Secondary Trauma and Self Care



Professional Self Care

Secondary Trauma and Self Care

By Lora Ohlensehlen, LCSW

Compassion Fatigue

Definition:

There are various terms for the psychological trauma experienced by caregivers, such as family and friends; and professionals, such as social workers, nursing staff, grief counselors, mental health workers, and therapists. Secondary trauma is also known as: secondary trauma, vicarious traumatization, secondary victimization, and compassion fatigue.

Compassion Fatigue can develop into the mental health categories of anxiety, depression, acute anxiety, and post traumatic stress disorder. These symptoms unmanaged and happening over long periods of time can cause damage to internal organs and function. Under perceived threat our bodies go into a fight or flight mode and we increase production of chemicals/hormones. After the perceived crisis the body dumps the adrenalin, cortisol, and other stress hormones into our body. The organs then have to deal with the chemicals and break them down. The organs become overworked and weakened if we are unable to control our perceptions of threats.

Women are 3 times more likely to feel the negative effects of stress. Women have a greater number of chemical stress receptors, which once enabled them to be hyperaware of potential threats to their young. Feelings of fight or flight; One key factor behind our stress response is our level of cortisol, a hormone excreted by the adrenal glands during moments of heightened anxiety. It functions as an air-traffic controller, prioritizing the body’s functions for maximum energy. High producers of cortisol tend to be Type A personalities whose sympathetic nervous system (which mobilizes fight or flight) are firing on all cylinders and thus find it hard to relax. Others may be equally high-energy until the danger passes and the para-sympathetic nervous system (the rest-and-digest system) takes over, causing them to crash hard. And someone who under produces cortisol may feel sensitive to even small amounts of stress, staying chronically fatigued and overwhelmed. (So Stressed: The Ultimate Stress Relief Plan for Women, McClellan and Hamilton)

Dr. Figley has an interesting theory of how to self regulate.

Recent brain imaging research has begun to demonstrate that anxiety is a brain killer-the more anxiety a person experiences, the less effectively our brains operate. When our nervous system is activated and dominant, we are preparing for fight or flight. Our circulation becomes constricted, heart rate increases, and our muscles become tense and ready to act. Inside our brain the neocortex becomes less functional while the brain stem, base ganglia, and thalamus become more active. This is because the perceived need to survive has superseded all other brain functioning. As we become “stressed” and the longer we are in this state of sympathetic dominance, the more likely we are to compromise the functioning of the higher order brain systems such as language, motor activity, filtering, and compassion. It is becoming apparent the professional and personal effectiveness requires self regulation skills. By relaxing the muscles in the pelvic region (kegels, sphincter, psoas), we are able to affect profound systemic muscle relaxation. This relaxation facilitates a shift from the sympathetic system (i. e. fight or flight reflex utilized during periods of perceived threat) to the parasympathetic system (i.e. relaxation and optimal functioning utilized during periods of safety). This return to parasympathetic dominance will allow the individual to regain optimal functioning of speech, language, motor coordination, filtering, and compassion. By maintaining this pelvic relaxation we are able thwart the autonomous nervous system from shifting to sympathetic dominance each time we perceive even the mildest of threats (criticism).

The release and relaxation of these muscles, we can gradually shift from sympathetic to parasympathetic dominance. The rewards of this transformation include comfort in our bodies, maximal motor and cognitive functioning, ability to tolerate intimacy, self-regulation, internal vs. external locus of control, ability to remain driven, increase tolerance, increased effectiveness, and increased health of our body’s systems. A person who becomes skilled in making this transition has developed an internal locus of control and is no longer a victim. (Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized, Figley)

Who is at risk: The young or newest among us

Those who are the most caring and empathetic.

Those who are the least well defended.

Those who tend to become overly involved.

Those in the most emotionally charged settings.

Those with unresolved personal issues.

Those who have recently experienced other loss(es) and are grieving.

Those who are the least trained, supervised, and/or supported.

Those who do not practice good self care and stress management.

The trauma specialists, especially those who may think they are immune.

(Weaver, )

Causes:

___ job overload ___personal feelings of inadequacy ___few rewards

___feelings of being unsuccessful ___long work hours ___little autonomy

___poor supports from colleagues ___feelings of weakness ___self blame

___ambiguous success ___erosion of ideals ___being a survivor

___feeling/being isolated

Symptoms: Be watchful of symptoms that have lasted longer than 4-6 weeks. Be aware when the behaviors or reactions impair with our daily activity and schedules. Understand the symptoms and gravity of the situation will have different effects on different people.

