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Bipolar disorder (BD) represents one of the most therapeutically complex psychiatric disorders. The development of a feasible comprehensive psychological approach to complement pharmacotherapy to improve its clinical management is required. The main objective of the present randomized controlled trial (RCT) was to test the efficacy of a novel adjunctive treatment entitled integrative approach in patients with BD, including: psychoeducation, mindfulness training, and functional remediation.
This is a parallel two-armed, rater-blind RCT of an integrative approach plus treatment as usual (TAU), v. TAU alone. Participants were recruited at the Hospital Clinic of Barcelona and randomized to one of the two conditions. They were assessed at baseline and after finishing the intervention. The main outcome variable included changes in psychosocial functioning assessed through the Functioning Assessment Short Test (FAST).
After finishing the treatment, the repeated-measures analyses revealed a significant group × time interaction in favor of the patients who received the integrative approach (n = 28) compared to the TAU group (n = 37) (Pillai's trace = 0.10; F(1,57) = 6.9; p = 0.01), improving the functional outcome. Significant effects were also found in two out of the six domains of the FAST, including the cognitive domain (Pillai's trace = 0.25; F(1,57) = 19.1; p < 0.001) and leisure time (Pillai's trace = 0.11; F(1,57) = 7.15; p = 0.01). Regarding the secondary outcomes, a significant group × time interaction in Hamilton Depression Rating Scale changes was detected (Pillai's trace = 0.08; F(1,62) = 5.6; p = 0.02).
This preliminary study suggests that the integrative approach represents a promising cost-effective therapy to improve psychosocial functioning and residual depressive symptoms in patients suffering from BD.
The Epilogue accounts for Israeli foreign policy since the return to power of Binyamin Netanyahu in 2009. It focuses on Israel’s response to the Arab uprisings, its conflict with Iran, wars with Hamas, rejection of the peace initiatives presented by the Obama administration, Israel’s emerging covert relations with Arab Gulf countries, and Israel’s endorsement of the 2020 Trump peace plan. The chapter traces and explains the concentration of power within the hands of Binyamin Netanyahu, whose premiership has been the main element of continuity in an otherwise changing decision-making forum. The chapter also accounts for the shift of the centerground of Israeli domestic politics and society to the right, and explores the implications of this change for Israeli foreign policy. The chapter ends with a critical evaluation of why Israel’s foreign policy reverted to entrenchment during the previous decade, 2009-2020, and explores its implications for Israel’s foreign relations.
Chapter 11 examines Israel’s foreign policy amid the demise of the Barak government and the rise to power of Ariel Sharon. As the Barak government entered its final phase, Israel’s foreign policy was marked by a serious contradiction. The minority government, headed by Barak, sought to salvage the peace process - by accepting the Clinton parameters for an Israeli-Palestinian final peace. However, the security network defied government by deploying overwhelming military force in response to the eruption of the al-Aqsa Intifada. Amid this Janus-faced foreign policy, the chapter explains the rise of Ariel Sharon to power, which was marked by a quandary. Sharon came to power as Israel’s engagement foreign policy stance was discredited. However, the idea of restoring Israel’s foreign policy of entrenchment and its corollary of clinging to a Greater Israel was also unfeasible as Israel remained signed up to the Oslo agreements. Thus, the foreign policymaking circle surrounding Ariel Sharon, who had a reputation for uncompromising resolve, determination, and tenacity, was left searching for a foreign policy paradigm.
Chapter 8 examines Israel’s regional foreign policy during the first Netanyahu government, in relation to three themes: the peace agreement with Jordan, relations with Syria, and relations with the Arab states in the Gulf. The chapter demonstrates that, during this period, Israel pursued a foreign policy of backtracking on engagement. The warm peace with Jordan became a cooler strategic peace. Relations with the Gulf countries were frozen and the Maghreb states all but severed their ties with Israel. Meanwhile, Syria and Israel were on the brink of war. The retraction from the foreign policy of engagement was entirely in line with the unmitigated hostility of the prime minister and his immediate circle towards the Arab world, and his clear preference for satisfying his core domestic political constituency over advancing the peace process. The chapter adds to the existing literature by exposing the divisions within Israel’s foreign policymakers, in government and the security network, amid the prime minister’s foreign policy of backtracking from engagement.
Chapter 17 provides the first analysis of the causes and consequences shaping Israel’s foreign policy towards established and emerging powers beyond the Middle East two decades after the end of the Cold War. The chapter identifies two contradicting trends in Israel’s foreign policy towards China, India, the EU, and the USA. On the one hand, the economic ties with all four countries had deepened and expanded significantly. On the other, Israel’s foreign policy towards all four power remains vulnerable to different degrees. In the case of the USA and EU, the deepening Israeli occupation of the Palestinians poses a normative threat to the long-term endurance of these relationships. As far as Israel-China and Israel-India ties are concerned, they are contingent on these powers’ economic interests in Arab Gulf States - and to a lesser extent Iran - and their burgeoning ties with Israel remaining compartmentalized.
