Be well. Practice big medicine.

The views expressed here reflect the views of the authors alone, and do not necessarily reflect the views of any of their organizations. In particular, the views expressed here do not necessarily reflect those of Big Medicine, nor any member of Team EMS Inc.

VIEWS: STEVEN CRIMANDO

Tracking Human Factors in the Financial Crisis:

Lessons for Pandemic Planning

A Special Report from

Extreme Behavioral Risk Management

A Division of ALLSector Technology Group Inc.

by Steven M. Crimando, MA, BCETS

and Cynthia L. Simeone, CBCP, PMP

[Feb 14 2009]

Abstract:

There are significant similarities between the current global financial crisis and a pandemic disease outbreak. These similarities are particularly pronounced in the area of human factors, specifically in the psychosocial response to adverse events that involve elements of uncontrollability, unfairness and loss. The sudden and dramatic onset of the economic crisis resulted in many organizations suspending their pandemic preparedness efforts in order to focus on the dire threat at hand. As the economic situation transitions from a "sudden crisis" to "smoldering crisis", business continuity planners and others charged with an organization’s pandemic influenza preparedness may benefit from identifying, understanding and benchmarking these dynamics to inform policies, plans and preparedness efforts for a pandemic.

Effective pandemic planning must be predicated on accurate assumptions about the individual and collective response to the threat. The global economic crisis, viewed as "pandemic-light", offers a unique opportunity to practice and prepare for the actual event. It may turn out to be the best test of pandemic preparedness possible, if approached in a thoughtful and structured manner.

Pandemic Defined:

Pandemic: From Greek "pan" (all) and "demos" (people): Occurring over a wide geographic area and affecting an exceptionally high proportion of the population.1

While the current financial crisis may have diverted the attention of business leaders, continuity planners and emergency managers away from pandemic influenza planning, the risk of a possible pandemic has not diminished. In recent weeks, avian and human influenza activity in the United Kingdom, China and India have thrust the flu back into the spotlight. As of January 27, 2009, the World Health Organization (WHO) has updated its statistics and now reports 403 human cases of the avian influenza, resulting in 254 deaths worldwide. The H5N1 virus responsible for these deaths is particularly powerful, proving lethal in more than 50% of the known cases. Each new human case heightens the possibility for the virus to make the critical leap in mutating to a deadly pandemic strain.

The H5N1 virus has several significant similarities with the influenza virus that swept the globe during the Great Pandemic of 1918. Not only has the pandemic influenza threat not abated, but communities, organizations and nations may be at even greater risk if the pandemic were to emerge during such vulnerable economic times.

The current economic crisis may in fact have a potentiating affect on the pandemic risk. A standard pandemic planning assumption is that possibly 30-40% of the nation’s workforce may be offline at any one time, due to illness or death, or remaining home out of fear or to care for the ill. If an organization is forced to layoff a substantial number of employees and is already operating with a depleted workforce in a down economy, further diminishing the remaining workforce by another 30-40% during the pandemic may have a paralytic - if not fatal - affect on the organization.

The current economic downturn has resulted in a continued reduction in the Gross Domestic Product (GDP) in the United States and in other industrialized countries. The arrival of a pandemic influenza in the midst of the global financial crisis would represent a "perfect storm" scenario resulting in potentially unimaginable consequences for the global economy, as well as individuals and families, communities and organizations.

Sudden and Smoldering Crises

Sudden crises tend to produce acute stress reactions in individuals, families, communities and organizations. These events can be said to have "bookends", in that it is clear when the event began, when it ended and whether one was directly impacted. A smoldering crisis often lacks these clear markers by beginning slowly, with many of the early warning signs remaining below the radar. Once the crisis begins, it is difficult to know exactly when it will end. It can also be difficult to determine exactly how badly one is affected since they are dynamic and shifting in degrees of severity over time. Smoldering crises tend to result in chronic stress reactions. They exhaust individual, organizational and possibly national resources. A pandemic that circles the globe in two or three "waves" of illness over the course of 12 months or longer may begin with a sudden realization that the outbreak has begun, that it is real and it is bad, but would generally be considered a smoldering crisis. Likewise, the economic crisis, though beginning with the initial "subprime" calamity, reached the sudden crisis phase on one specific weekend in September 2008, but will most likely be remembered as a long, complex and smoldering crisis.

Pandemic-Light

The global economic crisis may be viewed as "pandemic-light", while there is pain and psychosocial disruption, but without the body count.

The national strategy for surviving a pandemic and an economic crisis hinges on three key actions:

□ Stop, slow, limit spread of crisis 　

□ Mitigate impact, suffering and permanent damage (or death) 　

□ Sustain infrastructure/economy and functioning of society

Comparing the economic crisis to a pandemic can surface many interesting similarities that may inform pandemic preparedness efforts in both the public and private sectors. These similarities can be found in the areas of event dynamics, impact, response, planning and recovery. To demonstrate the similarities between the economic crisis and influenza pandemic useful to planners and decision-makers, the overlapping elements have been delineated in several categories.

Event Dynamics

Both the economic crisis and a potential influenza pandemic share many features, including the twenty identified below:

□ Global reach

□ Few, if any, are immune

□ Contributing factors identified long in advance of the onset of crisis

□ Small pool of experts warned of impending doom

□ Threat not fully recognized until reaching dramatic, irreversible levels

□ General public had little awareness of the risk

□ Highly technical/exotic factors triggered onset

□ Slow-moving but unstoppable once in motion

□ Long, complex crises

□ Progress in waves or cascading sequence

□ Disagreement among experts about best way to handle the situation

□ Remedy or vaccine not readily available, must be developed quickly

□ Initial attempts to "treat" the problem prove to be insufficient

□ Intensity and duration of crisis exhausts resources

□ Distinct social, economic and emotional consequences

□ Raise many ethical dilemmas

□ Characterized by loss

□ Contain aspects of both "sudden" and "smoldering" crises

□ Increases distrust of authorities

□ Create a sense of helplessness or powerlessness

Impact

The impact and response to "sudden" and "smoldering" crises differ. A sudden crisis has a definitive beginning and end and while shocking, the human impact is more easily compartmentalized because of the definitive timeline. With smoldering crises, the effects are usually more insidious and difficult to overcome because the emotional and behavioral cycles associated with the crises repeat over a sustained period of time. Recovery from a smoldering crises is often more complicated.

However, both events are characterized by loss and dread. While a loss of life is more likely in a catastrophic disease outbreak, other losses associated with the financial crisis may result in similar emotional and behavioral reactions, possibly further complicating response and recovery.

These losses include, but are not limited to the loss of:

□ Identity

□ Sense of community; belonging

□ Status and role

□ Control

□ Security

□ Trust

□ Confidence

□ Beliefs or faith (i.e., patriotism, religious beliefs, etc.)

□ Future and purpose

In Time Magazine reporter Amanda Ripley’s latest book, "The Unthinkable: Who Survives When Disaster Strikes-and Why", she isolates "dread" as a significant factor influencing the human response to threatening events. She has gone as far as developing a "dread formula" to explain these dynamics. Some, if not all, of the elements in this formula are equally present in both the economic crisis and most pandemic scenarios. Ripley’s dread equation is:

Uncontrollability

+ Unfamiliarity

+ Unimaginability

+ Suffering

+ Scale of Destruction

+ Unfairness

______________________

Dread

One can assign each of the elements of the dread formula to some aspect of both the economic crisis and a pandemic. Many commentators have been liberal in their use of the terms "unimaginable" and "unthinkable" in their descriptions of the financial meltdown. It is likely that those same labels would be recycled and applied to a devastating public health crisis as well.

The impact of both events can potentially reach all corners of the globe and all spheres of our personal and professional lives. Both in the home and in the workplace, there is a foreseeable range of affects, including:

In the workplace

A great deal of time, effort and money has been spent in the U.S. and abroad over the past several years developing plans and procedures to mitigate the effects of a pandemic on the workplace. While a pandemic strain of influenza has yet to emerge, the current financial crisis has triggered many of the same workplace dynamics anticipated by pandemic planners, including:

□ High levels of stress and fear

□ Diminished or depleted workforce

□ Significant reduction in productivity

□ Loss of capital and/or access to capital

□ Supply chain disruption (i.e., cargo stacked up or waiting off shore at sea ports)

□ Drastic decline in retail, travel, entertainment, construction and many other economic sectors

□ Escalating unemployment

□ Consolidation among businesses within certain industries

□ Disruption or closure of financial markets and institutions

In the household

The 2008 American Psychological Association (APA) "Stress in America" survey revealed that 8 of 10 Americans identify money matters as a leading source of daily stress (APA, 2008). Since that study was released in mid-2008, the economic climate has darkened substantially. The Conference Board’s January 27, 2009 Consumer Confidence Index documented a steady slide into despair, with the consumer confidence level reported at an all-time low. People are feeling stressed and anxious about their financial future. Many are unsure how they will handle a recession or more economic bad news.

Both the economic crisis and a pandemic will result in the closures of many businesses, lost earnings and many other hardships. In both instances, individuals and households may suffer great financial difficulties, such as:

□ Little or no household income

□ Depletion of savings

□ Increased dependence on credit cards to replace income

□ Risk of default on loans or mortgages

□ Potential for crisis-related financial scams

□ Increase of a overall financial stress/distress

Response

Emotional responses can range from simple distress to diagnosable mental health conditions, including:

□ Extreme fear and anxiety

□ Sadness and depression

□ Anger, blame

□ Helplessness, hopelessness

□ Increased rates of suicide

□ Traumatic stress reactions

□ Complicated grief and bereavement

Trauma and Grief

Grief has been described as our reaction to something (or someone) "good" leaving our lives, while trauma is our response to something "bad" coming into our lives. In the instance of a worker losing a job, baby boomers losing 40% or more of their retirement savings or a family losing their home, loss is loss and our minds and bodies do not necessarily distinguish between loss related to a health crisis or an economic disaster.

Behavioral reactions tied to our appraisal of the situation can lead to:

□ Increased alcohol and drug use

□ Increased irritability

□ Difficulty concentrating, problem solving and/or decision-making

□ Increased risk-taking

□ Increased emotional-eating (esp. sweet, salty and high-fat foods)

□ Social isolation, withdrawal

□ Change in sleep patterns

Many behavioral reactions affect interpersonal relationships in the home and workplace. These can be manifested as:

□ Increased conflict

□ Diminished communications

□ Difficulty parenting or supervising workplace subordinates

□ Poor spousal/partner and/or peer relations

Planning

Much can be done to reduce and/or mitigate many of the negative consequences identified above through conscientious planning in the home, workplace and community.

Planning in the Workplace

Guidance in pandemic influenza planning has focused on several areas of concern that are equally relevant in the financial crisis. These include ensuring critical processes, communications, physical and mental health issues, ability to travel to or attend work and, finally, developing organizational resilience. Successful consequence management through the economic pandemic will require attention to many of the same concerns.

In planning for a pandemic, it is important to ensure critical processes can continue with a reduction of workforce. If, during the economic crisis workforce reduction is necessary, insure the remaining workforce still retains the core skills and knowledge (corporate memory) to assure essential business functions can be accomplished, or make sure critical processes are documented so unskilled laborers can perform the required function.

"Crisis-sizing" the Workforce

"Crisis-sizing" or temporarily adjusting the size and configuration of an organization’s workforce due to economic pressures rather than illness may be a necessary part of a survival strategy in the face of this new threat. Pandemic planning guides have suggested that leaders should explore creative workforce restructuring for survival. Several businesses have recently received applause for implementing creative alternatives to layoffs, including reduced hours for all rather than lost jobs for some. Other cost-saving alternatives have included shifting some employees to working from home and job sharing to reduce their office space requirements and other fixed overhead costs. These strategies have been discussed in the context of pandemic flu planning as ways to cope with a workforce downsized by disease.

Changes in the workforce and financial health of critical vendors must also be assessed. If the organization is reliant on external resources or services, leaders should conduct business risk and impact assessments to identify critical suppliers, identify alternative sources and negotiate contract terms in advance of any potential disruption.

Communications

Immediately, organizations can provide the most value to their employees by communicating their priorities and survival strategies. In the workplace, survival is a shared responsibility. Clarity regarding roles and responsibilities during a crisis is crucial. To reduce anxiety, leaders should provide employees with two-way communication vehicles. During the financial crisis, as in pandemic preparedness, leaders should let employees know what the business is doing to mitigate risk. If there are serious concerns, it is not only much better from an ethical standpoint to openly communicate these challenges, there is a legal obligation documented in the Worker Adjustment and Retraining Notification (WARN) Act that indicates companies must provide 90 days’ notice prior to plant closure or mass layoffs, so affected employees can be as prepared as possible for negative outcomes.

