Biomedical Engineering Reference
In-Depth Information
to that found at a three-year follow-up of motor
vehicle accident survivors by Koren et al. (2001)].
PTSD often is comorbid with affective disor-
ders, particularly depression, and substance
abuse (Kessler et al., 1995). PTSD and unipolar
depression share symptoms of anhedonia,
emotional numbing, and social detachment, and
have similar although not identical symptomatic
features involving problems with sleep, anger, and
avoidance. Comorbid PTSD and depression are
associated with particularly severe risk (e.g., suic-
dality), functional impairment, and health care
utilization (Kramer et al., 2003) compared to either
disorder alone. Comorbid PTSD and substance
abuse similarly is associated with medical and
psychosocial morbidity.
of psychotherapy, phase-oriented trauma treatment
involves enhancing the recognition (rather than
avoidance) of post-traumatic self-dysregulation in
tolerable ways and amounts, in order to promote
proactive self-regulation.
11.4 Conclusion
Hospital-based psychiatry and social service
professionals have a crucial role to play in
societal preparedness for and responses to the
psychological trauma of disaster and terrorism.
Most survivors are unaware of available services
even after intensive public education campaigns
(e.g., Project Liberty in New York City after
September 11th). Unfortunately, not only medical,
nursing but also psychiatry and social service
professionals generally are not prepared to inform
patients or address psychological trauma in routine
practice, let alone as disaster responders. For
example, only 3% of immigrant primary care
patients who had prevalent PTSD due to exposure
to political violence had ever been asked about
violence exposure by their providers [27]. General
practitioners documented only 6% of patient-
reported symptoms of fatigue, anxiety, dyspnoea,
skin problems, and backache as related to an airline
crash disaster that these patients had survived, and
diagnosed depression (7%) more often than PTSD
(5%) (144).
A proactive approach is needed to prevent
the delays and gaps in knowledge (by providers,
as well as laypersons), access, coordination, and
continuity of acute and follow-up mental health
care that occurred despite often heroic efforts in the
wake of past disasters and terrorist incidents [28].
An approach also is needed that helps survivors and
affected individuals to recognize and enhance the
positive beliefs and emotions (e.g., increased hope
and trust as a result of experiencing compassion
and being inspired by the courage of survivors and
responders) that may emerge in disasters [29,30].
Given the propensity of disaster-affected persons
to seek informal help through natural caregivers,
attention must be paid to helping the helpers
as well as caring for patients. The challenge to
hospitals of dealing with the “terror” in terrorism
11.3.2 Psychotherapeutic and
Psychopharmacologic Treatments
for Post-Traumatic Disorders
The three phases of psychotherapeutic and
psychopharmacologic treatment for PTSD involve:
(1) developing a working alliance, enhancing
safety by stabilizing suicidality, impulsivity,
and pathological dissociation, and acquiring or
accessing core self-regulatory skills and sustaining
beliefs and relationships that were lost or never
attained in earlier development; (2) recalling
trauma memories with a goal of achieving “mastery
over memory” (Harvey, 1995)—a more inclu-
sive, emotionally modulated, and organized auto-
biographical memory and a more mindful and
self-determined orientation to present living and
future planning; and, (3) enhancing meaningful
ongoing involvement in viable interpersonal, voca-
tional, recreational, and spiritual relationships and
pursuits [26]. In practice, phase-oriented treatment
often takes the form of a recursive spiral: the issues
addressed and biopsychosocial processes involved
in each phase frequently are returned to in subse-
quent phases. For example, the shame, guilt, and
disgust associated with a sense of being damaged
or a terror of rejection, betrayal, and abandonment
tend to emerge anew in each treatment phase even
after apparently having been dealt with in earlier
phases of treatment. Across all theoretical models
