מחקרים בשיתוף סטודנטים

When the Pain Becomes​​ Unbearable: Case-Control Study of Mental Pain Characteristics Among Medically Serious Suicide Attempters

סטודנט/ית: סימונה גריסרו
מנחה: פרופ' יוסי לוי-בלז

Abs​​​tract:

The unbearable mental pain experience is recognized as a key antecedent of suicidal behavior. We aimed to examine the precise nature of the mental pain among medically serious suicide attempters (MSSAs), a population closely resembling those who died by suicide. We evaluated various factors of mental pain from the Orbach and Mikulincer Mental Pain Scale, as well as medical lethality and suicide intent. MSSAs were higher than non-MSSAs and psychiatric controls for Irreversibility of pain. Moreover, Emptiness predicted medical lethality, while Cognitive Confusion negatively predicted suicide intent level, controlling for hopelessness and depression. high sense of Irreversibility of pain as well as high Emptiness and low Cognitive Confusion are important risk factors for more severe suicidal behavior. Implications for identification of at-risk groups for suicide as well as for suicide prevention and treatment of suicidal individuals are discussed.

Levi-Belz, Y., Gvion, Y., Grisaru, S., & Apter, A. (2018). When the pain becomes unbearable: Case-control study of mental pain characteristics among medically serious suicide attempters. Archives of Suicide Research, 22(3), 380-293. doi: 10.1080/13811118.2017.1355288.

Suicide among Ethiopian origin soldiers in the IDF - A qualitative view of risk factors, triggers, and life circumstances

סטודנט/ית: אייל גרבר
מנחה: פרופ' יוסי לוי-בלז

Ab​​stract:

Background: Ethiopian soldiers in the IDF comprise an at-risk group for suicide. The study investigated the unique characteristics of these soldiers, compared with other suicides in the Israel Defense Forces (IDF). Method: The research group included all (n = 36) male soldiers born an Ethiopian family, who died by suicide during their compulsory military service in the years 1990-2017. The control group included all (n = 55) non-Ethiopian soldiers who died by suicide during their military service in the years 2009-2013. Socio-demographic, military-service, and suicide-related variables were examined. Results: Logistic regression analysis revealed that risk for suicide among Ethiopian soldiers were being incarcerated in a military prison, belonging to a bereaved family, seniority in the military service, and avoidance of help-seeking (explaining 87.8% of the variance). Discussion: Ethiopian suicide soldiers have endured heavy environmental pressure, such as financial problems and family bereavement. These circumstances could lead to conflict with the soldier's military service, resulting in absence from service or even imprisonment. When the Ethiopian soldier's distress goes un-expressed in words or actions with others, the psychological crisis signs remain unapparent to those around him, and the risk for eventual suicide is high. Limitations: The case analysis did not include retrieving information from family and relatives outside the military but was derived from archived material, collected primarily for legal purposes. This limitation was addressed by assembling objective variables and information collected prior to the suicide, along with postmortem information collected by mental health personnel in their assessments. 

Shelef, L., Yavnai, N., Gerber, E., Ben-Yehuda, A., & Levi-Belz, Y. (2020). Suicide among Ethiopian origin soldiers in the IDF - a qualitative view of risk factors, triggers, and life circumstances. Journal of Affective Disorders, 269, 125-133. doi:10.1016/j.jad.2020.03.034

Public Response to Suicide News Reports as Reflected in Computerized Text Analysis of Online Reader Comments

סטודנט/ית: גל רוזן
מנחה: פרופ' יוסי לוי-בלז

Abst​ract:

Previous research has documented the rise in rates of suicidal behaviors following media reports of celebrity suicide. Whereas most research has focused on documenting and analyzing suicide rates, little is known about more subtle psychological effects of celebrity suicide on the public, such as despair and feelings of abandonment. The Internet has revolutionized the responses to news reports, enabling immediate and anonymous responses potentially reflecting these psychological processes. Thus, the current study explored the unique psychological impact of a celebrity suicide on the public by analyzing the big data of readers' comments to suicide news reports, using computational linguistics methods. Readers’ comments (N ¼ 14,506) to suicide news reports were retrieved from 4 leading online news sites. The comments were posted in response to 1 of 1 types of reports: a celebrity suicide (Robin Williams), a non-celebrity suicide, and general reports of suicide as a social phenomenon. LIWC software for computerized linguistic analysis was used to calculate the frequency of the various types of words used. Comparison of the responses to the 3 types of suicide reports revealed higher frequency of first-person pronouns and for emotionally charged words on comments to a celebrity suicide, compared with comments to the other types of suicide reports. The findings suggest that celebrity suicide news reports evoke the expression of positive emotions, possibly related to the venerated celebrity, alongside negative, internalized emotions, and feelings of social isolation. Theoretical, practical, and methodological implications are discussed.

