Israeli hostages may need to fight to regain a sense of control in their everyday lives—expert explains

What the Israeli hostages have had to go through is unimaginable. The trauma of that unexpected, barbaric attack by Hamas, the murder of loved ones, then being violently abducted and dragged down into tunnels deep underground in Gaza. We live in a society where we often talk about trauma and post-traumatic stress disorder (PTSD) but it's rarely this bad.

The Northern Irish author Brian Keenan wrote the book An Evil Cradling about his experience of being held hostage by Shi'ite militiamen in the 1980s in Beirut. He was held for over four years in filthy rooms often smaller than a bathroom.

His initial response was denial "to trivialize or to minimize the event and the consequences it may have", but this approach was soon exhausted. The reality of his situation broke through, bringing depression and frustration.

To survive, he says "one has to learn to unhook from the past in order to live for the present". He developed strategies to alleviate his depressions, including imagining jokes that his friends in Belfast would make when he returned. To distract himself from the reality of his beatings and overhearing torture and executions, he concentrated on rewriting old movies in his head, or creating imaginary pictures.

Research on the psychological reaction of the hostages in the Moscow theater siege of 2002 at the hands of Chechen terrorists identified six stages of adaptation: startle-panic, disbelief (many thought initially that it was part of the show), then hypervigilance, resistance-compliance, depression and finally gradual acceptance.

Hostages quickly lost all sense of time. They felt powerless and emotionally numb and said it seemed "like a movie". Some suffered from Stockholm syndrome.

This occurs when hostages develop bonds of attachment to their captors as a result of an unconscious emotional response to the traumatic situation, where death seems as likely to come as a result of the actions of those outside trying to save them as from the captors themselves.

Being taken hostage can have profound psychological effects on people for many years. The psychological impact varies depending on the duration of captivity, the conditions endured, the person's resilience and their coping mechanisms.

Brian Keenan was more resilient than most, but still veered close to the edge. The Israeli hostages vary significantly in age, another important factor. The child hostages will not have developed the necessary coping strategies, and may not understand fully what is happening, if at all.

Some common psychological effects are associated with being a hostage, like PTSD, characterized by intrusive memories or flashbacks, nightmares, severe anxiety, persistent feelings of fear or helplessness. One Dutch study found that a third of ex-hostages were still suffering from PTSD nine years after the event.

Memories that don't fade

These kind of traumatic events are associated with what psychologists call "flashbulb" memories that don't fade like normal memories over time. All of the situational information associated with the event is stored by the brain.

Psychologists suggest that these processes have been shaped by our evolutionary past. The events are so traumatic that we must avoid the situation at all costs in the future, which is why the brain remembers them so well.

Hostages are also likely to experience high levels of anxiety and depression as a result of the trauma. Feelings of sadness, hopelessness, and anhedonia—a loss of pleasure in previously enjoyed activities—are common.

Anger and rage at how this event was "allowed" to happen by the intelligence failure of the Israeli government is likely to be another major issue. Being taken hostage can severely impact a person's ability to trust others. They may feel betrayed by their government's failure to protect them, and struggle with trusting others. They may fight to regain a sense of personal control in their everyday lives.

Hostages may also remain in a constant state of hypervigilance, always on guard for potential threats. This heightened state of alertness can lead to difficulties in relaxing, concentrating and sleeping.

Those hostages released early are also likely to experience survivor's guilt, given that others are still captive. Then there is the survivor's guilt associated with their very survival when so many others perished. They may struggle with feelings of guilt, shame, and self-blame for years.

Long-term therapy

After being released, hostages will require comprehensive psychological support to help them cope with the trauma. Typically this includes a combination of individual therapy, group therapy and specialized interventions.

Techniques such as cognitive-behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) can be used to address symptoms of PTSD. EMDR aims to alleviate the distress associated with traumatic memories or experiences.

The person focuses on the traumatic memory while simultaneously engaging in bilateral stimulation, following the therapist's finger movements with their eyes. This has been shown to be beneficial, reducing the vividness of the traumatic memory and lessening the emotional response.

Hostages will also need a safe and empathetic environment where they can express their emotions about what has occurred. Emotional disclosure where victims build a narrative of their experience integrating their understanding of the events with their emotional responses, is critical for both physical and mental health.

This can be achieved through individual counseling sessions or support groups with other survivors who have endured similar experiences. Educating victims about the common reactions and symptoms associated with trauma can also help, by helping to normalize their psychological reactions and reduce their feelings of isolation.

We must remember that the specific psychological support needed after release from a hostage situation will vary from person to person. Therefore, a comprehensive assessment by mental health professionals is crucial to determine the most appropriate and effective interventions for each victim. But, in the case of the Israeli hostages, it's important to recognize how enduring some of the effects may well be for the majority of them.

This article is republished from The Conversation under a Creative Commons license. Read the original article.