Dr. Damian Sendler Crisis Intervention Psychotherapy
Damian Sendler: If you're suffering from the effects of the 2019 Coronavirus Disease, crisis intervention psychotherapy (CIP) is an underappreciated form of therapy that can be used as a treatment during psychiatric disasters and emergencies (COVID-19). Problem solving, solution-focused, and trauma-informed, CIP is an individual or family-centered treatment. CIP is a brief form of psychotherapy delivered as a companion or follow-up to psychological first aid. The goal of crisis psychotherapy is to help people get through a difficult time and get back to their normal lives. COVID-19 patients and their families can receive up to 20 virtual sessions of treatment via CIP, which can be offered on a psychiatric inpatient unit or through a consultation-liaison service or outpatient settings, depending on the needs of the patients and their families. Critical incident stress management and its replacement, psychological first aid, are examined in this article. Crisis psychotherapy's history and fundamental principles, as well as its eight key treatment components, are described. Crisis psychotherapy has been made possible during the COVID-19 pandemic through the use of digital and virtual technology. COVID-19 has a direct impact on a family, and a case study is used as an example. Timelines, an ecological map and a wheel-and-spoke treatment plan are shown to be effective.
Damian Jacob Sendler: In the last two decades, we've learned a lot about how to respond to a wide range of emergencies, including hurricanes, epidemics, natural disasters, suicide, domestic violence, and other types of trauma. A crisis model has been used by hotlines, police, teachers, counselors, school and college counselors, attorneys and clergy in the aftermath of disasters and traumas.
Dr. Sendler: Professionals in the field of mental health offered a two-hour group session called a "critical incident stress debriefing" (CISD)1 to first responders in the wake of a disaster or trauma. There are various pre- and post-incident planning options, as well as group treatments and recommendations for education, training, and policy changes that go along with critical incident stress management (CISM).1
Traditional practitioners who had no training in mental health care provided both CISD and CISM together as a cohesive treatment. Discredited as psychotherapeutic treatments, but some aspects of these programs are still helpful. When it comes to trauma exposure, many first responders don't need to be treated, and many first responders get worse when they are forced to receive these interventions as mandatory treatment, according to two meta-analyses of CISD and CISM data (PTSD). 2,3
First responders are now being offered psychological first aid, which is the current approach for managing acute disasters.
It is always offered voluntarily, never mandated, and focuses on safety, calm, connection, self-efficacy, hope, referral and follow-up using all available resources.. Rather than being delivered in a group setting, it is tailored to meet the specific needs of each individual. Various forms of psychological first aid are currently being used around the world as a first-line strategy for dealing with mass trauma. They are not offered as a means of preventing or treating post-traumatic stress disorder (PTSD), nor are they meant to be given by mental health professionals. "Evidence-informed," but without proof of effectiveness, is the term used to describe psychological first aid. 5,6
This type of psychotherapy is typically provided by trained mental health professionals, and it can be offered following disasters. It is a trauma-informed, problem-solving psychotherapy that takes an individual, systemic, or family-centered approach. 7–9 There are no long-term goals with this brief psychotherapy other than to get you through the crisis and get you back to normal.
It can be used for COVID-19 emergencies on inpatient, consultation and liaison, and outpatient services with the caveat that crisis psychotherapy is a "wisdom-based" treatment with face validity. An example of a hotline built on this model can be found elsewhere. 13
An overview of crisis intervention psychotherapy's history and theory, as well as some of its most useful core characteristics, is provided in this article, as is an analysis of how this approach can be used in the age of COVID-19. A trained mental health professional with psychotherapy expertise can provide crisis intervention psychotherapy, which makes use of tools such as a 6-week timeline, an ecological map, a problem-solving wheel and spoke treatment plan, and eclectic psychotherapeutic techniques with an individual and/or systemic focus.. 14 A clinical case study of a family dealing with a COVID-19 crisis exemplifies how the crisis psychotherapy approach is used.
Thomas Salmon,15 a British military physician, was asked to examine and explain why French soldiers' "shell shock" (traumatic neurosis) was producing less psychological paralysis than British soldiers. He cited three reasons for France's superiority: French soldiers were given three things: (1) assurances that they would recover; (2) access to on-the-spot mental health services; and (3) prompt reassignment to the front lines. They became the cornerstone of all modern crisis theories and disaster management strategies because they stressed the importance of expecting recovery, treating patients immediately in a community setting rather than a hospital, and returning to normal daily activities as soon as possible.
In his research on the aftermath of the 1942 Boston Coconut Grove fire, Eric Lindemann16 used these principles. A single nonwar incident at that time saw the largest number of American lives lost. According to Lindemann's research, healthy people who have been through traumatic events may experience an emotional crisis that includes feelings of pain, confusion, and anxiety, as well as difficulty going about their daily lives for a period of six weeks on average. An individual's level of coping with a crisis was determined by the severity of their stressor, their personal reactions, the effects of their trauma on their family and friends and their community's level of disturbance.
