Post-Disaster Response: Learning from Research
|Matthew J. Friedman,
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
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
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.
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|Howard J. Osofsky,
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
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.
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
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
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
For more information on disaster readiness and response,
visit SAMHSA's Web site at www.samhsa.gov.
« See Part 1: Hurricane Recovery Guides Preparedness
« See Part 2: Hurricane Recovery Guides Preparedness
See Part 1: Post-Disaster Response: Learning from Research
Recovery Guides Preparedness Planning
Schools Offer Stability for Children of Disasters »
Documentary Features New Orleans High School »
Disaster Readiness Resources »
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