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MODULE 4

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    1. MODULE 4 Knowledge-Based Concepts Guiding Our Understanding of Post-Disaster Reactions and Behavior to Assist Survivors. The following slides present key areas of the behavioral sciences that have aided in understanding the processes that guide responses and reactions post-disaster. This area of knowledge continues to be researched. Professionals will interpret, understand and conceptualize the manifestations of post disaster reactions according to their theories and experiences. There are many approaches to assist survivors. You should be aware of the new knowledge as it is being published and add it to your basic repertoire of interventions.The following slides present key areas of the behavioral sciences that have aided in understanding the processes that guide responses and reactions post-disaster. This area of knowledge continues to be researched. Professionals will interpret, understand and conceptualize the manifestations of post disaster reactions according to their theories and experiences. There are many approaches to assist survivors. You should be aware of the new knowledge as it is being published and add it to your basic repertoire of interventions.

    2. DESCRIPTION: Introduces building-block knowledge to guide post-disaster intervention. PURPOSE: To present the basic content for understanding: Survivor reactions Formulating guidelines for post-disaster intervention. CONTENT: Basic concepts of : The content has been culled from documents and research publications in the last 20 years of Disaster Mental Health and psychosocial programs. The content has been obtained from the Behavioral Sciences and adapted to the intervention objectives of post-disaster situations. I have found these bio-psycho-social helpful in my work worldwide with developed and developing countries inhabited by diverse cultural and ethnic groups.The content has been culled from documents and research publications in the last 20 years of Disaster Mental Health and psychosocial programs. The content has been obtained from the Behavioral Sciences and adapted to the intervention objectives of post-disaster situations. I have found these bio-psycho-social helpful in my work worldwide with developed and developing countries inhabited by diverse cultural and ethnic groups.

    3. Content: Conceptual knowledge will be presented that gives support to the changes of processes across time: As mentioned in previous slides all bio-psychological systems are affected following the impact unleashed by the trauma of the disaster. Although we present each system with its unique boundaries to clarify the changes, it is important to be aware that these systems are linked, overlapping and interactive. The mechanisms of feed-back will in turn change the response which will result in differing influences on behavior manifestations pos-disaster.As mentioned in previous slides all bio-psychological systems are affected following the impact unleashed by the trauma of the disaster. Although we present each system with its unique boundaries to clarify the changes, it is important to be aware that these systems are linked, overlapping and interactive. The mechanisms of feed-back will in turn change the response which will result in differing influences on behavior manifestations pos-disaster.

    4. Learning Objectives: To identify theories of: Stressor/stress response Coping and adaptation Loss and mourning Social support systems Crisis response and resolution You should have some knowledge of these systems and processes to understand, evaluate and choose modalities of intervention. These theories capture the knowledge needed to conceptualize the type of behavior observed post-disaster but currently we have no bridge theories to clarify their interaction and influencing factors that may modify severity and cronicity.You should have some knowledge of these systems and processes to understand, evaluate and choose modalities of intervention. These theories capture the knowledge needed to conceptualize the type of behavior observed post-disaster but currently we have no bridge theories to clarify their interaction and influencing factors that may modify severity and cronicity.

    5. Learning Objectives: To identify basic building blocks of knowledge to guide post-disaster intervention. To acquire the knowledge needed to recognize survivors reactions and formulate post-disaster interventions. Knowing the sequence of coping and adapting processes will help you identify the changes througt the phases post-disaster. Noticing the change in thinking, feelings and behavior throughout time post-disaster you will notice how survivors cope and adapt to their new circumstances.Knowing the sequence of coping and adapting processes will help you identify the changes througt the phases post-disaster. Noticing the change in thinking, feelings and behavior throughout time post-disaster you will notice how survivors cope and adapt to their new circumstances.

    6. QUESTION: What Areas of Knowledge are Available to Conceptualize Reactions of Survivors During the Disaster Phases? The knowledge that will be presented in summary form are key to start your understanding of reactions and behavior of survivors post-disaster. Remember this course is to set guidelines so you have a sense of direction but it will not supply all the details of your daily work. Hopefully you will have colleagues to share experiences and develop answers to questions and problems.The knowledge that will be presented in summary form are key to start your understanding of reactions and behavior of survivors post-disaster. Remember this course is to set guidelines so you have a sense of direction but it will not supply all the details of your daily work. Hopefully you will have colleagues to share experiences and develop answers to questions and problems.

    7. Reactions to stressful events depend on characteristics of: the social environment the events individual resources the task required These variables are some of the issues that will influence the perception of danger following a disaster. These are modifiers that interact with the survivors capacity to regain their previous sense of safety and hope. You should keep this in mind as you are planning your intervention and assisting plans.These variables are some of the issues that will influence the perception of danger following a disaster. These are modifiers that interact with the survivors capacity to regain their previous sense of safety and hope. You should keep this in mind as you are planning your intervention and assisting plans.

    8. Depending on the pervasiveness and persistence of the stressor, the outcome may result in: growth temporary difficulty and/or psychopathology The quality of the stressor (Disaster effect) will impact on the bio-psychological aspects of the personality with differing outcomes. Each of these outcomes will necessitate different resources. Most of the survivors you will be assisting will be the distressed ones who will have temporary/recurrent difficulties produced by the emotional pain, anxiety and not able to see the light at the end of the tunnelThe quality of the stressor (Disaster effect) will impact on the bio-psychological aspects of the personality with differing outcomes. Each of these outcomes will necessitate different resources. Most of the survivors you will be assisting will be the distressed ones who will have temporary/recurrent difficulties produced by the emotional pain, anxiety and not able to see the light at the end of the tunnel

    9. Stressor-Stress Response Concept This biological and psychological response will be influenced by many variables including the genetic inheritance of the individual-current research has began to identify a number of genes that may influence the capacity of the individual to cope with differing degrees of stressors.This biological and psychological response will be influenced by many variables including the genetic inheritance of the individual-current research has began to identify a number of genes that may influence the capacity of the individual to cope with differing degrees of stressors.

