Refuge Module 3

Module 3: Stress

(Approximate time required: 60 minutes) 

Note: This reading comes from the Headington Institute, an organization that provides self-care techniques and resources to humanitarian organizations. This is a condensed version of module one from the online training by Lisa McKay titled “Understanding and Coping with Traumatic Stress.” 


The traditional image of helpers is that they are selfless and tireless. However, humanitarian workers are impacted by their work. They often leave at the end of the day feeling they have not done enough because the scope of the need is so overwhelming. They can be troubled by witnessing violence and poverty and by hearing the stories of refugees and disaster survivors. In this service-oriented profession, many humanitarian workers struggle to find a healthy balance between the demands of the work and the need to pay some attention to their own physical and emotional well-being. 

Part 1: Key Concepts Regarding Traumatic Stress

Stress is defined as any demand or change the human system (mind, body, spirit) is required to meet and respond to. Stress is a normal part of life. Without challenges and physical demands, life would be boring. Stress, however, becomes distress (or traumatic stress) when it lasts too long, occurs too often or is too severe. Traumatic stress can be defined as the reaction to any challenge, demand, threat or change that exceeds our coping resources and results in distress. 

Vicarious trauma or secondary traumatization 

Definition: These terms refer to stress and trauma reactions that can occur in response to witnessing or hearing about traumatic events that have happened to others. In these cases, other people are the victims, and you see them undergoing suffering or hear about traumatic events that have happened to them. 

Reactions: Vicarious trauma can trigger many of the same reactions that occur when you personally face a critical incident. Signs and symptoms are similar, although usually less intense, than those triggered by direct exposure to traumatic events. However, in some cases the level of traumatization can be almost as great in secondary victims as in primary ones. 

Who is at risk? It is now widely accepted that interaction with victims of traumatic exposure places helpers at high risk of experiencing some form of secondary traumatic stress response. Humanitarian workers in all roles regularly hear distressing stories, and face the realities of violence, poverty and disaster. Vicarious trauma is therefore inherent to humanitarian work and problematic for both field and home staff. The relevant issue becomes less about how to avoid vicarious trauma, and more about how to prepare for and deal with it. 

Part 2: Signs of Stress

Reactions to stress are complex and tend to manifest in different ways for different people. The 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) to influence people’s experiences and reactions. 

Stress chemicals can trigger physical reactions that can linger for days, weeks or sometimes months. In addition to triggering physical reactions, stress hormones and chemicals affect brain chemistry and impact the way we think and feel. Over time, as our bodies, emotions, and minds are affected by stress, this has implications for our spiritual selves, too. 

Spirituality is a core component of human nature. Spirituality shapes and informs our sense of meaning, purpose, faith, and hope. Whether experienced as an explicit belief in a deity, a more diffuse sense of connectedness with nature or a life force, or a belief in human nature and solidarity, most people believe that being fully human involves more than simply the physical dimensions of existence. Over time, the types of challenges aid workers face can impact their worldview – their conceptions of God, humanity, and where they derive their sense of meaning, purpose, and hope. 

With the mix of physical, emotional, mental, and spiritual symptoms, it’s not surprising stress often shows up in our behavior. The following are some common signs of cumulative stress: 


● Sleep disturbances 

● Changes in appetite 

● Upset stomach 

● Rapid heart rate 

● Fatigue 

● Muscle tremors and tension 

● Back and neck pain 

● Headaches 

● Inability to relax and rest 

● Being easily startled 


● Mood swings 

● Feeling “over-emotional” 

● Irritability 

● Anxiety 

● Depression 

● Anger 

● Emotional numbness 


● Poor concentration 

● Confusion and disorganized thoughts 

● Forgetfulness 

● Difficulty making decisions 

● Dreams or nightmares 

● Intrusive thoughts 


● Feelings of emptiness 

● Loss of meaning 

● Discouragement and loss of hope 

● Cynicism 

● Doubt 

● Anger at God 

● Alienation and loss of sense of connection 


● Risk taking (such as driving recklessly) 

● Overeating or undereating 

● Increased smoking 

● Loss of interest 

● Hyper-alertness 

● Aggression 

For personal reflection… 

Have you noticed any of these general signs of stress lately in your own life? • When you are under pressure, which of these signs of stress tend to appear first?

Part 3: Examining Your Own Well-Being

In the long run, taking care of our own well-being is an essential prerequisite for effectively helping others. It is one of the best ways to maintain fitness to continue in that helping capacity. 

The first step to taking care of your well-being and dealing more effectively with stress and burnout is 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. 

For personal reflection… 

• What are some of your typical self-care and coping strategies (both negative and positive) when you are stressed, fatigued, or anxious? 

• What sustains you in this work (i.e., what refreshes you, energizes you, and gives you hope)? • What helpful self-care strategy would you like to try? 

