Stress and the World Relief Staff Maintaining Your Well-Being

Stress: a demand or change that the human system is required to meet and respond to. Three types: Critical incident (acute, traumatic) Vicarious trauma Cumulative

Stress cannot be avoided - in fact it can be used as a motivator in life. The trick is to accept stress as a daily part of life, but learn how to control and dissipate it.

Critical Incident Reaction that occurs as result of traumatic event during which an individual is seriously threatened by harm or death Demands of event exceed available coping resources and results in severe stress Intense fear + helplessness + loss of control Most workers in field will experience at least one seriously disturbing/frightening incident Approx. 25% of workers will undergo life threatening event (Headington Institution)

Vicarious Trauma Occurs in response to witnessing or hearing about traumatic events that happen to others Signs and symptoms of stress usually less intense that critical incident Relief workers (RW) hear all types of stories so cannot avoid but need to learn how to prepare for it and deal with it More than 90% of RW surveyed had witnessed or heard about traumatic event during their current assignment (Headington Institute)

Cumulative Stress Less traumatic, more gradual but most problematic Usually related to low intensity but more chronic stressors that pile-up Examples are: Chaotic/reactive work environment Inadequate preparation and briefing Asked to complete tasks outside of area of training/competence Feeling overwhelmed with unmet needs Communication problems (work, cultural, personal) Facing moral and ethical dilemmas Personal/family problems Chronic sleep deprivation

Questions to Think About Which of the three types of stressors have you experienced? Which of the three seem to be the most problematic for you personally? In your own life can you identify with any of the characteristics of a relief worker? Do you think much about the stress in your life? If so, what do you do about it? Cultural Issues When thinking about stress you need to identify what it looks like in your own personal context and culture. How is stress conceptualized in this culture? Is there an individual concept of stress or mainly understood through family and group process? What are typical indicators of stress in this culture (experienced physically, emotionally, mentally, relationally, spiritually, or through behavior)? What have people in this culture traditionally done to deal with stress? What is the role of the individual or community in managing stress? What mechanisms are typically used to deal with stress (social, culture oral, and behavioral)? What do you believe are the most common stressors among your staff? What are the most common stressors of the people that you serve?

Signs of Stress Fight or flight – 1,500 biochemicals released Epinephrine & norepinephrine ↑ HR ↑ BP ↑ Blood flow changes to brain, heart, muscles, stomach ↑ Sharp thinking, auditory, and visual senses ↑ Readiness of muscles to contract ↑ Ability to act in present and sense potential danger ↑ Readies you for fight or flight

Signs of Stress(con’t) Cortisol → Counteracts pain & inflammation → Important when need to focus on solving problem or get to safety Endorphins production increased → Identical to morphine chemical makeup → Potent painkiller → Creates sense of well-being, even euphoria approaching carelessness → Cannot produce at high levels for extended length of time → Can lead to “aid junkie”

Signs of Stress(con’t) Women produce more oxytocin → Tend-and-befriend, counteracts fight-or-flight → Encourages women to care for children → Want to be close proximity to other women and when this occurs oxytocin increases again reinforcing the effects Men produce more testosterone → Enhances the fight-or-flight

Effects of Prolonged Stress Can sensitize your amygdale of brain and send into high alert easily Can cause cells in the hippocampus of brain to shrink – compromise brain’s ability to retain new memories Increased chance of stroke and/or heart disease Increases blood clotting Impairs effectiveness of immune system Increased level of stomach acid production Chronically depleted endorphin levels Increased incidents of vivid dreaming Get sick more easily and stay sick longer Feel tired, drained, and worn out May start to feel anxious, cynical, hopeless Relationships suffer May use drugs, alcohol or engage in risky behavior Emotional and spiritual effects

What symptoms are you or do you normally experience?

Risk Factors: Increase our vulnerability to stress Feeling of low status Unhappy marriage/relationships Quarreling with people Debts/money problems Health problems Unsatisfactory living conditions Lack of social support Boredom Unrealistic goals Work problems

Risk Factors: Personality Intense drive to advance oneself or one’s cause Adversarial and competitive manner – opinionated, often rigid, talks at others Easily irritated, intolerant of imperfections in others Taking on too much and will not give anything up Quick pace in walking, eating, speaking, gesturing – “hurry-up” disease Physical and mental alertness – habitually tense and poised for action Impatient, dislikes waiting Inability to relax – feel guilty when do

Risk Factors: Relief Workers Tends to be more of a risk taker and likes stress Nature and intensity of traumatic events experiences in the past Nature and intensity of work that may trigger a current reaction Number of stressors experiencing Length of exposure to stressful situation Work organizational factors History of previous psychiatric illness Pronounced introversion Negative and pessimism – may feel never have done enough May feel do not have enough resources to meet needs May face moral dilemmas Struggle to find balance between demands of work and own well-being

