It generally occurs when an individual encounters an unavoidable and intense stressful event and fails to mobilize the coping methods. There is obvious acute emotional, cognitive and behavioral dysfunction, and the individual is in a state of psychological imbalance. Out of control state.

Of course, crises also present opportunities for growth and change, and dangers and opportunities coexist.

After re-understanding and adjustment, most people in crisis situations can establish a new balance and survive the crisis.

The duration of the crisis is generally short, no more than 6 to 8 weeks.

① Developmental crisis:

②Situational crisis:

③Existential crisis:

① Effectively cope with and survive crises, gain experience and grow;

② The crisis has been temporarily overcome, but the impact of the crisis has not been truly resolved, but some cognitive, behavioral, and personality problems have been left behind, which will resurface under certain conditions in the future;

③Psychological and physiological breakdown, leading to substance dependence and abuse, suicide, attack or mental disorder, etc.

It is to provide brief and effective help to individuals who are in a state of psychological imbalance, so that they can survive the psychological crisis and restore their physical, psychological and social functional levels.

It is short-term and emergency psychotherapy, which is essentially supportive psychotherapy. It is developed to solve or improve the plight of the client. It focuses on solving problems and generally does not involve the personality shaping of the client.

The acute stage is most appropriate. The intervention process includes clarifying the essence of the problem through listening and caring, encouraging the client to develop his or her potential, rebuild confidence to cope with the potential, rebuild confidence to cope with the problems faced, and restore psychological balance.

It is to appropriately release accumulated emotions, change the cognitive attitude towards crisis events, and combine with appropriate internal coping methods, social support and environmental resources to help the parties gain independent control over their lives, survive the crisis, and prevent more serious and lasting occurrences. psychological trauma and restore psychological balance.

It is to appropriately release accumulated emotions, change the cognitive attitude towards crisis events, and combine with appropriate internal coping methods, social support and environmental resources to help the parties gain independent control over their lives, survive the crisis, and prevent more serious and lasting occurrences. psychological trauma and restore psychological balance.

Telephone hotline, consultation clinic, family and social intervention, letter and Internet, on-site intervention, etc.

The intervenor should make full use of various conditions and try to establish a certain relationship with the client as soon as possible in a way that is acceptable to the client, so that the client can be convinced that he is not dealing with it alone, encourage the client to describe the crisis and current feelings, and introduce himself and the purpose of the intervention. Show your willingness to help and gain the trust of the person involved.

There must be a certain degree of continuity and coherence. Any temporary approach may not only be ineffective, but also harmful.

Quickly determine the severity of events and crises; how the parties are coping with the current crisis; whether medication and other medical measures are needed; identify issues that need urgent treatment; provide necessary guarantees and support to ensure the physical and psychological safety of the parties.

Assessment content (4 items)

The overarching goal of intervention is to help the client survive the crisis, restore mental health, and achieve growth.

However, when specifically formulating intervention goals, realistic, operable, and achievable goals should be formulated based on the specific circumstances of the parties involved.

The intervention goal should be based on a comprehensive assessment of the client, discovering resources as much as possible, seeking evidence and methods to solve the problem, helping the client to formulate a clear and practical goal, special actions and timetable, and if necessary Provide certain coping strategies.

Before the specific implementation of intervention, the parties need to understand that solving the problem and overcoming the crisis require the parties' active cooperation and joint efforts.

On the premise of stimulating motivation, help clients understand that accepting the meaning of traumatic events will take time and may face various difficulties.

After the short-term goal is achieved and new coping skills are developed, the next goal can be determined. By constantly supervising and strengthening positive changes, the client will have significant improvement in symptoms and successfully resolve the crisis while acquiring new coping skills.

The specific intervention measures implemented during the intervention process include (9 technologies)

After active and effective intervention, most clients can successfully survive the crisis and restore their mental health.

