DISASTERS INTERVENTION FOR THE XXI CENTURY. April 8, 2016 Conference. Seoul, South Korea. Presenter Dr. Ignacio Jarero

Transcription

1 DISASTERS INTERVENTION FOR THE XXI CENTURY Korean Society for Traumatic Stress Studies April 8, 2016 Conference. Seoul, South Korea. Presenter Dr. Ignacio Jarero

2 DISASTER

3 Any situation that causes human needs or human suffering which cannot be alleviated without assistance. American Red Cross

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5 An occurrence of a severity and magnitude that normally results in deaths, injuries, and property damage American Red Cross

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7 and that cannot be managed through the routine procedures and resources of government. American Red Cross

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9 TYPES OF DISASTERS

10 Natural. Human-provoked. Technological-Industrial. Health: Epidemic, Pandemic. Terrorism. Urban Disasters: Every day disasters in your own communities like patients with cancer, their families and caregivers.

11 CATASTROPHIC INCIDENT: A SPECIAL TYPE OF DISASTER

12 The US Department of Homeland Security (DHS) describes Catastrophic Incident as: An event that could result in sustained national impact over a prolonged period of time. Almost immediately exceeds resources normally available to authorities in the impacted area. Significantly interrupts governmental operations and emergency services to such an extent that national security could be threatened.

13 EXAMPLES OF CATASTROPHIC INCIDENT

14 Lucy Artigas (Butterfly Hug originator) during the EMDR Group Protocol Preparation Phase after Hurricane Paulina. Acapulco, Mexico Revista Iberoamericana de Psicotraumatología y Disociación. ISSN:

15 Boys and Girls doing the EMDR Group Protocol for the First Time in History. Hurricane Paulina. Acapulco, Mexico Revista Iberoamericana de Psicotraumatología y Disociación. ISSN:

16 Hurricane Katrina, 2005

17 South Korean Sewol Ferry Disaster. April, 2014

18 PSYCHOLOGICAL PHASES OF DISASTER Threat Warning Impact Inventory Heroic Honeymoon Disillusionment PTSD Delayed Expression Reconstruction

19 PHASES OF DISASTER Myers and Zunin, 1990 WARNING THREAT PTSD DELAYED EXPRESION

20 An often overlooked cost of disasters is the psychological wounds that are not always visible, attended, or acute, like PTSD Delayed Expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate). DSM-5 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

21 Be aware of PTSD Delayed Expression in the years after the 2014 Sewol Ferry Disaster

22 South Korean Sewol Ferry Disaster. April, 2014

23 PSYCHOLOGICAL WOUNDS OF DISASTERS

24 Most frequent psychopathology after a Disaster. PTSD. Depression. Anxiety.

25 For more than 10 years, experts have concluded that the psychological casualties of a disaster will outweigh the physical by an estimated 4:1 ratio. Everly, G. S., Jr., Barnett, D. J., Sperry, N. L., & Links, J. M (2010). The use of psychological first aid (PFA) training among nurses to enhance population resiliency. International Journal of Emergency Mental Health, 12(1),

26 Children doing the EMDR Therapy Butterfly Hug after Hurricane Mitch in Nicaragua

27 Current literature indicates that the prevalence of posttraumatic stress disorder (PTSD), the most researched postdisaster psychological disorder, ranges from 11% to 40% among those who have been exposed to a natural or man-made disaster. Jarero, I., Artigas, L., Luber, M. (2011). The EMDR protocol for Recent Critical Incidents: Application in a Disaster Mental Health Continuum of Care Context. Journal of EMDR Practice and Research, 5(3).

28 Survivors doing the EMDR Therapy Butterfly Hug in a shelter in Armenia, Colombia after the 1999 earthquake. 28

29 TERRORISM: A UNIQUE TYPE OF DISASTER

30 The explicit goal of this human act is to create a condition of fear, uncertainty, demoralization, & helplessness as a coercive force.

31 Kill one, frighten ten thousand. Ancient Chinese saying

32 POTENTIAL TERRORIST WEAPONS Chemical Biological Radiological Nuclear Explosive

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34 The PSYCHOLOGICAL imprints of terrorism may be much larger than the PHYSICAL or MEDICAL Research has shown that human-made disasters are more psychologically pathogenic than are natural disasters. Terrorism may be the most pathogenic of all due to its UNPREDICTABLE and UNRESTRAINED nature. Diane Myers (2010). Terrorism: Psychological Impact and Implications.

35 Example Tokyo, Japan, 1995 Sarin (nerve agent) attack, subway 12 killed 900 required medical care psychological casualties (10:1 psychological: physical) -Obhu et al, 1997

36 PSYCHOLOGICAL REACTIONS TO TERRORISM Shock, numbness, disbelief. Anxiety, fear, vulnerability. Anger and Resentment. Crisis of faith. Suspicion of others. Grief. Guilt.

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38 EARLY INTERVENTION AND DISASTER MENTAL HEALTH

39 Various authors use different vocabulary and terms in their discussion of early intervention and treatment. Jarero et al. (2013). EMDR Individual Protocol for Paraprofessional Use. Journal of EMDR Practice and Research, 7(2).

