Rony Berger

School-Based Intervention for the Treatment of Tsunami-Related Distress in Children: A Quasi-Randomized Controlled Trial

Background: On December 26, 2004, a tsunami hit the southern coast of Sri Lanka, leaving thousands dead and injured. Previous research has found significant mental health problems among children exposed to major disasters. School-based universal interventions have shown promise in alleviating distress and posttraumatic symptomatology in children and adolescents. This study evaluated the efficacy of a school-based intervention in reducing stress-related symptomatology among Sri Lankan children exposed to the tsunami. Methods: In a quasi-randomized controlled trial 166 elementary school students (ages 9–15) with significant levels of tsunami exposure and previous traumatic background were randomly assigned to a 12-session structured program ‘ERASE Stress Sri Lanka’ (ES-SL) or to a waiting list (WL) religious class control group. Students were assessed 1 week prior and 3 months after the intervention on measures of posttraumatic symptomatology [including posttraumatic stress disorder (PTSD) and severity of posttraumatic symptomatology], depression, functional problems, somatic problems and hope. Results: This study shows a significant reduction on all outcome variables. PTSD severity, functional problems, somatic complaints, depression and hope scores were all significantly improved in the ES-SL group compared to the WL group. No new cases of PTSD were observed in the experimental group. Conclusion: This study adds to the growing body of evidence suggesting the efficacy of school-based universal approaches in helping children in regions touched by war, terror and disaster and suggests the need to adopt a two-stage approach toward dealing with trauma-exposed students, namely, starting with a universal intervention followed by targeted specialized interventions for those still suffering from posttraumatic distress.

A school-based, teacher-mediated prevention program (ERASE-Stress) for reducing terror-related traumatic reactions in Israeli youth: a quasi-randomized controlled trial

BACKGROUND Since September 2000 Israeli children have been exposed to a large number of terrorist attacks. A universal, school-based intervention for dealing with the threat of terrorism as well as with terror-related symptoms, ERASE-Stress (ES), was evaluated in a male religious middle school in southern Israel. The program was administered by the homeroom teachers as part of the school curriculum. It consists of 12 classroom sessions each lasting 90 minutes, and included psycho-educational material, skill training and resiliency strategies delivered to the students by homeroom teachers. METHODS One hundred and fourteen 7th and 8th grade students were randomly assigned to the ES intervention or were part of a waiting list (WL). They were assessed on measures of posttraumatic symptomatology, depression, somatic symptoms and functional problems before and 3 months after the intervention or the WL period. RESULTS Three months after the program ended, students in the experimental group showed significant reduction in all measures compared to the waiting-list control group. CONCLUSIONS The ERASE-Stress program may help students suffering from terror-related posttraumatic symptoms and mitigate the negative effects of future traumatic experiences. Furthermore, a school-based universal program such as the ERASE-Stress may potentially serve as an important and effective component of a community mental health policy for communities affected by terrorism.

Protective factors and predictors of vulnerability to chronic stress: A comparative study of 4 communities after 7 years of continuous rocket fire

Many communities across the world are chronically exposed to extreme violence. Responses of residents from a city and rural community in Southern Israel, both exposed to 7 years of daily mortar fire, were compared to residents from demographically, socio-economically and geographically comparable non-exposed control samples to examine protective factors and predictors of vulnerability to chronic war-related attacks. Samples from a highly exposed city (Sderot) and a highly exposed rural community region (Otef Aza), along with a demographically comparable comparison non-exposed city (Ofakim) and non-exposed rural community region (Hevel Lachish), were obtained in 2007 using Random Digit Dialing. In total, 740 individuals (81.8% participation rate) were interviewed about trauma exposure, mental health, functioning and health care utilization. In the highly exposed city of Sderot, 97.8% of residents had been in close proximity to falling rockets; in the highly exposed rural community region of Otef Aza, 95.5% were similarly exposed. Despite exposure to chronic rocket attacks, residents of Otef Aza evidenced little symptomatology: only one person (1.5%) reported symptoms consistent with probable posttraumatic stress disorder (PTSD) and functioning levels did not differ from those of non-exposed communities. In contrast, posttraumatic stress (PTS), distress, functional impairment and health care utilization were substantially higher in the highly exposed city of Sderot than the other three communities. Lack of resources was associated with increased vulnerability among city residents; predictors of PTS across all samples included being female, older, directly exposed to rockets, history of trauma, suffering economic loss, and lacking social support. Increased community solidarity, sense of belonging and confidence in authorities may have served a protective function for residents of rural communities, despite the chronic attacks to which they were exposed.

The mental health impact of terrorism in Israel: A repeat cross-sectional study of Arabs and Jews

Objective:  Since September 2000 Israeli society has been subjected to numerous deadly terror attacks. Few studies have studied the comparative mental health vulnerability of minorities and majorities to continuous terror attacks.

The impact of "training the trainers" course for helping tsunami-survivor children on Sri Lankan disaster volunteer workers.

