understanding & managing trauma ‘shattered assumptions….. broken lives’ ‘shattered...

Understanding & Managing TraumaUnderstanding & Managing Trauma

‘‘SHATTERED ASSUMPTIONS…..SHATTERED ASSUMPTIONS…..BROKEN LIVES’BROKEN LIVES’

‘‘SHATTERED ASSUMPTIONS…..SHATTERED ASSUMPTIONS…..BROKEN LIVES’BROKEN LIVES’

Andrew DaviesAndrew DaviesAndrew DaviesAndrew Daviesbybybyby

UNDERSTANDING AND MANAGING UNDERSTANDING AND MANAGING TRAUMATRAUMA

UNDERSTANDING AND MANAGING UNDERSTANDING AND MANAGING TRAUMATRAUMA


Aims….Aims….

• To facilitate a greater understanding of Trauma and To facilitate a greater understanding of Trauma and it’s impact on individuals and organisationsit’s impact on individuals and organisations

• To facilitate a greater understanding of how individuals To facilitate a greater understanding of how individuals and organisations can manage and recover from the and organisations can manage and recover from the trauma of critical incidentstrauma of critical incidents

• To emphasize that traumas cannot always be To emphasize that traumas cannot always be prevented but can be contained and managed once prevented but can be contained and managed once they have occurred if efficient and effective policies they have occurred if efficient and effective policies and practices are adopted.and practices are adopted.

• To facilitate a greater understanding of Trauma and To facilitate a greater understanding of Trauma and it’s impact on individuals and organisationsit’s impact on individuals and organisations

• To facilitate a greater understanding of how individuals To facilitate a greater understanding of how individuals and organisations can manage and recover from the and organisations can manage and recover from the trauma of critical incidentstrauma of critical incidents

• To emphasize that traumas cannot always be To emphasize that traumas cannot always be prevented but can be contained and managed once prevented but can be contained and managed once they have occurred if efficient and effective policies they have occurred if efficient and effective policies and practices are adopted.and practices are adopted.


““Every day in Africa an impala wakes up. It must run faster than the Every day in Africa an impala wakes up. It must run faster than the fastest lion or it will be killed. fastest lion or it will be killed.

““Every day in Africa an impala wakes up. It must run faster than the Every day in Africa an impala wakes up. It must run faster than the fastest lion or it will be killed. fastest lion or it will be killed.

Every morning a lion wakes up and knows it must outrun the slowest Every morning a lion wakes up and knows it must outrun the slowest impala or it will starve to death.impala or it will starve to death.

Every morning a lion wakes up and knows it must outrun the slowest Every morning a lion wakes up and knows it must outrun the slowest impala or it will starve to death.impala or it will starve to death.

Anonymous Anonymous Anonymous Anonymous

It doesn’t matter whether you are a lion or an impala… when the sun It doesn’t matter whether you are a lion or an impala… when the sun comes up you had better start running.”comes up you had better start running.”

It doesn’t matter whether you are a lion or an impala… when the sun It doesn’t matter whether you are a lion or an impala… when the sun comes up you had better start running.”comes up you had better start running.”

Our ContextOur Context(Living and working in an unsafe world)(Living and working in an unsafe world)(Living and working in an unsafe world)(Living and working in an unsafe world)


Our Context….Our Context….

• South African life has been characterized by violence South African life has been characterized by violence and crime both before and after the revocation of the and crime both before and after the revocation of the apartheid system.apartheid system.

• In some ways, trauma (whether realized or anticipated) In some ways, trauma (whether realized or anticipated) has become “part and parcel” of the South African has become “part and parcel” of the South African psyche.psyche.

• The burden of overwhelming trauma and its The burden of overwhelming trauma and its consequences has been experienced by South African consequences has been experienced by South African trauma counsellors for many years.trauma counsellors for many years.

• South African life has been characterized by violence South African life has been characterized by violence and crime both before and after the revocation of the and crime both before and after the revocation of the apartheid system.apartheid system.

• In some ways, trauma (whether realized or anticipated) In some ways, trauma (whether realized or anticipated) has become “part and parcel” of the South African has become “part and parcel” of the South African psyche.psyche.

