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Midterm Flashcards

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1
Q

Define Crisis

A

upset in psychological equilibrium or baseline level of functioning; caused by stressful event symptoms of stress, anxiety, and depression temporary inability to cope - Duration of 2-3 days - 1 month

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2
Q

Normative Stress

A

stressful events that happen frequently in normal course of life (ie. break-up or job loss)

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3
Q

Traumatic Stress

A

exposure to actual or threatened: death, injury, sexual violation

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4
Q

Normative Stress is consistent with a Dx of..

A

Adjustment Disorder

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5
Q

Traumatic Stress is consistent with a Dx of…

A

PTSD or Acute Stress Disorder

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6
Q

Type I Trauma

A

a single event (Crisis Intervention)

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7
Q

Type II Trauma

A

a series of events in the context of physical/psychological captivity and involving a life or death situation (new level of lower functioning; need Tx for PTSD or long-term Tx)

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8
Q

Factors which influence reaction to trauma (8)

A 
extent of exposure
cause of event
duration
warning
opportunity for action (do better if felt they could help out)
injury to person
extent of community loss
traumatic stimuli (sight/sound/smell)
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9
Q

3 things that cause Traumatizing Events

A

Human Malevolence
Human Error
Act of Nature

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10
Q

Factors related to the Individual (resilience)

A

Coping
Support
Meaning

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11
Q

Define Coping

A

activities conscious/unconscious to manage stress

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12
Q

Define Support

A

what’s available and willingness of indv to use it

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13
Q

Define Meaning

A

perception of the event - precipitating event often corresponds to an important area of the client’s life

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14
Q

What is the “homecoming” phenomenon

A

when the individual and their crisis is received negatively by their support system, they are more likely to develop PTSD

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15
Q

Why are borderline patients inappropriate for CI?

A

they have a chronic instability - always in upheaval (cannot maintain a state of crisis for an extended period of time)

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16
Q

Criterion A for Acute Stress and PTSD

A
  1. directly experiencing the traumatic event (s)
  2. witnessing the event as it occurred to others
  3. learning it happened to family/friend
  4. experiencing repeated or extreme exposure to aversive details of the traumatic event (ie. 1st responders/body collectors)

Does NOT apply to exposure through the media

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17
Q

Acute Stress Disorder DSM

A

9+ of the following from all 5 Categories
Persistent for 3 days - 1 month

  1. Intrusion: intrusive memories, dreams, flashbacks, intense distress/ physiological reaction to reminders
  2. Negative Mood: inability to experience pos emotions
  3. Dissociative Symptoms: derealization, depersonalization, dissociative amnesia
  4. Avoidance: avoid memories/thoughts/feelings, avoid external reminders
  5. Arousal Symptoms: sleep disturbance, irritable behavior, hypervigilence, poor concentration, exaggerated startle response
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18
Q

PTSD DSM

A

Duration of +1 month

  1. Intrusion: memories, dreams, dissociative reactions (flashbacks), Intense psychological distress at cues (internal and external), physiological reaction to cues
  2. Avoidance of cues: memories/thoughts/feelings, external reminders
  3. Negative alterations in cognitions and mood: inability to remember important aspect of the event, exaggerated neg belief/expectations, blaming self/others, neg emotional state (fear, anger, shame), no interest in significant activities, detachment from others, inability to experience pos emotions
  4. Alterations in arousal and reactivity: angry outbursts, reckless/self-destructive behaviors, hyper vigalence, poor concentration, sleep disturbance, easily startled
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19
Q

Define Crisis Intervention

A

Brief therapy (1-6 sessions) with goal of getting the individual back to normal functioning

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20
Q

Crisis Intervention - Initial Phone Call

A

stage I
Brief 10 -15 min: serves as triage
Gather basic info
Assess for mental health emergency (potential for emergency, see immediately– No emergency, wait 24hr and meet)
Don’t decrease anxiety too much - manage expectations

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21
Q

Crisis Intervention - First Session (Process)

A 
Take charge
Build rapport/ alliance
Normalize - normal reaction to an abnormal event
Active listening (avoid why Qs)
Client request
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22
Q

What is a client request

A

What they would like to accomplish in the session/time together (ie. advice, just to listen, social help)

You do not have to do it, but must make it explicit so client feels “heard”

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23
Q

Crisis Intervention - First Session (Content)

A

Retell story (chronology)
Hazordous situation prior to?
Establish there is a crisis (degree of impairment and previous baseline)
Assess: Coping, Support & Meaning - adaptive or maladaptive
Assess: Mental health emergency
Assess: traumatic stress/normative stress and symptoms - Dx
Define problem as something that can be changed

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24
Q

When establishing a crisis..

