Why step in? Shifting justifications for bystander behaviors through interventions with youth in the Middle East.

Research shows positive bystander intervention effectively mitigates bullying experiences. Yet, more evidence regarding bystander responses to bias-based social exclusion (BSE) is needed in intergroup contexts, especially in the majority world and in areas of intractable conflict. This study assessed the effectiveness of skills and skills + contact-based interventions for BSE among 148 Palestinian Citizens of Israel (Mage = 10.55) and 154 Jewish-Israeli (Mage = 10.54) early adolescents (Girls = 52.32%) in Tel Aviv-Yafo. Bystander responses were assessed by participants' reactions to hypothetical BSE scenarios over three time points. Repeated measures ANOVAs revealed both interventions significantly increased positive and decreased negative bystander responses, with changes maintained at the follow-up. The opposite result pattern emerged for the control group. Findings suggest that both interventions can effectively encourage youth to publicly challenge BSE, even amidst intractable conflict.

Trauma history predicts depression and posttraumatic stress symptoms better than a psychiatric diagnosis: Comparing wartime, routine time, and early COVID-19 in Israel.

Individuals with a psychiatric diagnosis and those with a history of trauma are at high risk for depression and posttraumatic stress symptoms (PTSS) following exposure to new traumatic events. Nevertheless, research is scarce on how having both a psychiatric diagnosis and a trauma history affect reactions to new traumatic events, and how different trauma types may affect individuals with a psychiatric diagnosis. We thus examined whether different stressful contexts (War and COVID-19) affected individuals with and without a psychiatric diagnosis differentially and whether results might be explained by prior trauma exposure. In the same cohort, we assessed depression and PTSS during wartime (2014), routine time (2016), and during the COVID-19 pandemic (2020) in a sample with (n = 89) and without (n = 104) a self-reported psychiatric diagnosis. This cohort was recruited during the 2014 Israel-Gaza War using social media, snowballing and outreach to mental health rehabilitation centres. We used a linear mixed modelling approach on data from the entire sample, as well as on the two study groups separately. We found that trauma history predicted PTSS and depression whereas a history of psychiatric diagnosis did not. Regarding trauma types, we found that individuals in the psychiatric diagnosis group relative to themselves had more symptoms during COVID-19 compared to war and routine time, while those without diagnosis had more PTSS and depression symptoms during wartime compared to routine time and COVID-19. In conclusion, a traumatic past may have an important influence on reactions to different types of traumatic events. Distinct traumatic events may affect individuals with or without a psychiatric diagnosis differentially.

Comparing Indirect and Combined Effects of Mindfulness and Compassion Practice Among Schoolchildren on Inter- and Intra-personal Abilities.

Objectives: During the last decade, mindfulness-based interventions have been implemented in the educational system. Such programs could follow several approaches, including an indirect approach, in which interventions are delivered only to teachers and a combination in which interventions are delivered to both teachers and students. Because of the importance of teacher's involvement in programs designed to help children, we compared students' impact of indirect, combined, and control groups over time. The indirect program delivered was the "Call to Care - Israel for Teachers," and the direct program was the "Call to Care Israel" for students. Both programs employ mindfulness, compassion, and training of social-emotional skills, with a unique emphasis on care. Methods: Two hundred 4th and 5th grade students were divided into indirect (2 classrooms), combined (3 classrooms), or control groups (3 classrooms). Each condition was implemented in a different school; schools were randomly divided into groups. The interventions were delivered by trained facilitators and included 20 weekly meetings. Outcomes for students were measured before the intervention, after it ended, and 6 months later. Results: Hierarchical linear models revealed that both the indirect and the combined approaches were effective in improving well-being, anxiety, attention, and teacher's availability and acceptance, while only the combined approach was effective in improving mindfulness, somatization, classroom atmosphere, and pro-social behavior. Conclusions: Our results suggest that the combined approach is more beneficial than the indirect approach. However, given the scalability and cost of the indirect approach, it should also be considered an effective alternative. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-022-01955-y.

Preschool Teachers' Psychological Distress and Work Engagement during COVID-19 Outbreak: The Protective Role of Mindfulness and Emotion Regulation.

