Implementation of Skills for Psychological Recovery

Kimberly Burkhart, PhD

Skills for Psychological Recovery (SPR; created by the National Child Traumatic Stress Network and National Center for PTSD) is intended for use with children, adolescents, caregivers, families, and adults and can be implemented in a variety of settings including emergency or crisis counseling centers, community mental health centers, primary care practices, and schools. SPR is intended to be delivered in the weeks and months post-disaster and/or when a more intensive intervention is needed beyond what can be offered through PFA.  SPR is designed to help survivors obtain strategies to manage distress and to improve coping.

SPR is based on the assumption that disaster survivors may experience a variety of reactions including those related to physical, psychological, behavioral, and spiritual functioning.  This empirically-supported modular approach does not assume psychopathology, but rather, places focus on helping survivors regain control and competence.  SPR can be delivered in a single session; however, experts recommend between three and five sessions.  SPR is designed to be delivered by a mental health care clinician or other medical provider.

Several guidelines have been identified for delivering SPR.  The provider should first assess what is going on in the survivor’s life now and how much time they have to devote to learning new coping skills.  SPR will look differently based on whether it is a single encounter provided four weeks post-disaster versus several sessions delivered one-year post-disaster. For example, if provided earlier on and intended to be time-limited, it is recommended that focus be placed on problem solving.  When over a period of time and after several encounters, focus would likely be placed on helpful/positive thinking.  The provider-survivor relationship should be built on fostering a skills-based approach with focus placed on the survivor’s perseverance, motivation and current strengths, and with the intention of learning new coping skills.  The clinician and the survivor will work collaboratively to identify goals and area(s) of focus.

There are four goals of SPR: Protect the mental health of survivors, enhance survivors’ abilities to address their needs and concerns, teach skills to promote recovery, and prevent maladaptive behavior through teaching adaptive coping skills.  These goals can be achieved through the following core skills as defined below. 

1. Building Problem-Solving Skills: Identify the problem, possible options, a solution, and evaluate the decision chosen
2. Promoting Positive Activities: Improve mood by identifying activities that promote positive feelings
3. Managing Reactions: Reduce physical and emotional reactions to upsetting situations through learning adaptive coping skills
4. Promoting Helpful Thinking: Identify negative automatic thoughts and learn how to counter those thoughts

SPR in Practice!

A 10-year-old girl (“Kara”) presents to the primary care clinic due difficulty falling and staying asleep, stomachaches, and headaches.  You review Kara’s chart in the EMR and see that 6 weeks ago, a tornado passed through her neighborhood.  You’ve been asked to respond to Kara.   

What Should You Do? 

Consult your SPR Field Operations Guide (accessed through the National Child Traumatic Stress Network).  Obtain information on how the tornado impacted Kara’s living situation, attendance in school, and current functioning in the following areas: Behavioral, Emotional, Physical, and Cognitive.

The hurricane destroyed part of Kara’s house.  It is going to be some time before she is be able to move back.  Currently, Kara and the rest of her immediate family are staying at an extended stay hotel.  Kara stated that at bedtime, she worries a tornado will occur in the middle of the night.  She gets stomachaches before going to school.  She is having difficulty separating from her family.  Headaches are typically occurring during the school day.  Kara and her mother agreed to four  sessions of SPR provided once a week for four consecutive weeks.  

Problem Solving Skills:  The problem as defined by Kara “is not feeling well”.  She states that she is staying up late to watch for tornadoes.  She stays awake by going on her phone. The clinician brainstormed options for falling asleep more quickly.  The following solutions were identified: Put phone away at least one hour prior to bed, have a bedtime routine, use relaxing imagery, and try to incorporate white noise.

Promoting Positive Activities: Kara enjoys reading, swimming, and playing volleyball.  To re-establish routine, a calendar is provided and enjoyable activities were identified. Mom agrees to taking Kara to the library every two weeks on Wednesday after school.  She is going to stay after school on Mondays and Tuesdays to practice for volleyball tryouts.  Increased engagement in positive activities is intended to increase positive affect. 

Managing Reactions: Kara has difficulty managing reactions when having to separate from her parents when going to school.  Kara is taught deep breathing and progressive muscle relaxation.

Promoting Helpful Thinking: Kara continues to think “something bad is going to happen to my family; my parents could die”.  Kara learns that these thoughts create anxiety.  The clinician works with Kara to identify and rehearse helpful thoughts.  Helpful thoughts could be “although my house was damaged, everyone in my family is okay; there is no evidence to support that my parents are going to die.”

After four sessions, Kara was able to identify physiological signs of anxiety.  She has a weekly schedule that includes positive activities, which has helped to improve her mood. She is putting her phone away and using progressive relaxation at bedtime.  This has decreased the time for sleep onset.  Kara uses helpful thoughts to manage anxiety such as “my family is okay”.