PSYCH - Stress, PTSD, & Crisis Intervention Flashcards
Definition of stress
feeling of emotional or physical tension; any event or thought that causes feelings of anger, frustration or nervousness
What are the two types of stress?
Acute and chronic stress
Definition: Acute Stress
- ST symptoms that develop quickly and do not last for long time periods
- usually in response to negative events but can be bouts of excitement
- experienced by EVERYONE at some time or another
Definition: Chronic Stress
- prolonged and constant feeling of stress; Sx last for long periods of time
- some people may become so adapted to chronic stress that they do not realize they have it
- can lead to serious health problems
Is stress as a concept absolute or relative to each individual?
relative
What can cause stress?
anything that incites the fight or flight response in the body
What is meta-cognition?
understanding one’s own thought processes (and the patterns behind them)
a management strategy for stress
What is Acute Sress Disorder and what is it also known ?
- aka Critical Incident Stress
- Defined as: “the development of specific fear behaviours that last 3 days to 1 month after a traumatic event. These symptoms always occur after the patient experienced or witnessed death or threat of death, serious injury or sexual assault”
- a psychological and/or physical response to a traumatic event
List 7 examples of critical incidents.
Anything that is death/threatening of death or some serious shit
- MVCs
- rape/sexual assault
- witnessing a death/assault
- natural disaster
- hostage situations
- violent crimes
- loss of patient after rescue attempts
Effects of Critical Incident Stress
- feeling overwhelmed, inability to cope with regular activities
- dramatic changes in attitudes/beliefs towards work(place)
- anger, rage, shame, humiliation
- restlessness, fatigue
- guilt, grief
- sleeping/eating disturbances
- paranoia, hypervigilance
- concentration/anxiety problems
- social withdrawal
- flashbacks
- suicide
Definition of Critical Incident Stress Management (CISM)
an intervention protocol developed specifically for dealing with traumatic events
- a formal, highly structured and professionally recognized process for helping those involved in a critical incident to share their experiences, vent emotions, learn about stress reactions and symptoms and given referral for further help if required
- not psychotherapy
- confidential, voluntary, educative process
- somtimes called “psychological first aid”
Types of interventions for critical incidents
1) Debriefing
2) Defusing
3) Grief and Loss session
4) Crisis Management Briefing
5) Critical Incident Adjustment Support
6) Pre-Crisis Education
Descibe the following intervention: Debriefing
What does this entail?
- discussing the experience typically shortly after the event
- designed to be psychologically safe environments where the individual(s) is/are able to vent and address concerns
- ideally held between 24-72 hours after incident
Descibe the following intervention: Defusing
What does this entail?
- shorter, less formal version of debriefing
- confidential and voluntary opportunity to learn about stress and discuss feelings about the incident
- lasts ~30-60 minutes, best conducted between 1-4 hours after incident
Descibe the following intervention: Grief and Loss Session
What does this entail?
- individual or group session following a death
- assists ppl in understanding response to grief, and creates a platform for people involved to discuss the circumstances of the death
Descibe the following intervention: Crisis Management Briefing
What does this entail?
- a large homogenous group intervention used before, during, and after crisis to present facts, facilitate a brief, controlled discussion, Q&A and info on stress survival skills and or available support services
- may be repeated as situation changes
Descibe the following intervention: Critical Incident Adjustment Support
What does this entail?
provides multi-faceted humanitarian assistance to individual, families or groups for coping with the aftermath of an incident and overcoming impact of a death/injury
Describe the following intervention: Pre-Crisis Education
- includes incident awareness, crisis response strategies and develops stress management coping skills that can prevent major problems should an incident occur
- format: employee handbook, e-book and/or workshops and training seminars
What sorts of interventions do paramedics typicall utilize?
debriefing (both normal and crisis management)
defusing
courtesy calls
Other options: telephone hotlines, meds, CBT, LT counseling
Define PTSD
- psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury
What % of the general population has PTSD, and in which population is it more common?
- 9% of general population
- affects 2x women
- common with other psych disorders: anxiety, mood, personality and substance use disorders
What are the 4 categories of risk factors for developing PTSD?
1. historial (pre-trauma) - family psych hx, family instability, personality disorders/traits, past hx of PTSD or trauma
2. severity of current trauma - perceived severity of event and how long the trauma was sustained
3. psychological response during trauma - the level of perceived threat; may have dissociative symptoms during or immediately after the event
4. life stressors and social support - level of support from social networks after event, resiliency
What is the diasthesis-stress model (factor that causes PTSD)?