40 Crisis intervention is the term used by Everly and Mitchell (2008) to describe the urgent psychological or behavioral care designed to first stabilize and then reduce symptoms of distress or dysfunction so as to achieve a state of adaptive functioning, or to facilitate access to a continuum of care when necessary (p. 8). Everly, G. S., Jr., & Mitchell, J. T. (2008). Integrative crisis intervention and disaster mental health. Ellicott City, MD. Chevron.

41 DR. NACHO PROVIDING THE EMDR-PRECI TO A BOY IN POSOLTEGA, NICARAGUA AFTER A LANDSILIDE IN

42 Other authors (e.g., Kehle et al.,2010) spoke of early mental health treatment, which is an intervention comprising psychotherapy and psycho-pharmacotherapy treatment. Kehle, S. M., Polusny, M. A., Murdoch, M., Erbes, C., Arbisi,P., Thuras, P., & Meis, L. (2010). Early mental health treatment-seeking among U.S. National Guard soldiers deployed to Iraq. Journal of Traumatic Stress, 23(1),

43 The U.S. Department of Veterans Affairs and Department of Defense (VA/DoD, 2010) called all treatment interventions for posttraumatic stress, acute stress reaction (ASR), ASD, acute PTSD, and chronic PTSD as management of posttraumatic stress. U.S. Department of Veterans Affairs and Department of Defense. (2010). VA/DoD clinical practice guidelines for management of post-traumatic stress. Version 2.0..

44 Pasta de Conchos mine tragedy in Mexico Miners children doing the EMDR Therapy Group 44

45 XX CENTURY DISASTERS INTERVENTION CONTINUUM OF CARE

46 Continuum of care is a a stepped progression of health care provided in an increasingly intensified manner. Everly, G. S., Jr., & Mitchell, J. T. (2008). Integrative crisis intervention and disaster mental health. Ellicott City, MD: Chevron.

47 XX CENTURY DISASTERS INTERVENTION CONTINUUM OF CARE Critical Incident ONLY PSYCHOLOGICAL FIRST AID FIRST 3 MONTHS Psychotherapy After 3 months Psychiatric Treatment. Hospitalization Rehab. for Psychiatric emergencies.

48 Haiti earthquake survivor doing the EMDR Therapy Butterfly Hug. 2010

49 EMDR THERAPY

50 Eye movement desensitization and reprocessing (EMDR) therapy is an integrative eight-phase approach that emphasizes the role of physiologically stored memory networks and the brain s information processing system in the treatment of pathology. Is a comprehensive approach to treatment of trauma, adverse life experiences, or psychological stressors. Shapiro, F., & Laliotis, D. (2015). EMDR Therapy for Trauma-Related Disorders. In M. Cloitre & U. Schnyder (Eds.) Evidence based treatments for trauma-related psychological disorders. A practical guide for clinicians. NY: Springer.

51 It is guided by the Adaptive Information Processing (AIP) model, which conceptualizes mental health problems, excluding those caused by organic deficits (e.g., genetic, toxicity, injury), to be the result of inadequately processed memories of adverse life experiences. Shapiro, F., & Laliotis, D. (2015). EMDR Therapy for Trauma-Related Disorders. In M. Cloitre & U. Schnyder (Eds.) Evidence based treatments for trauma-related psychological disorders. A practical guide for clinicians. NY: Springer.

52 DR. NACHO TEACHING BLS TO A GROUP OF CHILDREN IN POSOLTEGA, NICARAGUA AFTER A LANDSILIDE IN

53 According to this view, presenting symptoms result from memories of disturbing experiences that have been dysfunctionally stored, encoded with the original emotions, beliefs and physical sensations Shapiro, F., & Laliotis, D. (2015). EMDR Therapy for Trauma-Related Disorders. In M. Cloitre & U. Schnyder (Eds.) Evidence based treatments for trauma-related psychological disorders. A practical guide for clinicians. NY: Springer.

54 The World Health Organization (2013) and numerous international mental health review publications, such as the Cochrane Review, recommend eye movement desensitization and reprocessing (EMDR) therapy for treatment of PTSD in children, adolescents, and adults. World Health Organization. (2013). Guidelines for the managements of conditions specifically related to stress. Geneva, Switzerland: Author.,

55 Philippines after Haiyan Typhoon

56 According to Dr. Francine Shapiro, the possibility of using modified EMDR therapy protocols as one component of a comprehensive system of postdisaster interventions has important global implications. Shapiro, F. (2009a). Treating victims of trauma worldwide. Paper presented at the Evolution of Psychotherapy Conference, Anaheim, CA.

