Psychosocial support

1. Psychosocial support Icelandic Red Cross

2. Objectives • To know/comprehend normal reactions that people experience to critical events (difficult, painful) • To know what can be done to support people in crises • To become more confident in supporting and showing concern when people experience critical events/crisis

3. What have you need for when your life is difficult?

4. DSM-5 (Diagnostic and Statistical Manual of Mental Disorders by APA) An event that threatens life or causes death or causes serious injury or sexual violence Individual: • experiences the event • is a witness to the event that happens to someone else • gets to know that a close family member or a close friend has experienced a traumatic evetn, the event has to be violent or an accident • repeated or extreme experience of uncomfortable part of a traumatic event. For an instance a policeman who has to repeatedly handle the details of sexual violence against children (not an experience through the media unless it connects to work); rescue team members who have to collect body remains (not experienced through media, computers ... unless it connects to work) New: Sexual violence!

5. There are two types of crises • A crisis following unexpected and unforeseeable events, for example major accidents, violence or the death of someone close to you • A crisis many people experience when major changes during the life-span occur, for example puberty, separation or childbirth

6. Crisis process Oriented phase Trauma phase Process phase Response phase

7. Grief • Reaction to loss, bereavement • Grief is a natural reaction to loss • Grieving is not a disease • There will be a rapid change in people´s wellbeing ifthegrieving processpassessuccessfully

8. Trauma • A trauma is an unusual and sudden event which causes significant emotional distress and is usually associated with fear for ones life or the life of others. • Such events are typically thought to overwhelm ones normal coping mechanisms and can lead to changes in personality or physical illness if not managed quickly/or effectively.

9. It felt like an explosion and I got all numb. It was very quiet even though the traffic was heavy. I didn´t feel the rain when I stepped out of the car. The only thought that came to my mind was to get out to see what would meet me in front of the car”. Afterward I experienced a lot of intrusive thoughts both night and day. Especially the sound from the hood when the little girl hit it.

10. What makes an event traumatic? • Trauma not only causes pain and fear, but is also an event which: • Violates our belief in a “just world” • Violates our sense of self • Diminishes our trust in others • Violates our sense of safety • Following a trauma an individual must revise and re-evaluate: • his view of the world and/or his self image.

11. Common reaction to trauma • Increased consciousness of surroundings • Memory for details • Uneasiness, repeated memories of the event • Sensitivity to surroundings, for example the behavior of others • Total or partial loss of memory about the event • Numbness • Disinterest, apathy • Withdrawal which consists of isolation and diminished life energy

12. Altered consciousness • Altered sense of time so the individual feels that time stands still or passes very quickly • Feeling of unreality: • “This can´t be happening to me” • “I felt like I was outside of my body” • “It was like a movie” • “It´s like I´m a robot” • Overly conscious of ones surroundings • Overly conscious of details or numbness regarding surroundings and diminished memory

13. What determines how a crisis evolves? • The individuals perception of the event, what it means to him, consciously and unconsciously. • The individuals responses, how he/she resolves the crisis. • The response of the surroundings, what kind of support the individual gets from others. • The individuals prior experience.

14. Group discussion: ”What are some examples of stress reactions you have experienced or seen in others in the past?” ”In what situations do they typically appear?”

15. What is stress? Acute response to stress A mixture of 3 factors that relate to each other Cognitive factor Physical response Emotional factor Cognitive factor Physical response Emotional factor

16. Types of stress • Accumulated stress • Long-term exposure to high work-load, new responsibilities, constant conflicts etc. • Traumatic stress • Sudden critical incident, e.g., accident, catastrophe, assault, threat, hostage-taking etc.

17. Common stress reactions

18. Evaluate stress in your own life Answer the following 10 questions and use the scale: 0 = does not apply, 1 = almost never, 2 = sometimes, 3 = often. Then add the answers. 1. I have difficulty sleeping 2. I am irritated and/or uneasy 3. My sarcasm has increased 4. I am on alert towards looming dangers that I feel I face 5. I feel like I am distant from my coworkers and avoid them 6. The job does not spark any interest in me anymore 7. I am physically and mentally tired 8. I use drugs (also according to doctors advice) or alcohol to relax, to sleep , to make life easier 9. I am anxious, do things without thinking and/or take dubious risks 10. I experience serious events in my mind, my dreams and nightmares

19. What do you do to prevent or dimninish your stress?

20. Self-care and coping ”Self-care is taking time out to take care of ones emotional, physical and material needs so that stress reactions related to a difficult work task may be minimized.” ”Coping is dealing adequately with the stress reactions that still occur.”

