1. The Things We Say Vaughn Donaldson Midland, TX vaughn@cism1.com www.cism1.com

2. Things We Say Breathing Breathing Exercise Exercise Religion or Spirituality Religion or Spirituality Nutrition Nutrition Massage Massage Sleep Sleep Talk about it Talk about it

3. A Couple Extras For Your Consideration EMDR EMDR TFT TFT Rehab Rehab More on these later…….

4. Breathing Diaphragmatic breathing stimulates vagus nerve facilitating full relaxation Diaphragmatic breathing stimulates vagus nerve facilitating full relaxation Exhalation – may decrease neural firing in the amygdala and hippocampus – prolonged expiration may further reduce neural firing that can lead to calming Exhalation – may decrease neural firing in the amygdala and hippocampus – prolonged expiration may further reduce neural firing that can lead to calming Conscious breath control can get us back calm with associated reduction in pain and anxiety Conscious breath control can get us back calm with associated reduction in pain and anxiety

5. Pre-frontal lobes Limbic system Brainstem ETOH

6. Another View

7. Pre-frontal lobes Limbic system Brainstem

8. Pre-frontal lobes Limbic system Brainstem

9. Pre-frontal lobes Limbic system Brainstem

10. Pre-frontal lobes Limbic system Brainstem Stress

11. Pre-frontal lobes Limbic system Brainstem

12. Pre-frontal lobes Limbic system Brainstem

13. Strange Suicide In Bank-Slay Case Nebraska Trooper's Death 'Connected' To Bank Robbery Massacre Robbery Turned To Gunfire In NORFOLK, Neb., Sept. 27, 2002 Bank robbery suspects Jose Sandoval, left, and Jorge Galindo. (AP) A distraught state trooper killed himself Friday in the wake of a bank robbery that left five people dead a day earlier, the Nebraska State Patrol said.

14. Mark Zach, 35, shot himself with his service revolver at around 1 p.m. CDT just outside of Norfolk. Zach had stopped one of the four robbery suspects, Erick Fernando Vela, 21, last week and ticketed him for carrying a concealed weapon. However, Zach transposed two digits when entering the gun's serial number into a police computer, said Gov. Mike Johanns. Because of that mistake, the computer indicated that the weapon had not been stolen, the governor said. Zach was a 12-year veteran of the State Patrol based in Norfolk. He and his wife had six children, ranging in age from 4 to 15, Nesbitt said. Mark Zach, 35, shot himself with his service revolver at around 1 p.m. CDT just outside of Norfolk. Zach had stopped one of the four robbery suspects, Erick Fernando Vela, 21, last week and ticketed him for carrying a concealed weapon. However, Zach transposed two digits when entering the gun's serial number into a police computer, said Gov. Mike Johanns. Because of that mistake, the computer indicated that the weapon had not been stolen, the governor said. Zach was a 12-year veteran of the State Patrol based in Norfolk. He and his wife had six children, ranging in age from 4 to 15, Nesbitt said.

15. Pre-frontal lobes Limbic system Brainstem

16. Exercise

17. Exercise Is stressful but different than emotional related stress of living Is stressful but different than emotional related stress of living Stress = cortisol is released, breaks down adipose tissue, which releases FFA into bloodstream, during exercise FFA is being utilized by muscles, but during emotional related stress FFA is not utilized as well and converts to triglycerides then to LDL Stress = cortisol is released, breaks down adipose tissue, which releases FFA into bloodstream, during exercise FFA is being utilized by muscles, but during emotional related stress FFA is not utilized as well and converts to triglycerides then to LDL Facilitates degree of physical and psychological stress resistance Facilitates degree of physical and psychological stress resistance

18. Exercise Exercise stress preferentially releases norepinephrine while emotion related stress preferentially releases epinephrine. Circulating epinephrine represents the greatest risk to the integrity of the heart muscle because the ventricles are maximally responsive to epinephrine Exercise stress preferentially releases norepinephrine while emotion related stress preferentially releases epinephrine. Circulating epinephrine represents the greatest risk to the integrity of the heart muscle because the ventricles are maximally responsive to epinephrine

