Crisis Center

Managing Anxiety About Swine Flu

John A. Call, Ph.D., J.D., A.B.P.P. — Wed, 29 Apr 2009 21:50:33 +0000

In previous posts I've talked a lot about preparing for disasters, building resilience, developing a survival attitude, etc. Well now, with the developing swine flu crisis upon us it's time to put all that into practice. The American Psychological Association recently put out a brief statement regarding how to manage your anxiety about swine flu. You can find that discussion here. In essence the APA suggests the following: keep things in perspective, get the facts, maintain a hopeful outlook, stay healthy, build resilience, have a plan, communicate with your family, keep connected, and seek additional help when needed.

Of the above nine elements I wish to stress the following: get the facts, have a plan, keep connected. Where can we get the facts? What kind of a reasonable plan should I and my family follow? Who has the best information and how can I connect to it? The answer to these questions is the Center for Disease Control. Their website has numerous checklists for families, businesses, schools, and communities. You can access that information here.

In general the CDC acknowledges that in a flu pandemic social disruption may be widespread, that being able to work may be difficult or impossible, that schools may be closed for a long period, that transportation services may be disrupted, and that people will need advice about what to do. Their advice is to prepare and prepare now. The CDC suggests that families stockpile two weeks of food and water. More specifically the CDC states the following:

You can prepare for an influenza pandemic now. You should know both the magnitude of what can happen during a pandemic outbreak and what actions you can take to help lessen the impact of an influenza pandemic on you and your family. This checklist will help you gather the information and resources you may need in case of a flu pandemic.

1. To plan for a pandemic:
o Store a two week supply of water and food. During a pandemic, if you cannot get to a store, or if stores are out of supplies, it will be important for you to have extra supplies on hand. This can be useful in other types of emergencies, such as power outages and disasters.
o Periodically check your regular prescription drugs to ensure a continuous supply in your home.
o Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.
o Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home.
o Volunteer with local groups to prepare and assist with emergency response.
o Get involved in your community as it works to prepare for an influenza pandemic.

2. To limit the spread of germs and prevent infection:
o Teach your children to wash hands frequently with soap and water, and model the correct behavior.
o Teach your children to cover coughs and sneezes with tissues, and be sure to model that behavior.
o Teach your children to stay away from others as much as possible if they are sick. Stay home from work and school if sick.

3. Items to have on hand for an extended stay at home:
Examples of food and non-perishables Examples of medical, health, and emergency supplies
o Ready-to-eat canned meats, fish, fruits, vegetables, beans, and soups o Prescribed medical supplies such as glucose and blood-pressure monitoring equipment
o Protein or fruit bars o Soap and water, or alcohol-based (60-95%) hand wash
o Dry cereal or granola o Medicines for fever, such as acetaminophen or ibuprofen
o Peanut butter or nuts o Thermometer
o Dried fruit o Anti-diarrheal medication
o Crackers o Vitamins
o Canned juices o Fluids with electrolytes
o Bottled water o Cleansing agent/soap
o Canned or jarred baby food and formula o Flashlight
o Pet food o Batteries
o Other non-perishable items o Portable radio
o Manual can opener
o Garbage bags
o Tissues, toilet paper, disposable diapers

In conclusion, keep things in perspective and maintain a hopeful attitude. Frankly, I personally am affronted by much of what I what I see and hear the "talking heads" on television say about the current situation. Thus I recommend that you and your family avoid staying "glued" to the TV news programs but rather seek periodic updates from more credible sources such as the CDC website. Good luck.

PTSD in the Military: An Interview of a Military Wife

John A. Call, Ph.D., J.D., A.B.P.P. — Sat, 17 Jan 2009 16:37:31 +0000

As ever-increasing numbers of soldiers are being diagnosed with post-traumatic stress disorder (PTSD), the need to understand this complex and troubling experience grows larger. In order to better understand what soldiers are going through, I interviewed the wife of a veteran who was diagnosed with PTSD. Shelly is not her real name, but Shelly and her husband are real people and I have known Shelly for several years. This interview took place in January 2009.

