Psychological Interventions for People Exposed to Disaster

1. PSYCHOLOGICAL
INTERVENTIONS FOR
PEOPLE EXPOSED TO
DISASTER
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PARADOXES IN PSYCHOLOGICAL ASSISTANCE IN DISASTERS
(1) The pathogenic character of a disruptive situation lies in the situation itself, external to
the individual, more than in his/her biological or psychological condition.
(2) Why (Why Are Mental Health Professionals Necessary during a Disaster)?
They are needed because disruptive situations have the potential to cause various mental
disorders. Therefore, one function of these professionals is to serve as a bridge between
the disruptive external world and and the inner world of each persons.
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(3) What (What Is Our Objective While Assisting during Disaster?)
In collapsing environment, endangered or actually harmed psychological processing abilities are the
core of our interventions. There are two concepts to be stressed; (a) the recovery of the individual's
subjectivity; (b) the maintenance of the ability to elaborate the inner-outer world relation. Therapists
should be finely tuned with the timing, place and manner of the intervention and highly sensitive to
cultural characteristics.
(4) Who (Who Must Intervene to Ensure People's Psychological Stability?)
As the ratio between available practitioners and people in need of mental health care is so inadequate,
the population as a whole must become a resource. Mental health professionals play an important role
in acknowledging people's ability to assume responsibility.
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(5) Whom (Whom Are We Going to Assist?)
During disasters, mental health care is usually given to those showing their needs in the most evident
way. Yet, we need to be sensitive in order to identify those who remain silent, apart or make-believe that
"nothing happened to them". Some groups are special targets. Children, the erderly, pregnant woman,
disabled women, disabled people, and those at risk due to psychological weakness and lesser capacity to
deal with threats.
(6) Whose (Whose Do We Have to Intervene?)
This question concerns individuals and social institutions in two different aspects; (a) the mere presence
makes human beings subjectively responsible; even though we may have no relation at all with the
occurrence of external facts, we still are inevitably responsible for our reactions to them; (b) communities
must have institutions which are accountable socially and legally for disasters. That is, not only who is
"guilty" but who is in charge of administering assistance.

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(7) When (When Do We Have to Intervene?)
Intervention during disasters involves four different stages; (a) the pre-impact phase, in which actions
are directed towards building "mental immunity" in all members of the community so that they will
become capable of recognizing the nature and importance of the menace, organizing available
resources and acting properly and according to the circumstances. (b) the impact phase, in which
actions are directed to evaluate the impact for the event on the population and to respond to urgent and
acute needs; (c) the phase immediately after the occurrence of the event, in which actions are directed
to evaluate individual responses, tp prevent the development of pathogenic mechanisms and to
respond to emerging pathologies;
(d) the long-term phase, in which actions are directed to provide treatment to people that need long-
term assistance pr xcases of late appearance of mental disturbances, and in which strategies for
building "mental immunity" should be reinforced as a preventive measure for the future.
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(8) Where (Where Do We Have to Intervene?)
Mental health professionals will often need to be flexible and create adequate therapeutic milieus
even in completely inadequate environments. Any places can become a suitable one for therapy if
it is signified as such; for example, in the open by underlining the sheltering character of a tree.
We have called this process " from the couch to the stone".
(9) Ways (In Which Ways Are We Going to Intervene?)
Treatment can consist of individual , family or group interventions. Professionals must stick to
the core of their theoretical frameworks while adapting techniques to the circumstances.
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(10) Wholesale
Wholeness means an integrative approach based on the previous nine Ws and on a consistent
vision of the problem, the ways to intervene and the organization of assistance. The completely of
disasters requires not only the integration of psychiatric and psychological aspects, but also
knowledge about social, political, economic and cultural processes. This does not mean that we
will take care of all aspects pf the problem. On the contrary, we must restrict our interventions to
our specific role, preserving the ethical values of professions.

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COGNITIVE-BEHAVIORAL INTERVENTIONS
Cognitive-behavioral interventions are rooted in learning theories, especially, classical
conditioning and operant avoidance. Early studies focused exclusively on fear and anxiety
reactions. The first treatment approach to be proposed for treating trauma-related symptoms
was stress inoculation training (STD).

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EYE MOVEMENT DESENSITIZATION AND PROCESSING
Eye movement desensitization and reprocessing (EMDR) is a technique developed by Shapiro [50]
on the basis of the observation that lateral meye movements facilitate cognitive processing traumatic
material. It is form of exposure (desensitization) which evident cognitive components accompanied
by rhythmic eye movements. Designed originally as a treatment for traumatic memories, it was called
eye movement desensitization (EMD).

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SOMATIC AWARENESS APPROACHES
Persons who suffer a disruptive situation usually show an altered relationship among cognitive,
emotional and sensory-motor (body) levels of information processing. The sensory-motor (body)
processing level must be integrated with cognitive and emotional processing treatment of the
patient. By using the body rather than cognition or emotion) as a primary entry point in processing
trauma, sensory-motor psychotherapy aims to directly treat the effects of trauma on the body,
which in turn should facilitate emotional and cognitive processing.

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PSYCHOANALYTICALLY ORIENTED PSYCHOTHERAPY
Lindy used brief psychoanalytic psychotherapy techniques to treat PTSD. His therapy has three
elements; (a) therapeutic alliance; (b) disclosure and interpretation of transference; (c) detection
and therapeutic use of counter-transference. According to Lindy, the disruptive event damage
the patient's perceptive capacity negatively, affecting his/her reality judgment. The analyst must
bring the patient's attention to those aspects of everyday reality associated with trauma that can
be elaborated.