Stabilize

Stabilize (www.ptsd.va.gov’s PFA Training Manual, Version 2, pp. 49-52)

Goal

Calm and orient emotionally overwhelmed or disoriented survivors

“Most individuals affected by disasters will not require stabilization. Expressions of strong emotions, even muted emotions (for example, numb, indifferent, spaced-out, or confused) are expectable reactions, and do not of themselves signal the need for additional intervention beyond ordinary supportive contact. While expression of strong emotions, numbing, and anxiety are normal and healthy responses to traumatic stress, extremely high arousal, numbing, or extreme anxiety can interfere with sleep, eating, decision-making, parenting, and other life tasks. You should be concerned about those individuals whose reactions are so intense and persistent that they significantly interfere with a survivor’s ability to function.” (p.49)

If, in the course of seeking to comfort a survivor, you realize they may be in shock or emotionally unstable, the methods of helping described in the “comfort” stage are not helpful or appropriate. The first priority for these individuals is stabilization. Here are some signals that someone may be disoriented or overwhelmed:

• Uncontrollable crying, hyperventilating, rocking, shaking, trembling, or regressive behavior
• Feeling incapacitated by worry
• Engaging in risky activities
• Feeling extremely upset, agitated, withdrawn, fearful, or panicked

If a person expresses having recently experienced any of these behaviors or emotions, here are some helpful actions to consider:

• Address the person’s primary, immediate concern or difficulty
• Respect privacy; don’t push for details they seem reluctant to discuss
• Remain available, matching their pace (talking ahead of a person may only make them feel more overwhelmed)
• Help the person focus on specific, manageable feelings, thoughts, and goals
• Inform them
  • that intense emotions may come and go in waves
  • that strong startle reactions or feelings of shock are normal
  • that sometimes the best way to recover is to take a few moments for calming routines
    (For example: go for a walk, breathe deeply, practice muscle relaxation techniques)

If none of these things seem to work, or the person seems to be particularly unstable, a technique called “grounding” is very helpful. When your caller exhibits a need for grounding, follow these directions:

“You can introduce grounding by saying: ‘After a frightening experience, you can sometimes find yourself overwhelmed with emotions or unable to stop thinking about or imagining what happened. You can use a method called ‘grounding’ to feel less overwhelmed. Grounding works by turning your attention from your thoughts back to the outside world. Here’s what you do....’

• Sit in a comfortable position with your legs and arms uncrossed.
• Breathe in and out slowly and deeply.
• Look around you and name five non-distressing objects that you can see.
  For example you could say, “I see the floor, I see a shoe, I see a table, I see a chair, I see a person.”
• Breathe in and out slowly and deeply.
• Next, name five non-distressing sounds you can hear.
  For example: “I hear a woman talking, I hear myself breathing, I hear a door close, I hear someone typing, I hear a cell phone ringing.”
• Breathe in and out slowly and deeply.
• Next, name five non-distressing things you can feel.
  For example: “I can feel this wooden armrest with my hands, I can feel my toes inside my shoes, I can feel my back pressing against my chair, I can feel the blanket in my hands, I can feel my lips pressed together.”
• Breathe in and out slowly and deeply. (www.ptsd.va.gov’s PFA Training Manual, Version 2, p. 49)

Once the person has settled down, they may just need some time to relax. Pushing for information at this stage may not be helpful; it may only make them feel overwhelmed again. However, if they express a desire to discuss their difficulties further, you are now ready to return to the comfort stage.