Self-Study Unit

Introductory Module:
Stress and humanitarian work

Prof.Dr.Aung Tun Thet

Based on materials prepared by Headington Institute

Self-Study Unit

Introduction
 Introductory Module
• Not a comprehensive treatment of the subject

• Provides an overview of critical incident stress,

vicarious trauma, and chronic stress

• Provides a framework for a study program that

helps learning about it at their own pace

• Focuses primarily on chronic stress, burnout, and

self-care strategies
 Additional Modules
available
1. Trauma and critical incident care

3. Re-entry issues and work-life balance

5. Coping with vicarious trauma

7. Humanitarian work, traumatic stress and

spirituality
 Humanitarian workers
• Come in many shapes and sizes

• Work in on-site recovery and relief

missions, education, health training,
agricultural assistance, community
mobilization, economic development,
water and sanitation, and advocacy

• Common thread: a service-orientation in

the face of suffering and need
 Traditional Image

• Selfless and tireless

• Expect that because their work is for

a noble cause, they are immune to
pressures
 In reality
• Impacted by their work

• At the end of the day feeling frustrated

because the scope of the need so
overwhelming

• Troubled by witnessing tragedy, and by

hearing the stories of disaster survivors
 Challenge
• Struggle to find a healthy balance

• Between the demands of the work

and,

• The need to pay attention to their

own physical and emotional well-
being
 Humanitarian workers
• Consistently fail to pay attention to their
own self-care and well-being

• Work demanding, both physically and

emotionally

• Those who neglect their own needs, pay

the price
 The price
• Get sick more easily, and stay sick longer

• Feel tired, drained, and worn out

• Start to feel anxious, cynical or hopeless

• Relationships suffer

• In the end, end up hurting themselves and those

around them
 Support for Humanitarian
Workers
• To reduce the likelihood of developing stress-
related problems in stressful situations

• Provide basic information about stress, trauma,

normal reactions to stressful situations, and
helpful coping strategies

 Understand traumatic stress and know how

to help prevent or alleviate traumatic
stress reactions
 Aim of the Module
• To help humanitarian workers:

 Understand the different types of traumatic stress

associated with their work

 Recognize signs of stress and burnout

 Learn self-care techniques to help alleviate stress

reactions
 Expected Outcomes
• By the end of this module you will better
understand:

3. The nature of traumatic stress

4. Three common types of traumatic stress
associated with humanitarian work – critical
incident stress, vicarious trauma, and chronic
stress
5. The effects of traumatic stress
6. Why it is important for humanitarian workers to
know about these effects
7. How to monitor your own well-being
8. Self-care techniques to help alleviate stress
reactions
Self-Study Unit

Part One:
How can humanitarian work be
stressful?
Humanitarian work

Among the most exciting,

enriching, rewarding and
important work in the world
 Appeal
Moral: Service work for worthy
causes

Personal: Stretches and challenges

individuals to grow

Adventurous: Serving in the midst

of extreme and challenging
situations
 Personal Costs
• Living and working in the midst of
disastrous situations, and

• Facing overwhelming challenges

 Pressures associated with
humanitarian work

• Social dislocation: separation from

their social support networks - friends
and family

• Misery and deprivation: Live and

work in the midst of extreme misery
and associated suffering without
enough resources available to combat
the problems; lead to feelings of
impotence and being overwhelmed
 Pressures associated with
humanitarian work
• Moral dilemmas:

• The work environment: Interpersonal

conflict among team members forced
into prolonged closeness and
interdependence; role ambiguity; lack
of appropriate resources, personnel,
time, logistical support, or skills to do
the job expected; and heavy workload
and long hours
 Personal Reflections
• What do you find especially rewarding about
working in the emergency?

• What do you find especially challenging

(physically, emotionally, mentally, spiritually and
relationally) about working in the emergency?

