international conference of police chaplains

B3 – Stress ManagementB3 – Stress Management

B03 - Stress Management - Revised 2-8-12B03 - Stress Management - Revised 2-8-12

Presented byPresented byChaplain Mike DismoreChaplain Mike Dismore

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B03 - Stress Management - Revised 2-8-12

• International Conference of Police Chaplains B03 International Conference of Police Chaplains B03 Stress Management Core ClassStress Management Core Class

• Psychological Body Armor by George S. Everly, Jr., Psychological Body Armor by George S. Everly, Jr., Ph.D., ABPPPh.D., ABPP

• Stress Management for Emergency Personnel by Stress Management for Emergency Personnel by Chevron Publishing CorporationChevron Publishing Corporation

• The Relaxation & Stress Reduction WorkbookThe Relaxation & Stress Reduction Workbook

• Stress Management for Dummies by Allen Elkin, Ph.D.Stress Management for Dummies by Allen Elkin, Ph.D.

• Why Zebras Don’t Get Ulcers by Robert SapolskyWhy Zebras Don’t Get Ulcers by Robert Sapolsky

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• Basic stress conceptsBasic stress concepts• The two types of stressThe two types of stress• Coping methods for responding to stressCoping methods for responding to stress• Responding to stressResponding to stress• Concepts of traumatic stressConcepts of traumatic stress• Phases of Critical Incident StressPhases of Critical Incident Stress

B03 - Stress Management - Revised 2-8-12B03 - Stress Management - Revised 2-8-12 3

• Critical Incident Stress Management (CISM)Critical Incident Stress Management (CISM)• BurnoutBurnout• Burnout versus Compassion FatigueBurnout versus Compassion Fatigue• Post Traumatic Stress Disorder (PTSD)Post Traumatic Stress Disorder (PTSD)

B03 - Stress Management - Revised 2-8-12 4

A mental or emotional tension or strain A mental or emotional tension or strain characterized by feelings of anxiety, fear, etc.; characterized by feelings of anxiety, fear, etc.;

factor or combination of factors that causes such factor or combination of factors that causes such tension or strain as an urgent need or perceived tension or strain as an urgent need or perceived

threat (Webster)threat (Webster)


Forces from the outside world impinging on the Forces from the outside world impinging on the individual. Stress is a normal part of life that individual. Stress is a normal part of life that

can help us learn and grow. Conversely, can help us learn and grow. Conversely, stress can cause us significant problems. stress can cause us significant problems.

Stress released power neurochemicals and Stress released power neurochemicals and hormones prepare us for action (to fight or hormones prepare us for action (to fight or

flee). If we don’t take action, the stress flee). If we don’t take action, the stress response can lead to health problems. response can lead to health problems.

Prolonged, uninterrupted, unexpected, and Prolonged, uninterrupted, unexpected, and unmanageable stresses are the most unmanageable stresses are the most

damaging types of stress.damaging types of stress.B03 - Stress Management - Revised 2-8-12 6

Eustress – “Good Stress” – mental or physical Eustress – “Good Stress” – mental or physical reactions caused by pleasant, positive, reactions caused by pleasant, positive, enjoyable experiences resulting in euphoric enjoyable experiences resulting in euphoric feeling or positive energyfeeling or positive energy

Distress – “Bad Stress” – mental or physical Distress – “Bad Stress” – mental or physical strain imposed by pain, trouble, worry, or the strain imposed by pain, trouble, worry, or the like and usually suggests a state or situation like and usually suggests a state or situation that can be relievedthat can be relieved


Common denominator for stress – CHANGECommon denominator for stress – CHANGE Life changesLife changes Work related changesWork related changes Environmental changesEnvironmental changes Organizational changesOrganizational changes



The stress response is activated by our The stress response is activated by our perception of events.perception of events.

Our ability to change our interpretation of Our ability to change our interpretation of stressful events is a key to stress resilience!stressful events is a key to stress resilience!

““We are disturbed not by events, but by the We are disturbed not by events, but by the views that we take of them.” Epictetusviews that we take of them.” Epictetus

Stressors can be real or imagined.Stressors can be real or imagined.

