The profound psychological impact of the 7.8 and 7.6 magnitude earthquakes, the deadliest earthquake disaster in Turkey's history.

What awaits people of all ages and backgrounds affected during and after the earthquake?

Acute stress and trauma, such as an earthquake, negatively affect the human brain and brain-body connection. The most significant initial change in a person's brain is the loss of control, manifesting as acute stress, fear, and panic. If a person, their loved ones, or pets are trapped under rubble, the shock of having to struggle for survival disrupts their ability to make sense of the event. Thus, grief begins for both those directly experiencing the event and those observing it from afar. It is assumed that most people go through the five stages of grief in the face of tragic events. The five stages of grief are known as denial, death, bargaining, depression, and acceptance.

 

In her 1969 book, "On Death and Dying," Swiss and American psychiatrist Elisabeth Kübler-Ross pioneered a theory about the emotional stages patients go through when diagnosed with death.

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** Denial: "No, it's not me, this can't be true."

** Death: "Why, why me?"

** Bargaining: Attempts to delay death through "good behavior."

** Depression: "Unhappiness experienced in response to illness and preparation for death."

** Acceptance: "The final destination on the long journey."

Kübler-Ross described the grieving process as "a defense mechanism that humans use to cope with very difficult situations."**

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Grief is a difficult and disturbing process to control. The idea of ​​having a roadmap for navigating grief provides comfort.

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Post-earthquake migrations are considered another trauma and grief event.

Patients who experience head trauma (TBI and TBH) during an earthquake and develop Post-Traumatic Stress Disorder (PTSD) within 3-6 months after the earthquake generally experience similar symptoms.

The American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, 2000) defines Post-Traumatic Stress Disorder (PTSD) as individuals suffering from a traumatic event experiencing recurring dreams, flashbacks, and hallucinations; avoidance of thoughts, feelings, activities, places, and conversations related to the event; experiencing symptoms of hyperarousal; and having feelings associated with depression.

Several recent studies have shown that PTSD is one of the most common psychological disorders. In the American National Comorbidity Study, Kessler et al. (1995) found that approximately 84% of their sample had disorders at some point in their lives. Individuals with PTSD were found to be eight times more likely to have three or more additional disorders than individuals without a PTSD diagnosis.

The disorders most consistently found to co-occur with PTSD include major depression, other anxiety disorders, substance abuse, somatization disorder, insomnia, and Axis II disorders (personality and mental disorders) (Kessler et al., 1995; Shalev, 2000).

Furthermore, other health-threatening behaviors such as alcohol and drug use and high-risk behaviors (e.g., sexual abuse, unprotected sex, and suicide attempts) have also been associated with PTSD (O'Hare, Shen, Sherrer, 2010). Problems related to aggression toward others have also been observed in war veterans and prisoners with a history of early trauma (Van der Kolk et al., 1991).

Chronic anxiety and emotional numbness have been observed (Pennebaker, 1993). These individuals explain somatosynchronization disorders by their ability to relate to the world through their bodies. They experience distress not only psychologically but also physically (Saxe et al., 1994).

Limited research has examined the rate of PTSD development over time after TBI. One study reported high rates of PTSD symptoms in children who experienced motor vehicle accidents (MVAs) 6 and 13 weeks after injury, but there was no significant difference in PTSD rates for those with and without TBI (Mather et al., 2003).

 

Head injury syndrome (PCS) is the name given to long-lasting symptoms. Symptoms develop following an injury that results in a minor head trauma and persists for 12 months or longer. Patients with PCS experience symptoms that affect their daily lives. They don't seem to subside easily and are resistant to treatment, therefore they are a cause of lifelong disability.

Reported symptoms of PCS include:

Attention deficit and difficulty sustaining mental effort, fatigue and exhaustion, impulsivity, irritability, outbursts of anger and mood swings, learning and memory changes, problems with planning and problem-solving, inflexibility, poor concrete thinking and initiative, dissociation between thought and action, communication difficulties, socially inappropriate behavior, egocentrism, lack of insight and poor self-awareness, impaired balance, headaches, and dizziness.

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The transformation can develop. Personality changes, although rare, can also develop in individuals with TBD, and can be a serious complication.

In both TBD and PTSD groups, substance use disorders, psychosis or bipolar disorder, anxiety, depression, and other non-psychoactive, non-substance use disorders can commonly develop.

In both TBD and PTSD groups, brain maturation in children is negatively affected, and attention deficit, hyperactivity, aggression, sleep problems, urinary and fecal incontinence, anxiety, and depression may develop. If pregnant mothers are caught in an earthquake during the first three months of pregnancy, their chances of premature birth and low birth weight increase, and the likelihood of their children developing schizophrenia is several times higher than in the normal population.

 

According to ElectrodiagnosFC, the Clinical Neuroscience Society, and the Veterans' Administrators' Association, QEEG provides clinicians with accurate laboratory data and has been identified as a suitable diagnostic tool for testing disorders and TBI to aid in the detection and differential diagnosis of several common neuropsychiatric disorders.

Patients with Post-Traumatic Stress Disorder and Head Trauma (TBI and TBD) are often prescribed a combination of psychotropic medications that can worsen the condition. The use of any psychiatric medication during the grieving period is not recommended. Non-drug treatment methods, such as NeuroBiofeedback, have been found effective in facilitating grief, acute or chronic stress, and complaints arising from Post-Traumatic Stress Disorder and Head Trauma. Trauma expert Prof. Dr. Van der Kolk also explains in his studies that EMDR and psychotherapy are effective in Post-Traumatic Stress Disorder.

PTSD (TRAUMATIC POST-STRESS DISORDER):

At least two placebo or randomized studies published in the peer-reviewed journals below provide sufficient scientific evidence for MENTAL HEALTH CLINICIANS (such as specialist/clinical psychologists, psychiatrists) to use biofeedback in PTSD (Traumatic Stress Disorder).

Neurofeedback studies in treatment-resistant children with PTSD and polysymptomatic complaints found a significant effect on mood regulation and execution. It offers opportunities for learning, increased self-efficacy, and significantly improved social relationships. (Rogel et al., 2020)

In a randomized placebo-controlled study of PTSD, neurofeedback was found to be more effective than the control group. This result showed that NF has therapeutic properties in schizophrenia, depression, and epilepsy. (Ros et al., 2007)

A randomized controlled trial involving adults with Chronic Traumatic Illness (CTA) compared NF treatment (i.e., NF [WL] versus waiting list patients) with patients on the waiting list. Both groups showed a statistically significant reduction in CTA symptoms. Furthermore, statistically significant improvements in CTA symptoms were observed with NF one month after treatment. (van der Kolk et al., 2016)

A randomized controlled trial involving adults with CTA showed that when Breath Biofeedback is added to cognitive therapy, it can be safely and effectively applied to contribute to the recovery of CTA patients. (Polak, 2017)

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A randomized controlled study involving adults with chronic post-traumatic stress disorder (CSD) and war veterans combined breath biofeedback with mindfulness therapy and a control group comparison. The breath biofeedback study was found to be significantly more effective than the control group and the meditation-only group in cases of CSD. (Wahbeh, 2016)

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References:

Rogel A, Loomis AM, Hamlin E, Hodgdon H, Joseph Spinazzola van der Kolk B. The Impact of Neurofeedback Training on Children with Developmental Trauma: A Randomized Controlled Study. Psychological Trauma: Theory, Research, Practice, and Policy, 2020, DOI: 10.1037/tra0000648

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Ros T, Frewen P, Théberge J, et al. Neurofeedback Tunes Scale-Free Dynamics in Spontaneous Brain Activity. Cereb Cortex. 2017;27(10):4911-4922.

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van der Kolk BA, Hodgdon H, Gapen M, Musicaro R, Suvak MK, Hamlin E, et al. A randomized controlled study of neurofeedback for chronic PTSD. PLoS ONE [Internet]. 2016 [cited 2017 Oct 17];11(12):e0166752. Available from: https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC5161315/pdf/pone.0166752.pdf

 

Polak AR, Witteveen AB, Denys D, Olff M. Breathing biofeedback as an adjunct to exposure in cognitive behavioral therapy hastens the reduction of PTSD symptoms: a pilot study. Appl Psychophysiol Biofeedback [Internet]. 2015 [cited 2017 Oct 17];40(1):25-31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375291/pdf / 10484_2015_Article_9268.pdf

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Wahbeh H, Goodrich E, Goy E, Oken BS. Mechanistic pathways of mindfulness meditation in combat veterans with posttraumatic stress

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SS disorder. J Clin Psychol. 2016 Apr;72(4):365-83.

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Kessler R, Sonnega A, Bromet E, Hughes M, Nelson C. 1995. Posttraumatic stress disorder in the national comorbidity survey. Arch Gen Psychiatry,52,1048–1060.

 

Shalev A. 2000. Measuring outcome in posttraumatic stress disorder. J Clin Psychiatry, 61,33–39.

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Van der Kolk, B. A., Perry, J. C., & Herman, J. L. 1991. Childhood origins of self-destructive behavior. American Journal of Psychiatry, 148, 1665-1671.

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Pennebaker, J.W. 1993. Putting stress into words: Health, linguistic, and therapeutic implications. Behav. Pic. Therapy, 31(6), 539-548.

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Saxe, G.N., Chinman, G., Berkowitz, R., Hall, K., Lieberg, G., Schwartz, J., & van der Kolk, B.A. 1994. Somatization in patients with dissociative disorders. American Journal of Psychiatry, 151, 1329-1335.

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Mather FJ, Tate RL, Hannan TJ. 2003. Post-traumatic stress disorder in children following road traffic accidents: A comparison of those with and without mild traumatic brain injury. Brain Inj,17(12),1077-1087. [PMID: 14555366]