This document provides information on providing psychological support after a disaster. It discusses how disasters can cause psychological injuries in addition to physical ones. Most people will experience normal reactions to the abnormal situation, but some may have more severe or long-lasting symptoms. The role of disaster mental health workers is to help mitigate problems and promote resilience. Key phases people may go through after a disaster include heroic, honeymoon, disillusionment, and reconstruction. Essential skills for volunteers include active listening, empathy, and being non-judgmental. The goals of psychological first aid are to promote safety, calmness, connectedness, self-efficacy, and hope.
2. Unit ObjectivesUnit Objectives
1. Psychological impacts to expect after a
disaster – What happens for people?
2. How to work with the psychological
impacts in your role – Providing
psychological support.
3. Responder stress management and self-
care.
3. Are WeAre We
Psychologically Prepared?Psychologically Prepared?
For every physicalFor every physical
injury, there may be 5-6injury, there may be 5-6
psychological injuriespsychological injuries
This may overwhelmThis may overwhelm
and impede ourand impede our
emergency and/oremergency and/or
medical response.medical response.
4. Critical IncidentCritical Incident
Exposure to a traumatic event in which both of
the following were present:
The person experienced, witnessed, or was
confronted with an event or events that involved
actual or threatened death or serious injury, or a
threat to the physical havoc of self or others.
The person’s response involved intense fear,
helplessness or horror.
5. Into every life
a little rain must fall …..
But what happensBut what happens
when there is awhen there is a
flood?flood?
6. 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
reduce 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.
Coping MechanismsCoping Mechanisms
7. Consequences of Critical IncidentsConsequences of Critical Incidents
Often includeOften include LOSSLOSS
Tangible Loss
Loss of loved onesLoss of loved ones
Loss of homeLoss of home
Loss of material goodsLoss of material goods
Loss of employment / incomeLoss of employment / income
8. Consequences of Critical IncidentsConsequences of Critical Incidents
Often includeOften include LOSSLOSS
Intangible Loss
Loss of safety / security (security (real or perceivedreal or perceived))
Loss of predictabilitypredictability
Loss of social cohesion/connection/supportsocial cohesion/connection/support
Loss of dignity, trust and safetydignity, trust and safety
Loss of positive self-image/self-esteempositive self-image/self-esteem
Loss of trust in the future, identity,trust in the future, identity,
independenceindependence
Loss of hopehope
Loss of CONTROLCONTROL
9. Possible Psychological ReactionsPossible Psychological Reactions
to a Large-Scale Emergencyto 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 aJust because you have experienced a
disaster does not mean you will be damageddisaster does not mean you will be damaged
by it, but you will be changed by it.by it, but you will be changed by it.
10. Grief and LossGrief 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)
11. SupportingSupporting
OthersOthers
We’re a communityWe’re a community
that believes inthat believes in
‘‘love thy neighborlove thy neighbor’,’,
but right now we needbut right now we need
to love our neighborsto love our neighbors
a little bit more.a little bit more.
12. Role of Disaster Mental Health?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.
13. Role of Disaster Mental Health?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.
14. Psychological Response to Trauma
Key ConceptsKey Concepts
Experience has shown that:
No one who sees a disaster is untouched by it.No one who sees a disaster is untouched by it.
Most people pull together & function during andMost people pull together & function during and
after a disaster, but their effectiveness isafter a disaster, but their effectiveness is
diminished.diminished.
Most people do not see themselves as needingMost people do not see themselves as needing
mental health services following a disaster andmental health services following a disaster and
will not seek such services.will not seek such services.
15. Psychological Response to Trauma
Key ConceptsKey Concepts
Experience has shown that:
Survivors respond to active, genuine interest &Survivors respond to active, genuine interest &
concern.concern.
Survivors may reject disaster assistance of allSurvivors may reject disaster assistance of all
types.types.
Disaster mental health assistance is often moreDisaster mental health assistance is often more
practical than psychological in nature.practical than psychological in nature.
Social support systems are crucial to recovery.Social support systems are crucial to recovery.
