stress, traumatic stress, resilience and coping 1

8/2/2019 Stress, Traumatic Stress, Resilience and Coping 1

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Dr. Leo G. Labrador

TRAINING ON THE PSYCHOSOCIAL SUPPORT PROCESSINGIN EMERGENCY SETTINGS

Grand Royal Hotel, Davao CityNovember 23-25, 2011


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Nobody is exempted from stress.

Stress can be positive or negative.

Individual who are exposed to stressfulsituations may manifest various

responses either physical, emotional,cognitive, behavioral and spiritual, andthere is nothing wrong about.


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An emotional, mental or physical

response to events that causes bodily or

mental tension.

Any outside force or event that has aneffect on our body or mind.


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A physical or psychological stimulus that can

produce mental tension or physiological

reactions that may lead to illness.

The demands exceed the personal and social

resources the individual is able to mobilize. R.S. Lazarus


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Stress is not necessarily

something bad it alldepends on how you take it.

The stress of exhilarating,creative successful work isbeneficial, while that of

failure, humiliation orinfection is detrimental."

Hans Selye, 1956


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Eustress- positive stress arousal;motivates

Distress- negative stress arousal; leadsto dysfunction

Stressoran event, objects, person,stimulus that causes a person toexperience stress


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Physical symptoms

Mental symptoms

Behavioural symptoms

Emotional symptoms


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Sleep pattern changesFatigueDigestion changes

Loss of sexual driveHeadachesAches and painsInfections

Indigestion

DizzinessFaintingSweating & tremblingTingling hands & feetBreathlessnessPalpitationsMissed heartbeats


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Lack of concentrationMemory lapses

Difficulty in making decisionsConfusionDisorientationPanic attacks


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Appetite changes - too much or too littleEating disorders - anorexia, bulimia

Increased intake of alcohol & other drugsIncreased smoking

RestlessnessFidgeting

Nail bitingHypochondria


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Bouts ofdepression

ImpatienceFits of rageTearfulness

Deterioration ofpersonal hygieneand appearance


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Stress is not the same as ill-health,but has been related to such

illnesses as;

Cardiovascular diseaseImmune system diseaseAsthmaDiabetes


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Digestive disorders

Ulcers

Skin complaints - psoriasisHeadaches and migrainesPre-menstrual syndrome

Depression


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is caused by a traumatic event which isdifferent to a stressful event.


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It is a terrifying incident or ordeal that a personhas experienced, witnessed or learned about,especially one that is life-threatening or causesphysical harm.It can be a single event or repeated experience.

It is an overwhelming event that is outside therange of human experience

The experience causes that person to feelintense fear, horror or a sense of helplessness.


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Getting woundedBeing threatened with deathBeing subjected to gross human rights

violationsSignificant loss ( of people or property)Confrontation with actual fighting

TortureSexual violenceKilling ( strangers or loved ones)

Dead bodies, mutilations, severely woundedStories of traumatic experiences


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Support

Coping skills Personality

IMPACTEVENT

THE IMPACT OF TRAUMA


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COMPONENTS OF A TRAUMATIC MEMORY

Triggers

Emotions

...happy ...sad

...scared ...angry

...ashamed

ImagesSoundsSmells

PhysicalSensations

NegativeBeliefs

Or ThoughtsAbout Self

TRAUMA


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PSYCHOLOGICAL EFFECTS OF TRAUMA

Anxiety


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Depression



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PsychosomaticReactions


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Post

TraumaticStress

Disorder


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Most reactions last only a few days butthey can also last for weeks or even monthsand years (to as long as 30 years).

In some people, symptoms appear immediately. In others, symptoms may be delayed or they may not react at all.

CONSEQUENCES of Trauma


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Defusing

Psychological First AidDebriefing


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means to render something harmless

before it can do damage.

The over-all objective is to render thesituation harmless to those who were

exposed to it.


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A rapid reduction in the intense reactionsto a traumatic event

A normalizing of the experience so thatpeople can return to their routine duties asquickly as possible

An assessment of the personnel todetermine if a full debriefing is necessary.


