wellness of healthcare providers – successful recovery from vicarious trauma post-deployment...
DESCRIPTION
Learning Objectives: At the conclusion of this activity, the participant will be able to: 1. Participants will be able to describe three characteristics associated with vicarious trauma. 2. Participants will be able to identify three healthy behaviors to improve psychological and physical health. 3. Participants will be able to describe efforts that address post-deployment challenges related to recovery.TRANSCRIPT
Wellness of Healthcare Providers –
Successful Recovery from Vicarious Trauma Post-Deployment
Vladimir Nacev, Ph.D., ABPPDiplomate, Clinical Psychologist
Defense Centers of Psychological Health and Traumatic Brain Injury (DCOE)
Disclosures
• The presenter has no financial relationships to disclose.
• This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with AMSUS.
• Neither PESG,AMSUS, nor any accrediting organization support or endorse any product or service mentioned in this activity.
• PESG and AMSUS staff has no financial interest to disclose.
• Commercial support was not received for this activity.
Learning Objectives:
•At the conclusion of this activity, the participant will be able to:
1. Participants will be able to describe three characteristics associated with vicarious trauma.
2. Participants will be able to identify three healthy behaviors to improve psychological and physical health.
3. Participants will be able to describe efforts that address post-deployment challenges related to recovery.
The views presented herewith are personal viewpoints of the author and do not necessarily represent the official
views of the US government.
Disclaimer
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Topics
Literature ReviewTrauma BasicsBurnout, Compassion Fatigue, and Vicarious TraumatizationBehavioral Health IssuesSelf-Care
Literature Review
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Literature Review
Seventy-five percent of psychologists admitted to experiencing distress within the past few years More than a third of those psychologists recognized that their own personal distress negatively affected the level of care provided to their clients In general the medical community exhibits a relatively high level of particular mental health problems
(Tyssen & Vaglum, 2002)
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Literature Review (cont.)
Past history of abuse is a predictor of developing vicarious traumatization (Pearlman & MacIan, 1995; Lerias & Byrne, 2003)
Being a female is one of the most reliable predictors of vicarious traumatization (Lerias & Byrne, 2003)
Males experienced more cognitive disturbances related to intimacy and self-esteem than females (Way, I et al., 2004)
Female psychologists who were exposed to high levels sexual trauma experienced more trauma related disturbances than female psychologists who had less exposure to sexually-themed trauma (Way, I et al., 2004)
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Literature Review (cont.)
Many psychotherapists have a personal history of abuse or family dysfunction (Sherman, Michelle D.; Thelen, Mark H. (1998) and Elliott, D. M. and Guy, James (1993))
Survey of social workers, over 40% endorsed intrusive thoughts related to working with trauma victims (Bride, 2007)
Younger clinicians might be more susceptible to vicarious traumatization than older clinicians (Lerias & Byrne, 2003; Marmar, Weiss, Metzler, & Delucchi, 1996)
Older individuals may have more experiences to draw from that help them cope more efficiently (Lerias & Bryne, 2003)
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Literature Review (cont.)
Self-care plan should include maintaining personal and professional boundaries (Sexton, 1999)
Maintain a manageable caseload with a variety of clients (Sexton, 1999)
In a study on trauma providers, providers experienced anxiety, feelings of suspiciousness and vulnerability, hyper-vigilance, a change in sense of safety as well as a difference in how they viewed themselves (Culver, McKinney & Paradise & 2011)
Agency directors in the study noted their worldview had changed after working with trauma victims
Trauma Basics
Trauma Incidents
Sudden and unexpectedDisrupt our sense of controlInvolve the perception of a life-damaging threatMay involve emotional/physical lossViolate assumptions about how the world works
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Potential Effects of Trauma
Diminished cognitive functioningRecurring thoughts of the eventSleep deprivationRe-victimizationRegression
(Way et al., 2004)
Potential Psychosocial Effects of Trauma
FearLossAngerAnxietyHypervigilanceBeing violatedBeing vulnerableFeeling helpless
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Potential Physical Effects of Trauma
Chest painHeadachesElevated BPMuscle tremorsTeeth grindingVisual difficultiesWeakness
Chills Dehydration Fatigue Nausea Fainting VomitingDizziness
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Potential Cognitive Effects of Trauma
Poor problem solving and abstract thinkingPoor attention and concentrationDisorientation to time
ConfusionNightmaresUncertaintyIntrusive images
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Potential Emotional Effects of Trauma
DepressionEmotional outbursts Feeling overwhelmed Loss of emotional controlAgitation Irritability
FearGuilt Grief Panic Denial Anxiety
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Behavioral Effects of Trauma
• Withdrawal • Antisocial acts • Inability to rest• Intensified pacing • Change in social activity • Loss of appetite• Increased alcohol consumption
Vicarious Trauma
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Vicarious Traumatization
