Emotion regulation in mothers and young children faced with trauma.

The present study investigated maternal emotion regulation as mediating the association between maternal posttraumatic stress symptoms and children's emotional dysregulation in a community sample of 431 Israeli mothers and children exposed to trauma. Little is known about the specific pathways through which maternal posttraumatic symptoms and deficits in emotion regulation contribute to emotional dysregulation. Inspired by the intergenerational process of relational posttraumatic stress disorder (PTSD), in which posttraumatic distress is transmitted from mothers to children, we suggest an analogous concept of relational emotion regulation, by which maternal emotion regulation problems may contribute to child emotion regulation deficits. Child emotion regulation problems were measured using the Child Behavior Checklist-Dysregulation Profile (CBCL-DP; T.M. Achenbach & I. Rescorla, 2000), which is comprised of three subscales of the CBCL: Attention, Aggression, and Anxiety/Depression. Maternal PTSD symptoms were assessed by the Posttraumatic Diagnostic Scale (E.B. Foa, L. Cashman, L. Jaycox, & K. Perry, 1997) and maternal emotion regulation by the Difficulties in Emotion Regulation Scale (K.L. Gratz & L. Roemer, 2004). Results showed that the child's emotion regulation problems were associated with both maternal posttraumatic symptoms and maternal emotion dysregulation. Further, maternal emotion regulation mediated the association between maternal posttraumatic symptoms and the child's regulation deficits. These findings highlight the central role of mothers' emotion regulation skills in the aftermath of trauma as it relates to children's emotion regulation skills. The degree of mothers' regulatory skills in the context of posttraumatic stress symptoms reflects a key process through which the intergenerational transmission of trauma may occur. Study results have critical implications for planning and developing clinical interventions geared toward the treatment of families in the aftermath of trauma and, in particular, the enhancement of mothers' emotion regulation skills after trauma.

Post-combat adaptation: improving social support and reaching constructive growth.

BACKGROUND AND OBJECTIVES: Posttraumatic stress disorder, a commonly researched mental health outcome associated with trauma, does not develop in the majority of survivors. More common trajectories of adaptation include resilience, and posttraumatic growth (PTG). The objectives of the current study were to: (1) describe posttrauma adaptation profiles in a sample of Israeli male military veterans (N = 448); and (2) to explore the protective factors that promote constructive PTG within two profiles of posttrauma adaptation. METHODS: The study used secondary data to estimate latent profile mixture models and a series of logistic regression analyses. RESULTS: Demographic controls, combat related variables, endorsement of coping strategies, and reports of improvement in social support were not significant predictors of constructive growth in the resilient class. However, those in the struggling growth subset of the sample who reported improvement in perceived social support increased the odds of reaching constructive growth. CONCLUSION: These findings highlight the importance of tailored clinical interventions that account for more complex profiles of posttrauma adaptation; and further, provide evidence that adaptation takes place over time. Finally, these findings call for future research to continue to explore the quality of PTG and the contexts in which protective factors promote positive adaptation.

The Patient Rejection Scale in an Israeli sample: correlations with relapse and physician's assessment.

The Patient Rejection Scale (PRS), which was developed to assess the feelings of rejection that relatives experience toward mental patients, was administered to a sample of 50 family members living with schizophrenic outpatients in Jerusalem, Israel. PRS response distribution was similar to that reported for a New York City sample. Total rejection scores were significantly correlated with a number of demographic variables and with the treating physician's assessment of the degree of rejection, hostility and criticism of the respective family members. Physician's rating of emotional over-involvement did not correlate with PRS scores. Both PRS and treating physician's ratings correlated significantly with course of illness parameters. The findings and their implications are discussed in the context of expressed emotion (EE) research.

Brief psychotherapy for posttraumatic stress disorders.

A large-scale study of the effectiveness of psychotherapeutic methods for the treatment of posttraumatic stress disorders was conducted. The sample consisted of 112 persons suffering from serious disorders resulting from traumatic events (bereavement, acts of violence, and traffic accidents) that had taken place not more than 5 years before. Trauma desensitization, hypnotherapy, and psychodynamic therapy were tested for their effectiveness in comparison with a waiting-list control group. The results indicated that treated cases were significantly lower in trauma-related symptoms than the control group.

Nocturnal hallucinations in ultra-orthodox Jewish Israeli men.