• The burden of overwhelming trauma and its The burden of overwhelming trauma and its consequences has been experienced by South African consequences has been experienced by South African trauma counsellors for many years.trauma counsellors for many years.


Our Context…Our Context…(The trauma of everyday life)(The trauma of everyday life)(The trauma of everyday life)(The trauma of everyday life)

• Amongst the highest violent crime rates in the world Amongst the highest violent crime rates in the world (including murder, car-jacking, and violence in schools). (including murder, car-jacking, and violence in schools). Homicide accounts for 44.5% of deaths.Homicide accounts for 44.5% of deaths.

• The highest rates of rape, child abuse, and family The highest rates of rape, child abuse, and family violence in the world. violence in the world.

• Rampant HIV/AIDS infection rate.Rampant HIV/AIDS infection rate.

• Large disparity between rich and poor.Large disparity between rich and poor.

• Limited and inadequate community resources.Limited and inadequate community resources.

• SA employees are at risk for exposure to incidents of SA employees are at risk for exposure to incidents of traumatic stress.traumatic stress.

• Amongst the highest violent crime rates in the world Amongst the highest violent crime rates in the world (including murder, car-jacking, and violence in schools). (including murder, car-jacking, and violence in schools). Homicide accounts for 44.5% of deaths.Homicide accounts for 44.5% of deaths.

• The highest rates of rape, child abuse, and family The highest rates of rape, child abuse, and family violence in the world. violence in the world.

• Rampant HIV/AIDS infection rate.Rampant HIV/AIDS infection rate.

• Large disparity between rich and poor.Large disparity between rich and poor.

• Limited and inadequate community resources.Limited and inadequate community resources.

• SA employees are at risk for exposure to incidents of SA employees are at risk for exposure to incidents of traumatic stress.traumatic stress.


Definition of Trauma….Definition of Trauma….

• ““A sudden, unexpected (unprepared for) event thatA sudden, unexpected (unprepared for) event that• is is outside the range of normal human experienceoutside the range of normal human experience• involves actual or threatened death or serious injury involves actual or threatened death or serious injury

or a threat to the physical integrity of self or othersor a threat to the physical integrity of self or others• and would be markedly distressing to anyone”and would be markedly distressing to anyone”

• ““A sudden, unexpected (unprepared for) event thatA sudden, unexpected (unprepared for) event that• is is outside the range of normal human experienceoutside the range of normal human experience• involves actual or threatened death or serious injury involves actual or threatened death or serious injury

or a threat to the physical integrity of self or othersor a threat to the physical integrity of self or others• and would be markedly distressing to anyone”and would be markedly distressing to anyone”

• The event is so unpleasant and shocking that the human The event is so unpleasant and shocking that the human mind and body react in an autonomic defensive manner.mind and body react in an autonomic defensive manner.

• The event is so unpleasant and shocking that the human The event is so unpleasant and shocking that the human mind and body react in an autonomic defensive manner.mind and body react in an autonomic defensive manner.

• The traumatisation is caused by the event, not because The traumatisation is caused by the event, not because of some failing or weakness in the person.of some failing or weakness in the person.

• The traumatisation is caused by the event, not because The traumatisation is caused by the event, not because of some failing or weakness in the person.of some failing or weakness in the person.


Critical Incident Defined….Critical Incident Defined….

““A critical incident is an event that causes disruption to an A critical incident is an event that causes disruption to an organisation, creates significant danger or risk and organisation, creates significant danger or risk and traumatically affects individuals within the organisation”traumatically affects individuals within the organisation”

““A critical incident is an event that causes disruption to an A critical incident is an event that causes disruption to an organisation, creates significant danger or risk and organisation, creates significant danger or risk and traumatically affects individuals within the organisation”traumatically affects individuals within the organisation”

• These are events with circumstances that are unusual These are events with circumstances that are unusual or distressing and typically produce immediate and/or or distressing and typically produce immediate and/or delayed emotional reactions that surpass the individual’s delayed emotional reactions that surpass the individual’s normal coping mechanisms and have the potential to normal coping mechanisms and have the potential to interfere with usual functioninginterfere with usual functioning

• These are events with circumstances that are unusual These are events with circumstances that are unusual or distressing and typically produce immediate and/or or distressing and typically produce immediate and/or delayed emotional reactions that surpass the individual’s delayed emotional reactions that surpass the individual’s normal coping mechanisms and have the potential to normal coping mechanisms and have the potential to interfere with usual functioninginterfere with usual functioning

• Examples include: explosions, accidents, civil unrest, Examples include: explosions, accidents, civil unrest, assaults, fire, terror attacks, etc.assaults, fire, terror attacks, etc.

