Exposure to combat experiences: PTSD, somatization and aggression amongst combat and non-combat veterans

To this date, the prevalence of posttraumatic stress disorder (PTSD) and associated psychological symptom profiles amongst non-combatant community-based veterans in Israel has not been studied. Data were analysed from a web-based survey of veterans via a market research platform during September 2021 and included 522 non-combat (e.g. intelligence, office-based or education corps) veterans and 534 combat (e.g. front-line infantry) veterans. The survey assessed PTSD, depression, anxiety and somatic symptoms in addition to the prevalence of self-reported aggression. A two-way multivariate analysis of covariance indicated that higher PTSD and somatic symptoms were prevalent for those exposed to combat experiences even when not in a combatant role. A logistic regression indicated that of those who did not self-define as aggressive prior to service, those exposed to combat were three times more likely to be aggressive following their service than veterans not exposed to combat. This effect was not demonstrated for combat soldiers compared to non-combat soldiers. Results indicate that mental health outreach would be better targeted towards those who have been exposed to combat-type experiences during their service even in non-combat units. The current study highlights the effect of combat exposure on secondary PTSD symptoms; aggression and somatization.

Effect of Life Review Therapy for Holocaust Survivors: A randomized controlled trial

Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) of psychotherapy exists for this population, with very few on older adults in general. This RCT aimed to compare the efficacy of Life Review Therapy for Holocaust survivors (LRT-HS) relative to a supportive control group. Holocaust survivors with a probable diagnosis of full or subsyndromal posttraumatic stress disorder (PTSD) or depressive disorder were included. Exclusion criteria were probable dementia, acute psychotic disorder, and acute suicidality. The predefined primary endpoint was the course of PTSD symptom scores. In total, 49 of 79 consecutive individuals assessed for eligibility were randomized and included in the intent-to-treat analyses (LRT-HS: n = 24, control: n = 25; M_age = 81.5 years, SD = 4.81, 77.6% female). Linear mixed models revealed no statistically significant superiority of LRT-HS for PTSD symptoms at posttreatment, with moderate effect sizes, Time x Condition interaction: t(75) = 1.46, p = .148, d_within = 0.70, d_between = 0.41, but analyses were significant at follow-up, with large effect sizes, t(79) = 2.89, p = .005, d_within = 1.20, d_between = 1.00. LRT-HS superiority for depression was observed at posttreatment, t(73) = 2.58, p = .012, but not follow-up, t(76) = 1.08, p = .282, with moderate effect sizes, d_within = 0.46-0.60, d_between = 0.53-0.70. The findings show that even in older age, PTSD and depression following exposure to multiple traumatic childhood events can be treated efficaciously using an age-appropriate treatment that includes structured life review and narrative exposure.

Life review therapy for holocaust survivors: Two systematic case studies

Having reached the last phase of their lives, many Holocaust survivors (HS) experience an increase in vulnerability. Despite their remarkable ability to adapt, the process of aging presents them with new challenges, often leading to an increased need for therapy. This is made all the more difficult by the fact that there is little research on trauma therapy in old age. To date, no randomized controlled study has been carried out to examine the effectiveness of psychotherapy in HS. The present case studies report the implementation of life review therapy (LRT-HS) undertaken with two female HS with symptoms of post-traumatic stress disorder (PTSD). The mixed-methods approach sheds light to their individual therapy courses and potential mechanisms of change. Both therapies took place in the context of a randomized controlled study evaluating the efficacy of LRT-HS. This integrative, narrative therapy approach answers the natural need of elderly people to look back on their lives. Patients received about 20 sessions of LRT-HS, including a structured life review, narrative exposure, as well as cognitive and behavioral elements. Patient 1 showed reliable to clinically significant improvements on several quantitative symptom levels and with consistent qualitative findings (e.g., semistructured therapist interview). Symptoms of Patient 2 remained mostly unchanged, while life satisfaction and posttraumatic growth reliably improved and qualitative measures pointed to a reduction of suffering. The studies illustrate that reminiscence can be used in adaptive ways even after the experience of massive traumatization. The coexistence of resilience and vulnerability, complex individual symptom profiles, and influencing factors are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Multiple Traumas, Maternal Depression, Mother-Child Relationship, Social Support, and Young Children's Behavioral Problems

