Psychological Effects of Catastrophic Disasters

Group Approaches to Treatment

Joseph Rose, Henry I Spitz, Leon Schein, Gary Burlingame, Philip R. Muskin

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781317825463
• Edition: 1
• Topic: Politics & International Relations
• Subtopic: Politics
• Index: Politics & International Relations

A thorough, user-friendly guide of basic knowledge and group interventions for psychological trauma from terrorist attacks and other catastrophic disasters There is relatively little literature on the psychological trauma caused by catastrophic disasters, including terrorist attacks and the impending threats of terrorism. Psychological Effects of Catastrophic Disasters: Group Approaches to Treatment fills that gap by comprehensively discussing ways to minimize the psychological damage resulting from catastrophic disasters as well as the trauma developed from the threat of future terrorist attacks. The book provides thorough presentations of almost manualized group methods for the prevention and treatment of the acute and longer-term psychological effects for children, adolescents, and adults. Appropriate treatment immediately after a catastrophe can diminish harmful psychological effects, enhance an individual's quality of life, decrease psychosomatic illnesses and the exacerbation of chronic medical conditions, increase the effective utilization of medical facilities, and decrease medical expenses. In this book, internationally renowned authorities provide practical expert suggestions and helpful examples to illustrate the interventions and provide a quick reference for professionals facing the aftermath of prospective terrorist disasters and other catastrophic events. Psychological Effects of Catastrophic Disasters: Group Approaches to Treatment is divided into four sections. The first section provides an overview of the book; the second discusses the foundations and broad issues which potentially affect the outcome of group treatment; the third section presents group models which address the particular needs of children, adolescents, parents, emergency service personnel, and mental health practitioners; and the fourth part considers future directions of treatment. Designed to be used as a comprehensive single source for professionals working with victims of trauma caused by terrorism or catastrophic disaster, this book can be read and used in its entirety, or specific chapters detailing treatments can be chosen and used independently as needed. Extensive references allow opportunities for further research. Psychological Effects of Catastrophic Disasters: Group Approaches to Treatment presents unique first-person accounts of September 11th and examines:

• the neurobiological effects of a traumatic disaster
  
• the effective use of psychotropic medication
  
• the implications of living with ongoing terrorist threats
  
• a new framework for preparedness and response to disasters and trauma for children and families
  
• cultural, religious, and ethnic differences related to the prevention and treatment of psychological sequelae
  
• the diagnosis and treatment of traumatic grief
  
• retraumatization, distressing reminders, and their effects on post-traumatic adjustment
  
• the knowledge trauma therapists need to integrate small group principles
  
• the diagnosis and group treatment of acute and long-term effects with adults and children
  
• the use of spiritual principles after a terrorist disaster or catastrophic event
  
• nine types of groups appropriate for specific populations

Psychological Effects of Catastrophic Disasters: Group Approaches to Treatment is a timely, comprehensive reference for social workers, psychologists, psychiatrists, health professionals, mental health professionals, educators, and students. The royalties from this book shall be donated to organizations which provide direct services to those who continue to be affected by the events of September 11th, 2001 and Hurricane Katrina (August 29th, 2005).

Part I:
Overview

Chapter 1
Trauma, Terror, and Fear: Mental Health Professionals Respond to the Impact of 9/11—An Overview

Terence M. Keane

Linda A. Piwowarczyk

Extraordinary events require extraordinary responses. The events of September 11, 2001, were extraordinary by any definition or standard; the mental health communities in New York City, Washington, DC, and across the United States responded to these tragedies with alacrity and zeal. Collaboration and cooperation transcended traditional boundaries of profession, location, organization, and funding sources in an attempt to respond effectively to these attacks on our country. The goal was to help those suffering in the aftermath of one of the most destructive peacetime attacks on America in its history. The purpose of this book is to provide an overview of the lessons learned from these signal events for all mental health professionals. At the same time, it looks toward the future; in various chapters the lessons learned are integrated into theoretical models with a vision to future developments in the emerging field of early mental health interventions. Thus, this volume employs the lessons learned to direct future initiatives, an objective that can guide collaborations and planning well into the new century.

Terrorism is defined as

any systematic threat or use of unpredicted violence by organized groups to achieve a political objective. Terrorism's impact has been magnified by the deadliness and technological sophistication of modern day weapons and the ability of mass communications to inform the world of such acts. (Merriam-Webster, 2000)

Written more than a year before the fatal attacks in the United States, the definition is strikingly eerie as it portends well the 9/11 terrorist events in our country. The attacks on New York City and the Pentagon and the crash of a passenger plane in the fields of Pennsylvania all readily fit this definition, and the impact of these events affected America in ways that no prior singular attack on the United States had. On television stations worldwide for many days after the attacks, the almost constant availability of footage of the aircraft hitting the Twin Towers exposed the world, and especially all Americans, to the brutality of terrorism in unprecedented ways.

