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Rapid Crisis Response
Strategies for Psychological First-Aid after Terrorist Attacks
with Dwight Bain
"Be careful, keep calm and don't be afraid.
Do not lose heart." - Isaiah 7:4
2 Warning signs of an individual negatively impacted by dangerous psychological trauma
PHYSICAL Fatigue Sweating Shortness of
breath
Loss or increase of appetite
Nausea or Diarrhea
Elevated blood pressure
Tight chest/
chest pain
Muscle fatigue or weakness
Insomnia or Hyper-somnia
Increased cold or flu symptoms
Pacing Heart
Palpitations
Shallow breathing
Fainting Abdominal pain
EMOTIONAL
Anger Stress Anxiety Tension Apathy
Fear Panic Guilt Uneasiness Alarm
Numb inside Impatience Depression Shame Nervousness
Grief Loss Irritability Apprehension Overwhelmed
BEHAVIORAL
Restlessness Impulsive Avoidance Edgy Rapid speech Tense
muscles/neck
Easily startled or jumpy
Hyper-vigilance Withdrawal from others
Accident proneness Anti-social acts Inability to rest Intensified
pacing
Increased use of alcohol
Increased use of caffeine
COGNITIVE Easily
Distracted
Poor
concentration
Forgetfulness Errors in judgment
Mental Fog
Decreased decision making
Reduced creativity or mental focus
Diminished productivity
Loss of objectivity
Self-
consciousness
Confusion Fear of losing control
Frightening visual images
Fear of injury, death, pain
Flashbacks- nightmares
3 The more warning indicators identified in a single category or across multiple categories, the more that person may be over-exposed to dangerous levels of psychological trauma. Some of these conditions are quite common, so if only one or two
symptoms are present, it is not usually a cause for alarm.
When in doubt it’s best to review any symptoms that concern you with an experienced mental health professional as part of your own self-care to prevent STS or PTSD.
The Lord is near to the brokenhearted and saves those who are crushed in spirit. - Psalms 34:18
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4 TYPES OF NORMAL REACTIONS
TRAUMA –
Any event outside the usual realm of human experience that is markedly distressing, (which creates horror, helplessness or terror.) Such traumatic stressors usually involve the perceived threat to one’s physical integrity or to the physical integrity of someone in close proximity. This is the very intense psychological reaction to feeling highly threatened, which is normal.
SECONDARY TRAUMATIC STRESS
Traumatic stress overwhelms coping mechanisms leaving people feeling out of control and helpless. Continual exposure to the trauma create the normal reaction of being depleted, exhausted, or worse, self-destructive
Symptoms:
· Intrusive fearful thoughts
· Sadness or continual waves of grief
· Poor concentration or difficult remembering the most basic of tasks
· Second guessing every decision
· Detachment or emotional numbness
· Hyper-vigilance of danger
· Hopelessness about the situation
· Inability to embrace complex concepts
· Inability to listen to others
· Anger and cynicism at everything or continual irritation
· Sleeplessness or disturbing dreams
· Fear, anxiety or panic
· Chronic exhaustion or energy loss
· Physical ailments or muscle pain
· Minimizing the severity of the situation
· Survivor Guilt
·
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POST-TRAUMATIC STRESS DISORDER-
The term applied as the official diagnosis of a PTSD or syndrome, which is characterized by symptoms of:
1. excessive excitability and arousal,
2. numbing withdrawal, and avoidance, and
3. repetitive, intrusive memories or recollections or events related to the trauma, 4. duration of at least one month
Recall the last significant critical incident to which you were exposed. Using the list below, indicate which symptoms you experienced, and how long they lasted.
Nightmares (more than once a week) Intrusive memories (more than once a day) Irritability
Difficulty concentrating Rage/Hostility
Fear and/or avoidance of similar situations
Avoidance of people or things that remind you of the critical incident Stress-related physical complaints
Flashbacks
Withdrawal from usual activities Feeling “numb” or detached Depressed mood
Feeling guilty Feeling anxious
Feeling as though the world no longer “makes sense”
Questioning spiritual values
Hyper-vigilance or an Exaggerated startle response Difficulty sleeping
Difficulty remembering the critical incident
6 WE ARE HARD PRESSED ON EVERY SIDE, BUT NOT CRUSHED; PERPLEXED, BUT NOT IN DESPAIR,
PERSECUTED, BUT NOT ABANDONED; STRUCK DOWN, BUT NOT DESTROYED.THEREFORE WE DO NOT LOSE HEART.THOUGH OUTWARDLY WE ARE WASTING AWAY, YET INWARDLY WE ARE BEING
RENEWED DAY BY DAY.–ST.PAUL, 2CORINTHIANS 4:8
Traumatic Incident Recovery
You have experienced a traumatic event or a critical incident (any incident that causes personnel to experience unusually strong emotional reactions which have the potential to interfere with their ability to function either at the scene or later). Even though the event may be over, you may now be experiencing or may experience later, some strong emotional or physical reactions. It is very common, in fact quite normal, for people to experience emotional aftershocks when they have passed through a horrible event.