• How do you find yourself reacting to some of the

challenges you have listed?
Self-Study Unit

Part Two:
Key concepts regarding traumatic
stress
 Stress
• Any demand or change that the human
system (mind, body, spirit) required to
meet and respond to

• Part of normal life

• Without challenges and physical demands,

life boring
 Distress (or Traumatic
Stress)
• When stress

• lasts too long,

• occurs too often, or
• too severe
 Stress
• What distressful for one person not necessarily be
distressful for another

• Your individual perception (how threatened you

feel and how much control you have over the
circumstances) affect the degree of distress you
personally feel
 Traumatic stress

Reaction to any challenge,

demand, threat or change that
exceeds our coping resources and
results in distress 
 Three main types of traumatic
stress

• Critical incident stress or acute

stress

• Vicarious trauma or secondary

traumatization

• Cumulative stress
 Critical incident stress or
acute stress
• Definitions

• Refer to trauma reactions as the result of a

traumatic event during which an individual
seriously threatened by harm or death

• Often referred to as critical incidents and are

unusual and intense
 Critical incident stress or
acute stress
• Reactions

• Experiencing acute stress reactions (also

referred to as critical incident stress
reactions) after a critical incident

• Triggers an intense “fight or flight”

response
 Critical incident stress or
acute stress
• Who is at risk?

• More problematic for workers “in the field”

• Note: For more detailed treatment,

see Module on Trauma and critical
incident care
Vicarious trauma or secondary
traumatization
• Definition

• Refer to stress and trauma reactions that

occur in response to witnessing or hearing
about traumatic events that happened to
others

• Other people are the victims, and you see

them undergoing suffering, or hear about
traumatic events that happened to them   
Vicarious trauma or secondary
traumatization
• Reactions

• Trigger many of the same reactions that occur

when you personally face a critical incident

• Signs and symptoms similar, although usually

less intense, than those triggered by direct
exposure to traumatic events

• The level of traumatization almost as great in

secondary victims as in primary ones
Vicarious trauma or secondary
traumatization
• Who is at risk?

• Inherent to humanitarian work

• Less about how to avoid vicarious trauma, and

more about how to prepare for and deal with it   

• Note: For more detailed treatment on vicarious

trauma, see Training Module: Vicarious
Trauma     
 Cumulative stress
• Definition

• A less dramatic, more gradual form of

stress reaction

• Usually related to low-intensity but more

chronic stressors that pervade a person’s
life and “pile up,” one on top of the other
 Common sources
1. A chaotic and reactive work environment

3. Feeling overwhelmed by unmet needs

5. Tight deadlines and stressed coworkers

7. Communication difficulties

9. Inadequate preparation and briefing

 Common sources
1. Being asked to complete tasks outside your area
of training and competence

3. Facing moral and ethical dilemmas

5. Isolation from familiar social support network

7. Chronic sleep deprivation

9. Travel difficulties and delays  

 Cumulative stress
• Reactions

• Build up over time

• Chronic stressors trigger enduring stress reactions that

grow in intensity and become problematic over time

• Presence of multiple chronic stressors often a better

predictor of higher stress levels than the occurrence of the
occasional critical incident

• A sequence of relatively mild stressful events ultimately

create high stress levels if not dealt with effectively on an
ongoing basis
 Cumulative stress
• Who is at risk?

• Nearly everyone

• Striking the right balance between the urgency of

the work and other areas of life the most relevant
issue

• Workers who don’t take chronic stress seriously

and proactively prepare to meet the challenges
risk of “burning out”
 Summary
• All three types of traumatic stress
problematic for humanitarian workers

• Chronic stress reactions, such as burnout,

likely to be problematic

• Remainder of this module focuses

primarily on recognizing and managing
cumulative and chronic stress reactions 
 For personal reflection
• Which type of traumatic stress
(acute, vicarious, or cumulative) is
most problematic or troublesome for
you?
Self-Study Unit

Part Three:

Cultural issues
 Traumatic stress
• Not just a problem for international
humanitarian workers

• National humanitarian workers not

exempt
 Physiological and emotional
responses to disaster
• Broadly similar all over the world

• An individual’s interpretation of stress and

trauma shaped by culture, social context, and
personal experience

• Important to acknowledge differences across

cultures in how events are experienced and how
traumatic stress expressed
 Commonalities and
Differences
1. Many commonalities across cultures in
signs and symptoms of stress, and
effective self-care techniques and
important differences

3. An individual from one culture may

experience and readily discuss physical
signs of stress and tension, but feel much
less comfortable discussing emotional
reactions
 Commonalities and
Differences
1. Seeking solitude a very effective self-care
technique for people from one culture, but for
someone from another culture, may not find
solitude helpful and energizing, but strange and
discomforting

