Common causes are acute disability or acute serious diseases; Broken love relationship; Sudden loss of relatives (such as parents, spouses or children) or friends, such as sudden death of relatives or friends or breakdown of relations; Lovelorn; Bankruptcy or major property or housing losses; Fail an important exam; Promotion failed; Serious natural disasters such as fire, flood and earthquake.
2. Three stages of coping with psychological crisis normally
Everyone will respond to serious events, but different people have different intensity and duration of response to the same event. The general coping process can be divided into three stages: the first stage (immediate response), the parties show numbness, denial or disbelief; The second stage (complete reaction), feeling excited, anxious, painful and angry, but also feeling guilty, shrinking or depressed; The third stage (elimination stage) is to accept the facts and make plans for the future. The crisis process will not last long, such as the sudden death of relatives or friends, which usually disappears within 6 months, otherwise it should be regarded as pathological.
3. Characteristics of psychological crisis
(1) is usually self-limiting and disappears within more than 1 ~ 6 weeks.
(2) In times of crisis, individuals will send a signal that they need help and are more willing to accept outside help or intervention.
(3) The prognosis depends on the individual's quality, adaptability and initiative, as well as the help or intervention of others.
4. The main purpose of psychological crisis intervention
(1) Prevent excessive behavior, such as self-mutilation, suicide or attack.
(2) Promote communication, encourage the parties to fully express their thoughts and feelings, encourage their self-confidence and correct self-evaluation, and provide appropriate suggestions to promote the solution of problems.
(3) Provide appropriate medical help to deal with fainting, emotional shock or excitement.
5. The principle of psychological crisis intervention
(1) Quickly identify the problems that need intervention, emphasize the existing problems and take corresponding measures immediately.
(2) Family members or friends must participate in crisis intervention.
(3) Encourage self-confidence and don't let the parties feel dependent.
(4) treat psychological crisis as a psychological problem, not as a disease.
6. Common psychological crisis and its intervention
(1) Psychological reaction to physiological diseases;
(1) The psychological reaction of acute diseases is as follows:
First, anxiety, patients feel nervous, anxious and uneasy. In severe cases, people feel a catastrophe, accompanied by autonomic nervous symptoms, such as dizziness, palpitation, sweating, tremor, nausea, frequent defecation and so on. And there may be signs of excessive sympathetic nervous system activity, such as increased blood pressure, increased heart rate, flushed or white face, sweating, cold skin, muscle tension in the face and other parts, etc.
The second is fear. Patients are worried and suspicious about their illness, and in serious cases, they are scared.
Third, depression, because psychological stress can lead to depression, pessimism and despair, lack of interest in external things, reduced speech, reluctance to associate with people, lack of food, and even suicidal thoughts or behaviors in severe cases.
② Psychological reaction in chronic diseases:
First, depression, most people are depressed, especially introverted patients are prone to this psychological reaction. Will produce pessimistic thoughts, even suicidal thoughts or behaviors.
Second, personality changes, such as always complaining about others, complaining about doctors' careless treatment, complaining about family members' failure to take care of them wholeheartedly, deliberately finding fault, and often furious because of trivial matters. They are sensitive to minor changes in their bodies and often require excessive treatment or care, which leads to the tension or deterioration of the doctor-patient relationship and interpersonal relationship within the family. The principle of intervention is active supportive psychotherapy combined with drug therapy, so as to minimize their pain. When choosing drugs, we should consider the nature of the disease, the problems caused and the symptoms of depression and anxiety of patients. Take cancer for example. For example, morphine can be used to relieve pain, antidepressants can be used to treat depression, and antianxiety drugs can be used to treat anxiety.
(2) the relationship is broken:
Losing love will cause serious pain and resentment, and some may commit suicide, or turn love into hate, take aggressive actions, and attack lovers or so-called third parties. The principle of intervention is to fully talk with the parties concerned, pointing out that love and affection can't be forced, it's not worth dying for, and there must be a chance to find someone you love. Similarly, those who intend to attack should be prevented from doing so. Point out the criminal nature and possible serious consequences of this behavior, so it is necessary to prevent the parties from committing suicide and reckless attacks. Generally speaking, it won't last long, so giving appropriate help and advice can help the parties to tide over the crisis smoothly. For a long time after the crisis, the parties may think that they can't trust women (or men) in the world and have a bad belief, but this will not seriously affect their lives, and will gradually fade with the passage of time.
