Treating the psychological sequelae of proactive drug-facilitated sexual assault : knowledge building through systematic case based research

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

Treating complex post-traumatic stress disorder following childhood neglect, sexual abuse and revictimisation : interpretative reflections on the case of Khuselwa

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

The unbearable loneliness of COVID-19: COVID-19-related correlates of loneliness in South Africa in young adults

This is the first study to examine the association between COVID-19 related variables and loneliness among young adults in South Africa during COVID-19. Participants (N=337) were university students who completed the UCLA Loneliness Scale and five selected subscales of the WHO COVID-19 Behavioural Insights Tool. The mean loneliness scores were significantly higher than previous studies in other contexts as well as studies conducted in the time of COVID-19. Correlational analysis found that greater perceived risk of infection, limited perceived knowledge of COVID-19 and lower appraisals of resilience were associated with increased loneliness. In a regression analysis, when all COVID-19 variables were considered simultaneously, only resilience, self-rated knowledge, and risk perception emerged as significant correlates of loneliness. These findings suggest that loneliness is a significant public health concern in South Africa in the time of COVID-19. It also suggests that self-efficacy and resilience can potentially be reinforced by public health campaigns that focus on enhancing COVID-19-related knowledge and preparedness

The dynamics of appraisal: A review of 20 years of research using the Fortitude Questionnaire

Fortitude refers to the psychological strength to manage adversity and stay well. It is derived from adaptive cognitive appraisals of self, family, and social supports and has consistently been identified as a protective factor in psychological well-being. This study undertakes a scoping review of empirical research on the Fortitude Questionnaire, which was developed to assess levels of fortitude. The aims of the study were to categorize and catalogue studies that have used the Fortitude Questionnaire, identify the variables that have been linked to the scale, and determine the extent to which prior research has replicated the Fortitude Questionnaire’s psychometric properties. Arksey and O’Malley’s five-stage framework for scoping reviews was followed to review studies published between January 1999 and March 2020. A total of 51 studies met the inclusion criteria. The scoping review found that the Fortitude Questionnaire has been used in different contexts and among various sample groups across the lifespan, including vulnerable and high-risk populations. The scale has demonstrated sound reliability and studies have confirmed its factor structure

The loneliness–life satisfaction relationship: The parallel and serial mediating role of hopelessness, depression and ego-resilience among young adults in south africa during covid-19

Recently, with the onset of the COVID-19 pandemic, several lockdown and stay-at-home regulations have been implemented worldwide. In this regard, loneliness has been identified as the signature mental health consequence of this pandemic. The aim of this study is to explore the associations among loneliness, hopelessness, depression, ego-resilience and life satisfaction in a random sample of young adults (N = 337) at a university in the Western Cape of South Africa. Parallel and serial mediation analysis supported the hypothesis that loneliness is associated with hopelessness, which in turn is associated with depression, and that ego-resilience mediates the association between all the negative indices of psychological well-being and life satisfaction. These findings suggest that mental health interventions that boost ego-resilience and target loneliness may help in dealing with the mental health consequences of COVID-19

Victimisation in the lives of lesbian-identified women in South Africa : implications for clinical assessment and treatment

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

Vicarious trauma: The psychological impact of working with survivors of trauma for South African psychologists

Traumatic events are highly prevalent in South African society and psychologists who work with survivors of trauma have been identified as particularly at risk of being adversely affected by their work, and experiencing vicarious trauma . This study aimed to explore the experiences of a group of South African psychologists who work predominantly with trauma survivors. Individual semi-structured interviews were conducted with six psychologists (females = 67%). The predominant type of trauma encountered by participants in clinical practice was interpersonal trauma in the form of physical and sexual abuse (83%). Data were analysed using thematic analysis . All participants reported symptoms of vicarious trauma including disruption in cognitive schemas, symptoms characteristic of post-traumatic stress disorder, and somatic symptoms. Participants also reported vicarious post-traumatic growth including an enhanced sense of interpersonal connectedness and positive changes in their philosophy of life and self-perceptions. The findings serve to sensitise psychologists to the impact of working with trauma survivors so as to enhance the efficiency of psychological service delivery to traumatised populations.DHE

Histories of forced sex and health outcomes among Southern African lesbian and bisexual women: a cross-sectional study

BACKGROUND: Experiences of forced sex have been shown to be prevalent in Southern Africa. Negative outcomes of forced sex have been documented in general populations of women and men and include alcohol abuse, drug use, mental health problems, mental distress, sexual health problems and poor overall health. This study is the first to examine experiences of forced sex and associated health problems among lesbian and bisexual women in Southern Africa. METHODS: This study is based on data collected as part of a collaborative endeavor involving various Southern African community-based organizations. Lesbian and bisexual women in four Southern African countries participated in a cross-sectional survey, for a total study sample of 591. RESULTS: Nearly one-third of participants had been forced to have sex at some time in their lives. Thirty-one percent of all women reported to have experienced forced sex at least once in their life: 14.9% reported forced sex by men only; 6.6% reported forced sex by women only; 9.6% had had forced sexual experiences with both men and women. Participants experienced forced sex by men as more serious than forced sex by women; forced sex by women was more likely to involve intimate partners compared to forced sex by men. Participants who experienced forced sex by men were more likely to report drug problems, mental distress and lower sense of belonging. Forced sex by women was associated with drinking problems and mental distress. Having experienced forced sex by both men and women was associated with lower sense of belonging to the LGBT community, drug use problem and mental distress. CONCLUSIONS: The findings indicate that forced sex among Southern African women is a serious issue that needs further exploration. Clinicians should be made aware of the prevalence and possible consequences of forced sex among lesbian and bisexual women. Policies and community interventions should be designed to address this problem

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

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)