Discussion: self-care and Wellness program: Physical Activity

Discussion: self-care and Wellness program: Physical Activity ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: self-care and Wellness program: Physical Activity Due 03/19/2019 Reflect on work environments you have experienced. Choose one organizational practice that promoted self-care and wellness and one practice that inhibited self-care and wellness. Consider the self-care and vicarious trauma implications of each. Walden SOCW6333 self-care and Wellness program: Physical Activity Post a brief description of one organizational practice from your experience that promotes self-care and wellness and one practice that inhibits self-care and wellness. Explain the outcome of each experience, then explain the impact these practices had on you personally and professionally. Be specific. Discussion: self-care and Wellness program: Physical Activity Finally, explain how these practices may or may not impact the development or perpetuation of vicarious trauma. Walden SOCW6333 self-care and Wellness program: Physical Activity References Morrissette, P. J. (2004). The pain of helping: Psychological injury of helping professionals . New York, NY: Taylor & Francis. Chapter 7, “Vicarious Traumatization” (previously read in Weeks 2 and 3) Hernandez, P., Engstrom, D., & Gangsei, D. (2010). Exploring the impact of trauma on therapists: Vicarious resilience and related concepts in training. Journal of Systemic Therapies, 29 (1), 67–83. Sansbury, B. S., Graves, K., & Scott, W. (2015). Managing traumatic stress responses among clinicians: Individual and organizational tools for self-care. Trauma, 17 (2), 114-122. doi:10.1177/1460408614551978 Steinlin, C., Dölitzsch, C., Kind, N., Fischer, S., Schmeck, K., Fegert, J. M., & Schmid, M. (2017). The influence of sense of coherence, self-care and work satisfaction on secondary traumatic stress and burnout among child and youth residential care workers in Switzerland. Child & Youth Services, 38 (2), 159-175. doi:10.1080/0145935X.2017.1297225 sansbury_managing_traumatic_stress.pdf steinlin_the_influnece_of_coherence.pdf hernandez_exp TRAUMA Original Article Managing traumatic stress responses among clinicians: Individual and organizational tools for self-care Trauma 2015, Vol. 17(2) 114–122 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1460408614551978 tra.sagepub.com Brittany S Sansbury1, Kelly Graves2,3 and Wendy Scott2 There is a growing interest in conceptual frameworks related to preventing stress responses among mental health clinicians working with survivors of trauma. The following paper comprehensively compares and contrasts vicarious traumatization with compassion fatigue (i.e. secondary trauma), and it considers how these two traumatic stress responses can lead to professional burnout. It reviews the historical development and empirical support related to the effects of trauma work on clinicians, and it provides practical guidelines for both individuals and organizations to protect clinicians from traumatic stress responses. Keywords Vicarious trauma, burnout, compassion fatigue, clinician self-care Introduction There is growing attention to the prevalence of trauma and its negative consequences. A myriad of research studies have shown that trauma can chronically and pervasively impact multiple developmental areas, including social, cognitive, psychological, and biological development across the lifespan.1–3 Recent research has documented that trauma exposure can impact at the DNA level, as children who were exposed to trauma showed signs of biological aging (‘‘wear and tear’’) on DNA sequences called telomeres, which are responsible for aging and progression of disease states.4,5 In addition, the ?nancial costs of childhood trauma are astronomical-approximately $4379 per incident2 and $103.8 billion per year in the United States.6 If one expands statistics to both human-made and natural disasters, authors elaborate that over nine million deaths and 7000 traumas occurred around the world between 1951 and 2000.7 Although the ?eld has been looking intensively at the impact of trauma on clients, we know less as a ?eld about the impact of trauma-speci?c treatment on the ‘‘helpers’’. As many as 24 million or 8% of US residents will experience a traumatic stress response during their lives; but the rate is an estimated 15%8 to 50%,9 potentially nearly six times higher, among mental health workers. Traumatic exposure responses, in general, have been referred to as the ways in which the ‘‘world looks and feels like a di?erent place to you as a result of your doing your work’’.10 Trauma work demands that clinicians are astutely aware of the core principles of trauma-informed care, namely safety, empowerment, trust, collaboration, and choice.11 Every action that a clinician takes must be consistent with these core principles as trauma-informed treatment has been shown to be more bene?cial than the usual standard of care. Given the intensity of traumaspeci?c treatment, clinicians also must maintain self-care practices to manage their own traumatic stress responses. The next section compares and contrasts vicarious traumatization with compassion fatigue (i.e. secondary trauma). 