(3) marital barriers:
The relationship between husband and wife is broken, and the ending is mostly divorce. If both sides can accept it, it will not lead to a crisis, otherwise it may lead to a crisis.
(1) Temporary disputes between husband and wife, such as emotional conflicts at that time, may lead to impulsive behavior and even murder. The principle of intervention is to temporarily separate, wait for both sides to think calmly, accept appropriate psychological counseling, help solve problems, and prevent similar problems from happening again in the future.
(2) Long-term disputes between husband and wife, including mutual distrust, one party having an affair, being abused, property or economic disputes. This can lead to headache, insomnia, loss of appetite and weight loss, fatigue, upset, depression and so on. For both parties (especially the woman), in severe cases, there are suicide attempts or behaviors. The principle of intervention is to try to mediate the contradictions between the two sides, otherwise divorce is an inevitable outcome. People who attempt suicide should prevent suicide and give appropriate drugs to improve sleep, anxiety and depression.
(4) Sad reaction to the death of a loved one (bereavement reaction):
The closer the person is to the deceased, the more serious the sad reaction will be. If a loved one dies suddenly or unexpectedly, such as a traffic accident or natural disaster, the sad reaction is the heaviest.
① Acute reaction: extreme pain after hearing the bad news. In severe cases, emotional numbness or fainting may also lead to dyspnea or suffocation, or crying in pain, or being in a state of extreme excitement. The principle of intervention is to immediately put the fainter in the supine position, and if the blood pressure continues to be low, intravenous fluid replacement should be given. Those who are emotionally numb or seriously excited should take BZ to help them fall asleep. When mourners wake up, they should show sympathy and create a supportive atmosphere so that mourners can take logical steps to gradually alleviate their grief.
② Sad reaction: During mourning, you feel anxious and depressed, or feel guilty or guilty because you didn't care enough about the deceased before your death. The image of the deceased often appears in your mind or hallucinations, which makes it difficult for you to stick to your daily activities and even manage your daily life. It is often accompanied by gastrointestinal symptoms such as fatigue, insomnia and loss of appetite. Patients with major depression may have suicidal attempts or behaviors. The principle of intervention is to let mourners fully express their feelings and give supportive psychotherapy. Use BZ to improve sleep and reduce anxiety and depression. Suicide attempts should be supervised by special personnel.
③ Pathological mourning reaction: such as grief or depression lasting for more than 6 months, obvious excitement or dull depression, persistent suicide attempt, hallucination, delusion, apathy, panic attack, or excessive activity without sadness, hasty or irresponsible behavior, etc. The principle of intervention is appropriate psychotherapy and the treatment of antipsychotics, antidepressants and anxiolytics.
(5) Bankruptcy or major economic losses:
It can make the parties extremely sad and miserable, feel desperate and have suicidal thoughts, and then take suicidal actions. The principle of intervention is to fully communicate with the parties. Suicide can't recover the economic losses that have happened, and it is possible to make a comeback through renewed efforts. If the patient can't give up the suicide attempt through verbal communication, a special person should be assigned to monitor and prevent the relevant personnel from taking suicide action. After the crisis, the parties may gradually regain their confidence, or they may have long-term depression, insomnia, loss of appetite or other digestive symptoms. Supportive psychotherapy and antidepressants can be given.
(6) Failure in important exams: Failure in exams that are of great significance to individuals will cause painful emotional experiences, usually manifested as shrinking back and unwilling to contact with people, and in severe cases, suicide may be taken. The principle of intervention is to take measures to prevent suicide attempts. Most of these cases happen to young people, who are very resilient and can rebound after the crisis.
