Sara Freedman | Bar Ilan (original) (raw)

Papers by Sara Freedman

European Journal of Psychotraumatology, 2015

Background: Impaired social relationships are linked with higher levels of posttraumatic stress d... more Background: Impaired social relationships are linked with higher levels of posttraumatic stress disorder (PTSD), but the association's underlying dynamics are unknown. PTSD may impair social relationships, and, vice versa, poorer relationship quality may interfere with the recovery from PTSD. Objective: This work longitudinally evaluates the simultaneous progression of PTSD symptoms and social relationship satisfaction (SRS) in a large cohort of recent trauma survivors. It also explores the effect of cognitive behavior therapy (CBT) on the association between the two. Method: Consecutive emergency department trauma admissions with qualifying PTSD symptoms (n 0501) were assessed 3 weeks and 5 months after trauma admission. The World Health Organization Quality of Life evaluated SRS and the Clinician Administered PTSD Scale evaluated PTSD symptom severity. Ninety-eight survivors received CBT between measurement sessions. We used Structural Equation Modeling to evaluate cross-lagged effects between the SRS and PTSD symptoms. Results: The cross-lagged effect of SRS on PTSD was statistically significant (b 0(0.12, p 00.01) among survivors who did not receive treatment whilst the effect of PTDS on SRS was nil (b0(0.02, p 00.67). Both relationships were non-significant among survivors who received CBT. Discussion: SRS and PTSD are highly associated, and this study shows that changes in SRS in the early aftermath of traumatic events contribute to changes in PTSD, rather than vice versa. SRS impacts natural recovery, but not effective treatment. This study suggests that being satisfied with one's relationships might be considered as an important factor in natural recovery from trauma, as well as in intervention.

Prehospital and Disaster Medicine, Jan 1, 2010

Psychiatric …, Jan 1, 2011

Preventing posttraumatic stress disorder (PTSD) is a pressing public health need. Studies have sh... more Preventing posttraumatic stress disorder (PTSD) is a pressing public health need. Studies have shown significant barriers to obtaining early care. This study prospectively evaluated the acceptance of early assessment and treatment, the accuracy of recommending care, and the consequences of declining it. Researchers undertook systematic outreach to survivors of traumatic events consecutively seen in a general hospital emergency department. Structured telephone interviews were conducted 9.5±3.2 days after the emergency visit. Persons with acute stress disorder symptoms were invited for clinical assessment. Those clinically assessed as having acute PTSD symptoms were offered treatment. Telephone interviews, conducted 224.9±39.1 days from the traumatic event, evaluated those included in the initial assessment and a random sample of 10% of those not included because they were deemed not to have experienced a traumatic event. Telephone calls were made to 5,286 individuals, and 5,053 were reached (96%). Of these, 4,743 (94%) agreed to a telephone interview, 1,502 were invited for a clinical assessment, 756 (50%) attended the assessment, 397 were eligible for treatment, and 296 (75%) started treatment. Declining clinical assessments and treatment were associated with less symptom reduction over time. The prevalence of PTSD among those deemed not to have experienced a traumatic event, not to need clinical assessment, and not to need treatment were, respectively, 4%, 11%, and 3%. Despite successful outreach, many symptomatic participants declined clinical care and subsequently recovered less well. Screening for DSM-IV PTSD criterion A effectively identified survivors at low risk for PTSD. Systematic outreach is costly and might be reserved for exceptionally traumatic events.

The Israel journal of …, Jan 1, 2009

Psychotic symptoms appear frequently in schizophrenia and other related disorders, and until rela... more Psychotic symptoms appear frequently in schizophrenia and other related disorders, and until relatively recently were not generally considered to be amenable to psychological interventions. Recent studies have changed these conceptualizations. Theoretical models, based on a stress vulnerability perspective, show how misinterpretations of anomalous experiences are factors in both the development and maintenance of psychosis. This review describes CBT treatment for persons with psychosis which focuses on education about symptoms and the cognitive model as well as a collaborative exploration of thoughts and schemas surrounding delusions and hallucinations. Treatment outcome studies show that CBT is an effective and acceptable treatment for psychosis.

