Presentation on theme: "In Times of Crisis: Supporting Others, Supporting Ourselves"— Presentation transcript:
1In Times of Crisis: Supporting Others, Supporting Ourselves John Gaspari, LCSWExecutive DirectorUSC Center for Work and Family Life
2Importance of beginnings and endings IntroductionsImportance of beginnings and endings
3Center for Work and Family Life Available Services:Faculty and Staff CounselingFaculty, Management and Departmental ConsultationCritical incident responseWork/Life SupportFamily and Dependent Care: Consultation and ResourcesWorkplace Health and Wellness Programs
4Role ExpectationsAre 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 ObjectivesPsychological 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 injuriesThis may overwhelm and impede our emergency and/or medical response.
7Critical IncidentExposure 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 person’s response involved intense fear, helplessness or horror. (DSM-IV TR)
9Coping MechanismsPeople typically rely on past strategies to cope with new stressful situationsPast coping mechanisms can be functional or dysfunctional.Degree of hardiness (resilience) has been identified as a characteristic that can buffer extreme stress in older populationsChildren can be vulnerable because they have no experience or known patterns of actions as a response to the experience.Research tells us that the coping mechanisms developed in early life tend to be used throughout life. Many coping mechanisms are beneficial like seeking support, asking for help and reframing the experience in terms of the lessons learned.Disorganization, disbelief. And inability to act are normal reactions for some people to disaster situations. A person may not be able to respond appropriately to protect themselves. If this behavior becomes prolonged, it may reflect a dysfunctional response to severe disaster stressors. In those elders who may already have some degree of cognitive impairment, these reactions may be more dramatic.
10Into every life a little rain must fall ….. But what happens when there is a flood?According to an old saying, into every life a little rain must fall. That is to say, none of our lives are so simple and sunny that we are not challenged to adjust to an occasional rainstorm. For that matter, although the rain can become a problem, we also cannot do without it. So we have developed ways to keep the rain from interfering too greatly in our lives while making use of it to improve our lives. In this analogy, rain equals stress (a challenge we must adapt to). When it is raining, we cope (adjust our behavior to reduce the negative effects of the rain) by using devices such as umbrellas and raincoats. We can also cope with stress. However, should it rain very hard without pause for a long time, it will flood. A flood can be so powerful that it will kill many people and destroy homes and businesses. Entire landscapes can rapidly transformed and people's lives become a struggle for survival and recovery. While rain is seen as a normal component of life, flooding is not. The same applies to stress.
11Psychosocial Impact – Considerations Prior experience with a similar eventPrior traumaThe intensity of the disruption in the survivors’ livesThe resilience of the individual
12Psychosocial Impact – Considerations The length of time that has elapsed between the event occurrence and the presentPre-existing vulnerabilitiesMan-Caused vs.Naturally OccurringEventsChildren/familiesSeniorsDisabledBereavedHealth impairmentsWomen
13Psychological Response to Trauma Key Principles Man-Caused vs. Natural EventsAdult Coping & Adaptation
14Consequences of Critical Incidents Often include LOSS Tangible LossLoss of loved onesLoss of homeLoss of material goodsLoss of employment / incomeDisasters are numerous and are by their very nature a serious threat to the health and well-being of the people involved. They have social and psychological consequences that can interfere with a person's ability to carry on with his or her life.
15Consequences of Critical Incidents Often include LOSS Intangible LossLoss of safety / security (real or perceived)Loss of predictabilityLoss of social cohesion/connection/supportLoss of dignity, trust and safetyLoss of positive self-image/self-esteemLoss of trust in the futureLoss of hopeLoss of CONTROLDisasters are numerous and are by their very nature a serious threat to the health and well-being of the people involved. They have social and psychological consequences that can interfere with a person's ability to carry on with his or her life.
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 cardWhite Card - write down one of your favorite belongingsPink 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 processMay spawn other problemsNothing like T & T (Time and Talking)
21“We’re 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 situationImprove resistance, resilience and recovery.Identifying those at risk for severe social or psychological impairmentIdentify those in need of additional or special services.
