Transcript Stress Mangement

Stress Management
Department of State Health Services
Disaster Behavioral Health Services
512.206.5555
_________________________________
Jennifer Reid, LMSW
512.206.4840
[email protected]
Paul Tabor, MMiss
512.801.9816
[email protected]
What is stress?
Stress is difficult to define because it is a
subjective sensation associated with various
symptoms that differ for each of us.
Job stress is the leading source of stress for
adults.
(American Institute of Stress
www.stress.org)
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“Fight or Flight response”
(W. B. Cannon)
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“Sum total of wear & tear”
(H. Selye)
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A normal survival reaction
Eustress vs. Distress
Eustress
 Positive
 Motivating stress
Distress
 Excessive
 Debilitating Stress
The Stress Cycle
(http://www.samhsa.gov/dtac/proguide.asp)
The Stress Cycle
An event occurs
of neutral value
or meaning
After a period of rest,
the individual is able to
prepare for and meet a
new threat or challenge
Fatigue follows
the depletion of
biochemicals
from the exertion
The biochemicals are
depleted through the
exertion to meet the
threat or challenge
The individual
appraises whether
the event is a threat
or a challenge
Biochemicals are
released to enhance the
ability of one’s mind and
body to respond
The individual responds
to the threat or challenge
through fight or flight
173
The Stress Cycle
(http://www.samhsa.gov/dtac/proguide.asp)
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An event occurs
Individual appraises whether or not event is a
threat or a challenge
Biochemicals are released to enhance ability
to respond
Individual responds (fight or flight)
Biochemicals depleted to meet challenge
Fatigue follows
Rest and prepare for next threat or challenge
Who me?
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We often try to justify the warning signs of stress
within ourselves
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Common expressions:
“ I’m fine”
“Don’t worry about me, I will be okay”
“I have been doing this for a long time; I can
handle anything”
Job-Related Stressors
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Working long hours
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Staff shortage
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Repeated exposure to traumatic stories
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Exposure to survivor’s reaction to disaster
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Away from family/friends for extended periods
Signs That You May Need Stress
Management Assistance
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Difficulty communicating thoughts
Difficulty remembering instructions
Becoming easily frustrated and being
uncharacteristically argumentative
Inability to engage in problem solving and
difficulty making decisions
Signs That You Made Need Stress
Management Assistance
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Limited attention span and difficulty
concentrating
Colds or flu-like symptoms
Headaches/tremors/nausea
Loss of objectivity
Unnecessary risk-taking
Signs That You Made Need Stress
Management Assistance
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Inability to relax when off duty
Refusal to follow orders to leave the scene,
command post, etc.
Increased use of drugs/alcohol
Unusual clumsiness
Compassion Fatigue
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Also called “vicarious traumatization” or
secondary traumatization (Figley, 1995)
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Refers to the PTSD-related symptoms due to
working with patients and families who have
trauma and grief
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Differs from burn-out, but can co-exist
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Can occur due to exposure on one case or can
be due to a “cumulative” level of trauma
Compassion Fatigue vs. Burnout
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Compassion Fatigue
– a state of tension
and preoccupation
with traumatized
survivors. (Also called
Secondary Traumatic
Stress or Vicarious
Trauma)
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Burnout
– a state of extreme
dissatisfaction with
one’s work
Compassion Fatigue
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Re-experiencing
traumatic event(s)
Avoidance/numbing
of reminders
Increased anxiety
Burnout
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Burned out rather
than engaged in one’s
work
Exhaustion, no
energy (physical,
emotional, mental)
Increased cynicism
Compassion Fatigue
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Related/reaction to
one’s work with
survivor’s of trauma
history
The “Cost of
Empathy”
Occurs with
specialized work
Faster onset, occurs
with little warning,
faster recovery
Burnout
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Related to the work
environment
Generalized stress of
working with difficult
clients and situations
Occurs in any
profession
Gradual process that
gets increasingly
worse
Compassion Fatigue
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May lead to changes
in trust, feelings of
control, safety
concerns, intrusive
imagery. Symptoms
are physical,
emotional, cognitive,
spiritual, behavioral,
and interpersonal.
Burnout
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Does not necessarily
lead to changes
associated with
personal life.
Characterized by
emotional exhaustion.
Impact of Compassion
Fatigue on Professional
Functioning
(Figley, C.R. (1995) Compassion Fatigue
Coping with Secondary Traumatic Stress
Disorder in Those Who Treat the
Traumatized. New York: Brunner/Mazel,
Inc.)
Performance of Job Tasks
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Decrease in quality
Decrease in quantity
Low motivation
Avoidance of job tasks
Increase in mistakes
Setting perfectionist standards
Obsession about details
Morale
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Decrease in confidence
Loss of interest
Dissatisfaction
Negative attitude
Apathy
Demoralization
Detachment
Feelings of incompleteness
Lack of Appreciation
Interpersonal
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Withdrawal from colleagues
Impatience
Decrease in quality of relationship
Poor communication
Subsume own needs
Staff conflicts
Behavioral
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Absenteeism
Exhaustion
Faulty judgment
Irritability
Tardiness
Irresponsibility
Overwork
Frequent job changes
Small Group Exercise
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Discuss a case that caused you to take it
home with you or caused some symptoms of
compassion fatigue
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Identify what factors caused you to identify
with the person/victim/family/event
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Note commonalities and choose a person to
share these findings with the larger group
The ABC’s of Prevention
A= Awareness
 B=Balance
 C=Connections
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A= Awareness
Issues and Contributing Factors
What types of cases
contribute to your
stress level
increasing your
vulnerability to
compassion fatigue?