Dr. Call: Thanks for agreeing to this interview, Shelly. I appreciate your willingness to share your experience. So your husband is a veteran of the Iraq war?

Shelly: Yes, he is. He did a 13-month tour in 2005-2006.

Dr. Call: And when was he diagnosed with PTSD?

Shelly: In the spring of 2007. Many people think that in order to have PTSD, a person has to experience the symptoms during the traumatic event or right after it, but that's not true. Many people have delayed-onset PTSD, which surfaces a few months after the event is over. That's what happened with my husband. He seemed okay when he first got back, but then he started becoming depressed and he couldn't sleep.

Dr. Call: So how did he get help?

Shelly: He went to the mental health clinic at the military base. That was one of the most frustrating things about the experience. He kept going to the clinic and telling them that he needed help, that he was having trouble. But they kept sending him away. When he was having a panic attack, they told him to go home and lay down. They told him he would be fine. So he had to keep going back - 4 or 5 times - before they finally listened to him and gave him some help. I was really proud of him for being persistent. If he had listened to them and not gone back to the clinic, I don't know how he would be today. If there's anyone out there who is seeking help, don't be afraid to insist that you need help. "The squeaky wheel gets the grease," they say. That's definitely true in the military.

Dr. Call: Have his symptoms improved since being diagnosed with PTSD?

Shelly: Yes, they have. After he was diagnosed, he began seeing a psychologist and a psychiatrist on a regular basis. I think that really helped him. He takes sleep medication now, which has helped his insomnia so much. And he also takes anxiety medication, which helps him to stay calm when he gets anxious. Pairing these medications with therapy has done a lot for him, and he's a lot better off than he was two years ago.

Dr. Call: How has his PTSD affected you?

Shelly: For a long time, he didn't want to ever go out and do anything. He was depressed a lot, and I thought it was something I had done. It did have an affect on our relationship, but I tried to be patient with him and just give him time. To all the friends and family members of soldiers with PTSD, if there's anything you take from this interview, it should be this: give them time! Don't expect them to be the same person they were when they left. It takes time to recover from a horrible experience like war. Be patient and give your loved ones your support.

Dr. Call: Is there anything else you think is important for people to know about this topic?

Shelly: Many people won't understand what you are going through. One night after being in a crowded place, my husband got anxious and became angry and he punched a wall with his fist, breaking his hand. After hearing this story, some of my friends looked at him like he was a monster. This incident scared me, but I knew that my husband was just having a hard time adjusting to the little things, like being in a crowded store. I was patient with him and I stood by him when people walked away shocked after hearing the answer to the question, "What happened to your hand?" My point is that some people won't be able to understand what we are going through because they've never had to experience it. But that's okay. There are people who do understand and want to help. Don't hesitate to ask for help if you need it, because that's the only way you will get it.

Dr. Call: Thanks again, Shelly, for sharing your experience.

Shelly: You're welcome. People need to know that they are not alone in this.

Holiday Stress: How to Manage It

John A. Call, Ph.D., J.D., A.B.P.P. — Wed, 03 Dec 2008 16:17:08 +0000

The holidays are a great time to relax and spend time with family and friends, but many people find themselves being stressed out during this time. "How am I going to afford that gift?" "How am I going to make it through holiday dinner with bitter Aunt Alma?" "It just won't be the same this year without Grandma here." There are many sources of stress for people during the holiday season, especially with respect to family and money. Recent research suggests that women are more vulnerable to holiday stress, and they may be less likely to take the necessary steps to manage it.

There are several ways to help manage stress during the holidays. Here are a few:

*Find out what stresses you out. Is it a certain situation, a particular person, or that long list of things to do? Realizing what gives you stress is the first step to managing it.