Marc Gelkopf, Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa; NATAL, the Israel Trauma Center for Victims of Terror and War, and Psychologists, Psychiatrists and Social Workers Beyond Borders; Lev Hasharon Mental Health Center, Pardessia, Israel; Pamela Ryan and Sarah, J. Cotton, Issues Deliberation Australia/America, University of Texas, Austin; Psychologists, Psychiatrists and Social Workers Beyond Borders; Rony Berger, NATAL, the Israel Trauma Center for Victims of Terror and War, and Psychologists, Psychiatrists and Social Workers Beyond Borders. We thank the generous sponsors whose various contributions made this project possible: The Silverton Foundation for their financial contribution; Issues Deliberation Australia/ America (IDA) and NATAL, Israel Trauma Center for Victims of Terror and War for their commitment and “in kind” support; the staff and volunteers from Sumithrayo for their assistance in helping to set up the project and hosting the training for the ERASE Stress program. Finally, we thank the people of Sri Lanka who allowed us to walk a few steps with them on their journey of recovery. This work was the inaugural project of the international nongovernmental organization Psychologists, Psychiatrists and Social Workers Beyond Borders (PBB). We acknowledge the assistance of Rena Kurs in preparation of the article. The first and last authors have equally collaborated on this study. Correspondence concerning this article should be addressed to Marc Gelkopf, Lev Hasharon Mental Health Center, POB 9000, Netanya 42100, Israel. E-mail: emgelkopf@ 013.net.il

The inoculating role of previous exposure to potentially traumatic life events on coping with prolonged exposure to rocket attacks: A lifespan perspective

Relatively little research have addressed the effect of prolonged exposure to rocket attacks with a lifespan perspective and only a handful of these studies focused on the effect of this exposure as a function of aging. The present study examined the effects of seven years of rocket attacks fired toward the south of Israel on adult participants of different ages. We examined whether potentially traumatic life events (PTLEs) unrelated to rocket attacks moderated the association between post-traumatic stress (PTS) symptoms and age. Data were obtained from a 2007 telephone survey using the Random Digit Dialing method and including 343 individuals (76.7% participation rate). Exposure to rockets, PTLEs, global distress, and post-traumatic symptomatology were assessed. Older age was associated with a higher level of PTS symptoms. Higher PTLE levels attenuated the association between age and PTS symptoms. Our results suggest that age is a risk factor for developing PTS symptoms under prolonged exposure to rocket attacks. However, previous levels of exposure to other negative events, as well as gender, appear to inoculate a person to stress, thus modulating the age-PTS association.

Enhancing Visual Perception and Motor Accuracy among School Children through a Mindfulness and Compassion Program

The present study assessed the effects of the mindfulness/compassion cultivating program: “Call to Care-Israel” on the performance in visual perception (VP) and motor accuracy, as well as on anxiety levels and self-reported mindfulness among 4th and 5th grade students. One hundred and thirty-eight children participated in the program for 24 weekly sessions, while 78 children served as controls. Repeated measures ANOVA’s yielded significant interactions between time of measurement and group for VP, motor accuracy, reported mindfulness, and anxiety. Post hoc tests revealed significant improvements in the four aforementioned measures in the experimental group only. In addition, significant correlations were obtained between the improvement in motor accuracy and the reduction in anxiety and the increase in mindfulness. Since VP and motor accuracy are basic skills associated with quantifiable academic characteristics, such as reading and mathematical abilities, the results may suggest that mindfulness practice has the ability to improve academic achievements.

The Intergenerational Effect of Maternal Multicultural Experience on Children’s Tolerance: An Example From Palestinians and Jews in Israel

Although recent research has demonstrated the benefits of multicultural experience for reducing personal levels of intergroup bias, the potential for an intergenerational effect has yet to be explored. Using samples of Jewish-Israeli (Study 1a) and Palestinian-Israeli (Study 1b) mother–child dyads, we found that maternal multicultural experience was indirectly related to greater social tolerance among children via lower levels of maternal need for cognitive closure which, in turn, triggered higher levels of maternal social tolerance. These results show that when it comes to multicultural experience, its impact can extend beyond the self to also affect the next generation. Implications for developmental theories of prejudice acquisition and prejudice interventions are discussed.

The process of desistance among core ex-gang members

Research has established robust links between gang membership, delinquency, violence and victimization. Yet studies examining the process of gang desistance in general and that of core gang members in particular, are quite rare. The current study aims to identify factors associated with desistance of core gang members as well as describe the nature of the process that these “formers” have undergone. Thirty-nine core ex-gang members (80% males and 20% females) from the San Francisco Bay area and Los Angeles, with an average length of 11.6-years gang membership, were interviewed regarding their involvement in the gang and the desistance process. A systematic qualitative analysis based on grounded theory methodology was mainly utilized. We found that the decision to leave the gang is a result of a combination of push (e.g., personal and vicarious victimization, burnout of gang lifestyle, disillusionment by the gang) and pull (e.g., parenthood, family responsibilities, religious and cultural awakening) factors that evolved over time. Push factors were more dominant in this domain. We also found that while male core ex-gang members tended to leave the gang more frequently because of push factors, female ex-gang members were more inclined to desist due to pull factors. Our analysis also showed that core gang members shared a general pattern of the desistance process comprising of the following 5 stages: triggering, contemplation, exploration, exiting and maintenance. Based on these results, we outlined stage-specific recommendations for agents of societal change to help in facilitating the desistance of core gang members.

Impact of Exposure to Potentially Traumatic Events on Individuals With Intellectual Disability

This study explored the prevalence of posttraumatic symptomatology (PTS) and functional problems among Israeli individuals with intellectual disability (ID) who live in supported residential care settings and who have been exposed to political violence. The sample included 196 residents exposed to chronic missile attacks and 91 residents with ID who were not exposed. Results showed PTS and functional problems to be higher in the exposed group compared to the nonexposed one, although still low compared to the general exposed population. Exposure was found to be related to PTS and functioning problems suggested individuals with ID are reactive to political violence, though the underlying mechanisms are not clear. Implications for research, caretakers, and policy are discussed.