“Top Ten” Stress Resilience Tools & Techniques for Surviving Trauma, Transition, and Everyday Stress

I have been a co-founding partner of the Be Well Initiative for the Nepali Diaspora in America.  The tragic April 25, 2015 earthquake ignited a vision for a friend and colleague, Dr. DK Gurung.  (DK called me a day after, both for some venting and to share his communal dream.)  Born in Nepal, he understood that mental health services were needed in the face of such a natural disaster, but not just for people living in Nepal.  The stress was also great for family and friends 10,000 miles from ground zero.  But beyond the immediate disaster, cultural norms, honor and shame, and indirect or secretive communication patterns made it difficult for Nepalis to fully acknowledge let alone discuss emotional issues of stress, anxiety and depression.  The US Nepali community had to come out of the trauma, immigrant transition, and pressure of “Pursuing the American Dream” as well as everyday stress, closets.

This past year, Be Well Initiative has put into motion “Stress Survey” data collection, mind-body wellness and mental health educational reach out, along with running focus groups at various community events, centers, and programs.  We will close out the year with a memorial EQ15 service on April 24^th in Herndon, VA.  (Email stressdoc@aol.com if you’d like more information.)  As part of the interactive/community participation service, attendees will engage in small group discussion about past and present stressors and coping strategies.  Participants will also provide ideas for developing future mental health resources and services.  It should be a very moving, meaningful, and uniquely affirming experience.

“Top Ten” Stress Resilience Tools & Techniques

for Surviving Trauma, Transition, and Everyday Stress

This past year we have witnessed how imbalances and stressors in nature may suddenly erupt producing devastating consequences.  While not as cataclysmic, work-family-life imbalances and pressures may manifest in confusing, overwhelming and destructive, even life-threatening, emotions and behaviors.  As one Nepali community leader articulated:  “We too will erupt if our life gets out of balance, if we deplete ourselves, run ourselves to the ground, stretch ourselves thin, and live for all the wrong reasons.  We will either collapse into ourselves or explode onto others.”

We need a powerful stress tool kit to manage such stressors as: a) being emotionally connected to two homelands, b) separated from significant others as well as from geographical and cultural markers, c) everyday pressures pursuing the American Dream, including adapting to new cultural values, d) the challenges of finding meaningful employment, and especially, e) being an individual new to the US, feeling like “a stranger in a strange land.”

Perhaps most critical, as a community we need to affirm that reaching out for mental and emotional health services (the mind-heart) is as natural and normal as seeking help for physical illness (the body).  We must help our under-served community come out of the shadows of shame, stigma, and silence and discover a new horizon of hope!

Here is Be Well Initiative and the Stress Doc’s ™ “Top Ten” Stress Resilience Tools and Techniques for Surviving Crises and Everyday Stress:

1.  Find a “Stress Buddy.”  When it comes to stress, we initially may need to share our feelings outside of our immediate family, perhaps with a trusted friend or community leader.  Having another help put the situation in a more reasonable or calm perspective, may reduce feelings of guilt and self-blame and make it easier to later discuss the situation with family members.  If still relatively new in the US, it’s vital to have a “Stress Buddy” who understands the “trials and pressures” of immigrant stress.

2.  Speak to a Professional.  If you are feeling intense levels of stress, anger, and/or depression, with disrupted patterns of eating and sleeping, misusing alcohol and drugs or simply wanting to withdraw from life, it is time to speak with a person trained in providing mental health counseling.  There are Crisis Hot Lines for you to call.  If you are not sure where to go, contact one of the counseling/clinical members of the Be Well Initiative Team:

Bharati Devkota,  Nepali Speaking, Licensed Clinical Professional Counselor (LCPC) – telephone # 443-742-2575

Anshu Basnyat, Nepali Speaking, Licensed Clinical Professional Counselor (LCPC) – telephone #  443-574-3430; call for an appointment

Mark Gorkin, the Stress Doc, Licensed Independent Clinical Social Worker (LICSW) – telephone # 301-875-2567

3.  Join a Support Group.  Share your pain, purpose, and passion with a group of like-minded community members and a qualified facilitator; talking with one another, we lean on, learn from, and then provide an ear or a shoulder to our brothers and sisters.  Consider starting a Nepali/community support group.  BWI will be glad to assist.  Also, there are a variety of free, 12-Step Groups – from dealing with problem drinking (or being a family member of a problem drinker) to handling difficult emotions – located in schools, churches, community centers, etc., throughout the Greater DC-VA-MD area.

4.  Understand Change, Loss, and the Need to Grieve.  Whether it’s a devastating earthquake trauma or just a more quiet realization of missing loved ones, alive or deceased, no longer close by, or longing for our former life…we need to take time to remember.  The challenge of change is omnipresent for people adapting to a new land and way of life, or just going through transition.  Grief stages – shock, sadness, anger, fear, confusion, disbelief – are not just products of death and dying; grief can be stirred by the loss of a job, the loss of health and mobility, or the loss of a dream.  Grieving may help you make peace with both your past and present…and open paths for a more productive future.  Of course, there is not one way to grieve; each person has his or her own grief rhythm and time frame.  However, if after 2-4 weeks you are not back into your routine, find a trustworthy and understanding stress buddy or, even better, consider consulting with a professional counselor.

5.  Make Sleeping/Rejuvenating and Healthy Eating a Top Priority.  When it comes to sleep, we often provide solid guidance with our kids, but don’t follow our own advice.  Try to apply those sleep routine principles that you’ve designed for your children:  turn off the gadgets, take a shower or listen to soothing sounds of nature, or do quiet reading in bed.  And, limit alcohol and caffeine several hours before bedtime.  Meditation or taking a ten-fifteen minute “power nap” can be an effective way to rejuvenate during the day.