    10. The stress response is composed of changes in the: physiologic systems psychological mechanism and social behavior as indication that the individual has been impacted by a traumatic event. The application of this model to studies of psychosocial stress-response should increase our understanding of the complex interactions between psychosocial stressors, biological functions and post-disaster behavior. As mentioned before we do not have yet the research knowledge of hos these systems interact and influence each other. The application of this model to studies of psychosocial stress-response should increase our understanding of the complex interactions between psychosocial stressors, biological functions and post-disaster behavior. As mentioned before we do not have yet the research knowledge of hos these systems interact and influence each other.

    11. This definition conveys an understanding that certain life events produce a loss of habitual modes of behavior due to the personal turmoil, tension, and emotional pain that accompany stress response. The appearance of these multiple definitions of stress in the literature complicates a review of the effects of stressful stimuli originating not from the disaster event but also in addition to the emergence of a post disaster world with its beneficial and traumatizing efforts, trying to re-integrate the multiple broken pieces of life and territory The appearance of these multiple definitions of stress in the literature complicates a review of the effects of stressful stimuli originating not from the disaster event but also in addition to the emergence of a post disaster world with its beneficial and traumatizing efforts, trying to re-integrate the multiple broken pieces of life and territory

    12. This concept is associated with the response to the effects of a traumatic event impacting the individual. This concept generalizes the observation that all individuals are affected by a disaster-either by direct or indirect impact. You should be aware that you are going to react to the environment post-disaster and suffer from the contagion effect of the survivors suffering.This concept generalizes the observation that all individuals are affected by a disaster-either by direct or indirect impact. You should be aware that you are going to react to the environment post-disaster and suffer from the contagion effect of the survivors suffering.

    13. STRESSORS Events or situations that produce physical or psychological reactions. The brain reacts automatically to dangerous signals from wherever they get originated-whether they originate internally or externally. Survival processes get initiated and produce physiologic changes while the appraisal system weighing whether danger exists begins its function.The brain reacts automatically to dangerous signals from wherever they get originated-whether they originate internally or externally. Survival processes get initiated and produce physiologic changes while the appraisal system weighing whether danger exists begins its function.

    14. STRESSORS Can Be: Real or imagined Internal or external Absolute or perceived The associations to past memories plus symbolic meaning of the perceived danger is a powerful stimulus that sets into motion the cascade of biologic brain reactions. Current research is aiming at identifying the interpretation of sign/symbols that set Into motion the connections of brain messengers discharging electro-chemical connections.The associations to past memories plus symbolic meaning of the perceived danger is a powerful stimulus that sets into motion the cascade of biologic brain reactions. Current research is aiming at identifying the interpretation of sign/symbols that set Into motion the connections of brain messengers discharging electro-chemical connections.

    15. Stress Response This classification encompasses all the responses of the bio-psycho-cultural and spiritual characteristics of the survivor. It is unique and has important influences on behavior manifestations after a Disaster.This classification encompasses all the responses of the bio-psycho-cultural and spiritual characteristics of the survivor. It is unique and has important influences on behavior manifestations after a Disaster.

    16. The acute responses of the autonomic nervous system, Hypothalamus-Pituitary-Adrenal Axis, and CRF systems to stress are protective and promote adaptation. These systems are part of the brain wired function that gets stimulated by traumatic events.These systems are part of the brain wired function that gets stimulated by traumatic events.

    17. Stress is part of daily living but in disaster the increase danger elevates all the processes to a level of survival intensity and pervasiveness. The above list provides you with a measuring component to gage the severity of the stress response.Stress is part of daily living but in disaster the increase danger elevates all the processes to a level of survival intensity and pervasiveness. The above list provides you with a measuring component to gage the severity of the stress response.

    18. Perception of the trauma that can impact on individuals and leave them hopeless, defeated and dependent is one of the most powerful effects of disasters. That is why we need to understand the extent of the believe systems that the survivor perceives. There is a relation of the perception of danger and the capacity to recuperate adaptive behavior.Perception of the trauma that can impact on individuals and leave them hopeless, defeated and dependent is one of the most powerful effects of disasters. That is why we need to understand the extent of the believe systems that the survivor perceives. There is a relation of the perception of danger and the capacity to recuperate adaptive behavior.

    19. Each of these responses have different characteristics and serve the individual through a different modality of behavior.Each of these responses have different characteristics and serve the individual through a different modality of behavior.

    20. The categories are presented for clarity but in real life they are integrated and interrelated in the individuals life. As they respond and change the feed-back effect will in turn influence the capacity to modulate the coping and adaptive responses.The categories are presented for clarity but in real life they are integrated and interrelated in the individuals life. As they respond and change the feed-back effect will in turn influence the capacity to modulate the coping and adaptive responses.

    21. 5 We react to stress 5 ways Each of this response systems will help you to understand the personal reaction of individuals impacted by a stressor.Each of this response systems will help you to understand the personal reaction of individuals impacted by a stressor.

    22. Currently, the quality, intensity, or further effects of trauma can only be measured by observing the behavior manifestations of the impacted individual. *** The definitions of trauma, stressor and stress response are overlapping *** There are many aspects of these processes that are unknown or in the research area of human behavior. We have documented observations of survivors reactions which indicate a type of response to trauma but we lack currently the precise sequence of systems changes and outcomes.There are many aspects of these processes that are unknown or in the research area of human behavior. We have documented observations of survivors reactions which indicate a type of response to trauma but we lack currently the precise sequence of systems changes and outcomes.