The response of the mental health community was immediate and decisive: key mental health professions prepared their constituents for assisting in efforts of early intervention and promotion of recovery. Expertise stemming from past experiences with other disasters, traumatic events, terrorism, war, and stress informed professionals through the availability of conceptual models, evaluation strategies, and interventions. The present volume addresses the broad spectrum of knowledge derived from the 9/11 attacks and other types of traumatic events, integrating the knowledge in ways that at once assemble the treatments available while denoting specific needs that must still be addressed empirically and procedurally. Most important, the volume brings contemporary conceptual models and intervention methods to the care of those exposed to terrorism. The ultimate goal of the text, therefore, is to ensure that future generations of professionals learn from the experiences of those involved at multiple levels in the mental health profession's responses to the terrorism of 9/11.

Conceptual Models

When traumatic events occur, we must understand why some people develop lasting psychological problems whereas others, seemingly exposed to the same fundamental experiences, do not. To explain these distinct response patterns, researchers generally focus on individual difference models. For example, Keane and Barlow (2002) extended to post-traumatic stress disorder (PTSD) Barlow's (2002) model for the development of anxiety disorders. This triple vulnerability model specified the importance of (1) psychological vulnerabilities, (2) biological vulnerabilities, and (3) the characteristics of the traumatic event. The advantage of this type of individual difference model is that it points to the interactive importance of past experiences, biological constitution, and psychological factors (e.g., mood, arousal, and cognitive processes) that exist prior to the occurrence of a traumatic life event. A second advantage of this model is that it aligns itself with the same precipitating factors of other anxiety disorders, such as panic disorder, generalized anxiety disorder, and social anxiety disorder. From a heuristic perspective, this permits one to understand the common features of these various anxiety disorders as well as the features that differentiate them. In addition, it establishes a theoretical model that can be put to scientific test.

Other components of the triple vulnerability model include conditioned learning at the time of the traumatic event; this conditioned learning establishes the mechanism by which false alarms occur. Cues in one's environment come to elicit the emotional responses associated with the traumatic event. These flashback experiences are emotionally painful for survivors and precipitate anxious apprehension about the event, or even a triggered flashback, recurring. This apprehension is part of the preoccupation with the traumatic event that is apparent in most survivors who develop PTSD.

Mitigating factors determine who does and does not go on to develop PTSD once exposed to a traumatic event. Empirical studies suggest that one's coping style and level of social support are key variables in the aftermath of a traumatic event. Our model proposes that the presence of an active, instrumental coping style and the assurance that one can ask for and receive social support from friends and family may alter the trajectory of one's response to traumatic events.

Yet this model focuses largely on the individual level of analysis. This is a strength, but it is also a potential limitation in our efforts to understand the ultimate outcomes of terrorist attacks. Viewing the outcomes largely from the individual level may not provide the best prediction of impact. For example, the level of analysis following 9/11 might be the family, the neighborhood, the city, the state, the country, or even beyond. In the case of terrorism, the target is often the larger population. Is the impact at the societal level simply the mean (i.e., average) of the individual impact? This is not likely, as each level interacts with those that precede and follow it. How children react is known to be a function of how their parents react; how families react is in part a function of how the neighborhood responds. This interactive notion of how outcomes emerge following large-scale disasters is accepted as a tenet in the community psychology literature (Norris, 2001). Although conceptual models that work at the individual level, such as that proposed by Keane and Barlow (2002), serve multiple purposes when it is vital for the level of analysis to go beyond the individual and move to higher ordinates, it is imperative that interactive models be developed and considered. Models that incorporate individual, group, and societal levels of analysis will undoubtedly be more predictive of the cumulative response of communities to the adversity experienced via disaster.

The current text attempts to accomplish complex model building in several places. Borrowing on public health strategies for understanding and intervening in community-wide disasters, these models ultimately will assist mental health professionals in interfacing most effectively with extant non-mental health resources following traumatic events. Appreciating who is most vulnerable following a traumatic event, based on levels of exposure and known risk factors, is key to the delivery of scarce mental health resources to those in greatest need and at greatest risk for developing prolonged psychological distress. In addition, it highlights one of the central findings in all of disaster research: many people exposed to great adversity readjust over time, demonstrating the remarkable resiliency of human beings.

Future model development that includes societal, community, family, and individual levels of analysis would greatly assist public policy experts in understanding and developing strategies for the optimal allocation of resources. Studies that would empirically examine variables at each of these levels of analysis would be especially welcome at this time (see Green et al., 2003).

Levels of Intervention

Much of our knowledge about effective treatments for psychological distress stems from randomized-control clinical trials with individuals who meet criteria for a particular disorder. Typically, these trials include participants who meet certain inclusion criteria and do not meet other criteria, It is widely known that people can develop a wide range of psychological disorders following traumatic events such as a terrorist attack. These disorders include PTSD, depression, panic, and substance abuse. Frequently, these disorders appear concurrently and represent high levels of comorbidity (Keane & Kaloupek, 1997; Keane & Wolfe, 1990), yet the evidence for treatment efficacy rarely addresses individual cases with multiple comorbidities.