23Role of Disaster Mental Health? Mitigate post trauma sequelaeMay prevent future problemsHelps people to handle problems in a way that does not create MORE problemsConvey sense of compassion and support for people.
24Psychological Response to Trauma Key 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 Trauma Key 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 Trauma Key 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 survivalGrief and loss over loved ones & loss of valued and meaningful possessionsFear & anxiety about personal safety & the physical safety of loved onesA need to talk about events & feelings associated with the disaster, often repeatedlyA need to feel one is a part of the community & its recovery efforts
27Anniversary Reactions Phases of DisasterHoneymoon(community cohesion)llllllllllllReconstruction(a new beginning)HeroicPre-DisasterDisillusionmentWorking Through Grief(coming to terms)ThreatEVENTWarningInventoryTrigger Events andAnniversary ReactionsTime to 3 days 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 PhaseSometimes anxiety can escalate to become anger and agitation. An individual under a great deal of stress can sometimes become irrational and infuriated by what is going around them. One of the hallmarks of the Disillusionment Phase of a disaster is the emergence of anger, often directed at volunteers and public officials. In this module you will learn and practice basic listening and communication skills that can sometimes prevent people from becoming overly agitated or angry. However, anger and agitation may sometimes be unavoidable. To prepare you for this, you will also be introduced to specific strategies to assist in reducing distress or “de-escalating” someone who is already angry or agitated.
29Honeymoon (community cohesion) Survivors may be elatedHappy just to be aliveThis phase will not last
30Disillusionment Reality of disaster “hits home” Loss and Grief becomes prominent
31Psychological Support Your actions and interactions with affected people canhelp provide critical support to people in distress.relieve suffering, both emotional and physicalImprove people’s short term functioningAccelerate the individual’s course of recovery
32BrainstormingWhat 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 skillsPatientCaring attitudeTrustworthyApproachableCulturally competentEmpathetic
34Essential Attributes and Skills Non-judgmental approachKindCommittedFlexibleAble to tolerate chaosThe training provided in this manual will help volunteers to be more aware of some basic ideas and techniques which will aid them in their work. Most people have what it takes to be supportive to another person. It is the goal of this training to teach people how to recognize the skills they need and how to enhance and apply those skills more effectively. Once training has taken place, it is important to use and refine the skills and techniques learned. Since psychological support can be valuable in critical events of any size, most volunteers will find many opportunities to put new ideas and enhanced skills into action.
35Supportive Communication Supportive communication conveys:EmpathyConcernRespectConfidenceWhile it is likely that you already know and practice many of the ways of communicating, even experienced mental health practitioners can benefit from an occasional reminder course in this area.A skillful helper must use every available tool to help people in need. Because you will encounter people at various levels of distress, of various ages and backgrounds, gender and under varying conditions, this section attempts to anticipate and address those differences with helpful suggestions. However, situations will always arise that defy expectations where you will need to be flexible, confident and creative as required.
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 dangerBe direct and activeProvide accurate information about what you’re going to doReassureDo not give false assurancesRecognize the importance of taking actionProvide and ensure emotional support
39Crisis InterventionObserve safe practices by showing concern for your own safetyRemain calm and appear relaxed, confident and non-threateningYou must look and act calm even if you are notYou may come across someone who is extremely agitated and who may be having trouble calming down. Such people may become a danger to themselves or others. For instance, thoughts of suicide are a common theme. While psychological support is not intended as a solution for such situations, it is still important to have an understanding of how to react in a crisis. Above all, remember to maintain your own safety. If you do not feel safe with the person, get out and get help.
40Goals of Psychological First Aid Psychological first aid (PFA) promotes and sustains an environment of:SAFETYCALMCONNECTEDNESSSELF-EFFICACYHOPE
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? I’m Sorry This must be difficult for youI’m here to be with you
47Psychological First Aid DON’T: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 DON’T: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 DON’T: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 it’s like for you.” “Don’t feel bad.”“You’re strong/You’ll get through this.”“Don’t cry.”“It’s God’s 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 respondersMental Health Clinicians are often requested to assist other relief workers with grieving or angry people. Many disaster relief workers do not feel confident in their own ability to deal with the intense emotions these individuals may show. In general, these emotions are appropriate reactions to the situation and are not considered mental health emergencies. While it may seem as though a professional is needed, often the situation can be handled by a well trained community responder. Even in those cases when a clinician's skills are necessary, the community responder needs to know what to do until a Clinician (or in some cases security personnel) can arrive on scene and provide professional intervention.
