Thanks much for sending along, Mike. I have not yet read the Marshall
and Galea article and can't access it using my university computer
system. Do you know which two surveys they're referring to? My
understanding is that the major surveys conducted after 9/11 showed an
initial spike in PTSD symptoms followed by a pronounced regression back
to normal levels by about 5 months or so after the trauma. Moreover,
at least one of the major surveys, conducted by RAND, has been widely
criticized for setting extremely low thresholds for PTSD symptoms (but
I don't know if this is one of the surveys that Marshall and Galea are
referring to). Am curious to hear more...Scott
P.S. I certainly agree that researchers should not confine themselves
to looking at psychological after-effects of 9/11. I've not heard
anything about a heightened risk of heart attacks following 9/11, but
of course agree that this issue should be examined further.
Mike Palij wrote:
Editorial Note: one drawback of getting TiPS in
digest form is that one has to wait a day to see what
responses are made in a thread. I've checked the
website and noticed that there are two posts by
Scott Lilienfield that I would like to follow-up
(actually, I already followed up to one in email
but didn't realized that he had cc'ed me on a post
that he made to TiPS). Unfortunately, TiPS
doesn't allow one to respond directly to the list
from the website, so I've had to cut and past
the message below to respond to it.
Re: anti-therapy
Scott Lilienfeld
Thu, 02 Jun 2005 08:46:03 -0700
Ruth: Very good questions.....
I'm not aware of much survey data (which I suspect
we'd need) to address the question of how widespread
this general belief is. I would certainly say, however,
that it seems to be quite widespread in much of the
"popular psychology" community. Witness, for example,
the predictions by numerous mental health experts
following 9/11 of a massive epidemic of PTSD across
the country, which never materialized (the only markedly
increased rate of PTSD following 9/11 occurred in
lower Manhattan, and even then, most individuals didn't
experience PTSD).
I admit to being curious about the above statements,
(a) which specific experts made the claim of a "massive
epidemic" (what would that mean in actual numbers) and
(b) how Scott's comments on the limited amount of PTSD
experienced squares with the following:
R.D. Marshall and S. Galea, Science for the community:
Assessing mental health after 9/11, J Clin Psychiatry 65
(2004) (suppl. 1), pp. 37-43.
Abstract
Reactions to the September 11 attacks across the United
States were pervasive, and persons throughout the country
reported experiences akin to posttraumatic stress disorder
(PTSD) in the first week following the attacks. In the
New York area, 2 major surveys conducted 4 to 8 weeks
after the attacks found that approximately 1 in 10 persons
probably met full criteria for PTSD related to September 11.
Although tobacco, alcohol, and marijuana use did increase,
it was largely among persons already using these substances.
The greatest increase, not surprisingly, occurred among
persons with PTSD and major depressive disorder.
Nationwide during the same time period, rates of PTSD
related to September 11 were estimated at 2.7% to 4.3%,
a striking finding in that the attacks were witnessed primarily
on television outside the New York area. In all studies, having
anxiety symptoms or meeting criteria for PTSD was strongly
associated with number of hours of television watched on
September 11 and in the days afterward. A number of
explanations for this new finding are possible. These data
can inform our understanding of trauma-related diagnoses,
further the evolving diagnostic definitions of the Diagnostic
and Statistical Manual of Mental Disorders, and contribute
to etiologic models of PTSD. Future directions for postdisaster
survey research are briefly discussed.
I would also like to point out that focusing on just on PTSD
would miss the larger psychological and medical effects of
the 9/11 attacks, many of which are still under study. If I
may be allowed to provide an ancedote: my physician is
associated with a major NY medical center and actually
helped out at WTC in the days after 9/11. However, what
he found odd was that in the weeks following 9/11, the
number of persons experiencing heart attacks (and subsequent
deaths) seemed to rise significantly, even among people who
were not at the WTC. I assume that someone is looking at
this and will determine whether it is a real phenomenon or not
but the bottom line is that one shouldn't just limit the effects
of 9/11 to "just" psychological responses.
