Title: In Times of Crisis: Supporting Others, Supporting Ourselves
1In Times of CrisisSupporting Others,Supporting
Ourselves
- John Gaspari, LCSW
- Executive Director
- USC Center for Work and Family Life
2Introductions
- Importance of beginnings and endings
3Center for Work and Family Life
- Available Services
- Faculty and Staff Counseling
- Faculty, Management and Departmental Consultation
- Critical incident response
- Work/Life Support
- Family and Dependent Care Consultation and
Resources - Workplace Health and Wellness Programs
4Role Expectations
- Are you clear about your the role expectations
you carry as a member of the CERT? - Can you imagine having any unfulfilled
expectations or disappointments while functioning
in this role? - How might the many other roles you play at any
given time impact your role as a CERT member?
5Unit Objectives
- Psychological impacts to expect after a disaster
What happens for people? - How to work with the psychological impacts in
your role Providing psychological support. - Responder stress management and self-care.
6Are We Psychologically Prepared?
- For every physical injury, there may be 5-6
psychological injuries
- This may overwhelm and impede our emergency
and/or medical response.
7Critical Incident
- Exposure to a traumatic event in which both of
the following were present - The person experiences, witnessed, or was
confronted with an event or events that involved
actual or threatened death or serious injury, or
a threat to the physical integrity of self or
others. - The persons response involved intense fear,
helplessness or horror. (DSM-IV TR)
8CRISIS
danger peril
opportunity crucial point
9Coping Mechanisms
- People typically rely on past strategies to cope
with new stressful situations - Past coping mechanisms can be functional or
dysfunctional. - Degree of hardiness (resilience) has been
identified as a characteristic that can buffer
extreme stress in older populations - Children can be vulnerable because they have no
experience or known patterns of actions as a
response to the experience.
10 Into every life a little rain must fall
..
- But what happens when there is a flood?
11Psychosocial Impact Considerations
- Prior experience with a similar event
- Prior trauma
- The intensity of the disruption in the survivors
lives - The resilience of the individual
12Psychosocial Impact Considerations
- The length of time that has elapsed between the
event occurrence and the present - Pre-existing vulnerabilities
- Man-Caused vs.
- Naturally Occurring
- Events
- Children/families
- Seniors
- Disabled
- Bereaved
- Health impairments
- Women
13Psychological Response to TraumaKey Principles
- Man-Caused vs. Natural Events
- Adult Coping Adaptation
14Consequences of Critical Incidents Often include
LOSS
- Tangible Loss
- Loss of loved ones
- Loss of home
- Loss of material goods
- Loss of employment / income
15Consequences of Critical Incidents Often include
LOSS
- Intangible Loss
- Loss of safety / security (real or perceived)
- Loss of predictability
- Loss of social cohesion/connection/support
- Loss of dignity, trust and safety
- Loss of positive self-image/self-esteem
- Loss of trust in the future
- Loss of hope
- Loss of CONTROL
16Activity What if I lost
- You have been given three cards each of three
different colors - Blue Card - write the name of a person close to
you on each card - White Card - write down one of your favorite
belongings - Pink Card - write down something you enjoy, an
activity, or hobby. - After you have written on each card, place them
face down on the table and shuffle them around.
Close your eyes and pick three cards.
17Activity What if I lost
- These are the three things you will have lost in
a disaster. - Discuss with the group how you feel about losing
these things or people
18Possible Psychological Reactions to a
Large-Scale Emergency
- Many people survive disasters without developing
any significant psychological symptoms. - For other individuals, the reactions will
disappear over time.
- Just because you have experienced a disaster
does not mean you will be damaged by it, but you
will be changed by it. - (Weaver 1995)
19Grief and Loss
- Not an even process
- Takes time
- Can become stuck in the process
- May spawn other problems
- Nothing like T T (Time and Talking)
20Supporting Others
21- Were a community that believes in
- love thy neighbor,
- but right now we need to love our neighbors a
little bit more.
