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Psychological First Aid

Pakistan

ICITAP

Learning Objectives

Recognize the impact and importance of Psychological First Aid

Offer practical assistance to help deal with the emotional impact of a traumatic event

Recognize common stress responses in children/adults

Recognize the signs and symptoms of personal stress and learn strategies to decrease it in yourself and others

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What is Stress?

Stress: A very general term referring to the effect of anything in life to which people must adjust

For instance, anything we consider challenging causes stress, even if it is something we willingly choose to do

The key is that stress requires us to change our attention and behavior and makes demands upon our energy

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Psychological First Aid

Staying Healthy Before, During and After The Traumatic Event:

Cover Seek shelter and find a secure location. Look out for your friends and colleagues. Stay and feel safe.

Calm Relax. Take time to rest and get plenty of sleep. Eat, shower and maintain cleanliness. Exercise. Do daily activities and routines.

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Staying Healthy Before, During and After The Traumatic Event: (continued)

Connect Talk with others! Speak about what happened and share your experiences. Meet with friends and socialize.

Capacity Cope in good and positive ways

Confidence Be optimistic, positive and hopeful!

Expect to be okay. Feel assured and certain of oneself.

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Psychological First Aid

Uses skills that you already possess…

Reduces fear-driven behavior

Reduce exposure, illness, injury

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Individual Level:What are we trying to do?

Get people to do what is in their best interest

AND

Stop people from doing what is not in their best interest

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What are we trying to do?

Provide care for disaster survivors

Maintain care for current patients

Safeguard colleagues

Support other first responders

Lead effectively in crisis

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Psychological First Aid Basics

Encourage patient survival

Measure patient’s awareness and competence

Recognize patient’s strengths

Promote mental recovery

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Psychosocial Consequences of Disasters

Fear and Distress Response

Impact of Disaster Event

BehaviorChangePsychiatric

Illness

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An Event is More Stressful or Traumatic When…… Event is unexpected

Many people die, especially children

Event lasts a long time

The cause is unknown

The event is poignant or meaningful

Event impacts a large area 11

What assists our Emotional Adjustment?

Acceptance of the disaster and losses

Identification, labeling, and expression of emotions

Regaining a sense of mastery and control

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Common Physical Reactions in Adults

Sleep difficulties/headaches

Gastrointestinal problems (Diarrhea, cramps)

Stomach upset, nausea Elevated heart rate Elevated blood pressure Elevated blood sugar With extended stress, a

weakened immune system13

Common Physical Reactions in Children and Youths

HeadachesStomachachesNauseaEating problemsSpeech

difficultiesSkin eruptions

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Common Emotional Reactions in Adults

Fear and Anxiety Sadness and Depression Anger and Irritability Numb, withdrawn, or disconnected Feeling a lack of involvement

or enjoyment in favorite activities Feeling a sense of emptiness or

hopelessness about the future

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Common Emotional Reactions in Children/Youths

Anxiety & Vulnerability Fear of reoccurrence Fear of being left alone

Particularly if separated from family

Loss of “Sense of Safety” Depression Anger Guilt

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Common Behavioral Reactions in Adults

Family difficulties (physical, emotional abuse) Substance abuse Being overprotective of

family Keeping excessively busy Isolating oneself from others Being very alert at times,

startling easily Avoiding places, activities, or

people that bring back memories

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Common Behavioral Reactions in Children/Youths

“Childish” or regressive behaviorMay not be deliberate

acting out Bedtime problems

Sleep onset insomniaMid-night awakeningFear of darkFear of event reoccurrence

during night18

Common Psychological Reactions in Adults

Difficulty concentrating Difficulty with memory Intrusive Memories Recurring dreams or nightmares Flashbacks Difficulty communicating Difficulty following complicated

instructions

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Common Psychological Reactions in Children/Youths

Confusion, memory loss, and disorientation

Difficulty in concentratingMay appear as behavioral

problems in classroom School may be where child

functions bestContinuing Structure,

sense of controlSocial group

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Common Faith & Spirituality Reactions in Adults & Children

Reliance upon faith Questioning values and

beliefs Loss of meaning Directing anger toward a

higher being Cynicism

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Common Sensory Reactionsin Adults/Children in Trauma

SightSoundSmellTasteTouch

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SAFETYSAFETY FUNCTIONFUNCTION ACTIONACTION

Goals

RestoringRestoringphysical safetyphysical safetyand diminishingand diminishingthe physiologicalthe physiological

stressstressresponse.response.

FacilitatingFacilitatingpsychologicalpsychological

functionfunctionand perceivedand perceivedsense of safetysense of safety

and control.and control.

InitiatingInitiatingaction towardaction toward

disasterdisasterrecoveryrecovery

and return toand return tonormal activity.normal activity.

