Faculty Bibliography

Psychopathology is often studied and treated from an individual-centered approach. However, studies have shown that psychological distress is often best understood from a contextual, environmental perspective. This paper explores the literature on emotional contagion and symptom transmission in psychopathology, i.e., the complex ways in which one person's psychological distress may yield symptoms among others in his/her close environment. We argue that emotions, cognitions, and behaviors often do not stay within the borders of the individual, but rather represent intricate dynamic experiences that are shared by individuals, as well as transmitted between them. While this claim was comprehensively studied in the context of some disorders (e.g., secondary traumatization and the "mimicking" of symptoms among those close to a trauma survivor), it was very scarcely examined in the context of others. We aim to bridge this gap in knowledge by examining the literature on symptom transmission across four distinct psychiatric disorders: PTSD, major depression, OCD, and psychosis. We first review the literature on emotional contagion in each disorder separately, and then we subsequently conduct a comparative analysis highlighting the shared and differential mechanisms underlying these processes in all four disorders. In this era of transdiagnostic conceptualizations of psychopathology, such an examination is timely, and it may carry important clinical implications.

BACKGROUND/UNASSIGNED:Despite the immense impact of COVID-19 on mental health, there is a lack of prospective studies examining physiological predictors of current risk factors. Moreover, although physiological processes evidently interact with socio-demographic factors to modulate individuals' response to a crisis, it remains largely unknown how these complex interactions shape people's mental responses to COVID-19. To fill these gaps of knowledge, we chose a potent physiological marker of distress - heightened baseline electrodermal activity (EDA) measured before the pandemic began - and hypothesized it would be related to greater COVID-related fears and worries as a function of individuals' household size. METHOD/UNASSIGNED:185 individuals (71% women), who had participated in our lab studies 2-3 years ago, in which we assessed their baseline EDA, completed several questionnaires online, including assessments of their current fears regarding COVID. Participants also reported the number of people in their household, with whom they had been together during a lockdown which was taking place at the time. We used pre-pandemic EDA measures in combination with their household size to predict participants' current fears. RESULTS/UNASSIGNED:Pre-pandemic EDA measures predicted current COVID-related fears and worries. Specifically for the EDA measure "number of skin conductance responses", we further found that the number of people in the household during the lockdown, moderated the abovementioned relationship, such that it occurred in individuals with average and larger households and not in those with small households. CONCLUSIONS/UNASSIGNED:We provide a highly relevant and unique combination of physiological, socio-demographic, and psychological measures, which augments the potential to optimally target populations vulnerable to COVID-related distress, and subsequently offer them early mental health interventions.

BACKGROUND:The psychological effects of systemic lupus erythematosus (SLE) are tremendous. This pilot mixed-methods randomized controlled trial aimed to evaluate the effects of a mindfulness-based stress reduction (MBSR) adapted protocol on psychological distress among SLE patients. METHODS:= 12) also underwent qualitative interviews to assess their subjective experience of MBSR. RESULTS:Compared to the WL, the MBSR group showed greater improvements in quality of life, psychological inflexibility in pain and SLE-related shame. Analysis among MBSR participants showed additional improvements in SLE symptoms and illness perception. Improvements in psychological inflexibility in pain and SLE-related shame remained stable over six months, and depression levels declined steadily from pre-treatment to follow-up. Qualitative analysis showed improvements in mindfulness components (e.g., less impulsivity, higher acceptance), as well as reduced stress following MBSR. CONCLUSIONS:These results reveal the significant therapeutic potential of MBSR for SLE patients. With its emphasis on acceptance of negative physical and emotional states, mindfulness practice is a promising treatment option for SLE, which needs to be further applied and studied.

