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Horesh D, Lahav Y. When one tool is not enough: An integrative psychotherapeutic approach to treating complex PTSD. J Clin Psychol 2024. [PMID: 38577793 DOI: 10.1002/jclp.23688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
Complex posttraumatic stress disorder (CPTSD) is a term representing the psychopathological implications of exposure to chronic, inter-personal trauma. These include the main symptoms of PTSD, as well as changes in identity, emotion regulation, and inter-personal relationships. Self-harm and dissociation (i.e., disintegration of mental processes) are also quite common in CPTSD. Considering this complex and often severe clinical picture, mental health professionals often find it difficult to effectively treat CPTSD. In this paper, we present an integrative approach to the treatment of CPTSD based on a combination of techniques from several psychotherapy approaches. The case described here illustrates the need for therapeutic flexibility and eclecticism when treating individuals exposed to chronic trauma. We show the advantages of flexible therapeutic attunement, which enables the therapist to respond to the changing need of the patient, as well as her fluid clinical picture and symptom manifestation. The case also illustrates how interventions taken from psychodynamic therapy, Dialectical behavior therapy, and Eye Movement Desensitization and Reprocessing may be applicable in various stages of treatment, alleviating the patient's distress in several psychological and physical domains.
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
- Department of Psychiatry, Grossman School of Medicine, New York University, New York, New York, USA
| | - Yael Lahav
- Department of Occupational Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Helpman L, Saragosti GY, Oberman M, Avrahami I, Horesh D. Creating new life while lives are lost: birth in the face of war in Israel after the October 7 attacks. J Reprod Infant Psychol 2024:1-4. [PMID: 38571366 DOI: 10.1080/02646838.2024.2335782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Affiliation(s)
- Liat Helpman
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
- Israeli Society of Psychosomatic Obstetrics and Gynecology, Israel
| | - Gili Yovel Saragosti
- Israeli Society of Psychosomatic Obstetrics and Gynecology, Israel
- Tel Aviv Sourasky Medical Center, Lis Maternity & Women's Hospital, Tel Aviv, Israel
| | - Maya Oberman
- Israeli Society of Psychosomatic Obstetrics and Gynecology, Israel
- Kaplan Medical Center, Department of Obstetrics and Gynecology, Rehovot, Israel
| | - Inbal Avrahami
- Israeli Society of Psychosomatic Obstetrics and Gynecology, Israel
- Kaplan Medical Center, Department of Obstetrics and Gynecology, Rehovot, Israel
| | - Danny Horesh
- Israeli Society of Psychosomatic Obstetrics and Gynecology, Israel
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
- Grossman School of Medicine, Department of Psychiatry, New York University, New York, NY, USA
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Hasson-Ohayon I, Horesh D. A unique combination of horror and longing: Traumatic grief in post-October 7, 2023, Israel. J Trauma Stress 2024; 37:348-351. [PMID: 38487945 DOI: 10.1002/jts.23026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 04/04/2024]
Abstract
On October 7, 2023 (10/7), Hamas militants brutally attacked Israeli towns and villages surrounding the Gaza Strip, resulting in the killing of more than 1100 people, most of whom were civilians slaughtered in their own homes. The killings occurred under highly traumatic circumstances, including shooting, the burning of homes, hunting down people who attempted to escape, and severe sexual assault. Thus, many Israelis today experience a unique mix of both posttraumatic and severe grief reactions. Traumatic grief (TG) is often defined as a condition that results from the death of a significant other and includes symptoms similar to posttraumatic stress disorder (PTSD) that are specifically related to the deceased, such as intrusive thoughts and memories about the deceased and hypervigilance expressed by constantly looking for them or cues associated with them. However, whereas definitions, phenomenological descriptions, and clinical illustrations of PTSD are abundant and widely validated, TG has yet to receive formal diagnostic status. In this paper, we aim to reexamine TG in the context of post-10/7 Israel. We argue that TG is a critical concept for clinicians working in Israel and other conflict-exposed areas of the world today, as it accurately captures the painful mix of grief- and trauma-related symptoms. We also suggest potential explanations for the lack of acknowledgment of TG as a formal diagnosis and discuss the possible role of historical events in the formation of new, relevant psychiatric diagnoses.
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Affiliation(s)
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
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Seefeld L, Handelzalts JE, Horesh D, Horsch A, Ayers S, Dikmen-Yildiz P, Kömürcü Akik B, Garthus-Niegel S. Going through it together: Dyadic associations between parents' birth experience, relationship satisfaction, and mental health. J Affect Disord 2024; 348:378-388. [PMID: 38154585 DOI: 10.1016/j.jad.2023.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/27/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Previous research suggests that a negative birth experience is associated with symptoms of postpartum depression and anxiety in mothers and partners. However, this has mostly been investigated within the first year postpartum and research on the long-term effects is lacking. Additionally, the role of relationship satisfaction and the interdependence between parents have not been considered so far. METHODS Couples (N = 1992) completed questionnaires on their birth experience, relationship satisfaction, and symptoms of depression and anxiety at two months, 14 months, and two years after birth, respectively. RESULTS Actor-Partner Interdependence Mediation Models indicated no partner effects, but several significant actor and indirect effects. A more positive birth experience was associated with higher relationship satisfaction and less depression and anxiety symptoms for both parents. Higher relationship satisfaction was in turn associated with less depression (mothers and partners) and anxiety symptoms (mothers). The association between birth experience and depression symptoms was partially mediated by relationship satisfaction for mothers and partners, while the association between birth experience and anxiety symptoms was partially mediated by relationship satisfaction only for mothers. LIMITATIONS Due to the highly educated, very healthy sample with low levels of depression and anxiety as well as high relationship satisfaction, results cannot be generalized to less privileged parents. Moreover, all effects were very small. CONCLUSIONS Results highlight the importance of a positive birth experience for parents' relationship satisfaction and mental health. Negative birth experiences need to be avoided to prevent a negative impact on the whole family.
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Affiliation(s)
- Lara Seefeld
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine Technische Universität Dresden, Dresden, Germany; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine Technische Universität Dresden, Dresden, Germany.
| | - Jonathan E Handelzalts
- School of Behavioral Sciences, The Academic College of Tel-Aviv Yaffo, Tel-Aviv, Israel; Psychiatry Department, University of Michigan, Ann Arbor, MI, USA
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel; Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland; Department Woman-mother-child, Lausanne University Hospital, Lausanne, Switzerland
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | | | - Burcu Kömürcü Akik
- Department of Psychology, Faculty of Languages and History-Geography, Ankara University, Ankara, Turkey
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine Technische Universität Dresden, Dresden, Germany; Institute for Systems Medicine (ISM) and Faculty of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany; Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
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Zaks I, Dekel R, Zuckerman YS, Horesh D. Study protocol: A multimethod psychophysiological randomized controlled trial of a couple therapy for post-traumatic stress disorder. Contemp Clin Trials 2023; 132:107280. [PMID: 37419309 DOI: 10.1016/j.cct.2023.107280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/25/2023] [Accepted: 07/03/2023] [Indexed: 07/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) sequelae often have ripple effects on victims' families and spouses. Yet there has been a lag in the development and study of couple therapy for PTSD. To fill this gap, we present here a protocol for a study examining the efficacy of Cognitive Behavioral Conjoint Therapy (CBCT), a 15- session couple therapy protocol meant to alleviate PTSD and improve relationship satisfaction, in the Israeli context. The study will be a randomized controlled trial examining outcomes and processes of change via self-report questionnaires, qualitative interviews, and physiological measures (e.g., both partners' heart rate variability and electrodermal activity). We will employ a modified remote treatment protocol via video conferencing. The study will examine whether there is a reduction in couples' levels of symptomatic, emotional, and behavioral difficulties following CBCT and whether relationship satisfaction and couples' physiological synchrony increases. The study will also examine physiological and psychological change mechanisms in CBCT. Sixty Israeli couples (n = 120) will be randomly assigned to either a CBCT group or a wait-list control group. Outcomes will be assessed at four timepoints: before treatment, during treatment, post-treatment, and four months after treatment. The proposed study has the potential to shed light on the unique psychological and physiological mechanisms underlying CBCT and will be the first RCT study to employ this unique methodology in CBCT research, particularly in a video conferencing setting. This study may increase our ability to offer effective, cost-efficient, and attainable treatments for patients with PTSD and their spouses.
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Affiliation(s)
- Ilil Zaks
- Bar-Ilan University, Department of Psychology, Ramat Gan 590002, Israel.
| | - Rachel Dekel
- Bar-Ilan University School of Social Work, Ramat Gan 590002, Israel.
| | | | - Danny Horesh
- Bar-Ilan University, Department of Psychology, Ramat Gan 590002, Israel; Grossman School of Medicine, Department of Psychiatry, New York University, 550 First Avenue, New York, NY 10016, USA.
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Baumann S, Staudt A, Horesh D, Eberhard-Gran M, Garthus-Niegel S, Horsch A. Perineal tear and childbirth-related posttraumatic stress: A prospective cohort study. Acta Psychiatr Scand 2023. [PMID: 37550260 DOI: 10.1111/acps.13595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/03/2023] [Accepted: 07/15/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE Quantitative studies examining the occurrence of childbirth-related posttraumatic stress disorder (CB-PTSD) following severe perineal rupture are lacking. The objective of this population-based study was to investigate the prospective associations between the degree of perineal tear during childbirth and CB-PTSD symptoms, when adjusting for known covariates (maternal age, years of school education, premature birth, and parity). We hypothesized that women with different degrees of perineal tear will differ regarding (1) the level of CB-PTSD symptoms at 8 weeks and 2 years postpartum and (2) the rate of change in CB-PTSD symptoms from 8 weeks to 2 years postpartum. METHOD Secondary data analysis from the Akershus Birth Cohort, a large population-based prospective cohort study using self-report questionnaires and hospital record data. RESULTS The degree of perineal tear was significantly associated with CB-PTSD symptoms at 8 weeks and 2 years postpartum. However, the degree of perineal tear was not significantly associated with the change in CB-PTSD symptoms over time. Similar patterns were found for both total CB-PTSD symptoms as well as for avoidance and intrusion symptoms only. CONCLUSION Results seem to support a dose-response model, suggesting that the higher the severity of the perineal tear, the higher the posttraumatic morbidity.
