Magazine article Clinical Psychiatry News

PTSD Screening, Treatment Outreach Program Takes Shape. (Fallout from Terrorism)

Magazine article Clinical Psychiatry News

PTSD Screening, Treatment Outreach Program Takes Shape. (Fallout from Terrorism)

Article excerpt

As the immediacy of Sept. 11 recedes and the events become part of the history of life in the United States, psychiatrists and other mental health professionals in New Yor City and Washington, D.C., are preparing for a new challenge: preventing posttraumatic stress disorder.

With the recovery work well underway, clinicians involved in the relief effort are attempting to identify and treat those at high ris for developing posttraumatic stress disorder (PTSD). According to Dr. Jeff Aman, professor and chairman of the department of psychiatry at George Washington University in Washington, approximately 74% of people meeting thc diagnostic criteria for acute stress syndrome will go on to develop PTSD. Once symptom patterns become chronic, they are much more difficult to treat with either psychotherapy or medication. Given the scale of the Set. 11 disasters and the number of people experiencing acute trauma, the potential for PTSD is huge.

Dr. Akman and his department are currently involved in a joint project with clinicians at the University of New Mexico and the Washington Psychiatric Society to develop a screening and treatment outreach program for preventing PTSD among these affected by the Pentagon attac.

The project began when Dr. Michael Hollifield of the University of New Mexico's department of psychiatry and family and community medicine in Albuquerque contacted the Washington Psychiatric Society, wishing to be of service in the relief effort. He and the members of his department had volunteered their services after the Olahoma City bombings and developed a program of short-term cognitive-behavioral interventions that proved successful for many people touched by that incident.

In the weeks since Sept. 11, clinicians from the University of New Mexico have trained 20 D.C.-area volunteer psychiatrists to identify high-ris individuals and to implement the techniques shown to be effective in Olahoma City. Members of the joint project are now actively recruiting people in the D.C.-area for group therapy interventions consisting of 2-hour daily sessions for 5 days.

All individuals will have basic cognitive restructuring therapy aimed at identifying and changing the beliefs, emotions, and negative "automatic" thoughts and ears that drive stress symptoms.

The intervention also involves three other specific techniques:

* Imagery rehearsal, a combination of guided imagery and self-hypnosis aimed at alleviating the repetitive "daymares" or recurrent disaster images that plague many individuals exposed to trauma and violence. Dr. Aman noted that there are data supporting this approach; with repetitive practice at actively changing the internal images, many people can eliminate or at least attenuate the intrusive visualizations.

* Resource stabilization, a practical nuts and bolts approach to identify the specific losses--jobs, finances, loved ones, sense of optimism, ability to plan a future--that individuals have experienced. This technique also identifies resources and support systems that are still available to help people rebuild their lives.

* Life trajectory stabilization, aimed at addressing the sense of incoherence and loss of "life path" that many victims of violence experience. This approach identifies the lins between specific fears or experiences and the ways these have led to the incoherent state. In doing so, this therapy can help people define a new life trajectory in the wae of the tragedy. …

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