CHAPTER 1: INTRODUCTION 5. Disturbance is transitory.

What are hazards? 6. Disaster relief procedures have been called the “Second
● Potentially damaging physical events, phenomena, or Disaster.”
human activity 7. Disaster stress reactions may be immediate or delayed.
● May cause the loss of life or injury, property damage, 8. People respond to active interest and concern.
social, and economic disruption, or environmental 9. Informed early intervention can speed up recovery and
degradation prevent serious or long-term problems.
Natural hazards 10. The family is the first line of support for individuals.
● Naturally-occurring events or phenomena originating 11. Support systems are crucial to recovery.
from the following: 12. A response program must be aligned with the
○ Geological processes: involve the movement of the community’s needs and dynamic, for it to be accepted.
earth, soil, and tectonic plates. 13. A disaster can bring out the best and the worst in people.
○ Hydro-meteorological factors: involve weather Concerns during disasters
disturbances occurring in the air or water. ● Social
○ Biological phenomena: involve exposure to ○ Pre-existing (pre-emergency) social problems
pathogenic microorganisms, toxins, and bioactive ■ (e.g. extreme poverty; belonging to a group that
substances. is discriminated against or marginalized; political
Human-induced hazards oppression);
● Armed conflict: dangerous conflicts between or among ○ Emergency-induced social problems
armed groups, tribes, or states, causing widespread fear ■ (e.g. family separation; disruption of social
and destruction, and forcing many people to flee to safe networks; destruction of community structures,
places. resources, and trust; increased gender-based
● Everyday hazards and dangers particularly to children. violence)
● Technological hazards: damaging human-induced events ○ Humanitarian aid-induced social problems
originating from technological or industrial accidents, ■ (e.g. undermining of community structures or
dangerous procedures, or infrastructure failures. traditional support mechanisms).
Disaster ● Psychological
● Consequence of a danger ○ Pre-existing problems
● Actualization of the risk ■ (e.g. severe mental disorder; alcohol abuse);
RA 10121 ○ Emergency-induced problems
● A serious disruption of the functioning of a community or ■ (e.g. grief, non-pathological distress; depression
a society involving widespread human, material, and anxiety disorders, including post-traumatic
economic or environmental losses and impacts, which stress disorder (PTSD))
exceeds the ability of the affected community or society ○ Humanitarian aid-related problems
to cope using its own resources ■ (e.g. anxiety due to a lack of information about
Disaster Risk food distribution).
● The potential disaster losses when hazards occur. Impact of disasters
● Disaster risk is dependent on the strength of the hazard, ● Children
and extent of exposure, vulnerability, and capacity of a ○ Individual child
community to withstand the onslaught of the hazard. ○ Child in the family
Exposure ○ Child in the community
● The degree to which a community is likely to experience ● Adolescents
hazard events of different magnitudes. It also refers to
the physical location, characteristics, and population CHAPTER 2
density of a community that “exposes” it to hazards. Phases of disaster
Emergency ● Threat phase
● An unforeseen or sudden occurrence, especially danger, ○ days before the actual incident or no warning at all
demanding immediate action. ● Impact phase
● Can emergencies become a disaster? ○ Day 1 to 3
○ Yes. ○ getting over the destruction and its effects depends
on the extent
Mental Health ● Heroism
● A state of well-being in which every individual realizes his ○ Impact up to 1 week after
or her own potential, can cope with the normal stresses ○ struggle to prevent the loss of lives and property
of life, can work productively and fruitfully, and is able to damage
make a contribution to her or his community. ● Honeymoon
Effects of Disasters ○ 2 weeks to 2 months
● Emergencies erode normal protective supports, increase ○ relief efforts lift the spirit of survivors
the risks of diverse problems, and tend to amplify ● Disillusionment
pre-existing problems of social injustice and inequality. ○ several months to over a year
General Principles ○ unexpected delays and failures
