Psychosocial Capacity Building in Response to Disasters by Miller Joshua L.;

Author:Miller, Joshua L.;
Language: eng
Format: epub
Publisher: Columbia University Press
Published: 2012-01-18T16:00:00+00:00

CLINICAL INTERVENTIONS FOR MID- AND LONG-TERM TREATMENT

Clinical interventions, such as counseling and therapy, are often helpful to survivors of disaster in the weeks and months following the catastrophic event, particularly in Western cultures. Although many unresolved issues remain about when to offer interventions, what combinations of interventions are most effective, and how long services should be provided, sufficient evidence supports the use of certain interventions (McNally et al., 2003). The most promising types of interventions fall within the overall category of cognitive behavioral therapies (CBTs), both individual and group, many of which were derived from work with sexual assault survivors who had developed PTSD and other trauma syndromes (Australian Centre for Post-traumatic Mental Health [ACPMH], 2007; Halpern & Tramontin, 2007; McNally et al., 2003). Treatment is particularly targeted toward people with PTSD, ASD, and those who have developed lingering anxiety disorders. Cognitive behavioral therapies are a familiar part of the response repertoire in Western nations, where most of the research for their effectiveness has been tested, but are not necessarily appropriate for use in non-Western societies. In these cultures, psychological interventions are less familiar, if not alien, and strengthening social supports and social networks may be more effective and culturally consonant (McNally et al., 2003).

Behaviorally oriented strategies include systematic desensitization and exposure therapies (Halpern & Tramontin, 2007). With systematic desensitization, patients are taught muscle relaxation techniques and then gradually and systematically exposed to imagined distressing stimuli in increasing doses. Exposure therapy also involves imagining anxiety-inducing scenes but tends to introduce the aversive stimuli in a more full-tilt fashion. The goal is to help patients tolerate and manage overwhelmingly distressing images or frightening situations that they are avoiding. Another type of exposure therapy is eye movement desensitization and reprocessing (EMDR). This involves moving a finger back and forth in front of patients’ eyes or having them tap themselves on the shoulder, each shoulder in turn, as they imagine the dreaded events. It is still not clear why this is helpful (Halpern & Tramontin, 2007). If the exposure proves to be overwhelming, patients are taught to imagine a “safe space” that they can retreat to in their minds where the feelings of dread and anxiety should subside. Bryant and Harvey (cited in Halpern & Tramontin, 2007) caution against using exposure therapies if patients have some of the following symptoms: extreme anxiety, panic attacks, disassociation, borderline personality disorder, psychosis, anger as a primary stress response, severe depression, risk for suicide, substance abuse, or other complicating factors or ongoing stressors. As mentioned in chapter 4, somatic experiencing is being used to help people with trauma symptoms process and resolve their reactions. Somatic experiencing seeks to “unlock” traumatic symptoms encoded in the body by resetting the nervous system through “working with small gradations of somatic activation alternated with the use of somatic resources” (Leitch et al., 2009, p. 11). Attention is paid to posture, skin tone, breath, and other ways that trauma is stored in the body (Leitch et al., 2009).

Another way of approaching trauma and anxiety is through cognitive processing, as in cognitive processing therapy (CPT).

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