Gender Group Differences in Coping with Chronic Terror: The Israeli Scene

Gender group differences in terror–stress, cognitive appraisals, ways of coping with terror, and stress reactions were explored in a sample of Israeli adults following prolonged exposure to political violence. Data were gathered at the height of the Al-Aqsa Intifada uprising (May/July 2002) from a sample of 707 adult participants (60% women and 40% men) residing in Haifa and northern Israel. Israeli women reported that they were more distressed by political violence than the men did, and they also appraised the crisis situation as more threatening and less manageable. Women reported using more problem-focused as well as emotion-focused coping than men did; both men and women used a mixture of coping strategies. Compared to men, women reported that they experienced more somatic symptoms and more frequent posttraumatic stress symptoms than men did. Negative affectivity was found to mediate gender differences in appraisals, coping, and outcomes. Overall, the nexus of relations among key variables was found to be highly similar for men and women. These data suggest that women may be more reactive to chronic political violence situations than men are. The data are discussed and explicated in the context of stress and coping theory and prior research on political violence and community disasters.     

An Intensive Outpatient Program for Veterans With Posttraumatic Stress Disorder and Traumatic Brain Injury

Post-9/11 service members may return from military service with a complicated set of symptoms and conditions, such as posttraumatic stress disorder (PTSD), depression, substance misuse, and traumatic brain injury (TBI), that interfere with reintegration and impair functioning. Although evidence-based treatments that facilitate recovery exist, their successful delivery at a sufficient dose is limited. Barriers to accessing treatment combined with challenges compiling a comprehensive treatment team further delay delivery of effective evidence-based care for PTSD, TBI, and co-occurring mental health conditions. This paper describes the development of a comprehensive, multidisciplinary, 2-week intensive day program for post-9/11 veterans with complex mental health concerns. The treatment program combines skill building groups, family education, and integrative health approaches with evidence-based individual PTSD or TBI care. Initial results from the first 132 participants were notable for a 97% completion rate, as well as statistically significant and clinically meaningful reductions in PTSD, neurobehavioral, and depression symptom severity for the 107 veterans who completed the PTSD track and the 21 who completed the TBI track. These data suggest the intensive program approach is an effective, well-tolerated model of treatment for post-9/11 veterans with PTSD and/or TBI. Future controlled studies should examine the effectiveness of this intensive model compared to standard evidence-based therapy delivery, as well as longitudinal outcomes.     

A Steppenwolf called Brian: Reflections on childhood suffering and creativity

Through the life of the writer Brian Aldiss, this paper explores the idea that if parents are unable to give a child a solid sense of self, the child may grow up with a burning need to find that self through artistic creation. One not uncommon reason for this failure is if the child is a replacement for another child who has died and the parents have not been able to do the grief work required in mourning. This task is often more problematic in the case of a stillbirth. Examples are given of other creative people, such as Freud and Dali, where a previous death in the family may have been the spur to their finding a special identity through their creativity.     

Durability of Cognitive Behavioral Therapy Effects for Youth and Adolescents With Anxiety,Depression, or Traumatic Stress:A Meta-Analysis on Long-Term Follow-Ups

Cognitive behavioral therapies (CBT) for youth with anxiety, traumatic stress, and depression have demonstrated strong effects in individual studies and meta-analyses. Relatively more attention has been given to posttreatment effects, though, and assessment of follow-up effects has been limited at the meta-analytic level. The current meta-analysis aimed to (a) examine the effects of youth CBT at posttreatment, 1-month, 3-month, 6-month, 1-year, and long-term (2 + years) follow-up as well as (b) identify research-related variables (e.g., measure respondent type) that relate to effects. Using a random effects model across 110 child and adolescent CBT groups, within-group effect sizes were large at posttreatment (g = 1.24) and from 1-month through long-term follow-up (g = 1.23–1.82), and effect sizes did not significantly differ by treatment target (i.e., anxiety, traumatic stress, depression). However, availability of outcome data for effect sizes diminished across later follow-up assessments. Moreover, effect sizes were significantly associated with outcome respondent type across assessment timing, with outcome measures from caregiver and youth respondents associated with smaller effect sizes (B = -0.97, p < 0.001) relative to outcome measures that were evaluator-reported. Results provide initial support for the durability of treatment effects for youth CBTs and highlight the importance of some confounding variables. Implications for improving treatment research standards and prioritizing assessment of long-term follow-up assessment are discussed.     

