Psychic numbing

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Psychic numbing is a tendency for individuals or societies to withdraw attention from past experiences that were traumatic, or from future threats that are perceived to have massive consequences but low probability. [1] [2] Psychic numbing can be a response to threats as diverse as financial and economic collapse, the risk of nuclear weapon detonations, pandemics, and global warming. [3] It is also important to consider the neuroscience behind the phenomenon, which gives validation to the observable human behavior. [4] [5] The term has evolved to include both societies as well as individuals, so psychic numbing can be viewed from either a collectivist or an individualist standpoint. Individualist psychic numbing is found in rape survivors and people who have post-traumatic stress disorder. [6]

Contents

History

The original concept of psychic numbing argued by Robert Jay Lifton was that it manifests itself collectively. This means that a society or a culture adapts this withdrawn attention outlook and collectively applies it to current issues. [1]

Robert Jay Lifton: "Beyond Psychic Numbing: A Call to Awareness"

Lifton's 4 Focal Points:

  1. Hiroshima as a text for "psychic numbing"
  2. Nuclear Illusions
  3. What are nuclear weapons doing to us? (Nuclear fundamentalism)
  4. Hope for the future

Lifton's main area of focus was the Hiroshima bombing during World War II. He broke up his analysis of the bombing into psychological stages that spread at the societal level. Lifton's article, "Beyond Psychic Numbing: A Call to Awareness", [1] addressed a concern that was new at the time: nuclear warfare. He argued now that there is a single weapon in the world that can cause so much damage, humans need to be more alert and confront the images of nuclear power and an ever increasing nuclear actuality. [1] [2] There is a societal understanding now that countries can create nuclear weapons; this led to Lifton's coining of the term "nuclear fundamentalism". [1]

All these are argued by Lifton to be beneficial at times, however rather inadequate for helping people feel better about the ubiquity of nuclear weapons and potential warfare. There needs to be a sense of control [1] [2] [3] [6] in order to comprehend the consequences of nuclear warfare as well as strategies to combat the psychological grip it has on individuals.

Lifton's final argument regarding hope for the future is that society must take action. He uses Vietnam War veterans as a reference point. [1] [6] He has worked with them before and noticed partial changes, while he agrees this is good, society must adapt an awareness that aims to teach and educate as opposed to avoid and withdraw from the potential threats to survival. [1] [2] [6]

Neuroscience

Psychic numbing has been associated with post-traumatic stress disorder (PTSD) because they share the same attributes of withdrawal and behavioral changes when presented with a stimuli that triggers a reminder of the traumatic event or with a very intense neutral stimuli. [4] The observable emotional response is not enough to understand the concept of psychic numbing. Therefore, neuroscience and the biological activity that occurs within the brain is employed to give people a better understanding of the thought process of individuals who engage in psychic numbing.

Studies have also focused on the habituation of the rostral anterior cingulate cortex (rACC). [7] The rACC is part of the limbic system, which is responsible for emotional processing. It is hypothesized that the rACC determines the, "correct allocation of attention based resources to emotionally aversive stimuli". [7] This means it may play an active role in identifying important behavioral responses necessary to comprehend the consequences of the aversive stimuli. The limbic system also includes areas that are important for memory consolidation. The relationship between all the areas in the limbic system is an area of interest for psychic numbing because it encapsulates two factors that contribute to the phenomenon: emotions and memory. [7] These studies are also a good paradigm for the understanding of psychic numbing because they consider sustained aversive material and how the brain reacts in a habitual manner in an effort to remove the underlying emotional content. [4] [5] [7]

Neuropsychophysiology

Cortisol helps regulate the stress response via the negative feedback loop, which are activated when a person is subjected to specific situations that trigger the relationship between the emotionally charged memories of the traumatic event and the observable autonomic responses. [8]

Stress can also be considered a brain-body reaction due to external or internal cues, this can include the environment as well as memory. The areas of the brain that communicate with one another are the prefrontal cortex, amygdala, hippocampus, nucleus accumbens, and the hypothalamus. Through a series of feedback processes, the release of specific neurotransmitters as well as neuromodulators occurs. [8]

MRI posterior cingulate MRI posterior cingulate.png
MRI posterior cingulate

Norepinephrine (NE) is released by the Locus coeruleus, it is then transferred to the limbic system where much of the memory consolidation and fight or flight responses are facilitated.

