The association between looming cognitive style and posttraumatic stress symptoms: The case of older Holocaust survivors.

The looming cognitive style (LCS) refers to a tendency to produce mental illustrations and images of adverse events and potentially threatening situations with perceived accumulating threat and danger. LCS is a well-known cognitive vulnerability for anxiety, nevertheless few studies examined the relationship between LCS and posttraumatic reactions. Among the existing studies, a higher LCS was reported in Holocaust survivors relative to matched comparisons, and directly associated with posttraumatic stress symptoms (PTSS) in older Holocaust survivors. The current study aimed to expand the understanding of the relationship between LCS with PTSS in general, and among older Holocaust survivors in particular. Moreover, whether the number of Holocaust experiences encountered by Holocaust survivors moderated this relationship. The sample consisted of 153 older Holocaust survivors (Mage = 82.42, SD = 5.75). Participants were interviewed regarding their background characteristics, PTSS, LCS, and number of Holocaust experiences. Participants reporting higher LCS showed higher PTSS. There was an interaction between LCS and number of Holocaust experiences for predicting PTSS, suggesting that LCS was associated with higher PTSS to a stronger degree among Holocaust survivors who experienced a smaller number of Holocaust experiences. The findings indicate that Holocaust trauma may have influenced the LCS of Holocaust survivors throughout their lives and into old age. The results provide insight for mental health practitioners treating older Holocaust survivors in focusing on reducing schematic processing biases for threat information and anxiety to enhance better mental health for those suffering from posttraumatic stress symptoms.

Holocaust survivors: Health and longevity 70 years later.

BACKGROUND: Holocaust survivors (HS) alive today form a unique and disappearing population, whose exposure to systematic genocide occurred over 70 years ago. Negative health outcomes were widely documented prior to age 70. We examine the hypothesis that the experience of remote trauma continues to negatively affect health, functional status, and survival between the ages of 85-95. METHODS: The Jerusalem Longitudinal Study (1990-2022) followed a representative sample of Jerusalem residents born 1920-1921, at ages 85, 90 and 95. Home assessment included medical, social, functional, and cognitive status, and mortality data. Subjects were classified: (1) HS-Camp (HS-C): survived slave-labor, concentration, or death camps; (2) HS-Exposed (HS-E): survived Nazi occupation of Europe; (3) Controls: European descent, outside Europe during WWII. We determined Hazards Ratios (HR), adjusting for gender, loneliness, financial difficulty, physical activity, ADL dependence, chronic ischemic heart disease, cancer, cognitive deficits, chronic joint pain, self-rated health. RESULTS: At ages 85 (n = 496), 90 (n = 524), and 95 (n = 383) the frequency of HS-C versus HS-E versus Controls was 28%/22%/50%, 19%/19%/62%, and 20%/22%/58%, respectively. No consistent significant morbidity differences were observed. Mortality between ages 85-90 and 90-95 years was 34.9% versus 38% versus 32.0%, and 43.4% versus 47.3% versus 43.7%, respectively, with no significant differences in survival rates (log rank p = 0.63, p = 0.81). Five-year mortality adjusted HRs were insignificant for HS-C and HS-E between ages 85-90 (HR 0.87, 95% CI 0.54-1.39; HR 1.14, 95% CI 0.73-1.78) and ages 90-95 (HR 0.72, 95% CI 0.39-1.32; HR 1.38, 95% CI 0.85-2.23). CONCLUSIONS: Seventy years following their trauma and suffering during the Holocaust, the significant impairments of health, function, morbidity, and mortality which have accompanied survivors throughout their entire adult life, were no longer observed. Indeed, it is likely that survivors living >85 years old represent a uniquely resilient population of people, whose adaptation to adversity has accompanied them throughout their lives.

Determinants of the Negative Consequences of Secondary Exposure to Trauma in Caregivers of Holocaust Survivors Living in Poland.

The aim of the present study, involving 50 caregivers of Holocaust survivors, was to determine the degree of exposure to secondary traumatic stress (STS) and identify the mechanisms of its development. Several standardized measurement tools were used. It was found that a probable diagnosis of STS could be ascertained in 44% of caregivers. The multiple regression analyses model explains 72% of the total variance of STS. The strongest predictor, explaining 37% of the variability, turned out to be disruptions in beliefs about the meaning of life, spirituality and self-worth as a person. In order to reduce STS symptoms in caregivers, attention should be paid primarily to their cognitive functioning, including possible disruptions in basic beliefs.

