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Complex Posttraumatic Stress Disorder (CPTSD) is a condition resulting from exposure to chronic, interpersonal traumatic events, in which some form of control or power dynamics existed. Its clinical picture includes the main symptom clusters of posttraumatic stress disorder, accompanied by dysregulated emotion, problems in interpersonal relationships, and difficulties in identity integration. In addition, both clinical work and research have shown CPTSD to include highly distressing and complicated psychological phenomena, such as identification with the aggressor, various forms of dissociation, self‐harm and self‐destructive behaviors, and more. Due to this highly complex and multilayered clinical picture, the treatment of CPTSD poses a significant clinical challenge to therapists. In this special issue of In Session, we present a series of case studies, each representing a different therapeutic approach to CPTSD (e.g., skills training for affective and interpersonal regulation, Eye Movement Desensitization and Reprocessing, psychodynamic, integrative psychotherapy). These cases also represent a wide variety of patient populations, as well as different types of underlying traumatic events. Together, they reveal the breadth of clinical possibilities currently available to trauma therapists encountering cases of CPTSD. They also highlight the challenges and dilemmas that clinicians often face when treating this condition, as well as ways to overcome those. [ABSTRACT FROM AUTHOR]

This paper identifies the major aspects that affect the sustainability of organizations in terms of success and failure of IT implementation projects. A significant relationship between the deployment of internal project teams and sustainable results of IT implementation projects compared to professionals employed via outsourcing was found. Moreover, involving professional managers with hands-on experience and knowledge of the organization in decision-making processes positively affects the project outcomes and the sustainability of the organization. Employee workload concerns are the least impactful on project overrun, while other concerns are less sustainable. Finally, a methodology that enhances the likelihood of sustainable results in IT implementation projects by involving professional managers and forming in-house teams is presented. [ABSTRACT FROM AUTHOR]

This study examines which factors influence the preferences of mothers seeking advice on the use of infant formula in feeding practices. The effects of their close social circle, medical professionals and social network forums on feeding choices were evaluated. Data were collected from 638 questionnaires from mothers and were statistically analyzed. Our findings suggest that age may influence the preference to seek advice from a close social circle over consulting with medical professionals (p-value = 0.019 < 0.05). The educational level and the number of children impact the preferences of using infant formula over combining it with breastfeeding (p-value = 0.000 < 0.05 and p-value = 0.004 < 0.05, respectively). The research contributes to the understanding of the complex interplay between various demographic and socioeconomic factors and the decision-making process of mothers based on multiple social and digital sources of influence. The research presents valuable insights for healthcare policymakers and professionals in supporting mothers and providing them with up-to-date information. Feeding information can be distributed through all the communication channels that were examined in this study to benefit different socio-economic groups and to contribute to the well-being of infants in the long-run. [ABSTRACT FROM AUTHOR]

Complex posttraumatic stress disorder (CPTSD) is a term representing the psychopathological implications of exposure to chronic, inter‐personal trauma. These include the main symptoms of PTSD, as well as changes in identity, emotion regulation, and inter‐personal relationships. Self‐harm and dissociation (i.e., disintegration of mental processes) are also quite common in CPTSD. Considering this complex and often severe clinical picture, mental health professionals often find it difficult to effectively treat CPTSD. In this paper, we present an integrative approach to the treatment of CPTSD based on a combination of techniques from several psychotherapy approaches. The case described here illustrates the need for therapeutic flexibility and eclecticism when treating individuals exposed to chronic trauma. We show the advantages of flexible therapeutic attunement, which enables the therapist to respond to the changing need of the patient, as well as her fluid clinical picture and symptom manifestation. The case also illustrates how interventions taken from psychodynamic therapy, Dialectical behavior therapy, and Eye Movement Desensitization and Reprocessing may be applicable in various stages of treatment, alleviating the patient's distress in several psychological and physical domains. [ABSTRACT FROM AUTHOR]

This study explored the relation between guilt and identification with the aggressor (IWA) and the moderating role of IWA in the relation between intimate partner violence (IPV) and guilt. An online survey was conducted among a convenience sample of 700 women. IPV survivors demonstrated elevated guilt, and IWA was related to guilt. Furthermore, IWA moderated the relation between IPV and guilt: Among participants with low IWA levels, IPV was unrelated to guilt, but among participants with high IWA levels, IPV was related to guilt. These findings suggest that IWA may be a key element in explaining guilt among IPV survivors. [ABSTRACT FROM AUTHOR]

