Blog

Stress, Anxiety, and Fear

For many years I have interacted with groups on the topic of stress.  The discussion begins with asking people if they have ever experienced stress.  If there is so much as one person that doesn’t raise their hand it is a great opportunity to interact and ask then for their secret.  Stress is a universal phenomenon but is certainly not always negative – as in the case of the stress of starting a new job or moving to a new and improved housing location.  It is a deeper dive into the definitions for anxiety and fear.  After some participation I will often make the point that fear is real.  This is not to say that anxiety is imaginary it simply highlights the fact that the innate fear response is activated in the face of a tangible threat – the proverbial bear in the woods.  Anxiety by contrast often takes place in anticipation and is not necessarily triggered by a tangible stimulus – “what if there is a bear in the woods.”

There are several different ways in which anxiety manifests the first of which is simple phobias of things like dogs, snakes, and airplanes.  Panic is more to do with the fear of fear and thus is triggered by a fear response to the sensations of anxiety in the body such as increased heart rate and chest compression/ hyper ventilation.  Social anxiety has to do with fear of negative evaluation from others based on appearance (they will think I am weird/ creepy/ ugly) intelligence (they think I am stupid) or symptoms (they can see that I am shaking/ flushing/ sweating).  Anxiety can also arise in response to real time sensations that conjure past traumatic events.  It can also take place in response to unwanted intrusive thoughts (ie: did I leave the stove on/ will this burn down the house).  Among the more frequent of anxiety related concerns is Generalized Anxiety which manifests as worry.  Worry will glom on to all things in life in an ecompassing list: education, career, finances, health, and relationship.  It operates differently than other anxiety related concerns as the intensity appears to be much less.  In this way it is much more “death by a thousand paper cuts” relative to the heart stopping fear of phobia, panic, social anxiety, or obsessive-compulsive issues. 

Overcoming any anxiety involves facing fears.  People understand this intuitively if I ask them what they would recommend that I do if I were afraid of dogs to the point that I do not wish to leave home.  While few recommend that I avoid dogs at all cost, many recognize the importance of leaning in even if the starting point is looking at pictures of dogs.  They are describing the principle of prolonged exposure and may even include systematic desensitization (ie: start small, build up, and stay in the situation until your stress level acclimates). It seems counterintuitive to intentionally generate distress.  I am reminded of the power of this type of intervention having just recently finished listening to Sara Polley’s moving autobiography in which her final chapter outlines the story behind the book title “Run Toward the Danger.”  In it she described a riveting account of what it took for her to not listen to her body and instead overcome her fear of discomfort, nausea, and headaches associated with more than three years and many unsuccessful attempts to recover from post-concussion syndrome.  

I would welcome the opportunity to work with you whether your situation is one that involves situational stress or more long standing anxieties.  The work of leaning in and facing fears is challenging but extremely rewarding as you take steps toward doing things you never thought possible, feeling more like yourself, and living your best life.

Compassion Fatigue

This is an article that was first published in the Canadian Psychological Association communication, Psynopsis.

First responders have a job that is very demanding both physically, mentally, and emotionally.  I am not a first responder; the majority of my role involves individual and group counselling for post-secondary students.  On occasion there is a need for critical incident stress debriefing when the campus community is faced with an extenuating circumstance.  Part of my professional development involved participating in an Overcoming Compassion Fatigue workshop facilitated by Francoise Matthieu.  Following this introduction to compassion fatigue I became increasingly interested in the topics of health and wellness.  Babette Rothschild in her book “Help For The Helper” outlines how principles like neurobiological attunement and structures like mirror neurons are activated in response to bearing witness to human suffering.  She goes on to describe how providing care to others has the potential to slowly erode our ability to be empathic unless we are attentive to our own wellbeing both during and after providing care.

 

I recently had opportunity to provide a keynote address and a half day training on the topic of Compassion Fatigue in Winnipeg, MN for the Paramedics Association of Manitoba.  It was certainly a timely request from the organization to provide training for first responders stemming from the growing awareness that the work is quite challenging.  The presentation is focused on distinguishing the difference between burnout, compassion fatigue, and vicarious traumatization.  Burnout is something that can occur in any employment and stems from work demands that exceed capacity (ie: accountants during tax season).  Vicarious trauma is a term that highlights the fact that witnessing a traumatic event can result in symptoms of post-traumatic stress for the care provider.  Compassion fatigue refers to the “ninety-nine” that are not immediately in memory as opposed to the one that is impossible to forget.  Compassion fatigue is recognition of the fact that, while it is unclear where the images and stories go, there is an impact of providing care over time.

