Nesiller Arası Travma: Kuramsal Temelleri, Aktarım Mekanizmaları, Etkileri ve Müdahale Yaklaşımları

Öz

Nesiller arası travma; travmatik deneyimlerin çeşitli mekanizmalar aracılığıyla nesiller boyunca aktarıldığı, sosyal, kültürel ve biyolojik düzeylerde işleyen çok katmanlı bir süreç olarak tanımlanmaktadır. Soykırım-lar, savaşlar, zorunlu göç ve aile içi şiddet gibi makro ve mikro düzeydeki travmatik deneyimlerin, sonraki nesiller üzerindeki görünür ve gizil etkileri, geniş bir literatürle desteklenmektedir. Araştırmacıların geliş-tirdiği farklı kuramsal modeller ve yaklaşımlar, nesiller arası travmanın çok boyutlu yapısını kavrayabilme-miz açısından önemli bir zemin sunmaktadır. Bu modeller ve çerçeveler, nesiller arası travmanın psikolojik, sosyokültürel ve biyolojik düzeylerde nasıl işlediğini anlamamıza yardımcı olmaktadır. Literatürdeki çalış-malardan yola çıkarak, bu çalışmada, nesiller arası travmanın kapsamı, aktarım yolları, psikolojik sonuçları ve müdahale yaklaşımları gözden geçirilmiş ve Türkçe literatürdeki bütüncül çerçeve eksikliğinin giderilme-si amaçlanmıştır. Bu doğrultuda nesiller arası travmanın yalnızca bireysel psikolojik etkilerle sınırlı kalma-dığı; toplumsal, kültürel ve biyolojik düzeylerde de çok yönlü sonuçlar doğurduğu ortaya konulmuştur. Ayrıca, travmatik aktarımın yalnızca kırılganlık ve psikopatolojiye yol açmadığı, uygun sosyal destek, işlev-sel aile dinamikleri ve kültürel aidiyet gibi koruyucu faktörler sayesinde dayanıklılığın da nesiller boyunca aktarılabildiği vurgulanmıştır.

Anahtar Kelimeler

• nesiller arası travma
• psikolojik travma
• derleme

Intergenerational Trauma: Conceptual Frameworks, Mechanisms of Transmission, Impacts and Intervention Approaches

Abstract

Intergenerational trauma is defined as the process of transferring traumatic experiences across generations through various mechanisms; it is considered as a multi-layered transfer process that operates at social, cultural and biological levels. The visible and latent effects of macro and micro traumatic experiences such as genocides, wars, forced migration and domestic violence on subsequent generations are supported by a wide literature. The different theoretical models and explanatory frameworks developed by researchers provide an important basis for understanding the multi dimensional structure of intergenerational trauma. These models and frameworks help us understand how intergenerational trauma operates at psychological, sociocultural and biological levels. Based on the studies in the literature, this study reviewed the scope of intergenerational trauma, transmission paths, psychological consequences and intervention approaches, and aimed to eliminate the lack of a holistic framework in the Turkish literature. In this context, it has been demonstrated that intergenerational trauma is not limited to individual psychological effects; it also produces multifaceted results at social, cultural and biological levels. In addition, it has been emphasized that traumatic transmission does not only lead to fragility and psychopathology, but also that resilience can be transmitted across generations thanks to protective factors such as appropriate social support, functional family dynamics and cultural belonging.

Keywords

• intergenerational trauma
• psychological trauma
• review

References

1. Aburn G, Hoare K, Adams P, Gott M (2020) Connecting theory with practice: time to explore social reality and rethink resilience among health professionals. Int J Nurs, 26:e12893.
2. Ainsworth MDS (1978) The Bowlby-Ainsworth attachment theory. Behav Brain Sci, 1:436-438.
3. Alexander JC (2004) Toward a theory of cultural trauma. In Cultural Trauma and Collective Identity, (Eds JC Alexander, R Eyerman, B Giesen, NJ Smelser, P Sztompka):1-30. Berkeley, University of California Press.