Holocaust communication, attachment orientation and distress among descendants of female holocaust survivors.

The multiple studies that have examined the transgenerational transmission of Holocaust trauma from survivors to their descendants have yielded inconsistent results. These can be attributed to differences in assessment tools and to individual differences between survivors, such as their specific experiences during the Holocaust. This study examined the differences between daughters and granddaughters of female Holocaust survivors (HS) of concentration camps (CCS) versus survivors of other circumstances (ghettos, concealment, etc.; OCCS) in terms of communication about their mothers' or grandmothers' Holocaust trauma (Holocaust communication), their attachment orientations, and their psychological distress. The sample was composed of 79 dyads of daughters of HS and their own daughters, divided into two groups according to the survivors' Holocaust experiences (CCS-47 dyads; OCCS-32 dyads). The findings indicated that daughters of CCS reported a higher number of conversations about the Holocaust with their mothers, perceived their mothers as more distant during Holocaust communication, and reported more guilt feelings than daughters of OCCS. Holocaust communication between daughters and granddaughters was characterized by shorter conversations, and granddaughters perceived their mothers as sadder in the CCS group than in the OCCS group. No difference between groups was found in Holocaust communication between survivors and their granddaughters. No difference was found between groups in their psychological distress. The granddaughters of CCS scored higher on attachment anxiety than the other group. Most of the significant differences between groups were linked to subtle differences in the characteristics of communication and in the inter-personal sphere.

Afterwards-Forgetting, Remembering, Transmitting. Extreme Trauma and Culture in Post-National-Socialist Germany.

Facing the rupture the Shoah marks in the history of humanity and in the life of survivors and their relatives, this article approaches long-term psychosocial consequences-after Auschwitz. The dimensions of "forgetting" in post-Nazi Germany are brought into focus by the remembering and passing on of extreme traumatic experiences of persecution. To gain insights into these processes, this article differentiates between traumatization and extreme traumatization. Survivors remember and pass on their experiences of persecution, especially through non-verbal communication and in the form of unconsciously shaped "scenes." This Scenic Memory of the Shoah is conveyed in relationships with descendants, to fellow human beings, to the environment and thus also in experiences of anti-Semitism in Germany today. The fact that extreme traumatization is expressed precisely in scenes of coexistence also means that it must be understood as an embedded factor in society, in culture-in forgetting and remembering "afterwards."

Psychological reactions to the coronavirus pandemic: a comparative study of Holocaust survivors and other older adults in Israel.

BACKGROUND: The current study examines psychological reactions to the COVID-19 pandemic among older adults living in Israel. Based on the 'life events, stress, coping and health theory,' we hypothesized that due to their traumatic early life history and dearth of emotional and physical coping resources, Holocaust survivors would be more vulnerable than other older adults to the negative effects of this difficult and prolonged life event on their mental health. METHODS: Based on structured questionnaires with closed questions, we interviewed 306 Holocaust survivors and non-survivors aged 75 + during the COVID-19 pandemic. RESULTS: Univariate data analysis showed that Holocaust survivors had fewer coping resources in terms of health status and educational level than non-survivors. As expected, Holocaust survivors also reported a greater extent of COVID-19-related anxiety, and more depression, which worsened during the pandemic. However, both groups did not differ in their will to live, which is an indicator of general well-being and commitment to continue living. In multivariate analyses conducted to explain COVID-19 anxiety in the entire sample and separately on each of the two groups, the best explanatory variables were other psychological variables especially increased depression. CONCLUSIONS: It seems that Holocaust survivors are more emotionally vulnerable to the pandemic's negative effects than other older adults, in support of the 'life events, stress, coping and health theory,' but despite this, they show resilience in their will to continue living. Policy makers and practitioners are recommended to identify Holocaust survivors and other vulnerable older people and investigate their specific needs. Interventions should include practices for maintaining and boosting resilience and well-being by increasing appropriate emotional and cognitive internal and external coping resources, especially during prolonged periods of hardship.

