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Articles
Berk, Jay H. Trauma and resilience during war: A look
at the children and humanitarian aid workers of Bosnia. Psychoanalytic Review. 1998 Aug Vol
85(4) 639-65.
In the author's experience working with
Bosnian children, resilience in both the children and the humanitarian aid
workers helping them had aspects which appeared similar. Both groups required
support and a need to distance themselves from the
impact of the suffering.
Bramsen, I., Dirkzwager, M.A., % van der Ploeg (2000). Predeployment
personality traits and exposure to trauma as predictors of posttraumatic
symptoms: A prospective study of former peacekeepers. American Journal of Psyciatry,
157, 1115-1119.
In this study, predeployment personality traits and exposure to
traumatic events during deployment were related to the development of
symptoms of posttraumatic stress disorder in men who participated in the
United Nations Protection Force mission in the former Yugoslavia. Negativism and psychopathology as well as
exposure to traumatic events were found to be important predictors of
posttraumatic stress symptoms.
Bierens de Haan, Barthold (1998). Le debriefing emotionnel
collectif des intervenants
humanitaires: l'experience
du CICR [Emotional
group debriefing of humanitarian aid workers: the experience of ICRC]. Schweizer Archiv fur Neurologie und Psychiatrie, v.
149, no. 5, pp. 218-228.
Humanitarian aid workers working in armed
conflict and disaster situations are suffering from increasingly violent
emotional reactions. In order to help them to complete their job
successfully, to increase their resistance to stress and their efficiency in
the field, they must be supported. This paper reports on different
interventions from the ICRC Stress Management Unit. The principles of
emotional group debriefing are underlined. This procedure might be effective
because it is based on an encounter group whose healing capacity is well known.
A simplified four steps procedure is proposed to make the conduct of such
supportive groups easier. [A]
Britt TW, Adler AB. (1999). Stress and health during medical
humanitarian assistance missions. Military
Medicine, vol. 164 (4), 275-279
Team members deployed on a medical humanitarian assistance mission to Kazakstan were surveyed before and during their
deployment. They underestimated how much stress they would experience in
terms of isolation and inability to help the local population. They also used
less adaptive coping mechanisms than anticipated and showed elevations in
alcohol and cigarette consumption. Despite these negative experiences,
reports of depression and physical symptoms did not increase during the
deployment. Possible explanations are discussed. (M)
Danielli, Y. (1996). Who takes care of the caretakers: The
emotional consequences of working with children traumatized by war and
communal violence. In R.J. Apfel & B. Simon
(eds.), Minefields in their Hearts.
New Haven: Yale University Press, pp.
189-205.
Ditzler, T. (2001). Mental health and aid workers: The case
for collaborative questionnng. The Journal of Humanitarian Assistnace (http//:www.jha.ac/articles/a063.htm).
Suggests that humanitarian aid workers
and their supervisors can benefit from training to improve their skills in
identifying signs of excessive stress, developing preventive strategies, and
learning about resources to respond to stress. Suggests several approaches.
Eisenman, David P;
Bergner, Sharone; Cohen, Ilene (2000). An ideal victim: idealizing trauma
victims causes traumatic stress in human rights workers. Human Rights Review, v. 1 (4). 4, pp.
106-114.
The idealization of torture victims
leads to the collapse of the space necessary for self-reflection and self-care
on the part of the worker. Elevation of the survivor's needs and feelings
leaves insufficient room for the interviewer to recognize and to think about
the complex reactions and feelings sparked through the work. As a result,
selective features of the survivor's experience are focused upon and
emphasized, while other features, which contribute to the interviewer's less
visible feelings and reactions, are excluded. When such a situation develops
neither the survivor's nor the interviewer's experience is fully
acknowledged. [T, p. 106]
Eriksson, Cynthia B. (1997). Traumatic exposure and reentry symptomatology in international relief and development
personnel. Doctoral Dissertation: Fuller Theological Seminary, School of
Psychology, 1997
International relief and development
workers are often exposed to traumatic events which put them at risk for
developing PTSD symptomatology and emotional
distress during reentry to their home cultures. Surveys were administered to
returned staff from five Christian relief and development agencies. As
hypothesized, the amount of traumatic exposure reported correlated positively
with PTSD symptomatology, and a negative
correlation existed between perceived social support and report of PTSD symptomatology. A significant interaction existed between
social support and the level of trauma exposure in relation to PTSD symptoms.
