Transcript Psychology of a Crisis - Central Colorado Area Health

Psychology of a Crisis
Module 2
What Constitutes Crisis?
 Naturally occurring
 Earthquake
 Tornado
 Flood
 Wildfire
 Pandemic Disease
 Manmade
 Hazardous Material Release
 Terrorism
 Other Criminal Activity
Traumatic Events
 Sudden and unexpected
 Children more vulnerable – less experience in
coping with life
 Adults may be overwhelmed by events that
occur suddenly and are beyond their control –
may produce psychological reactions
including Post Traumatic Stress Disorder
(PTSD)
Public Perspectives
 61% fear terrorism more than natural disaster
 77% believe information to cope with fear and
distress are needed
 57% do not think the health system is
meeting the mental health needs resulting
from the threat of terrorism
 Information received after a crisis significantly
shapes reactions over the weeks and years
following
Immediate Reactions to a Crisis
 Disbelief
 Disorientation
 Dislocation
 Fear
 Feeling time is slowed down
 Feeling numb or disconnected
 Feeling helpless
 Feeling responsible (should be doing more)
HOW DO YOU FEEL?
Response to 9/11 Attacks
 First week
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44% of adults & 35% of children – 1 or more
substantial stress symptoms
Intrusive thoughts
Very upset when reminded
Nightmares, sleep disturbance
Poor concentration
Anger outbursts
Response to 9/11 Attacks
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20% of Americans know someone who was missing,
hurt or killed
64% had a shaken sense of safety & security
43% less willing to travel by airplane
 Within 2 months in Manhattan
 7.5% increase in PTSD (67,000 new cases)
 9.7% increase in Depression (87,000 new cases)
 Secondary trauma via TV and other media correlate
to PTSD symptoms – 60% witnessed via live TV
General Psychological Effects
 Emotional Effects
Grief, anger, despair, sadness, hopelessness,
numbness, denial, flashbacks, generalized Anxiety
Disorder, Panic Disorder, Post Traumatic Stress
Disorder (PTSD)
 Cognitive Effects
 Impaired concentration & decision-making,
impaired memory, disbelief, worry, tunnel vision
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General Psychological Effects
 Physical Effects
Fatigue, insomnia, cardiovascular strain, hyperarousal, health problems/concerns headaches,
decreased appetite, nonspecific distress, MUPS –
Medically Unexplained Physical Symptoms
(worried well)
 Interpersonal Effects
 Increased relational conflict, social withdrawal,
impaired performance, over-protectiveness,
feeling abandoned and rejected
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Who’s At Risk?
 Those with severe exposure, injury, threat to life,
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extreme loss, disrupted community, and high
secondary stress
Females age 40 -60 with no experience in coping
techniques
Young & middle aged adults (vs. older adults)
Prior exposure to violence and trauma
Ethnic minorities
Persons with prior psychiatric history
Adults with children
School children
First responders
Protecting the Public’s Psychological
Health
 Provide basic resources – food, shelter,
communication, transportation, and medical
services
 Programs to promote individual and
community resilience
 Surveillance for psychological consequences
 Treatment for acute and long-term effects of
the trauma
Protecting the Public’s Psychological
Health
 Human Services – reuniting families, child
care, housing, job assistance
 Risk Communication – dissemination of
information
 Training service providers to respond,
protected against psychological trauma
 Surge capacity
 Identifying the underserved, marginalized
persons needing psychological services
Traumatic Stress
Traumatic stress may affect:
 Cognitive functioning.
 Physical health.
 Interpersonal relations.
Mediating Factors
 Prior experience with a similar event
 The intensity of the disruption in the survivors’
lives
 The emotional strength of the individual
 The length of time that has elapsed between
the event occurrence and the present
Physiologic Response
 Stress Increases
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Heart rate increases
Motor skill ability decreases
Perceptual narrowing occurs – tunnel-vision
Response programming is delayed until threat
identified
Actions to Perform Under Stress
 Take a deep breath
 Look around during size up, view the BIG
picture
 Think before acting – develop a plan
 Remember:
 IT’S NOT MY EMERGENCY!
Phases of a Crisis
 Impact: stunned, shock
 Inventory: confusion, then assessment
 Rescue: inclined to act, compliant
 Recovery: relief, anger
 Reconstruction: grief, long term resolution
Possible Psychological Symptoms
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Acting differently than normal for this person
Performing activities that do not make sense for the time
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
Relationship conflicts/marital discord
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
Team Well-Being
Team leaders should:
 Provide pre-disaster stress management training.
 Brief personnel before response.
 Emphasize teamwork.
 Encourage breaks.
 Provide for proper nutrition.
 Rotate personnel.
 Phase out workers gradually.
 Conduct a debrief discussion.
 Arrange for a post-event debriefing later.
Critical Incident Stress Debriefing
Six phases:
 Introduction and a description
 Review of the factual material
 Sharing of initial thoughts/feelings
 Sharing of emotional reactions to the incident
 Instruction about normal stress reactions
 Review of the symptoms
 Closing and further needs assessment
Risk Communications - EPA
 Accept & involve the public as a legitimate
partner
 Listen to the audience
 Be honest, frank and open
 Coordinate and collaborate with other
credible sources
 Meet the needs of the media
 Speak clearly and with compassion
 Plan carefully and evaluate performance
Avoid Saying . . .
 “I understand”
 “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…”
 “I’m sorry for what’s happened to you”