 

Compassion fatigue is a construct that can be assessed.  Individuals can complete a Compassion Fatigue Self-Test known as the Professional Quality of Life Inventory (Proquol) developed by Dr. Beth Stamm and Charles Figley http://proqol.org/Home_Page.php.  Francoise Matthieu has also made this instrument available via an email auto responder.  If you email thingy@aweber.com you will receive the Proquol in a very easy to use self-scoring Excel file format.  The instrument measures not only compassion fatigue but also compassion satisfaction noting that it is the most caring who are most susceptible to developing compassion fatigue and vicarious trauma.  Interestingly there is also some suggestion that an increase in compassion fatigue generally correlates with an increase in the quantity and quality of work.  While this may seem counter intuitive it may be fitting in that an individual will attempt to work more in order to generate compassion satisfaction.  Unfortunately the eventual result is further erosion of empathy and decrease in overall wellbeing.  This trajectory is summarized nicely in a short video produced by a paramedic who evidenced signs of compassion fatigue and began to self-medicate using substance https://compassionfatigue.ca/a-video-to-watch-a-paramedic-reflects-on-his-trauma/

 

The most important part of any discussion about Compassion Fatigue is exploring protective factors.  While it is important for individuals to be aware of their own unique risk factors and vulnerabilities it is even more important to be empowered to grow in awareness regarding what can be done to mitigate compassion fatigue.  This shifts discussion toward the topic of maintaining wellness through healthy lifestyle.  When care providers are doing a good job of taking care of themselves they are in a much better position to be able to provide care.  Self-care can be represented in many different forms but often divides up into active and passive strategies.  Active strategies include activities such as exercise, socializing, art, and music.  Passive strategies include things such as relaxation, meditation, prayer.    Maintaining an effective work/ life balance is elusive but is something that each one of us should be reflecting on and striving toward in order to promote our own wellbeing with a view to providing quality care.

 

Rothschild, Babette (2006). Help For The Helper: The Psychophysiology of Compassion Fatigue and Vicarious Trauma.  New York: WW Norton & Company.

 

Stamm, B. Hudnall, Ed. (1995).  Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators.  Baltimore, MD, US: The Sidran Press.

 

http://compassionfatigue.ca/

 

http://proqol.org/Home_Page.php

 

 

Stress and Human Adjustment In Time of Social Isolation

COVID 19 in 2020 has brought us to an unprecedented moment that highlights globalization, economic disparity, and the profound impact of the internet.  While we are faced with a pandemic that has the potential to mirror the devastation of the Spanish flu of 1918 the impact has been mitigated by applying a very draconian “Stay at home unless absolutely necessary” message.  It is safe to say that a very large majority of people have heard and chosen to abide by the directive despite the personal, social, emotional, and economic impact.

While research is undoubtedly focused on developing a vaccine to accelerate herd immunity, social scientists are also taking note of situation.  Many questions arise but the general gist of research is likely to address individual differences that contribute to either flourishing or languishing under our current circumstance.  I am reminded of my second year of graduate study when I was given opportunity to teach a course in Human Adjustment.  It was an eye opening experience for me as an instructor not only to appreciate the challenge of developing lectures and assessing learning but also delving into the idea that we as humans are always, to a greater or lesser degree, in a state of flux and faced with uncertainty.

Everyone faces adversity and uncertainty but some seem to have more than their fair share and some seem to deal with it better than others.  Optimism and a sense of personal control are protective factors when it comes to dealing with uncertainty.  The concept of optimism should not be mistaken for a naive, polyanna, “everything is going to be fine” approach to reality.  Rather optimism stems from an important ability to focus on how we can effect change despite how little control we actually have in most situations.  For example, when seeking employment one cannot guarantee a job and is better off focused on getting resume feedback, circulating the resume widely, talking with friends, and networking to increase contacts with potential employers.  Staying focused on how much and how often one chooses to focus on these tasks helps to maintain a sense of accomplishment and forward momentum.

So what does optimism look like in the context of COVID and social distancing?  You may be facing a temporary or permanent job loss.  You may be facing social distancing that has started to morph into painful isolation.  Notice how our worry, uncertainty, and psychological challenges tend categorically toward education, career, finance and health/ relationship.  In short work and people.  Try and take note of the topic of choice for your reverie into wistful nostalgia (if only…) or apprehensive future projection (what if…).  This is an important first step in better understanding the situations, thoughts, and feelings that contribute to your worry/ anxiety and/ or despondency/ despair.

Right now you are preparing to tell me to kindly (or aggressively) keep my optimism to myself – thank you very much.  I struggle to remain silent about it and I have been known to offer abrasive, unsolicited feedback to family, friends, and acquaintances when they externalize their successes and focus on their failures.  “Hey I got a new role at work – they must be really hard up for people to promote.  I will probably screw it up and get fired like I did at my last job…”  Pessimism is insidious and it is resistant to change even when others offer emotional support “I think you will do great” or tangible evidence to the contrary “didn’t everyone get let go at the same time because the company went bankrupt?”

How are you finding ways to be optimistic amidst the major life changes that have resulted from social isolation?  Do you see opportunity to take the time to learn something new – like my son who has periodically picked up the guitar?  Have you taken the time to reach out to contacts you have not connected with in a while – knowing that they may be feeling lonely as well?  Have you had time to read, reflect, sift, sort, organize, and purge?  These exercises apply to all of us in all of our physical, emotional, spiritual, social, and material reality.