- Man talking after devastating tornados ripped
through his Tennessee neighborhood - 2/08
22Role of Disaster Mental Health?
- Primarily directed toward normal people who are
responding normally to an abnormal situation - Improve resistance, resilience and recovery.
- Identifying those at risk for severe social or
psychological impairment - Identify those in need of additional or special
services.
23Role of Disaster Mental Health?
- Mitigate post trauma sequelae
- May prevent future problems
- Helps people to handle problems in a way that
does not create MORE problems - Convey sense of compassion and support for people.
24Psychological Response to TraumaKey Concepts
- Experience has shown that
- No one who sees a disaster is untouched by it.
- Most people pull together function during and
after a disaster, but their effectiveness is
diminished. - Most people do not see themselves as needing
mental health services following a disaster and
will not seek such services.
25Psychological Response to TraumaKey Concepts
- Experience has shown that
- Survivors respond to active, genuine interest
concern. - Survivors may reject disaster assistance of all
types. - Disaster mental health assistance is often more
practical than psychological in nature. - Social support systems are crucial to recovery.
26Psychological Response to TraumaKey Concepts
- While there may be specific disaster-related
stressors, underlying concerns and needs are
consistent across a range of traumatic events.
These include - A concern for basic survival
- Grief and loss over loved ones loss of valued
and meaningful possessions - Fear anxiety about personal safety the
physical safety of loved ones - A need to talk about events feelings associated
with the disaster, often repeatedly - A need to feel one is a part of the community
its recovery efforts
27 Phases of Disaster
Honeymoon (community cohesion)
llllllllllll
Reconstruction (a new beginning)
Heroic
Pre-Disaster
Disillusionment
Working Through Grief (coming to terms)
Threat
EVENT
Warning
Inventory
Trigger Events and Anniversary Reactions
Time 1 to 3 days
1 to 3 years
28Phases of Disaster
- Heroic Phase
- Honeymoon Phase
- Disillusionment Phase
- May last from two months to several years.
- Strong feelings of anger and resentment can be
directed at volunteers and other public
officials. - Reconstruction Phase
29Honeymoon (community cohesion)
- Survivors may be elated
- Happy just to be alive
- This phase will not last
30Disillusionment
- Reality of disaster
- hits home
- Loss and Grief
- becomes prominent
31Psychological Support
- Your actions and interactions with affected
people can - help provide critical support to people in
distress. - relieve suffering, both emotional and physical
- Improve peoples short term functioning
- Accelerate the individuals course of recovery
32Brainstorming
- What main attributes and skills should a
volunteer have when offering psychological
support? -
- Spend 5 minutes brainstorming and writing down
those characteristics which are likely to be
required.
33Essential Attributes and Skills
- Good Listening skills
- Patient
- Caring attitude
- Trustworthy
- Approachable
- Culturally competent
- Empathetic
34Essential Attributes and Skills
- Non-judgmental approach
- Kind
- Committed
- Flexible
- Able to tolerate chaos
35Supportive Communication
- Supportive communication conveys
- Empathy
- Concern
- Respect
- Confidence
36Activity Supportive Statements
- As a group, generate a list of supportive
statements that you would find helpful if you
were in pain, injured, and/or acute emotional
distress.
37Activity Unhelpful Statements
- As a group, generate a list of statements that
you would find unhelpful if you were in pain,
injured, and/or acute emotional distress.
38Guiding Principles in Providing Psychological
Support in Your Role
- Protect from danger
- Be direct and active
- Provide accurate information about what youre
going to do - Reassure
- Do not give false assurances
- Recognize the importance of taking action
- Provide and ensure emotional support
39Crisis Intervention
- Observe safe practices by showing concern for
your own safety - Remain calm and appear relaxed, confident and
non-threatening - You must look and act calm even if you are not
40Goals of Psychological First Aid
- Psychological first aid (PFA) promotes and
sustains an environment of
SAFETY
CALM
CONNECTEDNESS
SELF-EFFICACY
HOPE
41Psychological First Aid
- Promote SAFETY
- Help people meet basic needs for food and
shelter, obtain medical attention. - Provide repeated, simple and accurate information
on how to get these basic needs met.
