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Coping with Trauma and Psychological First Aid for Disaster Survivors: Suggestions for American Indians


Coping with Trauma and Psychological First Aid for Disaster Survivors: Suggestions for American Indians EMERGENCY PREPAREDNESS CONFERENCE August 9, 2007 – PowerPoint PPT presentation

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Title: Coping with Trauma and Psychological First Aid for Disaster Survivors: Suggestions for American Indians

Coping with Trauma and Psychological First Aid
for Disaster SurvivorsSuggestions for American
  • August 9, 2007
  • Portland, Oregon

Research Professor Schools of Nursing and
Public Health andCommunity Medicine
Randal Beaton, PhD, EMT
Faculty Northwest Center forPublic Health
Practice University of Washington

Funding Support
  • CDC/ASPH Centers for Public Health Preparedness
    Cooperative Agreement
  • U09/CCU024247-03. (J. Thompson, PI)
  • HRSA Advanced Nurse Education Training grant 1
  • Disaster Environmental Health Nursing
  • (R. Beaton, PI)

Special Thanks
  • Linda Frizzell, E. Cherokee Lakota
  • June Strickland
  • Ticey Casey, Siletz
  • Joe Finkbonner
  • Jay LaPlante, Blackfoot
  • National Child Traumatic Stress Network

Learner Objectives
  • 1. To identify various ways of coping with
    traumatic events including disasters
  • 2. To examine some existing coping strategies in
    American Indians and other suggested potential
    coping strategies
  • 3. To analyze Psychological First Aid as a
    potential intervention for American Indian
    individuals and tribes in the aftermath of trauma

Traumatic Events
  • Traumatic stressors are events that challenge our
    existing ways of making sense out of our own
    reactions, our perceptions of others and
    challenge our fair world assumptions the
    world is safe, the world is predictable and bad
    things do not happen to good people
  • Traumata can evoke fear, uncertainty (can I
    cope?), helplessness hopelessness

Types of Traumatic Events
  • Time-limited single events- such as a motor
    vehicle accident or sexual assault
  • Sequential stressors which can have a cumulative
    effect such as the exposures that firefighters
    experience in line of duty
  • Complex long lasting exposures to danger such as
    war zone combat or intrafamilial child abuse

Disaster Magnitude
  • Crisis- almost routine. Usually can be handled
    by family support system e.g., job loss
  • Emergency- may require 911 response or visit to
    hospital e.g. injury or acute illness
  • Disaster- may require resources from outside
    community (FEMA definition)
  • Catastrophe- Poster child Katrina

Cataclysmic Events
  • These are events or a series of events that are
    of such a magnitude, scope and severity that
    disaster is not really the appropriate term.
  • For examplethe Historical Trauma of American
    Indians whichoccurred over a span of 500 years
    resulting in collective emotional injury over
    life spans across generations (Yellow Horse
    Brave Heart DeBruyn, 1998)

Types of Disasters- (From Beaton Bridges,
Disaster Nursing,in press)
Mental Health Are we ready?Ready for what?
Coping with Traumatic Events
  • Obviously depends on the nature, type duration
    of the trauma, threat or disaster
  • As examples, marriage, divorce death of a
    spouse are all major live events that tax our
    ability to cope.
  • Disaster Exemplar(s) Compare and contrast the
    Exxon Valdez Oil Spill/ Ecological Disaster with
    the Great Alaskan Earthquake/Tsunami of 1964

The Great Alaskan Earthquake
  • On Mar. 27, 1964 (536 pm Alaska standard time) a
    9.2 magnitude earthquake struck Alaska
  • Epicenter was North Prince William Sound
  • Earthquake lasted 4-5 minutes and spawned a
    deadly tsunami

The six-story Four Seasons apartment building in
Anchorage was completely destroyed.
Tsunami Mechanism
Close-up view of tsunami damage along the
waterfront at Kodiak.
Disaster Impact(s)
  • Resulted in 115 fatalities in Alaska 106 due to
    the tsunami
  • The tsunami caused damage and casualties along
    the Western Canadian, Washington and Oregon
  • 84 million in property damage in Alaska alone

