Natural disasters and extreme weather events such as earthquakes, floods, hurricanes and tsunamis have a direct impact on the physical and psychological landscape of a country. Following such events, mental health disorders are most likely to increase, thus demonstrating the importance of providing psychological support to communities impacted by natural disasters.

In Libya, the devastating floods caused by the storm Daniel on 12 September 2023 killed over 11,000 people whilst thousands more have still been declared missing. On 9 September 2023, a powerful earthquake stroke Morocco and made over 2,900 dead people recorded so far and thousands more injured.

In view of these recent events, we spoke to Dr Anwar Assadi, associate professor of clinical psychology and clinical psychologist, who shared with us some valuable insights on the emergence of mental health disorders following a natural disaster. He also stressed the importance of providing adequate psychological assistance to individuals who have been directly exposed to such traumatic events.

Medilink: How would you explain the consequences of natural disasters on the mental health of communities who have been exposed to these tragic events?

Dr Anwar Assadi: Following the exposure to these types of events, four main types of mental disorders can be experienced: flashback, feeling of loss, anxiety/depression and psychosis.

When an individual is experiencing flashback, it means that the memories of a past trauma will feel as if they were happening again. It is a vivid experience which can come suddenly and feel uncontrollable.

After such disasters, it is unfortunately very common for communities to have to deal with the concept of loss: loss of home, loss of people, loss of items… all these losses are affecting individuals on an emotional level, making it hard for them to establish new points of reference.

Anxiety and depression are also a common psychological issue that one can face following a traumatic event. If not treated properly, this can lead to severe depression, with the individual feeling the need to join people he has lost during such events.

Psychosis is another disorder that can emerge from the exposure to a natural disaster. This disease is usually coming from genetic inheritance, and might involve disturbed and confused pattern of thoughts, with a loss of contact with reality. It is very important to provide immediate medical treatment to individuals diagnosed with psychosis.

Medilink: What is the impact of natural disasters on the mental health of children?

Dr A. A.: Children are of course also mentally impacted by natural disasters that may in most cases displace families and interrupt education. We have observed a behavioural change in children who experienced such traumatic events. They may tend to isolate themselves, develop speech disorders or constant crying. If children are provided with appropriate psychological support soon enough, the risk for these mental disorders to become part of their personality is more likely to reduce.

Medilink: How are these mental issues addressed?

Dr A. A.: It is essential to provide adequate psychological support to these individuals who have been exposed to natural disasters. We use different approaches for adults and children. Adults will require Cognitive Behavioural Therapy (or CBT), which is a form of therapy that looks at how your thoughts, beliefs and attitudes affect your feelings and actions. It is a talking therapy that is used to help people manage their issues by changing the way they think or behave. It follows these different methods:

1. The technique of identifying automatic thoughts and correcting them

Automatic thoughts are thoughts that immediately precede any unpleasant emotion and which come up very quickly and automatically, sometimes without the person being able to realise it. These thoughts are unreasonable, and they are generating an incorrect reaction to a specific event. These automatic thoughts are always negative in nature, thus leading to the expectation of an unpleasant outcome in the end. There are many techniques that can help patients identify their negative automatic thoughts, such as:

• Discussing emotional experiences related to events:

In this method, the patient is asked to remember the last incident or situation related to his emotional topic; it must come from incidents or situations that he remembers well. The patient has to describe the incident in detail, so the therapist will try to make the patient remember the thoughts associated with the emergence and continuation of the emotional reaction. He can ask questions such as, “What is the worst thing you expected to happen when you were very worried?”, or, “What came to your mind at that time?”, “Did you imagine something at that moment?”.

• Using imagery to get the emotive experience back:

When automatic thoughts cannot be stimulated by using simple and direct questions, the therapist can ask the patient to imagine or act out the situation. If the situation involves interactions with others, an appropriate number of people can be used to play roles together with the patient.

2. Self-monitoring technique

Self-monitoring in behavioral therapy is about observing the patient and recording what he does when confronted with a difficulty, to develop tentative theories about what keeps the client’s difficulties going. After undergoing therapeutic treatment, self-monitoring is mostly aimed at changing undesirable behaviours.

3. Exposure technique

This technique is a major component of cognitive-behavioral therapy as well as behavioral therapy for psychological disorders, as continuous exposure to the stimuli that caused the disorder results in a dispersion of the disorder’s response. Exposure has several forms, including imaginary exposure, gradual exposure, and direct exposure (“reality”).

4. Ideas termination technique

Wrong ideas often have a greater impact, and we found that the correct idea may call for another idea. Thus, this technique helps the patient stop the flow of wrong thoughts through a confidence stimulus – whether this stimulus is real or imaginary – so that he/she can switch to other thoughts before this stream of thoughts comes back again.

Medilink: What techniques are used for children exposed to a dramatic event?

Dr A. A.: We approach children exposed to a traumatic event differently. In fact, children’s lack of awareness of the true extent of the tragedy may play a role in alleviating the psychological symptoms they may experience if they are dealt with properly. Therefore, it is important for parents or anyone who is in the child’s environment at the time of the disaster to remember that the way the child deals with the disaster depends primarily on the way those around him deal with it.

Also, implementing things that may seem simple compared to the scale of the disaster may help reduce the risk of developing symptoms of long-term psychological illnesses that children may experience. For example, hugging children and making them feel safe, whilst giving them enough space to talk about their feelings without urging them to remain silent or stop crying, are simple things that can be implemented.

This is why it is important to accompany both children and families or childcare providers to teach them methods and skills to deal with children exposed to a disaster.

Medilink: What advice would you share to help children overcome a traumatic event?

Dr A. A.: It is crucial to reassure children exposed to a disaster that they are safe, surrounded by parents or caregivers who are taking care of them, and that they are not threatened by any danger. If a child is able to talk about the incident that happened to him, it is better to allow him to express himself, and to listen to him carefully. The younger the child is, the more important it is to give him attention and care, especially when he goes to sleep. Giving children enough time to grieve and heal, whatever the reason for the sadness is (loss of a friend or family member, or loss of a pet), is essential.

It is also important to remember that every child expresses his feelings differently. We may find the child moody, very sad, or withdrawn into himself. Therefore, it is better not to tell him what he should think or feel after a traumatic event. Instead, we can encourage the child to express his feelings through playing, drawing and coloring.

If the child was exposed to a traumatic event which resulted from a death quartet, as it is the case in Derna (Libya), then it is essential to limit his exposure to media. Therefore, children must not be allowed to watch the news, especially before going to sleep. The parents should also monitor the TV and mobile phone used by children.

All of this should help children exposed to a disaster to return to a normal daily routine as quickly as possible.