What events or cases can cause
compassion fatigue?
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Events or situation that
causes one to
experience an
unusually strong
reaction
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Often overpowers one’s
usual coping
mechanisms
A= Awareness, continued
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Ability to function is
interfered with or
altered.
Situation or incident
does not seem “typical
or ordinary”, it feels
traumatic.
“Compassion stress”
impinges upon or breaks
through normal
boundaries
Awareness, continued
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Regularly waking up tired in the
morning and struggling to get to
work?
Feeling as if you are working
harder but accomplishing less?
Becoming frustrated/irritated
easily?
Losing compassion for some people while
becoming over involved in others?
Routinely feeling bored or disgusted?
Experiencing illness, aches and pains?
Even Mother Teresa
Understood Compassion Fatigue
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Recognized the effects
Wrote in her plan to her
superiors that it was
MANDATORY for her nuns
to take an entire year off
from their duties every 4-5
years to allow them to heal
from the effects of their
care-giving work.
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“The quality of strength lined with
tenderness is an unbeatable
combination…”- Maya Angelou
Self-Awareness Exercises
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How Do You Cope With Stress?
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Life Balance scale
Life Balance Wheel - Here is a tool you can use to
assess the level of your satisfaction with all aspects
of your life.
Place each aspect of your life in the space in each
segment. Some suggestions follow. Modify these to
represent those that are meaningful to you.
•Self Care
•Work
•Intimate Partner/Family
•Friends/Social Life
•Financial Aspects
•Health & Wellness/Body Image
•Spiritual Aspects
•Community/Service
Now rate your satisfaction with each aspect, using a
scale from zero to ten, with ten being very satisfied and
zero being completely unsatisfied. Place a mark
indicating your choice in each segment of the circle,
with zero at the center and ten at the rim. Connect all of
the marks around the circle to see how balanced your
wheel is.
B= Balance
Keeping Your Life in Balance
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Practice excellent self-care
Nurture yourself by putting activities in your
schedule that are sources of pleasure, joy
and diversion
Allow yourself to take mini-escapes- these
relieve the intensity of your work
Transform the negative impact of your work
(find meaning, challenge negativity, find
gratitude)
Small Group Exercise
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List one mini-escape or diversion that worked
well to restore and renew you
List one thing that brings you joy
Report back to larger group your unique
ideas
B= Balance
Keeping Your Life in Balance, continued
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Get medical treatment if needed to relieve
symptoms that interfere with daily
functioning- don’t use alcohol or drugs to selfmedicate
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Get professional help when needed to get
back on track- we all need coaches and
consultants at times
Balance for our Emotional Needs
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Emotions are a signal that
tell us when something is
wrong or we are out of
balance
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We all need meaning and
purpose in our life
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We all need autonomy and
freedom to make choices
that bring us balance and
happiness
Find Hidden Passion
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We all have hidden sources of energy and
healing power.
When you identify the things that fuel you, the
things that you have true passion for, your
fatigue will disappear.
Balancing your life involves putting the things
that we value and have passion for in our
schedule.
Balance for Your Soul
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Have quiet alone time in a calm, beautiful place- a
safe retreat where you feel renewed
Have an awareness of what restores and
replenishes you.
Find ways to acknowledge loss and grief
Stay clear with commitment to career goals or your
personal mission
Know how to focus on what you can control
Look at situations as entertaining challenges and
opportunities, not problems or stresses
Keep Yourself Physically Strong
Exercise
 Relax-Breathe
 Get adequate
sleep
 Good nutrition
and water
 Good medical
and preventative
care
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C= Connections
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Talk out your stress- process your
thoughts and reactions with someone
else (coworker, therapist, clergy,
friend, family, supervisor)
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Build a positive support system that
supports you, not fuels your stress
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Pets accept whatever affection you
are able to give them without asking
for more---Pets are basically
invulnerable to “provider burnout”-Blood pressure and heart rate
decrease when interacting with
animals
Put Joy, Love, Hope, Laughter and
Gratitude in Each Day
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Name 3 things you feel grateful for today-
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Think of something that has brought you a sense of
joy (Make your top ten list)
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Who do you love that you can reach out to today?
(Call them!)
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What made you laugh today? (Share it!)
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Hope does not take
away your
problems.
It can lift you
above them.
Maya Angelou
Humor
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Develop the characteristic of humor
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Reduces stress because it helps us to see the
paradoxes of life that befall all of us
It helps keep problems in perspective
Appears to reduce the physiology of stress
Use your sense of humor in stressful times
OR
Associate with those who have one
Burnout
(Anderson, K. (2005). Burnout Prevention: Caring for
Others versus Self Preservation. University of Missouri
School of Social Work.)