1 University of Memphis Institute on Disability, University of Memphis, TN, USA 2 Center for Behavioral Health and Wellness, North Carolina A&T State University, NC, USA 3 Department of Human Development and Services, North Carolina A & T State University, NC, USA Corresponding author: Brittany S Sansbury, The University of Memphis Institute on Disability, Ball Hall 100, Memphis, TN 38152 USA. Email: [email protected] Sansbury et al. 115 Vicarious traumatization Compassion fatigue In the 1990s,Walden SOCW6333 self-care and Wellness program: Physical Activity Pearlman and colleagues de?ned vicarious traumatization as ‘‘the transformation that occurs within the therapist (or other trauma worker) as a result of empathic engagement with clients’ trauma experiences and their sequelae’’.12 The transformation occurs when managing trauma among clients results in altered memory systems and cognitive schemas associated with ?ve need areas: safety, dependency or trust, power, esteem, and intimacy.13 When these disruptions occur, clinicians demonstrate increased vulnerability or awareness of how fragile life can be and can become suspicious or distrusting of others. These experiences can prompt unexplainable changes in a?ect, like anger or sadness, which can complicate how an individual interacts with both colleagues in the work environment as well as in interactions within their personal lives.14 The incidence and severity of clinician symptomology depends on how salient the need area is in his or her life.11 For example, a person who struggles with trust, is more likely to relive reports from a client about being betrayed or violated in family incest. These need areas also can be particularly salient for clinicians who have their own traumatic histories.12 More recent theory and research broadens the concept of vicarious traumatization to include countertransference, empathy, and emotional contagion.14 Related to countertransference, clinicians who fail to contain reactions to client emotion are susceptible to changes in their own belief systems,14,15 reduced awareness, and increased defensiveness. Related to empathy, the ability to connect with client su?ering helps the clients, but also increases vicarious trauma if clinicians cannot ‘‘manage’’ the empathic process.14 Finally, emotional contagion involves unconsciously reliving the trauma of a client, beyond simply attempting to understand it with empathy. Older studies support the ‘‘catching’’ of depression16 and anxiety symptoms by clinicians who seek to mimic or parallel clients’ a?ect.17 The capacity to put oneself in the emotional world of others can assist a trauma worker in learning about them. Nonetheless, emotional contagion is most dangerous when a lack of self-awareness gives way to an unconscious and prolonged shift from personal views to clients’ traumatic a?ect. Discussion: self-care and Wellness program: Physical Activity. Interviews with trauma clinicians con?rm several life areas impacted by vicarious traumatization such as seeing the world in a negative way, feeling unsafe, reduced sense-of-self, reduced connection to work, less interest in others, and increased negative a?ect.18,19 This collection of stress responses is a hallmark of vicarious traumatization. Figley20 coined the term secondary traumatic stress to denote su?ering acute emotional crisis due to interaction with trauma survivors, whether in personal relationships or the therapeutic alliance. Early on, the author renamed this adverse psychological functioning to compassion fatigue to reduce stigma against traumatic stress responses among professionals.21 Figley identi?ed three domains to explain the concept: (1) re-experiencing content from a client’s story; (2) avoidance and numbing toward potential triggers; and (3) burnout.20 The ?rst component refers to physical symptoms like sleep disturbance and gastrointestinal issues. A clinician also can endure emotional changes (the second component) such as unreasonable irritation, anxiety, or guilt. The third component is the behavioral component, which includes symptoms such over-eating or substance abuse. The last two components, pertaining to a?liations at work and with peers, involve clinicians psychologically or physically separating themselves from others. This withdrawal may result in di?culty performing tasks and consequently loss of relationships. Compassion fatigue di?ers from vicarious trauma in that compassion fatigue can occur with little to no contact with clients, whereas vicarious trauma only occurs when interacting directly with traumatized clients. Burnout Maslach and Jackson22 popularized the concept of burnout as an occupational syndrome in systems of care characterized by high demands and little support. Burnout is a gradual and progressive process that occurs when work-related stress results in emotional exhaustion, an inability to depersonalize client experiences, and a decreased sense of accomplishment.23 This traumatic stress response is globally a?liated with prolonged strain at work, not simply contact with clients who have experienced trauma. Walden SOCW6333 self-care and Wellness program: Physical Activity It is the principal assertion of this paper that burnout can emerge after extreme cases of either vicarious traumatization or compassion fatigue.24 Recent reports on helping professionals’ mental health provide empirical evidence of this triangular relationship.25–30 A report of 782 police o?cers, ?re?ghters, and medical responders indicates a correlation between vicarious traumatization and burnout.25 There is an inverse relationship between their role clarity and intrusive thoughts (r ¼ .23, p < .01), avoidance (r ¼ .31, p < .01), and emotional arousal (r ¼ .26, p < .01). Predictability at work has a moderate association with these three symptoms of vicarious traumatization (r ¼ .09, .16, .18, p < .01). A second study with 10 child welfare workers further corroborates the 116 relationship between the traumatic stress response and job-related psychological withdrawal.27 It recognizes countertransference and poor coping strategies, which are historically linked to vicarious traumatization, as precursors for burnout. Another set of studies attributes signi?cant variance in mental health outcomes to the positive relationship between compassion fatigue and burnout. For example, Meadors et al.29 write that burnout is responsible for nearly 32% of variance in the incidence of traumatic stress response for a group of 167 healthcare providers (r ¼ .56, p < .01). Vilardaga and collegues30 investigated how work-related variables impact burnout for addiction counselors. A set of factors, namely job control, coworker support, supervisor support, salary, workload, and tenure, account for considerable variance in traumatic stress responses. Speci?cally, the results demonstrate that these mediators for compassion fatigue explain 27% of the variance in counselors’ emotional exhaustion, 16% of the variance in their depersonalization, and 22% of the variance in their sense of accomplishment at work. Psychological demand is positively associated with distress, depression, and burnout (R2 ¼ .22, F ¼ 8.68, p < .01), with burnout showing the strongest association amongst the other mental health outcomes. Assessing traumatic stress responses Because burnout can emerge after extreme cases of vicarious traumatization or compassion fatigue, it is essential that clinicians, supervisors, and the organizations they work for monitor such symptoms. There are several measures to quantify the incidence and severity of traumatic stress responses by clinicians, and these scales allow clinicians to track and monitor symptoms of vicarious traumatization, compassion fatigue, and burnout. Accordingly, they serve as a ?rst line of defense in managing traumatic stress responses as it allows for the ?rst essential step (as described in more detail below), namely awareness of traumatic stress responses. Commonly used assessments include: The Traumatic Stress Institute Belief Scale (TSI-BSL) is an 80-item standard assessment for vicarious traumatization. The TSI-BSL evaluates a clinician’s impairment in self- and social-need areas such as safety, trust, control, esteem, and intimacy.31 Its 80 items prompt him or her to respond on a 6-point Likert scale, where higher scores indicate more disruption in the memory system and cognitive schemas. The resulting composite scale has a reported internal consistency reliability of .98, and its 10 subscales possess Cronbach alpha ratings that range from .77 for other-control to .91 for self-esteem. On average, trauma clinicians and Trauma 17(2) other mental health professionals score 166.83 on the TSI-BL,13 indicating little to no impairment, yet it remains unclear how to di?erentiate simpler adjustment challenges from clinical symptomology in need areas. Discussion: self-care and Wellness program: Physical Activity. The Compassion Fatigue Self-Test for Psychotherapists (CFST) is a 40-item scale including items on both compassion fatigue (CFST-CF) and burnout (CFST-BO) for a total composite score.32 Its items allow trauma clinicians and sta? members to respond on a 5-point Likert scale, where higher scores indicate more stress response from trauma work.Walden SOCW6333 self-care and Wellness program: Physical Activity The internal consistency reliability ratings have Cronbach alphas ranging from .86 to .94. The Professional Quality of Life Scale (ProQoL)33 has 30 items and represents attempts to combine earlier subscales on compassion satisfaction with compassion fatigue.33 Its 2002 version has three discrete subscales: the compassion satisfaction items evaluate the pleasure a trauma clinician derives from his or her work; the compassion fatigue items evaluate potential distress due to exposure to client cases; and the burnout items evaluate feelings of hopelessness and less sense of accomplishment. The subscales allegedly possess relatively high internal consistency reliability, ranging from .72 to .87. The ProQol asks trauma clinicians to answer all 30 items using a 6-point Likert scale, with higher scores indicating more psychological impairment. According to Stamm,33 clinician scores above a 17 on the compassion fatigue subscale or a 27 on burnout subscale re?ect the highest risk for severe traumatic responses. The Maslach Burnout Inventory is a 22-item self-report survey with three subscales: the emotional exhaustion (EE) items refer to a clinician being strained mentally and emotionally; the depersonalization (DP) subscale evaluates his or her ability to di?erentiate self from client experiences; and the personal accomplishment (PA) items assess grati?cation and sense of e?cacy from work.22,34 The PA subscale is reverse-scored, whereas higher scores on the EE and DP items indicate burnout. The entire assessment includes 22 items with 7-point Likert responses. Its composite internal consistency reliability is .91, with Cronbach’s alphas for the subscales from .81 to .92. It is worth noting that burnout and compassion fatigue scales have presented di?culties in past empirical studies that attempted to validate them conceptually.21,29 Speci?cally, there is some evidence that the domains are not reliably related to work with individuals who experience trauma. There are two assumptions to draw from this problem. Clinicians may report immediate and