Promoting positive adaptation in adult survivors of natural disasters

This article integrates the guidelines of American Red Cross and the Psychological First Aid: Field Operations Guide (Brymer et al., 2006) with adult development theories to demonstrate the promotion of adaptive functioning in adults after a disaster. Case examples and recommendations for counselors working in disaster situations are included. ********** Disasters, natural and human-made, strike with and without warning. Lifetime prevalence for a significant traumatic life event involving posttraumatic stress disorder (PTSD) is estimated at 60.7% for men and 51.2% for women (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Lifetime prevalence for exposure to a natural disaster is approximately 20% (Briere & Elliott, 2000; Kessler et al., 1995). Norris, Friedman, Watson, Byrne, et al. (2002) in a study of 60,000 disaster survivors found that between 18% and 21% of the participants indicated severe to very severe impairment. Survivors' rates of PTSD in technological and human-made disasters range from 29% to 54% (McMillen, North, & Smith, 2000), whereas survivors' rates of PTSD in natural disasters are lower, between 4% and 8% (Norris, Friedman, Watson, Byrne, et al., 2002). Study results also indicate that impairment from experiencing a disaster can endure for years (Briere & Elliott, 2000; Grace, Green, Lindy, & Leonard, 1993). Some researchers have called into question the low rates of PTSD because of the stringent criteria for PTSD and given the higher rates of other psychiatric disorders among those with PTSD (Yehuda & McFarlane, 1995). McMillen et al. (2000) proposed that the low rates of PTSD may reflect the stringency of PTSD symptom Criterion C, avoidance and numbing. In a study of Hurricane Hugo survivors 1 to 2 months postdisaster (Norris, Friedman, Watson, Byrne, et al., 2002), 83% met Criterion B (reexperiencing) and 42% met Criterion D (arousal), but only 6% met Criterion C. This criterion is more difficult to meet given that one must exhibit three symptoms in this category; however, the outpouring of community support that often occurs after a disaster may minimize social withdrawal and numbing symptoms (McMillen et al., 2000). McMillen et al. (2000) tested this hypothesis with 130 Northridge, California, earthquake survivors. Of the primarily female sample, 13% met the full criteria for PTSD, whereas 48% met both the reexperiencing and the arousal symptoms Criteria B and D, respectively. As noted earlier, much attention has focused on the psychological effects experienced by survivors in the aftermath of a disaster. Psychologists, licensed professional counselors, social workers, and marriage and family counselors assist survivors of disasters by serving on state and local disaster teams associated with the Disaster Response Network of the American Psychological Association (APA) or by volunteering with the American Counseling Association or the American Red Cross as a disaster mental health volunteer (DMHV). In this article, we integrate adult development theories, the guidelines of the American Red Cross (2005) disaster mental health training workbook, and the principles in the Psychological First Aid: Field Operations Guide (PFA; Brymer et al., 2006) developed by the National Child Traumatic Stress Network in the presentation of case examples of adult disaster survivors who received services from American Red Cross DMHVs. PROBLEMATIC RESPONSES Research on the mental health and psychosocial supports that are most effective during and immediately following a disaster is scarce (Inter-Agency Standing Committee [IASC], 2007). Most empirical studies are conducted in the months and years after a disaster. It is well known that specific subgroups of the population are considered to be at increased risk during a natural disaster. Women, children, older adults, individuals who are poor, and young men who become targets of violence are among the most vulnerable (Cronkite & Moos, 1984; Kessler et al. …