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World Assumptions Among Wives of Former Prisoners of War
Abstract
This study examines (a) secondary trauma by evaluating World Assumptions (World Assumptions Scale scores) among spouses of Israeli ex-prisoners of war (ex-POWs) and (b) the relationship between the husbands’ current posttraumatic stress disorder (PTSD) symptoms and PTSD trajectory and the wives’ world assumptions. Data were prospectively collected thrice for ex-POWs and comparable veterans, and twice for their spouses. This study extends current research as it links trauma, beyond PTSD symptoms, to more negative world assumptions among spouses of traumatized ex-POWs. Spouses of ex-POWs with PTSD symptoms reported lower benevolence of the people and self-worth and higher randomness compared with spouses of ex-POWs without PTSD symptoms. Spouses of ex-POWs who endorsed chronic PTSD symptoms also reported greater levels of self-control compared with the delayed PTSD symptoms group. Results suggest that the relationship between husbands’ PTSD symptoms and wives’ world assumptions may be mediated by wives’ PTSD symptoms. The implications of the findings are discussed.
... points. [44] These studies show that being a cancer patient has a significant negative impact on one's assumptions about the world. In the literature, it is stated about the issue that it may be related to the fact that cancer is inherently a lifethreatening disease suggesting the consciousness of death; the experience of suffering from cancer also entails that there is uncertainty about prognosis, optimal treatment, the likelihood of nonresponse to treatment, and possible future effects; and it is stated that it may be correlated to the progression of the disease and the constant presence of fear of relapse. ...
... Unique in this respect was a pioneering study among natural disaster survivors, in which the authors reported that when husbands' convictions regarding world benevolence were low, a negative association between their wives' beliefs in world benevolence and PTSS was evident (Monson et al., 2009). In contrast, the findings from a study that used the same sample as the present study suggested that the negative effects of PTSS among traumatized veterans were related to their wives' WAs, particularly with regard to lower ratings of world benevolence and higher perceptions of randomness (Bronstein et al., 2016). Finally, the findings from another study demonstrated that both fathers' primary PTSS and mothers' secondary PTSS were related to their children's secondary PTSS via both their parents' beliefs regarding world benevolence and their fathers' assumptions about self-worth (Bachem et al., 2020). ...
World assumptions (WAs) are cognitive schemas concerning an individual's views of themselves, the world, and others. Although it is well established that WAs are negatively distorted by trauma exposure and strongly associated with posttraumatic psychopathology, the potential impact of WAs on close interpersonal relationships remains largely uninvestigated. The current study explored the implications of veterans' and their spouses' WAs on their marital and parental relationships. Male Israeli veterans (N = 213) from the 1973 Yom Kippur War and their wives were assessed for WAs, marital adjustment, and positive parenting 35-37 years postwar. Analyses included actor-partner interdependence modeling with mediators (APIMem) and were conducted separately for the three domains of WAs: world benevolence, world meaningfulness, and self-worth. The results indicated that both husbands' and wives' lower scores for all domain-specific WA scales were associated with lower scores on measures of marital adjustment and positive parenting. Lower scores for both spouses on scales measuring world benevolence and self-worth were associated with a spillover from lower marital adjustment to lower positive parenting. Finally, associations between one spouse's lower WA scores and the other spouse's spillover from lower marital adjustment to lower positive parenting (i.e., cross-spillover effects) were identified for wives' world benevolence ratings and husbands' self-worth, ds = 0.14-0.72. These results point to the detrimental ramifications of negative WAs on family relationships and the dynamics between the marital and parental family subsystems.
... They also exhibited lower marital adjustment, more somatization, and reported lower general health compared to the veterans who were not held captive [26]. Furthermore, wives of ex-POWs with PTSD were more vulnerable in the advent of high levels of distress than those married to ex-POWs without PTSD [27], and they evinced more negative cognitions and lower levels of self-worth [28]. Moreover, when ex-POWs were found to have a chronic PTSD trajectory, which is typically characterized by more severe symptomatology as well as a more protracted duration of symptom manifestation, their wives also reported significantly higher PTSD symptoms and functional disability compared to wives whose husbands endorsed other PTSD trajectories. ...
This article examines of the aftermath of war captivity as implicated in the next (second) generation. Capitalizing on findings from a nearly four-decade and four-wave longitudinal study, we present cumulative evidence regarding the psychological and interpersonal ramifications of war captivity for former Israeli prisoners of war (ex-POWs), and underscore the intergenerational effects of both parents — fathers’/ex-POWs’ experiences and their spouses — on their adult offspring. Taking into consideration the relational context of the family system, the article addresses post-traumatic phenomena manifesting among the offspring as impacted by their fathers’ trauma and post-traumatic stress symptoms, their mothers’ secondary traumatic stress, and the complex interaction of familial sub-systems specifically parental functioning. As not all offspring of the traumatized are equally affected. We also assessed offspring characteristics that may render some of them vulnerable or resilient. These included: (1) gender, (2) “The Big Five” personality traits: Openness, Conscientiousness, Extroversion, Agreeableness, and Neuroticism (3) and differentiation of self. Findings indicate the strong intergenerational effects of trauma, particularly on sons; the mediating effects of parental PTSD; and the role of the offspring's personality characteristics. Clinical implications of the findings are discussed.
