Any stressful event or hazardous situation has the potential for precipitating a crisis. A crisis differs from stress in that a crisis results in a period of severe disorganization resulting from the failure of individuals usual coping mechanism or the lack of usual resources or both. Crisis is any transient situation that requires the reorganization of one's psychological structure and behavior, that causes a sudden alteration in the person's expectation of self, and that cannot be handled with the usual coping mechanisms.

1. Crisis
Prepared by
Sapana Shrestha
Lecturer
PAHS
1

2. 2

3. 3

4. Crisis:
• Introduction, definition
• Characteristics
• Types
• Phases
• Difference between stress and crisis
4

5. crisis
• Any stressful event or hazardous situation has the potential for
precipitating a crisis.
• A crisis differs from stress in that a crisis results in a period of severe
disorganization resulting from the failure of individuals usual coping
mechanism or the lack of usual resources or both.
• Crisis is any transient situation that requires the reorganization of
one's psychological structure and behavior, that causes a sudden
alteration in the person's expectation of self, and that cannot be
handled with the usual coping mechanisms.
5

6. Definition-
A crisis is any event that is or expected to lead to an
unstable and dangerous situation affecting an
individual, group, community or whole society.
• "Crisis is a perception or experience of an event or
situation as an intolerable difficulty that exceeds the
person's current resources and coping mechanisms"
James and Gilliland, 2001.
6

7. •According to the Taylor 1982 “Crisis is a state of
disequilibrium resulting from the interaction of an
event with the individual’s or family’s coping
mechanisms , which are inadequate to meet the
demands of the situation combined with the
individual’s or family’s perception of the meaning
of the event’’.
7

8. According to Seeger, Sellnow and Ulmer that crisis have four
defining characteristics that are
• specific,
• unexpected
• non routine events or series of events that create high levels
uncertainty and
• threat or perceived threat to an organization’s high priority goals.
8

9. Characteristics of crisis
• Temporary state of disequilibrium precipitated by an event
• Unexpected (i.e., a surprise). All crises are experienced as
sudden.
• Creates uncertainty
• In crisis situation, communication with significant others is
often decrease or cut off.
• Self-limiting-usually 4-6 weeks.
• Seen as a threat to important goals
• Crisis can promote growth and new behaviors.
9

10. Types of crisis
There are three types of crisis
• Maturational or developmental crisis
• Situational crisis
• Adventitious crisis
10

11. Situation 1
• In a family, they have six children one son and five
daughters and already grown up. They all are educated,
well manner, socially active, helpful; but nobody got
marriage. I thought that they are scared, fear about
marriage. In their child hood, father became alcoholic
and mother Was emotionally broken down. They did not
see positive aspect of family in early age.
11

12. 1. Developmental crises - (Maturational
crisis):
• also called as normative crisis.
• Normal transitional stages that often trigger crisis states, which all
people pass through while growing through the life span.
• Developmental crisis (also referred to as maturational or internal
crisis) may occur at any transitional period in normal growth and
development.
• The transitional periods where individuals move into successive stage
often generate disequilibrium. Individuals are required to make
cognitive and behavioural changes that accompany development.
12

13. contd…Developmental crises - (Maturational
crisis):
• Developmental crises are normal, transitional
phases that are expected as people move from
one stage of life to another that are accompanied
by changes in thoughts, feelings and abilities for
example birth, weaning, starting to school,
midlife, retirement etc.
13

14. Three main reasons of person unable to make role changes necessary to prevent a
maturational crisis are:
• Skills deficit for example, if a parent does not have the skills to be a parent, having
a baby could become a crisis situation.
• Inability to picture himself in a new role
• Lack of interpersonal resources like
• inadequate communication skills,
• not being able to achieve certain goals or
• inability to realize alternatives to his present life style
• Refusal by others in social system to see the person in a different role like when
the adolescents tries to assume the adult role, the parent may persist him in
keeping him the child role.
14

15. Some examples:
• Child birth: There are daily routine change, relationship change, increased
responsibility, increased expenditure. If the women cannot manage changing
responsibility and emotional feelings appropriately, crisis may occur.
• Weaning: It underlines a physical change associated with the ability to eat and
digest food other than milk or formula. Crisis occurs if baby cannot adopt new
food or care provider is unable to provide appropriate formula.
• School entry: a child faces new environment. There are too many unknown
faces, new rules, interaction with unfamiliar/less familiar language, and role-
change in home to interaction with school.
15

