FINAL Week 8: Crisis, Self-Harm, Suicidality, Abuse, Violence

Evolution of the concept of stress

physiologic response, stimulus, transaction

Allostasis

describes how cardio system adjusts to resting and active states

Transactional model

stress depends on how a stressor is appraised in relation individuals resources for coping with it

Stress is a relationship between

the person and the environment

Cognitive appraisal

the process by which individuals examine the demands and constraints of a situation

Primary appraisal and its three outcomes

is this situation a threat? Irrelevent, begnin-positive, stressfull

Secondary appraisal

what can I do about it and do i have resources to cope

Positive stress

that feels motivating, exciting, energizing

Negative stress

stress that is overwhelming and harmful

The freeze hide response

the tendency to produce a passive response to stress (when fight or flight isnt possible)

Tend and befriend

when fighting or running may put themselves at risk so instead there is bonding and befriending

The physiologic response to stress begins in the

CNS

Emotional response to stress

cognitive appraisal is fundemental to the experience of emotion because it shapes the meaning of a situation

Problem focused coping

changes the relationship between the environment and the person

Emotion focused coping

managing emotional distress

Defininition of crisis

time limited response to life event

Developmental crisis

life stages that cause conflict (moving away, marraige, retirement)

Situational crisis

events that are external and unexpected (loss in job, illness)

Disaster or unexpected situation

random events that are not part of everyday life (natural disaster, violent crimes)

Infancy Trust and Mistrust

develop basic trust in mothering figure

Early childhood autonomy vs shame and doubt

to gain some self control

Late childhood initiative vs guilt

to develop sense of purpose and initiate own actions

School age industry vs inferiority

to achieve confidence by learning, competing

Adolescence identity vs role confusion

to integrate taks mastered into a secure sense of self

Young adulthood intimacy vs isolation

to form intense lasting relationship

Adulthood gerativity vs stagnation

to achieve life goals established for ones self while also considering welfare fo future generations

Old age ego vs despair

to reviews ones life and derive meaning

Phase 1 of crisis

problem arises and increasing anxiety stimulates usual problem solving techniques

Phase 2 of crisis

usual techniques are not effective, trial and error to restore balance

Phase 3 of crisis

if trial error fails, the anxiety escaletes to panic and adopts comprimsing needs or redifing situation to reach acceptable solution

Phase 4 of crisis

all attempts are ineffective and there is a state of overwhelming anxiety causing cognitive impairement, emotional instability, behavioural distubances

Roberts 7 stage crisis intervention model

conduct assessment, establish rapport, identify dimentions of presenting problem, explore feelings, generate alternatives, develop an action plan, follow up plan

The goal of crisis intervention

to assist individuals to return to an adaptive level of functioning

Crisis assessment

assess immediate safety, bio, psycho, social, spitiual, suicide, homicide

Establish therapeutic relationship

be genuine, provide clear communitcation, eliminate distractions

Identify dimensions of presenting problem

why now, is there new risk

Explore feelings

active listening, validation

Generate alternatives

assess internal coping, discuss what worked previously

Develop a plan

integration of new skills, anticipate setbacks

Follow up

establish time frame, assess current state and risk for relapse

6 trauma informed approach principles

safety, trust, choice, collaboration, shared power, cultural issues

Acute crisis intervention

active suicidality

Mental health act form 1

physican completes when person is significant risk to self or toether, 72 hours hold

Form 2

family/nonmd can request from court and allows police to take person to hospital for assessment

Community treatment ordr

allows phuysicans to mandate supervised treatment of a patient when discharged

Common stimulus for suicide is

underable psychological pain

Common stressor in suicide is

fursterated psychological needs

The common purpose of suicide

to seek a solution

The common goal of suicide

cessation of consciousness

The common emotions in suicide

hopelessness and helplessness

The common internal attiitude toward sucide is

ambivalence

The common cognitive state is constriction or tunnel vision

The common interpersonal act in suicide is

communication of intention

The common action is suicide

regression or escpae

Egositic suicide

when person feels isolated and not connected to toethers

Altusiric suicie

when person is overly integrated into a group and sacrifices themselves for its goals

Anomic suicide

from lack fo social regulation during times of rapid change

Fatalistic suicide

happens under excessive control and oppression

Parasuicide

may mimic suicidal behaviour but primary motivating factor is not to kill ones self

Lethality

the probability that an individual will be successful in completing suicide

Contracting for safety

having pt agree to not harm themselves for a specific period

Somatic therapeutics

medication nd ect

Battering

repeated violence with intent of coercive control

Cycle of violence phase 1

tension building (minor incidents)

Violence phase 2

violence erupts (severe injury)

Violence phasr 3

remose ensues (perp becomes kind)