Chapter 5 examines Israel’s foreign policy of engagement in the wake of the assassination of Yitzhak Rabin. It traces and explains the key events, including rejection of the Beilin-Abu Mazen agreement, the rise and fall of the Wye River negotiations with Syria, the assassination of the Hamas leader, Yahya Ayyash, Operation Grapes of Wrath, and the defeat of Shimon Peres by Binyamin Netanyahu in the 1996 general elections. The chapter contributes to the literature by explaining why, following Rabin’s assassination, his successor, Shimon Peres, sought to apply his New Middle East vision to negotiations with Syria and the Palestinians and why this foreign policy approach failed. The chapter ends by examining the final demise of the Peres government and of Israel’s foreign policy of engagement amid Binyamin Netanyahu’s victory in the 1996 elections. It underscores that Netanyahu’s victory personified the rejection by the Jewish-Israeli public of Israel’s engagement policy, on the grounds that it compromised the country’s Jewish and Zionist identity and posed grave security threats.
Chapter 16 examines Israeli foreign policy towards the Middle East in the wake of the 2006 Israel-Hezbollah war. The chapter focuses on the key events during the remainder of the Olmert government including Hamas’s victory in the Palestinian legislative elections and the ensuing forceful takeover of the Gaza Strip; the destruction of the Syrian nuclear reactor by Israel; the resumption of the Israeli-Syrian peace negotiations through Turkish mediation; the unprecedented peace offer made by Olmert to the Palestinians; and Operation Cast Lead. The chapter provides the first analysis of the Olmert government in the context of Israel’s foreign policy since the end of the Cold War. It exposes the reasons why Israel’s offensive foreign policy towards Syria succeeded while its attempt to reinvigorate its foreign policy of engagement failed. The chapter highlights the cleavages within Israel’s leading decisions-makers and the waning domestic support for engagement.
Chapter 4 exposes the growing contradiction in Israel’s engagement foreign policy stance, which, in certain respects, was advancing. By September 1995, Israel and the PLO had concluded the Oslo II interim agreement; Israel’s emerging ties with Arab countries in the Gulf and the Maghreb were continuing; and negotiations with Syria at an ambassadorial level and between the respective countries’ militaries’ chiefs of staff were maintained. At the same time, the domestic challenges to Israel’s policy of engagement intensified, prompting a flawed response from the Rabin government. Amid deteriorating security, Israel deployed coercive measures against the Palestinians, undermining the political standing of the Palestinian leadership, economy, and public support for negotiations with Israel. Nonetheless, terrorist attacks against Israelis continued, weakening the domestic legitimacy of engagement in Israel and fueling domestic opposition. Shifting the lens to Syria, the government attempted to sway domestic opposition to negotiations via public diplomacy with Syria’s obstinate and hostile President al-Assad, which backfired as al-Assad rejected all Israeli overtures. The chapter ends by uncovering how the failure to produce a breakthrough with Syria influenced Israel’s Iran policy, highlighting that Israel’s foreign policy of engagement remained vulnerable and incomplete.
Chapter 12 evaluates Israeli foreign policy amid the 9/11 attacks and the ensuing US-led global war on terror. The chapter contributes to the literature by demonstrating how, amid the global war on terror, Israel pursued a foreign policy that amounted to a frontal attack on engagement, which reflected the collapse of the domestic support in Israel for this foreign policy stance. Accordingly, the Sharon government offered virtually no response to the Arab peace initiative, which was launched by the Arab League in March 2002. The chapter ends by unearthing how the global war on terror engendered a shift in the role, played hitherto by the USA, in the Arab-Israeli conflict. US foreign policy would no longer hinge on mediation. Instead, it would be based on the principles guiding its global war on terror, namely, transformative diplomacy, regime change, and democratization.
Chapter 9 examines the resurgence of Israel’s policy of engagement under the premiership of Ehud Barak, who used his position as primary decision-maker to redirect the focus of Israel’s peace negotiations from the Palestinians to Syria. The chapter scrutinizes this process by focusing on the Blair House meeting, the Shepherdstown summit and the encounter in Geneva between US President Bill Clinton, and Syria’s President Hafez al-Assad. The chapter provides a novel explanation of how Barak remained hostage to a set of domestic factors, which was decisive in the failure of the Israel-Syria peace process. These domestic factors included hostile Israeli public opinion to withdrawing from the Golan, Barak’s fractured coalition, and attempts to impose tough conditions through legislation on subjecting any peace agreement with Syria to referendum. However, the Syrian president was equally inhibited by domestic factors, which determined his decision to reject the Israeli offer relayed by US President Clinton, to withdraw from the Golan Heights in exchange for a comprehensive peace. Al-Assad’s domestic constraints included his own ill health, his commitment to Ba'ath ideology, and his concern that concessions to Israel might torpedo the succession of power from him to his son, Bashar.
Chapter 10 explores the foreign policy of Israel towards the Middle East in the wake of the collapse of the Israeli-Syrian peace process, focusing on its relations with Iran, Lebanon, and the Palestinians. The chapter provides the first account of Israel’s foreign policy towards Iran, arguing that, by 2000, it had matured around four principles - deterrence, defence, interception, and support for multilateral efforts to curb Iran’s nuclear program. In addition, it is the first analysis to demonstrate how and why the demise of Israel’s foreign policy of engagement gave rise to its unilateralism foreign policy posture. The analysis shows that, despite nine years of negotiations, rigid historical, national and religious narratives, political opposition, and hostile public opinion, were still preventing a land-for-peace exchange to end Israel’s conflict with the Palestinians. Israeli-Lebanon relations were free of these shackles, which is why Ehud Barak was able to order the IDF to withdraw unilaterally from Lebanon. Barak’s foreign policy style, which was based on untying Gordian knots swiftly and decisively, was a clear advantage in this context, as domestic political conditions were ripe and international legitimacy was forthcoming.