 | The examples and perspective in this article may not represent a worldwide view of the subject.(July 2015) |
Crisis intervention is a time-limited intervention with a specific psychotherapeutic approach to immediately stabilize those in crisis. [1] [2] [3]
A crisis can have physical or psychological effects. Usually significant and more widespread, the latter lacks the former's obvious signs, complicating diagnosis. [4] It is defined as a breakdown of psychological equilibrium, and being unable to benefit from normal methods of coping. [5] Three factors define crisis: negative events, feelings of hopelessness, and unpredictable events. People who experience a crisis perceive it as a negative event that generate physical emotion, pain, or both. They also feel helpless, powerless, trapped, and a loss of control over their lives. [6] Crisis events tend to occur suddenly and without warning, leaving little time to respond and resulting in trauma. [7]
In intervention for individuals facing personal or societal crises, there are five universal principles to guide the process. Prompt intervention is essential as victims are initially at high risk for maladaptive coping or immobilization. Stabilization involves mobilizing resources to help victims regain a sense of order and normalcy, promoting independent functioning. Comprehension of the traumatic event is facilitated to aid the individual in understanding and expressing their feelings about the experience. Problem-solving is a crucial aspect where counselors assist victims in resolving issues within their unique circumstances, promoting self-efficacy and self-reliance. Lastly, the goal is to help individuals return to normalcy by actively facilitating problem-solving, supporting the development of appropriate coping strategies, and assisting in their implementation. This approach aims to empower individuals to regain independence and resilience. [8] [9]
Critical incident debriefing is a widespread approach to counseling those in a state of crisis. This technique is done in a group setting 24–72 hours after the event occurred, and is typically a one-time meeting that lasts 3–4 hours, but can be done over numerous sessions if needed. Debriefing is a process by which facilitators describe various symptoms related PTSD and other anxiety disorders that individuals are likely to experience due to exposure to a trauma. As a group they process negative emotions surrounding the traumatic event. Each member is encouraged[ by whom? ] to continue participation in treatment so that symptoms do not worsen. [10]
Many[ vague ] have criticized critical incident debriefing for its effectiveness on reducing harm in crisis situations. Some studies show that those exposed to debriefing are actually more likely to show symptoms of PTSD at a 13-month follow-up than those who were not exposed. Most recipients of debriefing reported that they found the intervention helpful. Based on symptoms found in those who received no treatment at all, some critics[ which? ] state that reported improvement is considered a misattribution, and that the progress would naturally occur without any treatment. [11]
The SAFER-R Model, with Roberts 7 Stage Crisis Intervention Model, [12] [13] is model of intervention much used by law enforcement. [14] The model approaches crisis intervention as an instrument to help the client to achieve their baseline level of functioning from the state of crisis. This intervention model for responding to individuals in crisis consists of 5+1 stages.
They are: [15]
The SAFER-R model can be used in conjunction with the Assessment Crisis Intervention Trauma Treatment. ACT is a 7-stage crisis intervention model. [16] This model, along with the SAFER-R model, is used to restore one's mental state, but it is also used to prevent any trauma that may occur psychologically during a crisis. It can also help experts determine a solution for those who suffer from mental illness. [17] The seven stages/steps are:
The crisis intervention stage of Roberts' ACT model aims to resolve the client's present problems, stress, psychological trauma, and emotional conflicts using a time-limited and goal-directed approach with minimal contacts. It involves a seven-step process, including assessing the situation, building rapport, exploring the crisis, empowering the client, understanding coping styles, confronting feelings, challenging maladaptive coping, exploring solutions, educating on coping strategies, developing a concrete treatment plan, and arranging follow-up for ongoing evaluation and support. [16]
Other models include Lerner and Shelton's 10 step acute stress & trauma management protocol. [18] They are:
Lerner and Shelton's ten-step acute stress and trauma management protocol provides a comprehensive approach to treating trauma. The steps involve assessing danger/safety, addressing physical and perceptual injury, evaluating responsiveness, providing medical care, identifying signs of traumatic stress, building rapport, grounding through storytelling, offering support, normalizing emotions and coping styles, and helping the person focus on the present and future with necessary referrals. The aim is to eliminate stress symptoms and treat the traumatic experience after crisis interventions and assessments have been carried out.