• Examples include: explosions, accidents, civil unrest, Examples include: explosions, accidents, civil unrest, assaults, fire, terror attacks, etc.assaults, fire, terror attacks, etc.


The Psychological Impact of TraumaThe Psychological Impact of Trauma

Stress is a reaction to an event or situation that places Stress is a reaction to an event or situation that places pressure upon a person. When demands become pressure upon a person. When demands become extremely threatening, overwhelming, or severe, they extremely threatening, overwhelming, or severe, they provide a heightened state of physical, cognitive, provide a heightened state of physical, cognitive, behavioural and emotional arousal commonly called behavioural and emotional arousal commonly called “traumatic stress”“traumatic stress”

Stress is a reaction to an event or situation that places Stress is a reaction to an event or situation that places pressure upon a person. When demands become pressure upon a person. When demands become extremely threatening, overwhelming, or severe, they extremely threatening, overwhelming, or severe, they provide a heightened state of physical, cognitive, provide a heightened state of physical, cognitive, behavioural and emotional arousal commonly called behavioural and emotional arousal commonly called “traumatic stress”“traumatic stress”

StressStressStressStress Traumatic StressTraumatic StressTraumatic StressTraumatic Stress


The experience of trauma shatters two basic assumptions The experience of trauma shatters two basic assumptions about the self and the world:about the self and the world:

• The belief in personal invulnerability or immortality The belief in personal invulnerability or immortality

• The belief that the world is a meaningful and orderly The belief that the world is a meaningful and orderly place, and that events happen for a reasonplace, and that events happen for a reason

•Violence, shatters a third belief: the trust that other Violence, shatters a third belief: the trust that other human beings are fundamentally benign.human beings are fundamentally benign.

These 3 assumptions (or illusions) allow people to function These 3 assumptions (or illusions) allow people to function effectively & to relate to others. After trauma, individuals effectively & to relate to others. After trauma, individuals are left feeling vulnerable, helpless and out of control in a are left feeling vulnerable, helpless and out of control in a world that is no longer predictable.world that is no longer predictable.

The experience of trauma shatters two basic assumptions The experience of trauma shatters two basic assumptions about the self and the world:about the self and the world:

• The belief in personal invulnerability or immortality The belief in personal invulnerability or immortality

• The belief that the world is a meaningful and orderly The belief that the world is a meaningful and orderly place, and that events happen for a reasonplace, and that events happen for a reason

•Violence, shatters a third belief: the trust that other Violence, shatters a third belief: the trust that other human beings are fundamentally benign.human beings are fundamentally benign.

These 3 assumptions (or illusions) allow people to function These 3 assumptions (or illusions) allow people to function effectively & to relate to others. After trauma, individuals effectively & to relate to others. After trauma, individuals are left feeling vulnerable, helpless and out of control in a are left feeling vulnerable, helpless and out of control in a world that is no longer predictable.world that is no longer predictable.

Shattered Assumptions Shattered Assumptions (Janoff-Bullman)(Janoff-Bullman)


