Petros Levounis, MD, MAProfessor and Chair, Department of Psychiatry

Rutgers New Jersey Medical School

Project ECHO

Rutgers New Jersey Medical School

Newark, New Jersey

Friday, May 15, 2020

Psychological

First Aid

1. Psychological First Aid

2. Leadership

APPENDIX: Resources

Outline for Today

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1Psychological First Aid

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Morganstein JC and Ursano RJ, Frontiers in Psychiatry, 2020.

Responses to Disasters

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The Five Major Principles

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Adapted from: Hobfoll, Psychiatry, 2007.

❖ Safety

❖ Calmness

❖ Self-Efficacy

❖ Connectedness

❖ Hope and Optimism

Psychological First Aid

Safety✓ Establish safe areas and behaviors.

✓ Get accurate and updated information.

✓ Be safe, feel safe.

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Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.

Psychological First Aid

Calmness✓ Acknowledge/normalize distress reactions.

✓ Practice diaphragmatic breathing and

muscle relaxation techniques.

✓ Limit exposure to traditional and social

media as increased use enhances distress.

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Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.

Psychological First Aid

Self-efficacy✓ Safeguard and develop routines.

✓ Maximize physical health:o Nutrition

o Sleep and rest

o Sex

o Exercise

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Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.

Sleep Hygiene

1. Schedule: Stick to sleep time, even on weekends.

2. Ritual: Practice a relaxing bedtime ritual.

3. Exercise: Exercise daily.

4. Substances: Avoid sleep stealers (alcohol/caffeine).

5. Environment: Check temperature, sound, and light.

6. Bedding: Sleep on comfortable mattress & pillows.

7. Electronics: Turn off electronics before bed.

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Psychological First Aid

Connectedness✓ Promote collective self-efficacy.

✓ Use electronic media thoughtfully (and I

fully recognize how unsatisfying and

frustrating this recommendation is).

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Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.

Psychological First Aid

Hope and Optimism✓ While not denying risk.

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Adapted from: Uniformed Services University, Center for the Study of Traumatic Stress, CSTSonline.org, 2020.

2Leadership

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Yerkes RM and Dodson JD, Journal of Comparative Neurology and Psychology, 1908.

The Yerkes-Dodson Law

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The Five Major Requests

❖ Hear me

❖ Protect me

❖ Prepare me

❖ Support me

❖ Care for me

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Shanafelt T, JAMA, 2020.

Qualities to Strive For

❖ Benign

❖ Kind

❖ Present

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Ursano RJ, Disaster psychiatry: from war and terrorism to earthquakes and corona virus, Boston VA GRs, 2020.

APPENDIX:

Resources

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Psychiatry.org

ASAM.org

Primary Resource

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1. Breslau N, Kessler RC, Chilcoat HD, Schultz LR, David GC, Andreski P: Trauma and Posttraumatic stress

disorder in the community. Archives of General Psychiatry 55:626-632, 1998

2. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N: The psychological impact of

quarantine and how to reduce it: rapid review of the evidence. The Lancet 395(10227):912-920, March

14, 2020

3. Dobkin J, Diaz C: Coronavirus statistics: tracking the epidemic in New York. Gothamist. Published online

on April 19, 2020

4. Galea S, Merchant RM, Lurie N: The mental health consequences of COVID-19 and physical distancing:

the need for prevention and early intervention. JAMA Internal Medicine. Published online on April 10, 2020

5. Geller JL, Abi Zeid Daou M: Patients with serious mental illness in the age of COVID-19: what

psychiatrists need to know. Psychiatric News. Published online on April 7, 2020

6. Gruebner O, Lowe SR, Sykora M, Shankardass K, Subramanian SV, Galea S: A novel surveillance

approach for disaster mental health. PLoS ONE 12(7):e0181233, 2017

7. Hobfoll SE, Watson P, Bell CC, Bryant RA, Brymer MJ, Friedman MJ, Friedman M, Gersons BP, de Jong

JT, Layne CM, Maguen S, Neria Y, Norwood AE, Pynoos RS, Reissman D, Ruzek JI, Shalev AY, Solomon

Z, Steinberg AM, Ursano RJ: Five essential elements of immediate and mid-term mass trauma

intervention: empirical evidence. Psychiatry 70(4):283-315, discussion 316-69, 2007

8. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, Wu J, Du H, Chen T, Li R, Tan H, Kang L, Yao L, Huang M, Wang

H, Wang G, Liu Z, Hu S: Factors associated with mental health outcomes among health care workers

exposed to coronavirus disease 2019. JAMA Network Open 3(3):e203976, March 2, 2020

9. Levounis P: Addiction: not a hangnail, but not poverty either. Academic Psychiatry, 42:277-278, 2018

10. Morganstein JC, Fullerton CS, Ursano RJ, Donato D, Holloway HC: Pandemics: health care emergencies.

In Textbook of Disaster Psychiatry, 2nd Edition. Edited by Ursano RJ, Fullerton CS, Weisaeth L, Raphael B.

Cambridge, United Kingdom, Cambridge University Press, 270-284, 2017

References

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11. Morganstein JC, Ursano RJ: Ecological disasters and mental health: causes, consequences, and

interventions. Frontiers in Psychiatry. Published online on February 11, 2020

12. North CS, Nixon SJ, Shariat S, Mallonee S, McMillen JC, Spitznagel EL, Smith EM: Psychiatric disorders

among survivors of the Oklahoma City bombing. JAMA 282:755-762, 1999

13. Reger MA, Stanley IH, Joiner TE: Suicide mortality and coronavirus disease 2019—a perfect storm?

JAMA Psychiatry. Published online on April 10, 2020

14. Rosenberg AR: Cultivating deliberate resilience during the coronavirus disease 2019 pandemic. JAMA

Pediatrics. Published online on April 14, 2020

15. Shanafelt T, Ripp J, Trockel M: Understanding and addressing sources of anxiety among health care

professionals during the COVID-19 pandemic. JAMA. Published online on April 7, 2020

16. Shapiro J, Galowitz P: Peer support for clinicians: a programmatic approach. Academic Medicine

91(9):1200-1204, 2016

17. Stellman JM, Smith RP, Katz CL, Sharma V, Charney DS, Herbert R, Moline J, Luft BJ, Markowitz S, Udasin

I, Harrison D, Baron S, Landrigan PJ, Levin SM, Southwick S: Enduring mental health morbidity and social

function impairment in world trade center rescue, recovery, and cleanup workers: the psychological

dimension of an environmental health disaster. Environmental Health Perspectives 116(9):1248-53, 2008

18. Volkow ND: Collision of the COVID-19 and addiction epidemics. Annals of Internal Medicine, Published

online on April 2, 2020

19. Yerkes RM, Dodson JD: The relation of strength of stimulus to rapidity of habit-formation. Journal of

Comparative Neurology and Psychology 18(5):459–482, 1908

20. Zagury-Orly I, Schwartzstein RM: Covid-19 – a reminder to reason. The New England Journal of Medicine.

Published online on April 28, 2020

References (continued)

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Thank you

NJMS.Rutgers.edu/Psychiatry

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