FEAST Academy, Travis Case, Bible, Sermons, Church, Creation, Evolution, History, Prophecy, Religion, Love, Sex, Suicide
   CISD Training
   Critical Incident Stress Debriefing

Travis Case, Pastor/Teacher          Northgate Baptist Church          F.E.A.S.T Ministries
"A merry heart doeth good like a medicine:"   (Prov. 17:22)
"... the joy of the LORD is your strength."   (Neh. 8:10)


Index

Stress Fact or Fiction Quiz
Cumulative Stress Test
Personality Traits of Emergency Personnel
Type "A" Profile
Stress --- Distress
How To Recognize Stress / Distress Signals
Physical Reactions
Cognitive Reactions
Emotional Reactions
Behavioral Reactions
How To Cope With Trauma or Stress
Suggested Do's And Don'ts of CISD
Definitions
Why CISD Works
Lessons We Have Learned
Ineffective Use of Peers
CISD Debriefing
Outline of Debriefing Session
Introductory Phase
Fact Phase
Thought Phase
Reaction Phase
Symptoms Phase
Teaching Phase
Re-Entry Phase
Questions & Answers
Quiz
How To Stay Stressed
The Fulfilled & Balanced Life
Some People Are Stressed By Choice


Stress Fact or Fiction Quiz

How much do you know about stress?
Answer the following statements (True or False) to test your knowledge:

I. People who feel stress are nervous to start with.

II. You always know when you are under stress.

III. Prolonged physical exercise will weaken your resistance to stress.

IV. Stress is always bad.

V. Stress can cause unpleasant problems, but at least it cannot kill you.

VI. Stress can be controlled with medication.

VII. Work-related stress can be left at the office and not brought home.

VIII. Stress is only in the mind; it is not physical.

IX. Stress can be eliminated.

X. There is nothing you can do about stress without making drastic changes in your life-style.

The correct answer to all ten questions is False.

If you answered True to even one, you are a victim of a stress myth.

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Cumulative Stress Test

1 = no change
2 = little change
3 = moderate change
4 = considerable change
5 = a great deal of change

_____ 1. Do you tire more easily? Feel fatigued rather than energetic?

_____ 2. Are people annoying you by telling you, "You don't look so good lately"?

_____ 3. Are you working harder and harder and accomplishing less and less?

_____ 4. Are you increasingly cynical and disenchanted?

_____ 5. Are you often invaded by a sadness you cannot explain?

_____ 6. Are you forgetting appointments, deadlines, personal possessions?

_____ 7. Are you increasingly irritable? More short-tempered? More disappointed in the people around you?

_____ 8. Are you seeing close friends and family members less frequently?

_____ 9. Are you too busy to do even routine things such as making phone calls or reading reports or sending birthday cards?

_____ 10. Are you suffering from physical complaints (aches, pains, headaches, or a lingering cold)?

_____ 11. Do you feel disoriented when the activity of the day comes to a halt?

_____ 12. Is joy elusive?

_____ 13. Are you unable to laugh at a joke about yourself?

_____ 14. Does sex seem like more trouble than it is worth?

_____ 15. Do you have very little to say to people?

_____ Total

Scoring:

0-25: You are doing fine.
26-35: There are a few things that you should watch.
36-50: You are a candidate for cumulative stress.
51-65: You are well into cumulative stress.
over 65: You are in danger. Your physical and mental health are threatened.

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Personality Traits of Emergency Personnel

I. Need To Be In Control

A. They own the incident.

B. They need to control themselves, so they often avoid or suppress their own emotions.

C. They also demonstrate the need to be in charge of their own families, i.e., they tell others what to do.

II. Obsessive / Compulsive

A. They are detail-oriented Perfectionists.

B. They are apt to have a tremendous feeling of guilt if they are not right.

III. Action - Oriented

A. They are quick decision makers under pressure.

B. They are task oriented.

IV. High Need For Stimulation

A. They need to keep busy and want results now!

B. They have a high need for immediate gratification.

V. Easily Bored

A. Given a choice between the scene of a disaster and sitting around the station or office, they'll choose the disaster.

B. They frequently seek activities that are highly stimulating and exciting --- it keeps them alert.

VI. Risk-Takers

A. Frequently expose themselves to danger as they attempt to help others.

B. They keep a calm and measured attitude during the greatest risks.

VII. Highly Dedicated To Their Jobs & Families

The order, in terms of importance, seems to be:

1. Their job,

2. Their natural child(ren),

3. Their spouse,

4. Themselves.

VIII. Rescue Personality

A. They want to help others and are responsible for making life and death decisions.

B. It is difficult for them to say no.

IX. Strong Need To Be Needed

They keep helping others even when it may be harmful to themselves.

X. Strong Desire To Be Liked

A. Emergency workers have difficulty accepting the fact that people may be angry with them.

B. They are Histrionic (Egocentric, they like to be the center of attention).

C. One upmanship in actions and story telling.

D. They sleep with pagers / monitors so they don't miss a call.

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Type "A" Profile

Check all of the following Self-Descriptive statements:

_____ Speak the last few words of your sentence rapidly.

_____ Always move, walk, and eat rapidly.

_____ Feel impatient with the rate at which most events take place.

_____ Usually attempt to finish others' sentences.

_____ Become unduly irritated when traffic is slow.

_____ Find it intolerable to watch others do tasks you could do faster.

_____ Usually look for summaries of interesting literature.

_____ Indulge in polyphasic thought, trying to think of or do two or more things simultaneously.

_____ Ponder business problems while away from the office.

_____ Pretend to listen to others but remain preoccupied with your own thoughts.

_____ Almost always feel vaguely guilty when you relax.

_____ Do not take time to appreciate surroundings (i.e., sunsets, scenic beauty, etc.).

_____ Attempt to schedule more and more in less and less time.

_____ Possess a chronic sense of time urgency.

_____ Feel compelled to challenge another like yourself.

_____ Recognize aggressive behavior in yourself that may not be noticed by others.

_____ Frequently clench fist in conversation.

_____ Bang your hand on a table or pound one fist into palm of other to emphasize a point.

_____ Habitually clench your jaw or grind your teeth.

_____ Believe that your success has been due to your ability to get things done faster than others.

_____ Evaluate your own and others' activities in terms of numbers.

_____ Total

Key: --- Total the number of checks made above. If there are Seven or Fewer, there is little likelihood you are a Type A personality; Seven To Twelve checks indicates a tendency toward a Type A personality structure, while More Than Twelve suggests that you are a Type A personality.

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"Stress --- Distress"

II Timothy 1:7, "For God Hath Not given us the Spirit of Fear; but of Power, and of Love, and of a Sound Mind."