... First, a study among female survivors of a natural disaster and their husbands showed that negative WAs in both partners tended to be mutually reinforcing and led to more severe PTSS in the wives [31]. Another study found evidence to suggest that the negative effects of PTSS among traumatized veterans were related to their wives' lower sense of benevolence of the world and higher perceptions of randomness [32]. These findings suggest that WAs interact on a dyadic level and thereby influence the spouses' posttraumatic symptomatology. ...
Purpose
Among the most prevalent and adverse sequalae of traumatic experiences are negative world assumptions (WAs), which describe trauma-related negative cognitions regarding the self, the world, and others. Even though a wealth of studies has shown intrapersonal associations between negative WAs and posttraumatic stress symptoms (PTSS), there has been little research on how WAs may affect family systems. This study examined the intergenerational associations between parental WAs, paternal PTSS, and maternal secondary traumatic stress (STS) on adult–children’s STS in veterans’ families. It was hypothesized that negative paternal WAs would mediate the association between parental PTSS/STS and adult–children’s STS.
Methods
Three domains of WAs (benevolence of the world, meaningfulness of the world, and self-worth) and PTSS were prospectively assessed in 123 father–mother–offspring triads of former Israeli veterans of the 1973 Yom Kippur War, their wives and adult offspring. Data were collected in 2003, 2008, and 2014, and analyzed using triadic path modeling.
Results
Mothers’ STS was associated with children’s STS via negative maternal WAs on world benevolence. Fathers’ PTSS was related to children’s STS via fathers’ WAs on world benevolence and self-worth. Moreover, fathers’ WAs on world benevolence and self-worth mediated the intergenerational transmission of STS from mothers to offspring. No effects were found for meaningfulness WAs.
Conclusion
Findings suggest that parental WAs related to world benevolence and paternal self-worth contribute to intergenerational trauma transmission. Clinical implications favor cognitive and systemic approaches to therapy that address negative benevolence and self-worth assumptions and involve the entire family system.
... They also exhibited lower marital adjustment and more somatization and reported lower general health compared to the control group . Furthermore, wives of ex-POWs with PTSD were more vulnerable during times of great distress than those married to ex-POWs without PTSD (Greene et al. 2014), and they evinced more negative cognitions and lower levels of self-worth (Bronstein et al. 2016). When ex-POWs were found to have a chronic PTSD trajectory, which is typically characterized by more severe symptomatology as well as protracted symptom manifestation, their wives also reported significantly higher PTSD symptoms and functional disability compared to wives whose husbands endorsed other PTSD trajectories. ...
This chapter is devoted to an examination of the aftermath of war captivity as implicated in the next (second) generation. Capitalizing on findings from a nearly three-decade and four-wave longitudinal study, we present cumulative evidence regarding the psychological and interpersonal ramifications of war captivity for Israeli former prisoners of war (ex-POWs) and underscore the intergenerational effects of the fathers’/ex-POWs’ experiences on their adult offspring. Taking into consideration the relational context of the family system, the chapter addresses post-traumatic phenomena manifesting among the offspring as impacted by their fathers’ trauma and post-traumatic stress symptoms, their mothers’ secondary traumatic stress, and the complex interaction of familial subsystems, such as the marital and the parental relationships. Clinical and societal implications are drawn, and directions for future research in the field are discussed and encouraged.
... If such disclosure is performed openly in the family system, the offspring might be exposed to their mothers' weaknesses and vulnerabilities. Wives of veterans with PTSS have been found to perceive the world as less benevolent and predictable than wives of veterans without PTSS (Bronstein, Levin, Lahav, & Solomon, 2016). This may also apply to veterans' offspring. ...
Research indicates that posttraumatic stress symptoms (PTSS) induced by war trauma may be transmitted to veterans’ wives and offspring (secondary traumatic stress; STS). However, the interplay between family members’ characteristics has not been accounted for in such processes. Taking a family systems perspective, we examine the contributions of fathers’ PTSS, mothers’ STS, marital adjustment, and self-disclosure of both parents to offspring's STS and test whether marital quality applies as a mechanism of parent–child transmission. Combat veterans and former prisoners of war (N = 123), their spouses, and adult offspring were investigated in a multiple-step mediation analysis. The results highlight the mother's crucial role in trauma transmission and suggest that strengthening the marital relationship may buffer the transmission of fathers’ PTSS to offspring.
Según Helzer et al. (1987) y Pérez-Olmos et al. (2005), el trastorno de estrés postraumático (TEPT) tiene una prevalencia en el mundo del 1% al 4%. Es un trastorno que surge después de un acontecimiento traumático significativo. Tras la vivencia de un evento traumático, el cuidado de las víctimas con TEPT es imperativo. Por lo que los cuidadores directos o personas significativas al ser testigos o conocer del evento traumático tras convivir con la persona diagnosticada con TEPT, corren el riesgo de sufrir Trastorno de Estrés Traumático Secundario (TETS) (Figley, 1995). Por tanto, ¿quiénes son las personas significativas de las víctimas primarias que corren el riesgo de sufrir TETS? ¿qué signos, síntomas y trastornos mentales manifiestan tras la vivencia indirecta del evento y cuidado directo de la víctima primaria? Este estudio implicó una revisión narrativa de 321 estudios publicados entre el 2000 y 2017 en bases de datos académicas tales como EBSCO, LILACS, Pubmed, PsycINFO y SciELO. Se encontró que el 75% de las investigaciones identificaron a la pareja como persona significativa. Asimismo, los signos y síntomas de las personas significativas eran la tensión, angustia y problemas de pareja. Además, problemas en las relaciones sociales como la evitación al apego y las suposiciones negativas del mundo. Concluí la necesidad e importancia de realizar investigaciones sobre la persona significativa, así como su cuidado físico y mental. Esto permitirá combinar el conocimiento teórico con el trabajo de campo consiguiendo un adecuado esquema de prevención, tratamiento y control enfocado en la víctima secundaria.
