[Unit 7: Disaster Psychology]{.smallcaps}

**In this unit you will learn about:**

-   **Disaster Psychology:** The psychological impact of a disaster on
    rescuers and victims, and how to provide "psychological first aid."

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-   **Caring for Yourself, Your Buddy, and Victims:** Steps one can take
    individually and as part of a CERT before, immediately following,
    and after a disaster.

# Unit 7: Disaster Psychology

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| # Introduction and Unit Overview                                      |
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| CERT members should prepare themselves for their role during and      |
| following a disaster by learning about the possible impact of         |
| disaster on them and others, emotionally and physically. This         |
| knowledge will help CERT members understand and manage their          |
| reactions to the event and to work better with others.                |
|                                                                       |
| This unit will address techniques for managing one's personal         |
| situation so that the needs of the victims and those of CERT team     |
| members can be met.                                                   |
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| At the end of this unit, you should be able to:                       |
|                                                                       |
| -   Describe the disaster and post-disaster emotional environment.    |
|                                                                       |
| -   Describe the steps that rescuers can take to relieve their own    |
|     stress and those of disaster survivors.                           |
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| # Team Well-Being                                                     |
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| During a disaster, you may see and hear things that will be extremely |
| unpleasant.                                                           |
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| Vicarious trauma is the process of change in the rescuer resulting    |
| from empathic engagement with survivors. It is an "occupational       |
| hazard" for helpers.                                                  |
|                                                                       |
| Do not overidentify with the survivors. Do not take on the survivors' |
| feelings as your own. Taking ownership of others' problems will       |
| compound your stress and affect the CERT's overall effectiveness.     |
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| Be alert to signs of disaster trauma in yourself, as well as in       |
| disaster victims, so that you can take steps to alleviate stress.     |
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| # Team Well-Being (Continued)                                         |
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| Psychological symptoms may include:                                   |
|                                                                       |
| -   Irritability or anger.                                            |
|                                                                       |
| -   Self-blame or the blaming of others.                              |
|                                                                       |
| -   Isolation and withdrawal.                                         |
|                                                                       |
| -   Fear of recurrence.                                               |
|                                                                       |
| -   Feeling stunned, numb, or overwhelmed.                            |
|                                                                       |
| -   Feeling helpless.                                                 |
|                                                                       |
| -   Mood swings.                                                      |
|                                                                       |
| -   Sadness, depression, and grief.                                   |
|                                                                       |
| -   Denial.                                                           |
|                                                                       |
| -   Concentration and memory problems.                                |
|                                                                       |
| -   Relationship conflicts/marital discord.                           |
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| Physiological symptoms may include:                                   |
|                                                                       |
| -   Loss of appetite.                                                 |
|                                                                       |
| -   Headaches or chest pain.                                          |
|                                                                       |
| -   Diarrhea, stomach pain, or nausea.                                |
|                                                                       |
| -   Hyperactivity.                                                    |
|                                                                       |
| -   Increase in alcohol or drug consumption.                          |
|                                                                       |
| -   Nightmares.                                                       |
|                                                                       |
| -   The inability to sleep.                                           |
|                                                                       |
| -   Fatigue or low energy.                                            |
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+-----------------------------------------------------------------------+
| # Team Well-Being (Continued)                                         |
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| There are steps that CERT team leaders can take to promote team       |
| well-being before, during, and after an incident:                     |
|                                                                       |
| -   [Provide pre-disaster stress management training]{.underline} to  |
|     all CERT personal.                                                |
|                                                                       |
| -   [Brief CERT personnel before the effort begins]{.underline} on    |
