Cumulative trauma: The intersection between continuous security threats and the COVID-19 pandemic among Israeli older adults.

INTRODUCTION: Research on cumulative traumatic events and their consequences for older adults have yielded inconclusive findings, especially when the traumatic events are different types of events and happen simultaneously. OBJECTIVE: To explore older adults' perceptions of cumulative trauma, specifically exposure to continuous security threats via living in a war zone and COVID-19. METHOD: Seventeen in-depth, open-ended, and semistructured interviews were conducted with older adults living near Israel's border with Gaza. We used ATLAS.ti software to perform thematic analysis. RESULTS: Various perceptions of continuous security-related stress and COVID-19, indicative of categorical differences in the perceptions of the two, were found. Namely, the characteristics, difficulties, and emotions that accompanied each of the two abovementioned traumas revealed three trajectories: negative cumulative; positive cumulative; and unrelated. CONCLUSIONS: We suggest conceptualizing cumulative trauma responses as an intersecting trajectory model, between the effects of previous traumatic events and those of the current one, reflecting a combination of individuals' resilience and vulnerability. Suitable policies/practices in which each specific traumatic event is seen alone, as well as in tandem with others, should be implemented. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Long-Term Effects of Living in a Shared and Continuous Traumatic Reality: The Case of Israeli Families on the Border With Gaza.

This article presents a literature review of the concept of intergenerational transmission of traumatic stress among a specific population of Israeli parents and children living near the Israeli/Gaza border, an area that can essentially be viewed as a laboratory of shared, continuous, and stressful reality resulting from ongoing political violence. The Google Scholar database was used to search only for peer-reviewed articles written in English and published between 2002 and 2020, and the particular focus of the study was Israeli families living in the "Gaza envelope": communities that have been on the receiving end of rockets and mortars from Gaza for the past 20 years. The review was based on 35 articles and sheds light on the existence of studies using a variety of perspectives (e.g., psychological, biopsychosocial, and behavioral). Findings demonstrate the effects of continuous stress situations on the family dynamic, even before birth, among this small population. In addition, they show that to understand the unique process of intergenerational trauma transmission in a shared continuous traumatic reality, it is important to adopt a comprehensive perspective so as to understand the reciprocal, long-lasting, and transgenerational effects of being exposed to traumatic stress. This perspective can be used as a basis for developing family intervention strategies that are appropriate for preventing stress outcomes that derive from living in the context of persistent violence.

Living with spousal loss: Continuing bonds and boundaries in remarried widows' marital relationships.

The grief literature emphasizes widows' continuing bonds with their deceased spouses as a significant part of their grief process. Yet, little is known about what happens to those bonds when a widow remarries and there is a second spouse, and how these bonds are dealt with by the new family members. This study explored the continuing bonds of remarried Israeli widows, the role the second spouse plays in these processes, and the ambiguity and permeability of the boundaries between the first and the second marital relationships. Semi-structured interviews were conducted with 29 Israeli remarried military widows, over three decades after their first husbands' deaths. Data were analyzed by using thematic content analysis. Findings revealed that most of the women maintained continuing bonds with their deceased husbands, whereas a few of them severed these bonds. In all of the scenarios, however, the second husband played a major role, resulting in different levels of boundaries, from strict to blurred, between the first and the second marriages. These findings suggest that in order to obtain a full understanding of grief's impact on the second marital relationship, grief should be considered a couple-hood process in which the boundaries between the relationships are dynamic. The association between these patterns and personal and marital adjustment should be further explored.