3. Workers should take the time to consider stress

and self-care concepts in regards to their host
culture
 Culture Dimensions
• What constitutes stress and
trauma?
• relationally, spiritually or through
How is stress conceptualized?
• Is there a concept of individual
stress or is it experienced and
understood mainly through family
and group processes?
• How is stress typically
experienced?
• stress?
What are typical indicators of
stress?
• Does stress tend to be
experienced physically,
emotionally, mentally,
behaviour?
• How is stress usually expressed?
• What have people traditionally
done to deal with stress?
• What is the role of the individual
or the community in managing
• What individual, social and
cultural, oral and behavioural
mechanisms are typically used to
deal with stress?
Self-Study Unit

Part Four: Signs of stress

 Signs of stress
• Experiences that are perceived as threatening or
demanding trigger a series of approximately
1,500 biochemical reactions within the body

• Stress chemicals (such as adrenaline and cortisol)

dumped into the bloodstream and trigger the
“fight or flight” response

• For e.g., an elevated heart rate means that more

blood being pumped to our muscles and brain so
that we can assess the threat and either fight, or
run away faster
 Fight or flight response
• Prepare us to deal with threatening and dangerous events

• Not helpful to deal with the chronic stressors

• Fighting or running away not realistic options at work – not

if they want to keep their jobs!

• If fighting and running away not feasible, how do we

manage these stress reactions?

• First step is learning to recognize the signs of stress that

appear 
 Reactions to stress
• Complex and manifest in different ways for different people

• Characteristics of the person (e.g., their physical and mental

health, level of social support, and previous history of
trauma)

• Interact with the characteristics of the event (e.g., the

magnitude and type of stressful event, the presence of
cumulative stressors and other life events), and

• Influence people’s experiences and reactions

 Stress chemicals
• Trigger physical reactions that last for days,
weeks, or sometimes months

• Also affect brain chemistry and impact the way

we think and feel

• Over time, as bodies, emotions and minds are

affected by stress, has implications for spiritual
selves too
 Spirituality
• A core component of human nature

• Shapes and informs sense of meaning and purpose, faith

and hope

• Being human involves more than the physical dimensions

of existence

• Over time the types of challenges that aid workers face

impact their worldview – their conceptions of humanity,
and their sense of meaning, purpose and hope
 Signs of stress
PHYSICAL •Sleep disturbances
•Changes in appetite
•Stomach upsets
•Rapid heart rate
•Fatigue
•Muscle tremors and tension
•Back and neck pain
•Headaches
•Inability to relax and rest
•Being easily startled
EMOTIONAL •Mood swings
•Feeling “over- emotional”
•Irritability
•Anger
•Depression
•Anxiety
•Emotional numbness
 Signs of stress
MENTAL •Poor concentration
•Confusion and disorganized thoughts
•Forgetfulness
•Difficulty making decisions
•Dreams or nightmares
•Intrusive thoughts
SPIRITUAL •Feelings of emptiness
•Loss of meaning
•Discouragement and loss of hope
•Cynicism
•Doubt
•Anger at God
•Alienation and loss of sense of connection
 Signs of stress
MENTAL •Risk taking (such as driving recklessly)
•Over-eating or under-eating
•Increased
smoking
•Listlessness
•Hyper-alertness
•Aggression and verbal outbursts
•Alcohol and/or
drug use
•Compulsive behavior (i.e. nervous tics and pacing)
•Withdrawal
 For personal reflection
• Have you noticed any of these general
signs of stress lately?

• When you are under pressure, which of

these signs of stress tend to appear first?
Self-Examination Tool
 How stressed are you?
• Please note that this tool is not a clinical diagnostic
instrument and is provided for educational purposes

• Identifies some of the more common symptoms of stress

In the last month, how often has the following been true for you? For
each question, tick the number that fits your reality

Question Response
Never Seldom Sometimes Often Always
(0) (1) (2) (3) (4)
I feel tired.
I find it very hard to relax or “wind-down”.
I find it hard to make decisions.
My heart races and I find myself breathing rapidly.
I have trouble thinking clearly.
I eat too much or too little.
I get headaches.
I feel emotionally numb.
I think about my problems over and over again
during the day.
I have sleeping problems.
In the last month, how often has the following been true for you? For
each question, tick the number that fits your reality

Question Response
Never Seldom Sometimes Often Always
(0) (1) (2) (3) (4)
I have trouble feeling hopeful.
I find myself taking unnecessary risks or engaging in
behaviour hazardous to health and/or safety.

