FACING EMPLOYEE TRAUMA,
By Karen A. Sitterle, Ph.D. and John E. Deleray, Ph.D.
Without warning, your company faces a crisis that threatens the lives or well-being of everyone it touches. It can come in many
forms -- from a natural disaster such as a hurricane, earthquake or flood to a human-caused crime, perhaps a homicide or hostage
Such an event can explode suddenly at any organization anywhere at any time. It will be a critical turning point, the sort of defining moment that in many ways describes what kind of company you are and the ability of its leadership. In most instances the future fortunes of your company will be involved.
Your response will answer, in the minds of many, key questions. Was the company really concerned about its employees (or customers)? Was management prepared to move quickly to head off long-term problems for employees, customers and the organization itself? Was the response genuinely aimed at helping those involved, or simply a transparent attempt to avoid future litigation? Was management concerned about the effects of the incident on families of the victims? Did management move with foresight to control the overall situation, or did it simply react to each new ramification as it arose?
Early intervention by trained psychologists is needed in such cases--the sooner the better--to deal with post-traumatic stress disorder, a common occurrence in individuals overwhelmed by a sudden crisis that threatens death or serious injury.
When such an event occurs, management is actually faced with a "win-win" choice for recovery, although recognizing it in such a positive light may be difficult, if not impossible, at the time. Providing swift professional intervention can help employees recover and return to normalcy. It can prevent future emotional problems.
For the company, quick intervention can reduce the need for lengthy and more costly aftercare. Dollars also are saved as employees return to work faster and are less likely to develop chronic problems such as absenteeism and illness that often follow a critical incident. Your organization will be favorably perceived as one that is sensitive to the needs of people.
A study by Dr. George Everly of Harvard University shows a pattern of substantial savings when crisis intervention takes place soon after an event. The study found that where professional treatment is available within 24 to 72 hours of an incident, costs average about $5,000 per individual. When help is delayed beyond three or four weeks, costs associated with treatment, time lost from the job, disability and rehabilitation can escalate as high as $200,000 or more per individual.
Of course, the most important reason of all for providing such help is that it is the right thing to do. You know it, your employees know it, and the public that observes your actions knows it.
Within 48 hours of a workplace crisis, there is a potential for employees to side with or against the company. They can tighten their emotional ties to the company, or they can jump ship. We call that time frame in which these decisions are reached the "trauma membrane." During the 48 hours that the membrane remains open, employees, reacting to events and finding ways to cope, make decisions about their organizations. Mentally and emotionally, they may move back and forth through this membrane. But after 48 hours that membrane closes; attitudes are hardened and decisions are solidified, consciously or subconsciously. The employees who are left outside are likely to be less loyal and less committed to the organization and its goals. Obviously, the actions of a company within this 48-hour window are critical as employees come down for or against the company.
A convenience store worker had been murdered in a store robbery. The supervisor looked for advice on how to deal with the other employees and the family of the slain worker.
A psychologist met with the stores other employees and made several suggestions. The district supervisor was told to attend the funeral, representing the company. He talked to the victims survivors and offered the companys help wherever needed. The store closed for a brief period of time. Employees were given the opportunity to continue working at that store after it reopened, or being assigned to other stores in the same chain.
The supervisor made the best of a tragic situation. When the store reopened, after meetings with the psychologist every employee elected to remain with the company. The father of the victim made a special point of thanking the supervisor for his concern. No legal action against the company was taken by the family of the victim, even though it is common for survivors to sue and win large settlements in similar convenience store incidents.
After a critical incident when accountants total up the net financial impact of a disaster, they likely will overlook the soft dollar costs caused by the psychological impact on workers. But those expenses subtract from the bottom line just as much as the price of repairs and cleanup to the physical plant. Employees feel unsafe and insecure and do not want to return to work and call in sick instead. They are less motivated and production drops. Some people quit their jobs, resulting in costly turnover. Many more health claims are filed, and the number of workers compensation claims rises.
Events that trigger post-traumatic stress disorder might range from an automobile accident to a shattering explosion. Sexual assaults, robberies, suicides of close friends or co-workers, on-the-job homicides, earthquakes, floods, fires, hurricanes or tornadoes, multiple-injury accidents, or violent crimes all can cause post-traumatic stress disorders.
The way individuals respond is governed by many factors, such as the duration of the critical incident, the distance the individual is from the impact area, the type and cause of the incident, the number of deaths or injuries, media coverage and the post-incident environment. Furthermore, individual risk factors include such things as age, general health, and any disabilities that might affect a response to a sudden crisis. Previous exposure to critical incidents and other traumatic experiences also are factors that might govern individual stress reactions.
