Module 13: Understanding the psychosocial Impact of Disasters

Most commonly reported disorders after MCI

• depression (41%)

• PTSD (22 % - 59 %)

• Generalized anxiety disorder (GAD) (20% - 29%)

• Substance abuse disorders (14% - 22%)

Impact of disaster

1. The experience of terror when one’s own life is threatened or one is exposed to grotesque or disturbing sights

2. traumatic bereavement, which occurs when beloved friends or family members due as a result of a disaster

Bioterrorism

• man-made disaster

• occur over a longer period of time

• lead to mass sociogenic illnesses

• introduce fear, confusion, and uncertainty to victims

Acute Stress Disorder

• disorder most likely to be encountered by the disaster response team

• within the first month following a traumatic event, characterized by severe anxiety, dissociation, and other symptoms that can impair functioning. It may lead to PTSD if untreated.

Post traumatic stress disorder

• response to a recognizable, serious stressor

• generates waves of anxiety, anger, aggression, depression, and suspicion

• interferes with daily functioning

Criteria for diagnosis

1. nature of the traumatic event and the response it

   evoke

2. relates to the traumatic event and the development of symptoms

3. disturbance must cause “clinically significant distress or impairment in social, occupational, or other areas of functioning

therapeutic intervention

1. reducing distress associated memories

2. exposure therapy and cognitive-behavioral therapy

3. helping process thoughts and feelings

Critical incident stress management

strategies

• pre incident education/mental preparedness training

• individual crisis intervention and on scene support

• demobilization after large-scale events and defusing

• Critical incident stress debriefing

Role

• debriefing is just one component

• includes pre-crisis preparedness training

• consultation

• individual crisis counseling

• critical incident planning

Defusing

• occur within 24 hours of the incident & last for 20-45 minutes

• small groups of 6-8 individuals

Debriefing

• occur between 24 - 72 hours after the incident and last for 2-3 hours

• large groups

Goals of a debriefing group

• reduce cognitive, emotional, and physiological symptoms

• educate on stress reduction

• eliminate the fallacy of abnormality

Role of co-leaders

• encourage confidentiality & active participation

• focus on the participants needs not the team’s needs, like coping skills

• listen, stabilize, inform, normalize, & recover

psychological debriefing

• most well-known of the CISM interventions

• a systematic process of education, emotional expression and cognitive reorganization accomplished through information and group support

• applied within 24-72 hours

7 phases

1. introduction

2. facts

3. thoughts

4. reactions

5. symptoms

6. teaching/information

7. reentry

Fact phase

• Purpose: to describe traumatic event from each person’s perspective on a cognitive level\

• share facts about the incident and each participant’s role

questions to address

1. who are you?

2. what happened? what was your role in the incident?

3. what is your relationship to the victim?

4. how did you learn about the incident

Thought phase

• allows participants to describe cognitive reactions and to transition to emotional reactions

2 questions

1. what were some of your thoughts when you experienced or learned of the incident?

2. since you first dealt with the incident, what thoughts have you had about how this incident might affect you?

Reaction phase

• allows participants to describe their emotions

• most powerful of all phases

• everyone is allowed to speak at any time

common questions

1. what was the worst thing about it for you?

2. describe physical reactions and feelings since the incident

Symptoms phase

• Identify symptoms

• aid transition to more cognitive

• processing questions/statements

Teaching Phase

• normalize experiences

• educate about typical reactions

• introduce coping strategies

• role of the leader

Re-entry phase

• prepare for end of meeting

• summarize experiences

• clarify questions

• leader’s role

Post debriefing

• referral for counseling

• peer support and refreshment

• leaders meet and evaluate