​Psychosocial Factors Correlated with Undisclosed Suicide Attempts to Significant Others: Findings from the Adolescence SEYLE Study

סטודנט/ית: תימור גביש-מרום
מנחה: פרופ' יוסי לוי-בלז

Ab​stract:

Objective: Suicide attempt (SA) is recognized as one of the risk factors for completed suicides. The concealment of this behavior often hinders detection and management of suicide risk. Thus, in this study, we sought to shed light on adolescents’ psychosocial processes that could facilitate disclosure of SAs. Specifically, we sought to identify antecedents of adolescent SAs that had not been revealed to significant others. Method: A high school sample) N = 990 (completed a self-report questionnaire tapping psychiatric, personal, and interpersonal characteristics, as well as suicidality, as part of the SEYLE project. Twenty-seven adolescents acknowledged having made an SA without disclosing it to parents or to other significant others. They were compared with 47 adolescents who made SAs that were communicated to others and with a control group of 916 adolescents having no history of suicidal behavior. Results: Compared with disclosures and controls, non-disclosing suicide attempters were characterized by higher levels of suicide ideation, distress, and victimization. Low levels of self-disclosure and parental support were significantly associated with undisclosed SAs. Conclusions: Interpersonal difficulties may be related to loneliness and a thwarted sense of belongingness, which may explain the failure to disclose SAs. Implications related to assessment and prevention are discussed.

Levi-Belz, Y. Gavish, T. Barzilay, S., Apter, A., Hoven, C., Carli, V., Sarchiapone, M., & Wasserman, D. (2019). Psychosocial Factors Correlated with Undisclosed Suicide Attempts to Significant Others: Findings from the Adolescence SEYLE Study. Suicide and Life-Threatening Behavior, 49 (3), 759-773. doi: 10.1111/sltb.1247

​Moral Injury and Suicide Ideation Among Israeli Combat Veterans: The Contribution of Self-Forgiveness and Perceived Social Support

סטודנט/ית: נטע דיכטר
מנחה: פרופ' יוסי לוי-בלז

Abs​​tract:

Modern warfare within a civilian setting may expose combatants to severe moral challenges. Whereas most of these challenges are handled effectively, some potentially morally injurious events (PMIEs) may have deleterious psychological, spiritual, and interpersonal effects among them, which may increase the risk for suicide ideation and behaviors (SIB). In this study, we aimed to examine the protective role of self-forgiveness and perceived social support on the relationship between exposure to PMIEs and SIB among combat veterans. A sample of 191 Israeli combat veterans completed validated self-report questionnaires in a cross-sectional design study, tapping moral injury, SIB, perceived social support, and self-forgiveness. Veterans with a history of SIB revealed higher levels of exposure to PMIEs and lower levels of self-forgiveness and perceived social support than veterans with no SIB history. Moreover, beyond the contributions of the PMIE dimensions, significant contributions of self-forgiveness and perceived social support to current suicide ideation (SI) were found. Importantly, the moderating model indicated that higher social support moderated the link between PMIEs and current SI. Based on the current findings, it can be suggested that self-forgiveness and perceived social support are important contributors to lower SI levels among veterans with PMIEs. It can be further suggested that interpersonal support may help veterans develop a sense of belongingness and bonding, which is a plausible basis for diminishing the risk of SI following PMIE exposure. 

Levi-Belz, Y., Dicther, N., Zerach, G. (in press). Moral Injury and Suicide Ideation Among Israeli Combat Veterans: The Contribution of Self-Forgiveness and Perceived Social Support. Journal of Interpersonal Violence. Advance online publication. doi: 10.1177/0886260520920865.

סטודנט/ית: שחר אפק
מנחה: פרופ' יוסי לוי-בלז

תקצ​​​יר:

שיעורי האובדנות בקרב צעירים בישראל ובעולם נמצאים בשנים האחרונות במגמת עלייה. אף שקיימת התקדמות בזיהוי גורמי הסיכון לאובדנות, ניכר כי מושם דגש מועט מדי על בחינת גורמי החוסן לאובדנות ומעכבי אובדנות, ויותר מכך, חסרים מחקרים הבוחנים מודלים משולבים של גורמי סיכון וגורמי חוסן בקרב צעירים מתרבויות שונות. במחקר הנוכחי ביקשנו לבחון את התהליכים הנפשיים והבין-אישיים הקשורים לחשיבה אובדנית בקרב תלמידי בית ספר בישראל; זאת תוך בחינת מודל אינטגרטיבי המשלב בין גורמי סיכון וגורמי חוסן, התמקדות על מדדים רגשיים-תסמיניים ובין-אישיים והתייחסות להבדלים בין תלמידים יהודים וערבים מוסלמים. במחקר השתתפו 581 תלמידים בכיתות ט-יב )338 יהודים ו-243 מוסלמים( הלומדים בבתי ספר מקצועיים ברחבי הארץ. התלמידים מילאו שאלונים שבחנו תסמינים פסיכיאטריים, רווחה נפשית, חשיפה עצמית, תחושות עול וחוסר שייכות וסבילות לכאב נפשי. מהממצאים עולה כי תלמידים מוסלמים דיווחו על עוצמה גבוהה של מחשבות אובדניות, בהשוואה לתלמידים יהודים. בנוסף, נמצא כי רמת התסמינים הפסיכיאטריים, תחושת האדם כי הוא מהווה עול וסבילות לכאב נפשי תורמות תרומה ייחודית לניבוי מחשבות אובדניות. מעבר לכך, מאפיינים בין-אישיים נמצאו כממתנים את הקשר בין רמת התסמינים הפסיכיאטריים ובין מחשבות אובדניות, כך שיכולות בין-אישיות גבוהות מסייעות להפחית מחשבות אובדניות בקרב תלמידים גם כאשר מצוקתם הרגשית גבוהה. השלכות בהקשר של זיהוי והתערבות בעת משבר אובדני נדונות במאמר.

