HFB 3132 Mental Health Wellbeing for Paramedics David

HFB 3132 Mental Health & Wellbeing for Paramedics David Dawson 5 th August 2019 vu. edu. au Victoria University, RTO Code 3113 CRICOS Provider No. 00124 K (Melbourne) CRICOS Provider No. 02475 D (Sydney)

Week 4: Stress and Resilience 2

Week 3: Stress Part 1 focuses on stress. Part 2 focuses on resilience. Week Three Topics: Stress: What is Stress? The Resilience Model 3

HFB 3132 Mental Health & Wellbeing for Paramedics Week 4 Unit Learning Outcomes Covered: 1. Develop an understanding of the stress process and apply techniques or tactics for dealing with stress including those used by ambulance paramedics. 2. Explain how social support (social capital) relates to health and stress. 4

Aims For This Lecture 1. To put forward a definition of stress. 2. To present a model of resilience. 3. To relate the model of stress to the biopsychosocial model. 4. To identify sources of stress. 5

Objectives 1. To be able to describe the ways in which people have 2. 3. 4. 5. 6. 7. 8. 9. thought of stress (stimulus, response, process). To be able to give a definition of stress. To recognise that there are other views of stress (e. g. Hobfoll). To describe the role of appraisal in the experience of stress. To describe the biopsychosocial aspects of stress. To apply the resilience model to a stressful or challenging situation. To integrate the biopsychosocial aspects of stress with the resilience model. To identify the sources of stress. To apply the resilience model to personal circumstances as appropriate. 6

What Is Stress? (1) Can you think of some ways to describe and/or define stress? What are your immediate thoughts? Material for this week is in Chapter 3 of Caltabiano (2002 & 2008). 7

What Is Stress? (2): Symptoms of Stress 8

What Is Stress? (3): Outcomes of Stress 9

What Is Stress? (4) DVD, “Workplace Stress: Stopping The Juggernaut. ” Off-air recording of ABC-TV Catalyst program broadcast September 6, 2007. Copied under Part VA of the Copyright Act. DVD Identify the sources and effects of stress. Is stress real or important? Why? 10

Stress Caltabiano, et. al. (2002 & 2008, Chap 3, p 86) describes three ways of looking at stress. Stress may be thought of as a: 1/ Stimulus. 2/ Response 3/ Process. 11

Stress as a Stimulus. This approach basically says that what happens to people is important. Stress is caused by things (stressors) in a person’s environment. So if we all experience certain events then we will all experience stress. Started with the work of Hans Selye. Good stress (eustress) & bad stress. 12

Stress as a Response. This approach focuses on how people respond to stressors. The term ‘strain’ is often used to describe a person’s psychological and physiological responses or reactions to stressors. 13

Stress as a Process. This approach takes the view that stress is a process involving stressors, the way the person interacts and adjusts to these stressors and the resulting strain (or response to the stressor). This is the most current view of stress 14

One Model Of Stress Model taken from Caltabiano (2008) p 89. 15

Stress Alternative view – Conservation of Resources (Hobfoll) Stress occurs when a person’s resources are depleted as a result of an event or situation. Resources included everything one has access to that would help deal with a situation. 16

Stress Definition Of Stress Caltabiano, et. al. * describe stress as “the condition that results when personenvironment transactions lead the individual to perceive a discrepancy – whether real or not – between the demands of a situation and the resources of the person’s biological, psychological or social systems. ” *(2002, p 87 or 2008, p 90) 17

Stress When a person believes that they have the resources to cope with a demand then the diagram could look like this: Demand → Resources → No discrepancy perceived → No stress When a person believes that they do not have the resources to cope with a demand then the diagram could look like this: Demand → Resources → Discrepancy perceived → Stress 18

Stress There are many ways of viewing and describing stress. Nearly every textbook will have a different way of describing it. For example, this diagram has been taken from Montgomery & Evans (1984, p 14). 19

Stress Here are some very selective quotes taken from King, Stanley & Burrows (1987, pp 3 -4) to give one more description of stress: “…stress is a negative emotional experience which results from negative thoughts about our environment. ” “…an understanding of stress should include the idea that stress is a state of unacceptable divergence between perceived demands and capabilities to adapt. ” More briefly, but perhaps just as accurately: “stress arises from doubts about coping. ” 20

Week 4: Stress End of part 1. 21

Week 4: Stress Part 2. Resilience. Sources of stress at work (2 slides). 22

Questions related to resilience What is resilience? How can resilience be achieved? Can resilience be achieved? Should it be built before and/or after disasters? Is it possible to build resilience from a psychological and community perspective? 23

Resilience Definition: “An ability to avoid, overcome, or adapt to adverse circumstances” (de Terte & Becker) Definition: “The ability to bounce back after excessive stress” (Agaibi & Wilson) 24

Resilience Another definition: “The ability of an individual to maintain healthy psychological and physical wellbeing despite being exposed to adversity” (Bonnano) Note the absence of wider community influences in these definitions. 25

Resilience is NOT something an individual has or does not have. Rather it is something that can be learned. 26

Stress & Resilience Models of resilience can be found in the literature. Usually have these components: 1. 2. 3. 4. 5. Thoughts. Emotions. Behaviours. Physical response/activities. Environmental component This model taken from de Terte, et al. , (2009). 27

Stress & Resilience Components Of The Resilience Model: Event/Situation Thoughts Behaviours Emotions Physical Responses Social Context Managing the stress process means managing the components of the model. 28

Event/ Situation RESILIENCE MODEL Environment Family Community Society Physical Response Emotions Thoughts Manage your reaction Behaviours Your reaction OPTIMAL REACTION OUTCOME YES TEST Is your reaction helpful? Is it helping you achieve your goals? Is it normal in this situation? Is it realistic? NO ADJUST

Stress Event/situation. The event is simply the event or situation that has the potential to cause stress. This includes situations that are potentially or actually harmful, unpleasant or demanding and can include being insulted, being assaulted, frustrating situations and unreasonable demands. 30

Stress Thoughts. These are things that go through your mind in relation to the event (or potential stressor). A situation becomes a stressor for you when you see it as one. This is the appraisal part of the process. 31

Stress Thoughts cont. … Sometimes there are other but related thoughts that can go through your mind. Things like, “I’m no good, ” “They are all better than me, ” “I’m so useless, ” “I should be able to do better, ” “I feel so embarrassed, ” I feel ashamed, ” etc. These thoughts can be unrealistic and lead to more stress. 32

Stress Thoughts cont. … Essential cognitive components of resilience are: An individual’s optimism Problem solving skills Perseverance Resourcefulness 33

Stress Behaviours. This is what one does in response to the way the event is appraised. It is commonly called the ‘fight or flight’ response which means that you stay and deal with the situation or you run away from it. Either response can be appropriate although it does depend on the situation. 34

Stress Behaviours can also include violence, expressions of anger, avoiding the event, escaping from the event. Behaviours can be adaptive or maladaptive. Maladaptive behaviours can include smoking, drinking (or some other substance abuse) and overeating. 35

Stress But behaviours also can be things you do to cope like doing relaxation exercises or exercise. The stress response involves a physiological reaction the prepares you for action. So, one way to deal with it is to exercise – kind of uses up the chemicals (hormones) produced by the stress response. 36

Stress Note that ‘behaviour’ in this model may refer to actions individuals may do as a result of one of the other domains if the model. E. g. A person feeling sad may chose to engage in drinking, or chose to engage in exercise – both behaviours that have the aim of lifting the sad mood. 37

Stress Note that the category of ‘behaviour’ also encompasses preventative physical activities such as physical exercise, relaxation, sleep, rest and other aspects of individual self-care. 38

Stress Emotional responses. These are the negative feelings associated with stress. These feelings include things like unhappiness, dissatisfaction, feeling miserable, depression, feeling fearful, anxiety and feelings of hostility. 39

Stress The emotional component has been difficult to measure and determine Key component of the model due to its relation to mental illness ‘Emotional Intelligence’ is a key coping mechanism. 40

Stress Physiological responses. This the way your body responds biologically to the situation. It includes things like changes (increases) blood pressure, pulse rate, breathing rate and perspiration. There is also an increase blood flow to muscles and in muscle tension. Caltabiano (pp 94 -95) describes this as the General Adaptation Syndrome (GAS). 41

General Adaptation Syndrome Alarm Reaction: to mobilise bodies resources, very high arousal (that cannot be sustained) Stage of Resistance: the body tries to adapt to the stressor, high physiological arousal, increased susceptibility to other health problems Stage of Exhaustion: prolonged arousal, long term ill-health or death 42

Social Context “The most relevant environmental feature of this model is social support” – de Terte & Becker Your social context is all the people you interact with at whatever level. Partners, family, friends, colleagues etc. Community groups. Sports clubs. Society. Social resources like medical care, education. It is possible to have a negative social context. 43

Social Context Psychological resilience cannot be separated from resilience at the family, community or societal level as there are clear linkages between these aspects. A collection of resilient individuals does not guarantee a resilient community. When building resilience family, community and society must be taken into account. (Note the arrows on the model) 44

Appraising Events As Stressful Primary & Secondary Appraisal. Primary appraisal occurs when the event is first encountered. Could appraise the event as: Irrelevant Good Stressful 45