    23. Traumatic Stress This type of stress reaction defines the more intense responses to catastrophic events.This type of stress reaction defines the more intense responses to catastrophic events.

    24. Involves a threat (real or perceived) to physical integrity Elicits reactions of intense fear, horror and/or helplessness Represents a watershed event life experience changes in a fundamental way The individual facing a severe/catastrophic event will have intense responses needing help and assistance.The individual facing a severe/catastrophic event will have intense responses needing help and assistance.

    25. Traumatic events May affect: only one or two people (individual trauma) OR entire populations (disasters) Overwhelm capacity to cope The response to a catastrophe will affect the individual depending on the characteristics of the person and the situation. If the numbers are small it is less difficult to manage than if the numbers are in the hundreds/thousands. Also the destruction of their environment will have a major role to play post-event.The response to a catastrophe will affect the individual depending on the characteristics of the person and the situation. If the numbers are small it is less difficult to manage than if the numbers are in the hundreds/thousands. Also the destruction of their environment will have a major role to play post-event.

    26. You must remember that each individual will suffer and respond in their unique way but their expression and behavior may be influenced by culture, ethnicity and community customs.You must remember that each individual will suffer and respond in their unique way but their expression and behavior may be influenced by culture, ethnicity and community customs.

    27. Psychobiological Changes Post-Disaster All reactions/responses to a disaster are a combination of biologic changes and psychological coping and adaptation efforts. At times the behavioral response may resemble a clinical sign of pathology but due to the circumstances always explore the possibility that it is a coping effort. If it last too long or it impacts severely on the ability to function or if it produces intense emotional pain you should refer the survivor for further professional help.All reactions/responses to a disaster are a combination of biologic changes and psychological coping and adaptation efforts. At times the behavioral response may resemble a clinical sign of pathology but due to the circumstances always explore the possibility that it is a coping effort. If it last too long or it impacts severely on the ability to function or if it produces intense emotional pain you should refer the survivor for further professional help.

    28. Threat of harm Injury Noxious agents Grotesque scenes Encounter with death and destruction Disaster survivors have to deal with physical and psychological injuries which heal at different rates of time depending on many individual characteristics-genetics, past experiences, traumatic reminders, personality, coping mechanism and support systems.Disaster survivors have to deal with physical and psychological injuries which heal at different rates of time depending on many individual characteristics-genetics, past experiences, traumatic reminders, personality, coping mechanism and support systems.

    29. Multiple losses: Home and shelter Basic necessities Vehicles Personal items Community and social support There is a correlation between the number and extent of losses and the extension of psychological trauma. Each of these losses will have to be evaluated as far as priority and support for basic needs of the survivor. There is a correlation between the number and extent of losses and the extension of psychological trauma. Each of these losses will have to be evaluated as far as priority and support for basic needs of the survivor.

    30. Lack of information Dependency Immobility Inactivity An effective technique to assist survivors is to encourage activity and return to familiar schedules. Mobilization of survivors toward participating in organized efforts to regain comfort, security and obtaining needed resources, will assist in their recovery.An effective technique to assist survivors is to encourage activity and return to familiar schedules. Mobilization of survivors toward participating in organized efforts to regain comfort, security and obtaining needed resources, will assist in their recovery.

    31. The mantra of disaster psychology can be summed up in one sentence: Realizing that the traumatizing impact of the disaster has mobilized emotions and behavior which are part of the coping repertory will clarify for you that the behavior you are observing is expected in post Trauma. Also the universality of response attest to the normal reaction to a catastrophe. Noticing how these coping behaviors change as the situation becomes less painful will also give you testimony that these reactions are appropriate. Some individuals will manifest pathological, chronic responses that do not change even though the situation is better.Realizing that the traumatizing impact of the disaster has mobilized emotions and behavior which are part of the coping repertory will clarify for you that the behavior you are observing is expected in post Trauma. Also the universality of response attest to the normal reaction to a catastrophe. Noticing how these coping behaviors change as the situation becomes less painful will also give you testimony that these reactions are appropriate. Some individuals will manifest pathological, chronic responses that do not change even though the situation is better.

    32. Effect of Continuous Stress The price the body pays for adaptation to adverse psychosocial or physical stressors The result of too much stress or an inefficient operation of the stress response system The delicate balance between coping with stress and overwhelming stress determines the consequences on health vs.Illness. Following the impact of the disaster a series of difficulties-lack of food, shelter, electricity, gas, painful social interactions, bad luck--may overwhelm the coping capacity of the survivor. The delicate balance between coping with stress and overwhelming stress determines the consequences on health vs.Illness. Following the impact of the disaster a series of difficulties-lack of food, shelter, electricity, gas, painful social interactions, bad luck--may overwhelm the coping capacity of the survivor.

    33. Intense/Protracted Stress The wear and tear that the body experiences due to repeated cycles of stress as well as the inefficient turning-on or shutting off of these responses. Includes many aspects of an individual's life that affect the regulation and level of the mediators of the nervous system. Individuals that are subjected to random traumatic events in a short time may develop difficulties in functioning. Disaster impacts severely on individuals that have vulnerable systems of responding to stressors. Emotional pain, depression and anxiety can have long lasting debilitating effects on the lives of survivors.Individuals that are subjected to random traumatic events in a short time may develop difficulties in functioning. Disaster impacts severely on individuals that have vulnerable systems of responding to stressors. Emotional pain, depression and anxiety can have long lasting debilitating effects on the lives of survivors.

