FROM ORDINARY TO EXTRAORDINARY: DMORT Workers

1. FROM ORDINARY TO EXTRAORDINARY:DMORT Workers Denise Bulling University of Nebraska

2. Special Acknowledgement: Sandy Ramsey, Former member of DMORT 7, Contributed to the content of this presentation

3. Objectives • Describe individual characteristics that influence reactions to stress • Identify stressors unique to DMORT workers • Describe ways to mitigate the effects of stress (build resilience)

4. Individual Characteristics Skills Support Self Help Building Resilience ordinary EXTRAORDINARY stress

5. No one who sees a disaster is untouched by it Myers (1994)

6. What are the rewards? • Enormously rewarding work • See people at their best • Assisting people put their lives back together is meaningful

7. Witness the power of the human spirit • Challenging and personally satisfying • Work is immediate and intense

8. Phases of Disaster Honeymoon Reconstruction A new beginning Heroic Pre-disaster Disillusionment Warning Threat Working through grief Impact Trigger Events & Anniversary Reactions Inventory 1 to 3 Days -------------------TIME-------------------------------------------1 to 3 Years Zunin/Meyers

10. Disaster is characterized by loss • Loved ones • Material goods • Income and/or employment • Social cohesion • Feelings of safety • Trust in the future

11. Helping can be hard on the helper… • Personally affected by the disaster • Exposure to the unexpected • Physically difficult/exhausting tasks • Lack of sleep and/or nutrition • Survivor guilt • Separated from your own support system • Frustration

13. Hurry up and Wait . . . • “The disaster worker anticipates the stress of upcoming work before it actually begins and may already begin work with a substantial stress burden.” (Ersland, Weisaeth and Sund, 1989)

15. Disaster Scene • Dangerous • Unpredictable • Confusion/chaos • Lack of accurate information • Frequently/rapidly changing • Communication is difficult

16. On Scene • “Remember DMORT operational activities deal with sensitive issues. While on deployment remember the "world" is watching and listening. You are expected to be professional with respect to your behavior and conversation when you are out and about the area. Do not make the mistake of making off-the-wall comments or discussions that can be overheard.” DMORT Field Operations Guide

17. Individual Characteristics Skills Support Self Help Building Resilience ordinary EXTRAORDINARY stress

18. Stress reactions

19. Why do we respond the way we do? Picture from: www.rsu.edu/faculty/amarrero/brain_diag_page.htm

20. Early Nausea Muscle tremors Sweating Dizziness Chills Increased heart rate Increased blood pressure Hyperventilation Later Fatigue Increased use of alcohol and drugs Exaggerated startle response Sleep - related difficulties Stress reactions Physical

21. Early Confusion Difficulty in making decisions Impaired thinking Difficulty problem solving Memory loss Calculation difficulties Difficulty remembering names Later Decreased attention span Poor concentration Memory problems Flashbacks Stress reactions Cognitive

22. Early Anxiety Anger Fear Irritability Guilt Overwhelmed Grief Hopelessness Abandoned Searching for meaning Later Feeling abandoned Resentment Feeling alienation Withdrawal Numbness Depression Questioning Faith Deeper Faith Stress reactions Emotional

23. Stress reactions Social - Behavioral • Isolation from others • Increased conflicts with family • Avoiding reminders • Increase or decrease in appetite • Crying

24. Spiritual Questions • Loss of meaning or purpose to life • Questioning of beliefs • Greater/less religious involvement

25. DMORT – Unique Stressors • Exposure to the grotesque • Physical fatigue • Over-dedication • Profound sensory stimulation • Handling personal effects • Personal identification with the dead • Death of children

26. DMORT – Unique Stressors Why be concerned? Research has shown that regardless of profession or past experience, exposure to violent death can create additional victims in those who assist after a disaster. Ursano & McCarroll (2001)

27. DMORT – Unique Stressors • Intrusion increased significantly for those who were exposed to the dead • Avoidance increased for those with the greatest exposure to remains McCarroll, J.E., Ursano, R.J., Fullerton C.S., Liu, X., Lundy, A. (2001)