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Affiliation(s)
- Sophie Baumann
- Faculty of Medicine, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Methods in Community Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Andreas Staudt
- Faculty of Medicine, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Methods in Community Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
- Department of Psychiatry, NYU Grossman School of Medicine, New York City, New York, USA
| | - Malin Eberhard-Gran
- Women and Children's Division, Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Susan Garthus-Niegel
- Faculty of Medicine, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
- Faculty of Medicine, Medical School Hamburg, Institute for Systems Medicine (ISM), Hamburg, Germany
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
- Department Woman-mother-child, Lausanne University Hospital, Lausanne, Switzerland
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Frumer L, Marom Harel H, Horesh D. Why Does It Hurt So Much? Emotion Regulation Mediates the Association between Fibromyalgia Symptoms and Psychological Distress. Healthcare (Basel) 2023; 11:healthcare11101368. [PMID: 37239659 DOI: 10.3390/healthcare11101368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
While it is known that fibromyalgia patients often suffer from depression and stress symptoms, there is inconclusive evidence as to why these symptoms occur. The aim of this study is to examine the role of emotion regulation in mental health symptoms among treatment-seeking individuals with fibromyalgia. Ninety-three (93) participants (mean age = 47.25, SD = 12.4) were recruited from one of Israel's largest community healthcare providers. They were administered self-report questionnaires assessing fibromyalgia (FIQR), perceived stress (PSS), major depression (PHQ-9), and difficulties in emotion regulation (DERS). Associations were found between measures of fibromyalgia symptoms, psychological distress, and emotion regulation. Several sub-indices of emotion regulation showed significant correlations with psychological distress, with non-acceptance of emotional responses showing the strongest associations. Moreover, non-acceptance of emotion responses mediated the association between fibromyalgia symptoms and psychological distress. Our findings show that the connection between fibromyalgia symptoms and psychological distress is partially explained by difficulties in emotion regulation. Moreover, we show that specific emotion regulation strategies play a differential role in fibromyalgia patients' distress, thereby highlighting the importance of identifying unique psychotherapeutic targets. Specifically, regulating emotions through acceptance of emotional responses seems to be particularly important for fibromyalgia patients, as they cope with stigma and a lack of validation.
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Affiliation(s)
- Lee Frumer
- Department of Psychology, Bar-Ilan University, Ramat-Gan 5290002, Israel
| | | | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan 5290002, Israel
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, USA
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Sadeh DF, Frenk ML, Simha T, Horesh D, Steinberg T, Geva N, Nahon M, Dietrich A, Hoekstra PJ, Ruhrman D, Apter A, Fennig S, Benaroya-Milshtein N. Moderating Role of Depression on the Association of Tic Severity With Functional Impairment in Children. Pediatr Neurol 2023; 144:90-96. [PMID: 37196601 DOI: 10.1016/j.pediatrneurol.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Chronic tic disorders (CTDs) commonly co-occur with other psychiatric disorders. CTDs have been linked to functional impairment and reduction in quality of life. Insufficient research is available on depressive symptoms in patients with CTD, especially children and adolescents, yielding conflicting findings. To investigate the presence of depressive symptoms in a cohort of children and young adolescents with CTD and to test whether they moderate the link between tic severity and functional impairment. METHODS The sample consisted of 85 children and adolescents (six to 18 years) with a CTD who were treated in a large referral center. Participants were evaluated using gold-standard self- and clinician-reporting instruments to measure tic symptom severity and tic-related functional impairment (Yale Global Tic Severity Scale), depression (Child Depression Inventory), and obsessive-compulsive symptoms (Children Yale Brown Obsessive Compulsive Scale). RESULTS Depressive symptoms (mild to severe) were exhibited by 21% of our sample. Study participants with CTD and comorbid obsessive-compulsive disorder (OCD) and/or attention-deficit/hyperactivity disorder had higher rates of depressive symptoms compared with those without comorbidities. Significant correlations were found within and among all tic-related and OCD-related measures, yet depressive symptoms only correlated to tic-related functional impairment. Depression significantly and positively moderated the correlation between tic severity and tic-related functional impairment. CONCLUSIONS Findings suggest that depression plays an important part as a moderator in the link between tic severity and functional impairment in children and adolescents. Our study highlights the importance of screening for and treating depression in patients with CTD.
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Affiliation(s)
- Dana Feldman Sadeh
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel
| | - Mira Levis Frenk
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel
| | - Tomer Simha
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel
| | - Danny Horesh
- Department of Psychology, Faculty of Social Science, Bar-Ilan University, Ramat Gan, Israel; Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Tamar Steinberg
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nofar Geva
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel
| | - Matan Nahon
- Department of Psychology, Faculty of Social Science, Bar-Ilan University, Ramat Gan, Israel
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daphna Ruhrman
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel; Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Alan Apter
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Silvana Fennig
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Benaroya-Milshtein
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Staudt A, Baumann S, Horesh D, Eberhard-Gran M, Horsch A, Garthus-Niegel S. Predictors and comorbidity patterns of maternal birth-related posttraumatic stress symptoms: A Latent Class Analysis. Psychiatry Res 2023; 320:115038. [PMID: 36603381 DOI: 10.1016/j.psychres.2022.115038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/08/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
Birth-related posttraumatic stress symptoms (PTSS) place a significant burden on mothers and their families. The aim was to (1) identify differential profiles of maternal birth-related PTSS; (2) determine the predictive value of established risk factors; (3) examine comorbidity patterns related to depression and anxiety symptoms. As part of the Norwegian Ahus Birth Cohort, 2,088 (expectant) mothers completed self-report questionnaires from 17 weeks of gestation to 2 years postpartum. The Impact of Event Scale was used to assess PTSS 8 weeks after birth. Latent class analysis revealed four latent classes: a High birth-related PTSS class (4%), a Moderate birth-related PTSS class (16%) particularly characterized by endorsement of intrusion symptoms, a Mild birth-related PTSS class (47%), as well as a No birth-related PTSS class (33%). We found similar (younger age, worse subjective birth experience, higher fear of childbirth) and differential predictors (prior posttraumatic stress disorder, lower education, birth complications). Women classified with High, Moderate, or Mild birth-related PTSS showed higher depression and anxiety symptoms compared to women with No birth-related PTSS. A considerable number of mothers experienced birth-related PTSS, most on a subclinical level, but these women still showed signs of mental distress 2 years postpartum, calling for more universal prevention approaches.
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Affiliation(s)
- Andreas Staudt
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany; Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.
| | - Sophie Baumann
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany; Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel; Department of Psychiatry, NYU Grossman School of Medicine, New York, USA
| | - Malin Eberhard-Gran
- Norwegian Research Centre for Women's Health, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland; Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany; Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
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Horesh D, Kohavi S, Shilony-Nalaboff L, Rudich N, Greenman D, Feuerstein JS, Abbasi MR. Virtual Reality Combined with Artificial Intelligence (VR-AI) Reduces Hot Flashes and Improves Psychological Well-Being in Women with Breast and Ovarian Cancer: A Pilot Study. Healthcare (Basel) 2022; 10:2261. [PMID: 36421585 PMCID: PMC9690775 DOI: 10.3390/healthcare10112261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND AND AIMS Breast and ovarian cancers affect the lives of many women worldwide. Female cancer survivors often experience hot flashes, a subjective sensation of heat associated with objective signs of cutaneous vasodilatation and a subsequent drop in core temperature. Breast and Ovarian cancer patients also suffer from sleep difficulties and mental health issues. The present study aimed to assess the effectiveness of Bubble, a novel artificial intelligence-virtual reality (AI-VR) intervention for the treatment of hot flashes in female breast or ovarian cancer patients. METHODS Forty-two women with breast and/or ovarian cancer participated in the study. The mean age was 47 years (range: 25-60 years). Patients suffered from hot flashes at different frequencies. They used Bubble, a virtual reality (VR) mobile psychological intervention based on elements from both cognitive behavioral therapy and mindfulness-based stress reduction. The intervention took place in a VR environment, in a winter wonderland setting called Frosty. Patients were instructed to use Bubble at home twice a day (morning and evening) and when experiencing a hot flash. Participants were asked to use the application for 24 consecutive days. Before and after this 24-day period, patients completed self-report questionnaires assessing hot flashes, general psychiatric distress, perceived stress, illness perception, sleep quality, and quality of life. RESULTS Between pre- and post-intervention, participants reported a significant reduction in the daily frequency of hot flashes, stress, general psychiatric distress, several domains of QOL, and sleep difficulties, as well as an improvement in illness perception. In addition, they reported very high satisfaction with Bubble. Importantly, both age and baseline levels of psychopathology moderated the effect of Bubble on sleep difficulties. DISCUSSION This study showed preliminary evidence for the potential of VR interventions in alleviating hot flashes and accompanying mental distress among those coping with breast and ovarian cancer. VR is a powerful therapeutic tool, able to address mind-body aspects in a direct, vivid way. More studies are needed in order to fully understand the potential of this unique intervention.
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar Ilan University, Ramat Gan 5290002, Israel
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Shaked Kohavi
- Department of Psychology, Bar Ilan University, Ramat Gan 5290002, Israel
| | | | | | - Danielle Greenman
- Department of Medicine, Columbia University, New York, NY 10016, USA
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Negri O, Horesh D, Gordon I, Hasson-Ohayon I. Searching for Certainty During a Pandemic: A Longitudinal Investigation of the Moderating Role of Media Consumption on the Development of Posttraumatic Stress Symptoms During COVID-19. J Nerv Ment Dis 2022; 210:672-679. [PMID: 35394974 PMCID: PMC9426309 DOI: 10.1097/nmd.0000000000001518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The current study longitudinally examined the moderating effects of consuming different types of media ( i.e. , formal [news] and informal [social media, WhatsApp]) in the association among COVID-19-related worries, intolerance of uncertainty (IU), and posttraumatic stress symptoms (PTSSs). Data were collected at two time points during July and September 2020, with approximately 60 days between measurements. Results showed that both COVID-19-related worries and IU were found to be positively associated with PTSSs. An interaction with formal media consumption was found, so that when one's formal media consumption was high, he or she were most vulnerable to the aforementioned effects on the development of PTSSs. Our findings point to the interactive effects of both COVID-19 worries and IU with media consumption on the development of PTSSs. Although media consumption might provide information during uncertainty, it may also intensify PTSSs during times of crisis. Implications and limitations are discussed.
