Journal of Traumatic Stress

, Volume 6, Issue 4, pp 441–450 | Cite as

Early psychological responses to traumatic injury

  • Arieh Y. Shalev
  • Shaul Schreiber
  • Tamar Galai


Sixteen injured survivors of a terrorist act, hospitalized in a large medical center, were followed daily by a team of mental-health consultants. The survivors' rapidly changing mental states and the subsequent responses of their care-providers are described. Intrusive recollections of the event were experienced by all, however with various degrees of distress and arousal. Early psychological assistance was aimed at increasing the survivors' sense of self-control and their mastery over secondary stressors. Flexible and skilled therapeutic technique was required to meet the survivors' changing needs. The consultants' own emotional burden was addressed by structuring the interventions and providing opportunities for disclosure.

Key Words

trauma-psychological physical injury stress management secondary stressors consultation-liason psychiatry 


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  1. Breslau, N., and Davis, G.C. (1987). Post-traumatic Stress Disorder, the stressor criterion.J. Nerv. Ment. Dis. 175: 255–264.PubMedGoogle Scholar
  2. Buydens-Branchey, L., Noumair, D., and Branchey, M. (1990). Duration and intensity of combat exposure and posttraumatic stress disorders among Vietnam veterans.J. Nerv. Ment. Dis. 178: 582–587.PubMedGoogle Scholar
  3. Figley, C. R. (1978). Introduction. In Figley, C.R. (ed.),Stress Disorders Among Vietnam Veterans: Theory Research and Treatment Brunner Mazel, New York.Google Scholar
  4. Figley, C. R. (1987). Toward a field of traumatic stress.J. Traum. Stress 1: 3–16.Google Scholar
  5. Green, B. L., Grace, M. C., Lindy, J. D., Titchener, J. L., and Lindy, J. G. (1983). Levels of functional impairment following a civilian disaster: The Beverly Hills Supper Club fire.J. Consult. Clin. Psychol. 51: 573–580.PubMedGoogle Scholar
  6. Green, B. L., Wilson, J. P., and Lindy, J. D. (1985). Conceptualizing posttraumatic stress disorder: A psychosocial framework. In Figley, C. R (ed.),Trauma and Its Wake: Study and Treatment of Post-Traumatic Stress Disorder Brunner/Mazel, New York, pp. 53–69.Google Scholar
  7. Helzer, J. E., Robins, L. N., and McEvoy, L. (1987). Post-traumatic stress disorder in the general population.New Engl. J. Med. 317: 1630–1634.PubMedGoogle Scholar
  8. Holloway, H. C., and Ursano, R. J. (1987). The Vietnam veteran: Memory, social context and metaphor.Psychiatry 47: 103–108.Google Scholar
  9. Horowitz, M. J., Wilner, N., and Alvarez, W. (1987). Impact of Event Scale, a measure of subjective stress.Psychol. Med. 41: 209–218.Google Scholar
  10. Horowitz, M. J. (1974). Stress response syndromes: Character style and dynamic psychotherapy.Arch. Gen. Psychiatry 31: 768–778.PubMedGoogle Scholar
  11. Lazarus, R. S., and Folkman, S. (1984).Stress, Appraisal and Coping, Chapter 2, Cognitive Appraisal Processes. Springer Verlag, New York, pp. 22–54.Google Scholar
  12. Lifton, R. J. (1988). Understanding the traumatized self. In Wilson, J. P., Harel, Z., and Kahana, B. (eds.),Human Adaptation to Extreme Stress, from the Holocaust to Vietnam Plenum Press, New York, pp. 7–32.Google Scholar
  13. Lindy, J. D., and Grace, M. (1986). The recovery environment: Continuing stressor versus a healing psychological space. In Sowder, J., and Lystad, M. (eds.),Disasters and Mental Health: Contemporary Perspectives and Innovations in Services to Disaster Victims American Psychiatric Press, Washington, D.C., pp. 147–160.Google Scholar
  14. Malt, U. F., and Ugland, O. M. (1989). A long-term psychosocial follow-up study of burned adults.Acta Psychiatric Scand. Suppl. 355: 94–102.Google Scholar
  15. Patterson, D. R., Carrigan, L., Questad, K. A., and Robinson, R. (1990). Post-traumatic stress disorder in hospitalized patients with burn injuries.J. Burn Care Rehab. 11: 181–184.Google Scholar
  16. Pitman, R. K., Altman, B., and Macklin, M. L. (1989). Prevalence of post-traumatic stress disorder in wounded Vietnam veterans.Am. J. Psychiatry 146: 667–669.PubMedGoogle Scholar
  17. Rosser, R., Dewar, S., and Thompson, J. (1991). Psychological aftermath of the King's cross fire.J. Royal Soc. Med. 84: 4–8.Google Scholar
  18. Rosser, R., and Dewar, S. (1991). Therapeutic flexibility in the post disaster response.J. Roy. Soc. Med. 84: 2–3.Google Scholar
  19. Schwarzwald, J., Solomon, Z., Weisenberg, M., and Mikulincer, M. (1987). Validation of the Impact of Event Scale for psychological sequelae of combat.J. Consult Clin. Psychol. 55: 251–256.PubMedGoogle Scholar
  20. Shalev, A. (1992). Post-traumatic stress disorder among injured survivors of a terrorist attack: Predictive value of early intrusion and avoidance symptoms.J. Nerv. Ment. Dis. 180: 505–509.PubMedGoogle Scholar
  21. Solomon, Z., and Benbenishty, R. (1986). The role of proximity, immediacy, and expectancy in frontline treatment of combat stress reaction among Israelis in the Lebanon War.Am. J. Psychiatry 143: 613–617.PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1993

Authors and Affiliations

  • Arieh Y. Shalev
    • 1
  • Shaul Schreiber
    • 1
  • Tamar Galai
    • 1
  1. 1.Department of PsychiatryJerusalemIsrael

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