Early intervention for trauma: Where are we and where do we need to go? A commentary
VA Boston Healthcare System, National Center for PTSD, Massachusetts Veterans Epidemiological Research and Information Center, Boston, MA 02130, USA. Journal of Traumatic Stress
(Impact Factor: 2.72).
12/2008; 21(6):503-6. DOI: 10.1002/jts.20373
In this commentary, the author underscores the importance of early intervention for trauma and describes the challenges that lie ahead for researchers, decision makers, and care providers. The author also provides a review of where things stand, briefly reviews psychological first aid strategies, and underscores where we need to go from here. Although the field has advanced considerably in the last decade or so, and there are compelling trials underway, there is much work that needs to be done, especially in terms of effectiveness and the task of integrating early intervention into various work cultures, such as the military.
Available from: Gina Hechanova
- "In addition, it shows the value of adopting culturally-nuanced interventions. As suggested byLitz (2008), providers of psychosocial support during disasters should recognize, maintain, and strengthen the customs, traditions, rituals, structures, roles and bonds that facilitate survivors' coping. In the case of Katatagan, the use of local language, indigenous metaphors, and prayer and songs were some ways Filipino culture was emphasized. "
- "A survey of providers who responded to Hurricanes Gustave and Ike found that they perceived PFA as an appropriate intervention and regarded the core actions of contact, safety and comfort, and practical assistance to be the most helpful to survivors (Allen et al., 2010). Beyond the issue of efficacy, Litz (2008) advocated the need to adapt PFA to survivors' culture, ethnicity, religious affiliation, race, and languages. He suggested that providers of PFA should recognize, maintain, and strengthen the customs, traditions, rituals, structures, roles, and bonds that facilitate survivor coping. "
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ABSTRACT: Purpose – The purpose of this paper is to develop and evaluate a culturally sensitive and mindfulness informed psychological first aid (PFA) intervention for use with disaster workers in the Philippines intended to increase disaster knowledge and disaster coping self-efficacy. Design/methodology/approach – The study used a non-experimental, pre-test, post-test design. Measures of disaster knowledge and disaster coping self-efficacy were measured before and after the PFA intervention. Findings – Paired sample t-tests revealed significant pre/post-increases in knowledge about disaster reactions and disaster coping self-efficacy. Workshop evaluations indicated that the following proportions of participants rated these workshop components as the most useful: mindfulness, information about disaster reactions, small group sharing, information about coping, and the open space activity. Research limitations/implications – As in many disaster studies, it was not possible to include a randomized control group in the design. Another limitation was that only pre- and post-intervention data were collected. Future research should include longer-term follow-ups with participants to assess whether the benefits of the intervention are maintained over time. Future research may wish to address the limitations of the study including the lack of a control group and obtaining follow-up data to enable more robust conclusions. Practical implications – These results indicate how the use of a group-based intervention may be helpful especially in a collectivist culture. At the same time, acknowledging cultural values such as spirituality is an important component to providing psychosocial support for survivors. Mindfulness was found useful both as an initial calming activity as well as a means for helping survivors manage their stress reactions. Finally, the utilization of an open space activity can also be a helpful problem-solving mechanism when done in intact groups, as it enhances not just self-efficacy but also community efficacy among survivors. Originality/value – The study contributes to the dearth of knowledge on the use of PFA when used in a group, collective, and developing country setting.
Available from: David M Diamond
- "Third, effective therapies for PTSD need to address unique types and magnitude of trauma among specific patient populations. For example, combat and operational trauma is often multidimensional and extensive (Litz 2008), and may differ markedly from civilian traumas including witnessing of intense human suffering and cruelty, killing others in the line of duty, or perpetrating nonsanctioned violence (Steenkamp et al. 2011). A recent Institute of Medicine (IOM) report recommended " Research providing evidentiary support for use of emerging prevention methods, treatments, and rehabilitative services " (Institute of Medicine 2012). "
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ABSTRACT: In both civilian and military settings, emerging therapies for post-traumatic stress disorder (PTSD) are an area of intense scientific interest and need. Accelerated Resolution Therapy (ART) is an emerging, innovative exposure-based treatment for symptoms of PTSD that is delivered in just one to five sessions and requires no homework or skills practice, thereby reducing patient's commitment time and practi-tioner's intervention time to approximately one-fifth of the time required for traditional first-line evidence-based therapies for PTSD. The ART protocol uses the evidence-based components of imaginal exposure, imagery rescripting, and smooth pursuit eye movements. ART addresses the cardinal PTSD features of distressing emotions, thoughts, sensations, and images in particular, by viewing the development and maintenance of PTSD symptoms as a consequence of a failure of a traumatized individual to exhibit extinction of the affective component of the memory. As of this publication date, there are two completed empirical studies of ART and multiple other studies are in progress. The two empirical studies of ART completed among both civilians and military personnel with symptoms of PTSD provide strong indications of efficacy. However, controlled trials against current first-line evidence-based therapies have not been conducted and long-term post-treatment empirical research data do not exist for ART. These data are considered essential in fully evaluating and quantifying the potential benefit of ART as a first-line treatment option for civilian and military PTSD.
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