As for food and fuel intake, beware of picking up some of the sloppy eating habits of too many Americans.  Reduce your intake of salts, sugars, and saturated fats – those cans of soda and bags of chips.  Eat more fruits, especially the berries, and green and leafy vegetables; whole grains, beans and legumes and, if not going vegan, Omega-3 fish – salmon and sardines, are heart-healthy choices.  Listen to your grandmother!

6.  Get Regular Exercise.  Do you get thirty minutes of brisk exercise three-five times a week?  Regular exercise provides both physical and psychological advantages.  Thirty minutes (or even two fifteen minute segments) of vigorous, non-stop, large muscle movement activity – brisk walking, swimming, bike riding, dancing, etc. – releases brain chemicals such as endorphins and dopamine which are the mind-body's natural mood enhancers and pain relievers.  It's less a runner's high and more that we can step back and see things with a calmer disposition and fresher perspective. 

When stressed, everything feel’s up in the air.  The answer: to feel grounded.  There is nothing like a brisk thirty minute walk for creating a beginning and end point for a tangible sense of accomplishment and control.  Actually, you’re developing a “success ritual.”  And while I don’t always love to exercise, after my ten-minute “while still in bed” morning routine of stretching, sit-ups, push-ups, yoga positions, etc. and my early evening walk…well, I do like feeling virtuous.  And if you’re having difficulty getting started…find a walking partner.

7.  Learn to Say Set Limits.  During my workshops, more people have said to me, “Mark until I learned how to say ‘No’…I was living on the edge of stress!”  Remember, being a mature adult means that sometimes you will have to disappoint people.  For friends and family, for example, let them clearly know what you cannot do (at this moment in time) but also perhaps what you can do.  Give people the option to call you back in two days when your schedule might not be so busy. Naturally, expect that your initial “No” might prove upsetting.  But don’t overly explain your position; excess talking undermines your own sense of control and authority.  People see you as wishy-washy.  Briefly remind people of your stated position.

On the other hand, when relating with an impatient or “the sky is falling down” authority figure, e.g., the big boss at work, the key is not to let this person’s false or exaggerated sense of urgency become the only reality.  Remember, for something to be urgent or an emergency, it’s “life and death.”  Everything else can be prioritized.  So to regain some control, say to that boss, “I know this is a very important matter.  Because it is important, let’s take five minutes; help me prioritize – what should I put on the backburner while I focus on this new vital priority.”  Don’t let someone else’s false urgency become your anxiety!

8.  Identify and Defuse Stress Triggers.  We all have emotional areas in which we are especially sensitive or reactive – for example, someone questioning our honesty or intelligence, talking badly about a friend or family member, or trying to tell us how we must do something his or her way, etc.  We tend to overreact emotionally and verbally when someone hits our “hot button.”  To improve your capacity for self-regulation, before reacting:  a) take some deep breaths, b) pay attention to those “3 B” – Brain-Body-Behavior – stress smoke signals; as I like to say:  Count to ten...and check within, c) can I observe the other without making a snap judgement and if they are judging me not “shake, rattle and BLOW?,” d) learn to use assertive “I” messages instead of blaming “You” messages, for example, “I don’t agree” or “I am not comfortable with…” as opposed to “You’re wrong!” or “It’s your fault!”

Actually two of my favorite stress defusers also help set limits:

A firm “no” a day keeps the ulcers away and the hostilities, too.

Do know your limits and don’t limit your “No”s.

9.  Get Organized.  Chronic clutter in a room or office (or even a car) creates a messy mind.  Recognize that anger, fear, boredom, or depression often contributes to ongoing procrastination.  Develop an ABCD system:  “A” or “top priority” items deal with promptly; “B” or important items file in a “to do” file that’s visible or easily reachable; “C” items discard whenever possible; and have a “D” box or file for future reading or reference.  (Discard most items after a short period of time if not read.)   Again, if this ABCD system is not working, reach out to a concerned friend or a counselor.  Consider this variation of the “Serenity Prayer”:  Grant me the serenity to discard the things I really do not need, to save and file the things I do, and the wisdom to know the difference (or to brazenly eviscerate 90% of my in-box)!

10.  Discover a Hobby or Engage in an Art Project…Or Just Laugh.  A life that completely revolves around responsibilities to family and work, with no time for mind-body-spirit nourishment and rejuvenation, is a life at-risk.  Remember, burnout is less a sign of failure and more that we gave ourselves away!  Hobbies or art projects, engaging in sports or physical activity that especially integrate the mental-emotional-physical, e.g., digging in a garden, walking in parks or forests, going for bike rides, trying your hand at water coloring, writing poetry, playing tennis, regular meditation, taking dance lessons (research shows this is a an especially good activity for preventing dementia as it is both spontaneous and structured)…all enable us to step back, shift gears, have fun, and rediscover the sublime in nature and our true essence.  And if not quite ready for a hobby, at least read books or watch TV, videos, or movies that make you laugh.  Laughing with gusto is like “inner jogging,” giving vital organs a brief but hearty internal massage!

In closing, if you begin to apply these “Top Ten” tips and techniques you will become commander of your own stress ship, being able to navigate stormy seas and eventually reach your own island or homeland of mind-body-spirit resiliency and serenity.  Just remember…Practice Safe Stress!

Mark Gorkin, MSW, LICSW, "The Stress Doc" ™, a nationally acclaimed speaker, writer, and "Psychohumorist" ™, is a founding partner and Stress Resilience and Trauma Debriefing Consultant for the Nepali Diaspora Behavioral Health & Wellness Initiative.  A former Stress and Violence Prevention Consultant for the US Postal Service, he has led numerous Pre-Deployment Stress Resilience-Humor-Team Building Retreats for the US Army.  The Doc is the author of Practice Safe Stress, The Four Faces of Anger, and Preserving Human Touch in a High Tech World.  Mark’s award-winning, USA Today Online "HotSite" – www.stressdoc.com – was called a "workplace resource" by National Public Radio (NPR).  For more info, email:  stressdoc@aol.com.

