Basic Critical Incident Stress Management - Free Download PDF

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Basic Critical IncidentStress ManagementCritical Concepts ConsultingDaniel W. Clark, Ph.D.WSP Department Psychologist

What is Stress?Ø "The nonspecific response of the body toany demand made upon it" (Selye)Ø "Demands on the person which tax orexceed his adjustive resources" (Lazarus)Ø "A particular relationship between theperson and the environment that isappraised by the person as taxing orexceeding his/her resources andendangering his/her well-being"

Components of Stresslnecessary for lifelsubjectivelpositive and negativeanything that threatens uspushes usscares usworries usthrills us

Prolonged Stress Physical EffectsØ muscle tensionØ headachesØ lack of energyØ stomach problemsØimmune systemØ high blood pressureØ strokesØ sexual problems

Prolonged Stress.Psychological onfusionirritabilityimpatiencefearnegativismmemory problemshelpless/hopeless

Prolonged Stress.Behavioral effectsØ Alcohol and drug useØ Change in usualbehaviorØ WithdrawalØ Acting outØ Silence / talkativeØ Under / OvereatingØ HypervigilanceØ Impulsive

StressorAny event acting as a stimulus whichplaces a demand upon a person, agroup, or an organization.

What are your stressors?8Home8Work8Environment8Biogenic8Law Enforcement8Psychosocial8Cadet

Home StressorsØSpouse/SOØChildrenØFamily demandsØFinancesØRole in the homeØFamily illnessØShift changesØRelatives

Work StressorsØSupervisor/subordinatesØTime demandsØPersonal safetyØRole at workØEnvironmentØShift workØWork pace

Environmental StressorsØPollutionØCrowdingØTemperatureØNoise

Biogenic StressorsStimulants which cause stress by virtueof the biochemical actions they exert onthe body.CaffeineNicotineAmphetamines

Law Enforcement Stressors Irregular work schedule Danger of job/injury Human suffering/death Absence of closure Excessive paperwork Inadequate rewards Special assignments Unfavorable courtdecisions Corrections system Distorted media reports Public sentiment

Work Stressors

Military Stressors Irregular work schedule Danger of job/injury Frequent relocations Inadequate rewards Frequent deployments Field time Human suffering/death

Psychosocial StressorThose events that are interpreted orappraised as being challenging,threatening, or otherwise adverse.Like beauty -They lie in the eye of the beholder.

Cadet Stressors

“Real cesNutritionSecurity

Willpower Defeats FirepowerLAPD – 28 Feb 97

Critical Concepts ConsultingCoping Techniquesfor Managing Stress

Steps in stress management accept that you are constantly under stress explore areas causing negative stress practice effective stress management

Time ManagementDecide what's importantand worth worryingaboutGet organizedSchedule time forrelaxation andexerciseWrite it down!

Positive AttitudeHumorCommunicate andexpress yourfeelingsRally your supportsystemAdopt a problemsolving approach

Positive Attitude


Problem-solving ApproachCan I change this?YesNoAccept it!Do it!

Think Win/WinI LoseI WinYou WinLose/WinWin/WinYou LoseLose/LoseWin/Lose(from The Seven Habits of Highly Effective People by Covey)

RelaxationDo something you enjoy, whether indoorsor out, alone or with othersDo what is satisfying for youSet aside time for yourself

ExerciseExercise is a great way to relievephysical and mental tensionImproves physical resistance to stressChoose an activity that appeals to you

Don't accept substitutesfor stress management

Perfectionism“Perfectionsts aren’t people who dosomething perfectly. Perfectionists arepeople who fantasize about doingsomething perfectly.”John Perry, professor emeritus ofphilosophy at Stanford University

Self Care

Specific SuggestionsWhen helping othersDon’t take anger/feelings of others personallyListen non-judgmentallySpend time with themReassure themListen carefullyBe patient

Specific SuggestionsTo help selfTalk to peopleMental Health ProfessionalChaplainMedical doctorFamily membersFriendsState EAPSupervisors1800SafeCallNow

Crisis InterventionPeer SupportCritical Incidents

Post-Traumatic StressPost - traumatic stressis a normal reaction,in a normal person,to an abnormal event.

Post-Traumatic StressPost-traumatic stress is asurvival mechanism, PostTraumatic Stress Disorder is apathogenic version of thatsurvival mechanism.

