Mental Health Interventions in a General Hospital Following Terrorist Attacks

Abstract

Over three years of repeated terrorist attacks in Israel have shown that the victims suffering from acute stress syndromes constitute the bulk of the casualties. The large number of psychological victims presents an immediate problem of hospital surge capacity. The need for alleviating acute suffering and preventing chronic, disabling posttraumatic syndromes requires organizational and clinical skills. The article reviews deployment and intervention protocols for the treatment of victims and affected staff members in a general hospital setting.     

Treating Survivors of Terrorism While Adversity Continues

Abstract

The current situation in Israel of continuous terrorist attacks poses unique challenges to the treatment of Posttraumatic Stress Disorder (PTSD). This article addresses issues that arise when treating survivors of ongoing terrorism. These include: (a) Is PTSD treatable during ongoing adversity? (b) When should treatment be offered? (c) Is avoidance maladaptive or adaptive? (d) How does one deal with re-exposure? (e) How to define the end of treatment? and (f) What are the effects on the therapist when conducting treatment during ongoing adversity? Case studies are provided to illustrate these issues when treating clients with PTSD during ongoing terror.     

Follow-up of victims of one terrorist attack in Israel: ASD, PTSD and the perceived threat of Iraqi missile attacks

The first aim of the study was to examine the relationships between acute stress reactions and post-traumatic reactions following exposure to a terrorist attack. The second was to examine whether exposure to a terrorist attack increases the perceived threat and fear of renewed Iraqi missile attacks. Data were collected at two points in time: during the first month after the exposure to a terrorist attack (N = 54), and four months later (N = 44). Twenty-four percent of the exposed group had acute stress disorder (ASD), and a similar percentage had PTSD. Among participants who had ASD, the chances of developing PTSD were three times greater than among those who had never experienced ASD. Among participants who had been exposed to a terrorist attack and developed PTSD, the perceived threat of an Iraqi missile attack was greater than among those who had been exposed to a terrorist attack but did not develop PTSD, or among the participants in the control group. The discussion deals with the findings in light of the current controversy regarding ASD and the current situation in Israel.     

Engagement in community activities and trust in local leaders as concomitants of psychological distress among Israeli civilians exposed to prolonged rocket attacks

Background and objectives: Present study, conducted in the aftermath of the 2014 Israel–Gaza conflict, investigated psychological toll of exposure to rockets attacks in a sample of residents of central and southern Israel. Analyses focused on the distress-protective functions of collectively grounded resources: engagement in community activities and trust in local leadership.

Design: This cross-sectional study was conducted between 2 and 3 months after the hostilities.

Method: Participants (N?=?764) were recruited by an online survey company that distributed a questionnaire assessing, in addition to focal predictors, sociodemographic factors and prior exposure to trauma. The outcome variables were post-traumatic stress disorder (PTSD) and nonspecific distress symptoms.

Results: Conservative regression analyses revealed that greater exposure to rocket attacks was predictive of higher levels of posttraumatic stress symptoms. Higher engagement in community activities exhibited a partial trauma-buffering function. However, higher levels of trust in local leaders appeared to exacerbate, rather than diminish, negative impact of rocket exposure on PTSD. Symptoms of psychological distress were not influenced neither by trauma exposure nor by stressor interactions with resources. Trust in local leadership exerted a beneficial main effect on distress.

Conclusions: Collectively based resources are important for coping in times of community-wide stressors, yet their role is complex.     

Distinctiveness in flashbulb memory: comparative analysis of five terrorist attacks

The purpose of the present study was to find out whether a series of terrorist attacks, which share some common features, elicit flashbulb memories (of the personal circumstances in which the person first learned about these events) that are usually elicited by a single, unexpected, surprising, and personally important event. A total of 131 participants answered questions regarding details of five terrorist attacks that had taken place in Israel during the years 1995-1997. In addition, they assessed, for each of the five events, the number of overt rehearsals, and the degrees of emotional intensity, surprise, novelty, personal importance, and distinctiveness. Data analyses showed that most variables that are usually associated with the formation of flashbulb memories were also found in memories of the terrorist attacks that were judged by the participants as being distinctive. Distinctiveness may therefore be considered an important factor in the formation of flashbulb memories.     

