Meeting Outreach and Treatment Needs after a Major Terrorist Attack
After the 2005 London Bombings
A recently published paper by Brewin, et al. (2010) describes “the usage, diagnoses and outcomes associated with the 2-year Trauma Response Programme (TRP) for those affected by the 2005 London bombings.” This terrifying series of bombings took place over 17 days in July 2005. The initial bombing on July 7 injured 775 and killed 52, the largest mass casualty event in the UK since the second World War.
The TRP, funded by the UK Department of Health, used a three fold strategy. First, based on prior studies, it was assumed that the majority of those affected would recover spontaneously. Second, systematic efforts were made to identify and to screen those directly affected by the bombings. This outreach included reviewing hospital treatment records and police witness files in addition to referrals from general practitioners. This aggressive outreach effort reached 997 individuals of whom only 4% had been referred by their GPs for treatment. Third, those who were not “recovering naturally” were offered National Institute for Health and Clinical Excellence (NICE) recommended, empirically supported treatment with either trauma-focused cognitive-behaviour therapy (TF-CBT) or eye movement desensitization and reprocessing (EMDR) at specialist post-traumatic stress centers.
Out of the 997 individuals identified, 596 completed screening. Those scoring about the cutoff were given a detailed clinical assessment. 217 received treatment with either TF-CBT or EMDR. For reasons not made clear in the paper, the two NICE endorsed treatments were provided in dramatically unequal amounts. The majority (80 percent) received TF-CBT, and a minority (<10 percent) received EMDR or a combination of TF-CBT and EMDR (about 10 percent). No data is provided about treatment duration or outcomes by method of treatment. The results: “The effect sizes achieved for treatment of DSM-IV PTSD exceeded those usually found in randomized controlled trials (RCTs) and gains were well maintained an average of 1 year later” (Brewin, et al., 2010).
These results show the crucial importance of conducting a systematic outreach effort to identify the significant percentage of individuals who do not recover on their own from their PTSD symptoms after a terrorist attack. Since only 4% of those found in the TRP outreach had previously been referred for treatment of PTSD, it appears that 96% of those who were still suffering from PTSD might have failed to receive any treatment or would only have received delayed treatment after they developed secondary symptoms.
"’If this programme hadn't existed then there would be hundreds of people still suffering from post-traumatic stress or other psychological problems as a result of the 2005 terrorist attack. This intervention is really a new way of identifying traumatised people,’ explained Professor Chris Brewin, lead author of the study at UCL Department of Clinical, Educational & Health Psychology.” (EurekAlert, 2010).
Additional information on disaster, crisis and trauma including the final report of the TRP is available on the web site of The European Federation for Psychologists’ Associations (EFPA).
The TRP, funded by the UK Department of Health, used a three fold strategy. First, based on prior studies, it was assumed that the majority of those affected would recover spontaneously. Second, systematic efforts were made to identify and to screen those directly affected by the bombings. This outreach included reviewing hospital treatment records and police witness files in addition to referrals from general practitioners. This aggressive outreach effort reached 997 individuals of whom only 4% had been referred by their GPs for treatment. Third, those who were not “recovering naturally” were offered National Institute for Health and Clinical Excellence (NICE) recommended, empirically supported treatment with either trauma-focused cognitive-behaviour therapy (TF-CBT) or eye movement desensitization and reprocessing (EMDR) at specialist post-traumatic stress centers.
Out of the 997 individuals identified, 596 completed screening. Those scoring about the cutoff were given a detailed clinical assessment. 217 received treatment with either TF-CBT or EMDR. For reasons not made clear in the paper, the two NICE endorsed treatments were provided in dramatically unequal amounts. The majority (80 percent) received TF-CBT, and a minority (<10 percent) received EMDR or a combination of TF-CBT and EMDR (about 10 percent). No data is provided about treatment duration or outcomes by method of treatment. The results: “The effect sizes achieved for treatment of DSM-IV PTSD exceeded those usually found in randomized controlled trials (RCTs) and gains were well maintained an average of 1 year later” (Brewin, et al., 2010).
These results show the crucial importance of conducting a systematic outreach effort to identify the significant percentage of individuals who do not recover on their own from their PTSD symptoms after a terrorist attack. Since only 4% of those found in the TRP outreach had previously been referred for treatment of PTSD, it appears that 96% of those who were still suffering from PTSD might have failed to receive any treatment or would only have received delayed treatment after they developed secondary symptoms.
"’If this programme hadn't existed then there would be hundreds of people still suffering from post-traumatic stress or other psychological problems as a result of the 2005 terrorist attack. This intervention is really a new way of identifying traumatised people,’ explained Professor Chris Brewin, lead author of the study at UCL Department of Clinical, Educational & Health Psychology.” (EurekAlert, 2010).
Additional information on disaster, crisis and trauma including the final report of the TRP is available on the web site of The European Federation for Psychologists’ Associations (EFPA).
References
Brewin, C. R., Fuchkan, N., Huntley, Z., Robertson, M., Thompson, M., Scragg, P., et al. (2010). Outreach and screening following the 2005 London bombings: Usage and outcomes. Psychol Med, 1-9. doi:10.1017/S0033291710000206
Brewin, C. R., Fuchkan, N., Huntley, Z. (2009). Evaluation of the NHS Trauma response to the London bombings. Final report to the Department of Health Forensic Mental Health R & D Programme Clinical, Educational and Health Psychology, University College London.
EurekAlert! Outreach program brings relief to traumatized London bombing survivors. Public release date: 8-Mar-2010.
National Institute for Health and Clinical Excellence. (2007). Post-traumatic Stress Disorder.