I have back and neck pain, or other chronic tension-linked

pain.
I use caffeine or nicotine more than usual.
I feel overwhelmed and helpless.
I have nervous habits (e.g., biting nails, grinding my teeth,
fidgeting, pacing, etc.)
I forget little things (e.g., where I put my keys, people’s
names)
I have stomach upsets (e.g., nausea, vomiting, diarrhea,
constipation; gas)
I am irritable and easily annoyed.
I have mood swings and feel over emotional.
In the last month, how often has the following been true for you? For
each question, tick the number that fits your reality

Question Response
Never Seldom Sometimes Often Always
(0) (1) (2) (3) (4)
I find it hard to concentrate.
I have trouble feeling that life is meaningful.
I am withdrawn and feel distant and cut off from
other people.
I use alcohol and/or other drugs to try and help
cope.
My work performance has declined and I have
trouble completing things.
 Interpretation Guidelines

0-25 You are probably in great stress-shape

26-50 You may be experiencing a low to moderate degree
of stress
51-75 You may be experiencing a moderate to high degree
of stress
76-100 You may be experiencing a very high degree of
stress
Self-Study Unit

Part Five:
Risk and protective factors
• Risk Factors: Increase our
vulnerability to experiencing
traumatic stress reactions

• Protective factors Decrease our

vulnerability by increasing our
personal hardiness and resilience
and enabling us to deal with
increased levels of stress with less
distress
Factors leading to stress
• The nature and intensity of traumatic events experienced
in the past: Confronting the trauma of others trigger own
memories of hurt and betrayal

• The nature and intensity of the traumatic or stressful

event that triggers the current reaction: Experiencing or
witnessing a man-made disaster more stressful than experiencing
or witnessing natural disasters

• The number of stressors experienced: Those experiencing

multiple significant life events and changes more vulnerable

• The length of exposure to stressful situations: As exposure

lengthens, risk increases 
Factors leading to stress
• Organizational factors: Team relationships, leadership, clarity
of mission objectives, and agency structure

• History of previous psychiatric illness: Those with experience

of acute stress disorder or post-traumatic stress disorder more
vulnerable

• Lack of social support: Those with compromised social support

4 times more likely to experience traumatization and 2.5 times
more likely to experience some form of physical illness; Individuals
without partners also at greater risk

• Pronounced introversion: Introverted people more vulnerable

• Negativity and pessimism: Habitually negative, pessimistic

individuals more vulnerable
Risk Factors Protective Factors
• The nature and intensity of • Social support
any traumatic events • Optimism and healthy self-
experienced in the past esteem
• The nature and intensity of • Spirituality
the traumatic or stressful • Adaptability
events that trigger the
current reactions • Tendency to find meaning
• The number of stressors • Curiosity and openness to
experienced experience
• The length of exposure to • Aptitude
stressful situations
• Organizational factors
• History of previous
psychiatric illness
• Lack of social support
• Pronounced introversion
• Negativity and pessimism
 For personal reflection
1. Which of these risk and protective factors can
you recognize in your own life history, current
situation, and personality?

3. How do you see these factors interacting with

the stress you experience?
Self-Study Unit

Part Six: Burnout

 Burnout
• A process, not an event

• A type of cumulative stress reaction that occurs

after prolonged exposure to occupational
stressors

• Prolonged exposure to emotionally demanding

situations with inadequate support gradually
depletes an individual’s own natural resources for
dealing with stress and strain
 Contributing factors
1. Conflict between individual values and organizational goals and demands

3. Lack of managerial and/or social support

5. Overload of responsibility

7. Role confusion

9. Sense of having no control over quality or outcome of work

11. Little emotional or financial reward

13. Existence of inequity, lack of respect

15. Consistent exposure to traumatic material

 Road to burnout
• Often paved with good intentions

• Those with extremely and unrealistically

high hopes and expectations prime
candidates for burnout

• Unrealistic, highly idealistic job

expectations and aspirations lead to
failure and frustration
 Types of burnout
• Many

• Cluster in physical, emotional, mental, spiritual

and behavioral domains
PHYSICAL EMOTIONAL MENTAL SPIRITUAL BEHAVIOURA
L
•Exhaustion •Self-doubt •Emotional •Apathy •Decline in
•Headaches •Blame exhaustion •Inability to performance
•High blood •Negativity and fragility engage •Apathy
pressure •Disillusionm •Feeling •Wounded •Boredom
•Insomnia ent overwhelme ideals •Interpersonal
•Dreams •Reduced d •Cynicism difficulties
•Back pain sense of •Feeling •Irritability
and other accomplishm helpless •Increased
chronic ent and •Hopelessn addictions or
tension- purpose ess dependencies
linked pain •Feeling •Mistrust of •Reckless
•Stomach unappreciate
colleagues behavior
d or betrayed •Neglecting
complaints &
by the
supervisors ones own
organization
•Depression safety and
•Foggy
•Anxiety physical needs
thinking
•Mental
apathy
•Lack of
insight into
reduced
 What is the best defense
against burnout?
• Prevention!

