With the recent news that Facebook has agreed to pay £42m to content moderators as compensation for mental health issues developed on the job, it highlights the significant increase in staff being exposed to traumatic material via social media. In 2018, a group of US moderators hired by third-party companies to review content sued Facebook for failing to create a safe work environment. The moderators alleged that reviewing violent and graphic images - sometimes of rape and suicide - for the social network had led to them developing post-traumatic stress disorder (PTSD). Untreated PTSD can cause permanent damage to the brain due to the person living in a hyper-aroused state. The effects of PTSD can cause someone to put him/herself in danger or even endanger others including his/her family members. Misdiagnosed or untreated PTSD is commonly associated with substance abuse. Drugs or alcohol can act as a coping mechanism, provide a temporary escape or chance to get away or relieve physical and psychological pain. The misuse of alcohol or drugs can lead to a number of other complications in a life already complicated by PTSD. Alcohol and drug use only serve as a temporary solution. Once the substance wears off, a person will be in the same position or a worse one than before. One of the most popular workshops we offer at FD Consultants is our trademark Trauma and Vicarious Trauma awareness workshop for individuals and organisations. The training enables individuals to identify trauma symptoms, triggers, and have resources to process traumatic material. As a preventative training it helps to build a healthy organisational culture, with wellbeing at its heart, ensuring staff are working in a psychologically safe and compassionate work environment. Managers also feel confident to recognise the risk of trauma and help or signpost staff to the most appropriate support. We have seen an increase in demand for these workshops from Journalists, IT Companies, Artificial Intelligence Organisations, Mental Health charities and the Humanitarian Sector where teams are identified as in ‘high risk roles’ likely to be exposed to traumatic material directly or indirectly. FD Consultants are trained in the recommended (WHO, APA and NICE) treatments of trauma and PTSD which are Eye Movement Desensitisation and Reprocessing (EMDR) and Trauma-Focused Cognitive Behavioural Therapy (TF-CBT). Please do contact us at [email protected] if you require our psychological support services. For organisations looking for employee psychological support, FD Consultants are the trauma specialists and well-being service who will best deliver a reliable, quick, and bespoke support system in the workplace. FD Consultant’s team of accredited specialists will offer ongoing support to help manage stress, prevent burnout and provide specialist trauma care where required, enabling your staff with the tools to cope, and recover more quickly.
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A recent study published by PLOS ONE and carried out by a number of esteemed psychologists has found that Eye Movement Desensitisation and Reprocessing (EMDR) appeared to be the most cost effective intervention for adults with PTSD. Post-traumatic stress disorder (PTSD) is a severe and disabling condition that may lead to functional impairment and reduced productivity. A considerable proportion of people exposed to trauma, around 5.6%, will develop post-traumatic stress disorder (PTSD) [1]. For staff in the Humanitarian sector and emergency first responders research has suggested PTSD is as high as 30%. EMDR: how does it work? Francine Shapiro, PhD, Senior Research Fellow at the Mental Research Institute, Palo Alto, California and Executive Director of the EMDR Institute, California, is the ‘originator and developer’ of EMDR. Since then, EMDR has been adapted and reworked based on the research and contributions of therapists and researchers the world over. Initially used as a treatment with Vietnam veterans who weren’t recovering, it has since proven successful in treating various other presentations, including anxiety, phobias, addictions, depression, complicated grief, abuse and performance anxiety. The unique feature in EMDR therapy is that it uses bilateral stimulation (BLS) whilst processing the distressing memory. BLS can be conducted by following the therapist’s hand as it moves from left to right, watching a light bar, or tapping. The same can also be achieved through listening to alternating bilateral tones or holding buzzers. The BLS alleviates negative cognitions, negative emotion and unpleasant physical sensations associated with a traumatic or distressing memory. An important concept of EMDR is the ‘Adaptive Information Processing (AIP)’ theory. This means the client begins to reformulate and update dysfunctional self-beliefs and replaces them with positive self-reflecting beliefs. Therefore, EMDR promotes our innate healing process and reformats