Dealing with Adults – Trauma response in a highrise

For the Adult Population: the following excerpt is from a posting by Mark Reineke to the Academy of Cognitive Therapy ListServ. Reprinted with permission.

Subj: Re: [ACT] disaster in nyc
Date: Wed, 12 Sep 2001 5:14:06 PM Eastern Daylight Time
From: Mark Reinecke

I just did an interview with the Tribune regarding how we can help individuals living and working in highrises (e.g., Sears Tower, Hancock Center, Aon Building) to cope with feelings of anxiety. These are 100 story buildings in the Chicago loop which were frantically evacuated when the attacks began [reference to attacks in USA on September 11, 2001].

Here are my comments:

1) Acknowledge the validity of their concerns. They’re reasonable given recent events…we are, in fact, more vulnerable than we’d thought. These are horrific events and their reactions are normal. We’re all experiencing them.

2) Note that the the typical outcome to trauma is recovery. People are resilient. Feelings such as these typically remit spontaneously within two weeks.

3) Encourage expression and discussion of thoughts and feelings…talk it out; encourage natural resilience.

4) Seek support from friends, family church, and coworkers…you’re not in this alone. Provide support to others.

5) Provide reassurance as to safety measures taken.

6) Keep the probability of another attack in perspective. This was a horrific event, but it was localized. It’s still more likely that you’ll be injured in an automobile accident than by a terrorist attack. Although the risk isn’t zero, it remains extremely remote. (Attend to perceptual and memory biases that accompany anxiety disorders)

7) Don’t watch CNN. Saturation coverage and repeated exposure to images of the buildings collapsing will lead to increased anxiety, recurrent images of it, and possible nightmares regarding the attack. People can develop symptoms of PTSD vicariously, particularly when the identify with the victim. Don’t let this happen through repeated exposure to media.

8) Life is going on. It’s time to get to work…to help our families and communities. Maintain a normal routine. Ask, “What can I do to cope and to move forward for myself, my family, my colleagues, and my community?” Encourage rational problem-solving and behavioral activity. Resist withdrawal and avoidance.

9) In some individuals, symptoms may persist beyond 2 weeks and frank symptoms of PTSD may emerge. Unfortunately, there are few reliable predictors of response to trauma for individual clients. With this in mind, individuals whose symptoms persist or become disabling should seek professional attention (from a therapist using empirically-supported techniques).

Mark A. Reinecke, Ph.D.
Associate Professor of Child & Adolescent Psychiatry
Director, Center for Cognitive Therapy
Department of Psychiatry
University of Chicago

Helping Children Cope with Trauma - post 9/11

The following excerpt is from a posting by Mark Reineke to the Academy of Cognitive Therapy ListServ. Reprinted with permission.

Subj: [ACT] Helping children cope with trauma
Date: Thu, 13 Sep 2001 11:47:55 AM Eastern Daylight Time
From: Mark Reinecke

Dear Colleagues,

As a resource for helping children cope with this week’s tragedy [reference to attacks in USA on September 11, 2001], I wanted to share with you several tools prepared by the American Academy of Child and Adolescent Psychiatry (AACAP). Attached you will find links for the AACAP’s Talking Points – How To Talk To Children and Parents After A Disaster. They’re …somewhat short on specific recommendations for intervention, but are appropriate for sharing with parents.

The two Facts For Families can be downloaded at:
Facts for Families # 8 – Children and Grief
Facts For Families #36 – Helping Children After A Disaster.

The “Facts for Families” are designed to be reproduced and distributed. Please feel free to make these available to your patients and their families, schools, and any other organizations which may benefit from the information.

Mark A. Reinecke, Ph.D.
Associate Professor of Child & Adolescent Psychiatry
Director, Center for Cognitive Therapy
Department of Psychiatry
University of Chicago

Compulsory Debriefing of Victims of Trauma Should Cease:
Critical Incident Stress Debriefing (CISD) Information & References.

“There is no current evidence that psychological debriefing is a useful treatment for the prevention of post traumatic stress disorder after traumatic incidents. Compulsory debriefing of victims of trauma should cease. (from the Cochrane Report)

Authors’ conclusions:
There is no evidence that single session individual psychological debriefing is a useful treatment for the prevention of post traumatic stress disorder after traumatic incidents. Compulsory debriefing of victims of trauma should cease. A more appropriate response could involve a ‘screen and treat’ model (NICE 2005).

Rose SC, Bisson J, Churchill R, Wessely S. Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD000560. DOI: 10.1002/14651858.CD000560. Available online from

If the link is not working, try searching for the article title at

“The results suggest that no psychological intervention can be recommended for routine use following traumatic events and that multiple session interventions, like single session interventions, may have an adverse effect on some individuals. The clear practice implication of this is that, at present, multiple session interventions aimed at all individuals exposed to traumatic events should not be used.” (from Roberts, Kitchiner, Kenardy & Bisson, 2009)

Roberts NP, Kitchiner NJ, Kenardy J, Bisson JI. Multiple  session early psychological interventions for the prevention of post-traumatic stress disorder. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006869. DOI: 10.1002/14651858.CD006869.pub2. Available online from

For Current Guidelines

CISD References:

Thanks to our colleagues through the Academy of Cognitive Therapy (ListServ), the following list of references addresses the empirical outcomes of Critical Incident Stress Debriefing (CISD) research.