52Anxiety A state of intense apprehension, uncertainty and fear Results from anticipating a threatening eventIntense anxiety = “fight or flight”We all feel anxiety in dangerous situations. Anxiety can be defined as a state of intense apprehension, uncertainty, and fear resulting from the anticipation of a threatening event or situation. Sometimes, anxiety is so intense that the normal physical and psychological functioning of the individual is disrupted. At its most intense, we experience what is called "fight or flight". This is a physiologic response that prepares the body to "fight" or "flee" from a threat to our survival. This response can help us survive a threatening situation. It's perfectly normal to feel anxiety in an extreme situation. It's also normal to feel anxiety when you are with someone who appears to be out of control of their own emotions and behavior
53AgitationSometimes, despite our best attempts at active listening, people become agitatedIt is usually not personalThis is their reaction to an extremely abnormal situation, and it has nothing to do with youDo not become defensive and remember to practice your skills to help the person to re-gain control. This is what is referred to as de-escalation. To effectively de-escalate someone, we must be able to recognize when the behavior is rising, or escalating, and what the behavior will look like when it returns to normal.
54The Energy Curve Agitation Anxiety Tension Reduction Baseline When people experience an escalation of emotion, they also experience a rise in their energy level. As people become anxious, their energy level begins rising. By the time they are agitated their energy level may be very high. De-escalation can help bring someone’s energy level down, or reduce their level of tension to the point that they are able to regain control. When a person is calm again, they may feel like their energy level is lower than normal. Eventually, their emotion and energy will level off. This information is true for everyone, not just people affected by disasters.Baseline
55Elements of Escalation Challenging authority or questioningRefusal to follow directionsLoss of control, becoming verbally agitatedBecoming threateningThere are some identifiable elements of escalation people exhibit when they become upset. These elements do not necessarily follow in order, as everyone reacts differently to different situations. Challenging authority or asking questions that may not seem related to the situation is one common element seen in the behavior of people who are escalating from anxiety to agitation. Another is to refuse or balk at following directions. A person may also temporarily lose some control and seem to release or let loose of words they may not normally use. The agitated person may even become threatening or intimidating.
56Elements of Escalation Challenging Authority or QuestioningAnswer the questionRepeat your request in a neutral tone of voiceRemember that an ounce of prevention is worth a pound of cureAnswer the question.If you are following the rules and regulations of your organization, explain this, and then offer to find a supervisor for them to talk with regarding their concerns. Remember to use a neutral tone of voice and not to be defensive.Repeat your direction or request.This can be especially useful if you are attempting to give a direction that the person needs to follow for safety reasons. Repeat the same direction, in the same neutral tone of voice, over and over. For example: “Please lower your voice, please lower your voice, please lower your voice.” NOTE: Give the direction in a positive way, tell them what you WANT them to do, not what you DON'T want them to do. "Please lower your voice" is much more effective than "stop shouting". This should always be conveyed with kindness, but in a firm manner. Anxious people tend to be fairly verbal. They may demand to see someone, to talk to a supervisor, or to go to the head of the line. Their voices rise and they might speak more rapidly than usual. The best time to intervene is when someone is showing signs of anxiety, before it progresses to agitation. You've heard the phrase, "an ounce of prevention is worth a pound of cure"? In the case of someone who is anxious, and becoming angry, preventing the escalation is the "ounce of prevention". It does take a "pound of cure" when the person has escalated and needs you to help them regain control.