Employees may better prepare financially and emotionally for a reduction or loss of income with some degree of advanced notice rather than following a surprise or sudden reduction of work force. Warning enhances a sense of controllability and whenever possible proactive communications are recommended.

Proactive communications may also involve the development of draft "shelf-kits" by creating internal and external communication templates and having them pre-approved by corporate communications officers to help speed the delivery of timely communications for different contingencies. Establishing a "hot-line" can empower employees to ask questions and/or make suggestions to help stabilize their workplace environment.

Training

Many organizations active in pandemic planning had initiated training programs for executives and supervisors, as well as internal crisis management and first responder teams, to raise awareness of the unique physical and mental health challenges associated with an influenza outbreak. Such programs were designed to help decision-makers predict and prepare for a pandemic using accurate information about the disease and its likely impact on society, as well as the organization. Specialized training focused on the unique challenges associated with the financial crisis may be equally important. Understanding the human factor in both a pandemic and financial crisis can give planners an advantage in recalibrating business contingency plans appropriately for the current threat environment.

Sources of Emotional Support

We have previously discussed the concepts of trauma and grief as they relate to both a pandemic and the financial crisis. It is foreseeable that there may be an increased need for psychological support programs for workers and their families. Establishing or enhancing Employee Assistance Programs (EAPs) or community outreach programs can aid and educate employees with financial planning or other related services. A lesson learned is that natural support systems, in the home, community and workplace tend to be the most helpful in other smoldering crises. Promoting peer support programs and other mechanisms for employees to both give and get emotional support may prove invaluable in a long-haul scenario.

At home

Just as it is important for leaders to communicate in the workplace, providing family members with information goes a long way toward an effective response and recovery. The emotional demands of both a pandemic and the financial crisis can erode relationships in the home during a time when the support of loved ones is most needed. Sharing information about the affects of smoldering crises on homes and families can be beneficial and may help those affected anticipate the likely emotional traps that characterize long-term stress situations.

Employers can also provide additional assistance in financial planning and household money management. Those not yet seriously impacted by the financial crisis can modify the home budget and identify ways to curtail unnecessary spending. It is helpful to enlist all family members to watch spending. Even young children can understand the concept of saving for future benefit. Planning ahead will be necessary to ensure that basic needs will be met. Prudence and pragmatism will be of equal importance in both the current financial crisis and a possible pandemic in the future.

Tracking and Benchmarking Through a Smoldering Crisis

There is very little, if any, empirical research from the "Great Influenza Pandemic" or the "Great Depression" that can be applied to predicting human behavior in a smoldering health crisis or financial crisis. So what else can be done by organizations to utilize the lessons learned from the past to address the financial pandemic at hand?

Some organizations have begun to track the impact that employee benefit or wellness programs, such as weight reduction, smoking cessation and exercise programs, have on an organization’s bottom line. It would be beneficial to also document other human factors issues (absenteeism, performance, morale, conflict, others) in the home, business and community as we move through the various phases of the financial crisis. Such tracking can help leaders gain a better understanding how prolonged adversity impacts the "worried well" (those who are still employed or not otherwise derailed by the financial crisis) to inform pandemic flu policies, plans and exercises. Organizational benchmarking of human factor issues can be invaluable in developing the type of accurate behavioral assumptions that will be necessary to sustain productivity and the bottom line during a pandemic or other smoldering crisis.

Recovery

As with event, impact and response factors, the likely psychosocial challenges in the long-term recovery from both pandemic flu and the economic crisis are similar. In a typical disaster, the behavioral response cycle can quickly shift from neighbor-helps-neighbor to neighbor-fears-neighbor to neighbor-compete-with-neighbor as fear escalates. During the recovery period, the cycle gradually returns from self-preservation back toward community cohesion and support. In fact one of the lessons learned in other smoldering crises is that the natural support systems within the home, business or community become the most important and dominant source of help. Knowing this, families, businesses and communities should take every opportunity to bolster and promote cohesion in the early phases of a crisis, since it will become increasingly important as time goes on.

Resilience

Personal and organizational resilience is essential to the recovery from a smoldering crisis. Resilience is often defined as the "human capacity and ability to face, overcome, be strengthened by, and even be transformed by experiences of adversity."

The potential for resilience can be and should be nurtured. Smoldering crises are best approached by applying the discipline and strategy of the marathon runner, not the sprinter. Everyone wants out of a tough situation sooner, rather than later, but both the financial crisis and a pandemic are challenges of endurance. Those who have survived and thrived through smoldering crises in the past identify three common tactics:

□ Face the sources of their stress directly

□ Learn from past experiences

□ Reach out for and use resources

There will be numerous challenges in the wake of the financial crisis, as there certainly will be in a pandemic. These include, but are not limited to:

□ Overcoming loss or guilt from having survived through the storm

□ Taking inventory and examining the current state of one’s personal and professional affairs

□ Addressing both the physical and psychological consequences of the crisis

□ Developing a reconstruction plans to rebuild or recoup losses

□ Reaching out to friends and the community to give and get support

In Conclusion

Pandemic planning should remain a priority during the financial crisis. It can be particularly useful to revisit pandemic plans to see what elements can be recalibrated or repurposed for the current financial crisis.

The authors suggest that the current financial crisis may be one of the most realistic and productive pandemic influenza planning exercises business and community leaders may have in that both events are smoldering crises with many similar human factors and economic consequences. While recognizing that a catastrophic disease outbreak could result in a tremendous loss of life, therefore becoming a disaster of a whole different magnitude, there are enough similarities to allow business continuity and emergency management planners to track, benchmark and use their observations of the financial crisis to inform pandemic planning efforts. Likewise, prior pandemic planning efforts may also inform strategy and decision-making in the current financial crisis.

Lastly, it is important to reiterate that the pandemic risk is not diminished. This threat is still lurking in the shadows while the world turns its attention to the urgent financial situation. A weakened global economy may in fact leave nations, businesses, communities and families that much more at risk to a public health disaster.

The Perfect Storm:

Economic Stress and Holiday Stress Collide

[Nov 26 2008]

A 2004 poll from the American Psychological Association (APA) found that 61% of Americans identified money issues as the leading cause of stress during the holidays. Oh, for the good ol' days of 2004! Participants in that survey listed lack of money, lack of time, the pressures of gift giving and credit card debt as significant sources of strain. One in five Americans surveyed expressed concerns about their physical health and many reported increased eating or drinking to cope with the stress.

That was all long before the bottom fell out of the global economy. In a good year, the holidays can be stressful enough, taxing our relationships, finances and physical endurance. This year brings new challenges requiring a proactive approach to managing the effects of a potentially toxic blend of holidays and finances.

In this issue of the Behavioral Risk Bulletin, we explore the intersection of economic stress and the stress associated with the beginning of this year's holiday season. Holidays have an amplifying affect on emotions, both high and low. Much of this amplification is driven by the attitudes and beliefs we hold about the importance and meaning of the holidays, as well as our own expectations and the expectations of those around us. For many, the holidays are a time of reflection and review of the past, while also for planning and goal setting for the future. In an environment marked by uncertainty and fear, this holiday season may seem overwhelming. Understanding the unique challenges created by the confluence of economic and holiday strain can help us anticipate and perhaps prevent some of the potential emotional and behavioral hazards this holiday season may hold.

The Root of Anxiety

Cognitive dissonance - a term in the field of social psychology - is when one feels uncomfortable or anxious due to juggling two contradictory ideas or beliefs. Dissonance occurs when people experience an inconsistency or a gap between their ideas of how things should be and how they really are. Theorists suggest that the greater the gap, the greater the degree of anxiety, guilt, shame, anger or embarrassment. People can by haunted by the "tyranny of the shoulds": "I should have been able to get better/more gifts for people"; "I should feel happy, it's the holidays"; "I should have handled my money/career differently", etc. While one might believe that they should feel joyous during the holidays, this may contradict the reality that portfolio values are slashed, jobs are on the line or that many people are struggling to hold onto their homes.

Cultural norms, family traditions, office rituals and other forces may shape the individual's or group's expectations of how the holidays should be. From gift- giving to the annual bonus, there are many holiday- related activities that may require severe modification during the current economic downturn. Living up to holiday expectations can be tough, but this year they may be even tougher.

The Big Three: Sources of Holiday Stress

The Mayo Clinic has identified three main sources of holiday stress: relations, finances and physical demands. For those with families, pre-existing conflicts and tensions can be exacerbated, misunderstandings are more common, and simply being together for longer periods of time can be stressful. For those alone during the holidays, for whatever reason, separation and isolation can heighten feelings of loneliness and sadness. Financial stresses associated with the holidays can stem from overspending on gifts, travel and entertaining. The post-holiday crash often coincides with the arrival of the first credit card statement of the New Year. For many, the physical demands of the holidays represent the greatest stress, with increased shopping, cooking, socializing, and at the same time, increased eating, drinking and many late nights.

Seven Strategies for Coping

There is no one best way to cope with the emotional challenges of this unusual holiday season. You may discover a technique or strategy on your own, but here are seven different ideas to consider:

1. Manage Expectations: Denial can complicate many problems and failing to acknowledge the reality of your situation can lead to overextending yourself, physically, emotionally and financially. Have an honest discussion with those you normally exchange gifts with about how you might change a tradition or find new and creative ways to express your love. Although this may be difficult with young children, especially those who still believe in the magical aspects of the holiday, tempering expectations ahead of time may be very helpful.

2. Compartmentalize: Allow yourself your emotions and then let it go. Whether you are angry, anxious, sad or disappointed, permit yourself to have those thoughts and feelings and then turn them off. This takes some practice, but compartmentalizing allows you to pick and choose when you will deal with these emotions, rather than them controlling you. Find a time and place before a holiday gathering to get in touch with these feelings, but set a limit and when the time is up, leave them there and go onto festivities at hand. You can always go back to that physical and/or emotional place when the event is over.

3. Visualize Success: Make a conscious effort to mentally rehearse a holiday gathering. Use images that make you feel safe and cared for. Do not visualize conflict, upset or tension, only success and comfort at the gathering. Breathe slowly, center yourself and picture pleasant conversations and contact with your friends and family.

4. Limit Distressing Contacts: Don’t be afraid to say enough is enough and walk away from someone who is prying, making you uncomfortable or anxious. Be polite, try changing topics, but ultimately, it may be better for everyone if you find a way to extract yourself from the conversation to visit others at a gathering.

5. Let People Know What Would Help: Try to tell those around you what you really need, since they may not know how to help you, and ask for their understanding if you decline an activity. People may even avoid you if they feel uneasy or unsure what to say or how to help. During a time when emotional support and contact can be so helpful, don’t let a lack of communication create unnecessary barriers.

6. Easy Does It: Holidays are notorious as times for excessive eating and drinking. Finding comfort in familiar holiday foods is understandable and common, as is drinking more than usual or perhaps sensible. Be aware of this tendency and try to enjoy yourself without overdoing it.

7. Remember the Meaning of the Holiday: The winter holidays in most traditions are steeped with meaning and symbolism. We have heard again and again the complaint, “The holidays have become too commercial.” Here is an opportunity to simplify, reduce materialistic holiday habits and get in touch with the true meaning of the holiday. If nothing else, holidays are about family and friends, about pausing from the daily grind and stepping back to savor the things that are most important in our lives. This holiday less can be more.

Get Out of Your House, Get Out of Your Head

In many parts of the country the holiday season is also characterized by changes in the landscape. Get out, take a walk, breathe the cool clear air and stay in touch with nature. Physical exercise is a wonderful antidote for the winter blues. It is also therapeutic to get outside of our own emotional experience by volunteering and helping others in need. Doing so can reduce feelings of isolation and can help put your situation in perspective.

If you are having real difficulty letting go and giving yourself a break from the heavy thoughts and feelings related to a holiday season marred by economic woes, remember that you are not alone. Be on the lookout for symptoms of depression and the warning signs of potential harm to others as well - “If you see something, say something”. If you are worried or feel uncomfortable about behavioral and emotional changes in a loved one, a friend or co-worker, err on the side of safety and reach out. If you think that they are at risk in any way, seek professional assistance.

