Abstract: The bi-directional relationships between combat-induced posttraumatic symptoms and family relations are yet to be understood. The present study assesses the longitudinal interrelationship of posttraumatic intrusion and avoidance and family cohesion among 208 Israeli combat veterans from the 1982 Lebanon War. Two groups of veterans were assessed with self-report questionnaires 1, 3 and 20 years after the war: a combat stress reaction (CSR) group and a matched non-CSR control group. Latent Trajectories Modeling showed that veterans of the CSR group reported higher intrusion and avoidance than non-CSR veterans at all three points of time. With time, there was a decline in these symptoms in both groups, but the decline was more salient among the CSR group. The latter also reported lower levels of family cohesion. Furthermore, an incline in family cohesion levels was found in both groups over the years. Most importantly, Autoregressive Cross-Lagged Modeling among CSR and non-CSR veterans revealed that CSR veterans' posttraumatic symptoms in 1983 predicted lower family cohesion in 1985, and lower family cohesion, in turn, predicted posttraumatic symptoms in 2002. The findings suggest that psychological breakdown on the battlefield is a marker for future family cohesion difficulties. Our results lend further support for the bi-directional mutual effects of posttraumatic symptoms and family cohesion over time.
Abstract: Research investigating the link between stress and sexual activity has been limited and the findings equivocal. We examined the stress-sexual activity link and the moderating effects of gender and relationship satisfaction using a daily diary methodology. Seventy-five heterosexual Israeli adults were asked in an initial session to report on their relationship satisfaction. Then, these participants were asked to provide daily diary measures of stress and sexual activity for a period of 18 consecutive weekdays. We found that stressful days increased the probability of having sex on a subsequent day, and that sexual intercourse relieved stress for both men and women in satisfying relationships, but not in unsatisfying relationships. The discussion emphasizes the importance of sex in regulating emotions and maintaining psychological wellbeing, especially among those satisfied with their relationships.
Abstract: This longitudinal study examined the course and bidirectional relation between posttraumatic distress and posttraumatic growth (PTG). A sample of Israeli ex-prisoners of war and matched controls were followed over 17 years. Participants' posttraumatic stress disorder (PTSD), depression, and anxiety symptoms were measured at three time-points. PTG was assessed twice. Applying an autoregressive cross-lagged modeling strategy, initial PTSD predicted subsequent PTG above and beyond PTG stability, but not vice versa. Cross-lagged relations of PTG to depression and anxiety were not significant. Moreover, analysis of PTG trajectory revealed that individuals with PTSD reported higher PIG levels across times than those without PTSD. Thus, growth is facilitated and maintained by endorsement rather than absence of PTSD. The findings are discussed in the context of the illusionary versus adaptive notion of PTG.
Abstract: The aversive impact of combat and combat-induced posttraumatic stress disorder (PTSD) on parenting of young children has been examined in a few studies. Nevertheless, the toll of war captivity on parenting and the long-term relations between posttraumatic symptoms and paternal parenting of adult children remains unknown. This longitudinal study examined paternal parenting of adult children among war veterans, some of whom were held in captivity. Furthermore, we examined the mediating role of PTSD symptoms in the association between captivity and parenting. The sample included two groups of male Israeli veterans from the 1973 Yom Kippur War: ex-prisoners of war (ex-POWs) and comparable veterans who had not been held captive. Both groups were assessed via self-report measures of PTSD at three time points: Time 1 (18 after the war), Time 2 (30 after the war), and Time 3 (35 after the war) years after the war. Results shows that ex-POWs reported lower levels of positive parenting compared to comparison group veterans at Time 3. Furthermore, PTSD symptoms at Time I, Time 2, and Time 3 mediated the association between captivity experience and parenting at Time 3. In addition, it was found that increases in the levels of PTSD symptom clusters over time were associated with lower levels of positive parenting at Time 3.
Abstract: Attachment-related avoidance and anxiety have repeatedly been associated with poorer adjustment in various social, emotional, and behavioral domains. We examined 2 domains in which avoidant individuals might be better equipped than their less avoidant peers to succeed and be satisfiedprofessional singles tennis and computer science. These fields may reward self-reliance, independence, and the ability to work without proximal social support from loved ones. In Study 1, we followed 58 professional singles tennis players for 16 months and found that scores on attachment-related avoidance predicted a higher ranking, above and beyond the contributions of training and coping resources. In Study 2, we sampled 100 students and found that those who scored higher on avoidance were happier with their choice of computer science as a career than those who scored lower on avoidance. Results are discussed in relation to the possible adaptive functions of certain personality characteristics often viewed as undesirable.