Life review therapy for holocaust survivors: Two systematic case studies.

Having reached the last phase of their lives, many Holocaust survivors (HS) experience an increase in vulnerability. Despite their remarkable ability to adapt, the process of aging presents them with new challenges, often leading to an increased need for therapy. This is made all the more difficult by the fact that there is little research on trauma therapy in old age. To date, no randomized controlled study has been carried out to examine the effectiveness of psychotherapy in HS. The present case studies report the implementation of life review therapy (LRT-HS) undertaken with two female HS with symptoms of post-traumatic stress disorder (PTSD). The mixed-methods approach sheds light to their individual therapy courses and potential mechanisms of change. Both therapies took place in the context of a randomized controlled study evaluating the efficacy of LRT-HS. This integrative, narrative therapy approach answers the natural need of elderly people to look back on their lives. Patients received about 20 sessions of LRT-HS, including a structured life review, narrative exposure, as well as cognitive and behavioral elements. Patient 1 showed reliable to clinically significant improvements on several quantitative symptom levels and with consistent qualitative findings (e.g., semistructured therapist interview). Symptoms of Patient 2 remained mostly unchanged, while life satisfaction and posttraumatic growth reliably improved and qualitative measures pointed to a reduction of suffering. The studies illustrate that reminiscence can be used in adaptive ways even after the experience of massive traumatization. The coexistence of resilience and vulnerability, complex individual symptom profiles, and influencing factors are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Posttraumatic Stress and Posttraumatic Growth in Three Generations of Czech and Slovak Holocaust Survivors.

The psychological consequences of trauma related to the Holocaust have been primarily studied in samples derived from Israel, North America, and Western Europe. Few studies have examined postcommunist countries in Central and Eastern Europe. The present study focused on three generations living in the Czech Republic and Slovakia after World War II (WWII): Holocaust survivors (71-95 years of age), their children (30-73 years of age), and their grandchildren (15-48 years of age). We compared scores on measures of posttraumatic stress symptoms (PTSS; the Posttraumatic Stress Disorder Checklist-Civilian Version) and posttraumatic growth (PTG; the Posttraumatic Growth Inventory) derived from three focal samples with scores from age-matched comparison participants. Higher PTSS scores emerged for Holocaust survivors in all generations, η2 P=.087 but only participants in the first generation reported higher PTG scores relative to the comparison group, with small effect sizes for the overall group differences, η2 P=.029 . These results are discussed in the historical and political context of postwar Czechoslovakia.

The Holocaust Is a Significant and Independent Risk Factor of Late-Onset Cancers: A Systematic Review of the Literature and Original Data on Jewish Israeli, Jewish Non-Israeli and Non-Jewish Non-Israeli Survivors.

BACKGROUND/AIM: Seventy-six years after Auschwitz Liberation, the Holocaust keeps on persecuting its surviving victims. As witnessed by the psychiatric and medical literature in the last decades, in fact, the Holocaust survivors (HS) appear to suffer from several Shoah-related late-onset diseases impacting their survival, such as internal illnesses and post-traumatic stress disorder (PTSD). Cancer represents a further severe pathology which seems to be connected with the Holocaust experience. Our aim was to review the existing knowledge of Holocaust-related cancer in HS in order to assess its real incidence and clinicoprognostic significance. MATERIALS AND METHODS: We systematically reviewed the literature dealing with Israeli Jewish and non-Jewish non-Israeli HS developing cancer. We also reviewed and analyzed the cancer data of noted Jewish HS not resident or having resided in Israel available as public information. RESULTS: We found 16 and 15 studies on Israeli Jews and non-Jewish non-Israeli survivors, respectively. A statistically significant association between the Holocaust and development of late-onset cancer in HS was seen in most studies with cancer adversely impacting the survival. We also selected 330 noted Jewish non-Israeli HS: genocide-related late-onset cancer resulted to be a significant and independent risk factor of poor prognosis (p<0.0001) imparting shorter survival in affected versus non-cancer subjects (57 versus 64 years, respectively, p=0.0001). CONCLUSION: Although 76 years have passed, our review shows how the Holocaust keeps on burdening its survivors. Moreover, we offered the first analysis of Jewish HS not resident or having resided in Israel in terms of genocide-related late-onset diseases focusing on cancer. Further studies on Jewish non-Israeli HS are needed in order to corroborate our findings on late-onset cancer occurring in this targeted population.

