Crisis Reaction The normal human response to TRAUMA follows a similar pattern called the crisis reaction. It occurs in all of us
Physical response The physical response to TRAUMA is based on our animal instincts. It includes physical shock, disorientation, and numbness: frozen fright
Fight, Flight, Freeze -Events that are threatening to life or bodily integrity will produce traumatic stress in its victim. -This is a normal, adaptive response of the mind and body to protect the individual by preparing him to respond to the threat by fighting or fleeing. -If the fight or flight is successful, the traumatic stress will usually be released or dissipated allowing the victim to return to a normal level of functioning
Fight or Flight adrenaline/ brain chemicals heart rate digestive system breathing sweating-hyperventilation sensory perception tunnel vision/thinking increased strength decreased sensitivity to pain
SURVIVAL AND THE AUTONOMIC NERVOUS SYSTEM (ANS) Arousal, and therefore hyper arousal, is mediated by the Limbic System which is located in the center of the brain between the brain stem and the cortex. This part of the brain regulates survival behaviors and emotional expression, being primarily concerned with tasks of survival such as eating, sexual reproduction and the instinctive defenses of fight and flight.
Fight If the Limbic perception is that there is not time to flee, but there is adequate strength to defend
Flight If perception in the Limbic System is that there is adequate strength, time and space for flight, then the body breaks into a run
Freeze f the Limbic System perceives that there is neither time nor strength for fight or flight and death could be imminent -In this state, the victim of trauma enters an altered reality - it is one form of dissociation. -Time slows down and there is no fear or pain. In this state, if harm or death do occur, the impact is not so great
DEFENSIVE RESPONSE IN THE ABSENCE OF THREAT -When the Limbic System of the brain activates the ANS to meet the threat of a traumatic event, it is a normal, healthy, adaptive survival response. -When the ANS continues to be chronically aroused even though the threat has passed and has been survived, that is PTSD. -The body continues to respond as though it were under threat. This is the most perplexing feature of PTSD
Amygdala It is believed that the amygdala stores highly charged emotional memories, such as terror and horror and it has been shown that the amygdala becomes very active when there is a traumatic threat
Hippocampus The hippocampus, on the other hand, stores memory of time and space - puts our memories into their proper perspective and place in our life's time line -During traumatic threat, it has been shown, the hippocampus becomes suppressed. Its usual function of placing a memory into the past is not active. -The traumatic event is prevented from becoming a memory in the past, causing it to seem to float in time, often invading the present. It is this mechanism that is behind the PTSD symptom of flashback - episodes of reliving the trauma
Exhaustion Physical arousal associated with fight or flight cannot be prolonged indefinitely. Eventually, it will result in exhaustion
Stage one: Shock, Disbelief, and Denial Denial in this sense means truly believing something did not happen, or that it was not as bad as it actually was. This is a psychological defense mechanism that kicks in to protect a person from the full impact of what has happened
Stage two: Cataclysm of emotions -anger/RAGE -fear/TERROR -grief/SORROW -confusion/ FRUSTRATION -guilt/SELF-BLAME, and -violation/VULNERABILITY
Stage three: Reconstruction of equilibrium -Emotional roller coaster that eventually becomes balanced -In order for a person who has experienced a traumatic incident to return to normal cognitive functioning (and therefore be able to access the 'thinking' part of the brain), this equilibrium has to be restored
The Range of the Crisis Reaction Shock Depression and loneliness Panic Hostility and resentment Hope Emotion Physical symptoms of distress Guilt Inability to resume normal activities Affirming reality
Trauma is accompanied by a multitude of losses Control over one's life Sense of fairness or justice A sense of immortality and invulnerability Trust in God or in other people Personally-significant property, self, or loved ones Future Because of the losses, trauma response involves grief and bereavement
Sources of the secondary victimization may include: The criminal justice system The media Family, friends or acquaintances Clergy Hospital and emergency-room personnel Health and mental health professionals Social service workers Victim service workers Schools or educators