Distinctiveness in flashbulb memory: Comparative analysis of five terrorist attacks

The purpose of the present study was to find out whether a series of terrorist attacks, which share some common features, elicit flashbulb memories (of the personal circumstances in which the person first learned about these events) that are usually elicited by a single, unexpected, surprising, and personally important event. A total of 131 participants answered questions regarding details of five terrorist attacks that had taken place in Israel during the years 1995–1997. In addition, they assessed, for each of the five events, the number of overt rehearsals, and the degrees of emotional intensity, surprise, novelty, personal importance, and distinctiveness. Data analyses showed that most variables that are usually associated with the formation of flashbulb memories were also found in memories of the terrorist attacks that were judged by the participants as being distinctive. Distinctiveness may therefore be considered an important factor in the formation of flashbulb memories.     

The effect of constant threat of terror on Israeli Jewish and Arab adolescents

The effect on Israeli Jewish and Arab adolescents of living under constant threat of terrorist attacks was assessed in a sample of 346 adolescents. The study probed their direct and indirect exposure to terrorist attacks, avoidance of public centers, sharing feelings with significant others, and stress reaction symptoms. The adolescents showed mild to low levels of stress symptoms in reaction to terrorist attacks in Israel, with no significant differences between Jews and Arabs. The Jewish adolescents reported knowing more people involved in terror attacks and being more informed by their parents about them. Demographic and exposure variables explained 39% of the variance of stress reaction symptoms. Being female, knowing someone injured, having parents who discuss terrorist attacks or forbid going out, and more sharing of feelings were significantly related to higher stress symptoms. For Jewish adolescents, greater levels of sharing of feelings were related to higher distress. Jewish and Arab adolescents proved to be similarly affected by the threat of terror but were also resilient even in highly unusual circumstances.     

Post-Traumatic Distress in Israeli Adolescents Exposed to Ongoing Terrorism

Summary

This article examines the impact of exposure of ongoing terrorism on post-traumatic stress disorder (PTSD) symptoms, functional impairment, somatization, and depression among Israeli adolescents in the context of the Al Aqsa Intifada. An in-school screening of 1,010 adolescents was conducted in Jerusalem and nearby settlements that were subjected to intensive terrorist attacks. The screening procedure proved effective in identifying posttraumatic distress and triaging students for school-based treatments. The relationship between level of exposure and gender and the psychological sequelae, the differences between adolescents in Jerusalem and the settlements, and the role of spirituality and community are discussed.     

Facets of Right‐Wing Authoritarianism Mediate the Relationship Between Religious Fundamentalism and Attitudes Toward Arabs and African Americans

Since the September 11 terrorist attacks, hate crimes against Arabs have increased in the United States. Despite recent increases in anti‐Arab attitudes, little psychological research has been conducted to understand this prejudice. Across two studies, we tested a theoretical model of Arab and African‐American prejudice. We found the aggression facet of right‐wing authoritarianism mediated the relationship between religious fundamentalism (RF) and prejudice toward Arabs and African Americans. Results are interpreted in light of previous research on cognitive rigidity, RF, and prejudice, and implications are made for political leaders conversing about Arab nations and peoples.     

On the So-Called War on Terrorism

Abstract: Since the terrorist attacks on the United States in September 2001, the country has embarked on a so‐called war on terrorism. This essay argues that so‐called war on terrorism has used the pretext of responding to terrorist attacks in the U.S. in September 2001 to wage wars in Afghanistan and Iraq that have objectives other than stamping out terrorism. It further argues that war requires a moral justification that cannot be provided for either the war in Afghanistan or the war in Iraq.     

From Demonization to Identification: How Parents Who Lost Children in Terrorist Attacks Perceive the Attacker

The aim of this article is to examine how bereaved parents who lost children in terrorist attacks in Israel perceive the terrorist attack perpetrators. Forty bereaved parents were interviewed using a semistructured in-depth interview. The content analysis revealed a typology of reactions to the Arab attackers that included perceiving them as objects of anger, hate, and revenge; as demons; as negligible; and as people with whom they could identify. The way bereaved parents perceive the Arab attackers serves as a coping resource. Follow-up research to examine the efficacy of the different types of reactions towards attackers would contribute to gaining a deeper understanding of the coping process that bereaved parents experience.     