28. DMORT – Unique Stressors • Degree of experienceand level of exposure seems to be associated with increased levels of distress among body handlers. • Even the most experienced can be distressed McCarroll, J.E., Ursano, R.J., Fullerton C.S., Liu, X., Lundy, A. (2001)

29. Individual Characteristics Skills Support Self Help Building Resilience ordinary EXTRAORDINARY stress

30. Personal Characteristics that feed stress • Feeling over-responsible • Fear of loss of control • Fear of failure or making mistakes • Fear of being judged • Lack of belief in ``being good enough'' • Need to be perfect • Chronic guilt • Unresolved grief • Chronic anger, hostility, or depression

31. Personality – “Type A” • Often preoccupied with schedules and speed of their performance • Little time for self-reflection • Strong need for control • Temperament marked by excessive competitiveness, • Drive • Obsession with accomplishing tasks quickly and accurately • Impatient

32. TYPE B – Takes time to watch the sunset TYPE A – Snaps a picture while talking on the cell phone and jotting notes

33. Personal Characteristics – Posttraumatic Growth “There appear to be two basic personality qualities that may affect the likelihood that people can make positive use of the aftermath of traumatic events that befall them: EXTRAVERSION & OPENNESS TO NEW EXPERIENCES.” Tedeschi & Calhoun (2004)

34. Individual Characteristics Skills Support Self Help Building Resilience ordinary EXTRAORDINARY stress

35. Conceptual Frameworks • Risk:variables that increase an individual’s likelihood of psychopathology or their susceptibility to negative developmental outcomes(Goyos in Boydon & Mann 2004:4). • Resiliency:an individual’s capacity to recover from, adapt and remain strong in the face of adversity(Boydon & Mann 2004:4).

36. Disaster Psychology • Normal people responding to an abnormalevent (common stress reactions) • Watching for signs of distress in workers • Helping emotionally healthy people return to pre-disaster functioning

37. Maslow’s Hierarchy of Needs Self-actualization Esteem (self-respect, feelings of success) Belongingness and love Safety (security, order, stability) Physiological (hunger, thirst, shelter)

38. Biological Material Emotional WELL-BEING Social Mental Spiritual Cultural Security, Participation, Development (Williamson & Robinson, 2005)

39. Resiliency Variables(from Apfel & Simon, 2001) • Resourcefulness • Curiosity and intellectual mastery • Flexibility in emotional experience • Goal for which to live • Need and ability to help others • Vision of a moral order

40. Building Resilience • Make connections • Develop confidence in yourself • Look for opportunities for self discovery • Take action when appropriate • Give yourself time to put things into perspective

41. Posttraumatic Growth • Occurs in conditions of severe crisis rather than “lower-level stress” • Often accompanied by transformative life changes • Experienced as an outcome rather than a “coping mechanism” • Requires a shattering of fundamental schemas Hoffman (2005)

42. Individual Characteristics Skills Support Self Help Building Resilience ordinary EXTRAORDINARY stress

43. Ins and Outs… • In-briefing • Inexperienced can benefit from knowing what to expect • Out-briefing • Give permission to process the event on personal timelines

44. Skills, Support, Self-help • Helping others • Being warm when you feel cold • Look and act like you are listening • Problem solving • Helping yourself

45. Coping with Stress • Coping is a way to prevent, delay, avoid, or manage stress • Coping mechanism categories: • Changing the source of stress • Changing the view of the situation • Tolerating the stressor until it passes or becomes less troublesome

48. Warmth • SOLER • Sit squarely • Open Posture • Lean Forward • Eye Contact • Relax

49. Warmth • Soft tone • Smile • Interested facial expression • Open/welcoming gestures

50. Activity - Warmth Pick a partner. Turn to your partner and say: "My garbage pick up is on Tuesdays.” Taken from Nebraska Psychological First Aid Curriculum (2005)