Module 9: Self-care

• Eat regularly (breakfast, lunch, and dinner)
• Eat healthfully
• Exercise, go for walks, garden, workout at the gym, lift weights, practice martial arts
• Get regular medical care for prevention
• Get medical care when needed
• Take time off when you are sick
• Get massages or other body work
• Do physical activity that is fun for you
• Take time to be sexual
• Get enough sleep
• Wear clothes you like
• Take vacations
• Take day trips or mini-vacations
• Get away from stressful technology (e.g., smartphones, email, social media)

• Make time for self-reflection
• Go to see a psychotherapist or counsellor
• Write in a journal
• Read literature unrelated to work
• Do something at which you are a beginner
• Take a step to decrease stress in your life
• Notice your inner experiences (e.g., dreams, thoughts, imagery, feelings)
• Let others know different aspects of you
• Engage in a new area (e.g., go to an art museum, performance, sports event exhibit, or other cultural event)
• Practice receiving from others
• Be curious
• Say no to extra responsibilities sometimes
• Spend time outdoors

• Spend time with others whose company you enjoy
• Stay in contact with important people in your life
• Treat yourself kindly (e.g., by using supportive inner dialogue or self-talk)
• Feel proud of yourself
• Reread favourite books, watch favourite movies
• Identify and seek out comforting activities, objects, people, relationships, and places
• Allow yourself to cry
• Find things that make you laugh
• Express your outrage in a constructive way

• Make time for reflection, meditation and/or prayer
• Spend time in nature
• Participate in a spiritual gathering, community, or group
• Be open to inspiration
• Cherish your optimism and hope
• Be aware of non-tangible, nonmaterial aspects of life
• Be open to the unknown
• Identify what is meaningful to you and notice its place in your life
• Sing
• Express gratitude
• Celebrate milestones with rituals that are meaningful to you
• Remember and memorialise loved ones who are dead
• Nurture others
• Have awe-filled experiences
• Contribute to, or participate in, causes you believe in
• Read inspirational literature
• Listen to inspiring music

• Take time to eat lunch
• Take time to chat with colleagues
• Make time to complete tasks
• Identity projects or tasks that are exciting, growth promoting, and rewarding
• Set limits with colleagues and clients
• Balance your caseload so that you do not “burn out”
• Arrange your workspace so that it is comfortable and comforting
• Get regular supervision or consultation
• Negotiate for your needs
• Have a peer support group

• Actively engage in regular supervision and collective reflective practice.
• Reach out to someone. This could be your supervisor, a trusted friend or colleague, a counsellor or another support person.
• Find a way to escape physically or mentally including rest, reading, days off, holidays, walks, seeing friends, having fun, and doing things that make you laugh, playing with children and pets, and creative activities.
• Take your scheduled workday breaks, weekends, and annual leave.
• Evaluate your workspace to ensure it is conducive to wellbeing.
• Try to establish boundaries with the work required by the institution or company members that exceed your job functions.
• Practice active communication with your institution or company members about your personal and work situation and make individual or collective demands that you consider fair.
• Be kind and supportive to your colleagues and celebrate achievements.
• Practice self-compassion. In bearing witness to stories of abuse and violence, it is good to remember that an emotional response is also a human one. While it is important to maintain professional composure with victims, emotional responses related to abuse and violence are natural and appropriate. Staying connected with how you feel and having self-compassion will help you to be resilient and sustain your work.

Asking for support can not only help protect your own emotional wellbeing, but it can also mean you are happier and more effective at work.

One of the biggest causes of vicarious trauma is how much time is spent with people who experience trauma. How work is divided among staff within an organisation is very important.

For more information on how organisations can better support staff, see “What managers and organisations can do”, below.

There are many ways to take a break. What you do is not important as long as it gives you a chance to relax and recharge.

