July 2020 - Teh Healinghart Center

We Could All Use Some Psychological First Aid

These five elements can help psychological recovery after a crisis.

Posted by Mary McNaughton-Cassill Ph.D. on Jul 16, 2020

In the wake of a major disaster we often rush to meet people’s needs for water, shelter, and health care, but fail to address their psychological needs. This is unfortunate, because overwhelming stress can actually impede people’s ability to make effective use of the aid they are offered. Think for a minute about a scuba diver whose oxygen tank fails. Even if they have a backup plan, they have to remain calm enough to use it. The odds of their being able to do so also go up if they have a fellow diver there to help them.

As a Clinical Psychologist, I volunteer as a Disaster Mental Health Responder with the non-profit group called the Green Cross Academy of Traumatology (GCAT). Created after the Oklahoma City bombings, this all-volunteer group sends groups of Disaster Stress Management Specialists to assist survivors and responders on site. While the specifics of disaster events vary, we know that when people no longer fear for their lives, they find themselves coping with negative emotions such as anger, anxiety, and hopelessness. They may also experience stress-related difficulties with memory and decision making.

Helping people understand and cope with their distress makes it easier to begin the recovery process. But what happens when the disaster is not limited to a specific time or place, spreads invisibly, and has no clear end in sight? The coronavirus pandemic checks all of those boxes and has also focused our attention on the systemic discrimination and social inequities in our social system.

Fortunately, many of the flexible, time-limited strategies we use to help disaster survivors navigate their challenges can be adapted for use in the pandemic. In the immediate aftermath of a traditional disaster, life is not business as usual. Mental Health Responders don’t have access to quiet offices where they can talk to people on a regular basis about their life experiences and current situation. Instead, we talk to people on folding chairs in the corners of large shelters, behind food distribution centers, or in front of their damaged homes. We rarely see the same person more than once, and the focus is on helping them identify and cope with their most pressing needs.

This sort of intervention, sometimes called Psychological First Aid (PFA), can be learned and used by professionals and lay people alike. Like CPR, PFA is designed to be a short-term strategy to stabilize people in distress. Both are designed to help people in crisis, not to replace more traditional treatments. In an age of social distancing, we aren’t gathering in person, but we can certainly still reach out to people online.

Definitions of Psychological First Aid vary, but at least five components seem to be key. The first is: Help people feel safe. This is difficult to do during a raging pandemic, but in addition to encouraging people to take safety precautions, we also need to provide tangible support. When people are hungry and worried about their basic needs, they don’t cope well, so whether we are serving food from a Red Cross truck after a hurricane or a food bank distribution site during the current crisis, we are helping people to feel less vulnerable. Both offering support to others and receiving help ourselves can increase our sense of control.

The second principle of Psychological First Aid is to create a sense of calm by helping people manage their own emotions. This does not mean telling people how they should feel or dismissing their responses. It literally means listening to them while they talk (or cry or complain) and then helping them to reframe the situation so they can begin to think about how to move forward. Sometimes just expressing feelings reduces their intensity so we can think more clearly. Other times taking a break to socialize, exercise, practice a relaxation technique, or just breath can help us reset our responses. Feelings aren’t always accurate, but like pain, they are a warning system that won’t just go away if we ignore it.

Another aspect of PFA is helping people to regain a sense of control and self-efficacy. During and after a crisis people often struggle with feelings of helplessness. So, engaging them in problem solving and allowing them to determine what they need to cope can be empowering. I have seen victims of disasters regain their own footing after helping to clean up someone else’s yard, sharing their food with others, or even just being able to help other people find resources. We as humans don’t like feeling vulnerable, or out of control, so helping people realize that they still have agency can make a huge difference.

The fourth key to PFA is the need for social connection. In the wake of physical disasters, people often feel isolated and alone. Mobilizing social support in an age of social distancing can be difficult. But finding creative ways to reach out helps. Using virtual platforms to hold book clubs, collaborate on projects, or simply chat can enable us to connect. The key is to find a way to engage in an interaction with other people, not to simply observe their actions on social media.

Although it seems like an intangible concept, hope is also key for psychological recovery. That is ironic since we all acknowledge the destructive power of its opposite, despair. However, a little bit of perspective can go a long way! While our current situation seems dire, during the Civil War we took up arms against our fellow citizens, the Spanish Flu killed 50 million people worldwide, and wars have long resulted in people dying without having their family around them. If the past has taught us anything, it is that humans are resilient and that we can endure tough times. Psychological First Aid won’t cure the pandemic, but it can help us generate and maintain the hope that, like oxygen, is essential for our well-being.

References

https://www.hopkinsmedicine.org/news/articles/the-power-of-psychological-first-aid

https://www.psychologytoday.com/us/blog/when-disaster-strikes-inside-disaster-psychology/201810/psychological-first-aid

Green Cross Academy of Traumatology: gcat.org

Article Link: We Could All Use Some Psychological First Aid

Creating Student Success From the First Day of School

Developing positive teacher-student relationships with students with autism.

