Effective communication is a "resource multiplier" during a crisis, disaster, or emergency. For example, during a crisis you may find yourself overwhelmed with requests for information from the media and the public, managing misinformation, and conflicting messages being sent by other agencies. Use of effective communication techniques allows you to avoid resource over-utilization or misuse by managing or eliminating as many of these issues as possible.
Many of the expected negative individual and community behaviors can be mitigated with effective emergency and risk communication. Each crisis will carry its own psychological baggage. The practitioner must anticipate the mental stresses that the population will be experiencing and apply appropriate risk communication strategies to attempt to manage these stresses in the population. Risk communication is a fully legitimate tool of response and recovery, just like any other resource applied to a disaster. It is not an attempt at mass mental therapy. It is a reasoned and mature communication approach to the selection of message, messenger, and method of delivery for intended audiences. In this section, we will look at the different ways that people may react in an emergency or crisis.
It is important for the communicator to understand that in crisis, people often manifest the following psychological reactions:
- Vicarious rehearsal
- Denial
- Stigmatization
- Fear and avoidance
- Withdrawal, hopelessness, and helplessness .
Interestingly, experience has shown that people farther away (by distance or relationship) from the threat may actually exercise less reasonable reactions than those who are facing the real crisis. The communication age allows some people to vicariously participate in a crisis which they have no danger of actually experiencing and "try on" the courses of action presented to them. Because these "armchair" victims have the luxury of time to decide their chosen course of action among the possibilities, they may be much more critical about its value to them. In some cases, these people may reject the proposed course of action, choose another, or insist that they too are at risk and need the recommended remedy, such as a vaccination or a visit to an emergency room. In its most troublesome form, these "worried well" will heavily tax the recovery and response.
Members of the community will experience denial. The following are some of the ways people experience denial. Some people:
- Avoid getting the warnings or action recommendations
- May become agitated or confused by the warning
- May not believe the threat is real
- May not believe the threat is real to them.
An individual experiencing denial may not take recommended steps to ensure their safety until the absolute last moments, sometimes, perhaps, when it is too late. This maladaptive crisis response is often associated with people suddenly and deeply feeling that the universe is no longer a rational and orderly system.
In some instances, victims may be stigmatized by their communities and refused services or public access. Stigma, the fear and isolation of a group perceived to be contaminated or risky to be associated with, will hamper community recovery and affect evacuation and relocation efforts. In a disease outbreak, a community is more likely to separate from those perceived to be infected.
Fear is an important psychological consideration in the response to a crisis. The fear of the unknown or the fear of uncertainty may be the most debilitating of the psychological responses to disaster. With fear at the core, an individual may act in extreme, and sometimes irrational, ways to avoid the perceived or real threat.
Withdrawal, hopelessness, and helplessness
Some people can accept that the threat is real, but the threat looms so large that they feel that the situation is hopeless. They feel helpless to protect themselves and so, instead, they withdraw.
For more on the range of emotional reactions that a crisis can provoke, and ways to deal with these various emotions, see Dr. Peter Sandman's chapter on Beyond Panic Prevention: Addressing Emotion in Emergency Communication.
The following seven recommendations can help public health officials to communicate effectively in a crisis. These recommendations, selected by the CDC Office of Communication, are a subset of 26 Recommendations developed by Dr. Peter Sandman in the wake of the anthrax crisis. http://www.psandman.com/col/part1.htm
- Recommendation 1: Be careful with risk comparisons
- Recommendation 2: Do not over reassure
- Recommendation 3: Sensitive syntax
- Recommendation 4: Acknowledge uncertainty
- Recommendation 5: Give people things to do
- Recommendation 6: Stop trying to allay panic
- Recommendation 7: Acknowledge people's fears
The following summary of Dr. Sandman's recommendations on these seven issues intersperses his words with those of the ERC CDCynergy authors.
Recommendation 1: Be careful with risk comparisons
The true risk and perceived risk can be quite different. The source of the risk can be as troubling as the degree of risk. People do not like injustice. If they perceive that the risk has been imposed on them, that they have been unfairly singled out to experience the risk, or that a fellow human being deliberately put them in the position to be exposed to the risk, they are likely to perceive the risk with more concern or outrage. Dr. Peter Sandman cautions about risk comparisons in the following way by exploring both the true risk and the perception of that risk. He defines "hazard" as the seriousness of a risk from a technical perspective
"Outrage" is the seriousness of the risk in nontechnical terms. Experts view risk in terms of hazard; the rest of us view it in terms of outrage. The risks we overestimate are high-outrage and low-hazard. The risks we underestimate are high-hazard and low-outrage.
