Disaster's Wake Calls For Cautious Therapy
> 6/22/2007 2:44:40 PM

Building on a survey that followed the fatal 2005 terrorist attack on the London public transit system (involving coordinated bombs detonated on the subway tube and above-ground buses), British researchers assert that one-to-one counseling for the victims of large-scale tragedies such as bombings or natural disasters does not necessarily help them cope and may, in fact, further the likelihood of future PTSD diagnoses.

Contrary to popular images of pervasive chaos, panicked citizens rushing through the streets amid a momentary state of emotional upheaval and martial law, Professor Simon Wessely of the Institute of Psychiatry at King's College London points out that many individuals in London displayed a remarkable ability to cope, remaining particularly calm and rational in the company of others, and that this fellowship is far more effective than any immediate therapeutic intervention could be. The citizens most disturbed after the event were, understandably, those who could not contact friends and family:

Immediately after the July 7 bombings, 76% of Londoners contacted their family and friends and only 1% sought professional help. In comparable studies of combat veterans, researchers found that: Soldiers returning from war zones wanted to talk to their peers, family and friends, not mental health professionals. When surveyed, only 1% of more than 10,000 British soldiers returning from the war in Bosnia voiced any desire to visit a mental health professional.

Neither were British citizens, for the most part, deterred from moving along with their daily lives in the usual fashion after the bombings, choosing to adhere to routine not out of an abstract sense of defiance but enduring persistence. 3/4 of those surveyed reported that the bombings had no effect on their plans to continue using public transport.

In some cases, asking a patient to talk about what he or she has just experienced may be too harsh a demand. As much as we would not like to encourage a state of complete suppression or the persistent denial common to PTSD patients, many individuals need a brief respite, and asking them direct questions that amount to recreating the traumatic events could heighten their anxieties. Studies on the effect of "single-session-briefings" commonly offered to patients directly after their involvement in severely traumatic events concluded that, in a majority of cases, these sessions either made no difference in the mental and emotional state of the victims or actually hindered their progress by forcing them to return to the source of their anxieties. Researchers involved believe that these conversations lead many victims to expect post-traumatic stress syndromes, only increasing related distress. Group therapy, on the other hand, particularly that in which victims of the same tragedy can gather and share their reactions, is usually very helpful in allowing patients to externalize the experience with the encouragement of truly sympathetic peers.

This is not to say that one-on-one therapy and, if needed, medication cannot play a crucial role in recovery. Surveys conducted nine months after the deadly 2004 Indian Ocean tsunami, for example, placed the estimated number suffering from anxiety, depression and PTSD in the millions, and most of these victims would benefit from some form of individual counseling (of course, getting food, shelter and medicine to the hundreds of thousands affected is far more important in the direct aftermath). But in many such cases, mental health professionals may be best advised to allow for a waiting period before counseling begins. The initial symptoms of related trauma - insomnia, heavy grief, loss of concentration - will at least begin to fade after two to three months in most patients. If they continue, personal therapy will be needed to remedy a likely PTSD diagnosis.

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