When implementing intervention, the intervention goals should be verified and necessary adjustments should be made, and the intervention strategy should be adjusted based on the ongoing understanding of the situation, the responses of the parties and the progress of the intervention.

When the parties make certain progress, they should be good at summarizing and reviewing in a timely manner.

Before ending, the parties should continue to strengthen their use of coping methods, resource utilization and adaptive skills, so that the parties can accept and adapt to changes as much as possible, master new skills and utilize resources skillfully, and help predict and make necessary preparations for the future. Increase confidence in handling future stressful events.

In addition, timely intervention is required for those who implement the intervention to protect them from intense psychological pain.

Currently, there is a systematic method of reducing stress through talking - Critical Incident Stress Debriefing (CISD) to achieve protective intervention.

Purpose: To establish a trusting relationship and ground rules, with special emphasis on confidentiality, the purpose of the interview is to review the participant's response to the trauma, discuss it, find ways to cope with it and prevent future problems

Method: The instructor introduces himself, first explains the background of the event, the participants, introduces the CISD process and rules, carefully explains the confidentiality issues, asks the on-site personnel and puts forward the need for support.

Follow three basic principles:

Purpose: Individuals who have experienced a traumatic event recount the facts of the event

Method: Ask participants to describe themselves and some actual situations of the incident itself during the incident; ask participants where they were, heard, saw, smelled and did during these serious incidents; each participant must speak, and participants will feel that the whole incident is revealed. Understand expectations and facts, review the details of the event, and focus on the experience at the time. How did you know when the incident occurred? What do you see, hear, and smell? How do you know so far? What do you see, hear, and smell? What have you learned so far?

Purpose: To identify and confirm experienced acute stress reactions

How to: Ask questions about feelings

Purpose: To identify symptoms of acute stress disorder

Method: Participants were asked to describe their acute stress symptoms, such as insomnia, loss of appetite, constant flashes of events in their minds, inability to concentrate, decreased memory, decreased decision-making and problem-solving abilities, prone to losing temper, easy to frightened, etc.;

Purpose: Effective stress management education

Method: normal reaction

Purpose: Prepare to resume normal social activities and life order

Methods: clarify misconceptions, rebuild beliefs, discuss action plans

NOTE: To assess who needs further assistance:

Possible problems in actual operation:

(1) For those who are depressed or view CISD in a negative way, it may have a negative impact on other participants. CISD is not appropriate.

(2) Given that CISD is consistent with culturally specific recommendations, sometimes cultural rituals or religious ceremonies may be substituted for CISD.

(3) For people who are acutely grieving, such as those who have died in the family, it is not suitable to participate in CISD. Because of poor timing, it may interfere with cognitive processes and cause mental disorders; if involved in CISD, a highly traumatized person may cause even more catastrophic trauma to others in the same session.

(4) CISD is a group intervention method, and WHO recommendations generally do not support a single implementation among victims. After CISD, individual counseling and counseling should be combined to achieve better results.

(5) After the interview, the intervention team should organize the intervention personnel to conduct team interviews in a timely manner to relieve the pressure of the intervention personnel.

(6) Do not force the person involved to narrate the details of the disaster. Crisis intervention is a systematic project that requires the government, society, and multiple disciplines and professionals to face it together.

As an early intervention technique, CISD must be integrated with other methods of psychological crisis intervention, such as relaxation techniques, painting, etc., including follow-up psychological services, in order to better provide help to victims of traumatic events.

The incidence of deliberate self-injury is much higher than imagined, much higher than eating disorders, panic attacks, obsessive-compulsive disorder, and borderline personality disorder. Reports of deliberate self-injury are more common among those aged 12 to 18 years. At the same time, adolescents also have suicidal ideation. and the age at which attempts occur, therefore, this age is a high-risk stage for deliberate self-harm;

Due to attention and strengthened surveillance, the reporting rate of deliberate self-injury has increased year by year in recent years. However, due to the lack of follow-up surveys, the exact incidence of deliberate self-injury still needs further research.