This study examined whether maternal depression, mother-child relationships, and maternal perceived social support mediate the associations between child's exposure to multiple traumatic events and behavioral problems. We recruited a representative sample of 904 Israeli (Jewish and Arab) mothers and their 2- to 6-year-old children. Data collection was conducted through structured face-to-face interviews with the mothers between July and November 2011. All measures were completed by the mothers. We used the child's and mother's exposure to political violence questionnaires, Child Behavior Checklist (CBCL), a short version of the Parental Acceptance-Rejection Questionnaire (PARQ), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Medical Outcomes Study (MOS) Social Support Survey. The research study model was tested using path analysis. The model showed a very good fit to the data, suggesting that maternal rejection, maternal depression, and social support play an important role in child's behavioral problems in the context of multiple traumatic events. Higher levels of maternal rejection were significantly associated with greater children behavior problems. Maternal rejection mediated the associations between maternal depressive symptoms and child's behavioral problems. Maternal perceived social support mediated the associations between child's exposure to multiple traumatic events and child's behavioral problems; child's exposure to multiple traumatic events was associated with lower levels of maternal perceived social support. In turn, lower levels of perceived social support were associated with higher levels of behavioral problems. In conclusion, in accordance with the "social stress framework," social support has a mediation role in the association between exposure to traumatic events and child's behavioral problems. Thus, enhancing social support to mothers to young children in the context of multiple traumatic events is essential for children resiliency.

Life review therapy for holocaust survivors (LRT-HS): study protocol for a randomised controlled trial

BACKGROUND

The Holocaust was one of the most traumatic catastrophes in recorded human history. Survivors seeking psychotherapeutic help today, now in their seventies and older, often show symptoms of a posttraumatic stress disorder (PTSD), depression, or prolonged grief disorder. Established psychological treatments for PTSD (e.g. cognitive behaviour therapy, psychodynamic therapies) have been tested and assessed mainly with young and middle-aged adults; only very few studies examined them in old age. There is no therapy outcome study known to us for any treatment mode for Holocaust survivors. Moreover, there is a need for an age group-specific treatment of PTSD and other stress-related mental disorders. A narrative approach including life-review and narrative exposure seems to meet very well the natural need of older people to review their lives and is highly effective. However, most studies on the efficacy of life review therapy (LRT) focus on late-life depression. There is a lack of efficacy studies evaluating the effect of LRT on PTSD symptoms in older individuals that have experienced traumatic events.

METHODS

The main goal of this study is to evaluate the effect of LRT for Holocaust survivors (LRT-HS) on symptoms of PTSD and related mental health problems (depression, anxiety, prolonged grief), compared to a supportive control group. A secondary goal is to identify the characteristics of participants that seem to especially benefit from the treatment. The proposed study is a randomised, controlled follow-up trial including Holocaust survivors with one or more trauma-related disorders. The LRT treatment consists of 20-25 sessions. Before and after the treatment phase, participants in both conditions will be assessed. Follow-up will take place 6 months after the treatment. A sample size of 80 is required (drop-out rate included).

DISCUSSION

Efficacious treatments for trauma-related disorders in older people are of high importance, also because the probability of traumatisation and loss increases with age. Because this study is conducted with this specific group of multiply traumatised people, we are convinced that the results can easily transfer to other samples.

TRIAL REGISTRATION

ISRCTN, ISRCTN12823306. Registered 31 March 2018 - Retrospectively registered (first participant 22 December 2017).

Long-term impact of maternal posttraumatic symptoms on children's regulatory functioning: A four-year follow-up study

BACKGROUND

The interrelation between exposure to trauma, posttraumatic stress disorder (PTSD), and regulatory functioning in children is gaining increasing attention. This study examines the effects of maternal posttraumatic symptoms (PTS) on child deficits in sensory regulation, behavior regulation, and executive functioning.

METHOD

The sample at the first measurement (2011, T1) included 382 Israeli mothers and their young children (child's mean age = 3.89 years; SD = 1.26), and 240 of them were reassessed after 4 years (2015, T2). Mothers self-reported their trauma exposure and posttraumatic distress symptoms (PTSD) and filled out questionnaires on their children's sensory regulation (new version of the Short Sensory Profile including sensory processing and behavior regulation as well as their level of executive functioning (Dysexecutive Questionnaire).

