In Times of Crisis:
Supporting Others,
Supporting Ourselves
John Gaspari, LCSW
Executive Director
USC Center for Work and Family Life
Introductions
Importance of beginnings and
endings
Center for Work and Family Life
Available Services:
Faculty and Staff Counseling
Faculty, Management and Departmental
Consultation
Critical incident response
Work/Life Support
Family and Dependent Care: Consultation and
Resources
Workplace Health and Wellness Programs
Role Expectations
Are you clear about your the role
expectations you carry as a member of the
CERT?
Can you imagine having any unfulfilled
expectations or disappointments while
functioning in this role?
How might the many other roles you play
at any given time impact your role as a
CERT member?
Unit Objectives
1. Psychological impacts to expect after a
disaster – What happens for people?
2. How to work with the psychological
impacts in your role – Providing
psychological support.
3. Responder stress management and selfcare.
Are We
Psychologically Prepared?
For every physical
injury, there may be 5-6
psychological injuries
This may overwhelm
and impede our
emergency and/or
medical response.
Critical Incident
Exposure to a traumatic event in which
both of the following were present:
The person experiences, witnessed, or was
confronted with an event or events that
involved actual or threatened death or serious
injury, or a threat to the physical integrity of
self or others.
The person’s response involved intense fear,
helplessness or horror. (DSM-IV TR)
CRISIS
danger;
peril
opportunity;
crucial point
Coping Mechanisms
People typically rely on past strategies to
cope with new stressful situations
Past coping mechanisms can be
functional or dysfunctional.
Degree of hardiness (resilience) has been
identified as a characteristic that can
buffer extreme stress in older populations
Children can be vulnerable because they
have no experience or known patterns of
actions as a response to the experience.
Into every life
a little rain must fall …..
But what happens
when there is a
flood?
Psychosocial Impact –
Considerations
Prior experience with a similar
event
Prior trauma
The intensity of the disruption in the
survivors’ lives
The resilience of the individual
Psychosocial Impact –
Considerations
The length of time that has elapsed
between the event occurrence and
the present
•Children/families
Pre-existing vulnerabilities
Man-Caused vs.
Naturally Occurring
Events
•Seniors
•Disabled
•Bereaved
•Health impairments
•Women
Psychological Response to Trauma
Key Principles
Man-Caused vs. Natural
Events
Adult Coping & Adaptation
Consequences of Critical Incidents
Often include LOSS
Tangible Loss
Loss of loved ones
Loss of home
Loss of material goods
Loss of employment / income
Consequences of Critical Incidents
Often include LOSS
Intangible Loss
Loss of safety / security (real or perceived)
Loss of predictability
Loss of social cohesion/connection/support
Loss of dignity, trust and safety
Loss of positive self-image/self-esteem
Loss of trust in the future
Loss of hope
Loss of CONTROL
Activity – What if I lost…
You have been given three cards each of three
different colors:
Blue Card - write the name of a person close
to you on each card
White Card - write down one of your favorite
belongings
Pink Card - write down something you enjoy,
an activity, or hobby.
After you have written on each card, place
them face down on the table and shuffle
them around. Close your eyes and pick
three cards.
Activity – What if I lost…
These are the three things you will
have lost in a disaster.
Discuss with the group how you
feel about losing these things or
people
Possible Psychological Reactions
to a Large-Scale Emergency
Many people survive disasters
without developing any significant
psychological symptoms.
For other individuals, the reactions
will disappear over time.
“Just because you have experienced a
disaster does not mean you will be damaged
by it, but you will be changed by it.”
(Weaver 1995)
Grief and Loss
Not an even process
Takes time
Can become stuck in the process
May spawn other problems
Nothing like T & T (Time and Talking)
Supporting
Others
“We’re a community that
believes in
‘love thy neighbor’,
but right now we need to love
our neighbors a little bit more.”
Man talking after devastating
tornados ripped through his
Tennessee neighborhood - 2/08
Role of Disaster Mental Health?
Primarily directed toward “normal” people
who are responding normally to an abnormal
situation
Improve resistance, resilience and recovery.
Identifying those at risk for severe social or
psychological impairment
Identify those in need of additional or special
services.
Role of Disaster Mental Health?
Mitigate post trauma sequelae
May prevent future problems
Helps people to handle problems in a way that
does not create MORE problems
Convey sense of compassion and support for
people.
Psychological Response to Trauma
Key Concepts
Experience has shown that:
No one who sees a disaster is untouched by it.
Most people pull together & function during and
after a disaster, but their effectiveness is
diminished.
Most people do not see themselves as needing
mental health services following a disaster and
will not seek such services.