57Elements of Escalation Not Following DirectionsDo not take control, help the individual gain control of him/herselfRemain professionalConsider restructuring your requestGive the person time to think about your requestAs people become agitated, they may initially refuse to follow directions. In a disaster situation, this is potentially life-threatening so it is important to gain control of the situation quickly. However, shouting and demanding that they follow directions will not achieve the goal of gaining immediate compliance. Instead, it will probably throw fuel on the fire and cause the situation to escalate. Instead of thinking in terms of gaining control over the individual, tell yourself that you will help them gain control of themselves. This will lead you to react in a more helpful manner. As the person escalates, you must retain your professionalism. If you become defensive or irrational, you will have very little chance of defusing the situation. Irrationality breeds irrationality. If the person senses you are losing control, they will lose control also. It is often easier to react in a professional manner if you are not alone. Using the buddy system can be a very easy way to help you retain your professionalism when dealing with a difficult situation.Consider restructuring your request.You may have made a request or given a direction that the person did not understand or finds difficult to comply with. You could make your request in a way that gives the person some control – for example, instead of saying “please sit down” you could offer a choice, “would you like to sit down in chair A or chair B?” The person is not offered the choice of not sitting down, only a choice of seats.Give the person time to consider your request or direction.Sometimes the person needs time to process your request or direction. This is especially true if they are highly energized and your request was complicated. Consider simplifying the request and allowing the person a few moments to think before responding.
58Seek Assistance Loss of Control, Becoming Verbally Threatening Verbal VomitIf the person becomes threatening or intimidating and does not respond to your attempts to calm them, seek immediate assistancePeople who are escalating and becoming agitated may lose their filters and begin saying things they wouldn’t normally say. They may talk loudly and with energy about things that are bothering them. This surge of verbal energy can seem like “verbal vomit” as it spews forth as if a release valve has been opened. For example, a person comes to the family assistance center to apply for services and becomes upset about the long wait for service. In their agitation, they may become demanding, speak loudly and move quickly from topic to topic related to their complaints or concerns. They may claim special privilege or circumstances or say that the disaster was worse for them than for anyone else.
59Elements of De-escalation Establish a relationshipIntroduce yourself if they do not know youAsk the person what they would like to be calledDon't shorten their name or use their first name without their permissionWith 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 focusUse closed ended questions (yes/no)If the person is not too agitated, briefly explain why you are asking the questionFor 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 somethingEstablishing a point of agreement will help solidify your relationship and help gain their trustPositive language has more influence than negative languageActive listening will assist you in finding a point of agreement
62Elements of De-escalation Speak to the person with respectThis is communicated with:WordsPara-verbal Communication (how we say the words – e.g. tone, pitch)Non-verbal behaviorUse of words like please and thank you
63Elements of De-escalation Don't make global statements about the person's characterUse “I” statementsLavish praise / support / encouragement is not believableSaying "you're a nice guy" to someone who is angry or despondent will not de-escalate the situation – particularly if you have just met the person and have no basis upon which to make that statement. Your comment may seem insincere.Avoid using the word "we", as in "we need to calm down". It sounds parental and condescending.Use small, concrete compliments embedded in the conversation:I can see that you are trying to lower your voice, and I appreciate that.Try to avoid sounding condescending such as saying, “Good effort.”The key is treating the other person as an equal.
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: Helping the Helpers
67Adrenaline, Friend or Foe? Increase in speed and strengthTunnel vision – eyes revert to default survival position.Reduced Near, peripheral, depthHearing mutedChanges in reaction timeFreezing and unable to reactOverreactingIncrease in sensory acuitySlow motion timeMay act in a way that seems inappropriate for the situation (e.g. giggle, yell)The goal of the helper is to recognize where the person may be on the energy curve and to help them channel or harness that energy to return to a more normal energy level that allows them to be more in control of themselves.
