Papers by elisheva van der hal
Additional file 1. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protoc... more Additional file 1. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents This table includes the page number on which the items of the SPIRIT checklist were addressed
Journal of Traumatic Stress, 2023
Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) ... more Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) of psychotherapy exists for this population, with very few on older adults in general. This RCT aimed to compare the efficacy of Life Review Therapy for Holocaust survivors (LRT-HS) relative to a supportive control group. Holocaust survivors with a probable diagnosis of full or subsyndromal posttraumatic stress disorder (PTSD) or depressive disorder were included. Exclusion criteria were probable dementia, acute psychotic disorder, and acute suicidality. The predefined primary endpoint was the course of PTSD symptom scores. In total, 49 of 79 consecutive individuals assessed for eligibility were randomized and included in the intent-to-treat analyses (LRT-HS: n = 24, control: n = 25;Mage = 81.5 years, SD = 4.81, 77.6% female). Linear mixedmodels revealed no statistically significant superiority of LRT-HS for PTSD symptoms at posttreatment, with moderate effect sizes, Time x Condition interaction: t(75) = 1.46, p = .148, dwithin = 0.70, dbetween = 0.41, but analyses were significant at follow-up, with large effect sizes, t(79) = 2.89, p = .005, dwithin = 1.20, dbetween = 1.00. LRT-HS superiority for depression was observed at posttreatment, t(73) = 2.58, p = .012, but not follow-up, t(76) = 1.08, p = .282, with moderate effect sizes, d(within) = 0.46–0.60, d(between) = 0.53–0.70. The findings show that even in older age, PTSD and depression following exposure to multiple traumatic childhood events can be treated efficaciously using an age-appropriate treatment that includes structured life review and narrative exposure.
American Journal of Psychotherapy, Jul 1, 1998
Though their death sentence was lifted almost sixty years ago, child survivors of the Holocaust a... more Though their death sentence was lifted almost sixty years ago, child survivors of the Holocaust are often still uizsure whether they should have died with their parents. Group psychotherapy, as described in this papev, highlighted these conflicts in the group process and in the cotherapists' countertransference. Once these were fully acknowledged, the group could tolerate a termination process.
Journal of Traumatic Stress
Psychotherapy, 2021
Having reached the last phase of their lives, many Holocaust survivors (HS) experience an increas... more Having reached the last phase of their lives, many Holocaust survivors (HS) experience an increase in vulnerability. Despite their remarkable ability to adapt, the process of aging presents them with new challenges, often leading to an increased need for therapy. This is made all the more difficult by the fact that there is little research on trauma therapy in old age. To date, no randomized controlled study has been carried out to examine the effectiveness of psychotherapy in HS. The present case studies report the implementation of life review therapy (LRT-HS) undertaken with two female HS with symptoms of post-traumatic stress disorder (PTSD). The mixed-methods approach sheds light to their individual therapy courses and potential mechanisms of change. Both therapies took place in the context of a randomized controlled study evaluating the efficacy of LRT-HS. This integrative, narrative therapy approach answers the natural need of elderly people to look back on their lives. Patie...
International Journal of Group Psychotherapy, 1996
Group therapy with children of Holocaust survivors is known to be effective in breaking the consp... more Group therapy with children of Holocaust survivors is known to be effective in breaking the conspiracy of silence that is characteristic of many families in which one or both parents are Holocaust survivors. Therefore, therapeutic groups were offered at "Amcha," the Israeli Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation. Initial enthusiasm was great, but actual commitment to participate on a regular basis was surprisingly low. Very few groups got off the ground. We therefore devised a framework of monthly open groups. This article presents our rationale for an open group for this population and for having three facilitators, a description of how these groups actually function, a discussion of advantages and shortcomings, and a summary of our findings.
BMC Psychiatry, 2020
Background The Holocaust was one of the most traumatic catastrophes in recorded human history. Su... more Background The Holocaust was one of the most traumatic catastrophes in recorded human history. Survivors seeking psychotherapeutic help today, now in their seventies and older, often show symptoms of a posttraumatic stress disorder (PTSD), depression, or prolonged grief disorder. Established psychological treatments for PTSD (e.g. cognitive behaviour therapy, psychodynamic therapies) have been tested and assessed mainly with young and middle-aged adults; only very few studies examined them in old age. There is no therapy outcome study known to us for any treatment mode for Holocaust survivors. Moreover, there is a need for an age group-specific treatment of PTSD and other stress-related mental disorders. A narrative approach including life-review and narrative exposure seems to meet very well the natural need of older people to review their lives and is highly effective. However, most studies on the efficacy of life review therapy (LRT) focus on late-life depression. There is a lack...
American journal of psychotherapy, 1998
People, now in their fifties and sixties, who were children during the Nazi Holocaust in WWII, en... more People, now in their fifties and sixties, who were children during the Nazi Holocaust in WWII, endured persecution, massive traumatization, the constant risk of being killed, as well as the violent loss of (most of) their family members. They have internalized the resulting ongoing confusion and conflicts as to whether they should be alive or dead. This is maintained as an integral part of the child component of their compound personality, described in this paper. During the three years of the psychotherapy group, on which we focused here, these issues were expressed in different ways, such as suicide threats, occasional intolerance to physically remaining in the group, and outbursts of annihilating rage at the therapists. The confusion and conflicts about the legitimacy and risks of their survival came to a head during the termination process we insisted upon. Much attention has also been given to the intricacies of our countertransference--further complicated by our own connection...
