In this presentation we will:

• Describe the sources and types of crisis

•Highlight the history of & current criteria for PTSD

•Describe physical and psychological symptoms & stages of stress reaction & implications for the workplace

•Define the development of PTSD

Post-Traumatic Stress Disorder (PTSD) and Crisis Management

Part 1

Sources of Critical IncidentsCan be natural or human made, accidental or intentional:

Sexual Assault

Earthquake

Tornado

Terrorist Attack

Hostage Situation Toxic Spill

Traumatic Injury

Incest

War

Riot

Fire

Torture Physical Assault

Crisis

FloodShooting

Etc…

Critical Incidents…

• Are sudden and unexpected

• Disrupt our sense (illusion) of control

• Involves the perception of life threatening (or self identity) risk

• May involve physical or emotional loss

• Violates our values and beliefs about the way the world ought to work

• “The world is a good and safe place--bad things don’t happen to good people”

• “The world is meaningful, predictable, fair, and controllable”

• “Just do the right thing and everything will work out OK”

Characteristics of crisis prone organizations

• Denial: Refusal to acknowledge a threatening reality. “We don’t need to do anything unless the incident leaks; no new is good news” “Let’s wait to hear more.”

• Minimizing or Disavowal: Downplay importance of reality or low risk assessment. “Our 70% staff turnover is normal in this industry; we have more important things to do here; we’ll deal with it if it happens.”

• Fixation: rigid commitment to a particular course of action or attitude in dealing with crisis. “The only thing that should concern us is the bottom line; we’ll let corporate take care of it.”

• Grandiosity: feeling omnipotent. “We have the best staff and management system; only poor organizations need that; nothing can hurt us; it can’t happen here.”

• Over-protectiveness: concealing or withholding essential information. “we’re ok so long as this doesn’t get out; no one needs to know this.”

• Procedural: have plans completed but people not aware, trained, or practiced & ready

Origins of Post-Traumatic Stress Disorder (PTSD)

• Historically described but not recognized (e.g., Hebrew Patriarch Jacob in the Book of Genesis, Achillies in Homer’s Illiad)

• During the Civil War soldiers exposed to the horrors of war were afflicted with “nostalgia” or “Soldier’s Heart”

• During the 1870s “Railroad Spine” was prominent owing to lawsuits related to frequent and terrible railroad incidents

• By the end of the 19th century, “traumatic hysteria” and “traumatic neurasthenia” were conventional terms

• WWI brought awareness of shock to nervous systems & “Shell Shock”

• WWII introduced “Combat Fatigue” with one in three experiencing it

• Viet Nam eventually brought about the diagnostic term “combat stress” & eventually “Posttraumatic Stress Disorder” in 1980

• Checkout counter rage: a woman had half her nose bit off by another shopper when she insisted on remaining in express lane with more than the permitted 12 items

• Air rage: disruptive passenger who attempted to break into Southwest Air cockpit was beaten, choked, and eventually killed by other passengers

• Snowplow rage: frustrated by never-ending snowfall and the snowplow generated mountain of snow blocking driveway, a Framingham, MA, man beat the snow plow driver with his shovel

• Pub rage: Incensed for being refused service at a pub at closing time, a man with a tractor repeatedly smashed into the establishment, causing the pub’s walls to crumble

• ATM rage: when a bank machine at a convenience store swallowed his card, an enraged patron struck the ATM machine with a utility knife, cursed as a nearby clerk, hurled the knife at a cashier, and smashed the adjacent fax machine.

It’s all the rage: another bad day at the office…

ASSOCIATED PRESS    MARION, Miss., July 8 —   Police on Wednesday were trying to determine why an assembly-line worker described as “mad at the world” left a business ethics workshop at an aircraft parts plant only to return and gun down 14 colleagues, killing five. Doug Williams shot himself Tuesday following his rampage at the Lockheed Martin plant.

Traumatic event

Personal Impact

Personal reaction

Performance

Workplace implications

What makes an event “traumatic”?

What are determinants of personal impact?

What are cognitive, affective, behavioral responses to trauma?