Abstract: Although war captivity is a potent pathogen for psychiatric illness, little is known about the long-term trajectories of post-traumatic stress disorder (PTSD) among ex-prisoners of wars (ex-POWs). This study aimed to assess the long-term trajectories of PTSD and their predictors following war captivity. Three follow-ups (1991, 2003, 2008) were conducted over 35 years of 164 Israeli ex-POWs and 185 comparable combatants from the 1973 Yom Kippur War. Ex-POWs reported higher PTSD rates than controls at all three assessments. Four trajectories of PTSD were identified: chronic PTSD, delayed PTSD, recovery and resilience. The majority of POWs reported delayed PTSD, while the majority of controls were classified as resilient. While PTSD rates remained relatively stable over time among controls, a steep increase in rates was observed among POWs between 1991 and 2003, followed by stabilization in rates between 2003 and 2008. Finally, subjective experience of captivity was the variable that best distinguished between the resilience and PTSD groups of ex-POWs, followed by participation in previous wars and negative life events during childhood. War captivity carries long-lasting psychiatric implications, even decades after release. Aging processes, as well as unique stressors that exist in Israel, may account for the elevated PTSD rates found here. (C) 2012 Published by Elsevier Ireland Ltd.
Abstract: Attachment-related anxiety has repeatedly been associated with poorer adjustment in various social, emotional, and behavioral domains. Building on social defense theory, we examined a possible advantage of having some group members who score high in attachment anxiety a heightened tendency to deliver a warning message without delay. We led participants to believe that they accidently activated a computer virus that erased an experimenter's computer. We then asked them to alert the department's computer technicians to the incident. On their way, they were presented with four decision points where they could choose either to delay their warning or to continue directly to the technicians' office. We found that anxious individuals were less willing to be delayed on their way to deliver a warning message. This result remained significant when attachment avoidance, extroversion, and neuroticism were statistically controlled. Results are discussed in relation to the possible adaptive functions of certain personality characteristics often viewed as undesirable. Copyright (c) 2012 John Wiley & Sons, Ltd.
Abstract: The current research examined whether the associations between attachment orientations and support provision are mediated by personal distress, and whether these mediation paths are moderated by exposure to geopolitical stress. One-hundred and thirty-three married couples, who were exposed to different levels of geopolitical stress, participated in the study. We found that personal distress mediated the link between attachment anxiety and support provision, and that this effect was stronger among people in high-risk areas than in low-risk areas. Personal distress mediated the link between attachment avoidance and support provision, but only among people living in high-risk areas. Our results highlight the importance of considering personal, interpersonal, and contextual factors when studying marital support processes.
Abstract: Background The underlying mechanisms of delayed-onset PTSD are yet to be understood. This study examines the role of stressful life events throughout the life cycle in delayed-onset PTSD following combat. Methods 675 Israeli veterans from the 1982 Lebanon War, 369 with antecedent combat stress reaction (CSR) and 306 without CSR were assessed prospectively, 1, 2 and 20 years after the war. Veterans were divided into four groups, according to the time of first PTSD onset (first onset at 1983, 1984, and 2002 and no PTSD onset). They were assessed for post-, peri- and pre-traumatic life events, as well as military and socio-demographic characteristics. Results Our findings indicate that shorter delays in PTSD onset were associated with a higher risk for CSR, a higher number of pre- and post-war life events, more severe subjective battle exposure, greater perceived danger during combat and a more stressful military position. CSR was found to be the most powerful predictor of PTSD onset. A recency effect was also found, with more recent life events proving to be stronger predictors of PTSD onset. Conclusions First, our findings validate the existence of delayed-onset PTSD, as it was found among a substantial number of participants (16.5%). Second, post-, peri- and pre-traumatic life events are associated with the time of PTSD onset. Thus, practitioners and researchers are encouraged to examine not only the original trauma, but also the stressful experiences throughout the survivors' life cycle. In particular, identification of antecedent CSR may help mental help professionals in targeting high-risk populations.
Abstract: In 6 studies we examined procedural, scriptlike knowledge associated with 2 different kinds of attachment insecurity: anxiety and avoidance. The studies examined associations between attachment insecurities, the cognitive accessibility of sentinel and rapid fight flight schemas, and the extent to which these schemas guide the processing of threat-related information and actual behavior during an experimentally induced threatening event. Anxious attachment was associated with (a) greater accessibility of the sentinel schema in narratives of threatening events; (b) faster, deeper, and more schema-biased processing of information about components of the sentinel schema; and (c) quicker detection of a threat. Avoidant attachment was associated with greater accessibility of the rapid fight flight schema in narratives of threatening events and faster, deeper, and more schema-biased processing of information about components of the schema. We discuss implications of the findings for understanding the cognitive aspects of insecure people's coping strategies in threatening situations, as well as the potential benefits of these strategies to the people who enact them and to the groups to which they belong.
