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HURRICANE PREPAREDNESS: Worker Health Care; Mental Health William M. Furey, Ph.D. June 2008.

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Presentation on theme: "HURRICANE PREPAREDNESS: Worker Health Care; Mental Health William M. Furey, Ph.D. June 2008."— Presentation transcript:

1 HURRICANE PREPAREDNESS: Worker Health Care; Mental Health William M. Furey, Ph.D. June 2008

2 OBJECTIVES FOR TODAY Prevention of problems for you –Develop awareness of constellation of stressors & responses that prolong stress –Help you understand how you are affected by your clients and your jobs –Help minimize the potential negative effects and vulnerability –Increase your options for self-care Help you be in position to be truly empathetic, compassionate, and useful to people affected by the disaster

3 FACTORS LEADING TO COMPASSION FATIGUE Crisis workers view trauma as part of their work; a fact of everyday life Exposure is repetitive; this can have a cumulative effect Individuals who experience intense post-trauma imagery Those experiencing most acute symptoms immediately after, as opposed to delayed Age of individual; younger, less experienced more likely Degree of identification with the victim Unrealistic beliefs: –“God Syndrome” – belief they can save everyone –“John Wayne Syndrome” – macho attitude the admitting distressing feelings is sign of weakness

4 Pre-existing life events stress: marital problems, financial problems, a sick child, etc. Occupational influences include the “conspiracy of silence”, the “no talk rule” Availability of social supports

5 Post-Trauma Symptoms Documented in Crisis Workers Perceptual and time distortions –Over- & under-estimation of time involved in an incident Depersonalization –Sense of unreality during the event but continue to function Shock/numbing –No intense emotions for hours, days, or longer following an incident Intrusive thoughts and images about the disaster Anger, a sense of alienation Relationship and marital discord –Spouses often report feeling shut out; reluctance to share feelings; numbing

6 EMPATHY Allows us to relate to those in our care To have a sense of what they are feeling Helps us put their experiences into perspective Helps us understand how they are being affected by incidents Helps us to feel inside their world, which leads to compassion Alerts us to the needs of others and draws us to respond

7 Negative Risks First Responders Face Compassion fatigue Vicarious traumatization Secondary traumatization Burnout

8 Compassion Fatigue –General term applied to anyone who suffers as a result of serving in a helping capacity Burnout –Anyone whose health is suffering or whose outlook on life has turned negative because of impact or overload of their work

9 Secondary Traumatization –Family members and close associates who suffer from loved one’s trauma as a result of the closeness of the relationship –First responders who are eyewitnesses to incident they are meant to mediate, while not primary casualties, become overwhelmed by what they see and hear in person Vicarious Traumatization –Impact on first responders when working with traumatized individuals –First responders vicariously experience the client’s trauma in his/her own nervous system

10 What are the common symptoms of compassion fatigue? See Handout How is it that we come to experience and participate in the experiences of our clients?

11 Roots of empathy lie in the Central Nervous System –Somatic Markers There is a feedback system when we copy another’s emotional posture that has an effect on feelings Adopting a particular facial expression or posture may stimulate associated emotions Helps us understand what the client is feeling

12 Mirror Neurons –Brain cells that reflect/mirror the activity of another –Represents a link between two people Empathy not only a psychological phenomenon, but also a physical one Mirroring and mimicking enhance likelihood of empathy

13 How might awareness of mirroring help you to better care for yourself during and following your working with a traumatized individual? Emotional Contagion Mindfulness ANS reactions to happy faces are short-lived Reactions to angry faces were longer lasting

14 Ways to Unmirror Sit up straight Cross or uncross legs Change breathing Take a drink Stretch Visit the restroom Tense specific muscles Move around Take a deep breath Exhale

15 Stress Reactions in Adults: Feelings Rage, anger, irritability Resentment Anxiety, fear Despair, hopelessness Numb Terrified Guilty Sad Helpless, loss of control Uninterested Overwhelmed

16 Stress Reactions In Adults: Thoughts Difficulty concentrating and thinking Difficulty making decisions Forgetful Confused Distortion of sense of time Lowered self-esteem Self-blame Intrusive thoughts, memories, flashbacks Worry A sense of being cut off from reality Self-harm

17 Stress Reactions in Adults: Physical Effects Fatigue, difficulty sleeping Agitation Physical complaints (e.g., headaches, stomach problems) Decreased or increased appetite Decreased or increased sex drive Easily startled Increased cravings for and use of caffeine, nicotine, sweets, alcohol, illicit substances Lightheaded Weak

18 Stress Reactions in Adults: Behaviors Crying spells Angry outbursts Avoiding people, places, and situations Argumentative School and work problems Risky behaviors (driving erratically, multiple sexual partners, unsafe sex) Inattention to appearance, personal hygiene, self-care

19 Stress Reactions in Adults: Spiritual Change in relationship with or belief about God/Higher Power Abandonment of prayer, ritual, scripture, devotions, sacraments Questioning the beliefs of their faith Rejection of spiritual care providers Struggle with questions about the meaning of life, justice, fairness, afterlife Loss of familiar spiritual supports Loss of faith

20 Cognitions and Beliefs That Heighten Risk for Fatigue Putting others first Helping other people: –Will make their life worthwhile. –Will give their life meaning. –The world will be a better place for all. People will look up to them for helping. People will listen and follow your recommendations.