4. APA (2018) Disctionary of Psychology. https://dictionary.apa.org/trauma (Accessed 25.01.2025).
5. Ancharoff MRM, Munroe J, Fisher L (1998) The legacy of combat trauma: clinical implications of intergenerational transmission. In International Handbook of Multigenerational Legacies of Trauma, (Ed Danieli Y):257-276. Boston, Springer.
6. Asmundson GJ, Thorisdottir AS, Roden-Foreman JW, Baird SO, Witcraft SM, Stein AT et al. (2019) A meta-analytic review of cognitive processing therapy for adults with posttraumatic stress disorder. Cogn Behav Ther, 48:1-14.
7. Atkinson M (2013) The Transgenerational Transmission and Poetics of Trauma: A Fictional-Conceptual Manifesto. New York, Bloomsbury.
8. Auerhahn NC, Laub D, Peskin H (1993) Psychotherapy with Holocaust survivors. Psychotherapy (Chic), 30:434-442.

9. Bandura A (1977) Social Learning Theory. Englewood Cliffs, NJ, Prentice-Hall.
10. Bar-On D, Eland J, Kleber RJ, Krell R, Moore Y, Sagi A et al. (1998) Multigenerational perspectives on coping with the holocaust experience: an attachment perspective for understanding the developmental sequelae of trauma across generations. Int J Behav Dev, 22:315-338.
11. Barocas HA, Barocas CB (1980) Separation-individuation conflicts in children of holocaust survivors. J Contemp Psychother, 11:6-14.
12. Beck AT (1987) Cognitive models of depression. J Cogn Psychother, 1:5-37.
13. Belnap B (2019) Turns of a phrase: traumatic learning through the generations. In Lost in Transmission: Studies of Trauma Across Generations, (Ed MG Fromm):115-130. London, Routledge.
14. Berger SS (2014) Whose trauma is it anyway? Furthering our understanding of its intergenerational transmission. J Infant Child Adolesc Psychother, 13:169-181.
15. Berthelot N, Ensink K, Bernazzani O, Normandin L, Luyten P, Fonagy P (2015) Intergenerational transmission of attachment in abused and neglected mothers: The role of trauma‐specific reflective functioning. Infant Ment Health J, 36:200-212.
16. Bohacek J, Mansuy IM (2015) Molecular insights into transgenerational non-genetic inheritance of acquired behaviours. Nat Rev Genet, 16:641-652.
17. Bohus M, Kleindienst N, Hahn C, Müller-Engelmann M, Ludäscher P, Steil R et al. (2020) Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) compared with cognitive processing therapy (CPT) in complex presentations of PTSD in women survivors of childhood abuse: a randomized clinical trial. JAMA Psychiatry, 77:1235-1245.
18. Bonanno GA, Papa A, Lalande K, Westphal M, Coifman K (2004) The importance of being flexible: The ability to both enhance and suppress emotional expression predicts long-term adjustment. Psychol Sci, 15:482-487.
19. Bonasio R, Tu S, Reinberg D (2010) Molecular signals of epigenetic states. Science, 330:612-616.
20. Bowe C, Thomas C, Mackey P (2025) Perspective to practice: theoretical frameworks explaining intergenerational trauma, violence, and maltreatment and implications for the therapeutic response. Int J Environ Res Public Health, 22:321.
21. Bowen M (1966) The use of family theory in clinical practice. Compr Psychiatry, 7:345-374.
22. Bowlby J (1979) The Bowlby-Ainsworth attachment theory. Behav Brain Sci, 2:637-638.
23. Braga LL, Mello FM, Fiks JP (2012) Transgenerational transmission of trauma and resilience: A qualitative study with Brazilian offspring of Holocaust survivors. BMC Psychiatry, 12:134.