19. Exercise Exercise seems to fine tune the bodies response and secretion of these hormones. Physical exercise is capable of using the constituents in a healthy manner. Exercise seems to fine tune the bodies response and secretion of these hormones. Physical exercise is capable of using the constituents in a healthy manner. After exercise – muscles which have been tense as a result of stress relax and have less tension After exercise – muscles which have been tense as a result of stress relax and have less tension

20. Exercise After exercise – O2 is used more efficiently which leads to reduced cardio responses to stress, which leads to less coronary artery disease, may help in the prevention of osteoporosis, help in the prevention of colon cancer After exercise – O2 is used more efficiently which leads to reduced cardio responses to stress, which leads to less coronary artery disease, may help in the prevention of osteoporosis, help in the prevention of colon cancer Long term – exercise seems to be as effective as other forms of psychotherapy for mild to moderate depression Long term – exercise seems to be as effective as other forms of psychotherapy for mild to moderate depression

21. Exercise Exercise releases endorphins – Orgasm also releases endorphins. Exercise releases endorphins – Orgasm also releases endorphins. Helps you fall asleep faster and reduce high blood pressure, higher metabolism Helps you fall asleep faster and reduce high blood pressure, higher metabolism

22. Religion or Spirituality

24. 90% of studies showed those with religious beliefs have lower BP 90% of studies showed those with religious beliefs have lower BP A study in 1998 of people with Advanced Aids – 40 healers from various religions prayed from a distance. Prayer group had fewer out patient visits and fewer hospitalizations than nonprayer group. A study in 1998 of people with Advanced Aids – 40 healers from various religions prayed from a distance. Prayer group had fewer out patient visits and fewer hospitalizations than nonprayer group.

25. Religion or Spirituality 1988 double blind study of people in CCU patients were assigned to either a nonprayer group or a prayer group. Christians outside the hospital who were unknown to the patients were asked to pray daily for their rapid recovery. Prayer group did better with less chf, pneumonia, need for diuretics, cardiopulmonary arrest, need for ventilation/intubation, and a better overall outcome. 1988 double blind study of people in CCU patients were assigned to either a nonprayer group or a prayer group. Christians outside the hospital who were unknown to the patients were asked to pray daily for their rapid recovery. Prayer group did better with less chf, pneumonia, need for diuretics, cardiopulmonary arrest, need for ventilation/intubation, and a better overall outcome.

26. Nutrition Carbohydrates – simple = sugars, complex = starches, vitamins Carbohydrates – simple = sugars, complex = starches, vitamins Fats – fat cells contain triglycerides which is used for energy, this is good but if there is too much then they convert to body fat Fats – fat cells contain triglycerides which is used for energy, this is good but if there is too much then they convert to body fat Proteins – used to rebuild, repair and replace cells Proteins – used to rebuild, repair and replace cells

27. Nutrition When we are under excessive stress the body starts using protein for energy after carbs and fat are depleted. The body uses lean muscle tissue including the major organs such as the heart is converted to glucose for energy – hence, this is why we need to eat even though we may not be hungry When we are under excessive stress the body starts using protein for energy after carbs and fat are depleted. The body uses lean muscle tissue including the major organs such as the heart is converted to glucose for energy – hence, this is why we need to eat even though we may not be hungry

28. Nutrition This is also why we need to drink plenty of water to help maintain homeostasis – body is going to retain water, conserve, so we need to drink plenty to maintain balance This is also why we need to drink plenty of water to help maintain homeostasis – body is going to retain water, conserve, so we need to drink plenty to maintain balance Carbohydrates have serotonin and serotonin plays a role in eating and emotions Carbohydrates have serotonin and serotonin plays a role in eating and emotions

29. Nutrition When serotonin levels are low the brain sends impulses to eat. Having carbohydrates at every meal helps maintain the serotonin level When serotonin levels are low the brain sends impulses to eat. Having carbohydrates at every meal helps maintain the serotonin level During times of extreme stress digestion may be shut down or working inefficiently, so we must be careful not to overeat or have big meals….sympathetic is working, while parasympathetic is not. During times of extreme stress digestion may be shut down or working inefficiently, so we must be careful not to overeat or have big meals….sympathetic is working, while parasympathetic is not.