dysfunctional information to functional, so that it becomes adaptive information processing. ‘Just as the river flows to the sea and the body heals the wound, EMDR clears the trauma and brings integration and wholeness’ (Parnell, 2007, p. 6). In discussing EMDR, Professor Gordon Turnbull states: ‘Therapists and patients were reporting that problems that had been resistant to years of psychotherapy were being resolved in a very short amount of time – sometimes within a few sessions’ (Turnbull, 2011). In my experience of working within the field of trauma for over 15 years I have never witnessed such a powerful and successful way of working with traumatised and anxious clients: ‘EMDR works effectively and helps the client return to work quickly and safely after a traumatic event’ (Dunkley & Claridge, 2012). FD Consultants are trained in the recommended (WHO, APA and NICE) treatments of trauma and PTSD which are Eye Movement Desensitisation and Reprocessing (EMDR) and Trauma-Focused Cognitive Behavioural Therapy (TF-CBT). We have worked extensively with emergency first responders and aid workers globally to combat PTSD and vicarious trauma. All associates have over 10 years’ experience in the profession, are highly skilled, and qualified to meet the requirements to work for FD Consultants. We can offer appointments and training in various languages. Associates have experience of working with the humanitarian sector, emergency first responders and mental health charities. They have worked or lived internationally, facilitate training, and have trauma expertise; making them perfectly placed to support a broad cross-section of society and organisations. Please do contact us at [email protected] if you require our psychological support services. For organisations looking for employee psychological support, FD Consultants are the trauma specialists and well-being service who will best deliver a reliable, quick, and bespoke support system in the workplace. FD Consultant’s team of accredited specialists will offer ongoing support to help manage stress, prevent burnout and provide specialist trauma care where required, enabling your staff with the tools to cope, and recover more quickly. References 1. Koenen KC, Ratanatharathorn A, Ng L, McLaughlin KA, Bromet EJ, Stein DJ, et al. Posttraumatic stress disorder in the World Mental Health Surveys. Psychol Med. 2017; 47(13):2260–74. https://doi.org/10.1017/S0033291717000708 PMID: 28385165 Throughout July and August FD Consultants want to highlight the diverse expertise and professionalism amongst its associates. This week, the founder of FD Consultants, Fiona Dunkley, shares some of her background and expertise. FIONA DUNKLEY MBACP (Snr. Accred) UKRCP ESTSS EMDR is passionate about caring for the carers of our world and therefore founded FD Consultants which is a global psychological health consultancy. Fiona is a senior accredited BACP psychotherapist, trauma specialist, trainer, supervisor and mediator. Fiona has presented on television and radio as a trauma expert, has published several articles and has been asked to speak at various international conferences. Fiona is a published author, ‘Psychosocial Support for Humanitarian Aid Workers: A Roadmap of Trauma and Critical Incident Care’, published by Routledge (Dunkley, 2018). Fiona shares her experience of how FD Consultants originated. I began to see a thread of similar characteristics in the types of people that signed up for caring roles. These characteristics included being passionate, caring, and resilient, but also sacrificial and overlooking of their own self-care, over-working, and holding unhealthy boundaries. Although the tapestry created by weaving together these threads created a dynamic, vibrant, compassionate picture of humanity and hope, the underside showed a much darker, chaotic and disturbing picture with many loose ends ready to unravel from one crisis to the next. This underside resulted in staff experiencing burnout, anxiety, stress, and suffering from vicarious trauma and Post-Traumatic Stress Disorder (PTSD). I started my counselling career in the National Health Service (NHS) working in a Forensic Sexual Assault unit, often supporting individuals subjected to human trafficking. At times, I worked night shifts, and once I received a call out, I had to arrive at the hospital within one hour. I witnessed dedicated medical staff suffering from burnout and worked alongside Police Officers experiencing Post-Traumatic Stress Disorder (PTSD). It was also evident that people in these caring roles had not received sufficient training in the psychological impact of trauma. I witnessed this lack of training impacting not only the quality of treatment offered to survivors, but also the detrimental effect on the member of staff’s own mental health and wellbeing. This reminded me of the time, in my early twenties, when I was knocked unconscious whilst I had gone to the aid of someone else being attacked. I