1. Stress and the World Relief Staff
Maintaining Your Well-Being

2. 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

3. 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.

4. 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)

5. 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)

6. 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

7. 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?

8. 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

9. 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”

10. 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

11. 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

12. What symptoms are you or do you normally experience?

13. 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

14. 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

15. 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

16. Protective Factors

17. Decreasing & Dissipating Stress
Physical Activity
Rest

18. Decreasing & Dissipating Stress
Healthy Eating
Water

19. Decreasing & Dissipating Stress
Optimism
Curious

20. 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

21. 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

22. 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

23. Decreasing & Dissipating Stress
Laughter
Thankful

24. 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

25. 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

26. 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

27. 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

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

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

30. 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.

31. 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

32. 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

33. 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

34. References
Care International Safety and Security Handbook (200). Retrieved August 1, 2008 from: 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: Fawcett, J. (Ed.) (2003). Stress and Trauma Handbook. Monrovia, CA: World Vision Headington Institute (2007). Online Training Modules. Retrieved July 6, 2008 from: 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: Pan American Health Organization (2001). Stress Management in Disasters. Retrieved August 1, 2008 from: