Self-Study Unit

Introductory Module:
Stress and humanitarian work

Prof.Dr.Aung Tun Thet

Based on materials prepared by Headington Institute

Self-Study Unit

Introduction

Introductory Module
• Not a comprehensive treatment of the subject • Provides an overview of critical incident stress, vicarious trauma, and chronic stress • Provides a framework for a study program that helps learning about it at their own pace • Focuses primarily on chronic stress, burnout, and self-care strategies

Additional Modules available
1. Trauma and critical incident care 3. Re-entry issues and work-life balance 5. Coping with vicarious trauma 7. Humanitarian work, traumatic stress and spirituality

Humanitarian workers
• Come in many shapes and sizes • Work in on-site recovery and relief missions, education, health training, agricultural assistance, community mobilization, economic development, water and sanitation, and advocacy • Common thread: a service-orientation in the face of suffering and need

Traditional Image
• Selfless and tireless • Expect that because their work is for a noble cause, they are immune to pressures

In reality
• Impacted by their work • At the end of the day feeling frustrated because the scope of the need so overwhelming • Troubled by witnessing tragedy, and by hearing the stories of disaster survivors

Challenge
• Struggle to find a healthy balance • Between the demands of the work and, • The need to pay attention to their own physical and emotional wellbeing

Humanitarian workers
• Consistently fail to pay attention to their own self-care and well-being • Work demanding, both physically and emotionally • Those who neglect their own needs, pay the price

The price
• Get sick more easily, and stay sick longer • Feel tired, drained, and worn out • Start to feel anxious, cynical or hopeless • Relationships suffer • In the end, end up hurting themselves and those around them

Support for Humanitarian Workers
• To reduce the likelihood of developing stressrelated problems in stressful situations • Provide basic information about stress, trauma, normal reactions to stressful situations, and helpful coping strategies  Understand traumatic stress and know how to help prevent or alleviate traumatic stress reactions

Aim of the Module
• To help humanitarian workers:  Understand the different types of traumatic stress associated with their work  Recognize signs of stress and burnout  Learn self-care techniques to help alleviate stress reactions

Expected Outcomes
• 3. 4. By the end of this module you will better understand: The nature of traumatic stress Three common types of traumatic stress associated with humanitarian work – critical incident stress, vicarious trauma, and chronic stress The effects of traumatic stress Why it is important for humanitarian workers to know about these effects How to monitor your own well-being Self-care techniques to help alleviate stress reactions

5. 6. 7. 8.

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Part One: How can humanitarian work be stressful?

Humanitarian work
Among the most exciting, enriching, rewarding and important work in the world

Appeal
Moral: Service work for worthy causes Personal: Stretches and challenges individuals to grow Adventurous: Serving in the midst of extreme and challenging situations

Personal Costs
• Living and working in the midst of disastrous situations, and • Facing overwhelming challenges

Pressures associated with humanitarian work
• Social dislocation: separation from their social support networks - friends and family Misery and deprivation: Live and work in the midst of extreme misery and associated suffering without enough resources available to combat the problems; lead to feelings of impotence and being overwhelmed

Pressures associated with humanitarian work
• • Moral dilemmas: The work environment: Interpersonal conflict among team members forced into prolonged closeness and interdependence; role ambiguity; lack of appropriate resources, personnel, time, logistical support, or skills to do the job expected; and heavy workload and long hours

Personal Reflections
• What do you find especially rewarding about working in the emergency? • What do you find especially challenging (physically, emotionally, mentally, spiritually and relationally) about working in the emergency? • How do you find yourself reacting to some of the challenges you have listed?

