Therapeutic intervention can reduce trauma exposure on PTSD

The study examined PTSD symptoms among nearly 1,300 adult Israeli civilians exposed to missile attacks.

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January 1, 2017 03:41
A boy comforts his mother who was injured during an earthquake, at a trauma center in Kathmandu

A boy comforts his mother who was injured during an earthquake, at a trauma center in Kathmandu. (photo credit: REUTERS)

A firm belief that external forces govern one’s life events and poor control over media consumption may worsen the effects of trauma exposure on post-traumatic stress disorder (PTSD) symptoms during a period of national trauma, according to a new Bar-Ilan University study.

The study, recently published in Psychiatry Research, examined PTSD symptoms among nearly 1,300 adult Israeli civilians exposed to missile attacks during Operation Protective Edge in Gaza two years ago.

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During Operation Protective Edge in 2014, mobile apps continuously informed the public of missile attacks and videos of attacks were circulated on social media. National TV and radio channels broadcasted details of the fighting from early in the morning until late at night. With so much airtime to fill on TV, news, photos and clips were repeated in loops, and much inaccurate and irrelevant information about the conflict was disseminated.

The researchers set out to examine whether the effect of trauma exposure on PTSD symptoms could be moderated by a combination of two elements: feeling in control over media exposure information during a traumatic situation (as opposed to being drawn into and captivated by the media in an addicted way) and maintaining a locus of control characterized as “external.” Locus of control is a psychological factor associated with the belief that “I” control what happens to me (internal) vs. “others” control what happens to me (external).

“We expected to find that the coupling of low perceived media control (whereby one feels poor control over media consumption, especially when irrelevant and non-informative) along with a self-perception of external locus of control would render participants highly vulnerable to exposure. As expected, the results suggest that effects of exposure on PTSD are not automatic. Rather, the coupling of both low media control along with believing that life events are controlled by external factors exacerbates the effects of exposure,” said Dr. Yaakov Hoffman, of Bar-Ilan University’s Interdisciplinary Department of Social Sciences, who led the study.

Additional authors of the study include Prof. Amit Shrira, of the Interdisciplinary Department of Social Sciences, Sara Cohen-Fridel, of the Churgin School of Education, Dr. Ephraim Grossman, of the Interdisciplinary Department of Social Sciences, and Prof. Ehud Bodner, of the Interdisciplinary Department Social Sciences and Department of Music.

PTSD symptoms experienced due to missile attacks were assessed by the PTSD checklist in which the severity of symptoms was rated on a five-point scale ranging from 0 (not at all) to 4 (extremely). Exposure to missile attacks was indexed by seven yes/no questions addressing threat of death or physical injury either to oneself or to others.

Perceived control over the media was assessed by a single item requesting participants to indicate how much control they had over the media ranging from 1 (I had no control over my media exposure at all, I got completely absorbed in watching and listening even when it did not help me get new and relevant information) to five (I was completely in control over my media exposure and I was exposed only to relevant information). Locus of control was assessed by Levenson’s multidimensional scale. Each item was rated on a 5-point scale ranging from 1 (completely disagree) to 5 (completely agree).

Hoffman says that the findings bear theoretical implications concerning the somewhat elusive effects of exposure on PTSD symptoms. Results are also relevant to practitioners, as both media control and locus of control can be modified by therapeutic interventions that encourage less external locus of control along with higher media control. This combination would render one less vulnerable to the detrimental effects of traumatic exposure. Such interventions can be offered both during times of warfare and conflict, and especially between conflicts as a measure to reduce effects of potential exposure, thereby mitigating the probability of PTSD symptom development, said Hoffman.

SAFE TO GO HOME SAME DAY AFTER APPENDECTOMY


Patients who undergo a laparoscopic (“keyhole”) appendectomy can go home the same day of an operation without being harmed. They do not experience higher rates of postoperative complications or costly readmissions when sent home on the same day of their operations compared with patients hospitalized overnight, according to study results in the Journal of the American College of Surgeons.

Patients with acute appendicitis who undergo laparoscopic appendectomy (surgical remove of the appendix) do not experience higher rates of postoperative complications or costly readmissions when sent home on the same day of their operations compared with patients hospitalized overnight, according to study results published in the Journal of the American College of Surgeons.

Each year, more than 250,000 appendectomies are performed in the United States for acute appendicitis.

Increasingly, these patients are being sent home directly from the recovery room, avoiding an overnight hospital stay.

“Advances in early recognition and treatment of the disease process and minimally invasive techniques have allowed for some of the inflammatory response and the trauma from surgical treatment to be lessened and recovery to be faster. As a result, patients can get back to their lives much sooner,” said study principal investigator Dr.

Armen Aboulian, a colorectal surgeon at Kaiser Permanente in California.

“Now up to 60% of non-perforated acute appendicitis patients at Kaiser Permanente are treated without an overnight stay,” he said. To find out, researchers analyzed the medical records of 12,703 patients who underwent a laparoscopic appendectomy for non-perforated appendicitis at 14 hospitals owned by Kaiser Permanente between 2010 and 2014. The cohort was composed of 6,710 patients who were discharged on the same day of their procedure and 5,993 patients who were hospitalized overnight.

“In general, recovery at home is preferred by most patients and sleeping in your own bed has benefits that are difficult to measure,”Aboulian said.

“At the same time, the goal of the study is not to rush the patients home. Rather, the importance of this study lies in the confirmation that discharge from the recovery room is safe and surgeons across the nation may consider it directly from the recovery room in the appropriate setting.”


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