The Psychological Impact of TraumaThe Psychological Impact of Trauma

OUTCRYFear, sadness, rage

OUTCRYFear, sadness, rage

IncidentIncident

DENIALRefusing to face

memory of incident

DENIALRefusing to face

memory of incident

INTRUSIONUnbidden thoughts of

the event

INTRUSIONUnbidden thoughts of

the event

WORKING THROUGHFacing the reality of what has happened

WORKING THROUGHFacing the reality of what has happened

COMPLETIONGoing on with life

COMPLETIONGoing on with life PTSDPTSD

OVERWHELMEDOVERWHELMED

FLOODED STATESFLOODED STATES

EXTREME AVOIDANCEEXTREME

AVOIDANCE

PANIC OR EXHAUSTION

PANIC OR EXHAUSTION

PHASES IN THE REACTIONS TO TRAUMAPHASES IN THE REACTIONS TO TRAUMA


The following reactions commonly occur in response to The following reactions commonly occur in response to trauma (the response involves intense fear, helplessness trauma (the response involves intense fear, helplessness or horror): or horror):

The following reactions commonly occur in response to The following reactions commonly occur in response to trauma (the response involves intense fear, helplessness trauma (the response involves intense fear, helplessness or horror): or horror):

• Re-experiencing the trauma (recollections, physical reactivity)Re-experiencing the trauma (recollections, physical reactivity)• Avoidance or numbing (detachment, estrangement, forgetting)Avoidance or numbing (detachment, estrangement, forgetting)• Increased arousal (startle response, irritability, sleep problems)Increased arousal (startle response, irritability, sleep problems)• Other symptoms (depression, guilt, cognitive problems)Other symptoms (depression, guilt, cognitive problems)

• Re-experiencing the trauma (recollections, physical reactivity)Re-experiencing the trauma (recollections, physical reactivity)• Avoidance or numbing (detachment, estrangement, forgetting)Avoidance or numbing (detachment, estrangement, forgetting)• Increased arousal (startle response, irritability, sleep problems)Increased arousal (startle response, irritability, sleep problems)• Other symptoms (depression, guilt, cognitive problems)Other symptoms (depression, guilt, cognitive problems)

The signs & symptoms of PTSDThe signs & symptoms of PTSD

People often respond to a stressful or traumatic People often respond to a stressful or traumatic experience with very strong feelings. They start saying, experience with very strong feelings. They start saying, feeling and doing things that they did not do beforefeeling and doing things that they did not do before

People often respond to a stressful or traumatic People often respond to a stressful or traumatic experience with very strong feelings. They start saying, experience with very strong feelings. They start saying, feeling and doing things that they did not do beforefeeling and doing things that they did not do before


Third level Third level

Second level Second level

First level First level

Rescue & recovery personnel (fire, police

ambulance etc)

Rescue & recovery personnel (fire, police

ambulance etc)

Grieving relatives, friends and colleagues of first

level individuals

Grieving relatives, friends and colleagues of first

level individuals Individuals directly experiencing the

event who may or may not be physically

injured

Individuals directly experiencing the

event who may or may not be physically

injured

4th level casualties

The community/organisation as a whole

4th level casualties

The community/organisation as a whole

IncidentIncident

The Ripple EffectThe Ripple Effect


Definitions:Definitions:Vicarious traumatization:Vicarious traumatization: The transmission of The transmission of traumatic stress by observation and/or bearing witness traumatic stress by observation and/or bearing witness to the stories of traumatic events.to the stories of traumatic events.

Vicarious traumatization:Vicarious traumatization: The transmission of The transmission of traumatic stress by observation and/or bearing witness traumatic stress by observation and/or bearing witness to the stories of traumatic events.to the stories of traumatic events.

Secondary traumatization:Secondary traumatization: The overwhelming The overwhelming traumatic effect resulting from exposure to the trauma traumatic effect resulting from exposure to the trauma of the victim. of the victim.

Secondary traumatization:Secondary traumatization: The overwhelming The overwhelming traumatic effect resulting from exposure to the trauma traumatic effect resulting from exposure to the trauma of the victim. of the victim.

Burnout: Burnout: A state of physical, emotional, and mental A state of physical, emotional, and mental exhaustion caused by a depletion of ability to cope. exhaustion caused by a depletion of ability to cope. Burnout: Burnout: A state of physical, emotional, and mental A state of physical, emotional, and mental exhaustion caused by a depletion of ability to cope. exhaustion caused by a depletion of ability to cope.

Continuous traumatic stress:Continuous traumatic stress: A term used in place of A term used in place of PTS when trauma is so pervasive and unremitting that it PTS when trauma is so pervasive and unremitting that it falls within the range of normal human experience.falls within the range of normal human experience.