Introduction:

A. Christians suffer from Stress and Discouragement just as Non- Christians do.

1. Moses prayed to die.

2. Elijah prayed to die.

3. Job cursed the day he was born.

4. John, in prison, doubted that Jesus was the Messiah.

B. The Surgeon General estimates that "80% of the people who die of non-traumatic causes (accidents) actually die of Stress Related Diseases."

I. Stress may be Major Factor in causing:

A. Hypertension and Coronary Heart Disease,

B. Migraine and Tension Headaches,

C. Ulcers,

D. Asthmatic Conditions,

E. Chronic Backache,

F. Arthritis,

G. Allergies,

H. Hyperthyroidism,

I. Vertigo, and Multiple Sclerosis,

II. Stress not only affects our bodies, but it also Affects The Way We Think And Feel.

III. Stress may Lead To Harmful Habits such as smoking and overeating, which have been shown to cause or intensify still other diseases.

IV. Stress, Bereavement, and Depression can significantly Suppress Immunity --- making you More Susceptible to bacteria and viruses.

A. Stress suppresses immunity In Proportion To the Intensity of the stressor.

B. Prolonged Stress may be More of a suppressor of our immune system than Acute, Intense stress.

V. The following Stats indicate that we are Losing The War On Stress:

A. 30 Million Americans have some form of Major Heart or Blood-Vessel Disease ----- 1 Million Americans have a Heart Attack every year.

B. 25 Million Americans have High Blood Pressure.

C. 8 Million Americans have Ulcers.

D. 12 Million Americans are Alcoholics --- $15.6 Billion are lost by American industry each year because of Alcoholism.

E. 5 Billion doses of Tranquilizers --- 3 Billion doses of Amphetamines --- 5 Billion doses of Barbiturates are prescribed Each Year.

F. $19.4 Billion are lost by American industry each year because of Premature Employee Death.

G. $15 Billion are lost by American industry each year because of Stress-Related Absenteeism.

H. $700 Million are spent each year to Recruit Replacements for executives with Heart Disease.

VI. Life Without Stress Is Impossible.

A. For Most people --- "stress" is a description of their Daily Lives.

B. It is related to the Speed at which we live, as well as the Complexity of our lives.

C. Stress is Not designed by nature to Kill, but rather to Enhance life.

D. The Right Kind of stress is Helpful and actually Essential for a Full And Productive Life.

E. Without Stress there would be no change, no growth, and no productivity --- we would never accomplish anything of value.

F. Stress keeps our Hearts beating, our Digestion flowing and our Minds sharpened.

VII. When stress gets Out Of Control (Distress) it becomes a Destructive Force that has a negative impact on: our Health --- our Personalities --- our Jobs --- and our Families.

A. We must learn how to Control or Manage stress in our life.

B. Before we can control or manage anything, we must have a Sound Understanding of that which we seek to control.

VIII. There are Several Different Types of Stress:

A. Environmental stress factors:

1. Nose --- Dirt/dust --- Pollution --- Clutter,

2. Weather Conditions -- Temperature Extremes,

3. Threat of Nuclear War,

4. Confined Space --- Overcrowding,

5. Traffic,

6. lighting,

7. Rapid Decision Making,

8. The Swiftly Expanding Knowledge Base, etc.

B. Psychosocial stress factors --- almost anything that has to do with Contact With People:

1. Family Relationships,

2. Conflicts With Fellow Workers,

3. Conflicts With The Administration,

4. Lack of Appreciation From Superiors,

5. Abusive Behavior,

6. Taxes --- Financial Success, or Lack of It, The Economy,

7. Changing Values, etc.

C. Personality stress factors --- Focus Within Ourselves --- relate to ways in which we Think and Feel --- and the Memories of our past experiences --- including:

1. The Inability To Say "No" To Someone.

2. The Need To Be Liked.

3. Guilt Feelings When We Don't Help Someone.

4. Anxiety Over Our Own Professional Competence.

5. A Mental Outlook In Which We See Everything As Negative.

6. Personal Sensitivity To Criticism.

7. Extremely High Expectations of Ourselves.

8. Guilt Over Mistakes or Not Doing A Perfect Job.

9. Pressures To Achieve Status --- Popularity or The Lack of It, etc.

D. Stress for Young People may include some of these same stress factors --- they may also include:

1. Pressure To Make Good Grades,

2. Peer Pressure,

3. Need To Belong --- To Be Accepted --- To Be Loved,

4. Need For Recognition,

5. Need For A Support System, (Family, Friends, etc.),

6. Need To Communicate Effectively With Adults and/or Peers,

7. Need To Establish Independence,

8. Need To Prepare For A Career,

9. Need To Select A Mate,

10. Need To Develop Life Skills,

11. Need To Establish Personal Values And To Behave Consistently With Those Values.

IX. What Is Stress?

A. Distress is the Negative Response to a stress factor.

B. The perception that we are going to be Threatened causes a negative response --- resulting in stress.

X. Stress is Personal.

A. What is stressful for you may not brother the next person at all.

B. One person may enjoy Mountain Climbing --- the next person may be frightened to the point of nausea at the idea of climbing a Six Foot Ladder.

C. Phil sees the idea of Inviting Heather For A Date as threatening:

1. He is afraid of being rejected --- This fear makes him anxious and uncomfortable.

2. Danny, however, feels no threat --- being turned down is "no big deal" to him.

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How To Recognize
Stress --- Distress Signals
:

( Early Warning Signs / Indicators of Difficulty In Coping)


I. The following Stress Reactions are presented in categories so that they may be more easily recognized and understood.

A. There is no magic number of these symptoms that suggest difficulty in coping.

B. Rather, it is the extent to which the noted reaction is a Change From A Person's Normal Lifestyle that makes a reaction potentially important.

