There have been many discussions and arguments when it comes to how best to treat a trauma victim, so as to prevent the future onset of PTSD. There are too many views and ideas to even mention here, but a number of recognized international experts published their consensus on five essential elements of immediate and mid-term mass trauma intervention Hobfoll et. al (2007). These five elements incorporate Hobfoll’s COR (Conservation of Resources) theory and have a reasonable empirical basis. They are essentially formulated to deal with trauma on a community level, resulting in the ultimate goal of self-empowerment for future maintenance. . One should bear in mind, however, that as with the traumatic incident itself, the individual is also unique and different people and situations require different interventions. These elements are at most a framework on which to base trauma interventions.
1. Promote a sense of safety
When people are exposed to a traumatic event, their normally protected environment is threatened and their perceptions of reality change. It has been shown that once a sense of safety is restored the threat of developing PTSD decreases. A person who has experienced the trauma needs to separate their perceptions of safety from their actual safety. After a traumatic event, it is common to develop a twisted view that the world, in general, is no longer a safe place and never will be. If they are able to separate this belief from reality, and re-establish a sense of safety, research has shown that their symptoms after the incident with decrease. In order to assist this process, one needs to assist by giving corrective information, as well as appraise the past and future threats in a realistic manner.
Restoring the faith in a sense of safety is usually a lengthy process and must include a social systems perspective, as the community plays a large role and can affect the process positively and negatively. Safety includes protection from rumours, bad news, and negative media.
2. Promotion of Calming
A traumatic event will almost always result in marked increases in emotionality and arousal. This is completely normal, to a certain degree, but should decrease with time. It becomes a problem when it begins to interfere with sleep, hydration, eating, and making life decisions. One study showed that a person’s heart rate, following a trauma, could actually indicate whether they were at risk of developing PTSD or not. This study has not been confirmed, but it is interesting in note how emotionality affects recovery. It is therefore essential that a sense of calm is promoted as soon as possible to prevent this prolonged state of hyper arousal.
Ways in which to assist with this process include therapeutic grounding where the client is assured that they are no longer in the threatening situation. Other relaxation techniques, such as breathing retraining, deep-muscle relaxation, yoga, mindfulness, music paired with certain images and some calming medications have been shown to help too. SIT (Stress Inoculation Training) and Exposure Therapy have also been shown to assist. It is important that the person’s emotionality is not pathologized, but should also not be under-pathologized. By twisting the truth though, in order to calm someone, is doing more damage than good by undermining the trauma they have experienced.
3. Promotion of Sense of Self-Efficacy and Collective Efficacy
In life, believing that one’s actions can lead to a positive outcome, but even more so following a traumatic event, it is vitally important. This is self-efficacy. Collective efficacy refers to the belief that one belongs to a group whose actions can lead to positive outcomes. After a trauma, people lose confidence in their abilities to believe that they can handle issues that they may face. It is absolutely fundamental to reverse these feelings of a lack of competency in themselves, their families and their community, in order to regulate emotions.
In order to do this, the person must be made to believe they possess the necessary skills. CBT (Cognitive Behaviour Therapy) has been shown to make the person feel that they are the expert of a certain situation, and give them necessary coping skills so that they no longer require the assistance of a trained professional. It is also important to rebuild the sense of the community and its efficacy. Community mass rallies, religious activities and collective rituals can do this. When a community is successful and cohesive, this will flow down to the family as well as the individual level. To further assist with this, empowerment must be the focus. Having to rely on trained experts and disaster aid to address community needs, can easily lead to further set the community back.
4. Promotion of Connectedness
There has been a huge amount of research done on the importance of social support and connection in trauma recovery. It provides a space to relate and compare experiences as well as formal and informal support groups. A lack of social support and connections is recognized as one of the important risk factors for PTSD, but how exactly to translate this to an intervention has not yet been researched. However, approaches such as creating awareness about the social connections that are available and how to connect to them could assist. It is also important to eliminate negative social support where the victim is criticized or undermined. It is vitally important to identify those who seriously lack any positive social support/connections, and focus on them and building their social skills as they are the most at risk.
5. Instilling hope
Those who remain positive following a trauma have been shown to have more favourable outcome and recovery than those who are unable to. Therefore, instilling hope and promoting positivity are paramount in trauma interventions. Victims will often respond to trauma with a “shattered world view” and this negativity and lack of hope can deplete their coping skills leaving them more vulnerable to PTSD. Hope, in relation to psychology, has been defined as “positive, action–oriented expectation that a positive future goal or outcome is possible” (Haase, Britt, Coward & Leidy, 1992). Restoring this lost hope can include a strong belief in a God, a responsive government, or a positive superstitious belief, as well as positive mass media messaging. On an individual level, CBT (Cognitive Behaviour Therapy) has shown to help by decreasing the individual’s exaggeration of personal responsibility. CPT (Cognitive Processing Therapy) has been shown to help decatastrophize and the simple act of therapy shows a belief that with help things can get better. On a mass level, schools, universities, the media and natural community leaders can help enforce and rebuild hope by helping people focus on the positive and by rebuilding strengths by retelling stories
In conclusion, these 5 elements are core and should be included in all interventions and can be applied to all interventions, both individual and mass. More broader-based interventions are needed to include the communities and to make treatment more accessible to those who actually need it. This will also help provide empowerment for these communities which will assist with continued promotion of trauma prevention and assistance. These 5 principles are not, however, meant to suggest that they are all that is needed or that there is one approach that will suit ever situation, but it is certainly a step in the right direction.
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