Continuous traumatic stress:Continuous traumatic stress: A term used in place of A term used in place of PTS when trauma is so pervasive and unremitting that it PTS when trauma is so pervasive and unremitting that it falls within the range of normal human experience.falls within the range of normal human experience.


•Creating and maintaining an effective, well-tested Critical Creating and maintaining an effective, well-tested Critical Incident Incident Management PlanManagement Plan is perhaps the surest way to is perhaps the surest way to limit damages and hasten recovery while keeping limit damages and hasten recovery while keeping the the individual functional and the company individual functional and the company operationaloperational. .

•AA planned and structured model of crisis management will planned and structured model of crisis management will not only enhance not only enhance an organisationan organisation ability to recover from ability to recover from financial losses and return more efficiently to full financial losses and return more efficiently to full productivity, but will also assist productivity, but will also assist the companythe company to fulfil its to fulfil its moral responsibility to protect employeesmoral responsibility to protect employees..

•Responding to the needs of employees in a Responding to the needs of employees in a compassionate, sensitivecompassionate, sensitive and and helpful manner in the event helpful manner in the event of trauma affirms the value of employees to the company. of trauma affirms the value of employees to the company.

•Creating and maintaining an effective, well-tested Critical Creating and maintaining an effective, well-tested Critical Incident Incident Management PlanManagement Plan is perhaps the surest way to is perhaps the surest way to limit damages and hasten recovery while keeping limit damages and hasten recovery while keeping the the individual functional and the company individual functional and the company operationaloperational. .

•AA planned and structured model of crisis management will planned and structured model of crisis management will not only enhance not only enhance an organisationan organisation ability to recover from ability to recover from financial losses and return more efficiently to full financial losses and return more efficiently to full productivity, but will also assist productivity, but will also assist the companythe company to fulfil its to fulfil its moral responsibility to protect employeesmoral responsibility to protect employees..

•Responding to the needs of employees in a Responding to the needs of employees in a compassionate, sensitivecompassionate, sensitive and and helpful manner in the event helpful manner in the event of trauma affirms the value of employees to the company. of trauma affirms the value of employees to the company.

A Duty of Care……A Duty of Care……


These services also facilitate the normalisation of These services also facilitate the normalisation of personal experience personal experience These services also facilitate the normalisation of These services also facilitate the normalisation of personal experience personal experience

Guidelines for Responding to Trauma Guidelines for Responding to Trauma VictimsVictims

Trauma defusing and debriefing services are vital in Trauma defusing and debriefing services are vital in assisting individuals to process the traumatic experience assisting individuals to process the traumatic experience through an integrated, appropriate and effective method through an integrated, appropriate and effective method of interventionof intervention

Trauma defusing and debriefing services are vital in Trauma defusing and debriefing services are vital in assisting individuals to process the traumatic experience assisting individuals to process the traumatic experience through an integrated, appropriate and effective method through an integrated, appropriate and effective method of interventionof intervention


“…“…. relieving the emotional suffering of clients . relieving the emotional suffering of clients automatically includes absorbing information that automatically includes absorbing information that

is about suffering…. is about suffering….

Often it includes absorbing that suffering as well”Often it includes absorbing that suffering as well”

“…“…. relieving the emotional suffering of clients . relieving the emotional suffering of clients automatically includes absorbing information that automatically includes absorbing information that

is about suffering…. is about suffering….

Often it includes absorbing that suffering as well”Often it includes absorbing that suffering as well”

(Figley, 1995(Figley, 1995))(Figley, 1995(Figley, 1995))

A Note on Caring……A Note on Caring……


Defusing is the ventilation of thoughts and emotions Defusing is the ventilation of thoughts and emotions associated with the crisis event, and should be provided associated with the crisis event, and should be provided as soon as possible after the initial impact of the critical as soon as possible after the initial impact of the critical event to mitigate the effects of the trauma and promote event to mitigate the effects of the trauma and promote recoveryrecovery

