Psychological Psychological AAspectsspects of of

DDisasterisaster RRiskisk

MManagementanagement

Prof.Prof. Nuray KARANCINuray KARANCIMiddle East Technical UniversityMiddle East Technical University

Psychology DepartmentPsychology DepartmentAnkara, TurkeyAnkara, Turkey

karanci@metu.edu.trkaranci@metu.edu.trWorkshop on Disaster ManagementWorkshop on Disaster Management

September, 2007September, 2007

OutlineOutlineI:I: Psychological bases for mitigation and Psychological bases for mitigation and preparedness : Theoretical models and preparedness : Theoretical models and some emprical resultssome emprical results

II: What are the psychological impacts of II: What are the psychological impacts of disasters ?disasters ?

III: PsychoIII: Psycho--social interventions for disaster social interventions for disaster survivorssurvivors

I: Psychological Aspects of Mitigation I: Psychological Aspects of Mitigation and Preparedness for Natural Disastersand Preparedness for Natural Disasters

What needs to be done for strengthening preparedness What needs to be done for strengthening preparedness and mitigation behaviors: and mitigation behaviors:

•• Facilitatation of Community participationFacilitatation of Community participation

•• Modification of individual and community attitudes to Modification of individual and community attitudes to risk and P/Mrisk and P/M

Capacity building: empowerment of local communities Capacity building: empowerment of local communities /community organizations and networks/community organizations and networks

•• development of necessary skills for P/Mdevelopment of necessary skills for P/M•• Psychological services : Development & capacity Psychological services : Development & capacity

building for psychological services: Materials ; building for psychological services: Materials ; Training; Trauma Centers Training; Trauma Centers

COPINGCOPING WITH DISASTERSWITH DISASTERS (P/M)(P/M)

•• The importance of the The importance of the participationparticipation/ownership/ownership of of the local comthe local commmunitunitiesies for the execution of for the execution of successful disaster mitigation successful disaster mitigation is well recognizedis well recognized

•• IInvolvementnvolvement in decision making processes has in decision making processes has been repeatedly stressed been repeatedly stressed

•• BUT, BUT, unfortunately has not yet gained unfortunately has not yet gained wwidespread idespread implementation implementation

What is Citizen ResponseWhat is Citizen Response ??( Helsloot and Ruitenberg ,2004)( Helsloot and Ruitenberg ,2004)

1. prepare for disasters (M/P) and major accidents 1. prepare for disasters (M/P) and major accidents 2. before, during and after disasters and major accidents ; 2. before, during and after disasters and major accidents ; 3. with the intent to help themselves or others to limit the 3. with the intent to help themselves or others to limit the

effects of the disaster or major accident. effects of the disaster or major accident.

““Citizen participation processes and methods are Citizen participation processes and methods are likely to be related to culture and it is important likely to be related to culture and it is important to note that results from western cultures may to note that results from western cultures may not generalize to other culturesnot generalize to other cultures””. .

Different labels given for citizen Different labels given for citizen responseresponse

•• SSelf protective behaviors and precautionary elf protective behaviors and precautionary adaptation ( adaptation ( GrothmannGrothmann and and ReusswigReusswig, 2006), 2006)

•• RResponsibleesponsible behaviors (behaviors (KasapogluKasapoglu and and EcevitEcevit, , 2003)2003)

•• AAdaptivedaptive behavior or problem focused coping behavior or problem focused coping (Duval and (Duval and MulilisMulilis, 1999), 1999)

•• PPreparednessreparedness behaviors (behaviors (PatonPaton, Smith and , Smith and Johnston, 2005). Johnston, 2005).

•• Coping behaviors ( Coping behaviors ( Karanci & Karanci & AksitAksit, 2000, 2000) )

Do individuals engage in Do individuals engage in preparedness behaviors ?preparedness behaviors ?

•• People living in areas prone to natural People living in areas prone to natural hazards often fail to act, or do very little, hazards often fail to act, or do very little, to lessen their risk of death, injury, or to lessen their risk of death, injury, or property damageproperty damage(Peek and (Peek and MiletiMileti, 2002)., 2002).•• Therefore, the task of facilitating Therefore, the task of facilitating community members to act is a community members to act is a challenging areachallenging area. .

