Risk and Resiliencein Trauma-Exposed Work

2019 Reclaiming Youth Seminars

Sioux Falls, SD

Kari McCluskey

University of Winnipeg

Aurora Family Therapy Centre

Culture of Stress

We live and work in a culture where resources are limited and overextending ourselves is often valued.

Often, value is placed on fast results and bottom lines rather than employee wellbeing.

Optimal vs Toxic Stress

https://www.sites.google.com/site/officeofstressmanagement/what-is-stress

https://www.stress.org/how-stress-affects-your-body

https://www.physio-pedia.com/File:Effects_of_stress_diagram.jpg

Zones of Control

(Fisher, 2016)

15% - You have control

35% - You have some influence

50% - You have no control or influence

Systemic Workplace Stress

Job Related Stress

Burnout Harassment

(Fisher, 2016)

Traumatic Workplace Stress

Direct TraumaIndirect Trauma

Complex Stress Model

Burnout

Secondary Traumatic

Stress/ Vicarious Trauma

Compassion/ CaregiverFatigue

“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.”

- Naomi Rachel Remen

Vicarious Trauma

“Vicarious trauma is the process of change that happens because you care about otherpeople who have been hurt, and feel committed to or responsible to help them.

Over time this process can lead to changes in your psychological, physical, and spiritualwell-being.”

-Pearlman and McKay, 2008

Signs/symptoms

• Isolation/ Avoidance

• No time for self / family / friends / healthy living

• Anger/cynicism

• Feelings of emotional exhaustion

• Increased irritability at home

• Increased dissociation, memory lapses, concentration issues

• Heightened startle response

• Feelings of powerlessness / hopelessness

• Client frustration / student-blaming

• Sarcasm / “Dark” humour

• Denial (I’m fine)

• Increased substance use

• Guilt/shame

• Change in meaning/ purpose/ hope

• Grandiosity

Vicarious Resilience

“The positive effects on helping professionals whowitness the healing, recovery, and resilience ofpersons who have survived severe traumas intheir lives.”

(Hernandez, Gangsei, & Engstrom, 2007)

Inspiration and

awe

Seeing people

overcome adversity

Recognizing

people’s capacity to

heal

Reaffirming the

value of your work

Perspective

Goal!

Perseverance

Progress

Small Step

Engagement

Challenge/Crisis

Workplace Risk/Resilience Factors

1. Workload/expectations/nature of work

2. Professional History and Training

3. Trauma Exposure

4. Supervision/Administrative Support

5. Supportive Environment (Peers)

6. Emotional Labour

7. Societal Value and Perception

ResilienceRisk

Organizational Impact of Vicarious Trauma

• Quality of work, relationships, connections

• Cynicism, pessimism

• Lack of creativity

• Employee health and wellness

• Absenteeism

• Staff turnover

Personal Risk/Resilience Factors1. Rewards, Value, and Meaning in the Work

2. Personal Trauma History

3. Personal Support System

4. Coping Style

5. Current Life Context

6. Ability to Establish Boundaries

7. Trauma Exposure

ResilienceRisk

Increased Stress

Decreased Self-care

Injury

Increased Stress

Increased Self-care

Growth

Patricia Fisher, 2016

Low-Impact Debriefing

Formal

• Organized time and space

• Embraces vulnerability

• Creates space to share challenges, consult with peers and/or supervisor

Informal

• Conversing with peers

• Doorway sharing/support

• “Shedding”

“Sliming”

• Transfer of secondary trauma

• Over-sharing of traumatic details

Francoise Mathieu, 2013

Empathy & Compassion

o Empathy

- Feeling pain with others

- Risk of empathic distress which can be emotionally draining, and even debilitating

- Subjective to personal values, relationships, and experience

o Compassion

- Feeling concern for others

- Allows for intentional presence, understanding, and resourcing

- Resists taking on another’s pain

Singer & Klimecki, 2014

Shared Traits of Stress-Resistant People

1) Sense of Personal ControlUnderstanding of own capacity to influence life course

2) Pursuit of Personally Meaningful TasksPresent and engaged in life (creates space to manage higher stress).

3) Healthy Lifestyle ChoicesAvoid stimulants; engage in physical activity and relaxation.

4) Social SupportEngage in meaningful relationships that serve as a buffer during difficult times.

Bessel van der Kolk, 1987

Strategies for Transforming Vicarious Trauma

1) Practice Individual and Collective Wellness in the Workplace and Beyond

oPhysically – How do you release the built up tension and stress in your body?

oMentally – How do you care for your overall mental health?

o Emotionally – What intrinsically meaningful activities do you enjoy? How connected are you to your emotions?

oRelationally – Do you engage in meaningful connections with others?

o Spiritually – How do you tend to yourself spiritually?

2) Identify and Actively Engage Support Systemso Stay connected with the people you love

oAsk for help when life/work gets hard

o Spend time with those who bring joy and laughter to your life

oUnderstand you are not alone

Strategies for Transforming Vicarious Trauma

3) Engage in Debriefing and Consultation OpportunitiesoParticipate in opportunities to share how the work is impacting you

o Seek peer support when facing challenging situations

o Look to supervisors for support as necessary

Strategies for Transforming Vicarious Trauma

4) Engage mindfully and intentionally with your workoRemind yourself why you choose to do this workoUnderstand your role and what is expected of youoLook for opportunities to collaborate with colleagues oTake time for reflectionoContinue to learn and grow o Identify and challenge your own beliefsoDevelop transitions in and out of workoEstablish boundariesoPractice mindfulness

Strategies for Transforming Vicarious Trauma

Mindfulness

“Mindfulness is the energy of being aware and awake to the present moment. … To be mindful is to be truly alive, present and at one with those around you and with what you are doing.”