En las publicaciones sobre el duelo se hace hincapié en que las viudas continúen los vínculos con sus cónyuges fallecidos como una parte importante de su proceso de duelo. Sin embargo, se sabe poco acerca de lo que sucede con esos vínculos cuando una viuda vuelve a casarse y hay un segundo cónyuge, y acerca de cómo los nuevos miembros de la familia manejan estos vínculos. En este estudio se analizó la continuidad de los vínculos de viudas israelíes que volvieron a casarse, el papel que desempeña el segundo cónyuge en estos procesos y la ambigüedad y la permeabilidad de los límites entre la primera y la segunda relación conyugal. Se realizaron entrevistas semiestructuradas con 29 viudas de militares israelíes que volvieron a casarse durante tres décadas después de la muerte de su primer marido. Los datos se analizaron usando el análisis de contenido temático. Los resultados revelaron que la mayoría de las mujeres mantuvieron la continuidad de los vínculos con los familiares de sus maridos fallecidos, mientras que algunas los cortaron. Sin embargo, en todas las situaciones, el segundo marido desempeñó un papel importante y hubo diferentes niveles de límites, desde definidos hasta desdibujados, entre el primer matrimonio y el segundo. Estos resultados indican que, con el fin de comprender completamente el efecto del duelo en la segunda relación conyugal, el duelo debe considerarse un proceso de pareja en el cual los límites entre las relaciones sean dinámicos. Deberá analizarse más profundamente la asociación entre estos patrones y la adaptación personal y conyugal.

"Remarried military widows" grief in light of social policy upheavals.

Military widows' remarriages and their consequences have scarcely been studied. We examined how legal changes enacted on behalf of remarried war widows, who regained their official rights after many years without them, impacted their life experience. Based upon 29 qualitative interviews, we found that the reinstatement of official recognition of widowhood validated participants' personal longitudinal grief but also revived painful loss-related feelings, which were expressed in interpersonal spheres. Policy changes allowed some widows a higher measure of independence, alongside upsetting the current couple's power balance. Social and clinical implications of such interruptions in the longitudinal grief course are discussed.

Stress-related emotional and behavioural impact following the first COVID-19 outbreak peak.

The COVID-19 pandemic poses multiple psychologically stressful challenges and is associated with an increased risk for mental illness. Previous studies have focused on the psychopathological symptoms associated with the outbreak peak. Here, we examined the behavioural and mental-health impact of the pandemic in Israel using an online survey, during the six weeks encompassing the end of the first outbreak and the beginning of the second. We used clinically validated instruments to assess anxiety- and depression-related emotional distress, symptoms, and coping strategies, as well as questions designed to specifically assess COVID-19-related concerns. Higher emotional burden was associated with being female, younger, unemployed, living in high socioeconomic status localities, having prior medical conditions, encountering more people, and experiencing physiological symptoms. Our findings highlight the environmental context and its importance in understanding individual ability to cope with the long-term stressful challenges of the pandemic.

Behavioral Responses in Youth Exposed to Natural Disasters and Political Conflict.

PURPOSE OF REVIEW: The aim of this review was to focus solely on youths' behavioral responses to natural disasters and political conflicts in order to fully understand their impact and scope. RECENT FINDINGS: Recent studies in the field of trauma have shown that theoretical conceptions have moved away from a narrow focus on the individual and towards wider ecological perspectives and from a narrow focus on negative responses to trauma exposure towards positive prosocial responses. Although there is a distinction between youths' behavioral responses towards natural disasters vs. towards political conflicts, in both of these adverse situations, behavioral responses exist alongside emotional responses. Adolescents exposed to either type of adverse scenario are often able to turn their negative experiences into positive ones, take greater responsibility for themselves and others, contribute to recovery processes, and engage in prosocial behaviors. These responses must be investigated in the context of the trauma field's recent understandings regarding psychological, biological, environmental, and cultural factors.

Long-term grief and sharing courses among military widows who remarried.

OBJECTIVE: The long-term consequences of military spousal grief have not been adequately studied. Although the literature emphasizes the widow's connection with the deceased as part of the grief process, the importance of the sharing patterns of such grief has been overlooked. This study aimed to add to the understanding of remarried military widows' long-term grief, via 2 main processes: The first was to explore their grief processes, and the second was to reveal whether and how their grief processes were shared with others. METHOD: Semistructured interviews were conducted with 29 Israeli remarried military widows, more than 3 decades after their husbands' deaths. Data were analyzed by using thematic content analysis. RESULTS: Findings revealed 2 continuums, 1 for each process. The first continuum was the grief process timeline, which covered a spectrum going from time- and emotionally limited processes to prolonged mourning processes. The second continuum was the sharing process, which covered a spectrum ranging from solitary grief to shared grief. Consequently, we suggest that widows can be viewed as occupying shifting points, over the years, on these intersecting continuums. CONCLUSIONS: The findings illuminate varied courses of coping and sharing of grief among older remarried military widows. IMPLICATIONS: An integration of loss, aging, and family relations theories for clinical work is suggested. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Children and adolescents facing a continuous security threat: Aggressive behavior and post-traumatic stress symptoms.