Sociologist Erik Erikson17 introduced the concept of developmental stages and crises. Psychological tasks, transitions, and crises at specific ages were all part of the eight stages he described in his work. It's difficult to progress to the next stage if you can't handle a developmental crisis.
Erikson's idea of developmental milestones like adolescence and other developmental challenges like the first time one leaves home, the midlife crisis and parents' "empty nest syndrome" were incorporated by crisis practitioners. For many patients, a life transition, such as marriage, divorce, retirement, or an illness, can lead to a new developmental crisis.
Damian Jacob Markiewicz Sendler: In the 1960s and 1970s, Gerald Caplan (18,19) used these concepts in the development of crisis treatments that were widely used in the community mental health movement. An individual's personal psychological upheaval, caused by a "hazard," resulted in emotional turmoil and disruptions in daily routines, according to his definition of "crisis state." Using Caplan's example, we can see that a crisis is both "dangerous and an opportunity for growth." Most crises are resolved within six weeks, with four possible outcomes: (1) improved functioning; (2) returning to baseline functioning; (3) repeating mini-crises; or (4) stable but lower levels of functioning.
Many authors have contributed stepwise insights and interventions since the development of crisis treatment by these giants. Many researchers, including Flannery and Everly; Greenstone; Leviton; Kanel; Roberts; Feinstein; James; and Gilliland have all presented similar models with different elaborations. Most of these models are discussed in detail in Cavaiola and Colford26's recent and comprehensive book on crisis intervention. When it comes to understanding how crisis intervention is carried out in an integrated care setting, readers can turn to Simpson and Feinstein9.
In a normal situation, a person's psychological make-up and environmental supports are in homeostatic balance, allowing for stable day-to-day functioning. An individual's psychological equilibrium is determined by the individual's ability to strike a balance between their desires, fears, skills, and values. Having a stable balance between physical needs, interpersonal relationships, other social supports, resources and the integrity of the community is known as environmental equilibrium.
A person's normal equilibrium can be disrupted by a precipitant or a threat. In order to find out what triggered a crisis, ask, "Why now?" What's going on? Is there a location and a time?" 25 percent of precipitants have occurred on the day of initial outreach for treatment, 25 percent of stressors have occurred in the past week, and 50 percent of stressors have occurred within the previous six weeks, according to the crisis theory. 7–9,16
Damian Sendler
Within two years, half of patients who are exposed to many of these stressors will develop a serious medical or psychological condition. There are 51 external life stressors that may lead to a crisis, according to Hobson et al28. This scale's top 20 items fall into five categories: death and dying, health care, criminal justice system stress, financial or economic stress, and family stress. The most stressful event is number one on the new scale, and the least stressful event is number 51. A spouse's death comes in at number one, followed by a divorce at number seven, domestic violence at number eleven, and disaster survival at number sixteen. Additionally, there are some events on the scale that are both positive and stressful, such as getting married at number 32, having a large financial gain at number 42, and retiring at number 49. An emotional turmoil and a short-term inability to adapt are two indicators of an impending crisis caused by these common stressors.
The stressor is interpreted or added to by each individual according to his or her own psychological history and the diverse multiculturalism, religion, and ethnicity of his or her life's circumstances. Finding out what's causing the stress and what the stressors mean can help you come up with a solution. Suicide attempts may be considered honorable in Japanese culture for someone who has dishonored his family, but if the patient is Catholic, it may be considered a mortal sin. The significance of events must be examined (eg, to explore the psychological meaning of an affair, terrifying dreams, fears, panic, etc.).
Damien Sendler: When a crisis or internal turmoil or disorganization overwhelms a person's ability to cope and adapt, a precipitant is the first sign of trouble. "Danger" or "Opportunity" are two words that can be used to describe a crisis (for successful coping). 18,19 The primary goal of a crisis therapist is to identify the problem and find a solution, with the primary goal of restoring daily functioning, while promoting self-care, reducing stress, encouraging the person to avoid substance use, and so forth. In many cases, people in distress do not seek help themselves, but may be brought in by others, such as family members or police officers. Individuals may seek help for a loved one in crisis or for a coworker in crisis from family members or friends.
A patient's entire medical history may not be necessary or relevant to the current crisis. Though it may seem counterintuitive, a patient's selective history can be very helpful when trying to understand and resolve a current crisis. 15 A patient's selective history and relevant history of significant others (eg, past trauma, violence, suicide or substance use and the circumstances surrounding these past events) can provide valuable clues to understanding a similar current crisis. To gain a better understanding of the current crisis and possible solutions, look for anniversaries or resolutions to previous crises that are similar to this one. Patients may benefit from screening for traumas, losses, or deaths in their past that could help them better understand their current crisis.
