Secondary Trauma PRESENTED BY OLIVE CREST MENTAL HEALTH
Secondary Trauma PRESENTED BY: OLIVE CREST MENTAL HEALTH PROGRAM HOLLY MILLER, PSY. D. RHONNA REYES, LMFT JIM SCHOOLER, LCSW
Overview �Trauma Definition Possible Traumatic Experiences Trauma-Related Symptoms �Secondary Traumatic Stress Definition Prevalence Potential Causes Experience of STS Formal Assessments �Managing Secondary Traumatic Stress at Work
I. Introduction: What is Trauma?
Activity � Disney Movies and Trauma �Identify one Disney movie that has a traumatic event or scene �Identify the scene and why you would consider this as traumatic �Brief statement of how you think the character coped with the traumatic event
Disney Movies and Trauma
Disney Movie
Disney Movie
Disney Movie
Disney Movie
Disney Movie
What is trauma? �Definition a deeply distressing or disturbing experience a very difficult or unpleasant experience that causes someone to have mental or emotional problems usually for a long time A serious injury or shock to the body, as from violence or an accident An emotional wound or shock that creates substantial, lasting damage to the psychological development of a person, often leading to neurosis. An event/s that involve a threat to the physical integrity on oneself or others. The response to such events may involve intense fear, hopelessness or horror. Individual may be the victim or a witness
Types of Traumatic Event
Types of Traumatic Events
Types of Traumatic Event
Types of Traumatic Event
Types of Traumatic Events
Types of Traumatic Event
Types of Traumatic Events
Types of Traumatic Events
Types of Traumatic Event
Cognitive Triangle and Trauma Related Symptoms
Trauma Related Symptoms �Affective trauma symptoms Fear: response has been generalized to people, places, things or situations that are reminders of the traumatic event Anxiety: feeling of being generally unsafe, hypervigilant, sense of impending doom Depression: as a response to a sudden loss of trust in other people and the world ( feelings of guilt, shame, diminished self -esteem, feelings of worthlessness, detachment/isolation, diminished interest in significant activities, persistent inability to experience positive emotions, and even suicidality) Anger: may be seen as unpredictable rages or tantrums, physical aggression toward property or others, noncompliant behaviors
Trauma Related Symptoms Continued… �Cognitive Trauma Symptoms Intrusive images: nightmares, intrusive thoughts, flashbacks Intrusive sensations: physiological reactivity to reminders or triggers (sights, sounds, smells, anniversary dates, etc. ) Inability to remember an important aspect(s) of the traumatic event Persistent and exaggerated negative beliefs about oneself, others, or the world (e. g. I am unlovable, I am damaged, It is my fault, No one can be trusted) Development of irrational beliefs about causation in order to gain some sense of control or predictability but may lead to blame towards self or others. (e. g. He sexually abused me because of how I dressed; I should have stopped my friend from getting in that car)
Trauma Related Symptoms Continued… �Behavioral Trauma Symptoms Physical Arousal caused by trauma reminders or triggers: panic symptoms, headaches, problems with sleep, startle response, problems concentrating Avoidance of trauma reminders to escape overwhelming negative feelings may result in tension-reduction behaviors: Alcohol/substance abuse, isolation or social withdrawal (avoiding people, places, situations or things), self-harm behaviors (cutting, burning), workaholism, emotional numbness, binging
Response to Trauma �“People who have endured horrible events suffer predictable psychological harm. There is a spectrum of traumatic disorders, ranging from the effects of a single overwhelming event to the more complicated effects of prolonged and repeated abuse. ” (Herman, 1992) �Even after experiencing traumatic events , many individuals are resilient and do not develop enduring trauma symptoms.
II. Relevance to Your Work as Educators
"Parents and teachers who take care of themselves are able to take better care of their children and students. “ NCTSN Basic Facts About Child Trauma
How Does This Relate To YOUR Work? FACT: One out of every 4 children attending school has been exposed to a traumatic event �Trauma takes a toll on children, families, schools, and communities. Trauma can also take a toll on school professionals. �Any educator who works directly with traumatized children and adolescents is vulnerable to the effects of trauma
How Does This Relate To YOUR Work? �For educators… …work activities and responsibilities bring daily contact with children, a population that is often exposed to trauma. AND …helping professionals can develop their own trauma symptoms and reactions.