1. Everyone who sees a disaster is affected by it. ● Reorganization and recovery
2. Target population is primarily normal. ○ several years
3. How people have coped with crises in their past will be a ○ normal functioning is gradually reestablished
good indicator of how they will handle the disaster. Types of Disaster Victims
4. People do not disintegrate in response to disaster. ● Direct victims
 ○ those killed or injured ● Debriefing model
● Indirect victims ○ dominant early response
○ family, friends, co-workers of the direct victims ● Psychological first aid
● Hidden victims ○ first do no harm
○ crisis workers and service providers ● Long-term intervention focused on PTSD
Disaster Mental Health Research Massive Natural Disasters
Early Efforts ● Hiroshima & Holocaust survivors
● Freud's attempts to understand civilizations and their ● 1990 Luzon earthquake
discontents, the "traumatic" neuroses, and mourning and ● 1991 Mt. Pinatubo eruption - est. 20,000 evacuated
melancholia ● 2004 SE Asian tsunami - est. 250,000 deaths
● Lindemann's (1944) "Symptomatology and management ● 2005 Kashmir/Pakistan earthquake - est. 54,000
of acute grief" ● 2005 Hurricane Katrina
● Adler's (1943) paper on neuropsychiatric consequences ● 2011 Fukushima triple disaster (earthquake & tsunami)
for victims of the Coconut Grove Club fire ● 2013 Typhoon Haiyan/Yolanda
● Tyhurst's (1950) study on individual reactions to Rise of Resilience
community disaster and the natural history of certain ● The role of hope in positive outcomes (1997)
psychiatric phenomena ● Concept of posttraumatic growth (1998)
○ Disaster syndrome - the period of impact or ● Bonanno's concepts of resilience (vs. recovery) involving
immediately afterwards the person is dazed, those affected by loss or catastrophic events (2004)
stunned, unaware, frozen, or wandering aimlessly Systems for Response
● Lifton's (1967) study of Hiroshima victims, which ● WHO, UNICEF, World Psychiatric Association, World
portrayed the stressors and experiences of those directly Federation for Mental Health
affected ○ Rules of engagement
1970s-1980s Challenges for MH Response
● Mental health aspects of disasters ● Active engagement of the mental health field with key
○ Floods, tsunamis, earthquakes, volcanic eruptions, responding agencies
bush and forest fires, cyclones, hurricanes, tornados, ● Development, expertise, and "selling" of the role of
storms, etc mental health in providing effective interventions from
○ vehicle crashes, mine collapses, chemical accidents, the earliest stages
structural and building collapses, marine incidents ● Building mental health capacity for leadership
● Responders in emergency organizations ● Documentation systems
○ stress of body handling and disaster victim ● Establish levels of core knowledge, skills, and
identification competencies for basic and advanced levels of response
○ special needs of children, adolescents, families, older leadership and science
people ● Emerging systems challenges
● Sociological and mental health Trauma, Loss, Adversities & Community Effects
○ dislocation from communities Traumatic stressors
○ exposure to life threat ● Loss of life and traumatic bereavement
○ gruesome and untimely death ● Threat to life, injury, and fear
○ loss of loved ones ● Witnessing and horror
○ impacts on children Grief and loss
○ disruptions of social bonds ● Grief is defined as the psychological and emotional
● International collaborations experience following a loss
○ World Health Organization ● Loss is the central experience of any disaster
○ United Nations ● Mourning is a culturally appropriate process that helps
○ Red Cross people to pass through grief.
● Establishment of the International Society for Traumatic Loss of life & traumatic bereavement
Stress Studies ● Disasters characterized by high mortality are likely to
● Concepts of psychological first aid and psychological yield substantial psychological morbidity
debriefing, counseling for the bereaved, ● Bereavement is more closely linked to post disaster
psychotherapeutic outreach depression than to PTSD
● Critical Incident Stress Debriefing Model developed by ● Loss of an adult child was likely to lead to complicated
Jeffrey Mitchell grief
Research in Disaster Response ● Loss of a family member significantly contributed to
● Psychosocial Guidelines for Preparedness and depression and PTSD in adolescents.
