Research carried out with survivors of a variety of different traumata indicates that a large proportion of them perceive positive changes in themselves after the trauma. This study investigated whether posttraumatic growth also could be found among people who had been exposed to particularly severe traumata over a period of several years (1991 to 1995) during the war in the area of the former Yugoslavia. Included in the study were two representative samples of adult former refugees and displaced people who lived anywhere in former Yugoslavia before the war and were currently living in Sarajevo, Bosnia and Herzegovina, three and a half years after the war. The main instrument was a new Bosnian translation of the Posttraumatic Growth Inventory. Results indicated some differences in the factor structure as compared with the original instrument. The overall means for the scale were considerably lower than reported in most studies on other kinds of trauma. Younger people reported considerably more growth than older people.

The goals of this study were to estimate the lifetime prevalence of traumatic events, the current prevalence of Posttraumatic Stress Disorder (PTSD), and the connection between the kinds of traumatic events experienced and the probability of developing PTSD in three study samples in Sarajevo, Bosnia-Herzegovina, three years after the end of the war. A total of 311 people surviving the siege of Sarajevo were assessed with the Checklist for War Related Experiences (CWE) and an adapted version of the Posttraumatic Diagnostic Scale (PDS). The study groups consisted of a randomly selected residents sample (n = 98), a group of individuals in psychological treatment (n = 114), and a group in medical treatment (n = 99). Each individual survived an average of 24 traumatic events. According to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV; American Psychiatric Association, 1994) criteria, 18.6% of individuals in the residents sample, 32.7% of those in medical treatment, and 38.6% of those in psychological treatment developed PTSD.

Research attests to high levels of symptoms among post-war civil populations, in particular, when a loved one was killed, which can lead not only to trauma reactions but also to severe separation distress. Grieving the loss of a loved one is hampered if the death remains unconfirmed. Unconfirmed loss could be conceptualized as unfinished business in terms of Gestalt therapy, which offers empty-chair dialogue for resolving unfinished business and grief. Dialogical exposure therapy (DET) supports the client in gaining awareness of and expressing his or her inner dialogues concerning the traumatic event, using Gestalt empty-chair method. Short-term DET was effective in treating traumatically bereaved women but showed little additional effects in comparison with a supportive group treatment, so further research is warranted.

Background: Although there are effective treatments for posttraumatic stress disorder (PTSD), there is little research on treatments with non-cognitive-behavioural backgrounds, such as gestalt therapy. We tested an integrative gestalt-derived intervention, dialogical exposure therapy (DET), against an established cognitive-behavioural treatment (cognitive processing therapy, CPT) for possible differential effects in terms of symptomatic outcome and drop-out rates. Methods: We randomized 141 treatment-seeking individuals with a diagnosis of PTSD to receive either DET or CPT. Therapy length in both treatments was flexible with a maximum duration of 24 sessions. Results: Dropout rates were 12.2% in DET and 14.9% in CPT. Patients in both conditions achieved significant and large reductions in PTSD symptoms (Impact of Event Scale - Revised; Hedges' g = 1.14 for DET and d = 1.57 for CPT) which were largely stable at the 6-month follow-up. At the posttreatment assessment, CPT performed statistically better than DET on symptom and cognition measures. For several outcome measures, younger patients profited better from CPT than older ones, while there was no age effect for DET. Conclusions: Our results indicate that DET merits further research and may be an alternative to established treatments for PTSD. It remains to be seen whether DET confers advantages in areas of functioning beyond PTSD symptoms.

Many people go missing during war and acts of terrorism. Do their families suffer an additional or different kind of mental health burden than families of people who are known to have been killed? Two groups of respondents, each comprising 56 women living in Bosnia and Herzegovina, were included in the study. These were women whose husbands were either confirmed as having been killed during the 1992–1995 war or who were at the time of the study officially still listed as missing as a result of the war. These two groups filled in questionnaires on war events, postwar stressors, and mental health status. The results showed that the group with unconfirmed losses had higher levels of traumatic grief (measured on a version of the UCLA Grief Inventory) as well as severe depression (measured on the General Health Questionnaire), even when traumatic events and stressors were controlled for. This study represents one of the first empirical confirmations that, at least in a war context, suffering the unconfirmed loss of a family member has specific negative mental health consequences compared to suffering a confirmed loss. In particular the high levels of severe depression including suicidal ideation in this group give cause for concern.