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Affiliation(s)
- Ofir Negri
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
- Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Ilanit Gordon
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
- Gonda Brain Sciences Center, Bar-Ilan University, Ramat-Gan, Israel
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12
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Mayo O, Horesh D, Korisky A, Milstein N, Zadok E, Tomashin A, Gordon I. I feel you: Prepandemic physiological synchrony and emotional contagion during COVID-19. Emotion 2022; 23:753-763. [PMID: 35913856 DOI: 10.1037/emo0001122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The COVID-19 pandemic has a major impact on mental well-being and interpersonal relationships. Nonetheless, little is known about the complex interactions between one's overall perceived interpersonal closeness and physiological or psychological aspects of interpersonal functioning. This study aimed to understand the interaction between perceived interpersonal closeness during COVID-19 and interpersonal mechanisms in predicting well-being. We focused on two interpersonal mechanisms, one physiological and the other psychological: (a) prepandemic physiological synchrony, a physiological measure of interpersonal coupling, and (b) peripandemic emotional contagion, one's tendency to "catch" others' emotions. One hundred fifty-five participants took part in the study. Cardiological interbeat interval synchrony was collected 1.5 to 3 years prior to the beginning of the COVID pandemic in two previous lab studies. Participants were recontacted during the pandemic, this time to complete several questionnaires tapping into perceived interpersonal closeness, tendency for emotional contagion, and psychological well-being during COVID. As hypothesized, overall perceived interpersonal closeness was positively related to well-being. Moreover, this effect was moderated by one's tendency for emotional contagion or by physiological synchrony. Thus, individuals with higher emotional contagion scores or higher physiological synchrony had higher well-being if their interpersonal closeness was perceived as greater. Conversely, their well-being was lower if they perceived their interpersonal closeness as weaker. These results emphasize that individuals may be differentially susceptible to the effects of their relationships on their well-being. Future mental health interventions should consider both the quality of one's perceived interpersonal closeness and the extent to which one is sensitive to others' emotional experiences. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | - Adi Korisky
- Gonda Multidisciplinary Brain Research Center
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13
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Zerach G, Horesh D, Solomon Z. Secondary posttraumatic stress symptom trajectories and perceived health among spouses of war veterans: a 12-year longitudinal study. Psychol Health 2022; 37:675-691. [PMID: 33626993 DOI: 10.1080/08870446.2021.1879807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE War-related trauma may indirectly affect veterans' spouses both in terms of secondary posttraumatic stress symptoms (PTSS) and negative perceived health. The present study aimed to examine trajectories of secondary PTSS over a twelve-year period and its association with various measures of subjectively perceived health, among spouses of war veterans. METHODS Spouses of war veterans (n = 155) were assessed prospectively 30 (T1, 2003), 37 (T2, 2010), and 42 (T3, 2015) years after the 1973 Yom Kippur War. Participants completed self-report questionnaires of PTSS (PTSD inventory) in all three measurement waves, while perceived health measures (Short-Form Health Survey-SF-36) were assessed only at T3. RESULTS Most spouses were classified to the 'resilient' trajectory with low and stable secondary PTSS over time, followed by recovered, chronic, and delayed onset PTSS trajectories. Importantly, spouses in the 'chronic' and 'delayed' secondary PTSS trajectories reported a higher severity of general negative subjective health perceptions and health-related social malfunctioning. CONCLUSION Veterans' spouses who were grouped in the 'chronic' and 'delayed' PTSS trajectories are to be considered as at-risk populations for both PTSS and negative perceived health perceptions. Mental health professionals as well as family physicians should be aware of the ongoing nature of secondary PTSS which might negatively affect veterans' spouses medical conditions and ability to cope with the aging process.
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Affiliation(s)
- Gadi Zerach
- Department of Behavioral Sciences and Psychology, Ariel University, Ariel, Israel
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Zahava Solomon
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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14
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Heyne CS, Kazmierczak M, Souday R, Horesh D, den Berg MLV, Weigl T, Horsch A, Oosterman M, Dikmen-Yildiz P, Garthus-Niegel S. Prevalence and risk factors of birth-related posttraumatic stress among parents: A comparative systematic review and meta-analysis. Clin Psychol Rev 2022; 94:102157. [DOI: 10.1016/j.cpr.2022.102157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 02/05/2022] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
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15
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Horesh D, Milstein N, Tomashin A, Mayo O, Gordon I. Pre-pandemic electrodermal activity predicts current COVID-related fears: household size during lockdown as a moderating factor. Stress 2022; 25:22-29. [PMID: 34812098 DOI: 10.1080/10253890.2021.2006179] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Despite the immense impact of COVID-19 on mental health, there is a lack of prospective studies examining physiological predictors of current risk factors. Moreover, although physiological processes evidently interact with socio-demographic factors to modulate individuals' response to a crisis, it remains largely unknown how these complex interactions shape people's mental responses to COVID-19. To fill these gaps of knowledge, we chose a potent physiological marker of distress - heightened baseline electrodermal activity (EDA) measured before the pandemic began - and hypothesized it would be related to greater COVID-related fears and worries as a function of individuals' household size.Method: 185 individuals (71% women), who had participated in our lab studies 2-3 years ago, in which we assessed their baseline EDA, completed several questionnaires online, including assessments of their current fears regarding COVID. Participants also reported the number of people in their household, with whom they had been together during a lockdown which was taking place at the time. We used pre-pandemic EDA measures in combination with their household size to predict participants' current fears.Results: Pre-pandemic EDA measures predicted current COVID-related fears and worries. Specifically for the EDA measure "number of skin conductance responses", we further found that the number of people in the household during the lockdown, moderated the abovementioned relationship, such that it occurred in individuals with average and larger households and not in those with small households.Conclusions: We provide a highly relevant and unique combination of physiological, socio-demographic, and psychological measures, which augments the potential to optimally target populations vulnerable to COVID-related distress, and subsequently offer them early mental health interventions.
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Nir Milstein
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Alon Tomashin
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
- The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat-Gan, Israel
| | - Oded Mayo
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Ilanit Gordon
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
- The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat-Gan, Israel
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16
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Horesh D, Hasson-Ohayon I, Harwood-Gross A. The Contagion of Psychopathology across Different Psychiatric Disorders: A Comparative Theoretical Analysis. Brain Sci 2021; 12:67. [PMID: 35053808 PMCID: PMC8774068 DOI: 10.3390/brainsci12010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Psychopathology is often studied and treated from an individual-centered approach. However, studies have shown that psychological distress is often best understood from a contextual, environmental perspective. This paper explores the literature on emotional contagion and symptom transmission in psychopathology, i.e., the complex ways in which one person's psychological distress may yield symptoms among others in his/her close environment. We argue that emotions, cognitions, and behaviors often do not stay within the borders of the individual, but rather represent intricate dynamic experiences that are shared by individuals, as well as transmitted between them. While this claim was comprehensively studied in the context of some disorders (e.g., secondary traumatization and the "mimicking" of symptoms among those close to a trauma survivor), it was very scarcely examined in the context of others. We aim to bridge this gap in knowledge by examining the literature on symptom transmission across four distinct psychiatric disorders: PTSD, major depression, OCD, and psychosis. We first review the literature on emotional contagion in each disorder separately, and then we subsequently conduct a comparative analysis highlighting the shared and differential mechanisms underlying these processes in all four disorders. In this era of transdiagnostic conceptualizations of psychopathology, such an examination is timely, and it may carry important clinical implications.
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan 5290002, Israel; (I.H.-O.); (A.H.-G.)
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Ilanit Hasson-Ohayon
- Department of Psychology, Bar-Ilan University, Ramat Gan 5290002, Israel; (I.H.-O.); (A.H.-G.)
| | - Anna Harwood-Gross
- Department of Psychology, Bar-Ilan University, Ramat Gan 5290002, Israel; (I.H.-O.); (A.H.-G.)
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17
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Dekel R, Solomon Z, Horesh D. Predicting secondary posttraumatic stress symptoms among spouses of veterans: Veteran's distress or spouse's perception of that distress? Psychol Trauma 2021; 15:2022-08961-001. [PMID: 34855436 DOI: 10.1037/tra0001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE There is a relatively wide consensus that veterans' posttraumatic stress symptoms (PTSS) may lead to the development of secondary traumatization (ST) among their spouses. However, there is limited knowledge about the way the ST develops over time, as well as its predictors. The current longitudinal study examined ST trajectories among spouses of Israeli war veterans with PTSS, as well as the contribution of veterans' PTSS and wives' assessment of veterans' PTSS to these trajectories. METHOD Data were collected from both spouses at 3 time points, 30, 35-37, and 42 years after the 1973 Yom Kippur War (2003, 2008-2010, and 2015, respectively). RESULTS Using multiple-group Latent Class Growth Analysis (LCGA), we identified 4 distinct ST trajectories. The majority of wives (68%) were in the resilient group, 12% were in the recovery group, approximately 10% were in the chronic PTSS group and another 10% were in the delayed-onset group. Multinomial regressions revealed that veterans' PTSS predicted the 4 different trajectories among their wives. In addition, wives in the recovery and chronic groups who perceived their veteran husbands' PTSS to be higher also reported higher ST. CONCLUSIONS This study highlights the complexity of the development of ST trajectories over time. Findings supports the idea of PTSS contagion, and reveals the contributing role of both objective and perceived levels of veterans' PTSS in ST. Therefore, implementing interventions aimed at alleviating both individual and couple-level distress may be warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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18
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Gordon I, Horesh D, Milstein N, Tomashin A, Mayo O, Korisky A. Pre-pandemic autonomic nervous system activity predicts mood regulation expectancies during COVID-19 in Israel. Psychophysiology 2021; 58:e13910. [PMID: 34329495 PMCID: PMC8420474 DOI: 10.1111/psyp.13910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022]
Abstract
Despite the unfolding impact of the COVID‐19 pandemic on psychological well‐being, there is a lack of prospective studies that target physiological markers of distress. There is a need to examine physiological predictors from the pre‐pandemic period to identify and treat individuals at‐risk. In this study, our aim was to use pre‐pandemic markers of autonomic nervous system (ANS) parasympathetic and sympathetic regulation to predict individuals' psychological well‐being during the crisis. We also assessed the role of mood regulation expectancies as a mediator of the association between pre‐pandemic physiological measures and COVID‐related well‐being. In May to June 2020, 185 Israeli adults completed online questionnaires assessing their mood regulation expectancies since COVID‐19 began, and their current well‐being. These individuals had participated in lab studies 1.5–3 years prior to this assessment, where their physiological measures were taken, including respiratory sinus arrhythmia (RSA) and skin conductance level (SCL). RSA was positively related to mood regulation expectancies during COVID‐19 (b = 3.46, 95% CI [0.84, 6.05]). Mood regulation expectancies, in turn, positively predicted well‐being during the crisis (b = 0.021, 95% CI [0.016, 0.027]). The mediation was significant and moderated by SCL (index = −0.09, 95% CI [−0.02, −0.0001]), such that it was strongest for individuals with low SCL. We point to pre‐pandemic physiological mechanisms underlying individuals' mental well‐being during the COVID‐19 pandemic. These findings have theoretical, diagnostic, and clinical implications that may refine our understanding of the physiological basis of resilience to the COVID‐19 pandemic and thus may be implemented to identify and assist individuals in these times. Our study offers a unique psychophysiological approach to predicting mood regulation and mental well‐being during COVID‐19 from pre‐pandemic resting physiological activity. We show that pre‐pandemic markers of the autonomic nervous system, which were collected during routine 2–3 years prior to the pandemic, allow us to prospectively understand emotion regulation and well‐being during COVID‐19.