16. • Marriage: changes in value, belief, perception, responsibility,
environment, life style may aggravate crisis
• Middle age: if an individual unable to manage relationship with family
and society, unable to accept and manage physical health problems,
unable to meet the need of middle age
• Menopause: psychosocial crisis occurs if a woman is unable to accept
changes in feminine characteristics, identity crisis and social norms.
• Retirement: low self-esteem due to feeling of isolation, decrease
income, loss of self-identity, prestige, dignity
16

17. 2. Situational crisis-
• A situational crisis (sometimes called accidental or external
crisis) is a response to a sudden and unavoidable traumatic
event that largely affects a person’s identity and roles.
• The situational crisis arises out of external events over which a
person has no control. When situation is sudden, unexpected,
and unfortunate it can produce stress as the client tries to adapt
using his/her available resources.
17

18. • A crisis develops when the person's usual coping
abilities personality or other life circumstances
make the unplanned situation overwhelming for
example, sudden illness, accident, natural
disaster, power struggle, rape etc.
• That is too threatening to the person’s immediate
resources or ability to cope. It requires a change
in behavior.
18

19. Contd… Situational crisis-
• also known as accidental crisis.
• The time taken for healthy or unhealthy adaptation to occur is
usually from one to six weeks.
• It usually follows the loss of an established support or role.
• The threat or loss of a role necessary to maintain self-image,
usually will lead to a crisis state.
19

20. Situational crisis- eg:
• loss of a job,
• failure in school,
• loss of a spouse,
• birth of a retarded child,
• Diagnosis of a terminal or
chronic illness
• assault
• sudden loss of job or
status
• sudden onset of illness
20

21. Adventitious crisis
21

22. Adventitious crisis (social crisis)
• Social crisis is accidential, uncommon and unanticipated and result in
multiple losses and radical environmental changes.
• An adventitious crisis occurs outside the person precipitate by an
unexpected event. (eg.Natural disaster,fires,floods,war etc.)
• These crises affect many people who experience both acute and post
traumatic stress reaction.
• This type of crisis is unlike maturational and situational crisis because it
doesn’t occur in the lives of all people.
22

23. PHASES OF CRISIS
Before the normal function can be maintained, all crises
require sudden and restructuring of psychosocial integration.
Accordi to Fink (1986) phases of crisis are:
1. The shock phase / the initial impact phase
2. Defensive retreat
3. Recoil or acknowledgment
4. Resolution or adaptation and change
23

24. 1.THE SHOCK PHASE / THE INTIAL IMPACT PHASE
•In this phase , the person feels a high – level of
realization of threat or seriousness of the situation.
• The person feels overwhelmed and depersonalized .
•self esteem is threatened, thinking and behavior are
disorganized.
24

25. contd…THE SHOCK PHASE / THE INTIAL IMPACT
PHASE
• The person cannot plan and understand the situation.
• The shock phase usually lasts from 1 hour to 2 days.
• In this phase, the stress syndrome of alarm stage cannot be tolerated.
• Physically illness , injury may occur. The person either pays more
attention to the health or ignores completely.
• Socially; the person becomes withdrawn, hyperactive, decreased self
esteem and confused
• Basic needs cannot be maintained by the person himself or herself.
• Impaired judgement occurs
25

26. contd…THE SHOCK PHASE / THE INTIAL IMPACT
PHASE
• Socially; the person becomes withdrawn, hyperactive, decreased self
esteem and confused
• Basic needs cannot be maintained by the person himself or herself.
• Impaired judgement occurs
26

27. 2.DEFENSIVE RETREAT
• In the phase , the person approaches problem directly at
first, but behavior doesn't work, and then she/ he may
try to redefine problem or seek support from others.
• or the person tries previously successful ways of
problem solving and adjusting , but the situation is not
alleviated , feels increasingly upset and ineffective.
27

28. Cont…DEFENSIVE RETREAT
• In this phase, the person indulge into the self, avoiding reality,
denying, fantasize about how well the problem can be handled.
• Because of repression the person claims to feel all right and doesn't
perceive anxiety and ineffective behavior are observed.
28

