Using imagination in response to stress and uncertainty in the time of COVID-19: further validation of the Fantastic Reality Ability Measurement (FRAME) Scale.

Fantastic reality ability (FRA) is defined as the capacity to use imagination in response to stress or trauma. With the emergence of COVID-19 and associated social restrictions, there has been an uptick in imagination use as a coping strategy. This has allowed us to further validate the Fantastic Reality Ability Measurement (FRAME) Scale at this time of stress and uncertainty. Initial exploratory factor analyses (EFA) suggested that FRAME responses are measured by four first-order factors. Using confirmatory factor analyses (CFA), this study set out to confirm this finding and to ascertain if: First-order factors are correlated; or map onto a second or higher-order, fantastic reality ability latent construct. Also, FRAME responses are compared to established scales to demonstrate concurrent and discriminant validity. In accord with previous research and theory, CFA results indicate that each four factors (coping, control, transcendence, playfulness), contribute significantly to the measurement of a higher-order FRA latent construct (N = 437 Israeli adults). We also report robust correlations between FRAME and measures of resiliency and imagination abilities of complexity, directedness and frequency. Both adaptive and maladaptive applications of imagination use in relation to stress are discussed with focus on those who could foster resiliency. The FRAME enables one to briefly measure imagination use in response to stress and could serve as part of questionnaire batteries measuring individual differences and clinical research. Future research should assess the stability of this instrument across different populations over extended periods, specifically those at risk for trauma.

Do Attachment Orientations Relate to Coping with Crises? Lessons from a Cross-Sectional Study during the COVID-19 Pandemic.

This study was designed to explore whether attachment orientations were related to distress and resilience during the COVID-19 pandemic. The sample included 2000 Israeli Jewish adults who answered an online survey during the first phase of the pandemic. The questions referred to background variables, attachment orientations, distress, and resilience. Responses were analyzed using correlation and regression analyses. A significant positive relationship was found between distress and attachment anxiety, and a significant negative relationship was found between resilience and attachment insecurities (avoidance and anxiety). Women suffered higher distress, as did people with lower income, poor health, secular religious affiliation, a lack of a sense of spacious accommodation, and a dependent family member. The findings indicate that attachment insecurities are associated with the severity of mental health symptoms during the peak period of the COVID-19 pandemic. We recommend strengthening attachment security as a protective factor for psychological distress in therapeutic and educational settings.

Physiological indicators of emotional arousal related to ANS activity in response to associative cards for psychotherapeutic PTSD treatment.

SEE FAR CBT is an integrative treatment protocol for PTSD and anxiety disorders which combines CBT, body-mind (somatic experience) and imagery-based (fantastic reality; FR) methods. FR is introduced using associative therapeutic cards (COPE cards) to represent both "a pleasant/safe place" and the re-narrating process of the traumatic story. Although some preliminary evidence exists regarding the impact of COPE cards integration in psychotherapy, further validation is needed as to whether these cards can induce distinct arousal-affective states in the observer. The aim of this study was to examine whether exposure to COPE cards evoke different emotional-psychophysiological states using objective physiological measures reflecting autonomic nervous system responses; hence, to further validate its use as a potentially effective tool within the context of SEE FAR CBT therapeutic process. Ninety-five healthy under-graduate participants were first exposed to high-arousal, negatively-valenced cards and asked to put themselves in a state of emotional/physical arousal. Afterwards, they were exposed to low-arousal, positively-valenced cards and were asked to try to calm and relax to the best of their ability. Heart rate, blood pressure and heart rate variability (HRV) were measured at baseline, at the arousal phase and finally at the relaxation phase. It was found that exposure to arousing negative cards resulted in significant increase in blood pressure and a decrease in HRV, while exposure to relaxing positive cards resulted in significant decrease in blood pressure and an increase in HRV. These findings support the efficacy and utility of associative COPE cards in affecting psychophysiological arousal.

Conservation of Resources, Psychological Distress, and Resilience During the COVID-19 Pandemic.

Objectives: The Conservation of Resources (COR) theory suggests that stress results from threatened or actual loss of resources following significant life events. This study used COR theory as the framework to explore the reflection of loss of resources during the COVID-19 pandemic on psychological distress and resilience, in an adult Jewish Israeli population. Methods: We examined the association between background variables, stress, loneliness, concern, COVID-19-related post traumatic symptoms (PTS), resilience factors and COR via an online survey among 2,000 adults during April 2020. Results: Positive relationships were identified between resource loss and PTS (r = 0.66, p < 0.01), and between resource gain and resilience (r = 0.30, p < 0.01). Psychological variables were significantly associated with PTS and explained 62.7% of the variance, F (20, 1,413) = 118.58, p < 0.001. Conclusion: Loss of resources, stress, loneliness and concern were found to be risk factors for distress and PTS, whereas resilience factors played a protective role. We thus recommend using the COR theory to explore COVID-19 effects elsewhere.

Development and validation of the Continuous Traumatic Stress Response scale (CTSR) among adults exposed to ongoing security threats.

BACKGROUND: Current diagnostic criteria for posttraumatic stress disorder (PTSD) do not include symptoms resulting from exposure to continuous or ongoing traumatic stress. Thus existing assessment tools do not fully capture stress symptoms associated with exposure to threats that extend over months or years. To address this void, we enumerated the symptoms associate with ongoing exposure to stress including those that are distinct from existing PTSD diagnostic criteria. OBJECTIVES: To develop the Continuous Traumatic Stress Response Scale (CTSR) and assess its psychometric properties. METHOD: We sampled 313 adults exposed and unexposed to ongoing security threat between December 2016 and February 2017. Respondents lived in communities bordering the Gaza Strip in southern Israel where they are exposed to frequent rocket attacks, requiring they locate and find shelter in 30 seconds or less. We assessed the concurrent validity of CTSR relative to the Posttraumatic Diagnostic Scale (PDS). RESULTS: On the basis of exploratory factor analysis (EFA), we retained 11 of 25 items measuring three distinct factors: exhaustion/detachment, rage/betrayal, and fear/helplessness. We found moderate concurrence between the scales; that is, the CTSR appears to measure a construct related to, but distinct from PTSD. This conclusion is supported by confirmatory factor analysis (CFA) indicating that each factor significantly contributes to measurement of a higher-order, continuous traumatic stress latent construct. CONCLUSIONS: These results support the psychometric properties of CTSR. Future research is required to confirm these findings in other countries and cultures and among individuals exposed to other forms of continuous traumatic stress.

National Resilience: A New Self-Report Assessment Scale.

The current paper presents a new self-report national resilience assessment scale (NRAS). The scale was constructed and validated using a sample of 1022 Jewish Israeli adults. The internal structure of the 25-item was determined by a Varimax factor analysis, which emitted four distinct factors pertaining to identifying with the state, solidarity and social justice, trust in national institutions and trust in public justice; which explained 61% of the variance. These factor scores were validated against two national resilience promoting factors (community resilience and sense of coherence), and two national resilience suppressing factors (distress symptoms and sense of danger); as well as four demographic characteristics (level of religiosity, political attitudes, income and level of exposure to terror/ war experiences in the last year). Results supported the validity of the NRAS and its four components, showing that it was consistently correlated with resilience promoting and resilience suppressing factors.

Risk Factors as Major Determinants of Resilience: A Replication Study.

The present study was conducted in the context of current concerns about replication in psychological research. It claims that risk factors should be regarded as an integral part of the definition of individual resilience, which should be defined in terms of the balance between individual strength or protective factors, and individual vulnerability or risk factors (IND-SVR). Five independent samples, including 3457 Israeli participants, were employed to determine the effects of resilience promoting and resilience suppressing variables on the IND-SVR index of resilience, and on its two components: recovery from adversity, and distress symptoms. Five path analyses were employed for determining the role of distress symptoms as a measure of psychological resilience, as compared to other indices of this resilience. Results indicated the major role of risk factors (distress symptoms) as an integral component of resilience. This role was generally replicated in the five investigated samples. Risk factors are legitimate, valid, and useful parts of the definition of psychological resilience. Resilience research has shifted away from studying individual risk factors to investigating the process through which individuals overcome the hardships they experience. The present data seem to suggest that this shift should be reexamined.

Differences in posttraumatic stress characteristics by duration of exposure to trauma.

Ongoing exposure of civilian populations to war and terror is associated with adverse responses beyond those specified in DSM-5 for PTSD. Current PTSD assessment practices are not fully sensitive to the complex symptomatic picture observed among individuals exposed to ongoing stress and are therefore limited for use in these situations. The current survey aimed to portray the posttraumatic characteristics most salient to ongoing exposure to political conflict. A questionnaire enquiring about various aspects of the posttraumatic consequences of ongoing exposure to political conflict as compared with those associated with a single exposure to trauma was disseminated to therapists throughout the country. Participants were asked to rank 75 posttraumatic characteristics for their relevance to each trauma type (about the symptom frequency and severity) and item mean scores were compared. The sample consisted of 66 responses valid for analysis. Our findings pinpoint some of the posttraumatic characteristics most salient to ongoing exposure to political conflict and highlight the complexity of the posttraumatic picture observed in these situations. Incorporating these in post trauma assessment tools will allow for the development of standardized, reliable definitions, which in turn will allow for more accurate diagnosis and more effective treatment protocols.

Exposure to traumatic events at work, posttraumatic symptoms and professional quality of life among midwives.

OBJECTIVE: in their line of duty, midwives are often exposed to traumatic births that may lead to symptoms of compassion fatigue (CF), which includes burnout (BO) and secondary traumatic stress (STS).Conversely, midwives derive pleasure and great satisfaction in seeing the positive effect they have on their clients. This experience is known as compassion satisfaction (CS). Together, CS and CF comprise the professional quality of life (ProQOL). The aim of this paper was to study midwives' professional quality of life and traumatic experiences. The highly stressful environment of midwives may also include primary exposure to traumatic experiences and therefore PTSD levels were also assessed. METHOD: the participants (N=93) were professional midwives from four medical centers in Israel. The participants answered selfreport questionnaires that assessed their ProQOL and PTSD symptoms. FINDINGS: results indicated relatively high levels of CS which may mitigate, at least to some degree, the negative aspects of CF. PTSD levels significantly and positively correlated with STS and BO. Sixteen per cent presented with PTSD symptoms of clinical significance. Also, seniority was significantly and positively correlated with BO and PTSD symptoms. CONCLUSIONS: high ProQOL was found amongst the participants, with more than 74% scoring on the high range of CS. Nevertheless, we recommend further research and implementing strategies to maintain or further enhance CS and decrease CF levels. Finally, a more comprehensive understanding of the development of PTSD amongst midwives is vital in order to minimize its occurrence in the future.

Individual, Community, and National Resiliencies and Age: Are Older People Less Resilient than Younger Individuals?

OBJECTIVES: The resilience of older and younger Israelis was investigated. DESIGN AND SETTING: A representative sample of the Jewish population in Israel (N = 1,022) was used. PARTICIPANTS: The participants were three adult age-groups (18-35, 36-64, and 65+ years). Half of them were women, and they evenly represented left-wing and right-wing political attitudes. MEASUREMENTS: Resilience was measured by the ratio of strength and vulnerability of the individual, the community, and the nation. RESULTS: Older participants did not differ from younger people in sense of danger; reported lower level of distress symptoms; and showed higher individual, community, and national resilience scores based on strength to vulnerability ratio, compared with younger individuals. CONCLUSIONS: These data support the contention that older Israelis are more resilient than younger cohorts. Their long direct or indirect experience with wars and terror attacks has not decreased their resilience, and has perhaps even strengthened it.

Leveraging Social Computing for Personalized Crisis Communication using Social Media.

INTRODUCTION: The extensive use of social media in modern life redefines social interaction and communication. Communication plays an important role in mitigating, or exacerbating, the psychological and behavioral responses to critical incidents and disasters. As recent disasters demonstrated, people tend to converge to social media during and following emergencies. Authorities can then use this media and other computational methods to gain insights from the public, mainly to enhance situational awareness, but also to improve their communication with the public and public adherence to instructions. METHODS: The current review presents a conceptual framework for studying psychological aspects of crisis and risk communication using the social media through social computing. RESULTS: Advanced analytical tools can be integrated in the processes and objectives of crisis communication. The availability of the computational techniques can improve communication with the public by a process of Hyper-Targeted Crisis Communication. DISCUSSION: The review suggests that using advanced computational tools for target-audience profiling and linguistic matching in social media, can facilitate more sensitive and personalized emergency communication.

Community Resilience throughout the Lifespan--The Potential Contribution of Healthy Elders.

An increase in the exposure and predisposition of civilian populations to disasters has been recorded in the last decades. In major disasters, as demonstrated recently in Nepal (2015) and previously in Haiti (2010), external aid is vital, yet in the first hours after a disaster, communities must usually cope alone with the challenge of providing emergent lifesaving care. Communities therefore need to be prepared to handle emergency situations. Mapping the needs of the populations within their purview is a trying task for decision makers and community leaders. In this context, the elderly are traditionally treated as a susceptible population with special needs. The current study aimed to explore variations in the level of community resilience along the lifespan. The study was conducted in nine small to mid-size towns in Israel between August and November 2011 (N = 885). The Conjoint Community Resiliency Assessment Measure (CCRAM), a validated instrument for community resilience assessment, was used to examine the association between age and community resilience score. Statistical analysis included spline and logistic regression models that explored community resiliency over the lifespan in a way that allowed flexible modeling of the curve without prior constraints. This innovative statistical approach facilitated identification of the ages at which trend changes occurred. The study found a significant rise in community resiliency scores in the age groups of 61-75 years as compared with younger age bands, suggesting that older people in good health may contribute positively to building community resiliency for crisis. Rather than focusing on the growing medical needs and years of dependency associated with increased life expectancy and the resulting climb in the proportion of elders in the population, this paper proposes that active "young at heart" older people can be a valuable resource for their community.

Posttraumatic Symptoms and Posttraumatic Growth of Israeli Firefighters, at One Month following the Carmel Fire Disaster.

Wildfire disasters are potentially traumatic events which directly and indirectly affect both citizens and first responders. The study of posttraumatic growth is scarcely found in the context of firefighters and only few studies have addressed this construct. In the current study, posttraumatic symptoms and posttraumatic growth were investigated among Israeli firefighters (N = 65), approximately one month after the Carmel Fire Disaster. Eight firefighters (12.3%) were found to be above the cut-off score for probable PTSD, with intrusion symptoms as the most frequent finding compared to avoidance and hyper-arousal symptoms. Posttraumatic growth (PTG) was evident to a small but considerable degree; noticeable changes were found regarding personal strength and appreciation of life. Results also revealed significant linear and quadratic relationships between PTSD and PTG. Results are discussed in light of past research on psychological responses among firefighters and first responders.

Conjoint Community Resiliency Assessment Measure-28/10 items (CCRAM28 and CCRAM10): A self-report tool for assessing community resilience.

Community resilience is used to describe a community's ability to deal with crises or disruptions. The Conjoint Community Resiliency Assessment Measure (CCRAM) was developed in order to attain an integrated, multidimensional instrument for the measurement of community resiliency. The tool was developed using an inductive, exploratory, sequential mixed methods design. The objective of the present study was to portray and evaluate the CCRAM's psychometric features. A large community sample (N = 1,052) were assessed by the CCRAM tool, and the data was subjected to exploratory and confirmatory factor analysis. A Five factor model (21 items) was obtained, explaining 67.67 % of the variance. This scale was later reduced to 10-item brief instrument. Both scales showed good internal consistency coefficients (α = .92 and α = .85 respectively), and acceptable fit indices to the data. Seven additional items correspond to information requested by leaders, forming the CCRAM28. The CCRAM has been shown to be an acceptable practical tool for assessing community resilience. Both internal and external validity have been demonstrated, as all factors obtained in the factor analytical process, were tightly linked to previous literature on community resilience. The CCRAM facilitates the estimation of an overall community resiliency score but furthermore, it detects the strength of five important constructs of community function following disaster: Leadership, Collective Efficacy, Preparedness, Place Attachment and Social Trust. Consequently, the CCRAM can serve as an aid for community leaders to assess, monitor, and focus actions to enhance and restore community resilience for crisis situations.

Ongoing exposure versus intense periodic exposure to military conflict and terror attacks in Israel.

The manifestation of posttraumatic stress disorder (PTSD) symptoms in two clinical samples in Israel (N = 212) was examined. Individuals suffering ongoing exposure to shelling were compared with subjects exposed to intense periodic exposure. Elevated arousal and avoidance symptoms, but not intrusion were reported in the ongoing exposure group. When compared by age, young participants in the ongoing exposure group had significantly lower PTSD scores, whereas no differences were found between participants among the intense periodic exposure age groups. No gender differences in symptoms were found among participants from intense periodic exposure, whereas in the other ongoing group the difference was in avoidance. Results are discussed in light of past research on exposure to terrorism.

Social, psychological, and psychiatric interventions following terrorist attacks: recommendations for practice and research.

The terrorist attacks of September 11, 2001, and the constant threat of imminent terrorist activity have brought into the forefront the urgent need to prepare for the consequences of such attacks. Such preparation entails utilization of existing knowledge, identification of crucial gaps in our scientific knowledge, and taking steps to acquire this knowledge. At present, there is little empirical knowledge about interventions following terrorism and absolutely no available empirical knowledge about interventions following bioterrorism. Therefore, this paper reviews knowledge about (1) reactions following the September 11 terrorist attacks in New York City and other places, (2) the practical experiences accumulated in recent years in countries (eg, Israel) that have had to cope with the threat of bioterrorism and the reality of terrorism, and (3) interventions for acute and chronic stress reactions following other types of traumatic events (eg, rape, war, accidents). Our review found several treatments efficacious in treating individuals for acute and chronic post-traumatic stress disorder (PTSD) related to other traumatic events that will likely be efficacious in treating PTSD related to terrorist attacks. However, there were significant gaps in our knowledge about how to prepare populations and individuals for the possibility of a terrorist attack and what interventions to apply in the immediate aftermath of such an attack. Accordingly, we conclude the paper with several questions designed to guide future research.