E-Book, Englisch, 85 Seiten
Beutler / Housley Treating Victims of Mass Disaster and Terrorism
1. Auflage 2006
ISBN: 978-1-61334-321-0
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark
E-Book, Englisch, 85 Seiten
Reihe: Advances in Psychotherapy - Evidence-Based Practice
ISBN: 978-1-61334-321-0
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark
The mental health effects of disasters and terror events can be severe, and are most effectively characterized as differing stress reactions with psychological consequences. Empirical studies show that addressing these consequences requires a staged approach to care.
This volume, written by leading experts, provides professionals with practical, evidence-based guidance on diagnosis and treatment following disaster and terrorist events – and does so in a uniquely “reader-friendly” manner. It is both a compact “how-to” reference, for use by professional clinicians, as well as an ideal educational resource for students and professionals and for practice-oriented continuing education.
The unique feature of the book is that it outlines a staged approach for post-disaster mental health care, based on empirically supported principles of treatments that work. Practical and reader-friendly, it is a compact and easy-to-follow guide covering all aspects that are relevant in real-life.
Earn 5 CE credits for reading volumes of the Advances in Psychotherapy book series. Click here to find out more!
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1 Description
1.1 Terminology
Treatment is defined by the event not by a specific form of psychopathological response Unlike many treatments that are described both in this series and under the heading of “empirically supported” or “research-based” treatments, the intervention described in this volume does not focus on individuals by diagnostic classification. The treatment of survivors and first responders who have been exposed to mass trauma, and particularly to terrorism is defined by the event, not by a specific form of psychopathological response. While most people who are exposed to mass trauma, including terrorist trauma, will experience acute stress disorder (ASD) during the immediate postevent process, as time goes on, a wide variety of responses occur, including a return to normal functioning. Treatment must be broadly conceived and easily adaptable People are surprisingly resilient, and a substantial majority of those exposed will not warrant a mental health diagnosis at all, beyond the immediate postevent period. Thus, to focus on a specific syndrome, like posttraumatic stress disorder (PTSD), is both to assume a degree of homogeneity of response that is not present following mass trauma and to miss the variety of problems presented. Moreover, basing a treatment on exclusionary consideration of a single diagnostic condition will fail adequately to address the needs of many, if not most, of those who are needy of services and whose postadjustment is characterized by such syndromes as major depression and chemical abuse/dependence, family disruption, and generalized anxiety. Thus, the treatment of survivors of terrorism and disasters must be broadly conceived and easily adaptable to a variety of patient conditions over a substantial period of time. 1.2 Definition
ASD, PTSD, depression and substance abuse are some of the psychological reactions to disaster Because this book does not focus on a specific disorder, but rather on the broad range of psychological consequences that follow a terrorist-initiated event (or other mass casualty events), there is not a singular definition that can be provided of the disorder and problem to be treated. It is most efficient to characterize reactions to traumatic events through differing stress reactions (i.e., consequences). These consequences include those reactions normally associated with ASD and PTSD but also include other reactions. These other effects include any temporary or long-term, adverse psychological reactions that are stimulated by the trauma (e.g., use of negative coping in an effort to avoid memories or emotions through increased substance use, major depression, chemical dependence, etc.). One of the most pervasíve and consistent reactions to mass trauma is that of ASD, which is prevalent during the early, postevent period. But, for most people, this syndrome dissipates with time, even without specific treatment. ASD is but the nucleus of symptoms from which a variety of posttrauma reactions may evolve. PTSD, depression, and chemical abuse are the diagnoses most often seen among postterror and posttrauma survivors, and generally are considered to be stress-induced (e.g., Galea, Ahern, Resnick et al., 2002; Galea, Vlahov, Resnick et al., 2003). A host of other, nonsyndromal, stress-related problems are likely to also manifest themselves in response to terrorist events, however, and many of these require or are likely to be responsive to treatment. These problems may range from specific symptoms of depression and chemical abuse to vague symptoms of anxiety and family disruption. 1.3 Epidemiology