II. Also, it is the Combined Presence of Symptoms that determines the potency of the problem.

III. Indicators may be Isolated Reactions or Combinations among the three categories listed below.

IV. The Severity of The Difficulty In Coping is suggested by:

1. The Duration (how long the symptoms have been present and how long they last).

2. The Frequency of such incidents (how often they happen).

3. The Intensity (strength) with which they are present.

Over The Next Month, You May Experience Normal Reactions
To The Kind of Experience You Have Had Which May Include:

Physical Reactions:

Fatigue --- Exhaustion

Hyperactivity --- Under-activity

Insomnia (which may turn into hypersomnia)

Health Problems:

Low Resistance to Illness --- Excessive sick-leave

Nausea --- Vomiting --- Diarrhea --- Constipation

Change in Appetite

digestive problems

Weight gain/loss

Headaches

Sexual difficulty

Self Medication Abuse

Cognitive Reactions:

Memory Disturbance

Difficulty With Concentration

Mental Fatigue --- confusion

Amnesia of the Event

Flashbacks

Difficulty Solving Problems --- Making Decisions

Inability To Attach Importance To Anything Other Than This Incident

Difficulty Returning To Normal

Emotional Reactions:

Apathy --- The "Blahs" --- Recreation not pleasurable

Mental Fatigue --- Emotional Numbing --- Preoccupied

Startle Reactions --- Irritability --- Over-sensitivity --- Defensive

Arrogant --- Argumentative

Anger --- Outrage --- Hostile --- Violent Fantasies

Insubordinate --- Inflexible

Grief --- Crying --- Loss of Trust --- Suspicious

Amnesia of The Event

Anxiety --- Restless

Agitated --- Frustration With Bureaucracy,

Insecurity --- Feeling Worthless

Feeling of Helplessness --- inadequate --- Overwhelmed

Depression --- Fear --- Guilt --- Nightmares

Despair --- thoughts of suicide

Overcompensation --- Exaggeration

Denial --- Scapegoating

Work to exhaustion

Behavioral Reactions: - (Could Be The Results of The Above Three)

Withdrawal --- Avoidance --- Social Isolation

Neglecting / Reluctance to Accept Responsibilities

Alcohol / Drug Abuse

Promiscuity

Administrative Infractions:

Tardy to Work

Poor Appearance

Accident Prone

Legal Infractions:

Indebtedness

Shoplifting

Traffic Tickets

Child / Spouse Abuse

Fights

These are normal reactions, and, although painful, are part of the healing process.

There is not a lot anyone can do to make you not experience these uncomfortable feelings --- but there are things you can do to feel more whole.

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How To Cope With Trauma or Stress?

(Things To Know And Do)

I. It Is Natural For Your Judgment To Be Hampered By Stress.

A. Recognize That You Are In Stress And That It May Be A Painful Period of Adjustment.

1. Admit that you are hurting.

2. It is normal to hurt when you are in stress,

3. Especially if you have experienced a loss.

B. Do Not:

1. Have unrealistic expectations for recovery,

2. Expect the incident Not to brother you,

3. Look for easy answers.

C. Self-Doubts Are Symptoms of Stress.

1. So is an inability to concentrate.

2. When everything seems to be going wrong, it is hard to think about anything else.

3. Take an emotional breather -- Take all breaks, lunches, etc.

The ones you need the most are the ones you don't want to take.

D. Try To Avoid As Many Decisions As Possible, Especially Major Ones --- Do Not Make Any Big Life Changes.

1. Deal only with those major decisions that require immediate attention.

2. However, do make as many daily decisions as possible which will give you a feeling of control over your life.

3. For example, if someone asks you what you want to eat, answer them even if you are not sure.

E. Expect To Get Through Your Crisis.

1. There will be good days and bad days.

2. Do not be discouraged when your feelings seem to overwhelm you --- Just when you thought you were getting it all together again.

F. Know Yourself --- Expand or Develop An Introspective Attitude.

1. Know what you feel and why.

2. Be aware of prior conditioning.

G. Do Not Deny Your Feelings, But Do Not Dwell On Them.

Acknowledge them but do not encourage them.

H. You Are Normal And Having Normal Reaction --- Do Not Label Yourself Crazy.

II. Deal With One Thing At A Time --- Keep Your Life As Orderly As Possible.

A. Structure Your Time --- Keep Busy --- Make Schedules, Lists, Plans, Etc., And Try To Stick To Them.

1. Set appropriate goals.

2. Change what you can --- This is generally not "The System". Concentrate on smaller goals.

3. Schedule as much activity into the weekends as possible.

4. Do the same thing but do it differently.

B. Take Responsibility For Your Life (Your Actions).

1. Obey those in authority over you.

2. Respect the laws of the land.

3. Don't try to live Above Your Means.

C. Practice Time-Management Techniques In Your Daily Life.

D. It Is A Good Time, However, To Be Nice To Yourself --- Do Things That Feel Good To You.

Make a list of good things to do for yourself and use it to "treat" yourself from time to time.

E. Keep Your Life As Normal As Possible.


III. Accept The Help of Others --- And Be Willing To Help Others.

A. Understanding And Support Are Important When You Are In Stress.

1. Do Not Deny Yourself Assistance That May Be Available To You.

2. Do not withdraw from significant others.

B. Develop A Work And Personal Support Group.

1. Have a supportive family

2. Belong to some social or activity group that meets at least once a month (other than your family).

3. These will provide help, comfort, insight, comparison, rewards, humor, and escape from stress.

4. Reach out --- people do care --- Spend time with others.

C. Talk To People --- Talk Is The Most Healing Medicine.

1. Talk about what happened in as much detail as possible.

2. Talk about your feelings during the event.

3. However, avoid gripe and confrontational sessions.

D. If Possible, Surround Yourself With Things That Require Nurturing --- (Children, Plants, Pets, etc.)

E. Help Your Co-Workers As Much As Possible By Sharing Feelings And Checking Out How They Are Doing.

Realize those around you are also under stress.

IV. Protect Your Health With Adequate Rest, Proper Diet And Moderate Exercise.

A. Within The First 24 To 48 Hours, Periods of Strenuous Physical Exercise --- Alternated With Relaxation And Rest --- Will Alleviate Some of The Physical Reactions.

1. Exercise 30 minutes or longer at least three times a week.

2. Stay within 5 pounds of your "ideal" body-weight (considering your height and bone structure).

B. The Nutrition Almanac Recommends Supplementing Your Diet With Vitamins C, B2, B6 And Minerals, Calcium, And Magnesium.

1. Eat nutritionally balanced and wholesome meals.

2. Stay away from caffeine, nicotine, and alcohol.

C. This Is Not A Good Time To Over-Indulge In Alcohol, Drugs, Eating or Smoking.

1. Be aware of numbing the pain with overuse of drugs or alcohol.

2. You do not need to complicate this with a substance abuse problem.

3. Use medication only under doctors orders.

D. Practice Relaxation Techniques --- These Counteract The Body's Response To The Fight or Flight Syndrome.

Get ample rest.

V. Do Not Take Your Work Home With You.

A. Provide A Decompression Time Which Shifts The Energy Focus From Mental And Emotional Things To Physical or Relaxation-Related Things.