Psychological Response to Trauma
Key Concepts
Experience has shown that:
Survivors respond to active, genuine interest &
concern.
Survivors may reject disaster assistance of all
types.
Disaster mental health assistance is often more
practical than psychological in nature.
Social support systems are crucial to recovery.
Psychological Response to Trauma
Key Concepts
While there may be specific disaster-related
stressors, underlying concerns and needs are
consistent across a range of traumatic events.
These include:
A concern for basic survival
Grief and loss over loved ones & loss of valued and
meaningful possessions
Fear & anxiety about personal safety & the physical
safety of loved ones
A need to talk about events & feelings associated with
the disaster, often repeatedly
A need to feel one is a part of the community & its
recovery efforts
Phases of Disaster
Honeymoon
(community cohesion)
llllllllllll
Reconstruction
Heroic
Pre-Disaster
(a new beginning)
Disillusionment
Threat
Warning
EVENT
Inventory
Trigger Events and
Anniversary Reactions
Time
1 to 3 days
1 to 3 years
Phases of Disaster
• Heroic Phase
• Honeymoon Phase
• Disillusionment Phase
– May last from two months to several years.
– Strong feelings of anger and resentment can
be directed at volunteers and other public
officials.
• Reconstruction Phase
Honeymoon
(community cohesion)
Survivors may be elated
Happy just to be alive
This phase will not last
Disillusionment
Reality of disaster
“hits home”
Loss and Grief
becomes prominent
Psychological Support
Your actions and interactions with
affected people can
help provide critical support to people in
distress.
relieve suffering, both emotional and
physical
Improve people’s short term
functioning
Accelerate the individual’s course of
recovery
Brainstorming
What main attributes and skills should a
volunteer have when offering
psychological support?
Spend 5 minutes brainstorming and
writing down those characteristics which
are likely to be required.
Essential Attributes and Skills
Good Listening skills
Patient
Caring attitude
Trustworthy
Approachable
Culturally competent
Empathetic
Essential Attributes and Skills
Non-judgmental approach
Kind
Committed
Flexible
Able to tolerate chaos
Supportive Communication
Supportive communication
conveys:
Empathy
Concern
Respect
Confidence
Activity –
Supportive Statements
As a group, generate a list of
supportive statements that you would
find helpful if you were in pain,
injured, and/or acute emotional
distress.
Activity –
Unhelpful Statements
As a group, generate a list of
statements that you would find
unhelpful if you were in pain, injured,
and/or acute emotional distress.
Guiding Principles in Providing
Psychological Support in Your Role
Protect from danger
Be direct and active
Provide accurate information about what
you’re going to do
Reassure
Do not give false assurances
Recognize the importance of taking action
Provide and ensure emotional support
Crisis Intervention
Observe safe practices by showing
concern for your own safety
Remain calm and appear relaxed,
confident and non-threatening
You must look and act calm even if you are
not
Goals of Psychological First Aid
Psychological first aid (PFA) promotes and
sustains an environment of:
SAFETY
CALM
CONNECTEDNESS
SELF-EFFICACY
HOPE
Psychological First Aid
Promote SAFETY:
Help people meet basic needs for food
and shelter, & obtain medical attention.
Provide repeated, simple and accurate
information on how to get these basic
needs met.
Psychological First Aid
Promote CALM:
Listen to people who wish to share their
stories and emotions, & remember that
there is no right or wrong way to feel.
Be friendly & compassionate even if
people are being difficult.
Offer accurate information about the
disaster or trauma, and the relief efforts
underway to help victims understand the
situation.
Psychological First Aid
Promote CONNECTEDNESS:
Help people contact friends and loved
ones.
Keep families together. Keep children
with parents or other close relatives
whenever possible.
Psychological First Aid
Promote SELF-EFFICACY:
Give practical suggestions that steer
people toward helping themselves.
Engage people in meeting their own
needs.
Psychological First Aid
Promote HELP:
Find out the types and locations of
government & non-government services
and direct people to those services that
are available.
When they express fear or worry,
remind people (if you know) that more
help and services are on the way.
Do Say…
 Can you tell me what happened?
 I’m Sorry
 This must be difficult for you
 I’m here to be with you
Psychological First Aid
DON’T:
Force people to share their stories with
you, especially very personal details
(this may decrease calmness in people
who are not ready to share their
experiences).
Give simple reassurances like
“everything will be ok”, or “at least you
survived” (statements like these tend to
diminish calmness).
Psychological First Aid
DON’T:
Tell people what you think they should
be feeling, thinking or doing now or how
they should have acted earlier (this
decreases self-efficacy).
Tell people why you think they have
suffered by giving reasons about their
personal behaviors or beliefs (this also
decreases self-efficacy).
