Individual and Collective Crisis/Trauma Intervention and Debriefing: Ten Steps & Strategies

In light of events fifteen miles away (Baltimore) to 10,000 miles from my doorstop (Nepal), this essay titled, "Individual and Collective Crisis/Trauma Intervention and Debriefing: Ten Steps & Strategies," clearly has immediate relevance and application. Actually, the impetus for the article occurred last week when a friend and colleague (originally from Nepal) asked me to talk briefly about stress and trauma on a strategic planning phone conference with other Nepali-born individuals.

Always appreciate any ideas or feedback. If you think the piece works for any of your publications or for public transmission, please use or share. Thanks,

Mark
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Individual and Collective Crisis/Trauma Intervention and Debriefing: Ten Steps & Strategies

The devastating earthquake, with its mounting death toll, and the life-and-death challenge of speeding relief throughout Nepal, especially in more remote areas, clearly is the immediate national crisis. The destruction, disruption, and dislocation is generating human, societal, and cultural tragedy and trauma of epic proportions – be they personal, family, societal, cultural, and archeological. However, today, right now, and as the proverbial dust settles, many will need more than food, clothing, shelter. Also vital: psychological counsel, emotional grieving, and gradual healing; so too fostering stress resilience and hope as well as ongoing peer and community support and sustenance. The critical task: not just repairing and restoring homes and shrines but also rebuilding and reintegrating hearts and minds!

And these physical and psychological resources and responses are not only crucial for those in Nepal. The trauma and lingering uncertainty, especially for the safety and well-being of family and friends, is right at the doorstep of people of the Nepali Diaspora thousands of miles from ground zero.

Before listing key intervention tips, it’s necessary to define two terms – Crisis and Trauma:
1) Crisis: is a critical event or experience that triggers feelings of threat and loss while also challenging the individual’s, family’s, and/or social group-community’s coping resources and capacity for action. Crisis also involves a time-limited period of “danger” and “opportunity.” Systems are motivated to regain physical and psychological control; they are more open to reaching out for resources and unconventional problem-solving structures and strategies. Individuals and groups are more ready to grapple with feelings of loss and grief and receive vital emotional support. However, a lack of support for engaging meaningfully with such acute pain and problems in a timely manner can lead to regressive or maladaptive coping (e.g., increased drinking or drug use) and stress or trauma-induced mind-body illness.

2) Trauma: is a state of both overwhelming emotional and physiological arousal combined with intensely negative cognitive processing. According to the experts, trauma can occur from a one-time event or an ongoing experience, including trauma based on the nature of one’s role-relationship to the stressor, e.g., ground zero victim, the family members of a victim of violence, the second-hand trauma of witnesses to grisly violence, or the impact on individuals working with trauma victims. Trauma effects can range from being numb or immobilized to a state of panic, as well as feeling helpless and hopeless. And sometimes the reaction can be delayed; hence, Post-Traumatic Stress Reaction.

And responding effectively to both Crisis and Trauma is complicated by the fact that previous emotional experience with separation and loss, illness and/or disability, helplessness and hopelessness are, sometimes powerfully, at other times subtly, rekindled adding to the intensity of the present-day crisis and/or trauma fires.

Ten Individual and Collective Crisis/Trauma Intervention and Debriefing Steps & Strategies

1. Acknowledge Stressful Feelings. During a crisis, while wanting to immediately swing into action, at some point, sooner rather than later, it’s important to take an honest psychological self-inventory. Not addressing acutely intense or prolonged stress or depressed feelings is inviting mind-body health issues, even illness down the road. Of course, a certain amount of stress during trying times is natural and even useful, stimulating focus and determination. Extended hypervigilance without sufficient support is the problem!

2. Quickly Connect with Others. Both for support and problem-solving information reach out to trusted or credible resource people and organizations. By its nature, crisis problem-solving means plunging into unknown or uncertain waters. Partnering with people more familiar with the experience, or at least with managing crisis, grief, and/or trauma emotions, is vital. This is no time for Lone Rangers and Rambos or Rambettes.