1. Exercise

2. Take a nap

3. Enjoy a hot tub or sauna

4. Have some place in your home that you can go to in order to relax and/or be by yourself.

5. Meditate upon the Scriptures at least three times a week.

B. Establish Clear Boundaries Between Work And Home Life.

1. Non-working hours should be more than an absence of work.

2. Develop a life of your own.

3. Actively pursue a hobby.

VI. Re-Evaluate Negative Situations For Positive Results.

A. Force Yourself To Find or Create A Positive In Every Situation.

B. Keep A Journal --- Write Your Way Through Those Sleepless Hours.

C. Do Not Get Caught Up In "If-Onlys" And "What-Ifs." --- Don't Second-Guess Yourself or Others.

D. Recognize And Reward Yourself.

1. Do something that you really enjoy, "just for yourself", during the course of an average week.

2. Keep lists of your daily accomplishments.

3. Celebrate the small things.

VII. Don't Take Things Personally.

A. Objectify --- Then Analyze The Situation.

B. Do Not Get Upset When People Tell You How You "Should" Feel or "Ought" To Act.

1. Remember, these are Your feelings and they are important.

2. Give yourself permission to feel rotten, and share your feelings with others.

C. Remember That Emotional Wounds Take Time To Heal And That It Is Important To Heal At Your Own Pace.

After All, You Are Unique!

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Suggested Do's And Don'ts of CISD

Depending on the Critical Incident and Post-Trauma consequences, these are examples of coping skills for debriefing participants.

DON'T DO
Drink Alcohol Excessively.

Use legal or illegal substances to numb consequences.

Withdraw from significant other.

Stay away from work.

 

Reduce amount of leisure activities.

 

Use off duty time for training immediately after the event.

Have unrealistic expectations for recovery.

Expect the incident NOT to bother you.

Don't look for easy answers.

 

Get ample rest.

Maintain a good diet and exercise.

Take time for leisure activities.

Normalize post-trauma consequences.

Find and talk to support peers or family members about the event.

Learn about post-traumatic stress disorder.

 

Spend time with family and friends.

Get extra help from a CISD.

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Definitions:

"Critical Incident Stress Debriefing"

I. Critical --- Crisis --- Any Major Distressing Event or the Cumulative Effect of several small stressors.

A. Any serious Interruption in the steady state of a person, family, or group.

B. An Emotionally Significant event which acts as a Turning-Point for better or worse.

C. A Normal Response to an Abnormal Situation.

II. Incident --- Any Change in our environment (a "Stressor") --- which may create a crisis.

III. Stress --- The word "stress" comes directly from the ancient Latin Language. It meant "Force," "Pressure," or "Strain."

A. A Response to a perceived threat, challenge, or change.

1. A physical and psychological Response to any demand.

2. A state of Psychological and/or Physical Arousal.

B. It is related to the speed at which we live, as well as the complexity of our lives.

The Surgeon General estimates that "80% of the people who die of non-traumatic causes actually die of stress diseases."

C. As we experience Increasing Levels of Distress:

1. We begin to Lose Our Mental Efficiency.

a. Concentration is difficult and we become more easily distracted.

b. We lose our Mental Flexibility and become Rigid in our views of problems and solutions.

c. Criticisms of our ideas or suggestions are viewed as Criticisms of Ourselves and we respond defensively as though we had been attacked.

2. We Lose Our Sense of Humor and can no longer laugh at ourselves or the situation.

a. Humor is one of the primary coping strategies we use to help us through traumatic events in our lives.

b. Its loss leaves us more defenseless and vulnerable to stress-induced emotional depletion.

3. Our Ability To Trust Others Lessens.

a. The foundation for most intense personal relationships is trust.

b. We fear that others will not be capable of helping us.

4. We Withdraw From People who are our Primary Support.

a. We become isolated from the very people we Need The Most.

b. A Vacuum Is An Unnatural State in Physics and also in Human emotions.

D. The Losses we encounter as a part of our stress reactions are replaced with Increased Fantasies and Wishful Thinking.

E. Stress is Exhibited in our lives in Three Stages:

1. First, By Physical and Emotional Exhaustion.

2. Second, By Apathy.

3. Third, By a Deterioration In Performance.

F. Stress is a Necessary part of our life:

1. Stress Can Be Positive. Without it we are not Creative or Productive.

a. Stress is Not designed by nature to kill, but rather to Enhance life.

b. The right kind of stress is helpful and actually Essential for a Full And Productive Life.

2. Our job is to Manage Stress --- Not Take It Away!

G. There Four Main Types of Stressors:

1. Normal Stressors:

a. Environmental Stress Factors --- External situations that pertain to nature or conditions in the responders surrounding environment.

(1) Noise --- Dirt/dust --- Pollution --- Clutter,

(2) Weather conditions --- Temperature extremes,

(3) Threat of nuclear war,

(4) Confined space --- Overcrowding --- Spectators in the way,

(5) Traffic --- Speed on calls --- Pressures of rapid response,

(6) Lighting,

(7) Swiftly expanding knowledge base --- Rapid decision making, etc.

b. Psychosocial Stress Factors --- almost anything that has to do with contact with people:

(1) Family relationships,

(2) Conflicts with fellow workers,

(3) Conflicts with the administration,

(4) Lack of appreciation from superiors,

(5) Abusive behavior by patients --- Intoxicatedpatients --- Media at the scene,

(6) Taxes --- Financial success --- The Economy,

(7) Changing values, etc.

c. Personality Stress Factors --- focus within ourselves --- relate to ways in which we think and feel --- and the memories of our past experiences --- including:

(1) The inability to say "no" to someone.

(2) The need to be liked.

(3) Guilt feelings when we don't help someone.

(4) Anxiety over our own professional competence, Extremely high expectations of ourselves.

Guilt over mistakes or not doing a perfect job,

(5) A negative mental outlook.

(6) Personal sensitivity to criticism.

(7) Pressures to achieve status --- Popularity or the lack of it, etc.

d. Adolescence Stress Factors:

(1) Pressure to make good grades --- Need to prepare for a career --- Need to develop life skills,

(2) Peer pressure --- Need to belong --- to be accepted --- to be loved,

(3) Need for recognition --- Need to establish independence,

(4) Need for a support system, (family, friends, etc.),

(5) Need to communicate effectively with adults and/or peers,

(6) Need to select a mate,

(7) Need to establish personal values and to behave consistently with those values.

e. All of these are Normal Stressors, now notice some Adnormal Stressors:

2. Acute or Incident-Prompted Stress --- Symptoms of acute stress may begin at the scene of the incident or within 24 hours following the incident.

3. Delayed Stress or Held Over Stress --- The pathological end to incident prompted stress.

a. May occur days, weeks, months, years after the event.

b. Usually, delayed stress is indicated by Biochemical Reactions and other Physical and Emotional Symptoms.

4. Cumulative Stress or Burnout --- Usually caused by a combination of a wide range of Work and Non-work stressors.

a. It occurs as a result of Prolonged Exposure to Many stressors over a long time.

b. The condition is Slow To Develop (usually taking several years to manifest itself).

c. Impending cumulative stress reactions are Predominantly Emotional in nature.

d. May lead to PTSD.

IV. Post Traumatic Stress Disorder (PTSD) ---

--- The Abnormal end result of a powerful and overwhelming stressful incident.

A. When emergency workers resort to Excessive Suppression of their emotions --- and when they Avoid Preventive Strategies such as psychological debriefings after a traumatic event --- they may be setting themselves up for PTSD.

B. PTSD is Beyond The "Normal" response to stress.

1. PTSD is a Serious Condition that can lead to Personality Changes, Illness, and even Suicide.

2. PTSD is a Pathological state and a Anxiety disorder (not a psychosis).

3. It is called a disorder because it disrupts the normal functions of one's life.

C. PTSD is a Diagnosis that can Only Be Made By psychiatrists, psychologists, and other mental health professionals.

D. However, some of the Characteristic Signs and Symptoms of Post Traumatic Stress Disorder are:

1. Disturbing memories of the event which pop to mind unexpectedly.

2. Dreams or nightmares related to the incident.

3. Feeling as if the event were happening again.

4. Psychological distress around the anniversary of the trauma.

5. Numbing of one's emotions.

6. Avoidance of thoughts or feelings associated with the event.

7. Avoidance of activities that recall the incident.

8. Loss of memory associated with important aspects of the event.

9. Feeling detached and estranged from others.

10. Loss of loving feelings toward others.

11. A sense of a shortened future.

12. Difficulty falling asleep and staying asleep.

13. Intense irritability.

14. Difficulty concentrating.

15. Startle reflexes.

16. Excessive suspicion and caution in dealing with others.

17. Physical reactions in circumstances similar to the original incident.

18. Feeling keyed up and unable to relax.

19. Loss of emotional control.

E. PTSD does Not Just Disappear by itself.

1. It may hang on indefinitely,

2. It may produce unbelievable disruption in our life:

Alcoholism --- Marital or relationship discord --- Personality changes --- Loss of one's career --- even suicide.

3. A person suffering from PTSD would be well advised to seek out at least an evaluation by a mental health professional.

V. Debriefing --- A Peer driven, Clinician guided, group discussion of a traumatic event.

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Why CISD Works:

I. Peer Support Produces Psychological Support And Stability.

II. Actively Talking About Traumatic Experiences Leads To Reduction In Stress Arousal.

III. Providing A Designated Time And Forum To Express Worries Tends To Reduce The Frequency Of Intrusive Worries At Other Times Of The Day.

IV. Group Format Allows A Sharing Of Similar Reactions Dispelling The Fear Of Unique Vulnerability.

V. Structured Interventions Counteract Fears Of Ambiguity And Loss Of Control.

VI. Group Format Allows Sharing Of Successful Coping Strategies.

VII. Organized Effort Like CISD Demonstrate That Someone Cares.

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Lessons We Have Learned:

I. CISD is Not Psychotherapy.

II. The Population is Normal --- the Events they experience are Abnormal.

III. Debriefing --- a Peer Driven Clinician Guided group discussion of a traumatic event.

IV. CISD has Psychotherapeutic Elements.

V. CISD is Not helpful After the traumatic Event Has Become Fixed --- (Best time is after 24 hours --- before 72 hours)

VI. Most debriefing Lose Effectiveness After 8-12 Weeks.

A. Every day it goes by makes it less effective.

B. After 16 weeks you may do more harm than good.

VII. Debriefings Average 2-3 Hours. All personnel involved ventilation / information.

VIII. Never Probe Excessively.

(If it is a therapy issue it will come up later)

IX. Do Not Pursue Personal Items.

X. Respect The Right of Refusal.

(Required to tell them so)

XI. Do Not Embarrass Participants.

XII. CISD's Are Positive:

A. Short term

B.

C.

D. Educational

E. Sources of information

F. Encouragement for post-

G. Group relationship

H. Confidential

I. Used only when necessary.

XIII. Emergency people always Need To Be In Control.

XIV. Don't forget Special Groups:

A. SWAT Team

B. Corrections

C. Task Forces

D. Dispatchers \ Alarm Office

E. SAR (Search & Rescue)

F. Forest Fire Fighters

G. Command Staff

H. Overhead Teams

XV. Common CISD Mistakes:

A. Interruptions

B. Over-reacting

C. Under-reacting

D. Trying to do therapy

E. Probing

F. Not using silences --- (Allow silences to work)

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Ineffective Use of Peers:

1. Giving too much advice

2. Teaching off topic

3. Stopping effective anger

4. Not allowing questions

5. Limited summary comments

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Debriefing

(Critical Incident Stress)

Introduction:

Surviving Trauma: When To Seek Help

Use the following guide to help you know when the survival of a critical incident should be referred for post-trauma counseling.

A. When The Traumatic Event Involves:

1. Several Wilson chart ingredients at mid to high intensity.

2. or, One or more ingredients at very high intensity.

3. or, Any catastrophic events.

4. or, Any first very bad run or call.

B. When The Post-Trauma Symptoms:

1. Have not subsided in two or three days.

2. When numbing or withdrawal persists.

3. When Intrusive Recollections, flashbacks or sleep difficulties persist.

4. When there is a marked reduction of interest in one or more significant activities of the involved people.

I. The Critical Incident

A. The Situation

Any event which is extraordinary and produces significant reactions in emergency personnel.

B. Incident Examples:

1. Serious injury or death in the line-of-duty.

2. Suicide of an emergency person.

3. Serious multiple-casualty incident, especially where equipment and personnel are insufficient.

4. Hazardous material incident (even blood, body fluids).

5. Serious injuries or death of child or infant.

6. Events with excessive media interest --- extremely unusual attention to event.

7. Victims known to the emergency person.

8. Similarity of the victim to one's friends / relatives.

9. Death to a civilian caused by emergency operations such as an accident between the civilian's car and the responding emergency vehicle.

10. Human Sound of Pain --- (2000 - 4000 htz. are Painful to the human ear and Human Screams are at about 3000 htz.)

II. Types of Critical Incident Stress Debriefings:

A. On-Scene or Near-Scene Debriefing.

1. Provide One-On-One assistance with those emergency service providers who are obviously distressed.

2. This assistance is limited and Brief.

3. Observe the responders for signs of Fatigue or severe Stress reactions and act as an Advisor To Management if he/she feels particular individuals or crews should be relieved from duty.

4. Keep a Low Profile during this intervention.

5. Assistance to Victims and Family Members to help reduce possible Interference with emergency operations.

B. Initial Defusing

1. Purpose is to Stabilize the emergency service providers who have just worked an incident.

2. Allows for an initial Ventilation of feelings.

3. Detailed discussion providing Support and Reassurance.

4. Closure stage where Resources are mobilized.

5. Allows CISD team member to determine if a Formal Debriefing is Needed.

C. Formal CISD

1. Usually following 24 hours or more delay

2. Should be mandatory:

a. Serious line-of-duty injury or death.

b. Major disaster or major multi-casualty incident.

c. Peer suicide.

3. General Format:

a. Introduction phase --- Setting the stage

b. Fact phase --- Telling the story

c. Feeling phase --- Looking at the consequences of survival

d. Symptom phase --- Understanding the consequences of survival

e. Teaching phase --- Contracting for recovery

f. Re-entry phase --- Closing and evaluating

4. Three to four hours to cover all six elements

D. Follow-Up CISD

1. Several weeks or months after incident

2. Performed with group or portion of initial group

3. May take several sessions

E. Post-Trauma Consequences --- What To Do About Flashbacks:

1. Remember ....

2. Flashbacks may follow a "Trigger" .....

3. Learn how to talk to yourself .....

4. Learn how to talk to others ....

5. Flashback interference .....

III. Difficult Debriefings

A. Symbolic Debriefing.

1. When a current incident reminds a group of one or more powerful Past Events.

2. The group Shifts The Emphasis from the current incident to the past incident(s).

3. Trigger Mechanism --- what got you to thinking about the past incident?

B. Multiple Incident Debriefing.

C. Multiple Line of Duty Deaths.

D. Family Members Present.

E. Infiltration of Old Events (Personal Events)

F. Hysterical Reaction.

(Team-member takes them out)

G. Intoxicated Subject.

H. Highly Resistant Personnel or Administration.

1. Only allows one hour.

2. "It appears that you want this ..... to fail --- set-up to fail.

I. The Obstructionist.

J. The Soap Box. --- (Has an ax to grind)

1. Stop it --- don't let it go on.

2. "That's not the reason we are here.

K. The Obsessive Talker.

L. Eaters and Smokers.

M. Pagers and Radios.

1. Turn them off.

2. If required to have --- use earphones.

N. Media Relations.

1. Limit Contact

2. Provide Information

3. Proactive

4. Debrief Separately

5. Use To Contact The Public

6. Emphasize Normal Maintenance

7. Coordinate With Organization


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Debriefing

I. Introductory Phase:

A. Identify Yourself.

B. Describe What You Are There For.

1. To mitigate the impact of a critical incident.

2. To accelerate normal recovery and enable participants to return to work.

3. Gives participants a chance to vent their emotions about what happened.

4. Provides emotional reassurance and reduces the fallacy that their stress reactions are abnormal or unique.

5. Adds to or restores group cohesiveness.

6. Provides stress symptom information and forewarns those that have not been impacted that they might be later.

7. Serves as an opportunity for identifying those individuals which may need more assistance with stress management.

C. Introduce Other Counsellors.

D. Ground Rules of the game:

1. The Team Leader is in charge --- There is No Rank in the room.

2. No radios or beepers, and No Breaks will be taken

3. No note taking, tape recording, nor media personnel

4. Participants who choose to speak should speak for themselves only.

5. Participants must maintain strict confidentiality.

(This is not an investigation or operational critique of the incident)

6. Participants do not have to talk except for introducing themselves and telling what their job was at the incident.

7. Participants should not tell us about violation of regulations

E. Now, "Is There Anybody In This Room That Shouldn't Be Here?"

II. Fact Phase --- Task Oriented.

A. People Introduce Themselves And Describe Roles.

B. Structured, What Role Did You Play?

C. Establish Competence In The Individuals, Celebrate Successes.

III. Thought Phase --- What You Thought.

When did your first thoughts come up and what were they?

(Instead of reacting automatically because of your training --- you begin to think about it)

IV. Reaction Phase.

A. What was the worst part of the event for you to deal with?

B. "The part about the event that bothered me the most was ..."

C. The team leader encourages participants to share as they wish.

Out Cry --- Anger --- Denial --- Intrusion

V. Symptoms: --- (Left-overs)

What symptoms of stress did you experience as a result of the incident?

VI. Teaching Phase --- Hand Outs:

A. Discuss any stress symptoms which participants may experience but did not mention in the symptoms phase.

B. Re-affirm that all the symptoms discussed are normal reactions to the stress they have experienced.

C. Emphasize that the participants are normal people responding in a normal way to abnormal circumstances.

D. Discuss positive coping techniques.

E. Distribute handouts containing stress information.

VII. Re-Entry

A. Answer any questions participants may have.

B. Ask participants if anyone has anything to say which he/she did not say earlier.

C. Ask participants if anyone could find anything that they consider to be positive.

(Summary --- Comments by each debriefer)

Celebrate Accomplishments

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Questions & Answers

1. Q. Define the term "Critical Incident Stress."

A. The extreme stress reactions that emergency personnel experience after particularly stressful or "critical" incidents.

2. Q. Why is a certain amount of stress Natural and Necessary to perform you job?

A. Stress often contributes to the Mental Alertness and Physical Readiness you need to Respond Quickly and perform your job Efficiently during emergencies.

3. Q. List Five Incidents that often cause critical incident stress reactions.

A. Any five of the following:

a. Injury or death of a co-worker.

b. Incident where responder's own life or safety is threatened.

c. Death of a child, especially at the hands of an adult.

d. Mass casualty incident (auto accident, plane crash or other disaster), especially when triage is difficult.

e. Incident where victim is someone whom the responder knows or who reminds the responder of someone.

f. Victim's death despite a prolonged rescue attempt.

4. Q. The Four Types of Warning Signs of critical incident stress are Physical, Mental, Emotional and Behavioral, list Four of the possible Physical Warning Signs.

A. Any four of the following:

a. Elevated respiration or heartbeat.

b. Chest pains.

c. Nausea or diarrhea.

d. Muscle aches or tremors.

e. Dizziness or lack of coordination.

f. Excessive sweating or chills.

g. Headaches.

h. Difficulty sleeping.

5. Q. List Two of the Mental Warning Signs of critical incident stress.

A. Any two of the following:

a. Relive the event over and over.

b. Have nightmares about it.

c. Have difficult remembering things.

6. Q. List Three of the Emotional Warning Signs of critical incident stress.

A. Any three of the following:

a. Feel anxious or afraid.

b. Be easily startled.

c. Feel very angry or frustrated.

d. Feel guilty about the event.

7. Q. List Two of the Behavioral Symptoms of critical incident stress that a person may exhibit While On Duty At An Emergency.

A. Any two of the following:

a. Have Difficulty Concentrating.

b. Be overly active without accomplishing much.

c. Freeze up when faced with tasks.

8. Q. List Three of the Behavioral Symptoms of critical incident stress that a person may exhibit At Any Time.

A. Any three of the following:

a. Irritability or anger.

b. Marked difference in personality or personal habits.

c. Calling in sick more often.

d. Avoiding anything connected with the event.

e. Excessive drinking or drug use.

9. Q. How can stress affect Your Home Life?

A. Family members do not always understand how stress affects emergency personnel and misunderstandings may result. Continued tension can cause domestic problems.

10. Q. Chronic stress can adversely affect your health. List Three of the Five Major Illnesses that have been associated with stress.

A. Any three of the following:

a. Heart disease

b. Coronary artery disease

c. Diabetes

d. Peptic ulcers

e. Cancer

11. Q. Methods for reducing the effects of critical incident stress are called __________ __________ techniques.

A. Stress-coping

12. Q. Stress-reducing methods are used in Three Settings: in Groups, One-On-One, or On Your Own. What is the name of the stress-reducing method used in Groups?

A. Critical Incident Stress Debriefing

13. Q. What is the purpose of a critical incident stress debriefing?

A. To give all personnel involved in a critical incident a chance to react to the event and put it into better perspective.

14. Q. What is the Single, Most Important Ground Rule of a critical incident stress debriefing?

A. Maintaining confidentiality.

15. Q. One-On-One stress coping techniques usually take the form of discussions with co-workers after a critical incident. List Four Tips for Discussions with a co-worker.

A. Any four of the following:

a. Don't be afraid to ask how someone is doing.

b. Be prepared to just listen and say nothing.

c. Don't take anger or other reactions personally.

d. Share your own feelings about the incident.

e. Try not to impose our own ideas about why an incident happened.

f. Don't tell them they're lucky it wasn't worse.

g. Don't brush off the incident or encourage co-workers to "just forget about it."

h. Encourage co-workers to take advantage of employee assistance services.

16. Q. List Two Personal Coping Techniques that can be used During Critical Incidents.

A. Any two of the following:

a. Practice deep breathing.

b. Take breaks during prolonged incidents.

c. Concentrate on teamwork.

d. Use humor appropriately.

17. Q. What is the benefit of Vigorous Exercise after a critical incident?

A. Vigorous exercise relieves stress by putting your excess energy to good use.

(Discussion Point: Regular, vigorous exercise stimulates the release of natural body tranquilizers called endorphins. Consistent exercise will reduce the physical and psychological build-up of stress.)

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Quiz

1. (True or False) If you are experiencing stress due to difficulty in your personal life, it can contribute to work-related stress.

_X_ a. True

___ b. False

2. Check all the items below that add to the stress of a critical incident.

_X_ a. The high visibility of emergency response work.

_X_ b. The possibility of being sued later for treatment choices.

_X_ c. Depersonalization.

3. Check all the items below that apply to critical incident stress.

_X_ a. Delayed reactions to a critical incident may show up in a day, a week, or even months after the incident.

___ b. Individual reactions to critical incidents do not vary greatly.

_X_ c. Stress reactions can occur even if a particular incident is not that devastating.

4. Check the statements below that apply to the warning signs of critical incident stress.

_X_ a. Some individuals may never show any outward signs of stress, even though they may be severely stressed.

___ b. If left untreated, chronic stress will not adversely affect mental and physical health.

_X_ c. The warning signs of stress may be physical, mental, emotional or behavioral.

5. Choose the description below that best describes "depersonalization".

___ a. Emotional detachment an emergency responder may feel as a result of the stress of a critical incident.

___ b. Refusal to accept reality exhibited by victims of traumatic incidents after an extreme shock such as losing a loved one.

_X_ c. Technique in emergency response work that allows emergency personnel to put emotional distance between themselves and their victims.

6. In extreme cases, untreated stress can accumulate and may lead to (check all that apply):

_X_ a. Poor performance on the job.

_X_ b. Dissatisfaction with your job.

_X_ c. Job burnout, which could cause you to quit or be fired.

_X_ d. Relationship problems.

7. (True or False) Research shows that stress slows down the immune system, increasing susceptibility to colds and other illnesses.

_X_ a. True

___ b. False

8. As stated in the videotape presentation, there are five phases of a stress debriefing. For each description below, write the name of the correct phase. (Each phase may be used more than once.)

a. ___Reentry_____ Wraps up the session and describes how to obtain further assistance.

b. ___Fact________ Participants recall their role in the event to recreate the "big picture".

c. ___Reaction____ Allows participants to relate how they were feeling during and after the incident.

d. __Introduction_ The mental health professional explains the purpose of the debriefing and emphasizes confidentiality.

e. ___Teaching____ The facilitator explains that stress reactions are a normal, human response to abnormal events.

f. ___Reentry_____ Debriefing leader or peer counselor explains departmental employee assistance programs.

g. ___Teaching____ Provides information about the warning signs and stress-coping techniques.

9. Check all items below that describe pre-incident activities that reduce stress reactions after critical incidents: (check all that apply)

_X_ a. Training classes that improve procedural knowledge.

___ b. Deep breathing.

_X_ c. Review and reinforce standard operating procedures.

10. After a critical incident, talking things over with people you trust allows you to __________ your feelings. (select the best answer)

___ a. Control

___ b. Ignore

_X_ c. Ventilate

___ d. Pacify

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San Francisco Earthquake - 10/17/89

Randy Shilts, --- Full time Reporter for the San Francisco Chronicle, and one of the lead reporter covering the San Francisco earthquake 10/17/89, and author of the best selling book, "And The Band Played On;" as he appeared on "Nightline" with Ted Coppel said:

"People in the neighborhoods then started getting together, and turning to each other for support. Neighbors who never met each other, started getting to find out who their neighbors were as they begin to do what neighbors are suppose to do, which is to take care of each other.

You know we live in a humanistic age. And I think we all believe that, as human beings, we are the masters of the universe. You know, it was much easier for the people who lived in the dark ages to cope with things like earthquakes because they believed that they were nothing more than the pons of forces that were beyond their control. But we, in our enlightened age, have come to believe that we are the master of everything. People don't get sick because we have antibiotics. You know, we have clean water and we have heat, we have all these things that we never question and then something like this (earthquake) happens; and you realize that, you know, we are small creatures still."


Then Ted Coppel turned to:

Robert Maynard, --- editor president Oakland Tribune

and asked him to comment:

"I was touched by Randy Shilts' last line that we are reminded by this event that we are small creatures still. Despite the fact that we travel to space and we have conquered diseases and done so many things that make us seem so smart. Nature has a way of reminding us of the overwhelming power and force that has shaped the universe and we felt something of that force the other day and I think that we all are sobered, humbled, and perhaps a little matured by what we saw. --- ... every once in a while, nature comes alone and reminds us that what ever we may do nature has the upper hand when all is said and done.

