Understanding Crisis Intervention: Neurobiology, Signs & Long-term Effects

What constitutes a crisis?

Any event that directly or indirectly causes any sort of disruption in a person or community’s life (Jackson-Cherry & Erford, 2018). A crisis may or may not lead to a trauma. A few examples of crisis are public attack, natural disaster, domestic violence, death of a close one by murder or suicide etc. An on-going destructive event, idea that the particular event has caused a disruption and the reduced operation when the havoc causing event is not treated by the people or mechanism responsible for its treatment, These 3 elements are seen to define a particular crisis (Jackson-Cherry & Erford, 2018). A crisis can also be an event that demonstrated a real or predicted danger to life or safety. These kinds of events force a person to believe that his/her life or security is continuously in danger which results in physical and mental strain and further disability or weakness (Brooks, 2017).

A person stuck in a situation of crisis is always under enormous stress.  When a person recognises a situation as a crisis and begins to respond to it or think about it, psychological changes start to occur and hence the crisis mode of the brain activates.  This state of brain is a result when a person is no longer able to maintain a stable state of mind and their mind stops to overly function for a while and freezes or goes into flight or fight mode. This phenomenon helps a person to detect danger.  The mid-section of the brain called the limbic system that includes the hippocampus, amygdala and hypothalamus is used in the situation of a crisis (Brooks, 2017). When the flight mode is activated in a human brain it provides signals to instruct the person to run away from the danger as fast as they can and in fight mode the brain instructs to fight and gain protection against danger for them or close ones. This is also called the self-defence mode. When in the freeze mode the brain is in the state of shock and does not know what signal to send as a result of which a person freezes mentally or physically.

Signs of a person who is the victim of a crisis can be difficult to detect when the crisis is over in the past. In the eyes of a normal untrained person the sign a person exhibits in crisis is almost impossible to detect and might generally seem like ordinary reactions (Hargus, Crane, Thorslen, & Williams, 2010). It is generally known that the brain of a person in crisis will enter the flight, fight or freeze mode when he/she is in a crisis.

Some other symptoms that might showcase that a person is the victim of a crisis are unnatural appetite, irregular sleep pattern, difficulty in performing daily general activities, depression, isolation, suicidal, pessimistic, difficulty in management of emotions such as anger and sorrow (Kolski, Jongsma, & Myer, 2014).

Being stressed out emotionally and mentally for a long period of time can be extremely dangerous. Excessive stress results in the release of a hormone called cortisol which in a long run causes brain cell damage because it breaks down the hippocampus which is essential for storage of memory (Brooks, 2017). This might result in permanent mental sickness and the sickness might be incurable and even fatal.  The excessive releases of cortisol finally results in the decline of the production of other essential and feel good hormones such as serotonin ( Montoyar, Terburg, Bos, & Honk, 2012). When a person’s brain goes into flight, freeze or fight mode it releases adrenaline which constrains ability of clear and accurate thought and decision making ( Schmidt & Weinshenker, 2014).

Client Name: Ashley Cyrus	ID #:
Date and Time: November 26, 2018     11:00 am	Location: Parkersburg, WV
Ashley Cyrus has lost everything in the 9/11 attack; her husband, her 2 year old daughter, the rest of her family, her house and her clothing store which was the only source of income for the entire family. This severe crisis has left her in a deep trauma mentally and also left her homeless and starving. She does not respond physically and verbally to anything anyone says or does and is constantly in a freeze state. She has lost a lot of weight and has become extremely weak. Her homelessness has made her devoid of any nutrition and hygiene. She mostly roams around streets and picks food from the trash box due to the lack of any money.
List Factors
Risk Factors (What cognitions, affect, and behaviors pose a risk to the client’s well-being and to effective treatment/crisis resolution)	ü Blames herself ü Sudden loss of her family and financial possession from her life ü Does not express or share her sorrow and emotions ü Has lost any desire to restore any happiness and prosperity back to her life ü Is constantly terrified and hallucinates scenes from the attack
Protective Factors (Factors that mitigate the Risk Factors and/or that can be used in treatment)	ü She finds strength in praying to god ü Government has loan provision schemes for such cases. ü She was a clothing store owner and is thus experienced in selling clothes.

Plan (What can be done to assist this individual as they work through this crisis)	ü A face to face consultancy with a psychiatrist will help her to know about her complicated feelings and also share it with someone in order to lighten a little burden off her mind. This session will also provide her a place to express herself and let her emotions out without the fear of judgment (Khan, Faucett, Lichtenberg, Kirch, & Brown, 2012) . ü Take her to Nutritionist for proper medication and treatment. ü Get government help to take a loan to get her a house and provide her employment opportunity in a clothing store with respect to her past work experience. ü Get her employment at American Eagle (Eagle, 2018).
Referrals/Support Provided	• Grief Counselor—specialized with grief and loss from disaster • Group therapy session—for other people who have had problems similar to hers ( Farrer, Bennett, Christensen, Crisp, Mackinnon, & Griffiths , 2012). • Psychiatrist —to treat her depression • American eagle store owner- to give her a job. • Government Bank- to provide her a home loan.
Consultations obtained regarding this intervention (Include who was consulted, the time, the method—in person, telephone, etc.—and the content of his or her feedback):

The neurobiology of crisis

Follow Up (Who will do what and when)	A session will be fixed with a grief counselor in 5 days. A psychiatrist’s appointment will be taken for a week later for her mental checkup. A nutritionist appointment will be taken for 2 days later for physical treatment. She will be taken to the bank tomorrow to get her home loan sanctioned. She will be taken to the American eagle store for a job interview after 2 weeks.
Worker (Interventionist’s name)	Caroline Jennings

Long-Term Goal

Becoming mentally and emotionally stronger and move on.