Psychological variables related to Psychological variables related to the facilitation of protective the facilitation of protective behaviorsbehaviors•• risk/threat risk/threat & vulnerability & vulnerability appraisals appraisals

•• believing in the believing in the possibility possibility of coping and of coping and knowing about methods of copingknowing about methods of coping

(having (having selfself--efficacyefficacy beliefs and coping skills)beliefs and coping skills)

•• responsibilityresponsibility for taking actionfor taking action

Factors hindering responsible behavior: Factors hindering responsible behavior:

•• psychological factors like denial, fatalism and psychological factors like denial, fatalism and avoidanceavoidance

Variables common to PsychoVariables common to Psycho--Social Social Models explaining protective Models explaining protective

behaviorsbehaviors

1. Cognitive appraisals of : 1. Cognitive appraisals of :

•• risk (hazards and vulnerabilities) and coping risk (hazards and vulnerabilities) and coping

•• Coping skillsCoping skills

2.2. ResourcesResources

3.3. ResponsibilityResponsibility

The Person Relative to Event model The Person Relative to Event model ((PrEPrE ) ( Duval and ) ( Duval and MulilisMulilis, 1999), 1999)•• Based on Based on Lazarus Lazarus et al.,et al.,’’s s studies on stress, the studies on stress, the cognitive appraisal of stress and coping cognitive appraisal of stress and coping

•• Following threat perception Following threat perception appraisal processappraisal processtakes place : 1. Event appraisal :Appraisal of takes place : 1. Event appraisal :Appraisal of magnitude of threat and 2. Coping appraisal : magnitude of threat and 2. Coping appraisal : Appraisal of personal resourcesAppraisal of personal resources

•• Perception of risk and reduction > Resources = Perception of risk and reduction > Resources = No copingNo coping•• Perception of threat =/< Resources = Perception of threat =/< Resources = CopingCoping•• Perceptions of Perceptions of responsibility responsibility moderates this moderates this relationshiprelationship

The Protection Motivation Theory The Protection Motivation Theory (PMT)(PMT) (Rogers, 1983)(Rogers, 1983)

TTwowo major perceptual processes are important for major perceptual processes are important for explaining selfexplaining self--protective behavior.protective behavior.

1.1. TThreathreat perceptionperception:: involves the perceptions of involves the perceptions of probability and severity of the eventprobability and severity of the event and the and the fear evokedfear evoked

2.2. CCopingoping appraisalappraisal :involves the appraisals of :involves the appraisals of protective response efficacy protective response efficacy , , self efficacy self efficacy and and protective response costs protective response costs

The Protection Motivation TheoryThe Protection Motivation Theory

Threat Appraisal +

fear

Coping appraisal

Protectivemotivation

Non-protectiveDefensiveFactors

(denial,fatalism)

resources

Protective Behavior

+

+

-

+

The Disaster Preparedness Model (DPM)The Disaster Preparedness Model (DPM)((PatonPaton, Smith, and Johnston, 2005), Smith, and Johnston, 2005)

Critical

awareness

Risk:

Threat perception

Quake

anx 1

Quake anx 2

Outcome

expectancy

Self-efficacy

Action coping

Intention

to prep

Intention to

seek info

Preparing

for quakes

-

Responsibility

Commonalities of the three modelsCommonalities of the three models•• cognitive processingcognitive processing of riskof risk is importantis important•• appraisals of the appraisals of the coping abilities and resourcescoping abilities and resources•• motivation for protective behaviors are only motivation for protective behaviors are only converted into action under certain converted into action under certain circumstances, like the presence of selfcircumstances, like the presence of self--efficacy efficacy beliefs, a moderate amount of anxietybeliefs, a moderate amount of anxiety, presence , presence of resourcesof resources

•• TheThere are re are certain certain hindering hindering factors like denial factors like denial and high anxiety which may interfere with and high anxiety which may interfere with adaptive behaviorsadaptive behaviors

•• Economical constraintsEconomical constraints--resources are also resources are also stressedstressed

Selected Emprical FindingsSelected Emprical Findings

Coping: Is There A Risk For Coping: Is There A Risk For Future Earthquakes?Future Earthquakes?