3. Appreciate the Time-Limited Nature of Crisis. During this period of acute uncertainty and threats to survival, people will typically open up to new ideas, approaches, and actions, especially if guided by knowledgeable and purposefully reassuring leaders or guides. Crisis is a “no exit” challenge: an individual or group will either take positive or proactive problem-solving steps or they will hide out or freeze into self-defeating and escapist adaptations. (Hence the previous mentioned “danger” and “opportunity” crossroads of crisis. And the danger or disorientation is not just external; see #4.) Strike when the ego is hot!

4. Be Aware of Unconscious Intrusions. The acute stress of crisis generates cracks in our psychological defenses. These defenses normally keep at bay painful memories and feelings. However, under intense and unrelenting pressure, cracks emerge and subterranean emotions and images, memories and dreams often appear adding to stress levels and heightening a sense of confusion or disorientation. Sometimes people mistakenly believe they are going crazy; or can’t explain their own cognitions or coping. The confusion is a natural component of emotional crisis flooding. For example, a week after 9/11, a friend, a former artillery officer in Vietnam, was perplexed by his lingering angst. Certainly he had seen mayhem and destruction before. I suddenly recalled a tragic piece of his past family history, perhaps a contributing factor to his current dis-ease: “Hadn’t you lost your first wife in a house fire; and your personal rescue attempts were unsuccessful?” Momentarily startled, John poignantly said, “I hadn’t thought of that!”

5. Understand the Key Components of Grief and Trauma Debrief. For both powerful loss and trauma, the classic model of grief has relevance: there are the initial stages of shock, disorientation, sadness and or despair, rage, guilt, (or, for example, “survivor’s guilt” for those in the Nepali Diaspora), ambivalence, and/or withdrawal, etc. Then, through time, chemical rebalancing, and emotional support, as energy and clarity, confidence and possibility levels increase, the process typically progresses into refocused attention, focused aggression or determination, new exploration, individual and collective problem-solving, relief and, hopefully, hard-won acceptance of the loss. While still painful, memories are no longer paralyzing or inducing panic states. Heretofore hidden lights on the horizon of hope may finally be sighted. (Email stressdoc@aol.com for “The Seven Stages of Grief.”)

During times of crisis, an individual may have the capacity to quickly engage with grieving. In contrast, someone in the throes of trauma may need to move more slowly through the healing stages. Of course, for both pathways it’s not a linear evolution. One may take steps or stages forward and then fall back, needing more than once to rework and reintegrate sobering, troubling, or frightening thoughts and feelings. Also, with Post-Traumatic Stress, adaptive coping during the crisis period now starts to unravel. Once our survival guard is down, especially after prolonged and draining vigilance and tragic loss, then exhaustion, high anxiety, hyper-distraction, rage, despair, and/or depression may take over. Finally, research reveals that early childhood separations, losses, exposure to violent incidents, and other adverse, trauma-inducing experiences appear to be correlated with teen and adult PTSD-like reactions.

6. Grasp the Individual Nature of Grief and Paths of Healing. There is not one way to grieve; each person’s process is unique to his or her bio-psycho-social-cultural nature and history. Consider these approaches or styles:
a) Cognitive or head – trying to make immediate intellectual sense or order of the experience
b) Affective or heart – needing to experience and express the array of grief emotions
c) Sensual – needing to be touched or stroked, held and hugged
d) Social – needing to share ideas and/or emotions with others, especially those who can truly relate
e) Action – regaining a sense of purpose and emotional control by taking action plans and steps
f) Reflective – needing time alone to meditate upon and often creatively express pain and meaning; process may be reinforced interacting with nature, e.g., a number of Veterans have engaged in hiking the Appalachian Trail as part of their trauma recovery process.

Ultimately, reconciling or integrating head and heart, body and spirit along with new resources while rekindling a sense of hope, of pregnant possibility, perhaps even new partnerships and creative outpourings are some of the byproducts of a healing grief experience.

Finally, there’s no absolute time frame for moving through the grief stages. Don’t accept when people say some variation of, “It’s been a couple of months now; stop looking back; stop dwelling on the past; time to move on with your life, etc.” In fact, some powerful losses are never completely mourned. Eventually, life again feels worth living, but there will always be “grief anniversary” moments and memories. The only caveat: a month after the critical incident, if you are still stuck in the same dark emotional hole, (a shorter time frame, of course, if disruptive health or suicidal issues emerge) strongly consider contacting a professional health and/or mental health provider.