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Affiliation(s)
- Ilanit Gordon
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel.,The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat-Gan, Israel
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel.,Department of Psychiatry, Grossman School of Medicine, New York University, New York, NY, USA
| | - Nir Milstein
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Alon Tomashin
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel.,The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat-Gan, Israel
| | - Oded Mayo
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Adi Korisky
- The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat-Gan, Israel
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19
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Golan O, Haruvi-Lamdan N, Laor N, Horesh D. The comorbidity between autism spectrum disorder and post-traumatic stress disorder is mediated by brooding rumination. Autism 2021; 26:538-544. [PMID: 34318687 DOI: 10.1177/13623613211035240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
LAY ABSTRACT Autism spectrum disorder is a neurodevelopmental condition characterized by social communication difficulties and restricted repetitive behaviors. Individuals with autism spectrum disorder are often diagnosed with other psychiatric conditions, including attention deficit hyperactivity disorder, anxiety, and depression. However, research on post-traumatic stress disorder among individuals with autism spectrum disorder is scarce. Nonetheless, studies have shown that those with autism spectrum disorder may face an increased risk of exposure to traumatic events. Separate lines of research in autism spectrum disorder and post-traumatic stress disorder have shown that the two may share several vulnerability factors. One of those is ruminative thinking, that is, one's tendency to re-hash thoughts and ideas, in a repetitive manner. This article examined the role of two rumination types as potential factors connecting autism spectrum disorder and post-traumatic stress disorder: brooding (continuously comparing one's current condition to one's desired condition) and reflection (an introspective effort to cognitively solve one's problems). A total of 34 adults with autism spectrum disorder (with no intellectual impairment) and 66 typically developing adults completed questionnaires assessing post-traumatic stress disorder symptoms and rumination. The results showed increased post-traumatic stress disorder symptoms in adults with autism spectrum disorder, compared to typically developing adults. Brooding rumination was also higher among those with autism spectrum disorder. Finally, brooding, but not reflection, served as a mechanism connecting autism spectrum disorder and post-traumatic stress disorder, that is, those with autism spectrum disorder showed increased brooding, which in turn predicted more post-traumatic stress disorder symptoms. This study has potential clinical implications. Rumination and cognitive inflexibility, which are common in autism spectrum disorder, could exacerbate post-traumatic symptoms among individuals with autism spectrum disorder who experience traumatic events. Interventions targeting brooding rumination and cognitive flexibility may assist in alleviating post-traumatic symptoms in individuals with autism spectrum disorder.
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Affiliation(s)
- Ofer Golan
- Bar-Ilan University, Israel.,Autism Treatment and Research Center-Association for Children at Risk, Israel.,University of Cambridge, UK
| | | | - Nathaniel Laor
- Autism Treatment and Research Center-Association for Children at Risk, Israel.,Tel-Aviv University, Israel
| | - Danny Horesh
- Bar-Ilan University, Israel.,Autism Treatment and Research Center-Association for Children at Risk, Israel.,New York University, USA
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20
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Solomon Z, Horesh D, Ginzburg K. Trajectories of PTSD and secondary traumatization: A longitudinal study. J Psychiatr Res 2021; 138:354-359. [PMID: 33930614 DOI: 10.1016/j.jpsychires.2021.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
Ever since the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there has been a controversy around whether the inclusion of indirect exposure as a potential traumatic event for the diagnosis of posttraumatic stress disorder (PTSD) is justified. The aim of the current study was to examine the validity of PTSD resulting from secondary traumatization by evaluating the longitudinal trajectories and clinical picture of PTSD following both direct exposure and indirect exposure to war trauma. One-hundred-and-fifty-five war veterans of the 1973 Yom Kippur War and their spouses filled out self-report questionnaires assessing PTSD, 30 (T1), 38 (T2), and 42 years (T3) after the war. Findings revealed that although PTSD was more prevalent and intense among veterans, the relative distribution of PTSD trajectories was similar among veterans and spouses. In both groups, the most prevalent was the resilient trajectory (43% and 73%, respectively), followed by the recovered trajectory (28% and 15%, respectively), the chronic trajectory (21% and 7%, respectively), and the delayed trajectory (8% and 6%, respectively). In addition, the composition of PTSD symptoms was similar among veterans and spouses at T1 and T2, but not at T3. These findings demonstrate that although PTSD is more prevalent and intense among individuals who were exposed to traumatic events directly as compared to those who were traumatized secondarily, the similarities in the clinical picture support the inclusion of secondary traumatization in PTSD Criterion A.
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Affiliation(s)
- Zahava Solomon
- The Bob Shapell Scholl of Social Work, Tel Aviv University, Israel
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Israel; Department of Psychiatry, New York University School of Medicine, USA
| | - Karni Ginzburg
- The Bob Shapell Scholl of Social Work, Tel Aviv University, Israel.
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21
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel.,Department of Psychiatry, New York University Grossman School of Medicine
| | - Susan Garthus-Niegel
- Department of Medicine, Faculty of Medicine, Medical School Hamburg, Hamburg, Germany.,Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare-IUFRS, Faculty of Biology and Medicine, University of Lausanne, Switzerland.,Department Woman-Mother-Child, Faculty of Biology and Medicine, Lausanne University Hospital, Switzerland,
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22
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Horesh D, Kapel Lev-Ari R, Hasson-Ohayon I. Risk factors for psychological distress during the COVID-19 pandemic in Israel: Loneliness, age, gender, and health status play an important role. Br J Health Psychol 2020; 25:925-933. [PMID: 32656926 PMCID: PMC7404907 DOI: 10.1111/bjhp.12455] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/15/2020] [Indexed: 01/18/2023]
Abstract
Objective Research on the psychological toll of the COVID‐19 pandemic is being conducted in various countries. This study aimed to examine risk factors for mental health problems among Israeli adults during this crisis. Methods A total of 204 participants took part in the study. They completed self‐report questionnaires assessing perceived stress, anxiety, quality of life, and various questions related to quarantine, pre‐existing health issues, and worries related to the virus. The study took place during the last two weeks of March 2020. Results The majority of participants reported relatively high levels of perceived stress and corona‐related worries, but low levels of anxiety. Female gender, younger age, corona‐related loneliness, and pre‐existing chronic illness were all related to higher levels of psychological distress and lower levels of quality of life. Conclusions While considering the preliminary nature of these results, the current study highlights risk factors for psychological distress in light of the corona pandemic. Attention should be given to sociodemographic variables that were identified as related to psychological distress, as well as to the important role of loneliness, when screening and treating people during this crisis. More research is needed in order to fully understand the scope and correlates of psychological difficulties during these challenging times.