Damian Jacob Sendler
Family, friends, and coworkers are the primary sources of our daily social interactions. The community resources that provide housing, food, clothing, employment, education, money, and medical care allow for these kinds of social interactions to take place.. COVID-19 is an example of a local system supported by state, national, and international organizations like the WHO. Our legal and constitutional safeguards are part of our social systems, which underpin all of our infrastructure, from highways and airports to our monetary system. Stable social systems at multiple levels tend to provide the greatest protection against all kinds of crises and disasters. 29
COVID-19 has had a devastating impact on our medical services, resulting in both death and morbidity.
COVID-19 is now being shown to have significant negative effects on mental health. Anxiety, depression, and self-reported stress are common reactions to the COVID-19 pandemic in the general population, according to preliminary evidence. – 32 Also reported are insomnia, indignation, worries about their health and family, sensitivity to social risks, life dissatisfaction, phobias, avoidance, compulsive behavior (hand washing), physical symptoms, and social functioning impairment. 31 Those who are already suffering from medical, psychiatric, or substance use issues, as well as those who have recently suffered financial setbacks, are all at greater risk of experiencing crises and negative psychological outcomes. 30
Providers of healthcare are particularly vulnerable to emotional distress and crises because they are at risk of infection, worry about infecting and caring for their loved ones, lack of personal protective equipment, longer hours and involvement in ethically and psychologically fraught resource allocation decisions and interactions with COVID -19 households.
Nursing, women, those under the age of 25, healthcare workers in Wuhan, and mid-level professionals have all been found to have more severe mental health symptoms than other health care workers, according to researchers. 30
Domestic violence and child abuse are more likely to occur in the absence of a medical cure for COVID-19 as a result of quarantine, social isolation, and a reduction in social contact.
30 Loneliness and anxiety and depression are both exacerbated when people are cut off from their social networks. In addition, medical care has become more difficult to obtain as a result of people's tendency to withdraw from society. As we'll see in the section that follows, digital technology has a lot of potential for reducing social isolation.
Patients with previous psychiatric illness or personality disorder may not be able to cope or adapt during an acute crisis or trauma. A person with schizophrenia may be just as capable as others without a psychiatric disorder of dealing with an immediate crisis, such as a fire. There are many factors that influence a patient's ability to cope with an acute crisis or trauma: the precipitant, its meaning, its nature, and how well the patient's coping skills and adaptability are supported by his or her support network. A preexisting mental illness (eg, major depression, personality disorder, or addiction) can make it difficult to cope and adapt to a new crisis, especially if it is not treated. 29 In the case of COVID-19, it is clear that the pandemic exacerbates preexisting psychiatric disorders. 30 As a result, resolving the acute crisis may necessitate dealing with underlying mental health issues at the same time as the crisis itself.
The majority of patients recover from a crisis within six weeks, but some may continue to experience long-term effects for years. Pretraumatic, traumatic, and posttraumatic factors all play a role in determining a patient's long-term prognosis after a disaster or trauma. 29 Factors that can contribute to traumatic events include a history of mental illness or addiction, a history of child abuse or neglect and physical health issues. The type, severity, scope, and duration of the trauma or crisis are all traumatic risk factors. Individual coping, problem-solving style, and the availability of support and resources are all risk factors for posttraumatic stress disorder. There's a better chance of recovery after a shorter-duration crisis or less severe trauma. Long-term effects of COVID-19 are likely to be world-changing and recovery may take years or never occur in some locations. A new level of stability will eventually be achieved in many places, most at a lower level of functioning, but some may adapt and demonstrate an improved level of functioning as with all crises.
Global pandemics like COVID-19 serve as stark reminders of the growing importance of digital technology in providing access to crisis and mental health treatment resources.
There is no doubt that telemental health treatment is comparable to in-person services, and it is especially beneficial and cost-effective for use with current technology in isolated communities.
Telemedicine has become an essential service in the era of COVID-19. Treatments such as crisis psychotherapy or psychological first aid can be delivered via digital technologies (such as Zoom, Google Hangouts or Microsoft Teams) and apps36, which can help alleviate symptoms of isolation and social exclusion. Online gatherings can be used for a variety of purposes, including religious services and social gatherings. Using video conferencing, many places of business and educational establishments are establishing virtual workspaces. However, it is not clear how long-term effects (eg, Zoom fatigue; clinician-patient preference; consensus about efficacy; issues of confidentiality) will have on clinicians and their patients (eg, Zoom fatigue; clinician-patient preference; consensus about efficacy; issues of confidentiality). 33
The increased use and investment in digital health is already transforming health care and increasing accessibility, which is a likely silver lining.
As a result of advancements in digital technology, previously underserved or rural areas and communities with limited or no access to medical or psychiatric care can now benefit from high-quality virtual medical care. 33,34 There may be more pressure to solve the digital desert problems in our rural, poor and underservied communities as a result of rapid expansion into the digital world during the COVID-19 pandemic (e.g. the explosion of Zoom use).