Confidence in the iron dome missile defense system combined with a sense of resilience reduced the effect of exposure on posttraumatic stress disorder symptoms after missile attacks

To the Editor: In this study, we examined posttraumatic stress disorder (PTSD) symptoms in Israeli civilians following the 2014 Israel-Gaza conflict, during which more than 4,500 missiles were fired on 70% of the Israeli population.1 We addressed how 2 main putative protective factors may mitigate the impact of exposure to missile threat on PTSD symptom development.2 The first factor, resilience, refers to a trait or an intrapsychological process that results in positive adaptation to trauma.3–5 Psychological resilience, potentially related to adaptive belief systems,6 typically reduces the detrimental effects of trauma exposure on PTSD symptoms.7,8 Herein we address whether resilience effects can be strengthened when coupled with a second factor, namely, one's belief in the external protection of the new “Iron Dome” missile defense system. This system was developed in a joint United States/Israel venture, which was employed for the first time on a national scale during the 2014 Israel-Gaza conflict.1 Therefore, our main research question was whether internal resilience coupled with belief in external protection further mitigates the impact of exposure on PTSD.