What might you do if you are confronted with a traumatic incident? Would you confront the situation or would you run away, call for help or freeze on the spot? The three main reactions to trauma are ‘Fight’, ‘Flight’ or ‘Freeze’. The fourth, less acknowledged, reaction is ‘Fawn’ (appease). To describe all four reactions I will use an example of a team of staff who experience their manager as a bully. Some staff will become rebellious, try to ‘Fight’ the bully, or take out a grievance. Others will want to leave, taking up the ‘Flight’ reaction. Some staff may feel ‘Frozen’, unsure what to do, unable to act. And the fourth reaction, ‘Fawn’, may result in staff wanting to please all parties, as if turning a blind eye to what is occurring and pretend everything is fine. We see clear examples of the fawn response in the Jimmy Savile case, where so many people directly witnessed or suspected that Jimmy Savile was sexually abusing children and didn’t say anything. This is a trauma reaction, as these individuals are often frightened of the consequences of speaking up. In sexual violent crime ‘Freeze’ is often the most common response. When an individual feels ‘over-powered’, freeze may seem like the only option available. We do not know which survival response will be activated and different survival responses may be activated depending on the experience or may be impacted by our current life circumstances. The part of the brain that is activated under threat is disconnected from the analytical part of the brain, therefore the threat response does not have time to be analytical and considered in which survival response is activated. Consider situations in which, realistically, there’s no way you can defend yourself. You have neither the hormone-assisted strength to respond aggressively to the inimical force nor the anxiety-driven speed to free yourself from it. You feel utterly helpless: neither fight nor flight is viable, and there’s no one on the scene to rescue you. Under such unnerving circumstances, “freezing up” or “numbing out”—in a word, dissociating from the here and now—is the response that may be activated. Being physically, mentally, and emotionally immobilised by your consternation permits you not to feel the harrowing enormity of what’s happening to you, which in your hyperaroused state might threaten your very sanity. The fawn response, in my view, refers to the early and both consciously and unconsciously learned rules of survival in infancy and early childhood. Those imperatives concern who we can be, who we can't be, and what we can and cannot do if we are to be in relationship with significant others. The rules also address such questions as, "Who do I need you to be, and who do you need me to be, if we are to be in relationship with each other?" These accommodations have sometimes been referred to as the false self, but the view through the lens of the fawn response lends particular understandings to what that means, especially as it is distinct from fight, flight, or freeze. Unfortunately, as humans we start to criticise our response. Compared to animals who can shake off the trauma and get on with the next day, humans start to berate and judge themselves, for ‘getting it wrong’ or ‘not being good enough’. The four survival reactions are needed; they may save our lives! If these negative berating thoughts become unmanageable it may be helpful to reach out and seek support from specialist trauma therapists to talk about how you feel and challenge the irrational thoughts, to enable recovery from trauma symptoms, and to manage the feelings that the trauma has caused.
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Another damming report today on sexual exploitation and sexual violent crime taking place within the aid sector, by the Victoria Derbyshire BBC programme. We need to create channels to address these issues and to enable staff to feel safe talking about their experiences openly. Sexual violence has been described as entrenched and endemic within the humanitarian aid sector. Many have reported that perpetrators are often male figures in senior positions, which leaves staff feeling disempowered from speaking out and reporting. Staff describe a culture of scapegoating those who speak out, lack of psychosocial support for those impacted, and lack of sufficient and appropriate policies. Could this be defined as the final catastrophe of mission creep? Many individuals responded to today’s report defending and protecting the humanitarian sector and highlighting the great work that is being done. There is no question that fundamental and crucial work is carried out on a daily basis, often at the risk of the aid worker, within the humanitarian sector, but at no point should that overlook, or distract our attention from the cold harsh reality that sexual abuse is taking place within the aid sector. Any form of sexual abuse has always been an uncomfortable subject, and many want to turn a blind eye, as it can stir up difficult emotions. It is not a stain on the humanitarian sector, as we know this type of abuse happens in any profession that deals with power imbalances and vulnerable people, in fact these working environments can become a breeding ground for perpetrators if these issues are not addressed appropriately. So let us not be distracted by the shock factor, and get lost in debates about the good that is accomplished, or condemn the humanitarian organisations by reducing their funding. Let us address