This page intentionally left blank “This is a great and exciting book; a volume filled with stories of endeavour, achievement, appraisal and learning; stories of heroism, challenge and hope. It will become a handbook for all who would research the impact of disaster and terrorism on mental health and well-being.” Beverley Raphael Does terrorism have a unique and significant emotional and behavioral impact among adults and children? In what way does the impact of terrorism exceed the individual level and affect communities and specific professional groups, and test different leadership styles? How were professional communities of mental health clinicians, policy makers, and researchers mobilized to respond to the emerging needs post-disaster? What are the lessons learned from the work conducted after 9/11, and the implications for future disaster mental health work and preparedness efforts? Yuval Neria and his team are uniquely placed to answer these questions having been involved in modifying ongoing trials and setting up new ones in New York to address these issues straight after the attacks. No psychiatrist, mental health professional or policy-maker should be without this book. Yuval Neria is Associate Clinical Professor of Medical Psychology at the Department of Psychiatry at the College of Physicians and Surgeons, Columbia University; and the Department of Epidemiology, Joseph L. Mailman School of Public Health; and Associate Director of Trauma Studies and Services at The New York State Psychiatric Institute. Raz Gross is Assistant Professor of Epidemiology and Psychiatry, Department of Epidemiology, Joseph L. Mailman School of Public Health; and Department of Psychiatry, College of Physicians and Surgeons, Columbia University. Randall D. Marshall is Director of Trauma Studies and Services, New York State Psychiatric Institute; Associate Director, Anxiety Disorders Clinic, New York State Psychiatric Institute, and Associate Professor of Clinical Psychiatry, Columbia University College of Physicians and Surgeons. Ezra Susser is Professor of Epidemiology and Psychiatry at the College of Physicians and Surgeons, Columbia University; Chair of the Department of Epidemiology at the Joseph L. Mailman School of Public Health, Columbia University; and Head of the Department of Epidemiology of Brain Disorders at the New York State Psychiatric Institute. 9/11: Mental Health in the Wake of Terrorist Attacks This book is dedicated to those killed in the attacks of September 11, 2001; and is written for those who survived them, and mourned, and to all who have suffered because of what they saw and feared and felt, and lost. Yuval Neria: For Mariana, Michal, Oren and Maya, who shared this journey and created the safe space which enabled its fulfillment; and for my dear parents and sister with love. Raz Gross: For Natalie, Roy, Elie, and Daria; for my dear parents; and for my brother Aeyal and my sister Vardit, with great love. Randall Marshall: For Tessa, Rory and Thalia, and my parents and brother Rodney, who are my teachers on the nature of love; and for Reece Marshal (1971–2001), who would have understood. 9/11: Mental Health in the Wake of Terrorist Attacks Edited by Yuval Neria Raz Gross Randall D. Marshall Guest Editor Ezra S. Susser With a foreword by Beverley Raphael CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK First published in print format ISBN-13 978-0-521-83191-8 ISBN-13 978-0-511-33385-9 © Cambridge University Press 2006 Every effort has been made in preparing this publication to provide accurate and up-to- date information which is in accord with accepted standards and practice at the time ofpublication.Although case histories are drawn from actual cases,every effort has been made to disguise the identities ofthe individuals involved. Nevertheless,the authors,editors and publishers can make no warranties that the information contained herein is totally free from error,not least because clinical standards are constantly changing through research and regulation.The authors,editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use ofmaterial contained in this publication. Readers are strongly advised to pay careful attention to information provided by the manufacturer ofany drugs or equipment that they plan to use. 2006 Information on this title: www.cambridge.org/9780521831918 This publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written p ermission of Cambrid g e University Press. ISBN-10 0-511-33385-4 ISBN-10 0-521-83191-1 Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not g uarantee that any content on such websites is, or will remain, accurate or a pp ro p riate. Published in the United States of America by Cambridge University Press, New York www.cambridge.org hardback eBook (EBL) eBook (EBL) hardback Contents Acknowledgments ix Editors brief bio x List of contributors xiii Foreword xxvi Part I Introduction 