Identifying and Dealing with Stress

1. 8/31/2012 A Southwest Region CAP CISM Presentation 1 Identifying and Dealing with Stress ================================= Welcome remarks: Good morning (afternoon, etc.). I would like to welcome you to this CISM PEP Talk on identifying and dealing with stress. I�m (your name). Tell a little bit about yourself. As appropriate, tend to any �housekeeping� chores, eg, location of exits, bathrooms, break and lunch times, etc. ================================= Welcome remarks: Good morning (afternoon, etc.). I would like to welcome you to this CISM PEP Talk on identifying and dealing with stress. I�m (your name). Tell a little bit about yourself. As appropriate, tend to any �housekeeping� chores, eg, location of exits, bathrooms, break and lunch times, etc.

2. 8/31/2012 A Southwest Region CAP CISM Presentation 2 We call this presentation a PEP Talk� A �pre-exposure preparation talk.� It is not designed to train you to be a Critical Incident Stress Team member, but it is designed to give you an in-depth over-view of CISM and how we use it in the Civil Air Patrol.We call this presentation a PEP Talk� A �pre-exposure preparation talk.� It is not designed to train you to be a Critical Incident Stress Team member, but it is designed to give you an in-depth over-view of CISM and how we use it in the Civil Air Patrol.

3. 8/31/2012 A Southwest Region CAP CISM Presentation 3 Objectives State several causes of stress Describe the effects of stress on the body and mind, List cues to identify stress, and Identify tools to manage stress. ================================= Read slide================================= Read slide

4. 8/31/2012 A Southwest Region CAP CISM Presentation 4 Just What is Stress? ================================= Read slide title. Ask participants for their definitions. Then click again for answer to appear; again for graphic. We�ve all been here at one time or another.================================= Read slide title. Ask participants for their definitions. Then click again for answer to appear; again for graphic. We�ve all been here at one time or another.

5. 8/31/2012 A Southwest Region CAP CISM Presentation 5 Where Does Stress Come From? ================================= For every stimulus, there is some sort of response. Ask for examples: eg, kick a ball, it rolls away; call �ten hut,� and cadets, hopefully, snap to attention. :-) ; smell a pot roast cooking, begin to salivate. Likewise, for every stressor or demand in our lives, there is also a physical or psychological response.================================= For every stimulus, there is some sort of response. Ask for examples: eg, kick a ball, it rolls away; call �ten hut,� and cadets, hopefully, snap to attention. :-) ; smell a pot roast cooking, begin to salivate. Likewise, for every stressor or demand in our lives, there is also a physical or psychological response.

6. 8/31/2012 A Southwest Region CAP CISM Presentation 6 For example ... ================================= Here�s an example to which many of us can relate. Read or paraphrase each bullet. After the third bullet: And what does that give us? Click to bring in �airsickness.�================================= Here�s an example to which many of us can relate. Read or paraphrase each bullet. After the third bullet: And what does that give us? Click to bring in �airsickness.�

7. 8/31/2012 A Southwest Region CAP CISM Presentation 7 2 �Varieties� of Stress ... ================================= Read slide. Depending on time frame, ask participants to give some examples of good and bad stressors or provide these yourself. Some examples: Good stressors: Physical exercise Flying Birth of a child Holidays Bad stressors: Late to an appointment Work project behind schedule or over budget Traffic Disasters: natural or man-made Death of family or colleague================================= Read slide. Depending on time frame, ask participants to give some examples of good and bad stressors or provide these yourself. Some examples: Good stressors: Physical exercise Flying Birth of a child Holidays Bad stressors: Late to an appointment Work project behind schedule or over budget Traffic Disasters: natural or man-made Death of family or colleague

8. 8/31/2012 A Southwest Region CAP CISM Presentation 8 Some Generic Sources of Stress ... Biogenic Environmental Personality ================================= Some generic sources of stress are biogenic, environmental, and individual personality. Click to next slide.================================= Some generic sources of stress are biogenic, environmental, and individual personality. Click to next slide.

