ࡱ> xwMS( / 0LDArialԖ0Ԗ0ll~ׯ0" B .  @n?" dd@  @@`` 0#      "#$&%')*+,-. 0AA@3ʚ;ʚ;g4^d^d4~ ׯ0Pppp@ <4dddd8vS0ll~ 80___PPT10 NHURRICANE PREPAREDNESS:DWorker Health Care; Mental Health William M. Furey, Ph.D. June 2008EZE.OBJECTIVES FOR TODAY Prevention of problems for you Develop awareness of constellation of stressors & responses that prolong stress Help you understand how you are affected by your clients and your jobs Help minimize the potential negative effects and vulnerability Increase your options for self-care Help you be in position to be truly empathetic, compassionate, and useful to people affected by the disaster <nn%FACTORS LEADING TO COMPASSION FATIGUE&& Crisis workers view trauma as part of their work; a fact of everyday life Exposure is repetitive; this can have a cumulative effect Individuals who experience intense post-trauma imagery Those experiencing most acute symptoms immediately after, as opposed to delayed Age of individual; younger, less experienced more likely Degree of identification with the victim Unrealistic beliefs:  God Syndrome  belief they can save everyone  John Wayne Syndrome  macho attitude the admitting distressing feelings is sign of weakness*  Pre-existing life events stress: marital problems, financial problems, a sick child, etc. Occupational influences include the  conspiracy of silence , the  no talk rule Availability of social supports!1Post-Trauma Symptoms Documented in Crisis Workers22 Perceptual and time distortions Over- & under-estimation of time involved in an incident Depersonalization Sense of unreality during the event but continue to function Shock/numbing No intense emotions for hours, days, or longer following an incident Intrusive thoughts and images about the disaster Anger, a sense of alienation Relationship and marital discord Spouses often report feeling shut out; reluctance to share feelings; numbing Z9ZZ=ZZEZoZMZ 9=Eo  MEMPATHY 6Allows us to relate to those in our care To have a sense of what they are feeling Helps us put their experiences into perspective Helps us understand how they are being affected by incidents Helps us to feel inside their world, which leads to compassion Alerts us to the needs of others and draws us to respond77$Negative Risks First Responders Face%% LCompassion fatigue Vicarious traumatization Secondary traumatization BurnoutMM,   Compassion Fatigue General term applied to anyone who suffers as a result of serving in a helping capacity Burnout Anyone whose health is suffering or whose outlook on life has turned negative because of impact or overload of their workTXzXz  Secondary Traumatization Family members and close associates who suffer from loved one s trauma as a result of the closeness of the relationship First responders who are eyewitnesses to incident they are meant to mediate, while not primary casualties, become overwhelmed by what they see and hear in person Vicarious Traumatization Impact on first responders when working with traumatized individuals First responders vicariously experience the client s trauma in his/her own nervous systemT, %  What are the common symptoms of compassion fatigue? See Handout How is it that we come to experience and participate in the experiences of our clients?  TRoots of empathy lie in the Central Nervous System Somatic Markers There is a feedback system when we copy another s emotional posture that has an effect on feelings Adopting a particular facial expression or posture may stimulate associated emotions Helps us understand what the client is feeling P33   Mirror Neurons Brain cells that reflect/mirror the activity of another Represents a link between two people Empathy not only a psychological phenomenon, but also a physical one Mirroring and mimicking enhance likelihood of empathy<]{]{   How might awareness of mirroring help you to better care for yourself during and following your working with a traumatized individual? Emotional Contagion Mindfulness ANS reactions to happy faces are short-lived Reactions to angry faces were longer lasting { Ways to Unmirror Sit up straight Cross or uncross legs Change breathing Take a drink Stretch Visit the restroom Tense specific muscles Move around Take a deep breath Exhale $Stress Reactions in Adults: Feelings%% XRage, anger, irritability Resentment Anxiety, fear Despair, hopelessness Numb Terrified =Guilty Sad Helpless, loss of control Uninterested Overwhelmed $Stress Reactions In Adults: Thoughts%% Difficulty concentrating and thinking Difficulty making decisions Forgetful Confused Distortion of sense of time Lowered self-esteem  iSelf-blame Intrusive thoughts, memories, flashbacks Worry A sense of being cut off from reality Self-harmjj,Stress Reactions in Adults: Physical Effects-- Fatigue, difficulty sleeping Agitation Physical complaints (e.g., headaches, stomach problems) Decreased or increased appetite Decreased or increased sex drive   zEasily startled Increased cravings for and use of caffeine, nicotine, sweets, alcohol, illicit substances Lightheaded Weak{{%Stress Reactions in Adults: Behaviors&& SCrying spells Angry outbursts Avoiding people, places, and situations ArgumentativeTT School and work problems Risky behaviors (driving erratically, multiple sexual partners, unsafe sex) Inattention to appearance, personal hygiene, self-care%Stress Reactions in Adults: Spiritual&& Change in relationship with or belief about God/Higher Power Abandonment of prayer, ritual, scripture, devotions, sacraments Questioning the beliefs of their faith Rejection of spiritual care providers Struggle with questions about the meaning of life, justice, fairness, afterlife Loss of familiar spiritual supports Loss of faith5Cognitions and Beliefs That Heighten Risk for Fatigue66 Putting others first Helping other people: Will make their life worthwhile. Will give their life meaning. The world will be a better place for all. People will look up to them for helping. People will listen and follow your recommendations.