Intervention in Disaster (WHO, 1991) ● Culture shapes beliefs and expectations about death and
● International Handbook of Traumatic Stress Studies bereavement and defines death rituals
(Wilson & Raphael, 1993) Threat to life, injury & fear
● Journal of Traumatic Stress ● Life threat and injury are consistent risk factors for
The New Millenium psychopathology
● Terrorism ● Disaster exposure was associated with higher scores in
○ Mental Health Disaster Manual was prepared for the Trauma Symptom Inventory
Sydney Olympics 2000 ○ the type of disaster is far less important than the
○ September 11 attacks characteristics of exposure
○ bereaved population has been poorly researched Witnessing and horror
Interventions & Early Intervention
● witnessing was a significant predictor of postdisaster ● Displacement is correlated with depression in women
psychological disorder over and above the effects of and belligerence in children but had minimal effect on
threat or loss men
● rescue workers and body handlers Community effects & meanings
Loss ● Indirect effects of disasters
● Property damage and financial loss ○ 2 Broad categories of disaster victims (Bolin, 1985):
● Resource loss ■ Primary victims
Property damage & financial loss ■ Secondary victims
● Loss of possessions of personal value ○ Disaster is a community-level event with potential
● Property damage in combination with injury formed consequences even for persons who experience no
strongest predictors for psychopathology trauma or loss.
● effects of property loss decrease over time ● Media controversy
● disaster-related losses may interfere with recovery from ○ Indirect exposure
PTSD ○ PTSD symptoms correlated with exposure to extreme
Resource loss media images
● Hobfoll's theory of conservation of resources (CORs) ● Meanings
○ Individuals strive to obtain, retain, protect, and ○ Psychological experience of what the events implies
foster things that they value for the future
○ stress occurs when resources are: ■ long-term uncertainties regarding the nature of
■ Threatened the impact
■ Lost ■ fear that there might be unseen or delayed
■ Individuals fail to gain resources following an consequences
investment ■ anxieties regarding threat of recurrence
● Kaniasty and Norris (1996) suggested that loss of social ■ heightened potential of human- caused disasters
resources is an important aspect of disaster exposure ○ Fatalism refers to a collectivistic worldview that
○ social support deterioration model control lies within contextual or external forces
○ deterioration deterrence model rather than the individual.
● Erikson's (1976) proposition that the trauma experienced
by disaster survivors has two facets: CHAPTER 3
○ Individual trauma Brief History of Traumatology
○ Collective trauma Trauma
COR Theory ● Greek word, wound
● Object resources ● Greek historian Herodotus
○ housing ○ Spartan leader Leonidas dismissed his men from
● Personal resources combat because he realized they were mentally
○ optimism, safety exhausted from too much fighting
● Conditions ● Iliad describes PTSD when Homer says Ajax went mad
○ employment, social relationships under Athena's spell, slaughtering a herd of sheep that
● Energies he thought were the enemy, then killed himself
○ money, free time Trauma
Ongoing adversities ● rise of modern psychology
● Housing and rebuilding issues ● modern warfare
● Postdisaster life events and chronic stress ● rise of workers' compensation and legal issues
● Displacement and relocation Many names of trauma
Housing & rebuilding issues ● Nostalgia
● Settling insurance claims ○ Austrian physician Josef Leopold Auenbrugger
● Getting repairs done (1761) prescribed cures like listening to music,
● Taking time away from work regular exercise, useful instruction
● Postdisaster ecological stress is correlated to depression ● Homesickness
and posttraumatic stress ● Ester roto - to be broken
Postdisaster life events & chronic stress ● Soldier's heart, as called by IM doctor J.M. de Costa on
● Life events - discrete changes his studies on US civil war veterans and discovered they
○ strongest predictor of postdisaster symptoms over suffered from chest-thumping, anxiety, and shortness of
time breath.