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel.,Department of Psychiatry, New York University School of Medicine, New York, USA
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23
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Kapel Lev‐Ari R, Solomon Z, Horesh D. Far away, so close: The role of self‐differentiation in psychopathology among spouses of ex‐POWs and comparable combatants. J Clin Psychol 2020; 76:1904-1922. [DOI: 10.1002/jclp.22965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Zahava Solomon
- I‐CORE Research Center for Mass Trauma Tel Aviv University Tel Aviv Israel
- Bob Shapell School of Social Work Tel Aviv University Tel Aviv Israel
| | - Danny Horesh
- Department of Psychology Bar‐Ilan University Ramat Gan Israel
- Department of Psychiatry New York University Langone Medical Center New York New York
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24
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Horesh D, Brown AD. Traumatic stress in the age of COVID-19: A call to close critical gaps and adapt to new realities. Psychol Trauma 2020; 12:331-335. [PMID: 32271070 DOI: 10.1037/tra0000592] [Citation(s) in RCA: 349] [Impact Index Per Article: 87.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
THE ISSUE Coronavirus-19 (COVID-19) is transforming every aspect of our lives. Identified in late 2019, COVID-19 quickly became characterized as a global pandemic by March of 2020. Given the rapid acceleration of transmission, and the lack of preparedness to prevent and treat this virus, the negative impacts of COVID-19 are rippling through every facet of society. Although large numbers of people throughout the world will show resilience to the profound loss, stress, and fear associated with COVID-19, the virus will likely exacerbate existing mental health disorders and contribute to the onset of new stress-related disorders for many. RECOMMENDATIONS The field of traumatic stress should address the serious needs that will emerge now and well into the future. However, we propose that these efforts may be limited, in part, by ongoing gaps that exist within our research and clinical care. In particular, we suggest that COVID-19 requires us to prioritize and mobilize as a research and clinical community around several key areas: (a) diagnostics, (b) prevention, (c) public outreach and communication, (d) working with medical staff and mainstreaming into nonmental health services, and (e) COVID-19-specific trauma research. As members of our community begin to rapidly develop and test interventions for COVID-19-related distress, we hope that those in positions of leadership in the field of traumatic stress consider limits of our current approaches, and invest the intellectual and financial resources urgently needed in order to innovate, forge partnerships, and develop the technologies to support those in greatest need. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Adam D Brown
- Department of Psychology, New School for Social Research, New York University School of Medicine
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25
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Haruvi-Lamdan N, Horesh D, Zohar S, Kraus M, Golan O. Autism Spectrum Disorder and Post-Traumatic Stress Disorder: An unexplored co-occurrence of conditions. Autism 2020; 24:884-898. [PMID: 32245333 DOI: 10.1177/1362361320912143] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
LAY ABSTRACT People with Autism Spectrum Disorder show an increased risk of experiencing traumatic events, particularly social victimization. However, Autism Spectrum Disorder and Post-Traumatic Stress Disorder co-occurrence was hardly studied. We examined exposure to traumatic life events and Post-Traumatic Stress Disorder symptoms in adults with Autism Spectrum Disorder vs typical adults. Two groups took part in this study: Twenty-five adults with Autism Spectrum Disorder and 25 typical adults of similar age and male to female ratio. Participants completed questionnaires on potentially traumatic life events of social and non-social nature, as well as on Post-Traumatic Stress Disorder symptoms related to their most distressing event. Participants also filled out an autism traits questionnaire. Results showed a higher Post-Traumatic Stress Disorder rate in the Autism Spectrum Disorder group (32%) compared with the typical group (4%). Individuals with Autism Spectrum Disorder reported more Post-Traumatic Stress Disorder symptoms, particularly re-experiencing and increased physiological arousal, compared with typical adults, although the latter was elevated only in females with Autism Spectrum Disorder. Participants with Autism Spectrum Disorder, especially females, reported more negative life events, particularly social events, than typical adults. Sixty percent of Autism Spectrum Disorder participants, but only 20% of typical participants, chose a social event as their most distressing event. Individuals with Autism Spectrum Disorder who were also suspected as having Post-Traumatic Stress Disorder (based on their questionnaires) presented poorer social skills compared with those with Autism Spectrum Disorder alone. Results indicate that individuals with Autism Spectrum Disorder are more susceptible to trauma and Post-Traumatic Stress Disorder, particularly due to social stressors. Females with Autism Spectrum Disorder may be especially vulnerable to Post-Traumatic Stress Disorder.
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Affiliation(s)
| | - Danny Horesh
- Bar-Ilan University, Israel.,New York University, USA.,Autism Treatment & Research Center, Association for Children at Risk, Israel
| | | | | | - Ofer Golan
- Bar-Ilan University, Israel.,Autism Treatment & Research Center, Association for Children at Risk, Israel.,University of Cambridge, UK
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26
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Abstract
Eating disorders (EDs) are serious psychopathologies characterized by a persistent disturbance in eating or eating-related behavior. Studies have shown EDs' detrimental consequences not only for patients, but also for their families. Nevertheless, a specific group that has so far been neglected, in both the research and clinical fields, are siblings of individuals with EDs. In an effort to identify this population's needs, and to facilitate effective prevention and treatment, this paper aims to review the existing literature on the subject, and examine siblings' personal experience, ways of coping, and levels of psychopathology. PubMed and PsycNet databases were searched with no publication date restrictions, yielding 26 relevant papers. Studies were categorized according to common themes they addressed, and subsequently summarized by highlighting common features, as well as information unique to each study. Several themes emerged, including emotional well-being, psychopathology, social consequences, family dynamics, and coping strategies. Results show that EDs experienced by one individual have significant effects on one's siblings, such as a decrease in quality of life, social isolation, and elevated familial strain. In several studies siblings were found to have elevated levels of psychopathology and EDs related symptoms. Nevertheless, findings' nature and magnitude were highly varied. The review indicates the need for further studies that will examine possible intra- and interpersonal moderating factors for EDs' impact on well-being among siblings, and take into consideration the substantial heterogeneity in studies conducted thus far. Additionally, this review highlights the need for novel and effective interventions, specifically targeting this at-risk group.
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Affiliation(s)
- Iris Maon
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| | - Danny Horesh
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel.,Department of Psychiatry, New York University School of Medicine, New York City, NY, United States
| | - Yari Gvion
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel
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Levine D, Horesh D. Suicidality in Fibromyalgia: A Systematic Review of the Literature. Front Psychiatry 2020; 11:535368. [PMID: 33173505 PMCID: PMC7538832 DOI: 10.3389/fpsyt.2020.535368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/27/2020] [Indexed: 11/13/2022] Open
Abstract
Fibromyalgia (FM), a poorly understood rheumatic condition, is characterized by chronic pain and psychiatric comorbidities, most notably depression and anxiety. Additional symptoms include sleep difficulties, fatigue, and various cognitive impairments. Furthermore, FM is surrounded by social stigma, due to the unclear nature and etiology of this condition. While there is widespread evidence for the emotional and psychological suffering of those with FM, the scope of suicidality, as well as the underlying factors that are associated with suicidal ideation and behavior among this population, are not well understood. The present review, which is the first of its kind, aims to summarize existing data on the prevalence of suicide-related outcomes among FM patients, highlight factors associated with suicidal ideation and behavior in FM, and identify gaps in the literature to better inform research and clinical care. Studies were extracted from the literature that measured suicidal ideation, attempted suicide, and/or completed suicide among FM patients. Results indicated that both suicidal ideation and suicidal behavior were prevalent among individuals suffering from FM. Psychiatric comorbidity, sleep difficulties, and inpatient hospitalization were associated with both suicidal ideation and suicidal behavior. Functional impairment was associated with suicidal ideation in FM. Factors associated with higher levels of suicidal behavior in FM included female gender, unemployment and lower income, medical comorbidity, and drug dependence. While an understanding of currently recognized risk factors is important for improving FM research and clinical care, some clear methodological and conceptual limitations of the reviewed studies were identified. Future work should focus on longitudinal studies, as well as on gaining a better biological and psychological understanding of the underpinnings of FM and suicidality.
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Affiliation(s)
- Daniella Levine
- Department of Psychology, New York University, New York, NY, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.,Department of Psychiatry, New York University Langone Medical Center, New York, NY, United States
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel; NYU School of Medicine, Department of Psychiatry, New York, NY, USA
| | - Ilanit Gordon
- Department of Psychology and The Gonda Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
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Rahman N, Horesh D, Kouri NA, Kapel Lev-Ari R, Titcombe-Parekh R, Bryant RA, Marmar CR, Brown AD. Increasing self-efficacy reduces visual intrusions to a trauma-film paradigm. Anxiety, Stress, & Coping 2019; 32:202-215. [DOI: 10.1080/10615806.2019.1566532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nadia Rahman
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Danny Horesh
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Nicole A. Kouri
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | | | | | - Richard A. Bryant
- School of Psychology, University of New South Wales, Kensington, Australia
| | - Charles R. Marmar
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Adam D. Brown
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
- Department of Psychology, New School for Social Research, New York, NY, USA
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Horesh D, Nukrian M, Bialik Y. To lose an unborn child: Post-traumatic stress disorder and major depressive disorder following pregnancy loss among Israeli women. Gen Hosp Psychiatry 2018; 53:95-100. [PMID: 29934032 DOI: 10.1016/j.genhosppsych.2018.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Pregnancy loss (PL) can be a very difficult experience. However, the evidence regarding the prevalence and correlates of psychopathology following PL is inconsistent at best. The present study aimed to assess the prevalence of Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) following PL, and their differential predictors. METHODS Participants were 97 women, ages 23-47, who have experienced PL starting from the 2nd trimester. They were recruited at the Hadassah Ein-Kerem Medical Center in Jerusalem, Israel. The mean pregnancy week of loss was 27.92. Participants completed self-report questionnaires assessing PTSD (PCL-5), MDD (BDI-II), sociodemographic variables and factors related to the loss. RESULTS We have found high rates of probable PTSD (33.3%) and MDD (29.4%) among our sample, as well as high PTSD-MDD comorbidity. A more advanced gestational week of loss and shorter time since PL were positively associated with both PTSD and MDD. Younger age and lower religiosity were associated with more severe PTSD, but not MDD. CONCLUSIONS PL is a potentially-traumatic experience, entailing a heavy burden of PTSD and MDD. Mental health professionals are encouraged to closely monitor women following PL, particularly young mothers, who have experienced PL more recently, and at the advanced stages of pregnancy.
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan 5290002, Israel; Department Of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
| | - Malka Nukrian
- Department of Obstetrics and Gynecology, Hadassah Ein-Kerem Medical Center, Jerusalem 91120, Israel.
| | - Yael Bialik
- Department of Psychology, Bar-Ilan University, Ramat Gan 5290002, Israel
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.,Department of Psychiatry, New York University, New York City, NY, United States
| | - Adam D Brown
- Department of Psychiatry, New York University, New York City, NY, United States.,Department of Psychology, Sarah Lawrence College, Bronxville, NY, United States
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Steenkamp MM, Schlenger WE, Corry N, Henn-Haase C, Qian M, Li M, Horesh D, Karstoft KI, Williams C, Ho CL, Shalev A, Kulka R, Marmar C. Predictors of PTSD 40 years after combat: Findings from the National Vietnam Veterans longitudinal study. Depress Anxiety 2017; 34:711-722. [PMID: 28489300 DOI: 10.1002/da.22628] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 01/27/2017] [Accepted: 02/06/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Few studies have longitudinally examined predictors of posttraumatic stress disorder (PTSD) in a nationally representative sample of US veterans. We examined predictors of warzone-related PTSD over a 25-year span using data from the National Vietnam Veterans Longitudinal Study (NVVLS). METHODS The NVVLS is a follow-up study of Vietnam theater veterans (N = 699) previously assessed in the National Vietnam Veterans Readjustment Study (NVVRS), a large national-probability study conducted in the late 1980s. We examined the ability of 22 premilitary, warzone, and postmilitary variables to predict current warzone-related PTSD symptom severity and PTSD symptom change in male theater veterans participating in the NVVLS. Data included a self-report Health Questionnaire survey and a computer-assisted telephone Health Interview Survey. Primary outcomes were self-reported PTSD symptoms assessed by the PTSD Checklist for DSM-5 (PCL 5) and Mississippi PTSD Scale (M-PTSD). RESULTS Predictors of current PTSD symptoms most robust in hierarchical multivariable models were African-American race, lower education level, negative homecoming reception, lower current social support, and greater past-year stress. PTSD symptoms remained largely stable over time, and symptom exacerbation was predicted by African-American race, lower education level, younger age at entry into Vietnam, greater combat exposure, lower current social support, and greater past-year stressors. CONCLUSIONS Findings confirm the robustness of a select set of risk factors for warzone-related PTSD, establishing that these factors can predict PTSD symptom severity and symptom change up to 40 years postdeployment.
