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Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT March 21, 2003 "Freedom is the oxygen of the soul." - Moshe Dayan
Short Subjects
LINKS Mental Health Moment Online CONFERENCES AND WORKSHOPS:
Rocky Mountain Region
Disaster Mental Health Institute -
SPRING WORKSHOP SERIES
March 22 - Religious Aspects of
Domestic Violence
- Pat Bradley, MA, NACC, LAT
April 23, 24, 25 -
Crisis Counseling, Trauma, and Response:
A Multi-level Approach
- Marguerite McCormack, MA, LPC
May 3 - Suicide Risk Assessment and Risk Reduction: Tactics For The Trenches
- Jon Richard, PsyD
The Australasian Critical Incident
Stress Association Conference
The Right Response in the
21st Century
Location: Carlton Crest Hotel
Melbourne Australia
Friday October 3, 2003 thru
Sunday October 5, 2003
For further information
please contact the conference organisers:
ammp@optushome.com.au
Conference Website:
http://www.acisa.org.au/ conference2003/Summer Intensive Program
Graduate Certificate in
Disaster Mental Health
Disaster Mental Health Institute (University of South Dakota)
Location: Union Building
University of South Dakota Campus Vermillion, SD
Contact: Disaster Mental Health Institute
University of South Dakota
SDU 114 414 East Clark St
Vermillion, SD 57069-2390
Phone: 605-677-6575 or 800-522-9684
Fax: 605-677-6604
http://www.usd.edu/dmhi/Third Biennial International Conference
on Intercultural Research (IAIR)
May 16 - 19, 2003
Location: Taipei, Taiwan Contact: 2003 IAIR International Conference
C/o College of Education
NTNU, PO Box 7-763
Taipei, Taiwan 106
Tel: +(886)2-2321-3142
Fax +(886)2-2394-9243
Email: t14004@cc.ntnu.edu.tw
VIII European Conference
on Traumatic Stress(ECOTS)
May 22 - 25, 2003
Location: Berlin, GERMANY
Contact: Scientific Secretariat
VIII ECOTS Berlin 2003
c/o Catholic University of
Applied Social Sciences
Koepenicker Allee 39-57
D-10318 Berlin
Tel: +49-30-50 10 10 54
Fax: +49-30-50 10 10 88
E-mail: trauma-conference@kfb-berlin.de
Annual Conference Society for
Industrial/Organizational Psychology (SIOP)
April 12 - 14, 2003
Location: Orlando, Florida
USA
Contact: lhakel@siop.bgsu.edu
4th International Symposium on Bilingualism
April 30 - May 3, 2003
Location: Tempe, Arizona, USA
Contact:
4th International Symposium on Bilingualism
Arizona State University
PO Box 870211
Tempe, AZ 85287-0211, USA
Email: isb4@asu.edu
Annan pledges UN help and support to Iraqi people
20 March – Secretary-General Kofi Annan said today the United Nations will do whatever it can to bring assistance and support to the Iraqi people and called on all parties in the conflict to scrupulously observe the requirements of international humanitarian law. For full story, go to: http://www.un.org/apps/news/story.asp?NewsID=6519&Cr=iraq&Cr1=relief
Iraq: UN officials urge protection for refugees, children, respect for human rights
20 March – With war looming over Iraq today top United Nations humanitarian officials rallied to appeal for respect for human rights, protection for children – “the most vulnerable population” – and open borders for refugees fleeing the conflict. For the full story, go to: http://www.un.org/apps/news/story.asp?NewsID=6520&Cr=Iraq&Cr1=relief
Security Council to discuss adjustments to UN Oil-for-Food programme for Iraq
20 March – Concerned about the humanitarian situation in Iraq, the Security Council is scheduled to discuss a letter from Secretary-General Kofi Annan suggesting possible adjustments to the “oil-for-food” programme, the President of the 15-nation body said today. For the full story, go to: http://www.un.org/apps/news/story.asp?NewsID=6523&Cr=iraq&Cr1=oil
THE MEDICAL MINUTE: ANTIBIOTIC RESISTANCE A GROWING PROBLEM
According to the latest edition of the Medical Minute, a service of Penn State Milton S. Hershey Medical Center, it can be difficult to determine exactly when an antibiotic is needed for common respiratory infections. Doctors have been debating this in medical journals for decades. One thing is agreed --indiscriminate use of antibiotics is becoming a serious problem. Antibiotics are designed to kill bacteria, and upper respiratory infections are almost never bacterial at the beginning. Antibiotics won't be effective because viruses don't have the internal chemistry that antibiotics work against. Unnecessary use of antibiotics can contribute to the problem of antibiotic resistance -- which can lead to the creation of a so-called "super bug" and make some antibiotics less effective. For the full Medical Minute by John Messmer, visit http://www.psu.edu/ur/2003/medicalminute027.html
Green Cross
Based at Florida State University, this website contains very useful information about trauma, traumatology training and information on how to handle questions about war with family and friends and for military families and friends. Go to: http://www.greencross.org
Purdue University Extension offers advice for helping children cope with terrorist attacks and their aftermath: http://www.ces.purdue.edu/terrorism.