COVID-19 has dramatically affected the mental health and work environment of the educational sector. Our primary aim was to investigate preschool teachers' psychological distress and work engagement during the COVID-19 outbreak, while examining the possible protective role of participating in a mindfulness-based intervention geared to foster compassion (Call2Care-Israel for Teachers; C2C-IT) and emotion regulation. The prevalence of emotional distress, work engagement, and COVID-19 concerns were evaluated in 165 preschool teachers in the early stages of the COVID-19 outbreak in Israel through questionnaires. The findings showed that preschool teachers experienced increased emotional distress. Teachers who had participated in the C2C-IT intervention six months before the pandemic outbreak (N = 41) reported lower emotional distress, higher use of adaptive emotion regulation strategies, and higher work engagement, compared to their counterparts that had not participated in the intervention (N = 124). Emotion regulation strategies mediated the link between participating in CTC-IT intervention and emotional distress and work engagement. Teaching is a highly demanding occupation, especially during a pandemic, thus making it important to invest resources in empowering this population. The findings here suggest that the implementation of a mindfulness-based intervention during the school year can enhance teachers' well-being, even during stressful events such as the COVID-19 pandemic.

Risk factors for depression and anxiety during COVID-19 in Israel: A two-wave study before and during the pandemic.

Research indicates that mental health problems increased across the globe after the outbreak of the COVID-19 pandemic. However, there is a need for research examining specific risk factors for mental health problems, while accounting for symptoms before the pandemic. This study examined risk factors for depression and anxiety symptoms among Israeli adults following the first wave of the COVID-19 pandemic in Israel, above and beyond depression and anxiety symptoms reported 3 years before the pandemic. We performed a two-wave 3-year longitudinal study (W1 July-September 2017; W2 May-June 2020). The final sample included 578 participants who completed anxiety and depression self-report questionnaires at both waves. The W2 assessment additionally included being considered high-risk for COVID-19, and measures regarding loneliness, perceived stress, and COVID-19 worries. Both anxiety and depression symptoms were significantly higher at W2 during the pandemic. Worries related to COVID-19, perceived stress, loneliness, and prior mental health symptoms predicted depression and anxiety in W2. Additionally, being younger was associated with W2 anxiety. The current study highlights risk factors for psychological distress in light of the COVID-19 pandemic. Attention of clinicians and policy makers should be given to the important role of loneliness when screening and treating people during this pandemic.

Satisfaction with life among university students from nine countries: Cross-national study during the first wave of COVID-19 pandemic.

BACKGROUND: A cross-sectional study was performed to examine life satisfaction differences between university students from nine countries during the first wave of the COVID-19 pandemic. A cross-national comparison of the association between life satisfaction and a set of variables was also conducted. METHODS: Participants in the study were 2349 university students with a mean age of 23 years (M = 23.15, SD = 4.66). There was a predominance of women (69.26%) and individuals studying at the bachelor level (78%). The research was conducted between May and July 2020 in nine countries: Slovenia (n=209), the Czech Republic (Czechia)(n=308), Germany (n=267), Poland (n=301), Ukraine (n=310), Russia (n=285), Turkey (n=310), Israel (n=199), and Colombia (n=153). Participants completed an online survey involving measures of satisfaction with life (SWLS), exposure to COVID-19, perceived negative impact of coronavirus (PNIC) on students' well-being, general self-reported health (GSRH), physical activity (PA), and some demographics (gender, place of residence, level of study). A one-way ANOVA was used to explore cross-national differences in life satisfaction. The χ2 independence test was performed separately in each country to examine associations between life satisfaction and other variables. Bivariate and multivariate logistic regressions were used to identify life satisfaction predictors among a set of demographic and health-related variables in each of the nine countries. RESULTS: The level of life satisfaction varied between university students from the nine countries. The results for life satisfaction and the other variables differed between countries. Numerous associations were noted between satisfaction with life and several variables, and these showed cross-national differences. Distinct predictors of life satisfaction were observed for each country. However, poor self-rated physical health was a predictor of low life satisfaction independent of the country. CONCLUSIONS: The association between life satisfaction and subjective assessment of physical health seems to be universal, while the other variables are related to cross-cultural differences. Special public health attention should be focused on psychologically supporting people who do not feel healthy.

Mental health prevalence and predictors among university students in nine countries during the COVID-19 pandemic: a cross-national study.

