Traumatization or habituation? A four-wave investigation of exposure to continuous traumatic stress in Israel.

Abstract

Exposure to ongoing violence is a worldwide predicament and may generate different adaptations than those evident in cases of past trauma. Nevertheless, such continuous traumatic stress has only recently begun to attract scientific attention. The present longitudinal study assessed Israeli populations exposed to high and medium intensities of rocket fire in urban and rural communities. Over the course of 4 years, there were 4 assessment points: prior to, proximate to, during, and after a major escalation. Two main questions were addressed. First, does continuous exposure promote habituation and greater resilience or more traumatization, as indicated by posttraumatic stress symptoms? Second, drawing on the conservation of resources theory (Hobfoll, 1989), we examined the contribution of environmental, intrapersonal, and interpersonal resources. Results indicated that a greater exposure prior to escalation was associated with more resilience during high-intensity shelling, thus suggesting a habituation effect to continuous traumatic stress. However, various indicators of personal exposure revealed that more exposure was predictive of more symptomatology. Moreover, contrary to previous studies, urban rather than rural residency was associated with more resilience, as indicated by less posttraumatic stress symptoms. Results also indicated specific risk and protective factors, including education, marital status, age, and perceived personal and community resilience. Clinical implications of the findings are underscored, and future research is encouraged within the context of the study's limitations.

Emotional reactivity to war stressors: An experience sampling study in people with and without different psychiatric diagnoses

“…Current findings also shed light on the question of reactivity to high‐intensity recurring stressors within a lower‐intensity continuous stressful context. Contrary to some previous studies on a similar population, which suggested that the continuous stressful situation may create habituation and thus less reactivity to specific recurring stressors (Rosenberg, Heimberg, Solomon, & Levin, 2008; Stein, Levin, Gelkopf, Tangir, & Solomon, 2018), current findings show that within such a context, people do continue to react emotionally to specific stressors. Furthermore, it is important to mention that negative emotions under the lower‐intensity condition in the current study (i.e., when there are no sirens) are still more likely to be higher than during routine times, due to reactivity to other war‐related stressors (e.g., damage or fear of damage to self or loved ones, or to property/income) as well as the threat of future sirens, which could go off at any time (see also Greene et al, 2018).…”

Modeling Patterns of Polyvictimization and Their Associations with Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in the Israeli Population

“…However, the association between trauma exposure and posttraumatic sequalae in the Israeli population is debated: Bleich and colleagues () found that levels of terror‐related trauma exposure and objective threat were unrelated to the risk of PTSD, a finding corroborated in a study conducted by the authors a few years later (Bleich et al., ). These findings might be partially explained by a habituation effect whereby civilians become increasingly accustomed and adjusted to living under continuous threat to life and thus exhibit a decreased risk of developing symptoms of posttraumatic stress (Amir & Sol, ; Stein, Levin, Gelkopf, Tangir, & Solomon, ). Indeed, a habituation effect would be consistent with the finding reported by Shalev, Tuval, Frenkiel‐Fishman, Hadar, and Eth () that the disruption of daily life is more critical in determining PTSD risk than is the direct exposure to terror attacks itself.…”

A Jerusalem Synagogue Coping During the Coronavirus Pandemic: Challenges and Opportunities

“…Native-born Israelis or those who immigrated during their youth may consider themselves to be mentally tough, having grown up in a hostile region while the English speakers may be more willing to reveal vulnerability. Those growing up in Israel may have grown more accustomed to stresses because of wars and terrorist attacks (Stein et al 2018 ). In addition, there is a lack of appropriate use of mental health services in Israel (Elroy et al 2017 ), which may make it be less acceptable for native-born Israelis or those more acculturated to acknowledge and discuss mental health issues.…”