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Secondary traumatic stress: recognizing the signs and doing something about

them

Oregon Center of Excellence for Assertive Community Treatment (OCEACT)

Erin Kinavey Wennerstrom, Anders Wennerstrom & (Sondra Stegenga)

ARRIVAL2

Introductions – Who are we?

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Erin Kinavey

Wennerstrom M.Ed., IMH-E®

Anders Wennerstrom,

MBA, LSSMBB, ACC, RYT-200

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Session Objectives

• Define secondary stress• Recognize signs and symptoms• Practice simple stress reduction

and wellness techniques

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Who is in the room?

What age groups do you serve?

What is your

profession?

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Where do you work?

n o r m a l d e v e l o p m e n tl a y e r s o f t h e b r a i n

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Have you worked with a child or familywho has experienced trauma?

Abuse

NeglectThe death of a caregiver

Witnessed a violent eventHow did it make you feel?

Reflect on your experience

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Pair and share

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Without describing

the event itself, what experiences

and feelings have you had?

2 min each

Without describing

the event itself, what experiences

and feelings have you had?

2 min each

Definitions

Burnout

Secondary Traumatic Stress (STS)

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Burnout

Shows up as:

1. (Emotional) Exhaustion

2. Cynicism (depersonalization)

3. Feeling ineffective

• Due to chronic work stressors

• May result in relational problems and insensitive interactions.

(M aslach and Jackson, 1981)

Burnout in teachers is specifically correlated with:

1. Demographics

2. Lack of support

3. Job design

• Role conflict

• Role ambiguity (Hoffm an, Pa llad ino & Barnett 2007)

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Harrison and Westwood (2009) clarify that burnout is different from STS.

Secondary Traumatic Stress (STS), Compassion Fatigue (CF) and Vicarious Trauma (VT)

There is debate in the field about what the differences are between STS/Compassion Fatigue (CF) and Vicarious Trauma (VT). Several authors have been working on further refining and defining the differences (e.g. Harrison and Westwood, 2009; Avery, 2001; Bush, 2009; and Figley, 1995)

Secondary traumatic stress is rooted in empathetic engagement and builds on the underlying understanding of both compassion fatigue and vicarious trauma, but results in ‘an acute stress disorder or symptoms similar to post-traumatic stress disorder’ (Bush, 2009, pg.25). Symptom clusters of arousal, intrusion, and isolation.

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Secondary Traumatic Stress (STS)

Because they are more closely related and overlapping than not, for our purposes today we will treat STS, CF, and VT as synonymous--and an natural consequence for caregivers who are exposed to the trauma of others through personal relationships.

(Figley, 1995: Kinavey Wennerstrom, Stegenga, & Lund, 2018)

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A Model of Secondary Stress ResponseHears about

or sees someone close to

them struggle with a

stressful event or trauma

Arouses sympathetic

nervous system

Stress hormones release –cortisol,

adrenaline

Fight or flightIncrease in BP

shuts down non-essential

systems

Anxious, nervous,

depressedperceive threats

More stress is generatedIsolation,

arousal, and intrusion. Less able to be an empathetic caregiver

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Adapted from Boyatzis and McKee (2005)

C o m m o n r e s p o n s e s t o e x c e s s i v e s t r e s s a n d t r a u m a N O R M A L r e s p o n s e s t o A B N O R M A L e v e n t s aches and pains sweating, shortness of breath, heart palpitationschanges in appetite, sleep, activity level, immunityeasily startled, worriedmood swings, irritability, restlessnessnumbness, isolation, withdrawal, tendency to minimize the experiencedifficulty concentrating/rememberingfeelings of self-blame, survivor guilt, shameinterruption of equilibrium negative reinforcement of adaptive behaviors

Secondary Traumatic Stress (STS)

• Attunement can expose caregivers to secondary trauma, especially if affected individual is their responsibility

• Caregivers’ unmet basic needs result in reduced access to adaptive qualities, creativity & compassion - may compromise re-attunement, restoration of attachment and healing potential

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Potential Risk factors for STS

• Accumulation of stressful life events

• Poverty

• Trauma, abuse and neglect

• Lack of work life balance

• Difficulty setting boundaries and keeping them

• Witnessing physical and or emotional violence

• Social isolation

• Lack of peer supports

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What does it look like?Symptoms of STS

• Pre-occupation with the child’s story or situation

• Re-imagining child’s traumatic event

• Stomach or digestive issues

• Rapid heart rate/panic feelings

• Dissociation or detachment from day to day activities

• Neglecting ones own needs

• Pushing too hard to get things done

• Shift in feelings of safety17

Activity - Professional Quality of Life Scale (ProQOL)

The ProQOL• Measures Compassion Satisfaction, Burnout and

Compassion Fatigue.• One measure being used to quantify STS-• Free and available for use• Completing the survey is for your own reflection.