Participants reporting high levels of trauma exposure and low levels of
social support reported higher PTSD symptomatology
than those reporting high levels of exposure and high levels of social
support. Returning to one's home culture after working or studying abroad is
a difficult cross-cultural adjustment. International relief and development
staff work in environments that require facing war, famine, poverty, and
disease. These workers are routinely exposed to chronic stressors which put
them at risk for developing emotional distress during reentry to their home
cultures. As hypothesized, relief and development staff with higher levels of
chronic stressor exposure reported higher levels of reentry distress
associated with culture shock and negative affective states. A significant
negative relationship also existed between perceived social support and
culture shock distress. Returned relief and development staff reported
significantly higher scores on measures of negative affective states for
their feelings during the "worst day of reentry," than for how they
"generally feel." Both quantitative and qualitative data offer a
number of important practical suggestions for the agencies that sponsor
relief and development work. The narrative data collected in the
questionnaire offers rich insight into the range of experiences faced by
international staff in their working environment. These staff offer suggestions
for providing future colleagues with a more successful reentry transition.
[A]
Eriksson, Cynthia B; Vande Kemp, Hendrika; Gorsuch, Richard; Hoke,
Stephen; Foy, David W. (2001). Trauma
exposure and PTSD symptoms in international relief and development personnel.
Journal of Traumatic Stress, v. 14,
no. 1, pp. 205-212.
International relief and development
personnel may be directly or indirectly exposed to traumatic events that put
them at risk for developing symptoms of PTSD. In order to identify areas of risk
and related reactions, surveys were administered to 113 recently returned
staff from 5 humanitarian aid agencies. Respondents reported high rates of
direct and indirect exposure to life-threatening events. Approximately 30
percent of those surveyed reported significant symptoms of PTSD. Multiple
regression analysis revealed that personal and vicarious exposure to
life-threatening events and an interaction between social support and
exposure to life threat accounted for a significant amount of variance in
PTSD severity. These results suggest the need for personnel programs; predeployment training, risk assessment, and contingency
planning may better prepare personnel for service. [A]
Fawcett, J. (2000). Managing staff stress and trauma. In
M. Janz & J. Stead (eds.), Complex Humanitarian Emergencies: Lessons from Practitioners.
Monrovia, CA: World Vision , pp. 92-125. (ISBN No. 188798318).
Feinstein, A., Owen, J., & Blair,
N. (2002). A hazardous profession: War, journalists, and psychopathology. American Journal of Psychiatry, 159,
1570-1575.
The authors studied 140 war
journalists, comparing them to journalists who had never covered war. The war
journalists showed significantly elevated levels of PTSD, depression, and
substance abuse.
Holtz, T.H., Salama,
P., Cardozo, B.L., & Gotway,
C.A. (2002). Mental health status of
human rights workers, Kosovo, June 20900. Journal
of Traumatic Stress, 15, 389-395.
This paper reports on a
cross-sectional survey of 70 expatriate and Kosovar
Albanian staff engaged in collecting data of human rights violations in
Kosovo. Factors associated with elevated PTSD symptoms, depression, and
anxiety are reported.
Kilbourn, Phyllis Ann
(1995). Providing care for the
caregivers. In Kilbourn, Phyllis Ann (ed.). Healing the children of war: a handbook
for ministry to children who have suffered deep traumas, pp. 225-237.
