Helping mental health professionals in Japan cope with disaster

In the days immediately following Japan’s devastating March 11 earthquake and tsunami, survivors were grateful to have lived through it. But disasters that cause such wide-scale death, destruction and disruption to daily life also leave lingering invisible wounds.

Sheila A.M. Rauch, Ph.D., clinical research psychologist with Veterans Affairs Ann Arbor Healthcare System and assistant professor in the Department of Psychiatry, recently traveled to Japan as part of a team that conducted workshops to help health care professionals and community leaders address mental health concerns in the wake of the disaster, including preparing for future cases of post-traumatic stress disorder (PTSD).

Even after the physical needs of quake survivors have been met, a small but significant number of people are expected to experience after-effects like upsetting memories, trouble sleeping, feelings of detachment and irritability.

“A large truck rumbling by might trigger distressing memories,” says Rauch, who is also director of Serving Returning Veterans’ Mental Health (SeRV-MH), a program for veterans of the wars in Iraq and Afghanistan. “People need to know that the feelings they’re having are normal and can be treated.”

Experts in Japan fear a mental health crisis is looming because fewer than 20 therapists specializing in PTSD practice across the island nation, the Japanese newspaper Yomiuri Shimbun recently reported.

“We focus on confronting memories and reminders so people can start to integrate these traumatic experiences into their lives,” says Rauch, who notes disaster research shows about 20 percent of those who were directly affected will likely develop symptoms of PTSD. “We teach them to avoid avoidance.”

In late April, Rauch joined a team from the Medical University of South Carolina led by Peter Teurk, Ph.D. They conducted a two-day training workshop for mental health professionals and students at Tokiwa International Victimology Institute in Mito, Japan.

The workshop provided instruction in mental health responses to disasters and draft plans for PTSD screening and outreach in the coming weeks and months. In addition, they presented information on evidence-based psychotherapy techniques to address PTSD that may develop over the coming months and years. One emphasis of the instruction was on Prolonged Exposure, a therapy that focuses on confronting trauma memories and reminders.

“This is still going to be an ongoing trauma for many people,” Rauch says. “But in the next few months we expect to start identifying people who are experiencing continuing symptoms of distress that we would associate with PTSD.”

With the assistance of interpreters, the group also conducted a two-and-a-half-hour education session that was attended by 140 community leaders, who braved a dark and rainy night to attend. The session was broadcast live on national TV.

“Our biggest message to them was that it’s important to help people get back to normal life, to help reintroduce structure and stability,” Rauch explains. “And also to make sure that people know about effective treatments and have access to them.”

While they were there, the team was able to counsel one woman whose son was fearful of straying too far from the family’s “safe room” and would panic during the numerous, generally mild aftershocks. Shortly after their return, they received an e-mail update from the woman saying that the techniques had helped and that her son now even looked forward to outings.