By Dawn Brazell
Public Relations
As if the 12-hour flight from Detroit to Tokyo wasn't enough, there was the earthquake in the middle of the night that woke up psychologists Peter Tuerk and Matthew Yoder, and intern, Brian Hall. Not to mention they were traveling with a Geiger counter and radiation dosimeters.

Not the best formula for a good night's sleep.

These peaceful scenes from Japan were taken by MUSC psychologists who recently traveled there to provide disaster mental health training.

What was, though, were the 300 kazoos and whistles that the experts in Post Traumatic Stress Disorder (PTSD) had brought along. The toys were teaching tools to give to therapists attending workshops to better be able to help people hardest hit by Japan's magnitude 9 earthquake March 11. Tuerk, associate director of the PTSD Clinical Team at the Ralph H. Johnson VA Medical Center and assistant professor in MUSC's Department of Psychiatry and Behavioral Sciences, said the natural disaster was a triple whammy given the subsequent tsunami and radiation scare.

The toys were a reminder of the value of letting children living in temporary evacuation centers be children and to encourage normal activities such as play and homework. Fears regarding personal safety and anxiety in recalling traumatic events are common after natural disasters, but the important thing is to not avoid normal everyday activities. It was one of the main messages that the internationally-renowned researchers delivered in trainings for parents, therapists and community leaders.

Dr. Peter Tuerk lights a candle at a Buddhist shrine for the victims.

Part of a team invited to go to Japan April 16 to provide disaster mental health training, the psychologists met with students, community health workers and professors at Tokiwa University in Mito, Japan. The team provided a 14-hour workshop training for students and therapists and a 2.5 hour community education session (in Japanese, with translators) that was attended by 140 community leaders, including police chiefs, school principals and mayors. The community training was broadcast live on national television.

Tuerk said the goal was to provide education as a preventative measure against PTSD.

"When people don't have their houses—when there is a high resource loss—their risk for getting PTSD is much higher. So we're anticipating a lot of PTSD from this event. It takes awhile for PTSD to develop. In that interim, while some people might be developing symptoms, targeted education can help prevent the disorder."

Tuerk and Yoder focused the mental health worker's training on teaching about assessment and screening, which is crucial following these events to identify the 10 to 20 percent of the population that typically is vulnerable to PTSD following a tragedy. Yoder, also an assistant professor in MUSC's Department of Psychiatry and Behavioral Sciences, assisted after Hurricane Katrina and the Virginia Tech shootings, and he and Tuerk also will be presenting materials in Alabama to help those recovering from the storms.

Yoder said they had heard that people in Japan might be more closed and reserved because of their culture, but that they didn't find that to be the case.

Dr. Matthew Yoder gets a photo beside two Japanese shoppers beneath tsunami art. To see a video of the Japan trip, visit http://bit.ly/MUSCJapan.

"The people we trained were very open to our being there. To me, this was a reflection of a fundamental human desire to help in the face of suffering," said Yoder. "There was a hunger, among the people we trained, to assist fellow survivors, and we offered tools to do just that. Even though it felt like a very different culture, we were able to connect in this way, even in less than a week."

One touching story was that of a mother who wanted to help her 7-year-old son, who had stopped playing with his friends and avoided going outside. She came to them for advice, and Tuerk worked with her to develop a plan of action. The plan included stopping some of the avoidance behavior she was re-enforcing, and getting her to coax her son to his favorite restaurant, McDonald's, with the goal of staying there long enough for his fear to go away. Since the child enjoyed origami, they made origami birds while there.

Afraid to go out after the earthquake, this child got a reward for his first successful outing.

The outing, along with other non-avoidance strategies, worked. His grateful parents sent a thank-you e-mail with a picture of their son eating so much ice cream at McDonald's that he got a stomach ache.

Tuerk hopes to see that healing scenario played out throughout the devastated areas in Japan. "Hopefully, that one mother's experience will spread. She will tell her friends, 'Go ahead and take your kids out' or 'Don't spend too long in your family's earthquake safety room' or whatever the avoidance behaviors are."

And it's not just the mother they hope will be spreading the news, but everyone in the trainings.

Dr. Peter Tuerk, right, and Dr. Sheila Rauch, from the University of Michigan, collaborate with Dr. Nobukazu Nagae.

The trip also gave Yoder and Tuerk the opportunity to hear the experiences Japanese therapists are having with prolonged exposure treatment, which involves intentional prolonged exposure to feared stimuli in a safe setting to decrease anxiety. "There were more avenues to help than we originally had anticipated because we are experienced in training and disseminating that model," said Tuerk. "Similarly to the United States, in Japan there are not enough mental health providers trained and experienced in providing evidence-based treatment for PTSD. Hopefully we might be a part of its positive spread."

Prolonged exposure treatment helps a person's PTSD symptoms decrease with time. Yoder said people suffering from PTSD don't do what others do naturally to heal, which is to talk about the trauma and gradually resume regular living patterns. They withdraw and don't want to talk or think about it. "We help them stop the avoidance so the normal, natural healing process can take place."

Because Tuerk and Yoder have seen this type of therapy's effectiveness with veterans and other trauma victims with whom they work, they feel strongly about being advocates. One benefit that Tuerk was surprised to get from his Japan trip was a boost of inspiration.

He saw therapists there trying to do evidence-based treatment face the same institutional barriers that therapists in America do.

"It affirms the value of the hard work that we do every day—not in psychological practice—but in administration, infrastructure building, policy work, advocacy and education. These are the things that get evidence-based medicine and evidence-based psychotherapy to suffering individuals. To see different cultures struggling with the same issues helped put some gas in my tank for the barriers here."

Education, collaboration and research are powerful tools, though, he said.

"We have a great internship that teaches evidence-based therapy. Most prolonged exposure therapists become very strong advocates because they see its effectiveness for PTSD. Here at MUSC, our psychology interns are empowered not only to provide excellent care but also to do the research to understand how behaviors and systems work, to push on and expand the boundaries of effective care."