University of Minnesota, Children, Youth & Family Consortium has information on how parents can help their children with their concerns, fears and worries about war: http://www.cyfc.umn.edu/publications/newsreleases/ 3-10-03nr.html
Kansas State University Research and Extension has information on the impact of military deployment and related issues on families: http://www.humec.k-state.edu/news/2003/Militarymain.html
University of Minnesota Extension Service, Restoring Hope in the Wake of Terrorism: http://www.extension.umn.edu/administrative/disasterresponse/ terrorism.html
University of Minnesota Extension Service, Ready to Respond: http://www.extension.umn.edu/administrative/disasterresponse/ terror2.html
University of Illinois Extension Service, Talking with Children about Terrorism and War: http://web.aces. uiuc.edu/familylife/terrorism.htm
New York University Child Study Center, Talking to Kids About Terrorism or Acts of War: http://www. aboutourkids.org/articles/war.html
Healthy Parenting Tool Kit is a joint effort of University of Missouri (Human Environmental Sciences and 4-H/ ParentLink) and Lincoln University. Materials cover topics related to parenting young children during times of deployment, relocation, and dangerous work: http:// mfrc.calib.com/healthyparenting/dangerouswork.cfm
The National Extension System has a website regarding children and trauma and the University of Georgia Extension has produced publications as well: http://www.agctr.lsu. edu/eden/default.aspx
Center for the Family at Pepperdine University developed information on preparing for the war: http://www.pepperdine.edu/gsep/family/ Families,%20Trauma,%20and%20Terrorism.htm
Families and Work Institute has developed a Salute to Educators guide that addressees age- and developmentally- appropriate tips on how to communicate with children in all situations of crisis, trauma and tragedy: http://www.familiesandwork .org/salute.html
The Learning Network, Talking About Conflict and War: http://www.familyeducation.com/article/0,1120,20-6055,00. html
The Learning Network, Talking with Children about War - Pointers for Parents: http://www.familyeducation.com/article/0,1120,1-4412,00. htmlM
Children Now, Talking with Kids about the News: http://www.childrennow.org/television/twk-news.htm
Family Information Services has a web page of resources on “Families and Crisis:" http://familyinfoserv.com/ crisis.html
The Navy’s Roosevelt has a website and a “lifeline” link to other services on what to say to children, especially when they have a loved one that is so far away: http://www.spear.navy.mil and http://www.navy.mil and http://www.kidspeace.org/war.htm.
“Something to Remember Me By” Legacy Project has tips on helping children talk about and deal with war and terrorism, as well as activity ideas that children can do with parents and grandparents: http://www.somethingtoremembermeby.org/holidaykit/part2/hd2.6a.html
From the BBC, teaching resources on Iraq: http://news.bbc.co.uk/go/em/fr/-/cbbcnews/hi/teachers/citizenship_11_14/subject_areas/conflict_resolution/ newsid_2280000/2280663.stm
From Chick Moorman, “The Five Best and Worst Things You Can Say To Your Children About War:" http://www.ncfr.org/about_us/n_news_announcements.asp?newsid-407
APA SITES: The following APA sites contain information on Resilience In A Time of War: Articles; The Road To Resilience These and linked APA sites give information and free brochures for downloading and ordering online. http://www.helping.apa.org
THE STRESS OF TERRORISM
On September 11, 2001 terrorist attacks caused the catastrophic collapse of the twin towers of the World Trade Center in New York City. Approximately 40 minutes after the World Trade Center was attacked a similar terrorist attack was perpetrated against the Pentagon in Washington, D.C. Although the resultant physical devastation was beyond anything this nation has ever experienced, the psychological devastation may not be known for years. In attempts to assess this, stress experienced by responders and other survivors has been the focus of a number of studies.
The concept of stress has been around for some time. It is probably the most common problem of everyday life. Occupational stress can be considered as an accumulation of job stress related situations that are considered oppressive by most of us. Occupational stress is the interaction of work conditions with characteristics of the worker such that the demands of work exceed the ability of the worker to cope with them (Cano, 1999).
Much of the literature on stress and organizational outcomes has focused on organizational factors and has ignored extraorganizational stressors that lead to perceived stress. However, research in other fields and recent studies in management suggests that acute-extraorganizational stressors, such as traumatic events, may have potentially negative and costly implications for organizations. Byron and Peterson (2002) tested a theoretical model of traumatic stress and considered the relationship between strain from an acute-extraorganizational stressor, the terrorist attack on September 11, 2001, and absenteeism. Using a sample of 108 MBA and MPA students, their study suggests that strain caused by an acute-extraorganizational stressor can have important consequences for organizations. Namely, employees who report more strain from a traumatic life event are more likely to be absent from work in the weeks following the event. The increase in stress related medical leave did not occur in large numbers until months after the September 11 attacks. Repeated exposures at the site and the increasing number of funerals and memorial services that firefighters attended during the next 11 months might have contributed to stress related problems (Banauch et al, 2002).