    34. Chronic stress reactions Analogy Fire alarm that keeps ringing even after the fire has been put out This metaphor clarifies the observation that some survivors continue to show signs of stress even though their environment does not appear dangerous or threatening any more. Even though the conditions of stress have disappeared for many months some survivors will not be able to recover.This metaphor clarifies the observation that some survivors continue to show signs of stress even though their environment does not appear dangerous or threatening any more. Even though the conditions of stress have disappeared for many months some survivors will not be able to recover.

    35. Effect of Stress Response A sustained stress response may: damage the organism accelerate disease Due to continuous, unremitting hormonal/neural processes the organs are impacted and function becomes disorganized. Observations post-disaster are beginning to associate several trauma with somatic consequences. Research is finding associations in some cases of accelerated heart conditions that can be fatal.Due to continuous, unremitting hormonal/neural processes the organs are impacted and function becomes disorganized. Observations post-disaster are beginning to associate several trauma with somatic consequences. Research is finding associations in some cases of accelerated heart conditions that can be fatal.

    36. Failure to habituate to stressors Failure to turn off the stress response Inadequate hormonal stress response Internal human characteristics and external stimuli play a role. These are some of the theories that try to explain why some survivors will have long-term difficulties after a disaster.Internal human characteristics and external stimuli play a role. These are some of the theories that try to explain why some survivors will have long-term difficulties after a disaster.

    37. Disease and psychological distress results in these individuals because full-alert status: Comes on too often Fails to adapt to the same stressor over time Remains on after the stress has passed Wears out the ability of some organs to respond Causes other organs to overreact Psychological distress is manifested by survivors as a reaction to the impact of the disaster. Individuals who appear to cope well during a few weeks/months after the disaster may begin to show chronic problems,Psychological distress is manifested by survivors as a reaction to the impact of the disaster. Individuals who appear to cope well during a few weeks/months after the disaster may begin to show chronic problems,

    38. For each system of the body there are: short-term adaptive actions (protective) AND long-term effects (potentially damaging) Research is clarifying that the individual has different capacity levels to sustain stressors and although some systems seem to respond well others may become incapacitated over time. Research is clarifying that the individual has different capacity levels to sustain stressors and although some systems seem to respond well others may become incapacitated over time.

    39. Statistical association outcome studies are reporting findings that there seems to be some correlation between stress and these illness. The best lines of study are the illness associated with the immunologic system.Statistical association outcome studies are reporting findings that there seems to be some correlation between stress and these illness. The best lines of study are the illness associated with the immunologic system.

    40. Included in the effects of chronic stress you may find patterns of dysfunctional behavior that will aggravate the efforts to cope with difficult post-disaster problems. If this conditions last beyond several months or produce severe secondary dysfunctions of survivors you should ask for professional help.Included in the effects of chronic stress you may find patterns of dysfunctional behavior that will aggravate the efforts to cope with difficult post-disaster problems. If this conditions last beyond several months or produce severe secondary dysfunctions of survivors you should ask for professional help.

    41. Helpful Characteristics Genetic predisposition: Early development Learned healthy behaviors: Diet Exercise Smoking and drinking This is a list of modifiers that can ameliorate the effects of severe stress. Having the capacity not to resort to over-eating or abusing the use of alcohol can be helpful although at times difficult to curb.This is a list of modifiers that can ameliorate the effects of severe stress. Having the capacity not to resort to over-eating or abusing the use of alcohol can be helpful although at times difficult to curb.

    42. Support Systems Linking and/or developing relationships with individuals who are interested and sensitive to the well being of the survivor is a powerful resource toward recovery. You should include this objective as a priority in your strategies.Linking and/or developing relationships with individuals who are interested and sensitive to the well being of the survivor is a powerful resource toward recovery. You should include this objective as a priority in your strategies.

    43. Social Supports Concepts Research has demonstrated the value of support when it fits the needs of the survivor. You need to realize that some support individuals may be detrimental and slow down the capacity to cope and adapt. Be careful to expect family members to be supportive if they themselves are in need of helpResearch has demonstrated the value of support when it fits the needs of the survivor. You need to realize that some support individuals may be detrimental and slow down the capacity to cope and adapt. Be careful to expect family members to be supportive if they themselves are in need of help

    44. Assistance (at every level) to the individual in the aftermath of disaster person-to-person exchange. Provide support for identification Exchange of helpful information Opportunity to share coping techniques Support Systems (Mediators Regulators) There are different and varied periods of support needs-generally the need is related to the impact of the trauma. At first it seems that the survivor will ask you for multiple help but as time goes by this need will diminish.There are different and varied periods of support needs-generally the need is related to the impact of the trauma. At first it seems that the survivor will ask you for multiple help but as time goes by this need will diminish.

    45. Support increased sense of worth Reinforcement for change and maintenance of effort (feedback on performance) Provide concrete aid and serve as counselors Support Systems (Mediators Regulators) Intervention and assistance to survivors implies a constant level of support-this may fluctuate according to the problems the the survivor faces post-disaster. It is important not to become too entwined with the life of the survivor as time goes by.Intervention and assistance to survivors implies a constant level of support-this may fluctuate according to the problems the the survivor faces post-disaster. It is important not to become too entwined with the life of the survivor as time goes by.

    46. Problem-solving options and prioritization of solutions Supporting activity Supporting empowerment in the face of adverse conditions Support Systems (Mediators Regulators) At times you may be tired of the dependence the survivor expects from you. Examine your own behavior and feelings with regard to your participation in encouraging the dependence. The balance between helping and encouraging dependence is a difficult one.At times you may be tired of the dependence the survivor expects from you. Examine your own behavior and feelings with regard to your participation in encouraging the dependence. The balance between helping and encouraging dependence is a difficult one.