At a global level, when a mass trauma from an event like as a terrorist attack occurs, counselors are trained to provide resources, coping skills, and support to clients to assist them through their crisis. Intervention often begins with an assessment. [20] [21] In countries such as the Czech Republic, crisis intervention is an individual therapy, usually lasting four to six weeks, [22] [23] and includes assistance with housing, food, and legal matters. [24] Long waiting times for resident psychotherapists [25] and in Germany, explicit exclusions of couples therapy and other therapies complicate implementation. [26] In the United States, licensed professional counselors (LPCs) provide mental health care to those in need. Licensed professional counselors focus on psychoeducational techniques to prevent a crisis, consultation to individuals, and research effective therapeutic treatment to deal with stressful environments. [27]
The primary goal of school-based crisis intervention is to help restore the crisis-exposed student's basic problem-solving abilities and in doing so, to return the student to their pre-crisis levels of functioning. [28] Crisis intervention services are indirect. People often find school psychologists working behind the scenes, ensuring that students, staff, and parents are well-positioned to realize their natural potential to overcome the crisis. [29] School psychologists are trained professionals who meet continuing education requirements after receiving their degree. [30] They help maintain a safe and supportive learning environment for students by working with other staff, [31] such as school resource officers, law enforcement officers trained as informal counselors, and mentors. [32]
At a school-based level, when a trauma occurs, like a student death, [33] school psychologists are trained to prevent and respond to crisis through the PREPaRE Model of Crisis Response, developed by NASP. [4] [ where? ] PREPaRE provides educational professionals training in roles based on their participation in school safety and crisis teams. [34] PREPaRE is one of the first comprehensive nationally available training curriculums developed by school-based professionals with firsthand experience and formal training. [35]
Mobile Crisis Response teams (MCR) offer intervention to individuals that are experiencing a mental health crisis somewhere within the community including but not limited to their school, work or home. For safety purposes it is important that two people go out together to assess the individual who experiencing a crisis. MCRS support Emergency medical services (EMS) and work together to come up with the best solution for the person who is experiencing a crisis. [36]
In many countries police negotiators will be called to respond to those experiencing a mental health crisis, particularly where suicide is a risk. [37] However offers of help are frequently rejected in these situations, because they have not been directly sought by the person in crisis, who wants to maintain a level of independence. Supporting those in crisis to make independent decisions [38] , [39] and adapting terminology, for example using the phrase ‘sort (x) out’ [40] can aid in minimising resistance to the help being offered.
When using crisis intervention methods for the disabled individual, every effort should first be made to first find other, preventative methods, such as giving adequate physical, occupational and speech therapy, and communication aides including sign language and augmentative communication systems, behavior and other plans, to first help that individual to be able to express their needs and function better. Crisis intervention methods including restraining holds are sometimes used[ by whom? ] without first giving the disabled more and better therapies or educational assistance. Often school districts, for example, may use crisis prevention holds and "interventions" against disabled children without first giving services and supports: at least 75% of cases of restraint and seclusion reported to the U.S. Department of Education in the 2011–12 school year involved disabled children. Also, school districts hide their disabled child's restraint or seclusion from the parents, denying the child and their family the opportunity to recover. [10]
The U.S. Congress has proposed legislation, such as the "Keeping All Students Safe Act", to curtail school district use of restraint and seclusion. Even with bipartisan support, the bill has repeatedly died in committee.[ non-primary source needed ] [41]
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event and can include triggers such as misophonia. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.
Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.
Developmental disability is a diverse group of chronic conditions, comprising mental or physical impairments that arise before adulthood. Developmental disabilities cause individuals living with them many difficulties in certain areas of life, especially in "language, mobility, learning, self-help, and independent living". Developmental disabilities can be detected early on and persist throughout an individual's lifespan. Developmental disability that affects all areas of a child's development is sometimes referred to as global developmental delay.
Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.
The psychosocial approach looks at individuals in the context of the combined influence that psychological factors and the surrounding social environment have on their physical and mental wellness and their ability to function. This approach is used in a broad range of helping professions in health and social care settings as well as by medical and social science researchers.
Critical incident stress management (CISM) was a controversial process of psychological first aid which focused solely on an immediate and identifiable problem. It included pre-incident preparedness and acute crisis management through post-crisis follow-up. The purpose of CISM is to decrease the likelihood of post-traumatic stress disorder developing after a crisis.
Debriefing is a report of a mission or project or the information so obtained. It is a structured process following an exercise or event that reviews the actions taken. As a technical term, it implies a specific and active intervention process that has developed with more formal meanings such as operational debriefing. It is classified into different types, which include military, experiential, and psychological debriefing, among others.
Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.
Incident stress is a condition caused by acute stress which overwhelms a staff person trained to deal with critical incidents such as within the line of duty for first responders, EMTs, and other similar personnel. If not recognized and treated at onset, incident stress can lead to more serious effects of posttraumatic stress disorder.
In psychology, posttraumatic growth (PTG) is positive psychological change experienced as a result of struggling with highly challenging, highly stressful life circumstances. These circumstances represent significant challenges to the adaptive resources of the individual, and pose significant challenges to the individual's way of understanding the world and their place in it. Posttraumatic growth involves "life-changing" psychological shifts in thinking and relating to the world and the self, that contribute to a personal process of change, that is deeply meaningful.
