5.1 Verbal approach: “CISM critical incident stress management”
This sub-chapter is based on Stiftung Mayday, adapted by the author. [www.stiftung-mayday.de]
For the intervention of helpers the: SAFER Modell (Mitchell, Everly, and Müller-Lange, 2005) is suitable.
Stabilization: separate affected persons from the stressor
Acknowledgement: acknowledge crisis of the affected person
Facilitation: declare symptoms as normal reaction
Encouragement: basic principles of stress management
Restoration: ascertain functional capability or offer further treatment/therapy
A critical incident is defined as an event, which occurs suddenly and unexpected and which is perceived as individually extremely stressful. It can affect one’s own person or a person very close by (helpers, interpreters, reporters, members of aid organisations, ambulance, police, fire brigade, military, etc.). Critical Incident Stress Management (CISM) describes targeted measures, with which illnesses after such incidences can be avoided very successfully.
Defusing: 1st phase: immediately after the incidence or within 8-24 hours a cognitive exchange of derivatively traumatized persons should take place, moderated by a trained moderator, individually or in a group. The description of the incidence should occur as neutral as possible without expanding on emotions (danger of re-traumatization!). It is important to provide a clarification about possible reactions on all levels. The aim is stress relief, information, as well as the initiation of coping mechanisms.
If affected persons show strong, destabilized emotions such as rage, panic, despair then defusing and debriefing must not be carried out. In this case a medical intervention is necessary for stabilization.
Debriefing: 2nd phase: 3-8 days after the incidence one can ask about a description of the facts of the incidence and also about thoughts, emotions and reactions. No one has to speak; the moderator should not exert pressure, but only provide stability and safety! By speaking about the incidence and the reactions, eventually also of other affected persons the stress reaction can calm down. It is important to stress that these are normal reactions to exceptional situations. The conversations can lead to a fundamental relief. When symptoms still continue to appear, the affected person has to be referred to a medical-psychotherapeutic setting.
5.2 Physical approach: nonverbal initial intervention, which can be applied especially when there are language barriers
The „Trauma Tapping Technique“(TTT) (long and short variation) was developed by the US psychologists Roger Callahan und Fred Gallo. Both variations are suitable for affected persons who were directly or derivatively traumatized.
The method aims to mobilise burdening emotions by tapping with fingertips on certain acupuncture points in order to resolve them in mostly relatively short time or transform them into positive feelings. The technique is suitable for children, who can already from the age of 4 carry out the technique, for younger children adults can stimulate the points. The hypothesis is that stress reactions are saved in the body and in the autonomous nervous system. By gently tapping the points and the expression of the burdening issue the energy pathways along the meridians are activated, which in turn should bring emotions into the flow. Through breathing out, while concentrating on the problem and subsequently expressing a solution approach, the body can be freed from burdening emotions.
The techniques are described in detail in the Handbook for energetic psychotherapy (Gallo, 2008). With a trained instructor the technique is easy to learn in a couple of hours.
Another possibility is to watch a 5 minutes video clip [https://www.youtube.com/watch?v=1H4w_CCJAO4] by Gunilla Hamne and Robert Ntabwoba (see: www.peacefulheart.se) on You Tube. Both have widely used the technique for victims of war and genocide in Congo and in Rwanda. The Trauma Tapping Technique is equally applicable and learnable for adults as well as for children from the age of four years onwards.
Current relevance:
Here you find a video by Dr Siyana about TTT for Stress management in Lesbos in the current refugee crisis. [https://www.youtube.com/watch?v=0MNotAFWFa0]
5.3 Treatment sequence NAEM for stress release
This treatment sequence supports you to reduce or completely dissolve the stress on your burdening issue. There are six different treatment points.
Tap on each treatment points 10-15 times with a fingertip in the specified order:
HK – side of the hand = on the „fold“, when you make a fist, think briefly about the burdening issue. Address the issue quietly and tap on the four further points 10-15 times, breathe out slowly e.g. my fear of violence, my grief over the loss, my fear of darkness, my horror of…, etc.
ST- forehead = at the inner beginning of the eyebrow
UN – under nose = under the nose
UL – under lip = under the lip
TH – thymus at the breastbone between the collarbones
SP – sequence point = back of the hand, between small finger and ring finger, 3 cm at the back
Then stimulate the sequence point at the back of the hand and express a solution sentence (e.g. I let go of my fear and become calm, I let go of my grief and become calm, I have overcome and become calm, etc.). Then continue to stimulate the sequence point and:
Close your eyes
Open your eyes
Turn your eyes down to your right (while keeping your head straight)
Turn your eyes down to your left (while keeping your head straight)
Circle your eyes by 360 degrees clockwise
Circle your eyes by 360 degrees counter clockwise, afterwards visualise an image to resolve the issue (e.g. I am calm on a safe place, e.g. in nature, at the seaside, in the house of my grandparents, etc.)
