For a 'nation in trauma' rockets trigger underlying anxiety

20% of Israelis suffer from symptoms of post-trauma, the NATAL study found.

Smoke trails are seen as rockets are launched from the Gaza Strip towards Israel as seen from the Israeli border August 23, 2014 (photo credit: REUTERS/AMIR COHEN)
Smoke trails are seen as rockets are launched from the Gaza Strip towards Israel as seen from the Israeli border August 23, 2014
(photo credit: REUTERS/AMIR COHEN)
The phone was ringing off the hook on Wednesday at the Israel Trauma and Resiliency Center NATAL, after a Grad rocket destroyed a home in Beersheba and another rocket landed in the sea next to the central city of Bat Yam.
Gila Sela, help line manager of NATAL, told The Jerusalem Post that on days like these she sees a 100% increase in calls, coming in not just from the south, but from all over the country. "It's very reactivating of symptoms in people who remember what happened in previous incidents like this," she told Post. "The memories are coming back, even if you sat in a shelter in Tel Aviv in Operation Protective Edge [in 2014]."
Sela explained that the recent incidents trigger anxiety in people all over the country "because we are a nation in trauma."
Twenty percent of Israelis suffer from symptoms of post-trauma and are at high risk of that developing into Post-Traumatic Stress Disorder (PTSD) if they don't get help, according to a new study by NATAL.
NATAL strives to help people with their symptoms in time and prevent the development of PTSD.
The study explored the psychological resiliency, coping capacities and pressures among the citizens of Israel, as a result of terrorist attacks and particularly in the aftermath of Operation Protective Edge four years ago.
Data was collected between July and September of 2017, and the study was led by Prof.Marc Gelkopf, director of NATAL’s research and evaluation department, Prof Avraham Bleich, head of NATAL's professional steering committe and head of the community mental health department at the University of Haifa, Dr. Talya Greene of University of Haifa, and Liron Lapid Pickman of NATAL.
The study was conducted, with the support of the Lange Family Foundation, among 1,382 Israeli residents aged 18 and over, 500 of whom represent a representative sample of the population of Israel and 882 from specific populations (living in high-exposure areas, the Arab sector and immigrants). The data was collected, using questionnaires via the Internet and telephone, by the Brandman Institute for Research and Marketing Consulting.
The study found that among residents of Beersheba and the surrounding area, there are particularly high mental distress rates, almost 21% more than residents in the rest of the country (in the Jewish sector only). The margin of error of the study is +-4.5%.
While on regular days people manage to get on with their lives, Sela said, in times of tension, anxiety resurfaces.
What NATAL does, she says, is to try to help restore a sense of calm and routine, the latter which she stressed is important for achieving the former. Anything that interferes with routine -- such as the closure of schools, as was instructed by the Home Front Command in Beersheba and Gaza Border communities on Wednesday -- has a negative impact, particularly on those who are already nervous, she said.
"Resilience means routine and knowing what to expect so you can prepare for it," she said, highlighting the importance of regular drills and information circulated by the authorities.
"We saw it with the woman in Beersheba, who wasn't confused by the siren at 4 a.m., because in routine we are practicing all the time, so she took her children [to the shelter] and saved their lives," Sela noted.
In this vein, NATAL staff members guides parents to talk to their children about the situation in a way that they can understand it. "They need to know what is happening and what to do and this reduces anxiety and makes them feel that it's under control," Sela told the Post.
"What happens outside our homes has a very significant effect on what happens inside our homes, where we can control what happens to us -- we don't want the outside to come inside, we want to make a wall and bring back a feeling of control," Sela said. 
But many living in the Gaza border communities don't feel safe in their homes.
Symptoms witnessed by NATAL staffers in children include regression in language and bed-wetting, and fear of sleeping alone or of being alone at all.
Since some parents are themselves suffering from anxiety, that impacts on the children, who don't feel like they have anybody to protect them, said Vivian Reutlinger, clinical social worker and CBT psychotherapist at NATAL.
This, she said, has many psychological repercussion later in life, such as trust issues, insecurity, depression and hopelessness.
"You can see this in teenagers," Reutlinger told the Post over the phone after a day of working with children in southern communities. "They can't think about the future, because the future is so uncertain."
"We work with whole families, we understand it's shared," Dr. Tamar Lavi, NATAL's director of community outreach, told the Post, as she was on her way back from field work in the south. 
She stressed that the south has been experiencing a situation of insecurity and waves of conflict for almost 17 years.
"It's a chronic exposure, very long exposure, and the children of today -- their parents were teenagers when everything began," Lavi said. "They are second generation."
Citizens in the south, Lavi said, live with uncertainty of what will happen next. "There is a lot of hyper-vigilance and stress because you are always 15 seconds away from a disaster," she continued, 15 seconds being the amount of time Gaza border community residents have to get to a shelter from the moment the siren rings.
Lavi added that in recent months, the combination of rockets, sirens and incendiary kites and balloons, has been harsh: "That takes a toll on body, mind and spirit."
The fact that it’s a shared experience with everyone in the same surroundings, also causes problems, she notes, because both adults and children in the family, at schools, even in the social services are experiencing the same thing.
“Resources are impaired in the entire community,” Lavi highlighted, contrasting it to trauma experienced by an individual in a car accident, who can then lean on others, who have not been affected by that experience, for support.
Reutlinger recalls a family she once visited in the south. "The parents told me that one of their girls was scared, but then I saw the other children were walking in pairs...even in their own homes they don't feel secure,"  Reutlinger told the Post. "We help them feel that they can take care of themselves and, as much as possible, to feel that their home is a safe place."
Reutlinger heads up NATAL's "mobile units program," which was founded in 2006 when residents of Sderot were afraid to leave their homes -- so NATAL brought the therapy to them. What was supposed to be a temporary program has since expanded, meeting a growing demand across different cities and communities in the south.
NATAL provides parents with tools to help their children as well as helping the children help themselves. Sometimes the children even use those tools to help others, Reutlinger remarked, recalling how a girl had told her how she’d taught a fellow pupil breathing techniques.
"If you feel that the ground is not as solid under your feet, call us, because with a very mild intervention, with very mild tools, we can help people get back into routine," Sela urged.
On November 2, NATAL is  set to hold its annual "Running in Color" event, to raise awareness about the phenomenon of post-trauma from terror and war.