Where were you when the Twin Towers came down? Most of us can remember.

The terrorist attacks of September 11 stirred nations to war; triggered a decade of ‘Islamophobia’– and some even say – unified the people of USA. It has been the most televised and reported event in modern history.

In the hours and days following 9/11, thousands of counsellors travelled to New York to offer support for the traumatised. Although well-intentioned, were these psychologists actually doing more harm than good?

The Daily Mail recently reported that ‘[post trauma] therapy can drive you mad’. You can read their article here. Most people won’t be able to access the 7,000 word research paper they claim to report (without paying twelve bucks). So, if you’d like to know the truth behind the headline, read on… Needless to say, this is tabloid spin at its finest…

Is Post Disaster Counselling Dangerous?

Helping people to cope after disasters has long been a contentious issue.

Since the Vietnam War (when Post Traumatic Stress Disorder was first given a name), psychologists and the public have become increasingly interested in how the mind reacts to life-threatening situations.

Question:

After something terrible, should you give someone a hug? Probably.

Should you them offer an intensive ‘debriefing’ session? Probably not.

The journal American Psychologist dedicates this month’s issue to the lessons learnt since 9/11. Unlike the newspaper article claiming to report it, the focus of this periodical is not the dangers of post trauma counselling. Far from it: the article by Patricia Watson (upon which the newspaper piece is apparently based) barely even mentions them. To construe that her report says ‘therapy can exacerbate trauma and make things worse’ requires some pretty inventive and creative journalism…

What the Report actually says

What do Patricia and her two colleagues actually write about? Here’s a summary:

• The vast majority of Manhattan residents (probably over 90%) were left with no lasting psychiatric damage
• However, some people do need psychological help after a disaster
• The World Trade Centre Attacks have given psychologists a wealth of data to work out who is likely to need help (see below – ‘Am I at Risk from PTSD?’)
• Patricia (and colleagues) discusse the best ways to give support to those who need it (see below – ‘How to do PTSD counselling’)

So even if the Daily Mail grossly misreports this research, has the newspaper just made up the dangers of post disaster counselling? No – not entirely(!)
If done badly or inappropriately, trauma counselling can actually cause harm.

So why didn’t Patricia Watson and her colleagues write about it? Because it’s old news. – psychologists and psychiatrists have known this for years! Presumably, our beloved Daily Mail wanted an excuse to write a ‘shocking’ story – a slow news day perhaps? This month’s American Psychologist does not reveal hitherto unknown insights into the possible dangers of post trauma counselling as the newspaper claims.

How Not to Do Post Trauma Counselling

It has been known for at least ten years that some types of disaster counselling are unhelpful: Forcing someone to ‘relive their experiences’ or saying things like “There’s a good chance you’ll have nightmares or flashbacks” are likely to hamper the mind’s normal recovery. In a similar way, watching incessant TV footage of the 9/11 airplane crashes will impair the normal mental recovery if you have had firsthand experience. Put simply:

Most people get better.
Most people get better without a psychologist.
Some people need help.
Don’t force someone to relive their experiences.

Am I at Risk of Post Traumatic Stress Disorder?

One thing that Patricia Watson does highlight (that the Daily Mail doesn’t) is that not everyone is equal in terms of dealing with trauma. From those who experienced the WTC attacks, those most likely to suffer lasting psychological damage have (statistically speaking) these ‘risk factors’:

• Have been injured from the disaster
• Been near to the explosions, dust clouds or any of the 9/11 attacks
• Previously been under a lot of life stress before the attacks
• Have watched lots of 9/11-related TV coverage afterwards
• Been young, female, of a socially deprived background or not had many supportive friends/family.

There are many more ‘risk’ factors (and an equal number of ‘resilience’ factors that help people cope).

The basis of Watson’s report is to discuss the challenge of how to provide quality support to those who are most likely to need it: In the midst of the chaos following an earthquake, hurricane, terrorist attack or similar atrocity – how can professionals find and help those who need it most?

She offers suggestions – but no definite answers.

How to Do Post Trauma Counselling

A summary of what Watson (and the majority of clinical psychologists) suggest in the post disaster situation include the following:

• Begin with basic practical support (e.g. help with food, water and basic needs).
• Always promote a sense of safety, community, calm and hope.
• Offer psychological support to those who need it.
• Encourage the local community, family and friends to support one another wherever possible.

Needless to say, please don’t attempt to ‘do’ any form of counselling unless you are a fully qualified professional! (phew, lawsuit avoided)

Could I Have Post Traumatic Stress Disorder?

Sadly, psychiatric terms get thrown around pretty commonly – it’s all too easy to say “I feel depressed” or “I was left traumatised”.

In reality, ‘trauma’ or ‘Post Traumatic Stress Disorder’ is a clearly defined and altogether nasty condition: a combination of flashbacks and significant distress that prevents you living your life normally. To quality for PTSD you must have personally been exposed to a life-threatening or deeply horrific event. If something upset you on the TV – then you don’t have PTSD.

We all like to try and be an armchair psychiatrist, but Post Traumatic Stress Disorder can only diagnosed by a medically qualified consultant. If you’re interested, you can read the criteria for PTSD diagnosis here.

A ‘Silver Lining’ to 9/11?

Disasters, be they man-made or natural – have few upsides. However, thanks to the dedicated efforts of many researchers, much has been learnt (and will continue to be learnt) about how we should best respond to disaster – when it happens. The messages within September’s American Psychologist are surprisingly positive and constructive.

In a world like ours, we need to be have the same attitudes.

But then I guess that doesn’t sell many newspapers… 

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Thanks for reading – comments and feedback are warmly welcomed!

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INTERESTED IN THIS SORT OF STUFF? I’ve been part of a team that has just launched a new (free) bi-monthly digital magazine which aims to deliver understandable science writing but without compromising the facts. It offers undiscovered writers a chance to write to a growing audience of readers. You are welcome to check it out here!

DISCLAIMER: All of the writing in ‘Doctor Stu’s Science Blog’ are intended for educational and entertainment purposes only. Please do not base your healthcare decisions on the information contained in this blog: Always see your GP first!

SELECTED REFERENCES:

Watson PJ, Brymer MJ, & Bonanno GA (2011). Postdisaster psychological intervention since 9/11. The American psychologist, 66 (6), 482-94 PMID: 21823776

Neria, Y., DiGrande, L., & Adams, B. (2011). Posttraumatic stress disorder following the September 11, 2001, terrorist attacks: A review of the literature among highly exposed populations. American Psychologist, 66 (6), 429-446 DOI: 10.1037/a0024791

Bisson J, & Andrew M (2007). Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane database of systematic reviews (Online) (3) PMID: 17636720

Wessely, S. (2004). When Being Upset Is Not A Mental Health Problem Psychiatry: Interpersonal and Biological Processes, 67 (2), 153-157 DOI: 10.1521/psyc.67.2.153.35953