How To Stay Stressed?

Physical:

1. Don't Exercise.

Exercise wastes a lot of time you could be spending on stress-building activities. Exercise does nothing but tone up your muscles, improve your cardiovascular system, relax your body and change your brain chemistry to provide a natural high.

2. Eat Anything You Want --- Stay Overweight.

Ignore what the doomsayers claim about excessive cholesterol, fats, sugar, salt, red meat, vitamins, and fiber. To maximize the effects on stress on your body, especially your heart, try to stay at least 15% over your recommended weight.

3. Take Plenty Of Stimulants.

The old standards will do: caffeine, sugar, and cola. They cause a mini stress response and gets the adrenaline flowing.

Personal:

4. Get Rid Of Your Social Support System --- Be "Macho."

The mounting evidence that a strong social support system improves your physical health, psychological well being and probable life span should put you on guard. Don't call your friends when you have problems, let them call you. Be your own man.

5. Take All Criticism Personal.

If anyone disagrees with you, no matter how much they may deny any personal intent, don't believe them. They are mounting a personal attack on you. Don't waste time listening objectively or asking questions to clarify their meaning. Be offended.

6. Throw Out Your Sense Of Humor.

Take your choice: Either enjoy your sense of humor, or enjoy being stressed out. Humor give you distance from your problems and makes a creative solution more likely. The Bible even tells you that laughter has a positive effect on your body.

Professional:

7. Become A Workaholic --- Be A Perfectionist.

It's very easy to do. Just put your work in front of everything else. Be sure to take plenty home with you, and remind yourself that vacations or sabbaticals are for sissies. Expect everything to be perfect every time.

8. Reject Good Time Management Practices.

You can put a lot more pressure on yourself if you'll just:

1. Do the little things first and worry about the big ones whenever you get a chance --- Do projects in whatever order feels good.

2. Be constantly available to everyone, no matter what else you have to do --- let other people's priorities manage your day.

3. Avoid being the least bit assertive in getting your own family time needs met.

9. Avoid Setting Personal And Work Goals --- Procrastinate.

If you're naive enough to set goals, you run the risk of putting your life and ministry into perspective. Be sure when you do set goals to make them impossibly high, and then berate yourself when you don't meet them. Remember, put things off until the last minute, then you can work better under pressure.

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Stats That You May Contribute To:

1. 30 Million Americans have some form of Major Heart or Blood-Vessel Disease ----- 1 Million Americans have a Heart Attack every year.

2. 25 Million Americans have High Blood Pressure.

3. 8 Million Americans have Ulcers.

4. 12 Million Americans are Alcoholics --- $15.6 Billion are lost by American industry each year because of Alcoholism.

5. 5 Billion doses of Tranquilizers --- 3 Billion doses of Amphetamines --- 5 Billion doses of Barbiturates are prescribed Each Year.

6. $19.4 Billion are lost by American industry each year because of Premature Employee Death.

7. $15 Billion are lost by American industry each year because of Stress-Related Absenteeism.

8. $700 Million are spent each year to Recruit Replacements for executives with Heart Disease.

The Fulfilled & Balanced Life

For those of you who, instead of being stressed out, desire a fulfilled and balanced life; there are three things you must know. Man is a triune being (mind, body, and spirit) and all three aspects of your being must be provided for. Otherwise, your life is out of balanced and you will be stressed out.

1. Mind --- If you do not provide for and exercise your mind with mental gymnastics, you cease to be creative. This is why school children must take subjects they are not interested in, to train their minds to think. You can't have a fulfilled and balanced life if you cannot think and be creative.

2. Body --- Bind you arm to the side of your body for a year and you will loose all use of it. The muscles will deteriorate and become very weak. Whereas, exercise tones up your muscles, improve your cardiovascular system, and relaxes your body. You cannot have a fulfilled and balanced life if you are weak and sick all the time. Exercise at least thirty minutes, three times a week.

3. Spirit (Soul) --- If you do not provide for your soul, you are spiritually dead. Many millionaires, movie stars, celebrities, and others who "have it all" end up committing suicide because, to them, life is not worth living. Why? Because man is a spiritual being and without God, there is an emptiness that nothing in this world can fill. There is no way to live a fulfilled and balanced life without God. If you provide for your mind & your body but neglect you soul, you are unbalanced.

Matthew 16:26, "For what is a [man profited], if he shall gain the whole world, and lose his own soul? or what shall a [man] give in exchange for his soul?"

As you decide what God you are going to serve, why not choose the One And Only True And Living God? Why serve a god made of wood, stone, silver, or even gold, who cannot see, hear, speak, or help you in any way? Why not get real?

Acts 17:27-31, "That they should seek the Lord, if haply they might feel after him, and find him, though he be not far from every one of us: {28} For in him we live, and move, and have our being; as certain also of your own poets have said, For we are also his offspring. {29} Forasmuch then as we are the offspring of God, we ought not to think that the Godhead is like unto gold, or silver, or stone, graven by art and man's device. {30} And the times of this ignorance God winked at; but now commandeth all men every where to repent: {31} Because he hath appointed a day, in the which he will judge the world in righteousness by <that> man whom he hath ordained; <whereof> he hath given assurance unto all <men>, in that he hath raised him from the dead."


Some People Are Stressed By Choice!

If there is ever a flood that can be compared to Noah's, it is the flood of self-help material on the subject of stress management and "burnout." What has been the net result of these stress management and wellness programs? In many cases they have provided little or no help, because most individuals actually want to stay stressed. In other words, they are stressed because quite often it meets a need for them. Here are some benefits of staying stressed out:

1. Stress Helps You Seem Important.

Anyone so obviously stressed as you are must be working very hard, day and night. Your work must be very crucial, and you must be almost indispensable to the success of your business. Such stress may shorten your life but it sure makes a terrific impression on people.

2. Stress Helps You Maintain Personal Distance And Avoid Intimacy.

Anyone so busy, as you obviously are, cannot be expected to form emotional attachments, either professionally or personally. This lets you avoid all of the emotional hassles which intimate relationships often require. Besides you don't need relationships for your "highs." Stress is the cheapest drug on the street. Since adrenalin is chemically similar to amphetamines, you can give yourself a "hit" any time you choose.

3. Stress Helps You Avoid Responsibilities --- And Success.

First of all, you are too stressed to be given any more work to do. Second, you are stressed enough that you don't have the time or energy to be bothered with unimportant stuff. Stress can keep your performance level low enough that success won't be a threat. Why take the risk of being "successful" --- more responsibility, higher expectations, changes in life style, risky decisions, more people to care for? Who needs it?




If You Are Not Saved, Nothing Else Matters
There Is No Second Chance After Death!
Hebrews 9:27

                                                          

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