    47. Social Supports Concepts It is hypothesized that individuals with a strong array of social resources are less likely to have a given noxious circumstance override his/her defenses. Extending support to assist in problem solving is a continuous activity of the worker to help survivors. In his article Psychosocial modifiers of Response to Stress- C, David Jenkins: - 1979- offers models to relate stress response outcome, in relation to quality of support systems so as to measure adaptive capacity of the individual. All these processes are examined at the biological, psychological, interpersonal and sociocultural levels simultaneously and successivelyIn his article Psychosocial modifiers of Response to Stress- C, David Jenkins: - 1979- offers models to relate stress response outcome, in relation to quality of support systems so as to measure adaptive capacity of the individual. All these processes are examined at the biological, psychological, interpersonal and sociocultural levels simultaneously and successively

    48. Social Supports Concepts In the chaotic setting following a disaster Although it is very difficult to effectively match victims and helpful groups during this time, finding the right fit is crucial and may be one of the most important components of successful: Gerald Caplan has published a series of articles and books elucidating the characteristics of the useful variables in support - networks. Trying to combine the right fit between victims and helpful groups is difficult in the chaotic setting following a disaster. Gerald Caplan has published a series of articles and books elucidating the characteristics of the useful variables in support - networks. Trying to combine the right fit between victims and helpful groups is difficult in the chaotic setting following a disaster.

    49. Social Supports Concepts Intervention Goals: Finding the right fit for successful: a) Coping b) Problem Solving c) Adaptation of the Survivor This should be your optimal goal as you proceed toward the end of your interventions assistance. You will notice a diminution of dependent behavior manifested by the survivor as time goes by and will come to realize that the survivor has found a way to cope and became self sufficient.This should be your optimal goal as you proceed toward the end of your interventions assistance. You will notice a diminution of dependent behavior manifested by the survivor as time goes by and will come to realize that the survivor has found a way to cope and became self sufficient.

    50. Coping & Adaptation We cope daily with issues of daily living but in post disaster situation achieving successful coping and adaptation is very difficult in the first few weeks.We cope daily with issues of daily living but in post disaster situation achieving successful coping and adaptation is very difficult in the first few weeks.

    51. Coping & Adaptation Appraisal Shapes The Coping Process . What stimulates the antecedent of the appraisal? Our perception and interpretation of the understanding of what has happened will set into motion the type of response needed for survival, Past experiences and memories of traumatic events sets the stage for appraisal.Our perception and interpretation of the understanding of what has happened will set into motion the type of response needed for survival, Past experiences and memories of traumatic events sets the stage for appraisal.

    52. Coping & Adaptation What stimulates the antecedent of the appraisal? What is it about the person and the situational context that produces: Appraisals of harm/threat OR Appraisals that some benefit is possible or probable? There is a rapid evaluation of how the event will be perceived--dangerous vs safe. Some times the individual will misinterpret the meaning of the event and may have a maladaptive response.There is a rapid evaluation of how the event will be perceived--dangerous vs safe. Some times the individual will misinterpret the meaning of the event and may have a maladaptive response.

    53. Coping & Adaptation What stimulates the antecedent of the appraisal? We have a built-in neurological mechanism that responds to dangerous situations. Danger is mediated by complicated systems of the brain which eventually converge into the locus cerulean, a major modulator in the brain of anxiety which in turn has links to the stress response components: emotions, motor activity and physiologic responses.Danger is mediated by complicated systems of the brain which eventually converge into the locus cerulean, a major modulator in the brain of anxiety which in turn has links to the stress response components: emotions, motor activity and physiologic responses.

    54. Coping & Adaptation Memory is a key component of this mechanism, which serves the purpose of identifying and measuring danger signals to: Past Experiences Belief Learning Knowledge These sources of information give meaning to the effects of stressors, and in doing so, formulate the individualistic characteristics of the victims behavior post-trauma.These sources of information give meaning to the effects of stressors, and in doing so, formulate the individualistic characteristics of the victims behavior post-trauma.

    55. Coping & Adaptation Differences between ACUTE and CHRONIC stress Acute Stress Always associated with strong emotions Increases memory of the event that threatens the organism Helps remember avoid in the future These sources of information give meaning to the effects of stressors, and in doing so, formulate the individualistic characteristics of the victims behavior post-trauma.These sources of information give meaning to the effects of stressors, and in doing so, formulate the individualistic characteristics of the victims behavior post-trauma.

    56. Coping & Adaptation Differences between ACUTE and CHRONIC stress Chronic Stress Causes changes in the brain Forms new structures affecting cognitive functions Research is beginning to indicate the capacity of the brain to develop new connections between dendrites or strengthen them.Research is beginning to indicate the capacity of the brain to develop new connections between dendrites or strengthen them.

    57. Coping & Adaptation Differences between ACUTE and CHRONIC stress Chronic Stress New research is indicating that the hippocampus is distorted and may be associated with PTSD or depression. The research question that needs to be answered if why is it that a number of survivors develop chronic symptoms of maladaptation?The research question that needs to be answered if why is it that a number of survivors develop chronic symptoms of maladaptation?

    58. Every individual has a repertoire of strategies to deal with life situations. It will be helpful to you to find out what coping strategies does the survivor utilize to cope with post disaster situations nd problems. You need to notice if they are using maladaptive forms of behavior.Every individual has a repertoire of strategies to deal with life situations. It will be helpful to you to find out what coping strategies does the survivor utilize to cope with post disaster situations nd problems. You need to notice if they are using maladaptive forms of behavior.