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Part Two: Key concepts regarding traumatic stress

Stress
• Any demand or change that the human system (mind, body, spirit) required to meet and respond to • Part of normal life • Without challenges and physical demands, life boring

Distress (or Traumatic Stress)
• When stress • lasts too long, • occurs too often, or • too severe

Stress
• What distressful for one person not necessarily be distressful for another • Your individual perception (how threatened you feel and how much control you have over the circumstances) affect the degree of distress you personally feel

Traumatic stress
Reaction to any challenge, demand, threat or change that exceeds our coping resources and results in distress 

Three main types of traumatic stress
• Critical incident stress or acute stress Vicarious trauma or secondary traumatization Cumulative stress

Critical incident stress or acute stress
• Definitions • Refer to trauma reactions as the result of a traumatic event during which an individual seriously threatened by harm or death • Often referred to as critical incidents and are unusual and intense

Critical incident stress or acute stress
• Reactions • Experiencing acute stress reactions (also referred to as critical incident stress reactions) after a critical incident • Triggers an intense “fight or flight” response

Critical incident stress or acute stress
• Who is at risk? • More problematic for workers “in the field”

• Note: For more detailed treatment, see Module on Trauma and critical incident care

Vicarious trauma or secondary traumatization
• Definition • Refer to stress and trauma reactions that occur in response to witnessing or hearing about traumatic events that happened to others • Other people are the victims, and you see them undergoing suffering, or hear about traumatic events that happened to them   

Vicarious trauma or secondary traumatization
• Reactions • Trigger many of the same reactions that occur when you personally face a critical incident • Signs and symptoms similar, although usually less intense, than those triggered by direct exposure to traumatic events • The level of traumatization almost as great in secondary victims as in primary ones

Vicarious trauma or secondary traumatization
• Who is at risk? • Inherent to humanitarian work • Less about how to avoid vicarious trauma, and more about how to prepare for and deal with it    • Note: For more detailed treatment on vicarious trauma, see Training Module: Vicarious Trauma     

Cumulative stress
• Definition • A less dramatic, more gradual form of stress reaction • Usually related to low-intensity but more chronic stressors that pervade a person’s life and “pile up,” one on top of the other

Common sources
1. A chaotic and reactive work environment 3. Feeling overwhelmed by unmet needs 5. Tight deadlines and stressed coworkers 7. Communication difficulties 9. Inadequate preparation and briefing

Common sources
1. Being asked to complete tasks outside your area of training and competence 3. Facing moral and ethical dilemmas 5. Isolation from familiar social support network 7. Chronic sleep deprivation 9. Travel difficulties and delays  

Cumulative stress
• Reactions • Build up over time • Chronic stressors trigger enduring stress reactions that grow in intensity and become problematic over time • Presence of multiple chronic stressors often a better predictor of higher stress levels than the occurrence of the occasional critical incident • A sequence of relatively mild stressful events ultimately create high stress levels if not dealt with effectively on an ongoing basis

Cumulative stress
• Who is at risk? • Nearly everyone • Striking the right balance between the urgency of the work and other areas of life the most relevant issue • Workers who don’t take chronic stress seriously and proactively prepare to meet the challenges risk of “burning out”

Summary
• All three types of traumatic stress problematic for humanitarian workers • Chronic stress reactions, such as burnout, likely to be problematic • Remainder of this module focuses primarily on recognizing and managing cumulative and chronic stress reactions 

For personal reflection
• Which type of traumatic stress (acute, vicarious, or cumulative) is most problematic or troublesome for you?

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Part Three:

Cultural issues

Traumatic stress
• Not just a problem for international humanitarian workers • National humanitarian workers not exempt

Physiological and emotional responses to disaster
• Broadly similar all over the world • An individual’s interpretation of stress and trauma shaped by culture, social context, and personal experience • Important to acknowledge differences across cultures in how events are experienced and how traumatic stress expressed

Commonalities and Differences
1. Many commonalities across cultures in signs and symptoms of stress, and effective self-care techniques and important differences 3. An individual from one culture may experience and readily discuss physical signs of stress and tension, but feel much less comfortable discussing emotional reactions

Commonalities and Differences
1. Seeking solitude a very effective self-care technique for people from one culture, but for someone from another culture, may not find solitude helpful and energizing, but strange and discomforting Workers should take the time to consider stress and self-care concepts in regards to their host culture

3.

