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Psychological aspects of disasters - Part 2

Zdzisława Pilarz, Zygmunt Podbielski

You can read this text in 11 min.

Psychological aspects of disasters - Part 2

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What are the effects of disasters, what happens to people when such sudden events occur. We are publishing part two of an excerpt from a textbook for doctors and students: "Selected issues in clinical psychology".

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Table of contents:

  1. Prevention of the psychological effects of disasters
  2. Persistent psychopathological effects of disasters

Prevention of the psychological effects of disasters

How do we deal with survivors to minimise the negative and long-term effects of past experiences and prevent the perpetuation of pathological reactions? Psychological support aimed at working through the traumatic event at the level of individual experience is needed. Different people involved in the same event will have different experiences of it. In order to enable these to be worked through positively, it is necessary to help participants in the dramatic events to understand their own reactions and to create opportunities to express feelings and emotions, especially those inhibited and those related to the losses suffered. The next stage is to work through the grief, frustration and anger. It is only then that receiving support and problem-solving help promotes stress reduction and gradually rebuilds a sense of security.

An important element of therapeutic work with disaster victims is to search for and make sense of one's own experiences so that it is possible to accept the traumatic experience as part of one's own life. This makes it possible to overcome the "survivor syndrome" and the associated feelings of guilt, numbness and inner conflict between the need for care and undirected aggression.(Lis-Turlejska,1998). Survivors should be informed that it takes time to return to emotional equilibrium and may also go through a very difficult period after the immediate threat has passed. This allows for an easier inner acquiescence in the experience of mourning, mourning the loss and a greater patience in enduring one's own emotions and those of loved ones. Important decisions such as changing job or selling assets should not be taken at this time, as these can be rash and cause additional stress. You should be advised to lead an optimal lifestyle for your own psychological needs (increased sleep, proper nutrition, avoidance of alcohol, stimulants, etc., use of rest and relaxation), which will increase your capacity to cope with stress.

Other forms of psychological support in a crisis situation are:

  • helping to organise "hot" telephone lines and victim information offices;
  • accompanying families in identifying remains;
  • liaising with schools and running special classes to help de-brief the survivors and their emotions;
  • participating in crisis teams,
  • participation in support groups ;
  • cooperating with local government units, local administrations and the media in identifying the scope and effects of the disaster and organising aid points.

It is important that psychological support is provided at the scene of the accident, in parallel with other emergency services, as soon as possible after the events, based on direct contact with the victims.

A second factor that plays a decisive role in preventing the negative emotional effects of surviving disasters is social support. Support is the receipt of help from close people or institutions in the form of emotional support, practical help, advice or information.(Badura-Madej, 1999) There are several types of it. Emotional support is the transfer of supportive, reassuring and caring emotions, the creation of a climate of understanding, trust and emotional warmth, the release of hope. Instrumental support is the exchange of services, material goods, concrete material assistance (e.g. household utensils, foodstuffs, necessary machinery, animal feed, etc.) and financial assistance (benefits, compensation, preferential loans), as well as concrete physical action for the benefit of those in need (e.g. running field kitchens, preparing shelter, clothing, etc.). Informational support is the provision of such information that promotes a better understanding of the situation, the provision of feedback on, for example, the effectiveness of remedial actions, the exchange of experiences with people experiencing a similar crisis. Valuing support is supporting the self-esteem of the sufferer, expressing appreciation, admiration and acceptance of their efforts. Finally, social support is helping to fulfil the need for belonging (e.g. in support groups, relief committees, etc.), gratification associated with breaking isolation and social activity (e.g. neighbourhood help or fundraising and distribution).

The type of support offered depends on the situation and needs of the affected people and the capacity of the existing social network. This network consists of the victim's family members, neighbours, co-workers, relatives and friends (the so-called primary network) and members of the local community, police, health care, church institutions, governmental and non-governmental organisations, employers (the so-called secondary network). The very awareness of sources of support in the victim is supportive, as it satisfies the need for belonging and security. The more supportive the environment, the better the adaptation after stress. It is important to quickly organise and include victims in local support groups and to have people professionally trained in psychological support in these groups. Their effectiveness is also related to time - the sooner it is available, the better.

A separate issue is the prevention of the psychological effects of disasters on people involved in rescue operations: police officers, firefighters, emergency doctors, rescuers, soldiers, psychologists, members of crisis staff. These people are particularly vulnerable to developing post-stress disorders. In order to minimise the risk, it is recommended, among other things:

  1. maximum information preparation about the conditions that rescuers may encounter in action and the reactions from survivors that they can expect;
  2. working as part of a team to share duties and responsibilities, evenly distribute risks and provide an opportunity to defuse emotions;
  3. providing cyclical rest to avoid fatigue and physical exhaustion, which promote possible emotional decompensation;.
  4. team rotations from highly stressful tasks to less so;
  5. post-operational de-stressing sessions in which participants are encouraged to describe what they encountered and experienced;
  6. the appropriate use of human resources in the form of the inclusion of local professionals and the additional employment of people, especially those with skills in dealing with children, the elderly, members of national, ethnic or religious minorities.

Methods have also been developed to prevent the effects of stress on both emergency workers and workers in companies at risk of accidents (e.g. chemical plants, mining platforms, etc.).

When the risk of danger is high and happens relatively frequently, it pays to create a special team of people to prevent the effects of stress. The concept and working methods of such a team, created by Jeff Mitchell, are referred to as psychological de-briefing after a critical incident or debriefing (from the English name Critical Incident Stress Debriefing Team). In Poland, such a team has existed for several years, among others at LOT Polish Airlines.

