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Experiential/Motivational Intervention: Changing Beliefs & Behaviors in Stress Management AAHE Presentation Tampa, Florida April 3, 2009.

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Presentation on theme: "Experiential/Motivational Intervention: Changing Beliefs & Behaviors in Stress Management AAHE Presentation Tampa, Florida April 3, 2009."— Presentation transcript:

1 Experiential/Motivational Intervention: Changing Beliefs & Behaviors in Stress Management AAHE Presentation Tampa, Florida April 3, 2009

2 Session Goals Demonstrate that a one-time intervention can make a difference Outline the COMPLEX model process including its theoretical basis Demonstrate the COMPLEX model as an effective method of experiential learning

3 Session Objectives Attendees will gain a greater appreciation for: The significance of critical incident stress experienced by EMS providers The importance of pre-incident preparation for learning ways of proactive coping

4 Background Using the COMPLEX Model to Change Beliefs Regarding Proactive Coping Behaviors in Emergency Medical Service Trainees by Dale Maughan RN, EMT-P, PhD Submission for publication pending.

5 Why? “In over 25 years in EMS, the thing that is painfully obvious to me is the fact that we make a great effort to protect ourselves from infectious diseases, blood spatters, and hazardous materials. All the while, the most insidious and widespread problem out there for EMS practitioners, their families, and friends is the inability to leave EMS at the station. This eventually gets to the point of sacrificing close and meaningful relationships in our zeal for professional gratification. You need to make sure to take care of yourself while you are taking care of others.” Paul A.Werfel NREMT-P, Director, Paramedic Program Assistant Professor of Clinical Emergency Medicine, State University of New York at Stony Brook

6 Emergency Medical Service Stress Comparison High in emergency response (Boudreaux et al., 1997; Crabbe et al., 2004; Owen, 1997; Van Der Ploeg & Kleber, 2003; Weiss et al., 1995) Higher than other health-related occupations (Al-Nasar & Everly, 1999; Marmar et al., 1999; Hammer et al., 1986) Magnitude Exposure daily (Al-Nasar & Everly, 1999; Neale, 1991; Owen, 1997) Stressors Loss of control Shift work/lack of sleep Significant injury/death of a coworker or child Perceived or actual physical threat to self Domestic violence Dismembered body Multiple casualty motor vehicle crash Vicarious traumatization Consequences Post Traumatic Stress Disorder Acute stress disorder Secondary traumatic stress disorder Somatic disorders Strained relationships Burnout

7 Emergency Medical Service Stress Personality EMS personality – controversial (Grevin, 1996; Mitchell & Everly, 1994;Wagner, 2005) No clear evidence of protective characteristics (Moran & Britton, 1994) Training National Standard Curricula – minimal, didactic (DOT, 1996) Initial training time limited – max 120 hours (DOT, 1996) Prevention Evidence of the need (Bennett et al., 2005; Jonsson & Segesten, 2004; Harbert, 2000; Mitchell & Everly, 1994; Oster & Doyle, 2000; Regehr et al.) Documentation of efforts limited (EMS Agenda for the Future, 1996) Treatment Critical incident stress debriefing (Mitchell & Everly, 1994, 2000) Research Prevention – severely lacking (National EMS Agenda for Research, 2001)

8 Proposed Model Beliefs Goals Values Attitudes Perceptions Critical Incident Primary Appraisal Secondary Appraisal Coping Behaviors Consequences Physical Mental Emotional Spiritual Social Pre-Incident Preparation Realistic Expectation Development Wellness Education Proactive Coping Behavior Training

9 Coping Behaviors Breathing Simplest form of stress management (Luskin in Evans, 2005) Controlling the breath alters “fight-or-flight” response (Gordon in Evans, 2005) Attributed to arousal reduction (Chapell, 1994) More adaptive responding to negative stimuli (Arch & Craske, 2006) Positive Self-Talk Primary cognitive mediator of stress (Chapell, 1994) Must be believable to client, provides support, self-attributions for gain in anxiety control (Meichenbaum & Deffenbacher, 1988) Can tell the body no need for arousal (McKay, Davis, & Fanning, 1981) Cognitive Restructuring May enable workers to tolerate stressful work environments (DOVA & DOD, 2004) Evaluate validity/viability of thoughts/beliefs, elicits/evaluates predictions, explores alternative explanations, alters absolutist, catastrophic thinking styles (Meichenbaum & Deffenbacher, 1988) Process by which focus is on good in what is happening, discover opportunities for growth and how actions benefit others (Folkman & Moskowitz, 2000) Aside from problem solving, the most powerful crisis intervention (Pennebaker, 1999) Opportunity to learn from experience, focus on positive (Regehr, Goldberg & Hughes, 2002)

10 Results/Recommendations The COMPLEX model was effective in changing outcome expectancy and self- efficacy beliefs regarding the use of select proactive coping behaviors in EMS trainees. The next step is to evaluate actual adoption of behaviors.

11 COMPLEX Model A model for experiential learning Authors: Gary D. Ellis Catherine Morris Eric P. Trunnell World Leisure & Recreation, V. 37, 1995

12 COMPLEX Model Create Goals Orient Motivate Participation Log-Off Edify Examine

13 COMPLEX Model Theoretical Basis Arousal ( Berlynne, 1960; Ellis, 1873; Eysenck, 1982; Festinger, 1957) Expectancy Valence (Rotter, 1975) Self-Efficacy (Bandura, 1986) Attribution (Abramson, Seligman & Teasdale, 1978; Heider, 1958; Russell, 1992)

14 COMPLEX Model Create Goals Orient – Arousal Motivate – Expectancy-Valence, Self-Efficacy Participation – Self-Efficacy Log-Off Edify - Attribution Examine

15 COMPLEX Model Arousal People strive to maintain a level of alertness/activity/interest (arousal) that is appropriate to their circumstance.

16 COMPLEX Model Self-Efficacy Decisions to participate or not are dependent on one’s efficacy and outcome expectations. Performance Vicarious experience Verbal persuasion Arousal

17 COMPLEX Model Expectancy-Valence Decisions to participate or not are dependent on one’s desire for specific benefits and how much value are placed on them.

18 COMPLEX Model Attribution Causes identified for outcomes Internal vs. External Stable vs. Unstable Global vs. Specific

19 COMPLEX Model Blueprint COMPLEX Model Blueprint StrategyTheory/Content/Messages Create GoalsPurpose of the educational experience OrientArousal MotivateExpectancy Valence Expectancy: If I concentrate on my breathing, I can be in control of my stress response. Valence: It is important for me to be able to manage stressful situations. Self-Efficacy Performance: I watched you in total control of your breathing during our last session. Vicarious: Watch how Bob is able to focus on his breathing when distracted. Verbal persuasion: I know you will be able to do this when you are in a stressful situation. ParticipationSelf-Efficacy Performance: You are breathing evenly, demonstrating your ability to be in control. Vicarious: I can see you are able to concentrate on each breath like Ann is. Verbal persuasion: I bet you can do this regardless of the intensity of the stress you are experiencing. Attribution Internal: You are in total control of your breathing. Stable: You can do this again. Global: I believe you can do this when ……. Log-OffClose the experience EdifyAttribution Reflection: What did you experience? Generalization: Have you experienced something similar before? ExamineApplication: In what situations can you apply what you have learned in your own life? How can it be applied in other situations where the need to focus or be mindful is critical?

20 COMPLEX Model Key Components Experience Ordered messages Flexibility Processing Reflection Generalization Application

21 Questions?

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