Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that may develop among survivors who experience or witness mass catastrophes, such as the recent earthquake and tsunami in Japan. PTSD symptoms can include persistent fearful thoughts, haunting memories, sleep disorders or nightmares, heightened startle reactions, and feeling numb or detached from loved ones. The prevalence of PTSD among survivors one year after a mass catastrophe can be as high as 50%, depending on the severity experienced and proximity to the event.
Most mass trauma survivors will suffer an immediate distress reaction, characterized by feelings of horror, shock and nervousness. These symptoms will usually decrease with time as basic needs are reestablished for food, safe shelter, water, medical attention and finding loved ones.
Charles Raison, MD, an associate professor and clinical director of the Mind-Body Program and director of the Behavioral Immunology Program in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine, advises: “if there is also an element of dissociation to the immediate reaction, a feeling of unreality, that’s a strong sign that people could go on to develop PTSD. We know for sure that how people respond immediately to a stressor is very powerfully predictive of how much long-term trouble they are going to have. An acute response seems to set pathways in the brain or body and set the stage for later trouble.”
Psychological First Aid (PFA) is now widely considered by mental health experts to be the intervention of choice to help disaster victims manage post-disaster distress and to identify those who may need additional treatment. It is designed for delivery by mental health specialists who may be embedded in a variety of response units, including first responder teams, incident command systems, primary and emergency health care providers, school crisis response teams, faith-based organizations, and other disaster relief organizations.
The primary objectives of PFA are to:
* Establish a human connection in an unobtrusive, culturally sensitive manner
* Make survivors feel safe and secure both physically and emotionally
* Help survivors specify their immediate needs
* Connect people to social support networks
* Provide information that can help victims reduce stress reactions
* Support and encourage adaptive coping behaviors
Experts concur that “debriefing” survivors or forcing them to recount their experiences in the first week or two after a traumatic event is not recommended as that approach has been shown to make things worse. Further, it is important not to impose a particular method of treatment or a timeline for recovery.
Additional risk factors for developing PTSD after a traumatic event are: how much worse the stressor was compared to expectations, the history of past trauma, and the victim’s mental health before the event occurred. Sadly, the March 11, 2011, earthquake and tsunami that devastated parts of Japan has led to continuing stress for the survivors due to the massive destruction and the ongoing nuclear facility crisis.
Raison takes Japan’s history into account when he considers the potential prevalence of psychological distress among the survivors and says, “given the history of Japan as the only country to have ever been attacked by a nuclear weapon, the specter of this latest nuclear threat so soon after the initial destruction of the earthquake and tsunami means there will unfortunately be a great number of people in psychological distress for years to come.”
CONNECT THE DOTS
The PFA Field Operations Guide for first responders, primary and emergency health care providers and disaster relief organizations is available from the National Child Traumatic Stress Network or the National Centre for PTSD, in English and in Japanese. Visit the National Institute of Mental Health site to learn more about PTSD and anxiety disorders. The American Red Cross or Doctors Without Borders are also inspiring disaster relief organizations.