Culture Dimensions
• • • What constitutes stress and trauma? How is stress conceptualized? Is there a concept of individual stress or is it experienced and understood mainly through family and group processes? How is stress typically experienced? What are typical indicators of stress? • • • • Does stress tend to be experienced physically, emotionally, mentally, relationally, spiritually or through behaviour? How is stress usually expressed? What have people traditionally done to deal with stress? What is the role of the individual or the community in managing stress? What individual, social and cultural, oral and behavioural mechanisms are typically used to deal with stress?

• •

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Part Four: Signs of stress

Signs of stress
• Experiences that are perceived as threatening or demanding trigger a series of approximately 1,500 biochemical reactions within the body • Stress chemicals (such as adrenaline and cortisol) dumped into the bloodstream and trigger the “fight or flight” response • For e.g., an elevated heart rate means that more blood being pumped to our muscles and brain so that we can assess the threat and either fight, or run away faster

Fight or flight response
• Prepare us to deal with threatening and dangerous events • Not helpful to deal with the chronic stressors • Fighting or running away not realistic options at work – not if they want to keep their jobs! • If fighting and running away not feasible, how do we manage these stress reactions? • First step is learning to recognize the signs of stress that appear 

Reactions to stress
• Complex and manifest in different ways for different people • Characteristics of the person (e.g., their physical and mental health, level of social support, and previous history of trauma) • Interact with the characteristics of the event (e.g., the magnitude and type of stressful event, the presence of cumulative stressors and other life events), and • Influence people’s experiences and reactions

Stress chemicals
• Trigger physical reactions that last for days, weeks, or sometimes months • Also affect brain chemistry and impact the way we think and feel • Over time, as bodies, emotions and minds are affected by stress, has implications for spiritual selves too

Spirituality
• A core component of human nature • Shapes and informs sense of meaning and purpose, faith and hope • Being human involves more than the physical dimensions of existence • Over time the types of challenges that aid workers face impact their worldview – their conceptions of humanity, and their sense of meaning, purpose and hope

Signs of stress
PHYSICAL •Sleep disturbances •Changes in appetite •Stomach upsets •Rapid heart rate •Fatigue •Muscle tremors and tension •Back and neck pain •Headaches •Inability to relax and rest •Being easily startled •Mood swings •Feeling “over- emotional” •Irritability •Anger •Depression •Anxiety •Emotional numbness

EMOTIONAL

Signs of stress
MENTAL •Poor concentration •Confusion and disorganized thoughts •Forgetfulness •Difficulty making decisions •Dreams or nightmares •Intrusive thoughts •Feelings of emptiness •Loss of meaning •Discouragement and loss of hope •Cynicism •Doubt •Anger at God •Alienation and loss of sense of connection

SPIRITUAL

Signs of stress
MENTAL •Risk taking (such as driving recklessly) •Over-eating or under-eating •Increased smoking •Listlessness •Hyper-alertness •Aggression and verbal outbursts •Alcohol and/or drug use •Compulsive behavior (i.e. nervous tics and pacing) •Withdrawal

For personal reflection
• Have you noticed any of these general signs of stress lately? • When you are under pressure, which of these signs of stress tend to appear first?

Self-Examination Tool

How stressed are you?
• Please note that this tool is not a clinical diagnostic instrument and is provided for educational purposes • Identifies some of the more common symptoms of stress

In the last month, how often has the following been true for you? For each question, tick the number that fits your reality
Question Never (0) Seldom (1) Response Sometimes (2) Often (3) Always (4)

I feel tired. I find it very hard to relax or “wind-down”. I find it hard to make decisions. My heart races and I find myself breathing rapidly. I have trouble thinking clearly. I eat too much or too little. I get headaches. I feel emotionally numb. I think about my problems over and over again during the day. I have sleeping problems.

