1. Psychology of a Crisis Module 2

2. What Constitutes Crisis? Naturally occurring Earthquake Tornado Flood Wildfire Pandemic Disease Manmade Hazardous Material Release Terrorism Other Criminal Activity

3. Traumatic Events Sudden and unexpected Children more vulnerable – less experience in coping with life Adults may be overwhelmed by events that occur suddenly and are beyond their control – may produce psychological reactions including Post Traumatic Stress Disorder (PTSD)

4. Public Perspectives 61% fear terrorism more than natural disaster 77% believe information to cope with fear and distress are needed 57% do not think the health system is meeting the mental health needs resulting from the threat of terrorism Information received after a crisis significantly shapes reactions over the weeks and years following

5. Immediate Reactions to a Crisis Disbelief Disorientation Dislocation Fear Feeling time is slowed down Feeling numb or disconnected Feeling helpless Feeling responsible (should be doing more)

27. HOW DO YOU FEEL?

28. Response to 9/11 Attacks First week 44% of adults & 35% of children – 1 or more substantial stress symptoms Intrusive thoughts Very upset when reminded Nightmares, sleep disturbance Poor concentration Anger outbursts

29. Response to 9/11 Attacks 20% of Americans know someone who was missing, hurt or killed 64% had a shaken sense of safety & security 43% less willing to travel by airplane Within 2 months in Manhattan 7.5% increase in PTSD (67,000 new cases) 9.7% increase in Depression (87,000 new cases) Secondary trauma via TV and other media correlate to PTSD symptoms – 60% witnessed via live TV

30. General Psychological Effects Emotional Effects Grief, anger, despair, sadness, hopelessness, numbness, denial, flashbacks, generalized Anxiety Disorder, Panic Disorder, Post Traumatic Stress Disorder (PTSD) Cognitive Effects Impaired concentration & decision-making, impaired memory, disbelief, worry, tunnel vision

31. General Psychological Effects Physical Effects Fatigue, insomnia, cardiovascular strain, hyper- arousal, health problems/concerns headaches, decreased appetite, nonspecific distress, MUPS – Medically Unexplained Physical Symptoms (worried well) Interpersonal Effects Increased relational conflict, social withdrawal, impaired performance, over-protectiveness, feeling abandoned and rejected

32. Who’s At Risk? Those with severe exposure, injury, threat to life, extreme loss, disrupted community, and high secondary stress Females age 40 -60 with no experience in coping techniques Young & middle aged adults (vs. older adults) Prior exposure to violence and trauma Ethnic minorities Persons with prior psychiatric history Adults with children School children First responders

33. Protecting the Public’s Psychological Health Provide basic resources – food, shelter, communication, transportation, and medical services Programs to promote individual and community resilience Surveillance for psychological consequences Treatment for acute and long-term effects of the trauma

34. Protecting the Public’s Psychological Health Human Services – reuniting families, child care, housing, job assistance Risk Communication – dissemination of information Training service providers to respond, protected against psychological trauma Surge capacity Identifying the underserved, marginalized persons needing psychological services

35. Traumatic Stress Traumatic stress may affect: Cognitive functioning. Physical health. Interpersonal relations.

36. Mediating Factors Prior experience with a similar event The intensity of the disruption in the survivors’ lives The emotional strength of the individual The length of time that has elapsed between the event occurrence and the present

37. Physiologic Response Stress Increases Heart rate increases Motor skill ability decreases Perceptual narrowing occurs – tunnel-vision Response programming is delayed until threat identified

38. Actions to Perform Under Stress Take a deep breath Look around during size up, view the BIG picture Think before acting – develop a plan Remember: IT’S NOT MY EMERGENCY!

39. Phases of a Crisis Impact: stunned, shock Inventory: confusion, then assessment Rescue: inclined to act, compliant Recovery: relief, anger Reconstruction: grief, long term resolution

40. Possible Psychological Symptoms Acting differently than normal for this person Performing activities that do not make sense for the time Irritability, anger Self-blame, blaming others Isolation, withdrawal Fear of recurrence Feeling stunned, numb, or overwhelmed Feeling helpless Mood swings Sadness, depression, grief Denial Concentration, memory problems Relationship conflicts/marital discord

41. Possible Physiological Symptoms Loss of appetite Headaches, chest pain Diarrhea, stomach pain, nausea Hyperactivity Increase in alcohol or drug consumption Nightmares Inability to sleep Fatigue, low energy

42. Team Well-Being Team leaders should: Provide pre-disaster stress management training. Brief personnel before response. Emphasize teamwork. Encourage breaks. Provide for proper nutrition. Rotate personnel. Phase out workers gradually. Conduct a debrief discussion. Arrange for a post-event debriefing later.

43. Critical Incident Stress Debriefing Six phases: Introduction and a description Review of the factual material Sharing of initial thoughts/feelings Sharing of emotional reactions to the incident Instruction about normal stress reactions Review of the symptoms Closing and further needs assessment

44. Risk Communications - EPA Accept & involve the public as a legitimate partner Listen to the audience Be honest, frank and open Coordinate and collaborate with other credible sources Meet the needs of the media Speak clearly and with compassion Plan carefully and evaluate performance

45. 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…” “I’m sorry for what’s happened to you”