|     what they can expect to see and what they can expect in terms of  |
|     emotional response in the survivors and themselves.               |
|                                                                       |
| -   [Emphasize that the CERT is a team]{.underline}. Sharing the      |
|     workload and emotional load can help defuse pent-up emotions.     |
|                                                                       |
| -   [Encourage rescuers to rest and re-group]{.underline} so that     |
|     they can avoid becoming overtired.                                |
|                                                                       |
| -   [Direct rescuers to take breaks]{.underline} away from the        |
|     incident area, to get relief from the stressors of the effort.    |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   [Encourage rescuers to eat properly and maintain fluid            |
|     intake]{.underline} throughout the operation. Explain that they   |
|     should drink water or other electrolyte-replacing fluids, and     |
|     avoid drinks with caffeine or refined sugar.                      |
|                                                                       |
| -   [Rotate teams]{.underline} for breaks or new duties (i.e., from   |
|     high-stress to low-stress jobs). Team members can talk with each  |
|     other about their experiences. This is very important for their   |
|     psychological health.                                             |
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| -   [Phase out workers gradually]{.underline}. Gradually phase them   |
|     from high- to low-stress areas of the incident.                   |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   [Conduct a brief discussion]{.underline} (defusing) with workers  |
|     after the shift, in which workers describe what they encountered  |
|     and express their feelings about it.                              |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   [Arrange for a debriefing 1 to 3 days after the                   |
|     event]{.underline} in which workers describe what they            |
|     encountered and express their feelings about it in a more         |
|     in-depth way.                                                     |
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| CERT leaders may invite a mental health professional trained in       |
| Critical Incident Stress Management (CISM) to conduct a Critical      |
| Incident Stress Debriefing (CISD).                                    |
|                                                                       |
| A CISD is a formal group process held between 1 to 3 days after the   |
| event and is designed to help emergency services personnel and        |
| volunteers cope with a traumatic event.                               |
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+-----------------------------------------------------------------------+
| # Team Well-Being (Continued)                                         |
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| You should spend some time thinking about other ways to reduce stress |
| personally. Only you know what makes you able to reduce stress within |
| yourself. Expending the effort required to find personal stress       |
| reducers is worthwhile [before]{.underline} an incident occurs. You   |
| can take the following preventive steps in your everyday life:        |
|                                                                       |
| -   Get enough sleep.                                                 |
|                                                                       |
| -   Exercise.                                                         |
|                                                                       |
| -   Eat a balanced diet.                                              |
|                                                                       |
| -   Balance work, play, and rest.                                     |
|                                                                       |
| -   Allow yourself to receive as well as give. Remember that your     |
|     identity is broader than that of a helper.                        |
|                                                                       |
| -   Connect with others.                                              |
|                                                                       |
| -   Use spiritual resources.                                          |
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| Experienced rescue workers find these steps helpful in controlling    |
| their stress levels, but, in some cases, it might be necessary to     |
| seek help from mental health professionals.                           |
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| CISD is one type of interventions within a more comprehensive,        |
| multicomponent crisis intervention system that is based on a careful  |
| assessment of the needs of a group or individual. CISD should         |
| [not]{.underline} be used as a stand-alone intervention with other    |
| types be used in conjunction with other types of intervention.        |
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| A CISD has seven phases:                                              |
|                                                                       |
| -   [Introductions and a description]{.underline} of the process,     |
|     including assurance of confidentiality                            |
|                                                                       |
| -   [Review of the factual material]{.underline} about the incident   |
|                                                                       |
| -   [Sharing of initial thoughts/feelings]{.underline} about the      |
|     incident                                                          |
|                                                                       |
| -   [Sharing of emotional reactions]{.underline} to the incident      |
|                                                                       |
| -   [Review of the symptoms]{.underline} of stress experienced by the |
|     participants                                                      |
|                                                                       |
| -   [Instruction about normal stress reactions]{.underline}           |
|                                                                       |
| -   [Closing and further needs assessment]{.underline}                |
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| # Team Well-Being (Continued)                                         |
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| Participation in CISD should be voluntary.                            |