When technical people try to explain that a high-outrage, low-hazard risk is not very serious, they normally compare it to a high-hazard, low-outrage risk. "This is less serious than that," the experts tell us, "so if you are comfortable with that, you ought to be comfortable with this." In hazard terms, the comparison is valid. But the audience is thinking in outrage terms, and viewed in outrage terms the comparison appears false. Although "this" is lower hazard than "that," it is still higher outrage.
Terrorism is high-outrage and (for most of us, so far) low-hazard. You cannot effectively compare it to a low-outrage, high-hazard risk, such as driving a car - which is voluntary, familiar, less dreaded, and mostly under our own control. Even naturally acquired anthrax fails to persuade as a basis for comparison. People are justifiably more angry and frightened about terrorist anthrax attacks than about other natural outbreaks, even if the number of people attacked is low.
High Hazard High Outrage Low Hazard Low Outrage A volatile risk comparison can work if it is clear that you are trying to inform the public's judgment, not coerce it. If you are trying to inform the public about a risk, the most effective thing to do would be to bracket the risk: bigger than "X," smaller than "Y." If you only report that the risk is smaller than "Y," your audience can tell that they are being coerced.
To use risks for comparison, they should be similar in the type and level of emotion they would generate. Here is a risk comparison that can work:
Research indicates that a person is 10 times more likely to be killed by brain damage from a falling coconut than to be killed by a shark. In this case, the risks are both natural in origin, fairly distributed, exotic, and outside the control of the individual. Although being killed by a shark may cause greater terror or emotion, its comparison to being killed by a coconut helps the individual to see that they may be perceiving the risk as greater than it is. Most people have never considered their risk of dying by coconut.
Remember that all risks are not accepted equally. The following are examples:
- Voluntary vs. involuntary
- Controlled personally vs. controlled by others
- Familiar vs. exotic
- Natural vs. manmade
- Reversible vs. permanent
- Statistical vs. anecdotal
- Fairly vs. unfairly distributed
- Affecting children vs. affecting adults.
If you use risk comparisons, be sure to tell people how confident you are. Acknowledge uncertainty, especially beforehand (talking about future possible risks), but also in mid-crisis. The worst thing about risk comparison is the implication that you actually know how big the risk is, and thus can compare it to another risk. For more on Dr. Sandman's argument against over reassuring, see the section "Being alarming versus being reassuring...," of his article Dilemmas in Emergency Communication.
Recommendation 2: Do not over reassure
Expect high outrage if an emergency event is catastrophic, unknowable, dreaded, unfamiliar, in someone else's control, morally relevant, and memorable. Too much reassurance can backfire. For example, when people are in outrage, reassurance can increase their outrage because their perception is that you are either not telling them the truth or you are not taking their concerns seriously. An example of this is the CDC's experience in Puerto Rico. Instead, tell people how scary the situation is, even though the actual numbers are small, and watch them get calmer.
Even if reassurance worked, which it does not, it is important to remember that an over-reassured public is not your goal. You want people to be concerned, vigilant, and even hyper vigilant at first. You want people to take reasonable precautions: feel the fear, misery, and other emotions that the situation justifies.
During a crisis, if you have to amend the estimate of damage or victims, it's better to have to amend down, not up. It is "less serious than we thought" is better tolerated by the public than "it is more serious than we thought."
(It is important to note that the recommendation to "not over reassure" is considered controversial and is not universally accepted.)
Recommendation 3: Sensitive syntax: put the good news in subordinate clauses
The previous section does not mean that you shouldn't give people reassuring information. Of course you should! But do not emphasize it. Especially do not emphasize that it is "reassuring," or you will trigger the other side of your audience's ambivalence.
One way to avoid this is to use "sensitive syntax." Sensitive syntax means putting the good news in subordinate clauses, with the more alarming information in the main clause. Here is an example of using sensitive syntax:
"Even though we have not seen a new anthrax case in X days (subordinate clause with good news), It is too soon to say we are out of the woods" (main clause with cautioning news).
