Iom Stress Management Dha

Stress Management DHA South Africa

Stress Management Stress in humanitarian work What is stress How do we recognise stress How can we deal with stress Personally In the workplace Individual stress management plan Group destress/debrief

Why is stress management important Humanitarian aid work is inherently stressful. Stress takes a toll on humanitarian aid workers Staff stress adversely affects the organization and its mission Stress and its adverse effects can be lessened.

Humanitarian aid work is inherently stressful Separation from family Physically demanding working and living conditions Lack of privacy and personal space Long hours, heavy work loads, chronic fatigue Lack of time, resources, support to do job Conflicts within work team Conflicts with local authorities Chronic danger Repeated exposure to tales of horrific experiences Direct exposure to gruesome scenes and terrifying experiences Moral anguish over choices, triaging, limits to effectiveness

Stress takes a toll on humanitarian aid workers One-third or more of staff show clinically significant sign of emotional distress at end of assignment Post traumatic stress syndromes Vicarious (secondary) traumatization Burnout and compassion fatigue Depression Pathological grief Anxiety Multiple psychosomatic complaints

Staff stress adversely affects the organization and its ability to carry out its mission Less commitment to agency and higher rates of turnover Higher accident rates and higher rates of illness; increased absenteeism and greater health care utilization Poor decision making; behaviors that place team members and recipients at risk Lowered efficiency and effectiveness in carrying out assigned tasks Increased legal liability Potential for harm to beneficiaries

Stress and its adverse effects can be lessened Impacts of stress on individuals, on organisations, and on results for beneficiaries CAN be reduced IF stress is recognized, prioritized and properly managed Strategies Reduce exposure to stressors Lessen impact of stressors that do occur on individuals Increase capacity of individuals to deal with stress

What is Stress? Like the weight on the bridge, stress is the pressure in our lives. A small amount of pressure can show us what we are capable of. It can actually help to make us stronger. But when the pressure gets more intense, we can ‘bend’ and ‘strain’ like the bridge. We may start to feel unwell or anxious, or we might become irritable or unable to think clearly. Sometimes the stress is too much and we feel like our lives are going to fall apart If nothing is done, people can fall apart

Stress is pressure in our lives. A little pressure can be a good thing – it can help us perform better and make us stronger. Too much pressure, however, can make us feel as if we’re under strain, or even breaking

Types of stress Cumulative/chronic stress Traumatic stress Vicarious/secondary stress

What exactly is stress? Stress is a bio-psycho-social response to challenges in our environment It involves the release of certain hormones, physical changes, psychological changes etc that equip us to deal with challenging situations If these hormones and changes build up or are maintained, they can actually cause us damage Or, if there is a massive dose of stress at once, this can also be damaging

What causes stress Stress can be caused by anything and it is usually the combination of many little things that determines our stress levels. Causes of stress can include Pressure to perform at work Long working hours Continuous deadlines Arguments Financial difficulties Relationship problems Communication difficulties Physical problems Worries/anxiety

What causes stress Extra causes of stress in humanitarian work Separation from family Physically demanding working and living conditions Lack of privacy and personal space Long hours, heavy work loads, chronic fatigue Lack of time, resources, support to do job Conflicts within work team Conflicts with local authorities Chronic danger Repeated exposure to tales of horrific experiences Direct exposure to gruesome scenes and terrifying experiences Moral anguish over choices, triaging, limits to effectiveness

What influences stress tolerance? Your support network – A strong network of supportive friends and family members is an enormous buffer against life’s stressors. On the flip side, the more lonely and isolated you are, the greater your vulnerability to stress. Your sense of control – If you have confidence in yourself and your ability to influence events and persevere through challenges, it’s easier to take stress in stride. People who are vulnerable to stress tend to feel like things are out of their control. Your attitude and outlook – Stress-hardy people have an optimistic attitude. They tend to embrace challenges, have a strong sense of humor, accept that change is a part of life, and believe in a higher power or purpose. Your ability to deal with your emotions . You’re extremely vulnerable to stress if you don’t know how to calm and soothe yourself when you’re feeling sad, angry, or afraid. The ability to bring your emotions into balance helps you bounce back from adversity. Your knowledge and preparation – The more you know about a stressful situation, including how long it will last and what to expect, the easier it is to cope. For example, if you go into surgery with a realistic picture of what to expect post-op, a painful recovery will be less traumatic than if you were expecting to bounce back immediately.

