Post-Disaster Response: Learning from Research Part 2

Interventions

Matthew J. Friedman, M.D., Ph.D.

Matthew J. Friedman, M.D., Ph.D., Executive Director of the National Center for PTSD at the VA Medical Center in White River Junction, VT, focused his presentation on interventions for psychosocial distress following disasters.

He outlined a variety of possible psychosocial responses—including anger, fear, sleep problems, increased alcohol use or smoking, and social isolation, among others. He noted that PTSD is only one of many post-disaster responses.

Dr. Friedman emphasized the need to distinguish between the acute trauma response that most people display and the acute trauma response that leads to chronic disorders.

"Virtually all PTSD symptoms are reported at very high rates in the initial weeks after trauma," he said, but "most people will adapt in the following 3 to 6 months."

For many years, the most commonly used intervention immediately after a disaster was psychological debriefing, based on the assumption that disclosure of emotions and thoughts has a beneficial result, he said.

Debriefing usually takes place as a single, 1- to 3-hour session within 72 hours after trauma exposure. The affected person discusses the thoughts and emotions surrounding the event. The goal is to provide education, brief coping strategies, and referral information.

Despite its popularity, Dr. Friedman said, multiple studies have shown that there is no evidence that debriefing reduces PTSD, and other evidence has shown that it may cause some harm.

More recently, another intervention, psychological first aid, has received considerable attention. The goal of this intervention is to establish a sense of safety and security, connect the individual to restorative resources, and reduce stress.

Psychological first aid can be used immediately after the event or extended as needed, can be provided in single or multiple sessions, and can be adapted for use in group settings. Not yet tested empirically, the intervention is closer to the principle of "first do no harm" than to methods that use emotional processing.

Dr. Friedman also described cognitive behavior therapy (CBT), typically used several weeks after trauma for acute stress disorder. Following a traumatic event, acute stress disorder is characterized by dissociation, a re-experiencing of the event, avoidance behavior, and arousal.

Dr. Friedman cited study findings showing that individuals receiving CBT—typically given only to severely distressed individuals who meet diagnostic criteria for acute stress disorder—had better outcomes than those who received supportive counseling.

He briefly touched on the use of pharmacotherapy to reduce excessive stress responses, enhance inadequate stress responses, and promote rapid recovery of normal function—including immunologic function—which may be compromised by psychological stress.

For people who progress from acute distress to chronic PTSD, selective serotonin re-uptake inhibitors (SSRIs) such as Zoloft and Paxil have been found to be the best pharmacological treatment, he said.

Back to Top

New Orleans

Howard J. Osofsky, M.D., Ph.D.

Howard J. Osofsky, M.D., Ph.D., presented findings from work he and his wife, Joy D. Osofsky, Ph.D., performed in Louisiana following the fall 2005 hurricanes (see related article, SAMHSA News, Schools Offer Stability for Children of Disasters). Dr. Howard Osofsky is a professor and chairman of the Department of Psychiatry at Louisiana State University Health Sciences Center, and clinical director of the SAMHSA-funded Louisiana Spirit program that provides supportive counseling to assist people with feelings of trauma, grief, and loss following the hurricanes.

Dr. Osofsky presented preliminary findings from his work with Louisiana Spirit, which handled 300,000 brief mental health contacts and 100,000 extended contacts with New Orleans residents following the hurricanes.

In conjunction with the SAMHSA-funded National Child Traumatic Stress Network, Dr. Osofsky and his co-workers performed a needs assessment and screening on more than 4,000 children.

The survey sample included children of first responders living on cruise ships, children returning to school in the devastated St. Bernard Parish, children returning to school in New Orleans, and displaced children in the Louisiana Rural Trauma Services Center located in St. John Parish.

He found that slightly more than half met the cut-off criteria for consideration for mental health referral. Approximately one-third showed PTSD symptoms, including talking repeatedly about the hurricane, experiencing upsetting thoughts, avoidance, and worry about the future. Approximately one-third showed depressive symptoms, including feelings of sadness, difficulty concentrating, and irritability.

Dr. Osofsky also collected data from 394 first responders in New Orleans and St. Bernard Parish, including police, firefighters, and emergency medical technicians. Almost all were separated from their families and most had witnessed death and/or injury.

Twelve percent reported symptoms of PTSD and 26 percent reported symptoms of depression. The higher percentage of first responders with depression likely stemmed from demoralization due to the continuing devastation, slowness of recovery, and economic and personal uncertainties, Dr. Osofsky suggested. Close to half of the first responders reported increased marital conflict and expressed a wish for mental health services.

All three presenters acknowledged the exponential impact of disasters on pre-existing disabilities, medical conditions, and immunologic function.

"Emergency room doctors in hurricane-affected areas have been swamped with patients," Dr. Osofsky said, citing an increase in cases of asthma. He also observed that a disproportionate number of elderly people had been dying.

Dr. Friedman cited the examples of diabetes worsening or hypertension increasing after a disaster. He added, "Social support is the best way to prevent trauma after a disaster."

Dr. Tuma said that excellent sources of social support—often overlooked—include commonality with other trauma survivors, the compassion of strangers, and the bonds of family.

For information and resources on the behavioral health impact of disasters and appropriate responses, see Disaster Readiness Resources article.

More information on the "Spirit of Recovery" conference, including PowerPoint presentations, is available at www.spiritofrecoverysummit.com. For more information on disaster readiness and response, visit SAMHSA's Web site at www.samhsa.gov. 

« See Part 1: Hurricane Recovery Guides Preparedness Planning

« See Part 2: Hurricane Recovery Guides Preparedness Planning

« See Part 1: Post-Disaster Response: Learning from Research

See Also—Hurricane Recovery Guides Preparedness Planning

Schools Offer Stability for Children of Disasters »

Documentary Features New Orleans High School »

Disaster Readiness Resources »

See Photo Gallery »

See Also—Next Article »

Back to Top