The student population has been highly vulnerable to the risk of mental health deterioration during the coronavirus disease (COVID-19) pandemic. This study aimed to reveal the prevalence and predictors of mental health among students in Poland, Slovenia, Czechia, Ukraine, Russia, Germany, Turkey, Israel, and Colombia in a socioeconomic context during the COVID-19 pandemic. The study was conducted among 2349 students (69% women) from May-July 2020. Data were collected by means of the Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-8), Perceived Stress Scale (PSS-10), Gender Inequality Index (GII), Standard & Poor's Global Ratings, the Oxford COVID-19 Government Response Tracker (OxCGRT), and a sociodemographic survey. Descriptive statistics and Bayesian multilevel skew-normal regression analyses were conducted. The prevalence of high stress, depression, and generalized anxiety symptoms in the total sample was 61.30%, 40.3%, and 30%, respectively. The multilevel Bayesian model showed that female sex was a credible predictor of PSS-10, GAD-7, and PHQ-8 scores. In addition, place of residence (town) and educational level (first-cycle studies) were risk factors for the PHQ-8. This study showed that mental health issues are alarming in the student population. Regular psychological support should be provided to students by universities.

A Comparison of Depression and Anxiety among University Students in Nine Countries during the COVID-19 Pandemic.

The mental health of young adults, particularly students, is at high risk during the COVID-19 pandemic. The purpose of this study was to examine differences in mental health between university students in nine countries during the pandemic. The study encompassed 2349 university students (69% female) from Colombia, the Czech Republic (Czechia), Germany, Israel, Poland, Russia, Slovenia, Turkey, and Ukraine. Participants underwent the following tests: Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7), Exposure to COVID-19 (EC-19), Perceived Impact of Coronavirus (PIC) on students' well-being, Physical Activity (PA), and General Self-Reported Health (GSRH). The one-way ANOVA showed significant differences between countries. The highest depression and anxiety risk occurred in Turkey, the lowest depression in the Czech Republic and the lowest anxiety in Germany. The χ2 independence test showed that EC-19, PIC, and GSRH were associated with anxiety and depression in most of the countries, whereas PA was associated in less than half of the countries. Logistic regression showed distinct risk factors for each country. Gender and EC-19 were the most frequent predictors of depression and anxiety across the countries. The role of gender and PA for depression and anxiety is not universal and depends on cross-cultural differences. Students' mental health should be addressed from a cross-cultural perspective.

Teaching tolerance or acting tolerant? Evaluating skills- and contact-based prejudice reduction interventions among Palestinian-Israeli and Jewish-Israeli youth.

Although contact-based interventions are the cornerstone of prejudice reduction, in high-conflict environments, incendiary contact with outgroups can instead exacerbate negative attitudes. Supplementing contact interventions with social-cognitive/emotional approaches may, instead, help facilitate positive contact. This study evaluated the effectiveness of two prejudice reduction interventions among 148 Palestinian-Israeli and 154 Jewish-Israeli 5th grade students (Mage.years = 10.55, SD = 0.26) in a high conflict area. Schools in Jaffa, Israel were assigned to a social-cognitive/emotional skills-based intervention, a skills- and contact-based intervention (i.e., skills, skills+contact), or the control group-all delivered as part of the curriculum. Prejudice was assessed through participants' judgments of and justifications about hypothetical scenarios of intergroup exclusion in peer and home contexts at pre-test, post-test, and 6-month follow-up. Repeated measures ANOVAs showed various main effects including gender, ethnicity, and context in which the exclusion occurred (peer/home). Significant higher level interactions with group by time demonstrated the positive influence of both treatment groups on prejudice reduction. The skills and skills+contact groups became more rejecting while the control group became more accepting of exclusion across time. Additionally, the skills and skills+contact groups increased in moral and empathic reasoning over time, whereas the control group increased in social conventional and stereotyped prejudiced reasoning. These findings illustrate the effectiveness of in-school social-cognitive/emotional skills and combined skills+contact approaches in reducing the prejudiced attitudes of Palestinian- and Jewish-Israeli pre-adolescents, especially in areas with protracted conflict.

Enhancing resiliency and promoting prosocial behavior among Tanzanian primary-school students: A school-based intervention.

Children in Sub-Saharan Africa are living under chronic adversity due to poverty, serious health issues, physical and sexual abuse, and armed conflicts. These highly stressful conditions have deleterious effects on their mental health and socio-emotional adjustment. Since many children lack adequate access to mental health care, culturally adapted school-based resiliency programs could provide a resource to scaffold their development and promote their mental health. This study evaluated the efficacy of a universal school-based intervention in enhancing the resiliency of Tanzanian primary school children and cultivating prosocial behaviors. A total of 183 students from grades 4 to 6 were randomly assigned to either the 16-session "ERSAE-Stress-Prosocial (ESPS)" structured intervention or to a Social Study curriculum (SS) active control group. The original ESPS program was adapted by Tanzanians mental health professionals who modified the program based on local idioms of distress and indigenous practices. Students' resilience was evaluated before, after and 8 months following the intervention by assessing social difficulties, hyperactivity, somatization, level of anxiety, prosocial behaviors and school functioning as well as academic achievements and disciplinary problems. There was significant improvement on all outcome measures for the ESPS group compared to the control group post-intervention and at the 8-month follow up. The ESPS intervention was equally effective on most measures for students experiencing different adversity levels. The results indicate that a culturally adapted universal school-based intervention can be effective in enhancing Tanzanian students' resiliency and promoting prosocial behaviors. Should these results be replicated and found enduring, the modified ESPS could be a valuable mental health-promoting intervention in other low-income countries.