24. Bronfenbrenner U (1979) The Ecology of Human Development. Cambrdige, MA, Harvard University Press.
25. Cadet JL (2016) Epigenetics of stress, addiction, and resilience: Therapeutic implications. Mol Neurobiol, 53:545-560.
26. Caselli LT, Motta RW (1995) The effect of PTSD and combat level on Vietnam veterans' perceptions of child behavior and marital adjustment. J Clin Psychol, 51:4-12.
27. Catani C, Jacob N, Schauer E, Kohila M, Neuner F (2008) Family violence, war, and natural disasters: A study of the effect of extreme stress on children’s mental health in Sri Lanka. BMC Psychiatry, 8:33.
28. Cerdeña J, Rivera L, Spak J (2021) Intergenerational trauma in Latinxs: A scoping review. Soc Sci Med, 270:113662.
29. Chan JC, Nugent BM, Bale TL (2018) Parental advisory: Maternal and paternal stress can impact offspring neurodevelopment. Biol Psychiatry, 83:886-894.
30. Chernivsky M (2023) ‘Live on—Pass on?’. In PresentPast: Psychosocial Help for Traumatized After Politicized Conflicts and Collective Violence, (Eds M Chernivsky, L Welz):112-118. Fehldruck, Erfuhrt.
31. Choi-Kain L, Wilks CR, Ilagan GS, Iliakis EA (2021) Dialectical behavior therapy for early life trauma. Curr Treat Options Psychiatry, 8:111-124.
32. Cicchetti D (1984) The emergence of developmental psychopathology. Child Dev, 55:1-7.
33. Clarke HJ, Vieux KF (2015) Epigenetic inheritance through the female germ-line: The known, the unknown, and the possible. Semin Cell Dev Biol, 43:106-116.
34. Cohen ZP (2019) Üç kuşak kadın yetişkinin çocukluk çağı travmaları, dissosiyasyon ve şiddete yönelik tutumları bakımından incelenmesi (Uzmanlık tezi). İstanbul, İstanbul Üniversitesi Cerrahpaşa.
35. Connolly A (2011) Healing the wounds of our fathers: Intergenerational trauma, memory, symbolization and narrative. J Anal Psychol, 56:607–626.
36. Copping VE, Warling DL, Benner DG, Woodside DW (2001) A child trauma treatment pilot study. J Child Fam Stud, 10:467-475.
37. Copping VE (1996) Beyond over and under control: behavioral observations of shelter children. J Fam Violence, 11:41-57.
38. Craig C, Hiskey S, Spector A (2020) Compassion focused therapy: a systematic review of its effectiveness and acceptability in clinical populations. Expert Rev Neurother, 20:385-400.
39. Cramer S (2019) Intergenerational narrative practice in response to intergenerational trauma. Int J Narrat Ther Community Work, 1:1-11.
40. Dalgaard NT, Todd BK, Daniel SI, Montgomery E (2016) The transmission of trauma in refugee families: Associations between intra-family trauma communication style, children’s attachment security and psychosocial adjustment. Attach Hum Dev, 18:69-89.
41. Danieli Y (1998) International Handbook of Multigenerational Legacies of Trauma. New York, Plenum Press.
42. Danieli Y (2013) The treatment and prevention of long-term effects and intergenerational transmission of victimization: A lesson from Holocaust survivors and their children. In Trauma and Its Wake, (Ed CR Figley):295-313. London, Routledge.
43. Daskalakis NP, Lehrner A, Yehuda R (2013) Endocrine aspects of post-traumatic stress disorder and implications for diagnosis and treatment. Endocrin Metab Clin, 42:503-513.
44. Dass-Brailsford P (2007) A Practical Approach to Trauma: Empowering Interventions. Thousand Oaks, CA, Sage.
45. De Bellis MD, Baum AS, Birmaher B, Keshavan MS, Eccard CH, Boring AM et al. (1999) Developmental traumatology part I: Biological stress systems. Biol Psychiatry, 45:1259–1270.