• Take time to escape (physically or mentally, films, books, holidays)
• Have rest time (down time with no specific goal or time limit)
• Make the most of opportunities to enjoy yourself (develop positive emotions, do things that make you laugh or smile, take part in creative activities, play with children)

When you are doing challenging work or supporting people who need a lot from you, it is easy to take on too much. Remember you are only human, try to keep things in perspective.

• Be aware of the expectations you place on yourself – do they need to be more realistic?
• Accept that you are likely to be affected to a degree by doing demanding work
• Focus on things that are within your control
• Actively problem-solve difficult issues
• Take regular breaks (including each day at work, as well as longer breaks on weekends and for holidays)
• Try to understand yourself and your responses to stressful situations, including how stereotypes about your profession may impact your expectations

Being confident in your skills and working in a cooperative, supportive workplace are keys to doing your job well. Having the right skills for the job also helps manage stress. There are plenty of ways to improve your skills that do not require formal training.

• Read about or do training in vicarious trauma
• Ask for support from colleagues
• Request regular professional supervision
• Seek variety at work, try different tasks
• Develop professional networks and relationships
• Take this information to your manager or supervisor

It is important to keep a balance in your life and focus on the value of the work that you do. Keeping things in perspective can help make you more resilient and satisfied in both your work and personal life. These simple actions can have a big impact on the way you feel.

• Keep a healthy work-life balance, as well as balancing the types of tasks you do at work
• Remember the importance and value of the work you do
• Be mindful and appreciate the little things (for example a warm day, good coffee, a hug)
• Mark important events, celebrate and grieve with rituals or traditions
• Stay connected with loved ones
• Find small ways to refresh and ground yourself throughout the workday
• Focus on doing your best (instead of only specific goals that ‘must’ be completed)
• Recognise and challenge any cynical beliefs that come up
• Seek out strengths and successes (in yourself, as well as others and the work you do)
• Consider activities to encourage personal growth (for example creative activities, journaling, mindfulness)
• Find what renews you spiritually and connects you to greater meaning (nature, religious belief, community, and family) and do these things regularly
• Try a gratitude journal – at the end of each day write down three things you are grateful for, or three things that went well that day and why they matter

Managing the risk of burnout and vicarious trauma is an important part of workplace health and safety within an organisation. There are practical and important things that managers can do to support the wellbeing of their staff.¹¹

Two of the most important factors that can prevent burnout and vicarious trauma are:

• How work is allocated
• The support professionals receive

Management support strategies can include:

• Regular supervision and debriefing
• Rostering or alternated appointment systems, which are designed to minimise constant exposure to stressful environments
• Work allocation changes, such as providing duties that are not directly connected to the work with victims
• Establish a yearly rotation system from positions working with victims to positions working with professionals (e.g., teaching duties)
• Professional development opportunities such as workshops on domestic violence, burnout, and vicarious trauma
• Providing professional development pathways or study time – this can help reduce the effects of vicarious trauma, and can also help professionals to feel that their work and skills are valued
• Enhanced collaborative practice and inter-agency case management, so that professionals do not feel they are the only one working with, or responsible for, a victim’s or family’s safety
• Encouragement of self-care, down-time, lunch breaks and other re-fuelling practices

Organisations should have policies and procedures in place to: 

• Support professionals’ safety in everyday practice
• Document and debrief reportable and critical incidents
• Address concerns about misconduct, bullying and service quality

Given the high prevalence of domestic violence worldwide, it is highly likely that the workplace includes people with their own past or current lived experiences of domestic violence. Enabling sustainability requires dedicated workplace policies that recognise this reality and include confidential support strategies.

Breathing exercises are the simplest path to inner calm. Practicing 15 minutes a day can achieve a significant reduction in your stress-related symptoms. Breathing is one function controlled by both the voluntary and involuntary nervous system, forming a bridge between our inner and outer selves. To use the technique, take several deep breaths and relax your body further with each breath.

Diaphragmatic breathing

By performing this exercise, you engage the diaphragm (the most important muscle of breathing), which increases airflow in your lungs.

