T RAUMA PSYCHOLOGY T RAUMA PSYCHOLOGY Issues in Violence, Disaster, Health, and Illness volume 1 : VIOLENCE AND DISASTER Edited by Elizabeth K. Carll Foreword by H. E. Khunying Laxanachantorn Laohaphan Praeger Perspectives Contemporary Psychology Chris E. Stout, Series Editor Library of Congress Cataloging-in-Publication Data Trauma psychology : issues in violence, disaster, health, and illness / edited by Elizabeth K. Carll ; foreword by H. E. Khunying Laxanachantorn Laohaphan. v. ; cm. — (Praeger perspectives) (Contemporary psychology, ISSN 1546–668X) Includes bibliographical references and index. ISBN-13: 978–0–275–98525–7 (set : alk. paper) ISBN-13: 978–0–275–98531–8 (v. 1 : alk. paper) ISBN-13: 978–0–275–98532–5 (v. 2 : alk. paper) 1. Post-traumatic stress disorder. 2. Psychic trauma. 3. Violence— Psychological aspects. 4. Disasters—Psychological aspects. I. Carll, Elizabeth K. II. Series. III. Series: Contemporary psychology (Praeger Publishers) [DNLM: 1. Stress Disorders, Traumatic. 2. Crime Victims— psychology. 3. Disasters. 4. Violence. WM 172 T77755 2007] RC552.P67T552 2007 616.85'21—dc22 2007009459 British Library Cataloguing in Publication Data is available. Copyright © 2007 by Elizabeth K. Carll All rights reserved. No portion of this book may be reproduced, by any process or technique, without the express written consent of the publisher. Library of Congress Catalog Card Number: 2007009459 ISBN-13: 978–0–275–98525–7 (set) ISBN-13: 978–0–275–98531–8 (vol. 1) ISBN-13: 978–0–275–98532–5 (vol. 2) ISSN: 1546–668X First published in 2007 Praeger Publishers, 88 Post Road West, Westport, CT 06881 An imprint of Greenwood Publishing Group, Inc. www.praeger.com Printed in the United States of America The paper used in this book complies with the Permanent Paper Standard issued by the National Information Standards Organization (Z39.48–1984). 10 9 8 7 6 5 4 3 2 1 C ontents Foreword by H. E. Khunying Laxanachantorn Laohaphan vii Introduction by Elizabeth K. Carll xi Volume 1: Violence and Disaster chapter 1 The Psychological Aftermath of Terrorism: The 2001 World Trade Center Attack 1 Mary Tramontin and James Halpern chapter 2 The Trauma of Politically Motivated Torture 33 Judy B. Okawa and Ronda Bresnick Hauss chapter 3 The Psychological Impact of Kidnap 61 James R. Alvarez chapter 4 Workplace Violence and Psychological Trauma 97 Jakob Steinberg chapter 5 Stalking: Prevention and Intervention 125 Robert J. Martin chapter 6 Killing as Trauma 147 Rachel M. MacNair chapter 7 The 2004 Madrid Terrorist Attack: Organizing a Large-Scale Psychological Response 163 Fernando Chacón and María Luisa Vecina chapter 8 The Psychological Effects of War on Children: A Psychosocial Approach 195 Martha Bragin chapter 9 The Psychological Aftermath of Large- and Small-Scale Fires 231 Jeffrey T. Mitchell chapter 10 Online Psychotrauma Intervention in the Aftermath of the Tsunami: A Community-Building Effort 255 Eric Vermetten, Corine J. van Middelkoop, Luc Taal, and Elizabeth K. Carll chapter 11 First Responders: Coping with Traumatic Events 273 Harvey Schlossberg and Antoinette Collarini Schlossberg chapter 12 Xenophobia: A Consequence of Posttraumatic Stress Disorder 289 Rona M. Fields Index 307 About the Editor 319 About the Contributors 321 About the Editorial Advisory Board 329 About the Series 333 vi Contents F oreword Having worked in and traveled to many countries, most recently as the Ambas- sador and Permanent Representative of Thailand to the United Nations, I have seen people in different societies react to trauma in various ways. While experts contributed to this important book, Trauma Psychology: Issues in Violence, Disaster, Health, and Illness, I share my perspectives from serving the people of Thailand and other nations and from my experiences in the aftermath of the 2004 tsunami that struck the cities and towns in the Indian Ocean rim, including Thailand. However, in all cultures, it is essential to recognize the importance of the psychological well-being of communities as being essential to recovery in the aftermath of disaster and crises. We interpret and react to events in our lives according to our mindsets, which have been shaped by our upbringing. For example, people in the Buddhist culture may see death as a fundamental part of life. In Buddhism, we are taught that from the very minute we are born, we are already aging and dying. This might not be the case in other cultures. Another example is how Italians reacted to the announce- ment of the passing of Pope John Paul II. When they first learned of his passing, people in the square, directly in front of the Vatican, promptly gave a big round of applause. That was their reaction to the loss of the great spiritual leader. In my society, the average person would not think of applauding in this situation. These examples serve to illustrate how differently people from other cultures may react to events. In the immediate months and year following the tragedy of the tsunami, sur- vivors were still struggling to cope with its impact. Tens of