Adrenocorticotropin (ACTH) is released from the anterior pituitary, which triggers the release of glucocorticoids from the adrenals. The chronic exposure to stress affects organisms that deal with daily activities and it also interferes with one's coping mechanisms.

Once the HPA axis is activated, it triggers an increase in glucocorticoids. Once these hormones cross the blood–brain barrier, they interact with other neurotransmitters and change the brain's chemistry as well as structure. [8]

The process of habituation is important to consider because it is a prevalent variable in the phenomenon of psychic numbing. The constant exposure a society or individual has to a prolonged and sustained aversive stimuli, the emotional magnitude that the stimuli has decreases greatly over time to where it becomes unnoticeable to those who have been surrounded by it for a long period of time. This type of response is seen in Vietnam veterans and rape victims who suffer from PTSD. [6]

Additionally, studies describe the importance of the rACC and the cingulate cortex for comprehension and the feeling of a painful stimulus. [5] Taiwanese and American researchers recorded brain-wave readings from participants as the researchers observed body parts pricked with a pin, or dabbed with a Q-tip. Half of the subjects were physicians and the other half was a control group. The control group showed clear differences in his or her reactions to the pin-prick in comparison to the Q-tip. The physicians, who previously had experience managing sickness and pain, did not. The authors of the study theorized that the physicians unconsciously numbed their reaction to the pain of the pin-prick due to his or her profession. This may be a beneficial result because physicians need to block out the pain response and use more cognitive resources necessary for being of assistance in a time of need. [5] This further suggests the individual differences people have in regards to psychic numbing and the deviation away from more tragic accounts of rape and PTSD. This type of desensitization is not independent of the participant's lives, instead it is a result of years of experience woven into his or her daily lives, resulting in a numbed response. Figures of areas of the control group's brains showed activation in the rACC, and the physician's brains did not, suggesting there was already habituation.

Conceptualizations

Normative graphs of the value of life saving Normative graphs of the value of life saving.jpg
Normative graphs of the value of life saving

The original view of psychic numbing dealt with human extinction and the mass response to potentially life-threatening scenarios. Lifton argued the worry for these events was low and therefore generated an equally low probability of occurrence point of view. [1] This repeated exposure makes humans numb to the possibility that an event of that nature can occur. However, when asked to recall the probability that mass extinction will occur, people have a tendency to think counter-intuitively and rate the probability as high when it is in fact low and behaviorally respond opposite to his or her rating. [2]

Additionally, much of the individualist view comes from studying the behavioral traits of people who suffer from PTSD. Focus groups, clinical cases, as well as religion play a crucial role in one's ability to cope with the stress of traumatic stimuli. [6] Many studies have been conducted that address the value of these therapeutic interventions as well as their efficacy. There is a strong connection to depersonalization, emotional numbing, as well as dissociation from one's identity. This shows the shift of psychic numbing from a collectivist view to an individualistic view.

Collectivist

Robert Jay Lifton spearheaded the psychic numbing movement and his concentration was on a much larger scale. Psychic numbing is about the way a culture or society withdraws from issues that would otherwise be too overwhelming for the human mind to comprehend. In this respect, psychic numbing is a societal reaction to impending doom, chaos, and ultimately mankind's extinction. [1]

Paul Slovic, a prominent psychologist in the realm of risk, maintains the original interpretation posited by Lifton. Slovic's article, "Psychic Numbing and Mass Atrocity", returns to the collectivist model and most notably confronts the value of saving a human's life. The figures to the right denote both arguments for the hypothesized value of saving a human's life as well as the true value of saving a human's life established through Slovic's empirical research. [1] [2] Slovic introduced the concept of psychophysical numbing, which is the diminished sensitivity to the value of life and an inability to appreciate loss. [2] Essentially, the proportion of lives saved is more important than the number of lives saved. [2] One of Slovic's arguments for this outcome is that people suffer from innumeracy and cannot comprehend the emotional connotation associated with large numbers. The threshold, as stated by Slovic, where people cannot comprehend the emotional magnitude of the loss of life is two, as shown in the figure. Paul and researchers say findings can be summarized with "The more who die, the less we care." [2] [9]

