Stress Education

1. Stress Education Managing Critical Incident Stress

2. Overview • Stress Defined • Types of Stress • Coping with Stress • Fight or Flight Response • Dynamic of Fear • Five systems affected by Stress • PTSD • Introduction to CISD • Symptoms of CIS • The Mitchell Model • CISM • Three Increments of Stress Response • CISM Models

3. Stress Defined Definition: Hans Selye, M.D. in The Stress of Life says that “stress is essentially the rate of wear and tear on the body” and may be defined as “the nonspecific response of the body to any demand” made on it.

4. Types of Stress • General Stress • Experience by the living - ceases in death • Everyone has a normal (for them) stress level • Eustress (well or good) • Good stress initially • Example: promotion (long-term affect) • Distress (Not so good) • Acute stress resulting in trauma • Anxiety • Pain or, • Sorrow • Requires immediate assistance • Example: loss of a limb

5. Fight or Flight Response The Adrenaline Gland (s) – located above each kidney, composed of, • Cortex – secretes several steroid hormones • Medulla - secretes Epinephrine (Adrenaline) NOTE: Adrenaline is released into the bloodstream in response to stress and/or fear and initiates many bodily responses, including the stimulation of heart action, increased blood pressure, metabolic rate, and blood glucose concentration.

6. Dynamics of Fear • Fear - Normal Response to Perceived Threat • Fear is an Automatic Emotional Response • Perception & Reality are Same – may not be True • Fear is Useful as a Survival Instinct for humans • Fear is different from Panic • Fear may cause one to act out learned behavior • Panic may cause one to surrender to the threat or respond out of ignorance

7. Five Systems Affected byFear & Stress Physical Behavioral Cognitive Emotional Spiritual

8. L.E.O.

9. PHYSICAL • Fatigue • Chest Pain • Dizziness • Elevated Blood Pressure • Vomiting

10. BEHAVIORAL • Withdrawn • Inability to rest • Alcohol Consumption • Suspiciousness • Antisocial Acts

11. COGNITIVE • Confusion • Loss of Time • Disturbed Thinking • Nightmares • Intrusive Images

12. EMOTIONAL • Anxiety • Panic • Fear • Depression • Feeling Overwhelmed

13. SPIRITUAL • Anger at God • Questioning of basic beliefs • Withdrawal from place of worship • Faith practices and rituals seem empty • Loss of meaning and purpose • Uncharacteristic religious involvement • Sense of isolation from God • Anger at Clergy

15. Post Traumatic Stress Disorder (PTSD) • PTSD is past traumatic stress that has not been resolved. A pathological disorder caused by a critical incident stress event that could permanently change the brain functioning. • Chronology of the pathology: - The Event - Hyper-arousal in all - Physical symptoms Categories - Fear of Repetition - Recurrent flashbacks/dreams - Emotional symptoms - Symptoms must last for 30 - Cognitive dysfunction days to be diagnosed

17. PTSD Statistics • 40% with physical trauma will get PTSD • 50% of sexual assault victims will get PTSD • 60% of incest victims will get PTSD (majority attempting suicide) • 70% of people who witness torture will get PTSD • 90% of torture victims get PTSD What might be some indictors for ministry?

18. Introduction toCISD • Model developed by Jeffrey T. Mitchell, Ph.D. • Mitchell is Authority on Critical Incident Stress • Developed to mitigate Trauma stress • Developed for ESPs & Victims of CIS • Debriefing process may be Facilitated by a psychologist and/or a chaplain; and may include a Peer Debriefer

19. Shock Nausea Sleep Disturbances Sexual Dysfunction Problems with authority figures Hyperventilating Withdrawal Suicidal Thoughts Cynicism Time Distortion Symptoms ofCritical Incident Stress

20. Debriefing Room Setup Team Member Debriefer

21. The Mitchell Model Introduction Re-entry Fact Training Thought Symptom Reaction

22. Introduction • The facilitators set the ground rules for the session. • Confidentiality is discussed. • All participants are introduced – the group has the option to ask anyone present to leave that they feel will hinder the process. • The right of refusal must be respected.

23. The Fact Phase • Ask that they identify themselves and their role in the traumatic event. • The participant tells what happened from their perspective (without retribution). • This is NOT a counseling situation, no one should be forced into verbal interaction.

24. The Thought Phase • What was the first thought that popped into your head at the scene of the incident? What were you thinking? • The thought phase is not the “feel phase – Do NOT ask about their feelings. • Goal is to get the person to articulate thoughts and not to explain feelings.

25. Reaction • It is here that the debriefer will begin to assist those being debriefed to surface their emotions. Do not be alarmed by tears, shouting, swearing, etc. • Question – If you could change one thing about the incident, short of bringing the person back from the dead, what would that one thing be?

26. The Symptoms Phase • Have you noticed any physical, emotional, etc. symptoms since the incident? • Any nausea, sleep disturbances, cynicism, time distortions, etc. (see manual) This phase facilitates, • Common Symptoms share by others (relief) • Assists chaplain/psychologist in caring for those suffering from trauma

27. The Teaching Phase • Facilitator explain how body/mind react to stress. • Fight or Flight response. • Ask the group how they know they are experiencing stress and how they usually cope with stress. • Share stress symptoms, management & buffers. • Encourage a healthy lifestyle without alcohol or drugs.

28. Re-Entry Phase • Review & summarize group comments/concerns. • Encourage appropriate private counsel. • Encourage a visit with their medical doctor. • Emphasize lessons learned – Can you think of one good thing which resulted from this incident? • Remind the group to maintain confidentiality. • Ensure that transition to the cognitive domain has occurred.

29. Critical Incident StressManagement Stress management is a lifelong process, Questions for consideration, • How is stress managed successfully? • Who is a part of stress management process? • Can stress management be a “one shot” item? NOTE: Stress management is either a, • Preventive process, or a • Recovery process

30. Three Increments of Stress Response As manifested in those exposed to trauma, • Acute Stress Syndrome - Normal - Physiological/ Emotional responses to trauma • Delayed Stress Syndrome - Responses manifest from 2 weeks to 4 months following trauma • Cumulative Stress Syndrome – Accumulated traumas experienced over a short period of time

31. Critical Incident StressMethods • Defusing - A short intervention – 20-40 minutes that takes place shortly after a critical incident. • Demobilization – Also called de-escalation – 15-20 minutes – that is utilized during/following large scale incidents (earthquakes, tornadoes, hurricanes, and other mass casualty events).

32. Critical Incident StressMethods • On-Scene Support – Takes place on or near the scene of a traumatic event. Chaplain serves refreshments and encouragement to ESPs returning from the scene, while looking for signs of distress. The chaplains serves as, • Assistant to victims • On-scene consultant to the commander and others

33. The Mitchell Model Introduction Re-entry Fact Training Thought Symptom Reaction

34. Questions