PTSD symptoms, forgiveness, and revenge among Israeli Palestinian and Jewish adolescents

Higher Residence Attachment and Religiosity Are Associated With Less Depressive Symptoms After Terror Event Exposure

Introduction: We examined how community type, residence attachment, and religiosity contribute to resilience to depressive symptoms, psychosomatic complaints, residential stress, and avoidance behavior among students exposed to terror.

Methods: Undergraduate students from Ariel University (N = 1,413; 62.7% females; M_age = 26.5; SD = 6.03) completed a self-report questionnaire on socio-demographics, terror exposure, place attachment, and depressive/psychosomatic symptoms. Participants were divided into three residential groups: “Ariel,” “Small settlement communities in Judea and Samaria” or “Other places in Israel.”

Results: Participants from small settlement communities in Judea and Samaria showed significantly fewer depressive symptoms and greater adjustment– less avoidance, psychosomatic symptoms, and residential stress– compared to those living in Ariel or other places in Israel, despite significantly higher exposure to terror.

Conclusion: Greater religiosity and residence attachment may protect against depressive symptom development following terror exposure. Secular, temporary residents living in highly terror-exposed areas should be targeted for community strengthening interventions.

Using a biopsychosocial approach to examine differences in post-traumatic stress symptoms between Arab and Jewish Israeli mothers following a child's traumatic medical event

Background

Parents of children following traumatic medical events (TMEs) are known to be at high risk for developing severe post-traumatic stress symptoms (PTSS). Findings on the negative impact of TMEs on parents’ PTSS have been described in different cultures and societies. Parents from ethnic minority groups may be at particularly increased risk for PTSS following their child’s TME due to a host of sociocultural characteristics. Yet, differences in PTSS manifestation between ethnic groups following a child’s TME has rarely been studied.

Objectives

We aimed to examine: (1) differences in PTSS between Israeli-Arab and Israeli-Jewish mothers, following a child’s TME, and (2) risk and protective factors affecting mother’s PTSS from a biopsychosocial approach.

Methods

Data were collected from medical files of children following TMEs, hospitalized in a Department of Pediatric Rehabilitation, between 2008 and 2018. The sample included 47 Israeli-Arab mothers and 47 matched Israeli-Jewish mothers. Mothers completed the psychosocial assessment tool (PAT) and the post-traumatic diagnostic scale (PDS).

Results

Arab mothers perceived having more social support than their Jewish counterparts yet reported higher levels of PTSS compared to the Jewish mothers. Our prediction model indicated that Arab ethnicity and pre-trauma family problems predicted higher levels of PTSS among mothers of children following TMEs.

Conclusions

Despite reporting higher social support, Arab mothers reported higher levels of PTSS, as compared to the Jewish mothers. Focusing on ethnic and cultural differences in the effects of a child’s TME may help improve our understanding of the mental-health needs of mothers from different minority groups and aid in developing appropriate health services and targeted interventions for this population.

Differences in the association of spirituality, forgiveness, PTSD and stress among social workers and social work students treating trauma survivors

Providing professional assistance to trauma victims may cause significant emotional distress to those who provide the assistance. Dealing with such stress requires attention to significant personal resources. This study examined the relationship between tendency to forgive and spirituality with PTSD symptoms and stress among social workers and social work students (N = 157) who are at the front line dealing with trauma survivors. The study results demonstrated that social work students had higher levels of stress while no significant differences were found regarding spiritually, PTSD, and forgiveness. Examining the subscales revealed that social work students had higher negative PTSD alteration symptoms than trained social workers while trained social workers had higher levels of forgiveness to self. Additionally, structural equation models showed that among social workers, forgiveness to self and spirituality were associated simultaneously with lower PTSD symptoms and stress. However, among social work students, the tendency to forgive the self was associated with lower PTSD symptoms only. The findings illuminate spirituality and forgiveness as key factors that can help cope with the emotional toll of those who assist trauma survivors, while focusing on differences for trained professionals and training professionals. Theoretical and clinical implications are discussed.