RESULTS

A path model showed that maternal PTS at T1 predicted maternal PTS at T2, which in turn was associated with problems in their children's sensory regulation, behavior regulation, and their level of executive functioning. These results highlight the relationship between mother's posttraumatic distress and her child's regulatory functioning.

CONCLUSIONS

The study supports the construct of relational PTSD and broadens it to additional aspects of children's deficits in sensory regulation, behavior regulation, and executive functioning. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Burnout and perceived social support: The mediating role of secondary traumatization in nurses vs. physicians

AIMS

The study aimed to examine differences between paediatric nurses and physicians regarding burnout syndrome, secondary traumatic stress (STS) and perceived social support (PSS).

BACKGROUND

Paediatric nurses and physicians encounter cumulative effects of treating sick and injured children and helping their families, in situations that might promote burnout and STS.

DESIGN

Cross-sectional design.

METHOD

Nurses (n = 158) and physicians (N = 76) completed self-report questionnaires on STS, PSS and burnout.

RESULTS

Nurses and physicians had similar rates of STS and burnout but showed significant differences in PSS. Furthermore, STS mediated the association between PSS and burnout for both groups; however, the effect was stronger for nurses in comparison to physicians.

CONCLUSION

Paediatric nurses and physicians would benefit from participating in interventions geared towards reducing STS, thus minimizing burnout. Moreover, advocating social support within the organization is needed to bolster the ability for coping with sources of stress.

IMPACT STATEMENT

Nurses' and physicians' involvement in the physical, physiological and mental needs of their paediatric patients might lead to burnout and secondary traumatic stress (STS). However, research on social support in the context of burnout and STS among nurses and physicians is scant. Secondary traumatic stress and burnout were similar for nurses and physicians, though perceived social support (PSS) was higher for nurses. Secondary traumatic stress plays a mediating role in the association between PSS and burnout among nurses and physicians. However, the mediation effect was stronger for nurses. Policy makers would be wise to advocate institutional stress management interventions to reduce secondary traumatic and to reinforce organizational support for nurses and physicians.

Somatic Experiencing for Posttraumatic Stress Disorder: A Randomized Controlled Outcome Study

This study presents the first known randomized controlled study evaluating the effectiveness of somatic experiencing (SE), an integrative body-focused therapy for treating people with posttraumatic stress disorder (PTSD). There were 63 participants meeting DSM-IV-TR full criteria for PTSD included. Baseline clinical interviews and self-report measures were completed by all participants, who were then randomly assigned to study (n = 33) or waitlist (n = 30) groups. Study participants began 15 weekly SE sessions, whereas waitlist participants waited the same period, after which the second evaluation was conducted. All participants were evaluated a third time after an additional 15 weeks, during which time the waitlist group received SE therapy. Pretreatment evaluation showed no significant differences between groups. Mixed model linear regression analysis showed significant intervention effects for posttraumatic symptoms severity (Cohen's d = 0.94 to 1.26) and depression (Cohen's d = 0.7 to 1.08) both pre-post and pre-follow-up. This randomized controlled study of SE shows positive results indicating SE may be an effective therapy method for PTSD. Further research is needed to understand who shall benefit most from this treatment modality.

Stability and Change in Posttraumatic Distress: A 7-Year Follow-Up Study of Mothers and Young Children Exposed to Cumulative Trauma

In situations of cumulative trauma, it is often unclear why some people remain resilient, whereas others experience distress, and how likely these responses are to change over time. To investigate the constancy of responses to cumulative trauma, stability and change in posttraumatic distress and resistance (as defined by no evidence of clinical symptoms) were assessed twice in 140 Israeli children and mothers exposed to continual rocket attacks over approximately 7 years, when the children were 2-4 (Time 1) and 9-11 years of age (Time 2). Measures included trauma exposure, posttraumatic and depressive symptoms, and child behavioral problems. We identified 4 longitudinal courses (LCs): resilient (resistance at Time 1 and Time 2), recovered (clinical distress at Time 1 and resistance at Time 2), developed symptoms (resistance at Time 1 and clinical distress at Time 2), and chronic distress (clinical distress at Time 1 and Time 2). Results showed more stability than change in the frequencies of resistance at both times of measurement. The resilient LC was the most common longitudinal course for both mothers and children. Multinomial regression models indicated that maternal posttraumatic symptoms predicted the recovered and chronic distress LCs of the children.

