Crisis: Theory and Intervention Chapter 21: Crisis: Theory and Intervention Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Historic and Theoretic Perspectives Equilibrium Homeostasis Crisis intervention

Crisis Psychological disequilibrium Stressful event with the potential to overwhelm and strain coping A turning point for growth and change May encouragement movement from complacency

Four Defining Components Specific, unexpected and non-routine events Create uncertainty Perceptions of threat Transformational

Risk Factors for Crisis Concurrent or multiple bio-psychosocial stressors Multiple losses Limitations Chronic pain/disability Poor or inadequate support networks Limited access to health care

Types of Crisis External Internal Maturational Adventitious

Caplan’s Phases Individual is exposed to a stressor Prior coping strategies fail to relieve Mobilization of resources to resolve and alleviate discomfort Absence of crisis resolution leads to major disorganization

Human Response to Crisis A person’s response is often an ordinary response to an extraordinary event An attempt to restore balance Crisis disrupts bio-psychosociospiritual homeostasis

Potential Responses to Crisis Shock Numbness Denial Dissociative behavior Confusion Disorganization Difficulty making decisions Suggestibility Physiologic symptoms

Psychological Stages After a Disaster Heroic Phase Honeymoon phase Disillusionment phase Reconstruction

Situational Crises Result from external stressors: Threat to safety or well-being Job loss Divorce Death of loved one Serious medical condition Natural disasters Man-made disasters

Psychiatric Disorders Associated With Crisis Depression Anxiety disorders Adjustment disorders Posttraumatic stress disorder (PTSD)

Additional PTSD Symptoms in Children Regressed behavior Increased fears Poor concentration Decreased academic performance Increased oppositional behavior Irritability and aggression Emotional lability Depression

Method of Crisis Intervention Assessment Planning therapeutic intervention Intervention Resolution of crisis Anticipatory planning

Crisis Intervention Offer short-term strategic therapy. Provide timely intervention. Stabilize victims with order and routine. Facilitate understanding of event (gather facts, listen, teach). Use available resources to promote independent functioning. Encourage self-reliance. Assist with practical coping strategies.

Global Intervention Art and science of dealing with natural and man-made disasters Reduce loss of life and property Protect communities from hazards

Crises Caused by Psychiatric Emergencies Urgency Impending doom Intolerable anxiety Sense of being overwhelmed Inability to cope May not recognize the need for help

Psychiatric Emergencies Life-threatening behavior Life disrupting Life impairing

Robert’s Model A: Assessment and appraisal of immediate medical needs, threats, property damage, and trauma C: Connection to support and disaster relief T: Trauma treatment plans

Prevention Strategies Primary Secondary Tertiary