Revenge Fantasies After Experiencing Traumatic Events: Sex Differences

Experiences of humiliation, unjust hurt caused by another or anger naturally, elicit the desire to seek revenge and fantasies of revenge. The current study examined the associations between a history of traumatic events and feelings of injustice and levels of desire for revenge-seeking and fantasies of revenge. Specifically, it tested whether feelings of injustice mediated the associations between the number of past traumatic events and the desire for revenge or revenge fantasies. Based on recent studies showing that retaliatory violence is gendered, sex differences in levels of feelings of injustice, desire for revenge, and the presence of revenge fantasies were explored, as well whether participants' sex conditioned the mediation models. The results showed positive associations between feelings of injustice and the desire for revenge and revenge fantasies. The mediation model indicated that feelings of injustice mediated the associations between the number of previous traumatic events and the desire for revenge or revenge fantasies. Men had higher levels of revenge fantasies than women, whereas women tended to perceive revenge as pointless. A sex effect was found for the mediation model, which revealed significant regressed models for women but not for men. The clinical implications are discussed.

Coping with post-war mental health problems among survivors of violence in Northern Uganda: Findings from the WAYS study

Cognitive emotion regulation strategies and mental health problems were assessed in a sample of war-affected youth in Northern Uganda. Univariable and multivariable regression models were fitted to assess the influence of CERS on mental health problems. Maladaptive cognitive emotion regulation strategies (e.g., rumination) were significantly associated with more mental health problems while adaptive cognitive emotion regulation strategies (e.g., putting into perspective) were associated with reporting fewer symptoms of mental health problems. The youth with significant scores on mental health problems (scores ≥ 85th percentile) reported more frequent use of maladaptive than adaptive strategies. Interventions to reduce mental health problems should focus on enhancing the use of adaptive strategies.

Four decades following the Khmer rouge: sociodemographic factors impacting depression, anxiety and PTSD in Cambodia

BACKGROUND

Reliable population-based epidemiological data of Cambodian mental health is lacking.

AIMS

This study identifies the prevalence of and factors associated with anxiety, depression and PTSD in Cambodian adults.

METHODS

A nationally representative sample of Cambodian adults (N = 2690) was interviewed utilizing the Harvard Trauma Questionnaire (assessment of PTSD symptoms) and the Hopkins Symptom Checklist-25 (assessment of symptoms of anxiety and depression).

RESULTS

Respondents expressed high rates of anxiety (27.4%), depression (16.7%) and PTSD (7.6%). Correlations between symptoms and sociodemographic markers varied in significance. Women had significantly higher rates of mental health symptoms than men. Women who were in debt, widowed or divorced and had low levels of education were the most likely to report symptoms.

CONCLUSIONS

These findings can inform Cambodian mental health policies and development strategies, especially targeting the most vulnerable groups.

Interpersonal Sensitivity as Mediator of the Relations Between War Experiences and Mental Illness in War-Affected Youth in Northern Uganda: Findings From the WAYS Study

The pathways from war experiences to mental health problems are poorly understood. The current study aims to assess the role of interpersonal sensitivity in the relations between war experiences and mental health problems based on data from the War-Affected Youth Survey cohort study. The War-Affected Youth Survey is an ongoing research project of formerly abducted children in Northern Uganda assessing their war experiences and the risk and protective factors in the development of mental health problems. Mediation of the relations between war experiences and mental health problems by interpersonal sensitivity was analyzed using structural equation modeling. War experiences were related to posttraumatic stress disorder through interpersonal sensitivity accounting for 55% of the variance in their relations, to depression/anxiety through interpersonal sensitivity accounting for 89% of the variance in their relations (i.e., near complete mediation), and to psychotic symptoms through interpersonal sensitivity accounting for 53% of the variance in their relations. The direct relation between war experiences, on the one hand, and posttraumatic stress disorder and psychotic symptoms, on the other hand, attenuated but remained statistically significant. For depression/anxiety, the direct relationship ceased to be significant after including interpersonal sensitivity in the model. Interpersonal sensitivity is an important determinant of long-term mental health problems in war-affected youth. Interventions to improve mental health should target youth with high scores on interpersonal sensitivity. Cognitive–behavioral therapy to recognize and change cognitive schemas in youth prone to interpersonal sensitivity is recommended.

