Stress Management WSP Department Psychologist Daniel W Clark PhD What is Stress The nonspecific response of the body to any demand made upon it Selye Demands on the person which tax or exceed his adjustive resources Lazarus ID: 751639
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Slide1
Basic Critical Incident Stress Management
WSP Department Psychologist
Daniel W. Clark, Ph.D.Slide2
What is Stress?
"The nonspecific response of the body to any demand made upon it" (Selye)
"Demands on the person which tax or exceed his adjustive resources" (Lazarus)
"A particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his/her resources and endangering his/her well-being"Slide3
Components of Stress
necessary for life
subjectivepositive and negative
anything that
threatens us pushes us
scares us
worries us
thrills usSlide4
Prolonged Stress…Physical Effects
muscle tension
headaches
lack of energy
stomach problems
immune system
high blood pressure
strokes
sexual problemsSlide5
Prolonged Stress...Psychological effects
depression
anxietyangerconfusionirritability
impatience
fear
negativism
memory problems
helpless/hopelessSlide6
Prolonged Stress...Behavioral effects
Alcohol and drug use
Change in usual behaviorWithdrawalActing outSilence / talkative
Under / Overeating
Hypervigilance
ImpulsiveSlide7
Stressor
Any event acting as a stimulus which places a demand upon a person, a
group, or an organization.Slide8
What are your stressors?
Home
WorkEnvironmentBiogenicLaw Enforcement
Psychosocial Slide9
Home Stressors
Spouse/SO
ChildrenFamily demandsFinancesRole in the home
Family illness
Shift changes
RelativesSlide10
Work Stressors
Supervisor/subordinates
Time demandsPersonal safetyRole at workEnvironment
Shift work
Work paceSlide11
Environmental Stressors
Pollution
CrowdingTemperature
NoiseSlide12
Biogenic Stressors
Stimulants which cause stress by virtue of the biochemical actions they exert on the body.Caffeine
NicotineAmphetaminesSlide13
Law Enforcement Stressors
Irregular work schedule
Danger of job/injuryHuman suffering/deathAbsence of closureExcessive paperwork
Inadequate rewards
Special assignments
Unfavorable court decisions
Corrections system
Distorted media reports
Public sentimentSlide14
Psychosocial Stressor
Those events that are interpreted or appraised as being challenging, threatening, or otherwise adverse.
Like beauty --
They lie in the eye of the beholder
.Slide15
“Real Life”
Home
Job
Family
Personal
Nutrition
Finances
Security
Health
EnvironmentSlide16
Coping Techniquesfor Managing StressSlide17
Steps in stress management
accept that you are constantly under stress
explore areas causing negative stress
practice
effective stress managementSlide18
Time Management
Decide what's important and worth worrying about
Get organizedSchedule time for relaxation and exercise
Write it down!Slide19
Positive Attitude
Know yourself and your "automatic thoughts"Communicate and express your feelings
Rally your support systemAdopt a problem-solving approachSlide20
Can I change this??
Yes
No
Do it!
Accept it!
Problem-solving ApproachSlide21
Lose/Win
Lose/Lose
Win/Win
Win/Lose
I Win
I Lose
You Win
You Lose
(from
The Seven Habits of Highly Effective People
by Covey)
Think Win/WinSlide22
Relaxation
Do something you enjoy, whether indoors or out, alone or with others
Do what is satisfying for youSet aside time for yourselfSlide23
Exercise
Exercise is a great way to relieve physical and mental tension
Improves physical resistance to stressChoose an activity that appeals to youSlide24
Don't accept substitutesfor stress managementSlide25
Crisis InterventionPeer Support
Critical IncidentsSlide26
Post-Traumatic StressPost - traumatic stress
is a normal reaction,
in a normal person, to an abnormal event.Slide27
Post-Traumatic Stress
Post-traumatic stress is a survival mechanism, Post Traumatic Stress Disorder is a pathogenic version of that survival mechanism.Slide28
Post Traumatic Stress DisorderBrief History
First Named in DSM - III, 1980
Military awareness Civil War - nostalgiaWWI - war neurosis, shellshockWWII - combat fatigue/exhaustion
Post Vietnam - PTSD
Prevalence
General population: 1-2%
Emergency Services: 16-20%Slide29
PTSDDiagnostic criteria – DSM V (A-E)
Exposure to a traumatic event
(experienced/witnessed death/serious injury)Persistently reexperienced