Levi-Belz., Y. & Afek, S., Barkan, A., Hen-Gal, S. (in press). Between risk and resilience: The contribution of psychological and interpersonal characteristics to suicide ideation among Jewish and Muslim adolescents in Israel. Mifgash (Hebrew).

​​"I would like to Tell You Something”: The Contribution of Self Disclosure to Social Phobia Symptoms in a Non-Clinical Sample

סטודנט/ית: נופר אליס
מנחה: פרופ' יוסי לוי-בלז

Abstra​​ct:

Social phobia is characterized by intense anxiety from embarrassment and high levels of avoidance of social situations. Several studies have noted the presence of non-normative patterns of self-disclosure among socially anxious individuals. However, little is known regarding the contribution of self-disclosure to symptoms of social phobia in nonclinical populations. The current research aimed to fill this void by exploring the relationship between self-disclosure and social phobia symptoms. Non-clinical participants (N=188) completed questionnaires tapping self-disclosure, depression, as well as social anxiety. Findings showed that limited self-disclosure played a role in facilitating social phobia symptoms, beyond the contribution of depression. Focusing on the ability to share personal information to at least one close person can be seen as a buffer against social phobia symptoms. Implications regarding psychotherapy and population-based intervention are discussed.

Levi-Belz, Y. & Elis, N. (2017). "I would like to tell you something": The contribution of self-disclosure to social phobia symptoms in a non-clinical sample. Journal of Depression & Anxiety, 6(3). 1-4. doi:10.4172/2167-1044.1000288.

Does Early Emotional Responding to Initial Mindfulness Training Impact Intervention Outcome?

סטודנט/ית: אור הראל
מנחה: פרופ' יוסי לוי-בלז

Abs​​tract:

Rigorous study of the prevalence and functions of emotional responding to initial mindfulness training among meditation-naïve practitioners or clients is scarce, yet could be important for informing more personalized and effective delivery of mindfulness-based interventions. Accordingly, we modeled the function of emotional responding to initial mindfulness training on key outcomes of a 4-week mindfulness training intervention among N = 115 unselected meditation-naïve adults from the general community. We found that elevations and deterioration in both negative and positive affect in the week following initial mindfulness training did not predict prospective intervention retention/dropout, nor key intervention outcomes. These tests were statistically powered to detect small to moderate effects. In contrast to this pattern of null prospective effects on intervention outcomes, we found that the greater the degree of early elevation in positive affect, the greater the prospective likelihood of cultivating higher levels of trait mindfulness over the course of the intervention. Findings indicate that elevations in negative affect and deterioration of positive affect, in early phases of mindfulness meditation training, were not linked to an iatrogenic effect of the intervention nor to elevated risk of dropout. Together, the present findings may contribute to the emerging discourse on safety and adverse effects of mindfulness meditation and inform decision-making with respect to the delivery of mindfulness-based interventions to improve well-being and reduce vulnerability in the general community.

Harel, O., Hadash, Y., Levi-Belz, Y., & Bernstein, A. (2019). Does Early Emotional Responding to Initial Mindfulness Training Impact Intervention Outcomes?. Mindfulness, 10(4), 616-626. doi: 10.1007/s12671-018-1018-9

Forgive but not forget: From self-forgiveness to posttraumatic growth among suicide-loss survivors

סטודנט/ית: טל גילה
מנחה: פרופ' יוסי לוי-בלז

Ab​​stract:

Suicide-loss survivors often experience personal growth in the aftermath of a loss, depending on their personal and interpersonal characteristics. The current study focuses on the role of self-forgiveness (SF) as a contributing factor, both directly and indirectly, to posttraumatic growth (PTG) among suicide-loss survivors. Israeli suicide-loss survivors (N ¼ 124) completed questionnaires measuring SF and PTG as well as adaptive coping strategies, social support, and self-disclosure. SF positively contributed to PTG, both directly and indirectly, through interpersonal and cognitive processes. These findings highlight the value of actions promoting self-forgiveness, compassion, and acceptance in psychological interventions with suicide-loss survivors.

Gilo, T., Feigleman, W., & Levi-Belz, Y. (in press). Forgive but not forget: From self-forgiveness to posttraumatic growth among suicide-loss survivors. Death Studies.

Emotional Distress Among Suicide Survivors: The Moderating Role of Self-Forgiveness

סטודנט/ית: טל גילה
מנחה: פרופ' יוסי לוי-בלז

Abs​​​​​​tract:

Grief after suicide entails unique challenges and difficulties, such as intense feelings of anger and guilt, as well as various psychological risks. The current study examined the contribution of self-forgiveness (SF) to emotional distress (e.g., depressed mood and suicidal ideation) among suicide-loss survivors, compared with bereavement following sudden and expected death types. Bereaved individuals (N = 309; aged 18-84) completed questionnaires measuring SF, depressed mood, suicidal ideation, demographics, and personal characteristics concerning the bereavement. A significant interaction between SF and type of loss was found, in which suicide-loss survivors with low levels of SF manifested the highest levels of depression and suicidal ideation compared with other subgroups. The findings reflect the importance of SF as a protective factor against depression and suicidality among suicide-loss survivors as well as the possible efficacy of forgiveness-based interventions in this population.