Questions Think about when you have been stressed. What factors were causing those stressors? (Hint: Think of your work, environment, your family, home, health, friends, and other matters.) Think back to the bridge. If you are like that bridge, how much weight do you feel you are carrying – a light weight, a moderate weight, or a weight that is almost too much for you to bear? Can you think of a time when the “last straw broke the camel’s back” for you or someone you know? What was the last straw? What were some of the underlying reasons why you or they reacted that way?

What are the signs of stress? Stress affects everyone in different ways. Sometimes you may not notice that stress is affecting you until you notice small changes in your behavior or your health. Stress can affect our physical health; how we feel, think, and act; our spirituality; and how we relate to other people. The ‘damage’ that stress can cause includes: Mistakes and accidents (these are often due to fatigue or to trying to do things too quickly); Making poor decisions; Increased risk of various illnesses; Arguments and relationship problems; and Exhaustion and burnout. No-one is immune from the effects of stress, but different people are affected in different ways. Signs of stress can show up in our bodies, feelings, thoughts, behaviors, and spirituality.

How do we experience stress Physical Emotional Psychological/thinking Behavioural Spiritual

Questions How can you tell when you are under stress – what signs do you notice in yourself? (Hint, think about how stress can affect your bodies, feelings, behaviour, thoughts and spiritual outlook on life). What signs of stress have you noticed among other colleagues?

Common signs of stress - Physical Tiredness; Difficulty sleeping, or else spending a lot of time in bed; Nightmares; Headaches; Back pain; Inability to relax; Dry mouth and throat; Feeling sick or dizzy; Pounding heart; Sweating and trembling; Stomach-ache and diarrhea; Loss of appetite, or over-eating; Feeling very hot or cold; Shortness of breath; Shallow, fast breathing; Hyper-vigilance; .

Emotional Depression; Tearfulness, or feeling a desire to cry but being unable to; Mood swings; Anger (at self or others); Agitation; Impatience; Guilt and shame; Shock; Feelings of helplessness and inadequacy; Feeling different or isolated from others; Feeling overwhelmed or unable to cope; Feeling rushed all the time; Anxiety; Panic or phobias; Loss of sense of humor; Boredom; Lowered self-esteem; Loss of confidence; Unrealistic expectations (of self and others); Insecurity; Becoming self-centered, and unable to think about others; Feelings of vulnerability; Feeling worthless.

Behavioural Lack of initiative Working long hours; Poor productivity; Loss of job satisfaction; Carelessness; Absenteeism; Increased smoking or use of alcohol or drugs (including prescription drugs); Excessive spending or other activities to try to take one’s mind off the situation; Loss of motivation; Withdrawal from others or becoming dependent on them; Irritability; Critical of self and others; Relationship problems; Lack of self-care; Nail biting; Picking at skin; Speaking in slow monotonous voice, or fast, agitated speech; Taking unnecessary risks (e.g. when driving); Trying to do several things at once;

Thinking Concentration and memory difficulties; Indecisiveness; Procrastination; Pessimism; Thinking in ‘all or nothing’ terms; Very sensitive to criticism; Self-critical thoughts; Loss of interest in previously enjoyed activities; Imagining that the worst will happen; Preoccupation with health; Inflexibility; Confusion and disorientation; Excessive fears Trying to avoid thinking about problems; Avoiding any reminders of a traumatic experience; Flashbacks, or intrusive thoughts about difficulties; Hindsight thinking (‘If only...’ ‘why didn’t I...’); Negative thoughts about oneself, one’s work, family, the future, and the world; Time seems to slow down or speed up;

Spiritual Questioning the meaning of life; Loss of purpose; Loss of hope; Changes in beliefs; Doubts; Giving up faith; Cynicism; Loss of sense of community with others; Sense of being abandoned; Spiritual dryness; Unforgiveness; Bitterness; Feeling distant from God; Difficulty praying; Anger at God or at life.*Some of these signs can also be due to other causes, such as a physical illness – they are not always signs of stress.