(7) Promotion failure: occasional suicide or aggression, mainly because of being pessimistic about the future or ashamed to meet people. Sometimes I attack out of resentment. If I think my promotion failed because of someone's obstruction, I will attack or kill them. The principle of intervention is to prevent suicide and aggression, have a full conversation with the parties, let them vent their anger and give appropriate suggestions.
Psychological crisis intervention in earthquake-stricken areas
I. Preparation before intervention
Understanding the situation in the disaster area, including roads, weather, disaster situation, and the current government rescue plan and implementation, is an important preparation to ensure the smooth development of psychological rescue activities.
1. Determine the intervention site
2. Determine the objects of intervention and their distribution and quantity.
3. Formulate the implementation plan of crisis intervention.
4. Compile and print psychological crisis intervention assessment tools and related publicity materials.
5. Contact to understand the distribution and resettlement of the communities, hospitals, hospitalized injured people, victims and their families to be intervened, and formulate specific intervention processes and routes.
6. Accommodation arrangement of intervention group, personal belongings of intervention group members and preparation of commonly used drugs.
7. If possible, train local psychiatric medical staff on crisis intervention knowledge and expand human resources.
Second, the formulation of the action plan.
(A) the purpose of crisis intervention
Actively prevent, timely control and mitigate the social and psychological impact of disasters; Promote post-disaster mental health reconstruction; Maintain social stability and safeguard public mental health.
(2) principle
1. Integrate with the overall rescue activities, adjust the focus of psychological rescue in time, and cooperate with the overall disaster relief work;
2. Work under the premise of social stability, without increasing the overall burden of rescue work and reducing secondary injuries;
3. Comprehensive application of intervention technology to provide personalized help for current problems.
4. Protect the privacy of interveners and don't disclose personal information casually;
Obviously, psychological crisis intervention is a part of medical rescue, not a panacea.
(3) Methods
Combining assessment, intervention, education and publicity to provide psychological rescue services for disasters; Try to monitor and predict the social psychology of disasters, and provide early warning and solutions for rescue organizers to deal with sudden group psychological events; Promote the formation of a post-disaster community psychosocial intervention support network.
(four) to determine the target population and quantity.
People who were psychologically affected by this earthquake disaster can be roughly divided into five categories. At present, the key intervention targets start from the first-class population, and the general intervention propaganda covers the fifth-class population widely.
First-class people: people directly involved in earthquake disasters, families of victims and the wounded.
The second level crowd: individuals and their families who are closely related to the first level crowd may have serious sadness and guilt reactions and need to alleviate the secondary stress reaction; On-site ambulance personnel (firefighters, armed police officers and soldiers, 120 ambulance personnel, other ambulance personnel), and earthquake disaster survivors. This group is a high-risk group and the focus of intervention. Without psychological intervention, some of them may have long-term and serious psychological disorders.
Third-level people: off-site workers engaged in rescue or search (backup), people or volunteers who help rebuild or recover after the earthquake disaster.
The fourth group: community members outside the disaster-stricken areas, organizations that provide materials and assistance to the victims and are responsible for the possibility of disasters.
The fifth group of people: individuals who are out of control when approaching the disaster site are extremely vulnerable and may show signs of mental illness.
(5) Timetable
Arrange the work schedule according to the target population and the number of members of the intervention group.
(six) determine the intervention technology
ABC method:
First, psychological first aid to stabilize the mood
B, behavior adjustment, relaxation training, interview technology (CISD)
C, cognitive adjustment, interview technology (CISD)+ eye movement desensitization information reprocessing technology (EMDR)
1. First of all, we must gain the trust of the injured and establish a good communication relationship;
2. Provide opportunities for venting and encourage them to express their inner feelings;
3. To provide the interviewer with the knowledge of psychological crisis and crisis intervention, and explain the development process of psychological crisis, so that he can understand the current situation, understand the feelings of others, build self-confidence and improve his ability to cope with physical and psychological stress;
4. According to different individuals' reactions to events, different psychological intervention methods are adopted, such as actively coping with acute stress reaction, conducting psychological consultation, supportive psychotherapy, cognitive correction, relaxation training, interview technology (CISD), etc. In order to improve anxiety, depression and fear, reduce the occurrence of excessive behavior, and use sedatives appropriately when necessary;
5. In addition to the routine application of the above techniques for psychological intervention, the standardized and programmed psychological intervention method-eye movement desensitization information reprocessing technology (EMDR) is introduced;
6. Mobilize and play the role of social support systems (such as families and communities), encourage more contact and contact with family members, relatives and colleagues, and reduce loneliness and loneliness.
