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. Crisis • A crisis is a disturbance of an otherwise stable situation • A period • emotional turmoil • Difficult situations • Stuck • Can´t use your usual resources • Always temporary

6. 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

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

8. 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

9. 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.

10. 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.

11. Events that can cause trauma • Natural disasters • Earthquakes, Avalanches, Fires, Floods

12. Events that can cause trauma Accidents • Automobileaccidents • Suicide • Loss of physical ability or a body part • Causing a serious accident or serious damage

13. Events that can cause trauma Trauma caused by humans • War • Homicide • Terrorism • Sexualassault • Accidents involving pollution

14. Events that can cause trauma Highly stressful situations: • Domestic violence, • Bullying, • Sexual abuse, • Imprisonment, • Living in a refugee camp

15. 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.

16. 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

17. 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

18. 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.

19. 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

20. 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?”

21. What is stress? Stress is a normal response to a physical or emotional challenge and occurs when demands are out of balance with resources for coping.

22. What is stress? • Response and reaction of the central nervous system and of the body of an individual towards any kind of demands, comfortable or uncomfortable. • The individuals mechanism towards any type of strain/stress (defense, escape, paralysis, „fight, flight, freeze” ) • Involuntary response • Stress is a side effect from happy and/or serious events

23. The physiology of stress • The bodys response towards imminent crisis • Fight, flight, freeze • Increase in Adrenaline output • Heartbeat becomes more rapid • Blood flow towards the muscles increases • Broncho pulmonary expands and breathing becomes faster • Response from the digestive road • nausea, diarrhea • Involuntary response • Can be ineffective and inappropriate

24. Types of stress • Day-to-day 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.

25. Triggers of stress • Biological triggers of stress: • caffeine, amphetamines, nicotine • Psychosocial triggers of stress: • Experience of situations “It does not matter what happens to you but how you react to it that matters“ (Epictetus)

26. 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

27. Common stress reactions

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

30. 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.”

32. 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

33. 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

34. 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

35. 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)

36. 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

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

38. 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

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

40. 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.

41. 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

42. 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

43. 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

44. Reflection • “Are you saying that...?” • “When you said..., did you mean that...?” • “ do I understand you correctly when I think that you mean...?” • “I am not sure if I have understood you correctly” • “let‘s compare the things that we said” • “I am not sure if I have said it clearly enough” • It is good to follow a reflective comment with an open question

45. 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...”

46. 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”

47. 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

48. 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?”

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

50. 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