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Affiliation(s)
- Maria M Steenkamp
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
| | | | | | - Clare Henn-Haase
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
| | - Meng Qian
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
| | - Meng Li
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
| | - Danny Horesh
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
| | - Karen-Inge Karstoft
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
| | | | | | - Arieh Shalev
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
| | | | - Charles Marmar
- Department of Psychiatry, Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, NYU Langone Medical Center, New York, NY, USA
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Haruvi-Lamdan N, Horesh D, Golan O. PTSD and autism spectrum disorder: Co-morbidity, gaps in research, and potential shared mechanisms. Psychol Trauma 2017; 10:290-299. [PMID: 28726442 DOI: 10.1037/tra0000298] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND While autism and trauma were often linked in psychoanalytic theory, very few scientific attempts have been made to explore the associations and comorbidity between the two. Instead, each area has grown separately, yielding large bodies of theoretical and clinical knowledge. THEORETICAL FRAMEWORK In this article, we suggest several possible pathways that may link trauma and autism. First, autism spectrum disorder (ASD) may serve as a vulnerability marker for posttraumatic stress disorder (PTSD), specifically by increasing the risk for exposure to traumatic events. Second, PTSD, once it has appeared, may exacerbate certain ASD symptoms, for example, through maladaptive coping strategies and reduced help-seeking. Third, there may be shared underlying mechanisms for PTSD and ASD, including neurological abnormalities associated with both disorders, as well as cognitive and behavioral mechanisms, such as increased rumination, cognitive rigidity, avoidance, anger, and aggression. In addition, the unique characteristics of ASD may determine which events are experienced as particularly traumatic (e.g., social insults and degradation, sensory overstimulation, abrupt changes in known routines) and affect both the manifestation and severity of posttraumatic sequelae among diagnosed individuals. CONCLUSIONS AND RECOMMENDATIONS Research conducted separately in the areas of PTSD and ASD strongly suggests several potential pathways connecting both disorders. We conclude that there is a pressing need for more PTSD-ASD research, focusing not only on the prevalence of traumatic stress in individuals with autism, but also on their potentially unique perception of traumatic events, particularly from the social sphere. Such research may carry important clinical implications. (PsycINFO Database Record
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Affiliation(s)
| | | | - Ofer Golan
- Department of Psychology, Bar Ilan University
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Horesh D, Qian M, Freedman S, Shalev A. Differential effect of exposure-based therapy and cognitive therapy on post-traumatic stress disorder symptom clusters: A randomized controlled trial. Psychol Psychother 2017; 90:235-243. [PMID: 27561944 PMCID: PMC5326605 DOI: 10.1111/papt.12103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 07/05/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED A question remains regarding differential effects of exposure-based versus non-exposure-based therapies on specific post-traumatic stress disorder (PTSD) symptom clusters. Traumatized emergency room patients were randomized to receive prolonged exposure (PE) or cognitive therapy (CT) without exposure. PE/CT had no differential effect on individual symptom clusters, and change in total PTSD score remained significant even after controlling for the reductions in all three symptom clusters. In addition, baseline levels of PTSD avoidance/intrusion/hyperarousal did not moderate the effects of PE and CT on total PTSD symptom scores. Taken together, these findings challenge the notion that PE and CT are specifically, and differentially, useful in treating one particular PTSD symptom cluster. PRACTITIONER POINTS Despite their different theoretical backgrounds and techniques, the notion that PE and CT (without exposure) target different PTSD symptoms was not confirmed in this study. Thus, both interventions may in fact be equally effective for treating intrusion, avoidance and hyperarousal symptoms. Baseline levels of avoidance, intrusion and hyperarousal may not be good a priori indicators for PTSD treatment selection. The effect of PE and CT on PTSD as a whole does not seem to depend on a reduction in any specific symptom cluster. These findings indicate that exposure and non-exposure interventions may lead to similar results in terms of reductions in specific PTSD symptoms. It is quite possible that individual PTSD clusters may respond to therapy in an inter-related fashion, with one cluster affecting the other.
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan 5290002, Israel.,New York University School of Medicine, Department of Psychiatry, New York
| | - Meng Qian
- New York University School of Medicine, Department of Psychiatry, New York
| | - Sara Freedman
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan 5290002, Israel
| | - Arieh Shalev
- New York University School of Medicine, Department of Psychiatry, New York
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Abstract
Background and objectiveLate pregnancy loss (PL) is recognized as a very difficult life experience. Often, PL is regarded as a “feminine” trauma, experienced individually by the woman, thus neglecting the role of the parental dyad in coping with the loss. This study aimed to examine:– the prevalence of PTSD and major depressive disorder (MDD) following late PL;– the role of spousal relationship measures in vulnerability and resilience following PL.MethodsParticipants were 100 women, ages 24–49 (M = 35.07, SD = 5.28), who have experienced late PL. The mean pregnancy week of loss was 27.29, with the average woman being 22 months post-loss. 84.6% experienced stillbirth. Participants completed self-report questionnaires assessing PTSD, MDD, dyadic adjustment and dyadic self-disclosure.ResultsWe have found high rates of both PTSD (32.7%) and MDD (53%) among women following late PL, as well as high PTSD-MDD comorbidity rates. Interestingly, a negative association was found between the number of previous pregnancy losses and the severity of MDD, perhaps indicating an innoculation process. Both PTSD and MDD were negatively associated with the levels of dyadic consensus, dyadic self-disclosure regarding guilt and shame, and dyadic affectional expression.ConclusionsLate PL entails a heavy burden of PTSD and MDD, presumably since mothers are already strongly attached to their unborn child. PL is often experienced by both expecting mother and father. Thus, the quality of the spousal relationship following PL is an important protective factor. Therefore, there is a pressing need for novel interventions in couples therapy following PL.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Horesh D, Glick I, Taub R, Agmon-Levin N, Shoenfeld Y. Mindfulness-based group therapy for systemic lupus erythematosus: A first exploration of a promising mind-body intervention. Complement Ther Clin Pract 2017; 26:73-75. [PMID: 28107854 DOI: 10.1016/j.ctcp.2016.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/27/2016] [Indexed: 11/27/2022]
Abstract
Psychological effects related to systemic lupus erythematosus (SLE) are tremendous. While a variety of psychological treatments have been applied to assist SLE patients, the effects of mindfulness practice were never documented in SLE. Mindfulness-based psychotherapy includes several techniques, including body-scan, breathing exercises, and full awareness during daily activities. In this case report, we present a first attempt at conducting mindfulness-based group therapy among SLE patients. Six female SLE patients participated in an 8-week program. Improvement was observed in several areas: patients' increased ability to differentiate between themselves and the disease; increased ability to accept, rather than to actively fight the fact that one must live with the disease; and decreased behavioral avoidance. These observations speak to the significant therapeutic potential of mindfulness practice among SLE patients. With its emphasis on acceptance of negative physical and emotional states, mindfulness practice is a promising treatment option, which needs to be further studied.
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel; Department of Psychiatry, New York University School of Medicine, New York, NY, USA.
| | - Ittai Glick
- Shahaf Stress Reduction Clinic, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Renen Taub
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Nancy Agmon-Levin
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Ramat Gan, Israel; Incumbent of the Laura Schwarz-KipChair for Research of Autoimmune Diseases, Tel-Aviv University, Tel Aviv, Israel
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Horesh D, Aiello AE, Koenen KC, Uddin M, Uddin M, Koenen KC. An in-depth look into PTSD-depression comorbidity: A longitudinal study of chronically-exposed Detroit residents. J Affect Disord 2017; 208:653-661. [PMID: 27816322 PMCID: PMC6684032 DOI: 10.1016/j.jad.2016.08.053] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/24/2016] [Accepted: 08/23/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although PTSD-major depressive disorder (MDD) co-morbidity is well-established, the vast majority of studies have examined comorbidity at the level of PTSD total severity, rather than at the level of specific PTSD symptom clusters. This study aimed to examine the long-term associations between MDD and PTSD symptom clusters (intrusion, avoidance, hyperarousal), and the moderating role of gender in these associations. METHODS 942 residents of urban Detroit neighborhoods were interviewed at 3 waves, 1 year apart. At each wave, they were assessed for PTSD, depression, trauma exposure, and stressful life events. RESULTS At all waves, hyperarousal was the PTSD cluster most strongly correlated with MDD. For the full sample, a reciprocal relationship was found between MDD and all three PTSD clusters across time. Interestingly, the relative strength of associations between MDD and specific PTSD clusters changed over time. Women showed the same bidirectional MDD-PTSD pattern as in the entire sample, while men sometimes showed non-significant associations between early MDD and subsequent PTSD clusters. LIMITATIONS First, our analyses are based on DSM-IV criteria, as this was the existing edition at the time of this study. Second, although this is a longitudinal study, inferences regarding temporal precedence of one disorder over another must be made with caution. CONCLUSIONS Early identification of either PTSD or MDD following trauma may be crucial in order to prevent the development of the other disorder over time. The PTSD cluster of hyper-arousal may require special therapeutic attention. Also, professionals are encouraged to develop more gender-specific interventions post-trauma.
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar-Ilan University & Depratment of Psychiatry, NYU School of Medicine.
| | | | | | - Monica Uddin
- Department of Psychology, University of Illinois at Urbana-Champaign.
| | - Monica Uddin
- Department of Psychology, University of Illinois at Urbana-Champaign.
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health.