Defusing is the ventilation of thoughts and emotions Defusing is the ventilation of thoughts and emotions associated with the crisis event, and should be provided associated with the crisis event, and should be provided as soon as possible after the initial impact of the critical as soon as possible after the initial impact of the critical event to mitigate the effects of the trauma and promote event to mitigate the effects of the trauma and promote recoveryrecovery

DefusingDefusing

PHASESPHASES

• Introductory PhaseIntroductory Phase

• Exploration PhaseExploration Phase

• Information PhaseInformation Phase

• Do’s & don’tsDo’s & don’ts

• Cross cultural considerationsCross cultural considerations

PHASESPHASES

• Introductory PhaseIntroductory Phase

• Exploration PhaseExploration Phase

• Information PhaseInformation Phase

• Do’s & don’tsDo’s & don’ts

• Cross cultural considerationsCross cultural considerations


• Education about stress reactions Education about stress reactions

• Emotional ventilationEmotional ventilation

• The promotion of cognitivThe promotion of cognitive e reassurance that the stress response reassurance that the stress response . is controllable and that recovery is likely is controllable and that recovery is likely

• Mobilisation of resources within Mobilisation of resources within && outside the individual or group outside the individual or group

• Preparation for futurePreparation for future

• Intervention to assist in recovery from traumatic stressIntervention to assist in recovery from traumatic stress

• Screening for people who need additional supportScreening for people who need additional support

• Education about stress reactions Education about stress reactions

• Emotional ventilationEmotional ventilation

• The promotion of cognitivThe promotion of cognitive e reassurance that the stress response reassurance that the stress response . is controllable and that recovery is likely is controllable and that recovery is likely

• Mobilisation of resources within Mobilisation of resources within && outside the individual or group outside the individual or group

• Preparation for futurePreparation for future

• Intervention to assist in recovery from traumatic stressIntervention to assist in recovery from traumatic stress

• Screening for people who need additional supportScreening for people who need additional support

Psychological debriefing is an established multi-phase Psychological debriefing is an established multi-phase group crisis intervention process to help individuals work group crisis intervention process to help individuals work through their thoughts, reactions, & symptoms followed by through their thoughts, reactions, & symptoms followed by training in coping techniques.training in coping techniques. It is not therapy but Involves:It is not therapy but Involves:

Psychological debriefing is an established multi-phase Psychological debriefing is an established multi-phase group crisis intervention process to help individuals work group crisis intervention process to help individuals work through their thoughts, reactions, & symptoms followed by through their thoughts, reactions, & symptoms followed by training in coping techniques.training in coping techniques. It is not therapy but Involves:It is not therapy but Involves:

DebriefingDebriefing


““Healers must understand that caring does not only Healers must understand that caring does not only mean caring for others; it also means caring for oneself. mean caring for others; it also means caring for oneself.

We must be aware of our limits and know when it is We must be aware of our limits and know when it is necessary to nurture ourselves… No one can heal necessary to nurture ourselves… No one can heal

without being healed”without being healed”

““Healers must understand that caring does not only Healers must understand that caring does not only mean caring for others; it also means caring for oneself. mean caring for others; it also means caring for oneself.

We must be aware of our limits and know when it is We must be aware of our limits and know when it is necessary to nurture ourselves… No one can heal necessary to nurture ourselves… No one can heal

without being healed”without being healed”

(Elizabeth Kubler-Ross(Elizabeth Kubler-Ross))(Elizabeth Kubler-Ross(Elizabeth Kubler-Ross))


““We are not invulnerable, but if we maintain a strong We are not invulnerable, but if we maintain a strong sense of community among ourselves, we can be sense of community among ourselves, we can be

resilient”resilient”

““We are not invulnerable, but if we maintain a strong We are not invulnerable, but if we maintain a strong sense of community among ourselves, we can be sense of community among ourselves, we can be

resilient”resilient”(Catherall, 2001(Catherall, 2001))(Catherall, 2001(Catherall, 2001))


Thank youThank you

understanding & managing trauma ‘shattered assumptions….. broken lives’ ‘shattered...

Documents

managing trauma slide

trauma of critical incidentsto

burden of overwhelming

south african life

south african psyche

effective policies

apartheid system

unsafe world slide