Graph of the value of saving a human life Graph of the value of saving a human life.jpg
Graph of the value of saving a human life

Slovic also points to Weber's law, which states the difference between two stimuli is proportional to the magnitude of the stimuli. Additionally, Weber's law focuses on the just-noticeable difference between the two stimuli. Slovic addressed Weber's law from a different context - he considered the magnitude and value of a human life. Slovic took Weber's law and incorporated prospect theory, which is decision making based on potential gains and losses, not the actual outcome. Slovic found that when prospect theory and Weber's law are analyzed in regards to human life, the value of saving human lives is greater for a smaller tragedy than for a larger one. [2]

These are all considered collectivist views of psychic numbing because they encapsulate a general theory of mind held by the majority of citizens in a society. Additionally, these views remain consistent with the original concept of which collective avoidance and attention withdrawal becomes the active state of mind in regards to potential threats of mass extinction. [1] [2]

Individualist

Psychic numbing, as it shifts away from the collectivist view, is a common characteristic of people who suffer from PTSD. A general definition of psychic numbing is a diminished response to the external world. [10] There are three elements that attribute to psychic numbing: [10]

  1. Loss of interest in activity
  2. detachment from others
  3. restricted range of affect

These two mechanisms promote the inability to engage emotionally with a traumatic memory (acceptance), thus impairing the process of recovery. [10] [11]

Susan Gill bridges the disciplines of social psychology and neuropsychology in her analysis of psychic numbing by explaining that there are notable behavioral changes, the most typical trait is being zombie-like and in a "dead-zone". [12]

The state of being overwhelmed is different than complete shut-down. Overwhelmed responses follow moderate to prolonged stressful states and result in an active effort to regain control. [12]
The very anatomy of the brain can be manipulated under extreme cases of psychic numbing. The neurochemical reactions fail to metabolize and result in lack of synaptic connections and neuronal firing with no dendritic connections. There is also a loop of the same information that fails to connect with other areas of the brain, which results in the inability to get out of the "dead-zone". [10] [12]

Religion

Religion is also considered to be an internalized coping mechanism. The role of religious values in coping with life-threatening illnesses is another individualistic trait that people use to cope with the behavioral side-effects associated with the diseases. [13] Depersonalization is a very prominent behavioral trait associated with cancer patients. Findings show that people with cancer cope no worse than non-cancer patients. [13] [14] Cancer patients tend to blunt his or her experiences as a means of handling a painful reality. Avoidance and denial are typical tendencies of psychic numbing. [14] Cancer patients also report a self-distancing mechanism, and take on a third-person perspective as a means of dealing with the life-threatening disease. [13] It is argued that putting one's life within a framework of religion is a very important part of the coping process. This religious framework helps the patients understand that some things are out of one's control. As discussed earlier, a lack of control over one's stressful stimuli generates a degree of psychic numbing. However, by putting his or her life-threatening disease within a religious framework takes the mystery out of the disease and adds a sense of control. [13] As discussed earlier, the perceived sense of control as well as actual control are important contributors to adequately coping with psychic numbing. [13] [14]

As described earlier, research on psychic numbing has suggested that people who become desensitized to suffering may be more adept in dealing with an upsetting or dangerous situation.

Nuclear denial disorder

Many individuals fail to react effectively to the overwhelming threat of annihilation by nuclear warfare, and in 1987 Thomas C. Wear termed this nuclear denial disorder, a type of psychic numbing. It involves the over-use of a denial defense mechanism, and "an apathetic business-as-usual attitude toward the threat of nuclear annihilation". [15] Michael D. Newcomb viewed nuclear denial as an avoidant response to quite justifiable nuclear anxiety. [16]

Related Research Articles

<span class="mw-page-title-main">Fear</span> Basic emotion induced by a perceived threat

Fear is an intensely unpleasant emotion in response to perceiving or recognizing a danger or threat. Fear causes psychological changes that may produce behavioral reactions such as mounting an aggressive response or fleeing the threat. Fear in human beings may occur in response to a certain stimulus occurring in the present, or in anticipation or expectation of a future threat perceived as a risk to oneself. The fear response arises from the perception of danger leading to confrontation with or escape from/avoiding the threat, which in extreme cases of fear can be a freeze response. The fear response is also implicated in a number of mental disorders, particularly anxiety disorders.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones generally with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.