The Exxon Valdez Oil Spill
  • On March 24, 1989 just after midnight the Exxon
    Valdez oil tanker struck a reef in Prince William
    Sound and eventually leaked 10.8 million gallons
  • The oil covered large areas of the surface of
    Prince William Sound and drifted with the
    currents winds onto the rocky shores of many of
    the beaches in the region

Map of the Exxon Valdez Oil Spill
Exxon Valdez tanker circled with containment
Dead murrelet.
Oiled sea otter on shore.
Ecological Disaster Impact(s)
  • No human casualties
  • Animal deaths included an estimated
    250,000-500,000 seabirds, 2,800-5,000 sea otters,
    300 harbour seal, 250 bald eagles and 22 orca
  • Impact on fishery, fishing, seafood, sorts
    fisheries tourism industries- economic and
    lifestyle impacts
  • Protracted litigation

Coping may be viewed from a variety of
  • Individual
  • Family
  • Community
  • Tribal
  • In many cases trauma and disaster exceed the
    coping capability of individuals and families and
    require community and tribal intervention and

Coping Strategies Defined
  • Coping strategies refer to specific efforts
    social, behavioral, cognitive and emotional that
    people employ to master, tolerate or minimize
    threats associated with stressful events. (after
    Taylor, 1998)--

Problem- vs. Emotion Focusing Coping
  • Problem-focused coping- trying to figure out
    what the problem is, addressing the root cause of
    the problem and trying to resolve it
  • Emotion-focused coping- engaging in emotional
    discharge for example crying, yelling, venting
    e.g., rants
  • From Tiet et al (2006) Journal of
    Traumatic Stress, 19, 799-811

Approach Avoidance Coping
  • Approach coping making plans, confronting
    difficult situations, trying hard to work things
    out focusing on the positive
  • Avoidance coping Social withdrawal, trying to
    avoid and/or not think about the problem, avoid
    confrontations and conflict even emotional
    numbing (avoiding ones feelings)

Adaptive vs. Maladaptive Coping
  • Adaptive coping effective coping which protects
    or buffers us against stress and helps reduce
  • Maladaptive coping ineffective coping which
    neither reduces stress nor resolves the
  • (See Beaton Murphy, 2002)

The Importance of Stressor Appraisal
  • How we label our perceptions can influence our
  • Little difference in stress physiology between
    excitement and anxiety
  • Paramedics who label a task or event as a
    challenge as opposed to a stressor have lower
    blood pressure readings
  • Most people, most of the time are resilient- and
    say to themselves I know I can handle this

Coping Self-talk in Apollo Astronauts
Biological reaction to stress
  • Under extreme stress frontal lobe turns off,
    limbic system turns on.

H. Simpson
Coping in Puget Area Firefighters (Beaton et al,
Little empirical data are available to guide
suggestions for coping with trauma in American
  • Importance of tribal cultural traditions in
    building community resilience
  • Importance of ceremony and ritual in coping- the
    drums, the colors
  • Importance of tribal connectedness and cohesion
    through song, dance
  • Importance of native art as therapy

Skokomish Tribe
Importance of nature and resources Siletz
Sacred Places Siletz Medicine Rock
The Journey
  • Puget Sound canoe journeys promote tribal
    cohesion sense of community

Skokomish Tribe
Tribal healers elders
  • Wisdom and compassion
  • Sacred beliefs and customs
  • Contrast with non-Indian culture youth worship

Additive Coping Strategies
  • In addition to American Indian customs,
    traditions and tribal ways of coping
  • These coping strategies may or may not be
    culturally appropriate for some or most American
    Indian tribes-- Suggestions
  • Think of these additional coping strategies as a
    MENU pick and choose ones that may work for you,
    your family your tribe

Preventive Approaches to Coping with Disaster
  • Disaster planning- everybody and every family
    needs a family disaster plan.
  • Washington State Disaster Preparedness Handbook
    is available _at_ http//
  • This includes concrete suggestions for helping
    children adjust after a disaster

Helping Children After a Disaster (From Disaster
Preparedness Handbook, 2005)
  • Talk with the children about how they are
    feeling. Assure them that its OK to have those
  • Children should not be expected to be brave or
    tough. Tell them its OK to cry.
  • Dont give children more information than they
    can handle about this disaster.