The Readiness to Reconcile Inventory

Abstract. Although awareness of the importance of reconciliation in post-conflict societies has grown in recent decades, validated measures assessing victims’ attitudes toward reconciliation are lacking. To fill this gap, the Readiness to Reconcile Inventory (RRI) was developed and its factor structure and aspects of construct validity were psychometrically tested in two independent samples of survivors of the Khmer Rouge regime in Cambodia. Exploratory factor analysis in a sample of N = 247 survivors identified a 13-item, three-factor internal structure of the RRI that was confirmed by confirmatory factor analysis in an independent sample of N = 830 survivors of the Khmer Rouge regime. All RRI subscales showed good internal consistency (Cronbach’s αs from .80 to .83). Multiple-group analysis established configural, metric, and scalar invariance across sex. The RRI thus demonstrated good reliability and fulfilled some aspects of construct validity. It is a time-effective and easy-to-administer instrument for assessing readiness to reconcile in victims of war and conflict.

Psychological Aspects of the Israeli-Palestinian Conflict: A Systematic Review

Despite ongoing local and international peace efforts, the Jews, Arabs, and other residents of Israel and the Palestinian territories (i.e., the West Bank and Gaza) have endured decades of political, social, and physical upheaval, with periodic eruptions of violence. It has been theorized that the psychological impact of the Israeli-Palestinian conflict extends beyond the bounds of psychiatric disorders such as posttraumatic stress disorder (PTSD). Exposure to the ongoing conflict may lead to changes in the way Israelis and Palestinians think, feel, and act; while these changes may not meet the thresholds of PTSD or depression, they nonetheless could have a strong public health impact. It is unclear whether existing studies have found associations between exposure to the conflict and nonclinical psychological outcomes. We conducted a systematic review to synthesize the empirical research on the Israeli-Palestinian conflict and its psychological consequences. As a whole, the body of literature we reviewed suggests that exposure to regional political conflict and violence may have detrimental effects on psychological well-being and that these effects likely extend beyond the psychiatric disorders and symptoms most commonly studied. We found evidence that exposure to the conflict informs not only the way Israelis and Palestinians think, feel, and act but also their attitudes toward different religious and ethnic groups and their degree of support for peace or war. We also found that Palestinians may be at particularly high risk of experiencing psychological distress as a result of the conflict, though more research is needed to determine the extent to which this is due to socioeconomic stress. Our review suggests the need for more studies on the nonclinical psychological aspects of the Israeli-Palestinian conflict as well as for longitudinal studies on the impact of the conflict on both Israelis and Palestinians.

PTSD in Court I: Introducing PTSD for Court

The first part of the series of three articles on posttraumatic stress disorder (PTSD) in Court to appear in the journal reviews the history of the construct of PTSD and its presentation in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; American Psychiatric Association, 2013) and the ICD-11 (International Classification of Diseases, 11th Edition; World Health Organization, 2018). There are 20 symptoms of PTSD in the DSM-5. PTSD symptoms are arranged into a four-cluster model, which has received partial support in the literature. Other four-factor models have been found that fit the data even better than that of the DSM-5. There is a five-factor dysphoria model and two six-factor models that have been found to fit better the DSM-5 PTSD symptoms. Finally, research is providing support for a hybrid seven-factor model. An eighth factor on dissociation seems applicable to the minority of people who express the dissociative subtype. At the epidemiological level, individuals can expect trauma exposure to take place about 70% over one's lifetime. Also, traumatic exposure leads to traumatic reactions in about 10% of cases, with PTSD being a primary diagnosis for trauma. Once initiated, PTSD becomes prolonged in about 10% of cases. Polytrauma and comorbidities complicate these prevalence statistics. Moreover, the possibility of malingered PTSD presents confounds. However, the estimate for malingered PTSD varies extensively, from 1 to 50%, so that the estimate is too imprecise for use in court without further research. This first article in the series of three articles appearing in the journal on PTSD in Court concludes with discussion of complications related to comorbidities and heterogeneities, in particular. For example, PTSD and its comorbidities can be expressed in over one quintillion ways. This complexity in its current structure in the DSM-5 speaks to the individual differences involved in its expression.

