Critical Incident

intervention
Dr Ayedh Talha
A.B.Psych

Overview
Disaster victims and those who love them are
vulnerable to considerable emotional turmoil
All people experience traumatic events in their lives

Arwa story

Arwa story

Arwa story

Arwa story

Arwa story

Stages of bereavement and

grief
Denial
Anger
Bargaining
Depression
Acceptance

Denial

This cant be
happening to me.

Shocked disbelief
This stage lasts up to 2 weeks
Episodes of deep sighing,
lack of strength and appetite,
choking, and breathlessness may occur.
She may deny the death.
She may feel numb and cut off from the world.

Anger

Why is this
happening? Who is to
blame?
Awareness develops
Loss of vitality, physical symptoms of stress,
Emotional symptoms include outbursts
of weeping; hallucinations;
searching; pining; guilt; idealization;
loneliness; and
anger at doctors, other family members, the deceased,
or God.

Bargaining

Make this not happen,

and in return I will ____.

Bargaining
Individual attempts to strike a deal, or

bargain, with God to undo what occurred.

Depression

Im too sad to do
anything.

Depression may occur about 6 months

after the trauma.
Loss of interest in her own life and the
lives of others occurs.
Her life may seem to be without purpose.
Existing personality problems may worsen.
Social isolation is possible

ResolutionIm at peace with what

happened.
Acceptance
now believes she can cope.
Resolution may take 1-2 years.
She can begin to enjoy life without
feeling disloyal to the deceased.

Emotional response to disaster

Impact phase:
During the first few days, individuals often feel
stunned.
In the first week, disbelief, numbness, fear, and
possibly confusion to the point of disorganization occur

Emotional response to disaster

Crisis phase:
individuals can experience a number of feelings. may
alternate between denial and intrusive symptoms with
hyperarousal.
Persons may experience somatic symptoms (eg,
fatigue, dizziness, headaches, nausea) as well as anger,
irritability, apathy, and social withdrawal.
Individuals may be angry with caregivers who fail to
solve problems

Emotional response to disaster

Resolution phase:
Grief, guilt, and depression are often prominent during
the first year as individuals continue to cope with their
losses.

Emotional response to disaster

Reconstruction phase:
During this phase, reappraisal, assignment of meaning,
and the integration of the event into a new self-concept
occur.

Effect on Community

Potential outcomes of traumatic

events
Emotional reactions
Shock,
daze,
grief,
anxiety,
guilt,
anger, numbness, helplessness, shame, emptiness,
decreased ability to feel pleasure/interest/love; children
may regress

Potential outcomes of traumatic

events
Cognitive reactions
poor concentration,
unwanted memories of the disaster,
self-blame,
confusion,
disorientation,
indecisiveness, worry

Potential outcomes of traumatic

events
Physical reactions
Difficulty sleeping,
exaggerated startle response,
tension,
fatigue,
irritability,
aches and pains, tachycardia, nausea, change in
appetite, change in libido

Potential outcomes of traumatic

events
Interpersonal reactions
Distrust,
conflict,
withdrawal,
work problems,
school problems,
irritability, decreased intimacy, domineering demeanor,
feeling rejected or abandoned; children may become
clingy or oppositional

Signs the client needs help

Task-oriented activities are not being performed.
Task-oriented activity is not goal-directed, organized, or
effective.
The survivor is overwhelmed by emotion most of the time.
Emotions cannot be modulated when necessary.
The survivor inappropriately blames himself or herself,
and the self-blame generalizes to the entire self.
The survivor is isolated and avoids the company of others.
Thoughts or plans of suicide or homicide.

Basic Principles of Intervention

After Emotional Trauma
Reduce stress by all possible means.
Avoid increasing stress
Share the experience
Identify persons at high risk
Have faith in the normal healing processes.
Promote support networks

Reduce stress
Ensure that survivors have a safe environment.
Promote contact with loved ones and other sources of
support
Support self-esteem.
People reaction to the trauma is a normal reaction to an
abnormal situation, not a sign of weakness
Help the person to focus on immediate needs, like rest, food,
shelter, etc.
Help individuals to reframe any destructive cognitions, .
Seek more help from professionals.

Avoid increasing stress

Avoid prompting discussion of issues that cannot be
resolved.
Avoid abreaction in groups and the resulting contagion
effect.
Respect defenses, and do not force reality on persons
who cannot handle it yet.
Debriefing may be harmful.

Share the experience

Share the experience with persons who want to talk
about it.
avoid pressuring those who do not want to talk about it.

Identify high risk

Identify persons at high risk: Screen for physical causes
of psychiatric problems (eg, dehydration, head trauma,
infection, metabolic abnormality, toxins)

Risk factors
Persons who lost a loved one
Individuals who experienced an injury
Persons who witnessed horrendous images
Persons who had dissociation at the time of the event
Those who experience serious depressive symptoms
within a week and lasting for a month or more
Individuals with numbness, depersonalization, sense of
reliving the trauma, and motor restlessness after the
event

Risk factors
Those with preexisting psychiatric problems
Persons with prior trauma
Loss of home or community
Extended exposure to danger
Toxic exposure
Individuals with a lack of social supports or whose social
supports were also traumatized and are unable to be
adequately emotionally available

Be there
Be available, and do not allow a grieving person to
become isolated.
Take action (eg, call, send a card, give hugs, help with
practical matters).
Be available after others get back to their own lives.
Be a good listener, but do not give advice.
Do not be afraid to talk about the loss.
Talk about the person who died by name.

