Module 9: Self-care

1. Importance of self-care
2. Strategies on how to improve self-care
3. Stress
4. Burnout
5. Secondary traumatisation

Sources

1. Importance of self-care

Working with people who have experienced domestic violence can be extremely mentally challenging. It is quite normal to experience a range of feelings, when working with victims of domestic violence. Being aware of the potential impact on your own wellbeing and taking steps to minimise the negative impacts are important strategies of self-care.

Self-care can be defined as the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a health worker in form of acceptance and without resignation.¹

Difficult situations in the context of domestic violence

Frontline responders play an important role in providing emotional support to victims, improving their safety, and providing legal assistance, but they routinely encounter unpredictable and complex situations and confront a range of challenges while providing support to victims.²

Please click on the crosses to get more information.

Excursus: Dealing with frustrations

Victims of domestic violence very often stay in abusive relationships and find it difficult to allow intervention for various reasons, one of them being a sense of lack of support. This can be exhausting, frustrating, and difficult to handle. Though professionals may feel frustration, they may be their first and only point of contact.³

As a professional working with victims of domestic violence, it is important to address frustration when it arises, taking into consideration the following points:

• Realise early on that the victim may never leave the abuser.
• Recognise that leaving is a process, not an event – the timeline from the beginning of abuse to the point of leaving may take decades.
• Remind yourself, that it is the victim’s responsibility to leave an abuser, not yours.
• Get to know as much as you can about how domestic violence is being addressed at a local level. At the bare minimum, you should know the domestic violence support services in your area, so that you can provide accurate information for victims.
• Do not feel that you have to know everything that there is to know about domestic violence. Listening and communicating support and active contact details for an external support agency is better than not talking about it at all.
• Be aware of your own safety needs. Should a violent incident occur, arrange a staff debriefing session. Violence affects everybody differently.
• Have local contact details for domestic violence support available to all staff members.
• Look after yourself. Working with the effects of domestic violence professionally can bring personal issues to the surface, particularly if you are experiencing or have experienced abuse yourself.

2. Strategies on how to improve self-care

Being prepared for periods of stress can make it easier to get through them and knowing how to manage our wellbeing can help us recover after a stressful event. Resilience refers to our ability to manage stress. It is the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioural flexibility and adjustment to external and internal demands. A number of factors contribute to how well people adapt to adversities, predominant among them (a) the ways in which individuals view and engage with the world, (b) the availability and quality of social resources, and (c) specific coping strategies.⁴

There are things we can try to build our resilience against stress. But there are also factors that might make it harder to be resilient, such as experiencing discrimination or lacking support.⁵

Self-assessment tool: Self-care

Self-care activities are things you do to maintain good health and improve well-being. You will find that many of these activities are things you already do as part of your normal routine.

In this self-assessment you will think about how frequently, you are performing different self-care activities. The goal of this assessment is to help you learn about your self-care needs by spotting patterns and recognising areas of your life that need more attention.

There are no right or wrong answers on this assessment. There may be activities that you are not interested in, and other activities may not be included. This list is not comprehensive but serves as a starting point for thinking about your self-care needs.^6,7

Rate yourself, using the numerical scale: 5 = Frequently, 4 = Occasionally, 3 = Sometimes, 2 Never, 1 = It never even occurred to me

How often do  you do the following activities?

Tasks for reflection
Once you have completed the self-assessment, reflect on the following questions:
(1) Were there any surprises? Did the assessment present any new ideas that you had not thought of before?
(2) Which activities seem like they would be more of a burden than a benefit to you?
(3) What are you already doing to practice self-care in the physical, psychological, emotional, spiritual, and professional realms?
(4) Of the activities you are not doing now, which particularly sparks your interest? How might you incorporate them into your life sometime in the future?
(5) What is one activity or practice you would like to try starting now or as soon as possible?

The following strategies are recommended to improve self-care at work.⁹

Please click on the crosses to get more information.

You can use these specific strategies to improve your self-care.¹⁰

Tasks for reflection
(1) Are you aware of the expectations you place on yourself in your professional role? How might these expectations be influencing your stress levels and overall well-being?
(2) Do you believe your expectations of yourself are realistic given the demands of your work?
(3) How do you perceive the impact of demanding work on your mental health? Are you acknowledging its impact, or do you tend to minimise or ignore it?
(4) What aspects of your professional life do you feel are within your control?
(5) Are you comfortable seeking help and support when needed?
(6) How do you approach stressful situations or obstacles in your work? Are you proactive in finding solutions, or do you tend to feel overwhelmed or stuck?