46. De Bellis MD, Keshavan MS, Clark DB, Casey BJ, Giedd JN, Boring AM et al. (1999b) Developmental traumatology part II: Brain development. Biol Psychiatry, 45:1271–1284.
47. Dekel R, Goldblatt H (2008) Is there intergenerational transmission of trauma? The case of combat veterans' children. Am J Orthopsychiatry, 78:281–289.
48. Demos EV (2019) Intergenerational violence and the family myth. In Lost In Transmission: Studies of Trauma Across Generations, (Ed MG Fromm):131-138. London, Routledge.
49. Dias BG, Ressler KJ (2014) Parental olfactory experience influences behavior and neural structure in subsequent generations. Nat Neurosci, 17:89-96.
50. Dodge KA, Bates JE, Pettit GS (1990) Meisms in the cycle of violence. Science, 250:1678-1683.
51. Echterling LG, Presbury JH, McKee JE (2005) Crisis Intervention: Promoting Resilience and Resolution in Troubled Times. London, Pearson.
52. Epstein H (1979) Children of the Holocaust. The Atlantic Monthly, 243:37–52.
53. Eyerman R (2001) Cultural Trauma: Slavery and the Formation of African American Identity. Cambridge, Cambridge University Press.
54. Felsen I (1998) Transgenerational transmission of effects of the Holocaust: The North American research perspective. In International Handbook of Multigenerational Legacies of Trauma, (Ed Y Danieli):43-46. New York, Plenum Press.
55. Field NP, Muong S, Sochanvimean V (2013) Parental styles in the intergenerational transmission of trauma stemming from the Khmer Rouge regime in Cambodia. Am J Orthopsychiatry, 83:483-494.
56. Figley CR, Kleber RJ (1995) Beyond the “victim”: Secondary traumatic stress. In Beyond Trauma: Cultural and Societal Dynamics, (Eds RJ Kleber, CR Figley, BPR Gersons):75-98. New York, Plenum Press.
57. Flanagan L (2021) Object relations theory. In Inside Out and Outside In: Psychodynamic Clinical Theory and Psychopathology in Contemporary Multicultural Contexts, (Eds B Joan, F Laura, H Patricia):92-124. Lanham, MD, Rowman & Littlefield.
58. Fleckinger A, Gruber D, Senoguz P, Griese K, Poggio B (2025) Transgenerational traumatization and sexualized violence: A systematic review on an omnipresent, shadowed theme in social work theory and practice. Br J Soc Work, 55:2560–2581.
59. Fonagy P, Steele H, Steele M (1991) Maternal representations of attachment during pregnancy predict the organization of infant mother attachment at one year of age. Child Dev, 62:891-905.
60. Frankish T (2009) Women’s narratives of intergenerational trauma and post-apartheid identity: the ‘said’ and ‘unsaid’ (Master’s thesis). Durban, University of KwaZulu-Natal.
61. Franklin A, Kercher GA (2012) The intergenerational transmission of intimate partner violence: differentiating correlates in a random community sample. J Fam Violence, 27:187-189.
62. Freud S (1920a) A General Introduction to Psychoanalysis. NewYork, Garden City.
63. Freud S (1920b) Beyond the Pleasure Principle. London, Hogarth Press.
64. Freyberg JT (1980) Difficulties in separation-individuation as experienced by offspring of Nazi Holocaust survivors. Am J Orthopsychiatry, 50:87-95.
65. Galovski T, Lyons JA (2004) Psychological sequelae of combat violence: A review of the impact of PTSD on the veteran's family and possible interventions. Aggress Violent Behav, 9:477-501.
66. Gapp K, Bohacek J, Grossmann J, Brunner AM, Manuella F, Nanni P et al. (2014) Potential of environmental enrichment to prevent transgenerational effects of paternal trauma. Neuropsychopharmacology, 39:2384-2398.
67. Geller SM, Porges SW (2014) Therapeutic presence: neurophysiological mechanisms mediating feeling safe in therapeutic relationships. J Psychother Integr, 24:178-192.
