PSYCHOSOCIAL PROCESSING -
(CRITICAL INCIDENT STRESS DEBRIEFING)
Thelma Singson – Barrera, RNPsychosocial Care Specialist
PSYCHOSOCIAL PROCESSING
A PROCESS USED BY A MENTAL HEALTH PROFESSIONAL OR BY A HEALTH CARE PROVIDER TO ASSIST PEOPLE IN CRISIS & TO TRANSFORM THESE VICTIMS OF CRISIS INTO SURVIVORS
THELMA S. BARRERA, RN
A direct PSP intervention for individuals or groups of individuals aimed at:
Helping them reestablish equilibrium & harmony after the disaster;
Regaining personal control
THELMA S. BARRERA, RN
CRITICAL INCIDENT
Any event causing unusually strong or overwhelming emotional reactions which have the potential to interfere with work during the event or thereafter in the majority of those exposed.
THELMA S. BARRERA, RN
PSP – (CISD) A tool used by crisis workers, for the
victims to deal positively with the severe emotional impact of crisis, provide education about current & anticipated stress responses and information about stress management.
Used in identifying commonality & differences in the participants’ reactions
A Phase in Crisis Management
THELMA S. BARRERA, RN
PSP is….. A group session allowing
the ventilation and sharing of experiences, feelings, and reactions during the critical incident.
THELMA S. BARRERA, RN
PSP – Useful in Providing
1. Ventilation of Intense Emotion
2. Exploration of symbolic meaning of the event to those exposed
3. Group support under catastrophic conditions
4. Initiation of the grief process within a supportive environment
5. Reduction of the Fallacy of Uniqueness – that the participant is alone in his feelings
PSP – Useful in Providing (cont’d)
6. Reassurance that intense emotions under catastrophic conditions are normal
7. Preparation for the possibility of the development of a variety (Emotional, Cognitive, Behavioral, Physical, Spiritual) symptoms in the aftermath of a serious crisis
PSP – Useful in Providing (cont’d)
8. Education regarding normal and abnormal stress response syndrome and management
9. Encouragement for continued group support and/or professional assistance
PSP – Useful in Providing (cont’d)
Mass Casualty Incident
1. Ozone disco disaster2. Lung Center Fire3. Payatas tragedy 4. Earthquake of 19905. Mt. Pinatubo eruption in 19916. Armed Conflict in Mindanao 7. Rizal day bombing (Series of
bombings)8. Quezon Disaster (Typhoon)9. Landslide in Guinsaugon, Leyte10.Wowowee stampede
TARGET POPULATION
NOMAL PERSONS
who are capable of functioning effectively but due to Crisis, they show signs of emotional stress
THELMA S. BARRERA, RN
PURPOSES Share Experience Determine how
C.I. Affects & responses to Stress
Identify Coping Styles
Develop Contingency plans
THELMA S. BARRERA, RN
DEBRIEFING
(J. Mitchell model)
PSYCHOSOCIAL PROCESSING(Based on the TRAUMA
Framework)
Introduction RE-ESTABLISHMENT OF SAFETY
Sharing of Facts & Feelings
TELLING & RETELLINGFINDING COMMONALITY
Coping with Stress RECONNECTION
Contingency Plans ORGANIZING FOR COMMUNITY ACTION
Impressions/ Evaluation
PARTS OF PSP INTRODUCTION
FACTS & FEELINGS
STRESS RESPONSES
COPING STYLES
CONTINGENCY PLANS
INTRODUCTION
SELF PARTICIPANTS DEFINITION OF TERMS
PSP Critical Incident Target population Guidelines: Confidentiality, Non-
judgmental, Respect, No Right/Wrong answer, Openness
THELMA S. BARRERA, RN
SHARING OF FACTS & FEELINGS
EXPERIENCE FEELINGS then…. FEELINGS now…. MEANING OF
CRISIS - differences
- commonality - universality* STRETCH BREAK
THELMA S. BARRERA, RN
“Ano ang nangyari? Ano ang mga naramdaman/ naisip mo noon?”