Role of neuroinflammation and sex hormones in war-related PTSD

The susceptibility to develop posttraumatic stress disorder (PTSD) is greatly influenced by both innate and environmental risk factors. One of these factors is gender, with women showing higher incidence of trauma-related mental health disorders than their male counterparts. The evidence so far links these differences in susceptibility or resilience to trauma to the neuroprotective actions of sex hormones in reducing neuroinflammation after severe stress exposure. In this review, we discuss the impact of war-related trauma on the incidence of PTSD in civilian and military populations as well as differences associated to gender in the incidence and recovery from PTSD. In addition, the mutually influencing role of inflammation, genetic, and sex hormones in modulating the consequences derived from exposure to traumatic events are discussed in light of current evidence.

An application of an ecological framework to understand risk factors of PTSD due to prolonged conflict exposure: Israeli and Palestinian adolescents in the line of fire

OBJECTIVE

Adolescents living in Israel and the Palestinian authority are exposed to political violence. This review examines psychosocial risk factors for posttraumatic stress disorder (PTSD) organized within an ecological framework.

METHOD

Relevant articles were identified through PubMed and PsycINFO. Studies measuring risk and/or protective factors for PTSD in the Palestinian and/or Israeli adolescent populations because of conflict exposure from 1990 to present were included.

RESULTS

A total of 20 studies met inclusion criteria. Greater violence exposure, poor economic resources, living in rural compared with urban areas, poor family and peer relations, and poor coping skills were associated with PTSD symptoms.

CONCLUSIONS

The ecological framework is a useful approach to understanding factors affecting adolescent PTSD. Future research should focus on socioecological levels that have received limited attention. (PsycINFO Database Record

Making up 'national trauma, in Israel: From collective identity to collective vulnerability

We sketch a variety of institutional, discursive, professional, and personal 'vectors', dating back to the 1980s, in order to explain how 'national trauma' was able to go from a cultural into a professional category in Israeli mental health during the Al-Aqsa Intifada (2000-2005). Our genealogy follows Ian Hacking's approach to transient mental illnesses, both illustrating its fertility and expanding its horizon. Thus, we also explore the dynamics that developed in the Israeli mental health community with the advent of 'national trauma': while the vast majority of Israeli psychologists and psychiatrists did not adopt the category, they embraced much of its underlying logic, establishing a link between Israeli identity and the mental harm said to be caused by Palestinian terror. Remarkably, the nexus of national identity and collective psychic vulnerability also prompted the cooperation of Jewish and Palestinian-Israeli mental health scholars seeking to explore the psychological effect that the minority status of Israeli Palestinians had on them during the Al-Aqsa Intifada.

Mediating effects of forgiveness and emotion-focused coping on post-traumatic stress disorder symptoms caused by physical injury and perceived threat

INTRODUCTION

The purpose of this study was to develop and test a model (including cognitive appraisal, coping strategy, and forgiveness variables) predicting post-traumatic stress disorder (PTSD) in 127 adults who were involved in traffic accidents.

METHODS

Participants were recruited from the inpatient and outpatient departments of three urban hospitals in South Korea. We utilized the path analysis to identify the best fitting model to our data.

RESULTS

Path analysis showed that the baseline model compared with an alternative model was more appropriate for our data. Our results indicated that the severity of physical injury was directly related to the participants' perceived threat. The perceived threat had direct and indirect effects on PTSD symptoms through forgiveness and emotion-focused coping strategies. One of the significant findings was that victims' forgiveness of the person at fault for the accident reduced their PTSD symptoms. The severity of physical injury was not related directly to PTSD symptoms.

DISCUSSION

Our study demonstrates that victim's forgiveness of the person at fault in a traumatic situation can be useful in helping their recovery after trauma and the forgiveness process may be applied to traffic accident situations as well as other types of interpersonal trauma.

Risk factors for DSM 5 PTSD symptoms in Israeli civilians during the Gaza war

BACKGROUND

In light of the current modifications presented in the diagnostic criteria of posttraumatic stress disorder (PTSD) in the DSM 5, this study aimed at revalidating well-known PTSD risk factors, including gender, peritraumatic dissociation, social support, level of threat, and trait tendency for forgiveness.