How Not to Do a Mindset Intervention: Learning from a Mindset Intervention among Students with Good Grades.

The present study examined the effectiveness of a Growth Mindset intervention based on Dweck et al.'s (1995) theory in the Hungarian educational context. A cluster randomized controlled trial classroom experiment was carried out within the framework of a train-the-trainer intervention among 55 Hungarian 10th grade students with high Grade Point Average (GPA). The results suggest that students' IQ and personality mindset beliefs were more incremental in the intervention group than in the control group 3 weeks after the intervention. Furthermore, compared to both the baseline measure and the control group, students' amotivation decreased. However, no intrinsic and extrinsic motivation change was found. Students with low grit scores reported lower amotivation following the intervention. However, in the second follow-up measurement-the end of the semester-all positive changes disappeared; and students' GPA did not change compared to the previous semester. These results show that mindset beliefs are temporarily malleable and in given circumstances, they can change back to their pre-intervention state. The potential explanation is discussed in the light of previous mindset intervention studies and recent findings on wise social psychological interventions.

Enhancing Visual Perception and Motor Accuracy among School Children through a Mindfulness and Compassion Program.

The present study assessed the effects of the mindfulness/compassion cultivating program: "Call to Care-Israel" on the performance in visual perception (VP) and motor accuracy, as well as on anxiety levels and self-reported mindfulness among 4th and 5th grade students. One hundred and thirty-eight children participated in the program for 24 weekly sessions, while 78 children served as controls. Repeated measures ANOVA's yielded significant interactions between time of measurement and group for VP, motor accuracy, reported mindfulness, and anxiety. Post hoc tests revealed significant improvements in the four aforementioned measures in the experimental group only. In addition, significant correlations were obtained between the improvement in motor accuracy and the reduction in anxiety and the increase in mindfulness. Since VP and motor accuracy are basic skills associated with quantifiable academic characteristics, such as reading and mathematical abilities, the results may suggest that mindfulness practice has the ability to improve academic achievements.

The process of desistance among core ex-gang members.

Research has established robust links between gang membership, delinquency, violence and victimization. Yet studies examining the process of gang desistance in general and that of core gang members in particular, are quite rare. The current study aims to identify factors associated with desistance of core gang members as well as describe the nature of the process that these "formers" have undergone. Thirty-nine core ex-gang members (80% males and 20% females) from the San Francisco Bay area and Los Angeles, with an average length of 11.6-years gang membership, were interviewed regarding their involvement in the gang and the desistance process. A systematic qualitative analysis based on grounded theory methodology was mainly utilized. We found that the decision to leave the gang is a result of a combination of push (e.g., personal and vicarious victimization, burnout of gang lifestyle, disillusionment by the gang) and pull (e.g., parenthood, family responsibilities, religious and cultural awakening) factors that evolved over time. Push factors were more dominant in this domain. We also found that while male core ex-gang members tended to leave the gang more frequently because of push factors, female ex-gang members were more inclined to desist due to pull factors. Our analysis also showed that core gang members shared a general pattern of the desistance process comprising of the following 5 stages: triggering, contemplation, exploration, exiting and maintenance. Based on these results, we outlined stage-specific recommendations for agents of societal change to help in facilitating the desistance of core gang members. (PsycINFO Database Record

Reducing prejudice and promoting positive intergroup attitudes among elementary-school children in the context of the Israeli-Palestinian conflict.