The solution sentence should be repeated 3-5 times or until a calm feeling has arrived. It is advisable to carry out this treatment sequence twice a day over 5-9 weeks.
5.4 Trauma Tapping Technique TTT
There are 14 treatment points for this sequence.
[insert: Picture 5_TTT 1, Picture 6_TTT 2]
(Source Picture 5 and Picture 6: Dr Neumann)
AB – eyebrow (Augenbraue) = at the inner beginning of the eyebrow
SA – side of the eye (Seite des Auges) = ca. 1 cm on the side of the eye
JB – cheekbone (Jochbein) = immediately under the eye
UN – under nose = under the nose
UL – under lip = under the lip
SB – collarbone (Schlüsselbein) = below the collarbone, ca. 3 cm left + right from the breastbone
UA – under arm = ca. 10 cm below the armpit
RP – rib point = ca. 5 cm below the right nipple
KF – small finger (kleiner Finger) = at the thumb sided nail fold of the small finger
MF – middle finger = at the thumb sided nail fold of the middle finger
ZF – index finger (Zeigefinger) = at the thumb sided nail fold of the index finger
DP – thumb point (Daumenpunkt) = at the nail fold of the thumb, on the inside
SP – sequence point = back of the hand, between small finger and ring finger, 3 cm at the back
HK – side of the hand (Handkante) = on the „fold“, when you make a fist
The sequence runs as follows:
- SPECIFY YOUR FEELINGS ON A SCALE FROM 0 – 10 (e.g. fear: 10 = fear is very high, 0 = no fear exists)
- TAP BOTH SIDES OF YOUR HANDS (HK = see above) TOGETHER and vocalize the following sentences three times in a row:
„Although I have terrible images in my head, I love and accept myself as I am! “
Afterwards you say on time: “But now I will change that and chose … (e.g. to let go of these images and become free for my present life”)
- NOW TAP AT ALL THE 14 TREATMENT POINTS (no matter with which hand, whether with one hand or with both) and vocalize continuously your feeling (e.g. „my fear and my terrible images, my fear and my terrible images, my …”) and breath out slowly and concentrated.
- CARRY OUT A so-called BACK-OF-THE-HAND SEQUENCE: while you continuously tap on the sequence point (SP = see images), at the back of the hand you do the following:
Close your eyes, open your eyes, turn your eyes down to your right (while keeping your head straight), turn your eyes down to your left (while keeping your head straight), circle your eyes by 360 degrees clockwise, circle your eyes by 360 degrees counter clockwise, humming a melody, count from 5 back to 0, hum a melody
- REDETERMINATION OF THE BURDENING FEELING: classify your fear on a scale of 0 – 10. How has it changed? In the case it decreased already to 0: congratulations. You have reached a great deal in a short time (now chose a positive target sentence according to point
- CHOSE A POSITIVE TARGET SENTENCE:
In case some of your fear remains, please skip the next point 6. and continue with point I. see below.
Now chose a positive sentence, which feels coherent to you, such as e.g. „I remain calm and relaxed, it is over! “. Voice this sentence at least one minute again and again while continuously tapping the sequence point at the back of your hand. Enjoy the good feelings that thereby arrive.
IN CASE YOU FEEL SOME OF YOUR BURDENING FEELINGS STILL REMAIN continue as followed:
- Tap again both sides of your hands together (= HK) and voice thereby the following sentence three times in a row: “Although I still have some remaining fear, I love and accept myself as I am!” After that you can say one time: “But now I change that and choose… (e.g. to let go this fear entirely”)
- Tap again at all 14 treatment points and voice your burdening feeling, thus e.g. „My remaining fear, my remaining fear, my remaining fear, and so forth…“
III) Carry out a back-of-the-hand sequence according to point III as instructed above.
REDETERMINATION OF THE BURDENING FEELING: classify your fear on a scale of 0 – 10. How has it changed? In the case it decreased now to 0: congratulations. Chose a positive target sentence, while continuously tapping the sequence point (SP) and voice the sentence at least one minute again and again (according to Point 6). Enjoy the good feelings that thereby arrive! In case some of your fear remained, again start with point I. as detailed above and carry out step I. – III., until your fear has decreased fully to 0, thus, until it is fully resolved.