Acosta and Levenson (2002) discussed observations and stress responses of police officers at Ground Zero of the World Trade Center immediately after the attack on September 11, 2001. They offer a variety of clinical techniques for emergency mental health practitioners and first responders for use with victims of critical incidents. The suggested interventions are based on the theory and clinical practice of Emergency Medical Hypnosis, Neuro-Linguistic Programming, and Ericksonian Psychotherapy. They provide some examples of how they were applied with police personnel following the World Trade Center attack together with specific clinical guidelines. These interventions are designed to augment and enhance standard mental health and medical practice in the field.
Cassel and Blackwell (2002) Discuss the perceived urgent and immediate need for specialized health care for youth during crisis states such as the terrorist destruction of the World Trade Center. Such care typically begins with the family physician, and often includes the use of prescription drugs to allay anxieties. Typically that must include the services of a psychologist or psychiatrist working in close relation with the parents. Cassel and Blackwell stress the need to help such individuals develop sympathetic companionships, seen as the best suicide prevention possible.
Duffy (1988) discusses man-made disasters (e.g., plane crashes, dam bursts) and suggests that guilt and responsibility along with anger and nonacceptance may have serious mental health implications for the victims of this kind of disaster. The stages after a disaster (i.e., heroic, honeymoon, disillusionment) are outlined as they relate to such disasters.
A single act of violence or terrorism can adversely affect thousands of people. Such acts will invariably engender a psychological morbidity that will far surpass any physical morbidity. Heretofore, efforts in primary and secondary prevention have focused largely upon the physical consequences of these incidents, rather than their psychological consequences. Everly (2000b) describes a practical group psychological crisis intervention, the "crisis management briefing" (CMB), that may be used with large groups of individuals in the wake of terrorism, violence, disasters, and other crises. This intervention, which is one component of the Critical Incident Stress Management crisis intervention system, is designed to mitigate the effects of these crises and requires anywhere from 45 to 75 min to implement. The CMB may be employed with groups ranging from 10 to 300 individuals at one time.
The September 11, 2001 (9/11) terrorist attacks led to speculation about the vulnerability of psychiatric patients to psychological distress following such events. Franklin, Young and Zimmerman (2002) examined the impact of national terrorist attacks on 308 psychiatric and medical outpatients living approximately 150 to 200 miles from the attack site. Two to three weeks following 9/11, patients were given questionnaires assessing background information, healthcare service utilization, and posttraumatic stress disorder (PTSD) symptoms. Psychiatric patients (33%) were significantly more likely than medical patients (13%) to report distressing symptoms meeting criteria for PTSD (except for the duration criterion) despite no differences in learning about the attacks or personal involvement with the victims. Patients meeting PTSD criteria were more likely to schedule an appointment to speak with their physician about their reactions. Psychiatric patients not directly impacted by the 9/11 terrorist attacks are at increased risk for experiencing distressing symptoms following national terrorist attacks.
Galea et al (2002) assessed the prevalence and correlates of acute post-traumatic stress disorder (PTSD) and depression among residents of Manhattan 5-8 wks after the September 11, 2001, terrorist attacks. They used random-digit dialing to contact a representative sample of adults living south of 110th Street in Manhattan. Ss were asked about demographic characteristics, exposure to the events of September 11, and psychological symptoms after the attacks. Among 1008 adults interviewed (mean age 42 yrs), 7.5% reported symptoms consistent with a diagnosis of current PTSD related to the attacks, and 9.7% reported symptoms consistent with current depression. Among respondents who lived south of Canal Street (i.e., near the World Trade Center), the prevalence of PTSD was 20.0%. Predictors of PTSD in a multivariate model were Hispanic ethnicity, 2 or more prior stressors, a panic attack during or shortly after the events, residence south of Canal Street, and loss of possessions due to the events. Predictors of depression were Hispanic ethnicity, 2 or more prior stressors, a panic attack, a low level of social support, the death of a friend or relative during the attacks, and loss of a job due to the attacks.
Sixty-six persons with posttraumatic stress disorder (PTSD) exposed to battlefield experience, civilian terrorism, and work and traffic accidents were studied to assess the differential outcome of the various types of trauma as measured by PTSD core symptoms and associated features of depression, anxiety, interpersonal sensitivity, and somatization (Amir, Kaplan and Kotler, 1996) . The participants were assessed on a PTSD scale, Impact of Events Scale, and four Symptom Check List subscales. The results showed that the battle-experience group was more severely affected than the other groups. Time elapsed since the trauma was significantly positively correlated to PTSD core symptoms and associated features. Only the time elapsed since the trauma--not the division into type of trauma groups--was significantly correlated with severity. Education and army rank were found to be protecting variables.