Individual and Collective Crisis/Trauma Intervention and Debriefing: Ten Steps & Strategies

In light of events fifteen miles away (Baltimore) to 10,000 miles from my doorstop (Nepal), this essay titled, "Individual and Collective Crisis/Trauma Intervention and Debriefing: Ten Steps and Strategies," clearly has immediate relevance and application.  Actually, the impetus for the article occurred last week when a friend and colleague (originally from Nepal) asked me to talk briefly about stress and trauma on a strategic planning phone conference with other Nepali-born individuals.

 

Always appreciate any ideas or feedback.  If you think it works for any of your publications or for public transmission, please use or share.  Thanks,

 

Mark

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Individual and Collective Crisis/Trauma Intervention and Debriefing:

Ten Steps & Strategies

 

The devastating earthquake, with its mounting death toll, and the life-and-death challenge of speeding relief throughout Nepal, especially in more remote areas, clearly is the immediate national crisis.  The destruction, disruption, and dislocation is generating human, societal, and cultural tragedy and trauma of epic proportions – be they personal, family, societal, cultural, and archeological.  However, today, right now, and as the proverbial dust settles, many will need more than food, clothing, shelter.  Also vital:  psychological counsel, emotional grieving, and gradual healing; so too fostering stress resilience and hope as well as ongoing peer and community support and sustenance.  The critical task:  not just repairing and restoring homes and shrines but also rebuilding and reintegrating hearts and minds!

 

And these physical and psychological resources and responses are not only crucial for those in Nepal.   The trauma and lingering uncertainty, especially for the safety and well-being of family and friends, is right at the doorstep of people of the Nepali Diaspora thousands of miles from ground zero.

 

Before listing key intervention tips, it’s necessary to define two terms – Crisis and Trauma:

1) Crisis: is a critical event or experience that triggers feelings of threat and loss while also challenging the individual’s, family’s, and/or social group-community’s coping resources and capacity for action.  Crisis also involves a time-limited period of “danger” and “opportunity.”  Systems are motivated to regain physical and psychological control; they are more open to reaching out for resources and unconventional problem-solving structures and strategies.  Individuals and groups are more ready to grapple with feelings of loss and grief and receive vital emotional support.  However, a lack of support for engaging meaningfully with such acute pain and problems in a timely manner can lead to regressive or maladaptive coping (e.g., increased drinking or drug use) and stress or trauma-induced mind-body illness.

 

2) Trauma: is a state of both overwhelming emotional and physiological arousal combined with intensely negative cognitive processing.  According to the experts, trauma can occur from a one-time event or an ongoing experience, including trauma based on the nature of one’s role-relationship to the stressor, e.g., ground zero victim, the family members of a victim of violence, the second-hand trauma of witnesses to grisly violence, or the impact on individuals working with trauma victims.  Trauma effects can range from being numb or immobilized to a state of panic, as well as feeling helpless and hopeless.  And sometimes the reaction can be delayed; hence, Post-Traumatic Stress Reaction.Trauma effects can range from being to numb or immobilized to a state of panic, as well as feeling helpless and hopeless.  And sometimes the reaction can be delayed; hence, Post-Traumatic Stress Reaction.

 

And responding effectively to both Crisis and Trauma is complicated by the fact that previous emotional experience with separation and loss, illness and/or disability, helplessness and hopelessness are, sometimes powerfully, at other times subtly, rekindled adding to the intensity of the present-day crisis and/or trauma fires.

 

Ten Individual and Collective Crisis/Trauma Intervention and Debriefing Steps & Strategies

 

1.  Acknowledge Stressful Feelings.  During a crisis, while wanting to immediately swing into action, at some point, sooner rather than later, it’s important to take an honest psychological self-inventory.  Not addressing acutely intense or prolonged stress or depressed feelings is inviting mind-body health issues, even illness down the road.  Of course, a certain amount of stress during trying times is natural and even useful, stimulating focus and determination.  Extended hypervigilance without sufficient support is the problem!

 

2.  Quickly Connect with Others.  Both for support and problem-solving information reach out to trusted or credible resource people and organizations.  By its nature, crisis problem-solving means plunging into unknown or uncertain waters.  Partnering with people more familiar with the experience, or at least with managing crisis or trauma emotions, is vital.  This is no time for Lone Rangers and Rambos or Rambettes.

 

3.  Appreciate the Time-Limited Nature of Crisis.  During this period of acute uncertainty and threats to survival, people will typically open up to new ideas, approaches, and actions, especially if guided by knowledgeable and purposefully reassuring leaders or guides.  Crisis is a “no exit” challenge:  an individual or group will either take positive or proactive problem-solving steps or they will hide out or freeze into self-defeating and escapist adaptations.  (Hence the previous mentioned “danger” and “opportunity” crossroads of crisis.  And the danger is not just external; see #4.)  Strike when the ego is hot!

 

4.  Be Aware of Unconscious Intrusions.  The acute stress of crisis generates cracks in our psychological defenses.  These defenses normally keep at bay painful memories and feelings.  However, under intense and unrelenting pressure, cracks emerge and subterranean emotions and images, memories and dreams often appear adding to stress levels and heightening a sense of confusion or disorientation.  Sometimes people mistakenly believe they are going crazy; or can’t explain their own coping.  The confusion is a natural component of emotional crisis flooding.  For example, a week after 9/11, a friend, a former artillery officer in Vietnam, was perplexed by his lingering angst.  Certainly he had seen mayhem and destruction before.  I suddenly recalled a tragic piece of his past family history, perhaps a contributing factor to his current dis-ease:  “Hadn’t you lost your first wife in a house fire; and your personal rescue attempts were unsuccessful?”  Momentarily startled, John poignantly said, “I hadn’t thought of that!”