Counseling services may be accessible in the workplace through your organization’s Employee Assistance Program or in your community at local community mental health centers and faith-based agencies. If you are having difficulty locating sources of emotional support or are worried about how stress if affecting you, the National Mental Health Association has an online search tool to help you find nearby resources and a help line staffed by trained and qualified counselors. You can call to speak with a counselor at 1-800-969-6642 and explore more ideas for coping with the emotions arising from this unique holiday season.

A time for resilience

[Nov 10 2008]

Resilience is the ability to bounce back from adversity. It allows us to recovery from change or hardship, as individuals, families, communities and organizations. Resilience encompasses both strength and flexibility. It is associated with elasticity, buoyancy and adaptation. All of the attributes of resilience would seem essential in the current climate given market volatility and the unpredictability of global economic conditions. This issue of the Behavioral Risk Bulletin will focus resilience, its importance and strategies for building and enhancing resilience in times of crisis.

Aristotle, once said; "You are what you repeatedly do." What you do repeatedly through thoughts and actions eventually become your habits. Some theorists feel that resilience is a trait, inborn, hardwired into our being, that it is an innate aspect of our personality. Others suggest that resilience can be developed. Advances in brain science tell us that what you think and how you think can influence the actual anatomical structure of the brain, as well as neurocircuitry and neurochemistry.

This concept, known as "neuroplasticity" suggests that despite earlier ideas that our habits, thoughts and beliefs are set in stone, that in fact you can teach old dogs new tricks. The brain continues to grow, change and adapt to challenges across our entire lifespan. Our thoughts shape our brains as much as our brains shape our thoughts. This relationship is now known to be a two-way street. We can use this knowledge to promote resilience in ourselves and in our organizations.

What Does Resilience Look Like?

Resilience is defined by several cognitive, emotional and behavioral markers. How an individual acts when confronted with sudden change or adversity helps us see resilience in action, it is observable. Resilient people demonstrate flexibility, durability, and the ability to organize and manage ambiguity. These individuals tend to be proactive rather than reactive, to have an attitude of optimism and a mindset that is open to learning. The resilient person is positive and views life as challenging but full of opportunities.

These may sound like personality traits and some may be, but that does not mean that individuals cannot develop resilience. By identifying and practicing these behaviors individuals can build or bolster resilience in themselves and support resilience in others around them.

Ten tips for building resilience

Becoming more resilient is a process and requires conscious effort and a degree of patience. Fostering resilience as an element of an organization's culture requires even greater patience and consistent positive reinforcement from leaders. These efforts can pay off in meaningful ways but you are not likely to be able to reap the rewards of resilience without some significant effort. These tips can help you move to a higher degree of resilience in the face of current and future challenges:

1. Accept Change: Change is constant and inevitable. Some even say it is cyclical and foreseeable to a degree. Successful people accept change rather than resist it. Actively seek ways to become more comfortable with change.

2. Become a Continuous Learner: Many people resist learning new ways, cling to old behaviors and skills even when it becomes obvious that they don't work anymore. Focus on learning new skills, gaining new understanding and applying them during times of change.

3. Take Charge: Don't wait for someone else to lead the way, it may not happen. Instead embrace self-empowerment and take charge of your career and your own personal development.

4. Find Your Sense of Purpose: A clear sense of purpose helps you assess setbacks within the framework of a larger perspective. Develop a "Personal Why" that gives your work meaning or helps you put it into a larger context.

5. Pay Attention to Self-Identity: Form your personal identity apart from your job. A job is just one facet of your identity, and a career just one aspect of your life. To achieve some degree of resilience be sure to separate who you are as a person from what you do for a living.

6. Cultivate Relationships: Personal relationships can be a strong base of support and a critical element in achieving goals, dealing with hardships and developing perspective. Develop and nurture a broad network of personal and professional relationships as a component of your resilience-building strategy.

7. Reflect: Whether you are riding a wave of success or riding out hard times, make time for reflection. Reflection fosters learning, new perspectives and a degree of self-awareness that can enhance your resilience.

8. Skill Shift: Reframe how you see your existing skill set, consider transferable skills and develop new skills when possible. Questioning and perhaps even changing your definition of yourself or your career can lead to higher levels of resilience.

9. Develop Emotional Intelligence: Think creatively and flexibly when under stress. Focus on the future and gain strength from new opportunities that may present themselves. Expand rather than shut down when faced with a challenge.

10. Take Care of Yourself: It can be difficult to find the time, energy, enthusiasm or even the money to take care of yourself during tough times. Letting yourself become run down contributes to the problem rather than the solution. It is more important than ever to eat well, exercise and practice relaxation during times of high stress. Spend time with family and friends and regularly plan and enjoy fun activities.

Pulling It All Together

Resilience allows us to bend rather than break during stormy conditions. Being or becoming more resilient is a necessary survival strategy in unpredictable times. Working slowly but consistently toward greater resilience can help fortify you and your organization and help you weather this and other crises on the horizon.

The art of breaking bad news

[Oct 24 2008]

Being the bearer of bad news is never pleasant. Whether it is delivering the message at work or at home, finding the right way to share bad news can be tricky. It is known that how bad news is shared can greatly affect the emotional and behavioral response of those on the receiving end. Studies around the delivery of extremely bad news, like death notifications for example, demonstrate that the way the message is delivered influences both short- and long-term reactions and recovery.

In this week's Behavioral Risk Bulletin we would like to offer some guidance in breaking bad news. These general recommendations can be applied to situations as diverse as discussing sudden and necessary changes in college plans with a son or daughter, recalibrating retirement plans with a spouse or partner or informing employees of downsizing and layoffs. What we say and how we say it can have a significant and lasting impact on the recipient. After all, you may be delivering truly life-changing news. Doing it well is important.

The 5 T's of Breaking Bad News

The nature of human response to a crisis or disaster is both phase-specific and hazard- specific. How we react to a threat, real or perceived, varies from hour- one to day-one to week-one and so on along the time line of the event. Likewise, how we react to a hurricane is different than a disease outbreak and different yet than an economic crisis that may too threaten our security and survival.

The 5 T's provide a structure for developing and delivering your message. Integrating these ideas into your approach to sharing information about difficult or dangerous situations can help mitigate the adverse and unintended consequences of your task.

Take One Step at a Time

The 5 T's approach can be useful in structuring the content and delivery of bad news. Each of the T's is presented in a specific sequence and addressing each item in the recommended order will inform your decisions about the next.

The 5 T's are:

1. Target
2. Timing
3. Type
4. Tone
5. Text

When delivering bad news some of us just want to get right to the point. But style is important in breaking bad news. The very last consideration should be "what" you will say. The "what" is referred to as the "text" in this model. Before racing ahead to what you will say, you are encouraged to step back and address the first four T's.

Target

Target refers to "who" will be receiving the news. Is it an employee, a child, a spouse or a stockholder? Obviously each audience requires a different approach. It may be necessary to adjust language to be age-appropriate for children; key stakeholders may demand technical details; employees at various levels all may require different messages delivered in different ways. In fact, with any bad news scenario, it may be necessary to develop several versions of the core message, each intended for a different target.

Timing

Timing is about "when" the news will be delivered. The time of day, week, month and year may be significant, but it may be unavoidable that the news must be shared soon, if not right away. When it is possible, consideration should be given to timing. Combining these elements, the target or "who" helps inform decisions about "when" since each audience may receive the news on a slightly different time table.

Type

In this context, "type" means "how" or by what mechanism the bad news will be delivered. It is always preferable, but not always possible to deliver bad news in person. Telephone, e-mail and other forms of communication may be options for some but not all "targets." Addressing the "target" and "timing" questions can help you decide the best way to share the news. The more personal the relationship, the more personal the delivery should be. With close colleagues, family and friends bad news should always be shared face-to-face. With larger and more removed audiences, other means of communication may be appropriate, but still special attention should be given to make those messages as personal as possible. No one likes to get a form letter or the feeling of being just another account number when speaking to a telephone service rep. Even in written and electronic communications, it is important to project empathy to the recipient of bad news.

Tone

Using a business-like tone at home can be perceived as cold, impersonal and distant. Being too casual or familiar with employees or stakeholders can seem unprofessional. Striking the right tone is important. One of the key concepts in determining tone is "congruence." The tone of your message must be congruent, matching the other elements of your message in support of your delivery. In high-stress or high-fear situations, people become more reliant on non-verbal communications, therefore, para-verabal communication elements, such as tone, rate of speech and volume become increasingly important. Tone is determined by the previous T's: who is getting the message, when they will get it and how it will be delivered. Tone must also work in concert with the "text."

Text

The last crucial aspect of delivering bad news is developing the actual message, referred to here as the "text." It is important to find the right balance between language that is accurate, informative and straight forward, but not so complicated or detailed as to overwhelm or so simplified that it is condescending. If you work through the 5 T's in sequence, the text of your message may become more apparent and natural. As with other elements discussed above, the wording of your message will require adjustment for different audiences as well.

Don't Go It Alone

The more serious the news, the more helpful it can be to have a partner available to back you up. Mothers Against Drunk Driving (MADD) has developed structured guidelines for breaking extremely bad news, such as the death of a loved one. While most of us will never be in such a difficult and stressful position, some of the recommendations developed by MADD can be useful in delivering other less traumatic news. The National Center for Post-traumatic Stress Disorder (NCPTSD) has published these recommendations online. Having a partner along to help you deliver bad news and having expert advice such as that offered by MADD can help prepare you in the event that you must be the bearer of a tragic or powerful message.

Click here to read the MADD/NCPTSD notification guidelines.

Fear, performance and productivity

[Oct 17 2008]

Basic Concepts

In 1908, psychologists Robert Yerkes and J.D. Dodson developed a model of understanding the affects of fear and stress on performance. The "Yerkes-Dodson Law" dictates that to a degree fear and stress can motivate and drive performance, but that a tipping point is reached where performance greatly diminishes. This concept is widely used in sports psychology to help elite athletes find and stay in their "zone" of peak performance. Most of us have experienced this on some level and have a sense of where our own point of diminishing returns is set.

A far more eloquent and useful model to help us understand the type of fear generated by the current financial crisis is "crisis decision theory." Crisis decision theory helps us predict the responses people will choose to negative circumstances. Since a negative life event is largely subjective and shaped by our individual perception, crisis theory can be applied to a wide range of adverse events, from losing your wallet to losing your home. Crisis theory sets out to address two questions that may be helpful in anticipating the emotional and behavioral responses to the current crisis:

What are the decision processes people use when faced with a negative event

What are the factors that predict their response choices

Although the current discussion is limited to the financial crisis, crisis decision theory can also be applied to disaster scenarios, such as the factors involved in choices about evacuation, personal and family disaster preparedness and reporting to or remaining at work during a crisis or disaster. Business continuity planners and emergency management professionals should consider incorporating some of the important concepts of crisis decision theory into their response and recovery models.

Crisis Decision Theory

Let's explore a few of the central concepts in crisis decision theory. There are three stages of crisis decision-making delineated in crisis decision theory. These include:

Assessing the severity of a negative event

Determining response options

Evaluating response options

Applied to the financial crisis, individuals, families and businesses are still trying to assess the impact of recent events. One individual may know with certainty that they have lost their job, another may be sure that they have suffered serious financial loses in their investment portfolio, college savings plan or retirement account, but as the market undulates from 700 points up to 700 points down in a single day, they maybe unclear about how much of a loss the have truly suffered. For the small- or medium-size business owner, having their line of credit curtailed may mean trouble meeting this week's payroll and perhaps losing employee confidence or perhaps losing the employee who can not afford to come to work if pay day is not a sure thing. This phase of a crisis event can be chaotic and ambiguous, so as straight forward as this initial stage of crisis decision theory may seem, assessment often can not begin until the smoke clears.

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Since there are so many unknowns in the current financial environment, employers should enhance efforts to communicate with key stakeholders, including employees, about the company's financial position and provide reasonable warning if any difficulty is foreseen. Transparency about such issues can improve employee loyalty and mitigate rumors that can impact safety and performance.

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From a crisis decision theory perspective, the financial crisis holds some unique challenges, specifically that when a threat (physical, emotional, financial or otherwise) is so extreme, it may overwhelm people and paralyze their progress though later stages. The authors of crisis decision theory (primarily Kate Sweeney at the University of Florida), depict this potential in an inverted "U." If a crisis is not sufficiently scary, people may not be motivated to act in any way, and conversely, if the situation is extremely frightening, it can immobilize people and impede any meaningful action.

