This year hurricanes have rocked America and the Caribbean. Harvey, Irma, Jose and Maria have caused billions of dollars of damage and so far, left 103 people dead in the US alone. In addition to the carnage wreaked along the way, natural disasters such as hurricanes, cyclones and tsunamis leave many struggling to rebuild their lives and homes years after the initial hit.

As the rescue workers begin to depart, the scale of the damage hits home. For many the rebuilding of homes and damaged property brings neighborhoods together, garners much needed social support, and in some cases even improves lives following the disaster. For some, the rebuilding of lives becomes marred by the overwhelming symptoms of Post Traumatic Stress Disorder (PTSD) which is known to affect victims of natural disasters. Natural disasters can cause losses of homes, neighborhoods, belongings and even the death of family and friends. When exposed to life threatening situations or those which encompass significant loss or grief, PTSD can disrupt the lives of sufferers for years until they recognize the symptoms and seek help.

PTSD is both disabling and an added economic burden to families already suffering the loss of their homes and livelihoods. The hurricanes are not simply an economic blow because of the physical damage caused, they represent a mental health disaster which if not treated, will continue to spread as victims struggle to receive help and present with worsening physical symptoms and difficulties wherever they end up living. Following Hurricane Sandy, a brief telephone screening in the local area six months after the disaster identified 14.5% of adults as suffering from PTSD. When disaster strikes the most urgent needs such as housing and emergency medical care need to be taken care of but as the storm subsides the mental health clean up must begin.

Even if not directly affected by the flooding and hurricanes, being in close proximity to victims of the disaster can cause secondary traumatization, a condition which has been documented in spouses of war veterans, children of holocaust survivors and in medical, social work or mental health personnel. Just as a nasty cold passes from person to person, so too is trauma contagious.

Some of those at risk of developing PTSD from natural disasters are children. Whereas an adult hopefully has the cognitive ability to understand the traumatic event in the context of geographical causation, children often ascribe personal meaning to events which they struggle to comprehend. In a study comparing over 800 children’s experiences following Hurricane Katerina in 2005 and the Chilean earthquake and tsunami in 2010, regardless of which disaster the children experienced, over one third of children demonstrated enough mental health symptoms to warrant a referral for further evaluation. In a two year, long-term study following 400 youth directly affected by hurricane Katrina, while 71% demonstrated resilience and warranted no diagnosis of PTSD, a quarter of the youth suffered from PTSD but recovered by the end of the study and 4% still suffered from chronic PTSD at the study’s close.

Children often see traumatic events as punishment for misbehavior, ascribe unrelated causality, have difficulty discussing the event because of limited language skills and have poorer abstract reasoning skills which impacts their comprehension. While the study following Hurricane Katrina demonstrated that the vast majority of children do not suffer from PTSD symptoms, when the study’s authors mapped out which psychosocial elements could be used to identify protective factors related to the children’s resilience, they discovered that having supportive friends was the only predictor of PTSD resilience. Indeed, numerous studies attest to the protective factors of familial, professional and peer support and these contribute and boost personal resilience. Low socioeconomic status, prior traumas, poor education and the lack of a support network all contribute to increasing the risk of developing PTSD.

During the next few months, and as the effected regions begin to stabilize, providing psychological first aid is critical to ensure the rehabilitation of the region. Psychological first-aid is based primarily on the normalization of PTSD-related symptoms. In adults this may consist of helping them see how their panic attacks or outbursts of anger are familiar responses to stress and for a child, this may be expressed in arguments with friends or struggling at school. Psychological healing also includes challenging the inappropriate feelings of guilt, responsibility and shame which may come following the hurricanes, and providing adaptive coping mechanisms to address these thoughts and feelings. With adequate support, and trained mental health professionals providing expert de-briefing, post traumatic symptomology can be dramatically reduced.

While the symptoms of trauma may seem overwhelming and damaging, most people experience stress symptoms following a trauma but they generally subside over the following days or weeks. Finding it difficult to sleep, being more irritable, experiencing shock, confusion and anxiety are all common symptoms following a trauma but they do not make the sufferer a ‘victim’ or a ‘patient’. Just as making sense of the range of symptoms associated with PTSD is a crucial element of trauma therapy, so too is it important for self-soothing and recovery. Stress reduction interventions such as mindfulness, yoga and sports participation all have been shown to boost mood and strengthen resilience factors, protecting before trauma and healing after trauma.

Three months after a trauma occurs is when PTSD tends to be diagnosed amongst sufferers; those who will recover on their own have generally recovered and those who require more intensive clinical help can receive focused care. A large scale study was carried out on survivors receiving CBT (cognitive behavior therapy) for PTSD following Hurricane Sandy. The treatment was provided in just ten sessions and comprised of education and awareness, breathing re-training, behavioral activation, and cognitive restructuring. While these real-world studies are difficult to control (it is not ethical to withhold treatment to those seeking help), the study’s authors were able to demonstrate that whereas no significant change was demonstrated in the pretreatment phase, there was a significant reduction in trauma symptomology following the program and in the follow up stage.

Short-term interventions yielding long-term results show promise in reducing the pain of PTSD and are becoming more and more commonplace in disaster zones. Studies in Thailand, China and Italy have all demonstrated the efficacy of psychotherapy for youth exposed to earthquake related traumas.

Time will tell whether Houston, the Caribbean and Florida manage to mentally recover from the trauma of recent hurricanes but while the physical injuries will fade and the houses will be rebuilt, the psychological impact is likely to worsen. Implementing targeted psychosocial care is both a humanitarian need and an economic necessity—saving lives, jobs and families.