Appraising Events As Stressful If the event is appraised as stressful a further appraisal is made. Harm-loss – damage already done. Threat – the expectation of future harm. Challenge – the opportunity to achieve something positive. People high on neuroticism tend to appraise events as threatening. 46

Appraising Events As Stressful Secondary Appraisal – the ongoing assessment of the resources you have for coping. If you judge that you have the resources to deal with the situation then it is experienced as less stressful. It is an ongoing process of making appraisals as we interact with our environment. 47

Appraising Events as Stressful The kinds of appraisals you could make are: I can’t do it - I know I’ll fail. I’ll try, but my chances are slim. I can do it if I receive some help. I’ll try doing this way but if that doesn’t work I can try some others. I can do it if I work hard. No problem – I can do it. 48

What Factors Lead To Stressful Appraisals? Two general factors – the person & the situation. Person factors – intellectual, motivational & personality. E. g. personality: Self esteem > self-efficacy. E. g. Motivation: the more you want something that is threatened (loss) the more stressful the threatening event is appraised. Belief system: irrational beliefs can lead to negative appraisals. 49

What Factors Lead To Stressful Appraisals? Situation factors Strong demands and imminent are more stressful. Ambiguity. About role or job (role ambiguity), about harm (when it is not clear how harmful the situation might be). Desirability. How much the situation is disliked. Controllability. How much control you have over the situation. 50

Sources of Stress Throughout life. – Developmental stress The person. – Personal responses The family. – interpersonal conflict The community and society. Job stress 51

Sources Of Job Stress Factors Demands. This scale measures issues like workload, work patterns and the work environment. Control reflects how much say a person has in the way they do their work. Managerial Support. This factor measures encouragement, sponsorship and resources provided by the employer. 52

Sources of job stress Job Stress Factors cont. … Peer Support measures colleague encouragement and support at work. Relationships. Promoting positive working to avoid conflict and dealing with unacceptable behaviour. Role. This factor asks employees whether they understand their job role & whether their employer ensures that they do not have conflicting roles. Change. This scale measures how organizational change is managed and communicated at work. 53

Video. Activity for Next Week. “Ambos” Watch for stressful events and resilience… Cognitive, emotional, behavioural and physiological responses to these events Note the presence and absence of family, community and social support Note too the dissonance between what is stated, facial expressions and tone. How would you respond in these situations? 54

Sources of Stress: Severity Low work morale. Sleep disturbance, e. g. loss of, disruption, not enough. Lack of forward planning in the system from poor administration. Fear of lack of organisational support should I be injured. Dealing with the death of children. Inadequate funding of ambulance services. Having my own life threatened. Witnessing the death or serious injury of an on-duty colleague. Having no say in decisions that affect my work. Inability to be with the family on special occasions. Severity rated by paramedics on a 1 – 9 scale 55

Sources of Stress: Impact Sleep disturbance, e. g. loss of, disruption, not enough. Low work morale. Interruption to meals (lack of meals, rushed eating, spoilt meals). Lack of forward planning in the system from poor administration. Inadequate funding of ambulance services. Patients who abuse the ambulance system. Shift work. Being a shift worker. Hospital by-pass. Emergency work overload, multiple calls. Having no say in decisions that affect my work. Severity rated on a 1 – 9 scale. Frequency rated on a 1 – 9 scale. Impact = Severity x Frequency 56

Sources of Stress It seems that it is the everyday or more common things that have more impact over time. The more obvious severe sources of become less import when frequency of occurrence is considered. 57

Week 4: Stress End of Lecture. 58

Reference Read Caltabiano Chap 3. 59

Activity Question: Not all stressors (or events or situations) produce the same physical reactions. What are two factors that influence the way we physically respond to stress? Caltabiano identifies three main areas as sources of stress: from within the person, from the family and the community. Identify at least two sources of stress from each of these areas. One view of stress is that it is caused by events or things that happen to us. One way of assessing stress from this point of view is the ‘social readjustment rating scale’ (SRRS) developed by Holmes & Rahe. Go to the Social Readjustment Rating Scale (SRRS) on page 113 of Caltabiano. Identify which of those events have occurred to you in the last 12 months. You obtain your score by adding the values of those events that apply to you under the heading ‘mean value. ’ 60

The following slides are stored old slides and are no longer used. 61

Stress Components Of The (Montgomery & Evans) Stress Model: Event Thoughts Responses Behavioural Emotional Physiological 62

General Adaptation Syndrome Abbreviated to GAS. Is a biological response to stress. There are three stages: 1. Alarm reaction. 2. Stage of resistance. 3. Stage of exhaustion. 63