Despite the unfolding impact of the COVID-19 pandemic on psychological well-being, there is a lack of prospective studies that target physiological markers of distress. There is a need to examine physiological predictors from the pre-pandemic period to identify and treat individuals at-risk. In this study, our aim was to use pre-pandemic markers of autonomic nervous system (ANS) parasympathetic and sympathetic regulation to predict individuals' psychological well-being during the crisis. We also assessed the role of mood regulation expectancies as a mediator of the association between pre-pandemic physiological measures and COVID-related well-being. In May to June 2020, 185 Israeli adults completed online questionnaires assessing their mood regulation expectancies since COVID-19 began, and their current well-being. These individuals had participated in lab studies 1.5-3 years prior to this assessment, where their physiological measures were taken, including respiratory sinus arrhythmia (RSA) and skin conductance level (SCL). RSA was positively related to mood regulation expectancies during COVID-19 (b = 3.46, 95% CI [0.84, 6.05]). Mood regulation expectancies, in turn, positively predicted well-being during the crisis (b = 0.021, 95% CI [0.016, 0.027]). The mediation was significant and moderated by SCL (index = -0.09, 95% CI [-0.02, -0.0001]), such that it was strongest for individuals with low SCL. We point to pre-pandemic physiological mechanisms underlying individuals' mental well-being during the COVID-19 pandemic. These findings have theoretical, diagnostic, and clinical implications that may refine our understanding of the physiological basis of resilience to the COVID-19 pandemic and thus may be implemented to identify and assist individuals in these times.

LAY ABSTRACT/UNASSIGNED:Autism spectrum disorder is a neurodevelopmental condition characterized by social communication difficulties and restricted repetitive behaviors. Individuals with autism spectrum disorder are often diagnosed with other psychiatric conditions, including attention deficit hyperactivity disorder, anxiety, and depression. However, research on post-traumatic stress disorder among individuals with autism spectrum disorder is scarce. Nonetheless, studies have shown that those with autism spectrum disorder may face an increased risk of exposure to traumatic events. Separate lines of research in autism spectrum disorder and post-traumatic stress disorder have shown that the two may share several vulnerability factors. One of those is ruminative thinking, that is, one's tendency to re-hash thoughts and ideas, in a repetitive manner. This article examined the role of two rumination types as potential factors connecting autism spectrum disorder and post-traumatic stress disorder: brooding (continuously comparing one's current condition to one's desired condition) and reflection (an introspective effort to cognitively solve one's problems). A total of 34 adults with autism spectrum disorder (with no intellectual impairment) and 66 typically developing adults completed questionnaires assessing post-traumatic stress disorder symptoms and rumination. The results showed increased post-traumatic stress disorder symptoms in adults with autism spectrum disorder, compared to typically developing adults. Brooding rumination was also higher among those with autism spectrum disorder. Finally, brooding, but not reflection, served as a mechanism connecting autism spectrum disorder and post-traumatic stress disorder, that is, those with autism spectrum disorder showed increased brooding, which in turn predicted more post-traumatic stress disorder symptoms. This study has potential clinical implications. Rumination and cognitive inflexibility, which are common in autism spectrum disorder, could exacerbate post-traumatic symptoms among individuals with autism spectrum disorder who experience traumatic events. Interventions targeting brooding rumination and cognitive flexibility may assist in alleviating post-traumatic symptoms in individuals with autism spectrum disorder.

Ever since the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there has been a controversy around whether the inclusion of indirect exposure as a potential traumatic event for the diagnosis of posttraumatic stress disorder (PTSD) is justified. The aim of the current study was to examine the validity of PTSD resulting from secondary traumatization by evaluating the longitudinal trajectories and clinical picture of PTSD following both direct exposure and indirect exposure to war trauma. One-hundred-and-fifty-five war veterans of the 1973 Yom Kippur War and their spouses filled out self-report questionnaires assessing PTSD, 30 (T1), 38 (T2), and 42 years (T3) after the war. Findings revealed that although PTSD was more prevalent and intense among veterans, the relative distribution of PTSD trajectories was similar among veterans and spouses. In both groups, the most prevalent was the resilient trajectory (43% and 73%, respectively), followed by the recovered trajectory (28% and 15%, respectively), the chronic trajectory (21% and 7%, respectively), and the delayed trajectory (8% and 6%, respectively). In addition, the composition of PTSD symptoms was similar among veterans and spouses at T1 and T2, but not at T3. These findings demonstrate that although PTSD is more prevalent and intense among individuals who were exposed to traumatic events directly as compared to those who were traumatized secondarily, the similarities in the clinical picture support the inclusion of secondary traumatization in PTSD Criterion A.

