Identifying Vicarious Trauma and How to Minimize the Impact of it.

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1 Identifying Vicarious Trauma and How to Minimize the Impact of it. KARINA NAPIER, CARE COORDINATOR MEGAN PRIEST, WELLNESS COORDINATOR DEBI HAYWORTH, CERTIFIED RECOVERY SPECIALIST

2 Topics to be Covered Why is monitoring self-care important? What is vicarious (secondary) trauma and who is affected by it? What leads to burnout and compassion fatigue? How can I implement self-care into my daily life? What can I do to better manage work/family/stress/life --- this holiday season?

3 Awareness Test

4 Vicarious (Secondary) Trauma Defined as: Indirect exposure to trauma through the firsthand account or narrative of a traumatic event. The vivid recounting of trauma by the survivor and the helping professional s subsequent cognitive or emotional representation of that event may result in a set of symptoms and reactions that parallel PTSD (e.g., re-experiencing, avoidance and hyper-arousal ). Secondary traumatization, Compassion Fatigue, and Vicarious traumatization are words often used interchangeably. All can be described as, the cost of caring.

5 Vicarious Traumatization Can result from a single event, the effects of many events, or from the build-up (cumulative trauma).

6 Biological effects Biological effects have been well documented and include chronic pain, issues with gaining or losing weight, sleep disturbances, issues with drugs and alcohol and much more. The effects from witnessing or caring for victims that have experienced trauma can alter us physically and mentally long after the experience has ended.

7 3 self-report inventories that can measure vicarious trauma Compassion Fatigue Self-Test (CFST) TSI Belief Scale (TSI-BLS)(Pearlman, 1996) Secondary Trauma Questionnaire (STQ) (Motta et al., 2001).

8 Who is Affected by it? EVERYONE

9 What leads to Burnout and Compassion Fatigue Stress 44% of Americans have reported an increase in stress levels in the past 5 years. The top three causes reported are Money Work Economy Symptoms can include Deep Physical and emotional exhaustion (Sleep Disturbances) Loss of energy

10 Symptoms Increased Cynicism at work. Pronounced change in the helpers ability to feel empathy for their patients, loved ones, and their co-workers. (Mood changes). Dread of working with certain clients/patients

11 Symptoms Impaired ability to make decisions and care for clients/patients. Problems with intimacy and in personal relationships Disruption of world view, heightened anxiety or irrational fears(bodily symptoms)

12 Symptoms Intrusive imagery or dissociation Hypersensitivity or insensitivity to emotional material Difficulty separating work life from personal life

13 Symptoms Absenteeism missing work, taking many sick days. Difficulty concentrating Anxiety

14 Symptoms Increase use of alcohol and drugs Depression Loss of enjoyment of career. (Desire to quit a job)

Burnout When we prolong stress through worry, psychological rumination, and anticipation of problems these same physiological responses become chronic

15 Burnout When we prolong stress through worry, psychological rumination, and anticipation of problems these same physiological responses become chronic and can do damage. Over time, we can burnout and decrease our involvement and enjoyment in aspects of our life that are particularly stressful, like work.

16 Three Components of Burnout Emotional Exhaustion, which is defined as being overwhelmed by the job demands. Depersonalization of clients, which is characterizes as developing negative feelings and attitudes towards clients or blaming the victim. Loss of feelings of accomplishment, which includes negativity about one s own work.

17 Burnout Economic constraints and how systems are organized or disorganized can conflict with or seem to conflict with client needs which in turn increased vulnerability for burnout. Emotional responses to this conflict may included frustration, anger, anxiety, and depression.

18 Compassion Fatigue A Snap Shot Example Compassion Fatigue was first introduced as it related to burnout experienced by nurses. The original use of the term was broader (when applied to the nursing profession). In 2005 Canada published their first ever National Survey of the work and health of nurses. 1/5 of nurses reported their mental health made their workload difficult to handle during the previous month. In the year before the survey, over 50% of nurses had taken time off because of physical illness, and 10% reported they had been away for mental health reasons.

19 In 2005 Canada published their first ever National Survey of the work and health of nurses. 8 out of 10 nurses accessed their EAP which is over twice as high as EAP used by the total employed population. In 2000 a study of cancer care workers in Canada discovered that a significant number of them were considering leaving the field. 50% of physicians and 1/3 of other cancer care professions.

20 Survey Conti. All reported high levels of emotional exhaustion and low levels of personal accomplishment. Similar finds have been found among other helping professionals such as child protection workers, law enforcement, counselors and prison guards.

21 Compassion Fatigue Compassion Fatigue includes a sense of helplessness, isolation, and confusion, which may be disconnected from specific triggers.

22 Compassion Fatigue (CF) Compassion Fatigue can be viewed as a process (stages) 1. Compassion Discomfort 2. Compassion Stress 3. Compassion Fatigue

23 Compassion Fatigue (CF) Developing Compassion fatigue is a gradual cumulative process and so is healing from its effects. A few people can be fully restored by taking a holiday or going for a massage but most of us need to make life changes and put our own health and wellness at the top of the priority list.