Acute stress reaction (ASR), also known as psychological shock, mental shock, or simply shock, and acute stress disorder (ASD), is a psychological response to a terrifying, traumatic, or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).

Reduced affect display, sometimes referred to as emotional blunting or emotional numbing, is a condition of reduced emotional reactivity in an individual. It manifests as a failure to express feelings either verbally or nonverbally, especially when talking about issues that would normally be expected to engage emotions. In this condition, expressive gestures are rare and there is little animation in facial expression or vocal inflection. Additionally, reduced affect can be symptomatic of autism, schizophrenia, depression, post-traumatic stress disorder, depersonalization derealization disorder, schizoid personality disorder or brain damage. It may also be a side effect of certain medications.

<span class="mw-page-title-main">Emotional detachment</span> Inability and/or disinterest in emotionally connecting to others

In psychology, emotional detachment, also known as emotional blunting, is a condition or state in which a person lacks emotional connectivity to others, whether due to an unwanted circumstance or as a positive means to cope with anxiety. Such a coping strategy, also known as emotion-focused coping, is used when avoiding certain situations that might trigger anxiety. It refers to the evasion of emotional connections. Emotional detachment may be a temporary reaction to a stressful situation, or a chronic condition such as depersonalization-derealization disorder. It may also be caused by certain antidepressants. Emotional blunting, also known as reduced affect display, is one of the negative symptoms of schizophrenia.

Punishment is any change in a human or animal's surroundings which, occurring after a given behavior or response, reduces the likelihood of that behavior occurring again in the future. Reinforcement, referring to any behavior that increases the likelihood that a response will occurs, plays a large role in punishment. Motivating operations (MO) can be categorized in abolishing operations, decrease the effectiveness of the stimuli and establishing, increase the effectiveness of the stimuli. For example, a painful stimulus which would act as a punisher for most people may actually reinforce some behaviors of masochistic individuals.

Desensitization is a psychology term related to the treatment or process that diminishes emotional responsiveness to a negative or aversive stimulus after repeated exposure. This process typically occurs when an emotional response (feeling) is repeatedly triggered, but the action tendency associated with the emotion proves irrelevant or unnecessary.

Stress-related disorders constitute a category of mental disorders. They are maladaptive, biological and psychological responses to short- or long-term exposures to physical or emotional stressors. The National Institute of Environmental Health Sciences categorizes Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD) as stress-related disorders. However, the World Health Organization's ICD-11 excludes OCD but categorizes PTSD, Complex Post-Traumatic Stress Disorder (CPTSD), adjustment disorder as stress-related disorders.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

Incident stress is a condition caused by acute stress which overwhelms a staff person trained to deal with critical incidents such as within the line of duty for first responders, EMTs, and other similar personnel. If not recognized and treated at onset, incident stress can lead to more serious effects of posttraumatic stress disorder.

Emotional responsivity is the ability to acknowledge an affective stimuli by exhibiting emotion. It is a sharp change of emotion according to a person's emotional state. Increased emotional responsivity refers to demonstrating more response to a stimulus. Reduced emotional responsivity refers to demonstrating less response to a stimulus. Any response exhibited after exposure to the stimulus, whether it is appropriate or not, would be considered as an emotional response. Although emotional responsivity applies to nonclinical populations, it is more typically associated with individuals with schizophrenia and autism.

In psychology, avoidance coping is a coping mechanism and form of experiential avoidance. It is characterized by a person's efforts, conscious or unconscious, to avoid dealing with a stressor in order to protect oneself from the difficulties the stressor presents. Avoidance coping can lead to substance abuse, social withdrawal, and other forms of escapism. High levels of avoidance behaviors may lead to a diagnosis of avoidant personality disorder, though not everyone who displays such behaviors meets the definition of having this disorder. Avoidance coping is also a symptom of post-traumatic stress disorder and related to symptoms of depression and anxiety. Additionally, avoidance coping is part of the approach-avoidance conflict theory introduced by psychologist Kurt Lewin.

