Hello everyone. My name is Leanne Humphreys and today we’re speaking with Dr Kristi Heffernan.
Kristi is a clinical psychologist and a senior clinical specialist here at Phoenix Australia as well as continuing with her role as a clinical psychologist in private practice. Kristi was a full-time psychology officer in the army who, as well as being a veteran of operations in the Middle East and East Timor, was responsible for the coordination and oversight of the psychology support services provided to the floods in Pakistan in 2010, as well as the 2011 Queensland floods.
Today’s topic relates to anxiety in the aftermath of disaster. Hi there Kristi how are you?
Kristi: Good thanks Leanne how are you?
Leanne: Good, good.
Kristi, as health practitioners a lot of us are really familiar with working with anxiety. It seems to be one of the most common problems that individuals will request assistance for, and in the post-disaster periods it seems quite understandable that a proportion of people will experience some degree of anxiety. But as a clinician do you observe differences in how people experience anxiety following disasters?
Kristi: Yes I do Leanne, it’s a great question too because sometimes those differences can feel a little bit subtle, but I definitely notice differences in how people can present with anxiety particularly after a disaster and it can often be, because it can depend on the nature of that disaster and the nature of the impact of that disaster as well, but one of the things that I noticed in particular, are two common things really noticed, I noticed worry and rumination.
So they’re the two types of anxiety that I feel like you know you’ve noticed a lot of, you know, and worry and rumination are at some level like you said before, an understandable reaction post a disaster. But essentially they’re non-productive mental activities, they do contribute to people feeling bad and they often interfere with other more meaningful, helpful mental activities. So things like being able to problem solve and think those sort of things through.
Worry and rumination can get in the way of that okay, so I guess specifically what I mean by worry, is that focus on the future. So worry can take lots of different forms but the key part of worry is, are those ‘what ifs’ you know those ‘what-if’ kind of thoughts that begin with a ‘what if’ or include a ‘what-if’ in the statement so often it can be a ‘what if’ about, you know, health and well-being? Will things ever go back to the way they used to be? What if life never goes back to the way it was? What if I can’t rebuild? What if I can’t, you know, do the things that I used to be able to do?’ So a lot of that kind of ‘what if’ type of thinking.
Whereas rumination on the other hand, as we know, is a mental process that really gets people stuck in the past. So it’s that real focus on past things. That, ‘if only’ or ‘why didn’t I see that?’ I think yes you know ‘why didn’t I anticipate this bad thing happening?’ you know ‘why didn’t I leave earlier?’ those sorts of things. So focusing on the ‘why’ behind, behind things that have happened and you know in a way it’s a type of kind of wishful thinking and it’s non-productive because essentially none of us can change the past right?
Leanne: Yes.
Kristi: So it’s important I guess to think about those two things, worry and rumination in particular, you know, in a disaster context and how we might help clients through those.
Leanne: Okay.
Kristi: The other type of anxiety that’s important to mention I think is anticipatory anxiety when it comes to a disaster setting because that anxiety about something bad happening again, you know, and it’s really common after a disaster situation particularly as it’s honed in on those sort of environmental and contextual cues, as well as time related cues. So you know particularly now coming up to a bushfire season, a potential next bushfire season or you know that same season of things.
Leanne: Floods, cyclones.
Kristi: Yes exactly. You know coming into that sort of high-risk time you know in Australia and I think it’s really then, you know, understandable but common for people to kind of hone in on the fact it’s getting warmer. So the temperature is starting to increase, so it’s becoming familiar this feeling of getting hot again. You know sometimes it’s about the sky looking a particular colour on a particular day.
Leanne: Absolutely, yes.
Kristi: The way it does in this particular season. Really specific cues as well like clearly like the smell of fire or the sound of helicopters overhead you know from the emergency service responding. So yes, those sorts of cues can really hone people’s anticipatory anxiety about something bad happening again and we need to help and support clients through that you know those these sort of particular, I guess they’re kind of anniversary type events.
Leanne: Absolutely, absolutely, okay that’s really clear Kristi thanks for that. So, but given that those seem at some level entirely understandable, when does it actually tip into becoming a problem? How do we know it’s a problem?
