This book provides a comprehensive overview of the longest lasting mental health research and recovery program implemented after a natural disaster.
PREVIEW OF THE BOOK
On December 7, 1988, a strong tremor measuring 6.9 on the Richter scale shook northwestern Armenia, causing widespread destruction and death. In Gumri, Armenia’s second largest city, more than half of the structures were severely damaged or destroyed and 7% of the population died. The town of Spitak near the epicenter was almost completely razed and 16% of the population died. In the aftermath of the earthquake, Armen Goenjian, MD, LDFAPA, FACGS, initiated and directed the psychiatric awareness program and, with a group of dedicated volunteer mental health professionals, provided services to survivors for more than 2 decades.
Dr. Goenjian and his UCLA colleagues – Alan Steinberg, PhD and Robert Pynoos, MD – have studied the psychological consequences of the earthquake in Armenia and other major disasters in the United States, Greece, Nicaragua, Taiwan, Honduras, Thailand and Japan. . They recently published the book Lessons Learned in Disaster Mental Health: The Earthquake in Armenia and Beyond. The book provides a comprehensive overview of the most comprehensive mental health research and recovery program implemented after a natural disaster.
The book covers the evolution of the program, from the early acute phase of clinical field work to its expansion as a three-year program of teaching and training local therapists to building 2 mental health clinics in devastated cities. It provides a wide range of longitudinal data on the course of post-traumatic stress disorder (PTSD), depression, pain and separation anxiety between treated and untreated subjects.
“One of the reasons these treatment studies are unique is that preteens were followed up for up to 25 years after the earthquake,” according to Dr. Goenjian, a full research psychiatrist at the Semel Institute for Neuroscience and Human Behavior at UCLA. .
“Nearly all of the reported follow-up treatment outcome studies have been conducted 2 years or less after a disaster. Only a handful have followed subjects for up to 5 years, “said Dr. Steinberg, associate director of UCLA / Duke University National Center for Child Traumatic Stress.
In controlled studies, adolescents who received trauma and bereavement focused therapy at 1.5 years after the earthquake, PTSD and depressive symptoms were significantly lower than in the control group at 5 years and the benefits were maintained at follow-up to 25 years old. The new analyzes showed that symptoms in both the treatment and the control group stabilized between 4 and 5 years after the earthquake. “The findings indicate the importance of providing clinical intervention within the first few years and subsequent monitoring of chronic psychiatric and medical problems among severely affected survivors,” said Dr. Goenjian. “Those with post-traumatic stress disorder and / or depression at baseline had significantly more chronic medical illnesses.”
Another finding was the significant impact that post-disaster adversity (often called “disaster after disaster”) played into perpetuating post-traumatic stress disorder and depressive symptoms. The findings underscore the important role governmental and non-governmental agencies could play in the recovery of survivors by providing timely housing, heating, electricity, transportation and medical services. “These types of supportive measures complement the benefits of psychotherapy and apply to other types of natural and man-made disasters, wars and violence, including domestic violence,” said Dr. Goenjian.
Another valuable chapter concerns moral development and the functioning of conscience. “Spitak’s teenagers exposed to severe earthquake trauma exhibited pathological interference with the functioning of consciousness,” said Dr. Steinberg. For example, “these young people felt they had lost their conscience after the earthquake – that their conscience no longer works – and they thought it was justifiable to act without considering morality in order to survive”.
“Multigenerational genetic studies have shown the inheritance of vulnerability to PTSD, depression and anxiety. They also showed pleiotropy, ie sharing of genes between post-traumatic stress disorder, depression and anxiety, “said Dr. Goenjian. They also identified 2 serotonergic genes (TPH1 and TPH2) and 1 dopaminergic gene (COMT) associated with PTSD. The Whole Exon Sequencing results showed an association between OR4C3 (the gene for olfactory receptors) and PTSD. Carriers of these genes had an increased risk of PTSD. “These results give us hope that advances in psychiatric genetics a day will be translated into therapeutic and preventive approaches, “said Dr. Goenjian.
The book also discusses important organizational successes and pitfalls of implementing the post-disaster recovery program. Regarding factors related to therapist performance and minimizing Burnout, helpful steps included verifying candidates prior to enrollment; holding regular pre-departure group meetings with new members to disseminate information accumulated from previous groups and encourage spirit of the body; provide guidelines for decorum, such as refraining from political and religious activism; and be respectful of local religious traditions, customs and practices.
The therapists worked in pairs to support each other. They had regular debriefings with colleagues or group leaders to discuss difficult cases and their own stressful reactions to painful realities. They also took weekly rest days. These measures helped minimize Burnout.
“Despite the many emotional and physical difficulties of working in the aftermath of the earthquake, nearly all therapists recognized that providing help to survivors was one of their most rewarding life experiences,” said Dr. Goenjian.
He concluded by saying, “My favorite chapter that represents the soul of the book is the chapter that includes the poignant compassionate memories of the 2 therapists.”
Mr. Millman is a Senior Media Relations Officer at UCLA Health. Dr. Steinberg is the associate director of the National Center for Child Traumatic Stress in the UCLA Department of Psychiatry. Dr. Goenjian is certified in psychiatry. He is a research professor in psychiatry at UCLA Geffen School of Medicine and Chief Medical Officer of the CenExel-CNS Network.