42Psychological First Aid
- Promote CALM
- Listen to people who wish to share their stories
and emotions, remember that there is no right
or wrong way to feel. - Be friendly compassionate even if people are
being difficult. - Offer accurate information about the disaster or
trauma, and the relief efforts underway to help
victims understand the situation.
43Psychological First Aid
- Promote CONNECTEDNESS
- Help people contact friends and loved ones.
- Keep families together. Keep children with
parents or other close relatives whenever
possible.
44Psychological First Aid
- Promote SELF-EFFICACY
- Give practical suggestions that steer people
toward helping themselves. - Engage people in meeting their own needs.
45Psychological First Aid
- Promote HELP
- Find out the types and locations of government
non-government services and direct people to
those services that are available. - When they express fear or worry, remind people
(if you know) that more help and services are on
the way.
46Do Say
- Can you tell me what happened?
- Im Sorry
- This must be difficult for you
- Im here to be with you
47Psychological First Aid
- DONT
- Force people to share their stories with you,
especially very personal details (this may
decrease calmness in people who are not ready to
share their experiences). - Give simple reassurances like everything will be
ok, or at least you survived (statements like
these tend to diminish calmness).
48Psychological First Aid
- DONT
- Tell people what you think they should be
feeling, thinking or doing now or how they should
have acted earlier (this decreases
self-efficacy). - Tell people why you think they have suffered by
giving reasons about their personal behaviors or
beliefs (this also decreases self-efficacy).
49Psychological First Aid
- DONT
- Make promises that may not be kept (un-kept
promises decrease hope). - Criticize existing services or relief activities
in front of people in need of these services
(this may decrease hopefulness or decrease
calming). - Source Center for the Study of Traumatic Stress
50Avoid Saying . . .
- I understand what its like for you.
- Dont feel bad.
- Youre strong/Youll get through this.
- Dont cry.
- Its Gods will.
- It could be worse or At least you still have .
. .
51Intense Emotions
- Are often appropriate reactions following a
disaster - Can often be managed by community responders
52Anxiety
- A state of intense apprehension, uncertainty and
fear - Results from anticipating a threatening event
- Intense anxiety fight or flight
53Agitation
- Sometimes, despite our best attempts at active
listening, people become agitated - It is usually not personal
- This is their reaction to an extremely abnormal
situation, and it has nothing to do with you
54The Energy Curve
Agitation
Anxiety
Tension Reduction
Baseline
55Elements of Escalation
- Challenging authority or questioning
- Refusal to follow directions
- Loss of control, becoming verbally agitated
- Becoming threatening
56Elements of Escalation
- Challenging Authority or Questioning
- Answer the question
- Repeat your request in a neutral tone of voice
- Remember that an ounce of prevention is worth a
pound of cure
57Elements of Escalation
- Not Following Directions
- Do not take control, help the individual gain
control of him/herself - Remain professional
- Consider restructuring your request
- Give the person time to think about your request
58Seek Assistance
- Loss of Control, Becoming Verbally Threatening
- Verbal Vomit
- If the person becomes threatening or intimidating
and does not respond to your attempts to calm
them, seek immediate assistance
59Elements of De-escalation
- Establish a relationship
- Introduce yourself if they do not know you
- Ask the person what they would like to be called
- Don't shorten their name or use their first name
without their permission - With some cultures, it is important to always
address them as "Mr." or "Mrs.", especially if
they are older than you
60Elements of De-escalation
- Use concrete questions to help the person focus
- Use closed ended questions (yes/no)
- If the person is not too agitated, briefly
explain why you are asking the question - For example
- I'd like to get some basic information from you
so that I can help you better. Where do you
hurt?
