Lamorinda Community Emergency Response Team

1. LamorindaCommunity Emergency Response Team Unit 7: Disaster Psychology Released: 1 January 2017 Lamorinda CERT

2. Community Emergency Response Team Personal safety is ALWAYS the number one priority Work as a team Wear personal protective equipment…gloves, helmet, goggles, N95 mask and boots The CERT goal is to do the Greatest Good for the Greatest Number Hope for the best but plan for the worst Lamorinda CERT Visual 7.1

3. Unit Objectives Describe the disaster and post-disaster emotional environment for victims and rescuers Describe the steps that rescuers can take to relieve their own stress and that of disaster survivors Lamorinda CERT Visual 7.2

4. Vicarious Trauma The process of changes in the rescuer resulting from empathic engagement with survivors Lamorinda CERT Visual 7.3

5. Taking Care of Your Team Lamorinda CERT Visual 7.4

6. CERT team leaders or available professionals should: • Provide pre-disaster stress management training • Brief personnel before response • Emphasize teamwork • Encourage breaks • Provide for proper nutrition • Rotate team members • Phase out workers gradually • Conduct a brief discussion Team Well Being Lamorinda CERT Visual 7.5

7. While this technique is still widely used, research has revealed that psychological debriefing does not help trauma survivors, and it may even hurt them. Critical Incident Stress Debriefing Lamorinda CERT Visual 7.6

8. Due to drastic incidence of PTSD, the VA & DoD: • Invested in significant scientific research • Two therapies have evidence-based success: • Cognitive Processing Therapy—similar to CBT • Prolonged Exposure Therapy—from success with rape survivors • While these therapies are directed at PTSD they can be ultimately made available to professionals surviving more serious traumas • PTSD is a disorder of “stuckness” What Does Work Lamorinda CERT Visual 7.7

9. Taking Care of Yourself Lamorinda CERT Visual 7.8

10. Be aware that disaster-worker trauma/stress can follow disaster work • Explain to family member and friends how they can support you • Listen to you when you need to talk • Understand that you may not want to talk • Accept help from others Taking Care of Yourself Lamorinda CERT Visual 7.9

11. Get enough sleep • Exercise • Eat a balanced diet • Balance work, play, and rest • Allow yourself to receive as well as give • Remember that your identity is broader than that of a helper • Connect with others • Use spiritual resources Reducing Stress Lamorinda CERT Visual 7.10

12. You can experience trauma through • Your own personal losses • Working in your neighborhood • Assisting neighbors, friends, co-workers who have also been injured • Not feeling safe and secure Rescuer Psychological Trauma Lamorinda CERT Visual 7.11

13. Disturbing Legacy of Rescues: Suicide • Many cases of First Responder suicide have been attributed to vicarious trauma in the months and years following a variety of disasters. • Long after September 11th, First Responders including Firefighters, Law Enforcement, and EMTs are experiencing trauma. • In reality, YOU, as a volunteer first responder, can be subject to vicarious trauma as well. Lamorinda CERT Visual 7.12

14. Irritability, anger • Self-blame, blaming others • Isolation, withdrawal • Fear of recurrence • Feeling stunned, numb, or overwhelmed • Feeling helpless • Mood swings • Sadness, depression, grief • Denial Possible Psychological Symptoms Lamorinda CERT Visual 7.13

15. Younger people at greater risk than older people • Women greater risk than men • Volunteers have higher risk • Veterans of recent wars are more susceptible than Vietnam and Korea era vets • Those with previous psychological difficulties are more at risk • Lower social support increases risk Risk/Resiliency Markers Lamorinda CERT Visual 7.14

16. Loss of appetite • Headaches, chest pain • Diarrhea, stomach pain, nausea • Hyperactivity • Increase in alcohol or drug consumption • Nightmares • Chronic Insomnia: Inability to sleep • Fatigue, low energy Possible Physiological Symptoms Lamorinda CERT Visual 7.15

17. Post-traumatic Stress Lamorinda CERT Visual 7.16

18. Traumatic Stress Traumatic stress may affect: • Cognitive functioning – Thinking • Physical health – Behaving • Interpersonal reactions -- Feelings Lamorinda CERT Visual 7.17

