Psychological First Aid and Psychosocial Support Additional Materials
- Slides: 46
Psychological First Aid and Psychosocial Support Additional Materials Module for staff and volunteers 2 to 4 hrs
Traumatic event and stress reactions Definition Recognition Response
Reducing the gap Threat Gap Helplessness Lack of coping abilities
How to help • Reduce threat: collect examples • Enhance coping: collect examples
Stress vs. Loss Situations • Stress situations • Victims of violence • Witness of accident • … • Loss situations • Relative or friend of a person died or is severely injured /ill • …
Case examples Flooding in a village 1. 2. 3. Man and woman: lost two of their 3 children 7 and 12. Both bodies have been found immediately, the woman has major injuries and is in field hospital. She does not eat or drink, she is highly suicidal and wants to see her two dead children Two women: they have both lost their whole families (men and two children each). The bodies are not found until day four and five. The women do not want to sleep for fear their children or husbands could be found in the meantime. They have to go for identification several times during the week. Woman injured in hospital: her husband has not yet been found. She is waiting for news. He is found dead on day three. 6
Elements of the BASIS-Model B A S I S build a trustful relationship assess the affected person´s ability to act and decide and explore needs (re)structure the situation inform about everything that is needed strenghthen social networks 7
Case examples • (1) Relationship building via being present, husband giving tasks, wife passive, structure: trying to get bodies into hospital, information about next steps to be taken, finish: accompany home • (2) Relationship via being present, informing relatives at home, waiting for news and identifying bodies, giving information about next steps, finish: send home after identification accompanied by ps support from home country • (3) Relationship building via being present and giving information, talking important, information about finding dead body of husband, sending her home with relatives
Stress vs. Loss: Main focus Stress situations: Loss Situations: Acute needs Safety Information Sense of control Stress reduction Connectedness Hope Safety Information Sense of ontrol Stress reduction Connectedness Hope Focus: Person centred Relationship centred Safety, Normalising Stress reactions (Am I safe? Did I make a mistake? Why am I reacting like this? ) Understand how the death occurred and say first good bye to the deceased person (has he/she suffered? Why did he/she die? )
General Principles in dealing with acute • Go „with“ the symptom and not against it • Let people express their emotions („Contain“ emotions) • Respect Defense Mechanisms
Acute Stress Reactions • „Loud“ Reactions (e. g. crying, shouting, aggression, fear, …) • „Silent“ Reactions (e. g. not realizing what has happened, freezing, not being able to cry, numbing, …)
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What helps you to go back into your resilience zone? Collect examples from 3 different areas • Social contact (partner. . . ) • Routines (brushing teeth. . . ) • Rituals (taking a shower. . . ) • Actions (listening to music, breathing slowly. . . ) 13
„Loud“ Reactions • • Crying Fear Agitation Aggression
Crying • Crying may be tolerated by relatives and friends to a certain degree depending on the age and gender of the person as well as on their culture • If we see a person cry, we may feel the urge to comfort him or her; we also may feel overwhelmed by it and want to make her/him stop it or want to get out of the situation as soon as possible • Often relatives and friends go against the crying by telling the person to stop it or asking for medication-this might lead to an escalation
How to react • Stay calm • Let them cry • Respect privacy: do not touch without asking for permission • Respect cultural and gender specific ways of expression
Fear • Extreme fear may lead to various reactions that make it difficult to understand/make a diagnosis of the emotion and therefore may lead to mistakes in communication and interaction • Fear may lead to people running away or freezing but it can also make people act aggressively
How to react • Stay calm and reassure • Keep distance (here explain. WHY one keeps a distance? ) and do not frighten the person by shouting at them or acting in a nervous or agitated manner • Listen to what the person tells you-try to understand the cause of the persons´ fear even if it seems strange to you
Agitated/Aggressive behaviour • Sometimes persons become agitated in situations of extreme stress. • Sometimes people may become aggressive (shouting, throwing things, threatening others…)
How to react to aggression • • Keep distance but stay Walk with them if they are pacing Keep an eye on the person Talk slowly and not too loud Set clear limits and structures. If necessary protect yourselves Explore needs Give options for action 20
How to deal with Aggression – De-escalation • • • Your own protection and that of your team has the highest priority Keep a professional distance stay calm, do not take things personally, do not let yourself be provoked, do not involve yourself in a power struggle or discussion) Self control (body posture, breathing, eye contact, routine activities) Nonverbal Communication (no fast movements, no threatening facial expression or mimics. Gestures, keep eye contact but do not stare) Verbal Communication (calm voice, say name of the person, use a simple and understandable language, give clear information, no evaluations, no advice, open questions, , …. )
How to deal with Aggression – De-escalation • • • Understanding vs. Control of the Situation (take the person seriously, express understanding, active listening, talk about your own emotions, use I instead of you) Set clear limits (do not accept insults or menaces, stay on a factual level, do not threaten, do not reject the person, just her/his behaviour) If possible, open up space for compromise (do not force, make suggestions, do not make false promises, give information)
„Silent“ Reactions • Often we react only to the loud reactions but ignore the silent ones • What do we do when people freeze, are not able to express their emotions, feel numb or show disorganised behaviour?
