Stress Management

1. Stress Management Department of State Health Services Disaster Behavioral Health Services 512.206.5555 _________________________________ Jennifer Reid, LMSW 512.206.4840 jennifer.reid@dshs.state.tx.us Paul Tabor, MMiss 512.801.9816 paul.tabor@dshs.state.tx.us

4. 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)

5. STRESS • “Fight or Flight response” (W. B. Cannon) • “Sum total of wear & tear” (H. Selye) • A normal survival reaction

6. Eustress Positive Motivating stress Distress Excessive Debilitating Stress Eustress vs. Distress

7. The Stress Cycle (http://www.samhsa.gov/dtac/proguide.asp)

9. The Stress Cycle(http://www.samhsa.gov/dtac/proguide.asp) • 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

10. Who me? • We often try to justify the warning signs of stress within ourselves • 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”

11. Job-Related Stressors • Working long hours • Staff shortage • Repeated exposure to traumatic stories • Exposure to survivor’s reaction to disaster • Away from family/friends for extended periods

12. Signs That You May Need Stress Management Assistance • Difficulty communicating thoughts • Difficulty remembering instructions • Becoming easily frustrated and being uncharacteristically argumentative • Inability to engage in problem solving and difficulty making decisions

13. Signs That You Made Need Stress Management Assistance • Limited attention span and difficulty concentrating • Colds or flu-like symptoms • Headaches/tremors/nausea • Loss of objectivity • Unnecessary risk-taking

14. Signs That You Made Need Stress Management Assistance • Inability to relax when off duty • Refusal to follow orders to leave the scene, command post, etc. • Increased use of drugs/alcohol • Unusual clumsiness

15. Also called “vicarious traumatization” or secondary traumatization (Figley, 1995) Refers to the PTSD-related symptoms due to working with patients and families who have trauma and grief Differs from burn-out, but can co-exist Can occur due to exposure on one case or can be due to a “cumulative” level of trauma Compassion Fatigue

16. Compassion Fatigue – a state of tension and preoccupation with traumatized survivors. (Also called Secondary Traumatic Stress or Vicarious Trauma) Burnout – a state of extreme dissatisfaction with one’s work Compassion Fatigue vs. Burnout

17. Re-experiencing traumatic event(s) Avoidance/numbing of reminders Increased anxiety Burned out rather than engaged in one’s work Exhaustion, no energy (physical, emotional, mental) Increased cynicism Compassion Fatigue Burnout

18. 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 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 Burnout

19. May lead to changes in trust, feelings of control, safety concerns, intrusive imagery. Symptoms are physical, emotional, cognitive, spiritual, behavioral, and interpersonal. Does not necessarily lead to changes associated with personal life. Characterized by emotional exhaustion. Compassion Fatigue Burnout

20. 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.)

21. Performance of Job Tasks • Decrease in quality • Decrease in quantity • Low motivation • Avoidance of job tasks • Increase in mistakes • Setting perfectionist standards • Obsession about details

22. Morale • Decrease in confidence • Loss of interest • Dissatisfaction • Negative attitude • Apathy • Demoralization • Detachment • Feelings of incompleteness • Lack of Appreciation

23. Interpersonal • Withdrawal from colleagues • Impatience • Decrease in quality of relationship • Poor communication • Subsume own needs • Staff conflicts

24. Behavioral • Absenteeism • Exhaustion • Faulty judgment • Irritability • Tardiness • Irresponsibility • Overwork • Frequent job changes

25. Small Group Exercise • Discuss a case that caused you to take it home with you or caused some symptoms of compassion fatigue • Identify what factors caused you to identify with the person/victim/family/event • Note commonalities and choose a person to share these findings with the larger group

26. The ABC’s of Prevention • A= Awareness • B=Balance • C=Connections

27. A= Awareness Issues and Contributing Factors What types of cases contribute to your stress level increasing your vulnerability to compassion fatigue?

28. What events or cases can cause compassion fatigue? • Events or situation that causes one to experience an unusually strong reaction • Often overpowers one’s usual coping mechanisms

29. 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 A= Awareness, continued

30. Losing compassion for some people while becoming over involved in others? Routinely feeling bored or disgusted? Experiencing illness, aches and pains? 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? Awareness, continued

31. Even Mother Teresa Understood Compassion Fatigue • 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.

32. “The quality of strength lined with tenderness is an unbeatable combination…”- Maya Angelou

33. Self-Awareness Exercises • How Do You Cope With Stress? • Life Balance scale

34. Life Balance Wheel • 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.

35. B= BalanceKeeping Your Life in Balance • 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)

36. Small Group Exercise • 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

37. B= Balance Keeping Your Life in Balance, continued • Get medical treatment if needed to relieve symptoms that interfere with daily functioning- don’t use alcohol or drugs to self-medicate • Get professional help when needed to get back on track- we all need coaches and consultants at times

38. Balance for our Emotional Needs • Emotions are a signal that tell us when something is wrong or we are out of balance • We all need meaning and purpose in our life • We all need autonomy and freedom to make choices that bring us balance and happiness

39. Find Hidden Passion • 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.

40. Balance for Your Soul • 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

41. Keep Yourself Physically Strong • Exercise • Relax-Breathe • Get adequate sleep • Good nutrition and water • Good medical and preventative care

42. C= Connections • Talk out your stress- process your thoughts and reactions with someone else (coworker, therapist, clergy, friend, family, supervisor) • Build a positive support system that supports you, not fuels your stress • 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

43. Put Joy, Love, Hope, Laughter and Gratitude in Each Day • Name 3 things you feel grateful for today- • Think of something that has brought you a sense of joy (Make your top ten list) • Who do you love that you can reach out to today? (Call them!) • What made you laugh today? (Share it!)

44. Hope does not take away your problems. It can lift you above them. Maya Angelou

45. Humor • Develop the characteristic of humor • 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

46. Burnout (Anderson, K. (2005). Burnout Prevention: Caring for Others versus Self Preservation. University of Missouri School of Social Work.)

47. Characteristics of Burnout on the Work Environment • Quitting job • Decreased work performance • Increased absenteeism • Increased tardiness • Avoidance at work • Risk-taking

48. Workplace Challenges Contributing to Burnout • 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

49. 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 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 Individuals Least Susceptible to Burnout

50. Prevention of Burnout • Nurture a personal life • Engage in restorative activities: physical, spiritual, social, etc. • Develop and maintain personal relationships