Week 3 & Week 4 Flashcards
Briefly describe mindfulness
- Intentionally focusing attention on the present moment
- calmly acknowledging/accepting feelings/thoughts/ sensations
- observation of experiences without judgement
What is a “crisis”?
An UNBEARABLE DIFFICULTY, that EXCEEDS one’s resources and coping mechanisms
What is a trauma?
- when a person has witnessed or heard of an experience which involved DANGER or potential LOSS OF LIFE
*not necessarily their own life/own danger
List 5 differences between crisis and trauma
CRISIS
- personal/relative/subjective experience
- can be precipitated by a non- OR a traumatic event
- time limited (transient symptoms)
- intervention is action oriented (restore functioning
- not psychopath (not outside of normal emotional exps)
TRAUMA
- due to EXTERNAL event (psycho/emot/phys shock/wound to body) - but can also be subjective
- always precipitated by a TRAUMATIC event
- symptoms long lasting
- intervention is process oriented (e.g re-telling the story)
- may result in psychopath (PTSD/ASD)
Crisis and trauma perhaps exist….
along a continuum, and can be very enmeshed
Although there are the learnt definitions of trauma and crisis…..
don’t get bogged down by the definitions - use them as a guideline, but take it situation by situation
Briefly outline the difference between homeostasis, equilibrium and allostasis
homeostasis - maintaining stability - constant internal environment
equilibrium - balance (static or dynamic)
allostasis - adaptive change to maintain FUNCTIONING, stability through change (e.g raising HR to respond to external stress)
Name and briefly outline the 3 phases of a crisis.
- Acute - physiological/psychological reactions (numbness, change in sleep, agitation, withdrawal)
- Outward adjustment - efforts to regain mastery over life/crisis event, try to reintroduce normality but inward effects may remain
- Integration - apply inner workings to make sense of what happened, achieve cognitive and emotional balance
Name and briefly describe the two types of crises
- Situational - unexpected & unavoidable (e.g illness, death)
- Developmental/life cycle - inability to adjust to a new role (, middle age, parenthood, old age)
Outline what crisis intervention is
- IMMEDIATE psych assistance to indi in crisis
- short term
- target = specific behaviour (fix bad coping mechs
- return to functioning
- assistance/resourcing
- stabilization and support
SIT FAS
short term/ immediate/ targeted
Functioning/ assistance/ stabilizatio
The first person to conceptualize crisis theory was ….. .Who was followed by…
Erich Lindemann.
Gerald Caplan
Caplan build on Lindemann’s theory and said that crisis is a….
homeostatic imbalance in response to a stressful event
- when normal resources/coping mechs fail
Taplin and Halpern (in a break from Lindemann and Caplan) saw a crisis as a…
cognitive issue - that develops when one suffers a temporary interruption of their cog processes, impairing their ability to resolve stress.
Parad, Rapoport and France (who came after Taplin and Halpern) placed emphasis on the… and felt that….
Later, Roberts took a similar stance and said that…..
subjective experience
personality traits and the nature of the event contribute to the experience
perception of event and coping skills affect the experience and response
Give the 2 sections and their 3 steps of the 6 step crisis model
Listening steps
- Define the problem
- Establish patient safety
- Provide support
Action steps
- Examine alternatives
- Make a plan
- Obtain commitment
In the situation that someone drops a bomb and there’s no time to process/contain, what do you do?
- contact next of kin to alert them, ask them to follow up etc
Outline step 1 of the 6 step model:
Defining the problem:
- can use many resources (referrals, family, client etc)
- CS = open-ended q’s(mostly), passive and active listening
Outline step 2 of the 6 step model:
Establishing patient safety:
- physical safety, suicide, homicide, med emergency, emotional safety (acute feelings danger, dep, anx can impede recovery and worsen outcomes)
CS = closed-ended q’s and obs NB, MSE,
empowering ownerships statements (“I sounds like it might not be safe for you to walk home alone right now. Is there someone I can call to accompany you?”
Why are ownership statements sometimes needed in crisis intervention
- clients in a state of shock/crisis may not be in a good position to make decision. Ownership statements allow the therapist/RC to guide and suggest action while not making the client feel disempowered
Outline step 3 of the 6 step model:
Providing support:
- may be practical or psychological (containment, brainstorming, psycho-ed)
CS: psycho-ed, empathy, problem-solving, supportive counselling
Moving up and down the “polyvagal ladder” is…
The issue arises when…
- good! They’re all healthy responses.
- one is stuck in one. This is what causes psychopathology
When we are at the top of the “PV ladder” we can…..
- make sense of our experiences in the lower two rungs
Give the names and briefly outline the experiences in the 3 rungs of the PV ladder
Ventral vagal activation:
- SAFE, SOCIAL, ENGAGED
- at ease, empowered, connected to the world and the people in it
Sympathetic activation:
- MOBILZED, AGITATED, FRANTIC
- overwhelmed, not keeping up, anxious, irritated, world is dangerous, chaotic and unfriendly
Dorsal vagal activation:
- NUMB, COLLAPSED, SHUT DOWN
- buried, cannot get out, alone in my dispair, world is empty dead and dark
Along the lines of fight/flight response, what responses are found in the various rungs of the PV ladder
VVA: Social engagement
SA: Fight, Flight
DVA: Fold, Fawn, Freeze
Outline step 4 of the 6 step model:
Examining alternatives:
- ID support system
- collaborative resourcing (social, personal, professional (referrals), lifestyle)
- use resource list (area’s NPOs etc)
*become aware of resources in your area when you start practicing, have a list to provide.
*may only have one session with the client, so equipping them with other places to turn is NB
Outline step 5 of the 6 step model:
Making a plans:
- help client find tasks/goals that will take them back to pre-crisis functioning
- use SMART
*crisis counselling is more directive than other types, but be careful to let client find goals and plans at least WITH you, so to ensure buy-in
*specific, measurable, achievable, realistic, time bound
Outline step 6 of the 6 step model:
Obtaining commitment:
- client can summarize the plan and verbally commit
- explore any resistance
- encourage follow up sessions
Trauma is an….. that….
It is a threat to..
- external event
- overwhelms coping mechs and disrupts psych stability
- safety and connection
Trauma is a …… experience that is…..
- subjective
- filtered through context, culture, personal history, personality and biology
One of the effects of trauma on the body is a high level of…
This can ….
- cortisol (and adrenaline)
- disrupt growth and impede regulatory processes in the brain
A helpful metaphor for the continuum or stress, anxiety, trauma and burnout is….
Briefly outline the metaphor for each
cars on a highway
The continuum has to do with the amount of info confronting the NS relative to time and space (resources) the NS has to process the information.
- “good stress” = free flowing, some cars, stay alert but flowing
- anxiety = traffic build up, no flow, brain processing not efficient
- trauma = congestion and accidents, data into brain is too much for body and brain to process, overflow from highway into side streets
- burnout = gridlock, multiple accidents, no cars can even get onto the highway, shutdown and immobilization
What are the 6 stages of trauma response?
- Anxiety and shock (agitation or inactivity)
- Denial
- Anger
- Remorse
- Grief
- Reconciliation/acceptance
List 4 psychological disorders related to trauma responses
- adjustment disorder
- acute stress disorder (ptsd but < a month)
- PTSD
- dissociative disorder
What are the 6 basic human needs according to Rosenbloom and Williams?
- Safety (I can protect myself/the world is safe)
- Trust (I can rely on others/people are trustworthy)
- Power (I can prevent bad things from happening to me)
- Independence (I can control my thoughts/feelings)
- Intimacy (I can have meaningful relationships w others)
- Esteem (I am worthy, valuable, and have hope for the future)
S.T.I.P.I.E
What are the 5 stages of the Wits Trauma Model?
- Telling and Re-telling
- Normalizing symptoms
- Address self-blame/survivor’s guilt
- Encourage mastery (relaxation techniques)
- Creation of meaning
What are some of the critiques of the wits trauma model?
- assumes survivor has emotional capacity to process the event (re-telling can be more traumatic)
- certain level of verbal ability is required
- prevents working through LT effects of trauma
- does not work w older survivors (limited soc support, coping skills, emotional capacity and fixed beliefs)
- doesn’t address bereavement trauma well
- does not address physical injuries/body complaints
