اجتناب قابل توجه بالینی حمل و نقل عمومی پس از بمب گذاری های لندن: هراس مسافرتی و یا اختلال استرس پس از سانحه زیرآستانه؟

Following the London bombings of 7 July 2005 a “screen and treat” program was set up with the aim of providing rapid treatment for psychological responses in individuals directly affected. The present study found that 45% of the 596 respondents to the screening program reported phobic fear of public transport in a screening questionnaire. The screening program identified 255 bombing survivors who needed treatment for a psychological disorder. Of these, 20 (8%) suffered from clinically significant travel phobia. However, many of these individuals also reported symptoms of posttraumatic stress disorder [PTSD]. Comparisons between the travel phobia group and a sex-matched group of bombing survivors with PTSD showed that the travel phobic group reported fewer re-experiencing and arousal symptoms on the Trauma Screening Questionnaire (Brewin et al., 2002). The only PTSD symptoms that differentiated the groups were anger problems and feeling upset by reminders of the bombings. There was no difference between the groups in the reported severity of trauma or in presence of daily transport difficulties. Implications of these results for future trauma response are discussed.

Large-scale traumatic events, such as natural disasters and terrorist attacks, are a challenge for mental health services. Previous studies have found that there are high rates of mental disorders amongst direct survivors of terrorist attacks (Whalley & Brewin, 2007). The response to such events involves identifying those in need of immediate help (and those who may need it later) and deploying appropriate support and expertise. This response will depend in large part on our understanding of the way in which the traumatic event is likely to have affected those caught up in it. At the most basic level, this means screening for clinically significant psychological problems so that appropriate treatment can be initiated. Most research has concentrated on screening for posttraumatic stress disorder (PTSD; Brewin, 2005). There is, however, increasing awareness that other disorders such as depression and specific phobias are also common consequences of trauma (for a review see Brady, Killeen, Brewerton, & Lucerini, 2000). The present study focuses on the identification of travel phobia following the terrorist attacks on public transport in London. On 7 July 2005, four terrorist bombs exploded on the London transportation system. Three were detonated on underground trains at three different stations and one on a bus at a square in Central London. Fifty-two people were killed in the attacks and more than 775 injured from among the more than 4000 passengers involved. Surveys of the general population in London in the aftermath of the bombings (e.g., Rubin et al., 2007) indicated some persistent low-intensity changes in travel behaviour following the bombings. Persistent changes in travel behavior were identified as any reduction in travel by tube, train, bus and car as a result of the bombings that were reported both in July 2005 and at follow-up in February/March 2006. We expected that a proportion of those directly involved in the bombings would develop clinically significant travel phobia.