Alexander, D. A., & Wells, A. (1991). Reactions of police officers to body handling after a major disaster: A before and after comparison. British Journal of Psychiatry, 159, 547-555.

Avery, A., & Orner, R. (1998). First report of psychological debriefing abandoned-the end of an era? Traumatic Stress Points, 12(3).

Avery, A., King, S., & Orner, R. (1999). Deconstructing psychological debriefing and the emergence of calls for evidence-based practice. Traumatic Stress Points, 13(2).

Bisson, J. I., & Deahl, M. P. (1994). Psychological debriefing and prevention of post traumatic stress: More research is needed. British Journal of Psychiatry, 165, 717-720.

Bisson, J. I., Jenkins, P. L., Alexander, J., & Bannister, C. (1997). A randomised controlled trial of psychological debriefing for victims of acute harm. British Journal of Psychiatry, 171, 78-81.

Carlier, I. V. E., Lamberts, R. G., van Uchlen, A. J., & Gersons, B. P. R. (1998). Disaster related post-traumatic stress in police officers: A field study of the impact of debriefing. Stress Medicine, 14, 143-148.

Deahl, M. P., & Bisson, J. I. (1995). Dealing with disasters: Does psychological debriefing work? Journal of Accident and Emergency Medicine, 12, 255-258.

Deahl, M. P., Gillham, A. B., Thomas, J., Dearle, M. M., & Strinivasan, M. (1994). Psychological sequelae following the Gulf war: Factors associated with subsequent morbidity and the effectiveness of psychological debriefing. British Journal of Psychiatry, 165, 60-65.

Dishion, T. J., McCord, J., & Poulin, F. (1999). When interventions harm: Peer groups and problem behavior. American Psychologist, 54(9), 755-764.

Foa, E. B., & Meadows, E. A. (1997). Psychosocial treatments for posttraumatic stress disorder: A critical review. Annual Review of Psychology, 48, 935-938.

Gist, R. (1990, August). Debriefing and related activities. In G. A. Jacobs (Chair), Flight 232: Case study of psychology’s response to air disasters. Symposium conducted at the 98th annual convention of the American Psychological Association, Boston, MA.

Gist, R. (1996a). Is CISD built on a foundation of sand? Fire Chief, 40(8), 38-42.

Gist, R. (1996b). Dr. Gist responds (Letter to the editor). Fire Chief, 40(11), 19-24.

Gist, R., Lohr, J. M., Kenardy, J. A., Bergmann, L., Meldrum, L., Redburn, B. G., Paton, D., Bisson, J. I., Woodall, S. J., & Rosen, G. M. (1997). Researchers speak on CISM. Journal of Emergency Medical Services, 22(5), 27-28.

Gist, R., Lubin, B., & Redburn, B. G. (1998). Psychosocial, ecological, and community perspectives on disaster response. Journal of Personal & Interpersonal Loss, 3, 25-51.

Gist, R., & Woodall, S. J. (1995). Occupational stress in contemporary fire service. Occupational Medicine: State of the Art Reviews, 10, 763-787.

Gist, R., & Woodall, S. J. (1998). Social science versus social movements: The origins and natural history of debriefing. Australasian Journal of Disaster and Trauma Studies, 1998-1 Online serial at

Gist, R., & Woodall, S. J. (1999). There are no simple solutions to complex problems: The rise and fall of Critical Incident Stress Debriefing as a response to occupational stress in the fire service. In R. Gist & B. Lubin (Eds.), Response to disaster: Psychosocial, community, and ecological approaches (pp. 211-235). Philadelphia, PA: Brunner/Mazel.

Gist, R., Woodall, S. J., & Magenheimer, L. K. (1999). And then you do the Hokey-Pokey and you turn yourself about . . . In R. Gist & B. Lubin (Eds.), Response to disaster: Psychosocial, community, and ecological approaches (pp. 269-290). Philadelphia, PA: Brunner/Mazel.

Griffiths, J., & Watts, R. (1992). The Kempsey and Grafton bus crashes: The aftermath. East Linsmore, Australia: Instructional Design Solutions.

Hobbs, M., Mayou, R., Harrison, B., & Worlock, P. (1996). A randomised controlled trial of psychological debriefing for victims of road traffic accidents. British Medical Journal, 313, 1438-1439.

Hytten, K., & Hasle, A. (1989). Firefighters: A study of stress and coping. Acta Psychiatrica Scandinavia, 355(supp.), 50-55.

Kenardy, J. A. (2000). The current status of psychological debriefing: It may do more harm than good. British Medical Journal, 321, 1032-1033.