High school students' posttraumatic symptoms, substance abuse and involvement in violence in the aftermath of war

This study examined one-year after effects of exposure to war events on adolescents' Posttraumatic Stress Symptoms (PTS) and risk behaviors (substance use and involvement in school violence). In addition, it addressed two potential vulnerability factors: at the micro level, it examined whether childhood trauma raised the vulnerability of Israeli adolescents to PTS and risk behaviors when exposed to war events. At the macro level, we explored whether ethnicity, i.e., being an Israeli Arab, is a vulnerability factor to PTS and risk behaviors. We used a representative sample of 7th to 11th grade students from the north of Israel that included 4151 students: 1800 Jewish (54.4% boys) and 2351 Arab (41.5% boys). We assessed exposure to war events and childhood traumatic events, PTS and PTSD, substance use (alcohol, cannabis, Ecstasy) and involvement in school violence. The findings revealed extensive exposure to war events among both Jewish and Arab students. A year after the war, its effects on adolescents were still manifested in PTS, and involvement in school violence and substance use. Exposure to child physical abuse was associated with higher levels of PTS symptoms, substance use and involvement in violence. Exposure to other traumatic events was also associated with greater PTS symptoms and involvement in violence but not with greater substance use. Arab students were a more vulnerable population. They reported higher PTS symptoms, more cannabis use and greater involvement in school violence than Jewish students. However, exposure to war events had similar effects on both Arab and Jewish students. We conclude that war effects include a broad range of psychological distress and risk behaviors that last long after the war ends, especially among youth who have experienced childhood trauma and high exposure to war-related stressors.

Are community studies of psychological trauma's impact accurate? A study among Jews and Palestinians

We evaluated the accuracy of posttraumatic stress disorder (PTSD) and major depression (MD) diagnoses using brief assessment instruments conducted by phone. PTSD and MD were assessed by telephone interview in a randomly selected sample of Jewish and Palestinian residents of Jerusalem (N = 150) during a period of marked threat of terrorism and war. We utilized the PTSD Symptom Scale Interview Format (Foa, Riggs, Dancu, & Rothbaum, 1993) and the Patient Health Questionnaire-9 (PHQ-9; Kroenke, Spitzer, & Williams, 2001). We then conducted in-depth, in-person interviews within 2 weeks, assessing PTSD and MD using the Composite International Diagnostic Interview (CIDI; Kessler et al., 2004). The prevalence of PTSD and MD diagnosis ascertained by the 2 assessment modalities was similar. Indices of classification accuracy for the phone interview, using the in-person interview as the standard, ranged from modest to high. Brief phone and in-depth in-person measures of PTSD and MD also correlated similarly with other demographic, stress, and coping factors, suggesting convergent validity. Brief phone interviews appear useful for estimating the prevalence of psychological disorders in mass casualty contexts and may have a critical role in both epidemiologic work and guiding public health interventions.

The influence of war and terrorism on post-traumatic distress among Israeli children

The Middle East has been in conflict for many decades and wars have become the 'normative reality' of children residing in the area. Questions have been raised about children's vulnerability to the stresses that come with living in a war area. Are children more resilient because they are more flexible in their ways of coping? Or are children more vulnerable because their psychological development is influenced by the environment?

The influence of war and terrorism on posttraumatic distress among Israeli children

The Middle East has been in conflict for many decades and wars have become the ‘normative reality’ of children residing in the area. Questions have been raised about children's vulnerability to the stresses that come with living in a war area. Are children more resilient because they are more flexible in their ways of coping? Or are children more vulnerable because their psychological development is influenced by the environment?

Do adolescents know when they need help in the aftermath of war?

This study examined Israeli Arab and Jewish students' reports on needing help, a year after the Second Lebanon War and whether students' requests for support were associated with posttraumatic distress. The representative sample included 1,800 Jewish and 2,351 Arab students, grades 7-11. The questionnaires included items regarding (a) exposure to wartime events and other negative life events, (b) measures of posttraumatic stress disorder, and (c) needing help. The results showed that about 30% of the students reported needing help from any source (e.g., parents, peers) in the aftermath of the war. Arab students were more likely to report needing help than Jewish students. The students who reported needing help experienced higher levels of posttraumatic symptoms.

