HURRICANE PREPAREDNESS:

Worker Health Care;Mental Health

William M. Furey, Ph.D.June 2008

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

FACTORS LEADING TOCOMPASSION 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

Post-Trauma SymptomsDocumented in Crisis Workers

• 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

EMPATHY

• Allows 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

respond

Negative Risks First Responders Face

• Compassion fatigue• Vicarious traumatization• Secondary traumatization• Burnout

• 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 work

• 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 system

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?

• Roots 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

• 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

• Rage, 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

• Self-blame• Intrusive thoughts,

memories, flashbacks• Worry• A sense of being cut off

from reality• Self-harm

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

• Easily startled• Increased cravings for

and use of caffeine, nicotine, sweets, alcohol, illicit substances

• Lightheaded• Weak

Stress Reactions in Adults:Behaviors

• Crying spells• Angry outbursts• Avoiding people, places,

and situations• Argumentative

• 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 faith

Cognitions and BeliefsThat Heighten Risk for Fatigue

• 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.

• Inability 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

Contributing Factors to the Stress Response

• Disaster characteristics• Disaster response characteristics• Individual characteristics• Factors that affect you as a disaster responder

Disaster Characteristics

• Type 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.)

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

Individual Characteristics

• Age• Gender• Family composition• Cultural, ethnic, racial

background• Level of exposure to the

disaster

• Loss of or injury to family member, other loved ones, pets

• Loss of possessions• Pre-disaster stress• Connectedness with

others

Factors that Affect You As A Disaster Responder

• Leaving family members and loved ones to go on assignment

• Working in unfamiliar and challenging settings

• Staying in a staff shelter with little privacy

• 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 home

Information to Keep in Mindto Protect Against Compassion Fatigue

• 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

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.

Skills to Protect Against Compassion Fatigue

• Making a connection• Helping people be safe• Being kind, calm, and

compassionate• Meeting people’s basic

needs• Listening

• Giving realistic assurance• Encouraging good coping• Helping people connect• Giving accurate and

timely information• Taking care of yourself

Helping 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.

• Recognize 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.

Stories Illustrating Importanceof Cognitive Beliefs

• Starfish story• Two Monks• Edison• The Eternal Optimist

Closing

• Let 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.