these issues as fully as possible, so the lens can be readjusted back to the remarkable work the aid sector continues to accomplish. We need to support staff better, to enable them to feel safe and resilient within their workplace, not violated, exploited and frightened to speak out. An aid worker who went on her first deployment, was informed that ‘you will witness UN staff taking prostitutes into their hotel rooms, this happens, so turn a blind eye’! We cannot turn a blind eye to those suffering. This leaves a bad taste in the wide, diverse and hungry mouth of the humanitarian aid sector. Three professionals were interviewed about this topic on the Victoria Derbyshire programme this morning, Shaista Aziz (a previous aid worker), Alexia Pepper De Caires (Campaigner for women’s rights in aid sector), and Carl Wilding (National Council for Voluntary Organisations). Shaista opened the conversation stating ‘as someone who has worked in the sector for over 15 years I came across these masochistic cultures. Patriarchy is at the heart of this and power. Bartering for sex is about power and abuse.’ Shaista created an NGO safe place, which enables aid workers to tell their stories anonymously. She shared that they had received 80 reports within a two-week period, the majority from women, and a few from men. She also went on to state that these organisations should not be investigating themselves and therefore an independent body should be setup to carry out these investigations. Alexia agreed with this point stating, ‘The culture has not made it easy for any of us to talk about what we’ve experienced. The organisations are not open to us revealing the extent of the problems. This is the tip of the iceberg… The organisations are taking a line now that they have zero tolerance; it is very hard to believe…. We are not seeing the change and the transformation and the belief of women at the core of this.’ Carl added to this discussion, ‘we don’t have a sufficient culture yet, where people feel they can come forward and talk about these issues.’ So continuing to hold in our minds the amazing work the humanitarian sector do to support those who are disempowered, and holding our respect to the dedicated and passionate staff, how does the humanitarian sector address, as one colleague put it, ‘the dark side of the coin’. Below are some of the suggested solutions:
The #Metoo campaign has created a virtual community, empowering survivors of sexual abuse to speak out. The last thing we want to do is silence these courageous voices that have taken decades to be heard. Fiona Dunkley's new book has been described as 'the only source that explores the impact of trauma and critical incidents on aid workers, including sexual violence' and 'the book examines the impact of cumulative stress and trauma on the aid worker and provides practical actions to offer recovery and healing.' Psychosocial Support for Humanitarian Aid Workers, is available from Amazon. References https://www.eisf.eu/theme/managing-sexual-violence/ https://www.bbc.co.uk/programmes/p06bppxy #VictoriaLIVE #metoo #humanitarianaid #sexualabuse #sexualexploitation Resilience at work is now recognised as a defining characteristic of employees who deal well with the stresses and strains of the modern workplace. Resilience is a person’s capacity to respond to pressure and the demands of daily life. Dictionary definitions include concepts like flexibility, suppleness, durability, strength, speed of recovery and buoyancy. In short, resiliency affects our ability to ‘bounce back’. At work, resilient people are better able to deal with the demands placed upon them, especially where those demands might require them to be dealing with constantly changing priorities and a heavy workload. Resilience is not a characteristic gifted to some individuals and not others. The key here is that resilience is not a passive quality, but an active process. How we approach life, and everything it can throw at us, has a massive impact on our experience. Resilient people do more of the things that help maintain that responsiveness, and it is relatively easy for those of us who are feeling less resilient to develop habits that will increase our ability to perform under pressure, and perhaps more importantly, to live better despite circumstances that try us to the limit. Why do individuals overlook their self-care for the greater course? Sometimes the last person carers nurture is themselves. By carers I refer to aid workers, emergency first responders, medical staff, social workers, teachers or any role where staff take on a caring role. This neglect undermines healthy work practice, but can be corrected if clinicians not only pay attention to client care but also to self-care. Due to nature and demand of the job, carers frequently neglect to counsel themselves about self-care or heed the signs and symptoms of the hazards associated with their professional practices. The cost of that self-neglect is high and ranges from nagging stress that can erode health and wellbeing to compassion fatigue to job burnout so crippling that individuals may walk away from their chosen profession. Obstacles to Self-Care Among the obstacles experts identify as standing in the way of self-care are a lack of energy, too many responsibilities, and the fear of appearing weak or vulnerable. Another hurdle is a person’s difficulty in putting themselves first and the inability to acknowledge that his or her needs deserve to be made a