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CONTENTS
SPECIAL ISSUE
REGULAR ARTICLES
Introduction to the Special Series
Behavioral and cognitive-behavioral therapists and researchers have much to offer a society dealing with the aftermath of terrorism or mass violence. The purpose of this special series is to identify several areas in which behavioral scientists can provide recommendations for the amelioration or prevention of suffering, with specific emphasis on the aftereffects of September 11, 2001. Empirical evidence in several of these areas is reviewed, and suggestions are presented for ways in which we may effectively deal with the survivors of terrorism, the family members of those injured or killed in terrorist attacks, the children across the country who are exposed to descriptions of terrorism, and potential terrorists themselves.
Incidents of mass violence, such as the September 11, 2001, terrorist attacks on the World Trade Center and the Pentagon, have the capacity to produce profound emotional distress in thousands of people. Such distress is a normal human emotional response in the wake of such devastation, and in the vast majority of cases this distress remits in the weeks following the traumatic event. Despite the fact that only a small percentage of individuals fail to adjust positively following trauma, the magnitude and scope of incidents of mass violence dictate that a large number of individuals may develop enduring psychopathology as a result of such events. This paper reviews the empirical literature bearing on early interventions for trauma victims that have been developed to date. Promising cognitive-behavioral interventions that appear to overcome significant limitations of traditional early intervention approaches are delineated and discussed. Although early interventions for trauma remain underdeveloped and understudied, practice guidelines gleaned from preliminary but promising treatment approaches are offered. Attention to PTSD risk factors is paramount in order to facilitate the identification of individuals most likely to benefit from early posttraumatic treatment. These risk factors are presented and discussed in order to facilitate assessment and treatment planning.
The proximal and immediate response of psychologists and other counselors to victims of disaster, terrorism, and trauma has become a culturally expected practice and has provided an expanding niche for organizations, agencies, and practitioners. “Counselors will be on hand” has become a ubiquitous line in most any media report of tragedies great or small, and many corporations and organizations now provide immediate counseling and “debriefing” services to employees—sometimes with a mandate for all to participate. But these strategies have not proven greatly effective, and growing evidence exists that they can even complicate recovery for some. This article reviews the evolution of immediate assistance programs, the empirical evidence regarding efficacy and paradoxical outcomes, and evolving strategies showing empirical support for their efficacy and utility in programs of early assessment and intervention.
This study presents the findings of a services utilization and satisfaction survey of surviving family members of the Pan Am 103 (Lockerbie, Scotland) bombing. The goals of this study were to evaluate satisfaction with services provided; to gather information from surviving family members about experiences that might be expected to affect satisfaction; to estimate the psychological, physical, and financial impact of the homicide on surviving family members; to obtain recommendations regarding how services can be improved; and to solicit opinions regarding needs for future services. Participants were surviving family members who were interviewed twice using telephone interviews, once prior to completion of the criminal trial and again 7 weeks after the verdict. Results indicated that many surviving family members suffered from considerable problems associated with the loss of their loved ones. However, families found services provided by the United States Office of Victims of Crime, such as information about the court process, to be helpful. Finally, participants made specific recommendations for the improvement of services, including greater emotional support.
The terrorist attacks against the United States on September 11, 2001, have moved our country into a new era. In the aftermath of the attacks, and with the threat of terrorism continuing, it is important to better understand how children may be affected by these events. Common reactions of children following trauma have been examined in the literature; however, mediating variables, problems with assessment, and current diagnostic criteria related to PTSD may temper our understanding of the issues. Furthermore, the unprecedented nature of the terrorist actions raises new issues regarding how children may respond and cope with trauma. Because of the enormity of events, mental health services are available in an unprecedented fashion. As these services are developed and implemented, and as future services are planned, it is critical that intervention issues and ideas be examined in order to provide the most efficacious treatments to terrorism’s youngest victims.
Behavior therapy is relevant not just to the needs of victims of terrorism, but also to the understanding and modification of psychological processes that lead to the perpetration of terrorist acts. A key process of this kind is prejudice. In this paper, human prejudice is defined as the objectification and dehumanization of people as a result of their participation in evaluative verbal categories. Prejudice is difficult to deal with because (a) the same verbal processes that give rise to prejudice are massively reinforced in dealing with the external environment; (b) virtually all cultures openly amplify this process with stigmatized groups; (c) humans are historical beings and verbal/cognitive networks once formed tend to maintain themselves; and (d) many of the things humans do to change or eliminate undesirable verbal categorical processes are either inert or prone to making these processes more resistant to change. Mindfulness, cognitive defusion, acceptance, and valued action are suggested as alternative methods of fighting the war behavior therapy needs to help human society win: not just a war on terrorism, but a war on prejudice.
We tested the utility of the heart rate response as an indicator of emotional processing in prolonged exposure therapy for a female rape victim. Physiological data, for the first and the last available imaginal exposure to the rape, showed that the heart rate response was a useful index of successful activation and habituation of fear structures during therapy. The results suggest that the heart rate response may provide an objective and unbiased assessment of emotional processing that is not dependent on either self-report or interviewer-based assessments.
Readiness to change, particularly ambivalence or lack of awareness about the need to change, is a modifiable variable that may underlie poor posttreatment outcome found in some studies of combat veterans with PTSD. The authors describe the PTSD Motivation Enhancement (ME) Group, a manualized brief treatment that is conceptually based on the Stages of Change and draws on interventions from the literature on Motivational Interviewing techniques. The PTSD ME Group targets any PTSD symptom or related problem behavior (e.g., anger, hypervigilance, owning weapons, depression, and substance use) that patients report ambivalence about changing or feel no need to change. The goal of the group is to help patients make decisions about the need to change any behaviors, coping styles, or beliefs not previously recognized as problematic. Although definitive statements about the effectiveness of the group await controlled trials, initial findings indicate that patients are responding to the group as predicted. Further research will test the hypothesis that addition of the PTSD ME Group to a PTSD treatment program is associated with better learning, practice, and implementation of coping skills, which, in turn, should predict better posttreatment functioning.
Posttraumatic stress disorder (PTSD) is a common disorder following sexual assault. There is significant empirical evidence that cognitive-behavioral interventions are efficacious in the treatment of PTSD. People with mental retardation (MR) often are victims of sexual assaults, but the presence of comorbid PTSD and MR was not found in the current literature. In addition, there is no evidence showing that any specific short-term intervention is effective in treating PTSD with comorbid MR. The present article describes a case study in which short-term exposure therapy following numerous sexual assaults was effective in reducing the symptoms of PTSD in a woman with comorbid MR.
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