9. 8/31/2012 A Southwest Region CAP CISM Presentation 9 Some Biogenic Stressors ... Caffeine Nicotine Amphetamines Phenylpropanolamine Theophylline Illness Lack of sleep ================================= Read slide. FYI WARNING: Phenylpropanolamine can still be found in some cold remedies; however, PPA increases the risk of hemorrhagic stroke (bleeding into the brain or into tissue surrounding the brain), and the FDA recommends that consumers not use any products that contain PPA. Theophyline is a bronchodilator used to relieve acute bronchospasms. It can cause central nervous system, cardiovascular, gastrointestinal and respiratory reactions. Now let�s talk about environmental stressors. Ask for some examples, then click to next slide.================================= Read slide. FYI WARNING: Phenylpropanolamine can still be found in some cold remedies; however, PPA increases the risk of hemorrhagic stroke (bleeding into the brain or into tissue surrounding the brain), and the FDA recommends that consumers not use any products that contain PPA. Theophyline is a bronchodilator used to relieve acute bronchospasms. It can cause central nervous system, cardiovascular, gastrointestinal and respiratory reactions. Now let�s talk about environmental stressors. Ask for some examples, then click to next slide.

10. 8/31/2012 A Southwest Region CAP CISM Presentation 10 Some Environmental Stressors ... Rain Temperature extremes Sounds --- screams Mud Smells G-forces Time of day ================================= Read slide. What are some ways that these environmental stressors affect our bodies and psychological states? Get a couple of examples from the group. Click to next slide. ================================= Read slide. What are some ways that these environmental stressors affect our bodies and psychological states? Get a couple of examples from the group. Click to next slide.

11. 8/31/2012 A Southwest Region CAP CISM Presentation 11 Personality ================================= We�re all hard-wired differently, each with our own personalities and ways of coping with stresses that come our way. Of course, something that stresses any one of us may have little effect or a different effect on others of us. However�Click to next slide.================================= We�re all hard-wired differently, each with our own personalities and ways of coping with stresses that come our way. Of course, something that stresses any one of us may have little effect or a different effect on others of us. However�Click to next slide.

12. 8/31/2012 A Southwest Region CAP CISM Presentation 12 Stress is Cumulative It builds up over time ... ================================= Read slide.================================= Read slide.

13. 8/31/2012 A Southwest Region CAP CISM Presentation 13 Cumulative Stress Piles up (snowballs). Increases with time. Deteriorates: * Performance * Relationships * Health ================================= Cumulative stress is stress that can pile up or snowball. As it increases over time, it can ultimately cause deterioration of your performance (both at work and at play), in your relationships, and/or in your health.================================= Cumulative stress is stress that can pile up or snowball. As it increases over time, it can ultimately cause deterioration of your performance (both at work and at play), in your relationships, and/or in your health.

14. 8/31/2012 A Southwest Region CAP CISM Presentation 14 We Used to Call it �Burnout� Increased cynicism Increased physical lethargy Procrastination In the extreme � even � suicidal or homicidal thoughts or ideations ================================= We used to call this cumulative stress �burnout.� I�m sure we�ve all seen this manifested in many ways, such as� Read slide. These things can happen both at work and in our volunteer activities.================================= We used to call this cumulative stress �burnout.� I�m sure we�ve all seen this manifested in many ways, such as� Read slide. These things can happen both at work and in our volunteer activities.

15. 8/31/2012 A Southwest Region CAP CISM Presentation 15 Some Symptoms of Cumulative Stress Tardiness Fatigue Detachment Depression Medication or drug use Irritability �Gallows� humor Paranoia, or irrational fears. Derogatory speech or labeling of others Denial Increased workplace absences. Irresponsibility ================================= Here are some signs and symptoms that one might experience with cumulative stress. Read off a few from the slide. We may all feel some of these things from time to time. They become a problem as they build up and increase in number.================================= Here are some signs and symptoms that one might experience with cumulative stress. Read off a few from the slide. We may all feel some of these things from time to time. They become a problem as they build up and increase in number.