TRAUMA, PREJUDICE, LARGE-GROUP IDENTITY AND PSYCHOANALYSIS.

Escaping Nazi annexation of Austria, Sigmund Freud and his family left there in 1938 to live the rest of their lives in exile in the house now known as the Freud Museum in London. This paper is based upon the author's Holocaust Day Memorial Lecture delivered virtually at this museum on January 27, 2021, which marked the 75th anniversary of the liberation of Auschwitz-Birkenau, the largest Nazi death camp. Besides remembering those who were lost during World War II, the content of this paper includes a description of different types of massive traumas, with a focus on disasters at the hand of the Other, and their impact on individuals and large groups. Sigmund Freud's ideas about relationships between communities and countries with adjoining territories, as well as large-group psychology, are updated, and individuals' and large groups' needs to grasp onto large-group identities is explained and illustrated with case reports.

"Web-based, second-best togetherness": Psychosocial group intervention with children of Holocaust survivors during COVID-19.

Evidence from multiple samples of trauma-exposed populations across the globe suggests that intergenerational trauma constitutes a biopsychological risk factor which manifests itself throughout the life cycle of offspring of trauma survivors. Prior empirical studies have shown that adult children of Holocaust survivors (OHS, also referred to in select quotes as 2G for "Second Generation") are vulnerable to life-threatening situations. This study aimed to examine the reactions of OHS to the COVID-19 pandemic, which posed a serious threat to the lives of many, in particular to older adults. As they enter middle age, OHS were observed to have more medical health issues and less positive perceptions of their own aging relative to peers. Less positive subjective aging was associated with more negative psychiatric symptoms in relation to Covid-19-related loneliness, further suggesting that OHS are a group of aging adults with particular vulnerabilities to negative mental health effects of the pandemic and of the social distancing and isolation it imposed. This study is a qualitative report of experiences expressed by over 1,200 participants in several web-based interactive webinars for OHS during the period of "shelter at home" in March and April 2020. It is proposed that this format of "web-based, second-best" way of being together, an intervention that emerged spontaneously in response to the coronavirus and social distancing, offers a novel, nonpathologizing, effective form of supportive psychosocial intervention uniquely suited to the unprecedented challenges experienced during times requiring social distancing. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Parental PTSD and psychological reactions during the COVID-19 pandemic among offspring of Holocaust survivors.

OBJECTIVE: Previous evidence suggests heightened sensitivity to life-threatening challenges among offspring of Holocaust survivors (OHS). Therefore, this study examined the psychological reactions of aging OHS during the COVID-19 pandemic. METHOD: A convenience sample (N = 297, mean age = 66.85) of North American Jews rated posttraumatic stress disorder (PTSD) symptoms for their parents and for themselves. They further rated their psychological distress, COVID-19-related worries, loneliness, and social support. Respondents were divided into four groups: OHS with two parents with probable PTSD, with one such parent, with no such parent, and comparisons whose parents did not undergo the Holocaust. RESULTS: OHS with two parents with PTSD reported the highest levels of PTSD symptoms. Controlling for respondents' own PTSD, OHS with two parents with PTSD reported higher psychological distress relative to comparisons. Moreover, OHS with parental PTSD reported higher loneliness relative to OHS without parental PTSD or comparisons. The groups did not differ in COVID-19-related worries or social support. CONCLUSIONS: The distress experienced by OHS with parental PTSD seems more general, and is possibly related to the multiple coalescing crises that occurred since the pandemic began, rather than to the health risk associated directly with COVID-19. Moreover, while OHS acknowledge having good social support, some of them nevertheless feel lonely. This possibly reflects unique interpersonal difficulties characteristic in Holocaust survivor families. These findings suggest that OHS with parental PTSD (especially when both parents had symptoms) represent a group of older adults who are relatively susceptible to negative psychological effects of the current pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Working With a Holocaust Survivor's Daughter DURING THE CORONAVIRUS PANDEMIC.