● Hassles, strains, and chronic stress - ongoing stressful life ● Hysteria, James Beard (1980)
circumstances ● Compensation sickness or railway spine
● Children of parents who are distressed following a ● Shell shock, WW1 Battle of Somme 1914
disaster tend to exhibit greater emotional and behavioral ● Combat exhaustion, WW2 and Korean War
problems ○ combat fatigue
Displacement & relocation ● Stress response syndrome, DSM I (1952) and that
● Most disruptive Vietnam War soldiers were diagnosed with it
● Evacuation refers to the temporary withdrawal of persons ● Many names
from a potential impact area ○ Situational disorders, DSM II
● Forced or unwanted relocation is disruptive and stressful ○ In 1980, examination of traumatic responses led to
the inclusion of a distinct PTSD diagnosis in DSM III
 ■ Trauma is classified as an event existing "outside ● Early abandonment by a mother or any significant family
the range of usual human experience". member lowers serotonin in children
○ In DSM IV, trauma includes varied events ● Research suggests that severe/prolonged trauma may
○ Modern trauma theory conceptualizes trauma and disrupt and alter brain chemistry
traumatic responses as occurring along the ● If exposed to fear, stress, and overwhelming experience,
continuum neurochemical responses in the brain occur
● More complex PTSD is known as Disorders of Extreme ● Trauma increases stress hormone cortisol
Stress (DES) ● The goal of therapy is to calm the amygdala and allow the
○ Lasting personality changes as a result of traumatic hippocampus to record the traumatic event as over
experiences on some survivors Psychological effects of trauma
In DSM-5, PTSD ● Anxiety
● Trauma-Stressor-Related Disorders ○ fear, apprehension, or worry
● Diagnostic criteria ○ physical sensations
○ Exposure ■ heart palpitations, nausea, chest pain, shortness
○ Intrusion of breath, stomachaches, headaches
○ Avoidance ● Depression
○ Negative alterations in mood/cognition ○ symptoms of trauma seen as hopelessness,
○ Arousal and reactivity desperation, meaningless life, pessimism, lack of
○ Duration initiative, slow thought process, disturbances in
○ Significance sleeping and eating patterns, fatigue, difficulty
○ Not substance or medical concentrating, preoccupation with death or suicide,
Trauma decreased sex drive, feelings of worthlessness
● The physical or medical injury or a blow in the head or ● Psychosomatic Illness
other shocks of the body. ○ somatization
Psychotrauma ○ ways the body remembers trauma
● An extremely distressing experience that causes severe ○ survivors frequently have problems with their
emotional shock and may have a long-lasting digestive system, chronic pain
psychological effect on the person Posttraumatic stress disorder
Traumatic event ● complex health condition
● An event or incident that is outside the range of usual ● extremely distressing or traumatic experience that causes
human experience and that would be markedly a person to feel intense fear, horror, or sense of
distressing to almost anyone. helplessness
Characteristics of traumatic events ● not all persons who are traumatized will have PTSD
● Life-threatening
● Unpredictable
● Uncontrollable
● Meaningless
Examples of traumatic events
● seeing another person who has been injured or killed
● victims/survivors or witnesses of tragic vehicular
accidents
● war/armed conflict
● natural disasters
● tragic death or sudden loss of loved ones
Common Trauma Symptoms
● chronic or terminal illness
● recurrent thoughts or memories of the
● exposure to domestic violence
● most hurtful or terrifying events
● sexual abuse
● feeling as though the event is happening again
● extreme poverty
● recurrent nightmares
● crime
● feeling detached or withdrawn
● fire
● unable to feel emotions
● plane crash
● feeling jumpy
● school shooting
● difficulty concentrating
Stages of trauma
● trouble sleeping
● sudden occurrence of traumatic event
● feeling on guard/watchful
● physical effects
● feeling irritable or having outburst of anger
● shock or disbelief
● avoiding activities that remind you of the
● destabilization
● traumatic or hurtful event
● psychological effects
● inability to remember parts of the most
● coping/normalizing
● traumatic/hurtful event
● Recovery
● less interest in daily activities
Neuroscience
● feeling as if you don't have a future
● Frontal lobe damage leads to inability to cope with
● avoiding thoughts or feelings associated with the
situation
traumatic/hurtful event
● Research shows that adults abused as children, their
● sudden emotional or physical reaction when reminded of
hippocampus are smaller than non-abused
the most hurtful or traumatic event
● When traumatic events occur, amygdala gets activated
● feeling that people don't understand what happened to
you
● difficulty performing work or daily tasks
● blaming yourself for things that happened
● hopelessness
● feeling ashamed of the hurtful or traumatic events that
have happened to you
● spending time thinking about why these things happened
to you
● feeling as if you are going crazy
