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STAYING SANE
Presented by Carla Reece – Northwest Fire District
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• Stress - Why Should You Care?
Source
http://www.stressfreeworkweek.com - How To Manage Your Workplace Stress In Less Than One Day With These Three Easy Steps with Steven Stockwell.
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EUSTRESS vs. DISTRESS vs. DYSFUNCTION
Three intensity levels of stress:
Eustress = Positive, motivating stress
Distress = Excessive stress
Dysfunction = Impairment
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Potential sources of stress
• Personal/family life • Work schedules • Balancing family and work issues • Difficult Callers• Peer interactions and relationships • Training • Probation • Workplace environment• Critical Incidents
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Input from Audience
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Difficult CallersREMEMBER: It’s not personal, they don’t know you They are reacting to the situation and emotion shuts down logic Do NOT escalate the emotional content by yelling - Don’t argue
with the person Tell them what you can do for them Empathize and remain professional at all times
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PRACTICE AND LEARN DEFUSING SKILLS
Ventilation - allowing the person to speak, express their opinion without comment or challenge. The purpose is to allow the person to “blow off steam.” (in the 911 world – As time allows)
Allow the person to express their opinion
Set limits regarding personal attacks or insults
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PRACTICE AND LEARN DEFUSING SKILLSActive listening - includes validation, verification and reflective questioning. Tone of voice and empathy play a huge role here.
• Validation - let the person know that you understand they are in distress or angry
• Verification-the listener tells the person that he/she understands or is trying to understand their problem and why they are angry.
• Reflective listening - the listener asks the person questions about what he/she said in order to have them slow down and focus on the problem.
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BUILD RESILIENCY
• Self-Awareness
• Self-Control
• Optimism
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BUILD RESILIENCY
• Optimism (AGAIN)
• Mental Agility
• Strength of Character
• Connection
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Critical Incidents
CRITICAL INCIDENTS are unusually challenging events that have the potential to create significant human DISTRESS and can overwhelm one’s usual coping mechanisms.
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The psychological DISTRESS in response to critical incidents such as emergencies, disasters, traumatic events, terrorism, or catastrophes is called a PSYCHOLOGICAL CRISIS
(Everly & Mitchell, 1999)
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PSYCHOLOGICAL CRISISAn acute RESPONSE to a trauma, disaster,
or other critical incident wherein:
1. Psychological homeostasis (balance) is disrupted (increased stress)
2. One’s usual coping mechanisms have failed
3. There is evidence of significant distress, impairment, dysfunction
(adapted from Caplan, 1964, Preventive Psychiatry)
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CRISIS INTERVENTION
Goals: To foster natural resiliency through…
1. Stabilization
2. Symptom reduction
3. Return to adaptive functioning, or
4. Facilitation of access to continued care
(adapted from Caplan, 1964, Preventive Psychiatry)
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CRISIS INTERVENTION (CI):KEY POINTS
Crisis intervention (CI) has a rich history having been developed along two evolutionary pathways:
1) community mental health and suicide intervention, and 2) military psychiatry.
Crisis intervention is not a form of psychotherapy, nor a substitute for psychotherapy.
As physical first aid is to surgery, crisis intervention is to psychotherapy.