Predisposing factors include: losing a parent at an early age, being abandoned or abused by a parent; poor interpersonal relationships, such as discord between spouses, being blamed, etc.; economic and social environment, with a high incidence of deliberate self-harm among the unemployed; mental disorders , common ones include depressive disorders, anxiety disorders, substance dependence or abuse, personality disorders, dissociative disorders, post-traumatic stress disorder, schizophrenia, etc.

Predisposing factors: Mainly recent stressful life events, such as interpersonal conflicts and conflicts, unexpected events that are difficult to cope with, rejection or criticism, illness of oneself or relatives, etc.

The main external factors are stressful life events, and the internal factors are mainly insufficient emotional and cognitive regulation abilities, lack of interpersonal communication and adjustment abilities, leading to overreaction to stress, decreased regulatory function of emotion/cognition or social experience, and seeking social support. wait. Social learning, self-punishment, gaining attention, self-indulgence, etc. also play a role.

Functional Assessment of Self-Injury (FASM),

Deliberate Self-Injury Inventory (DSHI),

Suicide Attempt Self-Injury Interview (SASII),

Self-Injurious Ideation and Behavior Interview (SITBI), etc.

Key points for diagnosis of ASD:

1. Dissociation/Conversion Disorder The first onset of dissociation/conversion disorder often has obvious stress factors. Especially at the initial onset, it can manifest as hazy state, pseudodementia and other symptoms, making it difficult to distinguish it from acute stress disorder. However, due to the personality characteristics of patients with dissociation/conversion disorder, the symptoms are rich and changeable. They have recurring attacks under the influence of minor unpleasant life events, and the attacks are obviously performative, exaggerated, artificial, suggestive, and body transformation symptoms are common. can be identified.

2. Acute organic brain syndrome Acute organic brain syndrome (also called delirium) caused by infection, poisoning, cerebrovascular disease, etc. can manifest as states such as disturbance of consciousness, disorientation, psychomotor excitement or inhibition, etc. It needs to be distinguished from acute stress disorder. Acute brain organic syndrome has a certain organic basis. Consciousness disorders often have fluctuating characteristics of lightness and weight during the day and night, and are often accompanied by rich and vivid hallucinations, most commonly visual hallucinations. In addition, positive physical examination signs and Abnormal laboratory test results can also be identified.

Interventions should include crisis intervention after traumatic events and treatment for ASD.

The basic principles of therapeutic intervention are timely, nearby, concise and focused.

The best time for crisis intervention is when a traumatic event occurs. There are many methods of crisis intervention, but most of them follow the following principles:

First, the symptoms are severe, individual psychological treatment is ineffective or the anxiety and fear are particularly severe;

Second, they have had depressive disorder in the past and have responded to drug treatment;

Third, sleep disorders are severe and psychotherapy is ineffective.

Patient, female, 52 years old, bank cadre, college education

Two days ago in the evening, the patient's son was killed by gangsters while he was dating his girlfriend in the park. That night, after the patient learned the bad news, he rushed to the public security organ. The patient fainted immediately next to the bodies of his son and fiancée. When he woke up a few minutes later, his speech was incoherent, his consciousness decreased, he did not recognize his relatives, and refused to admit that the body was his child. Repeatedly chanting: "They went outside to play. Don't joke. Where is this place?" "They won't die. They were joking with their mother and wanted to scare her. They went on a trip to get married."

The patient calmed down after taking a sedative. After waking up the next day, I had obvious mood swings and often cried. Repeatedly blaming myself: "I wish I had left them with me that day." I am very disgusted with other people's persuasion, easily irritated, and have very obvious mood swings. After admission, he showed agitation, restlessness, uncooperation, unwillingness to talk more, disorientation, uncooperation during examination, and difficulty in establishing normal conversations.

Diagnosis: acute stress disorder