Benight et al (2000) studied 27 victims (mean age 41 yrs) of the Oklahoma City bombing are. Their research focused on the importance of subjective appraisals of coping self- efficacy in predicting psychological distress following this tragedy. Results supported the hypothesis that judgments of coping self-efficacy taken 2 months after the bombing added significantly to the explanation of general and trauma-related distress after controlling for income, social support, threat of death, and loss of resources. Coping self-efficacy judgments taken 1 year later were also important in explaining psychological distress after controlling for loss of resources and social-support perceptions. Although coping self-efficacy perceptions taken at 2 months were related to distress levels 1 year later, they did not remain significant in a regression analysis controlling for loss of resources and income. Implications of these findings for post-terrorist bombing interventions are important in similar situations.
Boscarino et al (2002) assessed mental health utilization in Manhattan following the September 11 terrorist attacks. A random-digit-dial telephone survey was conducted five to eight weeks afterwards, among 988 randomly selected householders over 17 yrs old. 16.9% reported using mental health services thirty days before the attacks and 19.4% reported using these services thirty days afterwards. 10.0% increased mental health utilization thirty days after the attacks, compared to thirty days before and 5.3% decreased utilization. Risk factors included: being 45-64 yrs of age, female, experiencing 4+ lifetime traumatic events, experiencing 2+ stressful life events in the past 12 mo, and experiencing an acute panic attack during the disaster. Neither current post-traumatic stress disorder (PTSD) nor current depression was predictive of increased post-disaster utilization when panic attack was included in the analysis. While a statistically significant increase in pre- vs post-disaster utilization was found among the general population, this increase was not substantial, except among specific subgroups (those who had a peri-event panic attack, those exposed to previous stressors, women, and those less than 65 yrs old).
Effects on Youth
Ben-Eli and Sela (1980) engaged 60 children in therapy who, as a result of the 1979 terrorist attack on Nahariya, Israel, evidenced the following symptoms: fear of noise, the dark, and the seashore; lack of concentration; and difficulty sleeping. Ss were divided into small groups (6-8 members) that met close to the time of original crisis. Strong emphasis was placed on catharsis and cognitive reconstruction of the traumatic events. Feelings of anger, terror, and blame were allowed to be vented freely. Results of this active coping with the stress situation and application of relaxation and desensitization techniques indicate that most Ss' school and home functioning improved.
International Effects
Apolone, Mosconi and La Vecchia (2002) conducted a survey to examine symptoms of stress in Italy following the September 11 terrorist attacks. 1,928 persons who were representative of the population of Italy participated. The results indicated a slight depression in the mental health score, and it is concluded that the terrorist attacks negatively influenced mental health outside of the United States.
Asukai and Kazuhiko (2002) describe the experiences and findings in the wake of the 1995 Sarin terrorist attack in the Tokyo subway system. Acute effects, early responses of victims and the public, incidence of posttraumatic stress disorder, and limitations of early interventions are described. The long- term health effects of Sarin poisoning are discussed, including the survivors' apprehensions of unknown health effects, continued physical complaints, and posttraumatic stress symptoms. Briefly noted is the difficulty in establishing a mental health care regime for such disasters. Generally, a relief program should provide poisoned victims and survivors with accurate health information and a sound physical health checkup system as well as supportive counseling including psychoeducation for posttraumatic stress symptoms.
Ayalon (1993) discusses the therapeutic and diagnostic aspects of injury in 3 out of 15 terrorist attacks which involved kidnapping and face-to-face killing of Israeli civilians in the years 1974 to 1980. They discuss the psychological harm caused by personal, communal, and societal trauma and examine the means of therapeutic interventions. They present information on phenomenological approaches to the evaluation of coping (e.g., circles of support, community support systems during a tragedy, crisis without aid, stress inoculation: preventive care, brief group therapy for a near-miss population); mass media and treatment (e.g., individual therapy for media-publicized bereavement); and suggestions about getting help to giving help; role changes; and strategic methods of short-term family therapy.
de Jong (2002)Describes a variety of programs to address mental health and psychosocial problems in low- income countries and conflict and post-conflict areas in Africa, Asia and the Middle East. Examples from 9 programs started or supported by the Transcultural Psychosocial Organization clarify how mental health can be approached within different sociocultural contexts, while also providing the historical, political and sociocultural background of different conflicts. The book focuses on the public mental health aspects of complex humanitarian and political emergencies. These emergencies combine several features: (1) they violate human rights; (2) involve the use of both state and non-state terror; (3) they often occur within a country rather then across state boundaries; (4) they include expressions of political, economics and sociocultural divisions; (5) they promote competition for power and resources and result in predatory social formations; (6) they affect large, displaced and mostly poor populations; and (7) they often are protracted in duration and accompanied by cycles of violence. Governments, non-governmental organizations, and United Nations agencies will find this book useful when setting up community mental health and psychosocial services.