Symptoms of Burnout:

Burnout refers to the symptoms of being emotionally, physically, mentally drained.

___Feeling drained and tired ___Depressed ___ Anger

___Lack of Productivity ___Frustration ___Cynicism

___Exhaustion, Mentally and Physically ___Poor behaviors, acting out

___Emotionally Detached ___Overly Emotional

At the burn out stages people may have little mental health resources or energy to stay with their profession. They may just walk away from their job or leaving the profession completely. In the worst case, their may be doing self-harm or planning suicide.

Debriefing and Use of Supervision: Caregivers and professionals need to use supervision as a time to debrief about a difficult experience and/or ongoing difficult cases. Workers need safe environments and encouragement to share the experience/s that is causing the stress, identifying their emotions, and feelings. In some cases, too much information should be monitored in order not to traumatize co-workers.

Supervisors need to model their own positive self care. Additional factors that need to be factored in are what else is happening in the co-workers life: divorce, death of a loved one or client, economic problems, life crisis or significant changes, or health care problems.

Compassion fatigue can be prevented through the development and maintenance of a nonanxious presence; self-validated caregiving and other self-care skills. (Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized, Figley)

SELF CARE and BRINGING BALANCE BACK TO YOUR LIFE

Self care needs to be proactive and planned out daily, weekly, monthly, and yearly.

Self validating Caregiving: The ability to give yourself acknowledgement and validation for the work you do. Resolving the threat perceived and remain relaxed when a client or peer is angry or judgmental with you ability to monitor and provide self with physical, emotional, and spiritual needs. (Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized, Figley)

Self Regulation: Self regulation is the ability to switch from the sympathetic to parasympathetic nervous system after you have determined that you are safe from threat. It requires relaxation of pelvic (psoas) muscles.

Know your learning style: Knowing your learning style can give clues in the best way to de- stress.

Kinesthetic: Visual and Tactile; sewing; cooking; projects that you both look at and can touch or manipulate.

Visual: Sight; books, looking at nature.

Auditory: Hearing; music, sounds in nature;

Tactile: running hands under cold water. Have a soft sweater or blanket to cuddle in; objects to touch that soothe.

5, 4, 3, 2, 1 Grounding Activity: Name 5 things you can see.

Name 4 things you can touch.

Name 3 things you can feel in/on your body.

Name 2 things you can smell or like the smell of.

Name 1 thing you did good for yourself today.

Centering and Breathing: Use deep (to the diaphragm), and slow breathing to calm yourself. Use breathing along with a progressive muscle relaxation to calm yourself.

Mantras: Develop a coping mantra. This is a reminder that you are safe and okay and cam handler any stress. I am well…I am safe and calm…I trust my ability to cope…I am surrounded by love and support…I can relax my body and mind. (The Relaxation and Stress Reduction Workbook, Davis, Eshelman, McKay)

Diet: Eat healthy and whole foods, and strife for a balanced diet; Monitor junk food and fast food; Drink lots of water; Use caffeine sparingly and alcohol cautiously; Salmon and tuna are high in the Omega Fatty Acids, they equal brain foods which increase thinking and coping skills. Be cautious with sugary soda pops which create energy from a sugar high, and then later crash. Try to keep meals at regular and consistent times.

Whole food sources of tyrosine and tryptophan, amino acids that help produce balancing neurotransmitters. Try chicken, yogurt, avocado, spinach, oats, and nuts. And don’t go hungry. Regular meals keep your blood sugar level steady and help your brain and perform at their peak. (So Stressed: The Ultimate Stress-Relief Plan for Women, McClellan and Hamilton)

Cortisol can keep you awake at night and run down during the day. (body + soul magazine, April, 2010; )

Exercise/ Sports/Physical Activities: Plan to be more physically active at least 3 times per week, aerobic activity is suggested. Go for a walk, hike, walk around in a park, ride a bike, and go to the gym. People who exercise will recover more quickly from stress. Use exercise and activity to develop a feeling of energy, aliveness, and vitality for life.

Sleep, Relax, and Pampering Self: Try to get at least 7 hours of sleep every night. Count your daily blessing as a way to de-stress and drift off to sleep; Have soft blankets to cuddle with; wear soft clothing; treat yourself with care after a crisis has been dealt with. Monitor violence and the television and do not watch the news for several days.

Positive Thinking: Do conscientious positive thinking; Surround yourself with other positive thinking people; See your cup as being half full; write positive messages on your water bottle; look up positive thinking and water on utube and watch the videos; if you notice that you are awfulizing a situation, do a Cognitive Thinking Error activity of telling your brain, “STOP,” and change the negative self talk to a positive statement, or give yourself a positive pep talk.

