Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres Truck attack: Fear of ISIS and reminder of truck attacks in Europe as associated with psychological distress and PTSD symptoms Michal Mahat-Shamir a, ⁎ , Yaakov Hoffman b , Shani Pitcho-Prelorentzos a , Yaira Hamama-Raz a , Osnat Lavenda a , Lia Ring a , Uzia Halevi a , Eytan Ellenberg c , Ishay Ostfeld c , Menachem Ben-Ezra a a School of Social Work, Ariel University, Israel b Interdisciplinary Department of Social Sciences, Bar-Ilan University, Israel c Bureau of Medical Affairs, National Insurance Institute of Israel, Israel ARTICLE INFO Keywords: ISIS attack Psychological distress Severe stress symptoms ABSTRACT Following an ISIS attack, the present study examined the association between psychological distress and severe stress symptoms with vulnerability variables: i.e. Physical proximity to the site of the terror attack, Associative memory of prior events, Danger perception and ISIS anxiety. Using an online survey, 397 adult participants were recruited, Seventy-two hours after an ISIS terror attack, and filled out Psychological distress Patient Health Questionnaire 4 and severe stress symptoms questionnaire as well as physical proximity to the site of the terror attack, associative memory of prior events, danger perception and ISIS anxiety scales. Physical proximity to the site of the terror attack and ISIS anxiety were found to be significantly associated of both psychological distress and severe stress symptoms. Regarding danger perception, only danger perception of terror attacks was asso- ciated with both psychological distress and with severe stress symptoms. Lastly, whereas being reminded of the 2014 Jerusalem tractor attack (tapping to association via location) was neither associated with psychological distress nor with severe stress symptom, the reminder of the truck attack in Berlin (tapping into association by recency and similarity) was associated with psychological distress but not with severe stress symptoms. The importance of the findings is discussed. 1. Introduction In recent years the Islamic state of Iraq and Syria (ISIS) has fought its wars predominantly in Muslim countries, while focusing to a lesser extent on terror attacks in western countries (Byman, 2016). Yet over a 1000 persons have been killed in ISIS terror attacks in Western coun- tries during the past three years (see Hoffman, 2017). These attacks are broadcasted on worldwide media, with ISIS releasing media content typically claiming responsibility and warning of future attacks. The impact of this media campaign is massive (Lowe, 2015). Hoffman and Shrira (2017) note several reasons for the salience of the ISIS threat to Israeli society. First, ISIS fighting and militia are felt on two out of three of Israel's borders. Second, ISIS has made direct threats to Israel both in Arabic and in Hebrew that echo the Holocaust by explicitly stating its aim of destroying Israel. 1 The genocidal ISIS tendency was actualized against Yazidi's in Iraq (Abdel-Razek and Puttick, 2016). Third, Israeli media covers ISIS fighting and terror very intensely, for example, in a search conducted this past summer in YNET, Israel's most popular news site, the term ISIS was mentioned 2666 times vs. the local terrorist group Hamas which was mentioned only 853 times. Finally, more than 100 Israeli Arabs have joined ISIS, 2 and there is actual danger of them re-entering this region as sleeper agents (see also Byman, 2015). However, only recently (January 8, 2017) has Israel experienced its first ISIS attack, in the heart of Jerusalem, where a truck rammed into a group of soldiers killing four soldiers and wounding tens of soldiers. As this is the first time that an ISIS terror incident occurred in Israel, we wished to gauge how Israeli civilians responded. On the one hand, during 70 years of existence, Israel has literally experienced thousands of terror attacks and thus this current ISIS attack may be just one more. On the other hand, given the above reasons explicating why ISIS terror may be unique to Israelis, following this first ISIS attack in Israel, we were interested to examine the associations between vulnerability variables, known to be associated with stress-related conditions, with both psychological distress and severe stress symptoms. We focus on psychological distress and on severe stress symptoms https://doi.org/10.1016/j.psychres.2018.06.021 Received 19 January 2018; Received in revised form 19 May 2018; Accepted 7 June 2018 ⁎ Corresponding author. E-mail address: mahatshamir@gmail.com (M. Mahat-Shamir). 1 http://www.investigativeproject.org/4446/isis-threatens-holocaust-against-jews 2 http://www.vocativ.com/world/isis-2/israelis-fighting-isis/ Psychiatry Research 267 (2018) 306–312 Available online 18 June 2018 0165-1781/ © 2018 Elsevier B.V. All rights reserved. T