• Cultivate a “certain sense of realism”

• Create balance in life

• Invest more in family and other personal relationships,

social activities and hobbies

• Spread yourself out so that your job does not have such an
overpowering influence on your self-concept and self-
esteem
• Thoughtfully examine your self-care
practices

• Helps prevent ordinary stress from

becoming distress, and distress from
becoming burnout
 For personal reflection

• Have you noticed any of these

general signs of burnout lately?
Self-Examination Tool
 Are you showing signs of
burnout?
• Please note that this tool is not a clinical diagnostic
instrument and is provided for educational purposes

• Identifies some of the more common symptoms of burnout

In the last month, how often has the following been true for you? For
each question, tick the number that fits your reality

Question Response
Never Seldom Sometimes Often Always
(0) (1) (2) (3) (4)
I feel tired and sluggish most of the time, even when I am
getting enough sleep.
I find that I am easily annoyed by other people’s demands
and stories about their daily activities.
I feel detached and like I don’t really care about the problems
and needs of other people.
I am having more and more trouble being interested in my
work.
I feel sad.
I have become absent minded. I forget appointments,
deadlines and personal possessions.
I find myself avoiding people and don’t even enjoy being
around close friends and family members.
I feel drained and even routine activities feel like an effort.
In the last month, how often has the following been true for you? For
each question, tick the number that fits your reality

Question Response
Never Seldom Sometimes Often Always
(0) (1) (2) (3) (4)
I have been experiencing physical problems like stomach
aches, headaches, lingering colds, and general aches and
pains.
I have sleeping problems.
I have difficulty in making decisions.
I feel burdened by responsibilities and pressures.
I have little enthusiasm for work and when I think about my
work me feelings are mostly negative.
At work, I consistently fall short of expectations that I have for
myself, or that others have for me. I’m less efficient than I
feel I should be.
I’ve been eating more (or less), smoking more cigarettes, or
using more alcohol or drugs.
I feel like I can’t solve the problems assigned to me at work.
In the last month, how often has the following been true for you? For
each question, tick the number that fits your reality

Question Response
Never Seldom Sometimes Often Always
(0) (1) (2) (3) (4)
I feel like my work is insignificant and doesn’t really make a
difference.
I feel “used” and unappreciated at work.
I get easily frustrated and irritable over small inconveniences.

I have trouble concentrating and completing tasks at work.

I feel like I have too much (or too little) to do at work.
I work long hours (more than 10 a day) or do not have at
least one day off work each week.
I find myself involved with conflicts with coworkers or family
members.
I have trouble caring about whether I complete my work or it
well.
I feel like my supervisor and coworkers are largely
incompetent and not doing their jobs well.
 Interpretation Guidelines

0-25 You are probably in good shape

26-50 You may be experiencing a low to moderate degree
of burnout
51-75 You may be experiencing a moderate to high degree
of burnout
76-100 You may be experiencing a very high degree of
burnout
Self-Study Unit

Part Seven:
Examining your own well-being
 Own Well-Being
• An essential prerequisite for effectively helping
others

• One of the best ways to maintain fitness to

continue in the helping capacity

• The first step - understanding your own self-care

strengths and needs

• Taking a personal inventory helps you understand

where your natural self-care strengths lie, and
which self-care areas need extra attention
• Before going on to the final section of
this module,

• pause for a moment and take

inventory of how you are doing, and
identify which helpful lifestyle-
balance strategies you use regularly
Self-Examination Tool
 Self care and lifestyle
balance inventory
• Please note that this tool is not a clinical diagnostic
instrument and is provided for educational purposes

• Identifies some of the more effective physical,

psychological and spiritual methods of staying balanced
In the last month, how often has the following been true for you? For
each question, tick the number that fits your reality

