R.E.Cohen
MD,
New areas of knowledge
Increased investigation in the
effect of stressors on the brain physiology: Based on findings of the
changes in homeostasis the response, labeled stress response, presents an array
of physiologic adaptations that ultimately resets the process toward
establishing a return to balance. The
best-studied secretions of the adrenal glands, epinephrine and glucocorticoids, which are secreted during stress response mobilize
energy for muscles, increase cardiovascular tone and turn off nonessential
activities. The final effect of this
“cascade” is to mobilize the organism for survival. The imbalance of neurotransmitters produces
many different observable behavioral expressions, which are sometimes
categorized as “normal reactions to an abnormal situation”, or pathological
expressions to intense stress. This area
of research is being investigated and many questions are being raised following
massive traumas worldwide. This
differentiating has important ramifications in term of prognosis and
appropriate treatment of all biologic functions the degree and duration of the
stressor will produce an acute or chronic reaction. Variables that influence
outcome:
*few
opportunities to process frustration
*lack of
social support
*loss of
control and sense of helplessness
*pessimistic
outlook
Relation
between biologic changes and adaptation: The limbic system is an important
organ for adaptation. One of its
structures-the amigdala-functions as a sensor of
threat and in turn mobilizes many of the neural path that controls coping
behavior. It also communicates with the
frontal lobes of the brain to make judgment calls and incoming information as
to the degree of danger. This continuous
awareness of our environment is coordinated and finally monitored by the limbic
structure.
Another important concept flows
from the memory traces that will be imprinted in the synapses of the
hippocampus-another structure where memory traces are recorded- following the
traumatic effects of the disaster.
Investigations are producing findings that painful, chronic memories may
affect and atrophy this structure.
Focus on resiliency and adaptation:
Increasing awareness is being focused on the survival and coping strength
of individuals as we search for intervention methods. Resiliency is defined as important process of
adaptation in the face of adversity.
Most individuals have differing degrees of coping abilities but it can
be strengthened by the following interventions and guidance:
*Stay active and participate in the
decisions affecting your life
*Become aware of healthy schedules
in spite of the chaos-sleep, eat, relaxation, use of assistance
*Try to deal with problems taking
each day at a time
*Try to reframe painful memories
*During crisis episodes accept help and try to analyze how problems can be interpreted from different perspective
The role of genetics in coping: Investigations
are identifying certain genes that code for the receptors of the
neurotransmitters. They may change or
alter the processes of synthesis or degradation of biologic substances
affecting mechanisms that impact or influence behavior. Coping behavior varies from individual to
individual due to the interplay between early, past experiences and genetic
inheritance which will in turn influence how one responds to stressful
environments produced by the disaster. Sequelae left by the loss (bereavement), chronicity, and intensity of the trauma will be
differentiated by the interplay of nature and nurture in the final results
DIFFERING CATEGORIES OF REACTIONS
The opportunity to identify
survivors and their reaction to disaster traumatic effects has increased both
by the research following man-made and natural disasters. Many of the expectations of pathology sequelae are being questioned and new findings are
beginning to emerge.
The categories of normal reactions
to catastrophic stressors are being recognized as well as the more clinical
significant of acute stress reaction or PTSD.
The identification of some manifestation of the clinical diagnosis
either in the acute or chronic stages as more significant than others as far as
pathology is being identified. Many
studies are clarifying the pre-disaster personality types or previous clinical
diagnosis that may make the individual more vulnerable to the effects of the
disaster trauma. (See studies by North;Shalev)
Although attention has been focused
on the traumatic symptomatology the different levels
of depression, anxiety and addiction has not received the same attention from
new investigations even though their prevalence may be larger in numbers.
TREATMENT MODALITIES
*Interactive methodology
The interventions used in assisting
survivor’s range from the behavioral-cognitive to the psychodynamic
models. The intervention differs whether
they are utilized in the acute phase-First –Aid type-to the longer, supportive
models. A theoretical approach is being presented which states that we need to
question whether ventilating the emotions and dredging the memories of the
traumatic event is beneficial to the survivor.
The underlying issue is whether these memories should be repressed
instead so as not to reinvigorate the intense stimuli to the limbic system in
the brain and so let these memories fade through the natural capacity of the
brain to return to a homeostatic balance with time and support. This area is still open for further inquire.
*Controversy over the range of
“debriefing” methods
The “debriefing” and “critical
incident” methods among others used for disaster workers became universally
accepted in the past. New investigations
are being published questioning their expected results (preventing PTSD or other
pathologies). Researchers are attempting to design studies that will
demonstrate whether or not debriefing decreases pathological morbidity. Further
studies need to be replicated due to the fact that many professionals are using
the group ventilation, remembering, sharing, and learning processes
differentially.
USE OF THECNOLOGY TO TRAIN
*Multimedia *Training at a distance
– The technology advancement in curriculum design and computer use is beguiling
to communicate professional content that can be used to prepare or train post
disaster workers through the Webb
*Instant communication for
consulting and problem-solving-This method is available to consortium of
professionals worldwide.