In Times of Crisis: Supporting Others, Supporting Ourselves

In Times of Crisis: Supporting Others, Supporting Ourselves
John Gaspari, LCSW Executive Director USC Center for Work and Family Life

Importance of beginnings and endings
Introductions Importance of beginnings and endings

Center 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

Role 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?

Unit 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.

Are 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.

Critical 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 person’s response involved intense fear, helplessness or horror. (DSM-IV TR)

CRISIS danger; peril opportunity; crucial point

Coping 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. 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.

Into 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.

Psychosocial Impact – Considerations
Prior experience with a similar event Prior trauma The intensity of the disruption in the survivors’ lives The resilience of the individual

Psychosocial 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

Psychological Response to Trauma Key Principles
Man-Caused vs. Natural Events Adult Coping & Adaptation

Consequences of Critical Incidents Often include LOSS
Tangible Loss Loss of loved ones Loss of home Loss of material goods Loss of employment / income Disasters 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.

Consequences 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 Disasters 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.

Activity – 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.

Activity – 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

Possible 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)

Grief 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)

Supporting Others

“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

Role 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.

Role 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.

Psychological 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.

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.

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

Anniversary Reactions
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 to 3 days to 3 years

Phases 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 Sometimes 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.

Honeymoon (community cohesion)
Survivors may be elated Happy just to be alive This phase will not last

Disillusionment Reality of disaster “hits home” Loss and Grief
becomes prominent

Psychological Support
Your actions and interactions with affected people can help provide critical support to people in distress. relieve suffering, both emotional and physical Improve people’s short term functioning Accelerate the individual’s course of recovery

Brainstorming 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.

Essential Attributes and Skills
Good Listening skills Patient Caring attitude Trustworthy Approachable Culturally competent Empathetic

Essential Attributes and Skills
Non-judgmental approach Kind Committed Flexible Able to tolerate chaos The 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.

Supportive Communication
Supportive communication conveys: Empathy Concern Respect Confidence While 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.

Activity – 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.

Activity – 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.

Guiding Principles in Providing Psychological Support in Your Role
Protect from danger Be direct and active Provide accurate information about what you’re going to do Reassure Do not give false assurances Recognize the importance of taking action Provide and ensure emotional support

Crisis 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 You 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.

Goals of Psychological First Aid
Psychological first aid (PFA) promotes and sustains an environment of: SAFETY CALM CONNECTEDNESS SELF-EFFICACY HOPE

Psychological 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.

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.

Promote CONNECTEDNESS: Help people contact friends and loved ones. Keep families together. Keep children with parents or other close relatives whenever possible.

Promote SELF-EFFICACY: Give practical suggestions that steer people toward helping themselves. Engage people in meeting their own needs.

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.

Do Say… Can you tell me what happened? I’m Sorry
This must be difficult for you I’m here to be with you

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).

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).

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

Avoid 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 . . .”

Intense Emotions Are often appropriate reactions following a disaster
Can often be managed by community responders Mental 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.

Anxiety A state of intense apprehension, uncertainty and fear
Results from anticipating a threatening event Intense 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

Agitation 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 Do 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.

The 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

Elements of Escalation
Challenging authority or questioning Refusal to follow directions Loss of control, becoming verbally agitated Becoming threatening There 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.

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 Answer 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.

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 As 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.

Seek 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 People 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.

Elements 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

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?

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

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

Don't make global statements about the person's character Use “I” statements Lavish praise / support / encouragement is not believable Saying "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.

Activity – De-escalation
May I have two volunteers?

Activity – 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?

Responder Stress and Well-Being:
Helping the Helpers

Adrenaline, 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) 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.

Psychological 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 & anxiety Grief & loss Shock Hopelessness Loss of Confidence Mistrust Sleep disturbances Physical pain Confusion Shame Shaken faith Aggressiveness

Possible 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

Possible 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

More 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. 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

For most people, things get better with time…

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.

Helpers 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 For 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.

Challenge 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 Stress 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.

Challenge 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

Categories 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

Loss 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

Stress A state of physical and/or psychological arousal
Often brought about by a perceived threat or challenge May be expressed differently by different cultures Reactions 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.

Coping 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 While 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.

Examples 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

Examples 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 In 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.

Activity – 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 Note 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

Self-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 Emotional 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.

Self-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 Maintain 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.

Self-Help Techniques (cont.)
Do not self-medicate Go easy on yourself Avoid inflated or perfectionistic expectations Seek professional advice if reactions continue Get 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.

Cognitive/Behavioral Approaches to Stress Reduction
Adequate Rest Exercise / Movement Diet / Balanced Nutrition Enough H2O Moderate Chemical Use Laughter / Tears Time Away From Work Role

Religious / Spiritual Relaxation Techniques / Breathing Yoga Meditation Social Support / Discuss Feelings Allow yourself to receive as well as give

Play: Hobbies / Personal Interests Exposure to Nature Biofeedback Massage / Human Touch Sex Professional Assistance Medication What Else Works for You???

Team 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

No 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.)

Critical 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.

When you come to the edge or You will be given wings.
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

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