The main clause is how seriously you are taking the situation or how aggressively you are responding to every false alarm.
Recommendation 4: Acknowledge uncertainty
Acknowledging uncertainty is most effective when the communicator both shows his or her distress and acknowledges the audience's distress: "How I wish I could give you a definite answer on that . . ." "It must be awful for people to hear how tentative and qualified we have to be, because there is still so much we do not know . . .." More information on acknowledging uncertainty can be found in Yellow Flags: The Acid Test of Transparency (http://www.psandman.com/col/yellow.htm) and in the section "Tentativeness vs confidence...," of Dr. Sandman's article Dilemmas in Emergency Communication.
Recommendation 5: Give people things to do
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Action helps with fear, outrage, panic and even denial. If you have things to do, you can tolerate more fear.
In an emergency, some actions communicated are directed at victims, persons exposed, or persons who have the potential to be exposed. However, those who do not need to take immediate action will be engaging in "vicarious rehearsal" regarding those recommendations and may need to substitute action of their own to ensure that they do not prematurely act on recommendations not meant for them. In an emergency, simple actions will give people back a sense of control and will help to keep them motivated to stay tuned to what is happening (versus denial, where they refuse to acknowledge the possible danger to themselves and others) and prepare them to take action when directed to do so.
When giving people something to do, give them a choice of actions matched to their level of concern. Give a range of responses: a minimum response, a maximum response, and a recommended middle response. For example, when giving a choice of actions for making drinking water safe, you could give the following range of responses:
Response Type Example Minimum response "Use chlorine drops." Maximum response "Buy bottled water." Recommended middle response "We recommend boiling water for two minutes." Another way of looking at this is a three-part action prescription:
1.
You must do X.
2.
You should do Y.
3.
You can do Z.
This type of clarity is very important in helping people cope with emergencies.
Some of the "things to do" are different types of behaviors:
- Symbolic behaviors - things that don't really help externally, but help people to cope (attending a community vigil)
- Preparatory behaviors - things to do now that will minimize your risk if bad things happen
- Contingent/"if then" behaviors - things to do not now, but only if bad things happen (implementing a family disaster plan)
The section "Democracy and individual control vs. expert decision-making" of Dr. Peter Sandman's article, Dilemmas in Emergency Communication, provides further information on these issues.
Recommendation 6: Stop trying to allay panic
Panic is much less common than we imagine. The literature on disaster communication is replete with unfulfilled expectations of panicking "publics." Actually, people nearly always behave extremely well in crisis.
The condition most conducive to panic is not bad news; it is double messages from those in authority. People are the likeliest to panic (though still not very likely) when they feel that they can not trust what those in authority are telling them; when they feel misled or abandoned in dangerous territory. When authorities start hedging or hiding bad news in order to prevent panic, they are likely to exacerbate the risk of panic in the process.
Experience shows that in a true emergency (matter of life and death) people do respond exceptionally well. However, it also seems that the inverse is true; that the further away the public is from the real danger (in place and time), the more likely they are to allow their emotions full range. This vicarious rehearsal ("How would I feel in an emergency? What would I do? Does this advice work for me?") can be over burdening in an emergency. Therefore, the communicator must recognize the differences among audiences. The person anticipating the "bad risk" is much more likely to respond inappropriately than the person "in the heat of the battle" who is primed to act on the information and does not have quite the same amount of time to mull it over.
The section "Planning for denial and misery vs. planning for panic" of Dr. Peter Sandman's article Dilemmas in Emergency Communication provides further discussion of these issues.
Recommendation 7: Acknowledge people's fears
When people are afraid, the worst thing to do is to pretend they are not. The second worst thing to do is to tell them they should not be afraid. Both responses leave people alone with their fears.
Even when their fear is totally unjustified, people do not respond well to being ignored; nor do they respond well to criticism, mockery, or statistics. And when the fear has some basis, these approaches are still less effective. Instead, you can acknowledge people's fears even while giving them the information they need to put those fears into context. Giving people permission to be excessively alarmed about a terrorist threat while still telling them why they need not worry, is far more likely to reassure them.
There are healthy psychological responses to terrorism. A good summary of these can be found in the International Journal of Emergency Mental Health.
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