INTRODUCTION

Human beings have to maintain balance in life, whenever he is exposed to stressor or stressful
situations he will try to overcome it by his own way of dealing with problems, by adopting
adequate coping strategy, with the help of situational support, he will ty to overcome it. Eustress
is always essential for the individual to lead qualitative life, but when an individual is exposed to
many stressors at a time, even with the utilization of balance factors adequately also or due to
one or more absence of balancing factors results in disequilibrium and it may lead to crisis. A
crisis is a critical event or period that brings about significant disruption, challenge, or danger,
often leading to urgent decision-making and action. It can arise from a variety of sources such as
natural disasters, economic downturns, social unrest, or personal emergencies. During a crisis,
normal systems or structures are overwhelmed, and individuals or communities may experience
heightened stress and uncertainty. The response to a crisis requires swift, effective measures to
manage its immediate impact and to mitigate long-term consequences. In some cases, crises can
also serve as turning points, prompting necessary change or innovation.
 TERMINOLOGIES
1. Stress -pressure or tension exerted.

2. Crisis -a time of danger or great difficulty Coping-deal effectively, or contend manage.

3. Ventilation - cause air to circulate freely (ie) to let out the feelings.

4. Potential -capable of coming into action or being.

DEFINITION

Crisis is a state of disequilibrium resulting from the interaction of an event with the individual's

or family's coping mechanisms, which are inadequate to meet the demands of the situation,

combined with the individual's or family's perception of the meaning of the event.

- Taylor1982

CHARACTERISTICS OF A CRISIS

1. Crisis occurs in all individuals at one time or another and is not necessarily equated with

psychopathology.

2. Crisis is precipitated by specific identifiable events.

3. Crisis is personal in nature. What may be considered a crisis situation by one individual

may not be so for another.

4. Crisis is acute not chronic will be resolved in one way or another within a brief period.

5. A crisis situation contains the potential for psychological growth deterioration.

 TYPES OF CRISIS

Baldwin (1978) has identified six classes of emotional crisis, which progress by degree of
severity. The measures of psychopathology increase the source of the stressor changes from
external to internal. The type of crisis determines the method of intervention.

Dispositinal crisis

Anticipated life transition

Crisis resulting from traumatic

stress

Maturatinal Crisis

Crisis reflecing Psychopathology

Psychiatric Emergencies

1. Dispositional Crisis: An acute response to an external situational stressor.

2. Anticipated Life Transition : Normal life cycle transitions that may be anticipated but

over which the individual may feel a lack of control.

3. Crisis Resulting From Traumatic Stress : Crisis precipitated by unexpected external

stresses over which the individual has little or no control and from which he or she feels

emotionally overwhelmed Example - Rope, Assault

4. Maturational or Developmental Crisis Maturational crisis are developmental events

requiring role changes.

 5. Crisis Reflecting Psychopathology: Emotional crisis in which pre-existing

psychopathology Emotion instrumental in precipitantly crisis or in has be

psychopathology significantly impairs of complicates adaptive resolution.

6. Psychiatrie Emergencies: Crisis situations in which general functioning has been

severely impaired and the individual rendered incompetent or unable to assume personal

responsibility.

DEVELOPMENTAL PHASES OF CRISIS

The development of crisis situation follows a relatively predictable course. Caplan (1964)

outlined four specific phases through which individuals progress in response to a precipitating

stressor and that culminate in the state of acute crisis.

PHASE:1 The individual is exposed to precipitating stressor. Anxiety increases, previous

problem-solving techniques are employed.

PHASE:2 When previous problem solving techniques do not relieve the stressor, anxiety

increases further. The individual begins to feel a great deal of at this point. discomfort

Coping techniques that have worked in the past are attempted, only to create feelings of

helplessness when they are not successful. Feelings of confusion and disorganization prevail.

