Objective : Post traumatic stress disorder (PTSD) may be the first reaction after disasters. Many studies have shown the efficacy of cognitive-behavioral therapy in treatment of post traumatic stress disorder. The main objective of this study is to evaluate the effect of group CBT in adolescent survivors of a large scale disaster (Bam earthquake).
Methods:In a controlled trial, we evaluated the efficacy of a short term method of group cognitive-behavioral therapy in adolescent survivors of Bam earthquake who had PTSD symptoms and compared it with a control group. The adolescents who had severe PTSD or other psychiatric disorders that needed pharmacological interventions were excluded. We evaluated PTSD symptoms using Post traumatic Stress Scale (PSS) pre and post intervention and compared them with a control group.
Results:100 adolescents were included in the study and 15 were excluded during the intervention. The mean age of the participants was 14.6±2.1 years. The mean score of total PTSD symptoms and the symptoms of avoidance was reduced after interventions, and was statistically significant. The mean change of re-experience and hyper arousal symptoms of PTSD were not significant.
Conclusion:Psychological debriefing and group cognitive behavioral therapy may be effective in reducing some of the PTSD symptoms.
Keywords: Behavior therapy, Cognitive therapy, Group psychotherapy, Post traumatic stress disorder, Adolescents, Earthquakes
Iran J Psychiatry 2009; 4:79-84
During past decades, psychological effects of earthquakes have been in the focus of attention. Studies that investigate the outcomes of natural events, demonstrate particular clinical responses after exposure to traumatic events in earthquake survivors such as loss of special persons, social construction and lack of social support (1).
Researches have shown that severe earthquakes lead to longtime disabilities. In two separate studies done following 1999 Turkey earthquake with 430 and 586 subjects, close relationships were found between the severity of disabilities and mental disorders like PTSD with severity and the level of exposure to trauma (2, 3). In general, PTSD is the survivors' first response to the disaster which is an important anticipator for these patients' long term mental and physical health conditions (4). Based on some studies, 18.3% of people who were exposed to these kinds of traumas suffered from PTSD (5).
A research in Taiwan showed that 21.7% of 323 participants had PTSD syndrome features. However, in general, there are different reports for PTSD prevalence in earthquake survivors which varies from 2.5 to 33% in adults and 28 to 70% in children .
Encountering level to a threat is a specific anticipator for disability. Additionally, types of coping strategies and defense mechanisms such as avoidance and demographic characteristics including female gender, low social class, younger or older age also have correlation with psychological distress (5). In another study, emotional problem backgrounds, use of neurotic responses and high level of dealing with life events have been related to disability length derived from PTSD after earthquakes (7).
Moreover, loss of social and family support, like parents' death, has been related to PTSD syndromes severity (8). Concurrent incidence of other psychiatric disorders is another problem which leads to disability in children. In one study on 218 survivor pupils from Armenia earthquake, a relationship between PTSD symptoms severity and depression symptoms incidence was reported (9).
PTSD Children experience clinical pain ,affecting their educational performance and other functional areas (10). Therefore, therapeutic interventions and prevention are needed. Various treatments have been introduced to control PTSD symptoms such as pharmacotherapy treatments (11,12) ; nonpharmacological treatments such as individual and group supportive psychotherapy ;and cognitive - behavior approaches including muscle relaxation, systematic desensitization and other psychotherapy treatments (13,14,15). …