- suggests that people with an underlying diathesis (strong predisposition), for PTSD are more likely than those without the diathesis to develop the disorder when faced with stressful events (may only need moderately severe trauma to develop disorder)
- statistically, most people do not have strong predispositions for the disorder and are resilient to stress
Neurological factors that contribute to PTSD
- amygdala is a cluster of brain cells that play a role in defining and regulating emotions
- inhibition of amygdala plays a role in fear extinction; insufficient inhibition may cause more fear and avoidance
Environmental factors that contribute to PTSD
- pre-trauma learning experiences
- poor coping skills
- exposure to uncontrollable stressors
Characteristics of PTSD vs Acute Stress Disorder
PTSD:
- stressor is unusually severe
- lasts longer > 1month
- If Sx persists <3 months, disorder is acute; greater than 3 months, disorder is chronic
- If symptoms begin >6 months after event, considered late onset
Acute Stress Disorder
- stressor is unusually severe
- occurs within 4 weeks of event
- lasts minimum of 2 days, max of 4 weejs
- if symptoms persists after one month, dx of PTSD
Define resilience
- “the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress”
- process of self-growth and being able to withstand and learn from traumatic experiences
What are the 4 ways to improve resiliency?
-
Connection
- prioritize relationships, social support and empathetic communication
- join a group - religious based, activity based, local organizations
-
Foster Wellness
- taking care of your own body (nutrition, sleep, exercise, etc.)
- mindfulness - yoga, journaling
- avoiding negative outlets - drugs, EtOH, risky behaviour
-
Healthy thinking
- keeping things in perspective
- accept change
- have hope
- learn from experiences
-
Meaning
- Helping others, setting goals and objectives
- be proactive, discover
Under what act are paramedics covered and entitled to benefits if diagnosed with PTSD during course of duty?
First Responders Act, Workplace Safety and Insurance Act (1997)
What’s a crisis?
a situation (eg a traumatic change) that produces significant cognitive or emotional stress in those involved in it
Crises can evoke emotions that are not addressed and cause further harm. Harm to the patient can occur in what ways?
cognitively
emotionally
physically
behaviourally
Physical effects of a crisis
- triggers fight or flight
- releases cortisol
- elevated HR, BP
- muscle tension
- potential for blood vessel damage from epi overload (this is long term) - higher risk of stroke and MI
- build up of fatty tissue, weight gain (from excess cortisol)
- inability to sleep
Cognitive effects of a crisis
- reduced cognitive load capacity (how much you can process at a time) - different lobes of the brain being turned on and off at different times
- linguistic and vocab changes
- mental distortions
- misinterpretations
- diminished concentration
- poor judgment
- indecisiveness
Emotional effects of crisis
- anger, irritability, mood changes
- feelings of “numbness”
- guilt
- panic
- obsession
Behavioural effects of crisis
- sleeping too much or too litle (body shutting everything off due to neuro overload)
- over- or under-eating
- social withdrawal
- substance abuse
- risky behaviours
- neglecting personal hygiene
Overt vs Covert behaviours
Overt behaviours: behaviours that can be seen and/or observed (yelling, threats, arguing, bodily movements)
Covert behaviours: those that cannot be seen or observed (thinking, feelings, nightmares, reasoning)
What are the three types of crises?
developmental crises
situational crises
existential crises
What is a developmental crisis?
- occurs as part of the process of growing and developing through various periods of life
- normal life events that cause stress and/or strain on an individual
- includes pregnancy, puberty
- hormones changing, brain is developing, so the world perception also changes
What is a situational crisis?
- an event that is sudden or overwhelming
- includes sexual assault, MVC, sudden loss or grief (of people, jobs, things, etc.)
What is an existential crisis?
- based on a person’s purpose and personal fulfilment
- often related to situations of regret or belief that life has passed them by
- includes midlife crisis, severe regret for past event
In times of crisis, people change the way they communication and how they make decisions. What may this present as?
1) Simplifying information/instructions: can’t handle multiple facets of info, can’t remember all of the info, or misinterpretation of message
2) Cling to current beliefs: avoiding evidence that contradicts what the person believes to be true, exploting any unclear msgs and making them consistent with current beliefs
3) Seeking additional information: wanting verification on information before doing anything, referring to others to see their response
4) Believing the first message: first msg will be the foundation of their beliefs, even if more accurate info changes/disproves this
Phases of a Crisis
*depends on the PERCEIVED level of crisis (which differs from person to person)
Phase 1: a problem arises that threatens a person’s self-concept, causing increased anxiety and stimulates the person’s usual problem-solving techniques
Phase 2: if the usual problem solving techniques didn’t work, anxiety continues to rise which produces feelings of extreme discomfort; person makes trial-and-error attempts to try and restore balance
Phase 3: If trial and error attempts fail, anxiety escalates to severe/panic levels. Person adopts automatic relief behaviours (such as compromising needs or redefining the situation to reach an acceptable solution)
Phase 4: Measures are ineffective and anxiety is not reduced. Person now transitions into a state of overwhelming anxiety which can lead to cognitive impairment, emotional instability, and behavioural disturbances that signal the person is in crisis
True or False. An event itself may not always produce a crisis response.
True.
It’s the circumstances, perceptions about the event, and the lack of resources to deal with it that has the ability to cause crisis
Definition of conflict
refers to a situation in which a person is motivated to engage in two or more mutually exclusive incompatible activities
if the conflict is not dealt with (via appropriate coping skills), that’s when things can escalate. Crisis is the peak point of a conflict
Types of conflict
Intrapersonal conflicts: internal conflicts
Interpersonal conflicts: conflicts between 2+ people
Unconscious conflicts: conflicts that may arise as a result of unconscious beliefs; conflicts that you may not be aware about
Most common types of crises in medics
PTSD
burnout
secondary traumatic stress
*NOTE: crises and PTSD can also be as a result of accumulation of stressors NOT JUST ONE PARTICULAR EVENT
Signs of secondary traumatic stress
- excessive fear or worry about something happening
- easily startled or “on guard”
- physical signs of stress
- nightmares, recurrent thoughts about trauma
- feeling that someone else’s trauma is yours
Signs of Burnout
- sadness, depression, apathy
- easily frustrated or irritable
- blaming others
- feelings of indifference
- isolation or disconnect from others
- poor self-care
- tired, exhausted, and/or overwhelmed
- feelings of failure, incompetence, and/or needing drugs to cope
What is crisis intervention?
- a ST management technique designed to reduce potential permanent damage to an individual affected by a crisis
- NOT a treatment plan
- designed to:
- help someone think through their situation
- identify the problem
- recognize how someone/others respond to the situation
Six-step method to crisis intervention
Step 1: Define the Problem: what are we trying to solve/prevent/create? Requires active listening, empathy, and genuineness
Step 2: Ensure safety: safety of everyone involved meaning suicide + homicide risk assessment; removing access to lethal means of suicide (weapons, forming by police)
Step 3: Providing Support: rapport building with person in crisis, expression concern re: their well-being, ask patient what is going on in their life, help/define resources to take care of basic needs
Step 4: Examining Alternatives: exploring potential solutions to situation; if pt’s coping skills not working, try:
- Situational supports- individuals connected to the pt who care about their well-being
- Coping mechanisms - actions, behaviours, environmental resources they can use (assess their coping skills, explore past present future)
- Positive and Constructive Thinking- find new ways of thinking about situation to help them re-assess
Step 5: Making Plans: shift to making concrete plans to allow to to re-gain control of situation (referral to LT care/resources, making realistic plans, including patient in plan, assist in navigating resources if need be)
- regardless you are transporting them to hospital for definitive care
Step 6: Obtaining Commitment: may/may not be done by paramedic (situation dependent) to empower pt; or psych professionals at hospital/outpatient
note that these steps are not always linear
Additional strategies that can be used at any point during crisis intervention
1) Creating awareness
2) Catharsis
3) Providing Support
4) Increasing Expansion
5) Emphasizing Focus
6) Providing Guidance
7) Promoting Mobilization
8) Implementing Order
Strategies during crisis intervention: Creating Awareness
helping patient identify their underlying thoughts and feelings
ec. someone who is suicidal - have you considered reasons for living or dying
Strategies during crisis intervention: Catharsis
the expression of emotion for therapeutic purposes
ex. crying, swearing, etc. (however keep watch on patient’s condition and vitals and coach breathing/grounding exercises if needed)
Strategies during crisis intervention: Providing Support
naturalizing/validating patient’s response to their situation
Strategies during crisis intervention: Increasing Expansion
helping patients get out of their tunnel vision (i.e. reframing to offer diff perspective)
Strategies during crisis intervention: Emphasizing Focus
emphasis on specific causes, problems, breaking down manageable steps to be taken
Strategies during crisis intervention: Providing Guidance
providing information and referral services
Strategies during crisis intervention: Promoting Mobilization
accessing family members, friends, loved ones, etc. & support like counselors, therapists (this is usually not done by medics)
Strategies during crisis intervention: Implementing Order
decide which steps are most important to take first (usually this is definitive care in-hospital and medic will be transporting)