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• As described herein, crisis intervention is not intended to be the practice of psychiatry, psychology, social work, nor counseling, per se, it is simply psychological/emotional first aid
• As described herein, consistent with NIMH guidelines and Federal “crisis counseling” models, crisis intervention may be practiced by mental health clinicians, as well as, medical personnel, clergy, & community volunteers (although we believe mental health guidance, supervision, or oversight is essential)
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SIGNS AND SYMPTOMS OF DISTRESS
I. COGNITIVE (Thinking)
II. EMOTIONAL
III. BEHAVIORAL
IV. PHYSICAL
V. SPIRITUAL
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DISTRESS (excessive stress). Rx…Identify, Assess, & Monitor
vs. DYSFUNCTION (impairment)
Rx…Identify, Assess, & Take action
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I. COGNITIVE (Thinking) DISTRESS• Sensory Distortion
• Inability to Concentrate
• Difficulty in Decision Making
• Guilt
• Preoccupation (obsessions) with Event
• Confusion (“dumbing down”)
• Inability to Understand Consequences of Behavior
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I. SEVERE COGNITIVE DYSFUNCTION
• Suicidal/ Homicidal Ideation
• Paranoid Ideation
• Persistent Diminished Problem-solving
• Dissociation
• Disabling Guilt
• Hallucinations
• Delusions
• Persistent Hopelessness/ Helplessness
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II. EMOTIONAL DISTRESS• Anxiety• Irritability• Anger• Mood Swings• Depression
• Fear, Phobia, Phobic Avoidance
• Posttraumatic Stress (PTS)
• Grief
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II. SEVERE EMOTIONAL DYSFUNCTION
• Panic Attacks
• Infantile Emotions in Adults
• Immobilizing Depression
• Posttraumatic Stress Disorder (PTSD)
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Posttraumatic stress (PTS) is a normal survival response; Posttraumatic Stress Disorder (PTSD) is a pathologic variant of that normal survival reaction.
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PTSDA. Traumatic event
B. Intrusive memories
C. Avoidance, numbing, depression
D. Stress arousal
E. Symptoms last > 30 days
F. Impaired functioning
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Predicting PTSD
1. Dose - response relationship with exposure
2. Personal identification with event
3. Very important beliefs violated
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PTSD results from violation of:
1. EXPECTATIONS
2. DEEPLY HELD BELIEFS (Worldviews)
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CORE BELIEFS (Worldviews)• Belief in a just and fair world
• Need to trust others
• Self-esteem, Self-efficacy
• Need for a predictable and SAFE world
• Spirituality, belief in an order and congruence in life and the universe
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Severity of PTSD• Dissociation
• Psychogenic amnesia
• Persistent sleep disturbance
• Panic
• Severe exaggerated startle response
• Evidence of seizures
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III. BEHAVIORAL DISTRESS
• Impulsiveness• Risk-taking• Excessive Eating• Alcohol/ Drug Use• Hyperstartle
• Sleep Disturbance• Withdrawal• Family Discord• Crying Spells• Hypervigilance• 1000-yard Stare
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III. SEVERE BEHAVIORAL DYSFUNCTION
• Violence• Antisocial Acts• Abuse of Others• Diminished Personal Hygiene• Immobility• Self-medication
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IV. PHYSICAL DISTRESS• Tachycardia or Bradycardia
• Headaches
• Hyperventilation
• Muscle Spasms
• Psychogenic Sweating
• Fatigue / Exhaustion
• Indigestion, Nausea, Vomiting
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IV. SEVERE PHYSICAL DYSFUNCTION•Chest Pain•Persistent Irregular Heartbeats•Recurrent Dizziness•Seizure•Recurrent Headaches
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IV. SEVERE PHYSICAL DYSFUNCTION•Blood in vomit, urine, stool, sputum•Collapse / loss of consciousness•Numbness / paralysis (especially of arm, leg, face)
•Inability to speak / understand speech
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It is imperative that all evidence of physical dysfunction be taken seriously and referred to a physician. The same is true when dealing with any physical distress that does not remit, may be suggestive of a medical disorder, or seems ambiguous.
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V. SPIRITUAL DISTRESS
•Anger at God
•Withdrawal from Faith-based Community
•Crisis of Faith
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V. SEVERE SPIRITUAL DYSFUNCTION
•Cessation from Practice of Faith
•Religious Hallucinations or Delusions
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NOTE!
ALL OF THE SIGNS AND SYMPTOMS OF SEVERE DYSFUNCTION WARRANT REFERRAL TO THE NEXT LEVEL OF CARE!
Also refer whenever in doubt.
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PSYCHOLOGICAL ALIGNMENT•Don’t argue•Don’t minimize problem•Find something to agree upon •Is the most important element in establishing rapport
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AVOID!• “I know how you feel.”
• “It’s not so bad.”
• “This was God’s will.”
• “God won’t give you more than you can handle.”
• “Others have it much worse.”
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AVOID!• “You need to forget about it.”
• “You did the best you could.”
(Unless person has told you that.)
• “You really need to experience this pain.”
• Psychotherapeutic interpretation!
• Confrontation