U.S. Ill-Prepared for Effects of Attack

The United States is not adequately prepared to deal with the mental health consequences of a terrorist attack, according to a new report to be published by the American College of Neuropsychopharmacology (ACNP).

University Provost Steven E. Hyman, who chaired the task force behind the report, said that scientists do not yet fully understand how to deal with the psychological ramifications of a terrorist attack.

“It is quite clear that we don’t know enough in terms of research on the impact of terrorism either on broad and healthy populations or on that minority who goes on to develop post-traumatic stress disorder (PTSD),” Hyman said. “It is well worth doing research in both areas.”

Hyman said that one of the primary assertions of the report is that terrorists aim to inflict psychological trauma.

“Terrorists do not believe that they are going to defeat us militarily. Terrorists are actually using their acts to spread fear, damage our confidence and force us to alter our way of life,” Hyman said.

The report said that current treatments are not effective, and that more research must be funded.

Task Force member Rachel Yahuda, a psychiatry professor at the Mt. Sinai School of Medicine, said that she would like the government to actively consult mental health researchers in preparation of terrorist attacks.

“What would be fantastic is if the Department of Homeland Security included the scientific community in some form in the planning of preparedness for disaster and made provisions to plan for mental health causalities,” Yahuda said.

Hyman said that while more funds should be given to researching mental health, he warns that this effort should not detract from other preparation efforts.

“There was a 1.7 billion increase in biodefense funding which is entirely appropriate, and I don’t want to take anything away from that,” Hyman said. “But there should be at least some incremental investment given the real risks in our society of additional terrorist events.”

One area of contention highlighted in the report was the effectiveness of psychological debriefing, which is a single session of therapy within days of a traumatic event, and whether or not it should be pursued at all.

“It should be abandoned,” Hyman said. “Their clinical trials’ data suggests that debriefing is at best ineffective or inert. There is one study that suggests that it may even be harmful.”

But Yahuda said that although debriefing may not work for everyone, it can still be an effective treatment.

“If I had to solve a problem that 100 people in a room were hungry, I could order 100 peanut butter and jelly sandwiches and that sounds like it might be a good solution,” Yahuda said.

“However, it would be very important for me to ascertain if anybody is allergic to peanut butter. It is important that we know about the people we are trying to help before we rush to help them with a peanut butter sandwich,” he said.

One alternative proposed by the report is brief cognitive behavior therapy (CBT). This treatment involves four to five therapy sessions beginning two to five weeks after the traumatic event.

Initial research has found that CBT can significantly accelerate recovery and reduce the probability of PTSD, but the treatment is expensive and few therapists are currently trained in the technique.

“An important goal is to modify CBT or develop other interventions that are briefer and less expensive,” Hyman said. “Should a situation like 9/11 repeat itself, having an effective therapy that we cannot disseminate is not useful.”

Hyman assured that while the United States is behind in preparing itself for the terrorist-related mental health problems, Harvard has implemented procedures to deal with an attack.

“Harvard has a comprehensive disaster plan which has gone through extensive scenarios,” Hyman said. “The University Health Services (UHS) are an important part of that so it would include mental health issues.”

Margaret McKenna, who is the acting director of UHS, wrote in an e-mail that she could not comment at this time on the existence of a formal mental health disaster plan, but that UHS is prepared to respond to any emergency.

“[I]n any emergency we can increase staff coverage and availability, send clinicians out on site where there is need [and] recruit additional assistance if necessary,” McKenna wrote.

Steven M. Mirin, a Harvard psychology lecturer and former director of the American Psychiatric Association, said that the Sept. 11 attacks demonstrated the need for disaster plans at colleges and universities.

“Sept. 11 woke us up not only to the political aspects of terrorism but the mental health aspects as well,” Mirin said. “I think that universities need disaster plans just the way high schools and secondary schools require them.”