How Schools Respond to Traumatic Events

Abstract

School systems face crises of a variety of types and forms, including the suicide death of a student, the death of a teacher, mass shootings, and the aftermath of terrorist attacks. This article examines ways for school systems to deal with the aftermath of those crises, both immediately and in the long term. Suggestions for classroom interventions, group experiences, and homework assignments are included. The impact of terrorism on school personnel is also discussed.     

Mental Health Services Preparing for the Psychological Consequences of Terrorism

Summary

The Israeli population has been subjected to the stresses of war and terrorist attacks since long before the state was founded. Confronting this extensive experience of terrorism-related psychological trauma, the Mental Health Services of the Ministry of Health designed and implemented a comprehensive emergency response system that operates in general hospitals and community settings to meet the psychological needs resulting from terrorism at both the individual and the population levels. This article describes general premises, basic elements, administrative structure and functioning of this system, as well as training programs for various service providers working with the victims.     

Contributors

Abstract

The terrorist attacks on the USA, and the responses to them, brought to light complex social forms and interactions ‐ and varying involvement by churches and religions ‐ amongst the peoples and governments involved. The first responses in the USA were to the attacks as destructive of meaning, with corresponding practical, moral and religious attempts to restore social meaning. Subsequent responses have employed notions of social life performed with the instruments more typical of a modern society, but these usually lack historical and religious awareness: economics, government and military power. The article traces some of the distinctive ideological, rhetorical and religious forms of society in the USA, interacting with those more historically formed, in Europe, the Middle East and amongst Islamists. It argues the need for an international socio‐religious — that is ecclesial ‐ response to present events, as now seen in ‘Scriptural Reasoning’, a movement in which Jews, Christians and Muslims join.     

Attachment in Psychotherapy

Abstract

Basic psychotherapy techniques are necessary for trauma intervention, including the terrorist attacks that occurred on September 11, 2001. The importance of these techniques is reviewed within various settings in the New York City area immediately following the World Trade Center disaster. The purpose included debriefing of practitioners, as well as the education of trauma symptoms and assessment for client intervention. Perhaps most importantly was the therapeutic technique modeled by the social work leader in these vignettes, since she and other practitioners simultaneously experienced symptoms of trauma. The practice of creating and maintaining a therapeutic atmosphere at this time was an essential challenge for all.     

Identification and Follow-Up by Primary Care Doctors of Children with PTSD After Terrorist Attacks

Abstract

Many children and adolescents were among the victims of the suicide bomb attacks in Israel since March, 2000. While the number with emotional and behavioral symptoms was expected to be high, very few children who developed terrorism-related posttraumatic stress disorder (PTSD) were actually referred to mental health professionals for assessment or treatment. Prolonged exposure to terrorism lowers even further the number of children who remain in treatment. This article discusses reasons and presents a training program for primary care providers (pediatricians, family doctors) in identifying PTSD in child victims, and for mobilizing them to carry out long-term follow-up of these children.     

Terror threat perception and its consequences in contemporary Britain

The terrorist attacks of 9/11, and subsequent terrorist acts around the world, have alerted social psychologists to the need to examine the antecedents and consequences of terrorist threat perception. In these two studies, we examined the predictive power of demographic factors (age, gender, location), individual values and normative influences on threat perception and the consequences of this perception for behavioural change and close relationships. In Study 1 (N=100), gender, benevolence values and normative influences were all correlates of threat perception, whilst sense of personal threat was correlated with increased contact with friends and family. In Study 2 (N=240) age, gender, location, and the values of openness to change and hedonism, all predicted threat perception, which, in turn, predicted behavioural change and relationship contact. Such findings point to the important role social psychologists should play in understanding responses to these new terrorist threats.     

Coping and anxiety in college students after the September 11th terrorist attacks

This study investigated the presence of a stress response after the September 11^th terrorist attacks in a sample of indirectly affected college students living in Boston, Massachusetts. Anxiety was examined at two time intervals, approximately 2 and 4 months after the attacks. Methods of coping with the stress of the attacks (assessed using the COPE Inventory) and their impact on initial and longer-term anxiety were also examined. Results demonstrated that the majority of college students in the study were severely psychologically impacted initially by the terrorist attacks. However, this initial impact appears to decay over time for most people. Several potentially maladaptive coping strategies were found to be predictive of initial anxiety, including denial, behavioral disengagement, mental disengagement, and focus on and venting of emotions. However, only focus on and venting of emotions was found to be uniquely predictive of longer-term anxiety.