Sometimes the emotional aftershocks appear immediately after the traumatic event.
Sometimes they may appear a few hours or a few days later. And, in some cases, weeks or months may pass before the traumatic reactions appear.
The signs and symptoms may last a few days, a few weeks or a few months and occasionally longer depending on the severity of the traumatic event. With
understanding and the support of loved ones the psychological reactions usually pass more quickly. Occasionally, the
traumatic event is so painful that professional assistance from a counselor may be necessary. This does not imply craziness or weakness.
It simply indicates that the particular event was just too powerful for the person to manage by themselves.
How to Help Family and Friends
• Listen carefully and compassionately
• Spend time with the traumatized person, it’s better to be together than alone after a major trauma
• Offer your assistance and a listening ear if they have not asked for help; consider reaching out to text or call friends you haven’t heard from since the incident
• Reassure they are safe once stability can be assured
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• Help them with everyday tasks like cooking, cleaning, caring for the family, or providing support with childcare to reduce daily stressors
• Don’t take their anger or other feelings personally. Crisis brings out the best and worst in people
• Don’t tell them that they are “lucky it wasn’t worse” –Instead, tell them that you are sorry such an event has occurred and you want to understand and assist
• Connect with compassion and empathy instead of trying to ‘fix’ them
• Help peers as much as possible by sharing feelings and asking about them
• Workplace self-care groups (for example, book clubs or meditation)
• Flextime scheduling as it fits work demands
• Create a Self-care accountability buddy system to check on one another
• Exercise and good nutrition, especially hydration with lots of water
• Encouraging all team members to be aware of stress overload, or STS and to keep the conversation moving forward.
• We can get through this together, but no one gets through crisis alone.
• Remind them these emotions are normal reactions to an abnormal situation
• Talking, remember if you can talk through it, you can get through it
Things to Remember After a Crisis
• There is no such thing as a “normal” reaction to an overwhelming event.
Expect a wide range of reactions in yourself and in others for the next few weeks
• Ask for help from friends and family. Talking about your reactions with people you care about and who care about you can help you and them through this difficult time and help you. Reach out your hand to others
• Exercise is helpful for your body and emotional state. Walk, sleep, breathe
• Try to maintain your routine schedule, but don’t force it. Don’t be alarmed if your body won’t cooperate. You appetite and sleep habits may be off kilter for a bit as you begin the process of adjusting to the event. Caffeine and alcohol tend only to intensify your reactions so avoid them during the recovery period
• Distressing things like dreams and flashbacks are part of the process of readjustment. Although unpleasant, they help us to come to grips with what has happened. They will fade over time but if troubled talk to someone about it
• Critical Incidents challenge our values…what we hold most dear: community, service, commitment, courage, family… hold tight to these value in the days to come as they help steady you in the midst of the crisis recovery stage.
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• Give yourself permission to ask for help from your family, friends, co-workers, neighbors, Employee Assistance Programs (EAP), counselors, and Pastors.
Seeking help is a sign of strength and resilience to get through a trauma
• Recovery from an overwhelming incident doesn’t happen all at once. It is a process, not an event. Some moments will be much better than others, but most people find that in time they emerge stronger, ready to face the next challenge.
Signs of stress in children who have survived a major Crisis
Sometimes parents need help identifying stress in children or teens. Here are some typical experiences and signs of stress in children of different ages who have
experienced major crisis.