Dyadic coping among breast cancer patients treated with radiotherapy

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Background: Cancer poses a major stressor for patients and their partners. Understanding dyad coping is useful for determining if one partner's involvement is beneficial or harmful to the other. We sought to evaluate whether dyadic coping enhances resilience in the context of other risk and protective factors for coping with serious illness. Methods: An IRB-approved questionnaire was offered to breast cancer patients and their spouses. Consent was obtained from 21 dyads who were queried prior to initiation of breast irradiation and within 2 weeks of completing treatment. The nature of dyadic coping (positive or negative), level of posttraumatic stress, functional impairment, depression, and markers of resiliency were assessed for each partner at the beginning and conclusion of therapy. Results: Depression was significantly higher in patients than in their spouses (df = 1, 13; F = 6.13; p = 0.028). Over the course of the radiotherapy, partner's depression improved while the patient's depression worsened (df=1,13; F=5.46; p=0.030). The patient's negative dyadic coping assessment before radiation therapy was positively associated with depression (β = 0.78; df = 31.3; t = 2.15; p = 0.04), as well as the partner's depression (β = 0.92; df = 31.3; t = 2.52; p = 0.017) and posttraumatic stress (β = 0.74; df = 31.7; t = 2.10; p = 0.04). Patient's pre-radiation negative dyadic coping was negatively associated with the partner's flexibility (β = -.21; df = 19; t = -2.28; p = 0.03) and self efficacy (β = 0.46; df = 21.8; t = 2.96; p = 0.007) at completion of therapy. Positive dyadic coping assessment was not associated with negative coping behaviors on the part of either the patient or partner. Conclusions: The results of this pilot study support interventions incorporating dyadic support to enhance the resilience of patients and partners. Intervention should promote flexibility and self-efficacy while providing tools for altering negative dyadic coping patterns.

No significant financial relationships to disclose.

Involuntary outpatient commitment: a naturalistic study of its use and a consumer survey at one community mental health center in Israel

The following study assessed the efficacy of involuntary outpatient commitment in promoting treatment adherence and preventing hospitalization during and after a period of compulsory treatment in one community mental health center in Israel and evaluated the attitudes of patients and psychiatrists. All patients referred for involuntary outpatient commitment over a two year period (N = 26) were followed up for 3-5 years. After the termination of the commitment, the patient and psychiatrist were interviewed. Although only three patients had been in regular outpatient treatment before the commitment, fourteen remained in regular care during the commitment's duration and ten remained for a further two years. Comparing the follow-up period with the identical duration before the commitment, the number of hospitalizations and number of days hospitalized were significantly reduced. Fifteen were rehospitalized during follow-up. Thirteen patients were interviewed at the termination of the commitment, and nearly all perceived the commitment in negative terms, although eight did not think it had a negative effect on their relationship with the psychiatrist and six thought their opinions were respected. Six of the psychiatrists considered they were not giving optimum treatment. Despite the presence of the commitment, psychiatrists were often sensitive to patients' wishes and the involuntary aspect of the care was often not pursued. While half of the sample were lost to community care, half remained for several years. The study reflects the delicate nature of involuntary care in the community, so that in practice it is often not involuntary, not for outpatients and not a commitment.

Construct Validation of the Dutch Version of the Impact of Event Scale

The Impact of Event Scale (ES; M. J. Horowitz, N. Wilner, & W. Alvarez, 1979) is a worldwide-used self-report measure to assess the frequency of intrusive and avoidant phenomena after a variety of traumatic experiences. The purpose of this article is to assess the psychometric value of the Dutch version of the IES (D. Brom & R. J. Kleber, 1985) in several samples of individuals who had experienced various traumatic stressors. The reliability and structure of the IES were evaluated in 3 different samples (total N = 1.588). The reliability of the Dutch version of the IES was adequate across the various stressors. The construct validity was assessed by using confirmatory factor analyses. Outcomes revealed a robust structure over the various samples, generally supporting the composition of the original IES.

Trauma and dissociation in psychiatric outpatients

BACKGROUND

We investigated the prevalence of exposure to traumatic events, the prevalence of post-traumatic suffering and dissociative symptoms, and the relationship between type of trauma and dissociation in a large sample of outpatient adults (ages 18-65) seeking treatment at an urban ambulatory mental health clinic in Jerusalem (N = 298).

