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Week 7 – Trauma & Empathic Distress Fatigue

This week we focus on trauma (including vicarious trauma), empathic distress fatigue and emotional exhaustion. How can we prevent PTSD? How do you nourish yourself and look after yourself when there is inevitable stress and trauma in the job, or when many people around you are experiencing high levels of traumatic stress and psychological distress? What self-care techniques do you practice to decompress, regulate and return to your window of tolerance? How do you regulate after trauma? How do you show care for others but ensure you don’t take on too much of other peoples’ energy, distress or trauma?

WISE Recap

  • Mindfulness can help us to overcome emotional exhaustion and lessen the impact of trauma. Mindfulness is a useful tool for regulating emotions by increasing awareness and developing flexibility and adaptability in responding to our own emotional experiences. Mindfulness encourages acceptance rather than avoidance of our experiences and decreases rumination about past and future events that can exhaust our energy. When we are mindful and accept sensations and thoughts that arise, we likely reduce our emotional numbing.
  • Our capacity to hold space for own our suffering and pain, directly correlates to our capacity to hold space for other’s pain. It is likely that many people have empathy tanks that are full (i.e. they have reached their own capacity for empathy). Empathic distress is very common after what we have all experienced collectively in the world. This is even more common in the emergency services sector.
  • The skill we have learnt this week is responding mindfully to trauma as well as others’ pain. We are working towards maintaining equanimity (inner balance), whilst also learning how to respect the trauma response and respond with kindness, compassion, warmth and care.
  • Kindness is good for our physiological wellbeing. It produces oxytocin which fills our heart with blood, dilates our blood vessels and lowers our blood pressure. Make your kindness acts this week unconditional (you don’t need anything back).
  • Remember the trauma response hand model we did at the start of the workshop (the hand opened with acceptance, allowing and compassion. The hand tightened with resistance and forcing a particular state to occur). There is often intelligence in the trauma response and ‘shutting down/closing off’ to protect and stay safe. This is a survival mechanism and hard-wired response. However,  when we communicate to ourselves and others with warmth, care, respect, kindness, love and compassion it helps create openness and helps us move through difficulties with more mindfulness, grace and composure.

Minimising the Impact of Trauma

Trauma is defined as a physical and/or emotional wound or shock that creates substantial, lasting damage to a person’s psychological development. Vicarious trauma (otherwise known as secondary trauma) refers to an individual’s own psycho-emotional reactions due to his or her exposure to others’ traumatic experiences. For sworn and unworn officers who are exposed to trauma, vicarious trauma is a serious issue because it can potentially compromise the individuals’ health and well-being.

Mindfulness can help us to overcome emotional exhaustion and trauma. We can learn effective self-directed techniques and tools to maintain equanimity in the face of danger, serious injury and human suffering, thereby reducing the incidence of PTSD, vicarious trauma or other stress-related health concerns.

Studies measuring stress in health care professionals and individuals working in emergency services/ trauma-related professions found an eight week mindfulness meditation program resulted in a significant decline in emotional exhaustion, empathy fatigue and trauma-related symptoms.

Firstly, let’s revise the window of tolerance so we can identify the early warning signs of trauma and dysregulation.

Window of Tolerance Chart

Know the Signs

Before we can respond to trauma, we firstly need to recognise it. It is important to notice the nonverbal cues that someone is struggling with traumatic stress. We can assess trauma through direct conversation (i.e. reading facial expressions and noticing nonverbal cues) as well as paying attention to the following basic internal and external signals that suggest someone may be experiencing trauma and are outside of their window of tolerance:

  • Muscle tone extremely slack (collapsed, noticeably flat affect)
  • Muscle tone extremely rigid
  • Noticeably pale skin tone
  • Hyperventilation
  • Exaggerated startle response
  • Excessive sweating
  • Noticeable dissociation (person appears highly disconnected from their body)
  • Person reports feeling they are a long way away
  • Person cannot hear our voice and/or constantly asks others to repeat questions
  • Person is staring off into space without blinking and not responding to any questions
  • Person loses sense of time and cannot remember what happened previously
  • Consciousness appears to fluctuate—you notice the person “isn’t there” or seems preoccupied with internal distraction
  • Person cannot maintain a continuity of story or experience in conversation (e.g., jumping from topic to topic)
  • In conversation with the individual who is experiencing trauma, you yourself may begin to feel foggy, confused, or like you’re floating. This can be a sign that the person you’re connected with is dissociating
  • Emotional volatility (enraged, excessive crying, terror)
  • Disorganised speech or slurring words
  • Reports of blurred vision
  • Inability to make eye contact during interviews/interactions
  • Reports of flashbacks, nightmares, or intrusive thoughts

