Mental Health

Published on 14/03/2015 by admin

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Last modified 14/03/2015

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Mental Health

Psychiatric problems can emerge or worsen in response to the demands of wilderness experiences. Even in the absence of psychiatric disease, travel produces some level of stress in everyone. Psychodynamic issues develop in most groups and threaten to derail those without a plan to deal with them. Management of emotional problems in the wilderness, including the use of psychotropic medications, both in people who have preexisting psychologic difficulties and in those who develop new emotional problems in the wilderness, is outlined in this chapter.

Modern interpersonal theory suggests that most healthy adults cope with stress by flexibly using different coping styles, but that all adults develop an inflexible coping style under extreme stress. Individuals vary with regard to the magnitude of stress they can endure before innately settling into one of these styles, which was developed in infancy as a response to caregivers. The key to successfully intervening once one of these coping styles becomes inflexible is to challenge the core belief rather than reinforce it, respond to the core belief and not the behavior displayed, and to avoid reinforcing the coping style.

1. Moving toward others:

a. Typically individuals with this coping style are highly emotionally expressive and may display “clinginess” and extreme dependence on others.

b. Core beliefs:

• I am incompetent.

• Group leaders and caregivers are unreliable and unlikely to meet my needs.

c. Strategy to intervene:

• Avoid rejecting or isolating the person, or coddling and overprotecting him or her.

• Encourage competence (e.g., assign easily achievable duties).

• Remain calm and accessible.

2. Moving away from others:

a. Individuals distance themselves from others and appear aloof and self-sufficient.

b. Core beliefs:

• I must appear superior to others.

• Group leaders and caregivers will not care for me, so I must be self-sufficient.

c. Strategy to intervene:

• Avoid ignoring the person. Instead, make it clear that the person is cared for, valued, and missed when he or she isolates himself or herself from the group.

3. Moving against others:

a. Individuals appear intimidating and act confrontationally.

b. Core beliefs:

• I must be in control.

• Group leaders and caregivers are frightening and unpredictable.

c. Strategy to intervene:

• Avoid appearing to be frightened or intimidated.

• Avoid reacting defensively/aggressively.

• Stay calm and assertive (not aggressive) and project confidence.

Anxiety

Signs and Symptoms

1. Excessive worrying out of proportion to the situation, with preoccupying concerns and fears

2. Increased heart rate, blood pressure, and respirations, sweaty palms

3. Nausea and diarrhea, muscular tension

4. Extreme: “fight or flight” with dramatic increase in physical manifestations; altered memory

Treatment

1. Provide ample reassurance.

2. Suggest and support constructive behaviors.

3. Build rapport.

4. Listen uncritically.

5. Administer lorazepam 0.5 to 2 mg PO bid for severe symptoms.

Phobia (e.g., Fear of Heights or Snakes)

Treatment

1. Consider alternate routes of travel.

2. Reassure or distract the person.

3. Administer lorazepam 0.5 to 2 mg PO bid for extreme symptoms (use caution if sedation or diminished motor coordination poses a danger to self or others).

Panic Attack

Signs and Symptoms

1. Typically lasts 10 to 30 minutes

2. With or without obvious cause or trigger

3. Sensation of pounding heart, chest pain, nausea, dizziness, numbness, chills, hot flushes, shortness of breath

4. Hyperventilation, sweating, trembling

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Field Guide to Wilderness Medicine