Relaxation techniques

Relaxation techniques are helpful tools for coping with stress and promoting long-term health by slowing down the body and quieting the mind. Here are three relaxation techniques that can help you to reduce your stress-related symptoms and gain a better sense of control and well-being in your life¹²:

Excursus: Wellbeing during times of crises

The COVID-19 pandemic has greatly impacted existing structural inequalities throughout Europe, heightening the risks and vulnerabilities associated with domestic violence and revealing the limitations and obstacles within the support system. It has led to a widespread shift to remote services for professionals working with victims of domestic violence, often for the first time, and has posed challenges in maintaining the mental health and well-being of these professionals in remote settings.

Find more information about domestic violence in times of disasters in Module 7.

What are managers’ responsibilities during times of emergency and crisis?

• Managers have a responsibility to ensure the safety and well-being of all professionals, both physically and mentally.
• Managers and supervisors must take steps to protect the mental health of professionals, especially those working remotely or from home.
• Managers should develop and implement strategies to help professionals create safe and suitable remote work environments, promote well-being, and offer support if mental health issues arise during emergencies and crises.

Organisations can take the following actions to improve crisis preparedness, response, and recovery, as well as to mitigate work-related stress, burnout, and other mental health problems during such times.¹³

Questions & Answers: Self-care¹⁴

3. Stress

Domestic violence is a problem for those directly affected but can also pose significant challenges for professionals. Problems, frustrations, and barriers can result in stress, or even burnout, and in some cases in vicarious trauma if not effectively managed. It is important for professionals to be aware of the risks and recognise the signs.

Definition of stress

Stress can be defined as a state of worry or mental tension caused by a difficult situation.^15,16

Stress can be “acute” or “chronic”¹⁷:

• Acute stress happens within a few minutes to a few hours after an event. It lasts for a short period of time, usually less than a few weeks, and is very intense. It can happen after an upsetting or unexpected event. For example, this could be a sudden bereavement, assault, or natural disaster.
• Chronic stress lasts for a long period of time or keeps coming back. You might experience this if you are under lots of pressure a lot of the time. You might also feel chronic stress if your day-to-day life is difficult, for example if you are a carer or if you live in poverty or if you experience domestic violence yourself. Additionally, chronic stress can result from working with traumatised people and/or regular exposure to stressful situations at work.

Stress and our body

Stress is our body’s reaction to a pressure situation (acute or chronic). When we are exposed to stress, our body produces stress hormones that trigger a fight or flight response and activate our immune system. The body then reacts with an alarm response. The release of stress hormones (e.g., cortisol and adrenaline) in the brain puts the body on alert and increases blood pressure, breathing and heart rate, among other things.

The following video shows how stress affects our body:

Learn more about how stress affects the brain in particular in the following video:

Signs and symptoms of chronic stress

Too much stress can leave us in a permanent stage of fight or flight, leaving us overwhelmed or unable to cope. Long term, this can affect our physical and mental health and physical, emotional, and behavioural symptoms develop. Our body’s autonomic nervous system plays an important role in some of those symptoms as it controls our heart rate, breathing, vision changes and more.

The body tries to adapt to a prolonged (chronic) stress situation. The following symptoms often occur during this so-called resistance phase:

The following video explains what happens to our body and brain when we do not get enough sleep:

As a result of chronic stress, a phase of exhaustion occurs due to the constant excessive demands: The immune system is less efficient, people fall ill more quickly or more often. The risk of developing mental illnesses such as anxiety disorders, burnout or depression also increases.¹⁹

Often, people with chronic stress try to manage it with unhealthy behaviours.²⁰

The following video explores the stages of how our memory stores information and how short-term stress impacts this process:

Causes of stress

Many things can cause stress. You might feel stressed because of one big event or situation in your life, or it might be a build-up of lots of smaller things. You can have stress from good challenges as well as bad ones.

Some situations that do not bother you at all might cause someone else a lot of stress. This is because we are all influenced by different experiences. We also have different levels of support and ways of coping. Certain events might also make you feel stressed sometimes, but not every time. Some of these situations may be considered even as happy events, but they can still feel very stressful (e.g., getting married or starting a new job).

Stress can occur in different areas of our lives.²¹ These may include:

Please click on the crosses in the corresponding circles to get more information on potential warning signals in these different areas of life.

The following illustration shows the progression of a stress curve from too little stress to burnout:

Too little stress

• Inactive: In this phase, stress levels are very low. Individuals might feel bored, disengaged, and lack motivation. There is insufficient pressure to stimulate action or focus.
• Laid back: As stress levels increase slightly, individuals may feel relaxed but still lack the drive to perform. There is minimal urgency or challenge to spur productivity.

Optimum stress

• Stress as a productive force: When stress reaches a moderate level, individuals begin to experience increased energy and focus. This phase is marked by heightened alertness and motivation, leading to high performance. This is the zone of optimal performance where stress acts as a positive force, however this can result in fatigue without any rest.

Too much stress

• Exhaustion: Beyond the optimal point, stress levels become too high, causing performance to decline. Individuals may experience physical and mental exhaustion, leading to decreased productivity. The stress starts to take a toll on the body and mind, making it difficult to maintain high performance.