Kristi: It’s a great question. So we’re always thinking about frequency, intensity and duration of those problems. So all the symptoms so, frequency in terms of – are they happening a lot? The intensity – is it actually really bothering the person, and the duration. So how long has it been getting in the way? So it’s those sort of frequency, intensity and duration of the cognitions. The worry, the rumination, the anticipatory anxiety, but also the behaviours that are then getting in the way. So the avoidance that people are engaging in as a result of the anxiety, you know, has that sort of become such a problem that no longer being able to kind of function and go about their normal daily lives, going to work, going to school, you know paying attention to things around them. So in conversations people can start to lose concentration and realise an entire conversation has happened with the person standing in front of them and they haven’t listened to an entire thing and certainly sort of, you know, then if those, you know, the intensity of the symptoms are then getting in the way of them being able to look after themselves basically, going back to that health and well-being and being able to really take care of themselves.
Leanne: Okay next, sorry go ahead, keep going.
Kristi: Yes I was just about to say, how do we measure it though? Like how do you know when the frequency intensity and duration is too much? And one of the really well validated tools that’s available to us is the depression anxiety and stress scale the DAS. So it’s a really good way of looking at the frequency intensity and duration of symptoms and of course it’s publicly available too, which is great.
Leanne: Okay terrific. So how do we help? What are the most effective strategies we can use Kristi?
Kristi: Well the first thing is, is awareness. Awareness of the problem so how raising clients awareness to the extent that their anxiety might be getting in the way of them being able to go about their normal daily lives.
So awareness is kind of the first thing. Sometimes people are overwhelmed after a disaster and sometimes they’re busy or sometimes they just don’t realize how much time they’re actually spending worrying or ruminating for example. Of course it’s prevent, if it’s preventing them from getting to sleep then they’ll be very aware of it. But if it’s happening during the day you often don’t really, fully aware of just how much you might be engaging in worry or rumination.
Self-monitoring can be really useful, so encouraging clients to start monitoring how much they might be worrying or ruminating on some, something or some event can be really useful. So, you know, it helps them become aware of what’s going on in their thinking and and also how it impacts their mood. So, you know, the fact that worrying too much can really start to get you down..
Leanne: Yes absolutely, yes.
Kristi: ..affect your ability to want to go out. And so from there I guess the important thing is behavioural strategies after that, so that can be a good place to start. There are often really practical strategies so for example with worry and rumination they’re these endless negative or cycles of negative thoughts if you like.
Being aware that it’s happening is useful and learning to interrupt the thought processes with distraction and grounding techniques can be useful. The kind of techniques that bring you into the moment and away from thinking about the past and the future.
Leanne: Yes, yes.
Talking things through with others is also a really useful strategy. So talking things out can really help get perspective I think, on being able to look at what’s going through your mind in a different way. So I think that can be really useful and for people who don’t like talking to, talking it out with other people journaling can also be really important. So being able to jot down your thoughts can be really useful ways of you know getting it out of your head I guess and down onto a bit of paper.
You know one of the techniques is also to be able to schedule some worrying or rumination time.
Leanne: So put some limits around it.
Kristi: Yes exactly, yes.
Actually saying to yourself ‘I’m going to stop doing this worrying all the time’ and I’m going to schedule it for you know a particular time of the day where then you do get to actually try and sit down and and have a think about those things that are worrying you and I think then, doing all of these things plus combining them with really good problem problem-solving strategies can be really helpful to keep the person sort of unstuck if you like, and maybe kind of get them out of that stuck point I guess, in terms of being in, stuck in the event..
Leanne: Absolutely.
Kristi: ..stuck in the anxiety as well.
There are also cognitive therapy techniques that can be employed to help identify and challenge negative anxiety related thoughts, and for those clinicians who are already competent in the use of cognitive therapy they’ll be used to these sorts of ideas and identifying challenging thoughts as being pretty common ways of helping people with anxiety. So you know it’s really, really important as you said, understandable reaction, common reaction, after a disaster but really important that we have really brief but good strategies to deal with it.
Leanne: Terrific Kristi that’s really very clear and very helpful. Thank you very much.
For people who are interested in understanding more about anxiety in the aftermath of disaster feel free to explore the materials and the resources on the page.
Thanks very much Kristi.
Kristi: Thanks Leanne.