Grief__Stress_Healthy Adapting-PPT-Dushanbe_Tajikistan-12-09-2024_Eng

1.

Grief & Stress:
Healthy Adapting
U.S. Embassy
Dushanbe, Tajikistan
December 9, 2024
R. Gregg Dwyer, MD, EdD, DFAPA
Regional Medical Officer/Psychiatrist

2.

• Normal, natural
occurrence after loss
• Not pathology
• Usually no need for
medical/professional
intervention…with a few
exceptions
• Resources to help
• Some normal symptoms
are like general stress
reaction symptoms

3.

“Stages”
• No true stages, because:
– Not set order
– Can move back and forth
through them over time
• Good and bad days
• No on/off switch regarding
work & home
• Reminders: obvious & not →
trigger response
• No set timeline

4.

Stages of Grief
• Denial
• Anger
• Bargaining
• Sad/depressed
• Acceptance
(Kübler-Ross model)
• Find meaning

5.

“What do I do?”
Let yourself experience the
stages
Recognize the grief
Follow what works for you in
terms of cultural and faithbased support and rituals
Keep your schedule: eat, sleep,
exercise, etc
No major decisions
Support groups and
professional assistance

6.

• Sudden loss
• Traumatic loss
When to
Seek
Pro
Help?
• Complicated grief
• New loss before resolved a past loss
• Other ongoing major stressors
• Preexisting general/mental health
condition
• Unsure…ask

7.

How Can You Help Others?
Recognition of the loss
Availability to listen and
be present
Support with boundaries
Normalize the experience
Permission to share
Don’t rush the process or
give “bumper sticker”
advice

8.

Helping as a
Supervisor
Make contact & offer condolences
Know the work policies
Be flexible
Cross coverage in place
Info to colleagues, if OK’d
Group acknowledgement, if appropriate
Plan for return to work: schedule, backup, workload, etc
Be aware of triggers, watch for warning signs, offer
resources

9.

Mind ↔ Body
Public speaking;
Major social event
Thyroid
Fever
Sleep deprived

10.

“Fight or Flight”
• General, adaptive response
• Caused by a variety of stimuli
(Dimsdale et al, 2000)
• “pleasant or unpleasant” demand
• “real, symbolic or imagined” threat
• acute and chronic
– Neurotransmitters [brain chemistry]
– Endocrine system [hormones]
– Immune system
(Kaplan & Sadock, 2003)

11.

Impact Effects
• Biological
– Heart rate & breathing
– Nausea
– Headache
• Behavioral
– Isolate
– Work-over/avoid
– Eating-under/over
– Substance use
• Psychological
– Helplessness
– Anger
– Memory-lost/intrusive
– Concentration-poor
– Hypervigilance-health
• Sleep

12.

• Process
• Behaviors
• Thoughts
• Healthy Outcome
• Not born with it
– Can learn it
– Can develop it
Ability to adapt and
recover from a difficulty,
impact, stressor, trauma
(APA, 2018)

13.

Manage Worry
• Don’t view crises as
“insurmountable”
• Past-Present-Future
• Living includes change
• “New normal”
• Seek self-discovery
• Keep perspective
(APA, 2018)
– Learn – do - plan
• Acceptance

14.

Increase (Sense of) Control
Make a list
Identify what you cannot [& can] control
Have a plan and a back-up plan
Model being calm, so others follow
“Long view” – you can do/have done this
(Dr. Sonia Lupien; Johnson, 2020)

15.

Options & Resources
• Your usual healthy approaches – use them
• CLO
• Health Unit – RMO, local MD,
MP, RN
• RMOP
• Center of Excellence in
Foreign Affairs Resilience
(CEFAR; FSI) [email protected]
+1-703-302-7272
• Local providers (varies)
• Employee Consultation Services
(ECS; DC)
[email protected]
+1-202-634-4874
* Support group online
• MED Wellness
(MED site under Occupational
Health and Wellness)
• Health insurance list
• Private pay providers online

16.

Employee Consultative Service:
[email protected]
Staff Care: [email protected]
GRIEF
RESOURCES
The 7 Best Online Grief Support Groups of
2021 from: https://www.verywellmind.com/best-onlinegrief-support-groups-4842333
* Best Overall: Grieving.com
Best Live Chat: Grief in Common
Best for Young People: Hope Again
Best Social Media Group: Grief Anonymous
Best for Specific Grief: Online Grief Support
Best for Email Support: GriefNet
Best Monitored Discussion Group: Grief Healing
Fischer, 2021

17.

• Grief is a normal process
• Unknown & unpredictable can induce stress
• Knowledge = foundation of prevention and
management
• Mental health symptoms = health symptoms
• Successful management is possible
• Seek help and don’t settle

18.

References
American Psychiatric Association. (2018). The road to resilience. Washington, DC:
American Psychiatric Association, URL: http://www.apa.org/helpcenter/roadresilience.aspx; Accessed: May 2018
Dimsdale JE, Keefe FJ, Stein MB. Stress and psychiatry. In Sadock BJ, Sadock VA
(eds) Comprehensive Textbook of Psychiatry Volume II, 7 th ed. Philadelphia:
Lippincott Williams & Wilkins, 2000, pp 1835-46
Johnson, Ned. How can we help kids increase their sense of control as the
coronavirus approaches? The Washington Post, March 2, 2020.
Kaplan BJ, Sadock VA. Synopsis of psychiatry behavioral sciences/clinical
psychiatry 9th ed. Philadelphia: Lippincott Williams & Wilkins, 2003

19.

RMOP
Richard Gregg Dwyer, MD, EdD, DFAPA
Regional Medical Officer Psychiatrist
Consulate General of the United States of America, Istanbul Turkey
Health Unit Phone: +90 212 335 9121 or 9141
Health Unit Email: [email protected]
Cell Phone: +90 (501) 706 3365
Teams Phone: +1 771-204-5476
Email: [email protected]
Region: Armenia (Yerevan), Azerbaijan (Baku), Cyprus (Nicosia), Georgia (Tbilisi),
Greece (Athens & Thessaloniki), Tajikistan (Dushanbe), Turkey (Adana, Ankara &
Istanbul), Turkmenistan (Ashgabat), Uzbekistan (Tashkent)
U.S. Department of State | Bureau of Medical Services |