Listening to graphic horrorsBearing witness to man’s crueltyParticipating in traumatic reenactmentsOccupational hazard for providers working with trauma survivorsEmpathic engagement and exposure to graphic and traumatic materialEmpathic engagement and exposure to man-made cruelty
(McCann & Pearlman, 1990; Pearlman & Saakvitne, 1995)
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Vicarious Traumatization
• Does not reflect pathology in the provider• Does not reflect intentionality by the
survivor• Impacts provider’s life and relationships• It is cumulative across time • Process that requires self-assessment,
prevention, and intervention
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Vicarious Traumatization
May interfere with effective treatment Disrupts cognitive schemasIntrusive thoughts and imageryDecreases sense of personal safetyHypervigilanceDifficulties with trust and intimate relations Self-esteem issuesIncreases cynicism, depression, discouragement, substance misuse (Way et al., 2004)
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Symptoms: Cognitive
Poor concentration DisorientationPreoccupation with suffering of patientsRigidityPoor memory
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Symptoms: Behavioral
RegressionIncreased startle responseMoodinessAccident pronenessRisk takingAddictive behaviorsShutdown
ImpatientIrritableWithdrawnNightmaresHypervigilanceLosing thingsAppetite changesLack of self-care
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Symptoms: Affective
AnxietyGuiltAnger/rageSadnessFearfulness
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Symptoms: Somatic
ShockBreathing difficultiesAches and painsDizzinessImpaired immune systemExhaustion
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Symptoms: Existential Dilemmas
Questioning spirituality, meaning of lifePervasive helplessness Shattered assumptions:
Life has meaningWorld is benevolentBad things happen to other peoplePower to change thingsForeshortened future
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Symptoms: Interpersonal Conflicts
With close relationships (physical/emotional)IsolationDread of working with clientsMistrustSexual dysfunctionLoss of boundaries
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Symptoms: Work Performance
Low morale and motivationErrors in judgmentStaff conflicts
ApathyAbsenteeismWithdrawal Late for workStigmaPoor communications
Coping Skills
Which is stronger, our desire to grow or our resistance to
change?
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Behavioral Health
The relationship between individual behaviors and the well-being of the
body, mind, and spirit
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Who is Affected?
Disaster professionalsHealthcare providersEmergency service personnelJournalists/war correspondents, photographersMass communication specialistsFamily caregivers
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Effective Coping Skills
Flexibility (ability to use multiple strategies)Accommodating (change the environment)Assimilating (acceptance of the environment)Positive attitude (hope)Variety (make it a part of daily life)
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Coping Skills
Cognitive restructuring: put things into perspective (Beck, 1976; Burns, 1999)Comforting thoughtsAppreciate and develop humor skillsBehavioral activation: hobbies, healthy pleasures (Ferster, 1973; Lewinsohn, 1975)Establish a support system
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Coping Skills
Adequate restProper dietProtection from the adverse elements in the environmentGroup cohesionSocial supportLeadership quality (be involved, be visible, and be a mentor)
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Sleep Hygiene
Impaired reflexesCognitive dysfunction
Affective instabilityBehavioral irritability
Sleep deprivation is a function of inadequate amount of sleep and insufficient quality of sleep
SideEffects
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Sleep Hygiene
Five factors to consider about sleep: Quantity QualityOptimal time for sleepOptimal amount of sleep neededEnvironment of sleep
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Sleep Hygiene
• Long-term sleep deprivation can result in: ‾ Depression, psychosis‾ Hypervigilance‾ Impulse control problems‾ Physical problems (ulcers, immune system,
weight gain)
Self-care
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The Whole Truth and Nothing But …
Truth #1: No one is immune to the effects of secondary traumatic stress - Choose fast or slow burn
Truth #2: The more dependent on work for self-worth and adequacy, the lower resiliency
Truth #3: With all the pain, the symptoms are an alert to take action
Professional Issues
Know the difference between advocacy and treatmentMonitor your own rescue fantasiesDraw on your own experiencesKnow your scope of practiceNo place for political agendas
Professional Issues
Be knowledgeable about trauma psychological healthDebrief yourself to diminish PTSD
Most difficultMost rewardingMost effective in countering VT
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Minimums for Self-care
Respect for dignity and self-worthResponsible for self-careUniversal right to wellnessPhysical rest, emotional rest and nourishmentTake breaks Share/talk with familyAvoid wishful thinking and self-blameAppreciate the rewardsSeek personal therapyRecognize the hazards of psychological practice – often grueling and demanding
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Processing Process with yourself
Most difficult and rewardingHow did it go?
Were participants activeWhat themes emerged
What was the hardest part? What worries you the mostWhat are you most likely to berate yourself aboutWhat are you most likely to feel bad about
Identify one thing you learned from this experienceWhat are you going to do to take care of yourself today?Any surprises?