In the last month, how often has the following been true for you? For each question, tick the number that fits your reality
Question Never (0) I have trouble feeling hopeful. I find myself taking unnecessary risks or engaging in behaviour hazardous to health and/or safety. I have back and neck pain, or other chronic tension-linked pain. I use caffeine or nicotine more than usual. I feel overwhelmed and helpless. I have nervous habits (e.g., biting nails, grinding my teeth, fidgeting, pacing, etc.) I forget little things (e.g., where I put my keys, people’s names) I have stomach upsets (e.g., nausea, vomiting, diarrhea, constipation; gas) I am irritable and easily annoyed. I have mood swings and feel over emotional. Seldom (1) Response Sometimes (2) Often (3) Always (4)

In the last month, how often has the following been true for you? For each question, tick the number that fits your reality
Question Never (0) Seldom (1) Response Sometimes (2) Often (3) Always (4)

I find it hard to concentrate. I have trouble feeling that life is meaningful. I am withdrawn and feel distant and cut off from other people. I use alcohol and/or other drugs to try and help cope. My work performance has declined and I have trouble completing things.

Interpretation Guidelines
0-25 You are probably in great stress-shape 26-50 You may be experiencing a low to moderate degree of stress 51-75 You may be experiencing a moderate to high degree of stress 76-100 You may be experiencing a very high degree of stress

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Part Five: Risk and protective factors

• Risk Factors: Increase our vulnerability to experiencing traumatic stress reactions • Protective factors Decrease our vulnerability by increasing our personal hardiness and resilience and enabling us to deal with increased levels of stress with less distress

Factors leading to stress
• The nature and intensity of traumatic events experienced in the past: Confronting the trauma of others trigger own memories of hurt and betrayal The nature and intensity of the traumatic or stressful event that triggers the current reaction: Experiencing or witnessing a man-made disaster more stressful than experiencing or witnessing natural disasters The number of stressors experienced: Those experiencing multiple significant life events and changes more vulnerable The length of exposure to stressful situations: As exposure lengthens, risk increases 

• •

Factors leading to stress
• Organizational factors: Team relationships, leadership, clarity of mission objectives, and agency structure • History of previous psychiatric illness: Those with experience of acute stress disorder or post-traumatic stress disorder more vulnerable • Lack of social support: Those with compromised social support 4 times more likely to experience traumatization and 2.5 times more likely to experience some form of physical illness; Individuals without partners also at greater risk • Pronounced introversion: Introverted people more vulnerable • Negativity and pessimism: Habitually negative, pessimistic individuals more vulnerable

Risk Factors

• The nature and intensity of any traumatic events experienced in the past • The nature and intensity of the traumatic or stressful events that trigger the current reactions • The number of stressors experienced • The length of exposure to stressful situations • Organizational factors • History of previous psychiatric illness • Lack of social support • Pronounced introversion • Negativity and pessimism

Protective Factors • Social support • Optimism and healthy selfesteem • Spirituality • Adaptability • Tendency to find meaning • Curiosity and openness to experience • Aptitude

For personal reflection
1. Which of these risk and protective factors can you recognize in your own life history, current situation, and personality? How do you see these factors interacting with the stress you experience?

3.

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Part Six: Burnout

Burnout
• A process, not an event • A type of cumulative stress reaction that occurs after prolonged exposure to occupational stressors • Prolonged exposure to emotionally demanding situations with inadequate support gradually depletes an individual’s own natural resources for dealing with stress and strain

Contributing factors
1. Conflict between individual values and organizational goals and demands 3. Lack of managerial and/or social support 5. Overload of responsibility 7. Role confusion 9. Sense of having no control over quality or outcome of work 11. Little emotional or financial reward 13. Existence of inequity, lack of respect 15. Consistent exposure to traumatic material

Road to burnout
• Often paved with good intentions • Those with extremely and unrealistically high hopes and expectations prime candidates for burnout • Unrealistic, highly idealistic job expectations and aspirations lead to failure and frustration

Types of burnout
• Many • Cluster in physical, emotional, mental, spiritual and behavioral domains

PHYSICAL •Exhaustion •Headaches •High blood pressure •Insomnia •Dreams •Back pain and other chronic tensionlinked pain •Stomach complaints

EMOTIONAL

SPIRITUAL BEHAVIOURA L •Self-doubt •Emotional •Apathy •Decline in •Blame exhaustion •Inability to performance •Negativity •Apathy and fragility engage •Disillusionm •Feeling •Wounded •Boredom ent •Interpersonal overwhelme ideals •Reduced •Cynicism d difficulties sense of •Feeling •Irritability accomplishm helpless •Increased ent and •Hopelessn addictions or purpose ess dependencies •Feeling •Mistrust of •Reckless unappreciate colleagues behavior d or betrayed •Neglecting & by the supervisors ones own organization •Depression safety and •Foggy •Anxiety physical needs thinking •Mental apathy •Lack of insight into reduced