A

Accept client’s definition of why they are in crisis

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25
Traumatic Stress with Death...
Treat Trauma 1st and Grief 2nd
26
Crisis Intervention - Subsequent Sessions
Work on Coping, Support & Meaning Coping - encourage adaptive and confront, undermine, or discourage maladaptive (develop new ones) Support - provide support, encourage utilization of support, formal support groups Meaning - (in time) confront grossly inaccurate depictions of reality Confront avoidances Limited goals - only focus on equilibrium Exposure principle
27
Violation of basic principles
Meaning reaction 3 types: personal invulnerability, predictable world, self is positive ---guilt supports these
28
Exposure principle
Repeated discussion of event = decrease in trauma symptoms
29
Crisis Intervention - Closing
Plant seed for future therapy follow up phone call a few weeks later don't get too involved
30
Define Critical Incident Stress Debriefing
1 session group meeting of 4 -12 participants who were effected by a traumatic event Designed to accelerate recovery of first responders (ie. work) Must occur w/in 72 hours of event and 24hr after phone call
31
Dissociation (4 Types least --> most severe)
Emotion Consciousness Memory Identity
32
Critical Incident Stress Debriefing (7 Phases)
``` Introduction Fact Thought Reaction Symptoms Teaching Re-Entry ```
33
CISD - Introduction Phase
Discuss purpose and what is going to happen (decreases anxiety) Goals: motivate/ create buy in; and set up rules (confidentiality and NO breaks)
34
CISD - Fact Phase
Each member required to answer: who are you? what was your role? what did you see?
35
CISD - Thought Phase
Discover what they felt | "what was your 1st thought?"
36
CISD - Reaction Phase
Move from cognitive --> emotional | "what part was most awful/ what would you erase?"
37
CISD - Symptoms Phase
"what behaviors happened afterwards?" | 4 Signals of distress: cognitive, physical, emotional, behavioral
38
CISD - Teaching Phase
Normalize and preparation for what will happen in the future - Teach around the incident (grief/stress)
39
CISD - Re-Entry Phase
New issues that have not been discussed? - If YES, back to phase 4 No, restate comments to tie the entire process together
40
Define Psychological First Aid
Only appropriate for a mass disaster. Go where the people are and no talk/therapy of the event. Used to identify quickly who needs help and who does not.
41
Psychological First Aid - Basic Assessment
Identify who needs help/ doesn't 1. Concrete needs - food/ shelter 2. Medical needs 3. Mental Health: - -When did you get out (before/during/after)? - -Are your friends/fam safe? - -Trouble coping? (no sleep/suicidal thoughts) - -Is there a particular person you are worried about?
42
Psychological First Aid (9 Parts)
``` Preparation Contact & Engagement Safety & Comfort Stabalization Info Gathering - Current needs and concerns only Practical assistance Connection w/ social support Information on coping Link w/ services ``` --No psych intervention for 2-4 weeks
43
Define Emergency Intervention
Mental health emergency that requires IMMEDIATE response in an effort to stop potential harm: potential suicide or potential violence most often happens in the span of a crisis
44
Emergency Intervention - Session Process
1. Assessment: in general and Risk (low/ moderate/ high) that they will act on thoughts 2. Intervention: what can you do in session to reduce the risk 3. Disposition/ Plan: containment for high risk (suicide- hospitalization or continual family watch violence- if mentally ill, hospitalize)
45
Wharff Article - FBCI
FBCI -Family Based Crisis Intervention is a useful strategy in lieu of hospitalization for suicidal teens. Is is feasible, less intrusive, and cost effective and keeps from disrupting the family, academics, and social aspects of child's life.
46
Augustin & Fagan Article -
What is the purpose of CI teams? - Discusses role of mental health professionals in developing responses to critical law enforcement incidents.
47
Cacciatore Article - Firefighters