21 Inability to fulfill expectations over time sets stage for dissatisfaction, unhappiness, compassion fatigue, and burnout –We may not be able to help every client. –We can feel guilty our lives have been so easy in comparison. –Certain types of clients require special nurturance, compassion, and understanding that drain our resources

22 Contributing Factors to the Stress Response Disaster characteristics Disaster response characteristics Individual characteristics Factors that affect you as a disaster responder

23 Disaster Characteristics Type of disaster –(e.g., natural or human-caused) When it occurs –(e.g., time of day, time of year) Who is affected –(e.g., number of people including children, injured, missing, or killed) What is affected –(e.g., damage to health care facilities, grocery stores, roads, telephone services, schools, etc.)

24 Disaster Response Characteristics Level of preparedness Post-disaster living situation –(e.g., individuals may need to evacuate their homes and stay in shelters, with friends or family, or in a hotel) Limited availability of food and water Delays in receiving relief services or medical care

25 Individual Characteristics Age Gender Family composition Cultural, ethnic, racial background Level of exposure to the disaster Loss of or injury to family member, other loved ones, pets Loss of possessions Pre-disaster stress Connectedness with others

26 Factors that Affect You As A Disaster Responder Leaving family members and loved ones to go on assignment Working in unfamiliar and challenging settings Staying in a staff shelter with little privacy Encountering unfamiliar cultural or ethnic populations whose primary language may not be English Listening to survivors’ stories Seeing disturbing sights Working with difficult supervisors and co- workers Returning home

27 Information to Keep in Mind to Protect Against Compassion Fatigue Individuals you helping are primarily normal, functioning individuals; they have not disintegrated. Establish an alliance with the individual –Be collaborative: you and individual working toward shared goals –Empower the indiv by giving choices regarding pace of disclosure & options for action –Act as “ally”: convey what happened was “wrong,” “unfair”; did not deserve it to happen –Provide conditions so individual can tell his/her “story”; not a cross-examination, not fact-finding

28 Educate the Client Educate client by blending into discourse of counseling –Traumatic events can produce symptoms in anyone, regardless of experience. It is normal response to an abnormal situation. –Use metaphor of psychological aftermath or aftershock to describe the immediate and delayed reactions. –It is not unusual to fear that one is “losing control.” –Comment on temptation and dangers of using alcohol and drugs as way to cope/avoid/reduce symptoms. –Reframe symptoms as “signs of coping” and “protective and healing.” –Indicate symptoms may get worse before they get better as one works through what happened and why. –Though hard to believe, there will be positive benefits to willingness to face and work through the experience.

29 Skills to Protect Against Compassion Fatigue Making a connection Helping people be safe Being kind, calm, and compassionate Meeting people’s basic needs Listening Giving realistic assurance Encouraging good coping Helping people connect Giving accurate and timely information Taking care of yourself

30 Helping Yourself and Others Physical Exercise –Weight lifting, regular workouts, dancing, walking, swimming, etc. all shown to help with stress management –Exercise helps with regulation of the autonomic nervous system –When exercising for calming, stop short of muscular exhaustion; stop when you begin to tire, while the exercise still feels good Reduce the fuel –Limit your exposure of watching TV, listening to radio, & reading about the disaster. Focus on the positive –Think about the courage & commitment of responders and volunteers who standing with and for those affected.

31 Recognize your own feelings –Knowing the physical, emotional, cognitive, spiritual problems you having are stress related helps reduce their effect on you. Talk to others about your feelings –Understand your feelings shared by others helps relieve stress. –Stay connected with your usual support systems. Accept help from others –To help put feelings in perspective, talk to mental health worker. –It does not mean you are crazy. –Means your coping skills are being stretched. Do something you enjoy –Whenever possible, take a few minutes to look out window at sunshine & flowers. There is still beauty in the world. –It’s OK to smile. Smiles can make you feel better. It is not disrespectful.

32 Stories Illustrating Importance of Cognitive Beliefs Starfish story Two Monks Edison The Eternal Optimist

33 Closing Let me emphasize that constant assessment, evaluation, or mindfulness is an important process for you to do with yourselves. Compassion fatigue is inevitable given your jobs as crisis workers, our neurology, and our desires to help. You can do much to mediate the potential problems. Burnout and vicarious traumatization are preventable.


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