METHOD

Five hundred and one Israeli civilians were assessed during real-time exposure to missile and rocket fire at the eruption of the Gaza war. Assessments took place approximately one to 2 weeks after the beginning of this military operation, relying on web administration of the study, which allowed simultaneous data collection from respondents in the three regions in Israel that were under attack.

RESULTS

A structural equation model design revealed that higher levels of forgiveness toward situations were associated with fewer PTSD symptoms, whereas peritraumatic dissociation and high levels of objective and subjective threat were positively associated with PTSD symptoms. Additionally, females were at higher risk for PTSD symptoms than males.

CONCLUSIONS

The findings of this study provide further evidence for the importance of directing preventive attention to those vulnerable to the development of elevated levels of PTSD symptoms. Theoretical and clinical implications of the findings are discussed.

Forgiveness, coping, and terrorism: do tendency to forgive and coping strategies associate with the level of posttraumatic symptoms of injured victims of terror attacks?

OBJECTIVE

The study examined the tendency to forgive (self, others, and situations) and coping strategies (problem-focused, emotion-focused, and avoidance) among terror attack victims as associated with posttraumatic stress disorder (PTSD) symptom severity.

METHOD

The sample included 108 terror victims who had been injured in terror attacks (mean age 46.23, standard deviation = 11.61; 58.3% male). Participants agreed to undergo assessments of their PTSD symptoms, coping strategies, and tendency to forgive.

RESULTS

A nested structural equation model design showed that tendency to forgive is positively associated with problem-focused coping and negatively associated with avoidance coping. Additionally, tendency to forgive and problem-focused coping are associated with decreased PTSD symptom severity, whereas emotion-focused coping is associated with elevated PTSD symptom severity.

CONCLUSIONS

Tendency to forgive and coping strategies are significantly associated with each other and with severity of PTSD symptoms among individuals injured in terror attacks. Theoretical and clinical implications of the findings are discussed.

The bidirectional dyadic association between tendency to forgive, self-esteem, social support, and PTSD symptoms among terror-attack survivors and their spouses

This study examined the dyadic association of terror attack survivors’ and spouses’ internal resources, tendency to forgive (self, others,and situational forgiveness), self-esteem, and the external resource of social support, as associated with victims’ and spouses’ posttraumatic stress disorder (PTSD) symptoms, using the actor–partner interdependence model. Based on lists by the One Family organization in Israel, 108 couples participated in the study. The study results demonstrate that in the dyad relationship, survivors’ tenden cyto forgive others and social support relate both to survivors’ decreased levels of PTSD symptom severity (β = −.20, p = .021;β =−.55 p < .001) and spouses’ decreased levels of PTSD symptom severity (β =−.21, p = .015; β =−.27, p = . 004), whereas spouses’ self-esteem relates to both spouses’ and survivors’ decreased levels of PTSD symptom severity (β =−.57, p < .001; β =−.14, p = .041).The findings underscore the role of the survivor–spouse unit by highlighting the dyad relationship of internal and external resources as associated with both survivors’ and spouses’ PTSD symptoms. Theoretical and clinical implications of the findings are discussed.

Posttraumatic stress disorder patients' experiences of hope

In this qualitative study we examined the experience and perception of hope of 10 Israeli soldiers with chronic posttraumatic stress disorder (PTSD), with the goal of achieving an understanding of the manners in which hope intertwines with trauma. The results indicate that hope is an integrative, changing, multidimensional phenomenon which plays a unique role in the individual's life. Viewing hope as a crucial aspect of human life was further evident when participants referred to the traumatic event. Hope and trauma are interconnected phenomena. The form of hope a person possesses thus shapes the manner in which the traumatic event is perceived, whereas the trauma clearly reshapes the individual's form of hope. We discuss practical implications for treatment of chronic PTSD, based on the important role of hope at times of trauma, as well as on the interrelation between hope and trauma.