MENTAL

What is the best defense against burnout?
• Prevention! • Cultivate a “certain sense of realism” • Create balance in life • Invest more in family and other personal relationships, social activities and hobbies • Spread yourself out so that your job does not have such an overpowering influence on your self-concept and selfesteem

• Thoughtfully examine your self-care practices • Helps prevent ordinary stress from becoming distress, and distress from becoming burnout

For personal reflection
• Have you noticed any of these general signs of burnout lately?

Self-Examination Tool

Are you showing signs of burnout?
• Please note that this tool is not a clinical diagnostic instrument and is provided for educational purposes • Identifies some of the more common symptoms of burnout

In the last month, how often has the following been true for you? For each question, tick the number that fits your reality
Question Never (0) I feel tired and sluggish most of the time, even when I am getting enough sleep. I find that I am easily annoyed by other people’s demands and stories about their daily activities. I feel detached and like I don’t really care about the problems and needs of other people. I am having more and more trouble being interested in my work. I feel sad. I have become absent minded. I forget appointments, deadlines and personal possessions. I find myself avoiding people and don’t even enjoy being around close friends and family members. I feel drained and even routine activities feel like an effort. Seldom (1) Response Sometimes (2) Often (3) Always (4)

In the last month, how often has the following been true for you? For each question, tick the number that fits your reality
Question Never (0) I have been experiencing physical problems like stomach aches, headaches, lingering colds, and general aches and pains. I have sleeping problems. I have difficulty in making decisions. I feel burdened by responsibilities and pressures. I have little enthusiasm for work and when I think about my work me feelings are mostly negative. At work, I consistently fall short of expectations that I have for myself, or that others have for me. I’m less efficient than I feel I should be. I’ve been eating more (or less), smoking more cigarettes, or using more alcohol or drugs. I feel like I can’t solve the problems assigned to me at work. Seldom (1) Response Sometimes (2) Often (3) Always (4)

In the last month, how often has the following been true for you? For each question, tick the number that fits your reality
Question Never (0) I feel like my work is insignificant and doesn’t really make a difference. I feel “used” and unappreciated at work. I get easily frustrated and irritable over small inconveniences. I have trouble concentrating and completing tasks at work. I feel like I have too much (or too little) to do at work. I work long hours (more than 10 a day) or do not have at least one day off work each week. I find myself involved with conflicts with coworkers or family members. I have trouble caring about whether I complete my work or it well. I feel like my supervisor and coworkers are largely incompetent and not doing their jobs well. Seldom (1) Response Sometimes (2) Often (3) Always (4)

Interpretation Guidelines
0-25 You are probably in good shape 26-50 You may be experiencing a low to moderate degree of burnout 51-75 You may be experiencing a moderate to high degree of burnout 76-100 You may be experiencing a very high degree of burnout

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Part Seven: Examining your own well-being

Own Well-Being
• An essential prerequisite for effectively helping others • One of the best ways to maintain fitness to continue in the helping capacity • The first step - understanding your own self-care strengths and needs • Taking a personal inventory helps you understand where your natural self-care strengths lie, and which self-care areas need extra attention

• Before going on to the final section of this module, • pause for a moment and take inventory of how you are doing, and identify which helpful lifestylebalance strategies you use regularly

Self-Examination Tool

Self care and lifestyle balance inventory
• Please note that this tool is not a clinical diagnostic instrument and is provided for educational purposes • Identifies some of the more effective physical, psychological and spiritual methods of staying balanced

In the last month, how often has the following been true for you? For each question, tick the number that fits your reality
Question Never (0) Seldom (1) Response Sometimes (2) Often (3) Always (4)

I have at least one full day of rest each week. I take some time for myself to be quiet, think, meditate, write and/or pray. I work for less than ten hours a day. I do exercise everyday (walking, running, swimming, etc.) for at least 30 minutes at a time. I do something I find fun. I practice muscle relaxation, pilates, yoga, stretching, meditation or slow-breathing techniques. I share how I am feeling with at least one friend or my partners. I sleep well and get at least 7 hours of sleep a night.