    59. You should notice how you cope with your assignments. This will help you notice if you are comfortable with the way the survivor handles their problems. Notice if you fell conflicted by their behavior and try to adapt and understand how individual are the strategies of adaptation.You should notice how you cope with your assignments. This will help you notice if you are comfortable with the way the survivor handles their problems. Notice if you fell conflicted by their behavior and try to adapt and understand how individual are the strategies of adaptation.

    60. Coping: Is the behavior that protects us from becoming psychologically and physiologically disorganized. Usually incorporates action-oriented behavior responses. It also employs cognitive, emotional, and perceptual appraisal processes. All bio-psycho socio cultural characteristics are implied in coping behavior.All bio-psycho socio cultural characteristics are implied in coping behavior.

    61. May attempt to change the source of the stress May attempt to redefine the threat situation (meaning, degree of severity) Attempts to find accommodation and compromise (passive acceptance; resignation; religious beliefs; destiny) These are the objectives of coping chosen by all of us to defend ourselves from loosing a sense of worth.These are the objectives of coping chosen by all of us to defend ourselves from loosing a sense of worth.

    62. Coping Behavior that protects the individual from internal and external stress Prevents and manages tension and stress We all have a limit of how much stress we can deal with before we become distressed. Emotional pain, sadness and hopelessness are present in all disaster survivor-the question is --how long does it last-how intense is it-how dysfunctional does it render the survivor.We all have a limit of how much stress we can deal with before we become distressed. Emotional pain, sadness and hopelessness are present in all disaster survivor-the question is --how long does it last-how intense is it-how dysfunctional does it render the survivor.

    63. Ability to orient oneself rapidly Planning of decisive action Mobilization of emergency problem-solving mechanisms Appropriate use of assistance resources These are examples of coping strategies which will aid us in adaptation to difficult situations.These are examples of coping strategies which will aid us in adaptation to difficult situations.

    64. 8. Development of strategies (contingency plans) to convert uncertainty into manageable risk process of situational mastery (worry work/rehearsal for life change stress). 9. Acknowledgement of increased dependency needs and seeking, receiving, and using assistance. One of the most painful realities of survivors is to acknowledge, ask and receive help. The dignity of the individual get trampled in many emergency situations when the resources are not sufficient to the number of survivors.One of the most painful realities of survivors is to acknowledge, ask and receive help. The dignity of the individual get trampled in many emergency situations when the resources are not sufficient to the number of survivors.

    65. 5. Ability to deal simultaneously with the affective dimensions of the experience and the tasks that must be carried out. 6. Appropriate expression of painful emotions 7. Acknowledgement of pain, without obsessing over troubled feelings Many times you may not be aware of how painful a situations has become to the survivor due to loss, uncertainty, shame to ask for clothing or food.Many times you may not be aware of how painful a situations has become to the survivor due to loss, uncertainty, shame to ask for clothing or food.

    66. 10. Tolerance of uncertainty without resorting to impulsive action 11. Reaction to environmental challenges (repertoire of active mastery skills) and recognition of their positive value for growth 12. Use of non-destructive defenses and modes of tension relief to cope with anxiety You can be very helpful if you are aware and sensitive of the struggle the survivor is silently dealing and ashamed to complain or demand. On the other hand, some individuals will be vocal in demanding needs to cover up the sadness and fear of the future.You can be very helpful if you are aware and sensitive of the struggle the survivor is silently dealing and ashamed to complain or demand. On the other hand, some individuals will be vocal in demanding needs to cover up the sadness and fear of the future.

    67. Relax Exercise Sleep Eat healthy Minimize: Caffeine Alcohol Sugar Monitor health status Seek help if needed This is a list of activities you need to encourage.This is a list of activities you need to encourage.

    68. Identify feelings Express feelings Be assertive Maintain open communication Find humor Seek help if needed Try to notice which of these emotional expressions are helpful to the survivor.Try to notice which of these emotional expressions are helpful to the survivor.

    69. Make a plan Set goals Get information Make small daily decisions Anticipate Problem-solve This are helpful objectives that will support the coping efforts of the survivor.This are helpful objectives that will support the coping efforts of the survivor.

    70. Engage in enjoyable activities Avoid risky behaviors Spend time with others Prioritize demands Seek time for self Seek help if needed Remember that these behaviors will also help you cope with difficult assignmentsRemember that these behaviors will also help you cope with difficult assignments

    71. Practice your faith Find spiritual support Pray or meditate Discuss your beliefs with others having similar beliefs Seek help if needed These are important supports for coping and adapting.These are important supports for coping and adapting.

    72. Avoidance Withdrawal Destructive venting of anger Giving up Excessive denial Poor reality testing Impulsive behavior Ritualistic behavior Although some of the behavior in the next 4 slides may be present for a few days post disaster or reappear after a subsequent difficult period if it lasts too long it may signal a pathological chronic development and poor future adaptation.Although some of the behavior in the next 4 slides may be present for a few days post disaster or reappear after a subsequent difficult period if it lasts too long it may signal a pathological chronic development and poor future adaptation.