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SAFEGUARDSAFEGUARD

SAFETYSAFETY FUNCTIONFUNCTION ACTIONACTION

Strategies

SUSTAINSUSTAIN

COMFORTCOMFORT

CONNECTCONNECT

EDUCATEEDUCATE

EMPOWEREMPOWER

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Remove from harm’s way.Remove from the scene.Provide safety and security.Provide shelter.Reduce stressors.

SafetySecurityShelter

What Survivors Need:What Survivors Need:

What To Do:What To Do:

Safety

SAFEGUARDSAFEGUARD

SAFETYSAFETY

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Psychological Exposure Risk Zones

ON SITE (eye witness)

DIRECT EXPOSURE (eye witness)

OUT OF VICINITY

IN NEIGHBORHOOD

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Provide food, water, ice.Provide food, water, ice.Provide medical care, alleviate pain.Provide medical care, alleviate pain.Provide clothing.Provide clothing.Provide power, light, heat, air conditioning.Provide power, light, heat, air conditioning.Provide sanitation.Provide sanitation.

Basic survival needsBasic survival needs

What Survivors Need:What Survivors Need:

What To Do:What To Do:

SAFETYSAFETY

Safety

SUSTAINSUSTAIN

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Sarin Attack on Tokyo Subways

Examined & discharged

4023

Killed 12

Severely injured 62

Hospitalized 984

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For every person who is physically injured or directly impacted by a disaster, there are 4 - 10 secondary victims who experience a significant impact on their behavioral health

Remember……………..

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Establish compassionate “presence.”Establish compassionate “presence.”Listen actively.Listen actively.Comfort, console, soothe, and reassure.Comfort, console, soothe, and reassure.Apply stress management techniques.Apply stress management techniques.Reassure survivors that their reactions areReassure survivors that their reactions are““normal” and expectablenormal” and expectable

Soothing human contactSoothing human contactValidation that reactions are “normal”.Validation that reactions are “normal”.

What Survivors Need:What Survivors Need:

What To Do:What To Do:

Function

FUNCTIONFUNCTION

COMFORTCOMFORT

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Trust Determination Factors In High Concern Situations

Listening/Caring/Empathy

50%

Listening/Caring/Empathy

50%

Competence/Expertise 15-

20%

Competence/Expertise 15-

20% Honesty/

Openness 15-20%

Honesty/ Openness 15-20%

Dedication/Commitment

15-20%

Dedication/Commitment

15-20%

Assessed First 30 Seconds

Listening/Caring/Empathy

50%

Dedication/Commitment15-20%

Competence/Expertise 15-20%

Honesty/ Openness 15-20%

Assessed First 30 Seconds

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Active Listening

Make it clear that you are listening

Body Language Eye contact Distance Body orientation Facial Expression Physical Tension

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Ways of Responding

Ask mostly open-ended questions

- Closed: “Are you feeling better?”

- Open-ended: “How are you feeling?” Paraphrase & Reflect Feelings

- Assist with formal problem solving

- “Lets look at all your options” Remember your role as supportive

helper

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Information on Coping

Provide the individual with information that may help them cope with the event and its aftermath, including information about:

Common psychological reactions to traumatic experiences and losses

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Agitation Sometimes, despite our best

attempts at active listening, people still become agitated

Refusal to follow directions Loss of control, becoming verbally

agitated Becoming threatening It is usually not personal This is their reaction to an

UNCOMMON situation, and

it has nothing to do with you

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Alarm Bells/When to Refer

Harm to self Saying they want to: “End it all” “Go to sleep and never wake up again”

Excessive use of substances Driving under influence In some cases working under influence

Harm to others Child abuse Spouse abuse

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Alarm Bells/When to Refer

Loss of control Significant withdrawal (as

change in behavior) Behavior is unusually (for that

individual) confused or bizarre Unable to care for self (cannot

eat, bathe etc. - Vulnerable)

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Practical Assistance

Offer practical assistance and information to address patient’s immediate needs and concerns

Identify the most immediate needs Clarify the needs Discuss an action response Act to address the needs

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It is Not OK to suggest that…

You should work toward getting over this Let’s talk about something else You are strong enough to deal with this I know how you feel You’ll feel better soon You did everything you could You need to relax It’s good that you are alive

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Promote Resilience

Everyone who experiences a disaster is touched by it

We have the ability to “bounce back” after a disaster to a “New Normal”

Resilience can be fostered

One goal of Psychological First Aid: support resilience in ourselves and others 42

Compassion Fatigue

There is a cost to caring. We professionals who are paid to listen to the stories of fear, pain, and suffering of others may feel, ourselves, similar fear, pain and suffering because we care.

Compassion fatigue is the emotional residue of exposure to working with the suffering, particularly those suffering from the consequences of traumatic events.

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Developing Disaster ResiliencePersonal & Family Preparation

Recognize pre-existing stress Develop healthy coping skills Participate in preparedness

exercises & drills Educate yourself on your

school, city, and county response plans and your response role in a crisis situation

Make pre-emergency individual and family response plans 44

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Questions?