1 Mental health in the wake of terrorism: making sense of mass casualty trauma 3 Yuval Neria, Raz Gross and Randall D. Marshall Part II The psychological aftermath of 9/11 2Preface 17 Ezra S. Susser, Yuval Neria, Raz Gross and Randall D. Marshall 3 Post-traumatic stress symptoms in the general population after a disaster: implications for public health 19 Sandro Galea, Jennifer Ahern, Heidi Resnick and David Vlahov 4 Coping with a national trauma: a nationwide longitudinal study of responses to the terrorist attacks of September 11 45 Roxane Cohen Silver, E. Alison Holman, Daniel N. McIntosh, Michael Poulin, Virginia Gil-Rivas and Judith Pizarro 5 An epidemiological response to disasters: the post-9/11 psychological needs assessment of New York City public school students 71 Christina W. Hoven, Donald J. Mandell, Cristiane S. Duarte, Ping Wu and Vincent Giordano v 6 Historical perspective and future directions in research on psychiatric consequences of terrorism and other disasters 95 Carol S. North, Betty Pfefferbaum and Barry Hong 7 Capturing the impact of large-scale events through epidemiological research 114 Johan M. Havenaar and Evelyn J. Bromet 8 Mental health research in the aftermath of disasters: using the right methods to ask the right questions 128 Sandro Galea Part III Reducing the burden: community response and community recovery 9 Community and ecological approaches to understanding and alleviating postdisaster distress 141 Fran H. Norris 10 What is collective recovery? 157 Mindy Thompson Fullilove and Lourdes Hernández-Cordero 11 Rebuilding communities post-disaster in New York 164 Mindy Thompson Fullilove and Jack Saul 12 Journalism and the public during catastrophes 178 Elana Newman, Joanne Davis and Shawn M. Kennedy 13 Effective leadership in extreme crisis 197 Richard E. Boyatzis, Diana Bilimoria, Lindsey Godwin, Margaret M. Hopkins and Tony Lingham 14 Guiding community intervention following terrorist attack 215 Stevan E. Hobfoll Part IV Outreach and intervention in the wake of terrorist attacks 15 Science for the community after 9/11 231 Randall D. Marshall Part IV A New York area 16 PTSD in urban primary care patients following 9/11 239 Yuval Neria, Raz Gross, Mark Olfson, Marc J. Gameroff, Amar Das, Adriana Feder, Rafael Lantigua, Steven Shea and Myrna M. Weissman vi Contents 17 Project Liberty: responding to mental health needs after the World Trade Center terrorist attacks 264 Chip J. Felton, Sheila Donahue, Carol Barth Lanzara, Elizabeth A. Pease and Randall D. Marshall 18 Mental health services support in response to September 11: the central role of the Mental Health Association of New York City 282 John Draper, Gerald McCleery and Richard Schaedle 19 The New York Consortium for Effective Trauma Treatment 311 Randall D. Marshall, Yuval Neria, Eun Jung Suh, Lawrence V. Amsel, John Kastan, Spencer Eth, Lori Davis, Marylene Cloitre, Gila Schwarzbaum, Rachel Yehuda and Jack Rosenthal 20 Evaluation and treatment of firefighters and utility workers following the World Trade Center attacks 333 JoAnn Difede, Jennifer Roberts, Nimali Jayasinghe and Pam Leck 21 The World Trade Center Worker/Volunteer Mental Health Screening Program 355 Craig L. Katz, Rebecca P. Smith, Robin Herbert, Stephen M. Levin and Raz Gross 22 Child and adolescent trauma treatments and services after September 11: implementing evidence-based practices into complex child services systems 378 Laura Murray, James Rodriguez, Kimberly Hoagwood and Peter S. Jensen 23 Relationally and developmentally focused interventions with young children and their caregivers in the wake of terrorism and other violent experiences 402 Daniel S. Schechter and Susan W. Coates Part IV B Washington, DC 24 The mental health response to the 9/11 attacks on the Pentagon 427 Elspeth Cameron Ritchie, Willis Todd Leavitt and Sandra Hanish 25 Learning lessons from the early intervention response to the Pentagon 446 Brett T. Litz Part IV C Prolonged-exposure treatment as a core resource for clinicians in the community: dissemination of trauma knowledge post-disaster 26 Psychological treatments for PTSD: an overview 457 Edna B. Foa and Shawn P. Cahill vii Contents 27 Dissemination of prolonged exposure therapy for posttraumatic stress disorder: successes and challenges 475 Shawn P. Cahill, Elizabeth A. Hembree and Edna B. Foa 28 Mental health community response to 9/11: training therapists to practice evidence-based psychotherapy 496 Lawrence V. Amsel, Yuval Neria, Eun Jung Suh and Randall D. Marshall Part V Disasters and mental health: perspectives on response and preparedness 29 The epidemiology of 9/11: technological advances and conceptual conundrums 521 Naomi Breslau and Richard J. McNally 30 Searching for points of convergence: a commentary on prior research on disasters and some community programs initiated in response to September 11, 2001 529 Krzysztof Kaniasty 31 What mental health professionals should and should not do 543 Simon Wessely 32 Coping with the threat of terrorism 570 Shira Maguen and Brett Litz 33 Life under the “new normal”: notes on the future of preparedness 592 Irwin Redlener and Stephen S. Morse 34 Lessons learned from 9/11: the boundaries of a mental health approach to mass casualty events 605 Arieh Y. Shalev 35 Learning from 9/11: implications for disaster research and public health 617 Randall D. Marshall Index 631 viii Contents [...]