Protective Factors

Decreasing & Dissipating Stress Physical Activity Rest

Decreasing & Dissipating Stress Healthy Eating Water

Decreasing & Dissipating Stress Optimism Curious

Decreasing & Dissipating Stress Know your strengths and weaknesses Appreciate how God has made you Be aware of strengths and accentuate Recognize weaknesses Work on being adaptable Be flexible Look for meaning in events Gain aptitude in areas where you may be called to work

Manage Your Emotions Is what you worrying about really going to make a diffence Be aware of resentment over the past and anger in the present Cannot change the past Not everyone is going to agree with you You are going to make mistakes

Decreasing & Dissipating Stress People with low social support: 4 times more likely to experience trauma 2.5 times more likely to experience some form of physical illness Greater risk for heart disease Social Support

Decreasing & Dissipating Stress Laughter Thankful

Decreasing & Dissipating Stress Need a breather and chance to step back on regular basis Ideally time off every week Need to do something fun and relaxing Needs to be on your calendar Take Time Away/Distractions

Decreasing & Dissipating Stress A way to express changes and cope with events Talk with friends, counselors, stories, poetry, painting, etc… Writing appears to be most effective way – detailed accounts of stressful events that links facts with feelings found to have positive impact on health Storytelling

Decreasing & Dissipating Stress Be Hardy Commitment: purpose to life and involvement – gives meaning Control: Perceive we have control over stressor or choice of how we react to it Challenge: Seeing difficulties as a challenge rather than a threat and accepting only thing in constant in life is change

Decreasing & Dissipating Stress Builds hardiness and resilience Helps maintain perspective Acts as a compass and anchor Sense of what is important in life Source of strength and hope Spirituality/Faith

Decreasing & Dissipating Stress Review past events Rehearse upcoming events Relax – deep breaths Decompress

Decreasing & Dissipating Stress Repetitive activities such as quilting, weaving, knitting, walking…) Techniques such as diaphragmatic breathing, muscle relaxation, reflective prayer) Relaxation

Using Protective Factors Place a + by a by the protective factors that are most commonly used in your culture. Place a √ by protective factors that you personally use on a regular basis. List one or two new protective factors that you are willing to start using.

Behavior if Exposed to Traumatic Events Live as normal a life as possible, and do things that make you feel good Keep away from mind-altering substances Exercise regularly and eat a healthy diet Be honest about your feelings – write them down or tell them to a trusted friend Do not isolate yourself, but do take time to sleep, relax, and to be alone Refrain from blaming others Do not make major decisions; will need to make some decisions and will help regain confidence Let go of feelings of guilt and self-blame Open up to others and spend time with them Pan American Health Organization

Behavior if Exposed to Traumatic Events Maintain a sense of humor even if you feel terrible Lend a helping hand to others, but do not overextend yourself Utterances fuelled by anger or ignorance are best left unsaid Tend to be more accident prone Structure your time and keep busy Think realistic and positive Realize that your reactions are neither unique or abnormal Accept your limitations and those of others Seek professional help if necessary Strive for inner peace Pan American Health Organization

What Not to Do Don’t believe that you have to care for your coworker or someone else if you feel mentally unable to do so – you won’t be able to. Don’t believe that you can’t say what you are feeling – you need to. Don’t attempt to reassure yourself or others that everything is “okay” – it is not. Don’t try to impose your explanation for what happened on others – it is just your opinion. Don’t blame yourself for what happened – this is not the time for accusing anyone. Don’t tell other people that you know how they are feeling – you don’t. Don’t say to the other person to simply forget about it – it isn’t that simple. Don’t feel pressured to respond when someone else is talking to you – just be there and listening is what matters most to that person. Don’t be afraid to ask someone else how they are doing – your concern may be very uplifting to them. Don’t try to talk someone else out of their feelings even if you don’t understand their reactions to an incident – just listen. Pan American Health Organization

References Care International Safety and Security Handbook (200). Retrieved August 1, 2008 from: http://ngosecurity.googlepages.com/English_CARE_International_Safety_and_Secu rity_Handbook.pdfTraits David Baldwin’s Trauma Information Page. Emotional Health Issues for Families of Disaster Workers by the American Red Cross. Retrieved July 10, 2008 from:http://www.trauma-pages.com/h/arcwkfm.php Fawcett, J. (Ed.) (2003). Stress and Trauma Handbook. Monrovia, CA: World Vision Headington Institute (2007). Online Training Modules. Retrieved July 6, 2008 from: http://www.headington-institute.org/Default.aspx?tabid=2258 Manning, G., Curtis, K. & McMillen, S. (1999). Stress Living and Working in a Changing World. Duluth, MN: Whole Person Associates. Pan American Health Organization (2001). Insights into the Concepts of Stress. Retrieved August 1, 2008 from: http://www.paho.org/english/ped/stressin.htm Pan American Health Organization (2001). Stress Management in Disasters. Retrieved August 1, 2008 from: http://www.paho.org/english/ped/stressmgn.htm