gained consciousness in the ambulance and as I was asked my name by the paramedics, I realised I had no idea who I was. How strange not to be able to answer that question. As I arrived in the hospital the suspected diagnosis was concussion and a fractured skull. As I was rushed through the Emergency and Accident unit, in hindsight, I can identify that the medical staff taking care of me at the time could also have benefited from further training in the impact of psychological trauma. The medical model mainly being focused on recovery from the physical impact of trauma. The nurse preparing me for x-ray became annoyed with me as I couldn’t stop shaking, stating, “you need to keep still for the x-ray to work”. Other members of staff came to hunt me out and whispered behind their hands, “she is the one who went to help someone else being attacked”. No one explained I would be projectile vomiting throughout the night, have lights shone in my eyes every hour, and not be able to move my jaw up and down. On discharge from the hospital, I received no signposting to psychological services or explanation of the symptoms of Post-Traumatic Stress Disorder. As a psychotherapist specialising in trauma, I now know how crucial it is for someone’s recovery that they are supported during those first few days after a traumatic event. At FD Consultants we advise and train staff in how to offer psychological first aid to colleagues directly after a critical incident. We offer guidance to managers to reduce the risk of re-traumatising their staff and how to support someone back into the workplace. We offer training to leadership teams in crisis management and implementing best practice evidence-based trauma management and wellbeing programmes into an organisation. After working four years in the NHS, I joined Transport for London (TfL) as the lead counsellor of an inhouse trauma and counselling service. I had arrived soon after the 7/7 London bombings. The counselling team had been successful in supporting staff back to work, but who had taken care of the counselling team? Over the next year, the majority of the counselling team left; suffering symptoms of compassion fatigue, burnout or vicarious trauma. Several years later, I joined InterHealth Worldwide supporting numerous International NGOs. Having worked in the public and private sector, I was shocked to find that when I joined the charity sector, the lowest value was placed on staffs’ wellbeing. Organisations can involuntarily take advantage of the good nature of staff, who often describe their jobs as more than a job, a calling, or a way of life, by dictating unmanageable workloads or exposure to deployments without appropriate risk assessments. I setup InterHealth Worldwide’s trauma service supporting organisations through a crisis response. I noticed the ripple effect of trauma, from those directly impacted in the field, to those indirectly impacted in the office such as staff taking the call. I created support procedures and policies to provide safety and containment for all staff impacted, whether directly or indirectly. I collated data from each incident we supported and found that the risk of traumatic exposure to aid workers was increasing, including sexual violence and kidnapping and hostage taking. Only a couple of days ago, I posted an article entitled “Jidadists in northeast Nigeria execute five abducted humanitarian workers”. I have supported individuals who were impacted by the 7/7 bombings, Earthquake in Nepal, Ebola response, Syrian civil war, Search and Rescue refugee crisis, Westminster terrorist attack, London Bridge terrorist attack, Brussel bombings, anti-government protests in Istanbul, Juba attacks on aid workers, the Grenfell Tower fire, and Covid-19, to name a few. At FD Consultants we also offer support to organisations going through restructuring, bullying and harassment cases, death of staff, and conflicts within teams. Having worked in large organisations witnessing staffs’ mental health deteriorating due to the nature of their work, I wanted to create a high-quality specialist trauma service to support individuals to recover quickly. I became more and more frustrated with the quality of care offered and the lack of understanding in what is good quality trauma care. FD Consultants help guide organisations in how to support their staffs’ mental health, reducing risk of further damage, resulting in longer-term health issues and long-term sick leave. From my personal experience of suffering with PTSD, to working with thousands of individuals impacted by trauma, I am passionate about making sure people get access to high quality evidence-based trauma care. I strongly believe everyone can recover from stress, anxiety, burnout, vicarious trauma and PTSD with the appropriate help and support. Please do contact us at [email protected] if you require our psychological support services. For organisations looking for employee psychological support, FD