Monrovia, California
Dealing with children's war-related
crises can be a very stressful experience. The more traumatic the event, the
more potential there is for caregivers to become traumatized. This chapter
explores some trauma-producing stress factors caregivers encounter and
describes some normal responses to these stress factors. Understanding the
stress factors and the caregivers' possible responses can provide helpful
insights into their needs. Iincluds key elements
and principles to assist in planning care for the caregiver [T, p. 226]
Kramer, Gabriele (1999). Traumatized women working with
traumatized women: reflections upon life and work in a war zone. Women and Therapy v. 22, no. 1, pp. 107-120.
In this article, the author shares
both her personal and professional experiences in working with women and
children who have been subjected to soul-destroying violence in the Former
Yugoslavia in recent years. [A]
McCall, M., & Salama, P. (1999). Selection,
training, and support of relief workers: an occupational health issue. British Medical Journal, 318:113-116.
Reports on a survey of humanitarian aid
organizations. Findings: Although emergency relief workers are at
considerable physical and psychological risk, their mental health has been
studied little. Procedures for recruitment, selection, training, field
support, and follow up of relief workers vary widely. Preventive mental
health measures for relief workers receive little attention . Discounting the
effects of psychological trauma on workers reflects disregard for their
wellbeing and that of the populations they seek to serve. Relief
organizations should develop a coordinated and cooperative approach to
training and managing field workers. [A]
Orsillo, Susan Marie;
Roemer, Lizabeth; Litz,
Brett T; Ehlich, Peter J; Friedman, Matthew J.
(1998). Psychiatric symptomatology associated with contemporary peacekeeping:
an examination of post-mission functioning among peacekeepers in Somalia. Journal of Traumatic Stress, v. 11,
no. 4, pp. 611-625
Paton, Douglas
(1996). Responding to international
needs: Critical occupations as disaster relief agencies. In Paton, Douglas (Ed); Violanti,
John M. (Ed). Traumatic stress in
critical occupations: Recognition, consequences and treatment. (pp.
139-172). Springfield, US, US: Charles C Thomas, Publisher; Springfield, US
This book chapter focuses on specific
problems posed by international disasters for relief workers and their
organizations. It discusses the preparatory and support needs of those who
will provide relief services, consequences of disaster work for the families
of relief workers, and organizational and management issues.
Pickett, Mary; Brennan, Ann Marie
Walsh; Greenberg, Helaine S; Licht,
Lois; Worrell, Judith Deignan. (1994). Use of debriefing techniques to prevent
compassion fatigue in research teams Nursing
Research, v. 43, no. 4, pp. 250-252.
Nurses often study subjects who have
experienced traumatic events involving intense and emotionally charged
consequences. This paper describes how the process of crisis debriefing can
be used to mitigate the concerns of interviewers who collect data from such
subjects. Some clinical practice settings, such as emergency, trauma,
intensive care, and home hospice settings, provide debriefing sessions that
incorporate some of the elements directed toward the prevention of secondary
PTSD. However, debriefing sessions designed specifically for research team
members who interview traumatized persons have not been reported in the
literature. [T, p 250]
Simon, Bennett (1993). Obstacles in the path of mental health
professionals who deal with traumatic violations of human rights. International Journal of Law and
Psychiatry, v. 16, no. 3-4, pp. 427-440.
The first part of this paper deals
with obstacles in the path of mental health professionals becoming more
involved in issues of human rights violations. The second part deals with a
few of the increasing number of instances in which mental health
professionals have become more involved. The discussion centers around issues
involving children, although most of what is said applies to both children
and adults. In referring to "human rights" violations, the
boundaries between the devastation of large scale wars between nations and
within nations (such as the Holocaust and the Cambodian genocide) and the
harm done in more narrowly defined "human rights" violations (such
as the arrest, torture, and often "disappearance" of thousands in
Argentina and Chile) are not exactly clear. For our purposes, the rough
working definition of human rights violations includes the devastation
wrought by plans to persecute and destroy individuals, classes. [T, p. 427]
Smith, Barbara; Agger,
Inger; Danieli, Yael; Weisaeth, Lars.(1996). Health activities across traumatized
populations: emotional responses of international humanitarian aid workers:
the contribution of non-governmental organizations. In Danieli, Yael; Rodley, Nigel S; Weisaeth, Lars
(ed.). International responses to
traumatic stress: humanitarian, human rights, justice, peace and development
contributions, collaborative actions and future initiatives, pp. 397-423.