priority. Additional reasons people fail to attend to their own care include self-esteem issues; over-stimulation coupled with ambition. When I have facilitated stress management and resilience building workshops, the most stressed person will always say, ‘they haven’t got time for themselves’. This is a red flag that something must change, so they can begin to prioritise their own self-care. Creating a Self-Care Plan In human services, especially carers, your most foundational instrument is you. To take care of that instrument, which is to take care of yourself, is a two-step process. The first is to heal, which is the minimum of self-care and encourages you to focus on obtaining what you need to survive. The second is to energise, which is a more advanced self-care and encourages you to focus on thriving. Peace and healing require that a person’s basic physical, mental, and emotional needs be met. This isn’t just a matter of getting enough sleep, nutritious food, and adequate exercise, though those are fundamental. It’s also leaning on trusted others for support, paying attention to when your body signals you to slow down and listening to it, and not pushing yourself to the point of breakdown. The most important practices are to develop healthy habits, create clear boundaries, ask for and accept help, find ways to centre yourself for peace, and manage perfectionist tendencies - to be aware of what you are humanly capable of. Part of self-care, too, is knowing when to seek help. Thus, seeking therapy can be an important tactic, not only because it provides perspective from a trained professional, but because the therapist can also assist carers in developing their self-care regimens. How do we keep an organisation resilient? Current events teach us that crisis and even disaster occur far more frequently than previously anticipated. Japan’s post-tsunami crisis and repeated tornadoes of the Southern and Midwestern US demonstrate the vulnerability of modern infrastructures to the forces of nature. Wall Street’s meltdown, the subsequent recession, and the consequent demise of discretionary spending remind us that human-made disasters can be devastating in other ways. The key to not only surviving such events, but to prospering during such upheavals, we argue, is human resilience. While human resilience may be thought of as a personality trait, in the aggregate, groups, organisations, and even communities can learn to develop a “culture of resilience” which manifests itself as a form of “psychological immunity” to, or the ability to rebound from, the untoward effects of adversity. Just as individuals can learn to develop personal traits of resilience, so too can organisations develop a culture of resilience. We would argue that a culture of organisational resilience is built largely upon leadership, what we refer to as “resilient leadership.” Consistent with the “Law of the Few” described in Malcom Gladwell’s book, The Tipping Point, we believe key leadership personnel, often frontline leadership, appear to have the ability to “tip” the organisation in the direction of resilience and to serve as a catalyst to increase group cohesion and dedication to the “mission.” They do this by demonstrating four core attributes of optimism, decisiveness, integrity, and open communications while serving as conduits and gatekeepers of formal and informal information flows throughout the organisation and enjoying high source credibility (ethos). All of these can be learned. Simply said, when a small number of high credibility individuals who serve as visible informational channels demonstrate, or model the behaviours associated with resilience, we believe they have the ability to change an entire culture of an organisation as others replicate the resilient characteristics that they have observed. To say we live in challenging times is an understatement, but crisis may also be understood as an opportunity. Those who cultivate a resilient organisation we argue will be better positioned to prosper when others falter. More and more organisations are beginning to add resources to take care of their staff and recognise the risks of vicarious trauma and building resilience. I am being asked to facilitate more and more stress management and resilience building workshops for teams of carers, including working with emergency first responders, various NGOs and Government organisations, and journalists. We encourage organisations to invest in the preparation and resilience of staff, as much as the psychosocial support post a critical incident. The more resilient staff and organisations are the better they will be placed to cope with disaster and recover well. With the anniversaries of the Grenfell Tower fire today, and the Manchester Arena bombing, the Westminster and London Bridge terrorist attacks, and attacks in South Sudan on Humanitarian Aid workers, over the last few months, this can be a traumatic time for many as memories of those events come flooding back. Anniversaries and the media coverage can often become triggers, reactivating the brains survival response and retraumatising individuals. In this week’s blog post I talk about triggers, what they are, how they are formed and how seeking professional advice and support can help individuals recover from trauma symptoms. What is a Trigger? Triggers can include stimulus such as smells, sounds, or specific places that remind individuals of the traumatic event. This reminder can cause a person to feel