Tsachi Ein-Dor

Comorbidity of posttraumatic stress disorder, anxiety and depression: a 20-year longitudinal study of war veterans.

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.

The Pushes and Pulls of Close Relationships: Attachment Insecurities and Relational Ambivalence

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) attitudinal ambivalence toward a romantic partner and (b) motivational ambivalence with respect to the goals of relational closeness and distance. Attachment-anxious individuals exhibited strong attitudinal ambivalence toward a romantic partner, assessed by both explicit and implicit measures. They also exhibited strong motivational ambivalence regarding 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.

The Attachment Paradox How Can So Many of Us (the Insecure Ones) Have No Adaptive Advantages

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.

Attachment insecurities and the processing of threat-related information: Studying the schemas involved in insecure people's coping strategies.

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 peoples 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.

Defenders of a Lost Cause: Terror Management and Violent Resistance to the Disengagement Plan

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 understanding real-life political crises.

Predictors of PTSD trajectories following captivity: A 35-year longitudinal study

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 and185 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.

An Experimental Study of Emotion Regulation During Relationship Conflict Interactions: The Moderating Role of Attachment Orientations

Romantic couples (N = 127) engaged in a relationship conflict interaction during which their autonomic physiology, emotional experience, and emotional behavior were recorded. Couples were assigned randomly to one of two interventions, or to a control condition: In the affective suppression condition, one partner was instructed to refrain from expressing emotions. In the positive mindset condition, one partner was instructed to think about the positive aspects of the relationship. Results revealed that emotion regulation interventions influenced the physiology, emotional behavior, and emotional experience of both the manipulated person and his or her partner, who was oblivious to regulation manipulations. Specifically, suppression increased, and positive mindset decreased cardiovascular arousal and negative affect. These effects were generally exacerbated among those high on attachment anxiety and attenuated among those high on attachment avoidance. The results of this research corroborate and extend the Temporal Interpersonal Emotion Systems model (Butler, 2011) in the context of relationship conflict interactions.

The relationship between posttraumatic stress disorder symptoms and paternal parenting of adult children among ex-prisoners of war: a longitudinal study.

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 1, 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.

Vulnerability and Vigilance: Threat Awareness and Perceived Adversary Intent Moderate the Impact of Mortality Salience on Intergroup Violence:

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.

Effective Reaction to Danger Attachment Insecurities Predict Behavioral Reactions to an Experimentally Induced Threat Above and Beyond General Personality Traits

People who score high on attachment anxiety or avoidance display poorer adjustment than secure individuals in various social, emotional, and behavioral domains. Yet it may be advantageous for groups to include insecure as well as secure members. The authors tested predictions from social defense theory concerning advantages to groups of including members with different attachment patterns. A total of 46 groups were unobtrusively observed in a threatening laboratory situation: The room gradually filled with smoke, apparently because of a malfunctioning computer. Attachment anxiety was associated with quicker detection of the danger and therefore with greater group effectiveness. Attachment-related avoidance was associated with speedier escape responses to the danger once it was detected and therefore with greater group safety. The results remained significant even when extraversion and neuroticism, two possible confounds, were statistically controlled. Implications of the findings for theory and research concerning group processes, threat detection, and individual differences in attachment are discussed.