Amityville, New York: Baywood.
Topics treated include: common
emotional reactions; Goma, Zaire 1994; Sarajevo,
Bosnia-Herzegovina, 1992- ; the traumatic effects; development of PTSD and
burn-out in an international humanitarian aid worker; stress (countertransference) reaction in helpers; enmeshment;
hostility and cynicism; self-destructive behavior; dissociative
responses; psychological support for aid workers; institutional factors (how
do humanitarian organizations support the professional efforts of aid
workers?; how do humanitarian organizations respond to aid workers' proposals
for innovation?; how do humanitarian organizations support aid workers'
collaboration with other organizations?; how do humanitarian organizations
meet aid workers' needs for emotional support?); employer responsibilities;
conclusion
Smith, Alison (2000). Lessons
from Western Kosovo for the documentation of war crimes. Psychiatry, Psychology & Law. Vol 7(2) 235-240.
Based upon experiences of the International
Crisis Group's Humanitarian Law Documentation Project in Western Kosovo, the
author advances a series of recommendations for effective intervention by aid
workers in areas where considerable trauma has been inflicted on civilians.
In particular, she argues that in documenting war crimes, the primary
responsibility of the interviewer is to the well-being of the witness. This
includes not only emergency survival needs such as adequate shelter, food and
clothing; it also means taking care of their mental health needs. This should
be done by training interviewers in recognizing symptoms of mental disorders
and providing immediate assistance for those who need it as well as ensuring
that there are facilities available in the longer term to address the
inevitable consequences of mass violence. In order to provide this type of
assistance, the mental health needs of humanitarian workers themselves must
also be addressed. There must be adequate facilities staffed by experienced
people to help both local and international workers deal with the type of
work they are doing, In both of these situations, the persons providing
training and treatment must themselves be trained in post-conflict situations
and issues arising as a result of mass trauma. (Author’s Abstract)
Spiers, Carole
(1997). Counselling and crisis intervention training for
humanitarian aid workers. International
Journal of Stress Management. Vol 4(4)
309-313. The author describes personal experiences training humanitarian aid workers in Serbia.
Specifically, the training involved a practical application of counseling
skills via role play, emphasizing crisis, trauma, and posttraumatic stress.
The author notes that in particular, the trainees needed additional skills to
help them deal with the multifarious problems presented by clients, most of
whom experienced the effects of war. Problems that exasperated posttraumatic
stress disorder (PTSD) included nightmares, panic attacks, problems of
separation, bereavement, identity crisis, re-settlement, rape, and murder.
[P]
Stearns, S.D. (1992). Psychological distress and relief work:
Who helps the helpers? Oxford: Refugees Studies Programme,
University of Oxford.
Stearns, Sarah D (1993). Psychological distress and relief work:
who helps the helpers? Refugee
Participation Network, v. 15, pp. 3-8
Much attention has been devoted to the
negative psychological effects of violence, war, famine and torture on
refugees. Less literature exists however, on the psychological difficulties
encountered by relief workers, reflecting a lack of awareness on the part of
institutions that trauma encountered by relief workers does not rank high on
the list of priorities in emergencies. When situations are extreme and
personnel is in short supply, there is little time to concentrate on workers
and their troubles. It is of course possible, as some have asserted, that
relief agencies are fully aware of the effects of psychological trauma on
their personnel, but refuse to recognize openly the fact lest they become
targets for disability claims. It is, however, important to recognize that in
many instances the problems relief workers encounter can limit the
effectiveness of humanitarian assistance. The psychological difficulties
helpers face may shape interactions between them and the people they endeavor
to assist. Models from disaster relief literature may be used to explore
methods for countering stressful or traumatic events. [T, p 13]
Zimmerman, George; Weber, Wesley
(September 2000).Care for the
caregivers: a program for Canadian military chaplains after serving in NATO
and United Nations peacekeeping missions in the 1990s. Military Medicine, v. 165, no. 9, pp.