Review These are all normal signs, found among many people who experience stress. They do not mean that you are weak or unable to cope. However, if you feel your stress symptoms are very severe, or significantly interfering with your life, consider getting help. Finally, as stress accumulates and stays at high levels for long periods of time, humanitarian workers are at increased risk of experiencing burnout. Burnout is a type of stress reaction linked to long-term exposure to work-related stressors.

Burnout Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed and unable to meet constant demands. As the stress continues, you begin to lose the interest or motivation that led you to take on a certain role in the first place. Burnout reduces your productivity and saps your energy, leaving you feeling increasingly helpless, hopeless, cynical, and resentful. Eventually, you may feel like you have nothing more to give. You may be on the road to burnout if: Every day is a bad day. Caring about your work or home life seems like a total waste of energy. You’re exhausted all the time. The majority of your day is spent on tasks you find either mind-numbingly dull or overwhelming. You feel like nothing you do makes a difference or is appreciated. The negative effects of burnout spill over into every area of life – including your home and social life. Burnout can also cause long-term changes to your body that make you vulnerable to illnesses like colds and flu. Because of its many consequences, it’s important to deal with burnout right away.

Burnout Work-related causes of burnout Feeling like you have little or no control over your work. Lack of recognition or rewards for good work. Unclear or overly demanding job expectations. Doing work that’s monotonous or unchallenging. Working in a chaotic or high-pressure environment Lifestyle causes of burnout Working too much, without enough time for relaxing and socializing Being expected to be too many things to too many people. Taking on too many responsibilities, without enough help from others Not getting enough sleep Lack of close, supportive relationships

Burnout Burnout is a serious condition that can have significant impacts on a persons functioning and take a long time to recover from Humanitarian workers have amongst the highest rates of burnout We all have individual and organisational responsibilities to prevent, recognise and deal with burnout

Questions What are the ways that you experience stress? Which signs of stress do you observe most frequently in your culture? Which signs do you see less in your culture? Do you notice any differences with other cultures/expatriates in how stress is commonly expressed? Are you currently experiencing any of these signs of stress? If so, which ones?

Preventing and coping with stress Recognizing that you have signs of stress and are ‘carrying a heavy weight’ is the first step in coping with stress. Understanding the causes of your stress is the second step. The next steps are to use strategies to reduce stress and/or cope better with unavoidable stress.

Dealing with Stress? Changing the situation – reducing the stressors

Dealing with Stress? Changing how you deal with stress

Dealing with Stress? Self-care – changing the way you look after yourself

Dealing with stress Dealing with stress can be done in several ways Changing the situation (the load on the bridge) Changing the way you deal with stress (how the load is spread out on the bridge) Changing the way you look after yourself (making the bridge stronger through healthy supports) Even when the situation cannot be changed, there are things you can do to help yourself feel less stressed. Although working to reduce or manage your symptoms of stress may not change whatever caused you to feel stressed in the first place, it can help you feel better and work more effectively. Just like stress can effect us physically, emotionally, behaviourally, thought patterns and spiritually, we can address all of these areas to deal with stress

Changing the situation Problem Solving Assertiveness Good Communication

Problem-solving Identify the problem as early as possible. Specify the problem accurately. Try to break it down into its different parts. What exactly is causing the problem? ‘ Brainstorm’ solutions. This means listing as many ideas as possible, without dismissing any that you think would not work. At this stage don’t consider whether they are good or bad ideas, just list them all. Sometimes listing a silly or impossible idea triggers us to think of one which is possible. List the advantages and disadvantages of each solution. Choose the best solution or combination of solutions. Try out the solution. Review the problem-solving process. How well did the solution work? If it did not work well, consider what you could do differently another time.