Abstract: In this study, we assessed the 17-year trajectories of attachment insecurities (anxiety and avoidance) and examined their relations to having been a prisoner of war and suffering from Posttraumatic Stress Disorder (PTSD). The sample included two groups of Israeli veterans from the 1973 Yom Kippur war: ex-prisoners of war and comparable control individuals who had not been held captive. They completed self-report measures of anxious and avoidant attachment and PTSD at three time points: 18, 30, and 35 years after the war. Ex-POWs were less secure with respect to attachment than the controls at the initial assessment, and although the controls experienced a decline in attachment insecurity over the 17-year period, the anxiety and avoidance scores of the ex-POWs increased over time. We also found that PTSD was associated with higher attachment insecurity scores at each time point, beyond the effect of war captivity. Implications of the findings for both attachment theory and the psychological effects of trauma are discussed.
Abstract: Objectives: This study examines the implications of acute stress disorder (ASD), following myocardial infraction (MI), in predicting subsequent posttraumatic stress disorder (PTSD) and impaired quality of life (QoL) 8 years post-MI. Methods: MI patients, who were assessed within a week of the MI (Time I; n=173), were followed up 7 months (Time 2; n=116) and 8 years (Time 3; n=90) post-MI. ASD was assessed at Time 1 and PTSD at Time 2 and Time 3. Health-related QoL was assessed at Time 3. Results: Unconditional latent class growth models revealed two distinct subpopulations: the recovered/resilient group (94%) demonstrated a decrease from 12.4% of ASD at Time 1 to 6.1% of PTSD at Time 3. Rates of posttraumatic stress syndromes in the chronic group (6%) were 85.3% at Time I and 75.7% at Time 3. The two groups differed in pre-MI life events, length of hospitalization, likelihood to have anterior MI, and perceived threat of death. The chronic group reported lower levels of QoL at Time 3. Conclusion: Although most ASD patients demonstrate a trend of recovery, ASD in the immediate aftermath of MI remains a marker of long term adjustment difficulties. (C) 2011 Elsevier Inc. All rights reserved.
Abstract: Attachment theorists have emphasized that attachment-anxious individuals are ambivalent in their relational tendencies. wishing to be close to their relationship partners but also fearing rejection. Here we report 6 studies examining the contribution of attachment anxiety and experimentally induced relational contexts (both positive and negative) to explicit and implicit manifestations of (a) altitudinal ambivalence toward a romantic partner and (b) motivational ambivalence with respect to the goals of relational closeness and distance. Attachment-anxious individuals exhibited strong altitudinal ambivalence toward a romantic partner, assessed by both explicit and implicit measures. They also exhibited strong motivational ambivalence retarding closeness (both explicit and implicit). and this motivational conflict was intensified in relational contexts that encouraged either approach or avoidance tendencies. Participants who scored relatively high on avoidant attachment proved to be implicitly ambivalent about distance issues but mainly in negative relational contexts. Several alternative interpretations of the results were considered and ruled out.
Abstract: Previous research has suggested that the physical aspects of human nature in general, and physical human frailties in particular become disagreeable and repugnant following death primes. The current research tested this hypothesis in two studies using an eye-tracking methodology. Participants were subliminally primed with death or with a control word and then viewed a series of arrays containing four pictures each, during which their eye-movements were monitored. In Study 1, the arrays included pictures of physical injury or neutral objects, and in Study 2 pictures of physical injury, threatening images, and neutral objects. The results indicated that in both studies death primes significantly decreased gaze duration towards pictures of physical injury, and did not have a significant effect on gaze duration towards neutral images. However, in Study 2 death primes increased gaze duration towards threatening images. The discussion examines the role of motivated unconscious attention in terror management processes. (C) 2009 Elsevier Inc. All rights reserved.
Abstract: Bowlby's (1969/1982) attachment theory has generated an enormous body of research and conceptual elaborations. Although attachment theory and research propose that attachment security provides a person with many adaptive advantages during all phases of the life cycle, numerous studies indicate that almost half of the human species can be classified as insecurely attached or insecure with respect to attachment. It seems odd that evolution left humans in this vulnerable position unless there are some advantages, under at least some conditions, to anxious and avoidant attachment styles. We argue that a social group containing members with different attachment patterns may be more conducive to survival than a homogeneous group of securely attached individuals. In making this argument, we extend the scope of attachment theory and research by considering a broader range of adaptive functions of insecure attachment strategies. We also present preliminary data to support our argument.
