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Managing the After-effects of Disaster Trauma – The Essentials of Early Intervention
The above corresponds with both psychodynamic and cognitive theories approximately 2–3,000 Norwegian tourists who were affected by
about how therapeutic processes take place. In the psychodynamic the disaster. In a survey of all of the 1,500 RGPs who were responsible
approach, the therapeutic effect may be dependent on the patient for victims, Hjemdal
54
found that the concerns of RGPs about actively
reaching a coherent narrative of his or her experience. In cognitive theory, calling their patients were not confirmed by the positive responses of
re-experiencing helps to correct distorted beliefs about one’s self and what their patients to being contacted. This finding supports the usefulness
occurred, and helps to desensitise the conditioned fear response. of the participation of RGPs in the psychiatric response to disasters.
Intervention by Whom? For the mental health professional, disaster psychiatry is an interesting
In European countries with national health systems, it is possible to use and demanding challenge. Knowledge in psychiatry is essential for
primary care physicians to systematically respond to psychiatric needs the management of the disaster trauma. When it comes to
after a disaster. This is in accordance with WHO’s recommendation.
3
implementation, however, some interventions may be more effective
For example, following the 2004 tsunami, Norwegian regular when applied by other types of disaster worker. Future challenges
general practitioners (RGPs) were given the main responsibility for include better co-operation between professions within the field of
the psychiatric evaluation, treatment and sometimes referral of the disaster management. ■
1. Norris FH, Friedman MJ, Watson PJ, et al., 60,000 disaster events and posttraumatic stress disorder in 4 postconflict WH Freeman, 1997.
victims speak: Part I. An empirical review of the empirical settings, JAMA, 2001;286:555–62. 37. Carver CS, Scheier MR, On the self-regulation of behaviour,
literature, 1981–2001, Psychiatry, 2002;65:207–39. 19. Porter M, Haslam N, Predisplacement and postdisplacement New York: Cambridge University Press, 1998.
2. Foa EB, Stein DJ, McFarlane AC, Symptomatology and factors associated with mental health of refugees and internally 38. Antonovsky A, Health, stress, and coping, San Francisco:
psychopathology of mental health problems after disaster, displaced persons: A meta-analysis, JAMA, 2005;294:602–12. Jossey-Bass, 1979.
J Clin Psychiatry, 2006;67(Suppl. 2):15–25. 20. Heir T, Weisæth L, Acute disaster exposure and mental health 39. Brewin CR, Posttraumatic Stress Disorder: Malady or Myth?,
3. World Health Organization, Psychosocial consequences of complaints of Norwegian tsunami survivors 6 months post London: Yale University Press, 2003.
disasters. Prevention and management, WHO, MNH/PSF/91.3, disaster, Psychiatry, in press. 40. Benight CC, Collective efficacy following a series of natural
Geneva, 1992. 21. Bleich A, Gelkopf M, Solomon Z, Exposure to terrorism, stress- disasters, Anxiety Stress Coping, 2004;17(A):401–20.
4. Guha-Sapir D, Panhuis WG, Conflict-related mortality: An related mental health symptoms, and coping behaviors among 41. War Office Committee of Enquiry into Shell Shock, Report of the
analysis of 37 datasets, Disasters, 2004;28:418–28. a nationally representative sample in Israel, JAMA, 2003;290: committee, Cmd. 1737, London: HMSO, 1922.
5. United Nations, International strategy for disaster reduction, 612–20. 42. Bryant RA, Sackville T, Dang ST, et al., Treating acute stress
UN/ISDR, Geneva, 2007. 22. Grieger TA, Fullerton CS, Ursano RJ, Posttraumatic stress disorder: an evaluation of cognitive behavior therapy and
6. Ursano RJ, Fullerton CS, Weisaeth L, Raphael B (eds), Textbook disorder, alcohol use, and perceived safety after the terrorist supportive counseling techniques, Am J Psychiatry, 1999;156:
of Disaster Psychiatry, Cambridge: Cambridge University Press, attack on the pentagon, Psychiatr Serv, 2003;54:1380–82. 1780–86.
2007. 23. Weisaeth L, Stress reactions to an industrial disaster, PhD 43. Bryant RA, Moulds M, Guthrie R, et al., Treating acute stress
7. Gersons BP, Olff M, Coping with the aftermath of trauma, BMJ, thesis, Faculty of Medicine, University of Oslo, 1985. disorder following mild traumatic brain injury, Am J Psychiatry,
2005;330:1038–9. 24. Pesonen AK, Räikkönen K, Heinonen K, et al., Depressive 2003;160:585–7.
8. Kornor H, Weisaeth L, Winje D, et al., Psychological interventions symptoms in adults separated from their parents as children: a 44. Bisson JI, Shepherd JP, Joy D, et al., Early cognitive-behavioural
after large accidents and disasters, Oslo: Norwegian Knowledge natural experiment during World War II, Am J Epidemiol, therapy for post-traumatic stress symptoms after physical injury.
Centre for the Health Services, 2006. In Norwegian; English 2007;66:1126–33. Randomised controlled trial, Br J Psychiatry, 2004;184:63–9.
summary available at: www.kunnskapssenteret.no/filer/ 25. Berle JO, Haver B, Karterud S, Group reactions as observed in 45. Bleich A, Gelkopf M, Solomon Z, Exposure to terrorism, stress-
rapport8_06_psykososiale_tiltak_nettversjon.pdf crisis intervention programs in hospitals, English abstract, Nord J related mental health symptoms, and coping behaviors among
9. Kornor H, Winje D, Ekeberg O, et al., Psychological interventions Psychiatry, 1991;45:329–35. In Norwegian. a nationally representative sample in Israel, JAMA, 2003;290:
after crisis and accidents, Oslo: Norwegian Knowledge Centre 26. Pfefferbaum B, Doughty DE, Reddy C, et al., Exposure and 612–20.
for the Health Services, 2007. In Norwegian; English summary peritraumatic response as predictors of posttraumatic stress in 46. Rubin GJ, Brewin CR, Greenberg N, et al., Psychological and
available at: www.kunnskapssenteret.no/filer/Psykososiale_ children following the 1995 Oklahoma City bombing, J Urban behavioral reactions to the bombings in London on 7 July 2005:
tiltak_ved_kriser_og_ulykker_nettversjon.pdf Health, 2002;79:354–63. Cross-sectional survey of a representative sample of Londoners,
10. Rose S, Bisson J, Churchill R, et al., Psychological debriefing for 27. Ahern J, Galea S, Resnick H, et al., Television images and BMJ, 2005;331:606–11.
preventing posttraumatic stress disorder, Cochrane Database probable posttraumatic stress disorder after September 11: The 47. Altindag A, Ozen S, Sir A, One-year follow-up study of
Syst Rev, 2002;(2). role of background characteristics, event exposures, and posttraumatic stress disorder among earthquake survivors in
11. van Emmerik AA, Kamphuis JH, Hulsbosch AM, et al., Single perievent panic, J Nerv Ment Dis, 2004;192:217–26. Turkey, Compr Psychiatry, 2005;46:328–33.
session debriefing after psychological trauma: a meta-analysis, 28. Lau JT, Lau M, Kim JH et al., Impacts of media coverage on the 48. Norris FH, Baker CK, Murphy AD, et al., Social support
Lancet, 2002;360:766–71. community stress level in Hong Kong after the tsunami on 26 mobilization and deterioration after Mexico’s 1999 flood:
12. Hobfoll SE, Watson P, Bell CC, et al., Five essential elements of December 2004, J Epidemiol Community Health, 2006;60: Effects of context, gender, and time, Am J Community Psychol,
immediate and mid-term mass trauma intervention: Empirical 675–82. 2005;36:15–28.