INFANTS AND TODDLERS
• Regression of sleeping, toilet training or eating; slowing down in the mastery of new skills
• Sleep disturbances (difficulty going to sleep; frequently waking)
• Difficulty leaving parent, extreme clinginess
• General crankiness, temper tantrums, crying
3-5 YEARS
• Regression-returning to security blankets/discarded toys, lapses in toilet training, thumb sucking or other age inappropriate behavior
• Immature grasp of what has happened; bewildered; making up fantasy stories
• Blaming themselves and feeling guilty about how the crisis affected their family
• Bedtime anxiety; fitful/fretful sleep; frequent waking or chronic worrying
• Fear of being abandoned by both parents; clinginess increases as child feels unsafe
• Greater irritability, aggression, or temper tantrums, especially from previously quiet children
6-8 YEARS
• Pervasive sadness; especially when perceived feelings of being abandoned or rejected
• Crying and sobbing can be a common reaction, and sometimes a healing one
• Afraid of their worst fears coming true, this is sometimes called “catastrophizing”
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• Fantasies that the stressful event didn’t happen and things will ‘just go back to normal’
• May become overactive or over-involved to avoid thinking about stressful issues
• Feel ashamed of the crisis; or feel they are different from other children because of the crisis
ADOLESCENTS:
• Fear of being isolated and lonely, separation anxiety increases in kids with other major losses.
• Fear loss of stability and security from parents leaving them or parents not available to them
• Feel hurried to achieve independence, partly to escape the crisis situation
• May tend to over-achieve academically or in sports to try and forget the crisis
• Worry about their own future; preoccupied with the survival of any stable situation
• Chronic fatigue; difficulty concentrating, physical complaints may indicate stuffed emotions
• Mourn the loss caused by the crisis or begin to understand that life can be a dangerous place
(Created by Kathleen O’Connell and Dwight Bain to help kids in crisis)
Strategies to help children after a Terrorist Attack
Children look to their parents for support and encouragement during any crisis. The following is a guide to help parents and teachers manage the flood of emotions that may come up because of the terrorist attacks.
Ages birth-6
It is recommended that children under the age of six not be given exposure to major traumatic events. Children of this age draw their support from their parents, so if the parents or guardians feel safe and secure, the children will as well. Parents should speak calmly around children about bad things that happen in the world, and that "we will remember the people that were hurt in our prayers." If the parents are able to maintain a sense of calmness, children will feel safe.
Ages 6-12
Children this age are more aware of the world around them, yet still need moms and dads to shield them from most of the bad news in our world. Very limited exposure to
10 the media is recommended at this stage, with more open discussions about any fears or insecurities that the child is feeling. Talking is encouraged for this age group, or write letters to emergency workers to thank them for helping the victims. Drawing pictures allows for healthy emotional expression, and something everyone needs is just being held close. A hug can help bring security to a child. Also remember to have special times of prayer. These steps help children better deal with their fears about bad things that happen in the world.
Ages 12-18
Young people have their own impressions of traumatic events. The older they are, the more likely they will have strong opinions, and it is normal for them to process their feelings with friends. This should be balanced with family, teachers, pastors or
counselors. They need time to verbally process how they feel about what happened ten years ago. Special emphasis should be placed on helping this age group talk through the issues and how it impacted them and not stay isolated. Silence is a warning sign that the crisis events of the past have been internalized. Strict limits on over exposure of media is essential to prevent anxiety or panic levels from rising.
Warning Signs
Stress signs of overexposure to painful memories from the past may occur immediately after the trauma or even a few years later. These signs are indicators that stress is beginning to overwhelm the individual. The longer the stress symptoms occur, the greater the severity of the traumatic event on the individual. This does not imply craziness or weakness rather it indicates that the memories are too powerful for the person to manage by themselves. Adults or children who display many of the following stress symptoms may need additional help dealing with the events of the crisis. They should seek the appropriate medical or psychological assistance.
Physical: Chills, thirst, fatigue, nausea, fainting, vomiting, dizziness, weakness, chest pain, headaches, elevated Blood Pressure, rapid heart rate, muscle tremors, difficulty breathing, shock symptoms, etc.
Emotional: Fear, guilt, grief, panic, denial, anxiety, irritability, depression,
apprehension, emotional shock, feeling overwhelmed, loss of emotional control, etc.
Cognitive: Confusion, nightmares, uncertainty, hyper-vigilance, suspiciousness, intrusive images, poor problem solving, poor abstract thinking, poor attention/memory and concentration, disorientation of time, places or people, difficulty identifying objects or people, heightened or lowered alertness, etc.
Behavioral: Withdrawal, antisocial acts, inability to rest, intensified pacing, erratic movements, changes in social activity, changes in speech patterns, loss of or increase of appetite, increased alcohol consumption, etc.
11 When in doubt, contact a trusted family member, a physician or certified mental health professional. It is important to actively deal with any painful past emotions to find
strength to cope with issues in the present. Remember there are caring people who can help you. You never have to go through a crisis alone.
Family Discussion Topics - Think about and discuss these issues with your children
· How you have changed since the terrorist attack?
· How is our family different since the attack?