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A re-establishment of the socialnetwork of the group so that people donot isolate themselves from each other,

but instead see that their reactions aresimilar to one another. In recognizingsimilarities to others, people are often

more willing to help each other introubled times.


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Eliminate the need to do a debriefingOR

It will enhance a debriefing if the debriefing is still necessary

A carefully applied and well-managed defusing will usually:

Note: The elimination of the need to provide a CISD is a by-product of a defusing, not a goal. It may happen naturally but one

is not working to achieve that effect.


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Target GroupsDefusing is aimed at the core working group thatwas most seriously affected by the event

Time CommitmentDefusing usually takes between twenty

minutes and one hour to complete.Sometimes they go on for slightly more thanan hour. If they continue much longer than an

hour, it is a signal that either the group ishighly traumatized or the defusing teamleadership is not in control of the defusing.


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Designed to be given within 8-12 hours ofthe conclusion of an incident. The first threehours after an incident is the ideal time

frame.

The rationale for such a tight time frame inproviding a defusing has to do with theprocess of traumatization following traumaticevents. During the incident, those exposedto it are in state of shock.


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Traumatized people, within a few hours oftraumatic event, shut off most outsideinfluences without distinguishing, betweenfriend or enemy. All influences are

interpreted as dangerous until they canstabilize themselves.

It is during the early hours after the trauma,when people are more open to help andbefore they have begun their shut down

that the defusing is most helpful.


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The defusing is held in a neutral environment,free of distractions.A defusing is never held at the scene of anincident.

The room should be adequate to accommodatethe small group, it should be comfortable and well-lit.The seats should be as comfortable as possible

and arranged in a circle.As long as the requirements of quiet and privacyare fulfilled, there are very few places in which adefusing could not be held.


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Since notice for the defusing is short,

it is rare that a defusing team will have

very much time to prepare for thedefusing.

A brief description of the incident isoften all the defusing team has to goon.


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A technique and an intervention intended to help a person or a group ofpersons deal with the physical or psychological condition resulted fromexposure to traumatic events and emergency situations.

Can be done right after the incident however, service provider should bear inmind that people react differently to a situation.


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Should be provided as soon as possible but usually no longer than the first 48to 72 hours after the critical event or situation. It can be done on or near the siteof the event.

The longer the time-span between exposure to the event and debriefing, theleast effective debriefing becomes.


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Debriefing alone is not sufficient to address traumatic stress brought about byhorrifying experiences rather it should be supported by other services asnecessary and should be part of the whole package of support/assistance.

Debriefers themselves need debriefing.


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STAGES / PROCEDURESOF DEBRIEFING

7 STAGES of DEBRIEFING


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7 STAGES of DEBRIEFING

STAGES


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Stage / Phase 1 OBJECTIVES / PROCEDURES

INTRO PHASE

Introduce intervention; explain process Introduce team members Set expectations Rules- when someone speaks, the rest listen; confidentiality, etc. Rapport

STAGES


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STAGES

Stage / Phase 2

FACT

CISD STAGES


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FEELING &THOUGHT

PHASEAnu- ano ang

mga

naramdamanmo? Ang

mga naisipan

mo?

Focus is on the feeling or emotion level (What or how did you feel at that time?)

they may hold negative thoughtsFacilitate expressions of intense emotionality; watch for abreactions let go of it, dont suppress Leads - How did you feel at that time of the event? Did you ever think you were going to die?, etc.

CISD STAGES

STAGES


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STRESSREACTION /

RESPONSE PHASEAnu-ano angmga napansinmo sa sarilipagkatapos ngpangyayari?(kilos, isip,katawan,pakiramdam)

Intense emotions can have various consequences Facilitate sharing of stress responses and reactions It is impt for them to discover that these experiences are also common in others Leads What did you notice in

your body after the incident?; Did you notice any change in your behavior? etc; How are you diff prior to the incident? Change in your functioning?

