Identifying sources and symptoms of stress

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The Headington Institute provides psychological and spiritual support to humanitarian aid and disaster relief personnel worldwide.

Introduction: Identifying sources and symptoms of stress

Identify participants’ own sources of stress

Here are some possible activities to help participants identify their sources of stress:

Ask the group to list the top 10 causes of stress for them in their work
If some people might dominate discussion, each person could be asked to list the top three work stressors for them. They could make notes for themselves, or they could write or draw a picture to illustrate each stressor and stick them on a wall or flip-chart sheet.

Identify stress symptoms

Divide the participants into groups. Ask each group to list signs that might indicate that someone is under stress. Give examples and prizes if it helps discussion. All of the following could be considered signs of stress.

Signs of stress

Physical

Tiredness; Difficulty sleeping, or else spending a lot of time in bed; Nightmares; Headaches; Back pain; Inability to relax; Dry mouth and throat; Feeling sick or dizzy; Pounding heart; Sweating and trembling; Stomach-ache and diarrhea; Loss of appetite, or over-eating; Feeling very hot or cold; Shortness of breath; Shallow, fast breathing; Hyper-vigilance; Irregular menstruation; Frequent need to urinate; Increased risk of ulcers, high blood pressure and coronary heart disease.

Emotional

Depression; Tearfulness, or feeling a desire to cry but being unable to; Mood swings; Anger (at self or others); Agitation; Impatience; Guilt and shame; Shock; Feelings of helplessness and inadequacy; Feeling different or isolated from others; Feeling overwhelmed or unable to cope; Feeling rushed all the time; Anxiety; Panic or phobias; Loss of sense of humor; Boredom; Lowered self-esteem; Loss of confidence; Unrealistic expectations (of self and others); Insecurity; Becoming self-centered, and unable to think about others; Feelings of vulnerability; Feeling worthless.

Behavioural

Withdrawal from others or becoming dependent on them; Irritability; Critical of self and others; Relationship problems; Lack of self-care; Nail biting; Picking at skin; Speaking in slow monotonous voice, or fast, agitated speech; Taking unnecessary risks (e.g. when driving); Trying to do several things at once; Lack of initiative; Working long hours; Poor productivity; Loss of job satisfaction; Carelessness; Absenteeism; Promiscuity, or loss of interest in sex; Increased smoking or use of alcohol or drugs (including prescription drugs); Excessive spending or other activities to try to take one’s mind off the situation; Loss of motivation; Self-harm or suicidal behavior.

Thought patterns

Concentration and memory difficulties; Indecisiveness; Procrastination; Pessimism; Thinking in ‘all or nothing’ terms; Very sensitive to criticism; Self-critical thoughts; Loss of interest in previously enjoyed activities; Imagining that the worst will happen; Preoccupation with health; Expecting to die young; Inflexibility; Confusion and disorientation; Excessive fears (e.g. about being attacked); Trying to avoid thinking about problems; Avoiding any reminders of a traumatic experience; Flashbacks, or intrusive thoughts about difficulties; Hindsight thinking (‘If only...’ ‘why didn’t I...’); Negative thoughts about oneself, one’s work, family, the future, and the world; Time seems to slow down or speed up; Suicidal thoughts.

Spiritual/Philosophical

Questioning the meaning of life; Loss of purpose; Loss of hope; Changes in beliefs; Doubts; Giving up faith; Legalism; Rigidity; Cynicism; Loss of sense of community with others; Sense of being abandoned; Submission to excessive control (e.g. may join a religious cult); Spiritual dryness; Unforgiveness; Bitterness; Feeling distant from God; Difficulty praying; Anger at God or at life.

Provide teaching about signs of stress

You might want to use list of signs of stress as a handout (follow these links to download handouts in English and Spanish).
Point out that no one person will have all these signs, but if someone has several of the signs it might be due to stress and they may benefit from making some self-care changes.
Acknowledge that some symptoms may also be due to illness or other causes.
Encourage discussion of these points, and ensure that people have a chance to ask questions. Possible discussion questions are:
- What do you think about this?
- How many of you have had some of these signs or know others who have?
- Has anything you’ve learned today so far surprised you?

The important thing for the group to learn is that it is normal to have these signs of stress when you are involved with humanitarian work (or live in a stressful environment). It is not a sign of weakness or a sign that you are ‘going mad’. Keep making this point, perhaps asking the group to say together in their own language, ‘It is normal’. Provided several members of the group acknowledge that they have at least some signs of stress, group discussion is a great way to ‘normalize’ signs of stress.

In some cultures there is a lot of stigma about showing ‘weakness’, and people do not readily talk about emotional distress. This presents a challenge to any attempt to show that stress is normal. Consider how best to overcome this within the culture (e.g. small group discussion; individual reflection; whole group discussion; indirectly through stories; setting an example by the trainer disclosing their own experience of stress; using language which makes it more acceptable like “frustration” or “tension” or “pressure”).

Stop and Think

Which of the signs of stress do you recognize in your everyday experience?
Which do you think your national staff would recognize from theirs?
How easy would they find it to talk about their own stress in a training workshop?
How can you make it easier for them?

Next: Stress-management: Removing the cause of stress