22. How to increase resistance to stress • Reduce speed and tension - stop and ask yourself and be prepared to discover something new • Learn to listen to your body and respect its needs, for example eat well and exercise • A persons expectations and attitudes are important. It is very important to accept your limitations and the limitations of others

23. Stress managementChange the way you think • See things from a different point of view • how do we look at occurrences in our lives • new context – less stress • Positive thinking • look at the bright sides • look at your virtues • make positive changes in your life

24. Stress managementChanges in behaviour • Work out arguments • Talk to those you trust • Arrange your life • Divide what you are dealing with into manageable proportions • Use humour

25. Stress managementChanges in lifestile • Learn to relax • Get a good nights sleep • Do not use alcohol and drugs in large amount • Do what you have stopped doing but gave you pleasure “An event isn´t good or bad in itself, but how we think of it” (William Shakespeare)

26. Ways to selfhelp • Turn to assistance/support from others • Support/assist others • Talk about the experience • Protect yourself and your family from more/further danger • Cultivate your relationship with friends and coworkers • Make a conscious decision to do the things that will help you become back to normal • Support or take the lead on social support

27. Ways to selfhelp • Physical exercises • Breath • Relaxation • Mindfulness – Meditation • Yoga • More...

28. Unhealthy responses to stress • Excessive consumption of coffee, alcohol and drugs • Isolation - avoiding contact with others • Outbursts of anger or rage • Extreme emphasis on both work and leisure

29. What is crisis intervention? • Psychological First Aid • Information and education • Defusing • Debriefing • Estimation of risk factors • Follow-up

30. What is a psychosocial support • Psychological first aid is • the physical and psychological care of someone who has been through trauma. • Its purpose is to support the individual in achieving his/her former balance and independence. • First hand and without delay • Here and now • Expectations and emphasis are clear- • feelings and experiences of the victim of trauma are in the spotlight • his prior experience and the aid-giver´s view and needs take a back seat.

31. How do you provide psychosocial support • Ensure emotional and physical security • Be calm both in your behavior and in what you say • Create safe surroundings, protect people from outside disturbances • Pay attention to basic needs, foods, clothes and shelter

32. Helpers performance • Keep calm • Speak calmly and in a balanced fashion • Give secure information • Assist with practical matters • Show concern • Discuss what is happening here and now • Perform with/show confidence • The last thing a helpless individual needs is another helpless individual

33. Expression • We express ourselves with words, tone of voice, facial expressions and gestures. People listen to others according to the following: • Body language is said to be 54% of our expression • The tone34% • The language, only 12% • Trauma causes people to listen to everything that is said and can: • Over-interpret the things they hear and respond very strongly to the message

34. What should you say? • “I am sorry that you have to ...” • “It is difficult for me to understand what you are going through. This is so much and so big” • “What can I do for you/how can I help?” • “It is very natural that your are ... (angry, upset, scared)” • “I wish that I could do something more“ • “This must have been a peculiar experience” • “I wish that I knew...”

35. What you should not say • “I know exactly how you feel“ • “I understand what you are going through” • “This could have been worse“ • “Look at the bright sides“ • “Time heals all wounds” • “You just have to go on and be strong” • “There are other people that are worse off than you”

36. Don‘t !! • Interrupt unless it is completely necessary • Have a debate • Offer assistance that you are not sure will help • Get defensive if the interviewee is angry or unfriendly • Tell him/her what he/she should do • Participate in allegations or other negative talk

37. Important to keep in mind Highlight the options that the interviewee has: • “In view of circumstances I think you can...” • “It seems to me that your are most concerned of...” • “it is correct to look at what options there are in this situation” • “What do you believe could help, what is most important to you now, what has worked for you before?”

38. Remember and Respect • We are different • Each and everyone is special • We have different experience • We have different background • We have different perspective

39. Listening • Show attention • Show interest • Show the person respect • Show respect even though we don‘t agree • Don‘t disturb • Get/Keep eyecontact • Repeat what has been said • Reflect what has been said • Ask as appropriate

40. Assignment • Work together in pairs of two • One shares something that is very important to him/her or • One talks about a good support that he/she has got • The other one listens actively and uses body language that shows interest • After X min. The roles are reversed • Discuss the experience, both as the speaker and the one that listens (How did it make you feel?)

41. THANK YOU FOR YOUR ATTENTION!