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Dr. Leo G.

Labrador

TRAINING ON THE PSYCHOSOCIAL SUPPORT PROCESSING IN EMERGENCY SETTINGS Grand Royal Hotel, Davao City November 23-25, 2011

Nobody

is exempted from stress.

Stress can be positive or negative.

Individual

who are exposed to stressful situations may manifest various responses either physical, emotional, cognitive, behavioral and spiritual, and there is nothing wrong about.

An

emotional, mental or physical response to events that causes bodily or mental tension.
Any

outside force or event that has an effect on our body or mind.

A physical

or psychological stimulus that can produce mental tension or physiological reactions that may lead to illness.
The

demands exceed the personal and social resources the individual is able to mobilize. R.S. Lazarus

Stress

is not necessarily something bad it all depends on how you take it. The stress of exhilarating, creative successful work is beneficial, while that of failure, humiliation or infection is detrimental."
Hans Selye, 1956

Eustress-

positive stress arousal;

motivates
Distress-

negative stress arousal; leads to dysfunction an event, objects, person, stimulus that causes a person to experience stress
Stressor

Physical
Mental

symptoms

symptoms symptoms

Behavioural Emotional

symptoms

Sleep

pattern changes Fatigue Digestion changes Loss of sexual drive Headaches Aches and pains Infections Indigestion

Dizziness

Fainting
Sweating

& trembling Tingling hands & feet Breathlessness Palpitations Missed heartbeats

Lack

of concentration Memory lapses Difficulty in making decisions Confusion Disorientation Panic attacks

Appetite changes - too much or too little Eating disorders - anorexia, bulimia Increased intake of alcohol & other drugs Increased smoking Restlessness Fidgeting Nail biting Hypochondria

Bouts

of depression Impatience Fits of rage Tearfulness Deterioration of personal hygiene and appearance

Stress is not the same as ill-health, but has been related to such illnesses as;
Cardiovascular disease Immune system disease

Asthma Diabetes

Digestive

disorders

Ulcers Skin complaints - psoriasis Headaches and migraines Pre-menstrual syndrome Depression

is

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

It

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

is an overwhelming event that is outside the range of human experience


The

experience causes that person to feel intense fear, horror or a sense of helplessness.

Getting

wounded Being threatened with death Being subjected to gross human rights violations Significant loss ( of people or property) Confrontation with actual fighting

Torture Sexual violence Killing ( strangers or loved ones) Dead bodies, mutilations, severely Stories of traumatic experiences

wounded

THE IMPACT OF TRAUMA

Support

EVENT

IMPACT

Coping skills

Personality

COMPONENTS OF A TRAUMATIC MEMORY

Triggers

Images Sounds Smells

Emotions ...happy ...sad ...scared ...angry

TRAUMA

...ashamed

Physical Sensations

Negative Beliefs Or Thoughts About Self

PSYCHOLOGICAL EFFECTS OF TRAUMA

Anxiety

PSYCHOLOGICAL EFFECTS OF TRAUMA

Depression

PSYCHOLOGICAL EFFECTS OF TRAUMA

Psychosomatic Reactions

PSYCHOLOGICAL EFFECTS OF TRAUMA

Post Traumatic Stress Disorder

CONSEQUENCES of Trauma
Most reactions last only a few days but

they can also last for weeks or even months and years (to as long as 30 years).

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

Defusing Psychological

First Aid

Debriefing

means

to render something harmless before it can do damage.


The

over-all objective is to render the situation harmless to those who were exposed to it.

A rapid

reduction in the intense reactions to a traumatic event


A normalizing

of the experience so that people can return to their routine duties as quickly as possible
An

assessment of the personnel to determine if a full debriefing is necessary.

A re-establishment of the social network of the group so that people do not isolate themselves from each other, but instead see that their reactions are similar to one another. In recognizing similarities to others, people are often more willing to help each other in troubled times.

A carefully applied and well-managed defusing will usually:

Eliminate the need to do a debriefing OR It will enhance a debriefing if the debriefing is still necessary

Note: The elimination of the need to provide a CISD is a byproduct of a defusing, not a goal. It may happen naturally but one is not working to achieve that effect.

Target Groups Defusing is aimed at the core working group that was most seriously affected by the event

Time Commitment Defusing usually takes between twenty minutes and one hour to complete. Sometimes they go on for slightly more than an hour. If they continue much longer than an hour, it is a signal that either the group is highly traumatized or the defusing team leadership is not in control of the defusing.

Designed

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

rationale for such a tight time frame in providing a defusing has to do with the process of traumatization following traumatic events. During the incident, those exposed to it are in state of shock.

Traumatized

people, within a few hours of traumatic event, shut off most outside influences without distinguishing, between friend or enemy. All influences are interpreted as dangerous until they can stabilize themselves.
It

is during the early hours after the trauma, when people are more open to help and before they have begun their shut down that the defusing is most helpful.

The

defusing is held in a neutral environment, free of distractions. A defusing is never held at the scene of an incident. The room should be adequate to accommodate the small group, it should be comfortable and welllit. The seats should be as comfortable as possible and arranged in a circle. As long as the requirements of quiet and privacy are fulfilled, there are very few places in which a defusing could not be held.