61Elements of De-escalation
- Come to an agreement on something
- Establishing a point of agreement will help
solidify your relationship and help gain their
trust - Positive language has more influence than
negative language - Active listening will assist you in finding a
point of agreement
62Elements of De-escalation
- Speak to the person with respect
- This is communicated with
- Words
- Para-verbal Communication (how we say the words
e.g. tone, pitch) - Non-verbal behavior
- Use of words like please and thank you
63Elements of De-escalation
- Don't make global statements about the person's
character - Use I statements
- Lavish praise / support / encouragement is not
believable
64Activity De-escalation
- May I have two volunteers?
65Activity Observation of De-escalation
- One of the volunteers will play an agitated
individual and the other will play a community
responder. - Observe closely to see what de-escalation skills
the community responder is using to help calm the
agitated individual. - What did you observe?
66Responder Stress and Well-Being
67Adrenaline, Friend or Foe?
- Increase in speed and strength
-
- Tunnel vision eyes revert to default survival
position. - Reduced Near, peripheral, depth
- Hearing muted
- Changes in reaction time
- Freezing and unable to react
- Overreacting
- Increase in sensory acuity
- Slow motion time
- May act in a way that seems inappropriate for the
situation (e.g. giggle, yell)
68Psychological Response to TraumaSurvivors Needs
and Reactions
- People often experience strong and unpleasant
emotional and physical responses following
exposure to traumatic events (e.g. disasters). - These may include a combination of
- Fear anxiety
- Grief loss
- Shock
- Hopelessness
- Loss of Confidence
- Mistrust
- Sleep disturbances
- Physical pain
- Confusion
- Shame
- Shaken faith
- Aggressiveness
69Possible Physiological Symptoms
- Loss of appetite
- Headaches, chest pain
- Diarrhea, stomach pain, nausea
- Hyperactivity
- Increase in alcohol or drug consumption
- Nightmares
- Inability to sleep
- Fatigue, low energy
70Possible Emotional/Psychological Symptoms
- Irritability, anger
- Self-blame, blaming others
- Isolation, withdrawal
- Fear of recurrence
- Feeling stunned, numb, or overwhelmed
- Feeling helpless
- Mood swings
- Sadness, depression, grief
- Denial
- Concentration, memory problems, confusion
- Relationship conflicts/marital discord
71More Typical Reactions
- Fear of darkness
- Fear of being alone or of crowds or strangers
- Sensitivity to loud noises
- Somatic complaints
- Guilt, anger, grief
- Reliving past traumas
- Main point Disaster stress is a normal
response to an abnormal circumstance. If symptoms
persist, they must be treated.
C. Fasser, 2004 B. Young, 2006
72Possible Psychological Reactions to a
Large-Scale Emergency
- For most people, things get better with time
73Possible Psychological Reactions to a
Large-Scale Emergency
- For some, however, the reactions may evolve
and even worsen.
- Victims of Hurricane Katrina Significant
increase in serious mental health problems two
years post Katrina (PTSD, suicidality,
depression, anxiety, substance abuse, domestic
violence) across all racial and socio-economic
groups.
74Helpers
- Responders are, by definition, exposed to a
critical incident - They may experience critical incident stress
because of the work they do - Often have a feeling of not having done enough
- Are sometimes overwhelmed by the needs of the
community - Need to cope with their own fears
75Challenge to Helpers
- Being part of the collective crisis
- Repeated exposure to grim experiences
- Carrying out physically difficult, exhausting or
dangerous tasks - Lacking sleep and feeling fatigued
- Facing the perceived inability to ever do enough
76Challenge to Helpers (cont.)
- Feeling guilt over access to food, shelter, etc.