Desivilya et al (1996) examined the long-term impact of a terrorist attack on adolescents focusing on the relationships between the extent of victimization and long term outcomes, notably the severity of traumatic stress symptoms. Ss were 59 31-40 yr old survivors of the 1974 Ma'alot event in Israel, in which a group of 120 high school students were taken hostage by armed Palestinian guerillas. In-depth interviews and a battery of questionnaires were given to the Ss, 17 years after the event, to measure two dimensions of the extent of victimization; degree of exposure and physical injury. Results indicated that very intense victimization, particularly in terms of physical injury, had the strongest effect on long term adjustment in comparison to moderate or minimal victimization in the same trauma. Findings revealed that traumatic face-to-face encounter with terror occurring at the developmental stage of adolescence was quite pervasive and long- lasting.
Duchet, Jehel and Guelfi (2000) conducted a longitudinal and prospective study of 56 victims of a terrorist bombing in the Paris, France transportation system on December 3, 1996. Five psychometric scales were administered: the French-language Life Events Scale (M. Ferreri et al, 1987) and the French- language versions of the posttraumatic stress disorder (PTSD) Interview **(C. G. Watson et al, 1991), the General Health Questionnaire, the Internal Powerful Others and Chance Scale (H. Levenson, 1981), and the Ways of Coping Check-List (P. P. Vitaliano et al, 1985)**. The major diagnoses and the main risk factors and protective factors in the development of psychotraumatic symptomatology were established. The case studies of two victims, a 34-yr-old woman and a 65-yr-old man, are presented to illustrate contrasting postevent clinical pictures. The findings indicate that the development of psychotraumatic symptomatology is related to the presence of acute stress, the subjective perception of the event, and the victim's psychological integration of the event. It is maintained that the absence of physical injury appears to hinder the diagnosis of psychological suffering.
Vicarious Exposure
Duggal et al (2002) report the case of an 11-yr-old boy who developed posttraumatic stress disorder (PTSD) along with major depression after watching on TV the terrorist attacks on the World Trade Center. The patient was in the 7th grade in a boarding school. Overwhelmed by the events, the patient impulsively decided to commit suicide, but was prevented from it. PTSD symptoms have been reported in children who have watched TV coverage related to Halloween, war, industrial disaster, and terrorist bombing. This case demonstrates that a child who is exposed to traumatic events on TV can develop PTSD symptoms and has implications for media personnel, teachers, parents, and clinicians.
Treatment Approaches
Behrman and Reid (2002) present a task-based group treatment approach to post-trauma intervention. When persons are traumatized, much of what they assume about themselves, others, and the purposes of their lives are disrupted and lose connectedness. Their model is designed to help individuals and the community of which they are a part recreate these connections in meaningful, creative, and responsible ways, which may result in change on informative, reformative, or transformative levels. Their model makes use of nine basic tasks in which the practitioner, individuals, and community are active participants. The tasks comprise welcoming, reflecting, reframing, educating, grieving, amplifying, integrating, empowering, and terminating/revisiting. Use of the model is illustrated in the first author's work with employees of the New York City Adult Protection Services, who were witness to the World Trade Center disaster.
Fredrickson et al (2003) extrapolating from B. L. Fredrickson's (1998, 2001) broaden-and-build theory of positive emotions, hypothesize that positive emotions are active ingredients within trait resilience. U.S. college students (18 men and 28 women) were tested in early 2001 and again in the weeks following the September 11th terrorist attacks. Mediational analyses showed that positive emotions experienced in the wake of the attacks--gratitude, interest, love, and so forth--fully accounted for the relations between (a) pre-crisis resilience and later development of depressive symptoms and (b) pre-crisis resilience and post-crisis growth in psychological resources. Findings suggest that positive emotions in the aftermath of crises buffer resilient people against depression and fuel thriving, consistent with the broaden-and-build theory. Discussion touches on implications for coping.
Difede and Hoffman (2002) describe the treatment of a survivor (aged 26 yrs) of the World Trade Center (WTC) attack of September 11 who had developed acute Post-traumatic Stress Disorder (PTSD). After she failed to improve with traditional imaginal exposure therapy, they sought to increase emotional engagement and treatment success using virtual reality (VR) exposure therapy. Over the course of six 1-hr VR exposure therapy sessions, they gradually and systematically exposed the PTSD patient to virtual planes flying over the WTC, jets crashing into the WTC with animated explosions and sound effects, virtual people jumping to their deaths from the burning buildings, towers collapsing, and dust clouds. VR graded exposure therapy was successful for reducing acute PTSD symptoms. Depression and PTSD symptoms as measured by the Beck Depression Inventory and the Clinician Administered PTSD Scale indicated a large (83%) reduction in depression, and large (90%) reduction in PTSD symptoms after completing VR exposure therapy. Although case reports are scientifically inconclusive by nature, these strong preliminary results suggest that VR exposure therapy is a promising new medium for treating acute PTSD.
