Rivka Tuval-Mashiach

Gender differences in responses to traumatic events: A prospective study

Gender differences in psychological responses to motor vehicle accidents were examined as part of a large-scale prospective study of PTSD. Participants were recruited from an emergency room (n = 275) and interviewed 1 week, 1 month, and 4 months later. No gender differences were seen in the prevalence or recovery from PTSD, or in symptom levels at 1- and 4 months. Women had a higher prevalence of lifetime- and postaccident generalized anxiety disorder. Gender differences were found regarding the type, but not the total number, of potentially traumatic events previously experienced. These results suggest that gender differences in responses to traumatic events are not explained by exposure as such, but rather may result from gender-specific attributes of the event.

Narrating Human Actions The Subjective Experience of Agency, Structure, Communion, and Serendipity

In this article, the authors offer a model for the exploration of the ways social actors narrate the forces that have driven their lives. They position this exploration in light of the notions of agency, structure, communion, and serendipity, as formulated in various social-science theories of human action, viewed as part of the cultural repertoire of discourses available to narrators. The authors suggest a model for understanding the interrelationships between agency, structure, communion, and serendipity—as worked out in the subjective experience of life-story narrators—and exemplify the model through the analysis of one womans life story.

Ethiopian Emerging Adult Immigrants in Israel: Coping With Discrimination and Racism

Experiences of discrimination and racism and individual coping strategies were examined among 22 emerging adult Ethiopian immigrants in Israel. In-depth interviews explored the way they perceive, understand, respond to, and cope with experiences of discrimination. Qualitative analysis identified an initial contrast between those interviewees who refuted the existence of personal and/or general experiences of racism and those who felt it acutely. Further analysis identified two strategies among those who refuted the existence of racism: a racism-free group who repudiated racism in general and a proactive strategy in which the young person felt that their own individual behavior prevented racism. Two strategies were identified among those who described frequent, painful racist experiences: (a) fighting back, involving confronting or talking back to the perpetrator, and (b) avoidance, choosing not to react openly to the situation. The article describes the different strategies together with the experience embodied in each of them in relation to integration in Israel and feelings of belonging to Israeli society. The results cast a spot light on the experience of discrimination and the ways of coping with it and suggest that active coping mechanisms are connected to a more positive internal feeling and to stronger feelings of belonging and integration, in particular when the strategy is based on an awareness of discrimination (as opposed to ignoring it).

Romantic Fantasies, Cross-Gender Friendships, and Romantic Experiences in Adolescence

Findings of this study, conducted on 142 adolescents (67 ninth graders and 75 eleventh graders), show that romantic experiences among adolescents are manifested in different forms: romantic fantasies, cross-gender friendships, and sustained interactions with a romantic partner. These three forms of experience are manifested differently across age and gender. Romantic fantasies, although not accompanied by any actual interaction, are emotionally intense and probably constitute one of the modes of romantic experience.

Loneliness and isolation in life-stories of Israeli veterans of combat and captivity

Loneliness holds detrimental ramifications for health and well-being. Nevertheless, loneliness references in the literature addressing combat-related trauma are few. Consequentially, the qualities and characteristics of such experiences in these posttraumatic realities remain uninvestigated empirically. In the current qualitative study we began filling this gap in the literature. We utilized thematic content analysis of life-stories of 19 combat veterans and 7 ex-POWs that have given testimony at the Israel Trauma Center for Victims of Terror and War (NATAL). Our findings suggest that the loneliness in the contexts at hand is primarily characterized by a sense of experiential isolation, rather than social, emotional, or existential. This is the sensation that due to the extraordinary nature of traumatic experiences the fulfillment of needs such as empathy and intersubjectivity may be unattainable. Integrating our findings with existing interdisciplinary literature regarding social sharing, trauma, and loneliness, we discuss implications for clinical interventions and further research.

The Social Construction of Loneliness: An Integrative Conceptualization

Loneliness may be seen as the epitome of relational deficit, and as an experience that may hold dire ramifications for health and well-being. Hence, it has become a phenomenon of growing interest in psychology, nursing, and health care. Although loneliness literature in numerous disciplines is replete with attempts to define and conceptualize the experience, a close examination of existing conceptualizations suggests they are lacking. Moreover, although researchers demonstrate how various theoretical approaches relate to loneliness, they have yet to examine how the various approaches relate to each other. We (a) address those shortcomings and suggest that they may be attributed to adherence to a positivistic view of the experience, (b) demonstrate manners in which previous conceptualizations and their construal mechanisms may be traced to their disciplinary traditions, and (c) argue for an interpretative social-constructionistic point of view by breaking down the experience of loneliness into its fundamental components. The result is an experiential model depicting seven components essential to the experience of loneliness as it is constructed within a Western interdisciplinary academic milieu: (a) a sense of isolation, (b) a relationship, (c) an experiencing self, (d) a representation of an Other, (e) a deficiency of relational need(s), (f) a sense of discrepancy, and (g) psychological pain or aversion. Interrelations among the elements, the models use for qualitative investigations and clinical practice, and its implications for future research investigating loneliness are discussed.

