Incident stress

For or other kinds of stress, see Stress.

Incident stress is a condition caused by acute stress which overwhelms a staff person trained to deal with critical incidents such as within the line of duty for first responders, EMTs, and other similar personnel. If not recognized and treated at onset, incident stress can lead to more serious effects of posttraumatic stress disorder.

Signs and symptoms

Symptomatology

Symptomatology associated with excessive acute or sustained stress may include cognitive impairments such as diminished memory, decision-making capacity, and attention span; emotional reactions such as anger, irritability, guilt, fear, paranoia, and depression; and physical problems ranging from fatigue, dizziness, migraine headaches, and high blood pressure to diabetes and cancer. Self-destructive and antisocial behavior may also be triggered.[1] Symptoms can vary depending on social factors, such as trauma severity, amount of social support, and additional life stresses.[2]

Causes

A critical incident that occurs to an individual is the starting point for incident stress if the individual is unable to cope. Critical incidents are defined as sudden, unexpected events that have an emotional impact sufficient to overwhelm the usually effective coping skills of an individual and cause significant psychological damage.[2]

Healthy attachment among adults is key to managing critical incident stress. Adults have four attachment styles: 1) fearful avoidant, 2) anxious-preoccupied, 3) dismissive avoidant, and 4) secure. Fearful avoidant adults have mixed feelings about close relationships, because they want emotional connections but are very reluctant to allow them. Anxious-preoccupied adults tend to deal with their stress by distancing themselves from the reality of the situation to avoid the emotional burden. They also tend to see themselves negatively and doubt their worth in relationships frequently. Dismissive avoidant adults view themselves as self-sufficient, and in no need of emotional connectedness. Secure adults have positive views about themselves, and feel comfortable with independence and intimacy. Secure adults typically cope better with critical incident stress, as opposed to non-secure adults, because they develop less stress by nature. Secure adults are also less likely to develop post traumatic stress disorder (PTSD).[3]

People exhibiting signs of incident stress require professional help to avoid the more serious condition of posttraumatic stress disorder.[4] The DSM IV-TR describes posttraumatic stress disorder (PTSD) as having three distinct symptom clusters: 1) re-experiencing the event, 2) avoidance of stimuli associated with the event and numbing of general responsiveness, and 3) increased arousal. The first symptom cluster, re-experiencing the event, is a mixture of physical and psychological reactions someone goes through after the critical event has occurred. Those includes nightmares, reoccurring thoughts/flashbacks, or panic attacks. The second symptom cluster, avoidance of stimuli associated with the event and numbing of general responsiveness, occurs when someone avoids anything that could possibly trigger memories of the critical event. This includes thoughts and feelings associated with the event, and even physical stimuli such as people and places having to do with the event. The third symptom cluster, increased arousal, produces anxiety-driven responses, such as trouble sleeping, excessive anger and irritability, hypervigilance, poor concentration, and exaggerated startle response. When these symptoms persist for more than 2 weeks, a diagnosis of acute stress disorder may be appropriate.[3] Factors, such as family psychiatric history, or childhood abuse may mediate the relationship between critical incidents and PTSD.[2]

Management

Critical incident-stress debriefings (CISDs) have proven to be a successful coping method over the past 15 years for individuals in high-stress, emergency response professions.[5] Nearly 300 CISD teams exist in the United States, offering intervention to fire, paramedic, police, and other emergency personnel. These debriefings are designed to offer emotional reassurance, time for ventilation of feelings, education about stress management, and consultation.[1] This technique was first implemented by Dr. Jeff Mitchell, of the International Critical Incident Stress Foundation, in 1983 to treat emergency care workers in the mental health profession. These debriefings were created to prevent worsening of the stress and also promote recovery. Judith Herman, author of Trauma & Recovery, identified three critical conditions that must be satsfied in order to progress toward recovery: 1) safety, 2) remembrance and mourning, and 3) reconnection. Safety is achieved when victims learn to feel relaxed and trust in the recovery process by recognizing there are disturbed emotions. "Remembrance and mourning" of the critical incident is necessary in order for the victim to move toward recovery. "Reconnection" occurs when the victim feels they are emotionally stable enough to pursue stress management and recovery.[6]

Problem solving appraisals were tested as another possible method for coping with critical incident stress. The first successful testing of this technique was done by Dr. Sarah Baker and Dr. Karen Williams in the United Kingdom, using a testing group of stressed firefighters. These firefighters filled out anonymous self-report questionnaires that gauged their level of stress. The research results supported the hypothesis that problem solving appraisals serve a moderating function between work stress and psychological distress.[7]

See also

References

  1. 1 2 Spitzer, W.J., & Burke, L. (1993). "A critical-incident stress debriefing program for hospital-based health care personnel". Health & Social Work. 18 (2): 149–156. doi:10.1093/hsw/18.2.149. PMID 8288143.
  2. 1 2 3 De Boer, Jacoba; et al. (2011). "Work-related critical incidents in hospital-based health care providers and the risk of post-traumatic stress symptoms, anxiety, and depression: A meta-analysis" (PDF). Social Science & Medicine: 316–326. doi:10.1016/j.socscimed.2011.05.009. PMID 21696873.
  3. 1 2 Bogaerts, Stefan & Daalder, Annelies L. & Van der Knaap, Leontien M. & Kunst, Martin J. & Buschman, Jos. (2008). "Critical incident, adult attachment style, and posttraumatic stress disorder: A comparison of three groups of security workers". Social behavior and personality. 36 (8): 1063–1072. doi:10.2224/sbp.2008.36.8.1063.
  4. ↑ First Aid/CPR/AED for the Workplace. Yardley, PA: StayWell. 2006. p. 63.
  5. ↑ Van Patten, Isaac T. & Burke, Tod W. (2001). "Critical incident stress and the child homicide investigator". Homicide Studies. 5 (2): 131–152. doi:10.1177/1088767901005002003.
  6. ↑ Rich, Robert (2007). "A synergistic approach". In Volkman, Victor R. Traumatic Incident Reduction and Critical Incident Stress Management. Library of Congress Cataloging. pp. 1–139.
  7. ↑ Baker, Sarah R. & Williams, Karen (2001). "Short communication: Relation between social problem-solving appraisals, work stress and psychological distress in male firefighters". Stress and health. 17 (4): 219–229. doi:10.1002/smi.901.
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