7. Consider these Two “Grief Dynamic” Passages and Reach Out for TLC:
a) There’s a real difference between feeling sorry for yourself and feeling your sorrow. When you are feeling sorry for yourself you typically blame others. When feeling your sorrow you have the courage to face your pain. And there are times in life when we all need to face our sorrow! And

b) Whether the loss is a key person, a desired position, or a powerful illusion, each deserves the respect of a mourning. The pit in the stomach, the clenched fists and quivering jaw, the anguished sobs prove catalytic in time. In mystical fashion, like spring upon winter, the seeds of dissolution bear fruitful renewal.

During highly uncertain or stressful times, try finding a “Stress Buddy.” (The concept was derived from working with military spouses. They would find a supportive partner, a fellow spouse, when their soldier went overseas, especially “down range, in harms’ way.”) However, a “Stress Buddy” should provide a variation on traditional TLC: Tender Loving Criticism and Tough Loving Care!

8. Create a Safe Space whether In-Person or in Cyber. When trying to console or counsel others, as much as possible, find a private place to share. Assure the person of your confidentiality, unless the individual threatens self-harm or harm to others. In light of the disorienting nature of crisis, try to be open to a wide range of emotional ventilation (along with cultural variation) without critical judgment. In my estimation, listening carefully to someone demonstrates real respect.

Virtual support systems are especially vital when trying to communicate with and connect people separated by wide distances. Of course, as more and more counseling services are provided technologically, through phone, email, or Skype, extra effort must be made to assure “message sent is message received.” And to expedite effective and efficient group communication, whether involving supportive or strategic planning services, whenever possible, an experienced facilitator is wise.

9. Keys for Comforting Others. While most appreciate an attentive ear or a sturdy shoulder during times of confusion, chaos, or crisis, reaching out or supporting others takes both some science and art. Perhaps the most important quality is being non-judgmental. Some make this mistake with the best of intentions, e.g., when trying to reassure another claiming, "Oh, you shouldn't feel that way." Or we can unintentionally trivialize someone's pain by saying, "I know how you feel." Unless you have truly walked in another's particular painful path, better to say, "I don't fully grasp your experience, (or 'I can only imagine'), please help me understand." Or, if you want to share, try saying, "I don't know if this is relevant, however, for me your story brought up this thought or memory…" Again, after sharing your idea or story, make sure you refocus ears and eyes, head and heart back on the person in crisis or trauma.

The communication key, of course, is not quickly offering advice, unless asked; (in general, avoid, “Here’s what you should do!”). Try asking sensitive, open-ended questions that invite the other’s ideas and emotions…then listen reflectively. Check out understanding by paraphrasing back to the person what you’ve heard. When feelings are particularly charged, check out whether “message sent is message received.” Finally, if giving advice, spoon it out in clear and concise, bite-sized chunks for easier intake.

10. Help People Find Purpose and Passion in Pain. Almost all of us want a sense of meaning and purpose in our lives. This can seem hopelessly lost in times of tragic loss and destruction. However, whether rapidly or patiently, enabling those in the throes of crisis and trauma to begin to embrace their pain -- to either open the emotional floodgates or to explore slow yet steady, gradual grief-steps – often means helping individuals, families, and communities discover unrecognized and untapped sources of strength. People may even regain or evolve a new sense of passion, especially wanting to help others in their community; one emerging from the trauma or crisis crucible may well seek a purpose larger than their own safety and well-being. (And remember, the root of “passion” is suffering, as in the “Passion Play,” that is, the sufferings of Jesus or, more generically, the sufferings of a martyr.)

As I once penned:

For the Phoenix to rise from the ashes
One must know the pain
To transform the fire to burning desire.

Closing

Along with traditional disaster rescue, resource, and recovery efforts, grief and trauma intervention and engagement, especially during double-edged, “strike when hot” times of crisis, can substantively assist overwhelmed individuals and families, groups and communities. Despite the immediate assault on a victim’s senses and sense of identity, with timely and knowledgeable support we can learn and evolve individual and collective stress resilience skills and strategies. We not only can survive the chaotic present but often develop psychological attitudes and aptitudes – head and heart muscles – that have us better prepared to survive, learn from, and creatively adapt to future hazardous events and challenges.