687-690.
The Mental Health Department of the
Canadian Forces Support Unit (Ottawa) developed the Care for the Caregivers
program to help participants deal with stressful events experienced directly
or vicariously from the NATO and United Nations military missions of the
1990s. The program was developed after complaints of postdeployment
stress were received from various military care providers. The objectives
were to improve the skills of support personnel and to reduce the distress
that some caregivers experienced. 31 chaplains who had been exposed to
stressful military operations participated in five workshops. These
educational 4-day small-group workshops covered topics such as PTSD,
vicarious traumatization, coping techniques, spirituality, self-care, and
family issues. An adult education model was chosen to encourage dialogue.
Outcomes included reports of professional and personal benefits, requests for
additional programs, local education initiatives, and referrals to mental
health professionals. Having met its objectives, the program has become a
normal concluding part of stressful deployments. [A]
II.
Resources on Burnout and Vicarious Traumatic
Stress Among First
Responders, Rescue and Relief Workers,
and Emergency Medical Workers
Books
Paton, D., & Violanti, J. (1996). Traumatic
stress in critical occupations: Recognition, consequences, and treatment. Springfield, IL: Charles C. Thomas. ISBN
No.0398065780.
Focuses primarily on first responders
(police officers, firefighters, emergency medical service professionals).
Discusses strategies designed to promote the recognition and identification
of the diverse personal, organizational, and event-related factors that
contribute to traumatic reactivity are discussed.
Articles
Alexander, David Alan; Klein, Susan.
(2001). Ambulance personnel and
critical incidents: impact of accident and emergency work on mental health
and emotional well-being. British
Journal of Psychiatry, v. 178, pp. 76-81.
Seeks to identify the prevalence of
psychopathology among ambulance personnel and its relationship to personality
and exposure to critical incidents. Data were gathered from ambulance
personnel by means of an anonymous questionnaire and standardised
measures. Approximately a third of the sample reported high levels of general
psychopathology, burnout and posttraumatic symptoms. Burnout was associated
with less job satisfaction, longer time in service, less recovery time
between incidents, and more frequent exposure to incidents. Burnout and
GHQ-28 caseness were more likely in those who had
experienced a particularly disturbing incident in the previous 6 months.
Concerns about confidentiality and career prospects deter staff from seeking
personal help. Concludes that the mental health and emotional well-being of
ambulance personnel appear to be compromised by accident and emergency work.
[A]
Andersen, Henrik
Steen; Christensen, Anders Korsgaard; Petersen, Gorm Odden (1991). Post-traumatic stress reactions amongst
rescue workers after a major rail accident. Anxiety Research, v. 4 no. 3, pp. 245-251
Rescue tasks under heavy strain may
act as traumatic events creating stress reactions among the rescue workers.
After a major rail accident the rescue workers were examined by questionnaire
at 3 and 7 months postaccident using the General
Health Questionnaire-28 (GHQ), Impact of Event Scale (IES) and a structured
questionnaire made for the purpose. 18 percent of the 77 rescue workers who
participated in the study had GHQ-case-score and 10 percent had
IES-case-score at 7 months using the usual GHQ-cut-off (4/5) and a low
IES-cut-off (19/20). For the case-scorers there was a tendency towards
increased GHQ- and IES-scores from 3 to 7 months. 5 (6 percent) had PTSD of
low to moderate severity at 7 months. [A]
Armstrong, Keith R; O'Callahan, William; Marmar, Charles
R. (October 1991). Debriefing Red
Cross disaster personnel: the multiple stressor debriefing model. Journal of Traumatic Stress, v. 4, no.