<+i]+i] KInability to fulfill expectations over time sets stage for dissatisfaction, unhappiness, compassion fatigue, and burnout We may not be able to help every client. We can feel guilty our lives have been so easy in comparison. Certain types of clients require special nurturance, compassion, and understanding that drain our resources*yy+Contributing Factors to the Stress Response,, Disaster characteristics Disaster response characteristics Individual characteristics Factors that affect you as a disaster responderDisaster Characteristics 2Type of disaster (e.g., natural or human-caused) When it occurs (e.g., time of day, time of year) Who is affected (e.g., number of people including children, injured, missing, or killed) What is affected (e.g., damage to health care facilities, grocery stores, roads, telephone services, schools, etc.)Z ZZ"ZZIZZcZ "I  c!Disaster Response Characteristics"" Level of preparedness Post-disaster living situation (e.g., individuals may need to evacuate their homes and stay in shelters, with friends or family, or in a hotel) Limited availability of food and water Delays in receiving relief services or medical care<6q[6q[Individual Characteristics cAge Gender Family composition Cultural, ethnic, racial background Level of exposure to the disasterdd |Loss of or injury to family member, other loved ones, pets Loss of possessions Pre-disaster stress Connectedness with others}}0Factors that Affect You As A Disaster Responder11 Leaving family members and loved ones to go on assignment Working in unfamiliar and challenging settings Staying in a staff shelter with little privacy Z Encountering unfamiliar cultural or ethnic populations whose primary language may not be English Listening to survivors stories Seeing disturbing sights Working with difficult supervisors and co-workers Returning homeZ"AInformation to Keep in Mind to Protect Against Compassion FatigueBB Individuals you helping are primarily normal, functioning individuals; they have not disintegrated. Establish an alliance with the individual Be collaborative: you and individual working toward shared goals Empower the indiv by giving choices regarding pace of disclosure & options for action Act as  ally : convey what happened was  wrong,  unfair ; did not deserve it to happen Provide conditions so individual can tell his/her  story ; not a cross-examination, not fact-finding*TT#Educate the Client Educate client by blending into discourse of counseling Traumatic events can produce symptoms in anyone, regardless of experience. It is normal response to an abnormal situation. Use metaphor of psychological aftermath or aftershock to describe the immediate and delayed reactions. It is not unusual to fear that one is  losing control. Comment on temptation and dangers of using alcohol and drugs as way to cope/avoid/reduce symptoms. Reframe symptoms as  signs of coping and  protective and healing. Indicate symptoms may get worse before they get better as one works through what happened and why. Though hard to believe, there will be positive benefits to willingness to face and work through the experience..8ZZ8-Skills to Protect Against Compassion Fatigue.. Making a connection Helping people be safe Being kind, calm, and compassionate Meeting people s basic needs Listeningvv Giving realistic assurance Encouraging good coping Helping people connect Giving accurate and timely information Taking care of yourselfHelping Yourself and Others %Physical Exercise Weight lifting, regular workouts, dancing, walking, swimming, etc. all shown to help with stress management Exercise helps with regulation of the autonomic nervous system When exercising for calming, stop short of muscular exhaustion; stop when you begin to tire, while the exercise still feels good Reduce the fuel Limit your exposure of watching TV, listening to radio, & reading about the disaster. Focus on the positive Think about the courage & commitment of responders and volunteers who standing with and for those affected.,Vl,Vl   ZRecognize your own feelings Knowing the physical, emotional, cognitive, spiritual problems you having are stress related helps reduce their effect on you. Talk to others about your feelings Understand your feelings shared by others helps relieve stress. Stay connected with your usual support systems. Accept help from others To help put feelings in perspective, talk to mental health worker. It does not mean you are crazy. Means your coping skills are being stretched. Do something you enjoy Whenever possible, take a few minutes to look out window at sunshine & flowers. There is still beauty in the world. It s OK to smile. Smiles can make you feel better. It is not disrespectful.ZZ#ZpZZZZZ#p  4Stories Illustrating Importance of Cognitive Beliefs55 4Starfish story Two Monks Edison The Eternal Optimist55$ Closing RLet me emphasize that constant assessment, evaluation, or mindfulness is an important process for you to do with yourselves. Compassion fatigue is inevitable given your jobs as crisis workers, our neurology, and our desires to help. You can do much to mediate the potential problems. Burnout and vicarious traumatization are preventable. SZS,2   0` 33` Sf3f` 33g` f` www3PP` ZXdbmo` \ғ3y`Ӣ` 3f3ff` 3f3FKf` hk]wwwfܹ` ff>>\`Y{ff` R>&- {p_/̴>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> $(    6~  `} ~ T Click to edit Master title style! !  0~  ` ~ RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S  0p~ ^ ` ~ X*  0~ ^  ~ Z*  0~ ^ ` ~ Z*H  0޽h ? 3380___PPT10. C! 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