Develop gratitude and a sense of thankfulness. Daily, think of three things you are grateful for.

Take a break: Every 2-3 hours, take a 10 minute break, get up, and move around. Ex. take a bathroom break, speak to a co-workers, delivery a piece of paper, step outside take a breath of fresh air. Take time off from work. Do not take on over-time work or extra projects, till you regain your strength. Make a safe zone in your house, for your self-renewal time. People and family members need to be respectful of your safe zone and stay outside of it.

Spirituality: Spirituality is experienced as a unifying life force, life principle, essence of being. Spirituality is expressed and experienced in and through connectedness with nature, the earth, the environment, and the cosmos. People express spirituality in and through connectedness with other people. Spirituality shapes the self-becoming and is reflected in one’s being, knowing, and doing. Spirituality permeates life, providing purpose, meaning, strength, and guidance in shaping the journey. (Spirituality and Healing, Burkhart and Nagai-Jacobson)

Forgive yourself and others around you for not being perfect. Forgiveness is capacity for letting go of hurt and anger.

Engage in contemplative prayer. Remind yourself that God, or your higher power, always loves you. Balance out your priorities, write them down, and follow through with your goals. Remind yourself that your self care is very important and needed. Use reflective writing, journaling, and poetry writing to express yourself and needs. Have spiritually meaningful conversations with friends. Attend spiritual events, it may be church, or it may be a movie or video about inspiring people and events. Use solitude as a time for healing.

The degree of spiritual support was the 2nd most powerful predictor of quality of life. This was particularly true for African-Americans and Hispanic people.

Meditation: Meditation increases concentration (which facilitates problem solving), increases your ability to identify sources and effects stress, and teaches you how to quiet and calm your mind. Repeating a word, sound, or phrase: select a word, sound, or phrase with which you are comfortable and repeat the word over and over again.

Paying attention to your breathing: find a comfortable place to sit; close your eyes to reduce distractions, bring your focus and awareness to your body; pay attention to your breathing; still paying attention to your breathing, begin to notice each time you inhale and exhale—as you monitor your breathing you should mentally say the word “rising” with each inhale, and “falling,” with each exhale. Whenever your mind begins to wander, bring it back by again mentally saying, “rising, falling.” (When Their Worlds Fall Apart, p. 459)

Visit art museums, enjoying nature and look for the beauty in life. Watch children play.

Work through grief reactions: Understand the way you, your family, and your culture deal with grief. Identify how grief work addresses: change, loss, transitions, losing an identity or ability, habitual losses, suffering, death, healing, and hope for the future. Are there rituals or services that need to be attended to?

Hypnosis and Massage: Learn from a hypnotherapist ways to do self hypnotic breathing to learn to relaxation techniques. Use massage therapists, sauna, and hot tubs to distress and relax your body.

Reaching out to Colleagues: Practice being a good co-worker. Use potlucks, group ordering in, and luncheons as a way to distress and reconnect with co-workers. Be the motivator of good self care practices. Be aware of co-workers stress or behaviors and reach out to talk or be of support. “The only way to have friend is to be one.” Ralph Waldo Emerson

Humor and Playing: Watching a favorite movie or sitcom that makes you laugh; Watching the comedy channels; Having cartoon books like Calvin and Hobbs; Reading the funny papers or cartoon page; play a board or card game; play on the Wii; play as hard as you work;

Having items on your desk or office that make you smile or laugh. Make the most of your office space: have comfortable textures, nice art work, pictures of vacations or times you were relaxed and enjoying yourself. Can you have a timer in your office and take a lunchtime nap? Have a healthy 3:00 snack available, granola bar, almonds.

Hobbies: Repetitive movement activities are often very calming. Sewing; quilting; cooking; going for a walk; painting; coloring; and drawing are calming activities.

Maintaining family and social relationships: Don’t isolate; Talk with your supervisor and colleagues about the problem; Stay in contact with family members; Attend relaxing social events, go to the movies. Remind yourself that there is life outside the work environment. Maintain healthy boundaries with family, friends, and co-workers.

Music: Put on your favorite music, listen to it and enjoy it. Identify which music you can play to change out a negative emotions and moods. Identify which music you can play to become calm. Get up and dance to music. Go dancing with friends. Play musical instruments you have learned to play. Take music lessons, become a drummer.

Monitor your self care: Make goals of how you want to care for yourself. Check on co-workers, are they also participating in self care. Be a support person to your colleagues.

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