Question Response
Never Seldom Sometimes Often Always
(0) (1) (2) (3) (4)
I have at least one full day of rest each week.
I take some time for myself to be quiet, think,
meditate, write and/or pray.
I work for less than ten hours a day.
I do exercise everyday (walking, running, swimming,
etc.) for at least 30 minutes at a time.
I do something I find fun.
I practice muscle relaxation, pilates, yoga,
stretching, meditation or slow-breathing techniques.
I share how I am feeling with at least one friend or
my partners.
I sleep well and get at least 7 hours of sleep a night.
In the last month, how often has the following been true for you? For
each question, tick the number that fits your reality

Question Response
Never Seldom Sometimes Often Always
(0) (1) (2) (3) (4)
I am careful about what I eat and eat a balanced
diet.
I drink at least 1.5 liters of water a day.
I laugh without malice or cynicism.
When I leave work at the end of the day, I can
disengage and leave the pressures of work behind.
I listen to my body’s signals and recognize when I
am becoming tired, run-down and vulnerable to
illness.
There are people who care about me that I trust, to
whom I can talk if I want.
I do something I find creative or expressive.
I feel I have the training and skills I need to do my
job well.
In the last month, how often has the following been true for you? For
each question, tick the number that fits your reality
Question Response
Never Seldom Sometimes Often Always
(0) (1) (2) (3) (4)
I set and maintain healthy boundaries for myself by
standing up for myself, saying “no” when I need to,
not letting others take advantage of me.
At work, I take a brief break at least every 2 hours,
and switch tasks regularly so that I don’t become too
drained.
I spend time with groups of people I trust and to
whom I feel close who are part of a community of
meaning and purpose.
My ability to communicate with (0) very poor; (1)
poor; (2) fair; (3) good; (4) excellent
I feel good about how I spend my time and energy in
relation to what is really important to me in my life.
I believe in myself and generally give myself positive
messages about my ability to accomplish my goals,
even when I encounter difficulties.
In the last month, how often has the following been true for you? For
each question, tick the number that fits your reality

Question Response
Never Seldom Sometimes Often Always
(0) (1) (2) (3) (4)

I set realistic goals for my life and work

towards them consistently.
I take good vacations every year.
I drink alcohol, smoke, or use other
recreational drugs.
(0) 3 or more times every day; (1) al least
once a day; (2) 3 to 6 times a week; (4) never
 Interpretation Guidelines

0-25 Your self care skills and lifestyle balance strategies

are poor
26-50 You have a low to moderate degree of self care skills
and life style balance
51-75 You have a moderate degree of self care skills and
life style balance
76-100 You have good self care skills and life style balance
Self-Study Unit

Part Eight:
Combating stress and burnout
 Stress management
• Dealing proactively with stress a learnable skill

• To help you grow and thrive as a result of the stressful

challenges that you face

• Recognizing natural self-care strengths already present in

your life and learning how to apply these, and additional
helpful strategies, more consistently

• No single technique will relieve all your stress, but paying

attention to three areas of self-care will build up your
hardiness (your ability to handle more stress with less
distress) and your resilience (your ability to “bounce back”
after particularly stressful or traumatic events)
 Physical
• Regular exercise • Limit your consumption of
alcohol
• Sleep
• Pilates or Yoga
• Healthy eating
• Relaxation techniques (such
• Drinking enough water as progressive muscle
relaxation, diaphragmatic
breathing, visualization and
• Humour and laughter mediation)

• Massage, whirlpool, sauna

• Repetitive activities (such as

cross-stitching, walking,
quilting, drawing and cooking)
 Emotional and relational
• Nurturing relationships
• Contact with home/friends
through email, phone,
tapes
• Talking
• Humour
• Ongoing support group
• Reflection: journaling,
writing, mediating, poetry
• Creative activity such as
drawing, sculpting,
cooking, painting and
photography
• Movies, books music
• Having balance priorities
• Understanding traumatic
stress and have realistic
expectations
• Counseling
 Spiritual
• Knowing your values: • Singing or listening to
Where do you tend to meaningful music
find meaning and
purposes in life? • Contact with religious
leaders or inspiring
• Participating in a individuals
community of meaning
and purpose • Time with art, nature or
music
• Regular times of prayer,
reading, meditation • Solitude

• Spiritually meaningful
conversations
 For personal reflection
• Which of these self-care strategies do you
use regularly?

• Which do you find most helpful to you?