Other Preventive Approaches to Foster Individual
Community Resilience
  • Survival and Red Cross Training learn CRP and
    basic survival skills
  • Join a community emergency response team such as
  • UW CERT webpage site http//

UW CERT Training Program
  • Training will touch on 8 subject areas and will
    provide basic skills needed to assist disaster
    victims. The courses are free and will take place
    over a period of only two and half days. The
    training will finish up with a 4 hour practical
    exercise designed to put all of the new CERT
    skills to the test. An example of a CERT module
  • Individual and Family Preparedness
  • Learn the types of hazards that are most likely
    to affect your homes and community
  • Learn the functions of CERTs and their role in
    immediate response
  • Identify steps to prepare yourself and your
    family for a disaster

CERT for Tribal Nations
  • In Nov. of 2002 members of five Midwest tribes
    the Kickapoo Tribe in Kanasa, the Omaha Tribe of
    Nebraska, the Praire Band of the Potawatomi
    Nation, the Sac and Fox Nation of Missouri and
    the Winnebago Tribe of Nebraska participated in
    a CERT course supported by a FEMA grant

Preventative Approaches
  • An ounce of prevention is worth a ton of cure.
  • Strategies that can prevent a crisis or emergency
    or mitigation strategies that minimize the impact
    of a disaster are the most important in terms of
    avoiding the harmful mental health effects of

Personal Strategies to Foster Resilience in the
Aftermath of Trauma and Disaster(Adapted From
APA, 2002 Resilience Fact Sheets)
  • Avoid viewing event as insurmountable I will
    recover, my family will recover, my tribe will
    survive and thrive
  • Rely on connections with family, friends, elders
    and tribal leaders
  • Accept that change and loss are part of living

Fostering resilience (continued)
  • Avoid withdrawal coping strategies- engage in
    problem solving and take action
  • Potential for posttraumatic growth- trauma can
    actually lead to opportunities for growth and
    self-discovery (Tedschi et al, 1998)
  • Meditation spiritual practices
  • Maintain a hopeful outlook. There is very, very
    little downside to optimism

Positive Illusions andCreative Self-Deception
Some Unrealistic Optimism may actually be
  • 50 of marriages fail within five years, yet
    marriage remains very popular
  • 95 of cancer survivors think they are doing
    better than most
  • Key is to avoid catastrophizing that is,
    assuming the worst (and even worse)
  • However, minimization (or an extremely positive
    skew) can be problematic when real hazards are
    downplayed or ignored.

Fostering Resilience in the Aftermath
  • Staying flexible sometimes it is fine to
    experience strong emotions other times you may
    need to control your emotions to continue to
  • Flexibility and balance in recovery sometimes
    you will need to deal with demands and other
    times you may need to step back and re-energize

Psychological First Aid (PFA) National Child
Traumatic Stress Network National
Center for PTSD
Basics of Psychological First Aid
  • What is Psychological First Aid?
  • An evidence-informed approach to assist children,
    adolescents, adults, and families in the
    immediate aftermath of disaster and terrorism
  • This approach to disaster survivors mental
    health has been adopted by
  • American Red Cross
  • Medical Reserve Corps
  • Community Emergency Response Teams (CERT)
  • Among others

How Do We Know How to Respond Following Disasters?
Youve lost your home, your job and your pet
how do you feel about that?
Sigmund Freud
Five Empirically-Supported Early Intervention
Promotion of Psychological Sense of Safety
  • Reduces biological aspects of traumatic stress
  • Positively affects thoughts that inhibit recovery

Promotion of Calming
  • Reduces anxiety, high arousal, numbing, or strong
  • Supports better
  • Sleep
  • Eating
  • Decision-making
  • Performance of life tasks
  • May reduce the probability of long-term
    psychological difficulties

Promotion of Self-Efficacy
  • Encourage disaster survivors to play an active
    role in their own recovery
  • Increases peoples beliefs about their
  • Increases self-control of thought, emotions, and