“Kumusta ka na ngayon?”“Ano ang tingin mo sa mga nangyaring yun sa iyo? Ano ang naging kahulugan nun sa iyo?”
Physical
Emotional
Cognitive
Behavioral
Spiritual
Stress Responses
THELMA S. BARRERA, RN
PHYSICAL RESPONSES
Headache Dizziness, faintness Tightness in the
throat/Stomach Chest pains Pounding Heart,
Shortness of Breath GUT reactions
(Diarrhea/Constipation)
Allergies Muscle tensions, Cramps
THELMA S. BARRERA, RN
PHYSICAL RESPONSES
Loss of Energy/ Restlessness
Overactivity Increase
Perspiration Rapid Pulse Extended Fatigue Feeling tired, Drained Frequent Physical
ailments
EMOTIONAL RESPONSES
Fear Shock & denial Anger & frustration Bargaining/
Remorse or Guilt Depression Acceptance/
Resignation/ Helplessness
THELMA S. BARRERA, RN
COGNITIVE RESPONSES Disbelief Confusion Inability/difficulty to
concentrate Absentmindedness Racing thoughts Preoccupation Difficulty in making
simple decisions
THELMA S. BARRERA, RN
COGNITIVE RESPONSE Paranoia/
Suspiciousness Reluctance to begin projects Feeling of
Overload Problems with
prioritizingTHELMA S. BARRERA, RN
BEHAVIORAL RESPONSE
Sleep disturbance Appetite disturbance (Loss of appetite/
Overeating) Increased Smoking, Use of
Alcohol/ Medications Avoidance Behavior Crying/ Inability to talk Restlessness/
Overactivity THELMA S. BARRERA, RN
BEHAVIORAL RESPONSES Uncalled for
Aggressiveness, Irritability
Accident Prone Nervous tics/
mannerisms Absenteeism Withdrawal
THELMA S. BARRERA, RN
SPIRITUAL RESPONSES
Declining investment in others
Doubt of value system/ religious beliefs
Questioning major life areas (profession, employment, etc)
Self pre-occupation Disillusionment
THELMA S. BARRERA, RN
SPIRITUAL RESPONSES Blaming God for what
happened” Kasalanan ng Diyos”
Attributing the disaster to God “Parusa ng Diyos”
Resignation/ Acceptance “Bahala na ang Diyos/Ipasa-Diyos na lang”
Directing one’s anger to God “Walang Diyos/ Anong klaseng Diyos Ka?”
THELMA S. BARRERA, RN
COPING STYLES
What they have done to cope?
Praying - universal coping
THELMA S. BARRERA, RN
POSITIVE & NEGATIVE COPING STYLES
“Ano ang mga ginawa mo nun? Pano mo nakayanan?”
COMMON COPING STRATEGIES
PRAY
MASSAGE
ANALYSE IT
HUGS
MEDITATE WORK
SEX GET HELP
CRY
ESCAPE
SLEEPIGNORE IT
SMOKE
SHOP
SHOP
HIKE
DRINK
SPORTS
SHARE IT
SIGHTSEE EAT
WALK JOG
LAUGH
MEDITATE
MUSIC
WARM B
ATH
CONFRONT IT
EXERCISE
ACCEPT IT
THELMA S. BARRERA, RN
Individual-family-community
CONTINGENCY PLANNINGOrganizing for Community
ActionAno ang balak mong gawin ngayon?
Ano ang mga plano mo sa hinaharap?(Pananaw sa kinabukasan)
CLOSING THE SESSION
Can be done in several ways: Ask participants to say a word or two
of support/ comfort addressed to the group
Meditation/ relaxation exercise A song
SPECIAL CLIENTS
THELMA S. BARRERA, RN
Drawings of children have an assessing and helping value.
By asking the child to draw and later allowing her to talk about his art, one can learn his inner world – his needs, fears, joys, apprehensions.
His art is also a graphic representation of the child’s experience.
Clay, sand, stick can also be used to represent what the child wants to express and share.
Feelings are assigned to different colorsFeelings are assigned to different colors Children can use the colors Children can use the colors to express to express
their feelingstheir feelings as they color their drawings. as they color their drawings. Processing is more important as each child Processing is more important as each child
shares the drawing and the facilitator is able shares the drawing and the facilitator is able to motivate the child to express verbally to motivate the child to express verbally
Venue for rapport buildingVenue for rapport building Graphic representations of the child’s Graphic representations of the child’s
experience, needs, joys, hopes and experience, needs, joys, hopes and innermost feelings otherwise not expressed innermost feelings otherwise not expressed verballyverbally
Enriches the facilitators’ pool of informationEnriches the facilitators’ pool of informationTHELMA S. BARRERA, RN
RED(ANGER)
GREEN(LONELY)
BLUE(SAD)
YELLOW(HAPPY)
WHITE(NERVOUS)
BLACK(SCARED)
BROWN(BORED)
ORANGE(EXCITED)
THELMA S. BARRERA, RN
Using
THELMA S. BARRERA, RN
• builds rapport• relaxes the children• serves as entry point• medium to convey messages• it is a natural way of expressing needs, feelings•helps children work out their fears
THELMA S. BARRERA, RN
NOTE: These activities are just
avenues for children to narrate or share their experience & express their feelings/ reactions.
To assure them that even extreme reactions are normal, experienced by normal people subjected to an abnormal situations.
PITFALLS THAT YOU CAN PONDER ON TO IMPROVE YOUR CONDUCT OF DEBRIEFING
1. Using untrained member
2. When there is no mental health worker to refer extreme cases
3. Debriefing is not a therapy
4. When there is inadequate facts
PITFALLS THAT YOU CAN PONDER ON TO IMPROVE YOUR CONDUCT OF DEBRIEFING
5. Inadequate networking/ coordination
6. Poor community approach7. Lack of emphasis on confidentiality8. Inadequate support for debriefers9. Writing notes on the session10. When it is intrusive
PITFALLS THAT YOU CAN PONDER ON TO IMPROVE YOUR CONDUCT OF DEBRIEFING
11. Lack of input on the part of the debriefer (educational aspect)
12. Role of the debriefer is not clear to the group/ organization/community affected
13. Debriefer is LATE in the session14. When participants are seated
apart15. None or not enough EYE CONTACT
PITFALLS THAT YOU CAN PONDER ON TO IMPROVE YOUR CONDUCT OF DEBRIEFING
16. When debriefer’s body language seems not to convey concern/warmth/sincerity
17.Late comers/ other disruptions18. Language barrier19. No follow-up/ appropriate referral20. No buddy system/ back up (in case debriefer
becomes highly emotional)
21. Accepting too many groups to be debriefed during the day
STRESS REDUCTION TECHNIQUES
TALK IT OUT ESCAPE FOR A WHILE (change of
environment) WORK OFF YOUR ANGER GIVE IN OCCASIONALLY DO SOMETHING FOR OTHERS TAKE ONE THING AT A TIMEMAKE
YOURSELF “AVAILABLE” SCHEDULE YOUR RECREATION MAKE YOURSELF “AVAILABLE”
THELMA S. BARRERA, RN
Some Suggestions to Handle Stress
Try Physical Activity
Talk to Friends It’s OK to cry Create a quiet
scene Avoid Self
medications Find time for fun
Avoid being alone Check your tasks.
Get organized Reduce time
urgency Know your limits.
Practice acceptance
Take care of yourself. Watch your habits.
ISANDOSENANG “S” – IWAS STRESS
1. SMILE2. SIESTA3. SPORTS4. SOCIALS5. SCHEDULING6. SPEAK TO ME7. SPIRITUALITY
THELMA S. BARRERA, RN
8. SOUNDS & SONGS
9. SELF AWARENESS
10. STRESS DEBRIEFING
11. SENSATION TECHNIQUES
12. SENSIBLE DIET & EXERCISE