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Coping – Constantly changing cognitive and Coping – Constantly changing cognitive and behavioral efforts to manage specific demands behavioral efforts to manage specific demands that are appraised as taxing or exceeding the that are appraised as taxing or exceeding the resources of the personresources of the person Maladaptive Coping – reduces stress in the short-Maladaptive Coping – reduces stress in the short-

term, but serves to erode health in the long-termterm, but serves to erode health in the long-term

Adaptive Coping – reduces stress while at the same Adaptive Coping – reduces stress while at the same time promotes long-term healthtime promotes long-term health



RESISTANCE, RESILIENCE, RECOVERYRESISTANCE, RESILIENCE, RECOVERY

ResistanceResistance ResiliencyResiliency RecoveryRecovery

• Education• Positive mental attitude• Preparation.• Practice, planning•Healthy living

• Crisis Intervention•Peer support• PFA• Support Services• Guidance , direction, information

• Self recovery• EAP• Therapy• Recovery programs• On-Site academy

Create ResistanceAssessmentInterventionEvaluation

Enhance ResiliencyAssessmentInterventionEvaluation

Speed RecoveryAssessmentInterventionEvaluation

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What are your typical “early warning signs” of What are your typical “early warning signs” of excessive stress?excessive stress?

What are the first changes that you notice in What are the first changes that you notice in yourself? yourself?

What do others notice?What do others notice?

What signs do you pay attention to?…which What signs do you pay attention to?…which signs do you ignore?…why?signs do you ignore?…why?

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MBI – Human Services SurveyMBI – Human Services Survey

Stress Self TestStress Self Test

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Eat regular, healthy mealsEat regular, healthy meals Normal exerciseNormal exercise Normal restNormal rest No self-medicatingNo self-medicating Meditation/PrayerMeditation/Prayer Reading/MusicReading/Music CounselingCounseling



Suddenness – surprise causes more stress.Suddenness – surprise causes more stress.

Intensity – how awful the experience.Intensity – how awful the experience.

Degree – how widespread is the impact.Degree – how widespread is the impact.

Duration – the longer the exposure, the Duration – the longer the exposure, the greater the harm.greater the harm.

Frequency – the more horrible events, the Frequency – the more horrible events, the greater a potential for a problem.greater a potential for a problem.

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““Any situation that results in an overwhelming Any situation that results in an overwhelming sense of vulnerability or loss of control” sense of vulnerability or loss of control”

Dr. Roger SolomonDr. Roger Solomon

““Any situation or event that causes strong Any situation or event that causes strong emotional reactions, that has the potential to emotional reactions, that has the potential to

interfere with an ability to function.”interfere with an ability to function.”

Dr. Jeffrey MitchellDr. Jeffrey Mitchell


Physical signs/symptomsPhysical signs/symptoms HeadachesHeadaches FatigueFatigue Rapid pulseRapid pulse Elevated blood pressureElevated blood pressure Nausea/vomitingNausea/vomiting Profuse sweatingProfuse sweating


Physical Danger SignalsPhysical Danger Signals Chest pain or difficulty breathing.Chest pain or difficulty breathing.

Excessive blood pressure.Excessive blood pressure.

Collapse from exhaustion.Collapse from exhaustion.

Unusual heart beat patterns.Unusual heart beat patterns.

Signs of severe shock (weak pulse, pale Signs of severe shock (weak pulse, pale color, excessive sweating, rapid breathing).color, excessive sweating, rapid breathing).

Excessive dehydration.Excessive dehydration.

Vomiting or having blood in feces.Vomiting or having blood in feces.B03 - Stress Management - Revised 2-8-12 19

Cognitive signs/symptomsCognitive signs/symptoms Hyper-vigilance (“Can’t come off Hyper-vigilance (“Can’t come off

duty”)duty”) Intrusive images/flashbacksIntrusive images/flashbacks Confusion/poor memoryConfusion/poor memory Decreased concentrationDecreased concentration Blaming (responsibility/guilt)Blaming (responsibility/guilt) Uncertainty Uncertainty


Cognitive Danger SignalsCognitive Danger Signals Decreased alertness to surroundings.Decreased alertness to surroundings. Difficulties making decisions requiring Difficulties making decisions requiring

immediate attention.immediate attention. Disoriented (cannot estimate time; unsure Disoriented (cannot estimate time; unsure

of where they are; unsure of who they are).of where they are; unsure of who they are). Unable to focus on one thought at a time.Unable to focus on one thought at a time. General state of mental confusion.General state of mental confusion. Seriously slow or disrupted thinking.Seriously slow or disrupted thinking. Cannot recall names of familiar equipment Cannot recall names of familiar equipment

or people.or people.B03 - Stress Management - Revised 2-8-12 21

Emotional signs/symptomsEmotional signs/symptoms Survivor’s guiltSurvivor’s guilt IrritabilityIrritability Intense angerIntense anger Grief/sadnessGrief/sadness DepressionDepression Feeling lost/aloneFeeling lost/alone Emotional outburstsEmotional outbursts


Emotional Danger SignalsEmotional Danger Signals Panic reactions.Panic reactions. Numb, shock-like state.Numb, shock-like state. Phobic reactions (extreme fear).Phobic reactions (extreme fear). General loss of control of emotions.General loss of control of emotions. Rage reactions and exaggerated Rage reactions and exaggerated

emotions.emotions. Overwhelming sadness that blocks Overwhelming sadness that blocks

action.action.