Promotion of Connectedness
  • Related to better emotional well-being and
  • Provides opportunities for
  • Information about resources
  • Practical problem-solving
  • Emotional understanding
  • Sharing of experiences
  • Normalization of
  • reactions and experiences
  • Sharing of ways of coping

Instilling Hope
  • Favorable outcomes
  • are associated with
  • Optimism
  • Positive expectancy
  • A feeling of confidence in life and/or self
  • Strong faith-based beliefs

Basics of Psychological First Aid
  • Who is it for?
  • Individuals experiencing acute stress reactions
    or who appear to be at risk for significant
  • Who is it delivered by?
  • Disaster response workers or others who are
    trained to provide early assistance
  • When is it intended to be delivered?
  • Immediate aftermath
  • Where can it be delivered?
  • A broad range of emergency settings, in either
    single or multiple sessions (shelters, community

Some Basics
  • Expect normal recovery
  • Assume survivors are competent
  • Recognize survivor strengths
  • Promote resilience

Contact and Engagement
  • 1 Establish a connection with survivors in a
    non-intrusive, compassionate manner.
  • Introduce self and describe role
  • Ask for permission to talk
  • Explain objective
  • Ask about immediate needs

Safety and Comfort
  • 2 Enhance immediate and ongoing safety, and
    provide physical and emotional comfort.
  • Are you cold do you need a blanket?

  • 3 Calm and orient emotionally-overwhelmed/distrau
    ght survivors.

Information Gathering Current Needs and Concerns
  • 4 Identify immediate needs and concerns, and
    gather additional information, and tailor PFA
  • Nature and severity of experiences
  • Death of a loved one (or family pet)
  • Concerns about the post-disaster circumstances
    and threat
  • Separation from or concerns about the safety of
    loved ones
  • Physical illness, mental health conditions, and
    need for medications
  • Losses incurred as a result of the disaster
  • Extreme feelings of guilt or shame
  • Thoughts about causing harm to self or others
  • Immediate developmental impact
  • Availability of social support
  • Prior alcohol or drug use
  • Prior exposure to trauma and death of loved ones

Practical Assistance
  • 5 Offer practical help to survivors in
    addressing immediate needs and concerns.
  • Identify the most immediate need(s)
  • Clarify the need
  • Discuss an action plan
  • Act to address the need

Connection with Social Support
  • 6 Help establish brief or ongoing contacts with
    primary support persons or other sources of
    support, including family members, friends, and
    community helping resources.

Information on Coping
  • 7 Provide information about stress reactions and
    coping to reduce distress and promote adaptive
  • What is currently known about the unfolding event
  • What is being done to assist them
  • Available services
  • Post-disaster reactions and how
  • to manage them
  • Self-care and family care
  • Coping
  • Alcohol substance abuse

Linkage with Collaborative Services
  • 8 Links survivors with available services needed
    at the time or in the future.
  • Provide direct link to additional needed services
  • What counseling services are available to your
    tribal members?

Possible Indications of a Need for a Referral
  • An acute medical or mental health problem
  • Threat of harm to self or others
  • Concerns related to the use of alcohol or drugs
  • Cases involving domestic, child, or elder abuse
    (be mindful of reporting laws as well)
  • Ongoing difficulties with coping (4 weeks or more
    after the disaster)
  • Significant developmental concerns about children
    or adolescents
  • When the survivor asks for a referral
  • Medication evaluation?

Summary and Next Steps
  • American Indian tribes and peoples have 500 years
    of experience of coping with trauma
  • Historical trauma has been considered a risk
    factor for PTSD but it may also serve as a
    source of strength
  • Effective ways of coping depend on the cultural
    context, the nature, intensity duration of the
    trauma or disaster

Summary and Conclusions Coping with Trauma and
  • American Indian tribes and individuals have a
    number of protective traditions, rituals and
    ceremonies as well as other cultural sources of
  • The principles and actions of Psychological First
    Aid might also assist American Indian tribes,
    families and individuals to cope in the aftermath
    of traumatic events including disasters