Stress and the World Relief Staff

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 StressKnow 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 StressBe 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: http://ngosecurity.googlepages.com/English_CARE_International_Safety_and_Security_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