57 EARLY EMDR THERAPY INTERVENTION

58 Early psychological interventions is the term used by Roberts et al. (2010) for interventions that began within the first 3 months after a traumatic event with the aim mostly of preventing PTSD or ongoing distress in those with traumatic stress symptoms, with acute stress disorder (ASD), or who are at risk for PTSD or other disorders. Roberts, N. P., Kitchiner, N. J., Kenardy, J., & Bisson, J. I. (2010). Early psychological interventions to treat acute traumatic stress symptoms. Cochrane Database of Systematic Reviews, (3),

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60 The U.S. Department of Veterans Affairs and Department of Defense Clinical Practice Guidelines for Management of Post-Traumatic Stress mentioned that early identification of PTSD and rapid referral to treatment can shorten suffering and lessen the severity of functional impairment. U.S. Department of Veterans Affairs and Department of Defense. (2010). VA/DoD clinical practice guideline for management of post-traumatic stress. Version 2.0..

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62 Experts (e.g., Bisson, Roberts, & Macho, 2003; Brewin et al., 2008) maintain that interventions should target those who are at highest risk for experiencing persistent psychological problems following exposure to potentially traumatic events. Bisson, J. I., Roberts, N., & Macho, G. S. (2003). Service innovations: The Cardiff traumatic stress initiative: An evidence based approach to early psychological intervention following traumatic events. Psychiatric Bulletin, 27(4), Brewin, C. R., Scragg, P., Robertson, M., Thompson, M., d Ardenne, P., & Ehlers, A. (2008). Promoting mental health following the London bombings: A screen and treat approach. Journal of Traumatic Stress, 21, 3 8.

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64 Early EMDR therapy intervention (EEI) has a natural place in the crisis intervention and disaster mental health continuum of care context and may be key to early psychological interventions as a brief treatment modality. Jarero, I., Artigas, L., & Luber, M. (2011). The EMDR Protocol for recent critical incidents: Application in a disaster mental health continuum of care context. Journal of EMDR Practice and Research, 5(3),

65 PROVIDING THE EMDR-PRECI AFTER A NATURAL DISASTER IN MEXICO

66 The clinical experience and work in the field with Early EMDR Intervention has been extensive. There is a body of research supporting the use of EMDR therapy protocols to treat PTSD symptoms in both group and individual formats following natural, man-made, technological disasters and cancerrelated PTSD symptoms. Maxfield, L. (2008). EMDR treatment of recent events and community disasters. Journal of EMDR Practice and Research, 2(2),

67 Early EMDR Interventions with evidence-based protocols, such as the EMDR-Integrative Group Treatment Protocol and the EMDR-Protocol for Recent Critical Incidents and Ongoing Traumatic Stress, has a natural place in the response strategies to reduce the burden of long-term psychological sequelae after a disaster. Jarero, I., Uribe, S., Artigas, L., Givaudan, M. (2015). EMDR Protocol for Recent Critical Incidents: A Randomized Controlled Trial in a Technological Disaster Context. Journal of EMDR Practice and Research, 9(4)

68 LUCY PROVIDING THE EMDR-PRECI TO CHILDS SURVIVOR OF THE MITCH HURRICANE IN MEXICO

69 This two evidence-based protocols, are part of the United Nations Institute for Training and Research (UNITAR) course for Peace Operations Personnel and Humanitarian Aid Workers

70 EVERY DAY DISASTERS 70

71 Within the context of Psycho-Oncology these two protocols addresses one of the major psychological dimension of cancer: the ongoing cancer-related stress responses with traumarelated disorders (e.g., Adjustment Disorders, Acute Traumatic Stress Disorder; PTSD) of patients, their families and caregivers at all stages of the disease: from diagnosis through treatment, to treatment completion through follow-up, and possible, to recurrence and diagnosis of terminal illness. 71

72 Female cancer patients during group EMDR Therapy treatment

73 The use of EMDR Therapy Protocols for Early Intervention, could be a Window of Opportunity to: a) The adaptive processing of trauma Memories. b) The prevention of the accumulation of negative associated memories. Jarero, I., Artigas, L., Luber, M. (2011). The EMDR protocol for Recent Critical Incidents: Application in a Disaster Mental Health Continuum of Care Context. Journal of EMDR Practice and Research, 5(3).

74 c) The prevention of later mental health complications. d) The reduction of trauma suffering e) The promotion of mental Health and resilience. Jarero, I., Artigas, L., Luber, M. (2011). The EMDR protocol for Recent Critical Incidents: Application in a Disaster Mental Health Continuum of Care Context. Journal of EMDR Practice and Research, 5(3).

75 Susana Uribe, Nacho Jarero and Lucy Artigas Providing EMDR Therapy After a Technological Disaster in Mexico. March, 2015.

76 Expanding our field of action with EMDR Therapy..

77 XXI CENTURY DISASTERS INTERVENTION CONTINUUM OF CARE

78 XXI CENTURY DISASTERS INTERVENTION CONTINUUM OF CARE Critical Incident PSYCHOLOGIAL FIRST AID + EARLY EMDR THERAPY INTERVENTION HELPERS SELF- CARE ALL THE TIME. for those who are at highest risk for experiencing persistent psychological problems following exposure to potentially traumatic events. EMDR THERAPY STANDARD TREATMENT. Psychiatric Treatment. Hospitalization for Psychiatric emergencies. Rehab.

79 THE FACE OF HOPE OF A LATIN AMERICAN GIRL LIVING IN A SHELTER. 1998