Confronting Trauma

Background The global problem of psychological trauma can hardly be overestimated. Big-picture ‘guesstimates’ of the current levels of trauma are staggering, running into the hundreds of millions of victims. Trauma adversely affects human and socioeconomic development, and even peace.

Trauma has not received the attention it deserves from the international community, including the United Nations (UN).

General lack of awareness about the availability of suitable, affordable, recognized and scalable treatment modalities has led to very low budgets being allocated for trauma treatment (and for the wider issue of mental health).

Recent innovations in trauma psychology have opened up new possibilities that could benefit affected populations, including personnel of organizations dealing with violent conflicts and natural disasters. Leaders and stakeholders in the international community need to be aware of these positive developments.

Large-scale trauma healing could enhance social, economic and cultural productivity, and individual educability, creativity and well-being. Effective trauma treatment could help break the chains of intergenerational violence, ending immense and insidious inner suffering.

Shehzad Noorani

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What are stress and trauma?

Psychological traumas are emotionally painful and distressing experiences that may overwhelm an individual’s ability to cope.

Trauma is a form of severe stress. Stress is the response of the entire person (physically, psychologically, spiritually, socially) to internal and external demands. Stress may be positive (e.g. when it motivates learning or higher performance), but can also have negative consequences if it is perceived to be undesirable, occurs in the context of other stressors, and is hard to predict/ control.

Traumatic stress is caused by events that are shocking and by emotionally overwhelming situations that may involve actual, or threaten, death, serious injury, or threat to physical integrity (*ISTSS). Such situations are generally, but not necessarily, outside the range of ‘usual’ experiences.

UN Photo/Stuart Price

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Post-traumatic stress disorder (PTSD) is a severe and disabling condition that may develop after an individual is exposed to one or more traumatic events, such as sexual assault, serious injury or the threat of death. PTSD is accompanied by symptoms such as disturbing recurring nightmares or flashbacks, avoidance or numbing of memories of the event, and high levels of anxiety.

These symptoms may show up immediately or lie dormant for weeks, months or even years. They can come up gradually or suddenly. Anything can trigger them: a gesture, a memory, a noise, a word or even a scent. If left untreated, PTSD does not ‘get better’ with time; instead, the symptoms and consequences of PTSD may last a lifetime.

*ISTSS - International Society for Traumatic Stress Studies

UN Photo/Antonio Tibaldi

Causes and consequences The causes of trauma, including PTSD, are many (see diagram of trauma tree) and so are its consequences. PTSD interferes with an individual’s educability, creativity and well-being. It also undermines the social, economic and cultural productivity of victims/survivors and of whole communities. Unresolved trauma, due to torture, abuse, bullying, humiliation or any other cause, may produce post-traumatic anger, an urge to revenge, impulsive aggression or lingering resentment that may erupt at any time to produce violence and new traumas in others. This is the intergenerational transmission of trauma - and causes wars and conflicts to perpetuate their violence.

Diagram: trauma tree

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Trauma healing Three effective approaches to trauma are now available and endorsed by the World Health Organization (WHO). They are:

PFA aims to provide an immediate humane, supportive response to people who have been exposed to traumatic circumstances or events. PFA can be practised by anybody interested in first aid, but only mental health professionals may dispense CBTTF and EMDR Therapy. However, efforts are currently underway to test these therapies in a simplified but effective form using paraprofessional workers. These developments hold great promise for scaling up in the near future.

CBT-TF aims to change the way victims/survivors feel and act by helping to change negative thoughts and behaviour patterns. It is mainly delivered through talking. EMDR Therapy aims to capitalize on the brain’s natural mechanism to process traumatic memories in a healthy way. This is achieved by recall of the traumatic memory while moving the eyes, which in turn stimulates the brain.

Shehzad Noorani

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Confronting stress and trauma Confronting Stress and Trauma: A Resource Kit for Personnel Dealing with Violent Conflicts and Natural Disasters provides the framework for a series of blended courses (a combination of online and face-to-face sessions), aimed at different target audiences. While the first course is designed for crisis personnel dealing with violent conflicts and natural disasters, subsequent courses will specifically address staff of international, regional and national/local organizations working with refugees and internally displaced populations (IDPs), survivors of sexual violence and torture, former combatants (including former child soldiers) and war veterans, survivors of natural disasters, crimes, abuses, and accidents. Although psychological treatment methods remain the same, the different contexts and content of the traumatic events call for specific adaptations.

Each course includes an advocacy module entitled To Confront the Global Burden of Trauma, which is aimed at key stakeholder audiences mostly at policy level, including diplomats, policymakers, politicians, donors, humanitarian leaders, journalists, and other human development stakeholders. This advocacy module presents the nature, extent and severity of the problem of psychological stress and trauma. It also aims to make the case to policy-makers for a bold plan to confront trauma globally, by 6

Confronting stress and trauma: a resource kit for personnel dealing with violent conflicts and natural disasters The first blended course is primarily designed to support and guide crisis personnel (humanitarian aid workers from NGOs and IGOs, as well as military, police and civilian peacekeepers, inside or outside the UN, during or after deployment) who have experienced an extremely distressing and traumatic event. The course will also be useful for crisis personnel in training, to raise their awareness about stress and trauma, and has lessons for those in strategic leadership and management roles. It offers an understanding of psychological stress and traumas, their origins, symptoms and the impact they have on people. The course highlights ways to strengthen resilience, reduce the risk of burnout and vicarious trauma, and describes effective treatments and other sources of support that may be available.

UN Photo/Sylvain Liechti

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Context Crisis personnel are in key positions of responsibility, as their presence and interventions in unstable settings aim to prevent casualties and safeguard human life. Their mandates are increasingly complex with many new tasks added, including the protection of civilians. They may themselves carry burdens of past traumas; they may be confronted with traumatic experiences on site; and/or they will come across peers who show stress or trauma symptoms. They will undoubtedly find themselves in positions to help or refer civilians in the community who are stressed or traumatized.

It is therefore important that crisis personnel learn to recognize early signs of stress and trauma, in themselves, as well as in others, to assess the symptoms and to manage needed follow-up. Through blended learning, crisis personnel and their managers can learn prompt and appropriate responses, including self-care, and (self-)referral in cases where more advanced professional and psychological skills are needed.

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UN Photo/Daniel Morel

The course The course represents a contribution to the application and dissemination of practical, effective and safe trauma treatment.

The course, to be completed over four to six weeks, is based on the resource kit, which is made up of eight modules.

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UN Photo/Marco Dormino

How to register Course schedule The course will be open upon request throughout the year.

Both groups and individuals will be eligible to participate. For institutions interested in enrolling a larger number of participants, please contact ptp@unitar.org; for individuals, please check course dates at: www.unitar.org/event or visit the website of any of the three partner organizations.

Certificates Successful course participants will receive a Certificate of Completion from UNITAR after successful participation in the course. Certificates will be signed by the UNITAR Executive Director or his/her authorized representative.

Technical requirement for the online component Flash: Flash player 10 or later (http://www.adobe.com/go/getflash) and one of the following browsers: Windows: Internet Explorer 6 and later, Google Chrome, Opera 9.5 and later; Mac: Safari 3 and later, Firefox 1.x and later, Linux: Firefox 1.x and later; HTML5

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UN Photo/Martine Perret