TUCSON, ARIZ. – One of the most important things physicians and mental health professionals can do for people struggling in the acute aftermath of a mass catastrophe is to emphasize explicitly that most individuals recover spontaneously.
"Transient stress reactions are not pathological in the least. Post-traumatic stress disorder is not a given," according to Patricia L. Haynes, Ph.D., a clinical psychologist at the University of Arizona, Tucson, who like other psychiatry department staff was deeply involved in helping Tucsonians come to grips with the tragic shooting of 19 people, including U.S. Rep. Gabrielle Giffords (D-Ariz.), at a political event outside a Safeway supermarket in January.
Another important point for caregivers to bear in mind is that while there is "absolutely no evidence-based consensus" regarding the existence of effective interventions for preventing PTSD –"We’re not really sure that any early intervention after stress events leads to better outcomes" – it is known that certain mental health interventions can actually increase the likelihood of PTSD, Dr. Haynes said at the psychopharmacology conference sponsored by the University of Arizona.
Interventions that might intuitively seem to make sense but actually have been shown to be potentially harmful include in-depth debriefing; encouragement of emotional venting; pathologizing an individual’s reactions by labeling them as "symptoms" or "diagnoses"; and focusing on the person’s helplessness, weaknesses, or mistakes.
It’s also a mistake for caregivers to assume that all survivors want or need to talk to a health care professional about what happened, or to make assumptions regarding the types of emotions they’re experiencing, the psychologist continued.
She credited many of these insights to the National Center for PTSD’s Psychological First Aid Manual, which she considers an extremely useful guide.
In the aftermath of the Tucson shootings, she and her colleagues in the mental health community relied to a great extent upon this first-aid manual as well as a landmark study by investigators at Kent (Ohio) State University, who reviewed the literature and identified five essential elements in successful interventions in mass trauma experiences. These five elements involve promoting a sense of safety, calming, self- and community efficacy, connectedness, and hope (Psychiatry 2007;70:283-315).
"It’s a fabulous paper. Everyone should read it. It has been named one of the most influential papers in psychiatry in the last 4-year cycle," Dr. Haynes said.
Promoting a sense of safety entails decreasing the threat perception; in this regard, Dr. Haynes and others found it helpful to instruct people to avoid hours and hours of watching 24-hour television news coverage replaying the Tucson tragedy. Limiting survivors retelling of their horror stories also proved helpful.
Grounding techniques, including deep breathing exercises, muscle relaxation, and yoga, were of benefit in interrupting stimulus generation and avoidance behavior so that people eventually could manage to go out to the grocery store.
Cognitive-behavioral therapy techniques proved quite useful in promoting self-efficacy, resiliency, and instilling hope by reducing self-blame, Dr. Haynes added.
It’s a good idea for mental health professionals and other caregivers to give some thought to how they can help the healing begin after a catastrophe. Even though it is human nature to believe "It can’t happen here," in fact, most communities are exposed to tragic events at some point. Indeed, since the 2007 mass shooting at Virginia Tech in Blacksburg, 52 mass shooting incidents have taken place in the United States resulting in 221 deaths, Dr. Haynes said.
She declared having no financial interests relevant to her presentation.