chapter 21: crisis: theory and intervention copyright © 2012, 2007 mosby, inc., an affiliate of...

Chapter 21:Chapter 21:

Crisis: Theory and InterventionCrisis: Theory and Intervention

Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

22Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Historic and Theoretic Historic and Theoretic PerspectivesPerspectives

EquilibriumEquilibrium HomeostasisHomeostasis Crisis intervention Crisis intervention


CrisisCrisis

Psychological disequilibriumPsychological disequilibrium Stressful event with the potential to overwhelm Stressful event with the potential to overwhelm

and strain copingand strain coping A turning point for growth and changeA turning point for growth and change May encouragement movement from May encouragement movement from

complacencycomplacency


Four Defining Components Four Defining Components

Specific, unexpected and non-routine eventsSpecific, unexpected and non-routine events Create uncertaintyCreate uncertainty Perceptions of threatPerceptions of threat Transformational Transformational


Risk Factors for CrisisRisk Factors for Crisis

Concurrent or multiple bio-psychosocial Concurrent or multiple bio-psychosocial stressorsstressors

Multiple lossesMultiple losses LimitationsLimitations Chronic pain/disabilityChronic pain/disability Poor or inadequate support networksPoor or inadequate support networks Limited access to health careLimited access to health care


Types of CrisisTypes of Crisis

1.1. ExternalExternal

2.2. Internal Internal

3.3. MaturationalMaturational

4.4. AdventitiousAdventitious


Caplan’s PhasesCaplan’s Phases

1.1. Individual is exposed to a stressorIndividual is exposed to a stressor

2.2. Prior coping strategies fail to relievePrior coping strategies fail to relieve

3.3. Mobilization of resources to resolve and Mobilization of resources to resolve and alleviate discomfortalleviate discomfort

4.4. Absence of crisis resolution leads to major Absence of crisis resolution leads to major disorganizationdisorganization


Human Response to CrisisHuman Response to Crisis

A person’s response is often an ordinary A person’s response is often an ordinary response to an extraordinary eventresponse to an extraordinary event

An attempt to restore balanceAn attempt to restore balance Crisis disrupts bio-psychosociospiritual Crisis disrupts bio-psychosociospiritual

homeostasishomeostasis


Potential Responses to CrisisPotential Responses to Crisis

ShockShock NumbnessNumbness DenialDenial Dissociative behaviorDissociative behavior ConfusionConfusion DisorganizationDisorganization Difficulty making decisionsDifficulty making decisions SuggestibilitySuggestibility Physiologic symptomsPhysiologic symptoms


Psychological Stages After a Psychological Stages After a DisasterDisaster

1.1. Heroic PhaseHeroic Phase

2.2. Honeymoon phaseHoneymoon phase

3.3. Disillusionment phaseDisillusionment phase

4.4. Reconstruction Reconstruction


Situational CrisesSituational Crises

Result from external stressors:Result from external stressors: Threat to safety or well-beingThreat to safety or well-being

Job lossJob loss DivorceDivorce Death of loved oneDeath of loved one Serious medical conditionSerious medical condition

Natural disastersNatural disasters Man-made disastersMan-made disasters


Psychiatric Disorders Psychiatric Disorders Associated With CrisisAssociated With Crisis

DepressionDepression Anxiety disordersAnxiety disorders Adjustment disordersAdjustment disorders Posttraumatic stress disorder (PTSD)Posttraumatic stress disorder (PTSD)


Additional PTSD Symptoms Additional PTSD Symptoms in Childrenin Children

Regressed behaviorRegressed behavior Increased fearsIncreased fears Poor concentrationPoor concentration Decreased academic performanceDecreased academic performance Increased oppositional behaviorIncreased oppositional behavior Irritability and aggressionIrritability and aggression Emotional labilityEmotional lability DepressionDepression


Method of Crisis InterventionMethod of Crisis Intervention

1.1. Assessment Assessment

2.2. Planning therapeutic interventionPlanning therapeutic intervention

3.3. InterventionIntervention

4.4. Resolution of crisisResolution of crisis

5.5. Anticipatory planningAnticipatory planning


Crisis InterventionCrisis Intervention

Offer short-term strategic therapy.Offer short-term strategic therapy. Provide timely intervention.Provide timely intervention. Stabilize victims with order and routine.Stabilize victims with order and routine. Facilitate understanding of event (gather Facilitate understanding of event (gather

facts, listen, teach). facts, listen, teach). Use available resources to promote Use available resources to promote

independent functioning.independent functioning. Encourage self-reliance.Encourage self-reliance. Assist with practical coping strategies.Assist with practical coping strategies.


Global InterventionGlobal Intervention

Art and science of dealing with natural andArt and science of dealing with natural and

man-made disasters man-made disasters Reduce loss of life and propertyReduce loss of life and property Protect communities from hazards Protect communities from hazards


Crises Caused by Psychiatric Crises Caused by Psychiatric EmergenciesEmergencies

UrgencyUrgency Impending doomImpending doom Intolerable anxietyIntolerable anxiety Sense of being overwhelmed Sense of being overwhelmed Inability to copeInability to cope May not recognize the need for helpMay not recognize the need for help


Psychiatric EmergenciesPsychiatric Emergencies

Life-threatening behaviorLife-threatening behavior Life disruptingLife disrupting Life impairingLife impairing


Robert’s ModelRobert’s Model

A: Assessment and appraisal of immediate A: Assessment and appraisal of immediate medical needs, threats, property damage, medical needs, threats, property damage, and trauma and trauma

C: Connection to support and disaster reliefC: Connection to support and disaster relief T: Trauma treatment plansT: Trauma treatment plans


Prevention StrategiesPrevention Strategies

PrimaryPrimary SecondarySecondary TertiaryTertiary

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