The mental health effects of wars, torture, and natural disasters raise important social, political, moral, human rights, and legal issues. The post-9/11 debate in the U.S. on the definition of torture is a case in point. There are many other unresolved issues concerning survivors of war, torture, and natural disasters. These issues can be effectively addressed only with an adequate understanding of how such events affect people. This requires an evidence-based approach, which has been largely lacking in this field. DABATEM undertakes research to address these issues, while also developing research methodology to facilitate study of mass trauma.

Mass trauma events affect millions of people around the world, causing a serious mental health problem. The impoverished and disadvantaged populations of developing countries are often the ones that are most severely affected by these events. Currently available treatments, mostly developed in Western  countries, are of limited value in developing countries because of their various limitations. Most importantly, none of them are suitable for cost-effective dissemination to large numbers of survivors as self-administered interventions. Self-help is is the only way forward in effective dealing with the mental health problem posed by mass trauma events.

In the early 1990s we proposed a learning theory formulation of torture trauma based on experimental learning theory models of anxiety in animals. We hypothesized that (a) unpredictability and uncontrollability of stressors plays an important role in traumatic stress and (b) interventions that enhance sense of control increase resilience and reverse the effects of trauma. The first part of this hypothesis was confirmed by a series of studies with torture survivors and later by a study of more than 2,000 war survivors in former Yugoslavia countries. These studies led to the development of Control-Focused Behavioral Treatment (CFBT) - a largely self-administered intervention designed to reduce traumatic stress by enhancing sense of control over distressing trauma memories or fear-evoking trauma reminders.

Following the 1999 earthquakes in Turkey, CFBT was tested in earthquake survivors and found to be highly effective in reducing traumatic stress, even when delivered in a single session. Preliminary evidence suggested that the treatment could be effectively delivered through media other than a therapist, such as a self-help manual. In addition, a highly effective Earthquake Simulation Treatment was developed, designed to enhance resilience against the traumatic effects of earthquakes by increasing sense of control over simulated earthquake tremors. These interventions were used as part of a mental health care model that was tested with more than 6,000 survivors using an Outreach Treatment Delivery Program. Other treatment dissemination methods included a Treatment Delivery Manual designed to guide lay therapists in delivering treatment in post-disaster circumstances where trained therapists are not available. We are now at a stage where we can consider the idea of disseminating treatment on a much larger scale through mass media channels.

DABATEM's database

Our work in the last 20 years included more than 40 research projects, which culminated in a large database on about 15,000 survivors. This database represents the largest body of empirical evidence to date on the applications of learning theory models of traumatic stress in humans. Because this theory deals with evolutionarily determined ‘universals’ in the behavior of organisms, its applications in humans have wide cross-cultural applicability. Furthermore, its focus on behavioral strategies for coping with unpredictable and uncontrollable stressors makes it a highly useful paradigm in developing effective self-help interventions for traumatic stress. The data also allow us to examine a wide range issues that are of significance to legal professionals, international law experts, social and political scientists, and human rights workers.

This website is designed to facilitate dissemination of the knowledge gained from 20 years of work. It contains a summary of all our trauma-related work to date with a focus on our mental health care model. Introductory information is provided on the various components of this model, including the new behavioral treatments, assessment instruments, and treatment dissemination tools.

More information about various theoretical and practical issues concerning this model is provided in a book recently published by Cambridge University Press (see below).

 NEW BOOK

A Mental Healthcare Model for Mass Trauma Survivors:
Control-Focused Behavioral Treatment of Earthquake, War,
and Torture Trauma

The book is published by Cambridge University Press in the U.K. on March 3, 2011. It can be ordered online directly from the publishers. Click here for online orders.

"Mass trauma events, such as natural disasters, war and torture, affect millions of people every year. Currently, there is no mental health care model with the potential to address the psychological needs of survivors in a cost-effective way. This book presents such a model, along with guidance on its implementation, making it invaluable for both policy-makers and mental health professionals. Building on more than twenty years of extensive research with mass trauma survivors, the authors present a model of traumatic stress to aid understanding of mass trauma and how its psychological impact can be overcome with control-focused behavioral treatment. This text offers a critical review of various controversial issues in the field of psychological trauma in light of recent research findings. Including two structured manuals on earthquake trauma, covering treatment delivery and self-help, the book will be of use to survivors themselves as well as care providers."

Click PREVIEW OF CONTENTS for more information. Read a BLOG POST about the book at Cambridge Medicine.

BBC WORLD SERVICE INTERVIEW ON JAPAN EARTHQUAKE

27.4.2011 BBC World Service interview with Metin Basoglu on likely mental health effects of Japan earthquake and a cost-effective mental healthcare model of survivor care: Basoglu says that earthquakes traumatise large numbers of people and self-help behavioral treatment delivered through booklets and other mass media means is the only cost-effective way of effectively addressing the psychological care needs of earthquake-exposed communities.