evidence, Psychiatry, 2007;70:283–315. 29. Fremont WP, Childhood reactions to terrorism-induced trauma: 49. Hobfoll SE, Canetti-Nisim D, Johnson RJ, Exposure to terrorism,
13. Jones N, Greenberg N, Wessely S, No plans survive first contact A review of the past 10 years, J Am Acad Child Adolesc stress-related mental health symptoms, and defensive coping
with the enemy: Flexibility and improvisation in disaster mental Psychiatry, 2004;43:381–92. among Jews and Arabs in Israel, J Consult Clin Psychol,
health, Commentary on Five essential elements of immediate 30. Lengua LJ, Long AC, Smith KI, et al., Pre-attack 2006;74:207–18.
and mid-term mass trauma intervention: Empirical evidence by symptomatology and temperament as predictors of children’s 50. de Jong JTVM, Public mental health, traumatic stress and
Hobfoll, Watson et al., Psychiatry, 2007;70:361–5. responses to the September 11th terrorist attacks, J Child human rights violations in low-income countries: A culturally
14. Weisaeth L, Dyb G, Heir T, Disaster medicine and mental Psychol Psychiatry, 2005;46:631–45. appropriate model in times of conflict, disaster and peace. In:
health: Who, how, when for international and national 31. Raphael B, When disaster strikes: A handbook for the caring de Jong J (ed.), Trauma, war and violence: Public mental health
disasters, Commentary on Five essential elements of immediate professional, Boston: Unwin Hyman, 1986. in sociocultural context, New York: Plenum-Kluwer, 2002;1–91.
and mid-term mass trauma intervention: Empirical evidence by 32. Gelpin E, Bonne O, Peri T, et al., Treatment of recent trauma 51. Zhang B, El-Jawahri A, Prigerson HG, Update on bereavement
Hobfoll, Watson et al., Psychiatry, 2007;70:337–43. survivors with benzodiazepines: a prospective study, J Clin research: Evidence-based guidelines for the diagnosis and
15. National Institute for Health and Clinical Excellence, Post- Psychiatry, 1996;57:390–94. treatment of complicated bereavement, J Palliat Med, 2006;9:
traumatic stress disorder (PTSD): The management of PTSD in 33. Mellman TA, Bustamante V, David D, et al., Hypnotic 1188–1203.
adults and children in primary and secondary care, National medication in the aftermath of trauma, J Clin Psychiatry, 52. Parkes CM, Bereavement in adult life, BMJ, 1998;316:856–9.
Clinical Practice Guidelines Number 26, London: Cromwell Press 2002;63:1183–4. 53. Heir T, Weisaeth L, Back to where it happened: Self-reported
Limited, 2005. 34. Pitman RK, Sanders KM, Zusman RM, et al., Pilot study of improvement of Tsunami survivors who returned to the disaster
16. Connor KM, Foa EB, Davidson JR, Practical assessment and secondary prevention of posttraumatic stress disorder with area, Prehosp Disaster Med, 2006;21:59–63.
evaluation of mental health problems following a mass disaster, propranolol, Biol Psychiatry, 2002;51:189–92. 54. Hjemdal O K, Follow-up of disaster victims. The role of general
J Clin Psychiatry, 2006;67(Suppl. 2):26–33. 35. Schelling G, Briegel J, Roozendaal B, et al., The effect of stress practitioners, Oslo: Norwegian Centre for Violence and
17. Wilson JP, Keane TM (eds), Assessing psychological trauma and doses of hydrocortisone during septic shock on posttraumatic Traumatic Stress Studies, 2007. In Norwegian; English summary
PTSD, second edition, New York: The Guilford Press, 2004. stress disorder in survivors, Biol Psychiatry, 2001;50:978–85. available at: www.nkvts.no/Bibliotek/Publikasjoner/Boker
18. de Jong JT, Komproe IH, Van Ommeren M, et al., Lifetime 36. Bandura A, Self-efficacy: The exercise of control, New York: RapporterNotater/Tsunamien_Fastlegerapport.pdf
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