Levi-Belz, Y. & Gilo T. (2020). Emotional Distress Among Suicide Survivors: The Moderating Role of Self-Forgiveness. Frontiers in Psychiatry, 11, 341. doi: 10.3389/fpsyt.2020.00341.

The emotional distress of asylum seekers in Israel and the characteristics of those seeking psychiatric versus medical help

סטודנט/ית: נעמה קיאט
מנחה: ד"ר רפי יונגמן

Abst​​ract: 

Israel has become a destination for asylum seekers. Asylum seekers often experience emotional distress, but have limited access to health services and rarely use psychiatric services. This study sought to understand and characterize the use of psychiatric versus medical services by asylum seekers in Israel. We compared the emotional distress, stressful life events and previous treatment consultations of 21 psychiatric service users (PSU) and 55 medical service users (MSU) at the Open Clinic of Physicians for Human Rights in Tel-Aviv. Participants completed a socio-demographic questionnaire, the General Health Questionnaire (GHQ-12), the Stressful Life Events Scale and the Health Care Utilization Questionnaire. PSU and MSU did not have significantly different levels of emotional distress. PSU reported significantly more stressful life events during the past year than MSU (M ¼ 5.81, SD 3.47 vs. M ¼ 3.8, SD 2.35, p < 0.01). In comparison to MSU, PSU utilized more medical (M ¼ 4.33, SD 2.28) and non-medical (M ¼ 2.38, SD 1.92) services (p < 0.001) than MSU. Asylum seekers who consulted multiple treatment agencies in the last year were 1.55 times more likely to seek psychiatric treatment than those who had consulted only a few treatment agencies. Emotional distress in asylum seekers appears to be under-diagnosed in the Open Clinic and under-treated by mental health professionals. To better detect this distress, a thorough screening is recommended at assessment. Collaboration with mental health professionals and community and religious leaders consulted in the past is important and can contribute to good health care outcomes in this population.

Kiat, N., Youngmann, R. & Lurie. I. (2017). The emotional distress of asylum seekers in Israel and the characteristics of those seeking psychiatric versus medical help. Transcultural Psychiatry, 54(5-6), 575-594.

Cultural Impact on SAD: Social Anxiety Disorder among Ethiopian and Former Soviet Union Immigrants to Israel, in Comparison to Native-born Israelis

סטודנט/ית: קלי חסנסון-עצמון
מנחה: ד"ר רפי יונגמן

Ab​​stract:

Background: Social Anxiety Disorder (SAD) is linked to social norms and role expectations which are culture dependent, such as the construal of one’s self as independent or interdependent in relation to others. The current study is the first to examine SAD symptoms among Ethiopian and former Soviet Union immigrants to Israel compared to a sample of native Israelis. We investigated the relationship between SAD, ethnicity and independent/ interdependent self-construals.          Methods: A total of 261 students (151 native-born Israelis, 60 Ethiopian immigrants and 50 students from the former USSR) were administrated the Liebowitz Scale (LSAS), the Self-construal Scale (SCS), Beck Depression Inventory (BDI) and a socio-demographic questionnaire.                                                                         Results: Ethiopians exhibited highest SAD scores while no differences were found between the FSU immigrants and native-born Israelis. Additionally, Ethiopians and native-born Israeli students exhibited similar high interdependence scores. Finally, SAD scores were predicted by gender, origin, independent and interdependent self-construals.                                                                                                               Conclusion: Immigration per se is not a universal risk factor of SAD and ethnological-cultural factors do contribute specifically to SAD. A possible psychological mediator between culture and the susceptibility to SAD are the interdependence and independent self-construals. When treating immigrants, clinicians and health care providers are advised to consider the effect of cultural influence on the mental well-being and integration process of immigrants into their host country. 

Hasenson-Atzmon, K., Marom, S., Sofer–Tsivion, T., Lev-Ari, L., Youngmann, R., Hermesh, H., & Kushnir, J. (2016). Cultural impact on SAD: Social Anxiety Disorder among Ethiopian and former Soviet Union immigrants to Israel, in comparison to native-born Israelis. Israel Journal of Psychiatry & Related Sciences, 53(3), 48-55.

Parental playfulness and children’s emotional regulation: the mediating role of parents’ emotional regulation and the parent–child relationship

סטודנטים/ות: אורי סוויסה, פידוט לבבי ואנאל סוויסה
מנחה: ד"ר מעיין שורר

Abstra​​ct: 

Parental playfulness describes a parent’s ability to act in a spontaneous, amusing, flexible and creative manner in different parent–child situations. This study examined the hypothesis that parental playfulness promotes children’s emotional skills and thus should be related to improved emotion regulation and lower anxiety. A sample of 137 parents of children aged 2–8 self-reported on their parental playfulness levels, their own emotion regulation ability, levels of parent–child closeness and conflicts, and their children’s emotion regulation and anxiety levels. Parental playfulness was associated with improved emotion regulation in their children. This association was mediated by the parent’s emotional awareness and the level of parent–child closeness. These findings underscore the importance of parental playfulness for the children’s emotional skills and the parent–child relationship.