How might PTSD affect work performance & organizational culture?

What can organizations do to facilitate recovery?

Planners should ask themselves a series of questions to frame the crisis issue:

Working assumptions about Crisis Intervention make it different from other kinds of intervention

• Crises have a specific onset, brief period, predictable course, stages, and are a normal reaction to an overwhelming situation

• They are self limiting in 4-8 weeks, some form of adjustment occurs within 2 weeks, best intervention is within 24 hours

• Stress symptoms may be an immediate reaction or gradual process

• Subjective perception of crisis is the determinant of intensity of reaction

• Risk increases with physical/psychological danger and decreases with coping skills

• Some events are critical for nearly everyone

• Initial intervener focus is on containment, control, and resolution

• Interveners should be active and direct rather than nondirective

Occurrence of PTSD– more often than we expect

• 7% exposed annually to trauma & disaster (17 million people)

• Two-thirds of Americans exposed to major trauma during lifetime; 9% show PTSD, 15% subclinical

• 17% of teens in some major cities have PTSD; Children witness 10-20% of homicides in US

• More than 30% of combat veterans have PTSD

• 69% of surviving spouses of police officer killed in duty have diagnosable PTSD

• 1 of 6 violent crimes occur in the workplace, and 1 of 4 are threatened, harassed, or attacked on the job

Criteria for PTSD

1. Exposure to traumatic event & reaction involves intense fear, helplessness, or horror

2. Traumatic event is persistently reexperienced

1. Recurrent/intrusive thoughts or images

2. Recurrent distressing dreams

3. Acting or feeling as if event were recurring

4. Psychological distress on exposures to reminders of event

5. Physiological reactions on exposure to reminders

3. Avoidance of stimuli associated with event and numbing of response

1. Efforts to avoid thoughts, feelings or conversations about the event

2. Efforts to avoid activities, places, or people that remind of the event

3. Inability to recall important aspects of event

4. Significantly diminished interest or participation in activities

5. Feeling detached or estranged from others

6. Restricted range of affect

7. Speaks or thinks of not having a future

4. Increased arousal not present before traumatic event

1. Trouble falling or staying sleep

2. Irritability or outbursts of anger

3. Difficulty concentrating

4. Hypervigilance

5. Exaggerated startle response

5. Symptoms for at least one month

6. Symptoms cause significant impairment in daily life

24 hours

3 weeks

6 months

1 year

Long term

0 20 40 60 80 100

24 hours

3 weeks

6 months

1 year

Long term

Immediate Responders Affected (%)

Duration of Critical Incident Stress Symptoms

Percent

• No adverse effects 3-10%

• Acute or delayed reaction with or without help and eventual full recovery 80-85%

• Continued lifelong PTSD 3-4%

In a catastrophe: • 10-15% will be calm

• 75% will be temporarily stunned

• 10-25% will have lasting impact

Trauma and the Brain

“Higher cortical functionsReason, planning, impulse control

Subcortical Areas (Limbic System)

“Stream of emotions”

• Survival emotions• Store/retrieve memory• Obsessional thinking• Hyper-responsiveness• Inhibit evaluation & categorization• Pre-existing personality exaggeration

Under stress the “higher” cognitive functions are often compromised and we react with our “emotional” brain

Stress and the Nervous System: Getting stuck in the “on” position

Sympathetic Branch:• acute hearing• visual scanning• pupil dilation• hyperalert• inhibit salivation• faster heart rate• rapid breathing• cold hands• muscle tension• adrenaline rush• liver releases glucose• loss of appetite• slowed digestion• contract sphincters• constipation

Parasympathetic Branch• slower, deeper breathing• slow heart rate• constricts pupil• warm extremities• hunger, digestion• tired, fatigued• relaxed muscles• contract bladder• release sphincters

Rebound Reaction

The sympathetic branch activates us to respond with “fight/flight” while the parasympathetic controls the relaxation response. Intense stress can “lock” the sympathetic response. When too intense, we can “rebound” and sleep or have fatigue even under high stress.