 

5.  Understand the Key Components of Grief and Trauma Debrief.  For both powerful loss and trauma, the classic model of grief has relevance: there are the initial stages of shock, sadness and or despair, rage, guilt, (or, for example, “survivor’s guilt” for those in the Nepali Diaspora), ambivalence, and/or withdrawal, etc.  Then, through time, chemical rebalancing, and emotional support, as energy, confidence, and possibility levels increase, the process typically progresses into refocused attention, focused aggression or determination, individual and collective problem-solving, relief and, hopefully, hard-won acceptance of the loss.  While still painful, memories are no longer paralyzing or inducing panic states.  New lights on the horizon of hope may finally be sighted.

 

During times of crisis, an individual may have the capacity to quickly engage with grieving.  In contrast, someone in the throes of trauma may need to move more slowly through the healing stages.  Of course, for both pathways it’s not a linear evolution.  One may take steps or stages forward and then fall back, needing more than once to rework and reintegrate sobering, troubling or frightening thoughts and feelings.  Also, with Post-Traumatic Stress, effective coping during the crisis period now starts to unravel.  Once our survival guard is down, especially after prolonged and draining vigilance and tragic loss, then exhaustion, high anxiety, rage, despair, and/or depression may take over.  Finally, research reveals that early childhood separations, losses, exposure to violent incidents, and other adverse, trauma-inducing experiences appear to be correlated with adult PTSD-like reactions.

 

6.  Grasp the Individual Nature of Grief and Paths of Healing.  There is not one way to grieve; each person’s process is unique to his or her bio-psycho-social-cultural nature and history.  Consider these approaches or styles:

 

a) Cognitive or head – trying to make immediate intellectual sense or order of the experience

b) Affective or heart – needing to experience and express the array of grief emotions

c) Sensual – needing to be touched or stroked, held and hugged

d) Social – needing to share ideas and/or emotions with others, especially those who can truly relate

e) Action – regaining a sense of purpose and emotional control by taking action plans and steps

f) Reflective – needing time alone to meditate upon and often creatively express pain and meaning; the process may be reinforced interacting with nature, e.g., a number of Veterans have engaged in hiking the Appalachian Trail as part of their trauma recovery process.

 

Ultimately, reconciling or integrating head and heart, body and spirit along with restoring a sense of hope and new possibility, perhaps even new partnerships, and creative outpourings are some of the byproducts of a healing grief experience.

 

Finally, there’s no absolute time frame for moving through the grief stages.  Don’t accept when people say some variation of, “It’s been a couple of months now; stop looking back; stop dwelling on the past; time to move on with your life, etc.”  In fact, some powerful losses are never completely mourned.  Eventually, life again feels worth living, but there will always be “grief anniversary” moments and memories.  The only caveat: a month after the critical incident, if you are still stuck in the same dark emotional hole, (a shorter time frame, of course, if disruptive health or suicidal issues emerge) strongly consider contacting a professional health and/or mental health provider.

 

7.  Consider these Two “Grief Dynamic” Passages and Reach Out for TLC:

a) There’s a real difference between feeling sorry for yourself and feeling your sorrow.  When you are feeling sorry for yourself you typically blame others.  When feeling your sorrow you have the courage to face your pain.  And there are times in life when we all need to face our sorrow! And

 

b) Whether the loss is a key person, a desired position, or a powerful illusion, each deserves the respect of a mourning.  The pit in the stomach, the clenched fists and quivering jaw, the anguished sobs prove catalytic in time.  In mystical fashion, like spring upon winter, the seeds of dissolution bear fruitful renewal.

 

During highly uncertain or stressful times, try finding a “Stress Buddy.”  (The concept was derived from working with military spouses.  They would find a supportive partner, a fellow spouse, when their soldier went overseas, especially “down range, in harms’ way.”)  However, a “Stress Buddy” should provide a variation on traditional TLC:  Tender Loving Criticism and Tough Loving Care!

 

8.  Create a Safe Space whether In-Person or in Cyber.  When trying to console or counsel others, as much as possible, find a private place to share.  Assure the person of your confidentiality, unless the individual threatens self-harm or harm to others.  In light of the disorienting nature of crisis, try to be open to a wide range of emotional ventilation (along with cultural variation) without critical judgment.  In my estimation, listening carefully to someone demonstrates real respect.

 

Virtual support systems are especially vital when trying to communicate with and connect people separated by wide distances.  Of course, as more and more counseling services are provided technologically, through phone, email, or Skype, extra effort must be made to assure “message sent is message received.”  And to expedite effective and efficient group communication, whether involving supportive or strategic planning services, whenever possible, an experienced facilitator is wise.

 

9.  Keys for Comforting Others.  While most appreciate an attentive ear or a sturdy shoulder during times of confusion, chaos, or crisis, reaching out or supporting others takes both some science and art. Perhaps the most important quality is being non-judgmental.  Some make this mistake with the best of intentions, e.g., when trying to reassure another claiming, “Oh, you shouldn’t feel that way.”  Or we can unintentionally trivialize someone’s pain by saying, “I know how you feel.”  Unless you have truly walked in another’s particular painful path, better to say, “I don’t fully grasp your experience, (or ‘I can only imagine’), please help me understand.”  Or, if you want to share, try saying, “I don’t know if this is relevant, however, for me your story brought up this thought or memory…”  Again, after sharing your idea or story, make sure you refocus ears and eyes, head and heart back on the person in crisis or trauma.

 

The communication key, of course, is not quickly offering advice, unless asked, (in general, avoid, “Here’s what you should do!”); rather, ask sensitive questions and listen reflectively.  Check out understanding by paraphrasing back to the person what you’ve heard.  When emotions are particularly charged, check out whether “message sent is message received.”  Finally, if giving advice, spoon it out in clear and concise, bite-sized chunks for easier intake.