•• Majority of respondents say Majority of respondents say YES YES for an earthquake and for an earthquake and believe that they are believe that they are vulnerable.vulnerable.

((Turkey: Turkey: ErzincanErzincan and Dinar and Dinar samplessamples (Karanci et al., (Karanci et al., 1995; 1999; 1995; 1999; ĐĐstanbul (Fistanbul (Fişşek ek et al, 2002et al, 2002))

Is It Possible To Take Action For Is It Possible To Take Action For Mitigation ?Mitigation ? (General Efficacy (General Efficacy Beliefs)Beliefs)•• YES ( Best predictor: Years of Education)YES ( Best predictor: Years of Education)

Erzincan : % 82Erzincan : % 82

Dinar: % 71Dinar: % 71

•• Can you do something for mitigation ?Can you do something for mitigation ?(Self(Self--Efficacy)Efficacy)

Erzincan: % 47Erzincan: % 47

Dinar: % 47 Dinar: % 47

WWhose hose Responsibility Is It To Responsibility Is It To Take Actions For Mitigation ?Take Actions For Mitigation ?

661414ConstructorsConstructors

/Engineers/Engineers

772323GovernorsGovernors

26263333CitizensCitizens

39393131MunicipalityMunicipality

46464949StateState

Dinar, 96Dinar, 96

%%

Erzincan,96Erzincan,96

% %

Have You Engaged In Any Kind Of Have You Engaged In Any Kind Of Preparation ?Preparation ?

•• Erzincan, 1993 : % 30Erzincan, 1993 : % 30•• Dinar, 1996: % 13Dinar, 1996: % 13•• ĐĐstanbul 2002: %2stanbul 2002: %2--%30 (Fisek et al)%30 (Fisek et al)Tents, moving house, strengthening house, Tents, moving house, strengthening house, stabilizing stabilizing

furniture; supplies; furniture; supplies; buying a car, foodbuying a car, food--clothing; clothing; insuranceinsurance

Predictors of preparednessPredictors of preparedness ((Erzincan,93Erzincan,93; ; ĐĐstanbul, 2002stanbul, 2002))•• Fear /AnxietyFear /Anxiety•• Perception of controlPerception of control•• EducationEducation•• IncomeIncome

Reasons for not engaging in any kind of Reasons for not engaging in any kind of Mitigation/preparedness (FiMitigation/preparedness (Fişşek et al, 2002, ek et al, 2002, ĐĐstanbul; N=254)stanbul; N=254)

REASONS %

• We trust our building 57 • Too expensive 54 • It is God’s will, what I do 41 won’t matter • No use 33 • None of my relatives,friends did something 30 • Don’t have time 29 • Don’t know what to do 25 • I am at rent 25 • No need, won’t happen soon 10 • Neighbors could not agree 9 • Insurance will take care of it 8 • Do not think to stay at this 7 house for a long while

Duval and Duval and MulilisMulilis (1999)(1999), Earthquake , Earthquake preparedness among preparedness among homeowners living in homeowners living in Long Beach, CaliforniaLong Beach, California

•• earthquake preparedness behaviors increased for earthquake preparedness behaviors increased for persons who were given communications portraying high persons who were given communications portraying high personal resources for dealing with quake threat in personal resources for dealing with quake threat in comparison to the magnitude of their threat perceptions comparison to the magnitude of their threat perceptions (i.e; the severity and probability of an earthquake) (i.e; the severity and probability of an earthquake) supporting the supporting the PrEPrE model. model.

•• perceptions of perceptions of responsibilityresponsibility for mitigation hafor mitigation had ad amoderating effect for preparedness behaviors, even moderating effect for preparedness behaviors, even when personal resources were viewed as sufficient, when personal resources were viewed as sufficient, which which showed the importance of taking showed the importance of taking responsibility responsibility for for preparedness. preparedness.