overwhelming sadness, anxiety, or panic. It may also cause someone to have flashbacks. A flashback is a vivid, often negative memory that may appear without warning. It can cause someone to lose track of their surroundings and “relive” a traumatic event. Babette Rothschild (psychotherapist and author of The Body Remembers) notes: Trauma continues to intrude with visual, auditory, and/or other somatic reality on the lives of its victims. Again and again, they relive the life-threatening experiences they have suffered, reacting in mind and body as though such events were still occurring. (Rothschild, 2000) Sometimes triggers are predictable. For instance, a veteran may have flashbacks while watching a violent movie. In other cases, triggers are less intuitive. A person who smelled incense during a sexual assault may have a panic attack when they smell the same incense in a store. The effects triggers can have on those affected by trauma include:
The exact brain functioning behind triggers is not fully understood. However, there are several theories about how triggers work. When a person is in a threatening situation their survival response: fight, flight or freeze is activated. The body is on hyperalert, prioritising all its resources to react to the situation. Functions that aren’t necessary for survival, such as the digestive system, are put on hold. One of the functions neglected during a fight, flight or freeze reaction is short-term memory. In some cases, a person’s brain may misfile the traumatic event in its memory storage. Therefore, rather than the memory being stored as a past event, the situation is labelled as a still-present threat. When a person is reminded of the trauma, their body acts as if the event is still happening. In some cases, a sensory trigger can cause an emotional reaction before a person realises why they are upset. Sensory information (sights, sounds, and especially smells) plays a large part in memory. The more sensory information that is stored the greater the risk of being triggered. During a traumatic event, the brain often ingrains sensory stimuli into memory. Even when a person encounters the same stimuli in another context, they associate the triggers with the trauma. In some cases, a sensory trigger can cause an emotional reaction before a person realises why they are upset. Habit formation also plays a strong role in triggering. People tend to do the same things in the same way. Following the same patterns saves the brain from having to make decisions. For example, say a person always smokes while they are driving. When a person gets in the car, their brain expects them to follow the same routine and light a cigarette. Thus, driving could trigger the urge to smoke, even if the person wishes to quit smoking. Someone can be triggered even if they don’t make a conscious connection between their behaviour and their surroundings. What Are Trigger Warnings? A trigger warning is a notice of potential triggers in future discussion or content. The aim is to let people with mental health concerns avoid or prepare themselves for triggers. It is impossible to predict or avoid all triggers, since many are unique to a person’s situation. When triggers are identified, individual’s can prepare themselves, by using certain grounding techniques, carrying a small bottle of scent that helps them to relax, or learning certain breathing exercises. Getting Help for Triggers Trigger warnings are useful in some cases, although avoiding one’s triggers will not treat the underlying mental health concerns, and unhealthy coping mechanisms such as alcohol and recreational drugs may be used to dull the senses. If triggers interfere with someone’s daily life, the person may wish to see a trauma specialist therapist. In therapy, people can learn techniques to manage their panic or anxiety activated from a trigger, can process the traumatic event therefore leaving it in the past, and reduce the emotional content connected to the trauma memory. The focus of trauma treatments is to move the processing of the traumatic material from activating the amygdala (the fire alarm system of the brain) to the hippocampus (the filing system of the brain); to make meaning, to create a narrative, to find a new perspective that is less derogatory of self, to reduce the symptoms of trauma and to find a way to regulate the body back to a relaxed state. Once the memory becomes processed and stored in the hippocampus we have more control over it, and we can choose when or if to view it. When it is stuck on replay and activating the amygdala, we feel as if we are back in the trauma memory, and it feels like it has control over us. If you want to read more in depth information on triggers and the trauma response have a look at my new book Psychosocial Support for Humanitarian Aid Workers, available from Amazon. Even though it focuses on Humanitarian Aid Workers, it is a guide for anyone who has been impacted by trauma. If you would like any further help or support please visit: www.fionadunkley.com and/or www.FDconsultants.net or email: [email protected] I’ve built a toolkit that helps my clients increase their resilience to acute stress and trauma. So far in my three part series on the subject, I’ve covered relaxation, education, social, and physical tools. This week, in my third and final post, I'd like to talk about exercise, creativity, and thinking. Exercise really does release hormones that make you feel yourself again. And coupled with basing