 

10.  Help People Find Purpose and Passion in Pain.  Almost all of us want a sense of meaning and purpose in our lives.  This can seem hopelessly lost in times of tragic loss and destruction.  However, whether rapidly or patiently, enabling those in the throes of crisis and trauma to begin to embrace their pain -- to either open the emotional floodgates or to explore slow yet steady, gradual grief-steps – often means helping individuals, families, and communities discover unrecognized and untapped sources of strength.   People may even regain or evolve a new sense of passion, especially wanting to help others in their community; one emerging from the trauma or crisis crucible may well seek a purpose larger than their own safety and well-being.  (And remember, the root of “passion” is suffering, as in the “Passion Play,” that is, the sufferings of Jesus or, more generically, the sufferings of a martyr.)

 

As I once penned:

 

For the Phoenix to rise from the ashes

One must know the pain
To transform the fire to burning desire.

 

Closing

 

Along with traditional disaster rescue, resource, and recovery efforts, grief and trauma intervention and engagement, especially during double-edged, “strike when hot” times of crisis, can substantively assist overwhelmed individuals and families, groups and communities.  Despite the immediate assault on a victim’s senses and sense of identity, with timely and knowledgeable support we can learn and evolve individual and collective stress resilience skills and strategies.  We not only can survive the chaotic present but often develop psychological attitudes and aptitudes – head and heart muscles – that have us better prepared to survive, learn from, and creatively adapt to future hazardous events and challenges.

 

 

Mark Gorkin, MSW, LICSW, "The Stress Doc" ™, a Licensed Clinical Social Worker, is a national keynote and webinar speaker and "Motivational Humorist & Team Communication Catalyst" known for his interactive, inspiring and FUN programs for both government agencies and major corporations.  The Doc is a training and Stress Resilience Consultant for The Hays Companies, an international corporate insurance and wellness brokerage group.  He has also led “Resilience, Team Building and Humor” programs for various branches of the Armed Services.  Mark, a former Stress and Violence Prevention Consultant for the US Postal Service, is the author of Resiliency Rap, Practice Safe Stress, and of The Four Faces of Anger.  See his award-winning, USA Today Online "HotSite" – www.stressdoc.com – called a "workplace resource" by National Public Radio (NPR).  For more info on the Doc's "Practice Safe Stress" programs or to receive his free e-newsletter, email stressdoc@aol.com or call 301-875-2567.

Critical Incident-Trauma-Grief Intervention & Debriefing: Train the Trainer/Caregiver Workshop

Just last week, Dr. Charles Hicks a Baltimore psychologist and life coach and Linked-In comrade, approached me about developing a proposal on Primary and Secondary Trauma/Grief Intervention and Debriefing.  He wanted to pitch it to a local “faith-based” organization.  The request was intriguing, and I immediately got on the keyboard.  As I was developing the package, it was soon clear I could integrate both ideas developed decades ago as a Crisis Intervention Adjunct Professor at Tulane University Graduate School of Social Work and more recent work as a Critical Incident/Stress-Trauma-Grief Debriefing Consultant.  (See below, “The Stress Doc’s Critical Incident Intervention-Chicken Gumbo Recipe for Soothing the Heart, Sustaining the Soul, and Searching Anew for Purpose and Passion:  Nine Steps.”)

In addition to a program blurb and objectives-outline and relevant testimonials, and a sample list of my trauma intervention experience, there are two powerful and relevant Resiliency Raps.”  Dr. Hicks thought the proposal “great.”  I hope you find it thought-provoking and, if applicable, of use to you, your group/organization, or other entities.  Please email or call with any questions, ideas, or suggestions.  Peace,

Mark

Mark Gorkin, MSW, LICSW
The Stress Doc ™

Stress & Change Resilience Counseling-Coaching-Consultation
Crisis Intervention-Burnout-Bullying/Conflict-Loss-Grief
Phone-Electronic-Skype-In-Person

301-875-2567
stressdoc@aol.com
www.stressdoc.com
http://www.orate.me/resume/mark-gorkin/  (ORATE Speakers Bureau)

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Critical Incident-Trauma-Grief Intervention & Debriefing:  Train the Trainer/Caregiver Workshop

In a world where encounters with sources of aggression and violence, trauma and grief are all too common, understanding the dynamics of “critical incidents/hazardous events” – both for adults and/or children directly impacted and for those encountering second-hand effects – is vital.  This “train the trainer/caregiver” workshop is for family members or close friends, colleagues, educators, religious or community leaders, emergency responders, or an array of helping professionals.  Critical Incident Intervention demands an ability to respond using both head and heart to connect and comfort those caught in the radiating circles of trauma.

And the Stress Doc’s lively, high-energy programs are the perfect answer.  In fact, the Doc’s workshops help audiences “Get FIT”…by being FUN-Interactive-Thought-provoking.  The program involves a mix of brief lecture, real world group exercises, and group discussion.  You will walk away with “hands on” tools and skills, techniques and strategies for responding purposefully, efficiently, and with compassion in times of trauma and crisis.   And these tools and strategies will enable you to effectively engage both individuals immediately impacted by trauma and loss, and especially with those emotionally connected to or in the emotional shadow of trauma or grief ground zero.

Program Objectives

The Critical Incident/Trauma Debriefing Professional needs to have working knowledge in the following key areas, including:

A.  Overview of Stress, Crisis, and Trauma

1. The Head and Heart Support and Resilience Goal of Critical Incident/Trauma Debriefing
2. Types of Stress, Smoke Signals, and Crisis Theory
3. Crisis Window of “Danger & Opportunity”
4. Different Types of Trauma/Grief Situations
5. Predisposing Factors to Traumatic Stress Reactions

B.  Dynamics of Loss and Grief

1. Unfinished Grieving and “Grief Ghosts”
2. Understanding the Multifaceted Nature of Loss and Grief
3. Stages of Loss and Grief, including Shock, Denial, Rage, Helplessness, Guilt, Ambivalence, etc.
4. Difference between “Feeling Sorry for Yourself” and “Feeling Your Sorrow”
5. The Magical Healing Path of Grief

C.  Critical Incident Settings and Use of Personal-Professional Self

1. Types/Settings of Interventions
2. Use of Personal/Professional Self in Critical Incident/Trauma Debriefing
3. Capacity for Relaxed Attention, being Focused & Fluid, Absorbing & Scanning, and Detached Involvement
4. Conscious Use of Verbal and Nonverbal Communication

D.  Key Critical Incident Communication Skills

1. How to Engage in Reflective Listening
2. How to Ask Courageous “Good Questions”
3. How to Tentatively Reflect and Appropriately Reveal

E.  Key Intervention Process Components, Tools and Techniques

1. Transitioning from Educator to Group Facilitator
2. “Nine Step Trauma & Grief Orientation-Engagement Recipe.”
3. Carefully Using Healing & Harmonizing Humor:  The Link between Comedy and Tragedy

F.  Taking Care of the Critical Incident Caregiver

1. Recognizing, Preventing, and Recovering from Burnout
2. Engage in Acclaimed Relaxation-Visualization Exercise
3. Stress Doc’s Natural SPEED Formula for Stress Resiliency and Brain Agility
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Credentials and Experience of the Primary Presenter

Mark Gorkin, MSW, LICSW, known as the Stress Doc ™, is a nationally recognized speaker, Stress Resilience and Critical Incident/Hazardous Workplace Expert.  Mark has been:

a) a Stress & Violence Prevention Expert for the US Postal Service; was the “Social Worker/Consultant on the Beat”

b) a Stress Resilience-Humor-Team Building Expert for the US Military,

c) a Critical Incident/Trauma-Grief-and Hazardous Workplace Debriefing Expert for numerous corporations, government agencies, and institutions

d) over the past fifteen years, under the banner of Total Learning Solutions, has led a series of one-day Stress Resiliency & Conflict Management programs for Managers and Supervisors at Washington Metro Area Transit Authority (WMATA)

e) taught Crisis Intervention/Brief Treatment for ten years at Tulane University Graduate School of Social Work

f) recognized stress, transition stress, burnout and grief, transforming anger and conflict speaker and writer; has worked with hundreds of companies, institutions, and federal, county, and city agencies

g) author of Practice Safe Stress:  Healing & Laughing in the Face of Stress, Burnout & Depression, The Four Faces of Anger:  Transforming Anger, Rage & Conflict, and Resiliency Rap:  The Wit & Wisdom of the Shrink Rapper ™

h) private practice therapist for nearly thirty years, specializing in stress, burnout, loss, grief, and couples counseling

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A Sample of Critical Incident/Trauma Debriefing Interventions includes:

a) bank personnel/robbery at gun point

b) with postal facility’s personnel after an employee threatens to shoot two colleagues

c) postal worker held up at knife point

d) beloved Manager killed by a stranger after work outside a club

e) federal supervisor threatened with a knife

f) employee having a fatal heart attack on the workfloor

g) employee suicide in the context of some conflict-laden work relations

h) employee having a psychotic break at work

i) intense racial antagonism, and/or sexual harassment, and/or bullying/emotional intimidation in the workplace

j) supervisor losing son to AIDS and husband to a heart attack in a two month period

k) supervisor killed in a head-on vehicular crash while driving to work

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Testimonials

 

University of Maryland's Diabetes/Endocrinology Center's Managing Diabetes Conference; 100 + Allied Health Professionals

 

Practice Safe Stress:  Stress and Change Resilience through Humor

3/12/2015

Hi Mark-

Great presentation. It really inspired me to improve my own presentation skills and brainstorm with my coworkers how to make our diabetes education classes more fun.

Please add me to your newsletter list.

Best Regards,

Alison Massye

Alison Massey MS, RD, LDN, CDE
Director of Diabetes Education, Mercy Medical Center
250 N. Calvert Street Baltimore, MD 21202
amassey@mdmercy.com
P: (410) 659-2833
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Developing Stress Resiliency, Humor, and Passion Power:  The Gift of Interactive Engagement; for Human Resources Palm Beach County (HRPBC), FL; Kickoff Speaker; 100 attendees; 1.25 hrs

Feb 27, 2014

Hello Mark.

HR Palm Beach County had the wonderful pleasure of having Mark Gorkin “The Stress Doc” present at one of our monthly dinner meetings. Mark’s presentation was both insightful and engaging. He has a way of captivating the audience and makes them want to hear more. We enjoyed his insights on the factors that cause stress and how to overcome them. We hope to hear more from “The Stress Doc”. It was definitely time well spent. We especially enjoyed his perspective of Passion and Power. Mark Gorkin is a must hear!

Tanya Vaughn-Patterson
HRPBC Program Chair

Diversity & Inclusion Consultant
NEXTERA ENERGY
Ofc: 561-694-4199
tanya.vaughn-patterson@fpl.com
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Fairfax County Government/Dept of Administration for Human Services; Keynote for 120 on "Energizing and Expanding Team Mindset, Motivation & Morale"

Subject:   THEY LOVE YOU IN DAHS
Date:     3/25/2013

Hi Mark,

Hope you had a great weekend.

I spoke with Gail this morning and she is absolutely DEE-lighted with the Stress Doc! 

[Gail Ledford, Department Director, was going to share her observations with Dept. of Public Work's Director James Patteson.]

WE have had nothing but rave reviews from the staff

“Engaging and Educational”

“Just a note to say how much I enjoyed yesterday’s event at the Government Center.  I think it changed the attitudes of many because not only were we ‘away’ from the office but also having Mark Gorkin as a guest speaker helped everyone connect better….and laugh. Thank you!”

“We are already using some of the tools and suggestions from the training. Our vote is more like this, whether it’s him or similar activities.”

I will be in touch. All the best,

Robyn L. McCoy
Resource Development and Training Manager
Department of Administration for Human Services

703-324-3597
Robyn.McCoy@fairfaxcounty.gov
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Counseling Testimonial

Oct 12, 2013

I am so glad you are offering your services to many. You are an insightful man who helped me to have clarity and find my strength in chaos. I honestly believe that "God" put you in my path. I am still unsure of my future but I do know that I made the right choice. Without your understanding, patience and knowledge, I would not have been able to make that move. I may have slip-ups but I hear your voice and your words in my head and you continue to guide me.