Kenardy, J. A. (1998). Psychological (stress) debriefing: Where are we now? Australasian Journal of Disaster and Trauma Studies, 1998-1. Online serial at

Kenardy, J. A., & Carr, V. (1996). Imbalance in the debriefing debate: What we don’t know far outweighs what we do. Bulletin of the Australian Psychological Society, 18(2), 4-6.

Kenardy, J. A., Webster, R. A., Lewin, T. J., Carr, V. J., Hazell, P. L., & Carter, G. L. (1996). Stress debriefing and patterns of recovery following a natural disaster. Journal of Traumatic Stress, 9, 37-49.

Lee, C., Slade, P., & Lygo, V. (1996). The influence of psychological debriefing on emotional adaptation in women following early miscarriage: A preliminary study. British Journal of Medical Psychology, 69, 47-58.

Mayou, R. A., Ehlers, A., & Hobbs, M. (2000). Psychological debriefing for road traffic accident victims. British Journal of Psychiatry, 176, 589-593.

McFarlane, A. C. (1988). The longitudinal course of posttraumatic morbidity: The range of outcomes and their predictors. Journal of Nervous and Mental Disease, 176, 30-39.

Macnab, A. J., Russell, J. A., Lowe, J. P., & Gagnon, F. (1998). Critical incident stress intervention after loss of an air ambulance: two-year follow up. Prehospital and Disaster Medicine, 14, 8-12.

Ostrow, L. S. (1996). Critical incident stress management: Is it worth it? Journal of Emergency Medical Services, 21(8), 28-36.

Raphael, B., Meldrum, L., & McFarlane, A. C. (1995). Does debriefing after psychological trauma work? Time for randomised controlled trials. British Journal of Psychiatry, 310, 1479-1480.

Redburn, B. G. (1992). Disaster and rescue: Worker effects and coping strategies. Doctoral dissertation (community psychology), University of Missouri-Kansas City [University Microfilms No. AAD93-12267; Dissertation Abstracts International, 54(01-B), 447].

Rose, S.,& Bisson, J. (1999). Brief early psychological interventions following trauma: A systematic review of the literature. Journal of Traumatic Stress, 11, 679-710.

Small, R., Lumley, J., Donohue, L., Potter, A., Waldenström, U. (2000). Randomised controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth. British Medical Journal, 321, 1043-1047.

Stephens, C. (1997). Debriefing, social support, and PTSD in the New Zealand police: Testing a multidimensional model of organizational traumatic stress. Australasian Journal of Disaster and Trauma Studies, 1. Electronic journal accessible at

Stuhlmiller, C., & Dunning, C. (2000). Challenging the mainstream: From pathogenic to salutogenic models of posttrauma intervention. In J. M. Violanti, D. Paton, & C. Dunning (Eds.), Posttraumatic stress intervention: Challenges, issues, and perspectives (pp. 10-42). Springfield, IL: Charles C. Thomas.


Post 9/11 letter: Dealing with Disaster
Dear Colleagues
We offer the following comments and resources from the *international cognitive therapy community

  • Click HERE for reprint of Ehlers, A & Clark, D.M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345 (see Trauma section)
  • See our Cognitive Therapy Training Audio CD PTSD for a three hour Padesky audio workshop. Dr. Padesky illustrates in detail the revised CT treatment protocol developed by Ehlers and Clark.
  • Suggestions you can disseminate in your communities
    • for the adult population
    • helping children cope with trauma
  • Recommendation emerging from the latest empirical findings regarding Critical Incident Stress Debriefing (CISD)
  • Prisoners of Hate: The Mind of the Terrorists by AT Beck (see Aaron T. Beck section)

*We are grateful to our colleagues at the Academy of Cognitive Therapy ListServ for allowing us to reprint these sources of empirical findings. And special thanks to Dr. Mark Reineke of the Center for Cognitive Therapy, University of Chicago, for permitting us to reprint his comments to the Chicago Tribune.

September 11, 2001 United States of America

“Attacks / Tragedy” refers to the September 11, 2001 terrorist hijackings in the United States which led to the crashing of four airliners full of passengers into the 110 foot tall Twin Towers of the World Trade Center, into the Pentagon and into the ground in Somerset County, Pa. The World Trade Center was completely destroyed killing thousands of people. The death toll at the Pentagon exceeds 190 people. The crash in Pennsylvania killed all 44 people on board. According to (09/19/01) “The number of confirmed dead and those reported missing from the September 11 attacks is more than 5,500.” Currently 62 countries have people dead and/or missing as a result of these acts of terrorism.

Errata: the above statistics reported September 19, 2001 were inaccurate. The most current information as reported by CNN is that a total of 3,030 people were killed in the terrorist attacks on New York City, Washington, DC and Shanksville, Pennsylvania. At the World Trade Center (WTC) site in Lower Manhattan, 2,753 people were killed. At the Pentagon in Washington, 184 people were killed. Near Shanksville, Pennsylvania, 40 passengers and crew members aboard United Airlines Flight 93 died when the plane crashed into a field.
Web reference: