Early Intervention for Trauma and Traumatic Loss

There is a unique challenge in designing research projects to study interventions for victims of trauma. The victims have been through a situation involving a catastrophic loss of control. They had no control over the disaster and are overwhelmed by anxiety afterward. Recovery involves regaining control over their lives. Patients need to become active participants in their recovery and to make choices. As Brett T. Litz and Matt J. Gray, the editors of Early Intervention for Trauma and Traumatic Loss, so elegantly put it, "We would ask the person what he or she needed and empower that person to decide the kind of help he or she wanted."

And what do researchers want? Control. They want random assignment and a standard treatment protocol. Along the way, the patient must fill out standardized instruments so that the statistician can do his or her work. The patient must obey the protocol or be dropped from the study.

This challenge may explain why, in chapter after chapter, the authors lament the dearth of solid, controlled studies. The purpose of the book is to present the work that has been done with survivors of large-scale disasters such as the World Trade Center attack, as well as survivors of individual events, such as motor vehicle accidents and rape. There are chapters on infants, children, adolescents, and adults. A chapter on complicated grief does a masterful job of differentiating complicated grief from normal grieving. Another chapter presents the theories of critical incident stress management and concludes that there is a lack of evidence that this procedure is helpful. Cognitive-behavioral therapy is presented as a better alternative.

This is an excellent resource book for researchers and policy makers alike. It explains what has already been done in a wide variety of fields and provides several hundred references. It guides future research by pointing out what is not known, what needs to be studied, and what methodologic and ethical considerations must be addressed. Reading this book would be much faster and much more enlightening than doing a Medline search.

However, if I knew I could read only one book before a Boeing 747 jumbo jet took off from a nearby airport carrying 568 passengers and 63,500 gallons of fuel and crashed right outside my office, this would not be the one. Once the survivors were in a safe place and had their basic physiological needs met, I would still be left with a very practical question: "What can I say to these people that will help them?" The practical guidance this book provides is mostly for researchers rather than for clinicians on the front lines caring for the survivors. It is the editors' hope that this volume will spur research to give readers better answers to this question.

Dr. Newell is affiliated with the department of medical education of Oakwood Hospital in Dearborn, Michigan, and with the University of Michigan in Ann Arbor.