- Facing moral and ethical dilemmas
- Being exposed to anger and lack of gratitude
- Being detached from personal support systems
- Feeling frustrated by policies and decisions by
supervisors
77Categories of Reactions After the Incident
- ASD / PTSD
- Grief
- Depression
- Resilience
Mental Health and Illness
- Avoidance (emotional)
- Substance abuse
- Risk taking
- Over Dedication
Human Behavior in High Stress Environments
Distress Responses
- Fear / worry
- Sleep disturbance
- Altered productivity
78Loss and Grief Signs of Trouble
- Avoiding or minimizing emotions
- Using alcohol or drugs to self-medicate
- Using work or other distractions to avoid
feelings - Hostility and aggression toward others
79Stress
- A state of physical and/or psychological arousal
- Often brought about by a perceived threat or
challenge - May be expressed differently by different
cultures
80Coping with Stress
- Coping is a way to prevent, delay, avoid, or
manage stress - Coping mechanism categories
- Changing the source of stress
- Changing the view of the situation
- Tolerating the stressor until it passes or
becomes less troublesome
81Examples of Coping
- Seeking help from others or offering to help
others - Using natural support systems
- Talking about their experiences and trying to
make sense of what happened - Hiding until the danger has passed
- Seeking information about the welfare of loved
ones - Gathering remaining belongings
82Examples of Coping (cont.)
- Beginning to repair the damage
- Burying or cremating the dead
- Following religious or cultural practices
- Setting goals and making plans
- Using defenses like denial
- Remaining fearful and alert to further danger
- Thinking long and hard about the event
83Activity Decompression
- Take a few moments to write down five things that
help you relieve stress and feel calmer - Share these methods with the rest of the group
84Self-Help Techniques
- Know the normal reactions to stressful events
- Be aware of your tension and consciously try to
relax - Use the buddy system
- Talk to someone you trust and with whom feel at
ease - Listen to what people close to you say and think
about the event - Reconcile expectations with results
85Self-Help Techniques (cont.)
- Work on routine tasks if it is too difficult to
concentrate on demanding duties - If you cannot sleep or feel too anxious, discuss
this with someone you can trust - Express your feelings in ways other than talking
- Draw
- Paint
- Play music
- Journal
86Self-Help Techniques (cont.)
- Do not self-medicate
- Go easy on yourself
- Avoid inflated or perfectionistic expectations
- Seek professional advice if reactions continue
87Cognitive/Behavioral Approaches to Stress
Reduction
- Adequate Rest
- Exercise / Movement
- Diet / Balanced Nutrition
- Enough H2O
- Moderate Chemical Use
- Laughter / Tears
- Time Away From Work Role
88Cognitive/Behavioral Approaches to Stress
Reduction
- Religious / Spiritual
- Relaxation Techniques / Breathing
- Yoga
- Meditation
- Social Support / Discuss Feelings
- Allow yourself to receive as well as give
89Cognitive/Behavioral Approaches to Stress
Reduction
- Play Hobbies / Personal Interests Exposure to
Nature - Biofeedback
- Massage / Human Touch
- Sex
- Professional Assistance
- Medication
- What Else Works for You???
90 www.despair.com
91Team Well-Being
- CERT team leaders should
- Provide pre-disaster stress management training
- Brief personnel before response
- Emphasize teamwork
- Encourage breaks
- Provide for proper nutrition
- Rotate
- Phase out workers gradually
- Conduct a brief discussion
- Arrange for a intermittent and post-event
debriefing
92No Macho (Wo)Man, No Pity Party
- Do not create an expectation there will be a
problem, but when there is a problem, - go get help.
- Lt. Col Dave Grossman (ret.)
93Critical Incident Stress Debriefing (CISD)
- Debriefing / Defusing
- is a specific technique designed to assist
responders in dealing with the physical or
psychological symptoms that are generally
associated with trauma exposure. - allows those involved with the incident to
process the event and reflect on its impact. - allows for the ventilation of emotions and
thoughts associated with the crisis event. - provided as soon as possible but typically no
longer than the first 24 to 72 hours after the
initial impact of the critical event.
94- When you come to the edge
- of all that you know,
- You must believe in
- one of two things
- There will be earth
- on which to stand,
- or You will be given wings.
-
Anonymous
95Questions / Discussion