Since

notice for the defusing is short, it is rare that a defusing team will have very much time to prepare for the defusing.
A brief

description of the incident is often all the defusing team has to go on.

A technique

and an intervention intended to help a person or a group of persons deal with the physical or psychological condition resulted from exposure to traumatic events and emergency situations.
Can

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

Should

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

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

Debriefing

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

themselves need debriefing.

STAGES / PROCEDURES OF DEBRIEFING

7 STAGES of DEBRIEFING

STAGES

Stage / Phase 1

OBJECTIVES / PROCEDURES

Introduce intervention;

INTRO PHASE

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

STAGES

Stage / Phase 2

FACT

CISD STAGES

Stage / Phase 3

OBJECTIVES / PROCEDURES

FEELING & THOUGHT PHASE

Anu- ano ang mga

naramdaman

mo? Ang mga naisipan mo?

Focus is on the feeling or emotion level (What or how did you feel at that time?) they may hold negative thoughts Facilitate expressions of intense emotionality; watch for abreactions letgoofit,dont suppress Leads - How did you feel at that time of the event? Did you ever think you were going to die?, etc.

STAGES

Stage / Phase 4

OBJECTIVES / PROCEDURES

STRESS REACTION / RESPONSE PHASE

Anu-ano ang mga napansin mo sa sarili pagkatapos ng pangyayari? (kilos, isip, katawan, pakiramdam)

Intense emotions can have various consequences Facilitate sharing of stress responses and reactions It is impt for them to discover that these experiences are also common in others Leads What did you notice in your body after the incident?; Did you notice any change in your behavior? etc; How are you diff prior to the incident? Change in your functioning?

STAGES

STAGE / PHASE 5

OBJECTIVES / PROCEDURES

COPING/ TEACHING PHASE

Make them understand that their stress reactions are normal responses to an abnormal event Understanding these will help them gain control of their unpleasant symptoms; not the other way around.

Papano mo nalampasan ang crisis na yon?

Very important they should gain insights from each other, how others cope effectively; learn from eachothersstylesofcoping.Tryto model from them.. if it works.

STAGES

STAGE / PHASE 6

OBJECTIVES / PROCEDURES

LEARNING PHASE (Lessons Learned)

Allow participants to share what they learned from the experience Not all crises are bad and
destructive some can bring tremendous lessons; they can make us more prepared, better persons in facing future crisis or similar experience These positive lessons learned can help in the healing and recovery

Anu- ano ang mga natutunan mo sa pangyayari/ krisis?

STAGES

STAGE / PHASE 7

OBJECTIVES / PROCEDURES

CLOSURE /

SUPPORT PHASE RE-ENTRY

Pagtatapos ng

sesyon Mga plano sa hinaharap Pananaw sa kinabukasan


Mga dapat gawin

This is not therapy or counseling; yet, it is imperative to make a sense of closure Assist participants in identifying or recognizing strategies and mechanics in order to support each other; what can they do to help each other. Identify from them / share with them available resources that may be needed even long after the session. Suggest, if any, possible institutions or agencies they can tap when further individual sessions would be needed.

Can

be done in several ways:

Ask

them to say a short message of support / comfort addressed to the group A prayer may do Meditation / relaxation exercise A song; memorial service, as appropriate

Arrange

sitting in circle.

Voluntary
Exhaust

Participation.

during sharing (ask Did you miss anything that you would want to add?).
Go

and debrief as a team, at least two debriefers/facilitators.


Always

include a mental health worker who is capable of identifying individuals who may need or

Strictly No No Not No

Confidential

Breaks Rank/Grade: Everyone is Equal Operational Investigation or Critique Notes Specific, Situational

Incident

Psychological First Aid

is designed to reduce the initial distress caused by traumatic events and to foster short- and long-term adaptive functioning and coping.

does not assume that all survivors will develop severe mental health problems or long-term difficulties in recovery. Instead, it is based on an understanding that disaster survivors and others affected by such events will experience a broad range of early reactions (for example, physical, psychological, behavioral, spiritual).

The three goals of providing psychological support include:


1.

Relieve suffering, both emotional and physical

1.

Improve peoples short term functioning


In

the immediate aftermath of a crisis, people may have reactions or make decisions with serious longterm implications. Helping people to function well in the short term can prevent future problems. psychological support may help to reduce or relieve stress, thus decreasing the chance of people developing long-term stress reactions, such as anxiety or depression.

1.

Accelerate the individuals course of recovery


Early

What are the Basic Components of Psychological First Aid?

Meeting basic physical needs, such as

Meeting psychological needs, such as

consolation, provision

physical

protection, establishing a sense of security, provision of physical necessities.

of emotional

support, provision of behavioral support, allowing emotional ventilation, fostering constructive behavior.

What are the Basic Components of Psychological First Aid?

Fostering social support, such as

Fostering ongoing care, such as

reuniting

victims with friends or family, utilization of acute social and community support networks.

triage

and referral for those in acute need, referral to subacute and ongoing support networks.

Basic Principles of Psychological Support

Do no harm Uses a Communitybased approach Recognizes and uses indigenous healing networks and practices Uses trained personnel Empowers affected people

Encourages Community participation Exercises Care with terminology Encourages Active involvement Values Early intervention Uses Viable interventions

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