Be there
Do not minimize the loss; avoid clichs and easy
answers.
Be patient with the bereaved; there are no shortcuts.
Encourage the bereaved to care for themselves.
Remember significant days and memories.
Do not try to distract the bereaved from grief through
forced cheerfulness

Tips to the victim

Get support
Turn to friends and family members
Draw comfort from your faith
Join a support group
Talk to a therapist or counselor
do not grieve alone

Tips to the victim

Take care of yourself
Face your feelings
Express your feelings in a tangible or creative
way
Look after your physical health
Dont let anyone tell you how to feel, and dont
tell yourself how to feel either
Plan ahead for grief triggers.

Myths and Facts About Grief

MYTH: The pain will go away faster if you ignore
it.
Fact: Trying to ignore your pain or keep it from
surfacing will only make it worse in the long run. For
real healing it is necessary to face your grief and
actively deal with it.

Myths and Facts About Grief

MYTH: Its important to be be strong in the
face of loss.
Fact: Feeling sad, frightened, or lonely is a normal
reaction to loss. Crying doesnt mean you are weak. You
dont need to protect your family or friends by putting
on a brave front. Showing your true feelings can help
them and you.

Myths and Facts About Grief

MYTH: If you dont cry, it means you arent sorry
about the loss.
Fact: Crying is a normal response to sadness, but its
not the only one. Those who dont cry may feel the pain
just as deeply as others. They may simply have other
ways of showing it.

Myths and Facts About Grief

MYTH: Grief should last about a year.
Fact: There is no right or wrong time frame for grieving.
How long it takes can differ from person to person

Care of Rescue Workers

Rescue workers may develop the same symptoms as
victims.
As many as 1 in 3 rescue workers develop PTSD.

Care of Rescue Workers

Encourage staying in touch with family and friends.
Be sure that rescue workers get rest, food, exercise, and
relaxation.
Encourage understanding of survival guilt.
Explain how chaos and confusion inevitably leads to
upset between individuals and groups that are
participating in the rescue effort.
Develop a buddy system, and encourage support of
coworkers.

Care of Rescue Workers

Encourage workers to defuse after troubling incidents
and following each shift.
After the rescue operation, workers should take a few
days to decompress and attend a debriefing.
Do not overwhelm children with talk of experiences as a
rescue worker; ask about their activities.

Debriefing
Debriefings are usually the second level of intervention
for those directly affected by the incident and often the
first for those not directly involved.
A debriefing is normally done within 72 hours of the
incident
gives the individual or group the opportunity to talk
about their experience
how it has affected them
identify individuals at risk
brainstorm coping mechanisms

Debriefing
inform the individual or group about services available
The final step is to follow up with them the day after the
debriefing to ensure that they are safe and coping well
or to refer the individual for professional counselling.
interviews are meant to allow individuals to directly
confront the event and share their feelings with the
counselor and to help structure their memories of the
event
it may harm individuals by increasing their arousal and
overwhelming their defenses

Reduce harm
Provide trained individuals to perform the intervention.
Avoid ventilating feelings at high levels; this can lead to
contagion and flooding, rather than calming and helping
cope with feelings.
Do not pressure individuals to talk about things they do
not want to; respect their defenses, including denial.
Critical tasks to cover include the following: education :
normal reaction to a very disturbing
situation.

Reduce harm
Discuss ways of improving coping skills, including
getting adequate rest, recreation, food, and fluids.
Avoid excessive exposure to media coverage of the
traumatic incident.
Discuss common cognitive distortions, such as survivor
guilt and fears that the world is totally unsafe.
Explain the signs and symptoms indicating that
someone should get professional help.

Stages
Classically, critical incident stress debriefing has 7 stages, including
(1) introduction (purpose of the session),
(2) describing the traumatic event,
(3) appraisal of the event,
(4) exploring the emotional reactions during and after the event,
(5) discussion of the normal nature of symptoms after traumatic
events,
(6) outlining ways of dealing with further consequences of the
event, and
(7) discussion of the session and practical conclusions.

Correct thinking errors

Malignant Schemata

Constructive Schemata

Life has no meaning.

Right now it is hard to make sense of what

happened.

I can't go on.

What happened is very painful. It is hard

but will get easier in time.

I behaved terribly.

I was frightened and unsure what to do and

made some bad choices.

The world is unsafe.

Disasters are rare. Many things can be done

to protect my safety.

I'm losing my mind.

Feeling confused and overwhelmed after a

traumatic experience is common.

It was my fault it happened.

What was done to me was a crime.

When to seek professional help

Marked depression
marked hyperarousal
extreme numbness
inability to control emotions even when important to do so
persistent problems in work or school
significant problems in self-care
Dissociative symptoms (eg, depersonalization, derealization,
fugue, amnesia)
Intrusive reexperiencing - Terrifying memories, persistent
nightmares, flashbacks

When to seek professional help

Substance abuse
Aggression
In children, aggression, risk taking, sexual acting out