11 Tools to Decrease Anxiety in Acute Trauma Settings

Disaster Behavioral Health refers to what can be done to help people in case of a crisis. Despite the fact that there are some general guidelines and practices, different organizations sometimes create their own preferred set of tools to cope with stress and decrease anxiety and depression.

Dr. Kira Mauseth trained Polish relief workers in Firlej, Poland.

Source: Dr. Kira Mauseth (used with permission)

I interviewed Kira Mauseth after she’d just come back from a 2-week trip in Poland, where she and her team trained Polish relief workers, including staff at Caritas in Lublin and Firlej, educators, and volunteers who are themselves Ukrainian refugees.

Mauseth and Tona McGuire, who are both clinical and disaster psychologists and co-lead the Behavioral Health Strike Team for the Washington State Department of Health, created their own set of tools when they came back the first time from helping people in Haiti in 2010. Following eight trips to Haiti after the earthquake in 2010, Mauseth and McGuire went to Northern Jordan to help Syrian refugees (working together with the relief organizations Save The Children and CARE) and lately to Poland, teaching their set of tools.

Because professional resources in Poland were overwhelmed, as they almost always are in large-scale disasters, Dr. Mauseth’s focus was to train local volunteers as well as health care workers and parents within the affected community on how to give support to each other, how to monitor their own symptoms, how to protect children and how to teach other people what they have learned.

“When it comes to behavioral health, you can train anyone," Mauseth said. "You don’t need a license to implement basic cognitive behavioral strategies that anybody can learn, that are evidence-based and indicated for disaster support.”

Among other tools, Mauseth's Health Support Team training offers a combination of many modules that are organized into four steps that trainees can follow when engaging in support for members of the affected community.

1. Listening and Learning: Learn about the person and listen to the problem using supportive communication and active listening techniques.
2. Offering Support: Foster resilience by supporting the person in identifying internal strengths and finding external resources, or refer them to others as needed.
3. Emphasizing Hope: Let the person know you are there for them, and that you are an encouraging, supportive resource for them when needed.
4. Providing Tools: Provide an active coping mechanism the person can learn and practice.

Here are 11 tools taught by Dr. Mauseth:

Among those tools, included in the Health Support Team curriculum are elements of psychological First Aid as well as other evidence-based disaster behavioral health tools.

1. Psychological triage and risk assessment.

First, the situation needs to be assessed: Do people have shelter? Food? Water?

Then, what is people’s level of distress? Sometimes people are very activated, sometimes panicking, sometimes it’s the opposite, where people are numb and even shut down. No reaction is "better" than the other. Different people react differently as they process their trauma in different ways.

2. Active listening.

Mauseth says that 50 percent of what she teaches is active listening concepts and techniques. Health care workers are often tempted to do trauma therapy but in an acute disaster setting, trauma therapy and problem-solving could be counterproductive.

What is acutely needed is active listening: If you are actively listening to a person in need, you should be attentive to non-verbal messages, facial expressions, and the tone of voice of the person speaking. You need to show empathy and try to genuinely understand what the speaker is saying without criticism or judgment.

In order to deeply understand what the person says, you can use your own words to describe what you think the person is saying and you can ask questions to understand better. You can also try to summarize what you understand the person is saying.

Studies have shown that active listening is key for people experiencing acute traumas. Indeed, Mauseth received a lot of comments from refugees describing how much better they felt after spending time with a volunteer who listened to them.

3. Evaluate the risk of suicide.

Some people are reluctant to ask about suicidal ideation because they think that they could plant the idea of suicide inside a person’s head. In reality, according to Mauseth, as well as the research literature, gently and directly asking about the desire to self-harm doesn’t increase the risk of suicide. Instead, it decreases that risk.

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If the question about self-harm is asked in a gentle and compassionate way and if the risk of suicide is high, it is important to immediately take appropriate actions.

In the case of a large-scale disaster like the war in Ukraine where there are millions of refugees, resources are scarce and referrals to therapists won’t be available. Instead, the key is to get other people in the community involved to help the person at risk of suicide and to make sure that person isn’t left alone at any moment. It is all about teaching people to help each other.

4. Establish routines, trust, and safety for adults and kids.

Because the family structure is often not intact anymore, it is important to establish a structure with routines, like when to go to bed, wake up, and have meals. Doing so at the same time every day helps ensure a sense of trust and safety for kids and adults.

5. Mindfulness and meditation.

Mauseth teaches people to be aware of the present moment, to calmly focus on body sensations and on breathing to decrease their fight or flight response and to control physiological responses. Focusing the mind on a particular object, thought, or activity helps regulate emotion response and reduces stress and anxiety.

It is important to note that not every tool works for every person. There are some people for whom mindfulness is triggering and not a good idea. Health Support Team volunteers are trained not to "force" anyone to participate in anything that makes them uncomfortable.

6. Biofeedback.

Mauseth teaches people how to decrease their heart rate with the goal of decreasing emotional or physical pain: First check your pulse, then breathe deeply, then check your pulse again. Each time you breathe deeply, your heart rate decreases and so does your body's response to stress.

7. Deep bubble breathing for kids.

For kids, a fun way to de-stress is to blow bubbles, focusing on trying to blow big bubbles by breathing deeply, slowly, and calmly.

8. Progressive muscle relaxation.

While breathing deeply, tightly contract the muscles in your hand making a fist, count until 10, then relax. Do the same thing with all your other body muscles, group by group.

9. Cognitive Behavioral Therapy (CBT) techniques.

One of the powerful CBT techniques taught by Mauseth is thought replacement. An example of thought replacement is replacing the thought “I can’t do this” with the thought “this is new and I am learning,” or replacing the thought “I can’t make it” with the thought “I have already survived a great deal."

10. Label and praise behavior for kids.

Examples of labeling and praising behaviors for kids are telling kids “thank you for raising your hand,” or, “thank you for keeping your bottom in the chair,” or, “I appreciate you using good manners," labeling the positive behaviors that you want to encourage.

11. Emotional Freedom Technique (EFT).

EFT uses tapping on acupuncture points, which helps people stay grounded in the present moment when experiencing trauma and distressing thoughts. The tapping points are on the forehead, on the bottom of the chin, on the lower part of the sternum, and on the side of the hand, while repeating a mantra in the head during gentle tapping.

Mauseth tells the story of a child in an orphanage who was having nightmares in the middle of the night. His friends went to him and gently used the tapping method to make him come back to a safe reality and get him out of his scary nightmare.

How those tools can be useful to everybody:

When a large-scale disaster or other critical incident that may cause trauma occurs, there is often no time or resources for psychological and behavioral health help, so, in the same way everybody needs to know how to perform CPR (Cardio Pulmonary Resuscitation), it would be good for everybody to know how to use the tools mentioned above which could come in handy for family, friends, and others to cope with stress.