Study questions: Although most women who are subjected to intimate partner violence attempt to leave their abusive partners, many return, and resultantly are at risk for even greater violence. Research to date has documented relations between several factors (income and economic dependence, frequency of intimate partner violence (IPV), fear of violence escalations, history of childhood abuse, and post-traumatic stress disorder symptoms) and women's returning to their abusive partners. Nevertheless, the contribution of women's emotional bonds with their violent partners, known as identification with the aggressor (IWA), in explaining their perceived likelihood of going back to the relationship, has remained unclear. Subjects: The current study, conducted among 258 Israeli women who had left their violent partners, aimed to fill this void. Methods: An online survey was conducted. Demographic variables, history of childhood abuse, frequency of IPV, economic dependence on former partner, fear of future violence escalation, post-traumatic stress disorder symptoms, IWA, and perceived likelihood of returning to the relationship, were assessed via self-report questionnaire. Findings: Results indicated that two aspects of IWA—becoming hyper-sensitive to the perpetrator and adopting the perpetrator's experience—were related to women's perceived likelihood of returning to the relationship. Furthermore, a logistic regression analysis indicated that only two factors—income and becoming hyper-sensitive to the perpetrator—uniquely contributed to explaining the likelihood of returning to abusive partners. Major implications: The current findings suggest that women's tendency to be highly attuned to their partners' feelings and needs, as a part of IWA, may impede their ability to permanently leave abusive relationships. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic may be experienced as traumatogenic and may fuel or exacerbate psychological distress and trauma-related symptoms. Based on trauma research, one might expect that survivors of childhood abuse would be susceptible to these negative outcomes during the pandemic, and that among this population a stronger relation between emotion regulation difficulties and symptomatology would be found. Aiming to explore these suppositions, an online survey was conducted among 710 Israeli adults. Of them, 370 were childhood abuse survivors. A history of childhood abuse, COVID-19-related stressors, overall psychological distress, and peritraumatic stress symptoms during the pandemic were assessed via selfreport measures. Participants with a history of childhood abuse had elevated overall psychological distress as well as peritraumatic stress symptoms during the pandemic, compared to nonabused participants, above and beyond demographic characteristics and COVID-19-related stressors. Emotion regulation difficulties were related to elevated psychological distress and peritraumatic stress symptoms among both childhood abuse survivors and nonabused participants. Nonetheless, a history of childhood abuse moderated the relations between the emotion regulation difficulty of being unable to engage in goal-directed behaviors when distressed (on one hand) and mental outcomes (on the other): Although the associations between inability to engage in goal-directed behaviors, overall psychological distress, and peritraumatic stress symptoms were nonsignificant among nonabused participants, they were significant among childhood abuse survivors. The current findings suggest that a history of childhood abuse might be a risk factor for distress in the face of COVID-19, and that childhood abuse survivors would benefit from clinical interventions that promote emotion regulation skills during this ongoing global health crisis. [ABSTRACT FROM AUTHOR]

Objectives Evidence suggests that individuals with physical disability may suffer from psychological distress and accelerated cellular aging, manifested by shortened telomere length (TL), compared with healthy individuals. Studies indicate that high levels of perceived stress and depression may increase the physiological susceptibility and, thus, may contribute to a short TL. However, the moderating role of perceived stress and depression within the relationship between physical disability and TL remains unknown. Method The participants consisted of 119 male subjects (mean age 54.36 years, range 35−70). Of them, 30 were able-bodied and 89 had a physical disability: 34 were due to poliomyelitis (polio) and 55 were due to spinal cord injury. Blood samples for TL analysis were collected; the participants completed questionnaires and underwent disability evaluation. Results Participants with disability had a shorter TL as well as elevated levels of perceived stress and depression compared with able-bodied controls. Both the perceived stress and depression were correlated with a shorter TL. Nonetheless, perceived stress, rather than depression, moderated the relationship between disability and TL; among participants with higher perceived stress levels, in particular, individuals with physical disability had a shorter TL than the able-bodied controls. Discussion The present findings suggest that individuals with physical disability and who exhibit high levels of perceived stress may be particularly vulnerable for accelerated cellular aging, suggesting that perceived stress can be used as a valuable target for intervention. [ABSTRACT FROM AUTHOR]