|                                                                       |
| To schedule a CISD, you should contact the Red Cross, local emergency |
| management agency, or community mental health agency. You could also  |
| ask your local fire or police department for help in contacting the   |
| appropriate person.                                                   |
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| # Working with Survivors' Trauma                                      |
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| Some research studies have indicated that survivors go through        |
| emotional phases following a disaster:                                |
|                                                                       |
| -   In the [impact phase]{.underline}, survivors do not panic and     |
|     may, in fact, show no emotion.                                    |
|                                                                       |
| -   In the [inventory phase]{.underline}, which immediately follows   |
|     the event, survivors assess damage and try to locate other        |
|     survivors. During this phase, routine social ties tend to be      |
|     discarded in favor of the more functional relationships required  |
|     for initial response activities (e.g., search and rescue).        |
|                                                                       |
| -   In the [rescue phase]{.underline}, emergency services personnel   |
|     (including CERTs) are responding and survivors are willing to     |
|     take their direction from these groups without protest. This is   |
|     why CERT identification (helmets, vests, etc.) is important.      |
|                                                                       |
| -   In the [recovery phase]{.underline}, the survivors appear to pull |
|     together [against]{.underline} their rescuers, the emergency      |
|     services personnel.                                               |
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| You should expect that survivors will show psychological effects from |
| the disaster---and some of the psychological warfare will be directed |
| toward you.                                                           |
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| A crisis is an event that is experienced or witnessed in which        |
| people's ability to cope is overwhelmed:                              |
|                                                                       |
| -   Actual or potential death or injury to self or others.            |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   Serious injury.                                                   |
|                                                                       |
| -   Destruction of their homes, neighborhood, or valued possessions.  |
|                                                                       |
| -   Loss of contact with family members or close friends.             |
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+-----------------------------------------------------------------------+
| # Working with Survivors' Trauma (Continued)                          |
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| Traumatic stress may affect:                                          |
|                                                                       |
| -   [Cognitive functioning]{.underline}. Those who have suffered      |
|     traumatic stress many act irrationally, have difficulty making    |
|     decisions; or may act in ways that are out of character or them   |
|     normally. They may have difficulty sharing or retrieving          |
|     memories.                                                         |
|                                                                       |
| -   [Physical health]{.underline}. Traumatic stress can cause a range |
|     of physical symptoms---from exhaustion to heat problems.          |
|                                                                       |
| -   [Interpersonal relationships]{.underline}. Those who survive      |
|     traumatic stress my undergo temporary or long-term personality    |
|     changes that make interpersonal relationships difficult.          |
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| The strength and type of personal reaction vary because of:           |
|                                                                       |
| -   [The victim's prior experience]{.underline} with the same or a    |
|     similar event. The emotional effect of multiple events can be     |
|     cumulative, leading to greater stress reactions.                  |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   [The intensity of the disruption]{.underline} in the survivors'   |
|     lives. The more the survivors' lives are disrupted, the greater   |
|     their psychological and physiological reactions may become.       |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   [The meaning of the event to the individual]{.underline}. The     |
|     more catastrophic the victim perceives the event to be to him or  |
|     her personally, the more intense will be his or her stress        |
|     reaction.                                                         |
|                                                                       |
| -   [The emotional well-being of the individual]{.underline} and the  |
|     resources (especially social) that he or she has to cope. People  |
|     who have had other recent traumas may not cope well with          |
|     additional stressors.                                             |
|                                                                       |
| -   [The length of time that has elapsed]{.underline} between the     |
|     event's occurrence and the present. The reality of the event      |
|     takes time to "sink in."                                          |
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| You should not take the survivors' surface attitudes personally.      |
| Rescuers may expect to see a range of responses that will vary from   |
| person to person, but the responses they see will be part of the      |
| psychological impact of the event---and probably will not relate to   |
| anything that the CERTs have or have not done.                        |
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+-----------------------------------------------------------------------+
| # Working with Survivors' Trauma (Continued)                          |
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| The goal of on-scene psychological intervention on the part of CERT   |
| members should be to [stabilize the incident scene by stabilizing     |
| individuals]{.underline}. Do this in the following ways:              |
|                                                                       |
| -   [Assess the survivors for injury and shock]{.underline}. Address  |
|     any medical needs first. Observe them to determine their level of |
|     responsiveness and whether they pose a danger to themselves or to |
|     others.                                                           |
|                                                                       |
| -   [Get uninjured people involved in helping]{.underline}. Focused   |
|     activity helps to move people beyond shock, so give them          |
|     constructive jobs to do, such as running for supplies. This       |
|     strategy is especially effective for survivors who are being      |
|     disruptive.                                                       |
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| -   [Provide support]{.underline} by:                                 |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   [Listening]{.underline} to them talk about their feelings and     |
|     their physical needs. Victims often need to talk about what       |
|     they've been through---and they want someone to listen to them.   |
|                                                                       |
| -   [Empathizing]{.underline}. Show by your responses that you hear   |
|     their concerns. Victims want to know that someone else shares     |
|     their feelings of pain and grief.                                 |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   [Help survivors connect to natural support systems]{.underline},  |
|     such as family, friends, or clergy.                               |
|                                                                       |
| Survivors that show evidence of being suicidal, psychotic, or unable  |
| to care for themselves should be referred to mental health            |
| professionals for support. (This will be infrequent in most groups of |
| survivors.)                                                           |
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| When providing support, they should avoid saying the following        |
| phrases. On the surface, these phrases are meant to comfort the       |
| survivors, but they do not show an understanding of the person's      |
| feelings.                                                             |
|                                                                       |
| -   "[I understand]{.underline}." In most situations we cannot        |
|     understand unless we have had the same experience.                |
|                                                                       |
| -   "[Don't feel bad]{.underline}." The survivor has a right to feel  |
|     bad and will need time to feel differently.                       |
|                                                                       |
| -   "[You're strong/You'll get through this]{.underline}." Many       |
|     survivors do not feel strong and question if they will recover    |
|     from the loss.                                                    |
|                                                                       |
| -   "[Don't cry]{.underline}." It is ok to cry.                       |
|                                                                       |
| -   "[It's God's will]{.underline}." Giving religious meaning to an   |
|     event to a person you do not know may insult or anger the person. |
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+-----------------------------------------------------------------------+
| # Working with Survivors' Trauma (Continued)                          |
+-----------------------------------------------------------------------+
| -   ["It could be worse" or "At least you still have]{.underline}     |
|     ..." It is up to the individual to decide whether things could be |
|     worse.                                                            |
|                                                                       |
| These types of responses could elicit a strong [negative]{.underline} |
| response or distance the survivor from you.                           |
|                                                                       |
| It is ok to apologize if the survivor reacts negatively to something  |
| that you said.                                                        |
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| ## One unpleasant task that CERT members may                          |
| face is managing the family members at the scene of the death of a lo |
| ved one. The guidelines below will help you deal with this situation: |
|                                                                       |
| -   [Cover the body; treat it with respect]{.underline}. Wrap         |
|     mutilated bodies tightly.                                         |
|                                                                       |
| -   [Have one family member look]{.underline} at the body and decide  |
|     if the rest of the family should see it.                          |
|                                                                       |
| -   [Allow family members to hold or spend time with the              |
|     deceased]{.underline}. Stay close by, but don't watch---try to    |
|     distance yourself emotionally somewhat.                           |
|                                                                       |
| -   [Let the family grieve]{.underline}. Don't try to comfort them    |
|     out of a need to alleviate your own discomfort.                   |
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| ## In some cases, the family may                                      |
|  not know of the death of their loved one, and CERT members may be ca |
| lled upon to tell them. Suggest that in this situation, CERT members: |
|                                                                       |
| -   [Separate the family members]{.underline} from others in a quiet, |
|     private place.                                                    |
|                                                                       |
| -   [Have the person(s) sit down]{.underline}, if possible.           |
|                                                                       |
| -   [Make eye contact]{.underline} and use a calm, kind voice.        |
|                                                                       |
| -   Use the following words to [tell the family members]{.underline}  |
|     about the death: "I'm sorry, but your family member has died. I   |
|     am so sorry."                                                     |
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