thousands of lives across 11 countries had been lost. It was one of the worst natural disasters in the history of humankind. Most of those affected had suffered almost complete losses of assets and homes, and the impact on their livelihoods will probably last for years to come. Where entire communities were destroyed, the loss of previously existing livelihood may be permanent. Experts discussed the effects of the tsunami on the psychological well-being of the victims, and it was reported that survivors had developed psychological disorders. For example, there were reports that in Indonesia alone, 70 percent of those who survived the tsunami were suffering from psychological problems ranging from anxiety to depression. In Thailand, there were also reports of survivors committing suicide because of their inability to cope with stress. I also heard of many Thai children who lost their parents unable to utter a word for months following the tragedy. Experts have pointed out that the key ingredient to recovery from such a trag- edy is social support. It is better for the survivors to cope with such adversity in a community, rather than as individuals, to know that they are not alone, that others are sharing the same plight and are suffering. In the aftermath of the tragedy, many in the community reached out to each other; I learned of projects initiated by a group of Thai writers to help child survivors to recover emotion- ally through writing to express their feelings. These kinds of projects need to be supported. I am pleased that, in Thailand, many innovative measures had been taken up by private individuals to help the survivors to cope with the impact of the tragedy, including the psychological impact. The government also upgraded medical units in the affected areas in order to provide psychological assistance to the survivors. Vocational and psychological counseling centers were set up to assist the survivors, especially orphans and widows. How people deal with events, disasters, or trauma also depends upon infra- structural factors in each society. For instance, when we talk about an important infrastructure such as the media and information technology, which I will use in the following examples, we need to also understand that while the availability of the Internet, newspapers, televisions, and radios in the United States and in Western societies is generally taken for granted, they may not be readily avail- able in other societies in remote corners of the world. In addition, media should not be limited to only television, radio, newspaper, Internet, but may include other means such as human media (religious and community leaders). Religious and community leaders can serve as messengers of hope and carriers of informa- tion and can serve to foster psychological well-being better than any news media would be able to do. In parts of the world where the Internet, television, and radio are not available, using human media can be even more effective. The media can be a positive force in mobilizing international support for the survivors and in creating a shared sense of sympathy. Responsible media should also be aware of negative effects that might develop as a result of their reporting. Avoiding the broadcasting of gruesome pictures of victims is also essential, as respect for the relatives of those who lost their lives. The comprehensive coverage of the consequences of the disaster by interna- tional news can have great impact in bringing attention and aid to a crisis. The responses to the humanitarian needs by the international community had been viii Foreword swift and generous. The United Nations, which coordinated the emergency re- sponse, described the relief efforts as the largest relief operation in the history of the organization. During his visit to Phuket, Thailand, in February 2006, former President Clinton informed Prime Minister Thaksin Shinawatra that about one- third of all American households had made some kind of donation to the victims of the tsunami. The swift and overwhelming responses from around the world came as a result of the media spotlight. From day one and throughout the media coverage of the catastrophe, we saw and heard heartwarming stories from Thailand about locals who were also survivors and had suffered tremendous losses of family members, and yet those people lent helping hands to foreign survivors by offering food, clothing, and shelter. We also heard other similar stories, both on television and in various Internet chat rooms, about students who volunteered as translators to help foreign survivors, or saw footage of people lining up at donation centers to donate blood and basic necessities. It is these kinds of heartwarming stories of people helping other people, or strangers reaching out to other strangers and survivors assisting other survivors, which I believe have positive effects on all of us. It is the kind of encouragement and social support that we all need. In conclusion, helping people cope with trauma, whether it impacts the individual, family, or the larger community, is important to the health and well-being of all communities. In order to provide beneficial support and services, we must also be sensitive to different cultures and constraints in each society to appropriately design strategies and tools that will best respond to the needs of a community. The key is to be sensitive and innovative and to ensure the sustainability of the measures adopted when designing support for the psychological well-being of those in need. H. E. Khunying Laxanachantorn Laohaphan Ambassador and Permanent Representative of Thailand to the United Nations, December 2006 Foreword ix [...]