Cognitive Behavioral Therapy for Post-Disaster Distress

A Promising Transdiagnostic Approach to Treating Disaster Survivors

Disasters are surprisingly common. In the last 10 years, there have been an average of 125 U.S. federally declared disasters per year. Not to mention the large number of smaller, local disasters that do not make national news or federal attention. Studies show that during disasters the occurrence of violence increases dramatically, especially sexual violence and domestic violence. During and after disasters, victim services agencies should be prepared to treat survivors of crime and violence, but also knowledgeable of treatment options for those who are suffering because of the disaster, those who may have post-disaster distress.

A recent study published in the Journal of Psychological Trauma: Theory, Research, Practice, and Policy by Jessica L. Hamblen, Fran H. Norris, Kerry A. Symon and Thomas E. Bow explored how survivors of disasters, such as Hurricanes Katrina and Sandy, could be treated for post-disaster distress. Post-disaster distress encompasses a range of cognitive, emotional, and behavioral reactions to disaster including symptoms of PTSD, depression, stress vulnerability, and functioning difficulties.

Cognitive behavioral therapy for post-disaster distress (CBT-PD) was developed to treat post-disaster distress in disaster and emergency situations. It is an 8 to 12 session intervention that works to identify and challenge maladaptive disaster related beliefs. It is conceptualized as a transdiagnostic treatment because it targets the core psychological processes of negative affect and avoidance that underlie a range of disorders common after disaster, rather than a specific disorder, such as PTSD or depression. CBT-PD includes four components psychoeducation, breathing retraining, behavioral activation, and cognitive restructuring. In this study, participants received the therapy in their homes, emergency relocation shelters, or new places of residence.

Participants in this study:

  • 80% were women
  • Average age was 57
  • 80% were non-Hispanic White
  • 12% were African American

Key Study Results

CBT-PD allows for a single treatment to address a range of presenting problems. CPT-PD is less stigmatizing and less expensive because patients do not require a psychiatric diagnosis or referral. Having more mid-level style mental health options also frees up the time and resources of the psychiatrists in the area to treat those with more severe psychiatric problems or diagnoses.

  • Participants had significant decreases in distress
  • All symptoms showed improvement over the course of the intervention and 5 months post-treatment:
    • Including general distress, intense reactions, avoidance, social dysfunction, and depression
  • This study shows that structured therapeutic interventions can be delivered in real-world post disaster situations
  • New York and Florida have initiated CBT-PD as part of state mental health responses funded by FEMA’s crisis counseling program

Consider Your Community

Service providers should pay attention to disasters, shootings, and other traumatic events in your area that may lead to an increase in post-disaster distress in your community.

Things to consider:

  • Finding local therapists who are interested in providing CBT-PD to disaster survivors
  • Being prepared for a potential increase in survivors during and/or following a disaster
  • Examining policies and procedures within your organization to ensure that staff are prepared to work with survivors of disasters who are also victims of crime and/or violence

    For more information on this study, see the abstract here: