Crisis Intervention Exam 3

Chapters 7, 8, and 16

stress

a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances

trauma

a deeply disturbing emotional shock following a stressful event

psychic trauma

the result of experiencing an acute overwhelming threat in which disequilibrium occurs

most people are

extremely resilient and will quickly return to a state of mental and physical homeostasis

acute stress disorder

when symptoms continue for a period of 2 days to 1 month and have an onset within 1 month of the traumatic event

if acute stress disorder symptoms develop, they will typically diminish in

1-3 months

hysterical neurosis

Freud called the condition that young Victorian women who had experienced childhood sexual abuse experienced

traumatized combat veterans (especially veterans of Vietnam) were said to have _ or _ when they showed effects of trauma without physical injuries

“shell shock” or “combat fatigue”

PTSD was introduced in the

3rd edition of the APA’s DSM (Diagnostic and Statistical Manual)

PTSD

a psychological disorder that’s triggered by a terrifying event

symptoms of PTSD may include

flashbacks, nightmares, and severe anxiety. as well as uncontrollable thoughts about the event

criteria for diagnosis. the person was exposed to…

death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence

4 major symptom clusters for PTSD

re-experiencing the event, heightened arousal, avoidance, and negative thoughts, mood, or feelings

symptoms of PTSD must be present for at least

1 month

PTSD preschool subtype

used to diagnose PTSD in children younger than 6 years old

PTSD is now developmentally sensituve, meaning that

diagnostic thresholds have been lowered for children and adolescents

PTSD dissociative subtype

diagnosed when PTSD is seen with prominent dissociative symptoms. these dissociative symptoms can be either experiences of feeling detached from one’s own mind or body, or experiences in which the world seems unreal, dreamlike, or distorted

_ to _% of children will experience at least 1 traumatic event by the age of 18

30-50%

_ to _% of boys will develop PTSD

3-16%

_ to _% of girls will develop PTSD

1-6%

nearly _ of children will develop PTSD if they see a parent killed or sexually assaulted

100%

nearly _ of children will develop PTSD if they are sexually assaulted

90%

nearly _ of children will develop PTSD if they witness a school shooting

77%

nearly _ of children will develop PTSD if they witness violence in their neighborhood

35%

diagnostic criteria for children

• must experience disorganized or agitated behavior

• may demonstrate regressive behaviors (i.e. bed wetting or thumb sucking)

• may relive trauma through repetitive play

• generalized nightmares (i.e. monsters)

• may believe that they can see into the future

• somatic complaints of headaches or stomachaches

type I trauma

sudden and distinct traumatic experience

type II trauma

long-term and persistent trauma. seems to change the personality of the sufferer

type II trauma 3 major symptoms

1. somatization (physical ailments)

2. dissociation (divisions of personality)

3. affect dysregulation (changes in impulse control, attention, perception, and significant relationships)

the Vietnam archetype

• hyper-vigilance

• lack of goals

• individual/individualizer

• bonding, debriefing, and guilt

• civilian adjustment

• substance abuse

• attitude

• antiwar sentiment

beginning treatment for PTSD

initiating intervention: victims may refuse early intervention because it’s too difficult to talk about the trauma and/or they believe that people of good character should be able to cope with traumatic events

importance of acceptance: disclosure is difficult because the events of the trauma may seem horrifying and socially unacceptable

grounding

a process by which the therapist refocuses the client’s attention to the current environment

cognitive processing therapy (CPT)

therapy designed to help individuals with PTSD by utilizing elements of CBT

3 phases of CPT

1. education regarding PTSD, thoughts, and emotions

2. formal processing of trauma

3. reinforce the skills

EMDR

form of psychotherapy developed by Francine Shapiro that emphasizes the role of distressing memories of PTSD. bilateral stimulation to mimic REM sleep to process memories. controversial

risks of PTSD treatment

• no magical cures

• intensity of treatment may impact occupations or relationships

• may get worse before it gets better

• re-experiencing the event is very painful

• difficult to give up thoughts of revenge related to the trauma

• pain associated with accepting the world as it is

• difficult to accept one’s own limitations

multiphasic/multimodal treatment

combining different therapeutic approaches to address various aspects of a condition

eclectic therapy

a flexible approach to therapy that draws on multiple theoretical orientations and techniques to tailor treatment to each individual's unique needs

instrumental acts of lethality

occur for a financial or concrete gain

expressive acts of lethality

attempt to reduce psychological pain

suicide

the act or an instance of taking one’s own life voluntarily and intentionally

women have a _ attempt rate of suicide

higher (3x men)

men have a _ completion rate

higher (3x women)

men tend to use more _ methods of suicide

violent (shooting, stabbing, or hanging)

women methods of suicide

drug overdose, cutting

suicide is related to _ and _

social support and marital status

one study found that half the subjects who had committed suicide were found to have

no close friends

_ have a higher suicide rate than married or cohabiting individuals

divorced people

long-term stressors can include:

• serious illness (especially those which cause great pain or severe disability)

• abusive environments from which there is little or no hope of escape

• occupational stress (psychologists, psychiatrists, nurses, dentists, lawyers, unskilled laborers, etc.)

many suicide attempts are preceded by

changes in mood

the most common mood change that precedes suicide is a rise in

sadness. increased anxiety, tension, frustration, anger, or shame are also common

suicide attempts may ALSO be preceded by

shifts in patterns of thinking. individuals may see suicide as the only effective solution to their difficulties and often develop a sense of hopelessness

hopelessness

a pessimistic belief that their present circumstances, problems, or mood will not change

Eastern culture may see suicide as a means of

relieving dishonor, shame, or humiliation from oneself or one’s family

Western culture commonly sees suicide as

a sin

Schneidman’s cubic model (1987)

when all 3 elements of the cubic model (psychache, pertubation, and press) occur, the individual experiences a critical mass that will allow suicide to occur

psychache

the hurt, anguish, soreness, and aching pain of the psyche or mind

pertubation

how disturbed one is and the degree of pain

press

stress due to negative factors piling up

Durkheim’s social integration theory (1897)

societal integration and social regulation are major determinants of suicidal behavior

societal integration

the degree to which people are bound together

social regulation

the degree to which the individual’s desires and emotions are regulated by social norms

4 types of suicide

egoistic suicide: related to one’s lack of integration or identification with a group

anomic suicide: related to perceived breakdown of the norms of a society (i.e., the financial ruin of the Great Depression)

altruistic: related to perceived social solidarity (i.e., suicide bombers)

fatalistic: occurs when a person sees no way out of an intolerable or oppressive situation (i.e., being confined to a concentration camp)

Schneidman’s 6 most common characteristics that are present when an individual attempts suicide

situational, motivational, affective, cognitive, relational, and serial

_% of murderers committed suicide after completing a homicide

30%

homicide followed by suicide is most likely to occur in these situations

elderly couples, domestic violence, infanticide by overwrought parents, and mental illness

nearly all suicidal/homicidal people offer

some kind of clues (verbal, behavioral, situational, or syndromic)

MMPI-2 (Minnesota Multiphasic Personality Inventory-2)

Robust Personality Inventory that detects the presence of common mental disorders as well as suicidal intent

Beck Depression Inventory

brief scale designed to detect the presence of depression

SAD PERSONS scale

brief scale designed to detect the presence of lethality

CAMS Suicide Status Form

clinical interview template that focuses on ascertaining lethality

intervention goal, change at least one of the 3 “I’s”

inescapable, intolerable, interminable (endless)

CBT techniques are commonly used for suicide intervention, such as

cognitive restructuring, emotional regulation, and changing destructive behaviors through psychoeducation

“no harm” contracts

involves having the client sign a contract to do no harm before the next session. controversial

psychological autopsy

an examination of detailed post-mortem mental histories following suicides or deaths where the cause of death was uncertain

analyzing suicide notes

not commonly left. 4 categories:

• problems are not of their own making but they know what they’re doing

• incurable physical or mental illness that has drained all strength

• love scorned and the note is directed toward the significant other

• “last will and testament” with instructions but little insight for motivation

helping professionals are _ for burnout

prime candidates

recipe for burnout

high levels of motivation, idealistic, and expectation that their work will give their life a sense of meaning

burnout

physical or mental collapse caused by overwork or stress

burnout consists of

• lost energy to the point of exhaustion

• lost enthusiasm to the point of absolute indifference

• passion is replaced by cynicism

• complete lack of confidence that your work is having any positive impact

stages of burnout

1. enthusiasm

2. stagnation

3. frustration

4. apathy (lack of caring)

typical MO of burnout is to

increase effort (actually increases the problem) rather than attempting to change the situation

countertransference

the attributing to the client, by the crisis worker, of traits and behaviors of past and present significant others or events in the crisis worker’s own life

vicarious traumatization

a transformation that occurs when an individual begins to change in a manner that mimics a client’s trauma-related symptoms

compassion fatigue (secondary traumatic stress disorder)

a phenomenon where the crisis worker has symptoms similar to PTSD, except that the exposure is to the person relating the event and not the event itself

people are able to prevent or recover from burnout when they have

meaningful relationships with friends, family, and coworkers

_ is essential to preventing burnout

self-care. this entails hobbies, friendships, time to oneself, eating well, and working manageable hours

private practitioner

a clinician creates a business where he/she offers mental health services

factors that increase the chance of burnout among clinicians in private practice

• isolation - crisis workers in private practice experience more isolation due to not having coworkers that have downtime to discuss issues

• business concerns - financial, client base, marketing services

• maintaining a public presence - clinicians in private practice must constantly maintain a public practice to ensure new clients see them as a viable option

• difficult work schedules - evenings, weekends, and few vacations

mass violence

an intentional violent criminal act that results in physical, emotional, or psychological injury to a sufficiently large number of people

a mass shooting occurs in the US every

12 1/2 days

5 types of violence typology (mass shootings)

criminal intent, customer/client, worker-on-worker/student-on-student, intimate partner, ideological violence

affective characteristics of mass shooting perpetrator

• lack of empathy coupled with aggression

• lack of remorse for wrongdoing

• shallowness of emotions

cognitive characteristics of mass shooting perpetrator

• projection of blame on others

• extremely egocentric, narcissistic

• intense sense of entitlement or injustice

behavioral characteristics of mass shooting perpetrator

• slick, manipulative, pushy

• does not read or respond well to social cues

3 phases for mass violence survivors

acute, intermediate, and long-term phases

unique challenges for mass shooting survivors

• the attack may have occurred in an environment they will frequent often

• media coverage can be a reminder of the attack

resilience

the ability to successfully adapt to stressors, maintaining psychological well-being in the face of adversity

ASD prevalence after a mass shooting event at rates ranging from _ to _%

7 to 33%

there is a _% chance of meeting the criteria for PTSD months after a mass shooting

30%