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.
See what we're tweeting about
9 Comments
Add CommentThank you for this article. The theme of resilience and stress reactions being a normal response to abnormal events is core to traumatic experience recovery in my professional experience as the mental health clinician over the past 25 years. I do wish to comment, however, that associating stress debriefings, designed originally to help first responders deal with events outside their usual response situations, and mental health crisis response should not be paired or compared. My clinical specialty for many years has been crisis response and longer term trauma recovery with individuals and groups from military combat members to abuse and hostage survivors , internment camp survivors and victims of crimes including family violence. I also am CISD advanced level trained and experienced. These techniques and their goals are entirely different. Each has merit in the correct context. I believe to repeatedly view CISD as a mental health response is erroneous and a disparagement of a technique that is much like a psychological autopsy, piecing together for responders and rescuers the mosaic of coordinated response so that their roles fit within a larger picture and their sensory and emotional experiences have a context of normal for them. The purpose of this is to quickly enable them to be on scene again without being brought to a standstill by evocation of neurosensory memory bringing them to a halt just when they need to be lightning fast in their work. The last piece of a CISD is to provide education for self-care and recommendations for support as and if needed without an assumption all are traumatized pathologically. With mental health crisis response the usual affected group is usually far more repeated trauma naive so that the sensory impact and resources for coping are not attuned. The type of response, whether individual or group is sensitive to this psychological exposure naivete and require tremendous cultural, generational and situational attunement. THe goals and techniques are completely different.
Reply | Report Abuse | Link to thisBest regards,
Aliceann Carlton, LCPC
For a thorough debunking of the 2002 JAMA paper, point by point, see
Reply | Report Abuse | Link to thishttp://www.psychologytoday.com/blog/the-skeptical-sleuth/201109/september-11-2001-did-americans-suffer-virtual-trauma-television-co
and
http://www.psychologytoday.com/blog/the-skeptical-sleuth/201109/after-911-the-mental-health-crisis-never-came
PTSD is a terrible thing. I have a friend who just returned from Iraq and he was suffering from PTSD. We try to help him but he is half the man he was.
Reply | Report Abuse | Link to thisAlvin, you are right and I am sorry for the loss of the friend you knew before his Iraq experience. This article is really trying to redefine what is acute stress and a normal and expected reaction and what is post-traumatic stress which persists and becomes debilitating over time. I take issue with the concept that there is less PTSD than the author and cited sources are presenting because whatever it is defined to be, a person exposed to such emotional and neurosensory impact is forever changed and will never be the same. So what is happening in the United States now is an effort to "neutralize" horror and turn it into something a resilient mind can survive. That's a "well duh" sort of claim as most of us who grew up with children whose parents were in Nazi death camps learned very quickly. It's like watching a sturdy tower collapse and then rebuild itself, sometimes haphazardly and sometimes with sand rather than stone and morter. I am literally stunned by the lack of inclusion of first responders and family members in the 9/11 NYC Memorial as the trauma was shared by all at ground zero, and by the entire country where the ripple effects still wash over the consciousness of citizens, fueled of course by a warmongering leadership for some years. To say that an acute stress reaction and post-traumatic stress problems are normal reactions to abnormal events is accurate, to say many "get over it" is partly accurate, to say that life resumes as normal for most people is inaccurate unless you also posit that "normal" is the adaptation to hypervigilance, hypersensory or hyposensory acuity, flashbacks triggered by normal life events many years after the experience, and relationship changes so profound many are ruptured or badly strained for ever.
Reply | Report Abuse | Link to thisI did not think about 9/11 disaster much in past decade but after bin ladens death its having an impact on my mind.Its like iam being lifted to a new state of mind.
Reply | Report Abuse | Link to thisHi,
Reply | Report Abuse | Link to thisMany years ago I fought in Vietnam.One of the things that often bothered me was I would wake up often thinking I was back there.It went on for years.
I did have a problem with depression .My kindly therapists recommended Recovery Inc.I have been going for several years now and have setbacks only whe I didn't practice their method.
Dr. Low the founder of Recovery Inc.has a saying about memories.The brain knows very well how to forget.All you have to do is not keep reviewing the past.Don't work up the past,it's outerenviroment and we can't control it.
My mental health is most important to me.That is why I continue going to Recovery Inc. meetings and practice.
John,
Reply | Report Abuse | Link to thisThank you for your service and sacrifice. Also, you are to be commended for your continuing work to deal with your PTSD.
My father was WWII veteran who fought at Gaudal Canal. When he was in his early '80's he was still waking up from nightmares screaming "Japs, Japs, Japs."
My father was always on edge. Some said he was a rage-aholic, but in my early adult years after reading about PTSD in children of alcoholics, I realized why my father was the way he was. My family was horrible. Because of my father's condition, by mother and the 4 kids were all abused emotionally and physically, to the point that we suffered PTSD ourselves. Few seem to realize the devastation that occurs not only to our Vets, but to their family members as well.
Those interested might appreciate the work of the Climate Institute who are looking into the effects of natural disasters on mental health. You can read more about the Climate of Suffering at www.climateinstitute.org.au
Reply | Report Abuse | Link to thisThose interested might appreciate the work of the Climate Institute who are looking into the effects of natural disasters on mental health. You can read more about the Climate of Suffering at www.climateinstitute.org.au
Reply | Report Abuse | Link to this