Building skills for psychological recovery after disaster

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In the aftermath of a disaster up to 20 per cent of people affected can suffer from post-traumatic stress disorder (PTSD). While response times vary across countries and across disasters, the Psychological First Aid (PFA) model is well-known and well-used in emergencies. The need for mental health treatment for those who continue to suffer beyond the immediate aftermath of a disaster is also well recognised.

For Dr Patricia Watson from the U.S. National Center for PTSD, what was missing was a way to support survivors beyond the early days to help them bridge the days and months following disaster.

Speaking at an AIDR and Australian Red Cross-hosted event on psychological recovery in Melbourne last month, Dr Watson noted: ‘There’s a lot of different ways of knowing about disaster intervention. There’s a lot of wisdom out there that cannot be quantified by research. Our job is to put it all together.

‘For the vast majority of people affected by a disaster event, information is enough. Getting people information and getting them connected to resources can help. They will get back on their feet and you don’t need to apply financial resources to give them more significant types of intervention.

‘For those who are not helped completely by information, there is a PFA model we developed. Then we created a model that goes between PFA and mental health treatment,’ she said.

The Skills for Psychological Recovery program was developed by the National Child Traumatic Stress Network and the National Center for PTSD with contributions from individuals involved in disaster research and response. It is an evidence-informed modular intervention that helps those affected by trauma to gain skills to manage distress and cope with post-disaster stress and adversity. Delivered by mental health professionals, crisis counsellors and other disaster recovery workers, it can be delivered in a variety of settings over just a few visits.

‘In the U.S. there is a crisis counselling program that is put in place in local communities after presidentially declared disasters. That program is funded by the Federal Government and it is started at around four weeks after the disaster. The government agency that funds the program asked us to create an intervention that would give crisis counsellors the ability to teach skills to people.

‘The program they had was primarily supportive listening and connecting people to resources. They realised that they needed more for some people. They needed to empower people to stand on their own two feet and get on with their lives.
Dr Patricia Watson presented at the psychological first aid forum. Image: AIDR

‘We created an intervention that was evidence-informed but also could be used in a flexible way, because after disaster we can’t ensure that people can come for five sessions or more. These interventions have to work even if you only see people only once or twice,’ she said.

The Skills for Psychological Recovery teaches six main skills:

• Gathering information and prioritising assistance helps survivors identify their primary concerns and pick the best strategy to focus on.
• Building problem-solving skills teaches the tools to break problems down into more manageable chunks, identify a range of ways to respond and create an action plan to move forward.
• Promoting positive activities guides participants to increase the number of meaningful and positive activities in their schedule with the goal of building resilience and bringing more fulfilment and enjoyment into their lives.
• Managing reactions helps survivors to better manage distressing physical and emotional reactions by using such tools as breathing retraining, writing exercises and identifying and planning for triggers and reminders.
• Promoting helpful thinking assists participants to learn how their thoughts influence their emotions, to become more aware of what they are saying to themselves and replace unhelpful with more helpful thoughts.
• Rebuilding healthy social connections encourages participants to access and enhance social and community supports while keeping in mind the current post-disaster recovery circumstances.

Dr Watson indicated that behind it all is still that basic PFA model of supportive listening

‘Supportive listening is the foundation. You can’t really move into teaching skills before you have a relationship that’s based on empathy, good connection with the person and good listening skills. Often times people might not be ready to learn these skills and you have to have to go back and forth between supportive and active listening and teaching skills. It’s a back and forth dance,’ she said.

And there are those who will still need referral to mental health treatment

‘Some people will have repeated or ongoing traumatisation. Many people might be fine in the early phases after a disaster but they’ve got ongoing adversity and that’s one of the highest risk factors that we’ve seen. If they lose their home or their job or they have to move, that can create a whole tumble-down effect for them.

‘Mental health treatment should always be an option for people who have been severely traumatised or who have a history of other traumas or other mental health issues. It isn’t always available in every community but it should always be part of a spectrum of services,’ she said.

The Skills for Psychological Recovery program has had good evaluation results from implementation both in the U.S. and internationally.

‘It was shown that those who were treated by counselling centres that used Skills for Psychological Recovery had fewer stress reactions. The counsellors themselves endorsed the program as being very helpful for the people they worked with. And there was also a significantly lower referral rate for mental health treatment,’ Dr Watson noted.

Yet there’s still more work to be done, especially when it comes to removing the stigma of asking for psychosocial support after a traumatic event.

‘People still don’t like to seek help for anything that seems emotional or mental. People compare themselves to others after disaster and they may feel like other people need services more than they do and they shouldn’t use the services and resources that are available. A lot of people like to handle things the way they’ve always handled things and they use the basic coping mechanisms they’ve used in the past.

‘For a good proportion of people that may be satisfactory. A lot of people don’t always know the line between being able to handle a traumatic event on their own and benefiting from receiving more professional help or structured help. They don’t always understand what the need is, or why it would be important. They feel like it means they’re weak if they ask for help,’ she said.

To find out more about the Skills for Psychological Recovery program, go to www.ptsd.va.gov/professional/materials/manuals/skills_psych_recovery_manual.asp.