Exposure to trauma: Who Is At Risk? Nurses Teachers Social workers Teachers aides Child welfare workers Law enforcement professionals First responders (paramedics, firefighters) Domestic and sexual violence advocates Prosecutors and judges Forensic investigators Physicians Therapists
III. What is Secondary Traumatic Stress (STS)?
Definitions � Vicarious trauma: profound negative changes in our worldview due to the exposure to traumatic content of clients (Saakvine & Pearlman, 1996). � Compassion fatigue: the deep emotional and physical wearing down that takes place when helping professionals are unable to refuel and renew (Figley, 1995). � Burnout: stress and frustration caused by the workplace (Saakvine & Pearlman, 1996). � Secondary traumatic stress: (through being exposed to others’ trauma…) the result of being a witness to a traumatic event or series of traumatic events, which can lead to PTSD-like symptoms (Figley, 1995). http: //www. olgaphoenix. com/statistics-painful-truth-about-vicarious-trauma/
STS: Who Is At Risk? � Common occupational hazard for professionals working with traumatized children � Risk appears to be greater among those who: are female have their on unresolved personal trauma(s) are isolated socially or organizationally feel they have been inadequately trained for their role/job are overworked and overwhelmed use coping strategies that do not help (i. e. addiction, numbing, isolation) � Protective factors: Longer duration of professional experience Perceived supportiveness of management Recognizing warning signs early and being proactive
Prevalence of STS � 70% of social workers exhibited at least one symptom of STS (Bride, 2007). � 42% of social workers said they suffered from secondary traumatic stress (Adams et al. , 2006). � 36 % of forensic investigators were experiencing moderate to high levels of secondary trauma (Perez et al. , 2010). � 50% of child welfare workers experienced STS symptoms in severe range (Conrad & Kellar-Guenther, 2006). � 34 % of female forensic interviewers reported experiencing symptoms of STS (Perron & Hiltz, 2006).
Potential Causes of STS �Direct/Indirect Contacts: Symptoms of trauma expressed in the classroom: � difficulty learning, forming relationships � emotion regulation troubles � poor concentration, inappropriate behavior � oversensitivity to sounds, unexpected changes etc. School misconduct/violence, bullying Being told details about personal traumatic experiences Discussion of current events/news Graphic drawings of trauma experiences Witnessing injuries, filing CPS reports
How Individuals Experience STS � Physical: Exhaustion, Insomnia/hypersomnia Somatic symptoms (headaches, stomachaches) Susceptibility to illness � Behavioral: Increased use of drugs/alcohol, Compulsive overeating, other addictions, Anger, Social withdrawal (Avinadav, 2011)
How Individuals Experience STS, Cont. � Psychological: Distancing Negative self-image Depression Inability to empathize Cynicism, bitterness Inability to have life outside of work � Workplace: Overly concerned with a particular student, Blurred boundaries at work, Absenteeism, tardiness, Lack of motivation Low job satisfaction and performance. (Avinadav, 2011) Heightened anxiety Irrational fear(s) Problems with intimacy Hypervigilance Intrusive imagery Loss of hope
Instrument Development �Compassion Fatigue Self Test- assesses one’s personal risk of burnout Adapted with permission from Figley, C. R. , (1995). Compassion Fatigue, New York: Brunner/Mazel. © B. Hudnall Stamm, Traumatic Stress Research Group, 1995 -1998 http: //www. dartmouth. edu/~ bhstamm/index. htm. http: //casat. unr. edu/docs/testa-smith. mary_ya. wa_08. pdf �Self-Care Assessment Worksheet- assesses one’s personal use of effective strategies to maintain self-care http: //www. ecu. edu/cs-dhs/rehb/upload/Wellness_Assessment. pdf
Formal Assessment of STS �Secondary Traumatic Stress Scale- assesses STS on 4 subscales (intrusion, avoidance, arousal, and total). Bride, B. E. , Robinson, M. R. , Yegidis, B. , & Figley, C. R. (2004). Development and validation of the Secondary Traumatic Stress Scale. Research on Social Work Practice, 14, 27 -35. http: //academy. extensiondlc. net/file. php/1/resources/TMCrisis 20 Coh en. STSScale. pdf �Professional Quality of Life Scale (Pro. QOL)- assesses compassion satisfaction and compassion fatigue http: //proqol. org/uploads/Pro. QOL_5_English. pdf B. Hudnall Stamm, 2009. Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (Pro. QOL).