There are several other factors that help shape people's perception about how bad a crisis really is. These include:

Cause: Who's to blame? If people see themselves to blame ("I should have...before this happened" or "If only I had...") they tend to perceive the crisis as more severe.

Comparisons: With their idea of how things should be; how they used to be; how the crisis affects others around them.

Consequences: Their fears of negative consequences yet to come.

Public Image: Events that damage a person's image in their company, their social circles or neighborhoods, are also experienced as more severe.

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There will be great variation in how individuals respond to the financial crisis. Although it may appear that two employees have sustained similar loses, their reactiona may be very different. Reaction to loss is influenced by dozens of factors, including temperament and culture.

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Weighing Response Options

After sizing up the problem, the next question is usually, "What can I do about it?" The two critical determinants in choosing a response option are the individual's perception of control over the crisis and the resources available to them to tackle the problem. Someone faced with a diagnosis of cancer may be presented a whole range of treatment options from doing nothing to a radical or high-tech treatment. If this person does not have sufficient financial resources and/or insurances, many, if not all of the options may be off the table. Another person may have great financial resources, but the nature of their illness is such that there are no viable treatments, perhaps in a late stage of a disease. All of the money in the world would not be helpful in such a bind. So, options and resources are closely linked.

This all boils down to controllability. People are more successful in dealing with crises that they feel they have some control over and when they believe they have the necessary resources. Unfortunately, in the case of the financial crisis, the activity of the markets and world governments is well outside most people's control and the loses experienced in the market melt-down can reduce the resources people might otherwise use to deal with a challenge.

Making a Choice

In a disaster planning scenario, employers may ask what factors help determine if workers will stay at their posts or come in to work during a crisis; who will perform the best and what can we do to encourage people to stick to the roles and responsibilities assigned to them in the organization's disaster plan? Crisis decision theory helps clarify how people weigh the pros and cons of their potential response. This theory suggests that three broad considerations are involved such decisions. They are:

The resources (money, time, physical effort, etc.) required;

The direct consequences of a response (i.e.-"I might get hurt trying to get to work." or "I might get fired if I don't go in.")

The indirect consequences of a response (i.e.-"My family will be upset if I leave them for work during a storm." or "My co-workers will never look at me the same if I don't show up and pitch in."

Summary

Crisis decision theory is one of the models that helps us predict how people will behave in disasters, emergencies and other crisis events. Such a theory can also help us improve how people respond, therefore improving safety, performance and continuity of operations. In our recent white paper, "From Bourbon Street to Wall Street," we apply disaster psychology principles to help us understand the human factor in this unpredictable climate. As we move forward through the financial crisis, XBRM will continue to offer insight and guidance in predicting and preparing for the emotional and behavioral challenges to come.

STEVE CRIMANDO & CYNTHIA L. SIMEONE

From Bourbon Street to Wall Street: Managing the Emotional Consequences of the Financial Crisis - Lessons Learned in Natural Disasters

A Special Report from
Extreme Behavioral Risk Management
A Division of ALLSector Technology Group, Inc.

[Oct 17 2008]

Like natural disasters, a sudden financial crisis can result in uncertainty, loss, and anxiety about the future. Much of what is known about the emotional and behavioral response to other types of disasters can be helpful in managing the psychological consequences of the financial crisis. Left unchecked, these consequences can further complicate individual, community and organizational recovery. Lessons learned and strategies for coping developed in other disasters can be employed in financial crises to mitigate the emotional and behavioral consequences of the situation.

It’s a Disaster

The wave of fear and uncertainty that has rolled over Wall Street is certainly different in many ways from the wall of water that inundated Galveston in mid-September, but from a psychological standpoint, both events are disasters. Whether you are a financial services professional directly experiencing the meltdown on Wall Street, an investor feeling the ripple effects or someone otherwise distressed about the current economic climate, the shock to the nation’s financial system can trigger a powerful and overwhelming emotional response. The September 15, 2008 Forbes.com article, “The Emotional Impact of the Wall Street Crisis,” reports that, “employees of the financial industry’s giants are likely experiencing an emotional state that’s unusual to them - complete and utter uncertainty about their futures.”

The terms “loss”, “grief”, and even “trauma”, can be applied to communities ravaged by the recent hurricanes and the financial communities in major cities around the world. Some of the core concepts in impact and coping with natural disasters can be helpful across a range of different types of crisis situations. It has been said that grief is our response to something good going out of our lives, while trauma is our response to something bad coming into our lives. In many disasters and crisis events, both grief and trauma are present and powerful forces to be reckoned with. Unfortunately, many individuals, communities and organizations have become too familiar with, and too practiced at dealing with the emotional consequences of natural disasters. A February 2008 Oxfam International study documented a quadrupling of natural disasters over the past two decades, from approximately 120 to more than 500 worldwide each year. But the type of crisis affecting the financial industry today has been a relatively rare, but not completely unprecedented event.

With the increase in other types of disasters, there has evolved a growing body of knowledge about how sudden, shocking and threatening events affect us, along with best-practices in "psychological consequence management." Much of what we know about the emotional response to other types of disasters can be applied to and helpful in dealing with the psychological challenges of the current financial crisis. The noted statistician, George Box was credited with saying that, "all models are wrong, but some are useful." While there is not a one-to-one comparison to surviving a hurricane and a financial crisis, many of the front line lessons in disaster response do apply.

What is Lost?

In major disasters there are unfortunately many instances when individuals and families truly do lose everything. Losses can include loved ones, a home, pets, irreplaceable keepsakes and more, including a sense of community or safety. Deeply-held personal or religious beliefs can be shaken. In many situations and specifically in financial disasters, those loses can be somewhat imperceptible and not obvious to others. A financial crisis can result in a loss of:

•Identity and belonging

•Control

•Security, financial and otherwise

•Status and role

•Trust

•Future or purpose

Grief reactions, similar to those experienced after other types of losses, such as the loss of a loved one, are not uncommon. As stated, grief is our response to something or someone good leaving our lives and mourning these losses can be tricky. Survivors (and sometimes others around them) of financial disasters often don’t compare themselves to those who have experienced natural or technological disasters. However, loss is loss, and we are finding that this is a fair and useful comparison.

Phase-specific, Hazard-specific and Individual Responses

How individuals react during a crisis varies from hour-one, to day-one, to week-one and out along the timeline of the event. To help individuals and organizations predict and prepare for the emotional fallout from a financial crisis, a basic disaster-behavior timeline can be helpful. This timeline is marked by several foreseeable phases or stages, each representing its own challenges and perhaps, opportunities.

1. Impact: The initial phase of any disaster or crisis event is characterized by disbelief, fear and uncertainty. Fear of the unknown is a universal source of anxiety and the early phase of a crisis is often filled with ambiguity and a lack of information or clarity. Early emotional reactions often appear as shock and numbness. 　

2. Inventory: Once the smoke clears, people generally get a sense of how the disaster or crisis has personally affected them. It becomes increasingly clear what was damaged or lost and some of the initial shock often gives way to anger and blaming, sadness and feelings of powerlessness.

3. Disillusionment: It seems that many people slide into a period of disillusionment after a major trauma or loss, but to what degree varies with the situation and the individual involved. This phase is characterized by resentment, hopelessness, anger and sometimes shame or guilt. Often people report just feeling “stuck” and unable to make any forward progress in rebuilding their career or life. In work-related crises, this can be tied to perceptions of unfairness over pay and severance; difficulty finding a new job; and recognition of the permanence of change in lifestyle or work.

Disillusionment can also be compounded and prolonged by a cascade of secondary stressors, such as mounting financial pressures in the home or problems in relationships. This is a phase in which some people have great difficulty seeing the light at the end of the tunnel. It can seem bleak and hopeless for some and good emotional support becomes critical during this phase.

4. Reconstruction: Rebuilding a career, a lifestyle and a sense of optimism can take time, like rebuilding a home or community in the wake of a disaster. Everyone moves through these phases in their own time and on their own terms. There is no best way or specific timeframe in which people move through these phases. Moving through the phases and reconstructing a professional and/or personal life is very individualized. For some the process can be weeks or months long, for others it may take years. Establishing a “new normal” requires patience and persistence from everyone involved.

5. Integration: For the survivors of any crisis, the process of integration involves weaving the crisis into one’s overall life story. We never forget the crisis or disaster, but it becomes an important milestone or even a battle scar, rather than an obstacle or preoccupation that dominates our daily lives. In summary, it becomes a story, rather than the story, in our personal history.

And then there are specific personality traits, cultural influences and community norms (such as within the organizational culture, the community of financial professionals, etc.) that all come into play. Simultaneously, there are somewhat predictable responses to a financial crisis and totally unique responses that are not necessarily foreseeable or expected.

Exposure and Duration

In response to any real or perceived threat to our safety, survival or way of life, the degree of exposure and the duration of the threat are critical influences. Exposure can be thought of in degrees, first, second and third, much like a burn.

First degree exposure is experienced by those directly impacted by the event, in this instance, those executives, brokers and traders employed in the financial industry. The radical and sudden restructuring of the financial services environment has pulled the rug out from under tens of thousands of employees who face the loss of their livelihoods and stock value. Of course, the spouses, partners and children of those financial professionals are also directly affected as household incomes drop and economic security of the family becomes the dominant theme in everyday life.

Those who are not employed in the financial sector, but may experience significant losses in investments or are dependent on the financial industry for their incomes, would be considered secondary victims or having second degree exposure to the situation. With countless jobs evaporating in New York, London and elsewhere, the restaurants, retail establishments and service industry catering to the financial districts will also suffer substantial and perhaps irreversible losses. Many small businesses will also cease to exist with the sudden exodus of so many jobs.

As the ripple effect of the crisis widens and moves out from its epicenter, the circles become larger. Third degree exposure potentially applies to the wider U.S. and international community already anxious about instability in housing, credit, commodities and energy. This is the “Main Street to Wall Street” connection the current U.S. presidential candidates frequently reference. Many people will not personally know of someone working in the financial sector or in a business serving the financial community, but they are concerned and vigilant on a day-to-day basis about the price of gas, milk, heating oil and housing. For those with third degree exposure, the vulnerability of financial giants, such as Lehman Brothers, Merrill Lynch and AIG can heighten a sense of personal vulnerability, “If firms with literally billions of dollars in assets can’t make it, how can we?”

Duration

Obviously, how the crisis affects any one individual, family or organization is a function of their relationship, proximity and exposure to the event or situation. The closer you are to the fire, the greater the potential injury. Likewise, the longer the threat exists, the greater the impact. In many instances, natural disasters are sudden and devastating, but the initial event can end as quickly as it began. Tornados are devastating, but fast moving. Certainly it can take months, years or a lifetime to rebuild after a tornado strikes a community, but the initial threat passes quickly.

Typically, the longer a threat persists, the more damaging it is from a psychological and social standpoint. The financial crisis is in some ways both acute and chronic. The news of the Lehman Brothers collapse and sale of Merrill Lynch may have been sudden and unexpected by some, especially with the news of what is being referred to as "Bloody Sunday” being sprung on a weekend when the public’s attention is not usually on the markets.

But at the same time that the news was sudden and dramatic, many of the current economic problems that caught up with Lehman and Merrill Lynch have been creating instability in the markets for some time. Chronic stressors tend to exhaust us, some believe leaving us more vulnerable to additional risks. We seem to be much better suited to manage sudden, but short-term crises. But when a crisis is both sudden, shocking and prolonged, it can result in more complex and challenging emotional reactions. Every disaster is unique and at the same time, may have many similarities to other disasters. The current situation is unlike anything we have ever seen and yet bears a strong resemblance to many previous financial crises.

Reactions Vary

For several reasons, individuals experiencing distress related to the financial crisis may not reach out for help in meeting the emotional challenges. Not wanting to appear weak or worried in front of family members or colleagues; intolerance of our own fear or anxiety; and the need to appear in control, can all become barriers to seeking assistance or admitting that the situation is taking an emotional toll. It is useful to note that even following natural catastrophes, most people don’t go running for psychological support. There is typically a delay in seeking assistance, at least through the impact and often into the inventory phase. Most people facing a financial disaster, including layoffs or the disappearance of an entire industry similar to what may be experienced in large-scale natural disasters, don’t go on to become psychologically-damaged goods. Most people experience some degree of emotional distress, considered natural, expected and even helpful in surviving the challenges they face.