Part 4: Combating Stress Through Self-Care

Dealing proactively with stress is a learnable skill often summed up by the phrase “stress management.” The objective of good stress management is not merely to help you survive your trip, but to help you grow and thrive as a result of the stressful challenges you might face. In short, it involves 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 of your stress, but paying attention to the following 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). 


• Regular exercise: 

Exercising at least three times a week with a mixture of aerobic exercise (e.g., running, walking, swimming), exertion (e.g., weights), and stretching (e.g., yoga) has multiple stress management benefits. For example, it helps our bodies process stress-related chemicals, reduce muscle tension, release“feel-good” chemicals called endorphins, help us stay fitter and healthier and improves our sleep. This is one of the single most effective stress management strategies. 

Sleep: Most adults need between seven and nine hours of sleep a night to function at their best. 

Healthy eating: Just as your car would not run well on poor quality fuel or no fuel at all, our bodies and brains function much better when we provide them with the right type of fuel. 

Drinking enough water: By the time you feel thirsty, you’ve already lost two to three percent of your body fluid. This lowers your blood volume, making your heart work harder to pump blood to your brain. Staying hydrated is one of the easiest ways to help ourselves function well. 

Laughter: Laughter and positive emotions release “feel-good” chemicals that act to undo the cardiovascular effects of negative emotions and help our bodies relax. 

Relaxation techniques: A variety of relaxation techniques (such as progressive muscle relaxation, diaphragmatic breathing, visualization, and meditation) can be used to produce the relaxation response. This acts to undo the muscular and cardiovascular effects of negative emotions and help our bodies relax. 

Repetitive activities: Repetitive and absorbing activities such as cross-stitching, walking, quilting, drawing, and cooking can function as a form of moving-meditation that is soothing and relaxing. 

Emotional and Relational 

• Nurturing relationships 

• Talking 

• Humor 

• Ongoing support group 

• Reflection: journaling, writing, meditating and poetry 

• Creative activities such as drawing, sculpting, cooking, painting and photography • Reading and listening to music 

• Having balanced priorities 

• Understanding traumatic stress and having realistic expectations 

• Counseling 

There are three main themes apparent in these emotional and relational self-care techniques: 

Interpersonal relationships: 

Social support factors play a major part in determining stress reaction factors and vulnerability. Our relationships with each other are so important that recent research suggests that “it may be our relationships that save us rather than our knowledge and skills” (Fawcett, 2003, p.124). If you don’t have a strong social support network, make an effort to create one. The most protective social networks aren’t necessarily large, but they are interconnected.

Time away/distraction: 

Allowing yourself a breather and the chance to step away on a regular basis is another crucial emotional self-care technique. Ideally, you should take some time off every week to disengage from work and issues that drain you. At least some of this time should be spent doing something fun and relaxing. It is especially important for humanitarian workers to be aware of these types of boundaries. Working in this field tends to sensitize you to international issues and the impact of disaster, making it difficult to disengage even when you’re not serving. 


Being involved in humanitarian work changes people. Seeking to understand and express these changes is an important method for dealing with the impact of the work. Storytelling can take several forms – talking with other participants or trip leaders, journaling, and writing letters, stories, poetry, or other more abstract forms of creative activity, such as painting. Writing appears to be an especially effective way of dealing with the impact of trauma and stress. Writing detailed accounts of stressful events in a way that links facts with feelings has been shown to have a positive impact on physical health. 


• Knowing your values: Where do you find meaning in life? 

• Participating in a community of meaning and purpose 

• Regular times of prayer, reading, and meditation

• Spiritually meaningful conversations 

• Singing or listening to spiritual music 

• Contact with religious leaders or inspiring individuals 

• Time with art, nature, or music 

• Solitude 

Paying attention to spirituality, just like physical and emotional self-care, builds hardiness and resilience. It helps you maintain perspective and acts as a compass or anchor when you’re feeling overwhelmed. It is almost impossible to do humanitarian work without it affecting your worldview and spirituality, your sense of what’s important to you in life, and your source of strength and hope. Profound challenges to spirituality and worldview are some of the most significant challenges humanitarian workers face during their careers. 

So how do we feed our faith? First, we feed our faith by understanding our personal values, what we tend to find most meaningful in life, and how this nurtures our spirituality. The second way is by seeking out things that are in line with our deepest values and where we tend to find meaning – these are the things that make us feel whole, alive, joyful, and connected with something beyond ourselves. Soul food includes prayer, reading scriptural texts, religious services, meditation, deep relationships, nature, art, and music. 

For personal reflection… 

• Which of these self-care strategies do you use regularly? 

• Which do you find most helpful to you? 

• Which strategies would you like to try using more regularly?