Stabilization

Goal

To calm and orient emotionally overwhelmed or disoriented survivors.

Most individuals affected by disasters will not require stabilization. Expressions of strong emotions, even muted emotions (for example, numb, indifferent, spaced-out, or confused) are expectable reactions, and do not of themselves signal the need for additional intervention beyond ordinary supportive contact. While expression of strong emotions, numbing, and anxiety are normal and healthy responses to traumatic stress, extremely high arousal, numbing, or extreme anxiety can interfere with sleep, eating, decisionmaking, parenting, and other life tasks. You should be concerned about those individuals whose reactions are so intense and persistent that they significantly interfere with a survivor’s ability to function.

Stabilize Emotionally Overwhelmed Survivors

Observe individuals for these signs of being disoriented or overwhelmed:

• Looking glassy eyed and vacant–unable to find direction
• Unresponsiveness to verbal questions or commands
• Disorientation (for example, engaging in aimless disorganized behavior)
• Exhibiting strong emotional responses, uncontrollable crying, hyperventilating, rocking or regressive behavior
• Experiencing uncontrollable physical reactions (shaking, trembling)
• Exhibiting frantic searching behavior
• Feeling incapacitated by worry
• Engaging in risky activities

If the person is too upset, agitated, withdrawn, or disoriented to talk, or shows extreme anxiety, fear, or panic, consider:

• Is the person with family and friends? If so, enlist them in comforting the distressed person. You may want to take a distressed individual to a quiet place, or speak quietly with that person while family/friends are nearby.
• What is the person experiencing? Is he/she crying, panicking, experiencing a “flashback,” or imagining that the event is taking place again? When intervening, address the person’s primary immediate concern or difficulty, rather than simply trying to convince the person to “calm down” or to “feel safe” (neither of which tends to be effective).

For children or adolescents, consider:

• Is the child or adolescent with his/her parents? If so, briefly make sure that the adult is stable. Focus on empowering the parents in their role of calming their children. Do not take over for the parents, and avoid making any comments that may undermine their authority or ability to handle the situation. Let them know that you are available to assist in any way that they find helpful.
• If emotionally overwhelmed children or adolescents are separated from their parents, or if their parents are not coping well, refer below to the options for stabilizing distressed persons.

In general, the following steps will help to stabilize the majority of distressed individuals:

• Respect the person’s privacy, and give him/her a few minutes before you intervene. Say you will be available if they need you or that you will check back with them in a few minutes to see how they are doing and if there is anything you can do to help at that time.
• Remain calm, quiet, and present, rather than trying to talk directly to the person, as this may contribute to cognitive/emotional overload. Just remain available, while giving him/her a few minutes to calm down.
• Stand close by as you talk to other survivors, do some paperwork, or other tasks while being available should the person need or wish to receive further help
• Offer support and help him/her focus on specific manageable feelings, thoughts, and goals.
• Give information that orients him/her to the surroundings, such as how the setting is organized, what will be happening, and what steps he/she may consider.

Orient Emotionally Overwhelmed Survivors

Use these points to help survivors understand their reactions:

Adults

• Intense emotions may come and go in waves.
• Shocking experiences may trigger strong, often upsetting, “alarm” reactions in the body, such as startle reactions.
• Sometimes the best way to recover is to take a few moments for calming routines (for example, go for a walk, breathe deeply, practice muscle relaxation techniques).
• Friends and family are very important sources of support to help calm down.

Children and Adolescents

• After bad things happen, your body may have strong feelings that come and go like waves in the ocean. When you feel really bad, that’s a good time to talk to your mom and dad to help you calm down.
• Even adults need help at times like this.
• Many adults are working together to help with what happened, and to help people recover.
• Staying busy can help you deal with your feelings and start to make things better.

Caution adolescents about doing something risky or impulsive, without discussing it with a parent or trusted adult. For example, you might say:

If the person appears extremely agitated, shows a rush of speech, seems to be losing touch with the surroundings, or is experiencing ongoing intense crying, it may be helpful to:

• Ask the individual to listen to you and look at you.
• Find out if he/she knows who he/she is, where he/she is, and what is happening.
• Ask him/her to describe the surroundings, and say where both of you are.

If none of these actions seems to help to stabilize an agitated individual, a technique called “grounding” may be helpful. You can introduce grounding by saying:

“After a frightening experience, you can sometimes find yourself overwhelmed with emotions or unable to stop thinking about or imagining what happened. You can use a method called ‘grounding’ to feel less overwhelmed. Grounding works by turning your attention from your thoughts back to the outside world. Here’s what you do….”

• Sit in a comfortable position with your legs and arms uncrossed.
• Breathe in and out slowly and deeply.
• Look around you and name five non-distressing objects that you can see. For example you could say, “I see the floor, I see a shoe, I see a table, I see a chair, I see a person.”
• Breathe in and out slowly and deeply.
• Next, name five non-distressing sounds you can hear. For example: “I hear a woman talking, I hear myself breathing, I hear a door close, I hear someone typing, I hear a cell phone ringing.”
• Breathe in and out slowly and deeply.
• Next, name five non-distressing things you can feel. For example: “I can feel this wooden armrest with my hands, I can feel my toes inside my shoes, I can feel my back pressing against my chair, I can feel the blanket in my hands, I can feel my lips pressed together.”
• Breathe in and out slowly and deeply.

You might have children name colors that they see around them. For example, say to the child, “Can you name five colors that you can see from where you are sitting. Can you see something blue? Something yellow? Something green?”

If none of these interventions aids in emotional stabilization, consult with medical or mental health professionals, as medication may be needed. Modify these interventions for a person who has difficulty with vision, hearing, or expressive language.

The Role of Medications in Stabilization

In most cases, the above-described ways of stabilizing survivors will be adequate. Medication for acute traumatic stress reactions is not recommended as a routine way of meeting the goals of Psychological First Aid, and medication should be considered only if an individual has not responded to other ways of helping. Any use of medication in survivors should have a specific target (for example, sleep and control of panic attacks), and should be time-limited. Medications may be necessary when the survivor is experiencing extreme agitation, extreme anxiety and panic, psychosis, or is dangerous to self or others.

You should be mindful of the following:

• Exposure to disaster may worsen pre-existing conditions (for example, schizophrenia, depression, anxiety, pre-existing PTSD).
• Some survivors may be without their medications, or face uncertainty about continued access to medications.
• Communication with their psychiatrists, physicians, or pharmacies may be disrupted.
• Monitoring of medication blood levels may be interrupted.

Gather information that will be helpful when referring to a physician, including:

• List of current medications
• Current medications that require ongoing monitoring by a physician
• Access to currently prescribed medications, doctors, and dispensing pharmacy
• The survivor’s compliance with medication
• Substance abuse/recovery issues
• Ongoing medical and mental health conditions

You may obtain more information about current medications from family and friends if the survivor is too distressed or confused to give an accurate report.

Outline

• Introduction and Overview
• Preparing to Deliver Psychological First Aid
• Core Actions
  • Contact and Engagement
  • Safety and Comfort
  • Stabilization (if needed)
  • Information Gathering: Needs and Current Concerns
  • Practical Assistance
  • Connection with Social Supports
  • Information on Coping
  • Linkage with Collaborative Services
• Appendices