Hallucinations that occur predominantly at night are reported in 122 out of a sample of 302 ultra-orthodox Jewish Israeli men referred for psychiatric evaluation. Demographic data and the content of a semistructured interview in 302 ultra-orthodox Jewish young men seen over a 10-year period in Jerusalem were evaluated retrospectively by two researchers. Of the 302 subjects, 122 reported hallucinations predominantly at night, 23 reported hallucinations with no diurnal variation, and 157 did not report hallucinations. Most of those with nocturnal hallucinations were in their late teens, were seen only once or twice, were brought in order to receive an evaluation letter for the Army, and had a reported history of serious learning difficulties. The nocturnal hallucinatory experiences were predominantly visual, and the images were frightening figures from daily life or from folklore. Many of the subjects were withdrawn, monosyllabic, reluctant interviewees. Ultra-orthodox Jewish beliefs include a belief in demons, particularly of dead souls, who visit at night. This cultural group's value on study at Yeshivas away from home places significant pressure on teenage boys with mild or definite subnormality, possibly precipitating the phenomenon at this age in this sex. Although malingering had to be considered as a possible explanation in many cases owing to the circumstances of the evaluation, short-term and long-term follow-up on a limited sample allowed this explanation to be dismissed in a significant number of cases. We suggest therefore that nocturnal hallucinations are a culture-specific phenomenon.

Recent trauma in psychiatric outpatients.

Psychiatric clinic outpatients were screened for recent traumatic events, and post-traumatic symptomatology was evaluated in those reporting occurrence of one or more events within the two years prior to screening. Clear symptoms of post-traumatic stress disorder were revealed in 18% of the reporting patients, and the distribution of diagnoses was found to be different in the trauma-reporting group than it was in a comparison diagnostic group.

The association between adolescents' attitudes toward suicide and their psychosocial background and suicidal tendencies.

The present study examined the relationship between adolescents' attitudes toward suicide and their psychosocial background. It also evaluated the association between attitudes toward suicide and the subjects' own suicidal tendencies. A questionnaire assessing these issues was administered to 525 Israeli adolescents. Results indicated that significantly more females, nonreligious adolescents, those exposed to suicidal behavior, and those with increased suicidal risk held more accepting attitudes. Ethnic origin, socioeconomic status, and living in intact/nonintact families were not associated with adolescents' attitudes toward suicide.

Child survivors of the Holocaust: symptoms and coping after fifty years.

Holocaust survivors who were children during WW II have now reached the age of 52 to 67. Until about 10 years ago their voices were barely heard in society. Their successful adaptation to life may have contributed to this invisibility. However, reaching this stage of life, which is associated with the need to review life and with the crises of retirement and renewed losses, has activated the survivors to deal with their childhood. The impossibility of avoiding traumatic memories and an urge to deal with them have also contributed to the societal process of the survivors organizing and speaking out. Very little is known about this group with regard to their mental health status and the way they cope with their childhood memories. The present controlled double-blind study uses a randomized nonclinical sample and focuses on the level of psychosocial and post-traumatic symptoms, on achievement motivation, and on the way child survivors perceive the surrounding world. The results indicate a slightly higher level of psychosocial symptoms in the child survivors group (CS) than in the control group, a high level of post-traumatic symptomatology, and achievement motivation based mainly on the fear of failure. Surprisingly, the child survivors group shows a pattern of more positive views of the world than does the control group. This can be understood as a greater need to compensate for the lack of security suffered in childhood by creating a meaningful world in a chaotic reality.

A controlled double-blind study on children of Holocaust survivors.

The effects of the Holocaust on the offspring of survivors have remained unclear in discussions between clinicians, clinical researchers and empirical researchers. The authors report on a controlled double-blind study designed to test these effects using the sensitivity of clinicians to intrapsychic constellations and processes. The all female sample was randomly selected from several Jerusalem neighborhoods. The index subjects (n = 31), born between 1946 and 1960, had at least one parent (mother) who suffered persecution at the hands of the Nazi regime during WWII. The controls (N = 31), matched for age, educational status and birth order, were born to parents who had not lived under the occupation of the Nazi regime and had not suffered losses of close relatives in WWII. In-depth double-blind interviews, conducted by experienced psychodynamic psychotherapists, focused on personality characteristics without questioning individual development. The only measure used was a 48-item questionnaire completed by the therapists at the end of the interview. The study showed that daughters of Holocaust survivors are characterized by more problems in the realm of separation individuation issues. It also confirmed previous findings that the offspring of Holocaust survivors do not show more psychopathology than the general population.

