Commentary

Could group CBT help survivors of Florence?


 

Rising waters forced hundreds of people, mainly in the Carolinas, to call for emergency rescues, and some people were forced to abandon their cars because of flooding. One man reportedly died by electrocution while trying to hook up a generator. Another man died after going out to check the status of hunting dogs, according to media reports. And in one of the most heart-wrenching tragedies, a mother and her infant were killed when a tree fell on their home.

Dr. Robert T. London of New York

Dr. Robert T. London

Watching the TV reports and listening to the news of Hurricane Florence’s devastating impact on so many millions of people has been shocking. The death toll from this catastrophic weather event as of this writing stands at 39. Besides the current and future physical problems and illnesses left in Florence’s wake, the extent of property damage and loss must be overwhelming for the survivors.

I worry about the extent of the emotional toll left behind by Florence, just as Hurricane Maria did last year in Puerto Rico. The storm and its subsequent damage to the individual psyche – including the loss of identity and the fracturing of social structures and networks – almost certainly will lead to posttraumatic stress disorder, depression, and utter despair for many survivors.

While monitoring Florence’s impact, I thought about Hurricane Sandy, which upended me personally when it hit New York in 2012. As I’ve written previously, Sandy’s impact left me without power, running water, or toilet facilities. Almost 3 days of this uncertainty shook me from my comfort zone and truly affected my emotions. Before day 3, I left my home and drove (yes, I could still use my car; the roads were clear and my garage was not flooded) to my older son’s home – where I had a great support system and was able to continue to live a relatively normal life while watching the storm’s developments on TV. To this day, many areas of New York, New Jersey, and Connecticut that were hit by Sandy have not fully recovered.

Back to the human tragedy still unfolding for the survivors of Florence: I believe – and the data suggest – that early intervention and treatment of PTSD leads to better outcomes and should be addressed sooner than later. There is no specific medicinal “magic bullet” for PTSD, although some medications may help as well as treat a depressive component of the disorder and other medications may assist in improving sleep and disruptive sleep patterns. It’s been shown, time and again, that cognitive-behavioral therapy, various types of prolonged exposure therapy, and eye movement desensitization therapies work best. The most updated federal guidelines from the Department of Veterans Affairs and the Department of Defense, coauthored by Lori L. Davis, MD, of the University of Alabama at Birmingham, reinforce those treatments.

I also believe that, in situations in which masses of people are affected or potentially affected by PTSD, another first line of care that should be added is supportive, educational, interactive group therapy. In other words, it is possible that a cognitive-behavioral group therapy (CBGT) approach would reach many more people, make psychiatric intervention acceptable, and help the survivors of Florence. A recent study by researchers at the University of Massachusetts Boston that examined the role of “decentering” as part of CBGT for patients with specific anxiety disorders, for example, social anxiety disorder, might provide some hints. Decentering involves learning to observe thoughts and feelings as objective events in the mind rather than identifying with them personally. Aaron T. Beck, MD, and others hypothesized decentering as a mechanism of change in CBT.

In the UMass study, researchers recruited 81 people with a principal diagnosis of social anxiety disorder based on the Anxiety Disorders Interview Scheduled for DSM-IV. Other inclusion criteria for the study included stability on medications for 3 months or 1 month on benzodiazepines (Behav Ther. 2018 Sep;49[5]:809-12). Sixty-three of participants had 12 sessions of CBGT. The researchers found that people who received the CBGT experienced an increase in decentering. An increase in decentering, in turn, predicted improvement on most outcome measures.

Just as primary care physicians and surgeons know how to address serious physical health issues related natural and man-made disasters, psychiatrists must quickly know how to address the mental health aspects of care. Group therapy has the greatest potential to help more people and perhaps treat – and even prevent not only PTSD but many anxiety disorders as well.

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