ON FIRE? BURNED OUT? BURNED UP?

1. ON FIRE? BURNED OUT? BURNED UP?

2. STRESS: Can it be dangerous?

3. THE TWO SIDES OF STRESS GOOD STRESS EUSTRESS BAD STRESS DISSTRESS • Stress is essential for: • Strength and toughness • Growth and development • Acquire new skills • Meeting challenges • Performing difficult missions • Stress can lead to: • Persistent internal distress • Functional impairment • Misconduct • Substance abuse • Mental disorders

4. Understanding and Managing Stress • Death of a loved one • Loss of a job • Chronic or terminal illness • Marital conflict • Family conflict • Financial problems • Work related problems • Life stage changes • Victim of any type of traumatic event

5. The Stress Response • Pupils dilate to increase the visual field • Capillaries near the surface of the skin contract to increase the amount of blood available to the muscles • Heart rate and blood pressure increase in order to deliver the blood to the muscles faster • The lungs expand to increase oxygen intake • Sweat increases for cooling purposes • Muscle fibers contract to be ready for sudden movement • The liver releases sugars and fats into the blood stream to fuel muscle cells

6. The Results of Unmanaged Stress • Muscle tension – Primarily in the neck and shoulders • Headaches, face feels hot, eyes hurt • Twitching and trembling, racy body feeling, fidgety • Dry mouth – difficulty swallowing, tight lips, jaw clenching • Stomach pain ( this may be the only symptom of stress, especially in children) • Dizziness • Rapid and irregular heart rate • Rapid breathing • Diarrhea or frequent need to urinate • Fatigue • Irritability, anger, jumpy, anxious • Sleep too much or too little – nightmares • Decreased concentration • Short term memory loss

7. Long Term Effects of Unmanaged Stress Over time an elevated unmanaged stress level can lead to more serious physical and emotional problems including the following. • High blood pressure( the silent killer) • Heart problems • Ulcers - Irritable bowel syndrome • Respiratory problems • Clinical depression (leading cause of suicide) • Panic attacks • Paranoia • New research indicates an increased risk of cancer

8. Stressor Crew Leader Responsibility Stress Continuum • Good to go • Well trained • Prepared • Fit and focused • Cohesive crews & stable families • More severe or persistent distress or impairment • Leaves lasting memories • Overreacting to events • Distress or impairment • Anxious, irritable, or sad • Behavior and attitude change • Stress injuries that don’t heal without help • Symptoms and impairment persist over many weeks or get worse over time CREW LEADER AND PEER RESPONSIBILITY Caregiver Responsibility

9. Most Important Distinction:Yellow Zone Reactions vs. Orange Zone Injuries Stress Reactions • Bending from stress • Very common • Normal • Always goes away Stress Injuries • Damage from stress • Less common • Risk for role failure • Risk for stress illness

10. Many Causes vs Only Four:Yellow Zone Reactions vs Orange Zone Injuries Legal problems Life threat Family separation Lack of sleep Loss of possessions Loss Money problems Hard work Harsh weather Loss of privacy Moral injury Boredom Relationship problems Conflicts with boss Minor illnesses Wear-and-tear Peer conflicts Physical injuries Yellow Zone Stress Orange Zone Stress

11. What Is Damaged in Mind & Brain?In Orange Zone Stress Injuries Life threat Loss Orange Zone Stress Injuries Moral injury Wear-and-tear

12. Stress Continuum Transitions • Healthy • Well • Fit • Safe • Connected • Capable • Confident • Drained • Sore • Irritable • Anxious • Down Routine Stressors Cumulative Stress Resilience • Hurt • Out of control • Symptomatic • Distressed • Dysfunctional • Clinically symptomatic • Impaired • Worsening • Disordered ? Toxic Stressors Recovery Recovery

13. Four Causes of Stress Injury Intense or Prolonged Disaster or Operational Stress Life Threat Inner Conflict Loss Wear & Tear • A traumatic injury • Due to an experience of death provoking terror, horror, or helplessness • A grief injury • Due to the loss of cherished people, things, or parts of oneself • A moral injury • Due to behaviors or the witnessing of behaviors that violate moral values • A fatigue injury • Due to the accumulation of stress from all sources over time without sufficient rest and recovery

14. SPIRITUAL FITNESS GUIDEThis is a self-assessment tool to help persons consider their spiritual condition .(This is a modified version of a model developed by the U. S. Navy Chaplain Corps) • POTENTIAL INDICATORS • Claims life has no meaning/purpose • Holds no hope about life/future • Extreme immoral behavior • Forgiveness is not an option • Abandons practices of faith disciplines • Complete disrespect to people of all faiths • Abandons core values/beliefs • Inappropriately makes worldview adjustments • POTENTIAL INDICATORS • Neglecting life’s meaning/purpose • Less hopeful about life/future • Makes some poor moral decisions • Difficulty forgiving self and/or others • Infrequently practices faith disciplines • Less respectful to people of other faiths • Neglects core values/beliefs • Adequately makes worldview adjustments • POTENTIAL INDICATORS • Engaged in life’s meaning/purpose • Hopeful about life/future • Makes good moral decisions • Able to forgive self and/or others • Routinely practices faith • disciplines • Respectful to people of other faiths • Engaged in core values/beliefs • Appropriately makes worldview adjustments • POTENTIAL INDICATORS • Loss sense of life’s meaning/purpose • Holds very little hope about life/future • Makes poor moral decisions routinely • Unable to forgive self and/or others • Discounts practices of faith disciplines • Strong disrespect to people of other faiths • Disregards core values/beliefs • Inadequately makes worldview adjustments

