PTSD after disasters: should we focus on
resilience rather than pathology?
Presentation for the FSC conference 13/11/2008
Chris Cocking & John Drury:
London Metropolitan University & University of Sussex
c.cocking@londonmet.ac.uk
Outline:
PTSD- Individual and collective
vulnerability or resilience?
New research proposal: To investigate
the relationship between PTSD and
resilience/ social support after mass
disasters
PTSD- a clinical perspective
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Well known that individuals can suffer psychological
trauma after stressful events
Various terms used over time (neurasthenia, shellshock, war neurosis etc- Wessely 2005)
Diagnostic criteria for PTSD
Stressor
 Re-experiencing
 Avoidance
 Arousal
 Duration
 Distress or Impairment
(DSM IV, APA 1994);
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Vulnerability
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PTSD after disasters, such as fires and
terrorist attacks can affect between 1/3
and ¼ of participants- with crippling
effects on sufferers- flashbacks,
avoidance etc.
But majority affected DON’T get PTSD
PTSD- Individual resilience
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Suggested as a trait that makes some
more resistant to trauma (Noppe et al
2006)
Recent work emphasises possibility for
post-traumatic growth in some
individuals (Joseph et al 2008)
Sociological perspectives on
resilience
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Some criticise pathologisation of responses to
adversity (Furedi 2004; 2007)
Studies of the emergency services (Dynes
2003) and communities post disasters
(Kendra & Wachtendorf 2001) emphasize
spontaneous and endogenous resilience in
groups and organizations
‘Social capital’ endures, even if physical &
human capital don’t
Resilience is the norm not the exception
Organisational responses on 9/11
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‘Prior experience with 1993 WTC had led to
significant learning among organisational tenants and
occupants of the Towers, and planning and training
contributed to their ability to respond in an adaptive
fashion to highly ambiguous and threatening
conditions’ (Tierney 2002)
Despite EOC in WTC 7 being lost!
99% of occupants of towers below where the planes
hit managed to escape (USA Today)
Concept of emergence- spontaneous response to
disasters by individuals & organisations
Popular myths about effects of
disasters, terrorist attacks
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Cause widespread individual and
collective disorganisation
Which impair responsible action
Which makes response and recovery
problematic
Which requires external authority to
insure continuity of social life
(from Dynes 2003)
But people are often more
resilient than expected
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Up to ½m New Yorkers expected to get PTSD
post 9/11 (Booth 2002), and PTSD type
symptoms experienced by up to 10% in some
samples (Hoven et al 2005)
But scale of psychiatric casualties much less
than expected (Silver et al 2002; Bonano et al
2006)
Persistent efforts to re-establish continuity of
social life- in contrast to popular images of
disorganization & vulnerability in the face of
disaster (Dynes 2003)
How resilience develops
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People are often resilient during emergencies
Resilience appears to be related to the
development of a common identity amongst
those affected in response to a shared threat
(Clarke 2002)
Common identity encourages co-operative
rather than selfish behaviour
Predicted by Social Identity Model, inspired
by work of Tajfel (1978) & Turner (1982)
Our research (Drury et al, In Press) has found
evidence for how and why this resilience
Current approaches
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Over-protective responses from government
may stunt the public’s natural resilience and
resourcefulness (Furedi 2007; Wessely 2005)
The crowd may be a source of strength that
can help people endure emergencies (Drury &
Winter 2004)
Survivor self-help groups may have
therapeutic benefits after the emergency
Lasting Resilience?
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Evidence shows common identity
develops in emergencies & this
encourages resilience during incident
(Drury & Cocking 2007)
Sense of shared identity seems to arise
from survivors’ shared fate in relation to
the emergency itself, and is basis of
mutual concern and helping behaviour
We need to know more!
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Does resilience endure once danger is over to
help shield people from PTSD?
Common identity that arises during disasters
may have enduring consequences for some
Evidence from some survivors of benefits of
mutual support groups
Some seek out contact with and/or support
from other survivors
Suggests that sharing experiences with
similar others may be beneficial
But not yet tested in any systematic way
Do support groups have therapeutic
consequences after emergencies?
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Need to investigate possible psychological
and health implications of any enduring social
identity
Evidence that lack of social support is a risk
factor for PTSD (Brewin et al 2000)
Usually considered in terms of support from
friends/family- not those affected by incident
Mutual support groups may help survivors
cope with psychological trauma
A new approach
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Appears to be need for new social
psychological model linking individual and
social resilience
Social identity models of stress currently
applied to health related areas (Haslam et al
2008) but not applied to PTSD yet, and little
about nature & content of how identities
emerge
New model may explain how and why people
survive psychologically in disasters, how the
emergency services can help this process,
and what this means for aftercare
Future research plans
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Proposed research would give a greater
understanding of the psychosocial factors associated
with PTSD (such as social support) and encouraging
resilience from its effects
This could improve clinical interventions by adopting
more group-based approaches
If the evidence supports the suggested therapeutic
role of mutual support groups for survivors in
ameliorating the effects of PTSD – this could be
facilitated by the health and emergency services
Possible disadvantages of
support groups?
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Not all survivors want to be in touch with
other survivors- some want to forget and/or
move on
Support groups for emergency workers may
be more popular/ therapeutic (existing strong
identity, continual exposure to stress, trauma)
Survivor groups can also be maladaptive, as
trauma/illness may become defining part of
victims’ identity- some evidence for this
(Bonano et al 2005)
Overview
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People and organisations are more
resilient in emergencies than they are
often given credit for
But does this resilience endure, and can
it be harnessed to protect people from
trauma post disasters?
Thanks for listening!
Any questions/ comments?
 Any ideas of organisations/
funding councils that may
fund our research plans?
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Current research findings available at;
http://www.sussex.ac.uk/affiliates/panic/applications.
html
References
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Booth (2002) Washington Post 7/9/2002
Brewin (2003) PTSD- Malady or myth?
Clarke (2002) Contexts, 1, 21–26.
Drury (2004) International Journal of Mental Health Vol. 32 pp. 77-93.
Drury et al (In Press). British Journal of Social Psychology.
Furedi (2004) Therapy culture
Furedi (2007) Invitation to Terror
Haslam et al (2008) Applied Psychology: an International review
Hoven et al (2005) Arch Gen Psychiatry. 2005;62:545-552
Joseph et al (2008) Trauma, Recovery & Growth
Kendra & Wachtendorf, (2001) Disaster Research Center.
Noppe, et al (2006) Death Studies, 30, 41–60.
Tajfel et al (1971) European Journal of Social Psychology, 1, 149–177.
Turner et al (1987) Rediscovering the social group: a social categorisation theory.
Tierney (2002) Available at http://www.ssrc.org/sept11
Wessely (2003&5) British Journal of Psychiatry 183 (12-14) 186 (459-66)
Wessely (2005) Journal of Mental Health, 14, 1-6