Perceptual distortions can occur during extreme stress

83% visual distortions

83% time distortions

69% auditory distortion

67% tunnel vision

67% slow motion

51% diminished sound

18% intensified sound

16% fast motion

16% heightened detail

These reactions can be very disturbing and people need to know that they are having a normal reaction to an abnormal situation

The Heart Rate is a barometer of Stress Effects (beats/min)

220

200

180

160

140

120

100

80

175 bpm:

• tunnel vision

• tunnel hearing

• loss of near vision

• loss of depth perception

• cognitive processing deteriorates

• vasoconstriction– reduced bleeding

145 bpm:• complex motor skills deteriorate

115 bpm:• fine motor skills deteriorate

60-80 bpm:• normal resting heart rate

Above 175 bpm:

• irrational fight/flight

• freezing

• submissive behavior

• voiding bladder/bowel

• best gross motor skills

115-145 bpm-- optimal survival & combat level

• complex motor skills

• visual reaction time

• cognitive reaction time

Yerkes-Dodson Stress Curve: Too little or too much

Stress Level

Pe

rfo

rma

nc

e

Too much or too little stress elicits poor performance. Optimal performance occurs under moderate stress.

Alarm Stage Recovery Stage Exhaustion Stage

Normal level of performance

“Burnout”

1 2 3

Initial shockConfusionDisorientationSlownessUnrealness

MobilizationFasterStrongerPerceptiveHypervigilant Fatigue

ExhaustionCollapseIllness

Selye’s General Adaptation Syndrome (GAS):Stages of the stress reaction

Selye’s research showed that people change in their stress reaction when prolonged. They initially react with intensity & disorganization, followed by resilience and coping, but without resolution they will eventually burnout.

“I feel your pain”…literally!

• Even when we simply observe others, “mirror cells” in the brain activate to reproduce the actions of the other person

• When we hear vivid stories or see intense reactions our own brain produces emotions expressed by the other person

• These occur unconsciously

• Suppressing our empathic response does not eliminate it

• When bad things happen to other people, we usually emotionally respond to them

Empathy & mirror cells

Friend or foe: Effects of adversarial vs collaborative investigations

• Sample: 125 child care agencies in 38 states (residential, group home, treatment foster care, day Treatment). All experienced at least one violation investigation

• Collaborative style: courteous, trust, mutual goal of protecting staff and clients, improvement in quality of care, learning from mistakes, sharing information

• Adversarial style: no notice, “reading rights,” threats, intimidation, predrawn conclusions, withholding information, arrogance

Swenson, D. X., Wolleat, R., & Grace, D. (2003). Friend or foe: The effects of adversarial versus collaborative styles of treatment violation investigation. Journal of Child and Youth Care Work. 17, 204-217.

Results… 25 % of facilities reported having negative experiences with investigation. Of them:

The Point: Most investigations are collaborative and constructive; prepare staff for the stress of investigation and those that are adversarial!

• 93% of staff had lower respect for the investigative system

• 83% of staff morale deteriorated as a result of investigation

• 80% discouraged staff commitment to the field

• 72% felt badly about themselves and the work they do

• 63% took a highly defensive position regarding investigation

• 43% showed self doubt and second guessing in subsequent case decision making

• 37% became very cautious in sharing information with parents

• 13% reported that the quality of treatment had declined

Impact of 9-11 on businesses

• Damage to >500 corporate & nonprofit firms and governmental agencies

• 30% transitory decline in airline traffic; 7-8% persistent negative decline ($300m/day losses)

• Global markets plunged & investors risk conscious• Gold prices & oil futures skyrocketed• High costs of added security• Customer insecurity & inconvenience• Restricted disaster insurance• 1/3 of companies of Fortune 1000 are no better prepared today than

before 9-11– due diligence• Charity scandals regarding misuse of $ (e.g., Red Cross $988.8m)• Borrowing soared to $46b (week before it was $<200m)• Workers compensation related to 9-11 >$4b• Decreased immigration– labor & higher education pool• Increase in PTSD• Organizational downsizing & reorganization continues• New regulatory compliance

Just waiting to happen…

end