Presentation Information
[O12-P08]Limitations of the Fear-Based Model and the Need for Comprehensive Support in Post-Earthquake PTSD: Literature Review and Interviews
*Yoshifumi Son1 (1. Sakae Higashi Senior High School)
Keywords:
Fear-based model,PTSD,Self-blame,Phycological support,Earthquake Disaster
§1 Introduction
Japan frequently experiences earthquakes, and the mental health of disaster survivors, particularly post-traumatic stress disorder (PTSD), is a major public health concern. PTSD is associated not only with decreased daily functioning but also with physical health risks.
Traditionally, PTSD has been explained by fear conditioning and the maintenance of avoidance behavior. This study defines this framework as the “fear-based model” and examines its consistency with real-world practice through a literature review and interviews with support professionals. Consistency here refers to the degree of agreement between theoretical assumptions about symptoms and interventions and the elements emphasized in practice.
§2 Literature Review
PTSD following natural disasters is characterized by three core symptoms: Re-experiencing, Hyperarousal, and Avoidance (Dai et al., 2016). Prevalence rates vary widely, from 5% to 60%, depending on disaster scale and population. Avoidance behavior based on fear often generalizes, leading to functional impairment (Sheynin et al., 2017).
However, research on the Great East Japan Earthquake shows that while mortality risk increases among elderly individuals with depressive symptoms, no clear association is found for PTSD alone (Li et al., 2019). This suggests that factors such as loss and depression, in addition to fear responses, play an important role in long-term outcomes, indicating limitations of the fear-based model.
§3 Treatment Models
PTSD treatment aims to intervene in the maintenance mechanisms of fear conditioning and avoidance behavior. Trauma-focused psychotherapies such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing (EMDR) are effective, focusing on reducing avoidance and promoting safety learning. Pharmacological treatment typically involves Selective Serotonin Reuptake Inhibitors (SSRIs) as first-line medication.
§4 Interview Analysis
An interview was conducted with a support professional specializing in disaster mental health. The findings indicate that post-disaster psychological problems consist of three overlapping layers: trauma (fear of life threat), loss (e.g., death of loved ones), and daily life stress (e.g., conditions in evacuation shelters). These aspects are not fully addressed by the fear-based model.
Recovery is influenced by prior knowledge and previous trauma experiences, which shape vulnerability. Self-blame, identified in DSM-5 as a core symptom, is particularly significant among those who have lost family members and is strongly linked to depression.
Although evidence-based treatments such as PE, EMDR, and CPT exist, their implementation is often delayed due to psychological burden, and practical support tends to prioritize stabilization of daily life.
§5 Discussion and Implications
The findings suggest that while the fear-based model is useful for explaining maintenance mechanisms, it is insufficient to fully account for post-disaster psychological problems. In particular, self-blame and depression associated with loss play a crucial role in long-term outcomes.
Many immediate post-disaster reactions are normal responses to abnormal situations, and should not be pathologized unless they persist and impair functioning. Furthermore, although evidence-based treatments are effective in theory, their application is often limited in practice. This gap reflects contextual constraints rather than flaws in the model itself.
Based on these findings, this study proposes that post-disaster psychological support should integrate fear-focused interventions with responses to loss, stabilization of daily life, and dissemination of coping knowledge. In particular, incorporating education on psychological reactions and coping strategies into school curricula may be effective. A phased approach that prioritizes stabilization before trauma-focused interventions is also important. Future research should empirically examine the effectiveness of this integrated support model.
Japan frequently experiences earthquakes, and the mental health of disaster survivors, particularly post-traumatic stress disorder (PTSD), is a major public health concern. PTSD is associated not only with decreased daily functioning but also with physical health risks.
Traditionally, PTSD has been explained by fear conditioning and the maintenance of avoidance behavior. This study defines this framework as the “fear-based model” and examines its consistency with real-world practice through a literature review and interviews with support professionals. Consistency here refers to the degree of agreement between theoretical assumptions about symptoms and interventions and the elements emphasized in practice.
§2 Literature Review
PTSD following natural disasters is characterized by three core symptoms: Re-experiencing, Hyperarousal, and Avoidance (Dai et al., 2016). Prevalence rates vary widely, from 5% to 60%, depending on disaster scale and population. Avoidance behavior based on fear often generalizes, leading to functional impairment (Sheynin et al., 2017).
However, research on the Great East Japan Earthquake shows that while mortality risk increases among elderly individuals with depressive symptoms, no clear association is found for PTSD alone (Li et al., 2019). This suggests that factors such as loss and depression, in addition to fear responses, play an important role in long-term outcomes, indicating limitations of the fear-based model.
§3 Treatment Models
PTSD treatment aims to intervene in the maintenance mechanisms of fear conditioning and avoidance behavior. Trauma-focused psychotherapies such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing (EMDR) are effective, focusing on reducing avoidance and promoting safety learning. Pharmacological treatment typically involves Selective Serotonin Reuptake Inhibitors (SSRIs) as first-line medication.
§4 Interview Analysis
An interview was conducted with a support professional specializing in disaster mental health. The findings indicate that post-disaster psychological problems consist of three overlapping layers: trauma (fear of life threat), loss (e.g., death of loved ones), and daily life stress (e.g., conditions in evacuation shelters). These aspects are not fully addressed by the fear-based model.
Recovery is influenced by prior knowledge and previous trauma experiences, which shape vulnerability. Self-blame, identified in DSM-5 as a core symptom, is particularly significant among those who have lost family members and is strongly linked to depression.
Although evidence-based treatments such as PE, EMDR, and CPT exist, their implementation is often delayed due to psychological burden, and practical support tends to prioritize stabilization of daily life.
§5 Discussion and Implications
The findings suggest that while the fear-based model is useful for explaining maintenance mechanisms, it is insufficient to fully account for post-disaster psychological problems. In particular, self-blame and depression associated with loss play a crucial role in long-term outcomes.
Many immediate post-disaster reactions are normal responses to abnormal situations, and should not be pathologized unless they persist and impair functioning. Furthermore, although evidence-based treatments are effective in theory, their application is often limited in practice. This gap reflects contextual constraints rather than flaws in the model itself.
Based on these findings, this study proposes that post-disaster psychological support should integrate fear-focused interventions with responses to loss, stabilization of daily life, and dissemination of coping knowledge. In particular, incorporating education on psychological reactions and coping strategies into school curricula may be effective. A phased approach that prioritizes stabilization before trauma-focused interventions is also important. Future research should empirically examine the effectiveness of this integrated support model.