Everly and Lating (2002), in an updated edition of A Clinical Guide to the Treatment of the Human Stress Response reflect upon the changes in this field over the past decade. This edition covers a range of new topics, including stress and the immune system, posttraumatic stress and crisis intervention, Eye Movement Desensitization and Reprocessing, Critical Incident Stress Debriefing, Crisis Management Briefings in response to mass disaster and terrorism, Critical Incident Stress Management, spirituality and religion as stress management tools, dietary factors and stress, and updated information on psychopharmacologic intervention in the human stress response. As with the previous edition, this volume is designed as a comprehensive and accessible guide to both the clinically relevant physiology and treatment of the human stress response. Discussion of treatment protocols using selected behavioral treatment strategies is purposefully brief and clinically targeted. Supplemental information for practitioners includes a flow chart on the nature of stress physiology and protocols for teaching the relaxation response. This book will be of interest to students, practitioners, and researchers in the fields of psychology, psychiatry, medicine, nursing, social work, and public health.
The concept of early psychological intervention in response to traumatic events has been a compelling notion since WWI (Everly, 2001). Recently, its wisdom applied to mass disasters such as the September 11th, 2001 terrorist attacks has been called into question. A review of relevant research on early psychological intervention, crisis intervention, critical incident stress debriefing, and critical incident stress management reveals support for their continued utilization, but not without caution. Crisis intervention in response to mass disasters should consist of an integrated multi-component intervention system, with a wide variety of interventions best suited to the needs of the specific disaster.
Cremniter et al (1997) examined the development of posttraumatic stress disorder (PTSD) in three groups of hostages after an aircraft hijacking who differed by virtue of timing and circumstances of their release and return home and evaluated whether a comprehensive psychological debriefing system could be established in a civilian context. Group 1 was composed of 35 evaluated survivors who were released before the plane took off. Group 2 was composed of 121 passengers who lived through all 54 hrs of being hostages and who returned to their original destination immediately after release. Group 3 included 68 passengers who were also released after the assault but who chose to stay overnight elsewhere before returning to their original destination. All groups received information about possible sequelae of trauma and were provided with psychological debriefing. In Group 1, 6 Ss suffered from severe psychological reactions, 3 with acute stress disorder, 2 with somatic reactions, and 1 with psychosomatic reaction. In Group 2, 6 Ss reported symptoms of anxiety and stress, including an early manifestation of Stockholm syndrome. In Group 3, 3 Ss suffered from immediate reactions of stress and acute psychosomatic reactions.
Difede et al (1997) describe the acute psychiatric responses of nine survivors (aged 25-45 yrs) of the 1993 terrorist explosion at the World Trade Center in New York City. The Ss completed a structural clinical interview, the SCID. Most of this self-referred sample had posttraumatic stress disorder (PTSD). The cluster of symptoms that comprise a PTSD diagnosis did not seem to capture the subjective experience of these trauma survivors. The four Ss who had a past psychiatric history experienced a recrudescence of their symptoms. They suggest that acute interventions for trauma survivors might be an examination of how trauma survivors' fundamental beliefs about themselves, the world, and others have been affected by the event to effectively integrate the experience and obtain symptom relief.
Some Responder Characteristics
Compassion fatigue is the latest in an evolving concept known in the field of traumatology as secondary traumatic stress, or the stress experienced by caregivers. Figley (2002) focuses on the assessment, treatment, and prevention of compassion fatigue. Through examination of contemporary theory and research, leaders in the field come together to further clarify the concept of compassion fatigue. Case studies address the trauma of working with special populations such as children, victims of terrorism, and major disaster survivors. Treatment methods offer comprehensive plans for recovery from burnout and the prevention strategies provided will be of use to those in the helping professions.