68. Goodman SH (2020) Intergenerational transmission of depression. Annu Rev Clin Psychol, 16:213-238.
69. Heart B, DeBruyn LM (1998) The American Indian holocaust: Healing historical unresolved grief. Am Indian Alsk Native Ment Health Res, 8:56-78.
70. Hesse E, Main M (2000) Disorganization in infant and adult attachment: Description, correlates, and implications for developmental psychopathology. J Am Psychoanal Assoc, 48:1097-1127.
71. Hirschberger G (2018) Collective trauma and the social construction of meaning. Front Psychol, 9:1441.
72. Hoek HW, Susser E, Buck KA, Lumey LH, Lin SP, Gorman JM (1996) Schizoid personality disorder after prenatal exposure to famine. Am J Psychiatry, 153:1637-1639.
73. Isobel S, Goodyear M, Furness T, Foster K (2019) Preventing intergenerational trauma transmission: A critical interpretive synthesis. J Clin Nurs, 28:1100-1113.
74. Isobel S, Goodyear M, Foster K (2017) Psychological trauma in the context of familial relationships: A concept analysis. Trauma Violence Abus, 20:549-559.
75. Janet P (1889) L’Automatisme Psychologique. Paris, Nouvelle.
76. Jung CG (1936) The concept of the collective unconscious. In Collected Works Vol. 9.1. Princeton, PrincetonUniversity Press.
77. Kaminer D, Eagle G (2010) Traumatic stress in South Africa, 2nd ed. South Africa, Wits University Press.
78. Kellerman NP (2001a) Psychopathology in children of Holocaust survivors: a review of the research literature. Isr J Psychiatry Relat Sci, 38:36-46.
79. Kellermann NP (2001b) Transmission of Holocaust trauma-An integrative view. Psychiatry, 64:256-267.
80. Kestenberg JS (1980) Psychoanalyses of children of survivors from the Holocaust: case presentations and assessment. J Am Psychoanal Assoc, 28:775-804.
81. Khan S, Denov M (2022) Transgenerational trauma in Rwandan genocidal rape survivors and their children: A culturally enhanced bioecological approach. Transcult Psychiatry, 59:727-739.
82. Kidron CA (2003) Surviving a distant past: a case study of the cultural construction of trauma descendant identity. Ethos, 31:513-544.
83. Kira IA (2001) Taxonomy of trauma and trauma assessment. Traumatology, 7:73-86.
84. Klein-Parker F (1988) Dominant attitudes of adult children of Holocaust survivors toward their parents. In Human adaptation to extreme stress: From the Holocaust to Vietnam, (Eds L Eitinger R Krell):193-218. Boston, Springer.
85. Krell R (1979) Holocaust families: The survivors and their children. Compr Psychiatry, 20:560-568.
86. Lehrner A, Bierer LM, Passarelli V, Pratchett LC, Flory JD, Bader H et al. (2014) Maternal PTSD associates with greater glucocorticoid sensitivity in offspring of Holocaust survivors. Psychoneuroendocrinology, 40:213-220.
87. Leslie CE, Walsh CS, Sullivan TN (2023) Implications of intergenerational trauma: Associations between caregiver ACEs and child internalizing symptoms in an urban African American sample. Psychol Trauma, 15:877-887.
88. Letourneau N, Tryphonopoulos P, Giesbrecht G, Dennis CL, Bhogal S, Watson B (2015) Narrative and meta‐analytic review of interventions aiming to improve maternal-child attachment security. Infant Ment. Health J, 36:366-387
89. Lev-Wiesel R (2006) Intergenerational transmission of sexual abuse? Motherhood in the shadow of incest. J Child Sexual Abuse, 15:75-101.
90. Lillycrop KA, Phillips ES, Jackson AA, Hanson MA, Burdge GC (2005) Dietary protein restriction of pregnant rats induces and folic acid supplementation prevents epigenetic modification of hepatic gene expression in the offspring. J Nutr, 135:1382-1386.