IV. Managing Secondary Traumatic Stress (STS) in Our Work
It’s a fact… �Working with people in crisis causes ongoing exposure to stress and traumatic stress �Reactions to stress and trauma are normal (and even helpful at times). They can become problematic if there is too much. �They most be addressed regularly �Failure to address them as a part of our work can lead to secondary trauma. We can be reactive or proactive with stress…
Let’s be proactive in dealing with stress… �Identify future situations that can cause stress so you can plan ahead �Recognize the signs/symptoms that you are stressed �Pay special attention to take care of yourself Practice immediate interventions (deep breathing, relaxation techniques) Engage in activities that you enjoy outside of work Make sure your body has everything it needs (healthy eating, regular sleep, etc. ) Know when to reach out and seek help
…not reactive…signs of unhealthy stress � Poor concentration � Fatigue, low energy � Indecision/second-guessing � Irritable � Cloudy thinking � Negative comments � Inconsistent attendance and time � No/little/diminished concern and keeping � Diminished achievements � Poor problem-solving � Poor/no long-term planning � Deadlines missed � Low/mediocre standard of work � Low level of motivation � Unrealistic about self care for others � Competitive behavior � Lack of a sense of humor
What to do in the midst of stress Physical Self-Care � � � � � Eat regularly (i. e. , breakfast, lunch and dinner) Eat Healthy Exercise Get medical care when needed (and take time off when sick) Get massages Dance, swim, walk, run, play sports, sing, or do some other activity that is fun Get enough sleep Wear clothes you like Take day trips or mini-vacations Make time away from telephones
What to do in the midst of stress Emotional Self-Care � Spend time with others whose company you enjoy � Stay in contact with important people in your life � Give yourself affirmations, allow yourself to receive compliments from others � Reread favorite books, review favorite movies � Identify comforting activities, objects, people, relationships, places and seek them out � Allow yourself to cry � Find things that make you laugh � Express your outrage in social action, letters, donations, marches, protests � Play with children
What to do in the midst of stress Psychological Self-Care � Make time for self-reflection � Have your own personal psychotherapy � Write in a journal � Read literature that is unrelated to work � Do something at which you are not expert or in charge � Engage your intelligence in a new area (e. g. , go to an art museum, history exhibit, sports event, auction, theater performance) � Practice receiving from others � Say no to extra responsibilities sometimes � Be curious, learn something new for fun (e. g. , photography building model airplanes, cooking/baking, etc. )
What to do in the midst of stress Spiritual Self-Care � Make time for reflection � Spend time with nature � Find a spiritual connection or community � Be open to inspiration � Be aware of nonmaterial aspects of life � Be open to not knowing � Identify what is meaningful to you and notice its place in your life � Meditate � Pray � Sing � Contribute to causes in which you believe � Read inspirational literature (talks, music, etc. )
What to do in the midst of stress Workplace or Professional Self-Care � Take a break during the workday (e. g. , lunch) � Take time to chat with co-workers � Make quiet time to complete tasks � Identify projects or tasks that are exciting and rewarding � Set limits with students and colleagues � Arrange your work space so it is comfortable and comforting � Have a peer support group
What to do in the midst of stress Teacher Self-Care! � Find your support system. Just like students, teachers need to protect � � themselves from becoming isolated. Seek help for your own trauma-related distress. If your signs persist for longer then two to three weeks, it might be a good idea to seek further assessment or assistance from a health professional. Use positive coping strategies to manage emotions and distress: Try out calm breathing techniques, muscle relaxation, and guided imagery. Challenge unhelpful thoughts that cause you distress. Look for resources to help you feel more in control. Maintain a structured classroom environment. This is a good thing for both children and teachers. Plan ahead where possible, and have back-up strategies for difficult situations so you don’t have to do it on your own. Kenardy, De Young, Le Brocque & March, CONROD, University of Queensland, 2011
Now think… What do you do at Olive Crest Academy to manage stress? What more could you do beyond what you are already doing?
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