METHOD

Study participants completed self-report measures regarding trauma history, post-traumatic symptoms of intrusion and avoidance phenomena, and both psychological and somatic dissociative phenomena.

RESULTS

98% of our sample reported experiencing at least one lifetime traumatic event, 83% of subjects who completed the Impact of Events Scale reported high levels of intrusion and avoidance symptoms, and 15% of the sample reported high levels of dissociative phenomena. Elevated dissociation was associated with physical and sexual abuse, particularly early childhood abuse, as well as increased prevalence of lifetime traumatic events. Diagnoses did not reflect the high levels of post-traumatic and dissociative symptoms.

CONCLUSIONS

Our findings indicate the need for increased awareness and improved screening of traumatic exposure and its psychological impact upon psychiatric outpatients.

Trauma and traumatized populations in Israel: the Israel Journal of Psychiatry and Related Sciences, 1963-2002

In Europe and the U.S., awareness of interpersonal traumatization has disappeared and reappeared, seemingly connected to socio-historical conditions. The authors wanted to explore this phenomenon in Israel, a complex, multicultural, society that has yet to know peace. Content analysis of a professional journal, the Israel Journal of Psychiatry, was the method of choice. This journal has existed since the fifteenth year of Israel's existence and, because it is published in English, is in active dialogue with the rest of the world. Striking parallels were found between the timing and focus on traumas in the published articles and the socio-cultural context.

A controlled double-blind study on children of Holocaust survivors

The effects of the Holocaust on the offspring of survivors have remained unclear in discussions between clinicians, clinical researchers and empirical researchers. The authors report on a controlled double-blind study designed to test these effects using the sensitivity of clinicians to intrapsychic constellations and processes. The all female sample was randomly selected from several Jerusalem neighborhoods. The index subjects (n = 31), born between 1946 and 1960, had at least one parent (mother) who suffered persecution at the hands of the Nazi regime during WWII. The controls (N = 31), matched for age, educational status and birth order, were born to parents who had not lived under the occupation of the Nazi regime and had not suffered losses of close relatives in WWII. In-depth double-blind interviews, conducted by experienced psychodynamic psychotherapists, focused on personality characteristics without questioning individual development. The only measure used was a 48-item questionnaire completed by the therapists at the end of the interview. The study showed that daughters of Holocaust survivors are characterized by more problems in the realm of separation individuation issues. It also confirmed previous findings that the offspring of Holocaust survivors do not show more psychopathology than the general population.

Child survivors of the Holocaust: symptoms and coping after fifty years

Holocaust survivors who were children during WW II have now reached the age of 52 to 67. Until about 10 years ago their voices were barely heard in society. Their successful adaptation to life may have contributed to this invisibility. However, reaching this stage of life, which is associated with the need to review life and with the crises of retirement and renewed losses, has activated the survivors to deal with their childhood. The impossibility of avoiding traumatic memories and an urge to deal with them have also contributed to the societal process of the survivors organizing and speaking out. Very little is known about this group with regard to their mental health status and the way they cope with their childhood memories. The present controlled double-blind study uses a randomized nonclinical sample and focuses on the level of psychosocial and post-traumatic symptoms, on achievement motivation, and on the way child survivors perceive the surrounding world. The results indicate a slightly higher level of psychosocial symptoms in the child survivors group (CS) than in the control group, a high level of post-traumatic symptomatology, and achievement motivation based mainly on the fear of failure. Surprisingly, the child survivors group shows a pattern of more positive views of the world than does the control group. This can be understood as a greater need to compensate for the lack of security suffered in childhood by creating a meaningful world in a chaotic reality.

