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September 2023
Stress First Aid for Veterinary Teams
Melyssa Allen, MA, CHWC, DACLM, aims to make first aid for stress just as second-nature for veterinary professionals. Allen describes the Stress First Aid framework, first developed for the US military and now available for healthcare workers, and why it should be part of every veterinary practice, just like antihistamines, Band-Aids, and an eye wash station.
A Chat with Melyssa Allen, MA, CHWC, DACLM
The concept of first aid has become such a part of life that it seems unimaginable not to have some essential tools on hand in case a minor injury or illness threatens to turn major. Melyssa Allen, MA, CHWC, DACLM, aims to make first aid for stress just as second-nature for veterinary professionals. Allen describes the Stress First Aid framework, first developed for the US military and now available for health care workers, and why it should be part of every veterinary practice, just like antihistamines, Band-Aids, and an eye wash station.
Katie Berlin: Can you tell us about Stress First Aid?
Melyssa Allen: Stress First Aid is a framework that was created by doctors, including Patricia Watson, PhD, [from whom] I learned how to facilitate. She and her colleague, Dr. Richard Westphal, created this program originally to serve the Navy and the Marine Corps to provide a model of peer support, provide some common language, and start the conversation about how to talk about these stress reactions and stress injuries. So it was originally developed for military populations, but there have been different iterations that have risen from this framework to serve other high-stress occupations. [They wanted to make sure] it was freely accessible to anyone who might need it.
Stress First Aid helps people start to recognize and identify stress injuries and reactions in themselves and in others, and then have a model of self-care actions and peer, leadership, and co-worker support to help ingrain this into the culture of different industries.
As you’re learning about Stress First Aid, you’re probably going to think, “Oh, well, I already do some of that stuff,” and chances are you’ve found ways of mitigating some stress reactions either in yourself or in others. But Stress First Aid provides more of a comprehensive and flexible framework. I think that’s the part I like about it the most too. You have to find what works best for you in whatever it is you’re trying to do in life, especially when it comes to behavior change and trying to establish new habits.
So first of all, [you’ve got to learn to recognize] where your stress is at certain points in time and think about it from a first aid model. When you’re getting trained in administering physical first aid, you can typically see there’s an injury that needs to be addressed or someone is unconscious on the floor, and that’s when your training kicks in. So what’s usually the first thing that you have to do? You have to check and make sure that the scene is safe, but then you also have to recognize what’s going on.
There is a stress continuum from green to yellow to orange to the red zone. Sometimes it’s hard to verbalize what it is you’re feeling at a certain time, so the stress continuum kind of breaks it down. Green is where you are functioning optimally. Yellow is where maybe there’s something a little off, something stuck with you or somebody kind of irritated you that day, but it’s not having a significant impact on your wellbeing or your performance. The orange and red zones are where that starts to show up. And at any point in time, you can fluctuate between the green to the red zone and back again, within the span of a day or even a few hours.
It’s really a tool to help you better identify and recognize, “Where am I right now?” Because that’s what’s going to inform what kind of action you take, and it can also help you recognize that in other people too… This framework can even come in handy when dealing with clients that are experiencing stress arousal and injury.
With regular first aid, there’s usually a physical injury that you can see with your eyeballs. You can’t really see that with a stress injury, right? It’s invisible and you either have to ask people the right questions or check in on that with yourself.
With stress injuries, there are usually four different categories that come up. And as I’m going through these, you’ll probably be like, “Yep, check, been there. Like maybe I’m there right now.”
“There is a stress continuum from green to yellow to orange to the red zone.”
—Melyssa Allen, MA, CHWC, DACLM
The first one is trauma, because in your roles, you’re going to experience some level of trauma in some way, shape, or form. When it comes to traumatic injuries, it is going to be subjective to each person, just like stress is also subjective. It’s our perception of a certain experience. Two people could be involved in a car accident and one could walk away just a little shaken up, but the other person could walk away and potentially develop something like posttraumatic stress disorder. It is going to be a unique and individual experience for everyone. But then there are also instances in which it’s more of a collective experience.
The second one is loss. So that’s a grief injury—something that we all experienced during COVID especially, whether it was loss of life, loss of opportunities to travel or have celebrations, loss of jobs. There are so many instances where loss can show up.