Across different types of disasters and crisis events, it is common for those individuals directly affected, as well as those in their immediate circles, to experience a range of reactions. And while these are natural and normal responses, they can certainly be unpleasant and add to one’s overall discomfort. Such reactions include physical, emotional, cognitive and behavioral changes that in some instances can complicate the situation and become barriers to coping with the challenges ahead.

Physical Reactions

- Shock-like reactions
- Insomnia
- Loss of appetite
- Headaches
- Fatigue
- Elevated blood pressure and heart rate

Emotional Reactions

- Depression, anxiety
- Numbness
- Constricted range of emotions
- Guilt, shame, doubt
- Intolerance of emotional response
- Global pessimism

Cognitive Reactions

- Distractibility
- Memory problems
- Decreased problem-solving ability
- Declining work performance
- Recurrent intrusive thoughts
- Nightmares

Behavioral

- Thrill-seeking, risk-taking
- Preoccupation with related news stories, rumors, etc.
- Increased substance abuse
- Jumpiness, feeling “wired”

Interpersonal

- Clinging, isolating
- Irritable, argumentative
- Distant, detached
- Increased/decreased need for physical intimacy
- Wanting to be only with co-workers/avoiding contact with co-workers

While these reactions are widely seen in response to natural and technological disasters, they are common in other interpersonal crises where there is an element of threat. Threat to one’s survival due to a financial crisis is no different. Most of these reactions are short‐lived and self‐resolved as the individual moves along the timeline of the event. For some, these reactions can be more pronounced and prolonged. There may even be instances in which, in a more extreme form, one or more of these reactions may represent the symptoms of a medical or psychological emergency.

Chest pains, arrhythmias or heart palpitations, as well as respiratory distress and acute abdominal pains may be the signs of something more serious and require medical attention. While potentially stress‐related, these reactions should not be ignored or thought to be "just in your head." Likewise, suicidal and/or homicidal thinking, as well as serious mental disorganization or disorientation may the signs of psychological emergencies and should be assessed by medical or mental health professionals.

Emotional Consequence Management

The concept of "consequence management" is widely accepted by business continuity professionals across most industries (e.g. risk mitigation and planning impacts risk consequence). Managing the emotional and psychological consequences of any disaster, natural, technological or economic, is critical to the recovery of the individual and their family, as well as the community and organization. The psychological impact of the current financial crisis should not be ignored or minimized. For many people this crisis represents substantial losses and a threat to personal and professional survival. This should not be underestimated in any way.

During a time of increased personal and professional demand, the impact of sleep problems, poor concentration, depression, apathy and increased use of alcohol and other substances can become serious obstacles to problem-solving and decision-making. Problems in personal relationships can create tension and distance from those who might be most helpful and supportive. The emotional consequences can be significant and difficult to address if not taken seriously and proactively.

There are coping strategies and techniques that can be helpful for individuals and families, as well as organizations. Many of these are similar to those being used today to assist the survivors of the recent spate of tropical storms and hurricanes.

Here are some useful suggestions for coping with the stress and anxiety stemming from the financial crisis:

- Limit your exposure to news stories and constant alerts about the situation
- Get accurate, timely information from credible sources; avoid rumors if possible
- Try to maintain a routine, even if you must create a new one
- Exercise, eat well and rest, even though it may be difficult to sleep
- Stay busy - physically and mentally

- Communicate with friends, family and supporters; let people know how they can help
- Use spirituality and your personal beliefs
- Keep a sense of humor
- Take one day at a time

Do Something

The great risk communications expert, Peter Sandman advises that, "Action binds anxiety." Doing something is almost always more psychologically helpful than doing nothing. Past financial crises have demonstrated that investors tend not to fight or flee but rather to freeze. In natural disasters, there can be irrational fighting and fleeing, but in most instances people find purposeful "next steps" that actually make the situation better. Individuals and organizations would do well to heed Dr. Sandman’s advice. Getting people active in support groups and social networks, as well as practical hands-on activities is important. We know that people who actively participate in rescue and recovery tasks during disasters fare much better, physically and mentally, than those who withdraw, become passive or apathetic. Keeping busy, focused and productive during stressful times is essential to counteracting feelings of helpless and fear.

Use Available Resources

Many firms offer Employee Assistance Programs (EAPs) or Wellness programs that include stress management and support services. Such programs often extend their services via hotlines as well and many of these employee support call centers have already begun to experience noticeable increases in utilization. But many affected by the financial crisis, such as those with second and third degree exposure, do not necessarily have access to such resources. There are non-profit organizations, such as those affiliated with the National Mental Health Association, that provide no-fee helpline support, often 24 hours a day, as well as referrals to support groups and mental health professionals with expertise and experience in dealing with acute stress reactions. These resources are made available to communities struggling with the emotional impact of natural disasters and violence and they can be useful in a financial crisis as well. If reaching out to an EAP or Wellness Program is not an option, you can locate a nearby affiliate of the National Mental Health Association online or contact them by phone at (800) 969-6642.

No One is Untouched

Deborah DeWolfe, Ph.D., author of one of the first field guides developed for disaster mental health response stated, "No one who experiences a disaster is untouched by the event." This is not to say that everyone is traumatized or damaged in some way, but a sudden, shocking and threatening event takes its toll. It is estimated that almost 9,000 employees lost their jobs in the Bear Stearns restructuring. Ultimately, job losses may be in the tens of thousands across the financial industry and countless more in service jobs that rely on financial sector workers as customers in the restaurants, bars and boutiques in and around the financial districts. A storm, earthquake or act of mass violence resulting in tens of thousands of lost jobs would certainly be called a disaster. Make no mistake, the life-changing events of the past several weeks in the global financial system are also a disaster and no one is left untouched.

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Cynthia L. Simeone, PMP, CBCP, is a New York City-based consultant, specializing in business continuity and organizational effectiveness helping clients understand and navigate the complex environments, relationships, and controls that their businesses must master to survive and thrive.

Contact: Cynthia L. Simeone

T: 646.321.2812

Accurate Disaster Behavioral Response Planning: A Guide for Business Continuity Planners [Dec 21 06]

Over the past several months, pandemic influenza planning has been a serious endeavor, consuming a great deal of time and energy for those tasked with continuity planning and disaster recovery in organizations around the world. Experts tell us that the risk of an influenza pandemic is very real, even though media coverage of new cases in birds, animals and humans is only a fraction of what it was a year ago. Despite the reduced news coverage, the H5N1 avian flu continues its march around the globe, with non-human cases now in 60 countries and human cases in 10. As of November 29th, there have been 258 people diagnosed with avian influenza and 154 people have died from the disease.

While there are many unknowns about the next pandemic, the three most significant questions still remain:

-When will it begin?
-How powerful will the strain be?
and
-How ready will we be?

The answers to the first two questions are unknowable, but by taking the risk seriously and acting now, we can influence the answer to the third.

A pandemic is a very different type of emergency. It is potentially much longer and more complex than other disasters that business continuity planners typically address and it represents a threat that leaves facilities and infrastructure intact and primarily targets an organization's people. As such, the human factor, both physical and emotional, become critical aspects of preparedness, response and recovery. This article offers executives and planners insight into the emotional and behavioral challenges critical to the business continuity planning process.

This article addresses 10 important disaster behavioral assumptions to inform your business continuity/disaster recovery planning efforts. "Accurate Disaster Behavioral Response Planning: A Guide for Business Continuity Planners" addresses key concepts of individual and organizational behavior before, during and after disasters and other violent or threatening events. The concepts can be applied to disasters, terrorism, workplace violence, public health emergencies and a wide range of potential crisis scenarios.

I invite you to read, discuss and share this article with your colleagues. Anyone involved in the business continuity planning process will hopefully find this information compelling and useful. Whether you are developing "all hazards" or hazard- specific plans, how employees act or don't act during a crisis will play a significant role in the effectiveness of your emergency plans. Accurately anticipating individual and group behavior can help ensure the safety, security and survivability of your workforce and your business.

Introduction

In most business environments, the term "behavioral" is typically associated with the mental health, wellness or employee assistance programs (EAPs) that address a range of emotional and psychological needs for employees and perhaps their families. From the perspective of those charged with crafting your organization’s disaster response and recovery plans, it is important that the planning efforts be accurately informed with empirical evidence about how employee behavior before, during and after a disaster can significantly increase or decrease the success of your emergency operations.

This guide was developed as an introduction for anyone who participates in the disaster preparedness and response discussion, in both the public and private sectors. It explains three useful behavioral response types and 10 important behavioral planning assumptions to assist planners in accurately informing their decision-making process across all phases of disaster and emergency management. These are evidence-informed assumptions, based on a thorough review of current research and literature, expert consensus, and field experience in disaster and terrorism response and planning. It is hoped that this guide will provide organizations around the world with some insights on effectively predicting and preparing for the likely human response to disasters, terrorism and other threatening events.

Accurate behavioral assumptions should be a standard part of overall disaster response and recovery planning. Nothing in this guide should be interpreted as suggesting that planners embark on an all-new way of approaching their jobs. Rather, inclusion of these ideas can fortify and enhance existing or evolving plans in critical ways that increase their effectiveness and value to the organization.

Emotional vs. Behavioral Responses

Emotional

For the sake of clarity, it is important to understand the distinction between emotional and behavioral responses to disasters. In this context the emotional response refers to what is typically thought of as "mental health" issues. For example, the numbers of those with either diagnosable and sub-diagnosable depression, anxiety, posttraumatic stress and other mental health problems are likely to increase following a disaster that results in a tremendous loss of life and/or disruption of personal, professional, and social functioning. In most disasters research suggests that only about 11-15% of those exposed go on to develop such long-term mental health problems. The majority of people will experience short-term emotional distress and rebound in their own time and on their own terms.

Human resources professionals and health, medical and EAP providers understand and anticipate "post-disaster" reactions, and there are typically many resources available to those experiencing the emotional consequences of a critical incident.

Behavioral

Disaster behavioral responses occur on a continuum from purposeful and productive to potentially harmful and counterproductive. The range of positive reactions includes heightened levels of motivation, greater attention to detail and increased group cohesion, but there are many potential "tipping points" within various disaster scenarios that can quickly influence individual and group reactions toward negative response behaviors.

Such negative reactions, at the low end of the continuum, are represented by unfocused, illogical or irrational behavior, such as panic, hoarding supplies, non-compliance with vaccination or quarantine orders, and so on. They are not the signs or symptoms of a mental illness, but rather significant behavioral alterations that may cause further harm to the individual, the community and/or to the larger society.

Where Emotion and Behavior Intersect

While a line has been drawn between emotion and behavior for planning purposes, emotion clearly influences behavior and that there are behaviors that will certainly increase or decrease emotional response. Two important concepts for planners, illustrating the inseparability of emotion and behavior during actual emergencies, are the cognitive and physiological responses to stress and fear.

Stress

A long-held and still valid concept in basic psychology addresses the relationship between stress and performance. Developed by psychologists Robert M. Yerkes and J. D. Dodson in 1908 and grounded within the discourses of biopsychology and neuroscience, this concept can be applied to the performance of the organization’s disaster planners, first responders, executives and general employee population, as they may operate in a high-stress scenario.

Simply put, the Yerkes-Dobson research demonstrated an empirical relationship between arousal (stress) and performance. Their research supported the common observation that low and moderate degrees of stress can pique performance, but that at some point stress overwhelms functioning and performance rapidly and dramatically drops off. The bottom-line finding:

There is an optimal level of arousal for a given task. While this concept can have day-to-day applications in our lives, it can take on much greater meaning for those working in high-stress and/or high-consequence environments.

Useful to planners is the idea that the "tipping point" is unique to the individual and the circumstance. In assigning roles and responsibilities in the planning process, it is important to have knowledge of the individuals’ skills, temperament, and even home-life situation as it "pulls" or creates "person/role conflict" during an actual disaster response. Planners are often surprised at the differences in the performance of personnel during drills and exercises, and real-time events, since it is very difficult for most people to simulate the high levels of fear or stress that are present in an actual disaster. The absence of realistic behavioral role-playing in drills and exercises unfortunately skews planning efforts from the largest government-run emergency management drills to drills in the school environment.

Fear

Much of what occurs in our basic fear response is deeply physiologically-driven. It is immediate, powerful and for many, seemingly uncontrollable. Like stress, fear can play a positive role. It is a necessary part of our basic survival kit. Also like stress, any potential positive reactions influenced by fear can pass a similar "tipping point" and begin to work against us.