Approach the situation practically and accept the loss and focus in making her life better.

Focus on restarting her business.

Become more socially active and increase emotional and physical activity to forget what happened (Jetten, Haslam, Alexander, & Haslam, 2012).

Cultivate a sense of happiness, wellbeing and amity.

Objective 1: Achieve fast and Receive efficient medical remedy.

1. Accompany and help Ashley to go to her psychiatrist.
2. Accompany her to the nutritionist.

Objective 2: Regularly discuss about medical process that is being carries on, taking care of her overall health and encourage and empower her to work for her own happiness, wellbeing and prosperity.

1. Talk to the doctor and the other medical staff who are engaged in the treatment of Ashley. Teach and prepare Ashley for real and practical expectations.
2. Encourage Ashley to accept that it was her ex-husband fault and she is not the one who is supposed to suffer. She must forgive him for her own good and move on.
3. Make Ashley realize that there will come new hope and happiness.
4. Tell Ashley that she has the responsibility of her own self and she has to be strong.

Objective 3: Check and fill up the screening tools in order to measure the extent of depression and associated symptoms of grief.

Look up Ashley’s extent and statistical frequency of grief responses. Check her mood, emotions and behavior patterns.

Symptom Checklist 50  Studied

Beck Depression Inventory II (Dozois, 2010)

Edinburgh Postnatal Depression Scale (Matthey, 2008)

Take Ashley to nutritionist to take medications and receive a list of do’s and don’ts for her diet.

Objective 4: Talk to her about any issue that has been left out that is still a cause for depression, sorrow, anger or any other negative emotion.

Cognitive behavioral therapy interventions

Thought documentation

Teach Ashley that keeping any emotions within her will only strengthen those negative emotions and will become more dangerous.

Inspire her to be more expressive about her feelings and share them with people.

Objective 5: Recognize and substitute thoughts of blaming herself and feeling hopeless with practical, positive and self-love talk.

Educate Ashley how her negative feelings are piling up by not answering for the loss and realizing and accepting that not having an answer is the last stage of grieving.

Encourage Ashley to eat good food in order to be physically strong and healthy.

Ask Ashley to stop blaming herself with more practical alternatives such as indulging in a hobby and building her career.

References

Farrer, L., Bennett, K., Christensen, H., Crisp, D. A., Mackinnon, A. J., & Griffiths , K. M. (2012). The Effectiveness of an Online Support Group for Members of the Community with Depression: A Randomised Controlled Trial. Plos One.

Montoyar, E. R., Terburg, D., Bos, P. A., & Honk, J. v. (2012). Testosterone, cortisol, and serotonin as key regulators of social aggression: A review and theoretical perspective. Motivation and Emotion, 36(1), 65–73.

Schmidt , K. T., & Weinshenker, D. (2014). Adrenaline Rush: The Role of Adrenergic Receptors in Stimulant-Induced Behaviors. Molecular Pharmacology, 4-50.

Brooks, J. (2017). Crisis Intervenstion: The neurobiology of crisis. Elani Publishing.

Dozois, D. J. (2010). Beck Depression Inventory?II. The Corsini Encyclopedia of Psychology.

Eagle, A. (2018). Retrieved December 2, 2018, from Americab Eagle: https://www.ae.com/international?cm=sIN-cINR

Hargus, E., Crane, C., Thorslen, B., & Williams, J. G. (2010). Effects of Mindfulness on Meta-Awareness and Specificity of Describing Prodromal Symptoms in Suicidal Depression. Emotion, 10(1), 34-42.

Jackson-Cherry, L. R., & Erford, B. T. (2018). Crisis Assesment, Intervention and Prevention (3 ed.). New Jersy: Pearson.

Jetten, J., Haslam, C., Alexander, & Haslam, S. (2012). The Social Cure: Identity, Health and Well-Being. Hove and New York: Psychology Press.

Khan, A., Faucett, J., Lichtenberg, P., Kirch, I., & Brown, W. A. (2012). A Systematic Review of Comparative Efficacy of Treatments and Controls for Depression. PLoS ONE, 7(7).

Kolski, T. D., Jongsma, A. E., & Myer, R. A. (2014). The Crisis counseling events treatment planner (2 ed.). New Jersy: John Wiley &Sons.

Matthey, S. (2008). Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders. Depression and Anxiety, 25(11), 926-931.