Shorer, M., Swissa, O. Levavi, P. & Swissa, A. (2019) Parental playfulness and children’s emotional regulation: the mediating role of parents’ emotional regulation and the parent–child relationship, Early Child Development and Care, DOI: 10.1080/03004430.2019.1612385

Stereotypical thinking as a mediating factor in the association between exposure to terror and posttraumatic stress disorder symptoms among Israeli youth

סטודנט/ית: חן גורן
מנחה: פרופ' אפרת נטר

A​​​bstract: 

Background and Objectives: The negative impact of exposure to terror on mental health, as well as on the perceptions of each side of the conflict toward the other, is well-documented. However, the association between stereotyping, concomitant with perceived threat, and anxiety, was rarely investigated. The current study examined information processing attributes and exposure to terror as predictors of PTSD symptoms among youth at inter-group conflict, with stereotypical thinking toward a threatening out-group as a possible mediator. Design: Cross-sectional, with exposure to terror, need for cognitive structure (NCS), efficacy at fulfilling the need for closure (EFNC) and self-esteem, predicting stereotypical thinking and PTSD symptoms. Method: Ninth graders (N = 263) from two residential areas in Israel, varying in their degree of exposure to terror, responded to a self-report questionnaire tapping the above variables. Results: Stereotypical thinking was found to mediate the association between exposure to terror and PTSD symptoms, but not the association between the NCS and EFNC interaction and PTSD symptoms. Conclusions: The findings support terror management theory, so that a negative and rigid perception makes it difficult to construct coherent world-view, thus contributing to aggregation of existential anxiety and PTSD symptoms.

Infertility Centrality in the Woman’s Identity and Goal Adjustment Predict Psychological Adjustment Among Women in Ongoing Fertility Treatments

סטודנט/ית: שירה גורן
מנחה: פרופ' אפרת נטר 

Abstr​act: 

Purpose: Some of the women that go through repeated fertility treatments will not adjust well to the treatments and will experience increased distress. The present study examined how centrality of the fertility problem in the woman’s identity and dispositional goal adjustment (disengagement and reengagement) are associated with the woman’s psychological adjustment. These issues are examined in a context of a pro-natal society (Israel) where parenthood is a major life goal.                                                

Methods: One hundred ninety-three women in ongoing fertility treatments filled out questionnaires, and follow-up on their psychological well-being was carried out after 3 months (N = 130).                                                                                                              Results: Women who perceived their fertility problem as more central to their identity experienced greater distress (β = 0.34, p < 0.01) and less well-being (β = − 0.31, p < 0.01). Concurrently, high ability for goal disengagement was a resource that protected women from these feelings. Women high on goal disengagement who were low on goal reengagement experienced greater distress (β of interaction = − 0.24, p < 0.01), probably because they remained with feelings of emptiness and lack of purpose. These findings were found in both cross-sectional and longitudinal analyses. Finally, the models predicting well-being and distress at T2 using centrality, goal adjustment, and T1 well-being/distress explained 42 and 47.5% of the variance, respectively.                                                                                                                

Conclusions: Much research and therapeutic attention has been invested in coping with fertility treatments, while the options of reducing investment in treatments and finding alternative goals did not receive adequate attention. This study discusses these issues and their possible clinical implications especially in a pro-natal context.

Neter, E., &amp; Goren, S. (2017). Infertility centrality in the woman’s identity and goal adjustment predict psychological adjustment among women in ongoing, fertility treatments. International Journal of Behavioral Medicine, 24, doi: 10.1007/s12529-017-9693-9. 14 citations. 

The association between sleep disturbances of children with anxiety disorders and those of their mothers

סטודנט/ית: בת-שבע גולדברג-רסקין
מנחה: פרופ' רחל בכנר

Ab​​​stract: 

Objective: Previous research has demonstrated a link between childhood anxiety and sleep problems, but little is known about the link between these difficulties and parental sleep disturbances. The purpose of the current study was to explore the association between anxious children's sleep difficulties and those of their mothers. Method: A total of 101 children aged 8e18 years and their mothers participated in this study. The clinical group included 66 children (mean age ¼ 11.45 years, standard deviation ¼ 2.79 years) diagnosed with anxiety disorders, and the control group included 35 age- and sex-matched normal healthy controls. Mothers completed questionnaires assessing their child's anxiety and sleep, as well as their own sleep. Children completed questionnaires assessing anxiety, sleep, depression, and obsessive symptoms. Results: Both children and mothers in the clinical group exhibited more sleep difficulties compared to controls. A regression analysis revealed that pre-sleep arousal negatively predicted children's sleep. Furthermore, children's anxiety level was associated with parental levels of sleep disturbances. This link was fully mediated by the children's sleep disturbances score. Conclusion: Mothers of children with anxiety disorders exhibit higher levels of sleep disturbances than controls. These difficulties are linked to children's anxiety and sleep problems. When treating children with anxiety, it is therefore important to assess their overall sleep disturbances, as well as parental sleep difficulties, and when appropriate to add a specific sleep intervention component.

