Personal story

One Session therapy

Psychological Usage of the Internet (computers and cellular phones) in Chemical, Biological and Radiological Terrorism Dr. Arnon Rolnick Ultrasis Plc. UK and Israel

Personal story It is the beginning of 1991, I have just retired from the Navy, and begun my private practice as a clinical psychologist At January 18, a siren was sound, and Iraqi Scud missiles descended on the country. There is a lot of uncertainty and confusion My family and I entered the sealed room and put on our gas mask.

The routine we developed was the following: In the morning – the patients came with some of them I used the biofeedback and breathing training to cope with mask related anxiety. In the nights the missile descended and I had to cope with my own anxiety…

After few nights like this I found myself doing a strange thing: I took my old apple IIc and connected to the bitnet and wrote to few of my friend in Israel and abroad.

What I know and what I do not know What I know: The use of computers and internet fot Psychological Intervention What I do not Know Or: What I am afraid to know The nightmare of living in sealed rooms for few weeks communicating via the internet

The main message All cases of terrorist attacks involve significant psychological reactions, and casualties. In cases of CBR there will probably be a huge amount of psychological reactions, many of them severe and debilitating.

The main message (cont.) Psychological intervention may be highly needed but quite limited: Due to manpower limitation Due to situational restrictions People will desperately seek Information

Which leads to…. There will be an intense need for MASSIVE REMOTE interventions INTERACTIVE The internet will prove to be a very efficient means of intervention.

Israel at the Gulf war Approximately 43% of the 773 casualties evacuated to hospitals were diagnosed as psychological casualties, Additional 27% had mistakenly injected themselves with Atropine. Data also indicated that triage of psychological casualties to hospitals was more a function of the rescue team's training and preparation than the severity or extent of injury or damage. Taken from Bleich et al.

Possible psychological consequences in case of chemical attack Chemical Attack will be conceived as escalation There will be a significant uncertainty High level of anxiety

Possible Psychological consequences in case of Chemical Attack (cont.) Fear of contamination From other Avoiding helping others

Computerized Therapy Delivered in the usual face-to-face, one-to-one manner, psychotherapy is expensive and its availability is likely to remain strictly limited. The methods of CBT (cognitive Behavior therapy), are amenable to detailed formalization, and lend itself readily to computerization. We developed few sets of interactive, multimedia program some of them are CD based, other are internet based.

Use of computerized psychological intervention As a homework tool As a tool within therapy session As a mean to deliver cognitive behavioral techniques – without therapist

The use of the internet in psychological intervention As a way to continue the therapeutic dialogue with a therapist after the session. Remote intervention (textual or audio-visual) Stand alone internet programs

How can computers and internet be added to the psychological work

Reducing the hyper arousal in case of CBR It is well documented that Immediate intervention is of crucial importance in the prevention of CSR and PTSD. Shalev has shown that the hyper arousal can discriminate between people who will develop PTSD and those who will adapt. If people will have with them available sets of multimedia relaxation instructions we might reduce later psychological problems.

BtB (Beating the Blues) with the Institute o Psychiatry, London The BtB used a number of interactive, multi-media techniques to enhance patient engagement and motivation, including menus, advice, feedback, and especially video vignettes of case-study ‘patients’ to act as models for the real patient based on Proudfoot et al

The effects of computerized interventions Patients who received computerized intervention showed significantly greater improvement in depression and anxiety compared to control group. This improvement was present at the end of treatment (8 weeks), endured without significant diminution until the final follow-up 6 months later. (based on Proudfoot et al, the institute of Psychiatry)

Possible psychological usage of the internet in case of massive terrorist attack Source of Information Vehicle to computerized multimedia psychological programs Vehicle to interactive remote human interventions Support group for the public Support group and source of information for the mental health professionals Continue the social ineractions under restricting coditions

Content of intervention as a function of phase

Content of intervention as a function of phase

Content of intervention as a function of phase

Content of intervention as a function of phase

The usage of the media the Gulf war experience in Israel The gulf war was undoubtedly one of the greatest hours of Israeli electronic media. Each warning siren was broadcast on radio and television, and was accompanied by instructions regarding appropriate behavior during the missile attack Extensive usage of various types of hotlines Massive presence of psychologists in the media, gave rise to both lay and professional criticism.

Media limitation Textual self help material Does not really demonstrate and teach Radio based program and information TV based programs and interventions Apply uniformly for all the population at the same time and with the same information Telephone hotlines Needs a lot of human operators some of them needs education

Optimized professional intervention Future psychological intervention must be adopted to the specific individual’s needs. Unlike classical media, the internet allows friendly, flexible exposure to information and aid.

New Media Computer based multimedia programs Clear and compelling instructions Internet based program and information Interactive. Let you choose what you want and need. Cellular phone uses A way to stay in touch with significant others. Transitional object that you carry with you take it near bed (like a teddy bear).

How does the new media may contribute to successful coping

How does the new media may contribute to successful coping

How does the new media may contribute to successful coping

How does the new media may contribute to successful coping

What I do not know and afraid to know Our models are based on past experience . The Gulf War experience was traumatic but unique: Short Term No real chemical attack “nights only” schedule

What will happen if people will have to stay in sealed rooms for a long period? There will be a need to continue the social and economic life The internet might be the main source of communication and human interactions Internet community of sealed rooms

Internet community of sealed rooms

Examples of possible governmental acts When supplying masks or antibiotics –add a multimedia CD with copying instructions. Build internet backbone for emergency conditions Insert new standards for the sealed rooms – Internet and mobile phone