The third one is inner conflict, and this is where moral injury comes in. And that’s where you are seeing things that go against your moral compass, but maybe there’s no opportunity for you to act in alignment with your values.
And then the last one I’m sure we’re all familiar with: it’s wear and tear. So it’s that fatigue injury. It’s that accumulation of stress over time that just wears and tears you down. So those are the four different categories of stress injuries, and that can be helpful when it comes to trying to conceptualize and identify what your stress is.
KB: Trauma, for sure, and grief, I feel like we sometimes put in a separate category from the wear and tear and the inner conflict—because wear and tear and inner conflict, that’s all day, every day in vet med. We have to work with other humans that make decisions or create the conditions we have to work under. So there’s very little control sometimes and that’s very hard.
It took me a while to realize that what we go through on a daily basis [in vet med] really is trauma and produces a lot of grief. Because, like you said, I think of a car accident, I think of war, I think of cancer. I think of trauma as being these enormous events, and that I don’t have a right to think about things I go through as trauma if they’re not those events.
And the same goes for grief. I heard a lot of conversations about this during the height of the pandemic where people were talking about grief and people would feel bad for not being able to go to a Taylor Swift concert when other people were dying. I heard an expert say that grief is grief, and the physical and emotional sensations are the same whether it’s due to this cause or this cause. Is that something that this framework helps us discuss and talk about, or is that something that you come into the framework having done a little bit of work to realize? Because there are a lot of people listening who are like, “I don’t go through trauma,” but we do.
“Even with grief, we run into this phenomenon called comparative suffering, where we minimize our own experiences because we think someone out there has it worse than we do.”
—Melyssa Allen, MA, CHWC, DACLM
MA: I think that’s one of the first big barriers. We don’t want to admit it to ourselves because it might be stigmatized as a weakness if you’ve experienced trauma. And even with grief, we run into this phenomenon called comparative suffering, where we minimize our own experiences because we think someone out there has it worse than we do. Stress First Aid helps you to recognize what’s going on for you with your stress and then, from there, be able to take self-care actions to support yourself through whatever it is that you’re experiencing—and even provide some coworker support if you notice changes in their behavior or if someone comes to you for help.
The meat and potatoes of Stress First Aid is the Seven Cs model, which walks you through the action steps that you take when there’s a stressor that’s been experienced. And whether you found it traumatic or not, if you notice you are off or you’re just feeling kind of funky, you can use this model to provide support for yourself, but you also have to be willing to support yourself through that too. And I know that there are some people out there who really want to take the “suck it up, buttercup” mentality, but it’s only going to do you more damage over time because our body responds differently to stress when we interpret that stress differently.
The first C is check. It’s such an important step because it shows up throughout the entire seven Cs model. Check and the second step, coordinate, are constantly present throughout that entire cycle.
And as much as we would love for it to go in a nice little circle, that’s usually not how it happens. Life is not as linear as we would like. That’s where you have to be flexible, use this as an informed model to really tackle some of these things, and just do the best you can. I think that’s one of the things I want people to walk away with; maybe you don’t have training in mental health but you don’t need it to be able to support someone and yourself in a way that shows you care.
So the second C, coordinate, refers to coordinating some sort of action. Do you need to coordinate follow-up resources for this person? Do you need to coordinate that next level of care? Especially if someone comes up to you saying that they’re in danger or someone else is in danger, that’s when you really need to focus on what needs to happen to keep everyone safe. And that’s the third C, which is cover—ensuring everyone is safe or getting them to a place where they can be safe, whatever that might look like.
And once they or you are somewhere safe, the fourth C is calm. This is where finding strategies to help down-regulate your nervous system a little bit—you’re not going to feel totally zen and completely relaxed, I think that’s a little unrealistic to expect—but it’s about finding some different strategies to help you feel grounded and secure and to help at least calm your physiological response. So that’s going to be deep breathing, grounding practices, like 5-4-3-2-1: Find five things that you can see in this room, listen for four sounds, find three things you can feel, two things that you can smell, and one thing you can taste, and walk through the senses to bring you back to the present moment.
That’s one of the fastest ways to help ourselves get out of that state of fight or flight, because when we deep breathe all the way into the belly, it tickles our vagus nerve.