- Thich Nhat Hanh

Mindfulness

“Mindfulness is both knowing where our mind is from moment to moment and directing our attention in skillful ways.”

- Chris Germer

Myths of Mindfulness

• Is an exercise in awareness and attunement, not a relaxation technique.

• Is presence, not transcendence

• Consciousness of body and mind, not removal of thoughts

• Is a practice, not a “fix”

• Makes space for emotional pain, it does not escape from it.

(Germer, 2009)

Benefits of mindfulness

• Improved concentration, attention, and memory

• Lowered stress activity• Improved immune system functioning• Effective anxiety and depression

response• Reduced inflammation• Chronic pain improvement• Improved cardiovascular function

(Fisher, 2016)

Mindfulness in Our Work

• Keeps us connected to ourselves in the work

• Provides a framework for understanding our intentions, motivations, and hopes

• Provides understanding of our position and purpose

• Presence and connection to ourselves keeps us anchored when exposed to unexpected, uncontrollable, and overwhelming events by creating space for unpleasant experiences

• Supports reflective practice

Negativity Bias

As human beings, we are evolutionarily wired with a negativity bias. Negative experiences tend to “stick” with us.

Negative Experiences

• Like “Velcro”

• 2/3 of amygdala (alarm system) on alert for bad news

• Quickly stored in memory (wired)

Positive Experiences

• Like “Teflon”

• Need to be held in awareness for 12 or more seconds to move to long-term memory

• Can easily go unnoticed/undetected

Hanson, R. (2009). The practical neuroscience of Buddha’s brain: Happiness, love, and wisdom. Oakland, CA: Harbinger.

Gratitude as an Intervention

“It is not happiness that makes us grateful,

but gratefulness that makes us happy.”

- Br. David Steindl-Rast

Practicing gratitude activates our parasympathetic (rest and digest) nervous system.

Engages the 12 (or more) seconds of positive thought needed to transform negativity bias.

https://gratefulness.org/resource/toxic-myths-of-scarcity-counteracting-cultural-conditioning/

Gratitude Practice

I am grateful for…

1)

2)

3)

3 things that happened today

1)

2)

3)

Gratitude Prompts

• Sunshine/rain

• Hot coffee/tea

• Soft pillow

• Important people in our lives

• Laughter

• Autumn colours

• Chocolate

• Books

• Furry friends

• Nature

• Water

• Morning

• Friendship

• Birds

• Waves

• Breakfast

• Slippers

• Clouds

• Children

• Art

• Stars

• Music

Building a Culture of gratitude in the Workplace

Developing gratitude “habits” in the workplace helps to support engagement, optimism, and workplace satisfaction.

Increases feelings of competence at work.

Becomes a workplace culture.

(New employees are likely adapt “cultural” behaviour.)

https://gratefulness.org/resource/four-myths-about-being-grateful-at-work/

Self-Compassion

Suffering = Pain x Resistance

What we resist persists.(Neff & Germer, 2018)

Self-Compassion is…

Treating ourselves with the same kindness we would offer to a loved one (or stranger) who is experiencing difficulty.

Stress Response Stress ResponseTurned Inward

Self-Compassion

Fight Self-criticism Self-kindness

Flight Isolation Common humanity

Freeze Rumination Mindfulness

Self-compassion is not…

• Judgement• A pity party• A sign of weakness• Selfish• A scapegoat/excuse• A lowering of personal standards

Benefits of Self-Compassion

• More happiness (less depression)• More life satisfaction (less anxiety)• More self-confidence (less stress)

Practice Self-Compassion, Balancing and Self-care

Differentiate between self-care and self-indulgent.

Mindfully balancing and looking after ourselves helps to effectively care for others.

Practice self-compassion

Remember that balancing and self-care are active processes, not end states.

If we want to give our best, we must be at our best. This is not selfish, it is best practice.

Recommended Reading

Websiteshttps://chrisgermer.com/https://self-compassion.org/category/exercises/http://www.donothingfor2minutes.com/https://www.tendacademy.ca/

Germer, G. (2009). The mindful path to self-compassion. New York: Guilford Press.

Kabat-Zinn, J. (2005). Wherever you go, there you are: Mindfulness meditation in everyday life. New

York: Hyperion.

Mate, G. (2004). When the body says no: The cost of hidden stress. Vintage, Ontario.

Mathieu, F. (2011). The compassion fatigue workbook: Creative tools for transforming compassion

fatigue and vicarious traumatization. New York: Routledge,

Neff, K., & Germer, C. (2018). The mindful self-compassion workbook: a proven way to accept

yourself, build inner strength and thrive. New York: Guilford Press.

Neff, K. (2011). Self-compassion: The proven power of being kind to yourself. New York:

HarperCollins,

Rothschild, B. (2000). the body remembers: The psychophysiology of trauma and trauma treatment.

New York: WW. Norton.Singer, T., & Klimecki, O. (2014) Empathy and Compassion. Current Biology, 24(18), pp. 875-878.

van Dernoot Lipsky, L., & Burk, C. (2009). Trauma stewardship. California: Bettet-Koehler

Publishers.

van der Kolk, B. (2014). The body keeps the score: brain, mind, and body in the healing of trauma.

New York: Viking.