Archives of General …, Jan 1, 2012

Preventing posttraumatic stress disorder (PTSD) is a pressing public health need. To compare earl... more Preventing posttraumatic stress disorder (PTSD) is a pressing public health need. To compare early and delayed exposure-based, cognitive, and pharmacological interventions for preventing PTSD. Equipoise-stratified randomized controlled study. Hadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity. Consecutively admitted survivors of traumatic events were assessed by use of structured telephone interviews a mean (SD) 9.61 (3.91) days after the traumatic event. Survivors with symptoms of acute stress disorder were referred for clinical assessment. Survivors who met PTSD symptom criteria during the clinical assessment were invited to receive treatment. Twelve weekly sessions of prolonged exposure (PE; n = 63), or cognitive therapy (CT; n = 40), or double blind treatment with 2 daily tablets of either escitalopram (10 mg) or placebo (selective serotonin reuptake inhibitor/placebo; n = 46), or 12 weeks in a waiting list group (n = 93). Treatment started a mean (SD) 29.8 (5.7) days after the traumatic event. Waiting list participants with PTSD after 12 weeks received PE a mean (SD) 151.8 (42.4) days after the traumatic event (delayed PE). Proportion of participants with PTSD after treatment, as determined by the use of the Clinician-Administered PTSD Scale (CAPS) 5 and 9 months after the traumatic event. Treatment assignment and attendance were concealed from the clinicians who used the CAPS. At 5 months, 21.6% of participants who received PE and 57.1% of comparable participants on the waiting list had PTSD (odds ratio [OR], 0.21 [95% CI, 0.09-0.46]). At 5 months, 20.0% of participants who received CT and 58.7% of comparable participants on the waiting list had PTSD (OR, 0.18 [CI, 0.06-0.48]). The PE group did not differ from the CT group with regard to PTSD outcome (OR, 0.87 [95% CI, 0.29-2.62]). The PTSD prevalence rates did not differ between the escitalopram and placebo subgroups (61.9% vs 55.6%; OR, 0.77 [95% CI, 0.21-2.77]). At 9 months, 20.8% of participants who received PE and 21.4% of participants on the waiting list had PTSD (OR, 1.04 [95% CI, 0.40-2.67]). Participants with partial PTSD before treatment onset did similarly well with and without treatment. Prolonged exposure, CT, and delayed PE effectively prevent chronic PTSD in recent survivors. The lack of improvement from treatment with escitalopram requires further evaluation. Trauma-focused clinical interventions have no added benefit to survivors with subthreshold PTSD symptoms. Trial Registration clinicaltrials.gov Identifier: NCT00146900.

Cyberpsychology, …, Jan 1, 2010

In this case study, virtual reality was used to augment imaginal exposure in a protocol based on ... more In this case study, virtual reality was used to augment imaginal exposure in a protocol based on prolonged exposure. A 29-year-old male patient developed posttraumatic stress disorder after surviving a deadly terrorist bulldozer attack on two civilian buses and several cars in Jerusalem; the traumas witnessed by the survivor included a decapitation. The crowded bus in which the patient was riding was pushed over onto its side by the terrorist, injuring, trapping, and terrifying the passengers and causing gasoline to leak. Guided by his therapist, the patient entered an immersive computer-generated virtual world to go ''back'' to the scene of the traumatic event to help him gain access to his memories of the event, process and reduce the intensity of the emotions (fear=anger) associated with his pathological memories, and change unhealthy thought patterns. Traumatic memories of childhood abuse and traumatic memories of the bulldozer terrorist attack were treated using imaginal exposure while the patient was in the virtual environment BusWorld. The patient showed large posttreatment reductions in PTSD symptoms, and his Clinician-Administered PTSD Scale (CAPS) scores dropped from 79 pretreatment to zero immediately posttreatment, and CAPS was still at zero 6 months later. Although case studies are inconclusive by nature, these encouraging preliminary results suggest that further exploration of the use of virtual reality during modified prolonged exposure for PTSD is warranted. As terrorist attacks increase in frequency and severity worldwide, research is needed on how to minimize the psychological consequences of terrorism.