(intrusive thoughts, dreams, flashbacks)
Avoidance of traumatic stimuli
(internal and external reminders)
Negative alterations in
cognition/mood
(amnesia,
anhedonia
, detached)
Increased arousal symptoms
(sleep changes, anger, startle, hypervigilance)Slide30
Critical Incident
In a career where day to day you respond to the abnormal events in other people’s lives;
A critical incident is the one that, for whatever reason, is abnormal even for experienced personnel.Slide31
Critical IncidentsThe Terrible 10
Line of Duty DeathSerious Line of Duty Injury
Suicide of a Co-WorkerDisaster / Multi-Casualty IncidentLaw Enforcement ShootingSlide32
Critical IncidentsThe Terrible 10
Events Involving Children
Relatives of Known VictimsProlonged Incident - Especially with lossExcessive Media InterestAny Significant EventSlide33
Intensity of Impact
Personal Relevance * Duration Sense of Loss
Previous History Guilt Social SupportCoping SkillsSlide34
Types of Interventions
Pre-Incident EducationOn Scene Support Services
Peer Support (Individual Consults)DefusingDemobilizationCritical Incident Stress DebriefingSlide35
Types of Interventions
Specialty DebriefingsSignificant Other Debriefings and Support
Follow Up ServicesMental Health Referral ServicesCommunity AssistanceSlide36
Pre-Incident Education
Heart of Successful CISM ProgramDiscuss Stress/Human Stress Response
Describe CISM ServicesExplain What CISM Is NotProvides Outline for CISM Access
Generates Positive ContactsSlide37
Peer Support/Individual Crisis InterventionSlide38
Individual Crisis Intervention
Positives
‘Been there, done that’CredibilityRapport
Negatives
May be too close
Very vulnerable to counter-transference
May over-identifySlide39
1:1 Crisis Intervention
Communication SkillsAwareness of Acute Stress Symptoms
Intervention ProtocolReferral OptionsSlide40
Rest Information Transition Services (RITS)Slide41
Rest Information Transition Services (RITS)
Renamed from DemobilizationProvided by trained CISM personnel.
10 minute informational talk. Describe stress reactions. List signs and symptoms.
Outline stress survival strategies.
20 minute rest after talk is completed.
Low fat, low sugar, low salt foods
Non-caffeinated drinksSlide42
Crisis Management BriefingSlide43
Crisis Management Briefing
“…a group psychological crisis intervention designed to mitigate the levels of felt crisis and traumatic stress in the wake of terrorism, mass disasters, violence, and other “large scale” crises.”
IJEMH v2(1) p. 53-57 (2000)Slide44
Crisis Management BriefingGoals
Inform and consultAllow psychological decompression
Stress managementSimilar to Demobilization but for
non-operational personnelSlide45
DefusingSlide46
DefusingDefusing means to render something harmless before it can do damage.Slide47
DefusingA small group intervention applied within
hours of a critical incident.Slide48
Defusing
Introduction
Exploration InformationSlide49
Critical Incident Stress DebriefingSlide50
Critical Incident Stress Debriefing
The goal of a Critical Incident Stress Debriefing
is psychological closure.Slide51
DebriefingConsiderations
Large scale incident.Prolonged incident.
Circumstances out of the ordinary.CISD is not therapyCISD is not a substitute for therapy.Slide52
DebriefingPhases
Introduction (C)
Fact (C) Thought (C E) Reaction (E)
Symptom (E C)
Teaching (C)
Re-Entry (C)Slide53
Mental Health ServicesPsychotherapy for employees and family members:
IndividualMarital/couples
GroupTrooper applicant screeningTraining/Academy instruction
Command consultationSlide54
Referrals & Appointments
Referrals:DirectedVoluntary
AppointmentsDays offMedical leaveSupervisor’s discretionSlide55
Confidentiality/Privileged Communication
Privacy: a personal right which limits the access of others to certain information about one’s self, body, mind, etc.
Confidentiality: a professional duty to refrain from speaking about certain mattersPrivilege: a
legal decision
which provides relief from the duty to speak in court proceedings about certain mattersSlide56
Limits of ConfidentialityRCW 71.05
RCW 26.44
RCW 74.34Danger to self or others
Abuse of children or DD adults
Abuse of vulnerable adults
Case reviewSlide57
Questions??Slide58
Daniel W. Clark, Ph.D.
Washington State Patrol
1405 Harrison Avenue NWSuite 205Olympia, WA 98502(360)-586-8492
wsp-psych@att.net