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Marmar CR, Schlenger W, Henn-Haase C, Qian M, Purchia E, Li M, Corry N, Williams CS, Ho CL, Horesh D, Karstoft KI, Shalev A, Kulka RA. Course of Posttraumatic Stress Disorder 40 Years After the Vietnam War: Findings From the National Vietnam Veterans Longitudinal Study. JAMA Psychiatry 2015. [PMID: 26201054 DOI: 10.1001/jamapsychiatry.2015.0803] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The long-term course of readjustment problems in military personnel has not been evaluated in a nationally representative sample. The National Vietnam Veterans Longitudinal Study (NVVLS) is a congressionally mandated assessment of Vietnam veterans who underwent previous assessment in the National Vietnam Veterans Readjustment Study (NVVRS). OBJECTIVE To determine the prevalence, course, and comorbidities of war-zone posttraumatic stress disorder (PTSD) across a 25-year interval. DESIGN, SETTING, AND PARTICIPANTS The NVVLS survey consisted of a self-report health questionnaire (n = 1409), a computer-assisted telephone survey health interview (n = 1279), and a telephone clinical interview (n = 400) in a representative national sample of veterans who served in the Vietnam theater of operations (theater veterans) from July 3, 2012, through May 17, 2013. Of 2348 NVVRS participants, 1920 were alive at the outset of the NVVLS, and 81 died during recruitment; 1450 of the remaining 1839 (78.8%) participated in at least 1 NVVLS study phase. Data analysis was performed from May 18, 2013, through January 9, 2015, with further analyses continued through April 13, 2015. MAIN OUTCOMES AND MEASURES Study instruments included the Mississippi Scale for Combat-Related PTSD, PTSD Checklist for DSM-IV supplemented with PTSD Checklist for DSM-5 items (PCL-5+), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and Structured Clinical Interview for DSM-IV, Nonpatient Version. RESULTS Among male theater veterans, we estimated a prevalence (95% CI) of 4.5% (1.7%-7.3%) based on CAPS-5 criteria for a current PTSD diagnosis; 10.8% (6.5%-15.1%) based on CAPS-5 full plus subthreshold PTSD; and 11.2% (8.3%-14.2%) based on PCL-5+ criteria for current war-zone PTSD. Among female veterans, estimates were 6.1% (1.8%-10.3%), 8.7% (3.8%-13.6%), and 6.6% (3.5%-9.6%), respectively. The PCL-5+ prevalence (95% CI) of current non-war-zone PTSD was 4.6% (2.6%-6.6%) in male and 5.1% (2.3%-8.0%) in female theater veterans. Comorbid major depression occurred in 36.7% (95% CI, 6.2%-67.2%) of veterans with current war-zone PTSD. With regard to the course of PTSD, 16.0% of theater veterans reported an increase and 7.6% reported a decrease of greater than 20 points in Mississippi Scale for Combat-Related PTSD symptoms. The prevalence (95% CI) of current PCL-5+-derived PTSD in study respondents was 1.2% (0.0%-3.0%) for male and 3.9% (0.0%-8.1%) for female Vietnam veterans. CONCLUSIONS AND RELEVANCE Approximately 271,000 Vietnam theater veterans have current full PTSD plus subthreshold war-zone PTSD, one-third of whom have current major depressive disorder, 40 or more years after the war. These findings underscore the need for mental health services for many decades for veterans with PTSD symptoms.
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Affiliation(s)
- Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York
| | | | - Clare Henn-Haase
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York
| | - Meng Qian
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York
| | - Emily Purchia
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York
| | - Meng Li
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York
| | - Nida Corry
- Abt Associates Inc, Durham, North Carolina
| | | | | | - Danny Horesh
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York3Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| | - Karen-Inge Karstoft
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York4Department of Psychology, University of Southern Denmark, Odense
| | - Arieh Shalev
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University Langone Medical Center, New York3Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| | - Richard A Kulka
- currently an independent consultant, Raleigh, North Carolina
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Horesh D. The Reconstruction of Criterion A in DSM-5: Is it a True Incorporation of Secondary Traumatization into the PTSD Diagnosis? Journal of Loss and Trauma 2015. [DOI: 10.1080/15325024.2015.1072016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Horesh D, Lowe SR, Galea S, Uddin M, Koenen KC. Gender differences in the long-term associations between posttraumatic stress disorder and depression symptoms: findings from the Detroit Neighborhood Health Study. Depress Anxiety 2015; 32:38-48. [PMID: 25044027 PMCID: PMC4289474 DOI: 10.1002/da.22267] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 02/27/2014] [Accepted: 03/01/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) and depression are known to be highly comorbid. However, previous findings regarding the nature of this comorbidity have been inconclusive. This study prospectively examined whether PTSD and depression are distinct constructs in an epidemiologic sample, as well as assessed the directionality of the PTSD-depression association across time. METHODS Nine hundred and forty-two Detroit residents (males: n = 387; females: n = 555) were interviewed by phone at three time points, 1 year apart. At each time point, they were assessed for PTSD (using the PCL-C), depression (PHQ-9), trauma exposure, and stressful life events. RESULTS First, a confirmatory factor analysis showed PTSD and depression to be two distinct factors at all three waves of assessments (W1, W2, and W3). Second, chi-square analysis detected significant differences between observed and expected rates of comorbidity at each time point, with significantly more no-disorder and comorbid cases, and significantly fewer PTSD only and depression only cases, than would be expected by chance alone. Finally, a cross-lagged analysis revealed a bidirectional association between PTSD and depression symptoms across time for the entire sample, as well as for women separately, wherein PTSD symptoms at an early wave predicted later depression symptoms, and vice versa. For men, however, only the paths from PTSD symptoms to subsequent depression symptoms were significant. CONCLUSIONS Across time, PTSD and depression are distinct, but correlated, constructs among a highly-exposed epidemiologic sample. Women and men differ in both the risk of these conditions, and the nature of the long-term associations between them.
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Affiliation(s)
- Danny Horesh
- Department of Psychology, BarIlan University, Israel,Department of Psychiatry, New York University, New York, New York
| | - Sarah R. Lowe
- Department of Epidemiology, Columbia University, New York, New York
| | - Sandro Galea
- Department of Epidemiology, Columbia University, New York, New York
| | - Monica Uddin
- Center for Molecular Medicine and Genetics and Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI
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Solomon Z, Bensimon M, Greene T, Horesh D, Ein-Dor T. Loneliness Trajectories: The Role of Posttraumatic Symptoms and Social Support. Journal of Loss and Trauma 2014. [DOI: 10.1080/15325024.2013.815055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Dekel S, Solomon Z, Horesh D, Ein-Dor T. Posttraumatic stress disorder and depressive symptoms: joined or independent sequelae of trauma? J Psychiatr Res 2014; 54:64-9. [PMID: 24703578 DOI: 10.1016/j.jpsychires.2014.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The nature of co-morbidity between posttraumatic stress disorder (PTSD) and depression has been the subject of much controversy. This study addresses this issue by investigating associations between probable PTSD and depressive symptoms in a prospective, longitudinal sample of combat veterans. METHOD Symptoms of PTSD and depression were assessed at 3 points of time (i.e., 1991, 2003, 2008) over a period of 17 years utilizing the PTSD Inventory and the SCL-90 (Derogatis, 1977). Two groups of combat veterans, 275 former prisoners of war (ex-POWs) and 219 matched combatants (controls), were assessed. Data were analyzed using descriptive statistics, latent variable modeling, and confirmatory factor analysis. RESULTS A series of χ(2) tests revealed that the prevalence proportions of depressive symptoms and probable PTSD were higher among ex-POWs compared to controls at all time points. The prevalence of depressive symptoms was higher than the prevalence of PTSD symptoms in both groups at the each of the times. Latent Trajectories Modeling (LTM) indicated that while ex-POWs' PTSD symptom severity increased over time, the severity of symptoms remained stable among controls. Parallel Process Latent Growth Modeling (PLGM) revealed a positive bi-directional relationship whereby PTSD symptoms mediated the affect of captivity on depressive symptoms and depressive symptoms mediated the affect of captivity on PTSD symptoms over time. Utilizing Confirmatory Factor Analysis (CFA), a single factor model emerged for depressive and PTSD symptoms. CONCLUSION The findings suggest that while depression and PTSD seem to be different long-term manifestations of traumatic stress, accounted for in part by the severity of the trauma, they both may be parts of a common general traumatic stress construct. Clinical and theoretical implications of these findings are discussed.
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Affiliation(s)
- Sharon Dekel
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA.
| | - Zahava Solomon
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Danny Horesh
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel; Department of Psychiatry, New York University, NY, USA
| | - Tsachi Ein-Dor
- School of Psychology, Interdisciplinary Center Herzliya, Herzliya, Israel
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Stein NR, Schorr Y, Krantz L, Dickstein BD, Solomon Z, Horesh D, Litz BT. The differential impact of terrorism on two Israeli communities. Am J Orthopsychiatry 2013; 83:528-35. [PMID: 24164524 DOI: 10.1111/ajop.12044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The authors evaluated 2 cohorts of individuals from different Israeli communities (Sderot and Otef Aza) that are repeatedly subjected to potentially lethal missile attacks. Although both communities border the Gaza Strip and face similar levels of threat, the authors hypothesized that the Sderot cohort would endorse higher rates of stress-related symptoms because it has fewer mitigating economic and psychosocial resources. The authors further hypothesized that there would be a significant relationship between exposure to terror and psychopathology regardless of community context. To test these predictions, the authors compared the levels of exposure to terror, posttraumatic stress disorder (PTSD), and depression in representative samples of adults from the 2 communities (n = 298 and n = 152, respectively). Residents of Sderot had a much higher rate of probable PTSD (35.2% vs. 6.6%), and community context was the most important predictor of PTSD and depression. The study also revealed a significant relationship between exposure and psychopathology, but for Sderot residents only. The conclusion is that researchers, mental health workers, and policy makers should pay attention to the influence of community characteristics, such as the availability of resources, the general sense of support, and the level of solidarity, on the mental health response to exposure to terror.