19. An event in which people experience or witness: • Actual or potential death or injury to self or others • Serious injury • Actual or threatened sexual violence • Destruction of homes, neighborhood, or valued possessions • Loss of contact with family / close relationships Traumatic Stress Lamorinda CERT Visual 7.18

20. Impact • May show no emotion • Inventory • Assess damage • Locate other survivors • Rescue • Survivors tend to cooperate with rescuers • Recovery • Survivors may show hostility toward rescuers Phases of a Crisis Lamorinda CERT Visual 7.19

21. Mediating Factors • Prior experience with a similar event • Intensity of disruption • Individual feelings about event • Emotional strength of individual • Length of time since event Lamorinda CERT Visual 7.20

22. The Road to Recovery Those survivors who could find something good that came out of the experience soon after it happened – "I realized how much I loved my family“, for example, or "I decided that life was too short not to follow my dreams" – had made a better recovery at the time of the follow-up interview. Lamorinda CERT Visual 7.21

23. Taking Care of a Victim Lamorinda CERT Visual 7.22

24. Assess the survivors for injury and shock • Get uninjured people involved in helping • Provide support by: • Listening • Empathizing • Help survivors connect with natural support systems Stabilizing an Individual Lamorinda CERT Visual 7.23

25. Put yourself in the speaker’s shoes • Listen for meaning, not just words • Pay attention to nonverbal communication • Paraphrase the speaker in their own words to show that you heard him/her • Practice compassion How to Be an Empathetic Listener Lamorinda CERT Visual 7.24

26. 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 . . . • What you really must do… (Discounts person, not understood, more alone) Lamorinda CERT Visual 7.25

27. “These are normal reactions to a disaster.” • “It’s understandable you could feel this way.” • “As you connect with others who have been through this, you’ll find that they may have experienced the same things you are feeling.” • “You can’t change what happened but you can change what you do with this experience.” • “Things may never be the same, but you may find some things from this experience that can help you help others.” Can Say … Lamorinda CERT Visual 7.26

28. Move the body to temporary morgue • Cover the body; treat it with respect • Have one family member look at the body and decide if the rest of the family should see it • Allow family members to hold or spend time with the deceased • Let the family grieve Managing the Death Scene Lamorinda CERT Visual 7.27

29. Separate the family members from others into a quiet, private place • Have the person(s) sit down, if possible • Make eye contact and use a calm, kind voice • Use the following words to tell the family members about the death: “I’m sorry, but your family member has died. I am so sorry.” Informing Family of a Death Lamorinda CERT Visual 7.28

30. Taking care of your team • Taking care of yourself • Traumatic stress • Taking care of a survivor • What you can and cannot say • Managing the death scene Unit Summary Lamorinda CERT Visual 7.29

31. OIF - Operation Iraqi Freedom March 2003 - September 2011 • OND - Operation New Dawn troop withdrawal September 2011 - December 2011 • OEF - Operation Enduring Freedom - Afghanistan October 2001 - ongoing • PTSD - Post Traumatic Stress Disorder • CISD - Critical Incident Stress Debriefing • VA - Veteran's Administration • DoD - Department of Defense Glossary Lamorinda CERT Visual 7.30

32. CBT - Cognitive Behavioral Therapy • CBT addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures. CBT is thought to be effective for the treatment of a variety of conditions, including mood, anxiety, personality, eating, substance abuse, tic, and psychotic disorders • CPT - Cognitive Processing Therapy • The theory behind CPT conceptualizes PTSD as a disorder of "non-recovery" in which erroneous beliefs about the causes and consequences of traumatic events produce strong negative emotions and prevent accurate processing of the trauma memory and natural emotions emanating from the event. Glossary Lamorinda CERT Visual 7.31

33. PE - Prolonged Exposure Therapy • Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder, characterized by re-experiencing the traumatic event through remembering it and engaging with, rather than avoiding, reminders of the trauma (triggers). Sometimes, this technique is referred to as flooding (psychology). Glossary Lamorinda CERT Visual 7.32