A

Long Island, NY
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Mark Gorkin, MSW, LICSW, "The Stress Doc" ™, a Licensed Clinical Social Worker, is an acclaimed keynote, kickoff and webinar speaker as well as "Motivational Humorist & Team Communication Catalyst" known for his interactive, inspiring, and FUN programs for both government agencies and major corporations.  In addition, the "Doc" is a Team Building and Organizational Development Consultant as well as a.  He is providing "Stress and Communication,” as well as “Managing Change, Leadership and Team Building" programs for a variety of units at Ft. Hood, Texas and for Army Community Services and Family Advocacy Programs at Ft. Meade, MD and Ft. Belvoir, VA as well as Andrews Air Force Base/Behavioral Medicine Services.

A former Stress and Violence Prevention Consultant for the US Postal Service, the Doc is the author of Practice Safe Stress and of The Four Faces of Anger.  The Stress Doc blog appears in such platforms as HR.com, WorkforceWeek.com, and MentalHelpNet.  His award-winning, USA Today Online "HotSite" – www.stressdoc.com – was called a "workplace resource" by National Public Radio (NPR).  For more info on the Doc's "Practice Safe Stress" programs or to receive his free e-newsletter, email stressdoc@aol.com or call 301-875-2567.

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Supporting Documents

The Stress Doc’s Critical Incident Intervention-Chicken Gumbo Recipe for Soothing the Heart, Sustaining the Soul, and Searching Anew for Purpose and Passion

Critical Incident Interventions come in many forms and functions, shapes and sizes.   For example, one common format:  providing a ten-minute overview of the effects of trauma and loss along with the signs and stages as well as the typical and individual workings of grief with a large group of employees (fifty or more).  You typically close by providing info about the Employee Assistant Program (EAP) for possible follow-up as needed.  Sometimes an intervention consists of meeting briefly with a team or segments thereof followed by consultations with individual employees.  These individual sessions may be scheduled beforehand; they also may arise right after a grief orientation, as an individual realizes s/he needs to talk.  In addition, an employee may be guided to you by a manager, or the start of an intervention can occur as you walk the halls, engaging people on the spot.

However, there’s another CISD (Critical Incident Stress Debriefing) model and method that appears to be effective for a time-limited orientation-intervention (e.g., 15-30 minutes) with a moderate-sized group (around 20-30 participants). Based on a recent 20-minute, 20-person group sessions, for maximizing intervention benefits consider this strategic, content-process, “Step-by-Step Trauma & Grief Orientation-Engagement Recipe.”  (Please know that deviations and trial and error experimentations will be highly likely and/or necessary.)  Let’s call this “The Stress Doc’s Critical Intervention-Chicken Gumbo for Soothing the Heart, Sustaining the Soul, and Searching Anew for Purpose and Passion.”

1.  First Impression.  Addressing the assembly, the Human Resources Director began her brief introduction, explaining who I was and why I was present.  Actually, her first words, not surprisingly, were a reflexive, “Good morning.”  My first words:  “Normally I would say ‘good morning,’ but today’s is not a good morning; it’s a very tough one.”  Immediately I had distinguished myself and my role while demonstrating an awareness of the emotional state and place of the folks in the room.  It wouldn’t be business as usual, yet…

2.  Getting Down to Business.  Having only 20 minutes necessitates a strategic opening and basic outline, including:

a) sharing some common traumatic effects of sudden and horrific death (a violent death often heightens the sense of trauma) and grief – e.g., an immediate state of shock, feeling numb, sadness, generalized angst, and/or anger (ranging from being angry with God and fate to the deceased, himself), social withdrawal, feeling bereft or emotionally out of control, possibly losing one’s appetite (or overusing substances to numb pain), having difficulty sleeping, etc.

b) placing these stress and loss smoke signals in a time frame, that is, the presence of some or a number of the above effects for a handful of days is fairly normal, (unless, of course, these grief signals are of overwhelming intensity); if the distracting or disturbing presence of any effects approach two weeks, then an assessment with an Employee Assistance Grief Counselor is strongly advisable.  And here’s why…

3.  Trauma takes off the Stress and “Grief Ghost” Cover.  Another piece of educational information relates to the disruptive potential of a sudden traumatic experience:

 

a) individuals currently experiencing high levels of stress in their lives, separate from the tensions related to the death of a colleague, are more likely to have heightened reactions to the immediate loss; they don’t have room to handle another stressor on their emotional plate and

b) consciously or not, we all carry around some emotional baggage from our psychosocial-historical past; if a person has not sufficiently grieved a previous loss or disruptive event – actual or psychological – especially regarding significant others or family/group relations, then the weight of this baggage becomes more onerous.  For such a burdened individual, a traumatic experience:

1) either increases the heaviness of one’s emotional load or

2) breaks open your luggage; now painful feelings and memories from the past – what I call “grief ghosts” – begin or are primed to flood your work-life space.  During trauma or “crisis,” defenses are lowered or punctured, the mask is uncovered.  People often wonder why they are having such a strong reaction to the immediate tragedy:  “Why am I suddenly thinking of people who don’t typically appear on, let alone crowd, my psychic radar?”  The short answer:  you are likely grappling with multiple losses – one’s both immediate and historic.  Consider this poignant example:  several days after 9/11, my webmaster, a former US Army officer and Vietnam combat vet, couldn’t understand why he was still having a vague sense of unease.  Asking a few questions helped him reconnect to the subterranean memory of having lost his first wife decades earlier in a tragic house fire.  He had been unsuccessful in his rescue attempts.  Trauma surfaces the overt and the covert.