This review summarizes studies on the intergenerational influence of the Palestinian disaster in 1948 (i.e., NAKBA). For the purposes of this review, it was investigated whether second-generation individuals were affected by war-related trauma to which first-generation individuals were exposed. In this study we examined the intra-family trauma communication style (i.e., disclosure/silencing) as a mediator variable. A path model was constructed to demonstrate how the influence of traumatic experiences was transmitted to the second generation. Finally we investigated the factors that might affect the willingness of Palestinians to reconcile with Jews and the state of Israel. This thesis includes a review and three articles, which consider the topic from different perspectives. In the first chapter, a literature review of the existing publications on the topic of the transgenerational impact of trauma and displacement is presented and the outstanding research questions are discussed. The subsequent three chapters refer to the results of the current study and finally a chapter summarizes the results in German.
In this chapter we present cumulative evidence about the psychological and interpersonal ramifications of war captivity on Israeli former prisoners of war (ex-POWs). Specifically, we address the associations between ex-POW husbands’ posttraumatic distress (i.e., PTSD) with their wives’ secondary traumatization. We also present findings from recent studies of both partners assessing their mutual and bidirectional influences regarding both distress and marital adjustment. Clinical implications and directions for future research in the field are presented.
In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The current study examines the impact that trauma work has on those who are working with traumatized clients, within the framework of both vicarious trauma (VT) and vicarious posttraumatic growth (VPTG), by using a metasynthesis of findings from 20 published qualitative articles. The synthesis found that the impact of trauma work can potentially increase short- and long-term levels of distress and that such psychological impact can be managed through personal and organizational coping strategies. Nevertheless, it also highlighted that distress does not necessarily preclude growth. Furthermore, it was found that trauma work leads to changes in schemas and day-to-day routines and that these changes can be both negative and positive, implying a nonbinary view of the impact of trauma work. The schematic changes correspond to both VT and VPTG, but for VPTG to occur, trauma workers will need to be exposed to the client’s own growth. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Work on the psychological aftermath of traumatic events suggests that people ordinarily operate on the basis of unchallenged, unquestioned assumptions about themselves and the world. A heuristic model specifying the content of people's assumptive worlds is proposed. The schema construct in social cognition is used to explore the role of these basic assumptions following traumatic events. A major coping task confronting victims is a cognitive one, that of assimilating their experience and/or changing their basic schemas about themselves and their world. Various seemingly inappropriate coping strategies, including self-blame, denial, and intrusive, recurrent thoughts, are discussed from the perspective of facilitating the victim's cognitive coping task. A scale for measuring basic assumptions is presented, as is a study comparing the assumptive worlds of people who did or did not experience particular traumatic events in the past. Results showed that assumptions about the benevolence of the impersonal world, chance, and self-worth differed across the two populations. Findings suggest that people's assumptive worlds are affected by traumatic events, and the impact on basic assumptions is still apparent years after the negative event. Further research directions suggested by work on schemas are briefly discussed.
If a client dealing with combat-related posttraumatic stress disorder (PTSD) presents for psychotherapy, should you consider including his or her partner in treatment? How could couples therapy be beneficial? What framework do you have to conceptualize the relational issues and potential treatment? Although clinicians have long been encouraged to include families in the treatment of combat-related PTSD, few specific couple-family therapies exist, and outcome research is scarce. Because of the adverse effects of PTSD on relationships, couples therapy can be a powerful adjunct treatment; however, few receive this service. A new framework for conceptualizing couples therapy organizes treatment around the 3 PTSD symptom clusters (reexperiencing, avoidance, and arousal). Relationship consequences of each symptom cluster are summarized, followed by useful treatment interventions and a case study. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article describes the development and validation of a new measure of trauma-related thoughts and beliefs, the Posttraumatic Cognitions Inventory (PTCI), whose items were derived from clinical observations and current theories of post-trauma psychopathology. The PTCI was administered to 601 volunteers, 392 of whom had experienced a traumatic event and 170 of whom had moderate to severe posttraumatic stress disorder (PTSD). Principal-components analysis yielded 3 factors: Negative Cognitions About Self, Negative Cognitions About the World, and Self-Blame. The 3 factors showed excellent internal consistency and good test-retest reliability; correlated moderately to strongly with measures of PTSD severity, depression, and general anxiety; and discriminated well between traumatized individuals with and without PTSD. The PTCI compared favorably with other measures of trauma-related cognitions, especially in its superior ability to discriminate between traumatized individuals with and without PTSD. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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. One hundred and sixty four Israeli ex-POWs and 185 comparable combatants from the 1973 Yom Kippur War were followed over 35 years, with three follow-ups (1991, 2003, 2008). 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.
The association between trauma exposure and mental health-related challenges such as depression are well documented in the research literature. The assumptive world theory was used to explore this relationship in 97 female survivors of intimate partner violence (IPV). Participants completed self-report questionnaires that assessed trauma history, world assumptions, and depression severity. Regression analyses revealed that diminished world assumptions mediate the relationship between trauma exposure and depression severity. As predicted, this relationship held for interpersonal forms of trauma, whereas noninterpersonal forms of trauma were related neither to diminished world assumption nor to depression severity. This suggests that our conceptual system of relating to the world, our core beliefs that comprise our assumptive world, may be challenged in the face of human-induced trauma, increasing our risk for developing adverse psychological outcomes such as depression.