91. Masten AS (2021) Multisystem resilience: Pathways to an integrated framework. Res Hum Dev, 18:153-163.
92. McCann IL, Pearlman LA (1990) Vicarious traumatization: A framework for understanding the psychological effects of working with victims. J Trauma Stress, 3:131-149.
93. Meaney MJ, Szyf M (2005) Environmental programming of stress responses through DNA methylation: Life at the interface between a dynamic environment and a fixed genome. Dialogues Clin Neurosci, 7:103–123.
94. Nakata MN (2007) Disciplining the Savages: Savaging the Disciplines. Canberra, Aboriginal Studies Press.
95. Painter RC, De Rooij SR, Bossuyt PM, Simmers TA, Osmond C, Barker DJ et al. (2006) Early onset of coronary artery disease after prenatal exposure to the Dutch famine. Am J Clin Nutr 84:322-327.
96. Painter R, Osmond C, Gluckman P, Hanson M, Phillips D, Roseboom T (2008) Transgenerational effects of prenatal exposure to the Dutch famine on neonatal adiposity and health in later life. BJOG Int J Obstet Gynaecol, 115:1243-1249.
97. Pears KC, Capaldi DM (2001) Intergenerational transmission of abuse: A two-generational prospective study of an at-risk sample. Child Abuse Negl, 25:1439-1461.
98. Perez LM (2009) Intergenerational dynamics of trauma. J Infant Child Adolesc Psychother, 8:156-168.
99. Rando OJ (2016) Intergenerational transfer of epigenetic information in sperm. Cold Spring Harb Perspect Med, 6:a023325.
100. Roseboom TJ, van der Meulen JHP, Osmond C, Barker DJP, Ravelli ACJ, Schroeder-Tanka JM et al. (2000) Coronary heart disease after prenatal exposure to the Dutch famine 1944-1945. Heart, 84:595-598.
101. Rosenwald M, Baird S, Williams R (2023) A social work model for addressing historical trauma: Theoretical foundations and practice implications. Br J Soc Work, 53:804-822.
102. Rotar O, Moguchaia E, Boyarinova M, Kolesova E, Khromova N, Freylikhman O et al. (2015) Seventy years after the siege of Leningrad: Does early life famine still affect cardiovascular risk and aging? J Hypertens, 33:1772-1779.
103. Rowland-Klein D, Dunlop R (1998) The transmission of trauma across generations: Identification with parental trauma in children of Holocaust survivors. Aust N Z J Psychiatry, 32:358-369.
104. Salberg J (2015) The texture of traumatic attachment: Presence and ghostly absence in transgenerational transmission. Psychoanal Q, 84:21-46.
105. Schore AN (2002) Advances in neuropsychoanalysis, attachment theory, and trauma research: Implications for self psychology. Psychoanal Inq, 22:433-484.
106. Schützenberger AA (2025) Oh, Meine Ahnen! Wie Das Leben Unserer Vorfahren in Uns Wiederkehrt. Heidelberg, Carl-Auer.
107. Schwerdtfeger KL, Goff BSN (2007) Intergenerational transmission of trauma: Exploring mother–infant prenatal attachment. J Trauma Stress, 20:39-51.
108. Scott KL, Copping VE (2008) Promising directions for the treatment of complex childhood trauma: The intergenerational trauma treatment model. J Behav Anal Offender Victim Treat Prev, 1:273–283.
109. Serpeloni F, Radtke K, de Assis SG, Henning F, Nätt D, Elbert T (2017) Grandmaternal stress during pregnancy and DNA methylation of the third generation: An epigenome-wide association study. Transl Psychiatry, 7:e1202.
110. Starrs CJ, Békés V (2024) Historical intergenerational trauma transmission model: A comprehensive framework of family and offspring processes of transgenerational trauma. Traumatology, 31:243-251.
111. Suah A, Williams B (2021) How should clinicians address a patient’s experience of transgenerational trauma? AMA J Ethics, 23:440-445.