(VII) Key points of intervention technology
1. Psychological first aid
(1) Contact and participation
Goal: Listen and understand. Respond to survivors, or start to contact survivors in a non-mandatory, compassionate and beneficial way.
(2) Safety confirmation
Goal: Enhance the sense of security at present and in the future, and provide practical and emotional relaxation.
(3) Stabilize the mood
Objective: To make survivors who have been emotionally destroyed or lost their sense of direction gain psychological peace and restore their sense of direction. Anger management technology, sadness intervention technology.
(4) dispel doubts and doubts
Objective: Identify problems that need immediate attention and explanation, and give possible explanations and confirmations immediately.
(5) Practical assistance
Objective: To provide practical help for survivors, such as asking about the difficulties in real life, and to help survivors adjust and accept the living environment and state changed by the earthquake, so as to cope with the real needs and concerns. Problem solving skills.
(6) Contact support personnel
Objective: To help survivors establish short-term or long-term contact with their main supporters or other sources of support, including family members, friends, community help resources, etc.
(7) Providing information
Objective: To provide information about stress response and how to deal with it correctly, so as to reduce pain and promote adaptive function.
(8) Contact other service departments
Objective: To help survivors get the services they need now or will need soon. Screening treatment.
2. Psychological interview
A method to relieve stress through systematic conversation and voluntary participation of individuals or groups. For patients with mild earthquakes in wards, or medical staff and rescuers, group interviews can be conducted according to different groups of people.
The goal of psychological interview: openly discuss inner feelings; Support and comfort; Resource mobilization; Help patients digest traumatic experiences psychologically (cognitively and emotionally). Time limit for group visits: 24-48 hours after the disaster is the ideal time to help, and the effect is not great after 6 weeks. Usually within 24-48 hours after the incident, regular group interviews are conducted under the guidance of qualified mental health professionals. Instructors must have a broad understanding of group help, and instructors must have a broad understanding of stress response syndrome. There will be no group interview within 24 hours after the incident. Everyone involved in the incident must attend a group interview.
Interview process: it is divided into six stages, and the second stage, the third stage and the fourth stage can be used in combination when operating under abnormal circumstances.
The first introduction period: Instruct the teacher to introduce himself, introduce the rules of group interview, and carefully explain the confidentiality issues.
The second fact period: participants are required to describe some actual situations of themselves and the event itself when the earthquake happened; Ask participants where they are in these serious incidents, what they heard, what they saw, what they smelled and what they did; Every participant must speak, and then the participants will feel that the whole event will be revealed.
The third feeling period: ask the feeling question: How did you feel when the incident happened? How are you feeling? Have you ever had a similar feeling before?
The fourth symptom stage: please describe your symptoms of stress response syndrome, such as insomnia, loss of appetite, the shadow of events constantly flashing in your brain, inattention, decreased memory, decreased decision-making and problem-solving ability, easy to lose your temper, and easy to be frightened. Ask participants what unusual experiences they had during the earthquake and what unusual experiences they have at present. How has life changed since the incident? Ask participants to discuss how their experiences have influenced and changed their family, work and life.
The fifth counseling period: introducing normal reaction; Provide accurate information and explain events and stress response patterns; Normalization of stress response; Emphasize adaptability; Discuss positive adaptation and coping styles; Provide information about further services; Remind possible co-existing problems (such as drinking); Give strategies to reduce stress; Self-identity symptoms.
The sixth recovery period: the collection is over; Summarize the interview process; Answer questions; Guarantee; Discuss the action plan; Reiterate that * * * is the same as reaction; Emphasize the mutual support of team members; Available resources; Moderator's summary.
