40. Residential Counselor 101 Pt. 7 - Resilience to Traumatic Stress

Psychological Debriefing is a technique for reducing the impact of traumatic stress after a neurologically intense experience.  On a neuropsychological level that experience could be anything that triggers a release of certain hormones such as cortisol (known as “the stress hormone”) and adrenaline. 

On a behavioral level that typically includes situations such as being involved in a physical intervention, being exposed to aggressive posturing, being yelled at, or really any situation that triggers significant danger signals in your body.  Exactly what moves a person significantly out of their comfort zone is going to differ from person to person based on individual physiology and psychology. 

Exposure to traumatic stress does not automatically result in serious mental health conditions such as Post Traumatic Stress Disorder.  However, traumatic stress has a cumulative effect and can trigger pre-existing PTSD.  Symptoms of PTSD include:

• Aggressive or emotional outbursts
• Nightmares and/or flashbacks
• Heart palpitations, trembling hands, or sweating
• A sense of self-blame, worthlessness, shame, or guilt
• Acute or chronic unexplained physical pain
• Avoidance of people, things, or situations related to traumatic event
• Jumpiness
• Difficulty with sleep, eating, or physical intimacy
• Digestion disruptions
• Weakened immune system
• Low mood
• Headaches
• Social isolation
• Feeling empty or hopeless
• Loss of interest in activities
• Irritability
• Distrust of others or the world
• Dissociation

The symptoms of traumatic stress are less extreme.  However, because stress is stored in the body, impacting all sorts of neurological and physiological regulatory systems, it’s important to take steps to reduce its impact on staff. 

There’s something about being exposed to intense negative experiences that parts of the brain have great difficulty processing.  Typically, during such incidents the parts of the brain that are responsible for your sense of time do not function at 100%.  Thus, an objectively short incident might feel like it was much longer and have a bigger impact on you.  Likewise, your ability to remember the exact sequence of what happened becomes impaired.  The result is that afterwards, there’s parts of your brain that feel confused about what just happened.

That sense of confusion can lead to perseverative thoughts.  So, as you commute home, you keep running the incident over and over again in your head.  Part of you is trying to process, to make sense of, what happened.  However, memories of intense situations are stored based on their emotional impact.  So, you start to feel emotional in thinking about what happened earlier, and that in turn impairs your ability to process it.  Round and round your thoughts go, without any real resolution.  In the meantime, the stress builds up, and is stored, in your muscles and nervous system, eventually impacting your immune system and other regulatory mechanisms in your body.

One of the most effective and practical ways to lessen that effect is through the regular use of Psychological Debriefing.

There’s four things that help reduce the impact of traumatic stress.

1. Overwriting the emotional load of the traumatic memories.
2. Clarifying the sequence of events.
3.   Feeling cared for and respected.
4. Use of self-centering techniques.

Neuropsychological research supports practice-wisdom suggesting that the exact timing of debriefing doesn’t matter, in terms of its effectiveness.  Sometimes, it can be done right after an incident.  However, it also works to reduce the impact of traumatic stress even hours later. 

Nevertheless, as a rule of thumb, it’s best if Psychological Debriefing can occur before the shift ends.  Otherwise, perseverating, repeatedly running through what happened in your own head, tends to reinforce the traumatic emotions tied to the memory.  You can try to debrief outside of work, but you’ll soon learn that family and friends can’t really relate to what you’re describing and are left simply questioning why you would do such work in the first place!

Instead, what’s most helpful is to have a fellow staff person, ideally a shift leader or supervisor, but really it can be any staff person, simply attentively listen as you describe what happened. 

Overwriting the emotional load of traumatic memories:

When you describe, in a relatively calm fashion, what happened in a stressful incident, you begin the process of overwriting the emotional load of traumatic memories.  Essentially what’s happening in your brain is that you are taking the memory of the stressful event, with it’s intense emotional load, and overwriting that memory with a new memory of describing the incident to someone else, with a much reduced emotional load.

In this way, some of the emotional power, the sting, of the memory is reduced.  Later, recalling what happened is less likely to trigger the intense emotions originally experienced.  Instead, that recall is tempered by the memory of calmly describing what happened to a colleague.

To some extent, writing up the incident can serve the same purpose.  However, on an emotional level, the memory of calmly writing an incident report is not as powerful as a memory of verbally describing what happened.  Debriefing with an attentive colleague works best.  The key is that the description of what happened should, at least initially, focus on the behaviors and not on the staff person’s emotions.  The idea is to be able to recount what happened while experiencing a relatively calm state-of-mind.

