Psychology of a Crisis

1. Psychology of a Crisis Module 2

2. What Constitutes Crisis? • Naturally occurring • Earthquake • Tornado • Flood • Wildfire • Pandemic Disease • Manmade • Hazardous Material Release • Terrorism • Other Criminal Activity

3. Traumatic Events • Sudden and unexpected • Children more vulnerable – less experience in coping with life • Adults may be overwhelmed by events that occur suddenly and are beyond their control – may produce psychological reactions including Post Traumatic Stress Disorder (PTSD)

4. Public Perspectives • 61% fear terrorism more than natural disaster • 77% believe information to cope with fear and distress are needed • 57% do not think the health system is meeting the mental health needs resulting from the threat of terrorism • Information received after a crisis significantly shapes reactions over the weeks and years following

5. Immediate Reactions to a Crisis • Disbelief • Disorientation • Dislocation • Fear • Feeling time is slowed down • Feeling numb or disconnected • Feeling helpless • Feeling responsible (should be doing more)

27. HOW DO YOU FEEL?

28. Response to 9/11 Attacks • First week • 44% of adults & 35% of children – 1 or more substantial stress symptoms • Intrusive thoughts • Very upset when reminded • Nightmares, sleep disturbance • Poor concentration • Anger outbursts

29. Response to 9/11 Attacks • 20% of Americans know someone who was missing, hurt or killed • 64% had a shaken sense of safety & security • 43% less willing to travel by airplane • Within 2 months in Manhattan • 7.5% increase in PTSD (67,000 new cases) • 9.7% increase in Depression (87,000 new cases) • Secondary trauma via TV and other media correlate to PTSD symptoms – 60% witnessed via live TV

30. General Psychological Effects • Emotional Effects • Grief, anger, despair, sadness, hopelessness, numbness, denial, flashbacks, generalized Anxiety Disorder, Panic Disorder, Post Traumatic Stress Disorder (PTSD) • Cognitive Effects • Impaired concentration & decision-making, impaired memory, disbelief, worry, tunnel vision

31. General Psychological Effects • Physical Effects • Fatigue, insomnia, cardiovascular strain, hyper-arousal, health problems/concerns headaches, decreased appetite, nonspecific distress, MUPS – Medically Unexplained Physical Symptoms (worried well) • Interpersonal Effects • Increased relational conflict, social withdrawal, impaired performance, over-protectiveness, feeling abandoned and rejected

32. Who’s At Risk? • Those with severe exposure, injury, threat to life, extreme loss, disrupted community, and high secondary stress • Females age 40 -60 with no experience in coping techniques • Young & middle aged adults (vs. older adults) • Prior exposure to violence and trauma • Ethnic minorities • Persons with prior psychiatric history • Adults with children • School children • First responders

33. Protecting the Public’s Psychological Health • Provide basic resources – food, shelter, communication, transportation, and medical services • Programs to promote individual and community resilience • Surveillance for psychological consequences • Treatment for acute and long-term effects of the trauma

34. Protecting the Public’s Psychological Health • Human Services – reuniting families, child care, housing, job assistance • Risk Communication – dissemination of information • Training service providers to respond, protected against psychological trauma • Surge capacity • Identifying the underserved, marginalized persons needing psychological services

35. Traumatic Stress Traumatic stress may affect: • Cognitive functioning. • Physical health. • Interpersonal relations.

36. Mediating Factors • Prior experience with a similar event • The intensity of the disruption in the survivors’ lives • The emotional strength of the individual • The length of time that has elapsed between the event occurrence and the present

37. Physiologic Response • Stress Increases • Heart rate increases • Motor skill ability decreases • Perceptual narrowing occurs – tunnel-vision • Response programming is delayed until threat identified

38. Actions to Perform Under Stress • Take a deep breath • Look around during size up, view the BIG picture • Think before acting – develop a plan • Remember: • IT’S NOT MY EMERGENCY!

39. Phases of a Crisis • Impact: stunned, shock • Inventory: confusion, then assessment • Rescue: inclined to act, compliant • Recovery: relief, anger • Reconstruction: grief, long term resolution

40. Possible Psychological Symptoms • Acting differently than normal for this person • Performing activities that do not make sense for the time • Irritability, anger • Self-blame, blaming others • Isolation, withdrawal • Fear of recurrence • Feeling stunned, numb, or overwhelmed • Feeling helpless • Mood swings • Sadness, depression, grief • Denial • Concentration, memory problems • Relationship conflicts/marital discord

41. Possible Physiological Symptoms • Loss of appetite • Headaches, chest pain • Diarrhea, stomach pain, nausea • Hyperactivity • Increase in alcohol or drug consumption • Nightmares • Inability to sleep • Fatigue, low energy

42. Team Well-Being Team leaders should: • Provide pre-disaster stress management training. • Brief personnel before response. • Emphasize teamwork. • Encourage breaks. • Provide for proper nutrition. • Rotate personnel. • Phase out workers gradually. • Conduct a debrief discussion. • Arrange for a post-event debriefing later.

43. Critical Incident Stress Debriefing Six phases: • Introduction and a description • Review of the factual material • Sharing of initial thoughts/feelings • Sharing of emotional reactions to the incident • Instruction about normal stress reactions • Review of the symptoms • Closing and further needs assessment

44. Risk Communications - EPA • Accept & involve the public as a legitimate partner • Listen to the audience • Be honest, frank and open • Coordinate and collaborate with other credible sources • Meet the needs of the media • Speak clearly and with compassion • Plan carefully and evaluate performance

45. Avoid Saying . . . • “I understand” • “Don’t feel bad” • “You’re strong/You’ll get through this” • “Don’t cry” • “It’s God’s will” • “It could be worse” or “At least you still have…” • “I’m sorry for what’s happened to you”