The debriefing team usually consists of about 20 members, some of whom are medical professionals. Within this team, groups of 4 people are formed to act on a case-by-case basis. Their aim is to prepare emergency service personnel to cope with the stresses arising at work and to provide assistance to those who have been adversely affected by traumatic events. In the case of major disasters, the groups work at the scene by holding short (approx. 45 min.) meetings with the rescue team to de-stress and stabilise emotionally before returning to duty or home. As well as providing an immediate respite, this allows the rescuers to understand their reactions and see that they are not abnormal, increases team cohesion and cooperation, and enables them to recognise those whose condition is most difficult and requires specialist action.

If a number of rescuers are under severe stress, begin to make overload-induced mistakes, distress signals persist for more than three weeks or the group itself asks for help, a debriefing with a psychiatrist or appropriately trained psychologist is organised within 24-72 hours. Its purpose is to trigger the rescuers' reprocessing of information on a cognitive and intellectual level and to verbalise experiences. Such a meeting usually takes about three hours and is essentially a structured discussion. It consists of several phases: presentation of facts (what who did during the action), accompanying thoughts, feelings, reactions. The facilitator then asks about the worst thing that happened to everyone during the action and about the symptoms of stress experienced. This is followed by a phase of learning how to deal with the symptoms and stress. At the end, each participant makes a personal comment and everyone gets support and information about the possibility of individual counselling. (Dudek, 2003)

The lasting psychopathological effects of disasters

If crisis intervention, de-briefing and reconstruction after a traumatic experience prove to be ineffective then permanent psychological trauma can occur, causing psychological disorders. Since 1980, the medical classification has adopted the term Post-Traumatic Stress Disorder (PTSD). For this diagnosis to be made, a person must have experienced a threat to life, serious bodily harm or a threat to physical integrity, experiencing intense fear and horror, impairing their functioning. PTSD is characterised by several groups of symptoms. These include:

  1. persistent involuntary reenactment of the traumatic event in one or more ways e.g.: through persistent memories, recurrent nightmares, strong anxiety reactions to stimuli associated with the event;
  2. persistent avoidance of stimuli associated with the trauma and reduced general reactivity, feelings of alienation and pessimistic assessment of the future;
  3. persistent increased agitation in the form of difficulty sleeping, outbursts of anger, difficulty concentrating;
  4. feelings of severe distress and impairment in various areas of social or occupational functioning.

The incidence of PTSD in participants of critical events depends on the type of event: about 5% in the case of natural disasters, 15% in war veterans , 31% in victims of terrorist actions and as high as 46% in Holocaust survivors. There is no upper limit to their duration - PTSD symptoms have persisted even 40 years after the events (Dudek, 2003). (Dudek, 2003) They are also often accompanied by depression (approx. 40%), anxiety disorders (approx. 20%), alcohol dependence (approx. 13%) and psychosomatic disorders (approx. 20%). PTSD also affects people professionally involved in disaster recovery, e.g. a study in Poland found that symptoms were found in 7.4% of firefighters involved in the most traumatic operations.

Also included in the ICD-10 classification are disease entities that arise as pathological changes after surviving a disaster. These are:

  • acute stress reaction,
  • post-traumatic stress disorder,
  • post-traumatic stress disorder combined with depression, anxiety symptoms, addiction;
  • dissociative disorders;
  • persistent personality changes following disasters.

Unlike post-disaster symptoms, the above disorders do not usually pass spontaneously over time. They require treatment in the form of psychotherapy and sometimes pharmacotherapy.

Due to the dynamics of post-traumatic stress disorder symptom development, the most effective therapeutic strategies are considered to be those based on learning and cognitive theory. It is assumed that not only the event itself, but above all the interpretation of the event by the individual is responsible for the persistence of the feeling of distress and the development of symptoms. By modifying cognitive schemas and learning other ways of coping, it is possible, through reworking memories, to change the memory of traumatic events and to extinguish excessive emotions. Hence, the most commonly used procedures are different variants of cognitive-behavioural and rational-motivational therapy. Regardless of theoretical assumptions, any type of therapy for PTSD patients must be based on:

  1. building trust and safety in the patient-therapist relationship,
  2. emphasising the normalcy of behaviour and reactions experienced in response to the 'abnormality' of the disaster,
  3. educating the patient about the consequences of post-traumatic stress on different areas of his life,
  4. strengthening the patient's self-confidence and mobilising him/her to continue living an active life,
  5. working in partnership to enable the patient to take co-responsibility for the course of treatment and the achievement of the planned therapeutic goals.

As far as pharmacological treatment is concerned, it can alleviate some symptoms and facilitate active participation in psychotherapy. Tricyclic antidepressants, serotonergic drugs and drugs that reduce tonic sympathetic nervous system overactivity are most commonly recommended (Friedman, 1998). However, it is always necessary to assess how the proposal of pharmacological treatment will be received by the patient, i.e. whether it will not deepen his or her sense of helplessness, lack of control and dependence on others, on the one hand, and, on the other, whether it will not result rather from a desire to escape, rejection of difficult topics, lack of faith in recovery. It is important to set up the treatment in such a way that the medication does not hinder the patient's rebuilding of the internal resources needed to cope effectively with stress and does not modify the internal stability and balance regained in therapy. Detailed arrangements and algorithms for medical treatment are still lacking in this area.Empirical and theoretical research is also still being conducted to better understand how psychological knowledge can be used to counteract the individual and social effects of disasters and cataclysms.

Part one is available at:
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