Assertiveness Many people have a negative view of assertiveness and think that it means demanding that you get your own way. This is especially true in certain cultures and faith groups where people believe that it is good to be modest and deferential and never say ‘no’ to the requests of other people. In fact, assertiveness is related to: Respecting and valuing other people and yourself; Listening to other people; Communicating honestly and clearly about your views and needs; Being able to politely say ‘no’ to requests when you want to. When you are assertive you clearly and honestly communicate your views and needs without anger or aggression, and also listen to and respect other people’s point of view.

Assertiveness How can you communicate assertively? Assertiveness can feel difficult to put into practice, but it’s not a complicated concept. It involves: Speaking about your own feelings about a situation, circumstance, or behavior using the formula, “I feel… when… because…”; Expressing what you would like to see happen instead (e.g., “I would appreciate it if…”); Being polite, clear, and honest; and Giving the other person a chance to speak, and listening to them with respect.

Good Communication Good communication can help to resolve problems and reduce stress at work, just as it can help a marriage or relationships with family and friends. This is especially true when working in a multicultural team where misunderstandings are common and can lead to tension. Having greater understanding about what is going on around you tends to help you feel more in control, and less stressed and frustrated. Good communication can help you understand more about what’s going on around you. This can help you feel more in control and less frustrated.

Good Communicating In a work setting, good communication is something that every team member is responsible for. Communication usually works best when it is two-way, so a good place to start with the topic of communication is thinking about how you are communicating with others. How are you helping other people understand your thoughts, actions, and intentions? Remember, the actual meaning of your message is what is received and understood, not necessarily what is given Asking questions is also a part of good communicating. Some of the time (especially in multicultural teams) other people won’t communicate what we need or want to know in a way we can understand it. That’s why asking questions when you would like an explanation or when you do not understand a decision is such an important part of good communication

Questions What helps you to feel better during stressful times in your life? What has helped you in the past? What has been negative? What do you do to relax and get away from work and your problems?

Coping strategies/self-care Different people need different techniques to reduce their signs of stress, so it is important that you find the ones which work for you. Try some strategies from every domain – physical, emotional, thinking, behaviour, and spiritual.

Physical strategies Be self-aware, and spot when you have symptoms of stress. Use this as a warning sign to encourage you to take stock and look after yourself. Physical exercise enhances mood and helps to relieve tension. Find an activity you enjoy (e.g. walking, swimming, running, cycling, playing sport, an aerobic video, gardening, or chopping wood). Eat a balanced diet with plenty of vitamins. Ensure you are eating enough (for energy), but don’t overeat. Drink plenty of water. Relaxation exercises can help your body feel more relaxed and take away aches and pains. Try tensing and relaxing your muscle groups (e.g. your hands, then your eyes, mouth, stomach, toes etc). Reduce your alcohol and caffeine intake, as these tend to magnify feelings of stress or depression. Get enough sleep. Stress is tiring, so you may need to sleep for longer than usual. Having a banana or cup of milk before bed may help.

Emotional Strategies Write a journal, including your thoughts and feelings. Or, if you prefer, write emails or letters, or tape record your thoughts, or talk to someone about them. This helps you process your experiences, and stops them going round and round in your head. Talk to friends, family, and/or colleagues about your experiences. Allow yourself to cry if you want to. Emotional tears contain a stress hormone, so crying helps people feel better. Smiling and laughing can help you feel better. Try watching a funny movie, reading something amusing, or having a laugh with friends. If you feel very distressed, consider seeking help.

Behavioural Strategies Do things that help you relax or that you enjoy (e.g. chat with friends; watch a film; go to a place you like; read; have a relaxing bath; listen to music; draw; make something). Don’t isolate yourself. Spend time with people you like. Give yourself treats; be kind to yourself. If you feel overwhelmed by having too much to do, try to set yourself small goals and just focus on doing one thing (perhaps starting with an easy task). Prioritize. Be assertive. Delegate tasks, and ask for time off if you need it. Be willing to ask for help.

Thought patterns Realize it is normal to feel low or have symptoms of stress when involved in humanitarian work. Don’t blame yourself – most people have such symptoms. It is not a sign of weakness, and does not mean that you are ‘not coping’. Remember that these feelings will likely pass, and you will feel better. Lower your expectations of yourself. You don’t have to do everything perfectly. Don’t become too introspective, or spend long periods of time just thinking about your worries. If you have negative thoughts (e.g. ‘I’m really bad at this job’), try to speak to someone else to get an objective, external perspective. Negative thoughts may be a sign of stress or depression, rather than reality. Remind yourself of times you have coped with stress before, and what helped you then. ‘Success breeds success’ – remembering past times of coping helps you to cope again.

Spiritual strategies Remind yourself of the value of the work you are doing. Remember the good things in the world – the people who are helping others, etc. If you have spiritual beliefs, use these to help you gain a sense of perspective and meaning. Talk with others who share your beliefs or values, or read some books which help sustain your inner life. If you have questions about the meaning of life or why there is suffering, find people to talk to about these matters. Meditate Pray, or ask people to pray for you. If necessary, forgive yourself or other people.

Looking After Yourself S leep T alking R est and Relaxation E xercise and Eating well S upport (to others and from others) S pirituality and silence

Questions Create your own list of stress-management techniques which work for you. Which techniques do you think you could start to use? Make sure you have at least one from each group (physical, emotional, behavioral, thinking, spiritual)

Individual stress management plan What are three things you like about your work? What are three things you find stressful about your work? What are the top causes of stress in your life right now? What signs or symptoms do you notice in yourself when you are stressed? What are three self-care strategies that already help you cope with the unavoidable stress in your life? What are two other self-care strategies that might help you cope better with the unavoidable stress in your life? What are three things you could do to reduce a cause of stress in your life (hint: think about problem-solving, assertiveness, and communication skills)? What are two things you can do during the next month to manage stress in your life? Write these things down as goals (e.g., I will…). These goals should be specific, realistic, and achievable. When will you do these things?

Organisational Actions – MINIMUM ACTIONS Ensure the availability of a concrete plan to protect and promote staff well-being for the specific emergency Prepare staff for their jobs and for the emergency context Facilitate a healthy working environment Address potential work-related stressors Ensure access to health care and psychosocial support for staff. Provide support to staff who have experienced or witnessed extreme events Make support available after the mission/employment

Remember Humanitarian work is….. inherently stressful Stress associated with humanitarian work will….. Inevitably take a toll on humanitarian workers Stressed humanitarian workers have an impact on Themselves Colleagues Organisation Beneficiaries Impacts of stress can…. Be reduced by….. Recognising Managing Prioritising

Resources 1. Action Without Borders/Idealist.org (2004). Website with resources on stress management for aid workers, managers and workers’ families. http://www.psychosocial.org 2. Antares Foundation (2005). Managing Stress in Humanitarian Workers. Guidelines for Good Practice . Amsterdam: Antares Foundation. www.antaresfoundation.org 3. Headington Institute (2005). Various resources and free online training modules on understanding and coping with the stress associated with humanitarian work. http://www.headington-institute.org 4. McFarlane C. (2004). ‘Adjustment of humanitarian aid workers’. Australasian Journal of Disaster and Trauma Studies . ISSN: 1174-4707, Volume 2004-1. http://www.massey.ac.nz/~trauma/issues/2004-1/mcfarlane.htm 5. National Child Traumatic Stress Network and National Center for PTSD (2006). Psychological First Aid: Field Operations Guide (Second edition). http://www.ncptsd.va.gov/ncmain/ncdocs/manuals/PFA_ 6. People in Aid (2003). Code of Good Practice in the Management and Support of Aid Personnel. http://www.peopleinaid.org/pool/files/code/code-en.pdf

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