How to support others in a crisis?

What are the different types of crises?

Psychologists define a crisis as an experience of change significant enough to cause substantial cognitive or emotional stress for those involved. There are many types of crises. They can be developmental, occurring when we experience changes typical of specific life stages, such as moving out of the family home at the threshold of adulthood while trying to adapt to a new situation. Another type is the situational crisis, which occurs as a result of sudden, unpredictable events, such as a natural disaster (e.g., a flood). A specific type of crisis involves mental health, which can arise, for example, with depression.

What should you look for if you suspect a loved one is in crisis?

Recognizing signs of a deteriorating condition is crucial when supporting someone going through a crisis. Here are the symptoms we should pay special attention to:

1. Neglect of personal care or responsibilities
   Neglecting hygiene, missing days at work or school, and failing to fulfill basic duties may indicate that a person feels overwhelmed or unable to cope with daily tasks. Such neglect can be linked to experiencing severe stress or depression.

2. Changes in behavior
   Significant changes in behavior can indicate a decline in mental health. These include withdrawing from social interactions, losing interest in previously enjoyed activities, or sudden changes in eating or sleeping patterns.

3. Increased agitation, nervousness, or irritability
   Increased irritability, anxiety, or unexpected anger can be a sign of escalating inner turmoil. These behaviors are often associated with acute stress reactions
   and may be linked to difficulties in coping or emotional overwhelm.

4. Expressing feelings of hopelessness or helplessness 
   If a person frequently verbalizes feelings of hopelessness (e.g., "It will never get better") or helplessness (e.g., "There is nothing I can do"), it may suggest a deepening crisis. Such expressions often precede more serious consequences (e.g., suicidal thoughts).

5. Drastic mood swings
   Sudden and extreme mood swings—such as rapidly shifting from sadness to euphoria or vice versa—can signal a crisis, so in such a situation, it is worth encouraging your loved one to seek professional help.

6. Unusual, risky behaviors
   Engaging in risky or reckless behaviors, such as substance abuse or reckless driving, may reflect difficulties with overwhelming emotions or indifference toward one's own safety and well-being.

7. Expressing the belief that one is a burden to others
   Repeatedly stating that a person in crisis feels like a burden to others or is unimportant is a serious warning sign. It may indicate deepening emotional pain and the onset of suicidal thoughts.

8. Isolation despite offers of support
   Withdrawing from relationships during a crisis is common. However, a noticeable change where a person isolates themselves even after repeated offers of support may indicate the need for immediate professional intervention. This type of isolation can be a factor leading to, for example, suicidal thoughts.

9. Preoccupation with death or self-harm
   Talking about death, expressing a desire to harm oneself, or making statements such as "The world would be better off without me" should be particularly alarming. Such remarks are often warning signs of suicidal thoughts, so it is important to consult a psychologist or psychiatrist immediately.

What to do and what not to do?

Supporting a loved one during a crisis while respecting their boundaries is a huge challenge. However, psychology provides us with valuable knowledge on how to provide support while also taking care of our own well-being. Here are tips on how to interact with someone experiencing a crisis:

1. ‍Active listening without judgment
   Active listening is the foundation of emotional support. Research indicates that providing another person with a safe, non-judgmental space to express their feelings and thoughts can reduce their anxiety and foster mutual trust. Active listening involves maintaining eye contact, using statements like "I am here for you," asking open-ended questions, and refraining from interrupting, offering solutions, or giving unsolicited advice. Studies also show that reflective listening and paraphrasing the other person's statements help them feel better understood.
2. Empathy and validating emotions
   Acknowledging and validating emotions is crucial when supporting someone in a mental health crisis. Research in emotion-focused therapy highlights that validating someone's feelings (using phrases like "It's understandable that you feel this way") reduces feelings of isolation. However, it is important to remember that this way of communicating does not necessarily mean agreeing with everything the other person says. It is rather about
   showing that we understand their emotions and accept them with respect.
3. Asking about needs instead of making assumptions
   One of the simplest yet most effective ways to provide support
   while respecting the other person's boundaries is to ask, "How can I support you right now?" Offering choices or asking open-ended questions prevents the imposition of unwanted advice and helps the other person maintain a sense of control during difficult times.
4. Being present
   Sometimes our mere presence is enough to make the other person feel less overwhelmed by their problem. Research on the supportive presence of loved ones shows that physical or emotional closeness can significantly lower stress levels. Being with the other person
   in silence, offering a comforting touch (if welcome), or being available
   when needed reinforces our role as a safe anchor.‍
5. Avoiding unsolicited advice
   Unsolicited advice and solutions can come across as dismissive, preachy, or an attempt to take control, even when intentions are good. Research on communication patterns during crises shows that advice is more helpful when the other person asks for it. Instead of giving advice, it is better to use phrases like, "Would it help if I shared what I think about this?" This allows the other person to maintain their autonomy while signaling that more concrete support is available if needed.‍
6. Encouraging professional help if necessary
   If the crisis is severe, gently suggesting that they seek professional help
   from a mental health expert can be a turning point. Research shows that many people
   in difficult situations feel relieved when someone they trust supports them in seeking therapy or counseling. It is helpful to use encouraging, non-intrusive statements, such as, "I care about you, and I think a specialist could provide you with more professional support."‍
7. Self-care