Narrative reconstruction therapy for prolonged grief disorder—rationale and case study

Background Prolonged grief disorder (PGD) is a potentially disabling condition affecting approximately 10% of bereaved people. It has been suggested that the impaired integration of the loss memory, as expressed in recurrent memories of the loss and disorganization of memory, is involved in the development of PGD. Narrative reconstruction (NR), originally designed for the treatment of posttraumatic stress disorder (PTSD) in an integrative therapy module, and consisting of exposure to the loss memory, detailed written reconstruction of the loss memory narrative and an elaboration of the personal significance of that memory for the bereaved, has been shown to be effective in the treatment of intrusion symptoms. Objective In light of findings that cognitive behavior therapy (CBT), including cognitive restructuring and exposure, is effective in the treatment of PGD, we suggest the implementation of a somewhat novel therapy module, NR, for the treatment of intrusive phenomena in bereaved patients. Method The rationale for the implementation of NR for PGD and a case study of the treatment of a woman suffering from PGD after the death of her father are presented. Therapy took place in a university outpatient training clinic. Results Evaluations conducted before and after treatment and at a 3-month follow-up demonstrated the effectiveness of NR in reducing symptoms of PGD and depression. The analysis of spontaneous narratives recorded before and after treatment showed an increased organization of the narratives. Conclusions This case report demonstrates an adaptation of NR for the treatment of PGD. The results provide preliminary support for the effectiveness of NR for PGD. The significance of the study and its limitations are discussed. Highlights of the article Prolonged grief disorder (PGD) affects approximately ten percent of bereaved people. Narrative Reconstruction (NR), an integrative therapy module originally used for PTSD patients, was adapted for PGD. NR consists of exposure to the loss memory, detailed written reconstruction of the loss and an elaboration its significance and meaning for the bereaved. NR was demonstrated in a case study. It was well tolerated and effective in the treatment of PGD.

Preparedness, Ideology, and Subsequent Distress: Examining a Case of Forced Relocation

The current study investigated the relationships between levels and modes of preparedness for relocation, ideology, and subsequent posttraumatic stress disorder (PTSD). A sample of 269 relocated residents from Gush Katif completed questionnaires examining their previous life stressors, preparation prior to their relocation, level of ideology, and current level of PTSD. Contrary to expectations, the findings showed a negative correlation between instrumental preparedness and PTSD, which suppressed the positive association between ideology and PTSD. These findings suggest that some modes of preparedness may lead to better psychological readjustment, while others may be irrelevant or even harmful when they contradict ones ideology. Further research on the unique and combined role of preparedness and ideology in coping with stressful events is needed.

The need for friendships and information: Dimensions of social support and posttraumatic growth among women with breast cancer.

OBJECTIVE Employing a cross-sectional design, the current study examined the relationships between various agents and types of support and posttraumatic growth (PTG) among women with breast cancer. METHOD Eighty married women who were coping with breast cancer completed social support and PTG questionnaires. RESULTS All agents of social support (family, friends, belief-based), excluding spousal support, and all types of social support were found to be related to the various PTG dimensions and its total score. Regression analyses revealed that, among the agents of support, only support provided from friends and belief-based support uniquely contribute to prediction of total PTG score. While examining the contribution of various types of support, only cognitive support had a unique contribution to prediction of total PTG score. SIGNIFICANCE OF RESULTS Various agents and types of support play different roles in the PTG process following breast cancer. Accordingly, friends as an agent of support and information as a type of support seem to be most important in enhancing PTG among women with breast cancer.

Self-stigma, insight, and family burden among Israeli mothers of people with serious mental illness: Ethno-national considerations

The current cross-sectional study investigated and compared the associations between insight, self-stigma, and family burden among Jewish and Arab mothers of an adult son or daughter with serious mental illness (SMI) in Israel. A total of 162 Israeli mothers of a person with SMI participated in the study; 95 were Jewish (58.6%), and 67 were Arab (41.4%). Insight, self-stigma, and family burden scales were administered. Jewish mothers reported higher levels of insight into their son’s or daughter’s illness and reported greater family burden compared to Arab mothers. No significant differences in self-stigma scores were found between Jewish and Arab mothers. The pattern of associations between insight, self-stigma, and burden differed between Jewish and Arab mothers. Self-stigma was found to mediate the relationship between insight and burden among Jewish mothers but not among Arab mothers. Ethno-national affiliation should be taken into consideration regarding how family members conceptualize and experience mental illness, as this might affect care.