16. 8/31/2012 A Southwest Region CAP CISM Presentation 16 An Example of Cumulative Stress ... ================================= One of the most tragic stories of the jet age revolves around the unfortunate de Havilland Comet (D.H.106 Comet). Following World War II, de Havilland developed and flew the first commercial jet aircraft in 1949. Because it represented such a revolutionary advance in commercial travel, the Comet was put through an extensive series of test flights and certifications over the next three years. These 500 hours worth of flight crew training and proving flights included long overseas flights, tropical operations, and high altitude takeoffs. Having successfully completed these tests with no apparent difficulties, launch customer BOAC received permission to begin commercial operations in early 1952. The first hint of trouble with the design came exactly one year after these operations began when a Comet mysteriously crashed shortly after takeoff on May 2, 1953. Two similar crashes in early 1954 forced British authorities to ground the entire fleet pending investigation. Over the following months, extensive tests were performed on the aircraft to determine what could have caused these mysterious accidents. The answer finally came after a fuselage had been submerged in a tank of water and repeatedly pressurized and depressurized to represent repeated flight cycles. After several thousand of these cycles, fatigue cracks were found to be spreading from the square edges of the windows in the passenger cabin. These cracks would eventually reach a critical size where they would grow rapidly resulting in a catastrophic depressurization that would destroy an aircraft in flight. http://aerospaceweb.org/aircraft/jetliner/comet/index.shtml ================================= One of the most tragic stories of the jet age revolves around the unfortunate de Havilland Comet (D.H.106 Comet). Following World War II, de Havilland developed and flew the first commercial jet aircraft in 1949. Because it represented such a revolutionary advance in commercial travel, the Comet was put through an extensive series of test flights and certifications over the next three years. These 500 hours worth of flight crew training and proving flights included long overseas flights, tropical operations, and high altitude takeoffs. Having successfully completed these tests with no apparent difficulties, launch customer BOAC received permission to begin commercial operations in early 1952. The first hint of trouble with the design came exactly one year after these operations began when a Comet mysteriously crashed shortly after takeoff on May 2, 1953. Two similar crashes in early 1954 forced British authorities to ground the entire fleet pending investigation. Over the following months, extensive tests were performed on the aircraft to determine what could have caused these mysterious accidents. The answer finally came after a fuselage had been submerged in a tank of water and repeatedly pressurized and depressurized to represent repeated flight cycles. After several thousand of these cycles, fatigue cracks were found to be spreading from the square edges of the windows in the passenger cabin. These cracks would eventually reach a critical size where they would grow rapidly resulting in a catastrophic depressurization that would destroy an aircraft in flight. http://aerospaceweb.org/aircraft/jetliner/comet/index.shtml

17. 8/31/2012 A Southwest Region CAP CISM Presentation 17 Like With The Airliner ... Stress is the �wear and tear� on our human coping systems. Over time minor stresses can have major and damaging effects. This is the cumulative effect of stress. ================================= Read first paragraph of slide. Click to have graphic appear. Then click for last of text and read it.================================= Read first paragraph of slide. Click to have graphic appear. Then click for last of text and read it.

18. 8/31/2012 A Southwest Region CAP CISM Presentation 18 Critical Incidents are events that have the potential to create significant human distress and can overwhelm the usual coping mechanisms of individuals and/or groups. ================================= Read slide. Not all critical incidents will create significant distress or overwhelm our coping mechanisms, but the potential is there, nonetheless. This is what we all must be aware of and watch for.================================= Read slide. Not all critical incidents will create significant distress or overwhelm our coping mechanisms, but the potential is there, nonetheless. This is what we all must be aware of and watch for.

19. 8/31/2012 A Southwest Region CAP CISM Presentation 19 Examples of Critical Incidents Line of duty death or death at workplace Serious line of duty injury or workplace injury Suicide of coworker, friend, family member Multiple casualty incidents (MCI�s), disasters Significant events involving children Prolonged events especially with loss Any powerful event which overwhelms a person�s normal coping mechanisms ================================= 90% of US citizens will be exposed to a traumatic event during their lifetime. (Breslau, et al., 1998) Here are some examples of critical incidents. Left click to add each example.================================= 90% of US citizens will be exposed to a traumatic event during their lifetime. (Breslau, et al., 1998) Here are some examples of critical incidents. Left click to add each example.

20. 8/31/2012 A Southwest Region CAP CISM Presentation 20 Critical Incident Stress �Any event in which there is a stressful impact sufficient enough to overwhelm the usually effective coping skills of either an individual or a group.� (Everly & Mitchell, 1999) ================================= Read slide. In other words, critical incident stress is a NORMAL REACTION in NORMAL PEOPLE to an ABNORMAL EVENT.================================= Read slide. In other words, critical incident stress is a NORMAL REACTION in NORMAL PEOPLE to an ABNORMAL EVENT.

21. 8/31/2012 A Southwest Region CAP CISM Presentation 21 ================================= Cumulative stress CAN make critical incident stress even worse.================================= Cumulative stress CAN make critical incident stress even worse.

22. 8/31/2012 A Southwest Region CAP CISM Presentation 22 How to Recognize Excessive Stress? ================================= Now let�s talk a little bit about recognizing excessive stress. Ask participants to identify some signs of stress in this picture from 9/11. Be sure to note that even the animals react to stress in their environment and need care as well.================================= Now let�s talk a little bit about recognizing excessive stress. Ask participants to identify some signs of stress in this picture from 9/11. Be sure to note that even the animals react to stress in their environment and need care as well.