In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.
The aim of this study was to assess the long-term impact of war captivity and combat stress reaction on rates of posttraumatic stress disorder (PTSD) in Israeli veterans of the 1973 Yom Kippur war.
One hundred sixty-four former prisoners of war (POWs), 112 veterans who had had combat stress reaction, and 184 combat veteran comparison subjects filled out the PTSD Inventory, a self-report scale based on the DSM-III-R criteria for PTSD. The inventory diagnoses past and present PTSD, assesses its intensity, and provides a symptom profile.
Thirty-seven percent of the veterans who had had combat stress reaction, 23% of the former POWs, and 14% of the comparison subjects had had diagnosable PTSD at some time in the past. The current rates were 13%, 13%, and 3%, respectively. The results showed different recovery rates over time: almost two-thirds of the veterans with combat stress reaction who had had PTSD in the past recovered, while less than one-half of the POW group showed this improvement.
These findings indicate that small but significant proportions of the POWs and veterans with combat stress reaction were still suffering from PTSD almost two decades after the war. The different recovery rates in the two groups may reflect the differences in duration and severity of stressors, the impact of immediate intervention on long-term adjustment, or both.
The PTSD Inventory, a self-report diagnostic questionnaire based on DSM-III criteria, was revised to meet the more recent DSM-III-R criteria. This study examined the validity of the revised inventory relative to a structured clinical interview (SCID) and the Impact of Events Scale (IES). Results showed a high degree of concordance between the instruments, supporting the use of the more standardized, easy to administer and economical PTSD Inventory.
Many people are exposed to loss or potentially traumatic events at some point in their lives, and yet they continue to have positive emotional experiences and show only minor and transient disruptions in their ability to function. Unfortunately, because much of psychology's knowledge about how adults cope with loss or trauma has come from individuals who sought treatment or exhibited great distress, loss and trauma theorists have often viewed this type of resilience as either rare or pathological. The author challenges these assumptions by reviewing evidence that resilience represents a distinct trajectory from the process of recovery, that resilience in the face of loss or potential trauma is more common than is often believed, and that there are multiple and sometimes unexpected pathways to resilience.
The authors examined the association between (a) personal world assumptions and (b) combat stress reactions (CSRs), posttraumatic stress disorder (PTSD), and PTSD's course among three groups of Israeli veterans: 109 veterans who suffered from CSR on the battlefield, 98 decorated veterans, and 189 control participants. Participants completed standardized questionnaires that measured PTSD and world assumption. Both CSR and chronic PTSD were associated with lower levels of self-worth and beliefs about the benevolence of people. In addition, the authors found a linear association between self-worth perceptions and levels of mental status. The authors examined the results of the study considering the extraordinary characteristics and meaning of war.
The study aims to examine the association between exposure to trauma, posttraumatic stress disorder (PTSD), and world assumptions. The study included 3 groups of subjects: PTSD myocardial infarction (MI) patients, non-PTSD MI patients, and matched controls. World assumptions were examined twice: within a week of the patient's MI (Time 1) and 7 months later (Time 2). The findings indicate that world assumptions are not related to exposure to trauma but are associated with PTSD.
This study examines secondary traumatization among 708 partners and 332 parents of Dutch peacekeepers (i.e., personnel who participated in military actions implemented by international organizations such as the United Nations). Partners or parents of peacekeepers with 4 levels of posttraumatic stress symptoms were compared on posttraumatic stress, health problems, the quality of the marital relationship, and social support. In comparison with partners of peacekeepers without posttraumatic stress disorder (PTSD) symptoms, partners of peacekeepers with PTSD symptoms reported more sleeping and somatic problems, reported more negative social support, and judged the marital relationship as less favorable. No significant differences were found for parents. Thus, peacekeepers' stress reactions were related to various problems of their partners. A systemic approach to the treatment of persons with PTSD appears appropriate.
Knowledge on the experience of prisoners of war's (POWs) wives is sparse, and mostly concentrates on the first decade after captivity. The present qualitative study examined the marital perceptions of seven wives of POWs after three decades. Participants were recruited through therapists who worked with families of POWs. Data were collected by a semi-structured, in-depth focus group interview. The findings of the study shed light on: (1) The place of captivity in the life of the family over time and (2) the women's perception of their role and place in the marital relation as being responsible mainly for the husband's well being and the couple's relationship, while struggling to preserve their personal needs. The meaning of the results is discussed together with implications for practice.
United States military prisoners of war (POW) held in Southeast Asia from 1964 through 1973 were held longer than any previous group of American POWs—an average of 5 years, compared to the 3 years for World War II POWs, 2 years for those held in North Korea during the late 1950s, and approximately a year for the Pueblo crew (1960s). Those men held the longest in Southeast Asia were imprisoned there for almost 9 years.
This study explored secondary traumatization among wives of former POWs. Forgiveness and self-differentiation were investigated for their role in wives'mental and marital distress. Participants included wives (N = 82) of former Israeli POWs (18 with PTSD [posttraumatic stress disorder] and 64 without PTSD) and a control group of 72 women whose husbands fought in the war but who were neither POWs nor suffered from PTSD. Compared to the other two groups, wives of former POWs with PTSD reported lower couple forgiveness and self-differentiation. High self-differentiation predicted low emotional and marital distress, whereas high couple forgiveness reduced only marital distress. Self-differentiation moderated the relationships between couple forgiveness and both types of distress. Findings highlight the challenges women face when living with partners with PTSD.
