MODULE ONE | Understanding and Coping with Traumatic Stress

PART TWO | Key Concepts Regarding Traumatic Stress

Stress can be defined as any demand or change that the human system (mind, body, spirit) is required to meet and respond to. Stress is therefore a part of normal life. Without challenges and physical demands, life would be boring. Stress, however, becomes distress (or traumatic stress) when it lasts too long, occurs too often, or is too severe. It is also important to note that what is distressful for one person may not necessarily be distressful for another. Your individual perception (how threatened you feel and how much control you have over the circumstances) can affect the degree of distress you personally feel. Traumatic stress can therefore be defined as the reaction to any challenge, demand, threat or change that exceeds our coping resources and results in distress.

There are three main types of traumatic stress to which humanitarian workers are exposed:

Critical incident stress or acute stress

Definition: These are two terms used to refer to trauma reactions that occur as the result of a traumatic event during which an individual is seriously threatened by harm or death. These types of events are often referred to as critical incidents and are unusual and intense. Examples of critical incidents that humanitarian workers may experience include being assaulted, being in situations where many people are dying, being within range of gunfire, or experiencing car accidents, bombings, kidnappings and carjackings.

Reactions: Experiencing acute stress reactions (also referred to as critical incident stress reactions) after a critical incident is a normal response to an abnormal situation. The traumatic event triggers an intense “fight or flight” response that results in a series of approximately 1500 biochemical reactions in the body. For example, sharp increases in the levels of stress chemicals such as adrenaline and cortisol lead to an increased heart rate and changes in blood flow as you prepare to deal with the threat.

Who is at risk? This type of traumatic stress tends to be more problematic for humanitarian workers who are posted outside the developed world. Research suggests that most workers “in the field” will experience at least one seriously disturbing or frightening incident during the course of their work. Approximately 25% of humanitarian workers in complex humanitarian emergency situations (e.g., working in countries such as Iraq, Afghanistan and the Democratic Republic of the Congo) can expect to undergo a life-threatening experience.

Vicarious trauma or secondary traumatization

Definition: These terms refer to stress and trauma reactions that can occur in response to witnessing or hearing about traumatic events that have
happened to others. In these cases, other people are the victims, and you see them undergoing suffering, or hear about traumatic events that have happened to them.

Reactions: Vicarious trauma can trigger many of the same reactions that occur when you personally face a critical incident. Signs and symptoms are similar, although usually less intense, than those triggered by direct exposure to traumatic events. However, in some cases the level of traumatization can be almost as great in secondary victims as in primary ones.

Who is at risk? It is now widely accepted that interaction with victims of traumatic exposure places helpers at high risk of experiencing some form of secondary traumatic stress response. Humanitarian workers in all roles regularly hear distressing stories, and face the realities of violence, poverty and disaster. Vicarious trauma is therefore inherent to humanitarian work and problematic for both field and home staff. The relevant issue becomes less about how to avoid vicarious trauma, and more about how to prepare for and deal with it.

Cumulative stress

Definition: Cumulative stress reactions are a less dramatic, more gradual form of stress reaction. They are usually related to low-intensity but more chronic stressors that pervade a person’s life and “pile up,” one on top of the other. Some common sources of chronic stress for humanitarian workers include:

  • A chaotic and reactive work environment
  • Feeling overwhelmed by unmet needs
  • Tight deadlines and stressed coworkers
  • Communication difficulties due to personality and cultural differences
  • Inadequate preparation and briefing
  • Being asked to complete tasks outside your area of training and competence
  • Facing moral and ethical dilemmas
  • Isolation from your familiar social support network
  • Chronic sleep deprivation
  • Travel difficulties and delays

Reactions: The negative effects of everyday stressors build up over time. Chronic stressors trigger enduring stress reactions that can grow in intensity and become problematic over time. The presence of multiple chronic stressors is often a better predictor of higher stress levels than the occurrence of the occasional critical incident. A sequence of relatively mild stressful events can ultimately create high stress levels if not
dealt with effectively on an ongoing basis.

Who is at risk? Nearly everyone experiences this type of stress reaction at some point during their lives. However, regardless of their particular role, most humanitarian workers are exposed to elevated levels of occupation-related chronic stressors. In addition to typical chronic stressors (such as traffic delays and job evaluations), humanitarian workers also face some of the chronic challenges that come with working in a crisis culture. How you manage to strike the right balance between the urgency of the work and other areas of life is the most relevant issue. Humanitarian workers who don’t take chronic stress seriously and proactively prepare to meet the challenges run a real risk of “burning out” within 3 to 5 years of high impact work.

All three types of traumatic stress can be problematic for humanitarian workers. However, research and anecdotal evidence suggests that chronic stress reactions, such as burnout, are likely to be problematic for the greatest number of humanitarian workers. Therefore, the remainder of this module focuses primarily on recognizing and managing cumulative and chronic stress reactions.

Case in point…

“The period before deployment was extremely stressful. There was so much to do and my experience made me feel inadequately prepared. My immediate medical chain of command seemed to offer little or no support or advice. In Kosovo I spent seven extremely demanding months. I felt completely responsible for ensuring that nothing would go wrong. I knew that I was pushing myself too hard and neglecting my own personal needs but I wasn’t able to let up.”

– Cheryl Netterfield on her experience as a medical officer deployed to Kosovo
(quoted in Danieli, 2002, p.50)

For personal reflection…

  • Which type of traumatic stress (acute, vicarious, or cumulative) is most problematic or troublesome for you?
© Headington Institute 2007