War and natural disasters cause far more damage than what meets the eye. Left in the wake of both are victims who have been exposed to physically harmful trauma that can evolve into emotional distress.
“Humans are built to process, store, and retrieve information,” said Peter Tuerk, Ph.D., Associate Professor in the Department of Psychiatry and Behavioral Sciences at the Medical University South Carolina (MUSC). “When something gets in the way of how we process emotional information, it can cause a lot of downstream problems.”
Tuerk also is Director of the Post-Traumatic Stress Disorder (PTSD) Clinical Telehealth Team at the Ralph H. Johnson VA Medical Center where he treats combat-related and post-disaster PTSD using behavioral exposure therapy, a type of treatment that minimizes distress from traumatic events. Patients are encouraged in exposure therapy to approach often-avoided traumatic thoughts, feelings and situations that otherwise cause distress. Veterans from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), as well as veterans of other war eras have demonstrated positive outcomes and remission of symptoms from the therapy Tuerk and his team have administered.
Tuerk began working with a Veterans Administration (VA) sponsored initiative to disseminate a type of exposure therapy for PTSD, prolonged exposure (PE), through providing training and education to clinicians throughout the country.
“Our data from the last eight years in the clinic clearly indicate that prolonged exposure therapy is just as effective for people who have had PTSD for forty years as it is for people who have had it for six years,” explained Tuerk. “Although not everyone decides to complete the treatment, results are quite striking for the majority of those who do.”
The promising results from PE therapy trainings allowed Tuerk and his associates to translate their research from combat-related PTSD to disaster victims. In 2011, Japan suffered an 8.9 magnitude earthquake and a subsequent tsunami that ravaged its eastern coast. Within 40 days of the disaster, Tuerk and his team were on the ground, responding to requests to provide training for students and volunteers in the community. They catered to the psychological needs of the victims, thereby minimizing what would otherwise be crisis-induced distress.
Although PTSD is just one potential post-disaster outcome related to mental health, it is one of the reliably predictable outcomes and it is treatable. Accordingly, Tuerk reported that early community trainings in general post-disaster coping set the stage in Japan for networking and longer-term education in evidence-based exposure-oriented treatment for PTSD.
“Evidence-based psychological treatments, such as exposure therapy for PTSD, are often most available in clusters around academic institutions,” said Tuerk. “It can be very difficult to locate clinicians, even domestically, who provide proven care for specific disorders. Promoting changes in the behaviors of health providers is perhaps just as difficult as changing behaviors in patients—it requires more than directive education or expert opinion. Our sense is that most often it requires investment in collaborative and responsive relationships.”
“Rather than going to Japan to tell health professionals what they need to do or that they need to learn exposure therapy for disaster-related PTSD, we asked ‘what kind of programs do you want,’” remarked Tuerk. “We then developed a set of replicable protocols to increase engagement between ourselves and institutions who desired more in-depth psychological training. Our engagement model was such that one initial training led to trainings, talks, or consultation with twelve other institutions regarding strategies to promote post-disaster mental health.”
Tuerk’s team developed and applied experimental criteria based on engagement, commitment, and ability to provide services to disaster survivors, to whittle down the collaboration to three health-related institutions eligible for in-depth training and supervision in exposure therapy for PTSD. The weeklong training was followed by six months of telehealth-supported clinical supervision and the tracking of clinical outcomes for those receiving services. The networking, training, and follow-up were supported by a grant that Tuerk received from the Boston Foundation and also by the MUSC Department of Psychiatry in collaboration with the University of Michigan School of Medicine.
In addition to providing official trainings to clinically licensed healthcare workers, Tuerk reported that providing informal education directly to the disaster-impacted community regarding the broad components of effective care for PTSD was also helpful. He spoke of a transformative case of a young male earthquake victim in Japan. The boy was very changed after the disasters, constantly confining himself to a panic room in his home when the slightest tremor occurred. He was afraid to leave his home at all and lost interest in playing with his friends. Tuerk consulted with the young child’s mother to use exercises that would enable him to confront his emotional distress in a supportive and playful manner.
After returning home, Tuerk received an email from the boy’s mother explaining that the exercises worked well, he was able to play, do origami and eat at his favorite restaurant, McDonalds, and his mood improved to pre-disaster levels. Tuerk reported that positive outcomes like this are a major motivation for him and his colleagues as they continue to research and disseminate effective models of care for traumatic stress symptoms in the U.S. and abroad.