With the growing interest in the role of cognitions in PTSD, this prospective study examined the course and bi-directional relationship between post-trauma cognitions and symptoms of PTSD. A sample of Israeli combat veterans, including former prisoners of war, was assessed in 1991, and later followed up in 2003 and 2008. PTSD symptoms were measured at three time points. Cognitions concerning the self and the world were measured twice. Applying Autoregressive Cross-Lagged (ARCL) modeling strategy, initial PTSD symptoms predicted subsequent negative cognitions but not vice versa. In addition, repeated measures design revealed that individuals with chronic PTSD symptoms had relatively negative cognitions that further amplified with time. More specifically, increasingly negative cognitions were documented among ex-prisoners of war. The main findings suggest that negative cognitions are fueled by PTSD and that in chronic PTSD there is an amplification of pathogenic outcomes over time. Discussion of the findings is in the context of current cognitive models of PTSD.
Twenty years after the last research was conducted on military families in the Israel Defense Forces (IDF), this study explores gender arrangements in families of male and female career military personnel as viewed by their civilian spouses. The research objective was to analyze the differences in attitudes toward family life and examine the differences in work—family practices among the IDF’s career servicemen and women. The findings indicate that the IDF’s heavy demands on career personnel, regardless of gender lead to the construction of family and couple arrangements that deviate from the norm in civilian Israeli-Jewish families of similar characteristics. For the servicemen, this demand creates a ‘‘traditional’’ role division model that places the entire burden of family work on their wives; for the servicewomen the same demands create a relatively ‘‘egalitarian’’ role division model, by placing more of the burden of ‘‘family chores’’ on their husbands.
This study examined marital adjustment and relations among couples where husbands had been a prisoner-of-war (i.e., POW) and couples where husbands were veterans, but not POWs. The study also examined the relative contribution of the husband's post-traumatic stress disorder (i.e., PTSD) and POW experience to both spouses' marital adjustment. Results from 157 couples (85 former POWs and spouses as well as 72 veterans but not POWs and their spouses as controls) indicated that former POW couples had lower marital adjustment, sexual satisfaction, and self-disclosure, and higher verbal abuse than the control couples. Captivity indirectly influenced the husband's marital adjustment through his PTSD. In turn, PTSD had an indirect effect on both spouses' marital adjustment, fully mediated through marital relations variables.
The learned helplessness phenomenon is proposed as a model for the emotional numbing and maladaptive passivity sometimes following victimization. Victims may learn during the victimization episode that responding is futile. This learning is represented as an expectation of future response-outcome independence (helplessness). Causal interpretations of the episode affect the chronicity and generality of deficits resulting from this expectation, as well as the involvement of self-esteem loss. We discuss several problems in applying the helplessness model to victimization, but we conclude that the theory may be useful in explaining why some victims become numb and passive.
When both therapist and client share a traumatic event, there are multiple levels of vulnerability to traumatization for the therapist. Our personal vulnerability is not only a backdrop for our clinical work but also an acknowledged fact in many therapeutic relationships, a situation that changes the frame of the work. In addition to clinical challenges, shared trauma increases a therapist's vulnerability to vicarious traumatization; VT is defined as the negative transformation of the therapist's inner experience as a result of his or her empathic engagement with and responsibility for a traumatized client. Emphasizing the importance of awareness, self-care, meaning, and community, the article summarizes important steps to anticipate, address, and transform the therapist's experience of vicarious traumatization.
Theorists and practitioners have long recognised that working with trauma clients can trigger reactions in the therapist similar to those experienced by the client. Nevertheless, research in this area has been lacking. One obstacle has been confusion regarding key terms. Vicarious traumatisation is the most appropriate concept given that it relates specifically to trauma work, incorporates intrinsic and extrinsic factors, and can be located within the framework of the constructivist self-development theory. Although limited, research has identified a range of factors that influence vicarious traumatisation, such as experience, personal trauma history and coping style. Future investigation is required to examine aspects that could enhance counsellor resilience. In addition, vicarious traumatisation needs to be studied in terms of a broad range of clientele and occupations.
The aim of this paper is to look at the impact of working with distressed and traumatized clients. The paper describes a survey involving 430 care workers who regularly work with distressed or traumatized clients. The survey involved the participants completing a 21-item beliefs inventory describing their supervision or support and recording whether they had any spiritual or religious beliefs. A factor analysis of the results of the inventory found four factors, three of which involved the negative impact of the work on beliefs while the fourth gave an indication of the positive beliefs or post trauma growth that comes from working in this area. The results showed that while doing a good job and experiencing fulfilment were higher in carers who experienced lower levels of distressing experiences and beliefs, an increase in competence and improved learning opportunities were associated with higher levels of challenge. A review of the information provided on supervision and support showed that there was a wide variation in the sources of support for the different professions. While around 46% of the carers had spiritual beliefs only 29% were members of a religious group. The discussion looked at the implication of the results of the survey including the possible benefit of using the carer belief inventory to identify carers who may be vulnerable to secondary trauma or compassion fatigue. The need to provide support to all professions undertaking caring work with distressed or traumatized clients was highlighted.
