As we learn in our course, psychological trauma can be categorized in terms of the time which lapsed since the critical incident has taken place.
Acute Stress Reaction (ASR) describes a victim’s response to a traumatic event up to 72 hours after it has occured, while Acute Stress Disorder (ASD) best describes persistent psychological distress from roughly 72 hours after the event up to one month’s time. Finally, Post-Traumatic Stress Disorder (PTSD) best describes a victim who has been experiencing traumatic stress symptoms for one month’s duration or longer. These categories are important as they help professionals understand where a victim is holding on the time continuum of trauma and help conceptualize what type or how much aid a trauma victim may require.
For those wanting to assist trauma victims quickly after a tragedy, there are several clinical challenges. Therapists are used to receiving patients months or even years after a trauma event, and they have the comfort of being able to tailor long treatment plans for their patient. Whether the therapist uses unstructured therapy models (e.g., psychoanalytic) or structured models of intervention (e.g., TF-CBT), they can generally work with their client for at least several months. If they wish, the therapist can also tailor their therapy around the symptoms of their client and work towards the goal of symptom reduction.
However, those providing immediate psychological aid like the responders in our unit have neither of these possibilities available to them. They have mere minutes or hours to work with their patient; victims have generally not yet developed any sort of psychopathology or psychological symptoms that the aid provider can use to guide their treatment.
To solve these problems, different models of psychological intervention have been developed specifically for immediate psychological aid. These models are not based on which symptoms a victim has; the model’s steps and core action are designed to be broad, practical and flexible to be able to be delivered to any sort of victim in a rapid manner.
First and foremost, our responders in Pittsburgh will be able to provide Dr. Moshe Farchi’s “6 C’s Model” (מודל המעש”ה בעברית) for those requiring immediate stabilization. For those not needing stabilization (ייצוב), the victims can be provided the eight core steps of the NCTSN’S PFA model. Adjunct to PFA’s eight steps, which we all know from the course, there is another complimentary model called “SPR” or “Skills for Psychological Recovery.”
SPR is designed to be delivered to victims already several days past when the trauma event has taken place and PFA may not be enough or has already been provided.
The Skills for Psychological Recovery model (SPR) include (from the NCTSN’s website):
Gathering Information and Prioritizing Assistance: Helps survivors to identify their primary concerns and to pick the SPR strategy to focus on.
Building Problem-Solving Skills: Teaches survivors the tools to break problems down into more manageable chunks, identify a range of ways to respond and create an action plan to move forward.
Promoting Positive Activities: Guides survivors to increase meaningful and positive activities in their schedule, with the goal of building resilience and bringing more fulfillment and enjoyment into their life.
Managing Reactions: Helps survivors to better manage distressing physical and emotional reactions by using such tools as breathing retraining, writing exercises, and identifying and planning for triggers and reminders.
Promoting Helpful Thinking: Assists survivors in learning how their thoughts influence their emotions as they become more aware of what they are saying to themselves, and replace unhelpful with more helpful thoughts.
Rebuilding Healthy Social Connections: Encourages survivors to access and enhance social and community supports while keeping in mind the current post-disaster recovery circumstances.
Aside from the Six C’s model, PFA and SPR, our team of experienced clinicians will use whatever tools appropriate to help orient and support those who were affected by the tragic event. In addition and perhaps most importantly, it may be our presence and visible effort to fly all the way across the world to come to their aid that may send strong messages of solidarity and support.
Written by Rabbi Avi Tenenbaum, deputy director of the psychotrauma and crisis-response unit, and one of the four team members on the ground in Pittsburgh.