Psychosocial Support Techniques

Disaster creates imbalance among individuals, families and communities. People will be in a state of confusion and look for support. Therefore, it is essential to render appropriate help for disaster survivors. This chapter talks about ten psychosocial techniques that are essential in the helping process. These techniques can be practiced by anyone who wants to assist the people hit by disasters and facilitates recovery. While applying these psychosocial support techniques, the caregivers should bear flowing points in minds;

• Disaster affects every individual in the community
• Reactions following a disaster are normal response
• Disaster contributes to both individual and collective trauma
• Even the survivors with good coping ability will have difficulties in sustaining the earlier level of functioning for the initial days after disaster
• Problems with daily living results in psychosocial issues among disaster survivors
• Cultural, religious and linguistic sensitivity is essential while developing community based psychosocial programmes
• Survivors need to be motivated to express about their disaster experiences
• Phase specific interventions need to be developed
• Rebuilding and maintenance of support systems is essential
• The caregivers should be open minded while engaging themselves in the caring process

Ventilation

Disaster minimises individuals' coping abilities and resources. Individuals generally suppress their strong negative emotions. These pent-up emotions and feelings get bottled up and affect the well-being of the individual. Channels need to be created for individuals to ventilate their emotional distress that would help in preventing emotional explosion. Creating space for the disaster survivor to talk about his/her negative emotions is like a whistle in a pressure cooker. The whistle regulates the pressure and if a whistle is absent, the pressure cooker might explode. The ventilation process facilitated by the caregiver would act as a safety valve for the survivor to release his/her negative emotions.

Timely expression of traumatic experiences, through talking, facilitate faster recovery and prevent development of mental health complications. Sharing of disaster specific experiences can happen individually or in groups. Individuals should not be forced to talk but s/he should know that there are people or facilities available for individuals to talk about their trauma. During the catharsis (venting of negative emotions) through crying or talking or other acceptable ways of expressing crisis, the caregiver should not interrupt or ask the person to stop crying or talking. Strict confidentiality has to be ensured and the information shared by the survivor should not be shared with others unless threat to self/others is observed. The caregivers should not interrupt the survivor while s/he is talking until and unless it is vital. The caregivers should not interrogate and should accept him/her as s/he is.

Active listening

People affected by disasters want to be heard and opportunities need to be created for disaster survivors to vocalise their feelings and emotions. Some of the barriers to active communication are lack of privacy, noisy environment, preoccupation of the care provider, poor help seeking behaviour among the survivor, negative attitude of the care provider and lack of training in the helping process.

The SLOWER technique helps in motivating the survivor to talk about the negative experiences.

S – Sitting squarely
L– Leaning forward
O – Openness
W– Withhold your judgement
E – Eye-to-eye contact
R – Relaxed posture

To make the individual know that s/he is being listened, the caregiver can paraphrase periodically, can ask whether s/he has understood the individuals' expression as the individual felt and use adequate non-verbal communication (nods, mirroring of emotions, etc.). When disaster survivors feel that they are listened to, they feel comforted and safe. Active listening helps in providing warmth and positive regard for the survivor.

Empathy

Empathy is one of the basic and crucial psychosocial care techniques that help in building rapport and trust with the disaster survivors. Here, the caregiver understands the subjective experience of the survivor and communicates it to the survivor. E.g., 'I understand it must be very difficult for you to witness the pain and suffering', 'I can't imagine being in that situation', 'I know you have tried your best to support your family', etc.

Expression of empathy can be practiced by these four basic elements;

• Viewing from the other person's perspective.
• Understanding their feelings and emotions.
• Non-judgmental acceptance.
• Communicating that the care provider has understood the other person's situation.

Empathy also means experiencing the circumstances, feelings and emotions of the other person despite not having the real traumatic experience. It is difficult to experience from the other person's point of view and it is an art which develops out of patient practice. Being empathetic towards the other person during the helping process will help in understanding the pain of the survivor and in initiating responsive psychosocial care activities for the survivor. Appropriate gender specific touch or gestures, adequate reassurances, mirroring of the other person's facial expressions/feelings and disclosure stories (when needed) aid in expressing empathy towards the disaster survivors.

Maintaining Routine

Disaster breaks one's routine. Restarting one's daily activities is essential to bring functionality among disaster survivors. Daily routine might involve healthy eating habits, proper sleep, engagement in household chores, resuming occupation, taking usual medicines, physical activity, following family rituals and other social activities. Restarting routine would be difficult initially because of factors like loss, confusion and personal vulnerabilities. The caregiver has to motivate the survivors to start doing their activities of daily living and can help those who have significant difficulty in resuming earlier life. The caregiver should also monitor closely such individuals and provide opportunities to ventilate and express their difficulties. 

