1. STAYING SANE Presented by Carla Reece – Northwest Fire District

2. Stress - Why Should You Care? Source http://www.stressfreeworkweek.comhttp://www.stressfreeworkweek.com - How To Manage Your Workplace Stress In Less Than One Day With These Three Easy Steps with Steven Stockwell.

3. EUSTRESS vs. DISTRESS vs. DYSFUNCTION Three intensity levels of stress: Eustress = Positive, motivating stress Distress = Excessive stress Dysfunction = Impairment

6. 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

8. Input from Audience

9. Difficult Callers REMEMBER:  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

10. 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

11. PRACTICE AND LEARN DEFUSING SKILLS Active 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.

12. BUILD RESILIENCY Self-Awareness Self-Control Optimism

13. BUILD RESILIENCY Optimism (AGAIN) Mental Agility Strength of Character Connection

14. 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.

15. 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)

16. PSYCHOLOGICAL CRISIS An 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)

17. 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)

18. 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.

19. 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)

20. SIGNS AND SYMPTOMS OF DISTRESS I. COGNITIVE (Thinking) II. EMOTIONAL III. BEHAVIORAL IV. PHYSICAL V. SPIRITUAL

21. DISTRESS (excessive stress). Rx…Identify, Assess, & Monitor vs. DYSFUNCTION (impairment) Rx…Identify, Assess, & Take action

22. 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

23. I. SEVERE COGNITIVE DYSFUNCTION Suicidal/ Homicidal Ideation Paranoid Ideation Persistent Diminished Problem- solving Dissociation Disabling Guilt Hallucinations Delusions Persistent Hopelessness/ Helplessness

24. II. EMOTIONAL DISTRESS Anxiety Irritability Anger Mood Swings Depression Fear, Phobia, Phobic Avoidance Posttraumatic Stress (PTS) Grief

25. II. SEVERE EMOTIONAL DYSFUNCTION Panic Attacks Infantile Emotions in Adults Immobilizing Depression Posttraumatic Stress Disorder (PTSD)

26. Posttraumatic stress (PTS) is a normal survival response; Posttraumatic Stress Disorder (PTSD) is a pathologic variant of that normal survival reaction.

27. PTSD A. Traumatic event B. Intrusive memories C. Avoidance, numbing, depression D. Stress arousal E. Symptoms last > 30 days F. Impaired functioning

28. Predicting PTSD 1.Dose - response relationship with exposure 2. Personal identification with event 3. Very important beliefs violated

29. PTSD results from violation of: 1. EXPECTATIONS 2. DEEPLY HELD BELIEFS (Worldviews)

30. 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

31. Severity of PTSD Dissociation Psychogenic amnesia Persistent sleep disturbance Panic Severe exaggerated startle response Evidence of seizures

32. III. BEHAVIORAL DISTRESS Impulsiveness Risk-taking Excessive Eating Alcohol/ Drug Use Hyperstartle Sleep Disturbance Withdrawal Family Discord Crying Spells Hypervigilance 1000-yard Stare

33. III. SEVERE BEHAVIORAL DYSFUNCTION Violence Antisocial Acts Abuse of Others Diminished Personal Hygiene Immobility Self-medication

34. IV. PHYSICAL DISTRESS Tachycardia or Bradycardia Headaches Hyperventilation Muscle Spasms Psychogenic Sweating Fatigue / Exhaustion Indigestion, Nausea, Vomiting

35. IV. SEVERE PHYSICAL DYSFUNCTION Chest Pain Persistent Irregular Heartbeats Recurrent Dizziness Seizure Recurrent Headaches

36. 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

37. 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.

38. V. SPIRITUAL DISTRESS Anger at God Withdrawal from Faith-based Community Crisis of Faith

39. V. SEVERE SPIRITUAL DYSFUNCTION Cessation from Practice of Faith Religious Hallucinations or Delusions

40. NOTE! ALL OF THE SIGNS AND SYMPTOMS OF SEVERE DYSFUNCTION WARRANT REFERRAL TO THE NEXT LEVEL OF CARE! Also refer whenever in doubt.

41. PSYCHOLOGICAL ALIGNMENT Don’t argue Don’t minimize problem Find something to agree upon Is the most important element in establishing rapport

42. 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.”

43. 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

44. Laughter is the Best Medicine