A new kind of psychological first aid
At the time of the September 11 attacks, the accepted protocol for handling large-scale traumatic events was to perform so-called critical incident stress debriefing, like that Dass-Brailsford led in New York, to discuss events and assess how people are reacting psychologically.
In the past decade, however, research has shown that sort of intervention, no matter how well intentioned, is probably not the most helpful response to get victims feeling better more quickly. As Watson notes, these sessions might well "be too brief to allow for adequate emotional processing, may increase arousal and anxiety levels or may inadvertently decrease the likelihood that individuals will pursue more intense interventions.
Since the late 1990s, the trauma-response field has been moving toward what is known as psychological "first aid." This triage approach "is designed to reduce distress, foster short- and long-term adaptive functioning, and link survivors with additional services," Watson and her co-authors explained in a new paper, also published in the September issue of American Psychologist. Psychological first aid's focus is on practical needs so that, the theory goes, other immediate stressors, such as finding a safe place or a way to reach relatives, do not exacerbate trauma from the event itself.
In the days after the 2010 earthquake in Haiti, for example, many public health officials worried that rather than infectious diseases, mental health was going to be a more pressing issue for the country. Sandro Galea, chair of the Department of Epidemiology of Columbia's Mailman School of Public Health, noted at the time that, "psychological first aid is giving people what they need to rebuild their lives. It will mean restoring people to their jobs, restoring people to their schools, restoring families."
Current guidelines, published in 2008, suggest a five-pronged approach to promote mental and emotional well-being after a disaster or during ongoing violence: "promoting a sense of safety, promoting calming, promoting a sense of self-efficacy and community efficacy, promoting connectedness and instilling hope," Watson and her colleagues summarized in their recent paper.
Treating terrorism's psychological wounds
The study of psychological reactions to terrorism is ongoing. But in the past decade researchers have made small steps in understanding how it is similar to other traumatic events, such as experiencing natural disasters, and how it differs. "Terrorism and human-caused disasters can have strong impacts on communities because of their uncertain and long-lasting nature, resulting in long-term stress and disruption," Watson notes.
To treat victims of terrorism, mental health practitioners have been turning to cognitive behavioral therapy, which has gained favor in recent years to treat many common mental ailments, including depression and PTSD. In this sort of therapy, patients work through traumatic events in a safe, supportive setting. This allows them to "reprocess the experience to support the natural extinction of the fear, extinction of the painful memories," Neria says. Taking lessons from the extensive work done with veterans and other survivors with PTSD, researchers have found that "the content of the treatment could be different" when treating terrorist attack survivors "but the strategies and interventions are pretty similar," Neria says.
But cognitive behavioral therapy might not be a cure-all. People experience trauma reactions differently, Watson notes, so the field should not limit itself to cognitive-behavioral approaches entirely. "Interventions should seek to address the multitude of possible effects of disasters," she says.