SWs benefit both firemen and the community who they serve by providing services during crisis situations
48
Campbell Article - Riding Third
SWs could play a crucial role in the psychosocial needs of patients and ambulance workers.
49
Palmer Article - Crisis after Stroke
Proposes a 1 session model
50
Compton Article - Force Preferences and Police
CIT trained officers use less force than those who haven't been trained when working with schizophrenia/ other mental health cases.
51
Kintzle Article - Intervention after Sudden Death
Deal with Trauma 1st and Grief 2nd
52
McCart Article - Acute Intervention w/ Victims of Violence
Movement towards waiting a few weeks to identify those who need coping then do CBT Themes (p 173) - People are more resilient than we think --> Avoid prescribing an intervention to every one
53
Callahan Article - School Based CI for Traumatic Events
Tier I, II, or III to determine approach ``` Crisis Plan: Team - meets prior to start of school next day (all teachers) - give written statement to be read 1st period 3 days of open doors for SW/Counselors Screening Support Group (two rings) Assist faculty Control media - one correspondent Community meeting if necessary ```
54
Charuvastra Article - Screen and Treat PTSD in Schools
Student jumped off roof to death - all 4th graders outside at time and were sent home w/ parents. Waited 3 months to do screening and referrals. Only Type II determined at risk - 5 had PTSD and were the only ones who received help. Issue w/ relying on Dx to determine need for help
55
Bonanno Article - Loss Trauma & Resilience
Not everyone needs professional help after a trauma 4 patterns: 1. Resilient - No symptoms (57%) 2. Recovery - Crisis Response (22%) 3. Delayed - Come home from war & PTSD (4-6%) 4. Chronic - Lower level of functioning (16%)
56
Bronish Article - Crisis after Tsunami
Friendliness of Thai culture inc neg reactions bc it gave flase hope that family was still alive - neighbors experienced shame (culturally based) if they did not know answer to mortality status and gave affirmations/vague responses Learned had to keep body handlers away from claiming fam members - made corpses into more than neutral bodies
57
Osofsky Article - Aftermath of Katrina
Author out of town and went back Cop suicide - unable to cope with conflict of helping others vs. helping own family Concept of not knowing if family was alive for weeks after
58
Hughes - Posttraumatic Stress after VA Tech
Stress bc couldn't find out status of friend's safety (common theme in most disasters)
59
Callahan Article - Debriefing OK Police
Debriefing happened 8 weeks after and was mandatory --> defenses were back up bc no longer in crisis
60
Rosser Article - Psych 1st Aid after Katrina
Psych first aid - identify quickly who needs help and who is doing ok/not
61
Vernberg Article -
Psych first aid
62
Watson Article -
Post 911
63
Hazordous situation
Already in a stressful situation and one event can push you into crisis - more vulnerable
64
3 Responses after Crisis
New equilibrium : better functioning, same, lower (Type II Trauma - PTSD/ASD/Adjustment Dx)
65
Post-traumatic growth is
Reaching a higher level of functioning than that experienced prior to the crisis
66
During Crisis...
Uncharacteristically open to using forms of treatment
67
Crisis Intervention Not appropriate for
Borderline and Type II trauma - these individuals are no longer in crisis (lower level of functioning)
68
Define Suicide Contagion
After one student does it, there is an increase for others (identification and imitation of person - dangerous for already at risk student --> Shifts ambivalence Debunk "romantic tragedy" ideal
69
CISD Critique
Original Claims: reduce time away from work; lessens impact of traumatic stress/PTSD Arguments: Not everyone needs it (mandatory) Could be upsetting/ re-traumatizing 1 session may not be enough Distress and impairment is not abnormal PPL can utilize natural healing methods/existing coping May have competing needs (safety/ food/ house)

Crisis (1 decks)

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