Maria Livanou

Traumatic stress responses in earthquake survivors in Turkey.

This study examined the rates of posttraumatic stress disorder (PTSD) and depression and associated risk factors in earthquake survivors in Turkey. A group of 1,000 people from 3 camps and 2 prefabricated housing sites in the epicenter region was assessed using the Screening Instrument for Traumatic Stress in Earthquake Survivors. The estimated rates of PTSD and major depression were 43 and 31%, respectively. Traumatic stress symptoms related to more intense fear during the earthquake, female gender, having been trapped under rubble, death of a family member, past psychiatric illness, having participated in rescue work, and lower education. Avoidance of trauma reminders was the most common symptom and needs special attention in survivor care because of its mental health, social, and economic implications.

Long-term psychological outcome for non-treatment-seeking earthquake survivors in Turkey.

This study examined the incidence of posttraumatic stress disorder (PTSD) and depression in 586 earthquake survivors living in prefabricated housing sites a mean of 20 months after the 1999 earthquake in Turkey. The estimated rates of PTSD and major depression were 39% and 18%, respectively. More severe PTSD symptoms related to greater fear during the earthquake, female gender, older age, participation in rescue work, having been trapped under rubble, and personal history of psychiatric illness. More severe depression symptoms related to older age, loss of close ones, single marital status, past psychiatric illness, previous trauma experience, female gender, and family history of psychiatric illness. These findings suggest that catastrophic earthquakes have long-term psychological consequences, particularly for survivors with high levels of trauma exposure. These findings lend further support to the need for long-term mental health care policies for earthquake survivors. Outreach service delivery programs are needed to access non-treatment-seeking survivors with chronic PTSD.

Traumatic stress responses in treatment-seeking earthquake survivors in Turkey.

This study examined the incidence of posttraumatic stress disorder (PTSD) and depression in 1027 earthquake survivors who were consecutively referred to a community center at a mean of 14 months after the August 1999 earthquake in Turkey. Seventy-seven percent of referrals were women. The estimated rates of PTSD and major depression were 63% and 42%, respectively. More severe PTSD symptoms related to greater fear during the earthquake, female gender, lower education, loss of friends, shorter time since the earthquake, and material loss. More severe depression symptoms related to female gender, longer time since the earthquake, lower educational level, loss of a family member, and past psychiatric illness. In conclusion, long-term public mental health policies are needed for postearthquake psychological problems. These policies need to take into account the risk factors for traumatic stress and the gender differences in referral patterns. The differential stressor-response relationship may have important implications for treatment.

A Study of the Validity of a Screening Instrument for Traumatic Stress in Earthquake Survivors in Turkey

The validity of a Traumatic Stress Symptom Checklist (TSSC), which was developed as part of a Screening Instrument for Traumatic Stress in Earthquake Survivors (SITSES), was examined in 130 survivors of the recent earthquake in Turkey. Data were obtained on the TSSC, which consists of 17 DSM-IV posttraumatic stress disorder (PTSD) items and 6 symptoms of depression. The Clinician-Administered PTSD Scale and the Major Depressive Episode module of the Semistructured Clinical Interview for DSM-IV were used for comparison with the TSSC. The results indicated that the TSSC has high internal consistency and satisfactory sensitivity and specificity in predicting the diagnosis of PTSD and major depression. The SITSES appeared to be a useful instrument in screening earthquake survivors for PTSD, major depression, illness severity, and risk factors associated with traumatic stress responses.

DO COGNITIVE AND EXPOSURE TREATMENTS IMPROVE VARIOUS PTSD SYMPTOMS DIFFERENTLY? A RANDOMIZED CONTROLLED TRIAL

This study (part of a larger one whose main outcomes were reported by Marks, Lovell, Noshirvani, Thrasher & Livanou, 1998) investigated the impact of exposure therapy and cognitive restructuring alone and combined on the individual symptoms of PTSD and on associated features. Exposure therapy was expected to act mainly on fear and avoidance, and cognitive restructuring mainly on detachment, restricted range of affect, and associated features of PTSD. Seventy-seven PTSD outpatients were randomly allocated to one of four treatments: 1) exposure alone; 2) cognitive restructuring alone; 3) combined exposure and cognitive restructuring; or 4) relaxation (placebo control). The active treatments were superior to relaxation in improving clusters of PTSD symptoms and associated features and some but not all individual symptoms and associated features of PTSD. Exposure and cognitive restructuring improved almost all individual symptoms similarly.

Cognitive-behavioral treatment of tortured asylum seekers: a case study

The present study examined results of cognitive-behavioral treatment (CBT) in a 22-year-old, male, tortured asylum-seeker living in Sweden. The patient received 16 sessions of CBT involving mainly self-exposure to trauma-related cues. Clinical measures (assessor- and self-rated) were completed at pre-treatment, weeks 6, 8, 12, and 16, post-treatment and at follow-up (1-, 3-, and 6-month). Treatment led to significant improvement across all measures of post-traumatic stress disorder, anxiety, and depression. The improvement was maintained at 6-month follow-up. The results suggest that CBT could be useful in treating tortured asylum-seekers and refugees despite the additional stressors experienced by asylum-seekers and refugees.

Psychological treatments for post-traumatic stress disorder: an overview

There is a growing research literature on the psychological treatment of post-traumatic stress disorder. This paper provides an overview and an evaluation of this research. The focus is mainly on cognitive-behavioural interventions, as they are the most widely studied and they have a sound evidence base. Other forms of psychological therapy are also considered. Some general issues pertaining to treatment efficacy are also discussed.

Single-case experimental studies of a self-help manual for traumatic stress in earthquake survivors

Studies showed that earthquake-related posttraumatic stress disorder could be reduced by a single session of therapist instructions for self-exposure to fear cues. Eight single-case experimental studies examined whether such instructions were as effective when delivered through a self-help manual after an initial assessment. After two baseline assessments conducted at the participants homes, the manual was delivered to the participants, who were then assessed at week 10 (post-treatment) and at 1-, 3-, and 6-month post-treatment. After minimal improvement during the baseline, treatment achieved marked improvement in seven survivors, leading to effect sizes comparable to those obtained by therapist-delivered treatment. Self-help appears to be a promising approach in cost-effective survivor care.

Cognitive Restructuring in the Treatment of Post-Traumatic Stress Disorder—Two Single Cases

Two single cases of chronic Post-Traumatic Stress Disorder following violent assault were successfully treated using cognitive restructuring. The techniques used are outlined, outcome measures reported, and the possible mechanisms of therapeutic change discussed.

Earthquakes, Stress Effects of*

Exposure to earthquakes is associated with the development of posttraumatic stress disorder (PTSD) and depression. Earthquake-related fears play a critical role in the development of PTSD. Brief behavioral interventions reduce earthquake-related PTSD and associated depression. Preventive efforts need to focus on training the public in effective coping with earthquake-related conditioned fears.