From Turkey; Earthquake From Turkey; Earthquake preparednesspreparedness

•• AAnxietynxiety about future quakes and perceived about future quakes and perceived control were positively related to preparedness control were positively related to preparedness behaviors among the survivors of the behaviors among the survivors of the ErzincanErzincan, , Turkey earthquakeTurkey earthquake ((RustemliRustemli and and KarancKaranci, i, 1999) 1999)

•• EEducationducation, employment, social security and , employment, social security and knowledge were important predictors of knowledge were important predictors of preparedness for future earthquakes among the preparedness for future earthquakes among the survivors of the 1999 survivors of the 1999 MarmaraMarmara earthquakeearthquake((KasapogluKasapoglu and and EcevitEcevit, , 2003)2003)

Flood Preparedness in GermanyFlood Preparedness in Germany((GrotthmannGrotthmann and and ReusswigReusswig,,2006), 2006),

•• Perceptual variables are important determinants Perceptual variables are important determinants of protective behaviors (such as purchase of of protective behaviors (such as purchase of flood protection devices and engaging in flood protection devices and engaging in structural measures),structural measures),

•• Threat and coping appraisals and house Threat and coping appraisals and house ownership appeared as significant predictors for ownership appeared as significant predictors for protective behaviors for floods, protective behaviors for floods,

•• NonNon--protective variables (such as denial) were protective variables (such as denial) were negatively related to protective behaviors negatively related to protective behaviors

Earthquake Preparedness , Earthquake Preparedness , 600 randomly 600 randomly selected homes in New Zealand. selected homes in New Zealand. ((PatonPaton et al.,2005)et al.,2005)

•• RRiskisk perception, critical awareness and earthquake perception, critical awareness and earthquake anxiety motivated preparedness and were directly linked anxiety motivated preparedness and were directly linked to outcome expectancy. to outcome expectancy.

•• The results showed that intentions were grouped into The results showed that intentions were grouped into two, intention to seek information and intention to two, intention to seek information and intention to prepare prepare ..

•• Only intention to prepare Only intention to prepare related to earthquake related to earthquake preparedness actions. preparedness actions.

•• TThose expecting an earthquake within the next 12 hose expecting an earthquake within the next 12 months months (time)(time) and those that had and those that had trusttrust in administrative in administrative agencies information sources were more likely to agencies information sources were more likely to engage in preparedness.engage in preparedness.

Importance of the degree of Importance of the degree of hazard faced:hazard faced:•• Degree of hazard faced influences how risk Degree of hazard faced influences how risk information is received.information is received.

•• CrozierCrozier, McClure, , McClure, VercoeVercoe and Wilson (2005), and Wilson (2005), in in their study on earthquake preparedness in New their study on earthquake preparedness in New Zealand, found that in low hazard zones, hazard Zealand, found that in low hazard zones, hazard information leads to the view that causes are information leads to the view that causes are manageable, whereas in high hazard zones manageable, whereas in high hazard zones information may induce a degree of fatalism. information may induce a degree of fatalism.

��Increase in Awareness in the Increase in Awareness in the PostPost--disaster Perioddisaster Period

��Preparedness (Preparedness (Risk Risk /vulnerability awareness; /vulnerability awareness;

Fear/anxiety; Belief in ControlFear/anxiety; Belief in Control; Resources and skills; Resources and skills))

Window Of OpportunityWindow Of Opportunity

Community Disaster Awareness Training Program Community Disaster Awareness Training Program in Turkey: Does it Influence Hazard Related in Turkey: Does it Influence Hazard Related Cognitions and Preparedness BehaviorsCognitions and Preparedness Behaviors ((ÇÇankankıırrıı) ) : A Case example (Karanci et al., 2005): A Case example (Karanci et al., 2005)•• CCommunityommunity disaster training programdisaster training program,, 20022002•• EEarthquakesarthquakes, floods and landslides, floods and landslides; ; •• CCoveredovered mitigation, preparedness and response mitigation, preparedness and response

aspectsaspects•• Four thousand community members participated in Four thousand community members participated in

the training program delivered by ninetythe training program delivered by ninety--five local five local trainerstrainers

•• One year after the program, four hundred randomly One year after the program, four hundred randomly selected participants of the training program selected participants of the training program (participants) and a comparable sample of four (participants) and a comparable sample of four hundred community members who did not participate hundred community members who did not participate in any disaster training program (nonin any disaster training program (non--participants) participants) were were comparedcompared

•• Survey focussing on attitudes, worry, expectations of Survey focussing on attitudes, worry, expectations of disasters and preparedness behaviors administereddisasters and preparedness behaviors administered

Some resultsSome results•• The results showed that participants of the The results showed that participants of the training program had more disaster training program had more disaster expectation, worry and loss estimation and expectation, worry and loss estimation and more preparedness behaviors.more preparedness behaviors.