23. 8/31/2012 A Southwest Region CAP CISM Presentation 23 Manifestations of Distress Can Take a Number of Forms... Physical Cognitive Emotional Behavioral ================================= Stress can manifest itself in several ways: Physical�the way our body responds Cognitive�the way we think or perceive Emotional�the way we feel Behavioral�the way we act================================= Stress can manifest itself in several ways: Physical�the way our body responds Cognitive�the way we think or perceive Emotional�the way we feel Behavioral�the way we act

24. 8/31/2012 A Southwest Region CAP CISM Presentation 24 Physical Manifestations Excessive sweating Nausea and/or vomiting Elevated pulse rate Elevated blood pressure Rapid breathing Dizziness ================================= Physical manifestations include such things as�.Read slide.Click to make each line of text appear. If time permits, ask one or two participants to describe a personal example of their physical response to either good or bad stress (their first solo, a near miss in flight, their wedding ceremony, or whatever).================================= Physical manifestations include such things as�.Read slide.Click to make each line of text appear. If time permits, ask one or two participants to describe a personal example of their physical response to either good or bad stress (their first solo, a near miss in flight, their wedding ceremony, or whatever).

25. 8/31/2012 A Southwest Region CAP CISM Presentation 25 Cognitive Signs Confusion. Mumbling of words Difficulty making decisions Decreased concentration Memory dysfunction ================================= Cognitive manifestations include such things as�.Read slide. If time permits, ask one or two participants to describe a personal example of their cognitive response to either good or bad stress (their first solo, a near miss in flight, their wedding ceremony, or whatever). ================================= Cognitive manifestations include such things as�.Read slide. If time permits, ask one or two participants to describe a personal example of their cognitive response to either good or bad stress (their first solo, a near miss in flight, their wedding ceremony, or whatever).

26. 8/31/2012 A Southwest Region CAP CISM Presentation 26 Emotional Signs Emotional Shock Anger Grief Depression Feeling totally overwhelmed ================================= Emotional signs include such things as�.Read slide. If time permits, ask one or two participants to describe a personal example of their emotional response to either good or bad stress (their first solo, a near miss in flight, their wedding ceremony, or whatever). ================================= Emotional signs include such things as�.Read slide. If time permits, ask one or two participants to describe a personal example of their emotional response to either good or bad stress (their first solo, a near miss in flight, their wedding ceremony, or whatever).

27. 8/31/2012 A Southwest Region CAP CISM Presentation 27 Behavioral Signs Changes in ordinary behavior Changes in eating habits Decreased personal hygiene Prolonged silences Withdrawal ================================= Behavioral signs include such things as�.Read slide. If time permits, ask one or two participants to describe a personal example of their behavioral response to either good or bad stress (their first solo, a near miss in flight, their wedding ceremony, or whatever). ================================= Behavioral signs include such things as�.Read slide. If time permits, ask one or two participants to describe a personal example of their behavioral response to either good or bad stress (their first solo, a near miss in flight, their wedding ceremony, or whatever).

28. 8/31/2012 A Southwest Region CAP CISM Presentation 28 So what can one do to alleviate or better cope with stress? ================================= Read slide and answer questions.================================= Read slide and answer questions.

29. 8/31/2012 A Southwest Region CAP CISM Presentation 29 Crisis Intervention is ... An exercise in psychological damage control. Stopping the bleeding! Not a cure An opportunity for assessment and for follow-up Guided by a mental health professional (MHP) ================================= Crisis intervention is psychological or emotional �first-aid.� Read slide. By way of analogy, then, crisis intervention is to psychotherapy, as physical first-aid is to surgery. Crisis intervention has 4 goals: 1. To stabilize symptoms of distress or impairment and prevent them from worsening 2. To reduce symptoms of distress 3. To re-establish functional capacity, or 4. To seek further assessment and/or a higher level of care.================================= Crisis intervention is psychological or emotional �first-aid.� Read slide. By way of analogy, then, crisis intervention is to psychotherapy, as physical first-aid is to surgery. Crisis intervention has 4 goals: 1. To stabilize symptoms of distress or impairment and prevent them from worsening 2. To reduce symptoms of distress 3. To re-establish functional capacity, or 4. To seek further assessment and/or a higher level of care.