Characteristics of Burnout on the Work
Environment
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Quitting job
Decreased work performance
Increased absenteeism
Increased tardiness
Avoidance at work
Risk-taking
Workplace Challenges Contributing to
Burnout
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Work overload vs. sustainable work
Lack of control vs. feelings of choice/control
Insufficient reward vs. recognition/reward
Unfairness vs. fairness, respect, justice
Breakdown of community vs. sense of
community
Value of conflict vs. meaningful, valued work
Individuals Least Susceptible to Burnout
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Willingness to confront and
resolve personal issues
Enthusiasm for learning,
curiosity
Learning/gaining wisdom
from other experiences
Values and understands the
complexity of the human
condition
Self Aware
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Non-defensive
Open to feedback
Able to attend to own
emotional well being
Aware of how their own
emotional health impacts
the quality of their work
Enjoys life
Will and desire to grow –
personally and
professionally
Prevention of Burnout
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Nurture a personal life
Engage in restorative activities: physical,
spiritual, social, etc.
Develop and maintain personal relationships
Prevention and Management of Stress
Two approaches:
The Organization
The Individual
Organizational Approach
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Effective management structure and
leadership
Clear purpose and goals
Nurture team support
Develop a plan for stress management
Create a buddy system to support and
monitor stress reactions
Education about signs of symptoms of worker
stress and coping strategies
Individual Approaches
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Manage your workload
Prioritize
Delegate
Recognize there will be periods of
“waiting” vs. periods when “overwhelmed”
Individual Approaches
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Limit on-duty work hours to no more than 12
hours per day
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Rotate work from high stress to lower stress
functions
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Rotate work from the scene to routine
assignments as practical
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Use counseling/CISM assistance programs
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Take frequent, brief breaks from the scene as
practical
Individual Approaches
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Balance your lifestyle
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Exercise and stress
management are
closely linked
Diet/Nutrition
Drink plenty of water and eat healthy snacks like
fresh fruit, whole grain breads and other energy
foods—balanced diet including carbs & fats
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Avoid junk food, caffeine, alcohol, tobacco
Adequate sleep/rest
Support system – talk with family and friends
Individual Approaches
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Apply stress reduction techniques
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What works for you? Stretching, meditating,
mindful walking
Use time off to decompress and recharge your
batteries (music, exercise, read, relaxing meal,
movie)
Talk about emotions/reactions with coworkers
during appropriate times – silence in this case
is not golden, it is destructive
Why is Talking About it Helpful?
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It lets us know we are not alone
It lets us get it off our chest and emotionally
we feel as if we have put down a great
burden
It gives us a broadened perspective of the
situation
The other person may not offer any specific
help or advice or answers but we benefit from
the process of sharing itself.
Our stress may not get solved but we feel
better and are better able to manage it.
Social Support
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Keep up your normal social routines
It is OK to spend time alone trying to make
sense of the stressful event (psychological
homeostasis) but balance that with time with
others
Social isolation is a potent depressant
Social contact allows one to feel calmed and
secure
Individual Approaches
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Practice Self-Awareness
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Recognize and heed warning signs of stress
Accept that you may need help
Recognize that over-identifying with
survivors’/victims’ grief and trauma may signal
a need for support
Examine personal prejudices and cultural
stereotypes
Individual Approaches
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Practice Self-Awareness
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Recognize when your own experiences with
trauma or personal history interferes with your
effectiveness
Be mindful of compassion fatigue/vicarious
trauma
Be aware of your personal vulnerabilities and
emotional reactions
Develop and Maintain a Positive Attitude
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Foster Positive Cognitions
Cognitive Reframing
Positive Memories
Identification with a Noble Motive
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A Can Do or Must Do Attitude often produces
results bordering on the Incredible
A Positive Mental Attitude from some degree
comes from Confidence but largely stems
from practice
See the glass as Half Full rather than Half
Empty
Develop and Maintain a Positive Attitude
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Look for the opportunity in every situation, no
matter how bleak it may at first appear
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Includes the quality of tenacity, the mental
toughness to stick with something we believe
in against overwhelming odds
Epictetus, 1st Century Greek Stoic Philosopher:
“We are disturbed not by events
but by the views which we take of them”
Self-Care Plan Summary
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Be realistic in job expectations
Set realistic limits and daily goals
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Take frequent breaks
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Don’t over identify with survivors
Learn about compassion fatigue
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Meet regularly with others to discuss problems
Seek social support; get back into or
establish new daily routines
Self-Care Plan Summary
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Eat well and healthy; sleep well; drink plenty of
fluids
Exercise and relax regularly
Read for pleasure
Smile! Use humor
“Take time off”
Playtime works for children and adults!
Have a life outside of your job!
Top 10…
Things To Do
In Coping with Stress
#10
Exercise
#9
Spend Time With Others
#7
Stay Calm
#6
Eat a Healthy Diet
#5
Do Things That Make You Feel
Good
#4
Use the Power of Prayer
#3
Get Plenty of Rest
#2
Remember, You’re Not
Crazy!
#1
Talk To Friends
Watch Out For Those Darn
Penguins !