Predictors of preparednessPredictors of preparedness: Regression, i: Regression, in the n the final stepfinal step::

•• gendergender (male)(male)((ββ = . 09, = . 09, t t = 2.02, = 2.02, p p < .05), < .05), years of educationyears of education ((ββ = .15, = .15, t t = 3.07, = 3.07, pp < < .01), .01), house ownershiphouse ownership ((ββ = .10, = .10, t t = 2.13, = 2.13, pp < < .05), .05), participation in awareness trainingparticipation in awareness training ((ββ = = .15, .15, t t = 3.37, = 3.37, pp < .001) and < .001) and worry about worry about future future disastersdisasters ((ββ = .14, = .14, t t = 2.53, = 2.53, pp < .01) < .01) werewere significantsignificant variablesvariables. .

Suggestions for community Suggestions for community disaster awareness programsdisaster awareness programs

•• Initially developing and increasing Initially developing and increasing an an awarenessawareness of risksof risks, hazards and vulnerabilities (Awareness , hazards and vulnerabilities (Awareness programmes/Various methods, use of the media)programmes/Various methods, use of the media)

•• Recognize hindering factors, like denial, fatalism etc. Recognize hindering factors, like denial, fatalism etc. •• To To empower empower community members community members with relevant with relevant skills to skills to

copecope with the event with the event (Skills training)(Skills training)•• Giving support and information on resources that can be Giving support and information on resources that can be

activated,activated,•• so that the person evaluates his/her resources relative to so that the person evaluates his/her resources relative to

the threats posed by the event, as sufficient to deal with the threats posed by the event, as sufficient to deal with them. them.

•• to facilitate self responsibility for managing threatto facilitate self responsibility for managing threat, thus , thus give ownership to citizens, nongive ownership to citizens, non--governmental governmental organizations etc.organizations etc.. .

•• SustainabilitySustainability

II: Psychological impact of disastersII: Psychological impact of disasters

Psychosocial StressPsychosocial Stressorsors Following Following Natural DisastersNatural Disasters•• Drastically altered physical Drastically altered physical

environmentsenvironments•• Economic lossesEconomic losses•• Disruption of daily and Disruption of daily and social activitiessocial activities•• HomelessnessHomelessness•• Emotional traumaEmotional trauma

((witnessing loss of lives, witnessing loss of lives, injury and property lossinjury and property loss))

•• Anxiety for future Anxiety for future occurrencesoccurrences

•• Collapse of basic Collapse of basic assumptions on predictability assumptions on predictability and safetyand safety

What is shattered ? : Basic What is shattered ? : Basic AssumptionsAssumptions

•• INVULNERABILITYINVULNERABILITY : Life is safe and : Life is safe and secure..wonsecure..won’’t happen to me ! t happen to me !

An awareness that we arenAn awareness that we aren’’t invulnerablet invulnerable

•• MEANING AND PURPOSEMEANING AND PURPOSE : Casts doubt on : Casts doubt on the meaning and purpose of our lives..but the meaning and purpose of our lives..but the traumatic event doesnthe traumatic event doesn’’t fit in..injustice t fit in..injustice of life; no meaning in lifeof life; no meaning in life

•• SELFSELF--RESPECTRESPECT :question our worth..self:question our worth..self--blameblame

Who are affected ? Who are affected ? Almost Almost EveryoneEveryone

•• The SurvivorsThe Survivors

•• Their relatives and friendsTheir relatives and friends

•• Rescue workersRescue workers, all emergency workers, all emergency workers, including the media, including the media

•• VolunteersVolunteers

•• Those who witness the event Those who witness the event (secondary traumatization)(secondary traumatization)

Multivariate Risk Factor Model For Predicting AdjustmentMultivariate Risk Factor Model For Predicting Adjustment(From Freedy et al. Natural Disasters And Mental Health)(From Freedy et al. Natural Disasters And Mental Health)