As for Scott's follow-up post to me regarding independent
replication of Pennebacker's results, I had sent him two
references via email (I didn't realize he had posted the request
to TiPS) and I reproduce them below along with a few others
I found afterwards:
Stone AA. Smyth JM. Kaell A. Hurewitz A. (2000).Structured
writing about stressful events: exploring potential psychological
mediators of positive health effects. Health Psychology. 19(6),
619-24..
Smyth JM. Stone AA. Hurewitz A. Kaell A. (1999).
Effects of writing about stressful experiences on symptom
reduction in patients with asthma or rheumatoid arthritis:
a randomized trial. JAMA. 281(14):1304-9, 1999 Apr 14.
Greenberg, M.A., Wortman, C.B., & Stone, A.A. (1996).
Emotional _expression_ and physical health: revising traumatic
memories or fostering self-regulation?
Journal of Personality and Social Psychology, 71(3), 588-602.
Christensoen, A.J., Edwards, D.L., Wiebe, J.S., Benotsch, E.G.,
McKelvey, L., Andrews, M., & Lubaroff. D.M. (1996).
Effect of verbal self-disclosure on natural killer cell activity:
moderating influence of cyncial hostility. Psychosomatic
Medicine, 58(2): 150-5.
Kelley, J.E., Lumley, M.A., & Leisen, J.C. (1997). Health
effects of emotional disclosure in rheumatoid arthritis patients.
Health Psychology, 16(4), 331-340.
(Note: the following is an interesting cognitive spin on the issue)
Klein, K., & Boals, A. (2001). Expressive writing can increase
working memory capacity. Journal of Experimental Psychology:
General, 130(3), 520-33.
Gidron, Y., Duncan, E., Lazar, A. Biderman, A., Tandeter, H.
& Shvartzman, P. (2002). Effects of guided disclosure of stressful
experiences on clinic visits and symptoms in frequent clinic
attenders. Family Practice, 19(2), 161-6.
Norman, S.A., Lumey, M.A., Dooley, J.A., & Diamond, M.P.
(2004). For whom does it work? Moderators of the effect of
written emotional disclosure in a randomized trial among women
with chronic pelvic pain. Psychosomatic Medicine, 66(2), 174-83.
Hemenover, S.H. (2003). The good, the bad, and the healthy:
impacts of emotional disclosure of trauma on resilient self-concept
and psychological distress. Personality and Social Psychology
Bulletin, 29(10), 1236-44.
The above studies demonstrate some positive benefits to
emotional disclosure that appear to be independently demonstrated
(i.e., reading of PsychInfo abstract provided no participation by
Pennebacker). So, it appears that Pennebacker's self-disclosure
effects have been independently replicated by different researchers
and in different populations. However, that being said, it is not
universally true that emotional self-disclosure produces benefits
(as shown by the Stroebe et al 2002 ref below), rather, some
groups seem to benefit from it more than others and, as represented
by the Norman et al 2004 article cited above, the question is
"For Whom Does It Work?".
Stroebe, M., Stroebe, W, Schut, H., Zech, E., van den Bout, J.
(2002). Does disclosure of emotions facilitate recovery from
bereavement? Evidence from two prospective studies.
Journal of Consulting and Clinical Psychology, 70(1), 169-78.
Mike Palij
New York University
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Scott O. Lilienfeld, Ph.D.
Associate Professor
Department of Psychology, Room 206
Emory University
532 N. Kilgo Circle
Atlanta, Georgia 30322
(404) 727-1125 (phone)
(404) 727-0372 (FAX)
Home Page: http://www.emory.edu/PSYCH/Faculty/lilienfeld.html
The Scientific Review of Mental Health Practice:
www.srmhp.org
The Master in the Art of Living makes little distinction between his work and his play, his labor and his leisure, his mind and his body, his education and his recreation, his love and his intellectual passions. He hardly knows which is which. He simply pursues his vision of excellence in whatever he does, leaving others to decide whether he is working or playing. To him – he is always doing both.
- Zen Buddhist text
(slightly modified)
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