*Find out how you deal with stress personally. Does stress give you a headache? Do you get moody with family members? Do you find yourself needing a drink to get through the day? Recognizing how you handle stress can help you determine if your coping style is an effective one.

*If you determine that your stress management behaviors are not healthy ones, try changing one at a time. Don't be too hard on yourself if you still feel irritated at your loved ones or you still feel that craving to have a drink. It takes time and effort to change!

*Remember to take good care of yourself during stressful times. Try to eat healthy, get out and exercise a bit, and get enough sleep. These things will keep your body healthy, which will cut down on stress.

*Go to your family and friends for support when you need it. Talking to your loved ones during hard times will help decrease the stress on your mind. And if you find yourself needing professional help, don't hesitate to seek out a mental health professional who can help you manage your stress in a more healthy way. Sometimes people benefit from a little help when learning how to handle stress effectively.

Good luck and enjoy the holidays!

How to Become a Happier Person: Is There a Way?

John A. Call, Ph.D., J.D., A.B.P.P. — Sun, 16 Nov 2008 01:34:38 +0000

Happiness: everyone wants it and most people can't get enough of it. Is there a way to become happier than you are now? Some research indicates that the saying "Think happy thoughts" is the way to go if you are looking for a way to increase your level of happiness. One study found that people who thought about positive events in their own lives for just eight minutes per day for three days felt better about their lives a month later. Their satisfaction with their own lives increased significantly by simply thinking about happy life events. So is that all we have to do? Just think about the day you got married, or the time when your kids were young, or your 16th birthday party when all your friends were there?

Sounds easy enough, but some people believe that there is a "set point" for happiness. A set point is the particular point at which a person tends to stay. Many people believe there is a set point for weight, and it's also been said that there's a set point for hair. Many people find that when they try to lose or gain a significant amount of weight, they usually gravitate back to their "normal" weight. Likewise, a person who usually sports long hair with bangs may cut their hair short, but they will eventually find their way back to that "long hair with bangs" look.

So is your grouchy boss destined to stay grouchy forever? The good news is that people can change their set points if they really work at it. A person who wants to lose a lot of weight and keep it off usually has to change their way of life to do so. They may need to start eating more vegetables and less McDonald's on a regular basis to be able to keep the weight off. In the same way, if you want to become happier, you have to be able to put effort into it. I'm not sure if simply thinking happy thoughts for a few minutes a day will make you happier, but it definitely won't work if you only do it for a few days. If you really want to change your life and make yourself happier, make a plan and stick to it! Take a few minutes every day to reflect on happy times, or take up a new hobby you know you can keep, or decide to go out with good friends once a week. But whatever you do, decide it's worth the effort to stick to your plan of becoming a happier person.

The Truth About Depression

John A. Call, Ph.D., J.D., A.B.P.P. — Fri, 07 Nov 2008 16:39:23 +0000

Depression is a disorder in which a person has thoughts of extreme sadness, hopelessness, and/or despair, and these feelings usually interfere with daily life, such as working, eating, or sleeping. These symptoms must persist for at least two weeks to meet the diagnosis for depression. The causes of depression are varied and range from negative life events to biological factors. Depression can also come about simply from the way a person thinks.

So what are the treatments for depression? Well, if you watch TV at all, you have seen that we now have many different medications for depression. Of course, there's a pill for everything nowadays, and it is my opinion that we have become a ‘pill-popping' society. The truth about medications for depression, though, is that they will not make you happy. They will only make you less sad, and that's only for some people. For people suffering from extreme depression, such as those who are considering suicide, medication may be necessary to correct a hormonal imbalance in the brain. But for many others who are just trying to get through the day, medication may not be the best answer.