There is extensive research evidence indicating that children and youth are the most vulnerable population for developing psychological symptoms relating to war and terror. Although studies have documented a wide range of detrimental emotional and behavioral effects of such exposure, much less is known about the effects of exposure to a continuous security threat for children and adolescents. Against this background, the current article examined the implications of continuous exposure to missile attacks among 1096 children and adolescents enrolled in public schools near the Israeli border with Gaza. Participants filled out quantitative questionnaires, which relate to the pathological consequences of continuous exposure to security threats, and to the role of the school and the community as a protective environment against disruptive behavior resulting from such exposure. The findings revealed that PTSS responses were mainly related to the security threat, whereas interpersonal aggression resulted from other types of traumatic events. Significant differences were found between aggression and posttraumatic symptoms, by age and gender. PTSS was found to be lower for older participants and higher for girls, whereas aggression was higher for boys and higher for older participants. Furthermore, the sense of belonging to the place of residence was negatively associated with PTSS as well as with aggressive behavior: the higher the participants' sense of belonging, the lower their levels of PTSS and aggressive responses. In contrast, the sense of belonging to the school was negatively associated only with aggressive behavior: the higher the participants' sense of belonging to the school, the lower their aggressive responses. The findings are discussed in the light of trauma theories and in light of the results of previous research. The study contributed to knowledge about the differential consequences of exposure to a security threat, and highlighted the importance of differential interventions with children who show post-traumatic symptoms versus those who show aggressive behavior. Accordingly, the security situation should not overshadow social issues that need to be addressed, such as family violence and aggression among school children.

Living in a continuous traumatic reality: Impact on elderly persons residing in urban and rural communities.

This study is an exploration of the contribution of exposure to the continuous threat of Qassam rocket attacks to PTSD among elderly residents of urban and rural communities. Specifically, we examined the contribution of sociodemographic variables, psychological resources, and perceived social support to PTSD, and whether this relationship is mediated by cognitive appraisals. The sample consisted of 298 residents of 2 different communities: urban (n = 190), and rural (n = 108). We examined the main research question by calculating the correlations of the sociodemographic variables, the psychological resource (self-esteem), social support, and cognitive appraisals with the dependent variable (PTSD). Our model explained the variance in PTSD (53% for urban residents, and 56% for rural residents). Higher levels of PTSD were found among the urban residents. Most of the predictors contributed to PTSD, but differences were found between each type of community with regard to the combination of components. Results indicated that the type of community is related degree of protection against stress-related triggers such as Qassam rockets. The psychological resource (self-esteem) and cognitive appraisal variables were found to be important for older people facing a continuous threat, and can serve as a basis for professional intervention. (PsycINFO Database Record

Continuous Traumatic Situations in the Face of Ongoing Political Violence: The Relationship Between CTS and PTSD.

This article presents a literature review of the concept of continuous traumatic situations (CTS), which relates to residents living in ongoing situations of political violence and national security threats. The first aim of this review is to narrow the gap regarding knowledge about the concept of CTS by presenting findings from studies that have assessed the effects of CTS on civilian populations. The second aim is to describe CTS in a way that highlights the differences and similarities between posttraumatic stress disorder and responses to CTS. This distinction is a necessary precondition for examining CTS, as is a careful clinical analysis of the development and course of symptoms. This literature review also highlights the importance of adopting a supplementary perspective for understanding the psychological impact of ongoing exposure to real threats, which can be used as a basis for developing intervention strategies that are appropriate for coping with life in the context of persistent violence. CTS can be manifested as emotions, behaviors, and perceptions among individuals, families, communities, and societies. The nature of the proposed model of CTS is a circular one, combining past and future perceptions and emotional reactions that have resulted from continuous and repeated traumatic experiences over an extended period of time. This wider understanding reflects the complexity of the CTS phenomenon. Various micro and macro interventions relating to CTS as the result of political violence situations and national security threats are presented, and recommendations for practice, policy, and future research are offered.

Continuous exposure to life threats among different age groups in different types of communities.