Positive experiencesPositive experiences

(Growth)(Growth)

Resource loss Resource loss (object; (object; condition; energy) condition; energy) ,,Coping beh.& Social Coping beh.& Social supportsupport

low predictabilitylow predictability

High life threatHigh life threat

Low magnitude life Low magnitude life eventsevents

Somatic Somatic complaintsSubstance complaintsSubstance abuseabuse

Stressful life events Stressful life events (acute& chronic)(acute& chronic)

Cognitive appraisal Cognitive appraisal of dis.: low controlof dis.: low control

High magnitude High magnitude life eventslife events

AnxietyAnxietyInitial distress level; Initial distress level; Conditioned ERsConditioned ERs

Mental health Mental health history (anx)history (anx)

DepressionDepressionBasic needsBasic needsIntensity of disaster Intensity of disaster exposureexposure

(sudden;threat to (sudden;threat to life;intentional harm; life;intentional harm; sights)sights)

DemographicsDemographics

(children;elderly;(children;elderly;

poor; women)poor; women)

MentalMental--Health Health outcomesoutcomes

Minor & transitory vs Minor & transitory vs persistent & debiliating persistent & debiliating for some.(17 % for some.(17 % increaseincrease))

PostPost--disasterdisaster

Acute and onAcute and on--goinggoing

WithinWithin--disasterdisasterPrePre--disasterdisaster

Factors related to adjustmentFactors related to adjustment(Parkinson, 2000 )(Parkinson, 2000 )

Adjustment is a processAdjustment is a process

Person-background

Personality

Prior traumatic events

Coping

resources

Event

Exposure

Severity

Loss

Reactions:

PTSD

Re-experience

Avoidance

arousal

Social support

Post-

event

Psychological Effects of Psychological Effects of DisastersDisasters

I: Psychological Shock Stage I: Psychological Shock Stage (First 24 hours or longer)(First 24 hours or longer)

•• Physiological arousalPhysiological arousal•• Difficulty in logical Difficulty in logical and rational thinkingand rational thinking

•• Everything seems Everything seems unrealunreal--dissociationdissociation

•• Absence of any Absence of any emotionemotion

•• Absence of the Absence of the sensation of pain sensation of pain

•• ShockShock

•• Memory and Memory and concentration problemsconcentration problems

•• Inability to make Inability to make decisionsdecisions

•• Some panic (20 %)Some panic (20 %)

•• Some freezeSome freeze

Shock StageShock Stagecont..cont..

Psychological firstPsychological first--aid (shock stage)aid (shock stage)

�� Creating a safe, secure, tranquil environmentCreating a safe, secure, tranquil environment�� Showing empathy, calm presence, touching if Showing empathy, calm presence, touching if

culturally acceptableculturally acceptable�� Listening, let the survivor talkListening, let the survivor talk�� DonDon’’t try to talk, dont try to talk, don’’t console, dont console, don’’t give t give

empty promises or divert his/her attentionempty promises or divert his/her attention�� Just be there with the survivorJust be there with the survivor�� Show respectShow respect

II: REACTION PHASE (approx. 2II: REACTION PHASE (approx. 2--6 days)6 days)•• Emotional chaos :anxiety, fear, anger, Emotional chaos :anxiety, fear, anger,

irritability, despair, helplessness, irritability, despair, helplessness, sadness, quilt, shame, distrust, Feeling sadness, quilt, shame, distrust, Feeling alineated and lonelyalineated and lonely

•• Somatic reactions : trembling, nausea, Somatic reactions : trembling, nausea, cardiac symptoms, muscle pains, cardiac symptoms, muscle pains, dizziness, fatique, restlessness; sleep dizziness, fatique, restlessness; sleep problems, change in appetiteproblems, change in appetite

•• Sleeping pills, sedatives, Sleeping pills, sedatives, smoking/alcoholsmoking/alcohol

•• Avoidance of the reminders of stimuli Avoidance of the reminders of stimuli that resemble the disaster situationthat resemble the disaster situation

•• Repetitive thoughts and images related Repetitive thoughts and images related to the disasterto the disaster