Psychotherapy offers a wide range of different types of therapy, from cognitive-behavioral (for those who may benefit from changing the way they think) to family therapy, for those people whose problems involve other people in their support system. There are many treatments that have been "empirically validated," which means they have been researched and found to work for certain populations. Another aspect of therapy that is highly overlooked these days is the therapeutic relationship. How many people simply need someone to talk to who will accept them as they are? A lot of people need this, especially depressed people. A licensed mental health care professional, such as a psychologist or counselor, can help people identify the problem areas in life and work towards repairing those areas.

One thing to remember if you are depressed is that you have options! You don't have to suffer through depression alone, and you don't have to take the pills a doctor throws at you either. The best thing to do is to find a competent professional who will work with you and let you know what options you have for dealing with depression. The same treatment doesn't work for everyone. A personalized plan of action for battling depression could really make the difference in your life. And remember, if one thing doesn't work, there are a lot of other options out there to try.

Posttraumatic Disorder--Temporary or Permanent?

John A. Call, Ph.D., J.D., A.B.P.P. — Fri, 03 Oct 2008 20:19:37 +0000

Posttraumatic stress disorder (PTSD) is a disorder that may develop after a person is exposed to a traumatic event, such as an assault, rape, car accident, terrorist attack, natural disaster, or military combat. These are the most common situations that lead to PTSD, but any life-threatening situation can lead to the disorder as well. Statistics say that about 8% of adults in the US will experience PTSD during their lifetime, and women are about twice as likely to struggle with it.

So what is PTSD? The disorder usually consists of flashbacks of the traumatic event, avoidance of reminders of the event (such as avoiding conversations about it), detachment or withdrawal from their surroundings, and some somatic complaints. Other symptoms, such as insomnia, hypervigilance (being on alert constantly), and increased fears, can accompany the disorder.

Obviously, this disorder is incredibly distressing to those who experience it. And some research seems to indicate that there is no "cure" for it--that PTSD never really goes away. But the good news is that there are several treatments that have been shown to decrease the symptoms of PTSD and improve the lives of its victims. Cognitive-behavioral therapy (CBT) is one treatment that has been very effective in reducing the symptoms. This form of therapy helps people to manage their fears and anxiety that stem from the traumatic event. Other therapies that are being used to treat PTSD include relaxation therapy, in vivo exposure therapy (which helps people re-experience the event while remaining calm), cognitive restructuring (which helps people restructure their thoughts to be more calm and positive), and psychoeducation (which helps people understand PTSD and its effects).

The best thing that people suffering from PTSD can do is to seek treatment. Even though the most natural response of these people is to try to forget what happened, being able to do that is highly unlikely. Those who try to avoid treatment for the disorder often develop substance abuse problems, sleep problems, and difficulties in their relationships. Seeking treatment through therapy is often very beneficial, and there are many competent professionals who are trained to help victims of traumatic events. The mental health community has created several groups and treatment centers specifically for victims of PTSD, and these include the Disaster Response Network of the APA, the National Center on Disaster Psychology and Terrorism, and the Disaster Mental Health Institute. In particular the National Center for PTSD website had a great deal of information on this disorder. You can find it here.

Multitasking--Efficient or a Waste of Time?

John A. Call, Ph.D., J.D., A.B.P.P. — Fri, 26 Sep 2008 14:56:20 +0000

We've all done it. Making breakfast while checking email. Paying bills while having a serious conversation with your significant other. And the most infamous one: driving while talking on a cell phone. It saves time, right? Getting two things done at once is better than just getting one thing done. Or is it?

Research shows that multitasking takes a toll on your mental energy, especially if the tasks are difficult ones. Apparently, the human brain is not designed to be able to do two or more things at once. A study showed that people are much slower when switching between tasks than they are when repeating the same task. Even when given more time between tasks, people were not as efficient when task-switching as when task-repeating. The brain can adjust to a new task, but the old task is still competing for mental energy with the new task. For example, driving while talking on a cell phone can get difficult when someone cuts you off in traffic. If you were mostly focused on your phone conversation, you would have to switch tasks to slam on the brakes. Switching back to the conversation after regaining your driving composure can be difficult - "What was he talking about??"