If you are willing to help us gain better understanding of STS in helping professions, please read the consent page and complete the demographics section and leave the survey behind when you leave. Thank you!

ProQOL v5 (2009) B. Hudnall Stamm

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What to do about it?

Individual level

• Simple techniques that can be practiced by the individual, for example self-care or mindfulness

Social level

• Build community, relationships and trust, e.g. sharing experiences

Structural level

• Making change to systems, routines, organization and environment

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If you do one thing, work on social/peer supports – James Caringi

Why Systems Level/Structural Strategies?

Promoting a positive and supportive workplace!

• Systems level structural supports can have some of the largest impact on outcomes (Tseng, Liu, & Wang, 2011)

• Organizational climate is linked to levels of provider stress

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Yet, how it can feel some days…

https://www.youtube.com/watch?v=vJV7TUF9Gxw

Systems level supports do not need to be expensive or time consuming to have an impact!!

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Systems/Structural Strategies

• Supportive and supported leadership - Hire and train leaders who have specialized knowledge in early childhood systems and supports and have enough time and capacity to support staff

• Regularly scheduled (e.g. annual) organization-wide training on STS

• Supportive practices built into organizational routines (e.g. reflective supervision)

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Systems/Structural Strategies

• In organizational materials, highlight work/life balance stories

• Incorporate stress management strategies into staff and team meetings (e.g. deep breathing, mindfulness, individual coaching)

• Leaders model and promote work/life balance

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Most of all…foster a climate of trust, respect, and collaboration! We are better together!

https://www.youtube.com/watch?v=An2OaIbPSII24

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Social StrategiesWork on relationships, knowing one another, building trust

Make sure everyone has someone safe to talk to and process their experiences

Social improvements are

• High impact• Accessible

• Cost effective25

Social StrategiesWhat this can look like

• Find informal time with peers

• Take a break together or have lunch together

• Structured time

• Set aside time to share experiences and emotions resulting from work

• Assign mentor or peer through a ‘buddy system’

• Reflective supervision

• Increase opportunities to spend time in groups to build community

• Provide training, e.g. in STS or compassion training

• Facilitated group work to work on organization structures – e.g. routines or schedules

• Host brown bag lunches or social events after work26

Individual Strategies

Self care

• Exercise• Rest

• Healthy diet

• Time with family and friends

• Hobbies• Massage

Activities that activate renewal processes

• Mindfulness (e.g. yoga, tai-chi, meditation)

• Hope

• Compassion

• Laughter, joy, playfulness

• Time in nature

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Adapted from Boyatzis and McKee (2009)

“You can’t reduce the stress, but you can increase renewal” - Boyatzis

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Mother Teresa understood compassion fatigueShe wrote in her plan to her superiors that it was MANDATORY for her nuns to take an entire year off from their duties every 4-5 years to allow them to heal from the effects of their care-giving work.

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Stress Reduction Techniques

There are several evidence based techniques for stress reduction, e.g.• Diaphragmatic breathing (yoga tradition)

• Progressive Muscle Relaxation (Jacobson, 1920s)

• Transcendental Meditation (Maharishi Mahesh Yogi, 1950s)

• Relaxation response (Benson, 1960s)

• Mindfulness-Based Stress Reduction (Kabat-Zinn, 1970s)Varvogli & Darviri (2011)

What do they have in common?

• Mindfulness, awareness

• Breathing exercises

• Activate parasympathetic nervous system29

Let’s PracticeBelly breathing

Extended exhale to hack into the body’s systems of downregulation

Slowly count as you breatheThe length of your inhale, 1-2-3-4Then, starting over, the length of your exhale, 1-2-3-4

Without striving, let the exhale extend by one, or maybe two more counts, 1-2-3-4-5-6Get curious, maybe there is a slight pause at the end of the exhale

Take a moment to notice the experience30

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Let’s Practice

Mindfulness sensory activity:

• First count 5 things you can see

• Next, count 4 things you can hear

• 3 things you can feel

• 2 things you can smell

• 1 thing you can taste

Take a moment to notice the experience

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Body scan

Bring awareness to the physical sensations in the body.