A systematic review on the mental health of children and adolescents in areas of armed conflict in the Middle East

For many decades, the Middle East has been troubled with numerous long-standing armed conflicts and wars. Children and adolescents were not spared the trauma and its consequences. Exposure to traumatic events can result in mental, behavioural and emotional problems in children and adolescents. To date, this is the first paper that aims to systematically review the literature on the mental health of children and adolescents living in areas of armed conflict in the Middle East, specifically Israel, Palestine, Lebanon and Iraq. It explores factors that mediate between exposure to armed conflict and mental, behavioural and emotional problems and places them in a cultural context. Pubmed was searched and papers were identified using specific inclusion criteria. Seventy-one eligible studies were included. The main findings are that children and adolescents living in these conflict zones are exposed to high levels of traumatic experiences. Number of conflict-related traumatic experiences correlates positively with prevalence of mental, behavioural and emotional problems. Prevalence of post-traumatic stress disorder in children and adolescents is estimated to be 5-8% in Israel, 23-70% in Palestine and 10-30% in Iraq (insufficient data for Lebanon). The main determining factors identified were level and type of exposure, age, gender, socio-economic adversity, social support and religiosity. These findings bring to light the pressing need to provide children and adolescents living in conflict areas with help. They are useful in designing new interventions to strengthen child and adolescent resilience in areas of conflict worldwide. Specific recommendations are included.

Affective and behavioral changes following exposure to traumatic events: the moderating effect of religiosity on avoidance behavior among students studying under a high level of terror event exposure

The goals of this study were to examine the development of affective and behavioral changes following exposure to traumatic events among Israeli students studying under a high level of terror event exposure and to assess the effects of religiosity on those changes development. A questionnaire was administered to 770 students in the Ariel University Center in Judea and Samaria. Higher levels of terror exposure were associated with higher levels of avoidance behavior, subjective feelings of insecurity, and emotional distress. Higher religiosity moderated avoidance behavior, even when controlling for the level of objective exposure to terror events exposure, but had no influence on subjective sense of insecurity, or the level of emotional distress. These findings suggest that religiosity moderates behavioral changes development after traumatic event exposure mainly by reducing avoidance behavior.

PTSD symptom clusters, feelings of revenge, and perceptions of perpetrator punishment severity in victims of interpersonal violence

Feelings of revenge have often been found to correlate with symptoms of posttraumatic stress disorder (PTSD). Which PTSD symptom cluster prevails in this association is, however, unknown. Furthermore, previous studies suggest that revenge may be satisfied by perceptions of perpetrator punishment severity, but did not control for concurrent symptoms of PTSD. Therefore, this study explored associations between PTSD symptom clusters, feelings of revenge, and perceived perpetrator punishment severity in a sample of victims of interpersonal violence. Results indicated that the re-experiencing/intrusion symptom cluster was the only index of PTSD which was related to victims' feelings of revenge (n=207). Revenge correlated negatively with perceptions of punishment severity in victim who knew that the perpetrator had been sentenced, but not after adjustment for PTSD symptoms (n=96).

Community-implemented trauma therapy for former child soldiers in Northern Uganda: a randomized controlled trial

CONTEXT

The psychological rehabilitation of former child soldiers and their successful reintegration into postconflict society present challenges. Despite high rates of impairment, there have been no randomized controlled trials examining the feasibility and efficacy of mental health interventions for former child soldiers.

OBJECTIVE

To assess the efficacy of a community-based intervention targeting symptoms of posttraumatic stress disorder (PTSD) in formerly abducted individuals.

DESIGN, SETTING, AND PARTICIPANTS

Randomized controlled trial recruiting 85 former child soldiers with PTSD from a population-based survey of 1113 Northern Ugandans aged 12 to 25 years, conducted between November 2007 and October 2009 in camps for internally displaced persons. Participants were randomized to 1 of 3 groups: narrative exposure therapy (n = 29), an academic catch-up program with elements of supportive counseling (n = 28), or a waiting list (n = 28). Symptoms of PTSD and trauma-related feelings of guilt were measured using the Clinician-Administered PTSD Scale. The respective sections of the Mini International Neuropsychiatric Interview were used to assess depression and suicide risk, and a locally adapted scale was used to measure perceived stigmatization. Symptoms of PTSD, depression, and related impairment were assessed before treatment and at 3 months, 6 months, and 12 months postintervention.

INTERVENTION

Treatments were carried out in 8 sessions by trained local lay therapists, directly in the communities.

MAIN OUTCOME MEASURES

Change in PTSD severity, assessed over a 1-year period after treatment. Secondary outcome measures were depression symptoms, severity of suicidal ideation, feelings of guilt, and perceived stigmatization.

RESULTS

PTSD symptom severity (range, 0-148) was significantly more improved in the narrative exposure therapy group than in the academic catch-up (mean change difference, -14.06 [95% confidence interval, -27.19 to -0.92]) and waiting-list (mean change difference, -13.04 [95% confidence interval, -26.79 to 0.72]) groups. Contrast analyses of the time × treatment interaction of the mixed-effects model on PTSD symptom change over time revealed a superiority of narrative exposure therapy compared with academic catch-up (F(1,234.1) = 5.21, P = .02) and wait-listing (F(1,228.3) = 5.28, P = .02). Narrative exposure therapy produced a larger within-treatment effect size (Cohen d = 1.80) than academic catch-up (d = 0.83) and wait-listing (d = 0.81).

CONCLUSION

Among former Ugandan child soldiers, short-term trauma-focused treatment compared either with an academic catch-up program including supportive counseling or with wait-listing resulted in greater reduction of PTSD symptoms.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00552006.

Support for religio-political aggression among teenaged boys in Gaza: part II: neuroendocrinological findings

Hormones seem to play important roles in the regulation of human aggression. Multiple studies have confirmed that testosterone (T) levels exhibit complex relationships with aggression, dominance, and/or risk-taking behavior. Some evidence suggests that cortisol (CORT) interacts with T and may also be associated with aspects of mood and aggression. However, almost no research to date has investigated the possibility that these neuroendocrine factors are associated with variations in political attitudes or with political aggression. During the second intifada, we tested the hypothesis that morning salivary T and/or salivary CORT levels might be associated with self-rated aggression or with support for religio-political aggression (RPA) among 14-year-old Palestinian boys living in Gaza. We obtained and averaged weekly 09:00 hr salivary measures of T and CORT for more than 1 month. Averaged morning T levels did not correlate with self-rated aggression, but were positively associated with agreement with the statement "religious ends justify any means," (r = .355, P = .014) and marginally associated with a composite measure of support for RPA (r = .247, P = .094). Average CORT levels were inversely correlated with self-rated aggression (r = -.328, P = .037) and with anger (r = -.373, P = .016), but CORT levels were not associated with support for RPA or with the statement "religious ends justify any means." Acknowledging that a modest sample size and methodological issues necessarily limit confidence in our conclusions, these results may represent the first findings regarding neurobiological correlates of support for political aggression.

Examining the relationship between resilience and posttraumatic growth

To extend the literature the present study aims to examine the interrelationships between resilience (defined by a lack of posttraumatic stress disorder following trauma) and posttraumatic growth. Two studies were conducted of Israeli: (a) adolescents exposed to terror (N = 2908), and (b) citizens and army personnel following the second Lebanon War (N = 588). Across studies the results showed that high levels of resilience were associated with the lowest posttraumatic growth scores. The results imply that although growth and resilience are both salutogenic constructs they are inversely related. The theoretical and clinical implications of these findings are discussed.

Posttraumatic growth in adolescence: examining its components and relationship with PTSD

To address gaps in the literature, this study examined the components of posttraumatic growth, and the relationship between growth and posttraumatic stress disorder (PTSD). Participants were from a pooled sample of 4,054 Israeli adolescents exposed to terror of whom 210 (5.5%) met criteria for PTSD. Measures included the Child Post-Traumatic Stress Reaction Index and Posttraumatic Growth Inventory. Principal components analysis showed two correlated components of outward and intrapersonal growth. Regression modeling showed that the relationship between the growth and PTSD measures was linear and curvilinear (inverted-U). These results replicated accounting for heterogeneity in PTSD, exposure and subsamples. Collectively, the results imply that posttraumatic growth in adolescence is characterized by two robust components, and is greatest at moderate posttraumatic stress levels.