Metiv Israel Center for the Treatment of Psychotrauma

Background

• Dutch trauma specialist, PhD in PTSD treatment methods.
• Founded the Dutch Institute for Psychotrauma and later METIV, the Israel Psychotrauma Center (1989).
• Immigrated to Israel in 1988, amidst the First Intifada.

Early Experiences in Israel

• Trauma was largely denied in psychiatric circles; not recognized or inquired about.
• Initial research: 1 in 3 psychiatric outpatients had recent trauma; 1 in 6 showed clear PTSD symptoms.
• Israeli psychotherapeutic practice was dominated by psychodynamic approaches, with little cognitive-behavioral therapy (CBT).

Evolution of Trauma Awareness and Services

• First psychosocial service for Holocaust survivors in Israel started only in 1987.
• Widespread societal avoidance and denial of trauma, especially regarding children.
• METIV aimed to shift attitudes and improve trauma care, integrating research and practice.

Understanding Survival Mode

• Survival mode is more complex than “fight, flight, freeze”; it includes profound changes in attachment and learning.
• Attachment becomes heightened—group cohesion as a survival mechanism, seen in both animal behavior and human societies (e.g., post-9/11, wartime Israel).
• Hormonal changes (oxytocin) foster bonding under stress.
• Survival mode affects brain structure and function, even in those without PTSD, and influences behaviors (e.g., aggressive driving).

PTSD and the Continuum of Trauma Responses

• PTSD is defined as being “stuck” in survival mode after threat subsides.
• Findings from METIV’s Peace of Mind program for soldiers:
  
  • 10–15% develop PTSD.
  • 20% show no symptoms.
  • The majority have subclinical or partial symptoms—remnants of survival mode.
• Spectrum model: Most people fall somewhere between full health and diagnosable PTSD.

Treatment Approaches and Challenges

• Standard therapies (CBT, Somatic Experiencing®, EMDR) help only about 35% of chronic PTSD cases.
• New research at METIV:
  
  • MDMA-assisted psychotherapy: Promising, but long (8-hour) therapy sessions alone may be as effective as MDMA.
  • Adjunctive methods: body-mind-breath groups, transcranial magnetic stimulation, sujok therapy (Korean hand acupuncture).
  • Importance of comprehensive, community-based interventions, especially for children (training teachers in resilience, screening for at-risk students).

Critiques of Current Societal and Systemic Approaches

• Overemphasis on therapy as the solution; neglect of community and mutual support.
• Government initiatives (e.g., therapy stipends for soldiers) may send the wrong message—implying individual helplessness and insufficient support.
• Explosion of trauma-related NGOs (397 in Israel post-October 2023) with little coordination or outcome research.
• Need to shift societal language from “everyone needs therapy” to “we are in this together”.

The Role of Community, Culture, and Coping Mechanisms

• Community attachment, humor, spirituality, and shared rituals (e.g., prayer, Talmud study) are vital for resilience.
• Israeli society’s high energy, collective action, and even humor serve as adaptive responses but can also perpetuate survival mode.
• The challenge is to facilitate healthy transitions out of survival mode when safety returns.

Conclusions

• Trauma responses exist on a continuum; diagnostic lines are somewhat arbitrary.
• Societal context and language significantly shape trauma experiences and recovery.
• Effective trauma care requires both individual treatment and community empowerment.
• The current proliferation of trauma services in Israel is unsustainable without coordination and research.
• Resilience is fostered not only through therapy, but also through community, meaning-making, and adaptive coping practices.

Key Takeaways

• Trauma is pervasive but often unrecognized unless directly addressed.
• Survival mode is biologically and socially embedded; leaving it requires safety and support.
• Community and attachment are as crucial as therapy in overcoming trauma.
• Israeli society faces unique challenges due to repeated conflict, but also possesses strong cultural coping tools.

Resources

• Comprehensive Trauma Care Presentation Slides: Mental Health in Israel After October 7 – Knowledge & Strategy

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Bio

Danny Brom is founding director of Metiv, the Israel Psychotrauma Center, affiliated with Herzog Medical Center in Jerusalem. Dr. Brom is a certified clinical psychologist and former associate professor at the Baerwald School of Social Work and Social Welfare of Hebrew University. Metiv develops new responses to the needs of traumatized populations that are not receving adequate interventions, such as young children, demobilized IDF soldiers, and victims of terror. Metiv’s primary current initiative is Peace of Mind, a comprehensive veteran care model supporting combat veterans after their military service.

Brom published the first controlled outcome study on brief therapy for PTSD in 1989. His publications include The Trauma of Terrorism: Sharing Knowledge and Shared Care, An International Handbook and Treating Traumatized Children: Risk, Resilience and Revery. His primary focus is bridging the gap between scientific data and the development of community-based services.