your thoughts in reality, these tools will enable you to stay much more resilient to stress and trauma. The resilience toolkit (Dunkley, 2018) Work demands and mental health risks to carers are ever increasing, so I have created a resilience toolkit acronym using the word RESPECT. I recommend accumulating a good balance of resources that cover the following areas: Relaxation Education Social Physical Exercise Creativity Thinking I suggest you try out some of the techniques in order to create your own personal resilience toolkit, ready to use when needed. What can exercise do to help us stay relaxed? The stress response releases hormones such as adrenaline, nor-adrenaline and cortisol. When we exercise we release feel good hormones, such as serotonin and endorphins. Exercise – Being active not only helps us to keep fit, but research has shown that it also helps keep our minds alert. Yoga, Thai Chi, Qi Gong and Martial Arts – These forms of exercise have been described as enhancing a spiritual or universal connection. The movements are performed in relationship with the breath, which encourages emotional regulation, with research also showing a reduction in heart rate variations (HRV). This enables control over our impulses and emotions, reduces anxiety and depression, and also the risk of physical illness (Sack et al, 2004). Van der Kolk and colleagues evidenced how ten weeks of yoga markedly reduced PTSD symptoms (Van de Kolk et al, 2014). Building physical strength – Building physical strength by exercising with weights has been shown to increase confidence. However, due to its adrenalin pumping nature this type of exercise can become addictive; so if this technique is your preferred resource, make sure you balance it with resources from the other categories. Core strength exercises such as Pilates can also encourage an inner confidence and strength. Some stress busting creative tools… Creativity can soothe the traumatised parts of the brain, creating distraction as well as healing qualities. Art – Painting or drawing is a great way to activate the creative part of the brain. This type of resource involves focus, and is therefore a good distraction that keeps us grounded in the present. The Tree of Life therapy, founded by Ncazelo Ncube and David Denborough (Denborough, 2008) involves clients drawing a tree as a metaphor to represent different aspects of their lives. Music – Music has often been used as a healer, connecting deeply to our emotions and offering comfort. Notice the music you are drawn to, and why. If you are listening to adrenalin pumping music and you feel hyperalert and anxious, you may want to listen to calming music for a while. Writing – It can be helpful to just allow words to form on paper, with no judgement or pressure to ‘get it right’, but just using writing as a means to ‘get it out there’. Narrative Exposure Therapy (Schauer, Neuner & Elbert, 2005) focuses predominantly on the client writing a detailed narrative timeline of all the traumatic events experienced. Safe place - Another exercise you can do to help relax your body and reassure yourself that you are safe is to do the ‘safe place’ exercise. This was originally used in hypnosis for reducing traumatic stress (Napier, 1996). Imagine a time when you were totally relaxed and happy. Become aware of all your senses as you recall this event: what did you see, feel, hear, taste, touch and smell? How did you feel at the time and where do you notice that feeling in your body? Using sensory information you can bring the memory alive, and recall it as a calming resource to use when you start to feel anxious. Experience the rational rather than the emotional. The emotional brain, rather than the rational brain, dominates the mind when we are stressed. Therefore we can be consumed with thoughts of ‘not being good enough’, ‘not having done enough’, or feeling ‘we are to blame’. These thoughts might ‘feel’ true, but they are often not based on reality. Challenging negative thoughts –Consider what you might say to a friend who had experienced a similar event. Write down these supportive statements, and try saying them to yourself. Affirmations/Mantras – Write a couple of affirmations (supportive statements about yourself) and keep them nearby, to refer to regularly. Avoid stimuli – Material on social media or TV can be triggering. Monitor what you are watching and your arousal levels. It may be that you need to spend a period of time avoiding certain subjects. A final word on RESPECT. If we can learn to ‘RESPECT’ ourselves more, listen to our bodies and prioritise our own well-being we can role-model good self-care to support ourselves and our staff/clients. Recently, a colleague who recovered from burnout and vicarious trauma shared, ‘I eventually became comfortable with my reinvented self-image. I had to reassess my work commitments and how much I was willing to do. Instead of talking a good “work/life balance” I had to hunt it down. Being outside, exercise, making time for people, smiling, being present, not pursuing a grand plan but finding great comfort in predictable stability, and understanding my own psychological make-up were all critical coping mechanisms.’ You can also find an in-depth look at the entire toolkit in my book, Psychosocial Support for Humanitarian Aid Workers, available from Amazon. In the meantime, feel free to comment with any questions or thoughts. Edited by John Kirkham |
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