Thursday, 14 April 2011

A Closer Look at the Japanese Earthquake, Tsunami and now nuclear radiation threats.

The Tsunami in Japan has resulted in worldwide concern; this has increased with the additional threats of nuclear radiation.  http://www.worldnewsco.com/news/japan-tsunami-radiation-threat.  Due to these contamination effecting a larger population and having potentially devastating effect on the Aid workers, creating a whole new dimension the to an already horrific natural disaster. The nuclear threats pose not only physical concerns but can increase the potential psychological problems of survivors developing PTSD and secondary traumatisation for Aid workers. http://www.newsweek.com/2011/04/10/too-much-trauma.html

The psychological impact after the Japanese Tsunami has been predicted to look rather dismal. Psychologists say that there is a 25% chance of survivors developing PTSD after the initial Tsunami. This percentage is likely to increase with the threats of nuclear radiation http://blisstree.com/feel/scary-psychological-effects-of-japans-earthquake-tsunami-and-nuclear-disaster/
Psychologists might estimate high rates of survivors developing PTSD after a critical incident, however it was shown that during the 9/11 attack on the world trade centres, people were not as likely to have developed PTSD as predicted. Resulting in many researchers to begin investigating the resilience of people and what helps survivors in such circumstances.  Resulting in the development of Psychological first aid, (see previous post) http://www.stockholmresilience.org/research/whatisresilience.4.aeea46911a3127427980004249.htmlhttp://ptsd.about.com/od/causesanddevelopment/a/Sept11_PTSD.htm

Although, the Tsunami is very different to the 9/11 attack, I think that as mental health workers we should be weary when estimating the extent to which PTSD might occur as to avoid the effects of a self-fulfilling prophecy. http://www.suite101.com/content/selffulfilling-prophecies-a15843 .If psychologists warn the survivors of the Tsunami about a potential at developing PTSD following the disaster and state the high probability of them developing the disorder, a self-fulfilling prophecy could occur, where more people develop PTSD due to them believing it is out of their control, because of what psychologists have said.

The risk of the survivors developing PTSD has already been discussed however, a real concern is the mental health of Aid workers, as they risk developing secondary traumatisation, which is also known as Vicarious trauma http://www.buzzle.com/editorials/6-27-2006-100635.asp.  Vicarious trauma is when a person witnesses a disaster and starts to develop an adverse reaction to the event, which holds many similar symptoms to PTSD.  This is found when people who are not directly affected by the disaster such as observers, Aid workers, rescuers, or even people watching on TV, start developing PTSD symptoms from what they have witnessed of a disaster.  http://www.uic.edu/orgs/convening/vicariou.htm . 
The prevalence of vicarious trauma is increased when rescuers have an increase in risk of their own life and wellbeing; hence the situation as it stands in Japan is affecting more than just the survivors.  With the nuclear radiation threats both the health and psychological states of Aid workers are now important components to consider, as the probability of them developing vicarious trauma is increased.http://www.headington-institute.org/Default.aspx?tabid=2649

As mental health workers responding to this crisis, it is important to remember the cumulative effect of this particular natural disaster. The initial earthquake, Tsunami and now the nuclear radiation threats accumulate and affect the mental health of the survivors.  Along with the survivors needs its necessary to investigate the effects of responding to this disaster as Aid workers and the real concern of Aid workers developing vicarious trauma.

For more information on the different reactions to trauma look at www.traumatrainingonline.com

Friday, 1 April 2011

How Should Mental Health Workers Provide Effective Psychological Aid in the Wake of Massive Natural Disasters?

As humans we have developed various technologies to be able to predict events happening on our earth. However, we are still unable to predict natural disasters, or create effective pre-warning systems that provide adequate time for people to successfully evacuate, resulting in many natural disasters having catastrophic effects. When these extraordinary events happen people from all over the world flock to the affected area, in the hope that they can help make the situation marginally better.
Since 9/11 the concept of Psychological First Aid (Psychological First Aid Field Operations Guide) has become widely accepted as an adjunct to the usual aid and rescue efforts. Its purpose is to assist individuals and communities cope with the massive psychological trauma that is usually associated with large scale disasters.
Psychological First Aid is firstly a response to the immediate needs of the survivors of a disaster before any counselling or mental help is given. These initial needs are usually for safety and protection and for reconnecting with family, before seeking professional help. The main purpose of Psychological First Aid is to set up a social support and resource system in the wake of a natural disaster, instead of merely providing one on one counselling. The need for counselling is usually not a priority shortly after the initial impact, and becomes relevant only later on when the more primary needs have been met, and it becomes evident that mental health issues are at stake.
Prior to the development of Psychological First Aid,  various techniques had been used as part of this immediate psychological response, the most popular being Critical Incident Stress Debriefing (CISD) which falls under the umbrella term of Critical Incident Stress Management (CISM). Although their efficacy is widely questioned, these techniques are still in common use today, when natural disasters strike, mainly because it is an easy recipe to follow in response to trauma. It has been particularly popular with volunteer counsellors.
CISD is a seven step debriefing method, where the facilitator goes through each phase sequentially with the client, which can also be conducted in a group setting (http://www.info-trauma.org/flash/media-e/mitchellCriticalIncidentStressDebriefing.pdf ). The phases of CISD are as follows; the facilitator begins with an assessment of the survivor’s situation, then any immediate safety concerns are removed, the facilitator then gathers the facts from the client, and then explores the feelings and symptoms that the client is experiencing, after which the facilitator begins to teach healthy coping strategies and then re-enters the client back into their environment. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VH7-3XG84F4-&_user=10&_coverDate=01%2F02%2F2000&_rdoc=1&_fmt=high&_orig=browse&_origin=browse&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=76e308ea061eab5502ff10e5a60e0f78

This technique (CISD) was designed to help reduce the long term effects of trauma and ultimately decrease the development of PTSD. However, the effectiveness of this method has been questioned by various authors with some arguing that the impact of CISD can increase the possibility of developing PTSD, as they can be re-traumatised as a result of too much processing of the event too soon after the incident has occurred. http://goliath.ecnext.com/coms2/gi_0199-10209751/Psychological-debriefing-may-not-be.html
Research shows that when a person experiences a traumatic event it is stored as a visual memory, which takes time to be encoded into words. Using this research of McNally, Bryant & Ehlers (2003) argue that people who talk about the incident immediately after a traumatic experience, may not yet have finished encoding the event into words. In many cases this results in some individuals compounding their traumatic memories. The normal processing of the event has been rushed, causing them to have a higher chance of developing PTSD (nspb.net/index.php/nspb/article/view/34/31).
As this debate presently stands people are moving away from using CISD to using Psychological First Aid. However, mental health aid workers are still confused about what is the most effective method to use in this field.  This confusion is only compounded in the wake of the Japanese Tsunami. When and how do you think mental health workers should respond specifically to the Japanese Tsunami, and generally to future natural disasters? http://healthland.time.com/2011/03/14/tending-to-japans-psychological-scars-what-hurts-what-helps/

Additional links:

For more information visit Trauma Training Online at http://www.traumatrainingonline.com/