Unfortunately, it is difficult to obtain accurate and reliable base rate data on minor and subclinical, stress-related conditions. The most accurate epidemiological picture of response to the specific case of a terrorist attack comes from mapping the incidence and prevalence rates observed among those who have been exposed to terrorism or other mass trauma onto the base-rates of stress-induced conditions of ASD, PTSD, major depression, and chemical abuse that existed previously in the observed population. The mental health impact of terrorist/mass trauma events can be estimated as the degree to which stress-induced conditions are increased above normative expectations, following a terrorist event. The best estimates of normative expectations for these comparisons are derived from three sources. The Epidemiologic Catchment Area Study (Narrow et al., 2002; Regier et al., 1998; Robins, Locke, & Regier, 1991), conducted by the National Institute of Mental Health, extracted census-based samples at five sites between 1980 and 1985. Over 20,000 individuals over the age of 18 were surveyed. The National Comorbidity Study (NCS; Kessler et al., 1997) was initiated a few years later in response to a congressional mandate to identify the prevalence of mental health and substance abuse disorders which could then serve as the basis for establishing a national policy for the treatment of mental health and drug abuse disorders. A partial replication of this latter survey (NCS-R; Kessler, Chiu et al., 2005; Kessler, Demler et al., 2005) was conducted about 10 years later, between 2000 and 2003, to replicate the NCS study and to determine changes in incidence and prevalence rates of various disorders. There are several important methodological differences in how these surveys were conducted. These differences, compounded with changes in the diagnostic system and the introduction of ASD in 1994, with the advent of DSMIV, resulted in some significant disparities among the ECS and NCS surveys, particularly in estimates of lifetime rates of various disorders. Nonetheless, there is reasonable consistency among the reports on the 12-month incidence rates of trauma-induced disorders (ASD, PTSD, depression, chemical abuse). Supplemented by some specialized and continuing surveys of specific problems (e.g., the Household Survey on Drug Abuse by SAMHSA, 2002; surveys following the events of September 11, 2001), a reasonable estimate is possible of the impact of mass terrorism. Women are twice as much at risk of PTSD than men Combining the results of the initial ECA report (Regier et al., 1998 and the two NCS reports (Kessler et al., 1994; Kessler et al., 2005), the probable, 12month prevalence rate of PTSD/ASD in the general population is about 8%. The risk rate for women is about twice that of men (10% versus 5%); among men, African-American males are at greatest risk. However, in all likelihood, the observed sex and ethnic differences are reflections of varying social roles, intensity of prior exposure to violence, and contexts rather than being reflections of inherent biological vulnerabilities (Galea, Vlahav, & Resnick, 2003). Prevalence rates of depression are somewhat more variable in the demographic, normative surveys than are rates of PTSD/ASD in the normative samples. Lifetime prevalence rates of depression vary from 8% in the ECA survey to 19% in the NCS survey, with 12-month rates being somewhat more consistent and hovering near 10% (Beutler, Clarkin, & Bongar, 2000). Adding the prevalence rates of comorbid and non-comorbid chemical abuse, which hover around 10%, results in a general population baseline, 12-month risk of between 22% and 24%. This is the expected rate, within a nonterrorismexposed population, of having the symptoms that are the most likely to be affected and exacerbated by a mass terror-initiated event. Against this base rate, one can compare the prevalence rates of these same stress-induced disorders in the New York City area, following the terrorism-initiated events of 9/11/01. It is uncertain how generalizable the resulting estimates of terrorist impact are, however. It is likely that they are culture and region/country specific because of wide variations in the frequency of exposure and cultural beliefs about terrorism that characterizes the responses of survivors from different areas and cultures. For our purposes, we will compare the baseline rates observed in the three U.S. surveys to the rates of problems present among those people who were most directly exposed to mass terrorism on September 11, 2001. Random surveys of residents of the New York City area following 9/11 have typically concluded that there has been an increase in mental health problems generally, in this region, especially among those most directly exposed to terrorism. However, actual demonstration that the post 9/11 prevalence is higher than the normative base rate expectations has been hard to come by, and estimates of actual incidence rates have varied widely among surveys. Population-based surveys have suggested slightly higher rates of PTSD-like symptoms than those surveys that have relied on less direct assessment methods (Galea, Ahern, Resnick et al., 2002). Nonetheless, it seems quite clear that symptoms of ASD during the first month following a mass trauma event affect most of the exposed population, and it is also clear that there is a high rate of general recovery even in untreated populations, over the following 6 months. Thus, somewhat surprisingly, diagnosable PTSD (which, by definition, can only be present after a month or more following the incident event) was not demonstrably different than the expected normative rates in the New York City area, within about six months of 9/11/2001. The data suggest that the greatest increases of stress-induced problems were in the areas of depression and chemical abuse, rather than in PTSD....