• Which strategies do you wish you used

more regularly?
 Self Quiz: Test your
knowledge
• Choose the best answer to each
of the 20 questions

• Meant to test your comprehension

of the material in the module

• An Answer Key provided at the

end of this 20-question quiz that
allows you to get your results
1. Humanitarian workers commonly experience stress from which of the following sources?
– a. Violence and threat
– b. Social dislocation
– c. Spiritual dislocation
– d. The work environment
– e. All of the above

2. Stress can be defined as any demand or change that the human system (mind, body, spirit) is required to meet and
respond to.
– a. True
– b. False

3. Stress can become distress, or traumatic stress, when it lasts too long, occurs too often, or is too severe.
– a. True
– b. False

4. Something that is very stressful for one person is always stressful for others.
– a. True: Everyone finds the same types of events stressful to the same extent
– b. False: Your individual perception (how threatened you feel and how much control you have over the
circumstances) can effect the degree of distress you personally feel.

5. Trauma reactions that occur as the result of a critical incident (a traumatic event during which an individual
experiences the threat of serious harm of death) are often referred to as:
– a. Critical Incident Stress
– b. Acute Stress Reactions
– c. Both of the terms above are regularly used to refer to this type of trauma reaction.
6. Experiencing traumatic stress reactions after a critical incident is a normal response to an
abnormal situation.
– a. True
– b. False

7. Traumatic stress reactions never occur in response to witnessing and/or hearing about traumatic
events that have happened to others.
– a. True: Individuals must be directly involved in traumatic events to be impacted by them.
– b. False: Interaction with people who have experienced traumatic events places helpers at
risk of experiencing some form of secondary traumatic stress response.

8. Some common sources of chronic stress for humanitarian workers include:

– a. A constantly chaotic and reactive work environment
– b. Feeling overwhelmed by the apparent need
– c. Inadequate preparation and briefing
– d. Being asked to complete tasks outside their area of training and competence
– e. All of the above

9. Over time, the presence of multiple chronic stressors is usually a better predictor of higher stress
levels than the occurrence of the occasional critical incident.
– a. True
– b. False

10. Humanitarian workers are at risk of experiencing which of the following types of traumatic stress?
• a. Critical Incident Stress
• b. Vicarious trauma
• c. Cumulative Stress
• d. All of the above
11. People from different cultures experience and express traumatic stress exactly the same way.
– a. True
– b. False

12. Which of the following is not a factor that increases the risk that you will experience traumatic stress reactions?
– a. Nature and intensity of any past traumatic events experienced
– b. The number of stressful events experienced
– c. Good social support
– d. Organizational factors
– e. History of previous psychiatric illness

13. Which of the following is not a normal sign of cumulative stress?

– a. Sleep disturbances
– b. Seeing things that aren’t there
– c. Fatigue
– d. Poor concentration
– e. Eating more than normal

14. Which of the following statements is true?

- a. Burnout is a process, not an event. It is a term used to refer to a type of cumulative stress reaction that
occurs after prolonged exposure to occupational stressors.
- b. Burnout happens suddenly. It is an acute breakdown of personal functioning that tends to happen with few
warning signs.

15. Which of the following is a helpful way of preventing or alleviating burnout?

- a. Cultivating a “certain sense of realism” about your job and its outcomes.
- b. Create balance in your life, invest more in family and other personal relationships, social activities and hobbies.
- c. Both of the above are helpful strategies in preventing or alleviating burnout.
16. When trying to increase your hardiness and resilience, it is important to pay attention to which of the following self-care areas?
• a. Physical
• b. Emotional and relational
• c. Spiritual
• d. It is important to pay attention to all of these areas.

17. Which of the following is not a good physical self-care strategy?

• a. Regular exercise
• b. Getting enough sleep
• c. Drinking a bottle of wine every night
• d. Laughing
• e. Practicing a relaxation technique

18. Which of the following is not a helpful emotional or relational self-care strategy?
• a. Talking to a good friend
• b. Spending all your time with people who only see the negative side of situations
• c. Writing in a journal
• d. Watching a funny movie
• e. Understanding stress reactions

19. Profound challenges to spirituality and worldview are usually some of the most significant tests that humanitarian workers face during their
careers:
• a. True
• b. False

20. Which of the following are helpful spiritual self-care strategies?

• a. Participating in a community of meaning and purpose
• b. Regular times of prayer/reading/meditation
• c. Spiritually meaningful conversations
• d. Time with art, nature or music
• e. All of the above
Answer key
1. e
2. a.
3. a
4. b
5. c
6. a
7. e
8. e
9. a
10. d
11. b
12. c
13. b
14. a
15. c
16. d
17. c
18. b
19. a
20. e