‘SHATTERED ASSUMPTIONS….. BROKEN LIVES’

1. ‘SHATTERED ASSUMPTIONS….. BROKEN LIVES’ UNDERSTANDING AND MANAGING TRAUMA by Andrew Davies

2. Aims…. • To facilitate a greater understanding of Trauma and it’s impact on individuals and organisations • To facilitate a greater understanding of how individuals and organisations can manage and recover from the trauma of critical incidents • To emphasize that traumas cannot always be prevented but can be contained and managed once they have occurred if efficient and effective policies and practices are adopted.

3. Our Context (Living and working in an unsafe world) “Every day in Africa an impala wakes up. It must run faster than the fastest lion or it will be killed. Every morning a lion wakes up and knows it must outrun the slowest impala or it will starve to death. It doesn’t matter whether you are a lion or an impala… when the sun comes up you had better start running.” Anonymous

4. Our Context…. • South African life has been characterized by violence and crime both before and after the revocation of the apartheid system. • In some ways, trauma (whether realized or anticipated) has become “part and parcel” of the South African psyche. • The burden of overwhelming trauma and its consequences has been experienced by South African trauma counsellors for many years.

5. Our Context… (The trauma of everyday life) • Amongst the highest violent crime rates in the world (including murder, car-jacking, and violence in schools). Homicide accounts for 44.5% of deaths. • The highest rates of rape, child abuse, and family violence in the world. • Rampant HIV/AIDS infection rate. • Large disparity between rich and poor. • Limited and inadequate community resources. • SA employees are at risk for exposure to incidents of traumatic stress.

6. Definition of Trauma…. • “A sudden, unexpected (unprepared for) event that • is outside the range of normal human experience • involves actual or threatened death or serious injury or a threat to the physical integrity of self or others • and would be markedly distressing to anyone” • The event is so unpleasant and shocking that the human mind and body react in an autonomic defensive manner. • The traumatisation is caused by the event, not because of some failing or weakness in the person.

7. Critical Incident Defined…. “A critical incident is an event that causes disruption to an organisation, creates significant danger or risk and traumatically affects individuals within the organisation” • These are events with circumstances that are unusual or distressing and typically produce immediate and/or delayed emotional reactions that surpass the individual’s normal coping mechanisms and have the potential to interfere with usual functioning • Examples include: explosions, accidents, civil unrest, assaults, fire, terror attacks, etc.

8. The Psychological Impact of Trauma Stress is a reaction to an event or situation that places pressure upon a person. When demands become extremely threatening, overwhelming, or severe, they provide a heightened state of physical, cognitive, behavioural and emotional arousal commonly called “traumatic stress” Stress Traumatic Stress

9. Shattered Assumptions (Janoff-Bullman) • The experience of trauma shatters two basic assumptions about the self and the world: • The belief in personal invulnerability or immortality • The belief that the world is a meaningful and orderly place, and that events happen for a reason • Violence, shatters a third belief: the trust that other human beings are fundamentally benign. • These 3 assumptions (or illusions) allow people to function effectively & to relate to others. After trauma, individuals are left feeling vulnerable, helpless and out of control in a world that is no longer predictable.

10. The Psychological Impact of Trauma OVERWHELMED OUTCRY Fear, sadness, rage PANIC OR EXHAUSTION DENIAL Refusing to face memory of incident EXTREME AVOIDANCE INTRUSION Unbidden thoughts of the event FLOODED STATES WORKING THROUGH Facing the reality of what has happened PTSD COMPLETION Going on with life PHASES IN THE REACTIONS TO TRAUMA

11. The signs & symptoms of PTSD People often respond to a stressful or traumatic experience with very strong feelings. They start saying, feeling and doing things that they did not do before The following reactions commonly occur in response to trauma (the response involves intense fear, helplessness or horror): • Re-experiencing the trauma (recollections, physical reactivity) • Avoidance or numbing (detachment, estrangement, forgetting) • Increased arousal (startle response, irritability, sleep problems) • Other symptoms (depression, guilt, cognitive problems)

12. Rescue & recovery personnel (fire, police ambulance etc) Third level Grieving relatives, friends and colleagues of first level individuals Second level Individuals directly experiencing the event who may or may not be physically injured First level 4th level casualties The community/organisation as a whole The Ripple Effect

13. Definitions: Vicarious traumatization: The transmission of traumatic stress by observation and/or bearing witness to the stories of traumatic events. Secondary traumatization: The overwhelming traumatic effect resulting from exposure to the trauma of the victim. Continuous traumatic stress:A term used in place of PTS when trauma is so pervasive and unremitting that it falls within the range of normal human experience. Burnout: A state of physical, emotional, and mental exhaustion caused by a depletion of ability to cope.

14. A Duty of Care…… • Creating and maintaining an effective, well-tested Critical Incident Management Plan is perhaps the surest way to limit damages and hasten recovery while keeping the individual functional and the company operational. • A planned and structured model of crisis management will not only enhance an organisation ability to recover from financial losses and return more efficiently to full productivity, but will also assist the company to fulfil its moral responsibility to protect employees. • Responding to the needs of employees in a compassionate, sensitive and helpful manner in the event of trauma affirms the value of employees to the company.

15. Guidelines for Responding to Trauma Victims Trauma defusing and debriefing services are vital in assisting individuals to process the traumatic experience through an integrated, appropriate and effective method of intervention These services also facilitate the normalisation of personal experience

16. A Note on Caring…… “…. relieving the emotional suffering of clients automatically includes absorbing information that is about suffering…. Often it includes absorbing that suffering as well” (Figley, 1995)

17. Defusing Defusing is the ventilation of thoughts and emotions associated with the crisis event, and should be provided as soon as possible after the initial impact of the critical event to mitigate the effects of the trauma and promote recovery • PHASES • Introductory Phase • Exploration Phase • Information Phase • Do’s & don’ts • Cross cultural considerations

18. Debriefing Psychological debriefing is an established multi-phase group crisis intervention process to help individuals work through their thoughts, reactions, & symptoms followed by training in coping techniques.It is not therapy but Involves: • Education about stress reactions • Emotional ventilation • The promotion of cognitive reassurance that the stress response .is controllable and that recovery is likely • Mobilisation of resources within & outside the individual or group • Preparation for future • Intervention to assist in recovery from traumatic stress • Screening for people who need additional support

19. “Healers must understand that caring does not only mean caring for others; it also means caring for oneself. We must be aware of our limits and know when it is necessary to nurture ourselves… No one can heal without being healed” (Elizabeth Kubler-Ross)

20. “We are not invulnerable, but if we maintain a strong sense of community among ourselves, we can be resilient” (Catherall, 2001)

21. Thank you