|Handbook for Emergencies - Second Edition (UNHCR, 1999, 414 p.)|
|22. Coping with Stress|
Preventing and Minimizing Harmful Stress
It is important to recognize that it is impossible to take care of others if you do not take care of yourself.
17. Being well prepared, both physically and psychologically, is an important way to reduce the chances of harmful stress. This preparation not only includes understanding stress and how to handle it, but also educating oneself in advance on the living conditions, job, likely problems, local language and culture. It is important to be both physically and psychologically fit to work in a particular situation.
18. To prevent stress overload during an emergency, firstly, know your limitations. In addition, there are several practical steps to take:
i. Get enough sleep;
ii. Eat regularly;
iii. Control intake of alcohol, tobacco and medicines;
iv. Take time for rest and relaxation;
v. Take physical exercise. Physical exercise releases tension and helps maintain stamina and good health (any sort of exercise for at least 20 minutes per day). Beneficial exercise for stress reduction also includes deep breathing and muscle relaxation exercises;
vi. Give expression to the stress: Put words to the emotions you feel - find a colleague whom you trust to talk with;
vii. Keep a diary, it may not be as effective as talking, but it can help.
The expression of emotion has proved to be an effective technique in reducing stress.
19. Other ways of reducing stress are:
i. Inward coping: When a person performs difficult work in physically and emotionally threatening conditions, internal dialogue can add to the stress if it is highly negative and self-critical. To remain focused on the task, avoid unhelpful internal dialogue such as, "I'm no good at this. Everything I am doing is making things worse". Instead make positive helpful statements to talk oneself through difficult moments. For example, "I don't feel like dealing with this angry person right now, but I have done it before, so I can do it again";
ii. Peer support: Use the "buddy system": staff members may agree in advance to monitor each other's reactions to identify signs of excessive stress and fatigue levels;
iii. Setting an example: Supervisors in particular have an important role to play as they can provide an example in the way they handle their own personal stress, e.g. by eating properly, resting and taking appropriate time off duty. The team leader who tells a colleague, "Remind me to eat, and get me out of here the moment you notice any sign of fatigue. I'm no good when I'm tired", is setting a positive example for the staff;
iv. Permission to go off duty: In a crisis many staff members need to be given permission to take care of themselves. People do better in difficult situations when they feel that other people care about them. Team leaders are responsible for giving such specific permission to themselves and to their staff, for example, by giving permission to take the afternoon off, etc. The correct use by staff members of Mars and Vari can serve to alleviate stress.
Dealing with Critical Incidents (Traumatic Stress)
20. Stress defusings and debriefings are ways of protecting the health of staff after crises. The person or people who experienced the critical incident talk about the incident, focusing on the facts and their reactions to it. They should take place in a neutral environment, and never at the scene of the incident. They should be led by a trained professional. The information given below is intended to illustrate these processes and does not give sufficient detail to enable an unqualified person to perform either a debriefing or a defusing.
21. Defusing is a process which allows those involved in a critical incident to describe what happened and to talk about their reactions directly after the event. A defusing should take place within a few hours of the event, its format is shorter than that of a debriefing. It consists of three steps:
Introduction of everyone present, a description of the purpose of the defusing, and stimulation of motivation and participation;
Discussion of what happened during the incident;
Advice to the participants about potential reactions to the incident, guidance on stress management, practical information, questions and answers.
Confidentiality is important. It should be possible to express strong emotions, secure in the knowledge that this will stay within the group.
22. Angry feelings can be a normal reaction to an upsetting event and staff should be able to "let off steam". This is not the time for criticism of professional performance - this should be dealt with at a separate meeting.
Critical Incident Stress Debriefing (CISD)
23. In cases where staff have to deal with intense distress, defusings may be insufficient and need to be followed by a formal debriefing from a mental health professional. Debriefing is a process designed to lessen the impact of a critical incident. It occurs in an organized group meeting and is intended to allow those involved in a critical incident to discuss their thoughts and reactions in a safe, non-threatening environment. The team leader or a responsible member of the emergency team should request the Division of Resource Management at Headquarters to provide or help identify a mental health professional to conduct a debriefing. Sessions are normally held for groups of staff having undergone intense stress. They aim to integrate the experience, provide information on traumatic stress reactions, and prevent long-term consequences including Post Traumatic Stress Disorder, and help staff manage their own personal reactions to the incident.
24. If a debriefing or defusing is not offered spontaneously after a trauma is suffered, request one. Information on individual consultations for UNHCR staff members and workshops on stress related issues can be obtained from the Staff Welfare Unit, HQ Geneva.
Telephone: 00 41 22 7397858
Confidential Fax: 00 41 22 7397370