Through a detailed clinical vignette, this essay explores the impact of a life-threatening pandemic on a Holocaust survivor's daughter whose father was a victim of life-threatening events. The following issues are discussed: intermingling of the patient's perception of the pandemic with her mental representation of the Holocaust, changes in analytic technique necessary during the period of lockdown, and the disentanglement of the patient's perception of current reality from her fantasies regarding her father's Holocaust past.

World assumptions and post-traumatic growth among older adults: The case of Holocaust survivors.

Traumatic events may lead to post-traumatic growth (PTG). Nevertheless, little is known about the mechanisms leading to PTG, especially among older adults. This study sought to examine the direct relationship between world assumptions and PTG and the indirect relationship between them via two possible mediation pathways: post-traumatic stress symptoms (PTSS) and meaning in life. One hundred fifty-nine Holocaust survivors participated in the study (mean age = 82.34, SD = 5.81). Participants completed questionnaires of world assumptions, meaning in life, PTSS and PTG. The findings showed that world assumptions were positive and were positively associated with meaning in life and PTG and negatively associated with PTSS. The results of the multiple mediation model suggest that meaning in life and PTSS partially mediated the relations between world assumptions and PTG. Positive world assumptions were associated with higher meaning in life, which was associated with higher PTG. In contrast, despite the direct association between PTSS and PTG, the mediating effect of PTSS was negative, thus the more positive the world assumptions, the higher the PTG mediated by lower PTSS. The results suggest that the relationship between world assumptions and PTG may be direct and indirect. These findings suggest possible mechanisms underlying PTG, especially in old age.

From a world of threat to a world at which to wonder: Self-transcendent emotions through the creative experience of Holocaust survivor artists.

OBJECTIVE: The present study aimed to explore the lived experience of the spontaneous creation in art by Holocaust survivor artists, and to gain new insight into the way creative engagement may relate to survivors' traumatic past. METHOD: Following the phenomenological paradigm of qualitative research, semistructured interviews were conducted with 30 Holocaust survivor visual artists residing in Israel (Mage = 80.6, SD = 5.5). Data were analyzed enabling the capture of various "lived experiences," aiming to establish an insider's conceptualization, understanding the essence of the phenomenon and identification of multiple meanings. RESULTS: Expressions clustered around two major themes. The first-Turning outward: from a world of threat to a world at which to wonder-that describes how, beyond the enduring inner world of abandonment and threat, enhanced through art is a realm of wonderment at the world beyond the self. The second-Connecting with the world and others through creative experience-relating to modes of moving outward in art toward an emotional experience of connection. CONCLUSIONS: Discussion of these themes pointed to the emotional state of self-transcendence as fundamental to survivors' artistic experience, and suggests how this may relate to their enduring struggle with trauma; thus, shedding new light on the redeeming potential of art in the face of trauma. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

[Special features of care for Holocaust survivors]. / Particularités de la prise en charge des survivants de la Shoah.

As they approach old age, Holocaust survivors (HS) face new challenges, including a decline in their health which can revive the extreme stress they experienced during their childhood or adolescence. HS are sometimes referred to as "problem patients" by the medical and paramedical profession, who do not always realize this extremely painful past. The objective of our work was to assess the difficulties faced by doctors providing HS to optimize their medical care.

'Never forget': fictionalising the Holocaust survivor with dementia.

This article asks what the reasons are for the frequent linking of the image of the Holocaust with that of dementia in contemporary discursive and representational practice. In doing so, it analyses some of the numerous 21st-century examples of fiction, drama and film in which the figure of a Holocaust survivor living with dementia takes centre stage. It explores the contradictory cultural effects that arise from making such a connection, in contexts that include expressions of fear at the spectacle of dementia, as well as comparisons between the person living with that condition and the inmate of a concentration camp. Detailed consideration of novels by Jillian Cantor and Harriet Scott Chessman as well as a play by Michel Wallenstein and a film by Josh Appignanesi suggests that the fictions of this kind can appear to provide solace for the impending loss of the eyewitness generation, yet also offer potential for a model for caregiving practice to those living with dementia in broader terms.