Numbing • In situations of extreme stress, one of the first reactions may be an inability to fully realize what has happened. • This may lead to a feeling of emotional numbness as well as to other dissociative symptoms. • These symptoms help us to cope with extreme stress by protecting us from their immediate and full impact.
How to react • Do not interpret numbing as lack of emotion towards the deceased person • Be calm, patient and reassure • Talk slowly and repeat if necessary but do not confront neccessarily • Respect the reaction as a defence mechanism, be patient
Derealisation • Here the person feels cut off from „reality“ • Sometimes persons have the feeling that the situation happens „like in a film“, they experience the events as „strange and far away“ • The feeling that the events are not real but only a dream or a film also protects us from their full impact. We might have to explain the difference between depersonalistion and derealisation?
Depersonalisation • Here the person feels cut off from his/her own body and feelings • Victims of violence often tell us that they perceived themselves from the position of an outsider • When persons tell about their violence experience they therefore often seem to be talking about somebody else
How to react • If persons tell you they do not feel anything or the feel numb, or they feel like in a film or outside their bodies, just tell them that this is the way we protect ourselves from too much stress. • If the state persists, you may tell them to try to feel the grip of your hand or concentrate on some other body experience • You may also try to distract them from the stressful event by leaving the room or asking distracting questions
Freezing • Freezing is an extreme stress reaction experienced by trauma victims. • During the situation, the person is not able to act freely any more, he or she feels ‚frozen‘ and unable to move. • As this is an extreme form of helplessness, it may lead to serious problems afterwards.
How to react • • Reduce the stress immediately Leave the distressing place Talk about something less stressful Try and re-establish trust and security, but at the person‘s own rythym
Dissociative stupor Stupor is an extreme form of panic reaction, where a person is not able to communicate or act any more. He or she may act like a robot if told to do something, but is not able to do anything out of his/her own fee will. Normally the person keeps sitting or standing somewhere with an empty glance, seemingly undisturbed or far away. In this case you should first try to help the person to gain some distance to the event, e. g. by asking him/her to concentrate on your firm touch of her hand or arm or by asking her to leave the room and change to another place.
How to react • Immediate stress reduction • If the state persists, an immediate transfer to a psychiatric unit is necessary or at least an immediate medical sedation is required. • Talk about every step you take (do not act as if the person does not hear you)
Cognitive disorganisation • If people experience distressing situations, they often fail to act in a logic way-this happens especially in situations for which persons are not prepared. • During these situations people often react in a stange way and tend to stick to the first thing that comes into their mind
How to react • Give clear framework for action • Coach people through the situation • Give clear and short explanations
Communication and listening skills
è Create a trustful relationship è Explore needs è Intervene and help to regain control
Communication and listening skills Guiding principles*: • Empathy, respect, genuineness • Sincere, positive regard and trying not to be judgemental • Empower the affected people • Try to maintain confidentiality
Communication and listening skills Non-verbal skills: • Face the person • Display an open, attentive and relaxed posture • Keep appropriate distance • Maintain sufficient eye contact
Communication and listening skills • How to become aware of people´s needs? • Look • Listen • Support
Look • Case example (Film) • How did the persons react? • What do they need? • Which of these needs can be fulfilled by the rc personnel?
Listen and explore • Introduce yourself • Start a conversation • Focus on the immediate situation
Listen and focus on immediate situation Exercise: pairs in two: first sentence is given • Use Case example of bus accident (husband wife not talking, son severely injured) • Just find out their immediate needs, do not try to solve the situation as a whole
Give information • Be careful to give only the information that people ask for • Let yourself be guided by people´s questions (Exercise, give information on critical medical condition)
Give Information • Give clear frame/information • Accompany persons to find their own solution • If you have got a narrow action or time frame: Open up a small space for decision making
Give tasks • Help people to regain control, let them be active wherever possible-give them tasks they are able to solve
Role play • Imagine the following situation: • Mother has just been told about the death of her son (17) and insists upon seeing his body immediately (the body is not released yet and can not be seen before autopsy) • Discuss how you could transform the principles: accompany persons to find their own decisions, give clear frame, open up small space for decision, discuss where you can open up a small decision frame for the mother
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