Managing cumulative trauma and stress: 7 signs to watch out for

This blog was written by Fiona Dunkley. The opinions expressed in this blog belong to the author and do not reflect the opinions of the European Interagency Security Forum (EISF) or any employee thereof.

Fiona is a senior accredited BACP psychotherapist, supervisor and trainer. She currently works part-time for InterHealth Worldwide supporting over 500 NGOs, missions and government organisations. She also has a private consultancy business. Fiona previously worked for the British National Health Service (NHS) within forensic sexual assault, often working with global human trafficking cases. At Transport for London, she was the Lead Therapist for the Trauma Service and was involved in researching the psychosocial impact on staff after the 7/7 bombings in London. In her consultancy work, she supports various NGOs and many emergency first responders including the British police and The London Fire Brigade. www.fionadunkley.com

‘I find ways around security, otherwise, I couldn’t do my job properly.’ (Laura*, humanitarian aid worker)

The above sentence rang alarm bells when I first heard it. Given my background as a psychotherapist, I knew this was someone who was clearly showing signs of cumulative trauma and stress and was not only finding it difficult to make good decisions but was really struggling to cope.

I have heard many similar individuals’ stories about their experiences in the aftermath of a security incident whilst researching a book I am in the process of writing on trauma and psychosocial support for humanitarian aid workers.

I met with Laura after she had just returned from a deployment to Afghanistan working in an orphanage. She found it hard to sit still in her chair, fidgeting constantly and looking down to the floor. She looked broken, fragile and exhausted. Laura had worked for two large NGOs over a period of 14 years and would describe herself as a ‘hardened aid worker’. Her unbroken chain of deployments took her from Sierra Leone to Somalia, CAR, South Sudan and most recently Afghanistan.

She spoke in a monotone voice about several security incidents she had experienced, which included being kidnapped for 24 hours, held at gunpoint, mugged, sexually harassed and receiving death threats, to name a few.

I looked at her pale face and glimpsed so much hidden pain in those short moments of eye contact. Laura was on a self-destruct mission, whether consciously or not, and it was going to take some effort from me to help her.

After a great deal of frank conversation, Laura finally acknowledged that she had reached her breaking point. My recommendations to Laura’s organisation included: not to deploy her to any high-risk environments for a period of time and six sessions of trauma specialist counselling.

What can NGO security personnel, colleagues or management look out for in cases like Laura’s to support individuals and prevent them from reaching breaking point?

7 signs to look out for:

• Risk behaviour: Laura’s statement, ‘I would find ways around security to do my job properly’, was a clear sign of someone who was struggling to make sound decisions and this was resulting in unreasonable risk-taking behaviour. These risk behaviours can include substance misuse, overstepping security protocols or being sexually promiscuous.
• Desensitisation: Laura spoke in a monotone voice when describing traumatic events. This can be a sign of someone normalising high-risk events and becoming desensitised. This puts an individual at risk because they will have a slower response and reaction to security incidents.
• Breakdown of communication: Unresolved cumulative trauma may result in systemic trauma (Tehrani 2010) that permeates teams and organisations. A clear sign of systemic trauma is when communication breaks down in teams. This is often evident when there is a culture of grievances, harassments and bullying, causing unsupportive communication and resulting in a potential hazard for security.
• Anger: Support the angry individual. I know this sounds like quite a challenge but often, the angriest person is the most frightened. For someone to be angry, the individual must feel threatened. This results in a reactive and primal manner of communication, predominantly activated by the survival part of the brain, or as Steve Peters would describe our ‘Chimp’. Empathise and listen to understand what the anger is about; this understanding will help de-escalate the situation.
• Adrenalin rush: Monitor whether someone is overworking to the point of feeling overwhelmed; as if on the ‘adrenalin train’, that they cannot stop. ‘If I stop, everything will fall apart, I’ll be letting everyone down.’ This behaviour becomes heightened when someone is managing a critical incident. I recall an emergency worker, based in Nepal after the earthquake, telling me he had worked a 72-hour shift with no sleep. When his manager told him he had to take a break, he became angry. It was not until he returned to his hotel room that he collapsed in an emotional heap and realised how desperately he had needed to stop working. Sometimes individuals prefer to keep going to avoid stopping and feeling the emotional impact of their work.
• Reduced memory and concentration: Watch out for someone who is struggling to remember information or instructions. The memory circuits of the brain start to malfunction when we are stressed or traumatised. Generally, individuals become more reactive, irritable, feel on edge and emotional.
• Survival response: Look out for behaviours that represent the fight, flight, freeze response (Van De Kolk 2014), such as aggressive behaviour, someone withdrawing socially or becoming frozen and unable to make decisions.

James* was suffering from trauma symptoms after being trapped in Istanbul during the failed violent coup-d’état. His organisation referred him for a psychological review appointment.

‘The offer of support was immediate following my raising the incident – the global security adviser recognised immediately that I needed psychological support. I cannot be sure that others would have recognised it or that offering psychological support following these incidents is standard practice or not.’

If someone is at risk of becoming unwell psychologically, do not ignore the signs.

The sooner someone gets the support they need, the sooner they will recover. Many individuals say they should have noticed how much they were struggling. Often it takes someone working closely with the affected individual to point out that they may need specialist support. It is actually hard for someone to see the signs in themselves.

When Laura completed her six sessions of trauma specialist counselling she felt more robust and resilient. She was able to set clear boundaries and make informed decisions about which deployments she took on, her work/life balance became more manageable, and she no longer experienced trauma symptoms.

Due to hearing so many stories like Laura’s and James’, I am in the process of writing a book on trauma and psychosocial support for humanitarian aid workers. This book will focus on best practices and guidance for organisations on how to provide or enable provision of psychosocial support to their staff. It will inform the reader of different trauma treatments and what signs and symptoms to look out for so individuals can support each other.

The book will also cover aid workers’ personal stories and experiences, so they are heard and taken seriously when considering good psychosocial support in the humanitarian aid profession. This book aims to highlight the risks and perils of such work, educate professionals responsible for the duty of care of staff, and bring together current thinking to promote collaborative working to support the carers of our world. The aim is to encourage aid workers to feel supported and stay as resilient as possible so they can continue to do this highly emotive and worthwhile work.

If you feel you would like to contribute in any way to this book or if you are willing to complete the attached questionnaire, then I would love to hear from you. The comments on the questionnaire will remain anonymous unless you state otherwise. I am interested in hearing your experiences of when you needed psychosocial support and whether the services you were offered were helpful or inadequate.

I look forward to hearing from you further.

NB: ^*Names have been changed to protect individuals’ identities.

References and Further Reading

Tehrani, N. 2010. Managing Trauma in the Workplace: Supporting Workers and Organisations. Taylor & Francis Ltd, UK.

Peters, S. 2012. The chimp paradox. The mind management programme for confidence, success and happiness. CPI Group, UK.

Van De Kolk, B. (2014). The body keeps the score: Mind, Brain and Body in the Transformation of Trauma. Penguin Group, UK.

InterHealth Worldwide – information sheets:

• Responding in a Crisis
• Resilience: Stress and burnout

https://www.interhealthworldwide.org/home/health-resources/health-information-a-z/?filter=R&page=0

InterHealth Worldwide – further training:

• Psychological First Aid
• Surviving Sexual Violence

https://www.interhealthworldwide.org/home/training-events/

Specialist trauma counselling – http://emdrassociation.org.uk/

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