Journal of Clinical Psychology, 2008
This study evaluated child Holocaust survivors with an emphasis on potential protective factors f... more This study evaluated child Holocaust survivors with an emphasis on potential protective factors facilitating participants' adaptation to post-Holocaust life. We examined salutogenic paradigm, testing the mediating and moderating effect of participants' sense of coherence (SOC) on the association between early childhood deprivation due to Holocaust persecution and posttraumatic stress later in life. The nonclinical sample, composed of 203 child Holocaust survivors born between 1935 and 1944 completed questionnaires on Holocaust survival exposure, inventories on current health, posttraumatic stress, and SOC. The results indicated that SOC moderates the association between traumatic experiences during the war and posttraumatic stress, and SOC acts as a protective factor, buffering the impact of traumatic Holocaust experiences on child survivors in old age. Survivors with a less coherent perspective on the meaning of their life showed greater vulnerability for posttraumatic complaints. The moderating role of the SOC may suggest promising avenues of therapeutic interventions for child Holocaust survivors and other
American Journal of Orthopsychiatry, 2007
The link between deprivation and trauma during earliest childhood and psychosocial functioning an... more The link between deprivation and trauma during earliest childhood and psychosocial functioning and health in later life was investigated in a group of child Holocaust survivors. In a nonconvenience sample 203 survivors, born between 1935 and 1944, completed questionnaires on Holocaust survival experience and several inventories on current health, depression, posttraumatic stress, loneliness, and attachment style. Quality of postwar care arrangements and current physical health independently predicted lack of well-being in old age. Loss of parents during the persecution, year of birth of the survivors (being born before or during the war), and memories of the Holocaust did not significantly affect present well-being. Lack of adequate care after the end of World War II is associated with lower well-being of the youngest Holocaust child survivors, even after an intervening period of 60 years. Our study validates concept of "sequential traumatization," and points to the importance of aftertrauma care in decreasing the impact of early childhood trauma.
Aging & Mental Health, 2008
Objectives: Late-life implications of early traumatic stress for the adreno-cortical system were ... more Objectives: Late-life implications of early traumatic stress for the adreno-cortical system were examined in a sample of 133 child survivors of the Holocaust, who were subjected to Nazi persecution during infancy. Method: In a non-convenience sample of child survivors, born between 1935 and 1944, basal circadian cortisol release and cortisol reactivity to a stressor were assessed. Results: Age, parental loss during the Holocaust, current depression, post-traumatic stress disorder (PTSD) and physical illness were not associated with differences in basal diurnal cortisol levels. Neuro-endocrine effects, however, were found in stress reactivity through elevated cortisol levels in male respondents in the youngest age group (born 1941–1945), and in male respondents suffering from PTSD-related functional impairment. Conclusion: The youngest survivors of Nazi persecution show late-life effects of traumatic stress during early childhood, evidenced by the early onset of differential neuroendocrine pathways to stress-regulating strategies.
Journal of Contemporary Psychotherapy, 1997
Intensive work with child survivors of the Holocaust has made us aware of the clinical importance... more Intensive work with child survivors of the Holocaust has made us aware of the clinical importance of understanding the ways children perceive their traumas and the conclusions they draw about how they must live their lives. When these perceptions are transformed congruently with the child's development, the survivors can cope quite well. In this paper we refer to now middle-aged survivors who are still guided by their child perceptions. We will describe how we have used conjoint group psychotherapy to facilitate processes of transformation even at this late stage. The model we provide for trauma work with Holocaust survivors whose traumatization occurred decades ago may well provide tools to reduce future suffering of children who are victims of massive traumatization today.
The link between deprivation and trauma during earliest childhood and psychosocial functioning an... more The link between deprivation and trauma during earliest childhood and psychosocial functioning and health in later life was investigated in a group of child Holocaust survivors. In a nonconvenience sample 203 survivors, born between 1935 and 1944, completed questionnaires on Holocaust survival experience and several inventories on current health, depression, posttraumatic stress, loneliness, and attachment style. Quality of postwar care arrangements and current physical health independently predicted lack of well-being in old age. Loss of parents during the persecution, year of birth of the survivors (being born before or during the war), and memories of the Holocaust did not significantly affect present well-being. Lack of adequate care after the end of World War II is associated with lower well-being of the youngest Holocaust child survivors, even after an intervening period of 60 years. Our study validates concept of "sequential traumatization," and points to the importance of aftertrauma care in decreasing the impact of early childhood trauma.
This study evaluated child Holocaust survivors with an emphasis on potential protective factors f... more This study evaluated child Holocaust survivors with an emphasis on potential protective factors facilitating participants' adaptation to post-Holocaust life. We examined salutogenic paradigm, testing the mediating and moderating effect of participants' sense of coherence (SOC) on the association between early childhood deprivation due to Holocaust persecution and posttraumatic stress later in life. The nonclinical sample, composed of 203 child Holocaust survivors born between 1935 and 1944 completed questionnaires on Holocaust survival exposure, inventories on current health, posttraumatic stress, and SOC. The results indicated that SOC moderates the association between traumatic experiences during the war and posttraumatic stress, and SOC acts as a protective factor, buffering the impact of traumatic Holocaust experiences on child survivors in old age. Survivors with a less coherent perspective on the meaning of their life showed greater vulnerability for posttraumatic complaints. The moderating role of the SOC may suggest promising avenues of therapeutic interventions for child Holocaust survivors and other
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Papers by elisheva van der hal