OBJECTIVE: /UNASSIGNED:War-related trauma may indirectly affect veterans' spouses both in terms of secondary posttraumatic stress symptoms (PTSS) and negative perceived health. The present study aimed to examine trajectories of secondary PTSS over a twelve-year period and its association with various measures of subjectively perceived health, among spouses of war veterans. METHODS: /UNASSIGNED:Spouses of war veterans (n = 155) were assessed prospectively 30 (T1, 2003), 37 (T2, 2010), and 42 (T3, 2015) years after the 1973 Yom Kippur War. Participants completed self-report questionnaires of PTSS (PTSD inventory) in all three measurement waves, while perceived health measures (Short-Form Health Survey-SF-36) were assessed only at T3. RESULTS: /UNASSIGNED:Most spouses were classified to the 'resilient' trajectory with low and stable secondary PTSS over time, followed by recovered, chronic, and delayed onset PTSS trajectories. Importantly, spouses in the 'chronic' and 'delayed' secondary PTSS trajectories reported a higher severity of general negative subjective health perceptions and health-related social malfunctioning. CONCLUSION: /UNASSIGNED:Veterans' spouses who were grouped in the 'chronic' and 'delayed' PTSS trajectories are to be considered as at-risk populations for both PTSS and negative perceived health perceptions. Mental health professionals as well as family physicians should be aware of the ongoing nature of secondary PTSS which might negatively affect veterans' spouses medical conditions and ability to cope with the aging process.

OBJECTIVE:Research on the psychological toll of the COVID-19 pandemic is being conducted in various countries. This study aimed to examine risk factors for mental health problems among Israeli adults during this crisis. METHODS:A total of 204 participants took part in the study. They completed self-report questionnaires assessing perceived stress, anxiety, quality of life, and various questions related to quarantine, pre-existing health issues, and worries related to the virus. The study took place during the last two weeks of March 2020. RESULTS:The majority of participants reported relatively high levels of perceived stress and corona-related worries, but low levels of anxiety. Female gender, younger age, corona-related loneliness, and pre-existing chronic illness were all related to higher levels of psychological distress and lower levels of quality of life. CONCLUSIONS:While considering the preliminary nature of these results, the current study highlights risk factors for psychological distress in light of the corona pandemic. Attention should be given to sociodemographic variables that were identified as related to psychological distress, as well as to the important role of loneliness, when screening and treating people during this crisis. More research is needed in order to fully understand the scope and correlates of psychological difficulties during these challenging times.

OBJECTIVE:War captivity entails severe posttraumatic implications for ex-prisoners of war (POWs) and their partners. This study examines the role of self-differentiation in secondary traumatization and dyadic adjustment among ex-POWs' spouses. METHODS:A total of 106 spouses of Israeli ex-POWs and 56 matched spouses of ex-combatants completed self-report questionnaires assessing secondary posttraumatic stress disorder symptoms (SPS), self-differentiation (fusion, cut-off, balanced), general psychiatric distress (GPD), and dyadic adjustment. RESULTS:Ex-POWs' spouses reported lower dyadic adjustment and higher levels of SPS, GPD, and fusion and cut-off differentiation, compared to ex-combatants' spouses. A "mixed" differentiation style characterized by high levels of both fusion and cut-off was associated with particularly high distress levels. Fusion differentiation moderated the association between SPS/GPD and dyadic adjustment. CONCLUSION/CONCLUSIONS:Self-differentiation plays an important role in posttraumatic spousal relationships. Women showing unstable differentiation may be particularly vulnerable when living with a veteran. Treatments for posttraumatic couples should target dysregulated interpersonal distance and promote adaptive differentiation.