Compassion Fatigue (CF) Prevention of compassion fatigue through stress management and self-care is essential to the well-being of caring professionals and those

24 Compassion Fatigue (CF) Prevention of compassion fatigue through stress management and self-care is essential to the well-being of caring professionals and those they serve. The most insidious aspect of compassion fatigue is that it attacks the very core of what brought us into this work: our empathy and compassion for others.

25 Stuck on the Escalator

26 Self-Care Cell phone batteries have to be recharged. There are 3 ways to do this: (1) wait until the battery is completely run down and live without power until a recharge can occur; (2) listen when the phone is bleating at you for attention and start recharging then; or (3) recharge regularly to always have power.

27 Self-Care This is an apt metaphor for stress management. Stress is capable of overwhelming a person, and the antidote is keeping personal batteries charged one of 3 ways: (1) after all your energy is depleted; (2) when your body, mind, and spirit are screaming for attention; or (3) in a proactive way that looks for balance between energy depletion and restoration.

28 Self-Care Children laugh, on average 400 times a day while adults average only 15 laughs each day. Children can teach us, show us and help us remember how to have fun and take care of ourselves.

29 Barriers to Self-Care Mistaken belief that when we take care of ourselves, we are being selfish. Guilt Guilt is meant to stop people from doing something illegal, unethical or immoral.

30 Barriers to Self-Care Lack of energy too many responsibilities and the fear of appearing weak or vulnerable. Difficulty in putting himself or herself first. Famous statement, I will do it when I need it

31 Acronyms to help with Self-Care NERS Nurture yourself Nutrition (Healthy Diet) Exercise (consistent exercise) Rest (adequate rest, not just sleep at night, but restful breaks not at your desk, and not skipping lunch breaks) Social Support Key components to stress management and burnout prevention.

32 COPS Call the Cops You may need them on speed dial if you work in a particularly stressful environment! Control (making correct judgments of what we can and cannot control) Outlets for Frustration (supervisors after frustrations have been processed, edited, and organized). Predictability (reduces stress by giving us a schedule) Social Support

33 BREAD Provide your own daily BREAD. Psychological BREAD B is for Belief System, spirituality, meaning. R is for Rituals (not rigidity). E stands for Education on self-care. A stands for Attitude (positive, that is) D is for Determination Physical Bread B reminds us to breathe properly R encourages us to relax regularly E Stands for Exercise (yes, again) A is for Activities (fun ones) D is for Dig in, or Dive in (tactile)

34 How Can I Implement Self-Care into my Daily Life? Self-Care Routine is a work-in-progress! Identify what activities help you feel your best. (Pleasure) Self-care for one person will mean something completely different for someone else. Put it on your calendar in ink! Carve out 1-2 hours for self-care and stick to it.

35 How Can I Implement Self-Care into my Daily Life? Sneak in self-care where you can. Fit in little moments of relaxation. Take care of yourself physically. When you physically take care of yourself you will reap the benefits emotionally, psychologically, health-wise, and in your relationships.

36 How Can I Implement Self-Care into my Daily Life? KNOW WHEN TO SAY NO AND DO IT. Nix anything that does not feel fulfilling; health and wellbeing come first. Sensory Try focusing on the sensations around you (Sights, smells, sounds, tastes, touch). Mental/Mastery Do a task that you ve been avoiding or challenging your brain in a novel way.

37 How Can I Implement Self-Care into my Daily Life? Check-in with yourself regularly (Emotional). Dealing with our emotions can be challenging. We label emotions as good or bad this isn t helpful. Ask yourself these critical questions: a. Are you working too much? b. Do you feel tapped out? c. What do you need to take away? d. What would you like to add?

38 How Can I Implement Self-Care into my Daily Life? Surround yourself with great people Social, connecting with others is an important part of selfcare. Upbeat, positive and know how to enjoy life. Consider the quality of self-care Go for quality when quantity is lacking.

39 How Can I Implement Self-Care into my Daily Life? Spiritual Get in touch with your values what really matters. Attend church, read poetry, light a candle. REMEMBER THAT SELF-CARE IS NON- NEGOTIABLE! In order to live a healthy and rewarding life, self-care is a necessity.

40 What can I do better to manage work/family/stress/life this holiday season? We can take care of ourselves and be vulnerable to others, feel taken care of and be available to others. Making self-care a priority means you become a better care-giver for yourself and all those you love.

41 What can I do better to manage work/family/stress/life this holiday season? We have talked about self-care and the aspects of eating healthy, getting enough rest, and exercise. Self-Care also includes self-compassion, setting boundaries, and having a good grasp of what is truly valued.

42 What can I do better to manage work/family/stress/life this holiday season? Being overly committed is like being the conductor of a runaway train. Many of us become that conductor during the holidays before we know what hit us. Exchange overdoing with fun or restful activities will refresh you. Fail to plan and you plan to fail Make an effort to initiate plans in advance. Having a plan is crucial for people who are clean/sober/abstinent.