The pastoral community represents a large and often untapped resource in times of crisis. It possesses a unique aggregation of characteristics that makes it uniquely valuable amidst the turmoil of a psychological crisis. In critical incidents such as terrorism, mass disasters, violence, the loss of loved ones, and any events wherein human actions result in injury, destruction, and/or death, the pastoral community may possess especially powerful restorative attributes (Everly, 2000a). Unfortunately, until now, there has existed no generally recognized and accepted manner in which the healing factors inherent in pastoral care have been functionally integrated with the well-formulated principles of crisis intervention. Everly (2000a)presents an initial effort to elucidate how the principles of pastoral care may be functionally integrated with those of crisis intervention. The amalgam is referred to as "pastoral crisis intervention." The goals of pastoral crisis intervention are fundamentally the same as those of non-pastoral crisis intervention, that is the reduction of human distress, whether or not the distress concerns a significant loss, a crisis of meaning, a crisis of faith, or a more concrete and objective infringement on adaptive psychological functioning. *************************************************************************************************
REFERENCES Acosta, Judith K., Levenson, Richard L. JR (Spr 2002). Observations from Ground Zero at the World Trade Center in New York city, part II: Theoretical and clinical considerations. International Journal of Emergency Mental Health, Vol 4(2), pp. 119-126.
Amir, Marianne, Kaplan, Zeev, Kotler, Moshe (Oct 1996). Type of trauma, severity of posttraumatic stress disorder core symptoms, and associated features. Journal of General Psychology, Vol 123(4), pp. 341-351. Journal URL: http://www.heldref.org/html/gen.html
Apolone, Giovanni, Mosconi, Paola, La Vecchia, Carlo (May 2002). Post-traumatic stress disorder. New England Journal of Medicine, Vol 346(19), pp. 1495-1496.
Asukai, Nozomu, Maekawa, Kazuhiko (2002). Psychological and physical health effects of the 1995 Sarin attack in the Tokyo subway system. In Havenaar, Johan M. (Ed); Cwikel, Julie G. (Ed); et al. Toxic turmoil: Psychological and societal consequences of ecological disasters. Plenum series on stress and coping. New York, NY, US: Kluwer Academic/Plenum Publishers. pp. 149-162.
Ayalon, Ofra (1993). Posttraumatic stress recovery of terrorist survivors. In Wilson, John Preston (Ed); Raphael, Beverley (Ed) International handbook of traumatic stress syndromes. The Plenum series on stress and coping. pp. 855-866.
Banauch, G., McLaughlin, M., Hirschhorn, R., Corrigan, M., Kelly, K., Prezant, D. (Oct 2002). Injuries and illness among New York City Fire Department rescue workers after responding to the World Trade Center attacks. JAMA: Journal of the American Medical Association, Vol 288(13), pp. 1581-1584. Journal URL: http://jama.ama-assn.org/
Behrman, Gary, Reid, William J. (Spr 2002). Post-trauma intervention: Basic tasks. Brief Treatment & Crisis Intervention, Vol 2(1), Special Issue: Crisis response, debriefing, and intervention in the aftermath of September 11, 2001. pp. 39-47. Journal URL: http://www.brief-treatment.oupjournals.org
Ben-Eli, Tzion, Sela, Miriam (Sep 1980). Terrorists in Nahariya: Description of coping under stress. Israeli Journal of Psychology & Counseling in Education, No 13, pp. 94-101.
Benight, Charles C., Freyaldenhoven, Robert W., Hughes, Joel, Ruiz, John M., Zoschke, Tiffany A., Lovallo, William R. (Jul 2000). Coping self-efficacy and psychological distress following the Oklahoma City bombing. Journal of Applied Social Psychology, Vol 30(7), pp. 1331-1344. Journal URL: http://www.bellpub.com/jasp/index.htm
Boscarino, Joseph A., Galea, Sandro, Ahern, Jennifer, Resnick, Heidi, Vlahov, David (Sum 2002). Utilization of mental health services following the September 11th terrorist attacks in Manhattan, New York City. International Journal of Emergency Mental Health, Vol 4(3), pp. 143-156.
Byron, Kristin, Peterson, Suzanne (Dec 2002). The impact of a large-scale traumatic event on individual and organizational outcomes: Exploring employee and company reactions to September 11, 2001. Journal of Organizational Behavior, Vol 23(8), pp. 895-910. Journal URL: http://www.interscience.wiley.com/jpages/0894-3796/
Cano, Johanna M. (Mar 1999). Passenger airline cabin staff stress reduction program. Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 59(9-B), pp. 5073.
Cassel, Russell N., Blackwell, John (Jun 2002). Caring for youth in relation to the terrorists' threats and crisis states of the social order. College Student Journal, Vol 36(2), pp. 310-313.
Cremniter, Didier, Crocq, Louis, Louville, Patrice, Batista, Guillermo et al. (May 1997). Posttraumatic reactions of hostages after an aircraft hijacking. Journal of Nervous & Mental Disease, Vol 185(5), pp. 344-346. Journal URL: http://www.jonmd.com/
de Jong, Joop, (Ed) (2002). Trauma, war, and violence: Public mental health in socio-cultural context. Series Title: The Plenum series on stress and coping. New York, NY, US: Kluwer Academic/Plenum Publishers. xii, 454 pp.
