Chicago Conference 2011

My book

ALD Conference presentation : "A Case study on the language Sourrounding PTSD in Rwanda : Ihahamuka vs Ihungabana"

Full details about the conference available at  http://www.alp.fas.harvard.edu/ald

Lecture at Harvard Medical School, HSPH and Boston Childrens Hospital

Lecture at Harvard School of Public Health

From Trauma to resilience; A lecture at the TCSPP, Los Angeles/Irvine, California, Us

Feebback from the participants to the Lecture, June 21, 2011 :

Participant 1 :

Hello Dr. Sezibera,

It was such a pleasure to meet you! Many of our students felt so honored to have the opportunity to hear you speak on such a vital topic. Risk and resiliency has been an area of great interest to me for many years, and your perspective was highly illuminating.

I hope that you enjoy the remainder of your time in California, and hope that you will return in the future. I look forward to continued communication!

Best regards,

Participant 2

Intervening on persistent PTSD and co-morbid depression: Rumination Focused Cognitive and Behavioral Therapy (RFCBT) in a randomized controlled trial

Abstract

The present study replicates results of a previous pilot intervention (Sezibera et al., 2009). The objectives consist in evaluating the effectiveness of a Rumination Focused Cognitive and Behavioural Therapy (RFCBT) in treating PTSD and comorbid depression in a randomized controlled trial (RCT) conducted with young multitraumatized from the 1994 genocide against Tutsi in Rwanda. Participants (N=38) were randomly assigned to treatment group (n=19) and control group (n=19). Treatment protocol included exposure monitoring and challenging negative rumination exercises, stress management skills, and social sharing exercises. Results demonstrate significant decrease in PTSD and depression symptoms in the treatment group at posttreatment, while no changes were observed in the control group. Improvement in PTSD is a function of the improvement in rumination, social sharing and loneliness. Regarding rumination mode, decrease in analytic “WHY” thinking rumination is the best predictor of the improvement in PTSD. Depression improvement is positively associated with loneliness. The findings suggest that an intervention affecting rumination mode, lowering loneliness and increasing social sharing is with beneficial effects on PTSD and comorbid depression symptoms.

http://www.ajol.info/index.php/rj/article/view/66526

Intervening on Persistent Posttraumatic Stress Disorder: Rumination-Focused Cognitive and Behavioral Therapy

Abstract:

This study assessed the outcome of a brief rumination-focused cognitive and behavioral intervention in treating posttraumatic stress disorder (PTSD) symptoms among Rwandan adolescent survivors of the 1994 genocide. All participants (54.5% female, N= 22) aged between 15 and 18 years (M = 16.55, SD = 0.96) met criteria for PTSD as assessed by the PTSD self-rating scale (UCLA PTSD index). Measures included questionnaires assessing PTSD, depression, and somatization. Data were obtained at four points: (1) 11 years after the genocide (baseline), (2) 13 years after the genocide (pretreatment), (3) posttreatment (2 weeks after the treatment), and (4) follow-up (2 months after the treatment). PTSD symptoms increased between baseline and pretreatment. The intervention was associated with a reduction in PTSD symptoms, with gains maintained at follow-up.

http://www.ingentaconnect.com/content/springer/jcogp/2009/00000023/00000002/art00001

Epilepsy and depression morbidity : prevalence and management in Rwanda

Epilepsy and depression are frequent pathologies especially in the developing countries where the level of health facilities and the standards of living are very low. Scholars have stated the relationship between epilepsy and depression but with less precision on symptoms and socio-demographic variables difference.

The study (in press) assessed the co-morbidity between the two different diagnostic entities, one neurologic (epilepsy) and the other psychiatric (depression). From a purposive sample of 392 people consulting for epilepsy in Ruhengeri Hospital (Nothern Province, Rwanda), only 105 (26.7%) patients whose EEG diagnosis was positive were recruited in accordance with the inclusion criteria. Screening for depression, the Hamilton Rating Scale for Depression (HRSD) was used for the depression prevalence screening. Results from the study showed that depression is strongly associated to epilepsy with significant odds for all symptoms like depressive mood, insomnia, work and activities poor performance, anxiety, and somatic symptoms. Patients with generalized seizure are likely to suffer from severe comorbid depression as compared to patients with partial seizure. Moreover, illiterate adult women were presenting severe depression.

Epilepsy treatment should incorporate depression diagnosis and management to ensure better management of the epilepsy burden. In additional, particular attention should be given to patients presenting convulsive symptoms with non-confirmatory EEG results for an epilepsy diagnosis. In a post-genocide context, the non-epileptic convulsive symptoms may mimic TBI (Traumatic Brain Injury) symptoms or somatic complications of chronic PTSD (Post-Traumatic Stress Disorder). Future research to explore these assumptions.

PTSD and Memory loss

PTSD sufferers report memory problems and these include cognitive problems (e.g intrusive recollections of the traumatic events), problems remembering facts, autobiographical details, appointments, etc. (see Moradi et al., 1999; http://www.mrc-cbu.cam.ac.uk/research/emotion/cemhp/documents/ptsd_everyday_memory.pdf, retrieved April 4, 2012).

From the authors, important psychological consequences of the trauma are durable and may affect the child education and school performance. Among the psychological consequences, the scholars note "altered attentional processes, deficits in cognitive systems necessary for learning, inefficient memory systems, deficits in effective responsiveness, and so on."

How this is possible ? What are the possible explanations of these memory deficits as a consequence of being exposed to traumatic event and thus presenting a PTSD ? There are two assumptions pointed out by the scholars (Moradi et al., 1999) :
- PTSD symptoms (instrusions, avoidance and hyper-arousal) affect the everyday memory and possibly the learning skills;

- Reduction of the hippocampus as a result of PTSD severity can be an alternative explanation. It is established that the hippocampus intervene in the memory functioning, thus it can be deducted that reduction in hippocampal volume affectnegatively the memory functioning.

Confirming the above mentioned assumptions, clinicians should have full informations about the PTSD sufferer memory state before the trauma exposure and the PTSD onset.