    73. Poor regulation of rest-work cycle Substance abuse Overeating Underrating Risk-taking Blaming Inability to use support systems

    74. Excessive denial Withdrawal Retreat Avoidance Frequent use of fantasy Poor reality testing

    75. Emotional suppression, possibly leading to hopeless-helpless-giving up syndrome Use of hyper ritualistic behavior with no purpose Fatigue and poor regulation of rest-work cycle Addiction Inability to use support systems

    76. Impulsive behavior Venting rage on weaker individuals Creating scapegoats

    77. Over-dependent Clinging Counter-dependent behavior Inability to evoke caring feelings from others

    78. In post disaster situations the resiliency of an individual is a source of strength. It will be a helpful characteristic aiding in return to function. Genetic, personality traits, past experiences and healthy life styles are some of the variables that are conducive to resilience.In post disaster situations the resiliency of an individual is a source of strength. It will be a helpful characteristic aiding in return to function. Genetic, personality traits, past experiences and healthy life styles are some of the variables that are conducive to resilience.

    79. WHAT IT IS Positive adaptation in the face of adversity Ordinary Commonly demonstrated Most individuals have differing levels of resilience to cope with life events. There is a balance between what and individual can deal with and when he/she is overwhelmed.Most individuals have differing levels of resilience to cope with life events. There is a balance between what and individual can deal with and when he/she is overwhelmed.

    80. Make connections develop a supportive network Avoid interpreting crises as overwhelming Accept that change is a part of living Move toward your goals Take decisive actions The list in the next 2 slides provides you with guidelines to help individuals who are having difficulty in dealing with the aftermath of a disaster. Remember these are objectives of your assisting the individual--how, when. at what rate will be your strategy depending on the capacity of the individual and the events that present themselves after the disaster.The list in the next 2 slides provides you with guidelines to help individuals who are having difficulty in dealing with the aftermath of a disaster. Remember these are objectives of your assisting the individual--how, when. at what rate will be your strategy depending on the capacity of the individual and the events that present themselves after the disaster.

    81. Look for opportunities for self-discovery Nurture a positive view of yourself Keep things in perspective Maintain a hopeful outlook Take care of yourself Many of the objectives to assist an individual are also good guidelines for your own performance aiding your efforts to help the survivor.Many of the objectives to assist an individual are also good guidelines for your own performance aiding your efforts to help the survivor.

    82. Loss & Bereavement In every disaster there are losses that will cause pain and suffering--they can be of loved ones, property, jobs, familiar landmarks, opportunities. mementos. Pets or sense of security. The extent and meaning of these losses will affect individuals in a different way.In every disaster there are losses that will cause pain and suffering--they can be of loved ones, property, jobs, familiar landmarks, opportunities. mementos. Pets or sense of security. The extent and meaning of these losses will affect individuals in a different way.

    83. Loss & Bereavement Definitions Bereavement - behavior reaction following death Grief - affect that accompanies loss Mourning - social behavior (different expressions in different cultures) following loss These definitions of the reactions to loss clarifies the definition of the responses following the death of a loved and important individual in the life of a survivor.These definitions of the reactions to loss clarifies the definition of the responses following the death of a loved and important individual in the life of a survivor.

    84. Loss & Bereavement Everything in the life of a survivor will suffer some degree of change due to the impact of the catastrophic event. With this change will come the realization of multiple loses so that mourning and coping with these events is a perennial activity of counseling the survivor. Disasters aftermath produce pain and sadness due to the fact that after the impact the lost familiar world of the survivor is gone. It will never be the same-whether better or worse. This type of sudden disappearance of familiar guidepost is one of the sorrows that most survivors experience.Disasters aftermath produce pain and sadness due to the fact that after the impact the lost familiar world of the survivor is gone. It will never be the same-whether better or worse. This type of sudden disappearance of familiar guidepost is one of the sorrows that most survivors experience.

    85. Loss & Bereavement Loss is an ongoing experience post-disaster Each of these categories of loss will produce pain and distress but the level pf intensity and duration will vary according to many individual factors. The common denominator will be the intensity of the bonds, meaningfulness, needs and sense of alones.Each of these categories of loss will produce pain and distress but the level pf intensity and duration will vary according to many individual factors. The common denominator will be the intensity of the bonds, meaningfulness, needs and sense of alones.

    86. Bereavement The fact of loss through death The death of a loved one will produce deep feeling and emotions that need to be processed toward a final and healing. An important information that most survivors need to know is how the individual died and did they suffer. Obtaining this information and gently providing it to the survivor will be helpful.The death of a loved one will produce deep feeling and emotions that need to be processed toward a final and healing. An important information that most survivors need to know is how the individual died and did they suffer. Obtaining this information and gently providing it to the survivor will be helpful.

    87. Death is a consequence of disasters and acts of terrorism. Mass violence and terrorism are intended to cause mass death. Both manmade severe catastrophes and terrorism act will produce the death of a number of individuals. This large scale loss will present you with a difficult assignment not only with the individual pain but the large number of individuals needing assistance. Both manmade severe catastrophes and terrorism act will produce the death of a number of individuals. This large scale loss will present you with a difficult assignment not only with the individual pain but the large number of individuals needing assistance.

    88. Principles of Grief Grieving is a natural reaction to death Every death is unique and is experienced differently Grief is ongoing Although you may be familiar with grief reactions in your personal life the quality of large number of individuals grieving will present you with a challenge. Having colleagues that can offer you support and opportunities to share your emotions will be helpful.Although you may be familiar with grief reactions in your personal life the quality of large number of individuals grieving will present you with a challenge. Having colleagues that can offer you support and opportunities to share your emotions will be helpful.

    89. Loss & Bereavement Quality and extent of loss Previous experiences with trauma Direct impact of the disaster Quality of support systems Capacity to cope Quality of resiliency These variables will influence the degree and capacity to recover from the loss. The inter action between past experiences, personality and support play important influences in grieving.These variables will influence the degree and capacity to recover from the loss. The inter action between past experiences, personality and support play important influences in grieving.