Square breathing

Also known as box breathing or 4×4 breathing. This technique is the simplest form of mindful breathing and aims to return breathing to a normal rhythm in only a few minutes.

One of the most popular and easy-to-use methods to relax is by doing progressive muscular relaxation. This approach is useful for relaxing your body when your muscles are tense. The key is to become aware of tension and its corresponding state, relaxation, in each of the body’s muscle groups. First, tense a group of muscles so that they are tightly contracted. Hold the muscles in a state of extreme tension for a few seconds. Then, let the muscles relax normally. Next, consciously relax the muscles even further so that you become as relaxed as possible. By tensing your muscles first, you will find that you are able to relax your muscles more than you could if you simply tried to relax your muscles directly.

Experiment with this method by forming a fist and clenching your hand as tightly as you can for several seconds. Relax your hand to its previous state, then consciously relax it again so that it is as loose as possible. Following this practice, you should feel deep relaxation in your hand muscles.

The relaxation response, first developed by Herbert Benson, is a simple form of meditation that anyone can use. Follow these steps for 10 to 20 minutes daily to decrease stress in your life and help you focus.

1. Sit quietly and comfortably.
2. Close your eyes.
3. Start by relaxing the muscles of your feet and work your way up to your head, relaxing the muscles.
4. Focus your attention on your breathing.
5. Breathe in deeply and then let your breath out. Count your breaths to yourself. Or pick a word, phrase, image, or prayer on which to focus. You might also choose to simply focus on your breath moving in and out.

• Consider the professionals’ preferences regarding remote or face-to-face work in the office.
• Discuss with staff the challenges of working remotely, such as the need for sensitive conversations, potential impact on shared living spaces, feelings of isolation, and stress.
• Ensure staff have the necessary tools and equipment for remote work, including internet access, computers, software, phones, ergonomic furniture, etc.
• Conduct meetings to assess and provide equipment for remote work and develop guidelines for staff to access tools and technology.
• Maintain confidentiality and privacy of client data by implementing secure storage systems for remote work settings.

• Monitor and manage staff well-being during crises, including regularly checking in with professionals, providing dedicated supervision sessions, facilitating peer support, and encouraging breaks from work.
• Supervising practice during emergencies involves focusing on the personal impact of domestic violence work, considering alternative supervision methods, discussing potential trauma spills in shared homes, and extending mental health services to others in shared homes.
• Maintaining social connections is essential by transitioning in-person rituals to virtual versions, scheduling regular team catch-ups via online platforms.
• Adaptive case allocation and management prioritise professionals’ well-being, considering workload, case complexity, and staff availability, and involves regular monitoring and review of caseloads and workloads.
• Staff recruitment during crises requires careful consideration, evaluating previous experience, qualifications, and cultural knowledge before making decisions about recruitment and induction of new staff.

• Communication is crucial during crises, and organisations should develop internal and external communication plans to address the challenges faced during emergencies.
• Internal communication plans should establish clear channels for conveying decisions related to case prioritisation and ensure that staff mental health and well-being are prioritised in all communications.
• External communication plans should outline channels for communicating with the public, providing clear and reassuring messages about service changes and availability during the crisis.
• Organisations must consider the impact of service alterations on both clients and staff, providing consistent information through central communication channels and appointing public information spokespeople to coordinate communication with the public, media, and government.

• Prioritise the health and safety of professionals during emergencies and crises by integrating mental health and well-being strategies into crisis response and recovery plans.
• Focus on building resilience in the workforce through systematic planning, implementation, and monitoring of mental health strategies during emergencies.
• As organisations transition from crisis response to recovery, emphasise workforce resilience and agility to adapt to future crises.
• Reflect on past experiences to identify strengths, gaps, and areas for improvement in crisis response, involving input from all levels of the organisation to inform future strategies.

• Accept their wishes.
• Wait for other opportunities, try again later.
• If you cannot find a solution, brainstorm with colleagues (maintain confidentiality).
• Try to say, “I did my best. I feel the need to take some distance aside from the case now.” It is your responsibility to offer pathways, not to take action for the victim.