The current study compared levels of posttraumatic symptoms (PTS) resulting from continuous exposure to missile attacks among residents of 2 types of communities (urban vs. rural) in 2 different age groups (elderly persons vs. young adults). We also took into account the contribution of individual resources (sociodemographic variables) and community resources (type of community of residence and sense of belonging to the community). The results revealed that, in general, the elderly residents were classified as suffering from more posttraumatic stress disorder (PTSD) and reported more PTS. Nonetheless, type of community of residence as well as individual and social resources contributed more to PTS symptoms than did the participants' age. The results are analyzed in light of the current literature on PTS, and in light of literature dealing with the impact of developmental life stage among populations that are continuously exposed to traumatic events.

Shared Resilience in a Traumatic Reality: A New Concept for Trauma Workers Exposed Personally and Professionally to Collective Disaster.

This article proposes a new concept, shared resilience in a traumatic reality (SRTR), which refers to trauma workers in shared reality situations. Based on the literature that emphasizes the positive effects of exposure to traumatic events for workers in this field, this article expands the perception of shared traumatic situations and examines the ability of trauma workers to cope, to show resilience, and to grow as a result of the mutual relationship with their clients. The literature review presents a variety of terms referring to the positive effects of working with trauma survivors on therapists as a basis for the new concept proposed here. These terms highlight the importance of empathic mutual aid relationships, which are a basic component for promoting resilience in a shared traumatic reality. The relative nature of shared resilience is discussed, bearing in mind that resilience can be manifested as emotions, behaviors, and conceptions. Various findings relating to shared resilience in traumatic situations are reviewed, and recommendations for research, practice, and policy are offered.

Social factors and mental health symptoms among women who have experienced involuntary job loss.

The growing proportion of women in the labor force and the current economic crisis has made women a target population for job loss. In that situation, they are likely to experience recurrent layoffs, which force them to cope with multiple job loss and with unemployment. The present study aimed to examine sociodemographic factors that help women succeed in coping with single or multiple experiences of job loss, and that even enhance their self-efficacy in returning to work. The population of participants consisted of 134 Israeli women aged 30-45 who had been laid off. The findings indicate that the women who had experienced multiple job loss expressed a stronger desire to return to work than did those who had been laid off only once. Married women showed a greater tendency to become accustomed to stress after being laid off than did never-married women. However, even though multiple job loss might be a forced solution to home-work conflict, never-married women were found to be at risk for distress responses after being laid off. There is a need to develop responses for women who are at risk for multiple job loss, and to enhance employers' awareness of the situation faced by women who are laid off.

Medical clowning: even adults deserve a dream.

The article examines the significance of the integration of medical clowns as an intervention strategy with adult outpatients suffering from chronic illnesses. The study is based on content analysis of the documentation of the work of two medical clowns over two years. The dominant theme involves the definition of the clown's role and includes perspectives on his integration into the hospital's multidisciplinary medical staff and his impact on the staff and on patients and their families. The finding is discussed in light of the dual role of the medical social worker as coordinator and as a case manager, and the challenge of integrating medical clowns in treatment of adult patients. There is room for further exploration of the contribution of medical clowns to assisting and improving the quality of life for patients and hospital staff.

Ways of coping and sense of belonging in the face of a continuous threat.

This study examined the contribution of ways of coping and sense of belonging to stress responses among students in a conflict zone. Students at a college situated in an area exposed to continuous threat were divided according to their place of residence: locations inside and outside of the conflict zone. Rate of posttraumatic stress disorder (PTSD) was similar to rates in previous studies conducted among Israelis who had been exposed to terror. Acceptance as a way of coping and sense of belonging contributed to reducing PTSD symptoms, whereas use of alcohol and seeking support contributed to increasing stress responses. The discussion examines the results in light of the literature on ways of coping and sense of belonging in the face of continuous threat.

Recurrent job loss and mental health among women.

