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The chapter highlights the idea that many individuals exposed to significant trauma do not develop acute stress disorder (ASD) or post-traumatic stress disorder (PTSD) and describes subgroups that may be at greater risk for these conditions in the aftermath of disaster. It reviews neurobiological mechanisms in normal and pathological traumatic stress responses. Traumatic experience results in both immediate and long-term endocrine changes that affect metabolism and neurophysiology. Some evidence exists to support the effectiveness of psychotherapeutic approaches immediately after trauma in preventing the development of ASD or PTSD. Cognitive-behavioral therapy (CBT) attempts to correct cognitive distortions and reduce the frequency and symptomatology associated with traumatic memories. Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line medication treatment for PTSD. The clinical interview remains the gold standard for the assessment of ASD or PTSD for several reasons. Future research should help to identify individual and group-specific risk factors or vulnerabilities.
This chapter describes the evolution of the workplace as an environment responsive to the mental health of employees; the kinds of traumatic incidents that occur in workplaces requiring planning and on-site interventions; and the roles and opportunities for health and mental health providers to assist organizations in planning, responding to and recovering from critical incidents. It concludes by providing a conceptual framework for mental health and occupational health providers to join with corporate professionals and workplace stakeholders in the public sector in developing, integrating and implementing disaster psychiatry principles and evidence-based interventions that can protect and help sustain the United States economic and social capital in the face of disasters and terrorism in the twenty-first century. Mental health professionals can consult with the employee assistance provider (EAP) and crisis management industry to ensure that providers and sub-contractors are providing quality crisis response services.