When Treatment is Traumatic: An Empirical Review of Interventions for Pediatric Medical Traumatic Stress

Pediatric medical traumatic stress (PMTS) is common among injured/ill children and is associated with elevated distress, treatment non‐adherence, and poor health outcomes. As survivorship of life‐threatening pediatric injury and illness continues to increase alongside rapid medical advancements, rates of PMTS and negative sequelae are expected to grow; however, research on prevention and treatment of PMTS is limited. The current study sought to systematically review the literature using a developmental framework to highlight research gaps. Sixteen peer‐reviewed studies were identified via a systematic literature search. Consistent with best practices for treatment of childhood trauma, caregiver involvement and CBT principles served as the foundation for most interventions. All studies reported improvements in PMTS; however, among the most methodologically rigorous, few found statistically superior reductions in PMTS between intervention and control groups. While many studies focused on a specific developmental stage and discussed developmental considerations, others took a “one‐size‐fits” approach. Interventions that demonstrated the most promising findings were online, self‐guided, or time‐limited. Future research would benefit from expanding diversity of participants, continuing to evaluate novel delivery methods, and integrating developmental considerations along with trauma‐informed care (TIC) approaches, given their useful framework for understanding child traumatic stress responses and avenues for prevention and treatment.     

School Counselors,Multiple Student Deaths,and Grief: A Narrative Inquiry

A team of 5 school counselors were interviewed to learn how they professionally and personally experienced the deaths of multiple students in 1 year in their school while attending to the needs of the school community. By using narrative inquiry, 5 themes emerged from the analysis: gravity of the losses, logistics of care, personal vs. professional conflicts, increased student cohesion, and efficacy. Recommendations for counselor preparation, research, and counseling practice are offered.     

持续性联结及其与丧亲后适应的关系

生者与逝者的关系不会因为死亡而终止, 在逝者离世之后, 生者可能继续与逝者保持持续的、内在的联结, 这被称为“持续性联结”。持续性联结在不同文化中均普遍存在, 已有研究从联结控制点、联结的引发者等维度对其进行分类, 近年来, 持续性联结对丧亲后适应的影响成为丧亲及哀伤研究中的热点。持续性联结与丧亲后适应的关系呈现出复杂且不一致的研究结论。未来的研究应该在本土文化背景下去探索持续性联结的表现及特定意义, 思考持续性联结的分类并编制本土化的测量工具, 与此同时, 应该在理论驱动下去开展持续性联结与适应关系的实证研究。     

创伤暴露程度、主观害怕程度对儿童创伤后应激障碍影响的追踪研究:社会支持的调节作用

为了考察创伤暴露程度、主观害怕程度、社会支持与创伤后应激障碍（PTSD）之间的纵向关系,本研究采用创伤暴露程度问卷、主观害怕程度问卷、社会支持问卷与儿童创伤后应激障碍症状量表对雅安地震半年后的303名小学生进行测查,并于震后一年半时进行再次测查。逐步回归分析的结果发现,创伤暴露程度对地震半年后的PTSD具有显著的正向预测作用,对震后一年半的PTSD没有显著的预测作用;无论是震后半年还是一年半,主观害怕都可以加剧PTSD、社会支持都可以缓解PTSD;社会支持在创伤暴露程度与PTSD之间不起显著的调节作用,但却可以显著地调节主观害怕程度对震后一年半的PTSD的影响,表现为主观害怕程度对震后一年半的PTSD的正向预测作用随着社会支持水平的增加而降低。     

Depression Following Traumatic Brain Injury: The Validity of the CES-D as a Brief Screening Device

The validity, reliability, and factor structure of the Center for Epidemiological Studies-Depression Scale (CES-D) was examined with 253 patients seen for neuropsychological evaluation following traumatic brain injury (TBI). All patients completed the CES-D; 31 also completed the Beck Depression Inventory (BDI) and 17 completed the Minnesota Multiphasic Personality Inventory-II (MMPI-II). The CES-D demonstrated good concurrent, construct validity, significantly correlating with the BDI (r = .673, p < .0001) and the MMPI-II (Depression Scale T score r = .536, p = .027). The CES-D also demonstrated good internal consistency (coefficient alpha = .8195) and split-half reliability (Spearman–Brown r = .8284). Principal components factor analysis with varimax rotation resulted in a four-factor solution that accounted for 56.01% of the variance. The factor structure differed from the originally reported factor structure, and indicated that somatic difficulties were strongly associated with dysphoric affect in TBI patients. The CES-D is a valid and reliable screening instrument for use with TBI patients.     

C. S. Lewis Surprised and Humanized by Joy

Abstract : C. S. Lewis' views on sexuality and the relationship between men and women changed radically through his relationship with Joy, his friend and later wife. Lewis makes a sharp distinction between love and friendship in his writings. This article shows how his concrete experience of love and grief with Joy transformed his understanding of relationships between men and women, and, eventually, the meaning of being human and its implications for Christianity.