It is important to remember that no matter how effective someone's coping skills may be, there are events, that can easily overwhelm those skills. This is true for each of us as individuals and each of us as members of our larger ministry groups. Stress reactions are common, normal reactions to any unusual and highly stressful situations.

People can experience several types of stress:

• Anticipatory stress - concerns over the future ("What if…?", "Am I ready for this?)
• Situational stress - the concerns of the moment (newness, uniqueness, and magnitude);
• Chronic stress - worry over time ("I thought this would end sooner!")
• Residual stress - unresolved issues from the past. The intensity of the each person's reaction to stress can be modified by several factors:
  • Duration - longer exposure to any stressful event usually makes it more severe;
  • Multiplicity - the more stresses there are, the greater the potential reaction;
  • Situational importance - greater importance of the event means greater reaction;
  • Individual's evaluation of the stress - how threatening is the situation and how prepared am I to cope with the consequences (we each have our own psychological Achilles' heel);
  • Reminders that trigger vivid memories (press coverage, trials/law suits, and similar incidents);
  • Stress tolerance - general ability to tolerate plus benefits of stress inoculation.

There are three categories of reactions to stress - thoughts, feelings, and behaviors. Here are a few examples of each:

Thoughts

• Recurring dreams or nightmares about the situation.
• Reconstructing the events surrounding your care-receiver’s situation in your mind, in an effort to make it come out differently.
• Difficulty concentrating or remembering things.
• Questioning your spiritual or religious beliefs.
• Repeated thoughts or memories of a traumatic event, or of loved ones effected by the event, which are hard to stop.

Feelings

• Feeling numb, withdrawn, or disconnected.
• Experiencing fear and anxiety when things remind you of a traumatic event, particularly sights, sounds, and smells.
• Feeling a lack of involvement or enjoyment in everyday activities.
• Feeling depressed, blue, or down much of the time
• Feeling bursts of anger, or intense irritability
• Feeling a sense of emptiness or hopelessness about the future.

Behaviors

• Being overprotective of your and your family's safety.
• Isolating yourself from others.
• Becoming very alert at times and startling easily.
• Having problems getting to sleep or staying asleep.
• Avoiding activities that remind you of the stressful sistuation, avoiding places or people that bring back memories.
• Having increased conflict with family members.
• Keeping excessively busy to avoid thinking about the disaster and what has happened to you.
• Being tearful or crying for no apparent reason.

No matter how good your coping skills or how many difficult situations you have coped with or experienced, there will come times when some aspect of a care-giving situation breaks through your defenses and makes you vulnerable to stress. It is clear in the research literature that there are relatively simple things that can be done to improve your resilience to stress.

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Breaks (take them) - A reasonable time frame is 10 - 15 minutes every two hours. More may be needed. Get away from the maelstrom for a few moments.

Diet - A healthy and balanced diet can significantly improve your ability to cope with high levels of stress. Beware of caffeine and alcohol. Both can significantly impair your ability to function. If you need caffeine to continue to function in this supercharged environment, you just aren’t getting enough sleep. Beware of too much junk food. Too much sugar can cause sugar lows in addition to the famous sugar highs.

Support - Be sure you don’t isolate yourself. Talk about things other than the care-giving situation with friends. Talk with your family back home. Call colleagues that understand what you’re going through.

Days off - Common practice for intensive care situations is one day off in every seven. This should be considered on a case-by-case basis and not held against any individual requesting additional time off.

It seems almost too basic. Self-care and stress management cannot possibly be that simple, can they? The answer is a resounding "YES" - these basic elements are consistently found to be the most effective components of effective self-care. With that in mind, let's now go into a bit more detail.

When multiple and prolonged exposures to stress are present, everyone is at risk - everyone will need to work at stress management and self-care. Some of us, however, may be at even greater risk, especially in the early stages of our involvement. Here is a list of persons to consider as being at higher risk for stronger reactions:

• The young and/or the newest among us.
• Those who are most caring / empathetic.
• Those who are the least well defended.
• Those who tend to become overly involved.
• Those in the most emotionally charged settings (e.g., childcare).
• Those with unresolved personal issues (e.g., rescue fantasies).
• Those who have recently experienced other loss(es) and are grieving.
• Those who are 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.

We will all have some reactions to the stressful situations we face during our outreach activities and this is perfectly normal. In fact, we all tend to be "changed" by the uniqueness and the intensity of our experiences, but we need not be "damaged" by these experiences.