Desivilya, Helena Syna, Gal, Reuven, Ayalon, Ofra (Oct 1996). Extent of victimization, traumatic stress symptoms, and adjustment of terrorist assault survivors: A long-term follow-up. Journal of Traumatic Stress, Vol 9(4), pp. 881-889. Journal URL: http://www.wkap.nl/journalhome.htm/0894-9867
Difede, JoAnn, Apfeldorf, William J., Cloitre, Marylene, Spielman, Lisa A., Perry, Samuel W. (Aug 1997). Acute psychiatric responses to the explosion at the World Trade Center: A case series. Journal of Nervous & Mental Disease, Vol 185(8), pp. 519-522. Journal URL: http://www.jonmd.com/
Difede, Joann, Hoffman, Hunter G. (Dec 2002). Virtual reality exposure therapy for World Trade Center post-traumatic stress disorder: A case report. CyberPsychology & Behavior, Vol 5(6), pp. 529-535. Journal URL: http://www.liebertpub.com/CPB/default1.asp
Duchet, C., Jehel, L., Guelfi, J.-D. (Aug-Sep 2000). A propos de deux victimes de l'attentat parisien du RER Port-Royal du 3 decembre 1996: Vulnerabilite psychotraumatique et resistance aux troubles. Translated Title: About two victims exposed to a terrorist bombing in the Paris transportation system, Port-Royal, 3 December 1996: Psychotraumatic vulnerability and resistance to troubles. Annales Medico-Psychologiques, Vol 158(7), pp. 539-548. Journal URL: http://www.elsevier.com/inca/publications/store/6/2/2/2/8/8/
Duffy, John C. (Aug 1988). The Porter Lecture: Common psychological themes in societies' reaction to terrorism and disasters. Military Medicine, Vol 153(8), pp. 387-390.
Duggal, Harpreet S., Berezkin, Gennady, John, Vineeth (May 2002). PTSD and TV viewing of World Trade Center. Journal of the American Academy of Child & Adolescent Psychiatry, Vol 41(5), pp. 494-495. Journal URL: http://www.jaacap.com/
Everly, George S. JR, Lating, Jeffrey M. (2002). A clinical guide to the treatment of the human stress response (2nd ed.). Series Title: The Plenum series on stress and coping. New York, NY, US: Kluwer Academic/Plenum Publishers. xix, 478 pp.
Everly, George S. JR (Fal 2001). Thoughts on early intervention. International Journal of Emergency Mental Health, Vol 3(4), pp. 207-210.
Everly, George S. Jr. (Win 2000). Crisis management briefings (CMB): Large group crisis intervention in response to terrorism, disasters and violence. International Journal of Emergency Mental Health, Vol 2(1), pp. 53-57.
Everly, Jr., George S. (Spr 2000). Pastoral crisis intervention: Toward a definition. International Journal of Emergency Mental Health, Vol 2(2), pp. 69-71.
Figley, Charles R., (Ed), (2002). Treating compassion fatigue. Series Title: Psychosocial stress series, no. 24. New York, NY, US: Brunner-Routledge. viii, 227 pp.
Franklin, C. Laurel, Young, Diane, Zimmerman, Mark (Dec 2002). Psychiatric patients' vulnerability in the wake of the September 11th terrorist attacks. Journal of Nervous & Mental Disease, Vol 190(12), pp. 833-838. Journal URL: http://www.jonmd.com/
Fredrickson, Barbara L., Tugade, Michele M., Waugh, Christian E., Larkin, Gregory R. (Jan 2003). What good are positive emotions in crisis? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001. Journal of Personality & Social Psychology, Vol 84(2), pp. 365-376. Journal URL: http://www.apa.org/journals/psp.html
Galea, Sandro, Ahern, Jennifer, Resnick, Heidi, Kilpatrick, Dean, Bucuvalas, Michael, Gold, Joel, Vlahov, David (Mar 2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine, Vol 346(13), pp. 982-987.
To search for books on disasters and disaster mental
health topics, leaders, leadership, orgainizations,
crisis intervention, leaders and crises, and related
topics and purchase them online, go to the following url:
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
RECOMMENDED READING
Living With the Boogeyman: Helping Your Child Cope With Fear, Terrorism, and Living in a World of Uncertainty
by Richard Bromfield
Book Description
A Reassuring Guide to Parenting in Troubled Times
Boys and girls have always worried about the monsters—the boogeymen—that their imaginations create out of normal fears and the angst of growing up. The terrifying events since September 11, however, have added a dimension of disturbing reality to their monster fears. That's why now, more than ever, your children need strong, committed, and wise parenting.
About the Author
Richard Bromfield, Ph.D., is a clinical psychologist on the faculty of Harvard Medical School and the author of Playing for Real and Handle with Care. He lives in Boston with his wife and two children.
Additional Readings at: Terrorism and Stress in the search engine. Also try looking here for Psychology and Terrorism.
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
Rocky Mountain Region
Disaster Mental Health Institute
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
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