PHASE:3 All possible resources, both internal and external, are called on to resolve the

problem and relieve the discomfort. The individual may try to view the problem from a different

perspective, or even to overlook certain aspects of it. New problem solving techniques may occur

at this phase, with the individual returning to a higher, a lower, or the previous level of pre-

morbid functioning.
PHASE:4 If resolution does not occur in previous phases, Caplan states that the tension mounts

beyond a further threshold or its burden increases over time to a breaking point. Major

disorganization of the individual with drastic results often occurs. Anxiety may reach panic

levels, cognitive functions are disordered, emotions, are labile, and behaviour may reflect the

presence of psychotic thinking.

DIFFERENT STATES OF CRISIS

1. Potential Crisis State

Whenever any acute problems or occurs, individuals will become sertine thecat and emergency
problem solving methods crisis, but it is ineffective

2. Pre-crisis State

When person has high probability of exposare stressful events, in an adequate support, lack of
coping abilities, poor history of handling atreme will be more upset and enter into a state of
disequilibrium

3. Immediate Crisis State

As tensions continue to build, they mobilize all internal and external resources to restore the
equilibrium.

4. Intermediate Crisis State

The problem may be re-evaluated and attacked from a new angle or the problem may be
distorted and viewed as unsolvable
5. Advanced Crisis State

Persons who have continued to draw all inner resources, have continued failing in attempts to
resolve the problems, emotional pressures continue to build and people become completely
disorganized or immobilized owing to serve anxiety or depression state.

6. Full Crisis State

Person, who has failed in all attempts to solve the problems, believes that all resources have been
used feels more stress.

SIGNS AND SYMPTOMS

1. Heavy burden of free floating anxiety, eg heightened emotional tension, the drive to act.
2. Depression.
3. Anger, guilt, tension, fear.
4. Neglects in performing self-care activities.
5. Low self-esteem.
6. Uncontrollable crying.
7. Lack of confidence.
8. Withdrawal behavior, aloofness.
9. Irritable.
10. Rigid in nature, denial.
11. Disorganized behavior unable to think realistically.
12. Impaired judgment.
13. Lack of self-control.
 CRISIS INTERVENTION

Crisis intervention refers to the methods used to offer immediate, short term help to individual
who experience an event that produces emotional, mental, physical and behavioural distress or
problems. A crisis can refer to any situation in which individual perceives a sudden loss of his or
her ability to use effective problem solving and coping skills.

DEFINTION OF CRISIS INTERVENTION

Crisis Intervention is a technique used to help an individual or family to understand and cope
with the intense feelings that are typical of a crisis.

GOALS OF CRISIS INTERVENTION

1. To decrease emotional stress and protect the crisis victim from additional stress.
2. To assist the victim in organizing and mobilizing resources or support system to meet
unique needs and reach a solution for the particular situation that precipitated the crisis.
3. To provide a correct cognitive perception of the situation.

PRINCIPLES OF CRISIS INTERVENTION

1. Be specific, use concise statements, and avoid over whelming the patient with irrelevant
questions or excessive detail.

2. Encourage the expression of feelings.

3. A calm, controlled presence reassures the person that the nurse can help.

4. Listen for facts and feelings: seeking clarification, paraphrasing and reflection are effective
strategies.

5. Allow sufficient time for the individuals involved to process information and ask questions.
6. Help patients legitimize feelings by letting them know that others in similar situations have
experienced comparable emotions.

7. Clarify distortions by getting persons to look at the situation realistically.

8. Empower person by allowing them to make informed choices.

9. Assist the person in confronting reality

10. Encourage the person to focus on one implication at a time.

STEPS OF CRISIS INTERVENTION

Crisis intervention is a short term therapy focused on 6 weeks. The goal of crisis intervention is
for the individual to return to a pre-crisis level of functionality.

1. ASSESSMENT

The first step of crisis intervention is assessment. At this time data about the nature of crisis and
its effect on the patient must be collected. From these data an intervention plan will be
developed. People in crisis experience many symptoms sometimes these symptoms can cause
further problems. For eg: problems at work may lead to loss of job, financial stress, and lower
self-esteem.