The current investigation tested the efficacy of the Extended Class Exchange Program (ECEP) in reducing prejudicial attitudes. Three hundred and twenty-two 3rd and 4th grade students from both Israeli-Jewish and Israeli-Palestinian schools in the ethnically mixed city of Jaffa were randomly assigned to either intervention or control classes. Members of the intervention classes engaged in ECEP's activities, whereas members of the control classes engaged in a social-emotional learning program. The program's outcomes were measured a week before, immediately after, and 15months following termination. Results showed that the ECEP decreased stereotyping and discriminatory tendencies toward the other group and increased positive feelings and readiness for social contact with the other group upon program termination. Additionally, the effects of the ECEP were generalized to an ethnic group (i.e., Ethiopians) with whom the ECEP's participants did not have any contact. Finally, the ECEP retained its significant effect 15months after the program's termination, despite the serious clashes between Israel and the Palestinians that occurred during that time. This empirical support for the ECEP'S utility in reducing prejudice makes it potentially applicable to other areas in the world, especially those that are characterized by ethnic tension and violent conflicts.

Reducing primary and secondary traumatic stress symptoms among educators by training them to deliver a resiliency program (ERASE-Stress) following the Christchurch earthquake in New Zealand.

The current investigation evaluated the impact of a universal school-based resiliency intervention (ERASE-Stress) on educators who were working with elementary schoolchildren exposed to the Canterbury earthquake in New Zealand. In the context of major disasters, educators may suffer from "dual trauma"; they can experience symptoms of both primary trauma (as a result of the disaster itself) and secondary trauma (as a result of working with traumatized students). Sixty-three educators were randomly assigned to either the ERASE-Stress intervention or an alternative Managing Emergencies and Traumatic Incidents (METI) program which served as a control group. Efficacy of the program was evaluated at the end of the training as well as at 8 months follow-up. Compared with educators in the control group, those in the ERASE-Stress intervention significantly reduced their posttraumatic distress and secondary traumatization symptoms, improved their perceived level of professional self-efficacy as a helper of earthquake survivors, developed an optimistic outlook regarding their personal future and enhanced their sense of hope, and honed some of their positive coping strategies and reduced the utilization of some maladaptive coping methods. These beneficial consequences of the ERASE-Stress training make it a potentially useful tool for educators working with traumatized students in the context of major disasters. (PsycINFO Database Record

The inoculating role of previous exposure to potentially traumatic life events on coping with prolonged exposure to rocket attacks: A lifespan perspective.

Relatively little research have addressed the effect of prolonged exposure to rocket attacks with a lifespan perspective and only a handful of these studies focused on the effect of this exposure as a function of aging. The present study examined the effects of seven years of rocket attacks fired toward the south of Israel on adult participants of different ages. We examined whether potentially traumatic life events (PTLEs) unrelated to rocket attacks moderated the association between post-traumatic stress (PTS) symptoms and age. Data were obtained from a 2007 telephone survey using the Random Digit Dialing method and including 343 individuals (76.7% participation rate). Exposure to rockets, PTLEs, global distress, and post-traumatic symptomatology were assessed. Older age was associated with a higher level of PTS symptoms. Higher PTLE levels attenuated the association between age and PTS symptoms. Our results suggest that age is a risk factor for developing PTS symptoms under prolonged exposure to rocket attacks. However, previous levels of exposure to other negative events, as well as gender, appear to inoculate a person to stress, thus modulating the age-PTS association.

Impact of exposure to potentially traumatic events on individuals with intellectual disability.

This study explored the prevalence of posttraumatic symptomatology (PTS) and functional problems among Israeli individuals with intellectual disability (ID) who live in supported residential care settings and who have been exposed to political violence. The sample included 196 residents exposed to chronic missile attacks and 91 residents with ID who were not exposed. Results showed PTS and functional problems to be higher in the exposed group compared to the nonexposed one, although still low compared to the general exposed population. Exposure was found to be related to PTS and functioning problems suggested individuals with ID are reactive to political violence, though the underlying mechanisms are not clear. Implications for research, caretakers, and policy are discussed.

A teacher-delivered intervention for adolescents exposed to ongoing and intense traumatic war-related stress: a quasi-randomized controlled study.