There have been many empirical studies of the effects of fear on performance that can realistically inform planners about behavior in disasters and emergencies. Some studies have successfully used physical indicators, such as heart rate, as milestones to mark behavioral "tipping points" and identify the conversion from positive to negative or counterproductive fear responses.

There is, of course, a range of variation in such models that is dependent on the unique characteristics of both the individual and situation, but one important concept is that physical conditioning does not change this equation. The underlying neuroanatomy and neurochemistry that drive "exercise-induced arousal" (i.e., heart rate, blood pressure, respirations, etc.) during intense exercise, and the mechanisms that drive "fear-induced arousal" are essentially two different systems that produce two different results. There is also a growing body of evidence that the "fear-induced" process is primarily responsible for post-disaster mental health problems, which further demonstrates how tightly linked the emotional and behavioral responses truly are.

The following three planning scenarios further distinguish these emotional and behavioral responses, incorporating both the individual and group responses.

Three Important Planning Scenarios

As a discipline, public emergency management is laced with certain behavioral assumptions that arise from a "game theory" model. As events have forced a closer partnership between public and private organizations in disaster and emergency management, much of this thought has saturated planning efforts within the business environment as well. The sort of "game theory" most of us are familiar with may have been introduced by the film, "A Beautiful Mind", about Nobel Prize winning mathematician John Nash.

Game theory assumes a level of cooperation between individuals that moves everyone toward a better response. Evidence of behavior in disasters suggests this is true in many instances, but not all, and when it is not true, it can so radically change the course of events, that planners must have a much broader view of the range of potential reactions.

Type I Response

The most common and/or foreseeable response to a disaster or crisis is a "neighbor-helps-neighbor" response. People look out for each other, help each other, follow instructions that they believe will help themselves and those around them. They do not panic, loot or impede emergency operations. This, of course, is the best case scenario, and in most instances, this is the response your organization’s disaster planners are banking on.

Type II Response

In some instances, particularly those that are perceived to be threats to health or security, a "neighbor-fears-neighbor" response is predictable. In most instances your neighbor or co-worker would gladly run over to lend a hand during and after a disaster, but if they believed that you might be sick and contagious, or in some other way a threat to them, then all bets are off. Obviously, as we perceive that others around us in the workplace or in the community are now part of the problem, we become more defensive and less likely to pitch in to the collective response or recovery effort.

For planners, a realistic approach to this response is based on the understanding that some people will cut and run. Research inquiring about behavioral responses to "dirty bomb" and smallpox scenarios suggests that substantial numbers of people would refuse to shelter-in-place or receive vaccinations if ordered, based on such fears. Another recent study indicated that nearly half of all public healthcare workers would stay out of work during an influenza pandemic. Therefore, it would be important to reconsider your available "people power" during Type II situations in which not all your employees may come in, stay in or be able to execute the response and recovery tasks you may be counting on.

Type III Response

A Type III response represents the worst-case scenario. It is statistically unlikely, but must be understood and considered in your general planning efforts. Such a response is characterized by panic. Panic, by definition, arises from two perceptions: 1) The perception of limited opportunity for escape; and 2) the perception of limited availability of critical supplies. The presence of panic changes all the rules; now it is a "neighbor-competes-with-neighbor" situation and becomes much more complex and dangerous. In theoretical form, there is a critical shift from "game theory" to "game theory with non-cooperative players" and everything changes in significant ways.

Planners should no longer count on social or organizational cohesion if such a "tipping point" is reached. Elements of public response to Hurricane Katrina unfortunately illustrate this point too well. Homeland Security officials’ comment that "…they did not foresee that lawlessness in New Orleans" demonstrates narrowness or "lack of imagination" in the minds of planners to incorporate behavioral considerations into disaster plans.

Recommendations

All disaster plans, public and private, are extremely behavior-sensitive. Changes in perception about the risk, the response or your company’s motives before, during and after a disaster can affect every aspect of your recovery. Understanding these behavioral considerations exclusively from a "mental health" standpoint is too narrow and not useful for disaster planning purposes, although it is essential to plan for emotional consequence management with qualified internal and external resources.

The following standard disaster behavioral planning assumptions are offered to help inform disaster preparedness and response efforts. Certainly they are not all inclusive, but may serve as a starting point as you craft new plans and recalibrate existing ones. Factor a realistic range of possible human behavior into your plans, work with partners who understand and can help validate these assumptions in your environment, and leave a flexible margin for variations in this behavior, since so much will be influenced by event-specific factors.

Standard Disaster Behavioral Assumptions

No one who lives through a disaster is untouched by the experience.

At both the emotional and behavioral level, anyone directly and many indirectly exposed to disasters, violence and other traumatic events experience some sort of impact. How and when this is experienced is very subjective and unique to the individual and can alter performance and behavior relative to disaster recovery operations. Understand and anticipate that even "hardboiled" disaster professionals are subject to this behavioral impact assumption.

Disaster behavioral response concerns are different than "mental health" concerns.

Do not rest easy with the idea that the behavioral concerns are someone else’s problem. Yes, EAP or Wellness providers are typically ready and able to address the emotional impact of disasters. Planners should ensure that there are sufficient numbers of such resources, that they are readily accessible, and also validate that their models of intervention are consistent with current "best practices" in the mental heath industry.

The mental health concerns are largely "post-event". Behavioral concerns are present in all phases of emergency preparedness and response. Do not expect that the behavioral concerns can be managed effectively post-event.

The response will be phase-specific.

Obviously how people respond to the threat of an approaching disaster or crisis is different from their response during and after the event. Fear and anxiety may be the dominant emotional reactions in the early phases of an event, diminishing communication and performance in the workplace. Later phases may be characterized by anger, sadness and hopelessness, impacting productivity and rates of return to work. Each phase holds its own challenges, so understand and incorporate the changing nature of the behavioral response across your response and recovery timelines.

The response will be event-specific.

All-hazards planning is an important and necessary advance in disaster management, but there are important scenario-driven behavioral responses that are not captured in the all-hazards approach. For example, plans to address unconventional acts of terrorism, such as chemical, biological or radiological hazards, must be informed with accurate information about how people react to being or believing that they have been exposed to such substances.

Reactions can be immediate, overwhelming and generate such acute levels of fear that prior assumptions about containment and decontamination may be moot. Informing your hazard-specific plans with a "clinical reality" of the behavioral response to such emotionally powerful events is essential. Reach into and outside of your organization and community for credible sources of this clinical information and compare it with your current hazard-specific thinking.

The behavioral response may greatly overshadow the medical/physical response.

In certain events, the behavioral "footprint" will dwarf the medical and/or physical "footprint" of the event. This is often true when the exact nature of a threat is not fully known, or is difficult to detect. Chemical, biological and radiological risks are again strong examples, since these harmful substances may be odorless, colorless and tasteless. It may be difficult or impossible at the onset of an incident to truly know which individuals or groups have been exposed, and the typical behavioral response is "as if." Therefore, people behave "as if" they have been exposed, by: generating (psychogenic) signs and symptoms of exposure or illness requiring medical attention; over-reacting to their normal stress reactions thereby elevating levels of personal and group fear; potentially triggering panic; and feeling damaged in both the short-and long-terms, potentially affecting many aspects of their personal and professional lives.

Research with those exposed to sarin gas in the Tokyo subways in 1995 and the anthrax postal attacks in 2001 clearly support this assumption, and suggest that especially in the response phase, the numbers of the "worried well" or otherwise experiencing acute behavioral reactions can greatly outnumber those with physical injuries.

Many/most all-hazard concepts can be generalized to the behavioral assumptions.

It is not necessary to have a stand-alone disaster behavioral response plan. In fact, it would be counterproductive. Behavioral planning should inform, and perhaps saturate planning efforts, but must be integrated, not isolated from general planning activities. From the behavioral standpoint, most disaster scenarios, natural and technological, have somewhat similar emotional and behavioral consequences that can be anticipated and incorporated into overall planning efforts. There is one useful distinction that may clarify if and where different assumptions are indicated, and that is along the dimension of time.

Most disasters can be thought to have "bookends." When the event occurs, you clearly know if you are in or out, when it started and when it ended, and can begin to take inventory in terms of the damage done. Given those dynamics, it is reasonable and empirically sound to assume that the emotional and behavioral response will be acute (short but powerful) and subside relatively quickly over time. It is also scientifically sound to estimate that only a small number of those exposed may need direct mental health support services, especially for the longer term.

In the sort of events discussed in Assumptions 4 and 5, when the threat is less clear, and it has a sense of "future orientation" (i.e. "I may get sick years from now from the chemicals or radiation I was exposed to today"), the impact is more long-term. There is a much greater possibility for chronic, long-term medical and mental health problems following an event that lacks such "bookends."

Addressing the emotional and behavioral considerations helps ensure effective emergency operations.

As the accuracy of your behavioral assumptions increases it is possible to revisit disaster plans with a new realism regarding how employees, stakeholders, and even the markets may behave during certain emergencies. Tempering your planning effort with sound behavioral assumptions can help you sleep a little more soundly as well. If you have developed plans with clear roles and responsibilities for all levels of personnel, it is certainly reassuring to know that people will actually be able to execute critical tasks, come and stay at work, and deal with the challenges that are likely present throughout the event and recovery.

The behavioral component is part of "Job #1".

Job 1-A: People’s safety is the first concern in a disaster;

Job 1-B: The bottom-line is a first concern in a disaster.

These are not mutually exclusive concerns by any stretch. The business organization has obligations, moral, ethical and legal, regarding the safety of its people and in the immediacy of a pending or breaking disaster, life safety trumps all other concerns. Beyond the obvious humanitarian considerations, this makes perfect business sense. Machines and technologies do not continue, maintain or recover businesses during or after disaster; people do. And once a business is perceived to care more about the bottom-line than its people, damage has been done that can be costly in many ways and for a long time to come.

At the same time, the business has similar obligations to its employees, stakeholders and others to maintain the business. Once the initial impact of the disaster is absorbed, the single greatest source of stress for most individuals and communities is the residual economic damage. Financial stresses stemming from a disaster continue to wear on people even years after the event and often become much more detrimental to overall recovery than the initial trauma of the event. One of the most responsible things the business can do is develop and maintain robust disaster response and recovery plans. Plans that are sensitive to the emotional and behavioral concerns are advantageous, but simply having and using a plan addresses some of people’s basic needs: to survive and to have a job to come back to when it’s over. The lesson: Job I-A and I-B are the same job. Don’t let anyone tell you otherwise.

Accurate behavioral assumptions should inform all four phases of your emergency plans.

Although this concept has been hinted at throughout several earlier assumptions, it is helpful to clarify the phased approach to planning. For the purpose of optimal interoperability between private and public organizations during disasters, the National Response Plan advocates for the use of the Federal Emergency Management Agency’s "All-Hazards" model. This time-tested approach to emergency management is based on a federal planning document known as "State and Local Guidance 101" which has long dictated that emergency management officials plan consequence management activities across four discrete phases or stages of disasters. These phases are defined as mitigation, planning/preparedness, and response and recovery.

Within your organization, emergency planning may exist in different formats, using different terminologies. That’s fine. From the behavioral planning assumption standpoint, it is important to remember Assumption 3, in that behavioral reactions are phase-specific. Therefore, as you work with your planning templates and timelines, imagine the likely behavioral response to each phase and thoughtfully consider effective countermeasures to address those foreseeable reactions before, while, and after they occur.

There are resources in your organization and community that can help you plan.

In many organizations there are pockets of expertise with varying degrees of familiarity with the emotional and behavioral response to disasters, violence and other traumatic events. These may exist in some unlikely places, and individuals with such insight do not often make it to the table for disaster planning activities. The same can be said of the community around you. Academic institutions of all types and sizes, community mental health centers, private practitioners, and others can be helpful as advisors.

It is extremely important to qualify your sources for such critical and sensitive information. As discussed, accurate disaster behavioral planning begins with a clear distinction between the emotional (mental health) issues and the behavioral issues specific to disasters. Most mental health professionals will have a working knowledge of the mental health side of this equation. Few will have empirically sound advice about the behavioral concerns. The advisors best able to help will have a balanced view of both, a depth of actual disaster experience and training, and affiliations with the relevant professional groups associated with disaster response work (ex: American Psychological Association’s Disaster Response Network, etc.). In this niche, it is not enough to be a licensed, practicing mental health professional. Your resources will require a higher level of sophistication.