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Horesh D, Solomon Z, Keinan G, Ein-Dor T. The clinical picture of late-onset PTSD: a 20-year longitudinal study of Israeli war veterans. Psychiatry Res 2013; 208:265-73. [PMID: 23294854 DOI: 10.1016/j.psychres.2012.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 12/05/2012] [Accepted: 12/06/2012] [Indexed: 11/27/2022]
Abstract
Delayed-onset posttraumatic stress disorder (PTSD) has been under medico-legal debate for years. Previous studies examining the prevalence and clinical characteristics of delayed-onset PTSD have yielded inconclusive findings. This study prospectively examines the prevalence and clinical picture of late-onset PTSD among Israeli war veterans. It also evaluates whether or not late-onset PTSD erupts after a completely non-symptomatic period. 675 Israeli veterans from the 1982 Lebanon War, with and without antecedent combat stress reaction (CSR), have been assessed 1, 2 and 20 years post-war. They were divided into 4 groups, according to the duration of delay in PTSD onset. Participants completed self-report questionnaires tapping psychopathology, combat exposure and socio-demographics. 16.5% of the veterans suffered from late-onset PTSD. A longer delay in PTSD onset was associated with less severe psychopathology. Also, CSR was associated with a shorter delay in PTSD onset. Finally, the vast majority of veterans already suffered from PTSD symptoms prior to late PTSD onset. Our results offer further validation for the existence of delayed-onset PTSD. Delayed-onset PTSD appears to be a unique sub-type of PTSD, with an attenuated clinical picture. In addition, delayed-onset PTSD may be the result of an incubation process, wherein symptoms already exist prior to PTSD onset.
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Affiliation(s)
- Danny Horesh
- Department of Psychiatry, New York University, New York, NY 10016, USA.
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Zerach G, Solomon Z, Horesh D, Ein-Dor T. Family cohesion and posttraumatic intrusion and avoidance among war veterans: a 20-year longitudinal study. Soc Psychiatry Psychiatr Epidemiol 2013; 48:205-14. [PMID: 22752110 DOI: 10.1007/s00127-012-0541-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 06/15/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The bi-directional relationships between combat-induced posttraumatic symptoms and family relations are yet to be understood. The present study assesses the longitudinal interrelationship of posttraumatic intrusion and avoidance and family cohesion among 208 Israeli combat veterans from the 1982 Lebanon War. METHODS Two groups of veterans were assessed with self-report questionnaires 1, 3 and 20 years after the war: a combat stress reaction (CSR) group and a matched non-CSR control group. RESULTS Latent Trajectories Modeling showed that veterans of the CSR group reported higher intrusion and avoidance than non-CSR veterans at all three points of time. With time, there was a decline in these symptoms in both groups, but the decline was more salient among the CSR group. The latter also reported lower levels of family cohesion. Furthermore, an incline in family cohesion levels was found in both groups over the years. Most importantly, Autoregressive Cross-Lagged Modeling among CSR and non-CSR veterans revealed that CSR veterans' posttraumatic symptoms in 1983 predicted lower family cohesion in 1985, and lower family cohesion, in turn, predicted posttraumatic symptoms in 2002. CONCLUSIONS The findings suggest that psychological breakdown on the battlefield is a marker for future family cohesion difficulties. Our results lend further support for the bi-directional mutual effects of posttraumatic symptoms and family cohesion over time.
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Affiliation(s)
- Gadi Zerach
- Department of Behavioral Sciences, Ariel University Center of Samaria, 40700 Ariel, Israel.
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Bensimon M, Solomon Z, Horesh D. The utility of Criterion A under chronic national terror. Isr J Psychiatry Relat Sci 2013; 50:81-83. [PMID: 24225434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
According to DSM-IV-TR, both an objective and a subjective exposure component (A1 and A2 criteria, respectively) are required in order to qualify for a Posttraumatic stress Disorder (PTSD) diagnosis. one proposed DSM-5 change is that Criterion A be more explicitly defined and made purely objective. the DSM and the ICD appear to be largely products of the north american and european societies and, therefore, may be culturally-biased. Compared with other societies, the latter are not exposed to chronic national traumatic stress. therefore, the current structure of Criterion A may be especially relevant to single traumatic incidents, rather than to chronic national scale. the current review raises the question of whether the proposed DSM-5 changes to Criterion A are congruent with the reality of nations where exposure to terror is persistent, constant and of national proportions.
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Affiliation(s)
- Moshe Bensimon
- The Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
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Solomon Z, Horesh D, Ein-Dor T, Ohry A. Predictors of PTSD trajectories following captivity: a 35-year longitudinal study. Psychiatry Res 2012; 199:188-94. [PMID: 22486946 DOI: 10.1016/j.psychres.2012.03.035] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 01/29/2012] [Accepted: 03/17/2012] [Indexed: 11/28/2022]
Abstract
Although war captivity is a potent pathogen for psychiatric illness, little is known about the long-term trajectories of post-traumatic stress disorder (PTSD) among ex-prisoners of wars (ex-POWs). This study aimed to assess the long-term trajectories of PTSD and their predictors following war captivity. Three follow-ups (1991, 2003, 2008) were conducted over 35 years of 164 Israeli ex-POWs and185 comparable combatants from the 1973 Yom Kippur War. Ex-POWs reported higher PTSD rates than controls at all three assessments. Four trajectories of PTSD were identified: chronic PTSD, delayed PTSD, recovery and resilience. The majority of POWs reported delayed PTSD, while the majority of controls were classified as resilient. While PTSD rates remained relatively stable over time among controls, a steep increase in rates was observed among POWs between 1991 and 2003, followed by stabilization in rates between 2003 and 2008. Finally, subjective experience of captivity was the variable that best distinguished between the resilience and PTSD groups of ex-POWs, followed by participation in previous wars and negative life events during childhood. War captivity carries long-lasting psychiatric implications, even decades after release. Aging processes, as well as unique stressors that exist in Israel, may account for the elevated PTSD rates found here.
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Affiliation(s)
- Zahava Solomon
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv 69978, Israel.
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Horesh D, Solomon Z, Zerach G, Ein-Dor T. Delayed-onset PTSD among war veterans: the role of life events throughout the life cycle. Soc Psychiatry Psychiatr Epidemiol 2011; 46:863-70. [PMID: 20582726 DOI: 10.1007/s00127-010-0255-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 06/07/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The underlying mechanisms of delayed-onset PTSD are yet to be understood. This study examines the role of stressful life events throughout the life cycle in delayed-onset PTSD following combat. METHODS 675 Israeli veterans from the 1982 Lebanon War, 369 with antecedent combat stress reaction (CSR) and 306 without CSR were assessed prospectively, 1, 2 and 20 years after the war. Veterans were divided into four groups, according to the time of first PTSD onset (first onset at 1983, 1984, and 2002 and no PTSD onset). They were assessed for post-, peri- and pre-traumatic life events, as well as military and socio-demographic characteristics. RESULTS Our findings indicate that shorter delays in PTSD onset were associated with a higher risk for CSR, a higher number of pre- and post-war life events, more severe subjective battle exposure, greater perceived danger during combat and a more stressful military position. CSR was found to be the most powerful predictor of PTSD onset. A recency effect was also found, with more recent life events proving to be stronger predictors of PTSD onset. CONCLUSIONS First, our findings validate the existence of delayed-onset PTSD, as it was found among a substantial number of participants (16.5%). Second, post-, peri- and pre-traumatic life events are associated with the time of PTSD onset. Thus, practitioners and researchers are encouraged to examine not only the original trauma, but also the stressful experiences throughout the survivors' life cycle. In particular, identification of antecedent CSR may help mental help professionals in targeting high-risk populations.
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bob Shappell School of Social Work, Tel Aviv University, 69978 Tel Aviv, Israel.
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Abstract
Terrorism creates lingering anxiety about future attacks. In prior terror research, the conceptualization and measurement of coping behaviors were constrained by the use of existing coping scales that index reactions to daily hassles and demands. The authors created and validated the Coping with Terror Scale to fill the measurement gap. The authors emphasized content validity, leveraging the knowledge of terror experts and groups of Israelis. A multistep approach involved construct definition and item generation, trimming and refining the measure, exploring the factor structure underlying item responses, and garnering evidence for reliability and validity. The final scale comprised six factors that were generally consistent with the authors’ original construct specifications. Scores on items linked to these factors demonstrate good reliability and validity. Future studies using the Coping with Terror Scale with other populations facing terrorist threats are needed to test its ability to predict resilience, functional impairment, and psychological distress.
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Affiliation(s)
- Nathan R. Stein
- National Center for PTSD, VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Yonit Schorr
- National Center for PTSD, VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Brett T. Litz
- National Center for PTSD, VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Lynda A. King
- National Center for PTSD, VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Daniel W. King
- National Center for PTSD, VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Zahava Solomon
- Bob Shappel School of Social Work, Tel Aviv University, Tel Aviv, Israell
| | - Danny Horesh
- Bob Shappel School of Social Work, Tel Aviv University, Tel Aviv, Israell
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Solomon Z, Horesh D, Ein-Dor T. The longitudinal course of posttraumatic stress disorder symptom clusters among war veterans. J Clin Psychiatry 2009; 70:837-43. [PMID: 19573481 DOI: 10.4088/jcp.08m04347] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 08/22/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to examine the long-term trajectories and interrelationships of posttraumatic stress disorder (PTSD) symptom clusters (intrusion, avoidance, and hyperarousal) in clinical and nonclinical groups of war veterans. METHOD Six hundred seventy-five Israeli veterans from the 1982 Lebanon War were assessed. The clinical group consisted of 369 who had combat stress reaction (CSR) during the war, and the nonclinical group consisted of 306 veterans with no antecedent CSR. The 2 groups were matched in age, education, military rank, and assignment. They were prospectively evaluated 1, 2, and 20 years after the war. RESULTS The clinical group endorsed a higher number of symptoms than the nonclinical group, both cross-sectionally and across time. In both the clinical and nonclinical groups, the clusters of intrusion, avoidance, and hyperarousal were interrelated at any given point in time and across 20 years. In both groups, avoidance was found to be a particularly stable symptom cluster over time. Finally, hyperarousal levels 1 year after the war were found to play an important role in both groups, as they predicted future avoidance and intrusion symptoms. CONCLUSIONS The findings of this study suggest that PTSD is not a monolithic disorder, as symptom clusters differ in several important aspects. Also, the course and severity of symptoms differ between clinical and nonclinical groups. Finally, practitioners are encouraged to focus on the identification and treatment of early hyperarousal due to its prominent role in the development of other PTSD symptoms.
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Affiliation(s)
- Zahava Solomon
- Bob Shappell School of Social Work, Tel Aviv University, Tel Aviv, Israel.
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