112. Švorcová, J (2023) Transgenerational epigenetic inheritance of traumatic experience in mammals. Genes (Basel), 14:120.
113. Van der Kolk, BA (1989) The compulsion to repeat the trauma: Re-enactment, revictimization, and masochism. Psychiatr Clin North Am, 12:389-411.
114. Van Steenwyk G, Roszkowski M, Manuella F, Franklin TB, Mansuy IM (2018) Transgenerational inheritance of behavioral and metabolic effects of paternal exposure to traumatic stress in early postnatal life: evidence in the 4th generation. Environ Epigenet, 4: dvy023.
115. Van Wert M, Anreiter I, Fallon BA, Sokolowski MB (2019) Intergenerational transmission of child abuse and neglect: A transdisciplinary analysis. Gend Genome, 3:2470289719826101.
116. Volkan VD (1998) Bloodlines: From Ethnic Pride to Ethnic Terrorism.New York, Basic Books.
117. Volkan VD (2001) Transgenerational transmissions and chosen traumas: An aspect of large-group identity. Group Analysis, 34:79-97.
118. Wadji DL, Ketcha Wanda GJM, Wicky C, Morina N, Martin-Soelch C (2022) From the mother to the child: The intergenerational transmission of experiences of violence in mother-child dyads exposed to intimate partner violence in Cameroon. J Interpers Violence, 37:NP3346-NP3376.
119. Walsh F (2003) Family resilience: A framework for clinical practice. Fam Process, 42:1-18.
120. Weaver IC, Champagne FA, Brown SE, Dymov S, Sharma S, Meaney MJ, Szyf M (2005) Reversal of maternal programming of stress responses in adult offspring through methyl supplementation: Altering epigenetic marking later in life. J Neurosci, 25:11045-11054.
121. Weaver IC, Cervoni N, Champagne FA, D’Alessio AC, Sharma S, Seckl JR et al. (2004) Epigenetic programming by maternal behavior. Nat Neurosci, 7:847-854.
122. Weingarten K (2004) Witnessing the effects of political violence in families: Mechanisms of intergenerational transmission and clinical interventions. J Marital Fam Ther, 30:45-59.
123. Wilbur RE, Gone JP (2023) Beyond resilience: A scoping review of Indigenous survivance in the health literature. Dev Psychopathol, 35: 2226-2240.
124. Yehuda R, Halligan SL, Bierer LM (2001) Relationship of parental Holocaust exposure to PTSD, depressive symptoms, and cortisol excretion in offspring. Am J Psychiatry, 158:188-1887.
125. Yehuda R, Engel SM, Brand SR, Seckl J, Marcus SM, Berkowitz GS (2005) Transgenerational effects of posttraumatic stress disorder in babies of mothers exposed to the World Trade Center attacks during pregnancy. J Clin Endocrinol Metab, 90:4115-4118.
126. Yehuda R, Bierer LM (2009) The relevance of epigenetics to PTSD: Implications for the DSM-V. J Trauma Stress, 22:427-434.
127. Yehuda R, Daskalakis NP, Bierer LM, Bader HN, Klengel T, Holsboer F et al. (2016) Holocaust exposure induced intergenerational effects on FKBP5 methylation. Biol Psychiatry, 80:372–380.
128. Yehuda R, Lehrner A (2018) Intergenerational transmission of trauma effects: Putative role of epigenetic mechanisms. World Psychiatry, 17:243-257.
129. Yehuda R (2021) Transgenerational an Inherited Trauma: Effective Treatment Strategies for Healing Legacies of Pain. Oxfordshire, PESI.
130. Young JE (1999) Cognitive Therapy for Personality Disorders: A Schema-Focused Approach, 3rd ed. Sarasota, FL, Professional Resource Press.
131. Zhu Z, Cao F, Li X (2019) Epigenetic programming and fetal metabolic programming. Front Endocrinol, 10:764.