•• Frightening dreams and nightmaresFrightening dreams and nightmares•• All these reactions are frightening and All these reactions are frightening and

the survivor fears that they are going to the survivor fears that they are going to get mad. (PSYCHOEDUCATION)get mad. (PSYCHOEDUCATION)

III: The Working Through and III: The Working Through and Processing StageProcessing Stage

•• Does not want to talk about it any moreDoes not want to talk about it any more•• Grieving for the lossGrieving for the loss•• Processing takes place internallyProcessing takes place internally•• Strong emotions may erupt, like sadness, Strong emotions may erupt, like sadness, longing, etclonging, etc

•• Difficulties in memory and attentionDifficulties in memory and attention•• Problems in interpersonal relationships, Problems in interpersonal relationships, irritability and conflicts, displaying rage to irritability and conflicts, displaying rage to external sourcesexternal sources

•• Wanting to be left alone Wanting to be left alone

IV: RECOVERY PHASEIV: RECOVERY PHASE

•• The intensity of reactions The intensity of reactions get lessget less

•• The survivor starts to The survivor starts to display interest in daily life display interest in daily life eventsevents

•• Plans for the futurePlans for the future•• Starting to feel emotionally Starting to feel emotionally

betterbetter•• The trauma/disaster event The trauma/disaster event

becomes a part of the becomes a part of the survivor, comes to mind but survivor, comes to mind but does not preoccupy it.does not preoccupy it.

ChidrenChidren’’s reactionss reactions•• Depends on the age (preDepends on the age (pre--school; adolescence)school; adolescence)•• Affected by reactions of parents and adultsAffected by reactions of parents and adults•• AvoidanceAvoidance•• Fear of reminders, being left aloneFear of reminders, being left alone•• Guilt , anxiety about futureGuilt , anxiety about future•• ĐĐrritability, acting out, agression, loosing trust in adultsrritability, acting out, agression, loosing trust in adults•• Problems in concentration; speechProblems in concentration; speech•• Change in characterChange in character•• Somatic problems and Sleep problemsSomatic problems and Sleep problems•• Become more active and may have difficulty in Become more active and may have difficulty in

controlling their own behaviorcontrolling their own behavior•• May regress May regress ––enuresis, thumb suckingenuresis, thumb sucking

2. 2. Avoidance & NumbingAvoidance & Numbing: : Persistent avoidance or numbing Persistent avoidance or numbing of general responsiveness in at least 3 of the followingof general responsiveness in at least 3 of the following

•• Efforts to avoid thoughts, feelings, or conversations associatedEfforts to avoid thoughts, feelings, or conversations associatedwith the traumawith the trauma

•• Efforts to avoid activities, places, or people that arouse Efforts to avoid activities, places, or people that arouse recollectionsrecollections

•• Inability to recall an important aspect of the traumaInability to recall an important aspect of the trauma•• Diminished interest or participation in significant activitiesDiminished interest or participation in significant activities•• Feeling of detachment or estrangement from othersFeeling of detachment or estrangement from others•• Restricted range of affectRestricted range of affect•• Sense of foreshortened futureSense of foreshortened future

3. 3. Arousal: Arousal: persistent arousal as shown by at least 2 of the persistent arousal as shown by at least 2 of the followingfollowing

•• Difficulty falling or staying asleepDifficulty falling or staying asleep•• Irritability or outbursts of angerIrritability or outbursts of anger•• Difficulty concentratingDifficulty concentrating•• HypervigilenceHypervigilence•• Exaggerated startle responseExaggerated startle response

ERZERZĐĐNCAN 1993: PNCAN 1993: PsychologicalsychologicalReactionsReactions

•• % 95 have been % 95 have been psychologically disturbedpsychologically disturbed

•• Fear/Anxiety; Somatic Fear/Anxiety; Somatic Complaints; Irritability Complaints; Irritability and nervousness; and nervousness; memory problems; memory problems; problems in family problems in family relationsrelations

Predictors:Predictors: Being female; Being female; evaluating home as evaluating home as unsafeunsafe

DDĐĐNAR, 1995 : Psychological NAR, 1995 : Psychological ReactionsReactions

WHICH FACTORS INCREASE WHICH FACTORS INCREASE PSYCHOLOGICAL DISTRESS?PSYCHOLOGICAL DISTRESS?