Abstract: This research examined the impact of stressful environments on marital relationships. In all, 133 Israeli couples exposed to different levels of terror threat and political uncertainty completed measures of attachment orientation, psychological distress, and marital satisfaction. Results indicated that in low-threat areas, spouses high on attachment avoidance did not express distress despite their marital dissatisfaction. In contrast, in high-threat areas, spouses high on attachment avoidance exhibited greater psychological distress, and psychological distress mediated the relation between attachment avoidance and marital dissatisfaction. Psychological distress only partially mediated the relation between attachment anxiety and marital dissatisfaction in the entire sample. The discussion stresses the importance of considering attachment dimensions when studying the effects of external stressors on marital relations.
Abstract: We used actor-partner interdependence modeling to explore associations among attachment-related dyadic processes, posttraumatic stress disorder (PTSD) in war veterans, and secondary traumatic stress (STS) in their wives. A sample of 157 Israeli couples (85 former prisoners of war and their wives and a comparison group of 72 veterans not held captive and their wives) completed self-report scales assessing attachment insecurities (anxiety, avoidance) and PTSD symptoms. For both groups of veterans and their wives, attachment anxiety was associated with the severity of their own and their spouses' PTSD and STS. Avoidant attachment was associated with PTSD and STS only in couples that included a former prisoner of war. A complex pattern of associations involving avoidant attachment was observed in the actor partner analyses of these couples. The study demonstrates that attachment-related dyadic processes play a role in the development and maintenance of PTSD in traumatized veterans and STS in their wives.
Abstract: Background: This study aims to: (a) follow-up the prevalence of comorbidity of posttraumatic stress disorder (PTSD), anxiety and depression; (b) determine the chronological relations between these disorder; and (c) examine whether PTSD comorbid with anxiety and depression is implicated in more impaired functioning than PTSD by itself. Methods: 664 war veterans were followed up 1, 2, and 20 years after their participation in the 1982 Lebanon War. Comorbidity was assessed by self reported PTSD, anxiety, and depression symptoms; impairment in psychosocial functioning was assessed by self reported problems in occupational, social, sexual and family functioning. Results: At each point of assessment, rates of triple comorbidity (PTSD, anxiety and depression; 26.7-30.1%) were higher than rates of PTSD, either by itself (9.3-11.1%), or comorbid with depression (1.2-4.5%) or anxiety (2.9-4.5%). PTSD predicted depression, anxiety, and comorbid disorders, but not vice versa. At time 1 and 2 assessments, triple comorbidity was associated with more impaired functioning than PTSD alone. In addition, triple comorbidity at Time 2 was associated with more impaired functioning than double comorbidity. Limitations: Since measurements did not cover the entire span of 20 years since the war, the entire spectrum of changes could not be monitored. Conclusions: Almost one half of war veterans would endorse a lifetime triple comorbidity, and those who do, are likely to have more impaired functioning. The findings support the perspective that views PTSD as the dominant disorder following traumatic events, which impels the development of comorbid anxiety and depression. (C) 2009 Elsevier B.V. All rights reserved.
Abstract: Objectives: To examine the effects of combat stress reaction (CSR) and posttraumatic stress symptoms (PTS) on the level and trajectories of self-rated health (SRH) over 20 years after war exposure. Methods: A total of 675 veterans comprising two groups, a CSR group (n=369) and a matched control group without CSR (n=306), were assessed in a prospective longitudinal design, 1, 2, 3, and 20 years after their participation in the 1982 Lebanon War. SRH and PTS were assessed repeatedly, at each point of measurement. Results: The CSR participants showed more impaired initial SRH than the controls. Although the CSR group showed an improvement in SRH over time, its SRH level remained lower than that of the control group in all 4 points in time. Initial levels of PTS were associated with more impaired SRH and lower improvement over time. In addition, increased levels of PTS in the first follow-up period were related to poorer SRH, in comparison to the predicted trajectory on the basis of CSR and initial PTS. Conclusions: Stress reaction to war trauma affected the trajectory of SRH over a 20-year period. Although the differences between veterans who had shown acute stress reaction and those who had not persisted over the entire period, there was slow improvement in SRH over time among the more impaired CSR group. PTS in the first years after the war slowed this improvement and thus played a key role in the relationship between war trauma and physical health.
