We are living through an unprecedented time; our lives have changed dramatically and without warning. We are all affected by fear of personal risk, potential loss of loved ones, through the consequences of self-isolation, loss of earnings, and uncertainty about the future. Many are working in the front line, as key workers, particularly NHS staff and other first responders. They are witnessing situations that are far from normal. Experiences that can leave an imprint on well-being and mental health. This short article shows how crisis can affect people and how trained therapists can help them going through critical and traumatic events with appropriate tools. It further highlights the importance of seeking help to be able to mobilise inner and outer resources early on, to develop a sense of agency and avoid further traumatisation. A crisis develops as an internal response to an external hazardous event. Stone (2009) identifies four major elements in the development of a crisis: a precipitating event which is perceived as a hazard or a threat, where personal coping mechanisms are considered inefficient, which results in a crisis experience.
A crisis event will have effects on any individual, which can go from mild and temporary to more permanent and profound, resulting in Post -Traumatic Stress (PTS) or Post -Traumatic Stress Disorder (PTSD). Reactions to distressing events are linked to our inner world of repressed feelings, previous history and experiences. Below the surface are the memories and experiences buried or forgotten. The effects of any traumatic experience or crisis, therefore, depend on pre-event factors, but also on post-event factors.
When people are held down, trapped, or otherwise prevented from taking effective action during a traumatic event, the brain may keep sending signals to the body to escape a threat that no longer exist. Traumatic reactions are psycho-physiological. This is due to traumatic experiences being organized in the brain not as coherent logical narrative, but in fragmented sensory and emotional traces. Stress hormone levels remain elevated stimulating ongoing fear, depression, rage and physical disease, the person remains in “crisis mode”.
The memories of a critical incident can be imprinted in our minds even before the event is over. Mental health and well-being support can help individuals cope with the stress related to the crisis. It also facilitates uncovering the necessary actions to avoid being stuck in “crisis mode”. Research seems to indicate that early intervention is beneficial and can prevent, sometimes, more damaging effects.
The ABC Model of Crisis Intervention, originally conceived by Jones in 1968, is not a form of therapy nor a substitute for long term treatment. It is, nonetheless, an effective approach to produce immediate relief and a way to mobilise necessary resources to manage any crisis. My experience with the ABC Model derives from working with victims of crime and my work in the military environment with soldiers affected by PTSD, and also in families with Domestic Violence.
This model considers the importance of establishing a relationship of empathy and trust with the person in crisis, as the initial step, to help the person to move from expressing their emotions to taking action. People facing a crisis need to know exactly what needs to be done, how they will do it and when. Coping actively with the problem, helps shift the focus from the negative, the crisis, to the positive or solutions. Making an ordered action plan would help people to develop discipline and a sense of agency, and to dispel fears of being unable to cope. Being powerless during a crisis event and immediately afterwards would have negative effects on individuals as we have seen. Studies support the idea, that promoting performance and skills acquisition for independent functioning, are an important part of the change agenda in crisis procedures. Talking to a trained professional will allow this process and will make a difference in the present and potentially the future.
Author: Edu Hardy, Psychotherapist at InsideOut
Date: 8th May, 2020
Egan, G. (2010). The skilled helper: a problem-management and opportunity-development approach to helping. (9th ed.). Cengage Learning
Flannery, R. B., & Everly, G. S. (2000). Crisis intervention: A review. International Journal of Emergency Mental Health, 2(2), 119-126.
Jones, W. (1968) The ABC Method of Crisis Management. Mental Hygiene (January): 87- 89.
Parkinson, F. (2000) Post-Trauma Stress. Fisher Books: Tucson, Arizona.
Roberts, A. R., & Everly Jr, G. S. (2006). A meta-analysis of 36 crisis intervention studies. Brief Treatment and Crisis Intervention, 6(1), 10.
Roberts, A. R. (Ed.). (2005). Crisis intervention handbook: Assessment, treatment, and research. Oxford University Press.
Rogers, C. (2003) Client Centered Therapy. London: Constable.
Rothbaum, Barbara O et al. (2014). “Early intervention following trauma may mitigate genetic risk for PTSD in civilians: a pilot prospective emergency department study” Journal of clinical psychiatry vol. 75,12:1380-7.
Stone, H. B. (2009). Crisis Counselling (3rd ed.). Fortress Press: Minneapolis.
Van der Kolk, B. (2014). The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma. Penguin Books: UK.