Emotional lateralization is the asymmetrical representation of emotional control and processing in the brain. There is evidence for the lateralization of other brain functions as well.

The management of traumatic memories is important when treating mental health disorders such as post traumatic stress disorder. Traumatic memories can cause life problems even to individuals who do not meet the diagnostic criteria for a mental health disorder. They result from traumatic experiences, including natural disasters such as earthquakes and tsunamis; violent events such as kidnapping, terrorist attacks, war, domestic abuse and rape. Traumatic memories are naturally stressful in nature and emotionally overwhelm people's existing coping mechanisms.

<span class="mw-page-title-main">Effects of stress on memory</span> Overview of the effects of stress on memory

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PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Early childhood trauma refers to various types of adversity and traumatic events experienced during the early years of a person's life. This is deemed the most critical developmental period in human life by psychologists. A critical period refers to a sensitive time during the early years of childhood in which children may be more vulnerable to be affected by environmental stimulation. These traumatic events can include serious illness, natural disasters, family violence, sudden separation from a family member, being the victim of abuse, or suffering the loss of a loved one. Traumatic experiences in early childhood can result in severe consequences throughout adulthood, for instance developing post-traumatic stress disorder, depression, or anxiety. The effects of this trauma can be experienced very differently depending on factors such as how long the trauma was, how severe and even the age of the child when it occurred. Negative childhood experiences can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. However, not all children who are exposed to negative stimuli in early childhood will be affected severely in later life; some children come out unscathed after being faced with traumatic events, which is known as resilience. Many factors can account for the invulnerability displayed by certain children in response to adverse social conditions: gender, vulnerability, social support systems, and innate character traits. Much of the research in this area has referred to the Adverse Childhood Experiences Study (ACE) study. The ACE study found several protective factors against developing mental health disorders, including mother-child relations, parental health, and community support. However, having adverse childhood experiences creates long-lasting impacts on psychosocial functioning, such as a heightened awareness of environmental threats, feelings of loneliness, and cognitive deficits. Individuals with ACEs are more prone to developing severe symptoms than individuals in the same diagnostic category.

Compassion fade is the tendency to experience a decrease in empathy as the number of people in need of aid increase. As a type of cognitive bias, it has a significant effect on the prosocial behaviour from which helping behaviour generates. The term was developed by psychologist and researcher Paul Slovic.

