[PREPARING CITIZENS RETURNING FROM CAPTIVITY TO ISRAEL AND MEETING THEIR FAMILY MEMBERS: INITIAL PROTOCOL FOR RECEPTION FROM THE RED CROSS UNTIL TRANSFER TO THE HOSPITALS IN ISRAEL].

INTRODUCTION: Delivery of the returnees from captivity by the Red Cross to military mental and medical professionals until they transfer to the medical staff in the hospitals and meetings with their families is a decisive challenge for the returnees and the professionals. The absorption time places the returnees in an exposed and vulnerable situation, in an intermediate space between captivity and reintegration into reality. The feelings of terror, the helplessness, and the danger to life that accompanied the kidnapping and the stay in captivity may develop into situations related to survival and adaptation to the conditions of captivity, including life-saving strategies. In addition, captivity is characterized by asymmetrical and distorted relationships. These distorted relationships, acquired in captivity without any choice, can have long-term consequences on future relationships and the process of adapting to life upon returning to Israel. Moreover, the fact that the reality that surrounded the returnees involved the loss of family members or others who were with them at the time of the kidnapping or during their stay in captivity adds to the complexity and the necessity of a sensitive and specially adapted professional reference on the part of the professional system. The expected reactions at the time of absorption can be varied and range from joy and euphoria to sadness, a feeling of alienation, anxiety, and disconnection. The initial reception time may be a window of opportunity during which interventions can be made to achieve effective adaptive responses upon returning to Israel. The purpose of the present article is to describe the preparations made in a relatively short period for the reception of the returnees and the development of the protocol for their initial reception to provide the best response to their needs. The protocol that is at the center of this article was formulated in the combat reaction unit, taking into account the needs of the returnees and the expected responses. Critical professional principles are applied, including an initial mental assessment, connection to personal, family, and community resources, as well as connection to the medical team, for continued treatment in the medical centers.

[WHAT DO WE KNOW ABOUT THE TREATMENT OF PRISONERS OF WAR?]

INTRODUCTION: The question of what we know about the treatment of soldiers who are prisoners of war and kidnapped civilians is more relevant today than ever. On October 7, 2023, for 239 Israelis, the transition from an independent and autonomous person to a captive was a sharp, brutal transition that interrupted the continuity of life. Taking prisoners of war (POWs) at this time included, in addition to soldiers, kidnapped civilians, older men, women, teenagers, children and toddlers. The existing knowledge about the treatment of such diverse populations, and in such large numbers, is scarce. Hence, it is a great challenge for all care providers when the POWs return home.

Treating posttraumatic stress disorder across cultures: A systematic review of cultural adaptations of trauma-focused cognitive behavioral therapies.

OBJECTIVE: Although trauma-focused cognitive-behavioral therapies (CBTs) for posttraumatic stress disorder (PTSD) have been applied worldwide, the nature of how these Western-based interventions are applied in diverse settings has varied. This paper systematically reviewed the literature on how trauma-focused CBTs have been applied and adapted cross-culturally. METHOD: A systematic review of studies that discuss the process of cultural adaptation of trauma-focused CBTs. RESULTS: Seventeen papers were included and varied in the comprehensiveness of the adaptation process. Two studies stated that a theoretical framework was followed. Almost one-third of the studies did not report whether local stakeholders were involved in the process of application. Fifteen studies examined the efficacy of the adaptations and the results were positive, but the methodology and quality varied. CONCLUSION: There are inconsistencies in how trauma-focused CBTs are culturally adapted. A systematic approach to the transportation of such therapies would enable greater investigation into the necessity and efficacy of such adaptations.

Adjustment profiles of Yom Kippur war veterans seeking delayed help from the IDF.

The most common stress reactions following combat are post-traumatic stress reactions. These responses have a great impact on quality-of-life and can damage victims' personal, familial, and social functioning. However, of the people who develop PTSD, only a few request psychological help. The first aim of the research was, therefore, to examine the long-term adjustment patterns of Yom Kippur War veterans who sought help only after a period of more than 30 years. The second aim was to classify the participants according to a common symptom profile. The participant sample consisted of 195 Yom Kippur War veterans who went through a process of assessment and evaluation via intake interviews conducted between 2006 and 2012, when they came to the Combat Stress Reaction (CSR) unit. Data were collected from the participants' files. The findings indicated that, by the time they arrived at the CSR Unit, 90.8% of the participants were experiencing PTSD. The findings support the argument that delayed onset of PTSD without a background history of symptoms is rare, and indicate that most people who seek help report that their low-level symptoms intensified over the years until these symptoms developed into clinically meaningful PTSD.

Combat-Related Multifaceted Trauma-Focused Group Therapy: A Pilot Study.

