of different research methods and acknowledges the significance of casebased research. To spell out some of these complementary links, a typology of seven research methods - including both experimental group comparison designs and individual case studies - is proposed and the contribution of each to the development of EBP is set out. Finally some suggestions are made for strategies to promote the publication of high quality case studies.
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- Date Issued: 2007
Restructuring implicational meaning through memory-based imagery: some historical notes
- Authors: Edwards, David J A
- Date: 2007
- Language: English
- Type: Article
- Identifier: vital:6239 , http://hdl.handle.net/10962/d1007851
- Description: This paper provides a historical perspective on the recent increase in the clinical application of imagery techniques to restructure systems of implicational meaning that drive emotional distress or self-defeating behaviors. Janet's early application of such techniques was largely ignored except by a few hypnotherapists. Current applications in cognitive therapy were adapted and extended in the early 1980s from Perls’ Gestalt therapy methods. Some precursors to Perls are examined, as well as the work of some of those who developed and formulated the integration of his techniques into Beck's cognitive therapy. It is argued that this process amounted to a significant paradigm shift.
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- Date Issued: 2007
Identifying and targeting idiosyncratic cognitive processes in group therapy for social phobia : the case of Vumile
- Authors: Edwards, David J A , Kannan, Swetha
- Date: 2006
- Language: English
- Type: Article
- Identifier: vital:6244 , http://hdl.handle.net/10962/d1007859
- Description: “Vumile” was a patient in a cognitive therapy group that was designed for socially phobic African students and based on a therapy model developed by Clark and Wells. The case narrative shows how Vumile constructed a personal model of the factors maintaining his social phobia, and within the group and through homework challenged negative beliefs, reduced selfconsciousness and engaged in a range of previously avoided behaviors. A significant maintaining factor, spontaneous images of women looking at him with pity or mockery, was only identified in the last session. However, Vumile was able to use the skills he had learned to investigate this further and to correct these processes, which were distorting his experience of social interactions with women. Significant gains were made after the end of the formal treatment program and these are reflected in scores at follow-up on several self-report scales measuring anxiety, depression and various aspects of social phobic behavior and cognition.
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- Date Issued: 2006
A successful cognitive-behavioural intervention that failed : a case study of adolescent conduct disorder at a school for the disadvantaged
- 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.
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- Date Issued: 2005
Critical perspectives on research on post-traumatic stress disorder and implications for the South African context
- Authors: Edwards, David J A
- Date: 2005
- Language: English
- Type: Article
- Identifier: vital:6228 , http://hdl.handle.net/10962/d1007778
- Description: This article introduces a special issue of the Journal of Psychology in Africa on post-traumatic stress disorder (PTSD) in Africa and particularly in South Africa and examines the critical debate that has surrounded PTSD research. It begins with an examination of the meaning of the term trauma, and of its specialised use within the clinical context and with respect to the concept of PTSD. The diagnostic approach to the detection of PTSD is presented, criteria in the DSM-IV-TR and the ICD-10 are summarised and differences between the two manuals are discussed. Arguments presented by critics of the concept of PTSD are presented and discussed. These concern the historical evolution of the concept, concerns about the universality of PTSD cross-culturally, and problems arising from understanding human suffering from a narrow medical perspective. It is concluded that while there are dangers in thinking of the sequelae of trauma as a medical/psychiatric problem, and while the alarming rate of traumatic events needs to be addressed at the political, economic and societal level, there is an important place for the provision of assessment and treatment of PTSD within a psychiatric/psychological clinical setting.
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- Date Issued: 2005