Focus on one part of the body at a time.

Move attention from toes to the head or vice versa.

Search for ‘body scan meditation’ to find videos with guided meditations.

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Alternate nostril breathing

According to the yoga tradition, alternates between upregulating (activating the sympathetic nervous system) and downregulating (activating the parasympathetic nervous system)

Use your fingers to close one nostril at a time.

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Summary

• Notice your physical experience

• Interrupt the stress response

• Shift into renewal

• Commit to practice over time

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Three Good Things Exercise

1. Think about the three things that have happened during the last couple of days that you are most happy about …

2. … and why they happened

https://youtu.be/ZOGAp9dw8Ac

Seligman on 3 good things35

Self-Care

“Self-care is an ethical imperative.

We have an obligation to our clients - as well as to ourselves, our colleagues, and our loved ones - not

to be damaged by the work we do”.

Saakvitne & Pearlman (1996), Pearlman and Caringi (2008).

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Keep in Touch - Continue the Conversation

• Tweet at us with the hashtag #AKIMH2019• @ErinKinavey• @Raviantllc

You can also find us at raviantllc.com and reach us by email at shine@raviantllc.com

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References • Bush, N. J. (2009). Compassion fatigue: are you at risk?. In Oncology nursing forum (Vol. 36, No. 1, p. 24). Oncology Nursing Society.

• Borntrager, C., Caringi, J. C., van den Pol, R., Crosby, L., O'Connell, K., Trautman, A., & McDonald, M. (2012). Secondary traumatic stress in school personnel. Advances in School Mental Health Promotion, 5(1), 38-50.

• Bush, N. J. (2009). Compassion fatigue: are you at risk?. In Oncology nursing forum (Vol. 36, No. 1, p. 24). Oncology Nursing Society.

• Caringi, J. C., Stanick, C., Trautman, A., Crosby, L., Devlin, M., & Adams, S. (2015). Secondary traumatic stress in public school teachers: Contributing and mitigating factors. Advances in School Mental Health Promotion, 8(4), 244-256.

• Hydon, S., Wong, M., Langley, A. K., Stein, B. D., & Kataoka, S. H. (2015). Preventing secondary traumatic stress in educators. Child and Adolescent Psychiatric Clinics, 24(2), 319-333.

• Figley, C. R. (1992, June). Secondary traumatic stress and disorder: Theory, research, and treatment. In First World Meeting of the International Society for

Traumatic Stress Studies, Amsterdam, June.

• Friedman-Krauss, A. H., Raver, C. C., Neuspiel, J. M., & Kinsel, J. (2014). Child behavior problems, teacher executive functions, and teacher stress in Head Start classrooms. Early education and development, 25(5), 681-702.

• Harrison, R. L., & Westwood, M. J. (2009). Preventing vicarious traumatization of mental health therapists: Identifying protective practices. Psychotherapy: Theory, Research, Practice, Training, 46(2), 203.

• Hoffman, S., Palladino, J. M., & Barnett, J. (2007). Compassion Fatigue as a Theoretical Framework to Help Understand Burnout among Special Education Teachers. Online Submission, 2(1), 15-22.

• Kinavey Wennerstrom, E., Stegenga, S., Lund, E. (2018). Coping with secondary Traumatic Stress: Self-Care Strategies for Early Childhood Professionals. Young Exceptional Children Monograph No. 16, 32-38.

• Maslach, Christina; Jackson, Susan E.Journal of Occupational Behavior (pre-1986); Chichester Vol. 2, Iss. 2, (Apr 1981): 99.

• Saakvitne, K. W., Pearlman, L. A., & Abrahamson, D. J. (1996). Transforming the pain: A workbook on vicarious traumatization. New York: WW Norton.

• Williams, M. E., Park, S., Anaya, A., Perugini, S. M., Rao, S., Neece, C. L., & Rafeedie, J. (2012). Linking infants and toddlers in foster care to early childhood mental health services. Children and Youth Services Review, 34(4), 838-844.

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