The efficacy of combat-related trauma-focused group therapy (TFGT) was tested using a unique technique that combines principles from prolonged exposure, cognitive processing therapy, and art therapy. Eighty Israeli male veterans exposed to traumatic events participated in the study. They were divided into eight therapeutic groups led by four pairs of trained therapists. Posttraumatic stress disorder and depression symptoms and levels of functioning were taken at pretherapy, end of therapy, and 6 months posttherapy. Analyses found that therapy helped in reducing posttraumatic and depressive symptoms at the end of therapy and at 6 months follow-up. It also showed that patients' functioning had significantly improved by the end of therapy and at 6 months follow-up. A significant clinical change in each parameter over time was also observed. In conclusion, the study provides preliminary evidence that combat-related TFGT may be efficacious in reducing psychological suffering and enhancing actual functioning. Follow-up randomized controlled trials to determine treatment efficacy are needed.

Benefits of a Psychodynamic Group Therapy (PGT) Model for Treating Veterans With PTSD.

OBJECTIVE: To examine the effectiveness of a treatment model of psychodynamic group therapy (PGT) for combat Veterans with posttraumatic stress disorder (PTSD). METHOD: A total of 158 male Veterans with PTSD (mean age = 30.09 years) were assigned to 15 treatment groups of 7-13 patients each. PGT was a 1-year therapy, 1.5 hour, once-a-week sessions administered in the following stages: group building activities, differentiation of group members, intimacy building, and termination. Levels of PTSD and depression symptoms, functioning, and hope were assessed at pretreatment baseline, posttreatment, and 12-month follow-up. RESULTS: Multilevel modeling analyses indicate that our group therapy is associated with reductions in PTSD and depressive symptoms at posttreatment, and that these effects were maintained at 12-month follow-up. The results also showed significantly improved patients' functioning by the end of therapy and at the 12-month follow-up point, and that the patients' hope level had increased. CONCLUSION: The findings show that our model of psychodynamic group therapy is associated with mental improvements in Veterans with PTSD. However, further randomized controlled trials are recommended to establish the advantages of our therapeutic method compared to other modes of therapy.

The moderating role of belongingness in the contribution of depression to suicide ideation following the October 7, 2023, terrorist attack in Israel: A nationwide prospective study.

INTRODUCTION: With >1300 civilians murdered, the terrorist attack of October 7 is one of the deadliest terrorist attacks in modern history. Previous research documented a sharp increase in depression in the aftermath of the attacks and the military conflict that followed. In this national prospective cohort study, we examined to what extent perceived belongingness (PB) moderates the association between depression and suicide ideation (SI) in the wake of the October 7th terrorist attack. METHODS: A representative sample of 710 Israeli adults (of them, 362 females, 51.1 %), Jews (557, 79.9 %), and Arabs (153, 20.1 %), aged 18-85 (M = 41.01, SD = 13.72) completed questionnaires assessing depression, current SI, and perceived belongingness at two timepoints: T1 (in August 2023) and T2 (in November 2023). RESULTS: Perceived belongingness at T1 predicted SI at T2 beyond demographic and trauma-related characteristics. Importantly, we found a significant interaction in which a PB at T1 moderated the link between depression and current SI at T2. Specifically, the level of depression at T2 contributed to current SI-T2 more strongly for individuals with low PB levels than for individuals with high PB levels. DISCUSSION: Our study highlights the impact of PB on SI following the October 7th terrorist attack. Clinicians treating individuals coping with depression should attend to their patients' sense of belongingness, as low PB comprises a significant risk factor for current SI. Moreover, community and national initiatives that could increase levels of PB among the citizens may help to diminish suicide risk in the aftermath of the attack.

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.

The Effectiveness of Early Group Intervention for Military Reserves Soldiers: The Role of the Repressive Coping Style.

This study had two aims: 1. To examine whether soldiers who participated in Early Group Intervention (EGI) would show less distress and better functioning and physical health than soldiers who did not participate in EGI, and 2. To examine the contribution of the intervention to participants with repressive coping style. The sample comprised 166 male reserve soldiers who fought in the Second Lebanon War. The intervention was conducted three months after the traumatic event, was based on military protocol, and took place over the course of one day. Data were collected at two points in time (four months apart). The findings indicated that after EGI, the intervention group experienced less post-traumatic distress than did the control group. In addition, four months after the intervention, the functioning and physical health of the intervention group was significantly better than that of the control group. Notably, the intensity of post-traumatic distress before the intervention was lower among repressors and low-anxious soldiers than among soldiers in the other two groups (high-anxious and defensive). No significant differences were found after the intervention with regard to the various styles of coping with post-traumatic distress. Future clinical implications of the findings are discussed.