Recommended Procedures For Notification of Death: -Notification should occur as soon as the deceased's identify has been established. -Get all the medical information possible about the person(s) to be informed of the death. -Go. Don't call! -At least one person should be in uniform. -Talk about your feelings with your partner. -If a child answers the door, request to speak to his or her parents. -Present your credentials and ask to come in Sit down. Don't be stiff and formal. -Convey the information simply and directly. -Ask parents or spouse if they want to tell the children or if they want you to tell them. -Don't discount feelings-theirs or yours -Be prepared if the bereaved goes into shock. -Empathize with the survivors in their grief. -Answer questions honestly. -Provide information without jeopardizing a criminal investigation -Offer to make calls. -Survivors should be informed that it might be necessary for them to identify the deceased. -Explain why an autopsy is necessary and how to obtain a copy of the report. -Tell hospital personnel what information the family has been given -Survivors should be informed that law enforcement officials might need to question them at a later time. -Don't leave the survivor(s) alone! -Stay with the survivor(s) if they wish and help with decisions. -Provide the survivor(s) with the officer's names and telephone numbers -The law enforcement officers should contact appropriate agencies in other jurisdictions to notify additional surviving family members. -Preserve and label the package containing the deceased's clothing and personal effects. -Allow hospitals adequate time to prepare the body for identification. -Provide survivors with sufficient time with the deceased -Talk to the media only if the family has given permission. -Give the survivor(s) an information sheet with pertinent information. -Next day - call! -Let the survivors know you care
Crime Victims Rights -The District Attorney, criminal district attorney, or county attorney SHALL designate a person to serve as victim assistance coordinator in that jurisdiction +The duty of the victim assistance coordinator is to ensure that a victim, guardian of a victim, or close relative of a deceased victim is afforded the rights -Each local law enforcement agency SHALL designate one person to serve as the agency's crime victim liaison -Each agency shall consult with the victim assistance coordinator in the office of the attorney representing the state to determine the most effective manner in which the crime victim liaison can perform the duties imposed on the crime victim liaison under this article -the right to receive information regarding compensation to victims of crime as provided by Subchapter B, including information related to the costs that may be compensated under that subchapter and the amount of compensation, eligibility for compensation, and procedures for application for compensation under that subchapter, the payment for a medical examination under Article 56.06 for a victim of a sexual assault, and when requested, to referral to available social service agencies that may offer additional assistance -The right to counseling, on request, regarding acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection and testing for acquired immune deficiency syndrome (AIDS), human immunodeficiency virus (HIV) infection, antibodies to HIV, or infection with any other probable causative agent of AIDS
Identify crime victim liaison's role and duties The duty of the crime victim liaison is to ensure that a victim, guardian of a victim, or close relative of a deceased victim
Victim Assistance Coordinator -Each law enforcement agency shall have one Crime Victim Liaison and they must collaborate with the office of the attorney representing the state to determine the most effective manner to perform duties -Duty is to ensure rights are granted of the victim, guardian of a victim, or close relative of a deceased victim is afforded the rights granted victims, guardians, or close relatives of deceased victims
Presence of advocate or representative during forensic medical examination -Medical examiner shall offer information about how to gain a sexual assault program working to help with support services -Services are fully paid by state/city and may not impede on the duties of the examiner to collect evidence or health services +Psychologist +Sociologist +Chaplain +Social Worker +Case Manager +Volunteer that has completed a sexual assault trying program
The patient has experienced or witnessed or was confronted with an unusually traumatic event that has both of these elements: -The event involved actual or threatened death or serious physical injury to the patient or to others -The patient felt intense fear, horror, or helplessness