During this phase the nurse begins to establish a positive working relationship with the patient.
The nurse should assess the followings:

 Precipitating event or stressor

 Patient's perception of the event or stressor
 Nature and strength of the patient's support systems and coping resources
 Patient's previous strengths and coping mechanisms
2. PRECIPITATING EVENTS
To help identify the precipitating event, the nurse should explore the patient's needs. Four
kinds of needs that have been identified are related to:
 SELF-ESTEM is achieved when the person attains successful social role experience.
 ROLE MASTERY is achieved when the person attains work, sexual, and family role
successes.
 DEPENDENCY is achieved when a satisfying interdependent relationship with others
is attained.
 BIOLOGICAL FUNCTION is achieved when a person is safe and life is not
threatened.
3. PERCEPTION OF THE EVENT

The patient perception or appraisal of precipitating event is very important. What may seem
trivial to the nurse may have great meaning to the patient. For eg. an overweight adolescent girl
may have been the only girl in the class not invited to a dance. This may have threatened her
self-esteem. Themes and suffering memories of the patient gives clues to the precipitating
events.

4. SUPPORT SYSTEMS AND COPING RESOURCES

The patients living situation and supports in the environment must be assessed. Does the patient
live alone or with family or friends? With whom is the patient close, and who offers
understanding and strength? Is there a supportive clergyman or friend? Assessing the patient's
support system is important in determining who should come for the crisis therapy session. It
may be decided that certain family members should come with the patient so that the family
members support can be strengthened. If the patient has few supports, participation in a crisis
therapy group may be recommended.

5. COPING MECHANISM

Next, the nurse assesses the patient's strengths and previous coping mechanisms. How has the
patient handled other crisis? How were anxieties relieved? Did the patient talk out problems? Did
the patient leave the usual surroundings for a period of time to think through or from another
perspective? Was physical activity used to relieve tension?
6. PLANNING AND IMPLEMENTATION

The next step of crisis intervention is planning, the previously collected data are analyzed and
specific interventions are proposed. Dynamics underlying the present crisis are formulated from
the information about the precipitating event. Alternative solution to the problem is explored,
and steps for achieving the solutions are identified. . There are four levels of crisis intervention;

 Environmental manipulation
 General support
 Generic approach
 Individual approach

TECHNIQUES OF CRISIS INTERVENTION

1. Catharsis

The release of feelings that takes place as the patient is about emotionally charged areas

force Tell me about how you have been feeling e you last your job.

2. Clarification

Encouraging the patient to express more clearly the relationship between certain events.

For eg: I have noticed that after you have an argument watch your husband you become sick and
cannot leave your bed

3. Suggestion

Influencing a person to accept an idea or belief, particularly the belief that the nurse can help and
that the person will in time feel better.

For eg: Many other people have found it helpful to silk about this and I think you will, too.

4. Reinforcement of Behaviour

Giving the patient the positive responses to adaptive behavior.

For eg: That is the first time you were able to defend yourself with your boss and it went very
well. I am so pleased that you were able to do it.

5. Support of Defence

Encouraging the use of healthy, adaptive defenses and discouraging those that are unhealthy or
maladaptive.

For eg: Going for a bicycle ride when you were so angry was very helpful because when you
returned you and your wife were able to talk things through.

6. Raising Self-Esteem

Helping the patient regain feeling of self-worth.

For eg: You are a very strong person to be able to manage the family all this time. I think you
will be able to handle this situation, too.

7. Exploration of Solution

Examining alternative ways of solving the immediate problem.

