Disaster mental health response

I was glad to see the several articles on responding to Katrina in the December Monitor. I was disappointed, however, by what seemed to me to be an overly heavy focus on providing individual psychological support to "help quell the inner storms" of individual Katrina "victims," and the lack of emphasis on providing broad, long-term psychosocial support for survivor communities and disaster workers.

Research on the effects of disasters worldwide suggests that most survivors of disasters are resilient. Some survivors may need individual mental health interventions, either in the immediate wake of the disaster or over the following months. But most of those affected by a disaster will not need ongoing individual mental health services. This implies that most "psychosocial" interventions for most survivors of catastrophic events are not made by providers of specialized mental health services and are not directed solely at individuals. Rather, they are made by all those who contribute to social and material recovery, in the many weeks and months following the disaster, as well as in the first stages of response.

One important, though indirect, way for mental health professionals to help the immediate survivors of a disaster is to help ensure the psychological well-being of the aid workers.

But even with respect to providing support for aid workers, individual intervention may not be the most important approach. The personal capacities and stress-reduction activities carried out by individual aid workers probably account for less of the variability in psychological outcome than do leadership and work-team (i.e., social support) factors. These are factors that are, to a greater or lesser degree, under the control of the organizations and agencies that employ aid workers.

Consequently, psychologists concerned with disaster response are paying increased attention to generating and disseminating information regarding the agency role in stress management. Over the last few years, several Web sites have been developed to provide resources for staff and agencies with respect to stress reduction and management (see www.psychosocial.org, www.headington-institute.org and www.humanitarian-psy.org). In addition an international working group of experts, assembled by the Antares Foundation, has prepared a set of "Guidelines for Managing Stress in Humanitarian Aid Workers," which is now being circulated widely in the humanitarian aid community.

John H. Ehrenreich, PhD

Sherman, Conn.

Marriage education effectiveness

The article 'Empirical research and family policy' (November Monitor) makes two important claims about the effects of marriage education. Some studies support these claims, but contradictory findings suggest caution in using current strategies in government-sponsored interventions.

The first claim, that 'marriage education improves couples' communication and problem-solving skills,' is not uniformly supported in studies of interventions designed to change communication. Halford and colleagues (2001) found differences after 12 months between couples receiving marriage education and control couples on one observed behavior-negative nonverbal communication-but not on conflict behavior, invalidation, positive discussion behavior or validation. A 2004 study by this same team revealed no treatment-control differences in communication.

Contrary to the second claim, that 'couples who learn to communicate more effectively report higher levels of marital satisfaction,' communication change and satisfaction are sometimes unrelated. Despite finding very few communication differences between treatment and control groups, Halford et al. (2001, 2004) did report changes in satisfaction. Studies by Kaiser et al. (1998) and Laurenceau et al. (2004) find the opposite: Interventions change behavior but not satisfaction. And other studies report paradoxical effects: Schilling and colleagues (2003) found that improvements in positive communication predict greater marital distress over five years.

Empirical research does not yet permit simple, unqualified statements about the effects of marriage education. The time is right for careful tests of models that capture unexamined influences (e.g., stress and poverty), and this work is likely to provide a more robust foundation for government efforts to enhance families.

Thomas Bradbury, PhD

University of California, Los Angeles