Post Traumatic Stress DisorderBrief History8 FirstNamed in DSM - III, 19808 Militaryawareness8Civil War - nostalgia8WWI - war neurosis, shellshock8WWII - combat fatigue/exhaustion8Post Vietnam - PTSD8 Prevalence8General population: 1-2%8Emergency Services: 16-20%

PTSD Exposure to a traumatic eventØ(experienced/witnessed death/serious injury) Persistently reexperiencedØ(intrusive thoughts, dreams, flashbacks) Avoidance of traumatic stimuliØ(forgets, anhedonia, shortened future) Increased arousal symptomsØ(sleep changes, anger, hypervigilance)

Fairchild AFBJune 1994

PTSD Exposure to a traumatic eventØ(experienced/witnessed death/serious injury) Persistently reexperiencedØ(intrusive thoughts, dreams, flashbacks) Avoidance of traumatic stimuliØ(forgets, anhedonia, shortened future) Increased arousal symptomsØ(sleep changes, anger, hypervigilance)

LAPD Officer Whitfield – 9L89

PTSD Exposure to a traumatic eventØ(experienced/witnessed death/serious injury) Persistently reexperiencedØ(intrusive thoughts, dreams, flashbacks) Avoidance of traumatic stimuliØ(forgets, anhedonia, shortened future) Increased arousal symptomsØ(sleep changes, anger, hypervigilance)

Critical IncidentIn a career where day to day you respondto the abnormal events in other people’slives;A critical incident is the one that, forwhatever reason, is abnormal even forexperienced personnel.

Critical IncidentsThe Terrible 101)Line of Duty Death2)Serious Line of DutyInjury3)Suicide of a Co-Worker4)Disaster / MultiCasualty Incident5)Law EnforcementShootingOKC, 19 APR 1995

Critical IncidentsThe Terrible 10Baby Jessica Rescue - 16 OCT 19876)Events Involving7)ChildrenRelatives of KnownVictims8)Prolonged Incident Especially with loss9)Excessive Media Interest10)Any Significant Event

Intensity of ImpactPersonal Relevance *DurationSense of LossPrevious HistoryGuiltSocial SupportCoping Skills

Types of InterventionsqPre-Incident EducationqOn Scene Support ServicesqPeer Support (Individual Consults)qDefusingqDemobilizationqCritical Incident Stress Debriefing

Types of InterventionsqSpecialty DebriefingsqSignificant Other Debriefings andSupportqFollow Up ServicesqMental Health Referral ServicesqCommunity Assistance

Pre-Incident Education§ Heart of Successful CISM Program§ Discuss Stress/Human StressResponse§ Describe CISM Services§ Explain What CISM Is Not§ Provides Outline for CISM Access§ Generates Positive Contacts

Peer Support/Individual Crisis Intervention

Individual Crisis InterventionPositivesØØØNegatives‘Been there, done – May be too closethat’– Very vulnerable toCredibilitycountertransferenceRapport– May over-identify

1:1 Crisis Intervention§Communication Skills§Awareness of Acute Stress Symptoms§Intervention Protocol§Referral Options

Demobilization24 MAY 2001, Jerusalem Wedding Collapse

Demobilization4 Providedby trained CISM personnel.4 10 minute informational talk.Describe stress reactions.List signs and symptoms.Outline stress survival strategies.4 20minute rest after talk is completed.Low fat, low sugar, low salt foodsNon-caffeinated drinks

Crisis Management Briefing

Crisis Management Briefing“ a group psychological crisis interventiondesigned to mitigate the levels of felt crisisand traumatic stress in the wake ofterrorism, mass disasters, violence, andother “large scale” crises.”IJEMH v2(1) p. 53-57 (2000)

Crisis Management BriefingGoalsInform and consultAllow psychological decompressionStress managementSimilar to Demobilization but fornon-operational personnel


DefusingDefusing means to render somethingharmless before it can do damage.

DefusingA small group intervention applied withinhours of a critical incident.

Defusing1)Introduction2) Exploration3) Information

Critical IncidentStress Debriefing

Critical Incident StressDebriefingThe goal of aCritical Incident Stress Debriefingis psychological closure.

DebriefingConsiderations8Large scale incident.8Prolonged incident.8Circumstances out of the ordinary.8CISD is not therapy8CISD is not a substitute for therapy.


Mental Health ServicesPsychotherapy for employeesand family members:IndividualMarital/couplesGroupTrooper applicant screeningTraining/Academy instructionCommand consultation

Referrals & AppointmentsØ Referrals: Directed VoluntaryØ Appointments Days off Medical leave Supervisor’s discretion

Confidentiality/Privileged Communication Privacy: a personal right which limits theaccess of others to certain information aboutone’s self, body, mind, etc. Confidentiality: a professional duty to refrainfrom speaking about certain matters Privilege: a legal decision which provides relieffrom the duty to speak in court proceedingsabout certain matters

Limits of Confidentiality RCW 71.05 RCW 26.44 RCW 74.34 Danger to self orothers Abuse of children orDD adults Abuse of vulnerableadults Case review


Daniel W. Clark, Ph.D.Washington State Patrol1405 Harrison Avenue NWSuite 205Olympia, WA 98502(360)[email protected]

What is Stress? Ø"The nonspecific response of the body to any demand made upon it" (Selye) Ø"Demands on the person which tax or exceed his adjustive resources" (Lazarus) Ø"A particular relationship between the person and the environment that is appraised by the person as taxing or