Not Just for Planners

Hopefully this knowledge will be useful for the Business Continuity Planner as well as human resources, legal and medical staff and others in your organization concerned with mitigating the entire range of disaster-related consequences. The emotional and behavioral reactions to violent or threatening events, whether naturally occurring or human-caused, factor greatly into all aspects of emergency management in public and private settings. Whether your current planning activities are focused on pandemic preparedness or the next storm season, understanding and incorporating accurate behavioral planning assumptions into your efforts can help take your disaster recovery plans to a whole new and more effective level.

By Steven M. Crimando, MA, BCETS

Managing Director

Extreme Behavioral Risk Management LLC

New York, NY

The Emotional and Behavioural Consequences of CBRN Events and Other Complex Public Health Emergencies: Part II [Mar 17 06]--In Part I of this article, the point was made that CBRN events (with the E for explosives purposefully left out of this discussion) were unlike other types of disasters in the psychosocial impact. Due to the prolong and ongoing threat of long-term health problems, exposure to CBRN agents is more likely to result in a chronic stress reaction, rather than the acute stress reactions typically associated with natural and man-made disasters, including acts of conventional terrorism using high-yield explosives.

Pandemic influenza may share other psychodynamics with CBRN hazards. Both scenarios are potentially “silent disasters” or “invisible threats”. One cannot see, hear, feel or taste the presence of many chemical, biological or radiological agents. Likewise, during the asymptomatic phase of the illness, one might be a carrier of the disease or exposed to others who are not yet aware they are sick. As a general state, people are typically more afraid of what they don’t know, than what they do. “Uncertainty in illness” is a universal source of anxiety, across ages and cultures.

In Part I of this article it was mentioned that unlike other forms of disaster, health emergencies do not have “bookends.” This means that it would be difficult to know exactly when the event began, when it ended, and exactly who was in the impact zone. Most natural and technological disasters are confined to a limited area, making mutual aid from surround communities possible. The possibility that thousands or tens of thousands of communities might be experiencing the pandemic simultaneously, combined with restricted movement, leads to a potentially overwhelming scenario in which the opportunity mutual aid is greatly diminished.

The expectation that the pandemic will occur in wave also greatly compounds the emotional and behavioral impact of the event. Stress research has clearly established that we, as humans, are better suited to cope with short-term, acute stress, rather than long-term, chronic stress. The results of prolonged stress exposure on individuals and communities can erode both physical and mental health, as well as the overall social fabric. A prolonged emergency occurring in waves is a worst case scenario from the stand point of psychological stress.

The psychosocial affects are much greater in number and in complexity than can be fully addressed in this article. They are in many ways like that great mass of an iceberg that remains below the surface. The emotional consequences of a pandemic may in fact be as great or greater than the medical consequences, and represent a significant challenge to emergency management professionals, health care workers and first responders who will be mobilized during a prolong health crisis. The cascading financial impact on markets, businesses and households can only further exacerbate the emotional impact of a pandemic. As mentioned, there are myriad factors related to pandemic influenza that may stimulate intense emotional and behavioral reactions that in turn may represent great challenges to the overall response and recovery from the event.

There are no established predictive models for the behavioral and emotional response to pandemic influenza

Although the emotional and behavioral consequences of unconventional terrorism is a relatively new area of academic inquiry, much is known that can help emergency management professionals and first responders predict and prepare of the short- and long term reactions of both individuals and communities. The same can not be said of pandemic influenza.

A comprehensive review of the literature yields no empirical studies addressing the behavioral or emotional consequences of a pandemic. The concepts used today to discuss mental health and human behavior was not in existence during the last great pandemic. The concept of a diagnosable traumatic stress disorder did not fully come into the literature until after the Viet Nam war. The bottom-line is that there are no existing models for the emotional and behavioral response that may grip the public during a long emergency, such as a global disease outbreak occurring in successive waves. What is called for is an entirely new paradigm for anticipating the human response to such a threat that may truly inform planners and responders in a way facilitates the best-possible response to the worst case scenario.

Leaders and policymakers must consider the following questions:

What are the range and severity of the expected emotional and behavioral consequences?

To what extent will these emotional and behavioral consequences affect the public health response?

What strategies and techniques should be used to reduce the emotional and behavioral consequences of a pandemic influenza?

No pandemic influenza plan can be considered complete until the emotional and behavioral dynamics have been integrated into the weave of the overall mitigation effort. The psychosocial impact on the general public, healthcare workers, emergency responders, and other groups cannot be ignore. Failure to anticipate the human factor in such a complex emergency is an invitation for disaster.

The concepts discussed in this article are considered evidence-informed assumptions about the risk of pandemic and the likely emotional and behavioral responses to such an event. There have been no detailed studies, no clinical trials or longitudinal outcome data. During the last great pandemic of 1918 very little was documented about the emotional and behavioral response of the public, so much was what is discussed here is extrapolated from other data sets sharing similar threat elements as a pandemic. Having made the appropriate and obligatory disclaimers, there are some very foreseeable emotional and behavioral responses to pandemic influenza that emergency managers and first responders must factor into their response and recovery strategies. Those foreseeable responses are the focus of this article.

Emotional and Behavioral Responses

For the sake of clarity, it is important to understand the distinction between emotional responses to disasters and other traumatic events. In this context the emotional response refers to what is typically thought of as “mental health” issues. For example, the numbers of those with either diagnosable and sub diagnosable depression, anxiety, posttraumatic stress, other mental health problems are likely to skyrocket following a 12 plus month health crisis that results in a tremendous loss of life, disruption of personal, professional, and social functioning.

It is also foreseeable that those in the population who already have some sort of pre-existing mental health problem may experience an exacerbation of their condition due increased stress, separation from caregivers and supportive programs, as well as disruption in psychiatric medications. These sorts of new or restimulated mental health problems are considered the emotional responses to a pandemic or other health emergency.

Behavioral responses are those reactions such as panic, hoarding medications or supplies, non-compliance with vaccination or quarantine orders, and so on. They are not the signs or symptoms of a mental illness, but rather significant behavioral alterations that may cause further harm, to the individual, the community or to the larger society.

One landmark study highlights the fact that emergency management professionals often fail to properly predict human behavior in crisis conditions. If you have not yet read the “Redefining Readiness: Terrorism Planning through the Eyes of the Public” study, it is a must for all first responders and emergency managers. You can find the study at: http://www.cacsh.org/pdf/RedefiningReadinessStudy.pdf.

In a nut shell, Dr. Roz Lasker and her colleagues sampled a significant number of U.S. citizens via random phone dialing to inquire how they would behave in two different emergency scenarios. The first was a dirty bomb detonation; the second was a smallpox outbreak.

In the first scenario about ¼ of all respondents said that regardless of what they were told by officials about sheltering-in-place or other life safety precautions, they would not stay put. Those individuals were willing to risk contamination and the problems of trying to travel during movement restrictions to get home to loved ones. In the smallpox scenario, roughly 2/5 of those surveyed said they would not get vaccinated even if mass vaccinations were ordered.

This sort of behavior can serious complicate the emergency and public health response to the emergencies at hand, and point to the fact that it should not be assumed that people will necessarily follow official directions.

In summary, the emotional and behavioral response, while closely linked in many instances, are not the same things. First responders and emergency management officials would do well to understand the difference and to factor both into response and recovery plans.

Understanding Panic

There are multitudes of potential emotional and behavioral responses that can occur in isolation or in combination with each other. For the sake of this brief article, the focus will be narrow but if reader interest dictates, others can be discussed in later issues. A natural place to begin this discussion is with the foreseeable risk of panic.

The potential for panic during pandemic influenza cannot be underestimated. Panic can seriously inhibit the public health response to the disease and further complicate an already extremely complex emergency. Every emergency manager and first responder should have a working knowledge of panic and its implications. Panic is not simply intense fear in an individual. Rather, panic is a group phenomenon, characterized by intense fear and driven by overwhelming survival impulse. To understand panic, one must understand economics. Economics is not confined to financial markets. By definition, economics is the allocation of scarce resources.

It is likely that the following economics may apply during pandemic influenza:

Demand for health care services will overwhelm current capacity;

Critical medical equipment will also be in high demand and low supply;

There is a likelihood of price gouging and the development of a “black market” for essential goods. Vaccines, antiviral medications, hospital beds, and later perhaps basic necessities will be in tremendous demand;

Other important goods, such as food, water, and power may be short supply, as may critical medicines like insulin, heart drugs, and other prescription medications; this includes masks, gloves, antibacterial soaps, and other protective gear. Panic is related to the perception of a limited opportunity for escape, a high-risk of being injured or killed, or that help and supplies will only be available to the very first people who seek it. Panicked individuals think only of their own needs and survival. In most disasters, there is a strong “neighbor-helping-neighbor” response, whereas, when there is panic, it is more likely to become a “neighbor-competes-with-neighbor” response as people scramble to get essential medicines or supplies. Panic also contributes to irrational fighting and fleeing, not the typical fight or flights reaction common in most disaster scenarios.

When, in the wake of Hurricane Katrina, high level officials stated that they did not foresee the lawlessness in New Orleans, it clearly indicates that they had not thoroughly through the potential catastrophe with any real depth. When the news media focused attention on looters or those shooting at incoming helicopters and supply trucks, many scratched their heads and asked why? Panic is illogical, irrational and dangerous. It is borne out of competition to survive.

The inadequacy of the current stockpile of vaccine, and the prolong nature of vaccine production once a novel strain is isolated, as well as the paucity of the antiviral supply will naturally and predictably fuel panic. Panic in turn can trigger all manner of seemingly senseless and counter productive behavior. It is not that the panicked individual or group is making a bad decision; rather they are not making a decision at all. They are on auto-pilot, caught up in a powerful “group-think” that steers them toward hypercompetitive survival behavior.

One model of economics often discussed with relation to this sort of crisis is “game theory.” Game Theory assumes as degree of cooperation between plays all interested in the best case outcome. Such a model may apply to other disasters when there is a degree of community cohesion, but does not apply in emergencies in which panic is a factor. This instead is a form of “Non-cooperative Game Theory” in which the player think only of their own needs, and essentially, all bets are off. Panic is one of the primary factors that negate predictive models of human behavior in a potential pandemic scenario.

Foreseeable Emotional Responses

Following most natural disasters the rate of posttraumatic stress disorder (PTSD) in the exposed population is usually in the 11-15% range. This is an elevation above the baseline rate of 8% in the general population. PTSD will be a concern in the pandemic and post-pandemic phases, but rates depression, anxiety, complicated grief and other mental health conditions will also be greatly elevated. This may occur during at a time when access to mental health care and medications may be greatly diminished.

There is a significant number of individuals in any community who struggle day-by-day with serious and persistent mental illnesses, such as schizophrenia and bi-polar disorder (manic depression). Those individuals deprived of their medications and support systems are likely to decompensate and begin to experience a resurgence of psychotic symptoms, such as hallucinations and delusions. The same interruption in medications and treatment for those afflicted with severe depression or anxiety may exacerbate these conditions and result in increases in suicidal and/or homicidal thoughts and acts.

During the SARS outbreak, the inability of families to see their loved ones in hospital, or to say, “good-bye” if they were dying, greatly complicated the grief and bereavement process. Inability to quickly get bodies back for funerals and other rituals also added to the angst of many surviving family members. The manner in which corpses may be handled en masse during a pandemic may also add insult to injury for many, especially if bodies are where housed due to shortages in caskets, burial plots or availability of crematory services.

Individual with addictions to various substances, such as alcohol, cocaine or heroin will soon see the supply of those commodities dry up as travel becomes limited and goods cannot move as easily from supplier to customer. In the instance of substance abuse dependency, acute withdrawal symptoms will create medical emergencies in many individuals and also contribute to increases in criminal activity and other social problems.

In Conclusion

There are myriad emotional and behavioral responses to a pandemic that will greatly impact upon all aspects of emergency management, public health and first responder activities. The affects of fear, anxiety and prolonged stress on healthcare and hospital workers, as well as others on the frontlines of this crisis must be anticipated and integrated into all phases of pandemic planning. While much is not known about the exact psychosocial consequences of pandemic influenza, there is enough known from our global experience with other disasters, CBRNE terrorism, SARS, HIV/AIDS and other serious threats to extrapolate and inform the planning process. Pandemic plans that do not fully incorporate the emotional and behavioral consequences of the crisis are deficient and risky. Now is the time to reach out to those in your academic, medical and behavioral health care communities to seek input and advice about the unique characteristic of your region’s emotional and behavioral risks and resources. This is not a facet of planning that can in anyway be ignored.