4, pp. 581-593.
During the 1989 San Francisco earthquake,
Red Cross disaster personnel were involved in providing services which put
them at risk for developing stress reactions including PTSD. This article
describes the disaster relief efforts in San Francisco and Oakland made by
Red Cross workers and the debriefing which was provided to these personnel.
Mitchell's Model for Critical Incident Stress Debriefing (CISD) was modified
to fit the broad spectrum of needs and stresses experienced by disaster
relief personnel. The Multiple Stressor Debriefing Model (MSDM) which evolved
from this experience is discussed with specific recommendations for mental
health workers involved in Debriefing Red Cross and other emergency personnel
who face multiple stressors over an extended period of relief operations [A]
Badger, James M (2001). Understanding secondary traumatic stress.
American Journal of Nursing v. 101, no. 7, pp. 26-33
Military combat is not the only
trigger of posttraumatic stress. To the nurse, a burn unit, emergency
department, or neonatal intensive care unit can be a 'war zone.' Suggests
ways of handling the extraordinary, as well as the ordinary, stresses of
nursing. [T, Introduction]
Bamber, Martin
(1994). Providing support for
emergency service staff. Nursing
Times , v. 90 no. 22, pp. 32-33.
This paper provides a comprehensive
review of the literature focusing on PTSD related to the experience of
involvement in major incidents. The structure, role and function of the staff
support team set up by the South Tees Occupational Health Psychology Service
is described. [A]
Bradford R, John AM. (1991). The psychological effects of disaster
work: implications for disaster planning. Journal of the Royal Society of Health, vol. 111(3), 7-10
The paper focuses on the issue of identifying staff who may be more
vulnerable to psychological distress and the need for services to plan
psychological screening and support for staff who will be exposed to the
trauma of dealing with the aftermath of disasters. Specifically, attention
should be paid to staff selection, training, use of resources, supervision,
debriefing, counseling and feedback [A]
Brandt, George T.; Fullerton, Carol
S.; Saltzgaber, Lee; Ursano,
Robert J.; et al (1995). Disasters: Psychologic
responses in health care providers and rescue workers. Nordic Journal of Psychiatry. Vol 49(2) 89-94.
Reports and questionnaire responses
from health care and rescue workers involved in an air show disaster in Germany were studied.
There were three characteristic responses to worker stress: identification, a
sense of helplessness and inadequacy, and psychological distancing. Exposure
to the grotesque, identifying with the rescue work, feelings of helplessness
and guilt, and psychological distancing were particularly
stressful, as was not participating
in relief efforts.
Brown, Jennifer M; Campbell, Elizabeth
A. (1991). Stress among emergency services personnel: progress and problems.
Journal of the Society of Occupational
Medicine (ISSN: 0301-0023), v. 41, no. 4, pp. 149-150.
PTSD has been diagnosed in British
emergency health professionals. This article examines some of the ways that
management and organizational failures contribute to this stress and how it
might be prevented
Brende, Joel Osler (1991). When
post traumatic stress "rubs off". Voices, v. 27, no. 1-2, pp. 139-143.
Briefly outlines a 12-point outpatient
program which initially developed in response to the needs of staff members
of a Veterans Administration hospital who were suffering from various PTSD
symptoms that their patients exhibited. Concludes that, "those of us who
do this kind of work need to recognize that this is a widespread problem that
we need not be ashamed of."
D'Andrea, Livia M; Waters, Charley (Winter 2000). Predicting post-incident stress in emergency
personnel: a guide for mental health professionals on critical incident
stress management teams. International
Journal of Emergency Mental Health, v. 2, no. 1, pp. 33-41.
The role of the Mental Health
Professional (MHP) on Critical Incident Stress Management (CISM) teams has
been described as one of assess and refer. That is, to assess participants
who are reacting strongly to a critical incident and refer them for
additional psychological help. The purpose of this article is to present
guidelines |