PURPOSE: For the past 8 years, the residents of Sderot-a town in southern Israel-have been exposed to ongoing and intense war-related threat due to daily rocket attacks and mortar shelling from the adjacent Gaza region. This study first evaluates the prevalence of posttraumatic symptomatology in a sample of seventh- and eighth-grade students, and then assesses the efficacy of a universal teacher-delivered skill-oriented and present-focused intervention in preventing and reducing adolescents' posttraumatic stress-related symptoms. METHOD: In a quasi-randomized controlled trial, 154 seventh- and eighth-grade students with significant levels of war-related exposure were assigned to participate in either a manualized active 16-session intervention (Extended Enhancing Resiliency Amongst Students Experiencing Stress, ERASE-Stress) or a waiting-list control group. They were assessed using self-report measures before and after the intervention on posttraumatic stress-related symptoms, somatic complaints, functional impairment, and anxiety. RESULTS: At baseline, 43.5% were found to have a likely diagnosis of posttraumatic stress disorder. A month after the intervention ended, students in the active intervention showed statistically significant reduction on all outcome measures compared with those in the waiting-list control group. CONCLUSIONS: Extended ERASE-Stress-a universal teacher-delivered skill-oriented program not targeting traumatic memories and involving trained and supervised homeroom teachers-may help students suffering from significant war-related posttraumatic symptoms reduce their level of symptomatology and can serve as an important and effective component of a community mental health policy for communities affected by chronic trauma, such as war and terrorism.

Protective factors and predictors of vulnerability to chronic stress: a comparative study of 4 communities after 7 years of continuous rocket fire.

Many communities across the world are chronically exposed to extreme violence. Responses of residents from a city and rural community in Southern Israel, both exposed to 7 years of daily mortar fire, were compared to residents from demographically, socio-economically and geographically comparable non-exposed control samples to examine protective factors and predictors of vulnerability to chronic war-related attacks. Samples from a highly exposed city (Sderot) and a highly exposed rural community region (Otef Aza), along with a demographically comparable comparison non-exposed city (Ofakim) and non-exposed rural community region (Hevel Lachish), were obtained in 2007 using Random Digit Dialing. In total, 740 individuals (81.8% participation rate) were interviewed about trauma exposure, mental health, functioning and health care utilization. In the highly exposed city of Sderot, 97.8% of residents had been in close proximity to falling rockets; in the highly exposed rural community region of Otef Aza, 95.5% were similarly exposed. Despite exposure to chronic rocket attacks, residents of Otef Aza evidenced little symptomatology: only one person (1.5%) reported symptoms consistent with probable posttraumatic stress disorder (PTSD) and functioning levels did not differ from those of non-exposed communities. In contrast, posttraumatic stress (PTS), distress, functional impairment and health care utilization were substantially higher in the highly exposed city of Sderot than the other three communities. Lack of resources was associated with increased vulnerability among city residents; predictors of PTS across all samples included being female, older, directly exposed to rockets, history of trauma, suffering economic loss, and lacking social support. Increased community solidarity, sense of belonging and confidence in authorities may have served a protective function for residents of rural communities, despite the chronic attacks to which they were exposed.

An intervention for reducing secondary traumatization and improving professional self-efficacy in well baby clinic nurses following war and terror: a random control group trial.

BACKGROUND: Due to the terror and war-related situation in Israel, well baby clinic nurses dealing with a large number of traumatized and highly distressed infants, toddlers and their parents have become overwhelmed. OBJECTIVES: (1) Assess the level of secondary traumatization, including lack of compassion satisfaction, burnout and compassion fatigue of well baby clinic nurses living under chronic threat of war and terror. (2) Assess the efficacy of an intervention aimed at providing well baby clinic nurses with psycho-educational knowledge pertaining to stress and trauma in infants, young children and parents. This intervention provides the nurses with screening tools for identifying children and parents at risk of developing stress-related problems and equips them with stress management techniques. DESIGN: Quasi-random control trial. SETTING: The intervention took place in Israel, in war (North) and terror (South) affected areas. PARTICIPANTS: Ninety well baby clinic nurses from the most war and terror affected areas in Israel were approached, 42 were randomly assigned the experimental intervention and 38 served as a waiting list group. METHODS: The intervention was comprised of 12 weekly 6-h sessions. Each session included theoretical knowledge, experiential exercises based on the nurses' work or personal life experience, and the learning of skills accompanied by homework assignments. Participants were assessed on self-report measures of secondary traumatization, professional self-efficacy, hope, sense of mastery and self-esteem before and after the intervention. RESULTS: (1) Well baby clinic nurses were found to have elevated secondary traumatization levels. (2) Compared to the waiting list group, the intervention group improved significantly on the professional self-efficacy measure as well as reducing the level of secondary traumatization. Furthermore, improvement on all secondary traumatization measures covaried with the improvement on the professional self-efficacy assessments. Based on additional informal reports, the improvement was observed to be clinically significant. CONCLUSIONS: Training of medical personnel who work with traumatized children and their families and who may also be under the threat of war and terror is essential to both improving their professional functioning, as well as reducing the vulnerability to secondary traumatization.