Posttraumatic Stress and Growth: The Contribution of Cognitive Appraisal and Sense of Belonging to the Country (Report‪)‬

Over the past decade, terrorism has become a worldwide problem, with people in many countries directly exposed. Studies of adults exposed to political violence in Bosnia and Croatia (Grgic, Mandic, Koic, & Knezevic, 2002), Palestine and Israel (Baker & Kevorkian, 1995; Bleich, Gelkopf, & Solomon, 2003), and the United States (for example, Galea et al., 2002; Silver, Holman, McIntosh, Poulin, & Gil-Rivas, 2002) revealed a range of detrimental consequences, including heightened anxiety; depression; a reduced sense of safety; an increased use of tobacco, alcohol, and drugs; and, most prevalent of all, posttraumatic stress (PTS) symptoms. These symptoms can be grouped into three main clusters. The first is persistent re-experience of the traumatic event, such as recurrent dreams and flashbacks. The second is persistent avoidance of internal or external cues associated with the trauma, such as avoiding thoughts, avoiding activities, diminished interest, detachment, restricted affect, and sense of foreshortened future. Finally, increased arousal is manifested in difficulty in sleeping, irritability, difficulty in concentrating, hypervigilance, and exaggerated startle response (American Psychiatric Association [APA], 1994). A growing body of empirical studies reveals that many trauma survivors also experience positive psychological changes after trauma. Posttraumatic growth (PTG) is described as the subjective experience of positive psychological change reported by an individual as a result of the struggle with trauma. PTG relates to a variety of positive psychological changes, including increased appreciation of life, setting of new life priorities, a sense of increased personal strength, identification of new possibilities, improved closeness in intimate relationships, or positive spiritual change (Tedeschi, Park, & Calhoun, 1998). Such outcomes have been documented following a variety of traumatic events, including natural disasters (Maercker & Herrle, 2003),war (for example, Fontana & Rosenheck, 1998), and terror (Butler et al., 2005).