Supporting someone in crisis can be emotionally draining. Research on caregiver burnout emphasizes that setting boundaries while helping protects against emotional exhaustion. Taking care of your own well-being is essential, as your mental health ensures you remain a stable source of support.

What should you do if you notice warning signs?

If a person in crisis shows symptoms of deteriorating mental health, you should offer support—here is what you can do:

• Monitor the person's condition with tact and empathy while respecting their boundaries—it is worth asking how they are feeling in a subtle way and expressing your concerns without judgment.
• Suggest seeking help from a mental health professional, emphasizing that reaching out for support is a sign of strength, not weakness.
• Be present, offering support to the person in crisis and reassuring them that they are not alone in their struggles.
• Seek help immediately if necessary. If the person in crisis is struggling with suicidal thoughts, you should contact emergency services or a crisis hotline right away.

Keep in mind that the stress caused by a crisis can impair a person's ability to process information effectively. As a result, they may downplay their symptoms or make decisions that do not improve their situation,
and may even make it worse. This is an important tip for loved ones, who should remain particularly vigilant and observant of the person's behavior during this time.

Bibliography:

1. American Psychological Association, APA Dictionary of Psychology (2nd ed.), 2015.
2. Van Orden K. A., Witte T. K., Cukrowicz K. C., Braithwaite S. R., Selby E. A. & Joiner T. E. Jr, The interpersonal theory of suicide, Psychological review, 117(2), 575–600, 2010, https://doi.org/10.1037/a0018697
3. Joiner T., Why people die by suicide, Harvard University Press, 2005.
4. Nock M. K. & Prinstein M. J., Contextual features and behavioral functions of self-mutilation among adolescents, Journal of abnormal psychology, 114(1), 140–146, 2005, https://doi.org/10.1037/0021-843X.114.1.140
5. Rudd M. D., Berman A. L., Joiner T. E. Jr, Nock M. K., Silverman M. M., Mandrusiak M., Van Orden K. & Witte T., Warning signs for suicide: theory, research, and clinical applications. Suicide & life-threatening behavior, 36(3), 255–262, 2006, https://doi.org/10.1521/suli.2006.36.3.255
6. Beck A. T., Weissman A., Lester D. & Trexler L., The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42(6), 861–865, 1974, https://doi.org/10.1037/h0037562
7. American Psychiatric Association, Diagnostic and statistical manual of mental disorders (5th ed.), 2013, https://doi.org/10.1176/appi.books.9780890425596
8. Bodie G. D., Vickery A. J., Cannava K. & Jones S. M., The Role of “Active Listening” in Informal Helping Conversations: Impact on Perceptions of Listener Helpfulness, Sensitivity, and Supportiveness and Discloser Emotional Improvement. Western Journal of Communication, 79(2), 151–173, 2015, https://doi.org/10.1080/10570314.2014.943429
9. Deci E. L. & Ryan R. M., Intrinsic Motivation and Self-Determination in Human Behavior, Berlin: Springer Science & Business Media, 1985.

https://doi.org/10.1007/978-1-4899-2271-7

10. Woldarsky Meneses C., Emotion-focused couples therapy. Person-Centered & Experiential Psychotherapies. 16. 1-20, 2017, https://doi.org/10.1080/14779757.2017.1330706.
11. Coan J. A., Schaefer H. S. & Davidson, R. J., Lending a hand: social regulation of the neural response to threat, Psychological science, 17(12), 1032–1039, 2006, https://doi.org/10.1111/j.1467-9280.2006.01832.x
12. Goldsmith D. J., Communicating social support, Cambridge University Press, 2004, https://doi.org/10.1017/CBO9780511606984
13. Corrigan P. W., Druss B. G. & Perlick D. A., The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care, Psychological science in the public interest: a journal of the American Psychological Society, 15(2), 37–70, 2014, https://doi.org/10.1177/1529100614531398
14. Zarit S. H., Reever K. E. & Bach-Peterson J., Relatives of the impaired elderly: correlates of feelings of burden. The Gerontologist, 20(6), 649–655, 1980. https://doi.org/10.1093/geront/20.6.649