Objectives The coronavirus disease 2019 (COVID-19) pandemic is an ongoing stressor that may have detrimental effects on mental health. Theoretical and empirical literature implies that individuals who are characterized by catastrophic appraisals of somatic cues, a tendency known as anxiety sensitivity, as well as by older subjective age, might be particularly vulnerable to depression and anxiety during the pandemic. Furthermore, subjective age might moderate the relations between anxiety sensitivity with depression and anxiety symptoms. Yet, research to date has not explored the contribution of both anxiety sensitivity and subjective age in explaining distress following stress in general, nor in light of the current COVID-19 pandemic. Method Filling this gap, a convenience sample of 828 participants (M age = 43.98, SD = 14.06) filled questionnaires measuring background variables, COVID-19–related stressors, anxiety sensitivity, subjective age, and anxiety and depression symptoms during the pandemic. Results Positive associations were found between anxiety sensitivity and subjective age, on the one hand, and anxiety and depression symptoms, on the other. Furthermore, subjective age moderated the relations between anxiety sensitivity with depression and anxiety symptoms. Although higher levels of anxiety sensitivity were related to depression and anxiety during the pandemic, these relations were significantly stronger among participants with an older subjective age. Discussion The findings are consistent with theories that view subjective age as an intraindividual construct involved in modulating important mental health outcomes in the context of coping with stress. [ABSTRACT FROM AUTHOR]

Childhood abuse survivors may display both inward and outward aggression manifested in self-injurious behavior (SIB) and violent acts toward others. Scrutinizing the literature reveals that the relational dynamics between victims and their perpetrators might be involved in these phenomena. Yet, research on this subject matter has been sparse. Filling this gap, this study investigated the contribution of the singular bonds between victims and their perpetrators, known as identification with the aggressor, in explaining survivors' aggression. The study was conducted among 306 Israeli college/university students who reported a history of childhood abuse. Results revealed that levels of adopting the perpetrator's experience, identifying with the perpetrator's aggression, and replacing one's agency with that of the perpetrator were significantly associated with survivors' inward and outward aggression. Moreover, profile type—that is, having high versus low levels of identification with the aggressor—was implicated in participants' SIBs, urge to harm others, and violent acts toward others, above and beyond the effects of gender and posttraumatic stress disorder (PTSD) symptoms. The present findings suggest that identification with the aggressor might make survivors prone to the re-enactment of past abusive dynamics, which, in turn, could eventuate in aggression toward themselves and others. [ABSTRACT FROM AUTHOR]

The present study sought to examine the relations between a history of childhood sexual abuse (CSA) and sexual motivations and to explore the moderating role of dissociation within these relations. The study was conducted among 889 men and women (ages 18–70). Results indicated a history of CSA was significantly related to higher scores on self-affirmation, coping, partner approval and peer pressure sexual motivations. Interactions between CSA and gender in explaining sexual motivations, were not significant. Among participants with a history of CSA (n = 365), dissociation was significantly related to sexual motivations, so that participants who had dissociation scores above the cutoff (reporting high levels of dissociation) scored higher on intimacy, self-affirmation, coping, and partner approval than did those with a history of CSA who reported low levels of dissociation. Analyzes revealed significant moderating effects for dissociation within the relations between CSA and intimacy, coping, and partner approval sexual motivations. The present study suggests CSA survivors and those who report high levels of dissociation in particular, utilize sex for intimacy, for coping with negative emotions, and for partner approval. Therapists working with CSA survivors should be aware of the potential effects the abuse has on the survivor's reasons to engage in sex. [ABSTRACT FROM AUTHOR]

Identifying with the aggressor is a process wherein victims of abuse, particularly during childhood, take on their perpetrator's experience. The victim defers to the perpetrator and adopts the perpetrator's experience, learns the perpetrator's desires and needs, and gratifies them. Although the clinical and theoretical literature suggests that identification with the aggressor occurs in the aftermath of abuse and has negative long-term implications, to date this concept has not been empirically investigated. To facilitate an exploration of this subject, the current study evaluated the psychometric properties of a new measure: the Identification With the Aggressor Scale (IAS). The study was conducted among convenience samples of students using online surveys. In Study 1, the IAS was administered to 318 students. In Study 2, the IAS, and a battery of questionnaires assessing features of abuse, dissociation, posttraumatic stress disorder (PTSD) symptoms, and posttraumatic guilt were administered to a convenience sample of 368 students. Four reliable IAS factors emerged from Study 1: Adopting the perpetrator's experience concerning the abuse, identifying with the perpetrator's aggression, replacing one's agency with that of the perpetrator, and becoming hypersensitive to the perpetrator. In Study 2, a confirmatory factor analysis confirmed the scale's underlying factor structure. A history of childhood abuse, recurrence and severity of abuse, and the perpetrator being a parental figure were all associated with higher IAS scores. In addition, IAS scores were correlated with dissociation, PTSD symptoms, and posttraumatic guilt. The present findings indicate that the IAS has good psychometric properties, making it useful as an assessment tool in future research. [ABSTRACT FROM AUTHOR]

Competing Interests: None.

