Friday, October 15, 2010

Psychological Interventions For Post Disaster Trauma

The world sighed a collective breath of relief when all 33 of the miners trapped in a Chilean mine for over two months were rescued this week. But the health risks for some of these minors may not be over. As I blogged previously here in the context of the serious emotional distress suffered by children affected by Hurricane Katrina, those who survive disasters are at significant risk of psychological problems such as post-traumatic-stress-disorder (PTSD), depression, anxiety and substance abuse.

It is imperative for those in the public health community to recognize that this risk can vary among individuals and that currently popular interventions may be ineffective and, more importantly, can actually cause harm in some cases. In a press release this week, The Association for Psychological Science cautions that post disaster interventions that attempt to deal with emotional distress should carefully focus on techniques with strong scientific evidence of effectiveness.

In an upcoming report on the psychological effects of disasters in Psychological Science in the Public Interest, a journal of the Association for Psychological Science, George A. Bonanno and colleagues note that
… '[f]ollowing disasters, the most common form of immediate psychological intervention is a single session known as critical incident stress debriefing (CISD). However, following a review of studies on the effectiveness of CISD, Bonanno and co-authors conclude that “multiple studies have shown that CISD is not only ineffective but, as suggested earlier, in some cases can actually be psychologically harmful.'

In a 2007 report in Perspectives on Psychological Science, a journal of the Association for Psychological Science, Scott O. Lilienfeld shows that a number of psychological therapies, including CISD, especially if forced upon survivors, may actually be harmful.

'The data on crisis debriefing suggest that imposing such interventions on individuals doesn’t work and may, paradoxically, increase risk for PTSD,' Lilienfeld says. 'If any of the miners want to talk to somebody to express their feelings, then by all means mental health professionals should be there to listen to them and support them. But for miners who would prefer not to talk much about the experience, it’s best to leave them alone and respect their own coping mechanisms.'

According to Bonanno and his co-authors, there are therapies that may be effective in helping survivors recover from disasters. Psychological first aid (PFA)—which, among other things, provides practical assistance and helps promote a sense of safety and calmness among survivors—is a promising approach. In addition, community-centered interventions—those that help maintain a sense of continuity, connectedness, and quality of community life—may be beneficial to survivors of disasters.



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