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Section 3
Cognitive Behavioral Therapy for Postdisaster Distress

Question 3 | Test | Table of Contents

In the previous section, we discussed strategies to use during the trauma. They include situational evaluation, vital self-care actions, and self-evaluation of shutting down or fading out.

In this section, we will discuss using the Future-Pull Approach to help natural disaster PTSD clients to focus on their future instead of dwelling on the past.

Often when dealing with trauma, especially when dealing with the trauma of natural disaster, clients tend to look into the past in order to cope with the trauma. With this technique, I encourage my clients to focus on the future in order to help influence their actions in the present in a positive way. I call this a Future-Pull Approach.

With the future-pull approach, clients are re-oriented from revisiting the past to focus more on future-oriented thinking. Here are a few tips to use to make the Future-Pull Approach successful with your client.

Tip 1: Reframing and Redirecting
I begin by redirecting my clients from their past to their future. By doing so, I turn their problems into preferences. To do this requires a subtle redirection from thoughts of the past (reflections, complaints, problems, pain, etc.) to positive thoughts about the future (longings, solutions, hope, etc.).

If you recall, Julie from the first section had lost her house in a hurricane while she was in the hospital having a baby. Julie was struggling with her conflicted feelings toward her baby boy. Julie stated, "I am frightened about how my husband and I will be able to raise our son in such an unstable time in our lives. I become really upset when I think that it would be better off if he had never been born. More than anything I want my son in my life."
Here is how I used Reframing and Redirecting with Julie.

1. Turn problems into preferences
Regarding turning problems into preferences, the problem for Julie is, "We have no place to live." Reframing this as a preference would look like this: "I would prefer a permanent home to live in rather than the transitional shelter we are in now."
2. Rephrase what the client does not want to what they do want
Julie rephrased her statement, "I do not want to raise my baby in such awful, unstable conditions." to "I do want a permanent, safe, clean home environment in which to raise my child."
3. Reorient from the past to the future
Reframe a renumeration of Julie’s trauma of seeing her flattened home to partialize and prioritize the first small step taken to find permanent housing, for example providing the phone number for disaster relief.
4. Focus on the presence of something instead of the absence of something else. Reframing the absence of lost family photos: "The beautiful baby bed her husband had finished," the furniture they had saved so long to purchase, etc.…reframe this to the presence of her healthy baby and her husband who still has a source of employment.
5. Encourage your client to focus on small steps rather than big changes
To assist Julie in focusing on small steps, I encouraged her with the phrase, "think small." In other words, what is the next small step she and/or her husband might do. When I sensed she was spinning into overwhelmingness, I would say to her, "Think small. What is the next small step that you might do?"

Keep in mind, of course, with the above 5 Reframing and Redirecting techniques that you are sensitive to the client's natural need to vent. However, reframing and redirecting moves them forward from the past "if only it hadn’t happened" stance of being stuck and not taking the needed action to improve their situation.

Tip 2: Expectancy Talk
With clients that have been through trauma, not only is it important to have them focus on the future rather than the past but it is also important to encourage a positive view of their future. To do this requires using phrases and questions that create a belief in a positive or improved future. Phrases like: "How quickly?", "Yet", "So Far", "After", "Before", "When", "Will".

While in a session with Julie, who was traumatized by a hurricane, using expectancy talk led to the following discussion:
Me: Thinking realistically, how long do you think it would take to lift this depression?
Julie: If something really helped I think days or a week.
Me: When this improvement happens, who would be the first person, other than you, to notice you feeling better?
Julie: At work they might notice since I would probably get my work done on time and speak up more at meetings.
Me: Who else?
Julie: Probably my brother since he tends to notice that stuff.
Me: What do you think he would notice?
Julie: He can always tell by my voice if I am in a bad or good mood.
Me: Have you found a way to diminish your flashbacks or stop your cutting?
Julie: …
Me: Do you think when the dissociation lessens, you will be more connected to people and the world?
Julie: I think that I would be more myself
Me: How have you acted when you feel disconnected?
Julie: I am definitely more quiet and alone with my thoughts. Usually I stay alone.
Me: So when things get better you will be more talkative?
Julie: Yeah.

Tip 3: Letter to Your Future Self

With clients who have suffered trauma after a natural disaster, like Julie who is living through the trauma of surviving a hurricane, I encouraged her to write a letter to her future self. Here are the four guidelines I give Julie to include in her letter:
1. Write a letter from your future self to your current self from a happier place where you have resolved your issues that are troubling you now.
2. Have your future self describe where you are, what you are doing, what you have gone through to get there, and so on.
3. Your future self can include the crucial things you realized or the steps you took to get to where you are. Write about crucial points that led to your future.
4. Give your present self some advice, and words of encouragement, from the future.

In this section we have discussed using the Future-Pull Approach to help natural disaster PTSD clients in order to focus on their future instead of dwelling on the past.

In the next section we will discuss revisiting the site of the trauma and how your client can make this a successful trip.
Reviewed 2023

Update
The effect of an Internet-based cognitive behavioral therapy
intervention on social support in disaster evacuees

Frenette, É., Ouellet, M. C., Guay, S., Lebel, J., Békés, V., & Belleville, G. (2023). The effect of an Internet-based cognitive behavioral therapy intervention on social support in disaster evacuees. Journal of clinical psychology, 10.1002/jclp.23497. Advance online publication. https://doi.org/10.1002/jclp.23497


Peer-Reviewed Journal Article References:
Everett, A., Sugarman, O., Wennerstrom, A., Pollock, M., True, G., Haywood, C., Meyers, D., Raines, A., Wells, K., Johnson, A., Arevian, A. C., Sato, J., & Springgate, B. (2019). Community-informed strategies to address trauma and enhance resilience in climate-affected communities. Traumatology. Advance online publication. 

Fox, J., Gupta, R., & Mitchell, G. (2018). Considering developmental concepts from attachment theory to inform graduate student training in global trauma and disaster psychology. International Perspectives in Psychology: Research, Practice, Consultation, 7(3), 189–201.

Grolnick, W. S., Schonfeld, D. J., Schreiber, M., Cohen, J., Cole, V., Jaycox, L., Lochman, J., Pfefferbaum, B., Ruggiero, K., Wells, K., Wong, M., & Zatzick, D. (2018). Improving adjustment and resilience in children following a disaster: Addressing research challenges. American Psychologist, 73(3), 215–229. 

Hamblen, J. L., Norris, F. H., Symon, K. A., & Bow, T. E. (2017). Cognitive behavioral therapy for postdisaster distress: A promising transdiagnostic approach to treating disaster survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 9(Suppl 1), 130–136.

Osofsky, H. J., Weems, C. F., Hansel, T. C., Speier, A. H., Osofsky, J. D., Graham, R., King, L., & Craft, T. K. (2017). Identifying trajectories of change to improve understanding of integrated health care outcomes on PTSD symptoms post disaster. Families, Systems, & Health, 35(2), 155–166. 

Smid, G. E., van der Velden, P. G., Gersons, B. P. R., & Kleber, R. J. (2012). Late-onset posttraumatic stress disorder following a disaster: A longitudinal study. Psychological Trauma: Theory, Research, Practice, and Policy, 4(3), 312–322. 

QUESTION 3
What are five techniques for reframing and redirecting a client who has experienced a natural disaster? To select and enter your answer go to Test.

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