Psychological Support for Front-Line Medical Staff (Part 2)

Psychological Crisis Intervention

The state of psychological crisis is often manifested in the impairment of physiological, psychological, and social functions. There are often cognitive, emotional, and behavioral impairments. When these impairments reach a certain degree, they are diagnosed as stress-related disorders. After this pandemic, a few people may have stress-related issues, such as acute stress disorder, post-traumatic stress disorder (PTSD), anxiety, depression, behavioral disorder, self-harm and suicidal ideation, substance abuse, and so on.

Psychological crisis intervention is meant to alleviate these symptoms immediately and over the long term, to restore the psychological functioning to the pre-crisis level, acquire new coping skills, and prevent the occurrence of future psychological crisis. No matter what kind of therapy model is adopted, the basic purpose of psychological crisis intervention is to provide humanistic care and psychological support.

Even when facing the same stress events, every individual's stress reaction is different. A person's stress response is the result of the interaction between the stress events (triggers or stressors) and the individual's personality. In psychological crisis intervention, attention should be paid to the characteristics of the individual person—their age, gender, marital status, social support system, social culture, personal belief, and other individualized factors.

The main components of support include empathy, relationship building, listening, unconditional positive regard, acceptance, holding, and normalizing, among other strategies. Among them, empathy is the most important and can help them explore their inner pain, have the courage to face this pain, and become more self-aware. Empathy can make them feel the warmth of psychological support and love, dissolve their pain, and move past the trauma.

Understanding Anxiety

Anxiety is a coping mechanism that alerts people to any signs of danger, whether real or perceived. Anxiety can also happen when you think of future events and predict a negative outcome.

Understanding Depression

Depression has the following clinical manifestations: sad or low moods; decreased will or desire to do anything; slowed thinking, speech, and action; lack of energy, easy fatigue; a lack of joy or pleasure; and sometimes, a state of deep despair. This is exacerbated when patients also lack external resources, such as social support, so they feel powerless, helpless, and hopeless.

Depression often appears along with anxiety in stress disorders. Both often coincide, and sometimes the process of recovering from depression is accompanied by increased anxiety—the patient first moves from depression to anxiety, and then from anxiety to a balanced emotional state.

Understanding Anger and Aggression

Common possible psychological causes of anger and aggression are frustration, unsatisfied needs, unfulfilled desires, grievances, extreme pain, or loss of family members. Anger and aggression are often rooted in a person feeling deep internal pain along with a sense of powerlessness. Venting anger allows one to pretend to be strong, alleviates a feeling of powerlessness, and allows one to take back control.

Understanding Survivor's Guilt

Survivor's guilt causes heightened anxiety and an inability to accept the reality and inner pain of bereavement. The person feeling the survivor's guilt believes that if they had done something differently, they could have avoided the death of their loved one(s), or they may regret that they didn't treat them as well as they could have before they died. After the death of relatives, survivors may have similar symptoms and hypochondriac tendencies ("I have the same symptoms; I must be ill too"). The possible causes are separation anxiety, wanting to join the deceased person ("Let me have the same disease and go with them"), wishing they could go in the deceased person's place ("I prefer to exchange my life for their death").

In psychological crisis intervention, patients may exhibit many more symptoms of psychological stress—too many to enumerate. It is important for others to truly understand and empathize with patients, so that they can support them in getting effective psychological support, reaching self-acceptance, and coming out of their pain. The most important thing is to explore these feelings with the patient; in the interactive process of exploration, the patient feels cared for and loved with emotional support and humanistic care.

Concluding Remarks

Timely psychological crisis intervention can help victims out of psychological crisis and restore their mental health. It is also important to encourage the front-line medical staff to engage in self-care, which can take on many forms.

Appropriate Expectations

Have realistic expectations for yourself. While you may be on the front line, accept that you are human, like everyone else. Everyone's ability is limited, and it is enough to do what you can. People should not expect or ask too much of themselves. They have a mission and a responsibility to save lives, which is honorable and lofty in itself, but they should be mindful of their limitations.

Reduce the pressure.

There may be ignorance and noncooperation from patients, resulting in negative outcomes of treatment. This may cause doctor–patient conflicts, resulting in anger, grievances, and other emotions. These emotions are reasonable, but they need to be released in a timely manner.

Excessive worry about your own family and loved ones is not helpful. Believe that your family can take good care of themselves, and that family, friends, society at large, and the government are standing behind them. Make more video or voice calls with distant or isolating family and friends. This gives everyone strength.

In addition to the work of pandemic prevention, do something that makes you feel more comfortable, such as listening to music, sports, or the like, to relax yourself. Try writing in a diary and freely expressing your emotions there; keeping a vision of the future, knowing that this, too, shall pass and the future will be good. At the same time, pay attention to the present, and the beautiful people and things around you. Remember to be grateful.

Accept these challenging emotions.

Anxiety is the normal response of individuals to a crisis. People should not deny and reject their own emotions, but instead identify and accept them. They should know that all their emotions at this time are normal; allow them to flow through the body. At the same time, take active measures to correct any negative automatic thinking.

Relax and encourage yourself.

• Practice deep breathing. Long, slow breathing can help relieve tense nerves and reduce anxiety.
• Express self-encouragement. Write some encouraging thoughts and affirmations. Every time you feel discouraged, read those. Self-dialogue and self-encouragement are also very effective relaxation methods.
• Focus on the present. Pay attention to the feeling of your body at this moment: Try to pay more attention to your foot, move your toes, and feel the contact between your foot and the ground.
• Seek psychological assistance when needed. No one can solve all problems. They should accept their own limitations and vulnerability. When they find they have mental problems that are affecting their work and life, they should seek timely psychological support to minimize the harm.

Socratic Dialogue

People can try to use the Socratic dialogue, a technique of speculation commonly used by small groups in cognitive behavioral therapy. It aims to inspire each other's thoughts step by step, correct incomplete and incorrect ideas, guide wisdom, and clarify each other's ideas and thoughts to carry out self-cognitive correction. For example, anxiety is often accompanied by disastrous thinking. You can adjust negative thinking by using rational and positive self-dialogue: "How likely is this to happen?"; "What's the best result?"; "What will happen if I change my disastrous thinking?"; "There is more positive information than negative information, isn't there?" Giving yourself positive psychological cues is good for mental health.

Find resources within.

Front-line medical staff can often be their own best resources, as well as resources of their teammates. They rely on each other and work together. They should have the courage to express their own understanding and emotional reflection of the situation. At the same time, they should also leave space in their hearts to listen to the emotional and psychological reflections of their coworkers.