Self-reported prescribing practices for schizophrenic patients among Israeli psychiatrists.

A "Schizophrenia Prescribing Practices Questionnaire" was developed and employed in order to obtain, directly from treating psychiatrists, information concerning their use of psychotropic medication in schizophrenia. The analysis of data furnished by 56 survey participants working in various institutions and treatment settings pointed to the following main findings: 1) the use of a wide range of antipsychotic (neuroleptic) drug dosages, 2) the use of high potency neuroleptics as the drugs of choice in all phases of treatment, 3) dissimilar dosing with the main high and low potency neuroleptics, 4) dissimilar haloperidol and chlorpromazine dosing in various types of treatment settings, 5) the use of combinations of neuroleptics and prophylaxis with antiparkinsonian drugs by more than 40% of the sample. The results of the survey are discussed in the context of recent research advances and current treatment recommendations.

The prevalence of posttraumatic psychopathology in the general and the clinical population.

Since the beginning of psychiatry, there has been a controversy about the consequences of traumatic events. Although there is no real dispute about human suffering caused by extreme stress events, social scientists have wondered whether traumatic events could lead to lasting psychopathology. This dispute was very strong in the first two versions of the the diagnostic and statistical manual of the American Psychiatric Association, which came out in 1952 and 1968. In DSM I (1), trauma could only lead to "gross stress reactions", which were part of "transient situational personality disorders". Extreme stress events were thought to lead only to a transient/temporary disturbance and if there was more disturbance than that, another diagnostic label had to be found. This attitude towards trauma has changed over the years and from 1980, in DSM III, there emerged the Posttraumatic Stress Disorder, a disorder which can be lasting or transient (2). In the past years, it has become clear that posttraumatic stress disorders are not the only form of psychopathology that follows after traumatic events. Major depressive episodes and dissociative disorders can also follow traumatic events. In this article, the results of two studies are reviewed. The first is a survey of the major studies into the prevalence of disorders after traumatic events. The main conclusion of this study shows that about 20% of the people that go through severely distressing events develop severe disorders. The second study focuses on the prevalence of disorders in the process of coping with traumatic events in a psychiatric outpatient clinic. Results of this study showed that clinically significant signs of these disorders were found to be present in 18% of the psychiatric outpatient referrals. In the discussion, the conclusion is drawn that posttraumatic psychopathology is a phenomenon that every clinician is confronted with on a regular basis. We might then wonder why specific treatment for posttraumatic psychopathology is still such a neglected area in psychiatry and psychotherapy.

Victims of traffic accidents: incidence and prevention of post-traumatic stress disorder.

The psychological consequences of traffic accidents have been rarely the subject of research. Responses of serious traffic accidents and the effects of an outreach program for victims were studied in a research project. Subjects selected from police registers participated in a preventive counseling program or in a monitoring group. Foci of this study were the way in which the subjects coped with the event and the symptoms that might develop. Measurements were carried out 1 month and 6 months after the accident. The results indicate that an average of about 10% of the victims suffer from post-traumatic stress disorders and that although counseling is appreciated by victims, it could not be proven that it was effective in preventing disorders.

Psychiatric hospitalization of tourists in Jerusalem.

Every year some 50 tourists visiting Jerusalem are hospitalized following psychotic episodes. The majority of these patients are from religious backgrounds, and Jerusalem's special place in the Jewish and Christian religions appears to influence the nature of the delusionary experiences. This report examines the factors involved in this phenomenon.

The association between attitudes toward suicide and suicidal ideation in adolescents.

The aims of this study were to determine whether adolescent attitudes to suicide could be grouped into distinct factors, and then to examine the relationship between these factors and the psychosocial parameters known to be associated with suicide, and between attitudes towards suicide and suicidal ideation. A questionnaire designed to assess attitudes to suicide was distributed to a total of 525 Israeli adolescents. Statistical analysis indicated that the attitude items could be grouped into four distinct factors: the right of society to prevent suicide; suicide as a symptom of mental illness; the right of the individual to talk about suicide; and taking suicidal behaviour seriously. Each factor was differentially associated with the various psychosocial parameters examined. The association between the attitude factors and subjects' suicidal ideation was significant and at least as strong as that of the psychosocial parameters normally associated with adolescent suicide, namely gender and exposure to suicide. A generally approving attitude towards suicide was correlated with a high level of suicidal ideation.