Vicarious trauma (VT) is a term invented by Irene Lisa McCann and Laurie Anne Pearlman that is used to describe how work with traumatized clients affects trauma therapists. The phenomenon had been known as secondary traumatic stress, a term coined by Charles Figley. In vicarious trauma, the therapist experiences a profound worldview change and is permanently altered by empathetic bonding with a client. This change is thought to have three requirements: empathic engagement and exposure to graphic, traumatizing material; exposure to human cruelty; and the reenactment of trauma in therapy. This can produce changes in a therapist's spirituality, worldview, and self-identity.
A psychological injury is the psychological or psychiatric consequence of a traumatic event or physical injury. Such an injury might result from events such as abusive behavior, whistleblower retaliation, bullying, kidnapping, rape, motor vehicular collision or other negligent action. It may cause impairments, disorders, and disabilities perhaps as an exacerbation of a pre-existing condition.
PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.
Psychological first aid (PFA) is a technique designed to reduce the occurrence of post-traumatic stress disorder. It was developed by the National Center for Post Traumatic Stress Disorder (NC-PTSD), a section of the United States Department of Veterans Affairs, in 2006. It has been endorsed and used by the International Federation of Red Cross and Red Crescent Societies, Community Emergency Response Team (CERT), the American Psychological Association (APA) and many others. It was developed in a two-day intensive collaboration, involving more than 25 disaster mental health researchers, an online survey of the first cohort that used PFA and repeated reviews of the draft.
Judith L. Daylen(previously Cutshall) is a board-certified psychologist. In 1982, she received her B.A. in psychology and philosophy from the University of North Carolina. In 1985, Dr. Daylen received her M.A. in cognitive psychology, and in 1994 she received her PH.D. in clinical psychology both from the University of British Columbia. Dr. Daylen currently works as a clinical and consulting psychologist- she assesses the harm suffered to sexual assault victims and provides expert testimony in court. Recently, Dr. Daylen has focused on providing psychological assessments of victims of physical and sexual assault; however, she has past experience in providing both individual and group treatment to assault victims. To better understand the experience of assault victims and to assist them during times of crisis, Dr. Daylen also volunteered at a rape crisis center. She has even contributed to a book: "Trauma, Trials, and Transformation, Guiding sexual assault victims through the legal system and beyond". In addition to her work with sexual assault victims, Dr. Daylen has contributed to assessing the reliability of eyewitness testimony. Along with John C. Yuille in 1986, Dr. Daylen published a psychological experiment which concluded that eyewitness testimony is often reliable and has merit. Dr. Daylen is also an ordained lay practitioner of Zen Buddhism.
Richard Allan Bryant is an Australian medical scientist. He is Scientia Professor of Psychology at the University of New South Wales (UNSW) and director of the UNSW Traumatic Stress Clinic, based at UNSW and Westmead Institute for Medical Research. His main areas of research are posttraumatic stress disorder (PTSD) and prolonged grief disorder. On 13 June 2016 he was appointed a Companion of the Order of Australia (AC), for eminent service to medical research in the field of psychotraumatology, as a psychologist and author, to the study of Indigenous mental health, as an advisor to a range of government and international organisations, and to professional societies.
Race-based traumatic stress is the traumatic response to stress following a racial encounter. Robert T. Carter's (2007) theory of race-based traumatic stress implies that there are individuals of color who experience racial discrimination as traumatic, and often generate responses similar to post-traumatic stress. Race-based traumatic stress combines theories of stress, trauma and race-based discrimination to describe a particular response to negative racial encounters.
Secondary trauma can be incurred when an individual is exposed to people who have been traumatized themselves, disturbing descriptions of traumatic events by a survivor, or others inflicting cruelty on one another. Symptoms of secondary trauma are similar to those of PTSD. Secondary trauma has been researched in first responders, nurses and physicians, mental health care workers, and children of traumatized parents.
Trauma in first responders refers to the psychological trauma experienced by first responders, such as police officers, firefighters, and paramedics, often as a result of events experienced in their line of work. The nature of a first responder's occupation continuously puts them in harm's way and regularly exposes them to traumatic situations, such as people who have been harmed, injured, or killed.
Disaster psychiatry is a field of psychiatry which focuses on responding to natural disasters, climate change, school shootings, large accidents, public health emergencies, and their associated community-wide disruptions and mental health implications. All disasters, regardless of exact type, are characterized by disruption: disruption of family and community support structures, threats to personal safety, and an overwhelming of available support resources. Disaster psychiatry is a crucial component of disaster preparedness, aiming to mitigate both immediate and prolonged psychiatric challenges. Its primary objective is to diminish acute symptoms and long-term psychiatric morbidity by minimizing exposure to stressors, offering education to normalize responses to trauma, and identifying individuals vulnerable to future psychiatric illness.