Goldberger-Raskin, B.S., Gothelf, D., Bachner-Melman, R., Lang, C., & Kushnir, J. (2018). The association between sleep disturbances of children with anxiety disorders and those of their mothers. Sleep Medicine, 43, 77-82.

Sexual orientation and dis​​ordered eating in women: A meta- analysis

סטונדט/ית: אביב דותן
מנחה: פרופ' רחל בכנר.

Abstr​act:

 Purpose: Homosexuality is a clear risk factor for disordered eating in men; however, for women, research has yielded contradictory results. We conducted a meta-analysis to examine the association between sexual orientation and disordered eating in women.                                                                                                                      Methods: PRISMA guidelines were used. Studies comparing disordered eating between lesbians and heterosexual women were identifed using PsycNet database and Google Scholar. Twenty-one studies met inclusion criteria. Overall disordered eating, restricting, binging and purging were examined for heterosexual, lesbian, bisexual and ‘mostly heterosexual’ women.                                        

Results: Whereas there was no signifcant diference in overall disordered eating between lesbians and heterosexual women, lesbians reported restricting less and binging more than heterosexual women. Bisexual women were more likely than lesbian women to restrict food intake and purge, and more likely than heterosexual women to have overall disordered eating and restrict food intake. “Mostly heterosexual” women were more likely than heterosexual women to restrict food intake, binge and purge.                                

Conclusions: Women of diferent sexual orientations show distinct patterns of disordered eating. Bisexual and “mostly heterosexual” women appear to be particularly at risk. Stress resulting from binegativity and rigid views of sexuality in a dichotomous society, rather than sexual orientation itself, may be associated with disordered eating in women. Findings should be viewed with caution because there were few studies with bisexual and “mostly heterosexual” women. This study elucidates the nature of the association between disordered eating and sexual orientation. Findings provide a possible explanation for previous inconsistencies, since opposing trends for diferent behaviors cancel each other out.                                    

Level of evidence: Level I, systematic review and meta-analysis.

Dotan, A., Bachner-Melman, R., and Dahlenburg, S. (2019). Sexual orientation and disordered eating in women: A meta-analysis. Eating and Weight Disorders (published online Dec 03, 2019). [Equal first authorship].

The asso​​​ciation between sexual orientation, susceptibility to social messages and disordered eating in men

סטודנט/ית: עידו גיגי
מנחה: פרופ' רחל בכנר

Abs​tract:

Objective: Much research points to higher levels of disordered eating and more negative body image in gay and bisexual men than in heterosexual men. The reasons for this difference, however, remain unclear. We hypothesized that disturbed body image and eating attitudes in gay and bisexual men would be partially explained by susceptibility to social messages.                                  

Methods: Two hundred and sixty-two men (203 heterosexual, 46 gay and 13 bisexual) between 18 and 35 years of age participated in the study. They completed measures of disordered eating, body image, internalization of attitudes toward appearance, and concern for appropriateness. In addition, they were asked to what extent they were influenced by ten advertisements, four that emphasized physical appearance, and six that did not.   Results: As shown in previous research, gay and bisexual men reported higher levels of disordered eating and dissatisfaction with their bodies than heterosexual men. In addition, the gay and bisexual men were more susceptible than the heterosexual men to social messages and reported being significantly more influenced than heterosexual men by advertisements focusing on physical appearance, but not by other advertisements. Susceptibility to social messages fully mediated the association between sexual orientation and disordered eating.                                                                                

Discussion: Results provide support for the hypothesis that sensitivity to social messages about appearance explains, at least partially, the link between sexual orientation and disordered eating in men.

Gigi, I., Bachner-Melman, R., & Lev-Ari, L. (2016). The association between sexual orientation, susceptibility to social messages and disordered eating in men. Appetite, 99, 25-33. [Equal first authorship]. 

Thankful for what? the efficacy of interventions targeting interpersonal versus noninterpersonal gratitude

סטודנט/ית: פינס ברגר
מנחה: פרופ' רחל בכנר

Ab​​stract:

Gratitude interventions have been shown to increase well-being but not trait gratitude. We tested whether gratitude would be sensitive to interventions if interpersonal gratitude (to another person), and noninterpersonal gratitude or appreciation were examined separately. Participants (N = 150) were randomly assigned to one of five 3-week interventions: (a) interpersonal gratitude list, (b) noninterpersonal gratitude list, (c) interpersonal gratitude letter, (d) interpersonal gratitude list   interpersonal gratitude letter, and (e) control intervention (writing daily about a negative and positive incident). Measures of interpersonal and noninterpersonal trait gratitude, positive and negative emotions, depression, and life satisfaction were completed before and after the intervention and 3 months later. All interpersonal gratitude interventions led to an increase in interpersonal but not noninterpersonal trait gratitude, and the noninterpersonal gratitude list led to an increase in both noninterpersonal and interpersonal gratitude. Overall, little support was found for the hypothesis that gratitude interventions can increase trait gratitude when the intervention targets the type of gratitude used as the outcome measure.

