Secondary prevention includes all therapeutic interventions that occur after exposure to trauma but before the development of a full-blown disorder. This phase is critical because it targets individuals who, despite being at risk after experiencing trauma, have not yet lost their full functionality. The primary goal of secondary prevention is twofold: first, to prevent a decline into severe illness such as depression, PTSD, or anxiety; and second, to help trauma-exposed individuals maintain their functionality. As global conflicts become more prolonged, there is a growing need to rethink the tools and role of secondary prevention. In the ongoing, long-lasting traumas we now face, we must shift from short-term interventions that preserve basic continuity to long-term support systems that ensure people can continue functioning in their lives and communities.
As Prof. Eyal Fruchter, Chair of the Advisory Board on Trauma for Israel's Ministry of Health and Director of Medical and Scientific affairs at ICAR Collective, explains: "Secondary prevention is designed to intervene before there is a need for diagnosis. The goal is to maintain people’s functionality so they do not require treatment. In prolonged conflicts, this approach is critical—without it, we risk overwhelming our systems, leaving people to cope with continuous trauma, or worse, leading them down the path to disability and dysfunction."
From Single Events to Prolonged Conflicts
Traditionally, secondary prevention was developed in response to single traumatic events like natural disasters, isolated battles, or accidents, where there was a clear beginning and end. The event occurred, secondary prevention was applied to mitigate the impact, and recovery followed. However, in conflicts that continue without a foreseeable end—such as the ongoing war in Israel or Ukraine—this model no longer fits. The traumas we now face, whether it’s the prolonged fighting, the unreturned hostages, or long-term displacement from homes, are not one-time occurrences but rather continuous processes that unfold over months and years.
At the recent NATO conference, this issue was at the heart of the discussions. "We are all stuck," shared Prof. Fruchter, reflecting the global sentiment. "Countries around the world are experiencing this shift. It’s no longer just about PTSD from a single battle, but about continuous confrontation with trauma. Alongside the ‘normal’ trauma response, there are significant components of moral injury that appear over time—a persistent sense of guilt and shame because these conflicts never truly end."
The ongoing reality of modern conflicts demands that we adapt secondary prevention. Instead of focusing on short-term solutions, the goal now is to maintain people’s ability to function over time. Whereas in the past, we might have used immediate tools to address trauma (such as the Magen or Maashe programs), and later emphasized the importance of resuming a continuous activity, we now need to expand our efforts to prevent disability, enable return to work, and reintegrate individuals fully into all aspects of life. This includes addressing issues that arise during this period—such as alertness, grief, anger, shame, and guilt—while simultaneously ensuring individuals continue to replenish personal resources, such as social connections, enjoyment, work, and more.
The ongoing support required to fulfill these needs necessitates education and the development of rehabilitation programs that are also aimed at otherwise healthy individuals who are currently struggling with the trauma. These programs are built on therapeutic interventions but are just as focused on social, familial, and community-based recovery.
Maintaining Functionality Amid Prolonged Trauma
One of the primary goals of secondary prevention is to help individuals continue functioning despite difficult circumstances. This means keeping people engaged in their work, maintaining their relationships, and enabling them to continue contributing to society. When successful, there is no need for diagnostic labels or formal treatment. As Prof. Fruchter emphasizes, "Our goal is not just to prevent PTSD or depression but to ensure that people remain connected to their lives. Functionality is the cornerstone of mental health in situations of prolonged trauma."
“The discussions at NATO revealed just how widespread this problem is,” Prof. Fruchter said. “All over the world, from Japan to the Netherlands, the focus is shifting to the issue of continuous trauma. What we see now is that the most important phase is not primary prevention, which focuses on building resilience, nor tertiary prevention, which deals with treatment after diagnosis. Instead, the focus must be on secondary prevention—stopping the progression from exposure to illness.”
Supporting Those on the Fringes: Lone Soldiers as an Example
While secondary prevention is crucial for anyone exposed to trauma, it is especially vital for those on the fringes of society. One of the most vulnerable groups in Israel’s ongoing conflict is Lone Soldiers—young men and women serving in the military without family support in the country, often due to new immigration or estrangement from their families.
"Lone Soldiers are at particular risk of being lost to support systems or sinking into disability and illness," explains Prof. Fruchter. "They don’t have the natural support systems that most soldiers rely on. In secondary prevention, we must not only prevent them from developing PTSD but also provide them with the community and resources they need to stay connected, functional, and mentally healthy."
Lone Soldiers face unique challenges. They are isolated not only geographically but often emotionally, which adds to the stress they experience during military service. Without intervention, they are at a higher risk of developing trauma-related disorders. Secondary prevention efforts, such as community programs, social support networks, and mentoring from veterans, can be critical in maintaining the sense of belonging and resilience of these soldiers.
"Secondary prevention isn’t just about psychological support," adds Prof. Fruchter. "It’s about making sure Lone Soldiers don’t fall through the cracks. Whether they are new immigrants without family or Israelis who have become estranged from their loved ones, these soldiers need tailored interventions that address their unique needs. The focus should always be on keeping them engaged in life, not just in military service, but in their communities as well."
A Global Shift in Trauma Prevention
The evolving understanding of secondary prevention is not limited to Israel or military contexts. Global discussions at NATO highlighted how this approach is becoming increasingly relevant across the world. From the prolonged war in Ukraine to ongoing instability in regions like Armenia and Georgia, the need for long-term secondary prevention efforts is becoming clearer.
“We see this problem everywhere,” Prof. Fruchter shared. “It’s not just soldiers—civilians are experiencing moral injury, a persistent sense of guilt and shame that stems from their involvement, even passively, in conflicts. At the NATO conference, we learned that the world is recognizing this as a widespread, cross-border phenomenon, which requires all of us to rethink how we approach prevention, because these conflicts aren’t ending.”
Redefining Secondary Prevention for Prolonged Conflicts
As conflicts drag on, secondary prevention must be redefined. It is no longer a short-term intervention but a continuous process. The goal is to prevent the need for medical treatment by maintaining individuals’ functionality, so they can continue to live meaningful lives despite the surrounding trauma.
Whether through programs for Lone Soldiers in Israel or global community-based interventions, secondary prevention focuses on stopping trauma before it takes root, preventing disability, and encouraging the rebuilding of daily routines, lives, and meaningful activities.
Prof. Fruchter’s final words remind us why this shift is so critical: "We don’t want to wait until people are diagnosed. We want to support them now, while they’re still functioning, so they can avoid needing treatment altogether. That’s the power of secondary prevention."
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