15. 1. Spirituality Creativity, order, connection

16. 2. Emotional/Mental/Physical HealthFitness, wellness, self-esteem, control

17. 3. RelationshipsSpouse, significant other, family, friends

18. 4. Roles in LifeLeader, coach, parishioner, citizen, provider

19. 5. Public BehaviorDriving, waiting, dealing with public, patience

20. 6. Work FunctionShop, supervisors, goals, promotion, rewards

21. 7. Money and FinancesBudget, purchases, credit, bills, savings

22. Intentional Listening & Language(Check & Coordinate, Cover, Calm, Connect) GOAL Stabilize persons by helping them tell their story, connect with you and determine with who else they might need to connect

23. Intentional Listening Hints = F 3 Focus on the person in front of you Follow what the person is saying Fixate on what you CAN DO! Titus 3:1, 14 (not on what you cannot do)

24. Intentional Listening & Language(Check & Coordinate, Cover, Calm, Connect) Key Techniques: Mirroring = saying it again in their words What I hear you saying is . . . Paraphrasing = saying it as summary in your words If I understand you correctly, . . . Questioning = directing to reveal more information Can you tell me more about . . . Zooming Statements (in & out) = spotlighting key observations about facts, feelings or dynamics You seem to be . . . (or) I think you mean . . .

25. Intentional Listening & Language(Check & Coordinate, Cover, Calm, Connect) Key Techniques: Mirroring = don’t sound like a parrot Are you just repeating everything I am saying? Paraphrasing = don’t jump in to quick or too often because this can become annoying Will you stop interrupting me and let me finish! Questioning = don’t become an interrogator Sound like you are giving me the third degree Zooming Statements (in & out) = don’t zoom too fast Let me set the pace on how quickly I focus

26. Intentional Listening & Language(Check & Coordinate, Cover, Calm, Connect) When using questions, start with closed-ended questions to gain insights and build trust then shift to open-ended questions to allow the person to elaborate and steer the dialogue What have you tried already? Have you considered other options? How does that make you feel? Can you tell me more about that? What seems to hurt the most right now?

27. Intentional Listening & Language(Check & Coordinate, Cover, Calm, Connect) Special things to listen for: Suicidal or homicidal ideations or actions Ask: Have you had thoughts about hurting yourself or some else?

28. Characteristics of Suicidal Stories 1. Unendurable psychological pain 2. Frustrated psychological needs 3. The search for a solution 4. An attempt to end consciousness 5. Helplessness and Hopelessness 6. Constriction of options 7. Ambivalence 8. Communication of intent (3 themes): Verbal, Behavioral, Situational 9. Departure 10. Lifelong coping pattern

29. Suicide Warning Signs“IS PATH WARM” I DEATION. Thoughts of suicide expressed, threatened, written or hinted S UBSTANCE USE. Increased or excessive alcohol or drug use P URPOSELESSNESS. No sense of meaning or purpose in life A NXIETY. Anxious, agitated, or unable to sleep. (Or sleeping all the time) T RAPPED. Feeling trapped, like there is no way out H OPELESSNESS. Feeling hopeless about self, others, the future. W ITHDRAWAL. Withdrawing from family, friends, usual activities, society A NGER. Rage or uncontrolled anger, seeking revenge for perceived wrongs R ECKLESSNESS. No regard for consequences, risky behavior M OOD CHANGES. Experiencing dramatic changes in mood.

30. Suicide Awareness Program Acronyms RACE ACE ACT Recognize distress Note changes in • Personality, emotions, or behavior. • Withdrawal from co-workers, friends and family. • Eating and sleeping patterns. Ask • Calmly question about the distress you observed. • If necessary, ask the question directly: “Are you thinking about killing yourself?” Care • Actively listen, don’t judge. • Peacefully control the situation; do not use force; keep everyone safe. Escort • Never leave your buddy alone. • Escort to chain of command, chaplain, medical, or behavioral health professional. Ask • Calmly question about the distress you observed. • If necessary, ask the question directly: “Are you thinking about killing yourself?” Care • Actively listen, don’t judge. • Peacefully control the situation; do not use force; keep everyone safe. Escort • Never leave your buddy alone. • Escort to chain of command, chaplain, medical, or behavioral health professional. ASK •Don’t be afraid to ask CARE •Listen, offer hope, don’t judge TREAT •Take action, get help, follow up!!

31. Intentional Listening & Language(Check & Coordinate, Cover, Calm, Connect) REFER to Resources: National Suicide Hotline = 1 (800) - suicide 1 (866) 273-TALK Call: 9-1-1 Take to the CLOSEST medical facility/E.R.