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New Guidelines from WHO on Treating Trauma

Posted on Aug 15, 2013 by Ailee Slater ()  | Tags: anxiety, bereavement, mental health, post-traumatic stress disorder, psychological trauma, trauma, WHO, World Health Organization

In the majority of its work, the World Health Organization focuses on physical health care: chronic disease, childhood disability, communicable illness and so on. However, in the past few years, WHO has put more and more focus upon mental health issues. In 2008, WHO created the Mental Health Global Action Programme, and just this August, the organization released important new guidelines instructing first-response and other health workers on how to care for patients suffering trauma or bereavement.

The Guidelines for the Management of Conditions Specifically Related to Stress were published by WHO, along with the United Nations High Commissioner for Refugees. Focusing on long-term post-traumatic stress disorder (PTSD); acute stress immediately following a traumatic event; and bereavement, these guidelines were created to address a lack of similar instructional material available for non-specialized health care workers. A first-response medic attending to earthquake victims, for example, may have little training in how to offer psychological support to a patient showing signs of mental as well as physical trauma. With a better protocol in place, that medic can be trained beforehand in simple techniques for addressing a patient's mental health needs.

In a press release from WHO introducing the guidelines, WHO Assistant Director-General for Noncommunicable Diseases and Mental Health Dr. Oleg Chestnov says that his department has for some time been receiving requests to better address the needs of trauma victims. Dr. Chestnov notes that with the newly released guidelines on managing traumatic stress and bereavement, health care workers without training in mental health issues should be able to offer more support and care to victims experiencing PTSD or another stress-related disorder.

For example, the guidelines recommend that for patients experiencing acute stress in the first month after a traumatic event, health care workers should consider cognitive-behavior therapy for the patient. In cognitive-behavior therapy, or CBT, a therapist will work with the patient to modify thoughts and behavior; conditioning the patient to experience less stress when faced with a traumatic memory. CBT has been shown to reduce the symptoms of anxiety and other mental troubles that can interfere with a survivor's ability to function on a day-to-day basis. Of course, in order to ensure that competent staff are available to provide cognitive-behavior therapy, more training in this treatment must be provided for health care workers - and WHO is hopeful that, with these new guidelines, such therapeutic training will become more common.

The guidelines also offer information on how to address insomnia in patients undergoing trauma-related stress. Firstly, health care workers are advised to treat any physical causes of sleeplessness; chronic pain, for example, or even exposure to an unusually noisy nighttime environment. Then, the guidelines state that if the insomnia is indeed trauma-related and debilitating, a health worker should offer the patient relaxation techniques and advice on better sleeping practices. Again, initial training for health care workers on how to resolve trauma-related insomnia will be useful to both medic and patient.

Along with information on assisting adult trauma survivors, the guidelines also include care protocol for helping children who have undergone a traumatic event or are experiencing severe bereavement. Some children will experience bed wetting following a stressful event, and health care workers should therefore be prepared to offer care in order to reduce these symptoms. The guidelines recommend that health workers give advice to parents or guardians on how to encourage toileting before bed, and create positive reinforcement to help the child overcome bedwetting without the use of punishment. Of course, as with insomnia, the guidelines make clear that medical workers should also assess the patient for other potential causes of bedwetting, in case the symptoms are related to a physical cause unrelated to the trauma experienced.

As well as giving health care workers protocol about what actions are useful for trauma survivors, the guidelines also offer advice about which treatment and first responses should be avoided. For example, if a trauma victim is hyperventilating, having that person breathe into a bag may cause more harm than good - this technique is risky for anyone with asthma or a heart condition, and can actually induce more stress. Instead, the guidelines recommend that a health worker coach the patient in calm, natural breathing techniques in order to keep anxiety at bay.

The guidelines also recommend against the use of anti-anxiety medications for sufferers of post-traumatic stress disorder. Psychoactive drugs to combat anxiety, commonly in the benzodiazepine group, can cause side effects such as constant drowsiness, difficulty concentrating and depression. Because benzodiazepines can also induce dependence, a PTSD sufferer may become addicted to the medication and experience withdrawal symptoms when eventually coming off the medication. These guidelines also discourage the use of anti-anxiety drugs for patients experiencing bereavement; health workers are instead advised to engage in other psychological interventions (such as CBT) and to encourage culturally appropriate mourning.

Many more precautions and recommendations are included in the guidelines, which WHO hopes will be of great use to training programs for health care workers without a thorough knowledge of how to help a patient suffering from psychological trauma, bereavement and stress. These guidelines may be especially useful seeing as a recent WHO study found that, of the research participants in 21 countries, a great deal had experienced trauma: more than 21 percent reported witnessing violence, and more than 18 percent had experienced violence themselves; 16.2 percent said they had been exposed to war, and 12.5 percent had seen trauma occur to a loved one.

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