Nocturnal hallucinations in ultra-orthodox Jewish Israeli men

Hallucinations that occur predominantly at night are reported in 122 out of a sample of 302 ultra-orthodox Jewish Israeli men referred for psychiatric evaluation. Demographic data and the content of a semistructured interview in 302 ultra-orthodox Jewish young men seen over a 10-year period in Jerusalem were evaluated retrospectively by two researchers. Of the 302 subjects, 122 reported hallucinations predominantly at night, 23 reported hallucinations with no diurnal variation, and 157 did not report hallucinations. Most of those with nocturnal hallucinations were in their late teens, were seen only once or twice, were brought in order to receive an evaluation letter for the Army, and had a reported history of serious learning difficulties. The nocturnal hallucinatory experiences were predominantly visual, and the images were frightening figures from daily life or from folklore. Many of the subjects were withdrawn, monosyllabic, reluctant interviewees. Ultra-orthodox Jewish beliefs include a belief in demons, particularly of dead souls, who visit at night. This cultural group's value on study at Yeshivas away from home places significant pressure on teenage boys with mild or definite subnormality, possibly precipitating the phenomenon at this age in this sex. Although malingering had to be considered as a possible explanation in many cases owing to the circumstances of the evaluation, short-term and long-term follow-up on a limited sample allowed this explanation to be dismissed in a significant number of cases. We suggest therefore that nocturnal hallucinations are a culture-specific phenomenon.

The association between attitudes toward suicide and suicidal ideation in adolescents

The aims of this study were to determine whether adolescent attitudes to suicide could be grouped into distinct factors, and then to examine the relationship between these factors and the psychosocial parameters known to be associated with suicide, and between attitudes towards suicide and suicidal ideation. A questionnaire designed to assess attitudes to suicide was distributed to a total of 525 Israeli adolescents. Statistical analysis indicated that the attitude items could be grouped into four distinct factors: the right of society to prevent suicide; suicide as a symptom of mental illness; the right of the individual to talk about suicide; and taking suicidal behaviour seriously. Each factor was differentially associated with the various psychosocial parameters examined. The association between the attitude factors and subjects' suicidal ideation was significant and at least as strong as that of the psychosocial parameters normally associated with adolescent suicide, namely gender and exposure to suicide. A generally approving attitude towards suicide was correlated with a high level of suicidal ideation.

Victims of traffic accidents: incidence and prevention of post-traumatic stress disorder

The psychological consequences of traffic accidents have been rarely the subject of research. Responses of serious traffic accidents and the effects of an outreach program for victims were studied in a research project. Subjects selected from police registers participated in a preventive counseling program or in a monitoring group. Foci of this study were the way in which the subjects coped with the event and the symptoms that might develop. Measurements were carried out 1 month and 6 months after the accident. The results indicate that an average of about 10% of the victims suffer from post-traumatic stress disorders and that although counseling is appreciated by victims, it could not be proven that it was effective in preventing disorders.

The Patient Rejection Scale in an Israeli sample: correlations with relapse and physician's assessment

The Patient Rejection Scale (PRS), which was developed to assess the feelings of rejection that relatives experience toward mental patients, was administered to a sample of 50 family members living with schizophrenic outpatients in Jerusalem, Israel. PRS response distribution was similar to that reported for a New York City sample. Total rejection scores were significantly correlated with a number of demographic variables and with the treating physician's assessment of the degree of rejection, hostility and criticism of the respective family members. Physician's rating of emotional over-involvement did not correlate with PRS scores. Both PRS and treating physician's ratings correlated significantly with course of illness parameters. The findings and their implications are discussed in the context of expressed emotion (EE) research.

Psychiatric hospitalization of tourists in Jerusalem

Every year some 50 tourists visiting Jerusalem are hospitalized following psychotic episodes. The majority of these patients are from religious backgrounds, and Jerusalem's special place in the Jewish and Christian religions appears to influence the nature of the delusionary experiences. This report examines the factors involved in this phenomenon.

Brief psychotherapy for posttraumatic stress disorders

A large-scale study of the effectiveness of psychotherapeutic methods for the treatment of posttraumatic stress disorders was conducted. The sample consisted of 112 persons suffering from serious disorders resulting from traumatic events (bereavement, acts of violence, and traffic accidents) that had taken place not more than 5 years before. Trauma desensitization, hypnotherapy, and psychodynamic therapy were tested for their effectiveness in comparison with a waiting-list control group. The results indicated that treated cases were significantly lower in trauma-related symptoms than the control group.

Brief psychotherapy for posttraumatic stress disorders

A large-scale study of the effectiveness of psychotherapeutic methods for the treatment of posttraumatic stress disorders was conducted. The sample consisted of 112 persons suffering from serious disorders resulting from traumatic events (bereavement, acts of violence, and traffic accidents) that had taken place not more than 5 years before. Trauma desensitization, hypnotherapy, and psychodynamic therapy were tested for their effectiveness in comparison with a waiting-list control group. The results indicated that treated cases were significantly lower in trauma-related symptoms than the control group.