Tools and Tips for Managing Employee Issues with Traumatic Stress Barry Beder, LICSW President, Beder Consulting, LLC 2015 NECOEM/MaAOHN Annual Conference, Dec. 3, 4, 2015 Newton, MA
Overview Review Acute Stress Disorder (ASD) vs PTSD Causes Overview of treatments Workplace Management What s in Your Toolbox? Resources
Critical Incident Stress
Critical Incident An event that is extraordinary and produces significant reactions for the intervening person. It may be so unusual that it overwhelms the natural abilities that people have to cope with difficult situations.
For External Events to be Critically Stressful They Must Meaningful Be: Potentially challenging or threatening Must threaten our sense of our own ability to cope
Critical Incident Stress CIS is the natural reaction of a normal person to an extremely abnormal situation. It may manifest itself as a physical, cognitive, behavioral and/or emotional response that may be experienced almost immediately or delayed days, weeks, or months.
Critical Incident Stress The essence of the problem in critical incident stress is the reverberations and adjustments of our mind and body to the intensity of feelings experienced.
Types of CIS Reactions Cognitive Physical Emotional Behavioral
PTSD The best predictor of PTSD is the degree of exposure to the disaster. The greatest risk of PTSD is in persons exposed to life threat and, perhaps in those exposed to terror, horror and the grotesque - Lima et al. 1987; Parker 1977; Ursano and McCarroll 1990; Ursano et al. 1995
PTSD Key Determinants Exposure to an extraordinary stressor outside the usual realm of human experience Intrusive psychological re-experiencing of the traumatic event Psychological numbing/avoidance of and involvement with the external environment Autonomic nervous system hyperactivity and/or hyperfunction The symptoms must last for at least one month
PTSD symptoms are generally grouped into four types: Intrusive memories Avoidance Negative changes in thinking and mood Changes in emotional reactions
Early Indications of Possible PTSD Flashbacks Traumatic dreams Memory disturbances Self-medication (e.g., alcohol abuse) Anger, irritability, hostility which is difficult to control Persistent depression, withdrawal A dazed or numb appearance Panic attacks Phobia formation
What you Can Do? Van der Kolk (1996) Given the paucity of controlled studies, we are left with the clinical impression that the initial response to trauma needs to consist of reconnecting individuals with their ordinary supportive networks, and having then engage in activities that reestablish a sense of mastery. Source: Van der Kolk, Bessel, et al., (1996)
Van De Kolk (now) I was looking for a way for people to regulate the core arousal system in the brain and feel safe inside their bodies. My interest came from doing research that discovered how trauma affects the brain. Yoga turned out to be a way to get people to safely feel their physical sensations and to develop a quiet practice of stillness. www.traumacenter.org
Workplace Plan Considerations/Elements Should contain elements that have been demonstrated to help mitigate, and limit stressful impacts Provide requested or required intervention and treatment after the fact. Identify internal and/or external resources
5 Key Support Principles Research shows that five basic principles hold a demonstrated positive impact on resiliency and resolution: (1) Restoring a sense of safety (2) Calming anxiety and agitation (3) Enhancing self-efficacy (4) Building connectedness (5) Facilitating hope. [11]
Debriefing Controversy The specific intervention element of critical stress debriefing in the scientific literature is contraindicated, as it has not been shown to be effective and may actually be harmful in some instances. According to current research, however, critical stress debriefing, the central intervention of most critical incident programs, shows no preventive efficacy and well-controlled studies suggests risk of impaired recovery for some participants, especially the most severely symptomatic. (12)
PTSD DSM 5 Criteria DSM 5 criteria Diagnosis of PTSD requires exposure to an event that involved or held the threat of death, violence or serious injury. Exposure can happen in one or more of these ways: Experience of the traumatic event Witness, in person, the traumatic event Learning someone close to you experienced or was threatened by the
Treatment and Drugs Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but often includes medication. Combining these treatments can help improve symptoms, teach skills to address your symptoms, and learn ways to cope if any symptoms arise again.
Reactions to Critical Incidents Employee Perspectives Employees respond to critical incidents differently Some employees feel guilty if they do not have a strong reaction after a critical event
Reactions to Critical Incidents Employee Perspectives Employees were in agreement that you never really know what event will get to you. The following describes some of the more difficult incidents. Accidents resulting in death of co-workers. Fatalities involving people who employees knew personally. Fatalities that involved children, especially if that worker has children of a similar age. War, violence and grotesque experiences
Whenever Possible Its not your fault
The Antidote for Isolation is Connection
What can you do to help your employees? Education - Educate managers and supervisors on plan and immediate response Support - Communicate listening, caring and understanding Referral EAP, VA
Additional Resouces Federal Benefits (The site most veterans, widows and families of veterans would use) www.va.gov State Benefits (MA only) Dept of Veterans Affairs Every veteran in MA can contact his/her Town Hall or town website for an agent to assist them All Directors and agents are listed with hours and phone numbers.
Laws Protecting Veterans with Service-Connected Disabilities http://www.eeoc.gov/eeoc/publications/ada _veterans_employers.cfm
Footnotes 11. Hobfoll, S.E., Watson, P.J., Bell, C.C., et al. (2007). Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry, 70(4), 283-315. [12] McNally, R.J., Bryant, R.A., & Ehlers, A. (2003). Does early psychological intervention promote recovery from posttraumatic stress?psychological Science in the Public
Thank you Barry Beder 617-680-1325 bbeder@me.com