Burnout

• At this stage, prolonged high stress may result in a complete breakdown. This phase is characterised by physical, emotional, and mental exhaustion.

4. Burnout

Definition of burnout

Some people who go through severe stress may experience suicidal feelings. This can be very distressing. In such situations, it is important to seek professional help, as integrating self-care routines like meditation and exercise may not be sufficient. Primary care physicians can be the first point of contact to help those affected to find ways out of this stress spiral can help navigate these challenging times safely.

The term “burnout” was coined in 1974 by the American psychologist Herbert Freudenberger. He used it to describe the consequences of severe stress and high ideals in “helping” professions. Doctors and nurses, for example, would often end up being “burned out” – exhausted, listless, and unable to cope.²²

The ICD-11 of the World Health Organization (WHO) defines burnout as an occupational phenomenon resulting from chronic workplace stress that has not been successfully managed.²³ It is classified as a mismatch between the challenges of work and a person’s mental and physical resources, but is not recognised as a standalone medical condition.

Burnout can lead to anxiety, anger, or panic, which may impair ability of those affected to function properly. Finally, chronic stress results in a complete breakdown, which may manifest as severe fatigue, depression, or total withdrawal from activities.

Symptoms that may indicate burnout

There are three main areas of symptoms that are considered to be signs of burnout²⁴:

• Feelings of energy depletion or exhaustion: People affected feel drained and emotionally exhausted, unable to cope, tired and down, and do not have enough energy. Physical symptoms include things like pain and gastrointestinal (stomach or bowel) problems.
• Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job: People who have burnout find their jobs increasingly stressful and frustrating. They may start being cynical about their working conditions and their colleagues. At the same time, they may increasingly distance themselves emotionally, and start feeling numb about their work.
• Reduced professional efficacy: Burnout mainly affects everyday tasks at work, at home or when caring for family members. People with burnout are very negative about their tasks, find it hard to concentrate, are listless and lack creativity.

Diagnosis of burnout

In 1981, Maslach and Jackson developed the first widely used instrument for assessing burnout, the Maslach Burnout Inventory (MBI). It remains by far the most commonly used instrument to assess the condition. The MBI operationalises burnout as a three-dimensional syndrome consisting of emotional exhaustion, depersonalisation (an unfeeling and impersonal response toward recipients of one’s service, care, treatment, or instruction), and reduced personal accomplishment.²⁵

The MBI originally focused on social professionals (e.g., teachers, social workers). Since that time, the MBI has been used for a wider variety of workers (e.g., health professionals). The instrument or its variants are now employed with many other professions.

Learn more about burnout in the following video:

5. Secondary traumatisation

Definition of secondary traumatisation

“Trauma” is an ancient Greek word meaning wound or injury. In psychology, trauma refers to a severe psychological injury. Trauma often arises from experiences where a person is subjected to significant threat and helplessness.²⁶ Secondary traumatisation is the impact of knowledge about another person’s traumatic experience on your own psyche; i.e., a trauma that you did not experience yourself. This occurs usually at a distance from the original trauma and unconscious.

Secondary traumatisation is also known by a handful of other names, including:

• Vicarious traumatisation
• Secondary trauma
• Second-hand trauma
• Secondary traumatic stress

Sometimes it can lead to post-traumatic stress disorder (PTSD) or other mental health difficulties, like depression and anxiety.²⁷

Signs and symptoms of secondary traumatisation

Symptoms of secondary traumatisation can be experienced physically, emotionally, and behaviourally:²⁸

• Nightmares with reliving the trauma material of the traumatised person
• Social withdrawal
• Stress-related medical conditions
• Flashbacks stemming from their own traumatic experiences (those affected get a racing heart and dry mouth, can sweat and be just as frightened as they were in the original situation).

Secondary traumatisation can happen to people who engage with trauma survivors or witness traumatic events, especially on a repetitive basis.²⁹ For this reason, secondary traumatisation is common among professionals known for helping others, like therapists, social workers, police officers, firefighters, paramedics, teachers, and doctors.

Who may be particularly at risk of being affected by secondary traumatisation?

• Persons with own previous and unresolved traumas (e.g., domestic violence)
• Situation paralleling one own’s life situation
• Own high level of stress

How can you prevent secondary traumatisation?

• Good self-care
• Good working conditions and collegial teamwork
• Tackling of conscious trauma with professional help

This video introduces secondary traumatisation and its possible effects on work and personal life. It also offers some techniques for addressing work-induced stress and trauma.

The following checklist contains more signs to be aware of.³⁰ The things on the list do not necessarily mean that you are suffering from burnout or secondary traumatisation. An answer of “yes” to any of the questions can alert you to the need to speak to someone to receive support.

All sectors include different case studies. Visit Module 9 for the police, health sector, and legal sector to find out more.

Factsheet: Self-care (IMPROVE)Download

Sources

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