Alexandra Klein Rafaeli’s research while affiliated with Ben-Gurion University of the Negev and other places

On October 7, 2023, a large-scale attack in southern Israel and the subsequent war resulted in extensive loss of life and injuries, with many individuals experiencing traumatic losses, such as family members or close friends being killed or kidnapped. This study aims to longitudinally examine its effects on mental health, specifically, clinical symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD). We anticipated greater symptom severity among individuals who experienced traumatic loss, were forcibly displaced, or suffered income loss, as well as among women and members of ethnic minorities. This three-wave online survey study assessed mental health symptoms in a sample of 1052 individuals, aged 18–40, residing in conflict zones in Israel from February 2024 (day 1), through March 2024 (day 30), to May 2024 (day 90). Symptoms of anxiety, depression, and PTSD were measured using the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Primary Care PTSD Screen (PC-PTSD). Individuals experiencing traumatic losses, forced displacement, or economic hardships, as well as females, consistently demonstrated higher rates of anxiety, depression, and PTSD symptoms compared to those without such experiences or to males, across all time points (F values ranged from 17.7 to 215.3, p < .001). For ethnic minorities (Arab and other), as compared to Jewish, anxiety and depression symptoms were higher at every time point (F = 8.3–97.1, p = .004 to < .001). This study highlights the urgent need for targeted mental health interventions in conflict zones, particularly for affected individuals. Further research should expand these findings to broader populations.

Interpersonal psychotherapy (IPT) is a time-limited, evidence-based treatment that focuses on patients’ social and interpersonal functioning, affect, and current life events. Ipt helps patients to explore affective experiences through the lens of the social and the interpersonal, and offers techniques to help the patient translate feelings into interpersonal interventions that ameliorate functioning in those domains. Ipt has been supported by numerous clinical trials over the last 40 years, and it continues to be applied and adapted across cultures, pathologies, and modalities. Among the many contemporary adaptations, is the use of IPT for posttraumatic stress disorder (PTSD). In this chapter, we will trace the theories that influenced the design, research, and practice of IPT as we describe in more detail the approach and its recent application to PTSD.

Clinical trials of psychotherapy require diagnostic homogeneity, which implies a convergence of clinical presentations. Yet research study patients present diversely, and patients who do not fit a treatment paradigm may greatly complicate delivery of the study psychotherapy. The research literature has not addressed this issue. The authors use case illustrations of three psychotherapies--Prolonged Exposure, Relaxation Therapy, and Interpersonal Psychotherapy--from an ongoing psychotherapy outcome trial of posttraumatic stress disorder to describe psychotherapeutic responses to complex, "atypical" patients who strain standard treatment paradigms. Therapists required flexibility, and occasionally deviations from strict protocol, in treating heterodox patients. Such heterogeneity of presentation may have implications for psychotherapy outcome in research trials. Despite lack of discussion in the literature, many trials may face such issues.

Interpersonal Psychotherapy (IPT), a time-limited, evidence-based treatment, has shown efficacy in treating major depressive disorder and other psychiatric conditions. Interpersonal Psychotherapy focuses on the patient's current life events and social and interpersonal functioning for understanding and treating symptoms. This case report demonstrates the novel use of IPT as treatment for posttraumatic stress disorder (PTSD). Preliminary evidence suggests IPT may relieve PTSD symptoms without focusing on exposure to trauma reminders. Thus IPT may offer an alternative for patients who refuse (or do not respond to) exposure-based approaches. Interpersonal Psychotherapy focuses on two problem areas that specifically affect patients with PTSD: interpersonal difficulties and affect dysregulation. This case report describes a pilot participant from a study comparing 14 weekly sessions of IPT to treatment with two other psychotherapies. We describe the session-by-session IPT protocol, illustrating how to formulate the case, help the patient identify and address problematic affects and interpersonal functioning, and to monitor treatment response.