● feeling that you are the only one who suffered these
events
● feeling that others are hostile toward you
● feeling that you have no one to rely on
● feeling someone you trusted betrayed you
● survivor's guilt
● sexual dysfunction
● finding out or being told by others that
● you have done something that you cannot remember
● feeling as if you are split into two people and one of you
is watching what the other is doing
Survivor’s guilt
● guilt that comes from the belief that our actions or
inactions during a traumatic event may have caused or
could have prevented the death, injury, or mistreatment
of others
● belief that one should have experienced death, injury, or
mistreatment but escaped from it
Reacting to trauma
● Pre-event factors
○ previous exposure to ALE
○ earlier depression that is not merely situational
○ ineffective coping skills
○ family instability
○ family history of antisocial or criminal behavior
○ early substance abuse
○ trouble with authority
○ absence of social support
○ multiple early losses
○ gender
● Event factors
○ geographic nearness to the event
○ level of exposure to the event
○ the event's meaning to you
○ age - being young at the time
○ victim of multiple traumatic incidents
○ duration of the trauma
○ existence of an ongoing threat that condition will
continue
○ being involved in an intentional event
○ participation in an atrocity as a perpetrator or
witness
● Post-event factors
○ absence of good social support
○ not being able to do something about what
happened
○ indulging in self-pity
○ being passive
○ inability to find meaning in suffering
○ developing acute stress disorder
○ having an immediate reaction that includes
physiological arousal and avoidant or numbing
symptoms
Physical Health Problems After Disasters
● Health problems existing before the disaster
○ Chronic diseases
■ may be exacerbated during and after the
disaster due to stress and excessive attention to
bodily symptoms
● Immediate health problems because of the disaster
(health problems that may have lasting consequences)
○ injuries, burns, fractures
○ cuts and lacerations
○ crush syndrome
○ acute renal failure
■ during & immediately after earthquakes
○ eye-problems
■ during & after the sarin attack in Tokyo
○ hearing problems during explosions
● ‘Health problems in the first year after disaster
○ physical symptoms, chronic in nature
■ PTSD, MDD, or GAD accompanied by physical
symptoms
○ Post-disaster wellbeing
■ acceptability of living conditions
■ compensation received in a timely manner
■ availability of information
■ actions taken by authorities are transparent
● Long-term health problems
○ minority of survivors develop chronic symptoms such
as:
■ fatigue, back pain
■ diseases - hypertension, diabetes mellitus
● Medically unexplained symptoms
○ physical symptoms that provoke care-seeking but
have no clinically determined pathogenesis after an
appropriately thorough diagnostic evaluation
■ Perceptual
■ Cognitive
■ Behavioral
○ MUS intertwine with psychological problems and
quality of life
○ related to functional impairment, increased illness
behavior, and comorbid psychological problems
○ Functional somatic syndrome
■ Fibromyalgia
■ multiple chemical sensitivity
■ Gulf War syndrome
● Illness
○ a subjective lack of wellness that is inferred through
words and behavior
● Disease
○ clinically identified pathophysiological process
● Diseases in the aftermath of disasters
○ Natural disasters
■ distress and depression
○ Human-made disasters
■ PTSD, anxiety
■ physical health
○ Physical health outcomes
■ effects on the respiratory tract
● bushfires, floods, hurricanes, volcanic gas
and ash exposures, chemical disasters,
explosions, terrorism
■ musculoskeletal tract
● after earthquakes and terrorism
■ gastrointestinal tract
● earthquake, bushfires, hurricanes, flood
■ skin
● bushfires, chemical disasters
○ Dioxin exposure in Seveso, Italy, 1976
■ nausea, headache, eye irritation
 ■ skin lesions and chloracne ■ can change over time as a result of the dynamic
■ chronic ischemic heart disease interplay of personality and social interactions
■ hypertension with key attachment figures
■ chronic rheumatic heart disease Social Cognitive Theory
■ chronic obstructive pulmonary disease
■ diabetes mellitus
■ dioxin-related cancers
○ Chernobyl disaster
■ thyroid cancer in children

CHAPTER 4
● Resilience
○ The ability of adults in otherwise normal
circumstances who are exposed to an isolated and ● Triadic reciprocal determinism
potentially highly disruptive event such as the death ○ dynamic nature of human adaptation where human
of a close relation or a violent or life-threatening beings self-regulate behavior through feedback
situation to maintain relatively stable, healthy levels systems both internally and externally
of psychological and physical functioning; as well as ● Self-regulation process
the capacity for generative experiences and positive ○ self-evaluation of successful or unsuccessful
emotions achievement of desired goals
○ Most of the people who ultimately show a resilient
profile tend to experience at least some form of
temporary stress reaction.
