Earthquake Simulation Treatment (EST) is a variant of control-focused behavioral treatment involving the use of an earthquake simulator. The purpose of treatment is to help the person gain control over earthquake tremors. It is a novel treatment developed by DABATEM and used for the first time with earthquake survivors in Turkey.

Evidence from our studies of earthquake trauma show that exposure to earthquake tremors is an intensely frightening and traumatizing experience. Unpredictable and uncontrollable occurrence of earthquakes leads to intense anticipatory fear and related chronic traumatic stress problems.

The earthquake simulator is specifically designed for the purposes of control-focused behavioral treatment. It is a small furnished house based on a shake table that simulates earthquake tremors up to 8 magnitude on a Richter scale. A computer executes the movements of the simulator in accordance with various preprogrammed earthquake scenarios.

The users can control the tremors from the inside using a mobile control switch, stopping or starting it anytime they want and increasing the intensity whenever they feel ready for it. Being in complete control of the tremors enables users to keep their distress or anxiety within manageable levels.

The experience often evokes two types of emotions: fear associated with the tremors and distress related to memories of the traumatic events during the earthquake. This allows opportunities for the users to exercise and gain control over both types of emotions. The session is terminated when the users feel in complete control of their distress or fear. In almost all cases the experience leads to a substantial reduction in these emotions.

The treatment session usually lasts 45 minutes. About 80% of the session time is spent on the lowest tremor intensity level (3-4 on the Richter scale).

An abridged video recording of a session (4 minutes) will be available here soon.

A creative depiction of a treatment session by José Carlos Fernandes - a well-known Portuguese artist
Portuguese daily EXPRESSO 14/4/2007 Courtesy of JCF

A treatment session

Study 1 (uncontrolled)

The effectiveness of EST was first examined in 10 survivors with posttraumatic stress disorder (PTSD). Eight out of 10 cases improved with substantial reduction in their fear of earthquakes, PTSD, and depression in 3 months. Improvement generalized to social, work, and family functioning.

No self-exposure instructions were given after the session to examine the effects of EST alone. Nevertheless, survivors became less avoidant of feared situations, indicating an increase in their sense of control over fear.

Study 2 - A randomized controlled study of earthquake simulation treatment combined with single-session behavioral treatment

Figure shows results in all survivors, including controls after treatment

IMPLICATIONS OF FINDINGS

• Combined treatment achieves 20% more reduction in PTSD than single-session behavioral treatment alone. Therefore, combined treatment should be the preferred option, whenever an earthquake simulator is available.

• EST can help survivors who are unable to initiate self-exposure because of high levels of anxiety.

• Groups of 5 to 10 people could be treated in a single session. This means EST is 50 to 100 times more cost-effective in terms of therapist time, compared to traditional treatments involving 10 sessions per person.

• The resilience-building effects of EST suggest that the intervention could also be used in psychologically preparing people against the traumatic effects of future earthquakes in earthquake-prone countries.
  

References
Basoglu et al (2003) A single session with an earthquake simulator for traumatic stress in earthquake survivors. American Journal of Psychiatry, 160, 788-790.
Basoglu et al (2007) Single-session behavioral treatment of earthquake-related posttraumatic stress using an earthquake simulator: A randomized waitlist controlled study, Psychological Medicine, 37, 203-213