Growing instability in the labor market has led to an increase in recurrent job loss, which primarily affects women (Tamir, 2007). Numerous studies have shown that job loss is a stressful, traumatic experience that has consequences for the individuals who are laid off. However, few studies have examined how recurrent job loss affects individuals. The present study of 134 Israeli women aged 30-45 years aimed to examine how recurrent job loss affected individual women's perceptions of the event and the extent to which it generated emotional stress and psychiatric symptoms. Most of the women perceived job loss as a challenging event and their assessments of job loss had a stronger impact on the development of mental health consequences than did the number of times they had actually been laid off. The more the women perceived job loss as threatening, the more they reported emotional stress and psychiatric symptoms. Conversely, the more they perceived job loss as challenging, the lower their levels of emotional stress. Never-married women were laid-off more, and they reported more mental health symptoms following recurrent job loss than did married women. The findings suggest that perception of job loss as a threatening event might cause mental health problems as results of lay-off.

Posttraumatic stress and growth: the contribution of cognitive appraisal and sense of belonging to the country.

The study has three aims: (1) to compare the effect of the Qassam attacks in two types of communities: development town and kibbutz; (2) to examine the relationship between posttraumatic stress (PTS) and posttraumatic growth (PTG); and (3) to examine the contribution that level of exposure, cognitive appraisal, and sense of belonging to the country make to PTS and PTG. The sample consisted of 134 residents, 67 living on two kibbutzim and 67 living in the development town of Sderot. Results revealed that the development town residents reported more PTS symptoms and more PTG than did the kibbutz residents, and the association between PTS and PTG was positive. In addition, the findings show that most of the predictors contribute to either PTS or PTG, or predicted them differently. The discussion examines the results in light of the current literature on PTS and PTG.

[The definition of the medical clown's role with adult patients].

In recent years, the healthcare system has grown increasingly aware of the need to develop and adopt new models and intervention methods aimed at improving patients' quality of life. As part of this perception, medical clowns have been integrated into hospitals, primarily in work with children. Recently, there have been attempts to integrate clowns into work with adult patients in emergency rooms, but this intervention method has not yet been systematically implemented and studied. This article describes and examines the definition of the medical clown's role as an intervention strategy with adult outpatients suffering from chronic and life-threatening illnesses. The study is qualitative and based on a content analysis of the documentation of the work of two medical clowns over two years. The dominant theme arising from this analysis involves the definition of the clown's role within the medical space of the hospital and includes perspectives on his integration into the hospital's multidisciplinary medical staff and his impact on the staff and on patients and their families. The findings indicate that, from the clowns' point of view, integrated medical clowns as part of the medical team, would contribute to the functioning of both patients and staff. This is in accord with additional studies conducted recently in medical centers around the world. Since this is a pioneering study, there is room to further probe and research the medical clown's contribution to assisting and improving patients' and staff's quality of life and to develop ways of increasing his integration and professionalism.

Training students for a shared traumatic reality.

A shared reality challenges students' ability to deal with threat and crisis. It requires several resources in terms of money and time, as students need a great deal of support, a containing environment, and a relevant knowledge base to establish effective helping relationships. We found a large gap between the design and implementation of the course, introducing modifications to provide the students with a professional shield so that they could work with the teenagers in an appropriate and ethical manner. The recent increase in traumatic events throughout the world, whether acts of terror or natural disasters, makes it necessary to train social work students for conditions of shared reality and to include such courses in their core curriculums, not merely to design them ad hoc as a response to acute situations. We recommend that suitable training programs continue to be developed and that sufficient time be allocated to theory and practice. Students need a more secure base of wider knowledge to be able to operate effectively in an intense experience. Furthermore, it is important to remember that the lecturers, too, are part of the same shared reality, a fact that is likely to affect their ability to teach and to analyze the experience. As the staff may be perceived as vulnerable, students might be reluctant to reveal to them their political views or unique needs as helpers (Nuttman-Shwartz & Shay, 2006). Thus in situations of shared reality, means should be found to support the staff as well.

Is there life without work?

The present study examined the way retirees perceive retirement and continue to work post-retirement. Using a longitudinal design, qualitative and quantitative analyses were performed to examine the effect of preoccupation with work on adjustment to retirement. The findings indicate a wide range of attitudes toward cessation of the working life on the eve of retirement. In addition, most retirees reported increased well-being and decreased distress one year after retirement. Although for all participants a correlation was found between adjustment and preoccupation with work on the eve of retirement, no difference in the adjustment measures emerged a year later between those who were fully retired and those who continued to work. The implications of the findings for both personal well-being and social policy are discussed.