The Emotional and Behavioral Consequences of CBRN Events and Other Complex Public Health Emergencies: Part I [Feb 24 06]--Author’s notes: The following material is intended as a primer on the unique psychosocial reactions to CBRN events. Part II of this series will focus on the anticipated emotional and behavioral reactions to a possible pandemic influenza. The reactions to such public health emergencies are complex and atypical in comparison to other disaster mental health reactions. Furthermore, how individuals, families and communities behave in such emergencies will either greatly facilitate or obstruct public health and emergency management efforts (ex: polio quarantine revolt of 1916, Oyster Bay, NY).

Readers of these materials often quickly point out that the common terminology for this group of hazards is “CBRNE.” For the sake of discussing the psychological considerations of such emergencies, it is important to recognize that accidental or purposeful detonations of explosives generally results in a psychological response similar to those following natural disasters. Of course in the instance of terrorism, there is the added dynamic that someone has deliberately set out to hurt or kill others, but stress reactions following explosions are usually more acute, while those following chemical, biological, radiological or nuclear exposures tend to be more chronic.

A good way to conceptualize this is with the idea of “bookends.” In a violent explosion, much like a natural disaster, victims and survivors clearly know when the event started, when it ended, and can more or less see the area of impact. They know if they were in or out. In the instance of CBRN exposure, the hazard may be colorless, odorless, tasteless and silent; therefore it is more difficult to determine exactly when it began, when it ended and if one was truly in or out of the affected area. Beyond the blurriness of clear boundaries marking the disaster, CBRN hazards often leave those exposed with fears of illness or death in the future. For example, someone exposed to radiation or certain chemical agents may be just as concerned about a serious disease, such as cancer, arising five years later, as any illness or injury today. This “future orientation” represents an ongoing stressor for the victim that often leads to chronic, long- term stress reactions, rather than the shorter, acute psychological reactions that accompany most natural and technological disasters

Therefore, the use of the abbreviation CBRN is purposeful, and not an oversight, at least for this limited discussion.

Introduction

The ultimate tool of the terrorist is not chemical, biological, nuclear or radiological...it is psychological. Terror is fear. Terrorism generates fear so intense that it can immobilize an individual, a community, a business or a nation. Terrorist attacks are intended to cause psychological, social and economic disruption, not simply to hurt or kill those in close proximity to the attack.

By definition, anti-terrorism involves efforts to prevent terrorist acts, such as hardening high-value targets, enhancing intelligence capabilities and developing detection technologies. Counterterrorism, on the other hand, is a form of consequence management. Since the intended consequence of terrorism is the creation and manipulation of fear, managing the psychological consequences of terrorism is a form of counterterrorism.
Community and business leaders need to know about the psychological impact of terrorism, as well as the key concepts of psychological counterterrorism, if they are to prepare and protect their properties and their people.

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FACT: Following the 1995 sarin nerve gas attack in the Tokyo subway system, the ratio of psychiatric casualties to medical casualties was 4:1.
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The emotional aftermath of a CBRN attack may be far greater than the physical response and even more disruptive to individual lives and business operations. A critical factor in operational assurance is a working knowledge of the psychological consequences of these unique hazards.

Unconventional terrorism involves the use of exotic substances, such as chemical, biological and radiological agents to inflict harm, generate extreme fear and create anxiety. There are several unique psychological reactions associated with this type of terrorism that differ greatly from the emotional response to natural disasters, conventional terrorism and other forms of mass violence. Within the business organization, it is critically important for senior managers to recognize and be able to respond to the emotional consequences of bioterrorism. A failure to predict and prepare for the psychological response of employees and the community can greatly reduce an organization's ability to effectively respond to, and rebound from a bioterror attack.

Once the initial emergency medical and HAZMAT response is complete, it becomes obvious that bioterror incidents are simultaneously public health and mental health emergencies. Anticipating a surge in healthcare-seeking behavior following a bioterror attack, emergency rooms should anticipate the numbers of the "worried well" to greatly exceed those of true medical emergencies. From the perspective of a community or business leader, it is unrealistic to expect that the local mental health system or a company's Employee Assistance Program (EAP) will be able to handle the surge in demand for crisis counseling services if their business or surrounding community has been the target of CBRN terrorism. Preparedness and Response Plans must incorporate the psychological aspects of this form of terrorism into all four phases: mitigation, planning, response and recovery. In most instances, the company's general disaster recovery plan will not sufficiently address this unique risk.

The Impact of CBRN Terrorism

Both the lay person and mental health professional often assume that the psychological byproduct of CBNR terrorism will be posttraumatic stress disorder (PTSD). Based upon this idea, leaders concerned with the psychological wellness of individuals and their families are over-prepared to recognize and intervene when traumatic stress reactions are present, but under-prepared to deal with the acute fear and anxiety created by CBRN terrorism, never mind the possibility of Mass Sociogenic Illness, misattribution of normal arousal symptoms, and acute distrust of authorities, possibly including executive managers. While these reactions seem complex and perhaps improbable, first hand experience at Anthrax Screening Centers, smallpox vaccination clinics and following accidental releases of CBRN agents has demonstrated that these are more likely than traumatic stress reactions. Caregivers and decision-makers should have a working understanding of these unique reactions if they are to prepare for these risks.

Mass Sociogenic Illness (MSI)

Mass Sociogenic Illness is best described as psychological contagion or epidemic hysteria. It is a social phenomenon of two or more people experiencing a cluster of physical symptoms for which there is no apparent medical cause. This type of reaction can be caused by all types of contaminants when individuals attribute their symptoms to a perceived toxic exposure. Despite evidence to the contrary, individuals who believe that they may have been exposed to a CBRN agent or are unsure if they were exposed, begin to experience physical symptoms triggered by their psychological response. For individuals having this type of reaction, their symptoms are very "real", and in most cases they will seek medical attention or at least behave as if they are truly injured or ill due to the perceived exposure. The term, "worried well", refers to individuals and groups experiencing this phenomena, as well as misattribution of normal arousal.

Misattribution of Normal Arousal

Most people are familiar with the basic "fight or flight" response to life-threatening situations. In the face of a real or perceived threat to life or limb, we all typically experience an elevation in vital signs: increased heart rate, increased blood pressure, faster, shorter breathing, and so on. In the immediate aftermath of a CBRN event, many of those exposed or who believe they were exposed to toxic substances, will experience this normal elevation in cardiac and respiratory functioning, but will be convinced that their pounding heart or shortness of breath is due to the biological or chemical agent, therefore proving that they are injured or ill as a result of the attack.

In a true CBRN event it can be extremely difficult for medical personnel to sort out which are true and which are pseudo-medical emergencies driven by psychological reactions. As a general rule, medical emergencies always triage higher than psychological emergencies, but when in doubt it is safer to treat medical complaints as medical emergencies until they are otherwise ruled out. This, of course, means treating the individual as if they were truly exposed to the CBRN agent, therefore possibly reinforcing their belief that they are injured or ill, and straining the emergency medical system.

The psychological response contributes to the overall number of individuals who may require immediate care, and in terms of business continuity, may significantly decrease the number of employees who are willing or able to return to work quickly in the wake of a bioterror attack. In extreme cases, employees may hold onto the idea that the workplace has become a "sick building", and cannot be decontaminated to their satisfaction. The anthrax attacks on both the Brentwood (DC) and Hamilton (NJ) postal facilities left those facilities unusable for years after the events.

Mistrust of Authorities

Even the most sincere government or business leader can be accused of spinning the facts following a tragic event in order to calm fears and get people back to work. In communities and organizations that have had a history of distrust between management and labor, or senior management and line staff, this dynamic is often exacerbated in times of stress or fear. In the instance of a CBRN attack, levels of fear or panic may be so high that there is little can do to assure employees that they are getting accurate information. Business leaders also may struggle with the question of how much information is too much information, and worry that they might further traumatize employees or contribute to greater emotional distress.

Just the Facts

Following most disasters, but especially in the wake of CBRN incidents, few individuals seek out crisis counseling services in the first hours and days. Instead, there is an immediate hunger for information. It is not unlikely that employees will gather information, opinions and rumors from many sources, including TV news, the Internet and word of mouth. At a time when fear may be running high, perception truly becomes reality, and it becomes clear how quickly media reports and rumors shape our perception.

A useful strategy for addressing this intense need for information is to offer "fact sheets" and other publications from credible sources. These may include the Center for Disease Control and Prevention (CDC), the World Health Organization and other well-known or trusted experts. Information must be timely and accurate. Because the news cycle accelerates during crises, business leaders must stay in touch with the most recent developments. Distributing dated or inaccurate information can be seen as management being "out of touch" with the crisis at hand.

A Neighbor Helping Neighbor Approach

In the wake of an actual CBRN attack against a company or community, basic Psychological First Aid may be more useful than formal "debriefing" and structured mental health interventions. Communities and businesses with Community or Corporate Emergency Response Teams (CERTs) can train responders in the fundamentals of Psychological First Aid, active listening skills and the recognition of psychiatric emergencies, so that they can deliver emotional support in conjunction with other emergency services.

Helping first responders within your community or organization to anticipate the emotional consequences of CBRN terrorism will reduce the likelihood of being blindsided by the powerful psychological reactions of those exposed. This, of course, applies to first responder's reactions, as well as the reactions of civilian victims of such an attack. The emotional power of CBRN terrorism creates universal vulnerability.

No one is immune from the acute fear and anxiety that follow such incidents and everyone who may be part of the response and recovery effort should be well briefed on the psychological aspects of CBRN terrorism.

Likewise, everyone can be part of the solution, by managing the emotional response as best possible and reaching out to their co-workers and neighbors in their home, at work and in the community with support and a willingness to allow others to share their thoughts and feelings about the situation.

Conclusion

Prior technological disasters, terrorist attacks and the use of unconventional weapons in warfare lead experts to believe that the psychological reaction to these events may be much greater, and more difficult to contain, than the physical or medical reaction. Conservative estimates predict a 4:1 ratio of psychiatric to medical emergencies following CBRN terrorism, but based on the experience at the Goiania, Brazil radiological accident; this ratio may be much higher in a "dirty bomb" scenario.

In the chaos that will likely follow a CBRN attack; the learning curve related to the psycho-social impact of the event will be very steep indeed. The time to learn about and plan for the emotional consequences of unconventional terrorism is now, when community and business leaders can thoughtfully predict and prepare for the aftershock of bioterrorism and other emerging risks.

Part II of this series will focus exclusively on the anticipated emotional and behavioral responses to pandemic influenza.

STEVEN M.

CRIMANDO

Steven M. Crimando

Steven M. Crimando, MA, BCETS, is a noted author, consultant and trainer to governmental agencies, NGOs and multinational corporations. He is the Managing Director of Extreme Behavioral Risk Management ("XBRM"), a consultancy focused on the human factor in disaster recovery, business continuity and homeland security. XBRM is a division of ALLSector Technology Group, Inc., a New York based full service technology consulting company offering systems integration, managed services and applications development and implementation. ALLSector Technology Group, Inc. is a subsidiary of the F∙E∙G∙S Health and Human Services System, one of the nation’s largest and most diversified not for profit organizations.

Contact:

Steven M. Crimando

T: 212.366.8343

Previously on Steven Crimando:

Tracking Human Factors in the Financial Crisis:
Lessons for Pandemic Planning
[Feb 14 2009]

The Perfect Storm:
Economic Stress and Holiday Stress Collide
[Nov 26 2008]

A time for resilience
[Nov 10 2008]

The art of breaking bad news
[Oct 24 2008]

Fear, performance and productivity
[Oct 17 2008]

From Bourbon Street to Wall Street: Managing the Emotional Consequences of the Financial Crisis - Lessons Learned in Natural Disasters
[Oct 17 2008]

Accurate Disaster Behavioral Response Planning: A Guide for Business Continuity Planners [Dec 21 06]

The Emotional and Behavioural Consequences of CBRN Events and Other Complex Public Health Emergencies: Part II [Mar 17 06]

The Emotional and Behavioral Consequences of CBRN Events and Other Complex Public Health Emergencies: Part I

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