In the last month, how often has the following been true for you? For each question, tick the number that fits your reality
Question Never (0) Seldom (1) Response Sometimes (2) Often (3) Always (4)

I am careful about what I eat and eat a balanced diet. I drink at least 1.5 liters of water a day. I laugh without malice or cynicism. When I leave work at the end of the day, I can disengage and leave the pressures of work behind. I listen to my body’s signals and recognize when I am becoming tired, run-down and vulnerable to illness. There are people who care about me that I trust, to whom I can talk if I want. I do something I find creative or expressive. I feel I have the training and skills I need to do my job well.

In the last month, how often has the following been true for you? For each question, tick the number that fits your reality
Question Never (0) Seldom (1) Response Sometimes (2) Often (3) Always (4)

I set and maintain healthy boundaries for myself by standing up for myself, saying “no” when I need to, not letting others take advantage of me. At work, I take a brief break at least every 2 hours, and switch tasks regularly so that I don’t become too drained. I spend time with groups of people I trust and to whom I feel close who are part of a community of meaning and purpose. My ability to communicate with (0) very poor; (1) poor; (2) fair; (3) good; (4) excellent I feel good about how I spend my time and energy in relation to what is really important to me in my life. I believe in myself and generally give myself positive messages about my ability to accomplish my goals, even when I encounter difficulties.

In the last month, how often has the following been true for you? For each question, tick the number that fits your reality
Question Never (0) Seldom (1) Response Sometimes (2) Often (3) Always (4)

I set realistic goals for my life and work towards them consistently. I take good vacations every year. I drink alcohol, smoke, or use other recreational drugs. (0) 3 or more times every day; (1) al least once a day; (2) 3 to 6 times a week; (4) never

Interpretation Guidelines
0-25 Your self care skills and lifestyle balance strategies are poor 26-50 You have a low to moderate degree of self care skills and life style balance 51-75 You have a moderate degree of self care skills and life style balance 76-100 You have good self care skills and life style balance

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Part Eight: Combating stress and burnout

Stress management
• Dealing proactively with stress a learnable skill • To help you grow and thrive as a result of the stressful challenges that you face • Recognizing natural self-care strengths already present in your life and learning how to apply these, and additional helpful strategies, more consistently • No single technique will relieve all your stress, but paying attention to three areas of self-care will build up your hardiness (your ability to handle more stress with less distress) and your resilience (your ability to “bounce back” after particularly stressful or traumatic events)

Physical
• Regular exercise • Sleep • Healthy eating • Drinking enough water • Humour and laughter • Limit your consumption of alcohol • Pilates or Yoga • Relaxation techniques (such as progressive muscle relaxation, diaphragmatic breathing, visualization and mediation) • Massage, whirlpool, sauna • Repetitive activities (such as cross-stitching, walking, quilting, drawing and cooking)

Emotional and relational
• Nurturing relationships • Contact with home/friends through email, phone, tapes • Talking • Humour • Ongoing support group • Reflection: journaling, writing, mediating, poetry • Creative activity such as drawing, sculpting, cooking, painting and photography • Movies, books music • Having balance priorities • Understanding traumatic stress and have realistic expectations • Counseling

Spiritual
• Knowing your values: Where do you tend to find meaning and purposes in life? • Participating in a community of meaning and purpose • Regular times of prayer, reading, meditation • Spiritually meaningful conversations • Singing or listening to meaningful music • Contact with religious leaders or inspiring individuals • Time with art, nature or music • Solitude

For personal reflection
• Which of these self-care strategies do you use regularly? • Which do you find most helpful to you? • Which strategies do you wish you used more regularly?