Psychological First Aid
DON’T:
Make promises that may not be kept
(un-kept promises decrease hope).
Criticize existing services or relief
activities in front of people in need of
these services (this may decrease
hopefulness or decrease calming).
 Source: Center for the Study of Traumatic Stress
Avoid Saying . . .
“I understand what it’s like for you.”
“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 . . .”
Intense Emotions
Are often appropriate
reactions following a disaster
Can often be managed by
community responders
Anxiety
A state of intense apprehension,
uncertainty and fear
Results from anticipating a
threatening event
Intense anxiety = “fight or flight”
Agitation
Sometimes, despite our best
attempts at active listening, people
become agitated
It is usually not personal
This is their reaction to an
extremely abnormal situation, and
it has nothing to do with you
The Energy Curve
Agitation
Anxiety
Tension Reduction
Baseline
Elements of Escalation
Challenging authority or questioning
Refusal to follow directions
Loss of control, becoming verbally
agitated
Becoming threatening
Elements of Escalation
Challenging Authority or Questioning
Answer the question
Repeat your request in a neutral tone of
voice
Remember that an ounce of prevention
is worth a pound of cure
Elements of Escalation
Not Following Directions
Do not take control, help the individual gain
control of him/herself
Remain professional
Consider restructuring your request
Give the person time to think about your
request
Seek Assistance
Loss of Control, Becoming Verbally
Threatening
Verbal Vomit
If the person becomes threatening or
intimidating and does not respond to
your attempts to calm them, seek
immediate assistance
Elements of De-escalation
 Establish a relationship
 Introduce yourself if they do not know you
 Ask the person what they would like to be
called
 Don't shorten their name or use their first
name without their permission
 With some cultures, it is important to always
address them as "Mr." or "Mrs.", especially if
they are older than you
Elements of De-escalation
Use concrete questions to help the
person focus
Use closed ended questions (yes/no)
If the person is not too agitated, briefly
explain why you are asking the question
• For example:
I'd like to get some basic information from you
so that I can help you better. Where do you
hurt?
Elements of De-escalation
Come to an agreement on
something
Establishing a point of agreement will help
solidify your relationship and help gain their
trust
Positive language has more influence than
negative language
Active listening will assist you in finding a
point of agreement
Elements of De-escalation
Speak to the person with respect
This is communicated with:
Words
Para-verbal Communication (how we
say the words – e.g. tone, pitch)
Non-verbal behavior
Use of words like please and thank
you
Elements of De-escalation
 Don't make global statements about
the person's character
 Use “I” statements
 Lavish praise / support /
encouragement is not believable
Activity – De-escalation
May I have two volunteers?
Activity –
Observation of De-escalation
One of the volunteers will play an agitated
individual and the other will play a
community responder.
Observe closely to see what de-escalation
skills the community responder is using to
help calm the agitated individual.
What did you observe?
Responder Stress and
Well-Being:
Helping the Helpers
Adrenaline, Friend or Foe?
Increase in speed and strength
Tunnel vision – eyes revert to default survival
position.
Reduced Near, peripheral, depth
Hearing muted
Changes in reaction time
Freezing and unable to react
Overreacting
Increase in sensory acuity
Slow motion time
May act in a way that seems inappropriate for
the situation (e.g. giggle, yell)
Psychological Response to Trauma
Survivors’ Needs and Reactions
People often experience strong and
unpleasant emotional and physical
responses following exposure to traumatic
events (e.g. disasters).
These may include a combination of:
•Fear & anxiety
•Grief & loss
•Shock
•Hopelessness
•Loss of Confidence
•Mistrust
•Sleep disturbances
•Physical pain
•Confusion
•Shame
•Shaken faith
•Aggressiveness
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
Possible Emotional/Psychological
Symptoms
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, confusion
Relationship conflicts/marital discord
More Typical Reactions…
Fear of darkness
Fear of being alone or of crowds or strangers
Sensitivity to loud noises
Somatic complaints
Guilt, anger, grief
Reliving past traumas
Main point – Disaster stress is a
normal response to an abnormal
circumstance. If symptoms persist,
they must be treated.
C. Fasser, 2004; B. Young, 2006
Possible Psychological Reactions
to a Large-Scale Emergency
For most people, things get
better with time…
Possible Psychological Reactions
to a Large-Scale Emergency
For some, however, the reactions may
evolve and even worsen.
*Victims of Hurricane
Katrina: Significant increase in
serious mental health problems
two years post Katrina (PTSD,
suicidality, depression, anxiety,
substance abuse, domestic
violence) across all racial and
socio-economic groups.