The patient repeatedly relives the event in at least one of these ways: -Intrusive, distressing recollections (thoughts, images) -Repeated, distressing dreams -Through flashbacks, hallucinations, or illusions, feeling or acting as if the event were recurring (includes experiences that occur when intoxicated or awakening) -Marked mental distress in reaction to internal or external cues that symbolize or resemble some part of the event -Physiological reactions (such as rapid heart beat, elevated blood pressure) in response to these cues
The patient repeatedly avoids trauma-related stimuli and has numbing of general responsiveness (absent before the traumatic event), as shown by three or more of these: -Tries to avoid feelings, thoughts, or conversations concerned with the event -Tries to avoid activities, people, or places that recall the event -Cannot recall an important feature of the event _Marked loss of interest or participation in activities important to the patient Feels detached or isolated from other people -Experiences restriction in ability to love or feel other strong emotions -Feels life will be brief or unfulfilled (lack of marriage, job, children)
The patient has at least two of the following symptoms or hyperarousal that were not present before the traumatic event: Insomnia (initial or interval) Angry outbursts or irritability Poor concentration Excessive vigilance Increased startle response
The phases victim's reaction to a crime Impact - Shock, Disbelief, + Denial Recoil - Reliving, regression, or set-back Reorganization- A new place or moving forward
THE RIPPLE EFFECT OF CRIME VICTIMIZATION -Immediate Victim -Secondary Victims: Family, friends, and acquaintance -Service Providers: EMS, police, + firefighters -Witnesses
CRISIS INTERVENTION Safety and Security Ventilation and Validation Prediction and Preparation
Tips for Responding to Victims' Three Major Needs
COME DDHFODHFODHSOSHOGSHG Victims Need To Feel Safe +People often feel helpless, vulnerable, and frightened by the trauma of their victimization.
WHAT DO VICTIMS NEED ... AND WHAT CAN THEY DO WITHOUT? The best antidote for hurtful actions of one person is the compassionate and helpful actions of others. The bad action of the criminal can be countered by the good action of the responding officers and victim assistance personnel as well as family members, neighbors and others
Listening Active Listening Skills Eye contact/body language/non verbal communication Paraphrasing/emotional labeling Minimal encouragers Open ended questions
Individuals may feel very childlike, for example Feeling very little Wanting mommy or daddy to come and take care of you Feeling very weak Feeling like you did when you were a child and something went terribly wrong
Individuals may do things that seem very childish later, for example Singing nursery rhymes Assuming a fetal position or crawling instead of walking Calling a law enforcement officer or other authority figure mommy or daddy.
Recovery from immediate trauma -Many people live through a trauma and are able to reconstruct their lives without outside help. This assumes, however, that they get a lot of informal support and assistance from friends, co-workers, peers, etc. in talking about what happened, in re-experiencing the emotions it triggered and in trying to make sense of what happened. -Most people find some type of benign outside intervention useful in dealing with trauma -Severity of crisis reaction -Ability to understand in retrospect what happened -Stability of victim/survivor equilibrium after event Supportive environment -Validation of experience (e.g., it was terrible; the feelings/thoughts you are having are natural and understandable given what you've been through, etc.) -They need to have somewhere to talk about it, to feel about it and to try to make sense of it. -This is true and natural for all humans - not a sign of weakness
Intensity continuum Crime-specific Victim-specific Cultural differences
Recovery issues for survivors include -Getting control of event in victim/survivor's mind -Working out an understanding of event and, as needed, a redefinition of values -Re-establishing a new equilibrium/life -Re-establishing trust -Re-establishing a future -Re-establishing meaning
Long-term crisis reactions -Not all victim/survivors suffer from long-term stress reactions. -Many victims may continue to re-experience crisis reactions over long periods of time. -Such crisis reactions are normally in response to trigger events that remind the victim of the trauma
Trigger events -Identification of the assailant -Sensing (seeing, hearing touching, smelling, tasting) something similar to something that one was acutely aware of during the trauma -Anniversaries of the event -The proximity of holidays or significant life events -Hearings, trials, appeals or other critical phases of the criminal justice proceeding -Media articles about a similar event
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