Self Quiz: Test your knowledge
• Choose the best answer to each of the 20 questions • Meant to test your comprehension of the material in the module • An Answer Key provided at the end of this 20-question quiz that allows you to get your results

1. Humanitarian workers commonly experience stress from which of the following sources? – a. Violence and threat – b. Social dislocation – c. Spiritual dislocation – d. The work environment – e. All of the above 2. Stress can be defined as any demand or change that the human system (mind, body, spirit) is required to meet and respond to. – a. True – b. False 3. Stress can become distress, or traumatic stress, when it lasts too long, occurs too often, or is too severe. – a. True – b. False 4. Something that is very stressful for one person is always stressful for others. – a. True: Everyone finds the same types of events stressful to the same extent – b. False: Your individual perception (how threatened you feel and how much control you have over the circumstances) can effect the degree of distress you personally feel. 5. Trauma reactions that occur as the result of a critical incident (a traumatic event during which an individual experiences the threat of serious harm of death) are often referred to as: – a. Critical Incident Stress – b. Acute Stress Reactions – c. Both of the terms above are regularly used to refer to this type of trauma reaction.

6. Experiencing traumatic stress reactions after a critical incident is a normal response to an abnormal situation. – a. True – b. False 7. Traumatic stress reactions never occur in response to witnessing and/or hearing about traumatic events that have happened to others. – a. True: Individuals must be directly involved in traumatic events to be impacted by them. – b. False: Interaction with people who have experienced traumatic events places helpers at risk of experiencing some form of secondary traumatic stress response. 8. Some common sources of chronic stress for humanitarian workers include: – a. A constantly chaotic and reactive work environment – b. Feeling overwhelmed by the apparent need – c. Inadequate preparation and briefing – d. Being asked to complete tasks outside their area of training and competence – e. All of the above 9. Over time, the presence of multiple chronic stressors is usually a better predictor of higher stress levels than the occurrence of the occasional critical incident. – a. True – b. False 10. Humanitarian workers are at risk of experiencing which of the following types of traumatic stress? • a. Critical Incident Stress • b. Vicarious trauma • c. Cumulative Stress • d. All of the above

11. People from different cultures experience and express traumatic stress exactly the same way. – a. True – b. False 12. Which of the following is not a factor that increases the risk that you will experience traumatic stress reactions? – a. Nature and intensity of any past traumatic events experienced – b. The number of stressful events experienced – c. Good social support – d. Organizational factors – e. History of previous psychiatric illness 13. Which of the following is not a normal sign of cumulative stress? – a. Sleep disturbances – b. Seeing things that aren’t there – c. Fatigue – d. Poor concentration – e. Eating more than normal 14. Which of the following statements is true? - a. Burnout is a process, not an event. It is a term used to refer to a type of cumulative stress reaction that occurs after prolonged exposure to occupational stressors. - b. Burnout happens suddenly. It is an acute breakdown of personal functioning that tends to happen with few warning signs. 15. Which of the following is a helpful way of preventing or alleviating burnout? - a. Cultivating a “certain sense of realism” about your job and its outcomes. - b. Create balance in your life, invest more in family and other personal relationships, social activities and hobbies. - c. Both of the above are helpful strategies in preventing or alleviating burnout.

16. When trying to increase your hardiness and resilience, it is important to pay attention to which of the following self-care areas? • a. Physical • b. Emotional and relational • c. Spiritual • d. It is important to pay attention to all of these areas. 17. Which of the following is not a good physical self-care strategy? • a. Regular exercise • b. Getting enough sleep • c. Drinking a bottle of wine every night • d. Laughing • e. Practicing a relaxation technique 18. Which of the following is not a helpful emotional or relational self-care strategy? • a. Talking to a good friend • b. Spending all your time with people who only see the negative side of situations • c. Writing in a journal • d. Watching a funny movie • e. Understanding stress reactions 19. Profound challenges to spirituality and worldview are usually some of the most significant tests that humanitarian workers face during their careers: • a. True • b. False 20. Which of the following are helpful spiritual self-care strategies? • a. Participating in a community of meaning and purpose • b. Regular times of prayer/reading/meditation • c. Spiritually meaningful conversations • d. Time with art, nature or music • e. All of the above

Answer key
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. e a. a b c a e e a d b c b a c d c b a e

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