Berger, P., Bachner-Melman, R., & Lev-Ari, L. (2019). Thankful for what? The efficacy of interventions targeting interpersonal versus non-interpersonal gratitude. Canadian Journal of Behavioural Sciences, 51(1), 27-36. Equal first authorship. 

Lives on the line: The online lives of girls and women with and without a lifetime eating diagnosis

סטודנט/ית: עינת זונטג-אורן
מנחה: פרופ' רחל בכנר

A​bstract: 

This study aimed to compare the scope, internet use patterns, and degree of online need satisfaction of girls and women with and without a lifetime eating disorder (ED) diagnosis. Participants were 122 females aged 12–30, 53 with a lifetime ED diagnosis recruited via a hospital-based treatment program, and 69 age-matched controls recruited via normative social media sites. Participants completed questionnaires assessing disordered eating, body image, positive and negative affect, general distress, and life satisfaction, and completed an online survey about the scope of their internet use, the frequency of watching and posting pictures and videos, online friendships and social comparison, fulfillment of needs online, and mood after internet use. All questionnaire scores differed significantly between groups in the expected directions. Whereas overall, ED and control groups spent similar amounts of time online (6.21, SD = 5.13), they spent this time differently. ED participants reported devoting 56.7% of their online time to eating, weight and body image, versus 29.1% for controls, and spent significantly more time than controls on forums and blogs (t = −5.3, p < 0.0001, Cohen’s d = 0.87). They also engaged more often in social comparison (t = 3.6, p < 0.005, Cohen’s d = 0.65), had a higher online–offline friend ratio (t = 3.7, p < 0.0001, Cohen’s d = 0.65), and more online friends with ED (t = 5.4, p < 0.0001, Cohen’s d = 0.89). In comparison to controls, ED participants reported that their use of forums and blogs gave them more eating- and weight-related advice, and a greater sense of belonging, social support, and safety resulting from anonymity, with effect sizes of 0.63–0.96. However, they also reported more negative affect after posting online. Most online behaviors and patterns correlated positively with measures of symptomatology and negatively with measures of psychological health, in both groups. Internet use was rarely addressed in therapy. Professionals, families and friends should help people with disordered eating and EDs to broaden the scope of their internet use. They should invest less in food and weight-related forums/blogs, expand their “real life” social lives and develop their interpersonal skills, so that their legitimate needs can be satisfied face-to-face, rather than virtually. Clinicians should address the online lives of their ED clients in therapy.

Bachner-Melman, R., Zontag-Oren, E., & Zohar, A., & Sher, H. (2018). Lives on the line: The online lives of girls and women with and without a lifetime eating disorder diagnosis. Frontiers in Psychology, 9(2128) [Equal first authorship].

Attachm​​ent, sense of entitlement in romantic relationships​, and sexual revictimization among adult CSA survivors

סטודנט/ית: מור לוי-אוגולניק
מנחה: פרופ' רחל בכנר

Abstract​​:

Inse​​​cure attachment orientations are disproportionately frequent in child sexual abuse (CSA) survivors and have been found to mediate some of the effects of CSA on adult interpersonal and romantic difficulties, including sexual revictimization (SR). A sense of relational entitlement (SRE) has received growing attention in psychological discourse and research in recent years. It reflects both adaptive (assertive) and pathological (restricted or inflated) attitudes to the assertion of needs and rights and has not been studied in adult CSA survivors. The purpose of this study was to examine associations between CSA, attachment orientations, SR, and SRE. Sixty-seven Israeli women aged 25 ± 3.95 years (30 adult CSA survivors and 37 healthy female controls with no history of CSA) completed a demographic questionnaire and self-reported measures of adult attachment orientations, sense of entitlement in romantic relationships, and adult SR. CSA survivors

Brenner, I, Bachner-Melman, R., Lev-Ari, L., Levi-Ogolnic, M., Tolmacz, R., & Ben-Amitay, G. (2019). Attachment, sense of entitlement in romantic relationships and sexual revictimization among adult CSA survivors. Journal of Interpersonal Violence, 1-24 (online ahead of print).

Can recovery ​​from an eating disord​​er be measured? toward a standardized questionnaire

סטודנט/ית: שי לי לב
מנחה: פרופ' רחל בכנר

Abst​ract: 

Background: There is a clear need for a standardized definition of recovery from eating disorders (EDs) and for self-report instruments to assess where individuals with an ED are situated at a given point of time along their process of illness and recovery. It has been acknowledged that psychological and cognitive symptoms are important to recovery in addition to physical and behavioral indices. This study proposes a 28-item multidimensional questionnaire encompassing the main features of recovery from ED, derived from the endorsement of different criteria by people with a lifetime ED diagnosis, family members and ED clinicians.        

Methods: Participants were 213 volunteers over the age of 18 (118 people with a lifetime ED diagnosis, 58 healthy family members of people with EDs and 37 ED clinicians), who completed the ED-15 and indicated online how important they thought each of 56 criteria were for recovery from an ED.                                            

Results: Four factors were identified in an exploratory factor analysis: Lack of Symptomatic Behavior (LSB), Acceptance of Self and Body (ASB), Social and Emotional Connection (SEC), and Physical Health (PH). Confirmatory factor analysis using the seven highest loading items from each subscale confirmed the structure validity of a shortened version of this questionnaire, the Eating Disorders Recovery Endorsement Questionnaire (EDREQ), which had excellent goodness-of-fit indices. Despite a few between-group differences, there was general agreement that LSB was most salient to recovery, followed by ASB, SEC, and PH in that order.        