•• Being femaleBeing female

•• Threat perception during the quakeThreat perception during the quake

•• Helplessness coping Helplessness coping

•• Lack of belief in controlLack of belief in control

•• NNegativeegative life events since the life events since the

quakequake

•• ProblemProblem--focused coping decreases focused coping decreases

distressdistress

POSTTRAUMATIC GROWTHPOSTTRAUMATIC GROWTHTedeschi, Park & CalhounTedeschi, Park & Calhoun

PTG as process and outcomePTG as process and outcome

Traumautic

Event

(Psychol. Seismic

event)

Cognitive

processing

PTG(cognitive & emotional)

”stress-related

growth”

distress

PostPost--traumatic Growthtraumatic Growth

•• Processing of Processing of and coping with and coping with traumatrauma

•• Initial high distress: the Initial high distress: the foundations of existing beliefs foundations of existing beliefs shakenshaken

•• Positive changes in the Positive changes in the perceptions of self, others and perceptions of self, others and the worldthe world

Who experiences PostWho experiences Post--Traumatic Traumatic Growth ?Growth ?

1.1.High initial distressHigh initial distress

2.2.High social support/ social High social support/ social integrationintegration

3.3.Helping others /Volunteer Helping others /Volunteer

workwork

4.4.Use of active coping skills Use of active coping skills

Principles of PsychoPrinciples of Psycho--Social Social InterventionsInterventions

•• Survivors need to be involvedSurvivors need to be involved•• the management of the postthe management of the post--disaster environment and disaster environment and

services is also very importantservices is also very important•• First attend to safety and basic needsFirst attend to safety and basic needs•• Empowerment : resource lossEmpowerment : resource loss•• Support loss. Support providers victims. Activate Support loss. Support providers victims. Activate

support networks.support networks.•• Return to normalcy, facilitate social activitiesReturn to normalcy, facilitate social activities•• Normalization of psychological reactions Normalization of psychological reactions

:Psychoeducation ; Psychological first:Psychoeducation ; Psychological first--aidaid•• Screen for PTSD, depression etc and referScreen for PTSD, depression etc and refer

PsychoPsycho--Social Support:Social Support:

•• Crisis CentersCrisis Centers

•• Telephone hotTelephone hot--lineslines

•• PsychoeducationPsychoeducation

•• DebriefingDebriefing

•• Written material on reactions and ways of Written material on reactions and ways of copingcoping

More specific psychological More specific psychological interventions:interventions:

1.1. Psychological debriefingPsychological debriefing

2.2. RelaxationRelaxation

3.3. Imaginal exposureImaginal exposure

4.4. InIn--vivo exposurevivo exposure

5.5. Cognitive restructuringCognitive restructuring

6.6. Eye movement desensitization and Eye movement desensitization and reprocessingreprocessing

General General ConclusionsConclusions

•• Community participation Community participation throughout all phases throughout all phases (pre(pre--post) post) needs to be strengthenedneeds to be strengthened

•• ReachReaching ing out for all segments out for all segments (Women(Women’’s outreachs outreach))

•• Focussing on and changing Focussing on and changing attitudes and beliefs in risk attitudes and beliefs in risk perception, mitigation and perception, mitigation and preparednesspreparedness

•• Empowerment/ Resilient Empowerment/ Resilient communities: Coping skills and communities: Coping skills and sense of control : combat sense of control : combat helplessnesshelplessness

•• Facilitate problem Facilitate problem focussed copingfocussed coping

•• Training in disaster Training in disaster management skillsmanagement skills

•• Facilitation of Facilitation of volunteer volunteer organisations organisations

•• Internalization of Internalization of responsibility and responsibility and ownershipownership

•• Sustainable training programs Sustainable training programs targeted at adults, children targeted at adults, children and NGO members and and NGO members and professionals, like emergency professionals, like emergency workers, psychologists and workers, psychologists and members of the mediamembers of the media

•• These longThese long--term interventions term interventions are likely to decrease are likely to decrease psychological distress in psychological distress in future disastersfuture disasters

Thank YouThank YouQuestions and Comments ?Questions and Comments ?