Building Resilience
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Psychological resilience is the sum total of psychological processes that
permit individuals to maintain or enhance their levels of well-being and
functioning when responding to adversity
Potential Definition of ResiliencePotential Definition of Resilience
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Resilience
• More proactive and adaptive than prevention
• Emphasizes transforming a challenging situation into an opportunity
• Overlaps with stress management and coping
• Helps individuals learn by reflecting on high performance and successful coping
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The Effects of Trauma on Resilience
Increased odds of developing PTSD Most providers adapt to a multitude of dangerous and unfamiliar circumstances, long working hours, and separation from loved ones
Figley, C.R. (Ed.) (1995)
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What Works – Building Resilience
Recognize signs of compassion fatigue in yourselfRecognize signs of compassion fatigue in fellow employees•Involves doing two difficult things, simultaneously, in a stressful situation…
Self Soothing/Self-ComfortingSelf Confronting
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What Doesn’t Work
Engaging in coping strategies that will perpetuate/intensify self-destructive behaviors
Drinking alcohol, druggingExcessive spending, gamblingEating unhealthy foodsIsolating from othersCaring for everybody but yourself
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Getting Professional Help …
•Thoughts are overwhelming to the point of being frightened or distressed•Thinking of harming yourself or others•Feedback from family or friends concerned about your well-being and advising you to seek help•Needing someone to talk to about your experiences and feelings
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Successful Clinicians
Counter isolation in professional, personal, and spiritual lifeDevelop mindfulness and self-awarenessConsciously embrace complexityPractice active optimismEngage in holistic self-careMaintain boundaries and honor limitsDemonstrate exquisite empathyProfessional satisfactionCreate meaning
Do GoodDo No Harm
Be Compassionate
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References • Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York:
International Universities Press.
• Bride, B. E. (2007). Prevalence of secondary traumatic stress among social workers. Social Work, 52(1), 63-70.
• Burns, David D. (1999). Feeling Good: The New Mood Therapy. Avon Books .
• Culver, L. V. , McKinney, B., & Paradise, L. (2011). Mental health professionals' experiences of vicarious traumatization in post-hurricane Katrina New Orleans. Journal Of Loss & Trauma, 16(1), 33-42. doi: 10.1080/15325024.2010.519279
• Elliott, D. M. and Guy, James (1993). Mental health professionals versus non-mental-health professionals: Childhood trauma and adult functioning, Professional Psychology: Research and Practice, Vol 24(1), Feb 1993, 83-90.
• Ferster, C. B. (1973). A functional analysis of depression. American Psychologist, 28 (10), 857e870.
• Figley, C.R. (Ed.) (1995). Compassion Fatigue: Secondary Traumatic Stress Disorders from Treating the Traumatized. New York: Brunner/Mazel.
• Jenkins, Sharon R and Baird, Stephanie (2002). Secondary Traumatic Stress and Vicarious Trauma: A Validational Study, Journal of Traumatic Stress, 15, 423-432.
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References
• Lerias, D. & Byrne, M. (2003). Secondary traumatization: Symptoms and predictors. Stress and Health, 19, 129-138. doi: 10.1002/smi.969
• Lewinsohn, P.M. (1975). The behavioral study and treatment of depression. In M. Hersen, R.M. Eisler, & P.M. Miller (Eds.), Progress in behavioral modification (Vol. 1, pp. 19–65). New York: Academic.
• Pearlman, L.A., & Saakvitne, K.W. ( 1995). Trauma and the Therapist. New York: Norton
• Pearlman, L., & Mac Ian, P. (1995). Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists. Professional Psychology: Research and Practice, 26, 558–565.
• Rothschild, J. M., Keohane, C. A., Rogers, S., Gardner, R., Lipsitz, S. R., Salzberg, C. A., Landrigan, C. P. (2009). Risks of Complications by Attending Physicians After Performing Nighttime Procedures. Journal of the American Medical Association, 302(14), 1565-1572.
• Racusin, Abramowitz, & Winter, 1981.
• Sherman, Michelle D.; Thelen, Mark H. (1998). Distress and professional impairment among psychologists in clinical practice, Professional Psychology: Research and Practice, Vol 29(1), 79-85.
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• Sexton, L. (1999). Vicarious traumatization of counsellors and effects on their workplaces. British Journal of Guidance and Counselling, 27(3), 393-403.
• Tyssen, R. & Vaglum, P. (2002). Mental health problems among young doctors: an updated review of prospective studies. Harvard Review of Psychiatry, 10(3), 154-65.
• Way, I. et al. (2004). Vicarious trauma: A comparison of clinicians who treat survivors of sexual abuse and sexual offenders. Journal of Interpersonal Violence, 19(1), 49‐71.
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