July 11, 2005
Advanced planning is crucial to managing post-traumatic stress disorder (PTSD) in large numbers of people after a terrorist event, say Tulane University researchers. Web- and phone-based counseling, preventive medication and limiting personal exposure to media coverage of the event, particularly for children, must all be considered in planning for the aftermath of a terrorist event, says Tulane psychiatrist and public health researcher Neil Boris. The article appears in the July edition of the journal Biosecurity and Bioterrrorism.
PTSD is a bundle of symptoms that occur for over one month in some people who have been exposed to what they see as a life threatening event. The symptoms usually occur in three categories: avoiding reminders of the event, involuntarily re-experiencing the event and high anxiety.
For example, people suffering with PTSD may feel emotionally numb or detached, may experience flashbacks or recurrent dreams, and may have difficulty sleeping. "Planning for a terrorist event must take the psychological impact into account. Even if only a small portion of exposed people develop PTSD or acute stress disorder in the wake of such an event, the total number of people affected would overwhelm local mental health resources," Boris says. "Developing a system-wide approach with a variety of tools to address the needs of a large number of people in advance is a necessary part of planning for possible terrorist events."
Boris, with the assistance of public health graduate students at the Tulane University School of Public Health and Tropical Medicine, analyzed existing research about management of PTSD in the wake of terrorist events and developed recommendations for further research and planning. They found that the traditional response of the therapeutic community, which involves one-on-one debriefing immediately after an event, might make PTSD worse for some people.
"The instinctive response of mental health professionals is to want to help people immediately. However, we learned that using a therapeutic approach known as cognitive behavioral therapy with people who develop PTSD symptoms in the following weeks is more beneficial," Boris says.
In the immediate aftermath of an event, the team recommends that food, shelter, reuniting families and sharing accurate information about the event take priority. At the same time, public health professionals must develop systems to track affected people for follow-up in future weeks. Boris recommends web- or phone-based counseling options as a cost-effective way to help large numbers of people. Boris also calls for further research into the use of medications after trauma that can prevent PTSD.
Even an intervention as seemingly simple as helping affected people get regular sleep could make a difference, Boris says. Boris acknowledges that the primary challenge is the sheer number of people who may be affected by terrorist events, both directly and through watching images of the event repeated over and over in the media. For children in particular, Boris says, constantly seeing the images of a terrorist event can lead to some level of psychological distress or PTSD.
"We need to do more research about the impact of media portrayals of an event on people's mental health," Boris says. "Clearly the media are necessary for sharing important information, but parents of children and people who were directly impacted by the event should limit how much coverage they watch afterwards." The journal is online at: www.biosecurityjournal.com
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