    90. Stages of Bereavement Immediate Intermediate Long-Term Effects The process of grieving will be manifested through time lapse following natural changes. It is very similar to the phases of community recovery where eventually a final stage of resolution and adaptations is achieve. Some individuals (just like communities) will be stuck in this process and may develop increased difficulties to recover.The process of grieving will be manifested through time lapse following natural changes. It is very similar to the phases of community recovery where eventually a final stage of resolution and adaptations is achieve. Some individuals (just like communities) will be stuck in this process and may develop increased difficulties to recover.

    91. Immediate Grief Reactions Shock, disbelief, unreality, nightmares Oscillation between intrusive reality and denial Range of emotions: sad, fearful, angry, helpless Sleep and appetite disturbances Social withdrawal Disorganized behaviors All the bio-psychosocial of the individual are affected. These will influence their sense of comfort, their thoughts and inter social relations. If you are familiar with these reactions you will recognize them and be able to assist by a sensitive listening, offering support and consolation.All the bio-psychosocial of the individual are affected. These will influence their sense of comfort, their thoughts and inter social relations. If you are familiar with these reactions you will recognize them and be able to assist by a sensitive listening, offering support and consolation.

    92. Intermediate Grief Reactions Preoccupation with the image of the deceased Bodily symptoms Waves of distress Work problems School problems Social withdrawal Irritability Mood changes These are some of the manifestations of individuals that are struggling to regain the capacity to deal with the loss. If they are not severe they will diminish over time.These are some of the manifestations of individuals that are struggling to regain the capacity to deal with the loss. If they are not severe they will diminish over time.

    93. Somatic/medical symptoms Interpersonal and social adjustment problems Damages to self-efficacy Utilization of health resources Internalizing and externalizing symptoms Decrements in academic performance These manifestation herald the problems that may appear due to difficulties to grieve and adapt to the loss. You may need to refer these survivors for further professional help.These manifestation herald the problems that may appear due to difficulties to grieve and adapt to the loss. You may need to refer these survivors for further professional help.

    94. Loss & Bereavement There is a constant need to remind the survivor of his/her: Strength Capacity Skills Resources Although grieving and depression are normal reactions, post-disaster care must be exercised to notice if the signs and symptoms do not abate and interfere seriously with the survivors daily life.Although grieving and depression are normal reactions, post-disaster care must be exercised to notice if the signs and symptoms do not abate and interfere seriously with the survivors daily life.

    95. Gender Female: higher rates of PTSD, depression Male: higher rate of substance abuse Marital status Pre-disaster level of functioning Preexisting psychiatric illness Social support Source: North, 2003 Research findings are beginning to factor in some variables that play a role in mitigating the pathological reactions to catastrophic events.Research findings are beginning to factor in some variables that play a role in mitigating the pathological reactions to catastrophic events.

    96. Depression Differing levels of depression are normal reactions post-disaster-the intensity of the loss, sense of hopelessness and difficulty to anticipate the end of all the trouble brought about by the catastrophe will produce depressive reactions.Differing levels of depression are normal reactions post-disaster-the intensity of the loss, sense of hopelessness and difficulty to anticipate the end of all the trouble brought about by the catastrophe will produce depressive reactions.

    97. Changes In: Mood Behavior Relationships Thinking Bodily Functioning Depression: Frequent Symptoms These reactions are the normal bio-psychological efforts to deal with the changes brought about by the impact and losses produced by the disaster. The important challenge that you face is whether they are part of the normal reactions to the catastrophe or are they early indications of pathological reactions.These reactions are the normal bio-psychological efforts to deal with the changes brought about by the impact and losses produced by the disaster. The important challenge that you face is whether they are part of the normal reactions to the catastrophe or are they early indications of pathological reactions.

    98. Depression: Frequent Symptoms Changes In: MOOD Feelings of sadness and depression Irritability Loss of pleasure Emotions will shift from time to time. Also as time goes by and new difficulties arise in the life of the survivor episodes of emotional turmoil will reappear.Emotions will shift from time to time. Also as time goes by and new difficulties arise in the life of the survivor episodes of emotional turmoil will reappear.

    99. Depression: Frequent Symptoms Changes In: BEHAVIOR Activity level Vocational/occupational performance Loss of interest in previously pleasurable activities Tearfulness Impaired parental functioning These behaviors will allow you to ascertain how the survivor is coping.These behaviors will allow you to ascertain how the survivor is coping.

    100. Depression: Frequent Symptoms Changes In: RELATIONSHIP Social avoidance Social withdrawal and isolation Interpersonal conflicts Expect this in the early days/weeks post impact but if it goes beyond several months then you will need to refer this survivor to a professions.Expect this in the early days/weeks post impact but if it goes beyond several months then you will need to refer this survivor to a professions.

    101. Depression: Frequent Symptoms Changes In: THINKING Low self-esteem Self-deprecation Preoccupation with death/suicide Inability to think or concentrate Negative expectations about the future Feelings of hopelessness Self-absorption As they talk with you try to notice whether this thoughts are interfering with function. Take the preoccupation with suicide very seriously. After a intense catastrophe and multiple losses of loved ones, individuals may not want to continue to live.As they talk with you try to notice whether this thoughts are interfering with function. Take the preoccupation with suicide very seriously. After a intense catastrophe and multiple losses of loved ones, individuals may not want to continue to live.

    102. Depression: Frequent Symptoms Changes In: BODILY FUNCTIONING Appetite Body weight Sleep Psychomotor activity Somatic complaints Monitor these changes carefully as they may indicate more chronic problems and dysfunctions.Monitor these changes carefully as they may indicate more chronic problems and dysfunctions.

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