If only there was one simple answer to that question. Then, perhaps we could fully inoculate everyone to the stress and protect volunteers as they serve others. Unfortunately, there is not always a pure, cause and effect relationship between exposure to traumatic situations and development of long-term problems. Most people now realize that one easily definable traumatic event can result in development of stress reaction (and possibly lead to development of PTSD).

Hearing the stories and feeling the pain of others can easily make us secondary victims. As we are working very hard at serving others, we often do not realize how much exposure we have had. That is because our exposure is often more of an insidious process, slowly building over time. A good way to think about it is that it is similar to secondhand smoke. It is very often hard to measure and it is even harder to predict what effect it may have on us in the future.

Several factors play a role in determining how each of us manages stress.

• Prior trauma experiences and stress inoculation;
• Gradation of exposure;
• Identification with the victim - reactions like "that could have been my mom or dad" and "survival guilt";
• Our own physical and psychological health status
• Other "routine" stresses - work, family, etc.

How well do we know ourselves? Coming up with an honest answer to that question is a good way to begin exploring whether or not to tackle the added stress of care-giving. We must work to develop an understanding of our vulnerabilities and we have to be careful with our expectations. Some of the common traits that can lead us directly into internal conflict.

• We like to be in control (and have things under control).
• We are generally perfectionists.
• We are action-oriented people.
• We have a high need for stimulation and excitement (easily bored).
• We often want/need immediate solutions/gratification.
• We tend to freely accept challenges and take risks.
• We are strong willed, highly motivated, and dedicated workers.

These same qualities that allow us to do a good job - the very things that others so value in us - are the qualities that can also land us in unwanted roles as secondary victims. How should we try to avoid these problems? We can begin by learning what it is that pushes our buttons and triggers our personal reactions to difficult situations. Most factors involve associations and similarities to our lives. These can be triggered by sights, sounds, and smells (e.g., elderly people who are the same age as our parents). Other triggers may be recent life events (still resolving death of a family member or friend) and reflections on our own fears/mortality (that could have been…). Helping situations should not be mistakenly viewed as opportunities to escape stresses/issues at home or to resolve prior life events.

We also need to able to accept the problems presented by our own frustrated desires and the frequent desire for closure. There can be a sense of helplessness and lack of control over events. Working with people for short periods of time as they begin the process of grieving, we seldom have a chance to see very much progress and it is too early to gauge outcomes.

We must avoid the natural tendency to beat up on own egos when things are not running a smoothly (perfectly?) as we would like. This is especially true when things actually go wrong. It is easy to become incapacitated by guilt, self-pity, fears of next time, and/or trouble letting-go.

If you are already grieving another loss or if you have recently been in a stressful situation put your own health first and say "NO" to volunteering this time. If you have more general doubts about your ability to handle this kind of work, avoid it altogether and stick with other, less-stressful volunteer activities.

Carefully consider how these issues fit into you personal and organizational stress management plans:

• Tasks-at-hand should be the immediate and central focus. Break up the work and start to do the little jobs well. At first, the big picture may just be too overwhelming.
• Stress management is critical
• Routines and rest periods must be established and maintained. Use daily schedule for work and for breaks/time off if you are in an intense long-term care situation
• Offbeat Humor - Where is the Line…? (How are volunteers using humor struggle with the situation?)
• Reality must be respected. Be realistic with both personal and organizational objectives. We can only do so much work and we can only handle so much pressure/stress.
• Peer Support is critically important. Develop and encourage use of a support group. Meet regularly (e.g. monthly) to tell the stories and vent the stress.
• Trust in the need for even the most basic forms of self-care. Eat well, get regular sleep, and listen to the inner voice when it tells you things like: "It's time for a break for a break."; "I really don't need that extra (cup of coffee, doughnut, dessert, cigarette, beer,)."
• Self-Talk is a good thing. Encourage use of that same inner voice mentioned above for developing and reinforcing a positive outlook. Self-defusing by keeping a journal is also possible..
• Dangers-of-downtime are often unexpected challenges to all. With rest there is the accompanying time, energy, and peaceful environment, all of which are conducive for reflection and asking, "Where is God in all of this?". Some will begin to process their thoughts and feelings. Others may try to escape with hectic entertainment or a premature return to their relief setting and role.