Clarifying the Sequence of Events:

Because the parts of the brain that keep track of time tend to get shut off during intense situations, the more cognitive parts of the brain can be left feeling somewhat confused about the exact sequence of events that took place.  Again, sticking to a description of the actions that occurred during the incident being debriefed can be helpful for restoring that sense of sequence which helps the person being debriefed feel more oriented and centered.

It's not uncommon to debrief a group of people simultaneously who were all involved in some intense incident.  Often times some staff people will not have been aware of what was happening with others on the team.  Again, a review of that together is orienting and centering.

It should be a clear expectation that shift leaders will debrief any critical incidents before sending staff home.  Debriefing can, sometimes, be done very briefly, in just a minute or two.  It can also be done as a small group, and sometimes can be blended with the writing of the incident report.

Feeling Cared For and Respected:

To some extent simply attentively listening to a staff person’s description of what occurred will make them feel cared for and respected.  That has a huge impact on reducing the impact of traumatic stress.

However, it may make sense to ask a few questions.  After incidents that involved physical intervention, it’s helpful to ask the staff if anyone was hurt or injured.  Frequently, staff members will ignore minor scrapes and bruises that don’t require medical attention.  However, being able to share these sorts of minor injuries has psychological / emotional benefit.  In some cases, staff will have become injured to an extent that should be reported and they need to be encouraged to do that follow through. 

Sometimes a staff person will be embarrassed that they received some minor injury.  Normalizing that performing physical interventions are difficult can be helpful.  Likewise, sometimes a staff person is very unhappy about some aspect of their own performance during a physical intervention.  Again, normalizing that this is an extremely difficult part of the job can be emotionally supportive and helpful.

Simply asking the staff person how they’re doing can be helpful.  From a trauma mitigation perspective, their answer is less important than their experiencing being asked.  Having supportive teammates who care about your well-being is a huge trauma protective factor.

As the debriefer, it is not your role to solve any problems, to brainstorm other things the staff person could have done in the incident, or to analyze the actions or motivations of the clients involved in the incident.  Instead, it is the debriefer’s role to attentively listen and to be generally emotionally supportive. 

Sometimes a staff person may be so emotionally impacted by an incident that follow up in individual supervision would be helpful.  Psychological Debriefing is intended to help, but is intended to be relatively brief.  Suggesting that a staff person bring up what happened in their next supervision may be good advice, or in some cases letting the person’s supervisor know that some follow up would be helpful is part of being a caring and professional colleague.

Use of Centering Techniques:

The impact of traumatic stress can be greatly lessened by the use of various centering techniques.  Staff members should be encouraged to use these sorts of strategies to help manage their own stress.  Psychological Debriefing can reinforce the use these actions and of acquiring a sophisticated understanding of traumatic stress.

Immediately after a traumatically stressful incident, it’s helpful for staff to attend to their own basic needs.  Sometimes, it’s helpful to be cued to do this by a colleague.  Basic needs include things like hydrating, using a bathroom, stretching a little, or perhaps taking a short break.  These things signal your body that the crisis is over and that your physiology can return to baseline.

During Psychological Debriefing, the debriefer can ask if the incident took that staff person by surprise or was something they were able to partly anticipate.  Intense situations that occur without anticipation tend to be more traumatically stressful.

Likewise, the debriefer can ask if the staff person felt that their training prepared them for the incident.  Feeling trained and some level of competence in an intense situation will tend to result in less traumatic stress being experienced.  Gaps in training can be brought to the attention of supervisors for future improved training.

Asking the staff person about their own body awareness during the incident can be helpful.  Maintaining an awareness of your own muscle tension, breathing, heart rate, and other internal reactions can help you feel in control and can reduce the impact of the traumatic stress.

Asking the staff person if they felt supported by their teammates during the incident can also be helpful.  Many times the staff person will report that they did feel supported and their recognition of that will help to lessen some of the lingering effects of the traumatic stress.  If a staff person didn’t feel supportive, that’s important information for the rest of the team and for supervisors so that teamwork improvements can be made.

There are numerous relaxation, meditation, and mindfulness exercises that can be helpful after exposure to traumatic stress.  Staff members should be taught some of these techniques and encouraged to use them after being exposed to traumatic stress.