... researchers and clinicians who were, at the time, themselves also experiencing the multiple, acute and subsequent stressors of the attack and its aftermath It is a further contribution in terms of the universal wish to make meaning of what has happened As mental health professionals and scientists, this surely, is one of our ways of making meaning A number of themes thread their way through this book: The enormity,... Epidemiology of Brain Disorders at the New York State Psychiatric Institute Much of his research focuses on the developmental origins of health and disease throughout the life course He heads the Center for Developmental Origins of Health, a collaborative xii Editors brief bio birth cohort research program in which epidemiologists seek to uncover the causes of a broad range of disease and health outcomes, including... was formerly director of the Center for Urban Epidemiologic Studies at the New York Academy of Medicine Following September 11, 2001, he worked in close partnership with the New York State Of ce of Mental Health and the New York City Department of Health and Mental Hygiene to coordinate the research and services response of the public and academic sectors He lead the preparation of a broad needs assessment... coping with adversity; and improve the medical and psychological treatment of individuals affected by trauma of all kinds, including terrorist attacks and major disasters Ezra Susser, MD, DrPH Ezra Susser is the Anna Cheskis Gelman and Murray Charles Gelman Professor and Chair of the Department of Epidemiology at the Mailman School of Public Health of Columbia University, and Head of the Department of. .. panic during the attacks is strongly associated with PTSD in people exposed to the WTC attacks (Galea et al., 2002) The nature and the impact of the immediate response of the public to disasters are yet to be understood and so far the findings are not conclusive (see Mawson, 6 Yuval Neria et al 2005; Raphael, 2005) Early reports on Londoners in the aftermath of the attacks during the summer of 2005 suggest... social habits such as entertainment in crowded spaces In Jerusalem, for example, many people have developed the so-called “security zones”, where they can socialize freely, creating 5 Mental health in the wake of terrorism the illusion of security or invulnerability In other cities (e.g., New York City), citizens are being monitored, their bags checked, and they are being questioned and asked to show... or indirectly (e.g., making or raising donations) These types of behaviors may be common in the first and the second post-disaster phases referred to respectively as the “rescue” and the “honeymoon” phases (Raphael, 2005) However, when the hard facts about the toll of the disaster sink in (e.g., scale of loss and destruction), and penetrate the “denial shield” typical to the immediate aftermath of the. .. and methodologies, which demonstrate the need for the reassurance of governance, coordination and structure in the face of chaos and uncertainty Researchers and commentators highlight the vital importance of evaluation, not only of individual treatments, but also of organizational response of the public health as well as the clinical initiatives The aims to provide the “highest quality evidencebased... had to prepare for war, and indeed there is the documentation of the many subsequent challenges of the anthrax attacks, wars in Afghanistan and Iraq, terrorist attacks elsewhere, and of course more recently by international and national natural disasters of catastrophic proportions, the Tsunami, Katrina, Pakistan earthquake to name a few The shadows of grief, the sadness of lost pasts, and future fears... splitting, fear and rejection of those who are different, perhaps in terms of ethno-cultural distinctions, need to be better understood This should include an understanding and tracking of what happens to the anger and rage in such settings and the complex social consequences, the coming to terms with the “darker side of human nature” – both in our attackers and ourselves What are the effects of no . Head of the Department of Epidemiology of Brain Disorders at the New York State Psychiatric Institute. 9/11: Mental Health in the Wake of Terrorist Attacks This. Elsewhere in his research, he has taken an active role in using epidemiology to better understand social inequalities of health by focusing in the health of inner