In the past decade, the professional literature has burgeoned with articles discussing the phenomena of secondary or vicarious traumatization, however, to a large extent the published literature has been primarily conceptual or anecdotal in nature. This article reviews the results of quantitative studies that address the impact of providing psychosocial services to traumatized populations relative to symptoms of trauma symptoms, disrupted cognitive schema, and general psychological distress. Further, findings associated with risk and protective factors are discussed and suggestions for future research are introduced.
This study assessed the beliefs and cognitions of bus-train collision survivors, 7 years following the accident. The sample consisted of 389 young adults who were adolescents at the time of the disaster. The sample was composed of 4 groups who differed in their levels of exposure to traumatic stress. Results indicated that (a) exposure to the traumatic accident was implicated in challenging survivors' beliefs about the benevolence of the world. Justice and luck were also associated with posttraumatic psychiatric and functional impairment; (b) the level of exposure had a direct bearing on dependent variables; and (c) cognitive schemata were associated with psychiatric symptomatology and problems in functioning, reflecting the coexistence of diverse traumatic sequelae. Theoretical implications of these results are discussed.
Every life is a story, and every story can be narrated from the perspective of its different protagonists. War stories, particularly heroic ones, are normally recounted from a male perspective. In this paper, the cases of Israeli POWs are presented from their wives' points of view. The role of the “hero's wife” assigned by the norms of Israeli society to women in general, is epitomized in the discourse of and about POWs' wives. Their narratives describe the sudden separation, the experience of coping with the long, uncertain period of waiting, and their reactions to the reunion. Out of these voices, the social role of the POW's wife is constructed. Her life, like that of her husband, acquires public interest and prominence which hold both positive and negative implications. Her role is defined by total loyalty to her man, the victim of hostile warfare, and by the limited autonomy allowed her temporarily during his absence. Society tends to negate or diminish the courage and the suffering experienced by the POW's wife, as the undergoes her own trauma and adjustment to political-personal events of her life.
While the long-term effects of combat trauma on veterans have been studied extensively, its impact on veterans' wives has yet to be investigated. This study examined the implications of combat-induced psychopathology — wartime combat stress reaction (CSR) and current posttraumatic stress disorder (PTSD) — in a sample of 205 wives of Israeli combat veterans of the 1982 Lebanon war. Results show that both CSR and PTSD were associated with increased psychiatric symptoms in the wives. In addition, current PTSD was particularly found to contribute to impaired social relations among veterans' wives in a broad range of contexts, from inner feelings of loneliness, through impaired marital and family relations, and extending to the wider social network. Implications of these findings for treatment and further research are discussed.
Within the context of their new constructivist self-development theory, the authors discuss therapists'' reactions to clients'' traumatic material. The phenomenon they term vicarious traumatization can be understood as related both to the graphic and painful material trauma clients often present and to the therapist''s unique cognitive schemas or beliefs, expectations, and assumptions about self and others. The authors suggest ways that therapists can transform and integrate clients'' traumatic material in order to provide the best services to clients, as well as to protect themselves against serious harmful effects.
The experiment tested the hypothesis that the stress experienced by a person who is unable to control aversive stimulation is not a function of lack of control per se, but of the attribution of causality that (s)he makes for failure to exert control. Subjects were given a problem-solving task, and were told that they could prevent aversive noise bursts by correctly solving the problems. Subjects then received false feedback that they had done either well or poorly on the problems. In addition, failing subjects received information that led them to attribute their performance either to their own lack of ability or to situational factors (task difficulty). Subjects who attributed their failure to their own incompetence felt considerably more stress than subjects who made situational attributions. In fact, the latter subjects experienced no more stress than subjects who were successful in controlling the stimulation. Surprisingly, subjects whose attributions for performance led them to feel personally incompetent performed better than the remaining subjects both on problems administered in the same situation, and on problems administered in a new and different situation. The implications of the results for future helplessness studies and for the learned helplessness model were discussed.
In spite of the continuous wars and political conflicts throughout the world and the compelling evidence establishing an association between PTSD and close relationship problems, only limited review and discussion of these issues have been done. In this review article, we provide a brief description of PTSD and its manifestation in close relationships, present current concepts and models which explain the association between PTSD and family relations and the empirical literature which supports them, present conjoint/family PTSD treatment efforts, and consider future directions for research in this important area.
This qualitative study identified protective practices that mitigate risks of vicarious traumatization (VT) among mental health therapists. The sample included six peer-nominated master therapists, who responded to the question, "How do you manage to sustain your personal and professional well-being, given the challenges of your work with seriously traumatized clients?" Data analysis was based upon Lieblich, Tuval-Mashiach, and Zilber's (1998) typology of narrative analysis. Findings included nine major themes salient across clinicians' narratives of protective practices: countering isolation (in professional, personal and spiritual realms); developing mindful self-awareness; consciously expanding perspective to embrace complexity; active optimism; holistic self-care; maintaining clear boundaries; exquisite empathy; professional satisfaction; and creating meaning. Findings confirm and extend previous recommendations for ameliorating VT and underscore the ethical responsibility shared by employers, educators, professional bodies, and individual practitioners to address this serious problem. The novel finding that empathic engagement with traumatized clients appeared to be protective challenges previous conceptualizations of VT and points to exciting new directions for research, theory, training, and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Is there a "cost of caring" for health care providers of traumatized patients?
The aim of this study is to review the literature on secondary traumatic stress in nurses in order to answer the following questions: What studies have been conducted on secondary traumatic stress in nurses in all clinical specialties? What instruments were used to measure secondary traumatic stress in nurses and what psychometric properties were reported?