16. Psychological Response to Trauma
Key ConceptsKey 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 survivalA concern for basic survival
Grief and loss over loved ones & loss of valued andGrief and loss over loved ones & loss of valued and
meaningful possessionsmeaningful possessions
Fear & anxiety about personal safety & the physicalFear & anxiety about personal safety & the physical
safety of loved onessafety of loved ones
A need to talk about events & feelings associated withA need to talk about events & feelings associated with
the disaster, often repeatedlythe disaster, often repeatedly
A need to feel one is a part of the community & itsA need to feel one is a part of the community & its
recovery effortsrecovery efforts
17. Phases of DisasterPhases of Disaster
Pre-DisasterPre-Disaster
Threat
Warning
HeroicHeroic
HoneymoonHoneymoon
(community cohesion)(community cohesion)
ReconstructionReconstruction
(a new beginning)(a new beginning)
llllllllllll
Time 1 to 3 days 1 to 3 years
Inventory
DisillusionmentDisillusionment
Trigger Events andTrigger Events and
Anniversary ReactionsAnniversary Reactions
W
orking
Through
G
rief
W
orking
Through
G
rief
(com
ing
to
term
s)
EVENTEVENT
20. What Do You Think?
What main attributes andWhat main attributes and
skills should a volunteerskills should a volunteer
have when offeringhave when offering
psychological support?psychological support?
21. Essential Attributes and SkillsEssential Attributes and Skills
Good Listening
skills
Patient
Caring attitude
Trustworthy
Approachable
Culturally aware
Empathetic
Non-judgmental
approach
Kind
Committed
Flexible
Able to tolerate
chaos
24. Activity –Activity –
Supportive StatementsSupportive Statements
What are some supportiveWhat are some supportive
statements that you wouldstatements that you would
find helpful if you were infind helpful if you were in
pain, injured, and/or acutepain, injured, and/or acute
emotional distress.emotional distress.
25. Do Say…Do Say…
Can you tell me what happened?
I’m Sorry
This must be difficult for you
I’m here to be with you
26. Activity –Activity –
Unhelpful StatementsUnhelpful Statements
What are some statementsWhat are some statements
that you would find unhelpfulthat you would find unhelpful
if you were in pain, afraid,if you were in pain, afraid,
injured, and/or dealing withinjured, and/or dealing with
tremendous loss.tremendous loss.
27. Avoid Saying . . .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 . . .”
28. Guiding Principles in ProvidingGuiding Principles in Providing
Psychological Support in Your RolePsychological 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
29. Crisis InterventionCrisis 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
30. Goals of Psychological First Aid
Psychological first aid (PFA) promotes and
sustains an environment of:
SAFETYSAFETY
CALMCALM
CONNECTEDNESSCONNECTEDNESS
SELF-EFFICACYSELF-EFFICACY
HOPEHOPE
31. Psychological First Aid
Promote SAFETY: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.
32. Psychological First Aid
Promote CALM: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.
33. Psychological First Aid
Promote CONNECTEDNESS:Promote CONNECTEDNESS:
Help people contact friends and loved
ones.
Keep families together. Keep children
with parents or other close relatives
whenever possible.
34. Psychological First Aid
Promote SELF-EFFICACY:Promote SELF-EFFICACY:
Give practical suggestions that steer
people toward helping themselves.
Engage people in meeting their own
needs.
35. Psychological First Aid
Promote HELP: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.
36. Psychological 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).
37. Psychological 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).
38. Psychological 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
39. AnxietyAnxiety
A state of intense apprehension,
uncertainty and fear
Results from anticipating a
threatening event
Intense anxiety = “fight or flight”
40. Agitation/Agitation/unrestunrest
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
41. The Energy CurveThe Energy Curve
AnxietyAnxiety
AgitationAgitation
BaselineBaseline
Tension ReductionTension Reduction
42. Elements of Escalation/Elements of Escalation/
making worsemaking worse
Challenging authority or questioning
Refusal to follow directions
Loss of control, becoming verbally
agitated
Becoming threatening
43. Elements of EscalationElements of Escalation
Challenging Authority or Questioning
Answer the question
Repeat your request in a neutral tone of
voice
Remember that an ounce of preventionRemember that an ounce of prevention
is worth a pound of cureis worth a pound of cure
44. Elements of EscalationElements of Escalation
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
45. Seek AssistanceSeek 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
46. Elements of De-escalationElements of De-escalation
Establish a relationshipEstablish 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
47. Elements of De-escalationElements of De-escalation
Use concrete questions to help theUse concrete questions to help the
person focusperson 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?