Avoiding maladaptive patterns

The techniques 1 to 9 foster positive coping strategies. During disaster situations, availability of resources will be limited or become scarce, exceeding the individual's coping abilities. The negative consequences of disaster make people adapt negative coping strategies. Along with encouraging disaster survivors to practice adaptive coping strategies (active problem solving, talking or writing about the feelings, giving and taking help), the caregivers should also discourage maladaptive coping strategies. Some of the commonly used maladaptive patterns are; using drugs or psychoactive substances, over or under eating, fighting/beating/quarrelling, avoiding or escaping from thoughts/people/place, gambling etc.

All the above psychosocial techniques help in speedy recovery of the survivors. Though all the techniques are important, the individuals can choose a particular or combination of techniques based on their need. Care to be taken to align these psychosocial techniques to the cultural and religious sentiments of the community.

Social Support

Social support makes people feel safe and assured. Social Support can be classified into three orders:

• Primary Social Support: Family,
• Secondary Social Support: Friends, Neighbours, Colleagues, and
• Tertiary Social Support: Government, Legal bodies, Non - Governmental Organisations, Religious Institutions.

All these three sources of support are important as they safeguard when individuals face distress. Social support also enhances a person's well-being and coping. Disaster situations disturb, uproot or wipe out social support units, especially the primary and secondary support. For example, an individual can lose his/her family members or friends in the disaster. It is essential for caregivers to develop strategies to recreate social support units, create opportunities for survivors to gather in groups and encourage individuals in family rituals and community engagement activities.

Yoga and relaxation

The unexpected confusion and uncertainty following any disaster, result in anxiety and fear. It would be difficult for individuals to relax because of the tremendous loss, continuous apprehension and fear of future. It is essential to train the survivors with anxiety or panic management strategies. Yoga and relaxation techniques can serve as such selfmanagement strategies. Some of the yoga/relaxation techniques that can be practiced on a daily basis even in a restricted environment are given below :

• Victorious Breathing (Ujjayi) : This technique helps in calming the mind and body. The participants are asked to fill the lungs with air and breathe through nose making a snoring/hissing sound.
• Bellows Breathing (Bhastrika) : It involves rapid inhalation and exhalation creating a yogic fire within oneself. The participants have to sit in a cross-legged position. Then they need to make a fist and place the folded arms near the shoulders. While the participant inhales, s/he has to raise the hands up and open the fists. Then exhale forcibly bringing the arms down and closing the fist. The process can be repeated for 20 rounds.
• Chanting : The participants are asked to create slow and progressive resonating vibration using the sounds aaa… uuu…. mmm….
• Purifying Breathing (SudharshanaKriya) : This is a cyclical breathing exercise in slow, medium and fast rates combining the victorious breathing, bellows breathing and chanting.
• Mindfulness : Imagining a peaceful and serene environment or natural ambience and focusing on breathing or looking at serene objects like illuminated candle, images of God, nature or meditating on religious texts with undivided attention.
• Jacobson’s Progressive Muscular Relaxation (JPMR) : It’s progressively tightening and loosening muscles in the multiple parts of the body starting from head to toe. It is proved that stress gets accumulated in multiple parts of the body and manifested as pain. Systematic tightening and loosening of body muscles helps in releasing supressed emotions. The individual has to breathe in while tightening and gently release the tightening muscles while breathing out slowly.

Recreation

Recreation helps in shifting one's focus from the negative emotions triggered by the disaster. People can be encouraged to participate in recreational activities like singing songs, dancing, playing and other culture specific activities. These recreational activities help in fast improvement of the normalization process. Recreation options can be made available in the community through folk lore, puppet shows and other cultural media. This also can be made use to provide disaster specific information and awareness. Humour can also be a part of recreation. Providing channels for people to laugh and cherish would drive faster recovery.

Spirituality

Spirituality refers to the positive inner experiences that provide optimistic outlook towards life. It aims at establishing the connection between inner self of an individual and outer world. Spirituality also involves caring for self, others and the environment. It believes that there are things that are outside one's control and testing times offer platform for bettering oneself. It is a movement towards self-fulfilment. India, being a country of multiple faiths and religions, belief in God/nature/ offers support and peacefulness during difficult times. Questioning the supreme power is a part of the grieving process. This might get extended during the acceptance phase. The caregiver should not force anyone to perform specific spiritual rituals, but encourage survivors to practice their spiritual practices.

Externalisation of interests

Individual's roles get disturbed during disaster. Hence, positive rearrangement of roles based on the demands of the current situation is important. This ensures adjustment among the survivors. Shifting the focus to other constructive activities keeps the person engaged. It enhances the person's functionality as well. The caregiver should look for the interests and skills among the individuals or groups and encourage practicing the same on a daily basis. Activities constructed to remember the interests and skills of the individuals would make the survivors feel that their skills match with the need of the emerging situation. This would make them feel that they are not a burden for others, but a useful resource in community restoration.

Source : National Disaster Management Authority