Behavioral signs/symptomsBehavioral signs/symptoms Sleep Sleep

disturbances/restlessness/nightmaresdisturbances/restlessness/nightmares Changed communicationsChanged communications Withdrawal/suspiciousnessWithdrawal/suspiciousness Appetite changes Appetite changes Increased alcohol consumptionIncreased alcohol consumption Changes in social activitiesChanges in social activities


Behavioral Danger SignalsBehavioral Danger Signals Significant changes in speech patterns.Significant changes in speech patterns. Excessive anger at minor inconveniences.Excessive anger at minor inconveniences. Excessive crying or laughing.Excessive crying or laughing. Violent physical reactions; destroying property.Violent physical reactions; destroying property. Curling up and rocking continuously.Curling up and rocking continuously. Meaningless repeated actions.Meaningless repeated actions. Withdrawal from others and hiding.Withdrawal from others and hiding. Wringing hands, body shakes, and/or facial Wringing hands, body shakes, and/or facial

tremors.tremors.


Spiritual signs/symptomsSpiritual signs/symptoms Questioning of faithQuestioning of faith Anger at GodAnger at God ““Distance from religion”Distance from religion” Belief that God is powerlessBelief that God is powerless ““How could God let this How could God let this

happen?”happen?” Anger toward religious leadersAnger toward religious leaders


Spiritual Danger SignalsSpiritual Danger Signals Withdrawal from place of worship.Withdrawal from place of worship. Uncharacteristic religious involvement.Uncharacteristic religious involvement. Sense of isolation from God.Sense of isolation from God. Religious obsessions or compulsions.Religious obsessions or compulsions. Religious hallucinations or delusions.Religious hallucinations or delusions.


Expressing feelingsExpressing feelings Attend a stress debriefingAttend a stress debriefing Getting back to workGetting back to work ExerciseExercise Healthy eating and drinkingHealthy eating and drinking Changing the memoryChanging the memory Pacing the painPacing the pain Accept enjoyment and diversionAccept enjoyment and diversion Don’t expect miracle curesDon’t expect miracle cures The Bottom Line – Face itThe Bottom Line – Face it


Posttraumatic stress (PTS)Posttraumatic stress (PTS)is a normal survival response.is a normal survival response.

Posttraumatic Stress Disorder (PTSD) Posttraumatic Stress Disorder (PTSD) is a pathologic variant of that normal is a pathologic variant of that normal

survival reaction.survival reaction.


A formally recognized psychiatric disorder A formally recognized psychiatric disorder which may result from an exposure to a which may result from an exposure to a

critical incident or “Traumatic event.” PTSD critical incident or “Traumatic event.” PTSD is identified by three characteristic clusters is identified by three characteristic clusters of symptoms which follow a psychologically of symptoms which follow a psychologically

distressing event which is considered distressing event which is considered outside the range of normal human outside the range of normal human

experience.experience.


1.1. EXPECTATIONSEXPECTATIONS

2.2. DEEPLY HELD BELIEFS (Worldviews)DEEPLY HELD BELIEFS (Worldviews)

~ Belief in a just and fair world~ Belief in a just and fair world

~ Need to trust others~ Need to trust others

~ Self - esteem, Self - efficacy~ Self - esteem, Self - efficacy

~ Need for a predictable and SAFE world~ Need for a predictable and SAFE world

~ Spirituality, belief in an order and congruence in ~ Spirituality, belief in an order and congruence in life and the universelife and the universe

(Everly & Lating, 2004, Personality Guided Treatment of (Everly & Lating, 2004, Personality Guided Treatment of PTSD, Wash. DC: APA.)PTSD, Wash. DC: APA.)