Posted by Brenda Smith Myles Ph.D. on Aug 20, 2018

As Jahil approached his classroom on the first day of school, he was very nervous. Last year, he and his teacher didn’t always get along. He never felt that he belonged, and if he were honest, he didn’t always care. Mrs. Fredericks, his new teacher, stood outside the classroom door. When she saw Jahil, she smiled and said, “You’re Jahil, aren’t you? I’m excited that you are in my class. By the way, cool shoes.” Jahil smiled and immediately relaxed. He thought to himself, “She’s not too bad.”

In that simple yet important interaction, Mrs. Fredericks set the stage for an emotionally healthy classroom where Jahil can learn and grow.

In their seminal study on teacher-student relationships, Aspy and Roebuck (1977) found that five teacher behaviors were strongly related to students’ social and academic gains: a) accepts student feelings, b) uses praise, c) accepts and/or uses student ideas, d) provides instruction e) justifies authority. The authors further reported that it is “… worthwhile making sure that teachers use high levels of interpersonal skills in interactions with their students because benefits accrue to the students in terms of increases on both mental health and cognitive indices.” (p. 223)

In that one interaction, Mrs. Fredericks recognized Jahil’s feelings of anxiety, showed acceptance, and used sincere praise. This is an evidence-based practice. Recent research, including a meta-analysis of over 350,000 students, supports the findings of Aspy and Roebuck (1977) and reveals that the quality of early teacher-student relationships has a long-lasting impact. (Cornelius-White, 2007)

Positive teacher-student relationships in elementary school increase the likelihood that all learners, including those with autism, will experience fewer episodes of negative behavior. In addition, students who have a positive relationship with teachers also have higher academic achievement, fewer behavioral problems, better social skills, and greater social inclusion (cf. McCormick & O’Connor, 2015; O’Connor, Collins, & Supplee, 2012; Robertson, Chamberlain, & Kasari, 2003), including into high school. (Murray & Malmgren, 2005) This clearly impacts the long-term trajectory of school and, eventually, employment. (Baker, Grant, & Morlock, 2008; O’Connor et al., 2012)

Teachers have a strong influence on their students. That is, students’ perspectives and attitudes are formed in response to those of their teachers. Cornelius-White found that when teacher use supportive behaviors, students are more like to have positive outcomes in learning, behavior, and social-emotional growth.

From the beginning of the year, what can teachers do to create positive teacher-student relationships? Research has identified simple yet powerful ways to build supportive alliances with students (Cornelius-White). When establishing supportive relationships with students who have autism, these same strategies apply; however, they may need to be modified to be effective for the autistic neurology (Myles, Aspy, Mataya, & Shaffer, 2018). The following strategies will help you think differently about developing a relationship with an autistic student.

1. Be empathetic

Rely less on facial expressions and body language to understand how a student feels and to show how you feel. Learn basic visual supports for communicating emotions.

2. Support independent and interdependent functioning, not dependence

Be prepared to explicitly teach skills for independence and interdependence. Don’t assume that autistic students know what most students have learned through “osmosis.”

3. Be supportive of student needs

Recognize that needs of students with autism may not be typical. Sensory and cognitive differences lead to different needs.

4. Be trustworthy

Recognize that students with autism may take your words literally. Explaining when words are figurative or when something will be true most of the time can help to maintain trust.

5. Be positive

Studies show that people with ASD often read resting faces as showing anger. You may need to use visual supports and clear words to show your positive attitude toward a student.

6. Feel close to students

Write the student brief notes about how he is important to the class and you. Talk sincerely with the student about her special interests.

7. Accept student ideas

Students with ASD sometimes think in ways that surprise neurotypical teachers and peers. Nonetheless, they need to feel validated and included.

8. Praise and reinforce

Use student special interests as reinforcers.

9. Accept student feelings

Recognize that students with ASD sometimes have difficulty recognizing or labeling their own feelings. They also often have difficulty modulating their emotions. Be prepared to provide calming strategies. Recognize that discussions about emotions may be especially challenging.

10. Involve student in decision-making

Help student to set goals for learning academic, social, and behavior skills. Graph improvements with the student, so that she can understand her progress.

11. Encourage high-level thinking

Use visuals, such as T-charts, graphic organizers, and lists, in instruction. Allow students to respond verbally instead of in written format.

12. Be responsive to learners’ developmental, social, and personal needs

Teach social and daily living skills so that the student can interact successfully with others.

13. Promote student success

Modify academic work so that it is presented at the student’s level. Structure social activities for success. Incorporate special interests in student work.

14. Limit conflict

Establish clear rules and routines. Students with ASD tend to function best when their world is predictable. Clear rules and routines will decrease student anxiety and thus decrease conflict.

How important are teacher-student relationships for learners on the spectrum? Very. Teachers set the stage for student social success: “Students with ASD who have a positive relationship with their teachers have a higher level of social inclusion, have more peer relationships, and experience fewer behavior problems.” (Robertson et al., 2003)

References

Aspy, D. M., & Roebuck, F. N. (1977). Kids don’t learn from people they don’t like. Amherst, MA: Human.

Baker, J., Grant, S., & Morlock, L. (2008). The teacher-student relationship as a developmental context for children with internalizing or externalizing behavior problems. School Psychology Quarterly, 23(1), 3-15.

Cornelius-White, J. (2007). Learner-centered teacher-student relationships are effective: A meta-analysis. Review of Educational Research, 77(1), 113-143.

Article Link: Creating Student Success From the First Day of School