48. Elements of De-escalationElements of De-escalation
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
49. Elements of De-escalationElements of De-escalation
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
50. Elements of De-escalationElements of De-escalation
Don't make global statements about
the person's character
Use “I” statements
Lavish praise / support /
encouragement is not believable
52. Adrenaline, Friend or Foe?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)
53. Psychological Response to Trauma
Survivors’ Needs and ReactionsSurvivors’ 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 & anxietyFear & anxiety
•Grief & lossGrief & loss
•ShockShock
•HopelessnessHopelessness
•Loss of ConfidenceLoss of Confidence
•MistrustMistrust
•Sleep disturbancesSleep disturbances
•Physical painPhysical pain
•ConfusionConfusion
•ShameShame
•Shaken faithShaken faith
•AggressivenessAggressiveness
56. 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 aMain point – Disaster stress is a
normal response to an abnormalnormal response to an abnormal
circumstance. If symptoms persist,circumstance. If symptoms persist,
they must be treated.they must be treated.
More Typical Reactions…More Typical Reactions…
C. Fasser, 2004; B. Young, 2006
57. Possible Psychological ReactionsPossible Psychological Reactions
to a Large-Scale Emergencyto a Large-Scale Emergency
For most people, things getFor most people, things get
better with time…better with time…
58. Possible Psychological ReactionsPossible Psychological Reactions
to a Large-Scale Emergencyto a Large-Scale Emergency
*Victims of HurricaneVictims of Hurricane
KatrinaKatrina: 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.
For some, however, the reactions may
evolve and even worsen.
59. HelpersHelpers
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
60. Challenge to HelpersChallenge 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
61. Challenge to Helpers (cont.)Challenge to Helpers (cont.)
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
Feeling guilt over access to food, shelter,
etc.
62. Categories of ReactionsCategories of Reactions
After the IncidentAfter the Incident
•ASD / PTSDASD / PTSD
•GriefGrief
•DepressionDepression
•ResilienceResilience
Mental HealthMental Health
and Illnessand Illness
HumanHuman
Behavior inBehavior in
High StressHigh Stress
EnvironmentsEnvironments
Distress
Responses
•Fear / worryFear / worry
•Sleep disturbanceSleep disturbance
•Altered productivityAltered productivity
•AvoidanceAvoidance (emotional)(emotional)
•Substance abuseSubstance abuse
•Risk takingRisk taking
•Over DedicationOver Dedication
63. Loss and Grief –Loss and Grief – Signs of TroubleSigns 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
64. StressStress
A state of physical
and/or
psychological
arousal
Often brought
about by a
perceived threat or
challenge
May be expressed
differently by
different people /
cultures
65. Coping with StressCoping 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
66. Examples of CopingExamples 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
67. Examples of Coping (cont.)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
68. What Are YourWhat Are Your
Preferred Approaches toPreferred Approaches to
Managing Stress?Managing Stress?
Do you practice ‘stressDo you practice ‘stress
management’ regularly?management’ regularly?
69. Self-Help TechniquesSelf-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
70. Self-Help Techniques (cont.)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
71. Self-Help Techniques (cont.)Self-Help Techniques (cont.)
Do not self-medicate
Go easy on yourself
Avoid inflated or
perfectionistic
expectations
Seek professional advice
if reactions continue
72. Cognitive/Behavioral Approaches
to Stress Reduction
Adequate RestAdequate Rest
Exercise / MovementExercise / Movement
Diet / Balanced NutritionDiet / Balanced Nutrition
Enough HEnough H22OO
Moderate Chemical UseModerate Chemical Use
Laughter / TearsLaughter / Tears
Time Away From Work RoleTime Away From Work Role
73. Cognitive/Behavioral Approaches
to Stress Reduction
Religious / SpiritualReligious / Spiritual
Relaxation Techniques / BreathingRelaxation Techniques / Breathing
YogaYoga
MeditationMeditation
Social Support / Discuss FeelingsSocial Support / Discuss Feelings
Allow yourself to receive as well as
give
74. Cognitive/Behavioral Approaches
to Stress Reduction
PlayPlay: Hobbies / Personal Interests: Hobbies / Personal Interests
Exposure to NatureExposure to Nature
BiofeedbackBiofeedback
Massage / Human TouchMassage / Human Touch
SexSex
Professional AssistanceProfessional Assistance
MedicationMedication
What Else Works for You???
75. Critical Incident StressCritical Incident Stress DebriefingDebriefing
(CISD)(CISD)
DebriefingDebriefing / Defusing:/ 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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.