... interpersonal violence, sexual assault, war, motor vehicle accidents, workplace violence, and catastrophic illness to trauma relating to acute and chronic health conditions Introduction xiii (e.g., cancer, heart disease, spinal cord injury, and paralysis), as well as other types of accidents violence, and illness Thus, the concept for the two volumes of Trauma Psychology: Issues in Violence, Disaster, Health, and. .. training courses for their own staffs Universities began looking into developing courses as the demand for trauma training increased In the early 1990s, I was often asked to define the term trauma psychology The term was not familiar to mental health professionals, although some were familiar with terms such as psychological trauma, PTSD, and psychotraumatology Trauma psychology focuses on studying trauma. .. significant traumatic components Having such a cross section of trauma issues reflects the broad and diverse field of trauma psychology The two volumes of Trauma Psychology: Issues in Violence, Disaster, Health, and Illness (Volume 1 and Volume 2) are unique, as both volumes include chapters that discuss recognized trauma- related events as well as those underrecognized important areas that reflect the evolving... to put these events in context with longer-term traumatic events as well as relate them to trauma issues presented by clients in their practice Since a training course or training manual that included all of these facets did not appear to exist in 1990, I began to develop training modules—including one on Trauma Psychology that were sponsored by the state psychological association and to which experienced... or mental well-being or results in feelings of intense fear, helplessness, or horror The major symptoms of PTSD include reexperiencing of the traumatic event (i.e., nightmares, intrusive thoughts, or flashbacks); avoiding reminders of the event and numbing (i.e., avoiding thoughts, people, and activities related to the trauma or an inability to recall aspects of the trauma) ; and also increased arousal... to trauma Trauma Psychology: Issues in Violence, Disaster, Health, and Illness offers chapters discussing well-recognized disasters such as tsunami and fires; accidental disasters such as explosions and transportation accidents; terrorism and violence such as 9/11 and the Madrid terrorist attacks; workplace violence; interpersonal violence; motor vehicle accidents; violence against women; violence and. .. members of the Network contributed information These training modules covered not only crisis intervention and immediate onsite response, but also looked at the continuum of services necessary to help individuals and communities recover In addition, the training took into consideration preexisting psychological conditions, both recent and longstanding, and the distinction between the use of emergency... of PTSD and depression was discovered Both invariant and changing variables were predictive of PTSD, including being directly affected, being Latino, being female, peri-event emotional reactions, ongoing traumas, and ongoing stressors Additionally, low social support was a central determinant Daily life stressors, not just other traumatic events, were independently predictive, thus strengthening a stress-vulnerability... the public and the community Training for volunteers was a priority Training included a compilation of modalities, including Critical Incident Stress Intervention, which was an adaptation of Jeffrey Mitchell’s Critical Incident Stress Management Model, as well as psychological first aid, and the distinction between crisis intervention, onsite intervention services, and long term psychotherapy In addition,... media; trauma and first responders; the impact of ongoing armed conflict and war on children’s development; integrating psychopharmacology into the treatment of PTSD; and the impact of medical illness on children and families The volumes also contain often underrecognized trauma- related topics Included are chapters discussing the impact and effects of politically motivated torture; stalking; kidnapping; . broad and diverse field of trauma psychology. The two volumes of Trauma Psychology: Issues in Violence, Disaster, Health, and Illness ( Volume 1 and Volume. such as psychological trauma, PTSD, and psychotraumatology. Trauma psychology focuses on studying trauma victims and examining inter- vention modes for