Lamorinda Community Emergency Response Team 01/01/2017 Lamorinda Community Emergency Response Team Unit 7: Disaster Psychology Released: 1 January 2017 Lamorinda CERT

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 Visual 7.1 Lamorinda CERT

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 Visual 7.2 Lamorinda CERT

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

Taking Care of Your Team Visual 7.4 Lamorinda CERT

Team Well Being 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 Visual 7.5 Lamorinda CERT

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

What Does Work 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” Visual 7.7 Lamorinda CERT

Taking Care of Yourself Visual 7.8 Lamorinda CERT

Taking Care of Yourself 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 Visual 7.9 Lamorinda CERT

Reducing Stress 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 Visual 7.10 Lamorinda CERT

Rescuer Psychological Trauma 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 Visual 7.11 Lamorinda CERT

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. Visual 7.12 Lamorinda CERT

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

Risk / Resiliency Markers 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 Visual 7.14 Lamorinda CERT

Possible Physiological Symptoms 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 Visual 7.15 Lamorinda CERT

Post-traumatic Stress Visual 7.16 Lamorinda CERT

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

Traumatic Stress 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 Visual 7.18 Lamorinda CERT

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

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

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. Visual 7.21 Lamorinda CERT

Taking Care of a Victim Visual 7.22 Lamorinda CERT

Stabilizing an Individual 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 Visual 7.23 Lamorinda CERT

How to Be an Empathetic Listener 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 Visual 7.24 Lamorinda CERT

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) Visual 7.25 Lamorinda CERT

Can Say … “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.” Visual 7.26 Lamorinda CERT

Managing the Death Scene 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 Visual 7.27 Lamorinda CERT

Informing Family of a Death 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.” Visual 7.28 Lamorinda CERT

Unit Summary 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 Visual 7.29 Lamorinda CERT

Glossary 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 Visual 7.30 Lamorinda CERT

Glossary 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. Visual 7.31 Lamorinda CERT

Glossary 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). Visual 7.32 Lamorinda CERT