A systematic review.
CINAHL, PubMed, and PsycINFO databases were searched for the years 1981 to the present. Keywords used in the database searches included secondary traumatic stress, compassion fatigue, vicarious traumatization, secondary trauma, PTSD, and nurses.
Research studies were reviewed for the following inclusion criteria: the sample included nurses, the secondary traumatic stress symptoms were measured, and the language was English.
Seven studies were found in which researchers examined secondary traumatic stress in nurses. The samples in five of these studies consisted of all nurses, whereas in the remaining two studies, nurses were included in the samples but the results were not specifically reported for the subgroup of nurses. Presence of secondary traumatic stress was reported in forensic nurses, emergency department nurses, oncology nurses, pediatric nurses, and hospice nurses. Three instruments were identified that measured secondary traumatic stress in practitioners who care for traumatized populations: Secondary Traumatic Stress Scale, Compassion Fatigue Self Test for Helpers, and the Compassion Fatigue Scale-Revised.
Presence of secondary traumatic stress in nurses was reported in all of the studies included in this literature review. The use of small samples and a number of different instruments to measure secondary traumatic stress symptoms, however, hindered the ability to make comparisons across studies and to draw conclusions. None of the studies conducted to date have focused on secondary traumatic stress in psychiatric nurses. Suggestions for future research and clinical implications for what can be done to protect nurses from secondary traumatic stress are addressed.
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.
The information criterion AIC was introduced to extend the method of maximum likelihood to the multimodel situation. It was obtained by relating the successful experience of the order determination of an autoregressive model to the determination of the number of factors in the maximum likelihood factor analysis. The use of the AIC criterion in the factor analysis is particularly interesting when it is viewed as the choice of a Bayesian model. This observation shows that the area of application of AIC can be much wider than the conventional i.i.d. type models on which the original derivation of the criterion was based. The observation of the Bayesian structure of the factor analysis model leads us to the handling of the problem of improper solution by introducing a natural prior distribution of factor loadings.
While the long-term effects of combat trauma on veterans have been studied extensively, its impact on veterans' wives has yet to be investigated. This study examined the implications of combat-induced psychopathology--wartime combat stress reaction (CSR) and current posttraumatic stress disorder (PTSD)--in a sample of 205 wives of Israeli combat veterans of the 1982 Lebanon war. Results show that both CSR and PTSD were associated with increased psychiatric symptoms in the wives. In addition, current PTSD was particularly found to contribute to impaired social relations among veterans' wives in a broad range of contexts, from inner feelings of loneliness, through impaired marital and family relations, and extending to the wider social network. Implications of these findings for treatment and further research are discussed.
The authors have encountered many troubled and symptomatic children whose fathers are being treated for PTSD(Posttraumatic stress disorder). They call this process secondary traumatization to indicate the relationship between the fathers' war experience and subsequent stress disorder and their children's problems. The following case report describes a child with symptoms of secondary traumatization.
To identify the associations between two personality variables (alexithymia, negative affect), social support, awareness of myocardial infarction, and the severity of post-traumatic stress symptoms.
A cross sectional design was adopted with simultaneous measures of both dependent and independent variables.
A random sample of 69 patients who had an MI between 6 and 12 months previously were sent postal questionnaires measuring alexithymia, negative affect, social support, awareness of myocardial infarction, the severity of post-traumatic stress symptoms and a number of demographic details.
Forty-four individuals completed and returned all the questionnaires. A 10% prevalence of post-traumatic stress symptoms was found. Regression analyses were conducted to identify independent associates of the dependent variables with and without the inclusion of the measure of negative affect. Alexithymia, age, social support and awareness at the time of having a myocardial infarction, were each strongly predictive of one or all measures of symptoms.
Evidence supporting the impact of each of the variables on the course of post-traumatic stress disorder was supported in a population of myocardial infarction patients. If these variables were found predictive in a longitudinal study, they would indicate possible risk factors for post-traumatic stress disorder in this population.
One way of understanding the impact of traumatic events is through exploration of cognitive changes that confront a traumatized individual. The author investigated changes in individuals' basic assumptions after traumatic experiences. The participants were 65 people who had been traumatized by representatives of the South African apartheid government. From the total sample, 36 participants had witnessed the violent death of a close relative (sibling, mother, or father). The remaining 29 had been tortured and detained. The author administered the World Assumption Scale (R. Janoff-Bulman, 1989), a semistructured questionnaire on basic assumptions developed for the present study, and the Post-Traumatic Stress Disorder Clinical Checklist (American Psychiatric Association, 1994). Traumatic events affected the participants' basic assumptions about the meaning and benevolence of the world. The tortured and detained group and the bereaved group showed differences in their assumptions of self-worth following the trauma. Cognitive approaches can yield invaluable therapeutic insights into strategies for coping with trauma.
This phenomenological study examined what it was like for the wives/female partners to live with a Vietnam veteran who suffers from post-traumatic stress disorder (PTSD).
Audio-taped interviews were conducted with 10 women and data were examined from three overlapping phases of the veteran/partner relationship: the early phase, the middle phase and the later phase.
The early phase was conceptualized as a period of adjustment in which three themes were identified: (1) attractors, (2) feelings and (3) communication. The middle phase, one of enmeshment, was characterized by six themes: (1) dealing with veteran PTSD symptoms, (2) substance abuse, (3) physical and/or emotional abuse, (4) roles, (5) feelings and (6) coping techniques. Three themes depicted the later phase of resolution/healing: (1) stress related symptoms, (2) staying or leaving and (3) activities that promoted an ongoing process of resolution/healing.