30. Nutrition Adrenalin releases glucose in the form of glycogen which gives us an extra burst of energy Adrenalin releases glucose in the form of glycogen which gives us an extra burst of energy

31. Nutrition When we are anxious or tense every muscle cell in our body is consuming energy. Theyre using B vitamins, vitamin C and magnesium. When under stress, we made need as much as twice as many vitamins than when were not under stress, but we dont need twice as much food….this is why we may need a supplement of B vitamins. This is also why we need to eat whole grains, oats, brown rice, and small amounts of high quality protein like fish, eggs, chicken, cheese When we are anxious or tense every muscle cell in our body is consuming energy. Theyre using B vitamins, vitamin C and magnesium. When under stress, we made need as much as twice as many vitamins than when were not under stress, but we dont need twice as much food….this is why we may need a supplement of B vitamins. This is also why we need to eat whole grains, oats, brown rice, and small amounts of high quality protein like fish, eggs, chicken, cheese

32. Massage

34. Massage Increases blood circulation and flow of lymph Increases blood circulation and flow of lymph Lymph carries away wastes and impurities Lymph carries away wastes and impurities Movement of lymph depends on muscle contractions – inactive people arent stimulating lymph movement, so wastes and impurities build up in body Movement of lymph depends on muscle contractions – inactive people arent stimulating lymph movement, so wastes and impurities build up in body

35. Massage Vigorous activity – produces more lactic acid and wastes than can be carried out, either way massage can help the body get rid of impurities Vigorous activity – produces more lactic acid and wastes than can be carried out, either way massage can help the body get rid of impurities Increased blood flow in turn helps oxygen and nutrients reach the cells while also doing a better job of carrying away wastes and toxins Increased blood flow in turn helps oxygen and nutrients reach the cells while also doing a better job of carrying away wastes and toxins Helps relaxation, insomnia, digestive problems, arthritis, carpal tunnel syndrome, sinusitis, reduce pain, helps w/depression, reduced heart rate and blood pressure Helps relaxation, insomnia, digestive problems, arthritis, carpal tunnel syndrome, sinusitis, reduce pain, helps w/depression, reduced heart rate and blood pressure

36. Sleep

38. Sleep Exxon Valdez, Chernobyl, Three Mile Island, Challenger, Bhopal chemical plant, Iraqi ambush near Nasiriya decisions were made after midnight by sleepy people Exxon Valdez, Chernobyl, Three Mile Island, Challenger, Bhopal chemical plant, Iraqi ambush near Nasiriya decisions were made after midnight by sleepy people Effects of sleep deprivation – cognitive decline, mood dysregulation, psychosis, delirium, hypothermia, death Effects of sleep deprivation – cognitive decline, mood dysregulation, psychosis, delirium, hypothermia, death

39. Sleep Alcohol may help one to fall asleep initially, but it increases the number of times you wake up later in the night Alcohol may help one to fall asleep initially, but it increases the number of times you wake up later in the night Rats normally live 2 or 3 years, but when deprived of REM sleep only live about 2 weeks Rats normally live 2 or 3 years, but when deprived of REM sleep only live about 2 weeks 24 hours without sleep leaves one just as impaired driving as someone legally intoxicated 24 hours without sleep leaves one just as impaired driving as someone legally intoxicated

40. Talk About It (Catharsis)

41. Talk About It Study with college students – experimental group wrote about traumatic experience while control group wrote about nonemotional topics (4 consecutive days for 15 minutes per session). Emotional writers had fewer doctor visits. Study with college students – experimental group wrote about traumatic experience while control group wrote about nonemotional topics (4 consecutive days for 15 minutes per session). Emotional writers had fewer doctor visits.

42. Talk About It Same results with senior-level engineers being laid off from their jobs, some after many years with the company. Experimental group wrote about being laid off while control group did not write. Experimental groups got jobs faster than control group. Same results with senior-level engineers being laid off from their jobs, some after many years with the company. Experimental group wrote about being laid off while control group did not write. Experimental groups got jobs faster than control group.