Traumatic EventTraumatic Event Intrusive Recollected ThoughtsIntrusive Recollected Thoughts Stress ArousalStress Arousal Numbing/Withdrawal/AvoidanceNumbing/Withdrawal/Avoidance Symptoms Last > 30 days Symptoms Last > 30 days Impaired FunctioningImpaired Functioning


FlashbacksFlashbacks DreamsDreams De’ja vuDe’ja vu AvoidanceAvoidance Sleep disturbanceSleep disturbance Loss of interestLoss of interest

DetachmentDetachment Emotional numbingEmotional numbing Increased startleIncreased startle IntensificationIntensification


PTSD Prevalence: 10 - 15% of Law PTSD Prevalence: 10 - 15% of Law Enforcement Personnel (See Everly & Mitchell, Enforcement Personnel (See Everly & Mitchell, 1999)1999)

PTSD Prevalence: 10 - 30% Of Those In Fire PTSD Prevalence: 10 - 30% Of Those In Fire Suppression (See Everly & Mitchell, 1999)Suppression (See Everly & Mitchell, 1999)

PTSD Prevalence: 16% Vietnam Veterans PTSD Prevalence: 16% Vietnam Veterans (Nat PTSD Study)(Nat PTSD Study)

PTSD Prevalence: ~ 12% Iraq War Veterans PTSD Prevalence: ~ 12% Iraq War Veterans (Hoge, et al., 2004, NEJM)(Hoge, et al., 2004, NEJM)


““A state of physical, emotional, and mental A state of physical, emotional, and mental exhaustion caused by long-term involvement in exhaustion caused by long-term involvement in

emotionally demanding situations.”emotionally demanding situations.”

Pines & AronsonPines & Aronson

““Burnout is used to describe a syndrome that Burnout is used to describe a syndrome that goes beyond physical fatigue from overwork. goes beyond physical fatigue from overwork.

Stress and emotional exhaustion are part of it, but Stress and emotional exhaustion are part of it, but the hallmark of burnout is the distancing that goes the hallmark of burnout is the distancing that goes

on in response to the overload.”on in response to the overload.”

MaslachMaslach


““The natural behaviors and emotions that The natural behaviors and emotions that arise from knowing about a traumatizing arise from knowing about a traumatizing event experienced by a significant other event experienced by a significant other

– the stress resulting from helping or – the stress resulting from helping or wanting to help a traumatized person.”wanting to help a traumatized person.”

FigleyFigley



BehavioralBehavioral High absenteeismHigh absenteeism Postponing client contactsPostponing client contacts Avoiding discussions at work with colleaguesAvoiding discussions at work with colleagues Irritability with clients and co-workersIrritability with clients and co-workers Avoiding work responsibilityAvoiding work responsibility Working harder and getting less doneWorking harder and getting less done Marital and family conflictMarital and family conflict

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CognitiveCognitive Feelings of anger and resentmentFeelings of anger and resentment NegativismNegativism Feelings of guilt and blameFeelings of guilt and blame DepressionDepression Feeling discouraged and indifferentFeeling discouraged and indifferent Sense of failureSense of failure Feeling powerless and hopelessFeeling powerless and hopeless


PhysicalPhysical Feeling tired during the workdayFeeling tired during the workday FatigueFatigue ExhaustionExhaustion Sleep disordersSleep disorders Frequent headachesFrequent headaches Frequent colds and fluFrequent colds and flu Frequent vague aches and painsFrequent vague aches and pains



Stress Survival Skills:Stress Survival Skills:Personal Resilience PlanPersonal Resilience Plan

Step 1: Self AssessmentStep 1: Self Assessment What are my early warning signs of What are my early warning signs of

excessive stress?excessive stress? What do I do now on a daily basis for self What do I do now on a daily basis for self

care?care? What do I do on a weekly basis to improve What do I do on a weekly basis to improve

self care?self care? What do I do when my stress level is What do I do when my stress level is

unusually high?unusually high? What do I do to address the impact of What do I do to address the impact of

vicarious trauma in my life?vicarious trauma in my life?41


Stress Survival Skills:Stress Survival Skills:Personal Resilience PlanPersonal Resilience PlanStep 2: Planning for the futureStep 2: Planning for the future

What can I add to my self care routine? What can I add to my self care routine? (identify several if possible)(identify several if possible)

How will I make time for these new strategies How will I make time for these new strategies for self care?for self care?

How often should I review what I am doing?How often should I review what I am doing? What challenges do I expect to have with self What challenges do I expect to have with self

care as I make these changes?care as I make these changes? How will I know if the changes are helping? How will I know if the changes are helping?

What do I hope will be the important What do I hope will be the important outcomes I will notice as I improve self care?outcomes I will notice as I improve self care?

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Stress Survival Skills:Stress Survival Skills:Personal Resilience PlanPersonal Resilience Plan

Step 3: Getting Support Step 3: Getting Support

Who can I turn to for support with my Who can I turn to for support with my plan?plan?

How often should I check in with How often should I check in with him/her?him/her?

What professional support is available to What professional support is available to me if I need it?me if I need it?

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