Control-Focused Behavioral Treatment of Earthquake Survivors Using Live Exposure to Conditioned and Simulated Unconditioned Stimuli

Abstract

Earthquakes lead to increased rates of mental health problems in the communities they struck. Few attempts have been made to develop effective psychological care strategies for earthquake survivors. During the course of our 6-year work with earthquake survivors in Turkey, we developed a control-focused behavioral treatment (CFBT) that aims to enhance survivors' resilience against traumatic stressors by helping them develop a sense of control over them. CFBT exposes the client to either (a) unconditioned stimuli (i.e., earthquake tremors) in a safe and controlled environment or (b) conditioned stimuli (e.g., earthquake reminders) until the person can tolerate and control associated distress. A single session of CFBT involving instructions to conduct self-exposure to distressing earthquake reminders achieved about 60% reduction in posttraumatic stress symptoms, resulting in global improvement in 80% of the survivors. The efficacy of CFBT was maximized by exposure to simulated earthquake tremors in an earthquake simulator. In a randomized controlled trial, earthquake simulation treatment combined with therapist-delivered instructions for self-exposure to conditioned trauma cues achieved 79% improvement in PTSD symptoms, resulting in generalized improvement in 92% of the cases. The relapse rate was very low in all studies despite ongoing threat to safety caused by numerous aftershocks and expectations of another major earthquake, suggesting increased resilience against traumatic stress induced by earthquakes. Evidence also suggests that CFBT can be effectively delivered as a self-help intervention using booklets and similar media. Based on variants of CFBT, a mental health care model for disaster survivors is proposed.