Understanding Stress, Trauma, and Resilience in the Workforce

 
Stress, Trauma, and Resilience:
A Focus on the Workforce
 
Nima Sheth MD, MPH
Senior Medical Advisor, CMHS
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
 
CMHS
August 18th, 2021
 
2
 
A Moment to Arrive…
 
An adaptive response to an environmental stimulus that
enhances survival, development and function
Not just an emergency response but an ongoing process of
adaptation
Mild stress improves performance=beneficial
Higher stress impedes performance
Severe stress can be toxic (can cause fear conditioning)
 
Good Stress~Bad Stress
 
3
 
Stress and Stress Response
 
Slide from Akil, 2021
 
W
e
 
a
r
e
 
a
l
l
 
F
r
a
g
i
l
e
 
a
n
d
 
R
e
s
i
l
i
e
n
t
 
4
 
Slide from Akil, 2021
 
5
 
Stress Injury Basics
 
6
The Stress Continuum Model
 
Feelings of helplessness/sense of control
Intimacy
Self esteem
Safety
Trust
*Historical/Intergenerational Trauma
 
(Resick et al, 2017)
 
7
 
Core Areas Impacted by Trauma
 
 
8
 
Stress/Trauma in Providers
Sources &
Signs of Stress
Anxiety
about your or
your loved
one’s health
Confidence
Level Drops
Guilt
from fear of
illness, not doing
more, not
wanting to work;
lack of empathy
Helplessness
loss of control;
reduced
functioning
Stigma & Lack
of Resources
Anger
about the
possibility of
being put in
danger
Grief
over multiple
losses
Demoralization
 
Adapted from:
https://www.thesch
wartzcenter.org/me
dia/Schwartz-
Center-Watson-SFA-
Final-PDF.pdf
 
Acting or
witnessing
behaviors
that go
against our
values and
moral beliefs
We may
perpetrate,
fail to
prevent, or
witness
events that
contradict
moral beliefs
Betrayal from
leadership,
others in
power or
peers
MORAL INJURY
Life and
death triage
or resource
decisions
 
Under
different
circumstance
s, a person’s
life may have
been saved
Work duties
affecting
one’s family
Not being
able to save
a particular
patient
 
May Affect
Spirituality
 
Not
wanting to
work
 
Survivor
Guilt
 
Compassio
n Fatigue
 
Feeling
Powerless
 
 
Guilt,
shame,
disgust and
anger
 
11
 
Resilience:
Multiple Interacting Systems
 
From molecules to culture
 
Slide from Akil, 2021
 
The ability to “bend but not break”
 
Is it a trait? A process? An outcome? Does it
cross domains? Is it static or dynamic?
The capacity of a dynamic system to adapt
successfully to disturbances that threaten the
viability, function or development of that system
(Masten et al 2014)
 
12
 
What Is Resilience
 
Slide from Akil, 2021
 
13
 
Resilience
 
Slide from Akil, 2021
 
14
 
Vicarious Trauma
 
15
 
 
• Emotional lability/ numbness
• Feelings of isolation, demoralization, or apathy
• Difficulty sleeping
• Somatic symptoms
• Irritability/ aggressive behaviors
• Conflict with loved ones
• Trauma symptoms (hypervigilance, avoidance,
destructive behaviors)
 
16
 
Vicarious Trauma
 
17
 
Questions/Comments
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This presentation delves into stress, trauma, and resilience in the workforce, highlighting the impact on individuals' mental health and well-being. It discusses the adaptive nature of stress responses, the effects of trauma on core areas such as self-esteem and trust, and the challenges faced by providers dealing with guilt, grief, anxiety, and helplessness. The content emphasizes the importance of recognizing signs of stress, addressing stigma, and coping with moral conflicts in professional settings.


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  1. Stress, Trauma, and Resilience: A Focus on the Workforce Nima Sheth MD, MPH Senior Medical Advisor, CMHS Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services CMHS August 18th, 2021

  2. A Moment to Arrive 2

  3. Stress and Stress Response An adaptive response to an environmental stimulus that enhances survival, development and function Not just an emergency response but an ongoing process of adaptation Mild stress improves performance=beneficial Higher stress impedes performance Severe stress can be toxic (can cause fear conditioning) Good Stress~Bad Stress 3 Slide from Akil, 2021

  4. We are all Fragile and Resilient 4 Slide from Akil, 2021

  5. Stress Injury Basics 5

  6. The Stress Continuum Model 6

  7. Core Areas Impacted by Trauma Feelings of helplessness/sense of control Intimacy Self esteem Safety Trust *Historical/Intergenerational Trauma (Resick et al, 2017) 7

  8. Stress/Trauma in Providers 8

  9. Guilt from fear of illness, not doing more, not wanting to work; lack of empathy Grief over multiple losses Anxiety about your or your loved one s health Helplessness loss of control; reduced functioning Sources & Signs of Stress Confidence Level Drops Anger about the possibility of being put in danger Adapted from: https://www.thesch wartzcenter.org/me dia/Schwartz- Center-Watson-SFA- Final-PDF.pdf Stigma & Lack of Resources Demoralization

  10. We may perpetrate, fail to prevent, or witness events that contradict moral beliefs Acting or witnessing behaviors that go against our values and moral beliefs Under different circumstance s, a person s life may have been saved Life and death triage or resource decisions Betrayal from leadership, others in power or peers Not being able to save a particular patient Work duties affecting one s family MORAL INJURY Guilt, shame, disgust and anger Survivor Guilt Not Feeling Powerless Compassio n Fatigue May Affect Spirituality wanting to work

  11. Resilience: Multiple Interacting Systems From molecules to culture 11 Slide from Akil, 2021

  12. What Is Resilience The ability to bend but not break Is it a trait? A process? An outcome? Does it cross domains? Is it static or dynamic? The capacity of a dynamic system to adapt successfully to disturbances that threaten the viability, function or development of that system (Masten et al 2014) 12 Slide from Akil, 2021

  13. Resilience 13 Slide from Akil, 2021

  14. Vicarious Trauma 14

  15. 15

  16. Vicarious Trauma Emotional lability/ numbness Feelings of isolation, demoralization, or apathy Difficulty sleeping Somatic symptoms Irritability/ aggressive behaviors Conflict with loved ones Trauma symptoms (hypervigilance, avoidance, destructive behaviors) 16

  17. Questions/Comments 17

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