 

Early Warning Signs Emotional Exhaustion/ Empathy Fatigue

  • Feeling emotionally exhausted and drained (unable to perform basic tasks)
  • Depression, guilt
  • Increased negative thought patterns
  • Sense of hopelessness
  • Reduced ability to feel empathy towards other individuals, including colleagues, family/friends or strangers
  • A sense of resentment towards demands being put on you at work and at home/ decreased job satisfaction
  • Feeling unappreciated
  • Difficulty concentrating or focusing
  • Change in appetite or sleep habits
  • Frequent headaches or muscle pain
  • Lowered immunity, frequent illnesses
  • Increased conflict in relationships
  • Withdrawal from friends/ family emotionally
  • Feeling trapped and defeated
  • Detachment, feeling alone in the world
  • Loss of motivation, passion or drive

WEEKLY PRACTICE TASKS

INFORMAL PRACTICE-  Unconditional Kindness

The informal practice this week is to do something kind for someone else. This is a RANDOM ACT OF UNCONDITIONAL KINDNESS which means that you are not doing this to get anything in return. Remember kindness produces a physiological effect which helps with equanimity ( inner balance) and offsets the impact of traumatic stress and empathic distress fatigue. Be creative- e.g. pay for someones coffee behind you in the drive-through, buy a parking ticket for someone and place it on their windscreen, cook a meal for an elderly neighbour, leave a note for someone expressing your gratitude about something they did well, write a letter to a colleague letting them know you appreciate them being a positive pillar, brighten someones day who appears to be having a bad day by leaving lollies or chocolate on their desk, leave flowers on a neighbours door-step, make a cup of tea or coffee for a  colleague. The possibilities are endless be creative!

Have fun with this activity and see if you can do something kind EVERY DAY. Would love to hear some kindness stories next week!

FORMAL PRACTICE- Movement Practice

The formal practice this week is Movement Practice. This is a mindful stretching practice to help us cultivate kindness, care and respect for ourselves. Quite often trauma gets trapped in our body and needs to be mobilised. Just like making healthy food choices, sleeping well and taking care of our mental health, carving out time for a stretching program should be a part of your wellbeing plan. Stretching is an excellent preventative measure to unlock tension in the body. Stretching can help similarly to meditation, allowing the mind and body to decompress simultaneously and be still.

Stretching fosters a greater sense of mind-body awareness, making you more conscious of your movements, your breath and ultimately, how you’re feeling. Stretching can help us better understand our internal emotional landscape that lives inside our body. It can be very helpful in igniting the parasympathetic nervous system, which is part of the autonomic nervous system that’s responsible for feeling more at ease to help improve your sleep, breathing, heart, and digestion and overall, help you feel less stressed.

Experiment with having different anchors of attention to support your window and help with grounding. This could be focusing on the soles of your feet, your palms, the back of your body, the sense of smell, sounds, sights around you (i.e naming objects internally (e.g., “couch; the color blue”) or placing a hand on a solid unmoving surface  that feels stabilising to touch such as a solid object or the floor. Don’t forget to include the breathing tools we have learnt (such as anchoring the mind on the breath, deep belly breathing etc) in the practice to restore balance to the body and calm the nervous system.

You may like to do the stretches and decompression exercises that are in the below video or create your own mindful movement routine. As you’re stretching, focus all of your attention on your breath and notice how your body feels. Notice the quality of your breath and any sensations that might arise in your body (make space for them even if they are uncomfortable or unpleasant). If your mind wanders, bring the attention back to the breathing cycle of inhaling and exhaling.

Movement Practice (15 minutes)