Objective: Tonic immobility (TI) is a peritraumatic response to extreme threats. It is associated with trauma psychopathology and poor treatment outcomes. Yet, previous psychometric evaluations have yielded inconsistent results regarding the number of latent factors of the Tonic Immobility Scale (TIS). Moreover, the TIS has never been validated in a Hebrew-speaking population. This study had two objectives: (a) to reassess previously proposed models of the TIS to determine whether it is best represented by a one-factor model of TI, a two-factor model of TI and fear, or a three-factor model of TI, fear, and detachment; and (b) to validate the TIS in a Hebrew translation., Method: A sample of Israeli adults was culled from an online survey following rocket attacks. Confirmatory factor analysis was applied to test the previously proposed models, and Pearson's correlations were used to test the association between each of the subscales representing the latent factors and psychological distress., Results: The best representation of the data was provided by a three-factor model with latent constructs of TI, fear, and detachment. All three peritraumatic responses had significant correlations with peritraumatic distress. Moreover, the internal consistency of the TIS was good for the three subscales; this supports the reliability of the Hebrew version., Conclusion: This study supports using a three-factor model with latent constructs, and the scale appears to be psychometrically sound when translated into Hebrew. Future research should seek to replicate these findings in different trauma populations and should study the unique association of trauma symptomatology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Tonic immobility (TI) and peritraumatic dissociation (PD) are common peritraumatic reactions associated with psychopathology following trauma. The present study aimed to test whether TI and PD mediated the relationship between perceived threat during an episode of rocket shelling and subsequent posttraumatic stress symptoms., Methods: In a prospective study among 226 Israeli civilians, data were collected both during rocket shelling, between May 14, 2021, until ceasefire on May 21, 2021 (T 1 ) and 1 to 2 months after ceasefire (T 2 ). Measures included the Tonic Immobility Scale, Peritraumatic Dissociative Experiences Questionnaire, and PTSD Checklist for DSM-5 . Four mediation models were applied for each posttraumatic stress symptom cluster., Results: Findings showed that a substantial proportion of participants had developed posttraumatic stress disorder (PTSD) symptoms at the time of follow-up (18.8%). Both TI and PD fully mediated the relationship between perceived threat and symptoms of intrusion, avoidance, and negative alterations in mood and cognition, but only PD mediated the relationship with alterations in arousal and reactivity., Conclusions: The present findings suggest that TI and PD may serve as mechanisms underlying the link between individuals' appraisals of threat during the peritraumatic phase and subsequent PTSD symptomatology. Future research should seek to replicate the present findings before any conclusions can be drawn. In particular, the association between PD and arousal and reactivity symptoms should be further explored, given that it might be multifaceted in nature., (© Copyright 2023 Physicians Postgraduate Press, Inc.)

Objectives: The coronavirus disease 2019 (COVID-19) pandemic is an ongoing stressor that may have detrimental effects on mental health. Theoretical and empirical literature implies that individuals who are characterized by catastrophic appraisals of somatic cues, a tendency known as anxiety sensitivity, as well as by older subjective age, might be particularly vulnerable to depression and anxiety during the pandemic. Furthermore, subjective age might moderate the relations between anxiety sensitivity with depression and anxiety symptoms. Yet, research to date has not explored the contribution of both anxiety sensitivity and subjective age in explaining distress following stress in general, nor in light of the current COVID-19 pandemic., Method: Filling this gap, a convenience sample of 828 participants (Mage = 43.98, SD = 14.06) filled questionnaires measuring background variables, COVID-19-related stressors, anxiety sensitivity, subjective age, and anxiety and depression symptoms during the pandemic., Results: Positive associations were found between anxiety sensitivity and subjective age, on the one hand, and anxiety and depression symptoms, on the other. Furthermore, subjective age moderated the relations between anxiety sensitivity with depression and anxiety symptoms. Although higher levels of anxiety sensitivity were related to depression and anxiety during the pandemic, these relations were significantly stronger among participants with an older subjective age., Discussion: The findings are consistent with theories that view subjective age as an intraindividual construct involved in modulating important mental health outcomes in the context of coping with stress., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)