29. Cont…DEFENSIVE RETREAT
• Physically; symptoms are minimal and feel better.
• Intellectually; rigid manner of thinking and expressing
same ideas repeatedly is noted. Other's ideas are not
accepted by the person. Behaviors ; are ineffective and
disorganized , cannot carry out daily activities.
• Socially; withdrawn or superficial, hyperactive and
unable to maintain social roles adequately.
29

30. 2. Cont…DEFENSIVE RETREAT
Denial mechanism is used with following three mental
mechanisms:
• Rationalization; about discomfort or symptoms and the cause of
the situation E.g. headache due to disturbed night sleep.
• Displacement; of dangerous, uncomfortable information about
the health team or family, often in the form of demands or
complaints.
• Projection; of personal feelings of inadequacy into others ; E.g.
how neglectful are others.
30

31. 3. RECOIL OR ACKNOWLEDGMENT
• This phase start when the facts of the
situation can no longer be denied.
•The person realizes the objective reality of
the situation and slowly begins to redefine it
and attempts to do problem solving.
• Process of mourning usually begins to
redefine it and attempts to do problem
solving.
31

32. Contd…3. RECOIL OR ACKNOWLEDGMENT
• Process of mourning usually begins at this point, however the person
may be depressed, low self esteem, apathy, agitation and reality may
seem harsh.
32

33. Cont…RECOIL OR ACKNOWLEDGMENT
• In this stage, tension and anxiety are again rise.
• Physically; may feel well or tension may be somatized
(expressed into in physical symptom)
• Intellectually; thinking may be disorganized at first, but
gradually the person can make appropriate plans and find
the solution by the trial and error.
• Socially; recognize him as a social burden and make plans
to resume the previous roles to degree as possible and
give up certain goals as unattainable.
33

34. 4. RESOLUTION OR ADAPTATION AND CHANGE
• in this phase, person perceives the crisis situation in a positive
way and integrates the painful event into the new self.
• Problem solving is successful and feelings about the event are
expressed.
• Person learns new coping mechanism and gained new attitudes
and behaviors that allow dealing effectively with the situation.
34

35. Contd…RESOLUTION OR ADAPTATION AND
CHANGE
• At this time the person should have higher level of
maturity and adaptation than earlier.
• A new sense of worth, a firm identity, gradual
satisfaction in mastering the situation and gradual
lowering the anxiety results in this phase.
35

36. Cont… RESOLUTION OR ADAPTATION AND
CHANGE
• Physically; functioning are at organized, appropriate resources and
abilities are used.
• Socially; resumes status and roles, repatterns behavior to cope, and
thus avoid future similar crisis.
• The person doesn't feel bitter about the event encountered or the
changes made and develop different concept of self and the lifestyle.
36

37. Cont… RESOLUTION OR ADAPTATION AND
CHANGE
• Resolving the crisis is made more difficult by the negative
influences such as additional hardship or complications.
37

38. Cont… RESOLUTION OR ADAPTATION AND
CHANGE
• Ineffective problem solving / mastery or lack of
expression of feelings
• may cause a restricted level of repressed and permanently
denied and unresolved or
• major disorganized, such as neurosis (depression, anxiety,), psychosis
(serious mental disorder characterized by thinking and emotions), socially
maladjusted behavior or chronic physical disability may occur.
38

39. •These phases of crisis are predictable; however each
stage is not sharply demarcated.
•One stage may merge into another or certain
behavior may not appear at all, particularly in
developmental crisis.
• The person may demonstrate behaviors of different
phases simultaneously.
39

40. DIFFERENCE BETWEEN STRESS AND CRISIS
S.N STRESS CRISIS
1 condition in which the
person responds to
changes in a normal
balanced state
A time when a problem, a bad
situation or an illness is at its worst
point.
2 continuous process
affecting day to day life
events
Sudden and dramatic event
interrupting the problem through
trial and error
3 can be managed by
normal coping mechanisms
Person's ordinary behavior is no
longer successful emotionally ,
intellectually or physically to
manage crisis.
40

41. DIFFERENCE BETWEEN STRESS AND CRISIS
S.N STRESS CRISIS
4 causes increases in wear
and tear of the body
often perceived as life threatening
situation
5 May not have change in
behavior
Realignment of behavior
6 May raise or worsen the
mental health
Has a potential for raising the level of
mental health
7 Support group may or may
not be necessary
Support groups are necessary during
crisis
41