4.  Grief Is Still Individual.  Finally, upon reviewing useful grief data, remind one and all there is no one right way or exact timetable for grieving.  The process is truly personal, based on one’s life stage and experience, temperament, cultural influence, etc.  I do close this portion of the session with a heartfelt Stress Doc ™ adage:  There’s a real difference between feeling sorry for yourself and feeling your sorrow.  When feeling sorry for yourself, you are likely blaming others.  When feeling your sorrow, you have the courage to face your pain.  And there will be times when each and every one of us must face and embrace our sorrow!”

5.  Changing Direction.  The educational component should not be more than 5-10 minutes.  Shifting idea and energy flow, I paused and asked if anyone wanted to speak.  In one group, initially, no one responded.  (This is not so surprising when many are feeling numb or are still in a state of shock; still others are not sure what to say.)  In the second session, one person shared a general observation about life’s vulnerability.  And then silence loomed; I affirmed this was understandable.

6.  The Power of Silence.  A suggestion:  consider going with the flow.  Ask for a minute of silence so all could all be with their own thoughts.  Based on my experience as a group facilitator, an uneasy or weighted quiet often is a stimulus and space for helping people focus, and get more centered.  Ironically, silence itself becomes a lubricant for communication.  And in fact, participants in both groups began sharing personal, heartfelt stories capturing some poignant or playful interaction with the deceased.  One or two revealed the recent death of a significant family member.  I noted my availability after the final grief session.

7.  Build On the Sharing.  I mentioned there may be several ways of memorializing the deceased, beyond a service, including a visual-verbal picture-board or scrapbook, planting a garden, or turning an activity that the deceased enjoyed into an annual event, etc.  (For example, one hospital department named a bocce tournament for a fallen colleague who enjoyed the pastime.)

Then, with time running down, I compressed a grief exercise into a head- and heart-provoking encounter.  After summarizing many of the positive qualities mentioned, and also surmising the deceased “wasn’t always an angel” – sometime he might even be a “pain in the butt” (which elicited some knowing laughter) – I then posed a powerful question…

8.  An Existential-Spiritual Challenge.  “What would happen if each one identified a trait or quality that they admired or valued in the deceased? … And, too, if all committed to cultivating that trait within ourselves?”  While time constraints did not permit group discussion, I answered as follows:  “First, I believe you’d be giving yourself a gift by honoring your colleague.  And second, if each person took up this challenge, while your colleague would no longer be physically present, his spirit would certainly walk the hospital halls.”  The energy rise in the room was palpable.

9.  Closing Review and Resources.  After thanking everyone for their attention and for the individual sharing, I briefly affirmed the depth of emotion that can be evoked by trauma and grief.  Also underscored was the importance, during such trying times, of having a personal and/or professional ear and shoulder to lean on; a “stress buddy,” as I like to call it.  Sometimes, after the shock wears off, the pain and confusion may warrant talking to a professional.  Again, I reminded people of the availability of the Employee Assistance Program for free time-limited stress and grief consultation or counseling.  And finally, the HR Director reminded people that I would be available for one-on-one meetings after the group session.

I hope this strategic content-process “step-by-step” yet fluid recipe for acute stress relief and grief counseling proves useful should your company or organization find itself in the throes of life-and-death trauma.  Unfortunately, such understanding and capacity for therapeutic response may be increasingly critical in a rapidly changing world that too often appears to be outpacing the human and organizational capacity to adequately adapt.  More than ever…Practice Safe Stress!
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Grief Ghosts:  A Viral or Vital Metamorphosis

And the Grief Ghosts will rise from the ashes
When one tries to bury the pain.
Feeding a fire that chokes dreams and desire
Oh when will your tears fall like rain?

Too late…look, soul-sucking phantoms
Spiral higher and higher, madly morph and conspire
As Trojan worms raiding while aerating your brain.

Wait…Perhaps there is still time to reach for the sublime:
Grieve, let go…and grow with the flow!

© Mark Gorkin  2012
Shrink Rap ™ Productions
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

As a Critical Incident Consultant, I’m poignantly aware how unexpected dramas and tragedies lurk behind every corner and crevice of our hearts and minds…and also lie in the shadows of our homes, schools, and places of work.  Out of the quiet, out of The Death of a Salesman closet, Arthur Miller screams:  Attention must be paid!  And sometimes we must risk trusting our gut, risk "overreacting" and being mislabeled, and say something to the right someone...or be the right someone!

Learning from the Fatal Flaw

Did she really take her life over a phone?
Taken from a colleague…now all’s undone!
One woman dead, one torn apart
Guilt spears a throbbing heart
Regret for filing that stolen report
Who is at fault?  Who is at fault?  Who is at fault?

Can one grasp obscure knowledge
On the all too human fatal edge?
To get on the same page, one must leave a stage
Masked by “got it together” pain and rage.
Even with the latest gauge, who knows faux-taupe from beige?
Who is a sage?  Who is a sage?  Who is a sage?

Yet a friend sensed her look, a fearful absent look.
Still her head stayed by the book...
Why didn’t she speak up?
Neither one trusted their gut
"Don’t be a pain in the butt!”
So we doubt?  So we doubt?  So we doubt?

Do we pass in the hall and nod
In a hazy-distant fog
And mouth, “How you doing?”…
But only reminiscing; more simply whistling
Who has time for real listening?
Do your thing?  Do your thing?  Do your thing?

Now so sad; maybe wiser: are we respecting one another?
Whatever happened to “sister” and “brother”?
Wide-eyed to foreign experience
Energized by expressive variance
Growing through world view contrariance.
Will you dance?  Will you dance?  Will you dance?

Is it too risky to share
Without some faith in the air?
Of course, you can’t flip a switch, still
Pull one from a ditch; let another bitch…
The sky’s not falling – more like a glitch.

For a culture to be rich, offer a broad-shouldered niche.

Hey, it’s "get real" or be a bust:
Now they might trust!  Now they might trust!  Now they might trust!

© Mark Gorkin  2014
Shrink Rap ™ Productions