Research roundup: Life after a disaster

Psychologists study disaster survivors and how they responded to different types of treatment interventions.

Disasters, ranging from destructive storms to terrorist attacks, can take an initial toll on people’s psychological well-being. Overtime, many are able to recover and go on with their lives. A smaller percentage, particularly those who are highly exposed to the disaster, can develop longer term psychological problems. Earlier disaster research on how people respond to disasters showed that taking proactive steps to cope in the aftermath of disaster can facilitate recovery. This premise leads psychologists, many active in APA’s Disaster Resource Network and Red Cross, to help communities prepare for, respond to and recover from disaster.

The following research studies examine how people fared in the aftermath of disaster and describe two promising psychological interventions. Psychologists are encouraged to explore the literature more completely to determine what may be useful to them in practice.

Tucker, P., Pfefferbaum, B., Nitiema, P., Wendling, T. L., & Brown, S. (2016). Intensely exposed Oklahoma City terrorism survivors. The Journal of Nervous and Mental Disease, 204 (3), 203-209. doi: 10.1097/NMD.0000000000000456.

Morris, K.A., & Deterding, N.M. (2016). The emotional cost of disaster: Geographic social network dispersion and post-traumatic stress among survivors of Hurricane Katrina. Social Science & Medicine, 165, 56-65. http://dx.doi.org/10.1016/j.socscimed.2016.07.034.

Hashoul-Andary, R., Assayag-Nitzan, Y., Yuval, K., Aderka, I.M., Litz, B., & Bernstein, A. (2016). A longitudinal study of emotional distress intolerance and psychopathology following exposure to a potentially traumatic event in a community sample. Cognitive Therapy Research, 40, 1-13. doi: 10.1007/s10608-015-9730-4.

Three recent studies looked at disasters’ psychological impact. In Tucker et al. (2016), the authors surveyed Oklahoma City Bombing survivors 18 1/2 years later. The survivors’ had both specific stress reactions to the bombing and more generalized depression and anxiety over time. Depression and anxiety were significantly higher for the disaster survivors (whether they stayed in Oklahoma City or moved away) than a community control group. Some post-traumatic growth (positive change in important personal ways) was seen among survivors who were female college graduates. Morris and Deterding (2016) studied parents (predominantly women) five years after Hurricane Katrina forced them to evacuate and relocate from New Orleans. These parents experienced emotional distress from the disruption of their social networks with close family and friends. While they adapted and made new friends, these relationships did not replace the significance of those left behind. The authors identified two variables: belonging (comfort and longtime connectedness) and mattering (meeting own and others’ expectations to fulfill essential roles) that were missing in these parents’ lives and causing them distress. Hashoul-Andary et al. (2016) surveyed survivors of a large-scale forest fire within 30 days of exposure, and at three and six months. Individuals with anxiety sensitivity (fear of the sensations of being anxious) and distress intolerance (inability to endure exposure to aversive stimuli) tended to avoid reminders of the fire. Avoiding reminders, such as sensations associated with anxiety and emotions connected to the fire, perpetuated distress and disrupted the possibility for recovery.

Hamblen, J.L. Norris, F.H., Symon, K.A., & Bow, T.E. (2016). Cognitive behavioral therapy for postdisaster distress: A promising transdiagnostic approach to treating disaster survivors. Psychological Trauma: Theory, Research, Practice and Policy. Advance online publication. http://dx.doi.org/10.1037/tra0000221.

This study sought to extend and replicate the findings of two previous studies on the use of Cognitive Behavioral Therapy for Post-Disaster Distress (CBT- PD) in treating disaster survivors. The authors recruited adult survivors of Hurricane Sandy to enroll in an eight- to 12-session intervention of CBT-PD. In addition to measuring distress, the researchers examined whether the post-disaster timing of treatment delivery or participants’ reported intensity of distress (moderate or severe) affected outcomes. Two hundred and two adults in the New York City metropolitan area enrolled in the treatment and completed a 12-item self-report measure, Short Post-Traumatic Stress Disorder Rating Interview — Expanded (Sprint-E) at four separate time periods, spanning pretreatment to post-treatment. A 57 percent subsample also completed the measure at a five-month follow up. The majority of participants were female (M age >40). The intervention was administered by therapists (eight licensed; one nonlicensed supervised) from the Visiting Nurse Service at individual participants’ homes. The therapeutic components included psychoeducation, breathing exercises, identifying and engaging in positive activities, and teaching and applying cognitive restructuring of maladaptive thoughts. Participants showed significant improvement in their level of distress after treatment and at follow-up. Also, for participants who began the intervention with higher levels of distress, they began to show significant improvement midway through the intervention, earlier than those who began the intervention with moderate distress. Timing of the intervention (nine to 14 months, 15-19 month or 20-26 months post-disaster) did not impact outcomes. Similarly, participants with moderate or severe symptoms prior to treatment both showed significant improvement.

Powell, T.M., & Bui, T. (2016). Supporting social and emotional skills after a disaster: Findings from a mixed methods study. School Mental Health, 8, 106-119 doi: 10-1007/s12310-01609180-5.

The authors’ recruited 110 middle schoolers from Moore, Oklahoma, who had been severely affected by a tornado, to participate in an eight-session Journey of Hope (JoH) school-based intervention. The middle schoolers were divided into a treatment and a waitlist control group. JoH addressed common post-disaster emotions by teaching skills in: creating personal safety; understanding and coping with fear, anxiety, sadness and bullying; and promoting self-esteem. Participants completed self-report measures at pre- and post-intervention on general self-efficacy, communication management, problem-solving, personal development and prosocial behaviors. Significant increases were found for the treatment group on communication management and prosocial behaviors. There were no differences in these measures for the control group. No significant results were found for general self-efficacy, problem-solving or personal development. A small subset of participants (n=16) also took part in semi-structured interviews. The resulting qualitative data indicated that intervention participants gained coping skills that helped them deal with anger, grief and stress. Participants also experienced increased peer support in developing new friendships, learning from each other and supporting each other.

Clinical implications

Clinicians understand that people who have been exposed to trauma are at risk for development of PTSD, as well as other anxiety and mood disorders or may simply show a range of difficult emotional and behavioral responses post trauma. The study by Tucker, et al. (2016), underscores how long-lasting the impact can actually be. Clinicians necessarily should be alert to such connections to past events and consider gently assessing for emotional and psychological responses to disaster and trauma, no matter the length of time since the experience. Additionally, the studies by Tucker, Morris and Hashoul-Andary all highlighted elements that are important for continued well-being. For instance, some individuals do experience post-traumatic growth following a horrific disaster and clinicians may be able to support and expand on that. Sensitivity to disruptions in social networks and efforts to help patients rebuild their networks, particularly by increasing the experience of belonging and mattering to others, may be quite important in developing overall psychological well-being. While clinicians may be quite familiar with the role of anxiety sensitivity and distress intolerance in maintaining anxiety disorders, these individual traits may need to be addressed to reduce distress and promote recovery after a disaster as well.

Both intervention studies indicate that structured, therapeutic interventions can be efficacious for distressed disaster survivors and successfully delivered in real-world post-disaster settings by community health personnel and school professionals. The Hamblen et al., study suggests intervening, even a few years after the disaster, still provides important benefits for individuals. Both studies underscored that individuals with mild or nonclinical levels of distress and symptoms still can demonstrate improvements in functioning and reductions in distress. Being alert to individuals’ experience of disaster and other trauma and providing interventions that build coping skills and self-management appear beneficial for a range of age groups and trauma survivors and might be readily incorporated into clinical practice and community interventions.