September – October 2008 http://pdm.medicine.wisc.edu Prehospital and Disaster Medicine COMPREHENSIVE REVIEW Abstract Given the personal and societal costs associated with acute impairment and enduring post-traumatic stress disorder (PTSD), the mental health response to disasters is an integral component of disaster response planning. The pur- pose of this paper is to explore the compatibility between cognitive-behavioral psychology and the disaster mental health model, and explicate how cognitive- behavioral perspectives and intervention methods can enhance the effective- ness of disaster mental health services. It is argued that cognitive-behavioral methods, if matched to the contexts of the disaster and the needs of individ- uals, will improve efforts to prevent the development of PTSD and other trauma-related problems in survivors of disaster or terrorist events. First, the similarities between models of care underlying both disaster mental health services and cognitive-behavioral therapies are described. Second, examples of prior cognitive-behavioral therapy-informed work with persons exposed to disaster and terrorism are provided, potential cognitive-behavioral therapy applications to disaster and terrorism are explored, and implications of cogni- tive-behavioral therapy for common challenges in disaster mental health is discussed. Finally, steps that can be taken to integrate cognitive-behavioral therapy into disaster mental health are outlined. The aim is to prompt disaster mental health agencies and workers to consider using cognitive-behavioral ther- apy to improve services and training, and to motivate cognitive-behavioral researchers and practitioners to develop and support disaster mental health response. Ruzek JI, Walser RD, Naugle AE, Litz B, Mennin DS, Polusny MA, Ronell DM, Ruggiero KJ, Yehuda R, Scotti JR: Cognitive-behavioral psychology: Implications for disaster and terrorism response. Prehospital Disast Med 2008;23(5):397–410. Introduction In the immediate aftermath of large-scale events and/or acts of terrorism, many of the survivors understandably experience shock, anguish, anxiety, and various symptoms associated with acute stress. Acute stress reactions involve a range of experiences, including painful re-experiencing of the event, emotion- al disengagement, difficulties with short-term memory, concentration, deci- sion-making, insomnia, hyperarousal, and exaggerated startle reactions. The acute psychological effects of trauma also can strain relationships and lead to impairments in work and school functioning. Even though the acute impact of disasters can be disruptive, most people do not require professional assistance 1,2 and return to normal functioning of their own accord. Nevertheless, between 9% and 37% of individuals exposed to traumatic events, will develop post-trau- 1. National Center for Post-Traumatic Stress Disorder, Veterans Administration (VA) Palo Alto Health Care System, Menlo Park, California USA 2. Western Michigan University, Kalamazoo, Michigan USA 3. National Center for Post-Traumatic Stress Disorder, Boston Veterans Affairs Health Care System, and Boston University School of Medicine, Boston, Massachusetts USA 4. Yale University, New Haven, Connecticut USA 5. Minneapolis Veterans Administration Medical Center, and University of Minnesota Medical School, Minneapolis, Minnesota USA 6. Massachusetts General Hospital, Boston, Massachusetts USA 7. Medical University of South Carolina, Charleston, South Carolina USA 8. Mount Sinai School of Medicine, and Bronx VA Medical Center, Bronx, New York USA 9. West Virginia University, Morgantown, West Virginia USA Correspondence: Josef I. Ruzek, PhD National Center for PTSD VA Palo Alto Health Care System Mail Code PTSD 334 MPD 795 Willow Road Menlo Park, CA 94025 USA E-mail: josef.ruzek@va.gov Keywords: cognitive-behavioral therapy; disaster mental health; disaster response planning; immediate response; post-traumatic stress disorder; psychotherapy integration; terrorism; trauma Abbreviations: DiMAG = Disaster Mitigation Advisory Group ISDR = International Strategy for Disaster Reduction Cognitive-Behavioral Psychology: Implications for Disaster and Terrorism Response Josef I. Ruzek, PhD; 1 Robyn D. Walser, PhD; 1 Amy E. Naugle, PhD; 2 Brett Litz, PhD; 3 Douglas S. Mennin, PhD; 4 Melissa A. Polusny, PhD; 5 Dianna M. Ronell, PhD; 6 Kenneth J. Ruggiero, PhD; 7 Rachel Yehuda, PhD; 8 Joseph R. Scotti, PhD 9 PAHO = Pan-American Health Organization SEARO = Southeast Asia Regional Office WADEM = World Association for Disaster and Emergency Medicine WHO = World Health Organization Received: 02 October 2007 Accepted: 18 October 2007 Revised: 25 January 2008 Web publication: 30 October 2008