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| ==Overview== | | ==Overview== |
| ==Psychotherapy== | | ==Psychotherapy== |
| It is essential for caregivers to remain available and not to allow a grieving person to become isolated. The following are helpful for adults who are grieving:
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| {| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
| | Whereas 70% of those receiving supportive therapy or no therapy after a traumatic event develop PTSD, only about 10-20% of those who receive cognitive-behavioral therapy (CBT) shortly after such an event develop PTSD.[7, 8, 9, 10, 11, 12] Moreover, patients who receive CBT with or without hypnosis report less reexperiencing and fewer avoidance symptoms than patients who receive supportive counseling. Individuals are aided by the following: |
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Steps taken to help grieved persons}}
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| ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Features}}
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
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| :Step 1
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| *Take action
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| **Call
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| **Send a card
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| **Give hugs
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| **Help with practical matters
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 2
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| Be available after others get back to their own lives
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 3
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| Do not be afraid to talk about the loss
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 4
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| Be a good listener, but do not give advice
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 5
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| Do not minimize the loss; avoid clichés and easy answers
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 6
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| Encourage bereaved individuals to care for themselves
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 7
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| Be patient with the bereaved; there are no shortcuts
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 8
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| Remember significant days and memories
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 9
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| Do not try to distract the bereaved from grief through forced cheerfulness
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 10
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| Remember significant days and memories
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| |}
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| When dealing with children who are grieving or traumatized, it is particularly important to offer reassurance regarding their own safety and the safety of their loved ones (insofar as is possible). It should be emphasized to these children that such devastating events are very rare, that people are there to take care of them, and that they will always be loved. The following are helpful for grieving or traumatized children:
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| If serious signs appear and last more than a couple of weeks, help should be sought. Signs that help is needed include the following:
| | Brief school intervention |
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| | A brief school intervention lasts 1-2 hours and uses 4 therapists per class. A teacher is present, and parents are informed. The intervention includes the following steps: |
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Steps taken to help grieving or traumatized children}}
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| ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Features}}
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
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| :Step 1
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| Be emotionally available to children despite personal loss (or fears)
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 2
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| Encourage them to share their feelings, to talk at weekly family meetings, and to use drawings and puppets to express their feelings
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 3
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| Give children more time than usual
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 4
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| Let them know it is all right to talk about unpleasant feelings (including sadness and anger) and listen to them; sharing personal feelings of sadness with them is all right as well
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 5
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| Check to see if children feel that they somehow caused the death or disaster or if they have other misunderstandings, and take pains to reassure them or correct any misunderstanding; do not assume children are fine just because they are not saying anything
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 6
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| Monitor and limit television watching after a disaster, lest this flood them or desensitize them to violence; when they do watch, watch it with them and discuss the events
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 7
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| Understand that children probably know more than you think they do; make sure to ask what the child knows and what questions he or she has
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 8
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| In discussing traumatic events with children, share only the details they can deal with; be honest, but do not overload them with facts
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 9
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| Understand that regression, fear, sleep problems, and anger toward remaining family members are common after a loss or trauma
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 10
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| Encourage action, such as sending letters to victims, to keep them from feeling helpless
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 11
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| Do not force children to go to the funeral if they do not want to, but help them create a ritual
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 12
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| Maintain as normal a schedule as possible
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Step 13
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| Encourage patients to eat balanced meals on time and drink fluids; to get enough sleep, relaxation, and exercise; and to avoid alcohol and caffeine
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| |}
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| Extended depression and loss of interest in activities and events
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| Inability to sleep, loss of appetite, or prolonged fear of being alone
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| Extended period of marked regression
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| Excessive imitation of the deceased or repeated statements about wanting to join the deceased
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| Withdrawal from friends
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| Serious drop in school performance or refusal to go to school
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| Persistent fears
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| Persistent irritability and being easily startled
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| Behavior problems
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| Physical complaints
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| Rescue workers may develop the same symptoms as victims, including those of acute stress disorder (ASD) or posttraumatic stress disorder (PTSD). As many as 1 in 3 rescue workers develop PTSD. Measures for helping rescue workers deal with stress after traumatic events include the following:
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| Encourage staying in touch with family and friends
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| Be sure that rescue workers get rest, food, exercise, and relaxation
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| Encourage understanding of survival guilt
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| Explain how chaos and confusion inevitably lead to upset between individuals and groups that are participating in the rescue effort
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| Develop a buddy system, and encourage support of coworkers
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| Encourage workers to defuse after troubling incidents and after each shift
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| After the rescue operation, encourage workers to take a few days to decompress and attend a debriefing
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| Do not overwhelm children with talk of experiences as a rescue worker; ask about their activities
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Number of steps}} | | ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Steps taken in Cognitive-behavioral therapy to help patients with ASD}} |
| ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Steps taken in Cognitive-behavioral therapy to help patients with ASD}} | | ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Features}} |
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| | style="padding: 5px 5px; background: #F5F5F5;" | | | | style="padding: 5px 5px; background: #F5F5F5;" | |
| Desensitization to painful memories via repeated controlled exposures and systematic desensitization | | Desensitization to painful memories via repeated controlled exposures and systematic desensitization |
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| |}
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| {| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stages of critical incidenct stress debriefing}}
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| ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Features}}
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
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| :Stage 1
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| Introduction (purpose of the session)
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Stage 2
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| Description of the traumatic event
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Stage 3
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| Appraisal of the event
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Stage 4
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| Exploration of the participants’ emotional reactions during and after the event
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Stage 5
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| Discussion of the normal nature of symptoms after traumatic events
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Stage 6
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| Discussion of ways of dealing with further consequences of the event
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| | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
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| :Stage 7
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| Discussion of the session and formulation of practical conclusions
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| |} | | |} |