The current study was designed to assess the impact of individual coping and societal variables on the severity of CTSR in a country actively at war. In the current, low exposure population, individual coping strategy and societal relationships were found to be more influential than measures of exposure severity in predicting severity of CTSR. Individual coping, specifically forward focused coping, and an individual’s ability to see national structures as just and fair, as measured by system justification, predicted the severity of CTSR. Furthermore, an interaction effect between forward focused coping and system justification was found such that higher levels of both factors predicted fewer CTSR symptoms but in conditions of low forward-focused coping CTSR symptoms remained higher even when system justification was high.
In the current study, direct and indirect exposure was low and reflected the experience of the general Israeli population. The lack of relationship between exposure and CTSR was surprising and not in line with our hypotheses. It may be indicative of the current study sample which, specifically at the time of data collection, was living under the threat of war developing in all areas of the country and thus exposure was akin to the “near-miss” exposure described in the CTSR literature [6]. Additionally, during the research period there were mass call-ups of reservists and the threat of intensified military action meaning exposure and direct contact to war experiences was constantly changing. In these situations, and as indicated by the high levels of emotional fatigue described by the current sample, exposure may be less important than inter- and intra- personal coping characteristics. Given the recency of the CTSR measure, it is not possible to compare the current scores with those outside times of war or direct threat, though the continued study of CTSR, not just PTSD, is seen as a priority, specifically following the development of the wars in Ukraine and Israel and the Palestinian Territories, which have been given greater research attention [6, 47, 48]. CTSR, as opposed to PTSD, is considered a sub-clinical syndrome and while it is associated with psychological suffering, it is not considered an acute disorder. For this reason, acute exposure may be less critical than accumulation of traumatic factors (threat level, certainty/uncertainty, duration of exposure to war) which were not studied in the current research.
Media exposure, a unique element of indirect exposure, demonstrated a relationship with CTSR. Those who demonstrated extreme media exposure (6 hours a day or more) had the highest CTSR though it could also be considered that those who suffered from the highest CTSR, and thus higher levels of pessimism and negative affect, were both more likely to seek war related media and more likely to be effected negatively by such viewing [49]. At times of national tragedy, such as the events of September 11, media viewing has repeatedly been associated with greater psychological suffering in children and adults [19, 50] though here too, bidirectionality has been considered with those suffering greater emotional distress either compelled to watch more media coverage or confined to home where they have greater opportunities for media exposure. In the current study, greater media exposure did not predict CTSR severity, rather those with extreme media exposure, were found to have higher CTSR severity.
In the current study, the most prominent predictor of CTSR was individual coping style. It had been predicted that flexibility in coping would demonstrate the greatest predictive value for psychological resilience [37] but in our current sample, when considered together, forward-focused coping was the only coping variable which predicted lower CTSR demonstrating its dominance in the current context of ongoing war. While in situations in which the traumatic and stressful event has come to an end, there is a need for processing alongside a return to structure and “normal” functioning, i.e. flexibility; in situations like CTS, processing the event appears to be less useful and even impossible, because the threat is still ongoing. Indeed, processing requires a certain distance from the traumatic event and processing immediately following a traumatic event, even when the event has concluded, shows limited long term functionality [51–53]. Similar findings have been found in the field of grief which correspond to the complexity of a country in mourning and at ongoing stress [54].
When the traumatic event is ongoing or the threat is still apparent, investing one's psychological resources in the future appears to be much more beneficial, not only because it helps detach the individual from their intrapsychic preoccupation with the event but rather by detaching him from the reality in which he is in. The current findings are in accordance with findings on CTS in acutely affected areas (on the Gaza border) [18] but differ from previous findings in early COVID-19 research which found higher meaning focused coping and lower avoidance coping to be predictive of greater psychological wellbeing [35]. It may be postulated that the global and chronic nature of COVID-19, was more appropriate for meaning making coping resources, while the current local and active trauma, even if ongoing, was more suited to forward focused coping. Future research is needed to compare these two coping styles as no direct comparison was made.
In addition to the benefit of forward- focused coping, the current study highlighted the impact of the unstable political arena within which the war began. Though traumatic events and CTS can damage one’s faith and trust in the self and others [6, 55], System justification, the ability to see the societal systems as fair and just, may play a protective role [27]. Although, the current study took place after a period of distinctive mistrust in the Israeli government and ruling authorities, despite on average reporting a slight declination towards a lack of system justification, those who demonstrated higher levels of system justification had significantly less CTSR severity. This reinforces findings regarding the importance of a sense of betrayal in acute trauma. When acute trauma invokes a sense of betrayal, numerous studies have demonstrated higher levels of symptoms and negative trauma appraisals [13, 56] and furthermore, a higher level of ongoing fear [57]. In terms of trauma treatment under CTS, enhancing trust and awareness of safety, appear to be key modifications of traditional PTSD therapies [47] and this is in concordance with current theoretical findings. When a higher level of trust and faith in organizing systems is present, specifically those structures that are relied upon highly in war (such as social services, the government and security services) there is a lower level of stress and emotional distress.
While system justification contributed uniquely to the predictive model of CTSR, when considered together with forward focused coping, the interaction effect accounted for all the predictability. In the current context, forward focused coping and system justification can be considered a unified coping mechanism and interdependent. Thus the combination of trust in systems and a forward focused view helps the individual perceive the situation in which he or she is in a broader perspective and provides an optimal psychological platform to reduce CTSR during CTS. Forward focused coping entails perceiving the stressful period or event in a broader temporal context, pragmatically investing on the future rather than on the past or present. System justification entails appraising the situation in a broader context in terms of trust and justification of wider social structures. When both these cognitive frameworks are present, there is the greatest psychological relief, even during unpredictable, changing and traumatic circumstances with the greatest influence of forward focused coping over and above that of system justifiation. This finding is similar to that demonstrated in first-responders exposed to the 9/11 terrorist attacks. Here too, forward focused coping predicted lower PTSD and interacted with social support to predict the lowest PTSD severity [38]. This interaction and specifically the importance of forward focused coping, has important implications for public health, because, unlike System justification, it is dependent on the individual. The promotion of forward planning, maintenance of routine and a broader, non-trauma focus is important to maintain psychological well-being at times of CTS and specifically, when a CTSR response is identified clinically or due to lack of functioning. Following these findings, it can be inferred that a valuable focus of treatment should be the rediscovery of purpose, and functional activity oriented towards the future.
In the current cross-sectional design, it is impossible to determine causation; whether the utilization of coping strategies leads to lower severity of CTSR or whether the individual engages in increased employment of coping strategies due to the experience of fewer CTSR symptoms though given the existing literature, directionality was hypothesized. Future research should investigate longitudinal assessments of coping strategies and CTSR symptomatology to elucidate their intricate relationship, incorporating examination of potential moderating and mediating factors such as the length or temporal proximity to the war. Additionally, despite concluding the lack of relationship between flexible coping and CTSR, it is possible that the PACT flexibility score, inadequately captures pivotal dimensions of coping flexibility, such as awareness, control, and intent in an individual's deployment of coping strategies. Such dimensions, may serve as moderators or mediators in influencing the impact of coping flexibility on CTS, and therefore are critical in future inquiry [42]. It is important too to note that the sample was predominantly female. While this impacts generalization of results it too reflects the societal situation whereby a large proportion of the male population were recruited to the military or serving in home front neighborhood protection units at the time of data collection.