42. DIFFERENCE BETWEEN STRESS AND CRISIS
S.N STRESS CRISIS
8 Communication may or
may not be interrupted
Communication is often
decreased or cut off.
9 People have development
problem solving method to
deal with them
People try to solve the problem
through trial and error
10 Faced by all Only developmental is faced by
all, not situational.
42

43. FACTORS AFFECTING OUTCOME OF CRISIS
There are different factors which influences how a person in
crisis reacts , and cope with.
1. Individual's perception of the event-
2. The physical and emotional status
3. Coping mechanism of the level of maturity;
4. Previous experience with similar situation
5. Cultural influences;
6. Support and family , friends and other resources;
43

44. FACTORS AFFECTING OUTCOME OF CRISIS
1. Individual's perception of the event-
• The person's perception determines his/her behavior
rather than the actual event. If the event or the
consequences of it conflicts with his/her value system
or wishes for the future, he/she is likely to define the
situation as hazardous.
•
44

45. • The perception of the situation is individual difference.
• For example, two person live through the disaster of land slide. One
loses all properties and and another loses his buffalo. The second
person may react with greater shock, denial, anger and depression
than the first one because he may perceive buying a new one as a
big challenge, but the second person may think that even if
properties are lost, God saved his entire family member.
• Because of their different perceptions, loss has a different meaning
to them.
45

46. FACTORS AFFECTING OUTCOME Cont…
2. The physical and emotional status;
•If the person is physically and emotionally strong they can
normally and easily perceive and cope with the situation.
•But if the person is emotionally disturbed, they may
perceive situation very seriously or not in reality.
•The physical and emotional status depends on their age,
sex, health status, amount of energy, height, weight, genetic
factor and biological rhythm
46

47. FACTORS AFFECTING OUTCOME Cont…
3. Coping mechanism and the level of maturity;
• if the person is already in stressful situation and
has ineffective coping, the crisis might be more
prominent.
• But if the person has effective coping in previous
stressful situation and met developmental task,
adopts more easily.
47

48. FACTORS AFFECTING OUTCOME
Cont…
4. Previous experience with similar situation
•The person needs to learn to cope with stress and
change. If a person resolved past crisis by distorting
reality or withdrawing, when similar crisis arise, he must
attempt to cope with a new situation.
•Crisis of any kind are often cumulative in effect. The most
recent crisis receives the denial, depression, anger or
maladaptation that was left unsettled or uresolved
48

49. FACTORS AFFECTING OUTCOME Cont…
5. Cultural influences;
• Peoples’ behaviour is highly influenced by their culture. During the
process of socialization, person is trained to solve problems and
meet crises in his home and in the society,
• Development and involvement in social support system,
expectation of the support from social group also has effect on
crisis.
49

50. FACTORS AFFECTING OUTCOME Cont…
6. Availability and support from the family, friends and other helping
resources including professional person
• The family system has influence on development of self-concept and
maturity, which increase or decrease one's vulnerability to crisis.
• The less readily available the person's environmental or emotional support
systems are to decrease stress his coping response, the more hazardous he
will define the event.
• When the person s involvement with others is Concentrated on only a few
family members, for example in the nuclear versus the extended family
support system-vulnerability is increased.
50

51. • The reaction to crisis is increased in today's mobile, urbanized
society because traditional support system of long-term family and
friends has been disrupted.
Thus a professional person is more likely to be needed and sought.
Even a small amount of influence exerted by a significant person
can be enough to decide the outcome for mental health and
against the mental illness.
51

52. 52

53. MCQs
• 1. In general adaptation syndrome (GAS), the sympathetic nervous system is
activated in the ______________stage?
a. Resistance
b. Alarm
c. Exhaustion
d. Recovery
53

54. • 2. which of the following statement correctly define “fight of flight’
response? The flight or fight is:
a.The acute response of the stress
b.The condition of parasympathetic stimulation
c.Stage of decrease immune function of the body
d.Always destructive
54

55. • 3. in which phase of crisis, the individual feel that event is unreal?
a.Shock
b.Defensive retreat
c.Recoil or acknowledgement
d.Resolution or adaptation
55

56. • 4. the person perceives the crisis situation in a positive way and
integrate the painful event into the new self in the phase of:
a.Shock
b.Defensive retreat
c.Recoil or acknowledgement
d.Resolution or adaptation
56