68Psychological Response to Trauma Survivors’ 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 & anxietyGrief & lossShockHopelessnessLoss of ConfidenceMistrustSleep disturbancesPhysical painConfusionShameShaken faithAggressiveness
69Possible Physiological Symptoms Loss of appetiteHeadaches, chest painDiarrhea, stomach pain, nauseaHyperactivityIncrease in alcohol or drug consumptionNightmaresInability to sleepFatigue, low energy
71More Typical Reactions… Fear of darknessFear of being alone or of crowds or strangersSensitivity to loud noisesSomatic complaintsGuilt, anger, griefReliving past traumasMain point – Disaster stress is a normal response to an abnormal circumstance. If symptoms persist, they must be treated.Heightened emotional states such as anger, fear, anxiety, depression, sleeplessness can result when medication is interrupted. In people with pre-existing dementias, greater confusion may be apparent. Confusion in the older person cannot always be attributed to dementia. Other conditions such as dehydration, injury, lack of medications, delirium, and depression may present as confusion but can be treated appropriately to return cognitive function. Memories of earlier traumatic events may resurface in nightmares or in reenactment behavior.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 doOften have a feeling of not having done enoughAre sometimes overwhelmed by the needs of the communityNeed to cope with their own fearsFor some years now, it has been acknowledged that support programs cannot afford to focus only on the people directly affected by the disaster. Helpers and other people exposed to emotional stress can also experience stress or crisis as a result of their work. This is especially so for young and inexperienced helpers. These facts have strong implications for the community responder in Nebraska.The traditional heroic role of helpers includes expectations that they are selfless, tireless, and somehow superhuman. Helpers are, however, affected by their jobs. Community responders will often leave their jobs with a feeling of not having done enough, because needs in many situations are so overwhelming that they far exceed their capabilities. A volunteer might be troubled by the tormenting stories of disaster survivors or first responders may feel guilt at the death of a victim.
75Challenge to Helpers Being part of the collective crisis Repeated exposure to grim experiencesCarrying out physically difficult, exhausting or dangerous tasksLacking sleep and feeling fatiguedFacing the perceived inability to ever do enoughStress is inherent in disaster situations. Helpers are exposed to unusual personal demands in the desire to help meet the needs of survivors. Many feelings need to be addressed; from those associated with providing services such as first aid, to being close to the center of the distressing event, and not least of all, dealing with emotionally distressed and physically injured people. The helper's situation and problems are often pushed into the background, but after the event, they must not hesitate to draw on the support of other people.
76Challenge to Helpers (cont.) Feeling guilt over access to food, shelter, etc.Facing moral and ethical dilemmasBeing exposed to anger and lack of gratitudeBeing detached from personal support systemsFeeling frustrated by policies and decisions by supervisors
77Categories of Reactions After the Incident ASD / PTSDGriefDepressionResilienceMental Healthand IllnessAvoidance (emotional)Substance abuseRisk takingOver DedicationHuman Behavior in High Stress EnvironmentsDistressResponsesFear / worrySleep disturbanceAltered productivity
78Loss and Grief – Signs of Trouble Avoiding or minimizing emotionsUsing alcohol or drugs to self-medicateUsing work or other distractions to avoid feelingsHostility and aggression toward others
79Stress A state of physical and/or psychological arousal Often brought about by a perceived threat or challengeMay be expressed differently by different culturesReactions may differ and obviously depend upon the severity of the situation. In addition, predisposing factors such as personality traits or previous history of mental disorders may make reactions more serious or intensify their course. Stress reactions are experienced at both the physical, cognitive (how we perceive and "think" about events), emotional and behavioral level.
80Coping with StressCoping is a way to prevent, delay, avoid, or manage stressCoping mechanism categories:Changing the source of stressChanging the view of the situationTolerating the stressor until it passes or becomes less troublesomeWhile the stress reactions outlined previously are normal, they can also interfere with recovery. By providing compassionate support for people affected by a critical event, we can help reduce their stress and make an essential contribution to their recovery.Coping effectively with adversity often requires a balance between changing the negative conditions, either through confrontation or avoidance, and adjusting to those things that are beyond anyone's power to change.
81Examples of Coping Seeking help from others or offering to help others Using natural support systemsTalking about their experiences and trying to make sense of what happenedHiding until the danger has passedSeeking information about the welfare of loved onesGathering remaining belongings
82Examples of Coping (cont.) Beginning to repair the damageBurying or cremating the deadFollowing religious or cultural practicesSetting goals and making plansUsing defenses like denialRemaining fearful and alert to further dangerThinking long and hard about the eventIn some way, each of these is an attempt to either reduce the anxiety brought on by stress or to alter the situation so that stress will not be sustained.