The [fifth C] is connect, connecting to social support, whether that’s professional support like seeking therapy services, connecting with groups that are going through similar challenges like peer support groups, or if you’re in the workplace and you are concerned about someone going home, making sure that they’re connected to people who care about them after they leave.
Number six is competence. If you mess up in the workplace, your ego takes a hit and then you beat yourself down when you’ve already fallen, and it doesn’t really help you get out of that. So instead of trying to take on something that maybe you’re just learning, try to go back to skills you have mastered. Things that you’re confident you’re not going to mess up. That’s going to help restore your belief in yourself and soothe that bruised ego a bit, and you’re going to start feeling like you can take on hard things again.
That’s when we come to [number seven,] confidence—being able to restore your self-esteem, restore your hope. You’re able to take on challenges again without kind of going into that negative spiral.
So those are the seven Cs of Stress First Aid. Allow yourself to practice different ways for yourself, for your teams, for your coworkers, to help create this flexible model of how to approach stress injuries and reactions in a way that is supportive. And ultimately the hope is for Stress First Aid to become ingrained within a workplace setting so that it’s second nature, and it helps to break the stigma around these conversations.
One of the ways I’ve seen it used is people doing a pulse check on their units. One of my favorite instances of this was a big whiteboard with different colored sticky notes, and people could go pick up a sticky note and slap it where they felt they were on the stress continuum for the day, so you could get a visual of where the team was.
And if there’s a lot of orange, a lot of red that you’re seeing, maybe you’re able to call a quick group together to ask, “What do we need?” Like a practice manager saying, “What can I do to support you all? Maybe let’s just all take a breath together. Let’s order some pizza.”
KB: What do you think we in vet med can learn from the work that’s being done in human health care and the adoption of frameworks like Stress First Aid?
MA: I think it’s going to provide a more robust approach to providing the support that’s necessary. It’s really about exploring [available resources] and knowing your teams and asking, “Is this something they would find beneficial?” If you have a team that’s maybe a little skeptical about things like this, just introduce it and say, “What do you all think about this?” And if your clinic is pretty crispy and burnt out, you’re probably going to get a bunch of eye rolls. But that could be the clinic that needs it the most. [And you can] plant those seeds and let people know this is available; keep it visible. [Hang it] somewhere that people can seek it out when they need it most.
KB: Do you have a plan to develop this for the veterinary community specifically?
MA: Yes, Dr. Watson and I are seeking funding to develop a veterinary-specific Stress First Aid kit and to be able to host focus groups with veterinary professionals to have relevant examples that really speak to the population it’s being delivered to. While there are a lot of parallels with human health care, there are also so many unique instances.
| The Stress First Aid information, including a booklet for health professionals, is found here: ptsd.va.gov/professional/treat/type/stress_first_aid.asp. |
KB: If you could put a Post-It on the bathroom mirror of every veterinary professional so that they would see it when they get up in the morning, what would it say?
MA: It would say, “Remember to be kind to yourself, because if being hard on yourself worked, it would’ve already worked by now.”
Central Line: The AAHA Podcast is generously sponsored by CareCredit.
Catch the full episode, and every other episode of Central Line: The AAHA Podcast, on major podcast platforms, YouTube, and at aaha.org/podcast.
Melyssa Allen, MA, DACLM, is a board-certified lifestyle medicine professional with a background as an animal trainer, fitness instructor, and mental health counselor. She received her bachelor’s degrees in biology and psychology and her master’s in clinical psychology from the University of Central Florida. Melyssa is passionate about helping veterinary professionals implement positive lifestyle habits as a veterinary well-being coach with her company, Mind-Body-Thrive Lifestyle. Find Melyssa on her website, veterinary-wellbeing.com, on Instagram @veterinary_wellbeing, on the Veterinary Teams Living Well Facebook group, and on Insight Timer (which you can use for FREE: insighttimer.com/mindbodythrive). |
Katie Berlin, DVM, CVA, is AAHA’s Director of Content Strategy. |
Photo credits: Evgeny Gromov/iStock via Getty Images Plus, PhotoTalk/iStock via Getty Images Plus, ©AAHA/Alison Silverman