Helpers
Responders are, by definition, exposed to
a critical incident
They may experience critical incident
stress because of the work they do
Often have a feeling of not having done
enough
Are sometimes overwhelmed by the needs
of the community
Need to cope with their own fears
Challenge to Helpers
Being part of the collective crisis
Repeated exposure to grim experiences
Carrying out physically difficult, exhausting
or dangerous tasks
Lacking sleep and feeling fatigued
Facing the perceived inability to ever do
enough
Challenge to Helpers (cont.)
Feeling guilt over access to food, shelter,
etc.
Facing moral and ethical dilemmas
Being exposed to anger and lack of
gratitude
Being detached from personal support
systems
Feeling frustrated by policies and
decisions by supervisors
Categories of Reactions
After the Incident
•ASD / PTSD
•Grief
•Depression
•Resilience
Mental Health
and Illness
Distress
Responses
•Fear / worry
•Sleep disturbance
•Altered productivity
•Avoidance (emotional)
•Substance abuse
•Risk taking
•Over Dedication
Human
Behavior in
High Stress
Environments
Loss and Grief – Signs of Trouble
Avoiding or minimizing emotions
Using alcohol or drugs to self-medicate
Using work or other distractions to avoid
feelings
Hostility and aggression toward others
Stress
A state of physical and/or
psychological arousal
Often brought about by a perceived
threat or challenge
May be expressed differently by
different cultures
Coping with Stress
Coping is a way to prevent, delay, avoid,
or manage stress
Coping mechanism categories:
Changing the source of stress
Changing the view of the situation
Tolerating the stressor until it passes or
becomes less troublesome
Examples of Coping
Seeking help from others or offering to help
others
Using natural support systems
Talking about their experiences and trying to
make sense of what happened
Hiding until the danger has passed
Seeking information about the welfare of loved
ones
Gathering remaining belongings
Examples of Coping (cont.)
Beginning to repair the damage
Burying or cremating the dead
Following religious or cultural practices
Setting goals and making plans
Using defenses like denial
Remaining fearful and alert to further
danger
Thinking long and hard about the event
Activity – Decompression
Take a few moments to write down
five things that help you relieve stress
and feel calmer
Share these methods with the rest of
the group
Self-Help Techniques
Know the normal reactions to stressful events
Be aware of your tension and consciously try to
relax
Use the buddy system
Talk to someone you trust and with whom feel at
ease
Listen to what people close to you say and think
about the event
Reconcile expectations with results
Self-Help Techniques (cont.)
Work on routine tasks if it is too difficult to
concentrate on demanding duties
If you cannot sleep or feel too anxious,
discuss this with someone you can trust
Express your feelings in ways other than
talking:
Draw
Paint
Play music
Journal
Self-Help Techniques (cont.)
Do not self-medicate
Go easy on yourself
Avoid inflated or perfectionistic
expectations
Seek professional advice if reactions
continue
Cognitive/Behavioral Approaches
to Stress Reduction
Adequate Rest
Exercise / Movement
Diet / Balanced Nutrition
Enough H2O
Moderate Chemical Use
Laughter / Tears
Time Away From Work Role
Cognitive/Behavioral Approaches
to Stress Reduction
Religious / Spiritual
Relaxation Techniques / Breathing
Yoga
Meditation
Social Support / Discuss Feelings
Allow yourself to receive as well as
give
Cognitive/Behavioral Approaches
to Stress Reduction
Play: Hobbies / Personal Interests
Exposure to Nature
Biofeedback
Massage / Human Touch
Sex
Professional Assistance
Medication
What Else Works for You???
www.despair.com
Team Well-Being
CERT team leaders should:
Provide pre-disaster stress management training
Brief personnel before response
Emphasize teamwork
Encourage breaks
Provide for proper nutrition
Rotate
Phase out workers gradually
Conduct a brief discussion
Arrange for a intermittent and post-event
debriefing
No Macho (Wo)Man,
No Pity Party
Do not create an expectation
there will be a problem, but
when there is a problem,
go get help.
Lt. Col Dave Grossman (ret.)
Critical Incident Stress Debriefing
(CISD)
Debriefing / Defusing:
is a specific technique designed to assist
responders in dealing with the physical or
psychological symptoms that are generally
associated with trauma exposure.
allows those involved with the incident to
process the event and reflect on its impact.
allows for the ventilation of emotions and
thoughts associated with the crisis event.
provided as soon as possible but typically no
longer than the first 24 to 72 hours after the
initial impact of the critical event.
When you come to the edge
of all that you know,
You must believe in
one of two things;
There will be earth
on which to stand,
or You will be given wings.
Anonymous
Questions / Discussion