<span class="mw-page-title-main">Dual representation theory</span>

Dual representation theory (DRT) is a psychological theory of post-traumatic stress disorder (PTSD) developed by Chris Brewin, Tim Dalgleish, and Stephen Joseph in 1996. This theory proposes that certain symptoms of PTSD - such as nightmares, flashbacks, and emotional disturbance - may be attributed to memory processes that occur after exposure to a traumatic event. DRT proposes the existence of two separate memory systems that run in parallel during memory formation: the verbally accessible memory system (VAM) and situationally accessible memory system (SAM). The VAM system contains information that was consciously processed and thus can be voluntarily recalled or described. In contrast, the SAM system contains unconsciously processed sensory information that cannot be voluntarily recalled. This theory suggests that the VAM system is impaired during a traumatic event because conscious attention is narrowly drawn to threat-related information. Therefore, memory of the trauma is heavily focused on fear, which affects information processing. This gives rise to PTSD symptoms such as trauma-related cognitions, appraisals, and emotions. The SAM system captures vivid sensory information during the traumatic event, which is automatically recalled through exposure to trauma-related triggers. This system is thought to be responsible for the presence of flashbacks and nightmares in PTSD symptomatology.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 Lifton, Robert Jay (October 1982). "Beyond psychic numbing: a call to awareness". American Journal of Orthopsychiatry. 52 (4): 619–629. doi:10.1111/j.1939-0025.1982.tb01451.x. PMID   7148983.
  2. 1 2 3 4 5 6 7 8 9 10 11 Slovic, Paul; David Zionts; Andrew K. Woods; Ryan Goodman; Derek Jinks (August 2011). "Psychic numbing and mass atrocity". New York University School of Law: 1–17. SSRN   1809951.
  3. 1 2 Gregory, Robert J. (Fall 2003). "Venturing past psychic numbing: facing the issues". Journal for the Psychoanalysis of Culture and Society. 8 (2).
  4. 1 2 3 van der Kolk, Bessel (1994). "The body keeps the score: memory and the evolving psychobiology of post traumatic stress". Harvard Review of Psychiatry. 1 (5): 253–265. doi:10.3109/10673229409017088. PMID   9384857. S2CID   23677122.
  5. 1 2 3 4 Decety, Jean; Yang, Chia-Yan; Cheng, Yawei (1 May 2010). "Physicians down-regulate their pain empathy response: An event-related brain potential study" (PDF). NeuroImage. 50 (4): 1676–1682. doi:10.1016/j.neuroimage.2010.01.025. PMID   20080194. S2CID   6081243. Archived from the original (PDF) on 18 October 2011. Retrieved 1 May 2012.
  6. 1 2 3 4 5 6 Rozynko, Vitali; Harvey E. Dondershine (Spring 1991). "Trauma focus group therapy for vietnam veterans with ptsd". Psychotherapy. 28 (1): 157–161. doi:10.1037/0033-3204.28.1.157.
  7. 1 2 3 4 Phan, K. L.; Israel Liberzon; Robert C. Welsh; Jennifer C. Britton; Stephan F. Taylor (2003). "Habituation of rostral anterior cingulate cortex to repeated emotionally salient pictures". Neuropsychopharmacology. 28 (7): 1344–1350. doi: 10.1038/sj.npp.1300186 . PMID   12784119.
  8. 1 2 3 Mora, Francisco; Gregorio Segovia; Alberto del Arco; Marta de Blas; Pedro Garrido (2012). "Stress, neurotransmitters, corticosterone and body-brain integration". Brain Research. 1476: 1–15. doi:10.1016/j.brainres.2011.12.049. PMID   22285436. S2CID   41412550.
  9. "Why 500,000 COVID-19 Deaths May Not Feel Any Different : Short Wave". NPR.org. 2021-02-09. Retrieved 2021-02-09.
  10. 1 2 3 4 Feeny, Norah C.; Lori A. Zoellner; Lee A. Fitzgibbons; Eden B. Foa (2000). "Exploring the roles of emotional numbing, depression, and dissociation in ptsd". Journal of Traumatic Stress. 13 (3): 489–497. doi:10.1023/a:1007789409330. PMID   10948488. S2CID   42116540.
  11. Hicks, David; Andy Bord (2001). "Learning about global issues: why most educators only make things worse". Environmental Education Research. 7 (4): 413–425. doi:10.1080/13504620120081287. S2CID   144017632.
  12. 1 2 3 Gill, Susan (2010). "The therapist as a psychobiological regulator: dissociation, affect attunement, and clinical process". Clin Soc Work J. 38 (3): 260–268. doi:10.1007/s10615-009-0213-5. S2CID   10669064.
  13. 1 2 3 4 5 Acklin, Marvin W.; Earl C. Brown; Paula A. Mauger (1983). "The role of religious values in coping with cancer". Journal of Religion and Health. 22 (4): 322–333. doi:10.1007/bf02279928. PMID   24306829. S2CID   19133263.
  14. 1 2 3 Solomon, Zahava; Mario Mikulincer; Rivka Arad (1991). "Monitoring and blunting: the implications for combat-related post-traumatic stress disorder". Journal of Traumatic Stress. 4 (2): 209–221. doi:10.1002/jts.2490040205.
  15. Thomas C. Wear (1987). "Nuclear denial disorder". The Humanistic Psychologist. 15 (3): 215–218. doi:10.1080/08873267.1987.9976800.
  16. Smith, Tom W. (Winter 1988). "A Report: Nuclear Anxiety". Public Opinion Quarterly. 52 (4): 557. doi:10.1086/269131.