Essentials of terror medicine, Jan 1, 2009

Page 1. 24 Psychological Effects of Terror Attacks SARA A. FREEDMAN Terrorism is about psychology... more Page 1. 24 Psychological Effects of Terror Attacks SARA A. FREEDMAN Terrorism is about psychology [it] is about imagining the monster under our beds or lurking in dark closets the faceless, omnipotent enemy who might be our neighbor . ...

annual meeting of the International …, Jan 1, 2007

Journal of aggression, …, Jan 1, 2005

Page 1. Treating Survivors of Terrorism While Adversity Continues Rhonda S. Adessky Sara A. Freed... more Page 1. Treating Survivors of Terrorism While Adversity Continues Rhonda S. Adessky Sara A. Freedman SUMMARY. The current situation in Israel of continuous terrorist at-tacks poses unique challenges to the treatment of Posttraumatic Stress Disorder (PTSD). ...

… handbook of human …, Jan 1, 2000

18 Prospective Studies of the Recently Traumatized SARA FREEDMAN And ARIEH Y. SHALEV Reactions to... more 18 Prospective Studies of the Recently Traumatized SARA FREEDMAN And ARIEH Y. SHALEV Reactions to traumatic events, their course, and their presumed etiology have been studied throughout this century (eg, Rivers, 1918; Fraser &amp;amp; Wilson, 1918; Grinker et al., 1946), although it is ...

Medicine, science, and the …, Jan 1, 1996

This paper describes the successful treatment of a depressed shoplifter, using cognitive therapy ... more This paper describes the successful treatment of a depressed shoplifter, using cognitive therapy combined with exposure, an approach not previously described in the literature for this problem. Definitions of shoplifting behaviour are discussed, and other treatment methods examined.

The British Journal of …, Jan 1, 2008

… of Catastrophic Disasters: Group Approaches to …, Jan 1, 2006

Journal of Clinical …, Jan 1, 2006

Terrorism and …, Jan 1, 2003

Clinical intervention for survivors of prolonged adversities Arieh Y. Shalev, Rhonda Adessky, Rut... more Clinical intervention for survivors of prolonged adversities Arieh Y. Shalev, Rhonda Adessky, Ruth Boker, Neta Bargai, Rina Cooper, Sara Freedman, Hilit Hadar, Tuvia Peri, and Rivka Tuval-Mashiach Introduction Remaining an efficient clinician during massive adversities ...

Psychiatry: …, Jan 1, 2004

The immediate period following a traumatic event is a crucial time in the survivors' process of r... more The immediate period following a traumatic event is a crucial time in the survivors' process of recovery. During this time, a narrative of the trauma is generated and constructed, alongside a process of cognitive processing of the traumatic events. In the first part of the article we present the outlines of the narrative and cognitive attitudes to trauma; the second part will illustrate the developmental process through which the trauma narrative is shaped, in the stories of five survivors of a terror attack. We suggest that by analyzing three main components of the trauma narrative (coherence, finding meaning and self-evaluation), together with the equivalent cognitive attitudes, it is possible to evaluate the process of recovery, identify foci of difficulties in this process and pinpoint possible therapeutic interventions in the early stages after the trauma.

Journal of traumatic …, Jan 1, 2001

Based on therapeutic studies revealing positive prognostic factors and on research jindings revea... more Based on therapeutic studies revealing positive prognostic factors and on research jindings revealing how trauma is processed, we developed the memory structuring intervention (MSI) in attempt to prevent posttraumatic stress disorder (PTSD). The MSI attempts to shifr processing of traumatic memory from uncontrollable somatosensory and affective processes to more controlled linguistic and cognitive processes by providing patients organization, labeling, and causality. In a single-blind randomized-contmlled pilot study, I7 traffic accident victims at risk for PTSD (heart rate >94 BPM) were assigned to two MSI or two supportivelistening control sessions. Three months later; MSI patients reported significantly less frequent intrusive, arousal, and total PTSD symptoms than controls. A replication study with a larger sample is underway.

Psychiatry research, Jan 1, 2002

Journal of Traumatic …, Jan 1, 2002

Gender differences in psychological responses to motor vehicle accidents were examined as part of... more Gender differences in psychological responses to motor vehicle accidents were examined as part of a large-scale prospective study of PTSD. Participants were recruited from an emergency room (n = 275) and interviewed I week, I month. and 4 months later. No gender differences were Seen in the prevalence or recovery from PTSD, or in symptom levels at 1and 4 months. Women had a higher prevalence of lifetimeand postaccident generalized anxiety disorder. Gender differences were found regarding the type, but not the total number, of potentially traumatic events previously experienced. These results suggest that gender differences in responses to traumatic events are not explained by exposure as such, but rather may result from gender-specific attributes of the event.