The last phase of crisis intervention is evaluation when the nurse and patient evaluate whether
the intervention resulted in a positive resolution of the crisis. Specific questions the nurse might
ask include the following-

 Has the expected outcome been achieved and has the patient returned to the pre-crisis
level of functioning
 Have the needs of the patient that were themed by the event been met?
 Have the patient's symptoms decreased or been resolved?
 RSEARCH INPUT

Sarah L. Baker, Jennifer M. Evans, and Mark T. Wilson made a study on "Effectiveness of
Crisis Intervention Training for School Counselors: A Longitudinal Study" in 2022, which
was published in Journal of School Counseling.

This longitudinal study investigates the effectiveness of crisis intervention training (CIT) for
school counselors. With rising incidents of mental health crises and school violence, there is a
growing need for effective crisis management within educational settings. The study examines
how crisis intervention training improves the emotional responses, coping strategies, and
intervention skills of school counselors when dealing with students experiencing trauma, self-
harm, suicidal ideation, and other acute psychological distress. Over a one-year period, school
counselors who received CIT were compared to a control group who did not undergo the
training. The findings suggest that crisis intervention training significantly enhanced counselors'
ability to assess crises, implement immediate interventions, and manage their own stress levels
during these critical moments.
 SUMMARY

Crisis intervention involves immediate, short-term assistance to individuals experiencing

emotional, mental, or physical crises. The process begins with a quick assessment of the
individual's situation and risk level. The primary goals are to ensure safety, provide emotional
support, and stabilize the individual's mental state. Intervention strategies include active
listening, de-escalation techniques, and problem-solving to address the crisis. It also involves
connecting individuals with appropriate resources and referrals for ongoing support. Ultimately,
the aim is to alleviate immediate distress and help the individual regain a sense of control and
stability.
 CONCLUSION

In conclusion, crisis intervention plays a crucial role in providing immediate support to

individuals facing acute psychological distress. By offering timely and effective assistance, crisis
intervention helps individuals regain control, reduce emotional turmoil, and prevent long-term
psychological damage. Whether in the context of mental health crises, natural disasters, or
traumatic events, appropriate crisis intervention strategies, such as psychological first aid or de-
escalation techniques, can significantly improve outcomes for affected individuals. Continued
research and training are essential to refine intervention methods, address the unique needs of
diverse populations, and ensure that crisis responders are equipped to handle the complexities of
such situations. Ultimately, effective crisis intervention not only aids in immediate stabilization
but also fosters resilience, enabling individuals to recover and rebuild after experiencing
adversity.
 REFERENCES

1. Mary C. Townsend, Psychiatric mental health nursing, concepts of care in evidence based
practise, 5h edition, F.A. Davis Company, pp. 237-251
2. Gail W.Stuart, Michelle T.Lauria, Principles and practise of psychiatric nursing, 8ª edition,
mosby publications, page no.267-271
3. Mohr.K.Wanda; Psychiatric Mental Health Nursing( Evidence Based Concepts Skills And
Practices), 7h edition, Lippincott, Williams & Willies, Wolters, Kulwer; page no.752-758.
4. R Sreevani, A Guide to Mental health and psychiatric nursing, 3rd edition, jaypee
publications, page no 267 - 270
5. https://www.scribd.com/document/160498529/Crisis.
General objectives

After the seminar students will be able to understand the crisis and its intervention and will be
able to apply it positively in clinical Settings.

Specific Objectives

Students will be able to:

1. define crisis.
2. chracteriatics of crisis
3. phases of crisis
4. stages of crisis
5. signs and symptoms of crisis
6. define crisis intervention
7. goals of crisis intervention
8. Principles of crisis intervention
9. Steps of crisis intervention
10. Techniques of crisis intervention
11. research input
12. summary
13. conclusion
14. references.
 COLLEGE OF NURSING L.L.R.M MEDICAL COLLEGE, MEERUT

SEMINAR ON: CRISIS AND INTERVENTION

SUBMITTED TO- SUBMITTED BY-

Sanjay Saini Chandrima Sarkar

Assisted Professor MSc (N) 1ST Year
College of Nursing College of Nursing
L.L.R.M Medical College L.L.R.M Medical College

Submitted on-17/02/2025