Conclusion: Despite the absence of a standardized definition of recovery from ED, there is a general consensus about its components. The EDREQ is a psychometrically sound questionnaire containing items that people with an ED history, their family members and therapists all define as important components of recovery. The inclusion of emotional and psychosocial aspects of recovery in addition to symptomatic and medical aspects is important to expand treatment goals and the concept of recovery from EDs beyond symptom relief and the absence of disease markers. As a clinical tool, the EDREQ stands to assist in setting and refining therapeutic goals throughout therapy, and in establishing standardized, comparable norms for recovery levels in research.

Bachner-Melman, R., Lev-Ari, L., Zohar, A.H., & Lev, S.L. (2018). Can recovery from an eating disorder be measured? Towards a standardized questionnaire. Frontiers in Psychology, 9, 2456.

The eating disorders rec​overy questionnaire: Psychometric properties and validity

​סטודנט/ית: מיכל לינקצקי
מנחה: פרופ' רחל בכנר

Abst​ract:

Purpose: There is no standardized measurement of recovery from an eating disorder (ED). We examined the psychometric properties and construct validity of the “Eating Disorders Recovery Questionnaire” (EDRQ), which defnes recovery beyond symptoms to include self-acceptance, social emotional and physical health.             

Methods: Twenty-eight recovery-related items were administered to 978 people (9.5% men) aged 18–76. 172 participants had a current ED diagnosis (AN, BN or BED), 104 had a past ED diagnosis (AN, BN, BED or>one diagnosis), 105 had another past or present ED, and 579 had no lifetime ED. Participants also completed the Eating Disorders Examination Questionnaire, Dresden Body Image Questionnaire-35, Positive and Negative Afect Schedule—Short Form, Patient Health Questionnaire-9, Satisfaction with Life Scale and Positive Eating Scale.                                                       

Results: Exploratory and confrmatory factor analyses yielded four factors (CFI=0.93, RMSEA=0.07): lack of symptomatic behavior, acceptance of self and body, social and emotional connection, and physical health. Group comparisons showed that currently ill women scored lower on EDRQ and positive indices and higher on negative indices than controls and previously ill women. Previously ill women scored similarly to controls on ED symptomatology, positive body experiences, depression, and positive and negative afect but had lower BMI, life satisfaction and positive eating. The EDRQ–EDEQ correlation was r=0.67, indicating both overlap and distinct variance.                                                        

Conclusion: The EDRQ is a valid, reliable measure of ED recovery, defned more broadly than symptom remission. We recommend its incorporation into a standardized operationalization of recovery and its use by consumers, carers and service providers to monitor ED recovery status

Level of evidence: Level III, case–control analytic study.

Bachner-Melman, R., Lev-Ari, L., Zohar, A., & Linetsky, M. (2021). The Eating Disorders Recovery Questionnaire: Psychometric properties and validity. Eating and Weight Disorders, 1-11.  

Attitudes towards eating disorders clinicians with personal experience of an eating disorder

סטודנט/ית: מיכל שלום
מנחה: פרופ' רחל בכנר

Abstr​act:

Purpose: This study explores the perspectives and opinions towards ED clinicians with lived experience of ED.                              

Methods: Three hundred and eighty-five ED clinicians and 124 non-clinicians from 13 countries, between 18 and 76 years of age completed an online survey about attitudes towards ED clinicians with a personal ED history. Almost half the respondents (n=242, 47.5%) reported a lifetime ED diagnosis. Survey items included ten multiple-choice and three open questions about clinician disclosure, employer hiring practices, and perceived advantages and disadvantages of clinicians with a personal ED history practicing in the ED feld. Multiple-choice responses from clinicians with and without a personal ED history were compared with responses from non-clinicians with and without a personal ED history. Open questions were examined using thematic analysis.      

Results: Clinicians with no ED history, whose responses often difered from both ED-history groups (clinicians and nonclinicians), were more likely to indicate that clinicians with an ED should not generally treat ED patients, and that clinicians should self-disclose their ED history to employers but not to their patients. Thematic analysis of the open-ended questions revealed that advantages of having clinicians with an ED history include a deep experiential understanding and the ability to be empathic and non-judgmental, whereas disadvantages include the lack of objectivity and the risk of clinicians being triggered.                                                      

Conclusion: Further research informing guidelines for ED clinicians with a personal ED history, their colleagues and employers are needed to protect and empower the signifcant minority of ED professionals with “lived experience” of EDs.                                      

Level of evidence: Level III, case-control analytic study.

Bachner-Melman, R., de Vos, J. A., Zohar, A. H., Shalom, M., Mcgilley, B., Oberlin, K., Murray, L., Lamarre, A., & Dooley-Hash, S. (2020). Attitudes towards eating disorders clinicians with personal experience of an eating disorder. Eating and Weight Disorders, 1-11 (online ahead of print).