43 What can I do better to manage work/family/stress/life this holiday season? Have a back-up and exit plan. Pamper yourself Holidays can bring up a lot of emotions and it s good to give yourself some extra love. Make a commitment to yourself that on special occassions, holidays, and anniversary dates that you will live in the present moment.

44 What can I do better to manage work/family/stress/life this holiday season? Enjoy Spending time with your family, your children, and friends. Be of Service this may sound strange for self care, the truth is when you aren t focused on your own misery, you are taking care of yourself. Can be a moral booster.

45 What can I do better to manage work/family/stress/life this holiday season? The Usual Suspects Don t forget the self-care you do on a regular basis during the busy holiday season. You might double your efforts. Know your strengths, you don t have to have all the answers.

46 What can I do better to manage work/family/stress/life this holiday season? Unplug from screens, TV, Facebook, smartphone, tablets real face time beats digital face time any time. Maintain healthy boundaries Monitor your schedule and do not overload.

47 What can I do better to manage work/family/stress/life this holiday season? Monitor your schedule and do not overload. Eliminate items from your schedule if they don t serve your purpose. Be ruthless about task you take on. Delegate tasks to your family members.

48 What can I do better to manage work/family/stress/life this holiday season? Before adding an item to your schedule ask yourself if it: A. benefits yourself, is fun or relaxing. B. is required for pursuing your mission or values. C. Benefits your family or meets your family s needs. D. Benefits or meets your professional needs. Ask for help when you need it. Say NO without guilt and mean it. No one else will do this if I don t or It won t get done right if I don t do it. SAY NO.

49 SELF CARE IS NOT SELFISH SELF CARE IS SELF LOVE! Self-Care means taking care of our basic needs. If we don t do this, who will??

50 When the well s dry, we know the worth of water. ~ Benjamin Franklin

51 Where to go for HELP when your well has ran dry? Being able to recognize that one s level of compassion fatigue is creping up to the red zone is the most effective way to implement strategies immediately before things get worse. Personal Level Improve Self-Care (put your needs first) Carefully and HONESTLY assess your life situation for balance between nourishing and depleting activities Access to regular exercise, non-work interest, personal debriefing.

52 Personal Level Peers/Co-workers Supervisor Employee Assistance Program (EAP) Outside help (Blue Cross Blue Shield Waiver)

53 Where to go for HELP when your well has ran dry? Organizational Strategies Openly discussing and recognizing compassion fatigue in the workplace Develop a supportive work environment that will encourage Proper debriefing Regular breaks Mental health days Peer support Assessing and changing workloads Improve access to further professional development Regular check-in times (supervision) where staff can safely discuss the impact of the work on their personal and professional lives.

54 What if I think someone close to me is suffering from Compassion Fatigue? HAVE COMPASSION Be kind and supportive and start small, it can be hard to hear that something you have been trying to hide is obvious to others. Talking about the effects of the work can be helpful and a good starting point.

55 CHALLENGE Take time to complete a personal inventory of your personal and professional life. Give yourself a letter grade as to your current level of self-care. (A, B, C, D, or an F). Track progress through 2016, Find someplace that you will have access to one year from now, Nov/Dec 2016 and write down your current grade.

56 CHALLENGE Next year when you see your 2015 grade, again review your personal and professional life and level of self-care. Grade yourself and evaluate if your grade as improved, stayed the same, or has gone down. Explore what you could do different over the next year.

57 Summary Video

58 Sources Berry, J. (2012). My Clients, My Students, My Patients, Myself. In Self-Care Advice for Caring Professionals. Norman: The University of Oklahoma Health Sciences Center, College of Medicine. Brown, B. (n.d.). We can't practice compassion with other people if w don't treat ourselves kindly. Bonzena, C. (Director). (1988). NOBODY NEEDS TO KNOW [Motion picture]. USA: Child and Family Services, Inc., Hartford Connecticut. Evans, A. (2010, November 1). Self-Care During the Holidays. Metro Family Magazine.

59 Sources Jackson, K. (2014). The Ovelooked Core Competency. Social Work Today, 14(3), Markway, B. (2014). Seven Types of Self-Care Activites for Coping with Stress. Psychology Today. Mathieu, F. (2007). Running on Empty: Compassion Fatigue in Health Professionals. Rehab and Community Care Medicine. Mathieu, I. (2011). Self-Care During the Holiday. Psychology Today.

60 Sources Polce-Lynch, M. (2013). Self-Care is not selfish. Virgina Womens Center. Tarakovsky, M. (2013). How Clinicians Practice Self-Care & 9 tips for Readers. PsychCentral. Retrieved on November 4, 2015 from Zimering, R., & Bird Gulliver, S. (2003, April 1). Secondary Traumatization in Mental Health Care Providers. Retrieved September 27, 2015, from

Compassion Fatigue: Are you running on fumes?

Compassion Fatigue: Are you running on fumes? What is compassion? Feeling deep sympathy and sorrow for another who is stricken by suffering or misfortune, accompanied by a strong desire to alleviate the