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Harvard Commentaries
35320
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Minding Your Mind Minding Your Mind
 

Does Everyone Need Psychological Help After a Tragic Event?


November 14, 2013

By Michael Craig Miller M.D.

Harvard Medical School


The attacks of September 11, 2001, were extremely traumatic. Every anniversary is a reminder of the physical and emotional trauma experienced by thousands of people on that day. The emotional trauma continues for many of the men and women in the military who are fighting in conflicts that resulted from the 9/11 attacks.

In the wake of any significant trauma, the first impulse is usually to rush to the scene with a zealous willingness to help. In times of large-scale crisis, there is often a push to provide a large force of mental health clinicians to help everyone affected. But a more cautious approach to providing help may be the better option.

So what does the research suggest is most helpful in the wake of tragedies?

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One Size Does Not Fit All

Research suggests that help should be individualized. The one-size-fits-all approach does not take into account each person's unique responses to trauma and capacity for resilience. Some people may want to talk about the experience. But for others, talking may just reinforce and intensify memories that are better forgotten. In fact, repeatedly broadcasting the images of collapsing towers on TV may have intensified mental distress especially for people who lived in New York City, closest to the disaster.

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First Do No Harm

An example of a type of treatment that should probably be avoided is an approach called "critical incident stress debriefing." This technique became popular in the 1980s for emergency service workers, such as firefighters and police officers. It involves reviewing traumatic experiences in a group setting. By the end of the 1990s, researchers found that a single critical incident stress debriefing session did not reduce the risk of developing post-traumatic stress disorder (PTSD). In fact, it appeared to increase the incidence of psychological distress in some cases.

Researchers have evaluated a variety of treatments proposed for people who had experienced a frightening loss of life, a life-threatening injury or a grave threat.

One review looked at a wide range of established techniques: cognitive behavior therapy, stress management, relaxation, eye movement desensitization and reprocessing, teaching of coping skills or general psychological information. These studies were conducted in various countries. They involved a range of traumatic events, such as physical assault, armed robbery, traumatic births and traffic accidents.

Unfortunately there was no evidence that any of the treatments were effective in preventing symptoms of PTSD, anxiety or depression. And, as with debriefing, some people may have gotten worse.

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Group Therapy Can Backfire

You'd expect that providing group support and reassurance, and teaching coping skills and relaxation techniques would be helpful to all trauma victims. But research has found that the simple act of attending a group session may cause some people to go over and over the traumatic events when they would not otherwise do so. Just talking to others in the group about the events can increase PTSD symptoms in some people.

Bottom line: Some people exposed to traumatic events do not benefit from psychological help. More research is needed to help clinicians decide what intervention is best for each individual and — perhaps more important — when to intervene.

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The Need for Help Doesn't Go Away

During a tragedy, people want to come together and help. But eventually the crisis passes and people go back to their regular lives. They have to. This is when it often becomes more difficult to get the kind of formal or informal help a person may need to adjust to a new reality. The needs are often great and resources are limited.

Some experts believe that the goal with trauma is to remember less, rather than more. The goal, in other words, is to help someone extinguish the painful reactions over time. We still don't know the best way to provide that kind of help.

Given what we do know about large-scale attempts to provide mental health services, perhaps more of those resources should be set aside for later. Ultimately, the aim is to help people get on with their lives. It may sound less dramatic, but it may be more beneficial.

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Michael Craig Miller, M.D., is editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 25 years.

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