Defusing is the term given to the process of talking it out. It works like taking the fuse out of a bomb (or an explosive situation), by allowing volunteers the opportunity to ventilate about their related memories, stresses, losses, and methods of coping, and allowing them to do so in a safe and supportive atmosphere. Simply giving eye contact to someone who needs to talk is often enough to start the process. The other person simply needs to be present, listen, and offer support.

The defusing process usually involves informal and impromptu sessions. Although they are generally brief and immediate, the defusing sessions often become mini-debriefing sessions and can follow one of the same formats discussed below. Because the allotted time is often too short, it is simply a starting point. Further intervention is sometimes required and this can be anything from offering ongoing support (e.g., briefly touching base with the persons/groups in the coming days/weeks) to scheduling and providing formal group support sessions.

Debriefing ( a Support Group) is a formal meeting, done individually or in small groups. Any location that is large enough to accommodate the participants, and can be secured so as to assure privacy, is appropriate for use. This session may require a block of time that is several hours in length.

The focus for defusing or debriefing sessions should be on sharing the most important issues and answering any specific questions the volunteers may pose. Teaching about any predictable stresses/reactions that are to come is another important activity. Save any in-depth discussions of feelings for last part of meetings, so as to not lower needed defenses and healthy denial too soon to allow completion of the tasks at hand.

There are now several debriefing models. While they differ in the number and type of phases (or stages), they all get at the same basic elements. All help people examine the sights, sounds, smells, thoughts, feelings, symptoms, and memories that are all part of a normal stress reaction. Here are the phases used in one approach:

Introductions

Phase 1 - Disclosure of Events

Phase 2 - Feelings and Reactions

Phase 3 - Coping Strategies

Phase 4 - Termination

To be most effective, members need to allow lots of time for participants to ventilate, especially during the initial phases/stages of the process, when facts, thoughts, and feelings are being discussed. Encourage detailed expression of the most vivid or graphic, negative images and memories. Think of it as cleaning out an emotional wound before allowing it to heal with foreign material still on the inside. Improper procedure with a bad cut promotes infection. Improper procedure here will mean the emotional wounds can be too easily reopened by future stressful events.

Here are some general debriefing guidelines that will also apply to work in the childcare settings:

• Try to group participants by common experiences and exposure levels.
• Use several leaders (2 per group and a 3rd as gatekeeper near the door).
• When running formal groups with people seated in a circle, leaders should sit opposite each other.
• Go around in a circle a couple of times for introductions and descriptions of the events as they experienced them (get everyone involved from the beginning).
• Clean the wounds by spending lots of time on the facts, feelings, and reactions.
• Highlight the common elements of their stories, writings, art, and/or play.
• Validate their feelings and normalize their reactions.
• BE SURE TO ANCHOR A POSITIVE.
• Thank everyone for coming and sharing his or her stories.
• Leaders must be the last ones to leave the room (anyone needing special attention will seek you out).

Feel free to call the Pastoral Assistant for Volunteers, Sr. Francine Barber at 782-2810 ext. 106 for any assistance or materials. She may be reached by email at Franopl@stjohnsea.org. Or you may go to the staff page and click on her name.

• When you have the opportunity, allow yourself to feel sadness and grief over what has happened. Talking to others about how you are feeling is useful.
• Try to keep in place routines such as regular meal times and other rituals. These will help you to feel some sense of order.
• Upsetting times can cause people to drink alcohol or to use drugs in a way that causes other problems. Recognize that potential in yourself and your team.
• Forgive yourself and others when you act out because you are stressed. This is a difficult time, and everyone's emotions are closer to the surface. But also be certain that your stress does not become an excuse for abusive management styles.
• Don't let yourself become isolated. Maintain connections with other volunteers, but also with friends and family. Try to keep a sense that there is a real world outside the care situation.
• Maintain boundaries between your life and your assignment. Having some measure of healthy emotional distance from your work is very useful.
• Set aside time to maintain your spirituality. Attending Mass and engaging in contemplative prayer are helpful to many volunteer helpers.

A few general guidelines may be useful in deciding when normal reactions to stress become problems requiring a referral:

• When disturbing behaviors or emotions last more than four to six weeks;
• When a person's behaviors or emotions impair his/her normal functioning (including functioning on and/or off duty); or
• Anytime an individual feels uncomfortable or concerned about his or her behaviors, emotions, or thought processes.

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