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.

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

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:

□ 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:

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.

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.

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.

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.

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.

___

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.

___

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.

___

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.

___

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.

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.

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.

___

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.

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."

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.

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.

_______________________________________________________________
FACT: Following the 1995 sarin nerve gas attack in the Tokyo subway system,
the ratio of psychiatric casualties to medical casualties was 4:1.
_______________________________________________________________

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, 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.