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Post-traumatic Stress Disorder
emotions of anger, anxiety, psychic numbing, despair, etc. impair a In order to reach the many affected in post-disaster situations, the
person’s sense of control and effectiveness. The myths of the mental health professional has to work through others.
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This can be
helplessness of the disaster survivor and of the omnipotence of the achieved by mobilising human networks such as families, neighbours,
disaster worker are likely to underestimate the capacity of the survivor to friends and work-mates to provide social support. A ‘honeymoon
accomplish purposeful and relevant activities that are effective in phase’, which frequently occurs after a disaster, creates an altruistic
regulating effects. Such activities will also empower the disaster victim.
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community characterised by out-reach and social support.
Calming techniques need to be employed in panic prevention and
treatment. A properly executed medical examination is an excellent Mental health professionals must consider several factors when trying
psychological first aid. Psycho-education that emphasises the normative to foster connectedness. Avoidant behaviour, personality styles and
and adaptive function of stress reactions is recommended. effective coping strategies should be taken into account when
connecting with others. The ‘art’ of intervention involves balancing the
Medication is often used for symptomatic relief during the acute need for contact with respect for avoidance, which is part of the post-
phase of a disaster. Facilitation of sleep is important because sleep traumatic stress response.
deprivation reduces stress tolerance. The use of benzodiazepines in
the management of disaster stress reactions is controversial. They Hope
initially have an calming effect, but they are shown to not decrease the A disaster event creates strong feelings of helplessness and
risk of later PTSD.
32,33
Interesting attempts have been made to use powerlessness in victims as well as in many disaster workers. It is
propranolol
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and hydrocortisone
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in the acute phase to prevent post- essential that helplessness is not transformed into hopelessness. This
traumatic stress reactions, but no conclusions can yet be drawn on the risk is likely to be greatest among those who have suffered severe or
preventative effect of medical intervention. multiple losses. Post-traumatic stress reactions after a disaster often
undergo a gradual reduction. Knowledge about this natural
Self-efficacy attenuation can be used to foster hope. Quick and effective disaster
Psychologically traumatised people are hypersensitive to situations they rescue, relief and reconstruction counter pessimism and catastrophising
cannot personally control. Providing a sense of control, whether real or while also raising hope. Housing, employment and insurance
perceived, is important. Here, some theoretical concepts are useful, such reimbursements help people to restore their lives and re-establish
as establishment of positive response, result and recovery expectancies.
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hope.
12
Early CBT interventions counteract negative thoughts and
This can be achieved through encouraging support from a care provider, install positive, action-orientated expectations about the future.
as well as self-regulation of thoughts, emotions and behaviour.
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In a
study of people who maintained mental health during and after It is important not to pathologise grief. Grief is not an illness and
disastrous events, Antonovsky
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introduced the notion of ‘the sense of should not be treated as such. Initially, prolonged grief cannot be
social coherence’ as a crucial factor for resilience. This notion consists easily differentiated from normal grief: the two conditions manifest
of the combined effect of comprehensibility (i.e. true understanding of similarly.
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The differentiation between acute depression and intense
what is happening to me), manageability (i.e. the ability to act and grief, on the other hand, is important. Grief is characterised by
influence the situation) and the personal meaningfulness of the stressful intense yearning for the deceased and pangs of sadness elicited by the
event. In contrast, a disaster experience that reactivates a latent identity realisation of one’s loss.
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In contrast, depression is characterised by a
dominated by helplessness, powerlessness, pre-determined bad luck or stable depressed mood, a lack of positive expectations, negative
the belief that the world is an evil place puts the person at high risk of thoughts directed against one’s self and lowered self-esteem.
developing prolonged stress reactions.
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In contrast to individual trauma,
disasters offer a collective experience. Collective efficacy, or the belief Controlled Re-exposure
that one’s group can achieve a positive outcome, has been shown to be All effective psychosocial treatments of PTSD have one thing in
beneficial.
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People find strength in numbers. common: in vitro or in vivo exposure. Exposure is important to
desensitise the nervous system, and it may be indicated for victims who
For a long time, strategies that enhance resilience have been advocated avoid necessary life situations associated with the trauma. Early
by the military to reverse incapacitating stress reactions in combat- attempts should be made to regain control over important life activities;
stressed soldiers.
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Such stress management programmes include survivors should be encouraged to ‘get back on the horse’. For those
recovery through activity and the positive expectancy of recovery.
14
The who are plagued by traumatic stress symptoms for many weeks or
efficacy of cognitive–behavioural therapy (CBT) in preventing months after a disaster, a more systematic exposure therapy is useful.
prolonged PTSD is evidence-based.
15,42–44
CBT promotes active coping, For example, in one of our studies of Norwegian tsunami survivors, we
individual skills and self-help, elements that are critical for maintaining evaluated the effect of returning to the disaster area under the
or restoring self-efficacy. guidance of a psychiatric team.
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Participants were motivated survivors
who were still suffering from significant post-traumatic stress
Connectedness problems. Considerable improvements in anxiety symptoms were
Fostering connection quickly after mass trauma is critical for recovery.
45,46
reported and observed in both adults and children. No apparent cases
Research evidence has demonstrated the importance of social support of re-traumatisation occurred. Many stated that the visit to the disaster
such as sharing a group identity, having emotional contact, getting area had given them a better perspective of events. This contributed to
practical help, receiving information and receiving social guidance and the drawing together of discontinuous and fragmented images into a
limits. Social support serves as a buffer to stress, and is related to better more comprehensible whole picture: that is, the mental processing of
emotional wellbeing and recovery following mass trauma.
47–49
overwhelming impressions.
68 EUROPEAN PSYCHIATRIC REVIEW