30. 8/31/2012 A Southwest Region CAP CISM Presentation 30 Crisis Intervention Is but one aspect of a continuum of care. It requires specialized and unique training. ================================= Read slide. ================================= Read slide.

31. 8/31/2012 A Southwest Region CAP CISM Presentation 31 Critical Incident Stress Management (CISM)is one type of crisis intervention. It is a comprehensive, systematic program for the mitigation of critical- incident related stress. ================================= There is no single model of crisis intervention. CISM is a relatively new term that has emerged in the mental health literature within the last decade. CISM is a comprehensive, systematic program designed to mitigate stress resulting from a critical incident. ================================= There is no single model of crisis intervention. CISM is a relatively new term that has emerged in the mental health literature within the last decade. CISM is a comprehensive, systematic program designed to mitigate stress resulting from a critical incident.

32. 8/31/2012 A Southwest Region CAP CISM Presentation 32 CISM deals with the current circumstances, the current event or crisis � NOT � personal histories. ================================= CISM is not designed to deal with personal histories. It deals with the current event or crisis only. It is not designed to provide definitive care or psychotherapy. It does provide mental health �first aid� and referrals if further care is needed. ================================= CISM is not designed to deal with personal histories. It deals with the current event or crisis only. It is not designed to provide definitive care or psychotherapy. It does provide mental health �first aid� and referrals if further care is needed.

33. 8/31/2012 A Southwest Region CAP CISM Presentation 33 All CISM Interventions Are Strictly Confidential! ================================= All CISM interventions are strictly confidential. Anything--thoughts, feelings, and behaviors--brought out in an intervention are not talked about outside of the intervention. ================================= All CISM interventions are strictly confidential. Anything--thoughts, feelings, and behaviors--brought out in an intervention are not talked about outside of the intervention.

34. 8/31/2012 A Southwest Region CAP CISM Presentation 34 How well does CISM work? Let�s compare two airliner crashes to see ... ================================= Let�s take a look at how well CISM works by comparing the responses to two airliner crashes. ================================= Let�s take a look at how well CISM works by comparing the responses to two airliner crashes.

35. 8/31/2012 A Southwest Region CAP CISM Presentation 35 San Diego 1978 v. Cerritos 1986 ================================= As you can see, both crashes are similar with respect to loss of life, damage, and number of emergency service personnel involved.================================= As you can see, both crashes are similar with respect to loss of life, damage, and number of emergency service personnel involved.

36. 8/31/2012 A Southwest Region CAP CISM Presentation 36 San Diego v. Cerritoscont�d � ================================= After the San Diego crash, only sporadic 1-on-1 crisis interventions were performed. After the Cerritos crash, a number of crisis interventions were used including: critical incident stress debriefings, demobilizations, a crisis hotline, and follow-up referrals to mental health professionals. Here are the results of the interventions. Click to next slide. ================================= After the San Diego crash, only sporadic 1-on-1 crisis interventions were performed. After the Cerritos crash, a number of crisis interventions were used including: critical incident stress debriefings, demobilizations, a crisis hotline, and follow-up referrals to mental health professionals. Here are the results of the interventions. Click to next slide.

37. 8/31/2012 A Southwest Region CAP CISM Presentation 37 San Diego v. Cerritos ================================= Take a look at the personnel losses among responders within 1 year of the event. San Diego clearly had greater losses, especially among EMS responders, while Cerritos lost only 1 responder from their fire department. There is also significantly greater utilization of mental health services in San Diego vs Cerritos. ================================= Take a look at the personnel losses among responders within 1 year of the event. San Diego clearly had greater losses, especially among EMS responders, while Cerritos lost only 1 responder from their fire department. There is also significantly greater utilization of mental health services in San Diego vs Cerritos.

38. 8/31/2012 A Southwest Region CAP CISM Presentation 38 CISM Works! ================================= Click to bring in graphic. As you can see, CISM works!================================= Click to bring in graphic. As you can see, CISM works!

39. 8/31/2012 A Southwest Region CAP CISM Presentation 39 For More Information ... Call Chaplain Don Brown at (936) 394-3310 or email him at lonecap@ev1.net. Sign up for the �Basic Critical Incident Stress Management� and other ICISF CISM courses. ================================= Read slide.================================= Read slide.

40. 8/31/2012 A Southwest Region CAP CISM Presentation 40 Any Questions? ================================= Read slide and answer questions.================================= Read slide and answer questions.

41. 8/31/2012 A Southwest Region CAP CISM Presentation 41