When trauma strikes immediate attention may be the best cure.
By Michelle Yakobson
When we talk about treating Post Traumatic Stress Disorder, dialogue usually focuses on time. In most settings, and in most capacities—clinically, socially, forensically, and medically — the immediate questions are: How long ago were you first exposed to trauma? When did you realize you had PTSD? How long did the symptoms last? When did they remit? When will they remit?
What we don’t talk about enough is what to do immediately after a traumatic event occurs. Internationally known PTSD expert Dr. Arieh Shalev has been studying trauma in Israel, where his team did something few professionals have done: they assessed trauma survivors within hours and sometimes days following a traumatic experience. His goal was to identify why some people develop PTSD, and others do not, by following individuals’ recovery process for months or years.
Dr. Shalev’s and his team’s work is focused on timing intervention. Notably, Dr. Shalev’s early work took place in a country where risk might be presumed high. One might believe the constant ravages of war would push mental health down the list of priorities. Similar to urban communities in America, where gun violence rules, Israelis are constantly in an environment of war too. A difference is that in Israel, officials react quickly. In America, support is often delayed. In Israel, a trained mental health professional may have more capacity to provide services in a timely fashion than the Veterans Health Administration takes just to set up the first appointment for a primary care physician. In August 2015, CNN reported the average wait for new patients seeking mental health care at the Los Angeles VA was 43 days.
Studies are inconclusive regarding early intervention for PTSD, and the role of early emergency triage is still unclear. The data tells us that victims may fare better in the face of trauma if intervention is early. Although no two trauma experiences are alike, what we can say with increasing confidence is that taking too long to help any individual—civilian or military– following a traumatic event stalls treatment and ultimately, recovery.
The first intervention to consider is looking at how to triage for PTSD in emergency rooms. In most cases a woman who was just raped is given an exam and then provided a referral for a social worker or psychologist, who may or may not be available for immediate treatment. Similarly, when do we process trauma for a soldier who returns from battle if the trauma occurs on the field? Research must assess what we can do at those critical, initial moments post-trauma. For all intents and purposes, “post-trauma” can have many meanings: it can also involve the delay between the traumatic incident and the first opportunity to seek treatment. Several indicators of the risks for developing PTSD have been identified—including the intensity of early symptoms— but the “how, where” and importantly the “when” have yet to be added to the “why?”
Michelle Yakobson is currently in the clinical psychology doctorate program at St. John’s University.