Treating PTSD in South African contexts: a theoretical framework and a model for developing evidence-based practice

Abstract

Several psychological factors contribute to the development and maintenance of post-traumatic stress disorder (PTSD) because they interfere with the emotional processing of the traumatic event. These include problematic and painful emotions such as anxiety, shame, guilt and grief, distorted or dysfunctional cognitions, and cognitive, emotional, and behavioural avoidance mechanisms. Analysis of these maintaining factors provides the basis for current approaches to treatment which support traumatised individuals in facing emotional pain, working to resolve shame, grief and guilt, and expanding existing schemas to accommodate the traumatic event(s). Randomised controlled trials (RCTs) are reviewed in which the efficacy of some of these treatments have been evaluated. While many South African practitioners are familiar with current evidence-based approaches and are skilled at adapting them to local cultural and contextual conditions, a great deal still needs to be done to build a sound research base for local practice in the treatment of PTSD and disseminating that research to practitioners in the field. It is recommended that a case-based evaluation strategy be used to complement the findings of international RCT studies in order to build a foundation of locally contextualised and applicable scientific knowledge.