· Talk about what was important to you on the day of the attacks… and what is important to you today.
(Core Values)
60 Critical Incident Coping Skills to Rebuild “New Normal”
Physical:
• Sleep, (7-9 hours)
• Sleep rituals- Same time to wake up and go to bed
• Predictable daily schedule
• Healthy Diet with Regular mealtimes
• Hydration throughout day
• Nutritional supplements
• Low impact exercise
• Yoga/Pilates/Stretching
• Deep breathing
• Relaxation routines/massage or energizing naps
• Regular physical checkups, including blood work
• Medication, (as prescribed by your physician)
Emotional:
• Esteem building exercises, especially with photos or images
• Laughter/Fun/Playtime
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• Face anger, anxiety and apathy directly
• Journal out negative emotions
• Let go of painful past memories
• Say “NO” to bad habits
• Talk through issues to get through issues
• Identify and process hurtful emotions
• Write letters to vent out disappointment, (then tear them up)
Relational:
• Face relationship issues
• Voice your needs to others
• Confront conflict directly
• Connect with friends/family
• Share your burdens with others
• Join a support group
• Utilize counseling supports
• Join a hobby group which involves others
• Say “NO” to manipulative behavior
• Hugs/affection, (from pets or people)
• Learn the love language of those close to you
Behavioral:
• Daily planning time
• Utilize organizational planners
• Short term goals
• Daily hobbies for enjoyment
• Creative activities for relaxation
• Develop victory list of accomplishments
• Create a bucket list of lifetime goals
• Reading for personal development
• “Pay it forward” to do good for others
• Learn something new everyday
• Take on new challenges
• Leave work stress at work
• Take a training course to gain a new skill
Spiritual:
• Meditation
• Volunteer to help others
• Reading for spiritual growth
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• Forgive those who have wronged you and forgive yourself
• Listen to inspirational music
• Attend spiritual development classes
• Attend inspirational services
• Make prayer a regular part of your day
• Observe a day of rest
• Memorize scripture to develop your soul
• Remember, “Things come to pass – not stay”
• Re-create spiritual peace in nature
• Build spiritual strength through meaningful experiences
• Attend prayer vigils to experience greater spiritual and community connection
You will find as you look back upon your life that the moments when you have truly lived are the moments when you have done things in the spirit of love.
-Henry Drummond
What is your most important take away strategy to protect you, your leadership team and those you serve in ministry?
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Dwight Bain is an author and clinical therapist who guides people through major crisis from his home in Orlando. Follow his blog at www.DwightBain.com or follow online for updates to manage daily life
@DwightBain across all social media platforms
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Warning Signs of Dangerous Trauma
Below are the warning signs and symptoms that become noticeable in an individual who has been negatively impacted by dangerous levels of psychological trauma. This includes concentrated exposure to high conflict situations like domestic violence or repetitive and stressful situations, which could include overload from repeated viewing
of traumatic events on Social Media or the Internet.
PHYSICAL
Fatigue Sweating Shortness of
breath
Loss or increase of appetite
Nausea or Diarrhea Elevated blood
pressure
Tight chest or chest pain
Muscle fatigue or weakness
Insomnia or Hyper-somnia
Increased cold or flu
symptoms
Pacing Heart
Palpitations
Shallow breathing
Fainting Abdominal pain
EMOTIONAL
Anger Stress Anxiety Tension Apathy
Fear Panic Guilt Uneasiness Alarm
Numb inside Impatience Depression Shame Nervousness
Grief Loss Irritability Apprehension Overwhelmed
BEHAVIORAL
Restlessness Impulsive Avoidance Edgy Rapid speech
Tense
muscles/neck
Easily startled or jumpy
Hyper-vigilance Withdrawal from others
Accident proneness Anti-social acts Inability to rest Intensified
pacing
Increased use of alcohol
Increased use of caffeine COGNITIVE
Easily Distracted
Poor
concentration
Forgetfulness Errors in judgment
Mental Fog Decreased
decision making
Reduced creativity or mental focus
Diminished productivity
Loss of objectivity
Self-
consciousness Confusion Fear of losing
control
Frightening visual images
Fear of injury, death, pain
Flashbacks- nightmares
The more warning indicators identified in a single category or across multiple categories, the more that person may be over-exposed to dangerous levels of psychological trauma. Some of these stress-related conditions are quite common after a
traumatic incident, so when only one or two symptoms are present, it is not usually a cause for alarm. However, when in doubt it’s best to review any symptoms that concern
you or someone you care about with an experienced counselor or physician.