These acute reactions might be physical, such as disturbed sleep, headaches, trembling, dizziness or fainting, chronic fatigue, increased susceptibility to allergies, flu or colds, changes in appetite or weight, frequent bouts of nausea and upset stomachs, and vague body complaints such as muscle aches and pains. Psychological reactions often include feelings of helplessness, depression or sadness, apathy, uncontrolled mood swings, frequent irritability, anger and hostility, periods of crying, feelings of frustration, and survival guilt.
Cognitive reactions also are common, such as trouble concentrating and remembering, difficulty making decisions, rigid thinking and loss of objectivity, confusion, nightmares, questioning of spiritual beliefs, loss of judgment, preoccupation with the critical event, and even amnesia.
Behavioral reactions from such incidents might be isolation from others, increased use of alcohol or drugs, increased conflicts with family and co-workers, hypervigilance and startled reactions, and avoidance of any reminders. Individuals also might have either a sudden increase or a sudden decrease in appetite. Frequently they will be reluctant to return to work.
Such signs and symptoms, seen within 24 hours after a critical incident, should be regarded as completely normal, but they are warnings. Although they do not indicate physical or mental illness, they show a need for corrective action.
Delayed stress reactions also may appear weeks or months after an event. The signs and symptoms may be just as real and painful, but because they occur after a considerable period of time has elapsed they sometimes are not as easy to detect and attribute to the critical incident. A person who appears to have few reactions immediately after a crisis might display the symptoms months or even years later, often when some other event triggers such a response.
Individuals involved in such an incident often bring to the event a personal background of cumulative stressful situations to which they have been exposed over a period of time. Events unrelated to the immediate crisis are factors that may strongly influence a person's reaction when unexpectedly confronted with a new emergency. Anyone who has recently experienced stressful events--for example, the death of a child, parent or spouse, or a divorce, or perhaps involvement in a legal tangle that might bring jail or financial ruin--is likely to experience a more stressful reaction to a crisis than others who have not undergone such emotion-wrenching happenings.
It should be assumed that in almost all cases, there will be a ripple effect in which people who are not direct victims of the disaster become affected, either because of their relationship to a victim, their own job, or even through media coverage. These people are considered secondary or hidden victims, rather than the primary victims. They may show many of the same reactions that are suffered by primary victims.
Immediately following a disaster, some victims may be hysterical with symptoms such as screaming or moaning, uncontrolled weeping, fainting, nausea, amnesia, paralysis, emotional instability and extreme anxiety. More common and not as easily detected is the subdued victim--an individual who shows an overall lack of activity, sitting and staring into space, or wandering aimlessly. Such a person may be virtually paralyzed by fear and often has very serious emotional damage that must be treated immediately.
At the scene of a disaster some individuals, typically as many as 25 percent, will be functioning adequately. They will show no signs of shock and may assist other victims and rescue workers. Such victims still need help, although not as immediate as the other two categories.
If these early stress reactions are ignored or left unattended, they can develop into a serious post-traumatic stress disorder. This is a condition that can lead to personality changes, illnesses and suicides. It can be diagnosed by a professional and treated with preventive strategies.
Recent experience has shown that any organization--no matter how large or small it may be and no matter where it is located--can be struck by an unexpected disaster. Organizations that cope most effectively almost always are those that have prepared in advance and have an up-to-date and comprehensive crisis plan. Many companies have plans covering such things as continuality of management and resumption of operations and services. To such preparations should be added training and planning for psychological support services and also a crisis communications plan. Key employees and supervisors should be trained to deal with emergencies, and internal crisis management systems should be put in place. Trained professionals are available to help organizations with such preparations.
Emergency services workers who respond regularly to crisis situations, or hospital emergency room personnel who deal with human tragedy on a daily basis, are especially at risk for cumulative stress. Jeffrey T. Mitchell, Ph.D., of the University of Maryland, Baltimore County, has established a Critical Incident Stress Debriefing (CISD) process aimed at preventing or mitigating post-traumatic stress among these people whose jobs expose them frequently to emergencies and other stressful situations. CISD, structured psychological debriefings conducted in small groups, now is widely used by professionals dealing with emergency service personnel. Although the original targets were public safety, disaster response, military and emergency service personnel, Mitchell says CISD can be used by skilled intervention teams dealing with any population segment, including children.
A CISD debriefing should be led by a mental health professional who has special training in debriefing techniques and trauma. The debriefer/psychologist meets with the group of affected persons, who will discuss the event and their reactions to it. The purpose of the discussion is to make participants relive the incident with others who went through the same thing, rather than bottling up their emotions. The debriefer/psychologist also will educate and instruct group members on how to recognize and cope with their reactions.
John E. Deleray, Ph.D., is a clinical psychologist at the University of Texas Southwestern Medical Center. Karen A. Sitterle, Ph.D., is a clinical psychologist who specializes in the treatment of post-traumatic stress disorders.
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