43. Talk About It Even writing years later can be beneficial. Holocaust survivors in the DFW area were assigned to either a control group or experimental group. The experimental group wrote about the holocaust, while the control group did not write. Experimental group had fewer doctor visits. Even writing years later can be beneficial. Holocaust survivors in the DFW area were assigned to either a control group or experimental group. The experimental group wrote about the holocaust, while the control group did not write. Experimental group had fewer doctor visits.

44. Talk About It Writing has been found to boost t-helper cell growth which helps our immune system, also lowered pain and medication use, lowered depression in students taking the GRE. Writing has been found to boost t-helper cell growth which helps our immune system, also lowered pain and medication use, lowered depression in students taking the GRE. Comparable results have also been found by talking about it. Comparable results have also been found by talking about it.

45. Talk About It Studies have also shown writing to provide positive benefits with maximum security prisoners, medical students, distressed crime victims, arthritis and chronic pain suffers and women who have given birth. Studies have also shown writing to provide positive benefits with maximum security prisoners, medical students, distressed crime victims, arthritis and chronic pain suffers and women who have given birth.

46. Avoids Too much caffeine – amphetamine like stimulant, triggers release of stress hormones which increase heart rate, increases bp and O2 demands of the heart Too much caffeine – amphetamine like stimulant, triggers release of stress hormones which increase heart rate, increases bp and O2 demands of the heart Caffeine can be lethal Caffeine can be lethal Frequent side effects include anxiety, irritability, diarrhea, arrhythmia and inability to concentrate Frequent side effects include anxiety, irritability, diarrhea, arrhythmia and inability to concentrate

47. Salt Excessive fluid retention Excessive fluid retention Which increases nervous tension in the general nervous tissue and cerebral tissue Which increases nervous tension in the general nervous tissue and cerebral tissue Excessive fluid retention can also lead to high bp Excessive fluid retention can also lead to high bp BP may become high enough to increase the risk of CVA or MI BP may become high enough to increase the risk of CVA or MI

48. Nicotine Stimulates the adrenals, which releases the stress hormones – increased bp, heart rate, release of fatty acids and glucose Stimulates the adrenals, which releases the stress hormones – increased bp, heart rate, release of fatty acids and glucose Physiological functioning continually elevated to where arousal state becomes normal Physiological functioning continually elevated to where arousal state becomes normal Being without nicotine leads to mild depression and desire for more nicotine Being without nicotine leads to mild depression and desire for more nicotine

49. Noise Can produce cardiovascular changes Can produce cardiovascular changes Moderately high noise frequencies can reduce circulation to arms, legs, hands and feet Moderately high noise frequencies can reduce circulation to arms, legs, hands and feet May result in a permanent rise in bp due to structural adaption of heart and blood vessels May result in a permanent rise in bp due to structural adaption of heart and blood vessels

50. Other Techniques Time management Time management Task reduction Task reduction Self talk Self talk Cognitive reframing Cognitive reframing Expectations Expectations Join a social group Join a social group Avoid change / plan for change Avoid change / plan for change Serenity prayer Serenity prayer

51. Good for Traumatic Stress TFT – Thought Field Therapy TFT – Thought Field Therapy EMDR – Eye Movement Desensitization and Reprocessing EMDR – Eye Movement Desensitization and Reprocessing Rehab – sometimes folks just need that extra help that only rehab can provide Rehab – sometimes folks just need that extra help that only rehab can provide

53. Dont ever lose your sense of humor

54. THE END

55. Conclusion The next time were teaching about coping with critical incident stress lets not just tell people to eat right and exercise, but explain WHY we need to eat right and exercise. The next time were teaching about coping with critical incident stress lets not just tell people to eat right and exercise, but explain WHY we need to eat right and exercise.

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61. Best Available Everly, G. S., A clinical guide to the treatment of the human stress response. 2 nd Ed., Chevron Publishing Everly, G. S., A clinical guide to the treatment of the human stress response. 2 nd Ed., Chevron Publishing