Continuous Traumatic Situations in the Face of Ongoing Political Violence

Abstract

This article presents a literature review of the concept of continuous traumatic situations (CTS), which relates to residents living in ongoing situations of political violence and national security threats. The first aim of this review is to narrow the gap regarding knowledge about the concept of CTS by presenting findings from studies that have assessed the effects of CTS on civilian populations. The second aim is to describe CTS in a way that highlights the differences and similarities between posttraumatic stress disorder and responses to CTS. This distinction is a necessary precondition for examining CTS, as is a careful clinical analysis of the development and course of symptoms. This literature review also highlights the importance of adopting a supplementary perspective for understanding the psychological impact of ongoing exposure to real threats, which can be used as a basis for developing intervention strategies that are appropriate for coping with life in the context of persistent violence. CTS can be manifested as emotions, behaviors, and perceptions among individuals, families, communities, and societies. The nature of the proposed model of CTS is a circular one, combining past and future perceptions and emotional reactions that have resulted from continuous and repeated traumatic experiences over an extended period of time. This wider understanding reflects the complexity of the CTS phenomenon. Various micro and macro interventions relating to CTS as the result of political violence situations and national security threats are presented, and recommendations for practice, policy, and future research are offered.

Psychological distress related to COVID-19 – The contribution of continuous traumatic stress

“…Unceasing exposure to trauma leads to a substantial degradation of individuals’ psychological, social, and economic resources (e.g., Hobfoll et al, 2008 ), and this degradation could in turn limit one's capacity to handle a new stressor. Furthermore, the reality of ongoing threat/danger not only deprives one of the opportunity to experience recovery in a safe and protected environment ( Lahad and Leykin, 2010 ; Nuttman-Shwartz and Shoval-Zuckerman, 2016 ), but also repeatedly confirms a sense of threat and helplessness. As such, the negative effects of the ongoing trauma and subsequent PTSD symptoms on coping with an additional stressor might be particularly potent.…”

“…Survivors of previous traumatic events (that are not ongoing) might benefit from evidence-based treatments such as trauma-focused cognitive behavior therapy (TF-CBT; Hobfoll et al, 2008 ), which could be provided online and would tap specific challenges that survivors might experience when dealing with the pandemic. Individuals exposed to CTS, on the other hand, need specific clinical interventions that are tailored to the particular struggles that they face ( Nuttman-Shwartz and Shoval-Zuckerman, 2016 ). Treatment for individuals exposed to CTS should be directed towards managing anxiety and physical symptoms, and the acquisition of day-to-day coping skills, and not on a reprocessing of the trauma, as is generally done when treating survivors of traumatic events that are not ongoing ( Diamond et al, 2010 ).…”

“…One of the main goals of CTS treatment is to teach patients to differentiate between adapting to an actual danger versus symptomatic reactions to trauma reminders. Core elements of stress management therapy such as relaxation, breathing exercises, and mindfulness-based practices might be beneficial (e.g., Nuttman-Shwartz & Shoval-Zuckerman, 2016 ) and a biopsychosocial approach, which is based on cognitive behavioral methods ( Hamblen et al, 2012 ), might also be effective for individuals exposed to CTS. Given that numerous populations around the world are exposed to CTS, providing these clinical tools via online mental health services during the ongoing COVID-19 pandemic is of substantial value.…”

An application of an ecological framework to understand risk factors of PTSD due to prolonged conflict exposure: Israeli and Palestinian adolescents in the line of fire.

“…These symptoms must last more than one month to qualify for a clinical diagnosis of PTSD (American Psychiatric Association, 2013). Chronic exposure to political violence is different than acute exposure in the nature of its accumulative effects and is associated with increased PTSD (Buka, Stichick, Birdthistle, & Earls, 2001; Nuttman-Shwartz & Shoval-Zuckerman, 2015). …”

Social Work in the Context of an Ongoing Security Threat: Role Description, Personal Experiences and Conceptualisation

“…Moreover, because people living under conditions of ongoing traumatic stress are currently in danger, their responses to the emergency situation, including avoidance and hyperarousal, can be understood as natural, protective and adaptive (Nuttman-Shwartz and Shoval-Zukerman, 2015). In those situations, trauma workers (including social workers) have reported that they temporarily shift their attention to the emergency.…”