• Reconsider which information is crucial to get/are essential and who could provide them.
• Identify risk factors before taking action.
• Brainstorm with colleagues what other sources of information could be used.
• Make a plan for your approach.
• Ensure the atmosphere is conducive.
• Share information and ideas to get responses.

• Consider carefully whether it may be necessary to call the police.
• Inform colleagues and ask for their support.
• If there is immediate danger, call the police immediately.
• In the case of verbal aggression, do not call the police immediately. In cases of physical aggression and when the victim is in danger of life, call the police immediately, otherwise you may encounter problems.
• If there is no immediate danger, try to talk to the victim.

• Be open to new suggestions.
• Use humour.
• Ask your colleague if he/she can give you some insights into his/her work.
• Good meetings with and support from your colleagues can be very fruitful and empowering in cases of violence.

• Try to find the right way and tone to say what you want to say.
• Find a way to express your disappointment over a colleague and/or immediate supervisor. Try to not make it personal.

• Try to be attentive to “alarm signals”, such as tension in the neck and shoulder area, fatigue, restlessness, sleep problems, nervousness, etc.
• Try to solve the problems on different levels (personal, interpersonal, at the workplace, in the organisation).

• Initiate a de-briefing with colleagues.
• Talk to friends, but do not share personal data.
• Relax, take long walks, have a warm bath.
• Take deep breaths.

• Ask colleagues for support.
• Talk to your supervisor about reorganising your tasks.
• Propose a team meeting to discuss the issues.
• Try to reorganise yourself.
• Make a commitment to take time for yourself and for your family and friends.

• Acknowledge and communicate these signs.
• Encourage seeking professional help.
• Promote self-care activities.
• Create a supportive environment.

Physical symptoms of stress can include¹⁸:

• Faster breathing and heartbeat
• Panic attacks
• Sleep problems
• Muscle aches and headaches

If people are stressed, they might feel these symptoms the most often:

• Feeling irritable, angry, impatient or wound-up
• Being anxious, nervous or afraid
• Unable to enjoy yourself (e.g., you have lost your sense of humour)
• A sense of dread
• Unable to concentrate
• Unable to remember things, or make your memory feel slower than usual
• Constantly worry or have feelings of dread
• Grind your teeth or clench your jaw
• Experience sexual problems, such as losing interest in sex or being unable to enjoy sex
• Withdraw from people around you

If people are stressed, they may observe in their daily life the following:

• Smoke
• Use recreational drugs
• Drink alcohol more than they usually would

• Are your relationships with close friends, family, children, or partners changing for the worse?
• Are you finding yourself irritable, anxious, agitated or “snapping” more frequently than usual?
• Are you worried about your work performance?
• Are you avoiding, or getting anxious about engaging with work, clients, or patients?
• Do you notice mood swings or feel your moods are sometimes out of your control?
• Are you feeling flat, sad, lacking energy, overtired for no reason, or as though you are “spacing out” from things around you when you are stressed?
• Are you getting run down or catching more colds or infections than usual?
• Do you feel unsafe or overly anxious about your safety?
• Are you self-soothing in ways that might be numbing or can cause you increased stress later, such as mindless eating, alcohol or substance use, or smoking?
• Do you feel you have lost hope, or that there is little “goodness” in humanity?
• Do you have nightmares, poor sleep, intrusive thoughts, or images that are upsetting?

Emma is a physician working in the emergency department of an urban hospital. She regularly encounters victims of domestic violence who require medical assistance. In her role, she focuses on treating the physical injuries of the victims and ensuring they receive the necessary support.

As a physician, Emma is accustomed to working in stressful and emotionally taxing situations. She has learned to remain professional while attending to the needs of her patients. However, she often feels overwhelmed by the number of patients she must treat and the severe injuries she witnesses. She realises that she is increasingly feeling exhausted, often feeling guilty when she takes breaks or seeks assistance.