Multitasking involves two distinct stages: one is goal shifting and the other is rule activation. Goal shifting consists of deciding to focus on another task than the one you are currently focused on. Rule activation consists of turning off the "rules" for one task and turning on the "rules" for another. Going back to our driving example, not only would you have to consciously decide to return to the conversation after the traffic incident, but you would also have to think, "Ok, now that I can return to the gas pedal, I need to concentrate on what my friend was saying and answer him back." Navigating these two stages within your brain can actually take up as much as 40% of your productive time.

So what does all this mean in terms of daily life? Understanding that multitasking can put a serious strain on your mental energy can make a difference in your life. Instead of trying to cram everything into 5 minutes, take your time and do only one thing at a time. It may actually save you time and energy!

Common Reactions to Disasters and Ways to Cope with Them

John A. Call, Ph.D., J.D., A.B.P.P. — Wed, 17 Sep 2008 17:33:47 +0000

On September 1, Labor Day, as a member of the Oklahoma Medical Reserve Corps, I spent the day working with about 2,000 Louisianans who had just been bused to Oklahoma City to shelter from Hurricane Gustav. They were sheltering in a huge unused warehouse-the Lucent Technology Center in southwest Oklahoma City. By far the majority of our "guests" were a stalwart group. In particular I met and talked with a man, about my own age (older rather than younger), who worked as a maintenance man in the courthouse complex in New Orleans. We started the conversation with him teaching me the best way to eat MREs (meals ready to eat)-which menus were the best, how to mix the gravy with the meat, and the best way to open the cheese packets. He had been through Katrina and decided that had been enough; so when the mayor of New Orleans had urged people to evacuate he took him up on it. Even though my new friend was coping I saw that he was also unhappy. Who wouldn't be given his situation? Disasters are an all too common experience nowadays.

You know, natural disasters such as hurricanes can have a huge impact on those who survive them. People usually have strong emotional reactions to these situations. Common responses immediately following the event are denial and shock. Feeling overwhelmed or numb is also common. In the weeks and months following the disaster, people may begin to have varied reactions. All of the following are common reactions to trauma, but everyone is different, so remember to take that into consideration when evaluating yours or a friend's emotional reactions.

*Feelings may become intense, even to the point of having mood swings. Some people become irritable or overly emotional. Feelings such as anxiety and guilt have been reported in many people in the wake of a disaster.

*Behaviors and thoughts are expected to be affected by the disaster. Many people have recurring vivid memories of the disaster, known as flashbacks. Sometimes flashbacks are triggered by images or sounds that bring back memories of the event. Some people have difficulty concentrating, eating, and sleeping.

*Relationships with friends and family may become strained as the survivor goes through this cycle of intense emotions. Some people experience more conflict with loved ones, while others tend to become withdrawn and quiet when around friends and family.

*It is becoming increasingly common for people to experience physical symptoms in response to stress or trauma. Headaches, stomach aches, and rapid heartbeat can take the place of strong emotions about the event or can accompany a person's emotions.

Now that you know about these reactions, you may be thinking, "Ok, how can I cope with all this?" There are several ways to help yourself or a loved one heal emotionally after a disaster. First of all, be patient. Give yourself time to experience these emotions and expect that things will not go back to normal overnight. Let yourself experience emotions and try to deal with them as they come. If you feel like you are alone in this, ask for support from your family and friends or try to find support groups of people who have experienced the same thing. Talking with others about your traumatic experience can help lift a heavy burden. In addition to communicating your experience to others, try to get into a daily routine. People need to experience some sort of stability after trauma, and routines can help to establish stability in your life. Try to get plenty of sleep and remember to eat healthy. Taking care of your body will ease the stress on your mind. If you try these things and still don't experience any relief, remember that contacting a psychologist or counselor for extra support can be very helpful for those who have experienced a traumatic event. And, finally, remember that when opening the cheese packet in an MRE don't open the whole packet, just tear off one corner--that way it's easier to spread the cheese on your MRE crackers.

What to Do Immediately After a Disaster

John A. Call, Ph.D., J.D., A.B.P.P. — Fri, 12 Sep 2008 16:35:07 +0000

The topic of disasters is not one people like to think about, but we all need to be prepared to deal with the aftermath of a disaster if ever caught in that situation. There are several things you can do to help restore peace to yourself and your family immediately after a disaster. First and foremost, deal with any physical injuries you or your loved ones may have. Restoring physical health will aid in restoring your mental health as well.

After taking care of your immediate physical needs, make a plan for you and your family. Where will you sleep tonight? Do you have relatives or good friends that have not been affected by the disaster? Ask them for help. If you don't have anyone you can call to help you, locate the nearest emergency shelter. They can help. After making sure you have somewhere to stay for the next few days, take a deep breath. Realizing all that has happened after a disaster can be very overwhelming. You may want to talk with someone about your feelings and thoughts of the disaster.

In addition to trying to slow things down and take in all that has happened, there are a few things you can do to help cope with the disaster. Limit your exposure to the news media, such as TV and radio, since there will inevitably be extended coverage of the disaster. Try to rest and drink water to restore your health. Accept the help that others may offer you: you need it. Try spending as much time with your loved ones as possible and engaging in things that you all enjoy. Keep in touch with your friends and family in order to maintain your support systems. Last but not least, try to get into a routine for eating and sleeping: this will help give a sense of normalcy to a difficult situation.

The Role of a Psychologist at a Disaster Site

John A. Call, Ph.D., J.D., A.B.P.P. — Tue, 26 Aug 2008 14:31:03 +0000

When a disaster happens, disaster sites are set up to assist people with their immediate needs. Psychologists go to these sites to assist people with their emotional needs-to provide Psychological First Aid. They provide help by talking to people and answering questions they may have about their situation. They may also help people understand their emotions and reassure them that their emotions are normal.

Specifically, what do psychologists do when they offer support at a disaster site? Here are a few duties they may fulfill:

*Listen! It's what psychologists do best, and it's one thing that people really need after being in a disaster: someone to listen to them. Psychologists listen as people talk about their experience and their concerns for the future. They may even listen as people talk about concerns outside the realm of the disaster, such as the recent death of a loved one or the loss of a job. The combination of a disaster and another major life stressor can be especially hard for people to handle.

*Help people in dealing with their immediate living conditions. Psychologists may help people get used to living in a shelter for the present time and they may provide information about other places to go to get food, clothes, and medical care. They may provide direct assistance in helping people meet their physical needs.

*Help people develop resilience. Psychologists may use relaxation techniques or just talk to people and help them cope with their situation. They may educate people on the normal reactions to disasters and help people understand their own reactions. They also may help people solve conflicts within themselves or with others at the disaster site.

*Psychologists may help people develop a recovery plan for themselves and their families. A recovery plan may include developing a new support system or reaching out to a current support system, and making plans for where people are going to live, work, and where children are going to go to school.

*Psychologists may work with children to help them cope with what's going on. Since children may have very different reactions than adults, psychologists can help them manage their stress and determine if they need professional help in the long run.

*Lastly, psychologists provide the necessary information for seeking long-term psychological assistance after the disaster is over if and when people need it.

Does one have to be a licensed mental health professional to provide psychological first aid? Absolutely not! Interested individuals can obtain training in Psychological First Aid from the American Red Cross or from their local Medical Reserve Corp to name just two organizations who provide such training. Then you will be able to deploy with your Voluntary Organization Active in Disaster (VOAD) of choice as a mental health volunteer. To obtain an overview of just what is Psychological First Aid download the Field Operation Guide from the National Center for PTSD. You can find it here.