83Activity – Decompression Take a few moments to write down five things that help you relieve stress and feel calmerShare these methods with the rest of the groupNote to presenter: Engage the participants in a general discussion about "recharging their batteries" and ask them to brainstorm ideas that have not already been presented
84Self-Help Techniques Know the normal reactions to stressful events Be aware of your tension and consciously try to relaxUse the buddy systemTalk to someone you trust and with whom feel at easeListen to what people close to you say and think about the eventReconcile expectations with resultsEmotional reactions to distressing events are normal and should be expected both from the people affected and the helpers. The majority of the reactions are short term with no lasting consequences. Both physical care and psychological support are important to successful recovery A number of self-help techniques have been identified that the individual helper can use to minimize stress while coping with the myriad of emotions that may arise as a result of their work. Understand that these reactions are normal. It can be useful to express emotions and acknowledge these reactions – even those that are frightening and strange.Slow your breathing and relax your muscles. Try taking deep breaths that fill your chest. Roll your head and neck, releasing tension that may be developing.Checking in every hour or so with your buddy will allow you to touch base with each other and ensure that you are both handling your stress in a pro-active manner. It’s easier to keep your cool and perspective when you aren’t in it alone.You process the unpleasant experiences when you talk about them. Sometimes talking at the end of a shift or assignment in a relaxing setting can help you make the transition to your personal environment.It has affected them too, and they may share insights that will benefit you. Rather than shutting out those around you, listen and join in the support they can provide.
85Self-Help Techniques (cont.) Work on routine tasks if it is too difficult to concentrate on demanding dutiesIf you cannot sleep or feel too anxious, discuss this with someone you can trustExpress your feelings in ways other than talking:DrawPaintPlay musicJournalMaintain as normal a schedule as possible and resist the urge to withdraw. Taking part in routine tasks can help you relax, experience a sense of normalcy, and help you focus. Don’t try to do complicated tasks right after a stressful event.Sometimes talking can help move the thoughts to a place in your mind that will allow you to relax and sleep. Talking to someone you can trust may also help you decide if you need to seek professional assistance.Sometimes it is easier to express your feelings by doing other than talking. These can be very private, personal activities or they may be shared.
86Self-Help Techniques (cont.) Do not self-medicateGo easy on yourselfAvoid inflated or perfectionistic expectationsSeek professional advice if reactions continueGet medical advice.It takes time to evaluate how you will view things after a distressing event has occurred. Don’t expect too much from yourself.Often expectations that are too high can lead to disappointment and conflict. This is particularly true in regard to a helper’s expectations of perfection. When these thoughts are detected, check them against what you would realistically expect from others in your situation.It is a sign of strength and personal awareness to seek professional advice if personal reactions that interfere with normal living. Professional advice may come from a trusted medical professional, a mental health professional, or faith leader with appropriate training and/certification.
87Cognitive/Behavioral Approaches to Stress Reduction Adequate RestExercise / MovementDiet / Balanced NutritionEnough H2OModerate Chemical UseLaughter / TearsTime Away From Work Role
88Cognitive/Behavioral Approaches to Stress Reduction Religious / SpiritualRelaxation Techniques / BreathingYogaMeditationSocial Support / Discuss FeelingsAllow yourself to receive as well as give
89Cognitive/Behavioral Approaches to Stress Reduction Play: Hobbies / Personal Interests Exposure to NatureBiofeedbackMassage / Human TouchSexProfessional AssistanceMedicationWhat Else Works for You???
91Team Well-Being CERT team leaders should: Provide pre-disaster stress management trainingBrief personnel before responseEmphasize teamworkEncourage breaksProvide for proper nutritionRotatePhase out workers graduallyConduct a brief discussionArrange 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.
94When you come to the edge or You will be given wings. of all that you know,You must believe inone of two things;There will be earthon which to stand,or You will be given wings.Anonymous