Sep 11 attacks (9/11)
● Resilient individual
○ little or no symptoms of PTSD or depression
○ high levels of positive adjustment
○ higher levels of positive affect than other
participants
○ extremely low levels of depression
○ significantly lower use of cigarettes and marijuana
○ no differences from other participants in alcohol
consumption
○ survivors were functioning well below normal levels
at each assessment point during the first 18 months
after hospitalization
Demographic variables
● Hurricane Katrina, 2005
○ racial/ethnic minority
■ risk for PTSD greatest among Hispanics
Personal & social resources
● Hobfoll's conservation of resources (COR) theory
○ resource change
■ resource loss or gain
● influence on the generation or amelioration of stress
● Social resources Social support after disasters
○ most consistently identified predictors of adjustment ● Social interactions that provide individuals with actual
following PTEs assistance and embed them into a web of social
● Personality characteristics relationships perceived to be loving, caring, and readily
○ survivors of PTEs influence the extent to which they available in times of need
seek social support and perceive their social support ○ Received support - most prominent facet for the
networks majority of people
● Additional life stress ■ assessments of specific behaviors that are
○ PTSD and increased life stress before and following involved in the expression of support
the traumatic event ■ estimation of "natural helping behaviors"
● Flexible adaptation & pragmatic coping ○ Perceived support - most prominent facet for the
○ PTE is an extreme event that occurs outside the majority researchers
range of normal human experience ■ cognitive appraisal of being reliably connected
○ Pragmatic coping involves behaviors that under to others
normal circumstance may be less effective or even ■ assess an individual's confidence that adequate
maladaptive support will be available if needed
○ Adaptive flexibility ■ characterize the primary social environment as
■ capacity to shape and modify one's behavior to helpful or cohesive
meet the demands of a given stressor event ○ Social embeddedness - more structural aspects of
social networks
 ■ number of connections an individual have with 10. Identify possibility/ongoing psychopathology
significant others in their environments ○ Refer to psychiatrist if psychopathology is present
When is mourning finished
● When 4 tasks of mourning is done
● When one can talk/think about the deceased without
pain
2 Frameworks which can be related to wellbeing
Wellbeing Framework
1. Biological - necessary requirements to function
2. Material - basic needs
3. Mental - thinking, cognitive
4. Emotional - feelings
ADDITIONAL NOTES 5. Social - human interactions
● Loss - the central experience of any disaster. 6. Cultural - learned patterns of behavior
Determinants of Grief 7. Spiritual
1. Who was the person Bilog ng Buhay Framework
2. Nature of attachment
3. Mode of death - NASH (Natural, Accident, Suicidal,
Homicidal)
○ Natural - old age, sickness
○ Accident, Suicidal, Homicidal - Untiming deaths
4. Historical antecedence - relationship
5. Personal variables
6. Social variables - ex. Di naagapan sa hospital yung
emergency = death
4 Tasks of Mourning ● Kaginhawaan - peace of mind
1. Increase our reality of the loss of the person ● Kakayahan - empowerment
2. Accept reality of loss
3. Adjust in an environment where the person is
missing/gone
4. Withdraw emotional energy & invest in other
relationships
5 Stages of Grief [ Acc. to Kubler Ross]
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
5 Stages of Bereavement [ Acc. to C.M. Parker ]
1. Alarm
2. Numbness
3. Pinning or searching
4. Depression
5. Recovery & reorganization
4 Phases of Bereavement [ J. Bowlby ]
1. Numbness or protest
2. Yearning & searching
3. Disorganization & despair
4. Reorganization
When is grief abnormal?
1. Timing - delayed/prolonged
2. Intensity - decreased/increased
3. Symptoms - diminished/increased
Goals of Grief Processing
- Help survivors complete any unfinished business with the
deceased.
Tasks of Grief
1. Help survivor actualize loss
2. Help survivor identify & express their feelings
3. Assist the living
4. Facilitate emotional withdrawal from deceased
5. Provide time for them to grieve
6. Interpret behavior
7. Allow individual diff
8. Provide continuing support
9. Examine & look into their defenses & coping style