Consultants are the trauma specialists and well-being service who will best deliver a reliable, quick, and bespoke support system in the workplace. FD Consultant’s team of accredited specialists will offer ongoing support to help manage stress, prevent burnout and provide specialist trauma care where required, enabling your staff with the tools to cope, and recover more quickly. We are now witnessing the highest levels of displacement on record, with more than 65 million forcibly displaced people and over 20 million refugees worldwide. Over 44,000 people a day are forced to flee their homes because of conflict and persecution; currently the greatest numbers of refugees are from Syria (UNHCR, 2018). We hosted Aleppo Supper Club, for the FD Consultants team day, a Psychosocial Support and Trauma Specialist Service. Ahmad shared his refugee journey with us, which was overwhelmed with trauma upon trauma stories. Only just surviving he persevered from one abuse to another in the hope to find freedom from torture, corruption, threat of death, and exploitation. He travelled from Turkey, Algeria, Libya and landed in what he though was Germany. As he walked along the road he was stopped by police and was informed he was in the UK. He has lived in the UK for three and a half years now. Ahmad’s journey does not end here, as it has been another journey laced with misunderstandings, fear and prejudice. After a couple of years he has found a place to call home, for now, where he is gradually learning to feel safe and trust people again. He is disturbed by trauma memories, as he describes, ‘I can shut my body off, but not my mind’, and speaks about how difficult it is to get to know people and make friends. I asked him what he wished for in his future, he said ‘I cannot return home to Syria, it will take a long time before things can change there’. He wants to ‘sleep like normal people, get an education, a job and build a family of [his] own.’ Since being in the UK, Ahmed has been diagnosed with Post-Traumatic Stress Disorder (PTSD), which haunts him through the night. I worked for an organisation based near the Turkish/Syrian border. I was supporting Syrian refugees working in Turkey. We found that 41% of individuals were experiencing high levels of trauma symptoms suggesting PTSD. The key stressors reported were: the Syrian conflict, instability and transition, and concern for family and friends still living in Syria (Dunkley, 2018). According to the Centres for Disease Control and Prevention (CDC), between 30 and 70 per cent of people who have lived in warzones bear the scars of PTSD and depression (Badkhen, 2012). Eye Movement Desensitisation and Reprocessing (EMDR) training was conducted in Istanbul with mental health professionals, made up of 42 per cent from Syria, 32 per cent from Iraq and 7 per cent equally from Egypt, Jordan, Libya and Palestine. The ‘Need for Trauma-based Services Questionnaire’, concluded that ‘PTSD was the most prevalent problem reported by 80% of the Iraqi participants and 69% of the Syrian participants’ (Abdul-Hamid et al., 2016). However, participants could only meet 39 per cent of these trauma-clients’ needs, due to lack of specialist trained clinicians and resources. Ahmed, at times, has also fallen through the net of care and still awaits trauma specialist support. At FD Consultants we are acutely aware of the need for specialist trauma services, and the longer it takes for someone to get support, the more complex their symptoms can become. We offer EMDR and TF-CBT trauma specialist services as recommended by the NICE guidelines, APA and WHO. How can you help? We can all learn to provide support and care to refugees and be willing to find out more about individual’s’ personal stories. We can support Amhad, and other Syrian refugees like him, by inviting the Aleppo Supper Club to provide food for any event. The food is typically Syria such as, Humous, Mohamarrah, Yabrak and Baba Ghanouch, and, speaking from personal experience, is delicious. ‘Ultimately we want to get to a place where a lot of people are anticipating in such dinners and support for refugees becomes demonstrable and visible on the part of multiple segments of the public and that has a positive impact on public opinion and discourse and debate which, the hope is, will incentive Governments to do what’s needed to help refugees wherever they are’ (David Ponet, UNICEF Global). After a day of networking and mutual support, Ahmad states, ‘people cannot go to Aleppo, so my idea is to bring Aleppo to your table and your plate’. In his time spent with us, he brought so much more such as, insight, understanding and a deep human connection. Aleppo Supper Club contact details:
The case study below presents a first-hand experience of how EMDR works. I came to therapy after experiencing trauma symptoms following a trip to Turkey where I witnessed a violent failed coup d’état. Despite having triggered the emergency/security protocol while in Turkey, upon my return I was not offered counselling to debrief the incident. The incident was considered important as the executive director and other senior managers were being briefed on my situation twice daily while still in Turkey. In that sense, I did not feel my organisation supported me in dealing with the fall outs of the incident. I had to request for help through HR and it was almost two months before I was able to see a counsellor. Through this experience, I wondered whether other colleagues who may not have been as comfortable going to see a therapist, or afraid of the stigma attached to doing so, would have requested the support. I believe my organisation should make post-incident debriefing mandatory, as part of the incident management protocol. It would help those who may need a little bit more encouragement to seek help. EMDR addressed my PTSD symptoms effectively. It enabled me to understand why I was reacting the way I was, rather than being left to feel weak or stupid for experiencing such distress. It has now been over six months since the treatment and I have not experienced any symptoms in that time. The changes in how I felt and the reduction of the symptoms I was experiencing was quick. I now feel that the issue is resolved and this is not something I will continue to carry with me. (Chris, aid worker) There are several different approaches to psychotherapy, which can be confusing if you are searching for a therapist. It is important to be aware that some therapists will state that they work with trauma but will not have had specialist trauma training. In basic terms there are three main approaches to psychotherapy: Psychodynamic, Humanistic and Cognitive Behavioural therapies. I would describe myself as an Integrative therapist, and therefore I work with a combination of these approaches. Additional trauma specialist models include: Trauma-Focused Cognitive Behavioural Therapy (TF-CBT), Eye Movement Desensitisation Reprocessing (EMDR), Narrative Exposure Therapy (NET) and Sensorimotor Therapy. There are other models of working with trauma but further research is needed into the efficacy of these various approaches. All trauma approaches aim to help the client to create a trauma narrative, find meaning in the event, and reduce the trauma symptoms, whether through talking, drawing, play or writing. Most trauma models follow a three-step treatment programme: stabilisation, processing and integration (Herman, 1997). EMDR: how does it work? Francine Shapiro, PhD, Senior Research Fellow at the Mental Research Institute, Palo Alto, California and Executive Director of the EMDR Institute, California, is the ‘originator and developer’ of EMDR (Shapiro, 1989). Since then, EMDR has been adapted and reworked based on the research and contributions of therapists and researchers the world over. Initially used as a treatment with Vietnam veterans who weren’t recovering, it has since proven successful in treating various other presentations, including anxiety, phobias, addictions, depression, complicated grief, abuse and performance anxiety. The unique feature in EMDR therapy is that it uses bilateral stimulation (BLS) whilst processing the distressing memory (Shapiro, 2005). BLS can be conducted by following the therapist’s hand as it moves from left to right, watching a light bar, or tapping. The same can also be achieved through listening to alternating bilateral tones or holding buzzers. The BLS alleviates negative cognitions, negative emotion and unpleasant physical sensations associated with a traumatic or distressing memory. An important concept of EMDR is the ‘Adaptive Information Processing (AIP)’ theory (Parnell, 2007). This means the client begins to reformulate and update dysfunctional self-beliefs and replaces them with positive self-reflecting beliefs. Therefore, EMDR promotes our innate healing process and reformats dysfunctional information to functional, so that it becomes adaptive information processing. ‘Just as the river flows to the sea and the body heals the wound, EMDR clears the trauma and brings integration and wholeness’ (Parnell, 2007, p. 6). In discussing EMDR, Professor Gordon Turnbull states: ‘Therapists and patients were reporting that problems that had been resistant to years of psychotherapy were being resolved in a very short amount of time – sometimes within a few sessions’ (Turnbull, 2011). In my experience of working within the field of trauma for over 15 years I have never witnessed such a powerful and successful way of working with traumatised and anxious clients: ‘EMDR works effectively and helps the client return to work quickly and safely after a traumatic event’ (Dunkley & Claridge, 2012). The EMDR protocol sets out an eight-phase treatment plan:
For more information on EMDR Treatment I encourage you to buy my new book Psychosocial Support for Humanitarian Aid Workers, available via Amazon. |
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