In addition, virtually all the treatment outcome data that exist apply to treatments delivered at the individual level. Few randomized studies examine the role of group therapy in the treatment of PTSD (Keane, 1997). Among the lessons learned from 9/11, one is unremitting: addressing a major public health disaster such as a terrorist attack is impossible with only individual-level treatments. Alternatives are necessary. Group treatments, the subject of this book, are commonly employed in clinical settings, and virtually all mental health professionals receive training in some form of group therapy. An expressed goal of this text is to bring together the long clinical history surrounding the use of group-based interventions with the needs of the public when disaster strikes. How should groups be assembled? For how long should groups continue? Who should be included in groups? What type of intervention yields maximal results? When following the disaster should the interventions be provided? What types of interventions are effective in the short-term as preventive actions? What types of interventions can be provided in the mid- to long-term? Should couples and families be seen together with others? What professional qualifications are needed to run group therapy? These are only a few of the fundamental questions that many of the chapters in this text address.

However, group therapy alone may also be inadequate when extraordinary events occur and needs are great. When questions about the meaning of life and the loss of life predominate, what are the most appropriate and effective interventions? Clearly, public health models and messages must serve as the backbone of any comprehensive approach when thousands and even millions are affected by a traumatic event or series of events. Much as the impact of the 9/11 assaults was heightened by the presence of telecommunications, our approaches to managing the mental health impact of such events must make intelligent use of television, radio, and other forms of telecommunication. Broadcasts that include valuable information for managing one's own reactions and those of one's family and friends can form a preventive strategy that will reach large numbers of the affected population readily and quickly. In addition, telecommunications can minimize and address the nefarious effects of rumors and misinformation rapidly and definitively.

Similarly, the Internet and World Wide Web constitute an important and relatively new resource for responding to the needs of those affected by disaster and terrorism. Web sites such as those of the National Center for PTSD (www.ncptsd.org), the International Society for Traumatic Stress Studies (www.istss.org), the American Psychological Association (www .apa.org), and the American Psychiatric Association (www.psych.org) all contain important information for trauma in general; all responded to the events of 9/11 with enhanced sites to assist those suffering from the aftermath of the assaults.

Each of these methods can mitigate the effects of terrorism, disaster, and other types of traumatic events. Individual treatments, group treatments, public health strategies, and the use of technology to deliver relevant and needed information on coping and other resources comprise a comprehensive strategy for intervening in mass disasters. Conceptualizing the approach to assistance as one requiring multiple levels of intervention can result in a coordinated and systematic effort that will maximally utilize available resources and reach the largest number of people.

In a related text, Green and colleagues (2003) attempted to develop intervention strategies for entire countries adversely affected by mass trauma and disasters. Baron, Jensen, & de Jong (2003) devised a set of principles based on an inverted triangle that placed the highest priority at the level of interventions reaching the largest numbers of people with the lowest levels of intensity, resources, and cost. Such efforts as public health interventions coupled with national policies and procedures to minimize the impact of mass disasters are portrayed in this model as optimal, especially when resources are scarce. In places such as Rwanda, Burundi, Congo, Cambodia, Gaza, and Sudan, interventions based on public health models using Western and indigenous strategies are seen as the highest priorities. Specific culturally based interventions that address the psychological impact of traumatic events are important features to include in any blending of Western and indigenous interventions as they may improve acceptance of the intervention while enhancing the effectiveness of the treatment. This is particularly the case when few professionally trained mental health professional resources are available in a region or a country.

For example, when Kuwait was recovering from the invasion by Iraq in 1990-1991, considerable financial resources were available, but due to cultural variables, resources were modest in terms of trained clinical psychiatrists, psychologists, and social workers in that country. Alternative interventions were required. Efforts to work extensively through family and religious networks became the priority. Telecommunications also served as an important medium for assisting families and individuals in the recovery process following exposure to that war.

Controversies

For many decades mental health professionals have been actively involved clinically in the immediate aftermath of disasters. From a research perspective, involvement of mental health professionals possibly dates back to Lindeman (1944) who studied the psychological impact of the Coconut Grove nightclub fire in downtown Boston. The field of crisis intervention, beginning in the 1960s with the community mental health movement in the United States, was the clear forebear of our current clinical involvement. Employing psychological first aid and screening strategies, these initial forays into the field of disaster mental health set the stage for more comprehensive involvement. Yet this involvement has in recent years been fraught with controversy.

The stage for controversy is in the specific nature of mental health professionals' involvement following disasters and similar critical incidents. Most people recognize and acknowledge the need for psychosocial support for those exposed to a critical incident, but there is less agreement about the components of any particular intervention. It appears from the literature that what is needed is a clearly defined process rather than any technique. All involved in the debate agree that a single intervention of whatever type is likely to be inadequate to prevent the occurrence of untoward psychological outcomes. What the process should be and how the process unfolds over time constitute the nature of the discus...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• About the Editors
• Contributors
• Preface
• Acknowledgments
• PART I: OVERVIEW
• PART II: FOUNDATIONS
• PART III: GROUP MODELS
• PART IV: FUTURE DIRECTIONS
• Index