The whole process takes about 2 hours to complete. Follow-up within weeks or months after a serious incident.
Matters needing attention in interview:
(1) Those who are depressed or look at the interview in a negative way may have a negative impact on other participants.
(2) Because interviews are consistent with specific cultural cues, sometimes cultural ceremonies can replace interviews.
(3) For people with acute grief, such as the death of family members, it is not suitable for group interviews. Because of the bad timing, if you attend the interview, those who are highly traumatized may bring more catastrophic trauma to others in the same meeting.
(4) WHO does not support single implementation only for victims.
(5) After interviewing the victims, the intervention group should organize group members to conduct group interviews to reduce the pressure of the interveners.
(6) Don't force the details of the disaster.
3. Relaxation technology
Except for those with obvious separation reaction, all the people who were intervened were taught a relaxation technique: breathing relaxation, muscle relaxation and imagination relaxation.
Third, the psychological crisis intervention process
(a) the expert group shall make recommendations to the government and relevant departments in a timely manner.
1. If the wounded and their families in some hospitals are too concentrated, it will bring some hidden dangers to the rescue work and aftercare. It is recommended to treat it as decentralized as possible;
2. The families of the deceased should be scattered as far as possible, accompanied and provided with support and help; Prevent them from having an emotional outburst together, so as not to deal with the aftermath passively.
3. The information of casualties and their families should be open, transparent, true and timely, so as not to cause disturbance and bring secondary difficulties to the rescue work.
4. While providing psychological assistance to the wounded and their families, government departments should pay attention to the psychological pressure of rescuers and organize them to participate in the collective psychological counseling provided by the working group.
5. Mobilize social forces to participate, use media resources to publicize the knowledge of psychological crisis and mental health to the affected people, publicize effective methods to deal with disasters, mobilize local government personnel, rescuers, medical personnel, community workers or volunteers to receive training from the working group, and let them participate in psychological assistance activities.
6. Hold regular information conferences to let the public know the progress of the rescue work and the work that has been done, pay attention to sorting out the information that must be conveyed before the release, answer the reporter's questions as accurately and completely as possible, and ensure the truth as much as possible. If there is no information or the information is unreliable, answer truthfully; Be proactive and guide public opinion.
7. It is suggested that the headquarters can further coordinate the relationship between various departments in order to carry out psychological crisis intervention smoothly.
After the proposal is put forward, we should try our best to communicate with the local government in order to get attention and adoption, and take effective measures to implement it.
(2) Work flow
1. Contact the rescue headquarters and the hospital to determine the hospitalization distribution of the earthquake victims and the medical staff entering the scene for rescue.
2. Draw up the contents of psychological crisis intervention training, brochures and psychological crisis assessment tools, and print them urgently.
3. In the evening, convene personnel to hold technical training to unify thoughts and technical routes, including psychological crisis intervention techniques, processes and evaluation methods.
4. Call the personnel and equipment of the local mental health center urgently.
5. Group to hospitals and communities, interview earthquake victims and related medical staff, and distribute publicity materials on psychological crisis intervention.
6. Using evaluation tools, psychological screening, key population evaluation and crisis dynamic analysis were conducted for interviewers one by one.
7. According to the evaluation results, conduct preliminary psychological intervention on the spot for those who have psychological stress reaction.
8. In every hospital, hospital leaders are told about the guidance, diagnosis and treatment of patients, the communication skills between staff and patients, and the staff's own mental health care technology.
9. Follow up every patient with acute psychological stress, strengthen psychological intervention and necessary psychological treatment, and conduct psychological evaluation again after treatment.
10. Interventions such as collective lectures, individual counseling and collective interviews were conducted for community cadres and hospital medical staff. It is found that there are obvious stress reactions among the medical staff on the spot, which are mainly manifested in flashback of traumatic earthquake disaster scenes, emotional instability, anxiety, loss of appetite, insomnia, and decreased work efficiency.
1 1. Every night, members of the working group hold a meeting to summarize the work of the day, adjust the work plan and deploy the next step. Supervise interveners.
I can't go into too much detail.