STAGES

STAGES


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STAGE / PHASE 5 OBJECTIVES / PROCEDURES

COPING/

TEACHINGPHASE

Papano monalampasan

ang crisis nayon?

Make them understand that their stress reactions are normal responses to an abnormal event

Understanding these will help them gain control of their unpleasant symptoms; not the other way around.

Very important they should gain insights from each other, how others cope effectively; learn from each others styles of coping. Try to model from them.. if it works.

STAGES

STAGES


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STAGE / PHASE 6 OBJECTIVES / PROCEDURES

LEARNINGPHASE

(LessonsLearned)Anu- ano angmga natutunanmo sapangyayari/krisis?

Allow participants to share what they learned from the experience

Not all crises are bad and destructive some can bring tremendous lessons; they can make us more prepared, better persons in facing future crisis or similar experienceThese positive lessons learned can help in the healing and recovery

STAGES

STAGES


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STAGE / PHASE 7

OBJECTIVES / PROCEDURES

CLOSURE /SUPPORT PHASE

RE-ENTRY

Pagtatapos ngsesyon Mga plano sahinaharap

Pananaw sakinabukasanMga dapatgawin

This is not therapy or counseling; yet, it isimperative to make a sense of closure Assist participants in identifying orrecognizing strategies and mechanics inorder to support each other; what can theydo to help each other. Identify from them / share with themavailable resources that may be neededeven long after the session. Suggest, if any, possible institutions oragencies they can tap when further

individual sessions would be needed.

STAGES


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Can be done in several ways:

Ask them to say a short message ofsupport / comfort addressed to the group

A prayer may doMeditation / relaxation exerciseA song; memorial service, as appropriate


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Arrange sitting in circle.

Voluntary Participation.

Exhaust during sharing (ask Did you miss anythingthat you would want to add?).

Go and debrief as a team, at least two

debriefers/facilitators.

Always include a mental health worker who is

capable of identifying individuals who may need or


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Strictly Confidential

No Breaks

No Rank/Grade: Everyone is Equal

Not Operational Investigation or Critique

No Notes

Incident Specific, Situational


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Psychological First Aid

is designed to reduce the initial distress causedby traumatic events and to foster short- andlong-term adaptive functioning and coping.

does not assume that all survivors will developsevere mental health problems or long-termdifficulties in recovery. Instead, it is based on an

understanding that disaster survivors and othersaffected by such events will experience a broadrange of early reactions (for example, physical,psychological, behavioral, spiritual).

The three goals of providing


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The three goals of providingpsychological support include:

1.Relieve suffering, both emotional and physical

1.Improve peoples short term functioningIn the immediate aftermath of a crisis, people may

have reactions or make decisions with serious long-term implications. Helping people to function well inthe short term can prevent future problems.

1.Accelerate the individuals course of recoveryEarly psychological support may help to reduce or

relieve stress, thus decreasing the chance of peopledeveloping long-term stress reactions, such asanxiety or depression.

What are the Basic Components


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What are the Basic Componentsof Psychological First Aid?

Meeting basicphysical needs, suchasphysical protection,establishing a sense of

security,provision ofphysical

necessities.

Meeting psychologicalneeds, such asconsolation,provision of emotional

support,provision of behavioralsupport,

allowing emotionalventilation,

fostering constructivebehavior.

What are the Basic Components


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What are the Basic Componentsof Psychological First Aid?

Fostering socialsupport, such asreuniting victims with

friends or family,

utilization ofacutesocial and communitysupport networks.

Fostering ongoingcare, such astriage and referral for

those in acute need,

referral to subacuteand ongoing supportnetworks.

Basic Principles of Psychological


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Basic Principles of PsychologicalSupport

Do no harmUses a Community-based approach

Recognizes and usesindigenous healingnetworks and practicesUses trained

personnelEmpowers affectedpeople

EncouragesCommunityparticipation

Exercises Care withterminologyEncourages Activeinvolvement

Values EarlyinterventionUses Viableinterventions

stress, traumatic stress, resilience and coping 1

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