heightened a?ect after sessions with their clients, even if they appear only minimally Sansbury et al. impacted by changes in their belief systems over time. Lastly, one can also assume that other scales could identify risks and symptoms better than the CFST or ProQol. If compassion fatigue is a construct largely focused on theory and unseen changes in cognition, applied research to monitor measurable traumatic stress for clinicians can bene?t from utilizing more psychometrically established assessments. Practical guidelines for individuals and organizations There is a need for more practical guidelines that can unify the conceptual frameworks related to preventing traumatic stress response. As Lipsky and Burk describe: ‘‘There is a di?erence between feeling tired because you put in a hard day’s work and feeling fatigued in every cell of your being. Most of us have experienced a long day’s work and the reward of hard-earned exhaustion. . .That is one kind of tired. The kind of tired that results from having a trauma exposure response is a bone-tired, soul-tired, heart-tired, kind of exhaustion. . .’’ (p.110).10 There are positive consequences to traumaspeci?c work such-as when providers gain a sense of accomplishment from helping someone achieve a goal, heal from a di?cult situation, or develop a pathway for recovery. In a 2012 New Delphi study, focus groups with 102 paramedics and ?rst-responders in the UK National Health Service con?rmed that knowing what happens to survivors or learning how better to assist impacted families provided more satisfaction. They reported being unsatis?ed with the status quo, implying that their service inspired them to improve the quality of care for those a?ected by trauma.35 Inversely, there are also negative consequences of therapeutic work, some of which are at the conscious level, and some are unconscious. As Hil?ker36 states, ‘‘All of us who attempt to heal the wounds of others will ourselves be wounded; it is, after all, inherent in the relationship’’.Walden SOCW6333 self-care and Wellness program: Physical Activity The primary question is: how can people in the helping ?eld work toward facilitating the healing of others while limiting the negative impact on themselves? We propose that the answer to that question has multiple levels of responsibility. Both individuals and organizations have a responsibility to create an environment of wellness and support. Practical guidelines for individuals When considering the ways in which clinicians can actively work to prevent burnout, it is important to understand that the process of preventing burnout is 117 an active one. The clinician is not a passive recipient in which all the stress gets wiped away by breaks or organizational magic wands. Instead, the clinician must be actively involved in a process of self-care. Readers are encouraged to review the 16 signs of trauma exposure responses as outlined in Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others,10 for speci?c examples of the ways in which trauma responses ‘‘show themselves’’ in the everyday lives of clinicians. Here, we have reviewed and synthesized a four-step process for clinicians to utilize on their journey to self-care. Step 1 – Know thyself. Clinicians must be aware of their own arousal states. Rothschild and Rand24 indicate that ‘‘we are most vulnerable to compassion fatigue or vicarious traumatization when we are unaware of the state of our own body and mind’’. This is the ?rst step to creating an individual climate of selfcare. Mindfulness regarding the ‘‘status’’ of one’s body and autonomic nervous system activity, otherwise known as arousal awareness, is a core tenet of ‘‘knowing thyself.’’ Step 2 – Commit to address the stress. The ?rst step should be closely followed by the second one of knowing or learning how to manage various identi?ed arousal states (i.e., reducing stress). This requires recognizing that distress may, at times, be present at a somatic level. Clinicians should pay attention to their own body posture, facial expressions, muscle tensions, breathing patterns, and other bodily sensations.24 Particularly during the process of joining with the client and providing empathy while the client is sharing emotional content, it is quite possible for clinicians to start unconsciously mimicking the somatic feelings of their clients. It is thereby essential for clinicians to develop the skills in which they can dually monitor the somatic experiences of not only their client but also of themselves. Part of this monitoring process may be to understand boundaries not only in terms of work-life balance, but also within the therapeutic context. For those who are healing from trauma, this modeling opportunity can be strong therapeutic material that can set the stage for how they can set appropriate, healthy boundaries in other relationships. For clinicians, the concept of boundaries also extends to physical space. Simple adjustments can be made that can create a sense of safety, such as altering the space between the client and therapist chair or the room layout. Clinicians also can create personal space through eye contact. Hodges and Wegner documented that simply changing your gaze from a client to something else, even if momentarily, can assist clinicians in regulating their own emotional responses to the 118 client.36 Wilhelm Reich37 has since coined the term ocular defense to describe this process. Addit … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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