Abstract: Three studies examined whether perceived adversary intent and personal vulnerability moderate the effects of mortality salience (MS) on violent solutions to conflict. In Study 1, following MS, Israeli participants read a description of de-escalating or escalating Iranian rhetoric. In Study 2, following MS, Israeli participants read about tensions with Iran and reflected on the personal ramifications of the conflict or on the content of the passage. In Study 3, Israeli participants with direct war exposure were compared to participants with no war exposure, and following MS, read a description of escalating or de-escalating Hezbollah rhetoric. Results revealed that MS increased support of violence under escalating conditions and low perceived vulnerability. However, for persons with direct war exposure, MS induced support of violence contingent on adversary rhetoric. Thus, direct experience with war leads to a more nuanced contingent response to existential threat not present among those without direct war experience.
Abstract: Objective: The aim of this study was to examine the long-term trajectories and interrelationships of posttraumatic stress disorder (PTSD) symptom clusters (intrusion, avoidance, and hyperarousal) in clinical and nonclinical groups of war veterans. Method: Six hundred seventy-five Israeli veterans from the 1982 Lebanon War were assessed. The clinical group consisted of 369 who had combat stress reaction (CSR) during the war, and the nonclinical group consisted of 306 veterans with no antecedent CSR. The 2 groups were matched in age, education, military rank, and assignment. They were prospectively evaluated 1, 2, and 20 years after the war. Results: The clinical group endorsed a higher number of symptoms than the nonclinical group, both cross-sectionally and across time. In both the clinical and nonclinical groups, the clusters of intrusion, avoidance, and hyperarousal were interrelated at any given point in time and across 20 years. In both groups, avoidance was found to be a particularly stable symptom cluster over time. Finally, hyperarousal levels I year after the war were found to play an important role in both groups, as they predicted future avoidance and intrusion symptoms. Conclusions: The findings of this study suggest that PTSD is not a monolithic disorder, as symptom clusters differ in several important aspects. Also, the course and severity of symptoms differ between clinical and nonclinical groups. Finally, practitioners are encouraged to focus on the identification and treatment of early hyperarousal due to its prominent role in the development of other PTSD symptoms. (J Clin Psychiatry 2009; 70(6):837-843) (C) Copyright 2008 Physicians Postgraduate Press, Inc.
Abstract: Three studies examined the hypothesis that mortality salience (MS) will increase prosocial behaviors when the prosocial cause promotes terror management processes. However, when the prosocial cause interferes with these processes, MS will reduce prosocial behavior. In Study 1, following a MS procedure, participants indicated their willingness to donate money to charity or to donate to an organ donation organization. In Study 2, a research assistant randomly distributed fliers with reminders of death or back pain, and another research assistant solicited participants' assistance from either a charitable fund booth or an organ donation booth. Study 3 examined the impact of MS on helping a wheelchair-bound confederate or a walking confederate. The results indicated that MS increased charitable donations and increased help to a walking confederate. However, MS significantly decreased organ donation card signings and decreased help to a wheelchair-bound confederate. The discussion examines the tension between personal fear and worldview validation.
Abstract: Two studies, conducted 3 months before the Israeli pullout from the Gaza Strip and the Northern West Bank, examined whether reminders of death would lead right-wing, Israelis to endorse violent resistance against the disengagement plan. More specifically, we hypothesized, that this reaction would be particularly strong among participants high. in denial-those who were unable to come to terms with the Israeli withdrawal. In Study 1 (N = 63), right-wing Israeli undergraduates were primed with death and asked to indicate whether they view violent resistance as legitimate and whether they would be willing to partake in such violence. In Study 2 (N = 42), Israeli settlers in the Gaza Strip completed a similar procedure as in Study 1. In both studies, primes of death led to greater support, of violent resistance, but only among participants high in denial. The discussion examines the applicability of terror management theory to under-standing real-life political crises.
Abstract: To examine whether the soothing effect of food may be related to terror management processes, 149 Israeli college students were assigned to a mortality salience, fail salience, or neutral condition. Then, they were exposed to 1 of 3 tasting conditions ranging from pleasant to unpleasant or to a fourth condition with no tasting. Following this procedure all participants were asked to judge the severity of 10 social transgressions and recommend punishments. The results showed that in the no-tasting condition mortality salience led to more severe judgments of social transgressions than in the 2 control conditions. However, this effect was attenuated in the tasting conditions, especially in the positive taste condition wherein death primes led to less severe judgments of transgressions than in the other conditions. The discussion examines the utility of a terror management perspective in understanding the relation between stress and overeating.
