Advanced Training in the

Psychological Management
of Trauma and Disasters
Dr. Kevin Becker
and
Dr. Guy Sapirstein
The course is offered by NISE and
Sponsored by IBM
 PSYCHOLOGICAL REACTIONS
TO DISASTER

SAMHSA
 PHASES OF DISASTER REACTION

• Warning of threat
• Impact
• Rescue or Heroic
• Remedy or Honeymoon
• Inventory
• Disillusionment
• Reconstruction and Recovery
Key Principles in Disaster work
• SAFETY
• PREDICTABILITY
• CONTROL
 Biopsychosocial Model
• Biological – Brain and physiology
• Psychological – cognitive and
emotional
• Social/community – Behavior,
interpersonal interactions and
community functioning
 Behavioral Reactions

• Sleep Problems
• Crying Easily
• Avoiding Reminders
• Excessive Activity levels
• Increased conflict with family
• Hypervigilance, startle reactions
• Isolation or social withdrawal
 COGNITIVE REACTIONS

• Confusion, disorientation
• Recurring dreams or nightmares
• Preoccupation with disaster
• Trouble concentrating or remembering things
• Difficulty making decisions
• Questioning spiritual beliefs
 EMOTIONAL REACTIONS

• Depression, sadness
• Irritability, anger, resentment
• Anxiety, fear
• Despair, hopelessness
• Guilt, self-doubt
• Unpredictable mood swings
 PHYSICAL REACTIONS

• Fatigue, Exhaustion
• Gastrointestinal distress
• Appetite change
• Tightening in throat, chest or stomach
• Worsening of chronic conditions
• Somatic Complaints
 EFFECTS OF LONG-TERM DISASTER STRESS

• Anxiety and vigilance

• Anger, resentment and conflict
• Uncertainty about the future
• Prolonged mourning of losses
• Diminished problem-solving
• Isolation and hopelessness
• Health problems
• Physical and mental exhaustion
• Lifestyle changes
Myths About Children
•They are better off not knowing…
•They forget about bad events easily
•Boys should not express sadness
•Living through tough times makes you
stronger
•Hitting them helps them learn better
 Symptoms of PTSD
• Criterion A: Exposure to a traumatic event
which included:
• the person witnessed or was confronted with an
event that threatened death or serious injury to
self or others
• and the person’s response included intense fear,
helplessness or horror
 Traumatic Events include...
• Natural Disaster
• Violent/Sudden Death of Loved One
• Witness to Violence
• Physical Assault
• Rape
• Child abuse and exploitation
• War
• Serious car accidents
• Other serious life events
 Symptoms of PTSD
• Criterion B: Re-experiencing
• Intrusive recollections, images, thoughts or
perceptions
• Recurrent distressing dreams
• Flashbacks (not simply remembering)
• Distress at exposure to reminders
• Physiological reactivity to reminders
 Symptoms of PTSD
• Criterion C:Avoidance
• Efforts to avoid thoughts, feelings, activities, places, or people
associated with the trauma
• Inability to recall important aspects
• Markedly diminished interests
• Restricted range of affect
• Sense of detachment
• Foreshortened sense of future
 Symptoms of PTSD
• Criterion D: Hyperarousal
• Difficulty falling or staying asleep
• Irritability or outbursts of anger
• Difficulty concentrating
• Hypervigilance (being ‘on guard’ all the time)
• Exaggerated startle response
 Symptoms of PTSD
• Criterion E:
• The duration of symptoms is more than 1 month
• Criterion F:
• Causes significant distress or impairment in social,
occupational, or other important areas of functioning
 Complex PTSD
in Children - Adolescents
• History of multiple traumas
• Alterations in affect regulation
• Alterations in consciousness (Dissociation)
• Alterations in perception of self
• Alterations in cognition
• Alterations in attachments with others
• Alterations in behavior controls
• Alterations in biology/physiology
Techniques for managing traumatic
stress
• Grounding
• Diaphragmatic breathing
• Relaxation
• Safe place exercise
Coping Strategies
Secondary Traumatization

“There is a cost to caring”

---Charles Figley, Ph.D.
 Secondary Traumatization
Signs and Symptoms:
Work addiction
Nightmares
Disconnected from loved ones
Social Withdrawal
Increased sensitivity to violence
Heightened startle response
Sense of hopelessness
Hypervigilance: being on edge
 Secondary Traumatization
• Secondary Traumatization:
Interaction based
Traumatic material
Develops suddenly (often)
PTSD symptoms
Worldview changes
 Secondary Traumatization
What makes helping work?
…empathy/identification/safety/trust/intimacy/
control

What makes helping hurt?

…empathy/identification/safety/trust/intimacy/
control
 Addressing VT/STS
• AWARENESS

• BALANCE

• CONNECTION
 Secondary Traumatization
Self-Care Strategies
• Balance your work & personal life
• Seek non-victim related activities
• Respect your personal boundaries
• Develop realistic expectations
• Experience/Address emotions
• Avoid professional isolation
• Know your vulnerable areas
 Specific issues with children and
adolescents:
• Multiple systems
• Power differential
• Less communication
• Bias against children
• Earlier development
• Stronger rescue fantasies
• Not enough adequate training in trauma therapy
with children
 Potential problems in organizations
• No respite for staff
• Dealing with many people who have been
affected
• No supervision
• Denial of the impact on staff
 Contributing factors
The situation:
• Nature of the work
• Cumulative exposure to trauma
• Organizational context
• Social and cultural context

The individual:
• Personal history
• Personality
• Current life context
• Training and professional history
• Supervision
“It takes two to tell the truth: One to say it and the
other to listen.

H.D. Thoreau
 WEB RESOURCES ON TRAUMA
• www.ncptsd.org National Center for PTSD
• www.traumacenter.org Boston, Trauma Center
• www.trauma-pages.com David Baldwin’s trauma pages
• www.nctsnet.org National Child Traumatic Stress
Network
• www.EMDRIA.org EMDR International
• Dr. Kevin Becker Kevin@ORIConsulting.com
• Dr. Guy Sapirstein Guy@ORIConsulting.com