The central meaning statement that best described the experience of wives/female partners who live with a Vietnam veteran with PTSD is that the experience is a gradual process of becoming enmeshed in the veteran's pathology, with all energies being directed at minimizing the effect on self and family, culminating in intermittent movement towards resolution/healing. This study has implications for practitioners who treat Vietnam PTSD veterans and their wives or female partners.
This study examined whether signs of secondary traumatic stress were present in a community sample of couples who experienced World War II. The authors hypothesized that symptoms of posttraumatic stress disorder (PTSD) in either spouse may be predicted not only by his or her own war experiences but also by the war experiences and posttraumatic symptoms of the partner. Approximately 50 years after the end of World War II, 444 couples from a community sample of elderly Dutch citizens answered a questionnaire. A multilevel regression analysis was performed with symptoms of PTSD as the dependent variable. The most important predictors of PTSD symptoms were the number of war events reported by the participant and the current level of PTSD symptoms of his or her spouse. The results lend empirical support to the notion that posttraumatic stress reactions of both members of a couple are not independent from each other. Several explanations of the findings are discussed.
This comment summarizes the findings of the article by A. J. E. Dirkzwager, I. Bramsen, H. Adèr, and H. M. van der Ploeg (2005; see record 2005-06518-006) and notes that it can serve as a reawakening about the immediate and long-term psychosocial consequences of war, not only for those troops who are deployed but also for the loved ones who await their return. The lessons learned once again--that the mental health of the returning peacekeeper parallels that of his or her partner, that partners of traumatized soldiers report more posttraumatic stress disorder symptoms, somatic and sleep problems, negative social support, and low marital morale than partners of nontraumatized soldiers--are consistent with systemic traumatology theory. This comment traces the historical and theoretical foundations that underlie the concept of secondary trauma (i.e., compassion fatigue) and discusses the implications for family psychology practice in helping veterans and their families recover from their ordeals.
The psychological responses to captivity were measured in a sample of former prisoners of war (POWs) 18 and 30 years after release from captivity.
209 Israeli veterans of the 1973 Yom Kippur War (103 ex-POWs and 106 controls) who had taken part in a previous study conducted in 1991 participated in the current study conducted in 2003. The study assessed current rates of posttraumatic stress disorder (PTSD), changes in PTSD over time, and the contribution of captivity severity (objective and subjective), sociode-mographic variables, and psychological appraisal and coping with captivity to predicting PTSD using standardized self-report questionnaires.
Twenty-three percent of the ex-POWs met PTSD criteria and were 10 times more likely than controls to experience deterioration in their psychological condition in the 12-year interval between the 2 assessments. Almost 20% of ex-POWs who did not meet PTSD criteria in 1991 met criteria in the current assessment, in comparison to almost 1% of the controls. Current PTSD was predicted by younger age at the time of captivity, by loss of emotional control and higher subjective appraisal of suffering in captivity, and by a greater number of PTSD symptoms in the 1991 assessment.
It is important to follow up and offer treatment to former POWs. Special attention should be paid to those who lost emotional control in captivity and to those who felt that the conditions of their captivity were severe.
The aim of the study is to examine secondary traumatization of wives of former prisoners of war (POWs) as manifested in posttraumatic stress disorder (PTSD) symptoms, additional psychiatric symptoms, and marital adjustment. In addition, it assessed the role of several contributors to the wives' secondary traumatization: the husband's PTSD, the level of his verbal and physical aggression, and the wife's level of self-disclosure.
The study compared three groups of Israeli wives: wives of POWs with PTSD (N=18), wives of POWs without PTSD, (N=64), and a control group of wives of veterans without PTSD (N=72).
The highest level of distress in all measures was endorsed by the wives of POWs with PTSD. Moreover, in addition to husband's PTSD and captivity, both the man's aggression and the wife's self-disclosure played a role in the wife's level of distress.
The findings show that the husbands' PTSD was more strongly associated with the wives' secondary traumatization than their captivity.
The factor structure of the World Assumptions Scale (WAS) was assessed by means of confirmatory factor analysis. The sample was comprised of 1,710 participants who had been exposed to trauma that resulted in whiplash. Four alternative models were specified and estimated using LISREL 8.72. A correlated 8-factor solution was the best explanation of the sample data. The estimates of reliability of eight subscales of the WAS ranged from .48 to .82. Scores from five subscales correlated significantly with trauma severity as measured by the Harvard Trauma Questionnaire, although the magnitude of the correlations was low to modest, ranging from .08 to -.43. It is suggested that the WAS has adequate psychometric properties for use in both clinical and research settings.
The goal of this exploratory study was to examine correlates of sexual assault disclosure and social reactions in female victims with and without drinking problems. An ethnically diverse sample of sexual assault survivors was recruited from college, community, and mental health agencies. Ethnic minority women were less likely to disclose assault, and women with a greater number of traumatic life events disclosed assault more often. Although there were no differences in disclosure likelihood by drinking status; of those disclosing, problem drinkers told more support sources and received more negative and positive social reactions than nonproblem drinkers. Correlates of receiving negative social reactions were similar for normal and problem drinkers; however, negative social reactions to assault disclosure were related to more problem drinking for women with less frequent social interaction. Implications for future research and possible support interventions with problem-drinking victims are provided.