Midterm

Question 1

Define Crisis

Answer 1

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

Question 2

Normative Stress

Answer 2

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

Question 3

Traumatic Stress

Answer 3

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

Question 4

Normative Stress is consistent with a Dx of..

Answer 4

Adjustment Disorder

Question 5

Traumatic Stress is consistent with a Dx of…

Answer 5

PTSD or Acute Stress Disorder

Question 6

Type I Trauma

Answer 6

a single event (Crisis Intervention)

Question 7

Type II Trauma

Answer 7

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)

Question 8

Factors which influence reaction to trauma (8)

Answer 8

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)

Question 9

3 things that cause Traumatizing Events

Answer 9

Human Malevolence
Human Error
Act of Nature

Question 10

Factors related to the Individual (resilience)

Answer 10

Coping
Support
Meaning

Question 11

Define Coping

Answer 11

activities conscious/unconscious to manage stress

Question 12

Define Support

Answer 12

what’s available and willingness of indv to use it

Question 13

Define Meaning

Answer 13

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

Question 14

What is the “homecoming” phenomenon

Answer 14

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

Question 15

Why are borderline patients inappropriate for CI?

Answer 15

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

Question 16

Criterion A for Acute Stress and PTSD

Answer 16

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

Question 17

Acute Stress Disorder DSM

Answer 17

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

Question 18

PTSD DSM

Answer 18

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

Question 19

Define Crisis Intervention

Answer 19

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

Question 20

Crisis Intervention - Initial Phone Call

Answer 20

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

Question 21

Crisis Intervention - First Session (Process)

Answer 21

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

Question 22

What is a client request

Answer 22

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”

Question 23

Crisis Intervention - First Session (Content)

Answer 23

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

Question 24

When establishing a crisis..

Answer 24

Accept client’s definition of why they are in crisis

Question 25

Traumatic Stress with Death...

Answer 25

Treat Trauma 1st and Grief 2nd

Question 26

Crisis Intervention - Subsequent Sessions

Answer 26

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

Question 27

Violation of basic principles

Answer 27

Meaning reaction 3 types: personal invulnerability, predictable world, self is positive ---guilt supports these

Question 28

Exposure principle

Answer 28

Repeated discussion of event = decrease in trauma symptoms

Question 29

Crisis Intervention - Closing

Answer 29

Plant seed for future therapy follow up phone call a few weeks later don't get too involved

Question 30

Define Critical Incident Stress Debriefing

Answer 30

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

Question 31

Dissociation (4 Types least --> most severe)

Answer 31

Emotion Consciousness Memory Identity

Question 32

Critical Incident Stress Debriefing (7 Phases)

Answer 32

``` Introduction Fact Thought Reaction Symptoms Teaching Re-Entry ```

Question 33

CISD - Introduction Phase

Answer 33

Discuss purpose and what is going to happen (decreases anxiety) Goals: motivate/ create buy in; and set up rules (confidentiality and NO breaks)

Question 34

CISD - Fact Phase

Answer 34

Each member required to answer: who are you? what was your role? what did you see?

Question 35

CISD - Thought Phase

Answer 35

Discover what they felt | "what was your 1st thought?"

Question 36

CISD - Reaction Phase

Answer 36

Move from cognitive --> emotional | "what part was most awful/ what would you erase?"

Question 37

CISD - Symptoms Phase

Answer 37

"what behaviors happened afterwards?" | 4 Signals of distress: cognitive, physical, emotional, behavioral

Question 38

CISD - Teaching Phase

Answer 38

Normalize and preparation for what will happen in the future - Teach around the incident (grief/stress)

Question 39

CISD - Re-Entry Phase

Answer 39

New issues that have not been discussed? - If YES, back to phase 4 No, restate comments to tie the entire process together

Question 40

Define Psychological First Aid

Answer 40

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.

Question 41

Psychological First Aid - Basic Assessment

Answer 41

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?

Question 42

Psychological First Aid (9 Parts)

Answer 42

``` 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

Question 43

Define Emergency Intervention

Answer 43

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

Question 44

Emergency Intervention - Session Process

Answer 44

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)

Question 45

Wharff Article - FBCI

Answer 45

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.

Question 46

Augustin & Fagan Article -

Answer 46

What is the purpose of CI teams? - Discusses role of mental health professionals in developing responses to critical law enforcement incidents.

Question 47

Cacciatore Article - Firefighters

Answer 47

SWs benefit both firemen and the community who they serve by providing services during crisis situations

Question 48

Campbell Article - Riding Third

Answer 48

SWs could play a crucial role in the psychosocial needs of patients and ambulance workers.

Question 49

Palmer Article - Crisis after Stroke

Answer 49

Proposes a 1 session model

Question 50

Compton Article - Force Preferences and Police

Answer 50

CIT trained officers use less force than those who haven't been trained when working with schizophrenia/ other mental health cases.

Question 51

Kintzle Article - Intervention after Sudden Death

Answer 51

Deal with Trauma 1st and Grief 2nd

Question 52

McCart Article - Acute Intervention w/ Victims of Violence

Answer 52

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

Question 53

Callahan Article - School Based CI for Traumatic Events

Answer 53

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 ```

Question 54

Charuvastra Article - Screen and Treat PTSD in Schools

Answer 54

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

Question 55

Bonanno Article - Loss Trauma & Resilience

Answer 55

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%)

Question 56

Bronish Article - Crisis after Tsunami

Answer 56

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

Question 57

Osofsky Article - Aftermath of Katrina

Answer 57

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

Question 58

Hughes - Posttraumatic Stress after VA Tech

Answer 58

Stress bc couldn't find out status of friend's safety (common theme in most disasters)

Question 59

Callahan Article - Debriefing OK Police

Answer 59

Debriefing happened 8 weeks after and was mandatory --> defenses were back up bc no longer in crisis

Question 60

Rosser Article - Psych 1st Aid after Katrina

Answer 60

Psych first aid - identify quickly who needs help and who is doing ok/not

Question 61

Vernberg Article -

Answer 61

Psych first aid

Question 62

Watson Article -

Answer 62

Post 911

Question 63

Hazordous situation

Answer 63

Already in a stressful situation and one event can push you into crisis - more vulnerable

Question 64

3 Responses after Crisis

Answer 64

New equilibrium : better functioning, same, lower (Type II Trauma - PTSD/ASD/Adjustment Dx)

Question 65

Post-traumatic growth is

Answer 65

Reaching a higher level of functioning than that experienced prior to the crisis

Question 66

During Crisis...

Answer 66

Uncharacteristically open to using forms of treatment

Question 67

Crisis Intervention Not appropriate for

Answer 67

Borderline and Type II trauma - these individuals are no longer in crisis (lower level of functioning)

Question 68

Define Suicide Contagion

Answer 68

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

Question 69

CISD Critique

Answer 69

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)