Contents Foreword by Neil Greenberg xix Acknowledgements xxiii Prologue xxix Introduction xxxv Part I The Impacts 1 1 Who Is Affected? 3 First-line Responders 3 Second-line Responders 4 Scale of Impact and Trauma Exposure 4 Model 1: The Ripples in the Water Model 5 Proximity to the Traumatic Event 7 High Emotional Demands 7 2 Factors Affecting the Traumatic Impact 9 Protective and Risk Factors 10 Model 2: The Strain Model 11 References 12 3 The Traumatic Event 13 Duration of the Traumatic Event 13 An Acute Short-term Strain 13 A Series of Stressful Events--Accumulated Strain 14 Long-term, Continuous Strain 14 Risk of Reoccurrence 14 Is the Traumatic Event Over--Or Still Ongoing? 15 The Nature of the Traumatic Event 15 Threats 15 Loss and Death 15 Human-made or Natural Events 16 Human-made Events 16 Natural Events and Natural Disasters 16 Climate-related Natural Disasters 16 Witnessing the Suffering of Acquaintances or Children 17 Number of People Involved 17 Sensory Impressions 17 Where Did the Incident Occur--And Was It Anticipated? 17 Near Misses 18 References 18 4 Managing the Traumatic Event 20 Organisational Factors 21 Trauma Education 21 Supervision 21 Social Support 21 Clarity of Task and Role 22 The Organisation of Work--Alone or as Part of a Workgroup? 22 When Are Tasks Carried Out? 22 Caseload 23 Leadership Well-being and Responsibility Fatigue 23 Individual Factors 23 Personal Factors 24 Gender 24 Current Life Situation 24 What Stage of Working Life Are You in? 24 Personal Trauma History 25 Role in the Incident--Active or Passive? 25 How You Assess Your Own Performance 26 Coping 26 Need to Clarify the Causes 27 Compassion Satisfaction 27 References 27 5 Other Factors 30 Social Status of the Job 30 Complaints About Possible Errors 31 Media Coverage 31 The Impact of Digitalisation and Technology 32 Flexibility and Fatigue 32 Administrative Overload and Documentation 33 AI in the Helping Professions 35 The Myth of Constant Availability 35 Helpful Digital Tools 35 References 36 6 Global Crises and Cumulative Strain--Helping in a Time of Permacrisis 38 When Crises Collide 38 Living on the Fault Line 39 The Crisis on Repeat: Understanding Permacrisis 39 The Helpers on the Front Lines 40 From Paralysis to Possibility 42 When the System Feels Broken 43 Final Thought: Remember to Breathe 44 References 44 Part II The Reactions 47 7 Mental Tilting and Sustainability 49 Mental Tilting 49 Sustainable Organisation of Work 50 Key Challenges 50 Invisible Symptoms 50 Model 3: The Sustainability Model 51 Distancing 52 Getting Used to It 52 References 53 8 Warning Signs of Mental Tilting 54 20 Signs of Mental Tilting at the Individual Level 54 Five Physical Signals 54 Five Cognitive Signals 56 Five Emotional Signals 57 Five Signals in Your Behaviour and Relationships to Others 59 10 Warning Signs of Mental Tilting in Teams and Workgroups 62 Anger, Grumbling, and Dissatisfaction 63 Problem Shifting 64 Humour 65 Destructive Humour 65 References 66 9 Mirror Neurons and the Red-Green-Blue Model 68 Mirror Neurons 68 The Downside of Mirror Neurons 69 The Red-Green-Blue Model 71 Model 4: The Red-Green-Blue Model 71 Staying Attuned and in Contact 71 Being Over-involved 74 Being Under-involved 74 Company Culture 75 Gender and Roles 76 Group Dynamics 76 Individual Preferences 77 References 77 10 From Warning Signs to States of Strain 79 Stress 80 Burnout 80 Mild Anxiety 81 Mild Depressive Symptoms 81 Mild Post-traumatic Reactions 82 Increased Stimulant Consumption 82 Moral Stress and Moral Injury 82 Moral Stress: The Strain Before the Injury 82 Moral Injury and PTSD 83 The Three Roads to Injury 84 Responsibility and Its Shifting 84 Existential Pain 85 References 86 11 Trauma-related Mental Disorders 88 Adjustment Disorder 88 Post-traumatic Conditions 89 Post-traumatic Stress Disorder--PTSD 89 Secondary Traumatisation 90 Complex PTSD 91 Anxiety 92 Depression 92 Suicide 93 Substance Use and Addiction 93 Assessment of Well-being and Mental Tilting 94 WHO-5 94 Professional Quality of Life Scale 94 References 95 Part III The Strategies 97 12 HR Policy Framework 99 Developing Strong HR Policies 99 Standard Operating Procedures (SOPs) 100 Organisational Maturity 100 Turning Preventive Procedures into Practice 101 Tacit Knowledge 101 References 102 13 Psychological Safety as a Shared Resource 103 Psychological Safety in Emotionally Demanding Work 103 Signs of Psychological Safety in Practice 104 A Shared Condition--Not an Individual Trait 105 The Leader''s Role--From Framework to Response 105 Setting the Stage 105 Inviting Participation 106 Responding Productively 106 Psychological Safety and Sustainable Strain Management 106 Final Reflections 107 References 107 14 The Strain Square 108 X-axis--Objective Strains 108 Model 5: The Strain Square 109 Y-axis--The Subjective Vulnerability 109 Vulnerability Related to the Past 109 Vulnerability Related to the Present 110 Vulnerability Related to Identification 110 Vulnerability Related to Personally Knowing Those in Need of Your Help 110 The Four Fields 111 The Good Workday Routine 111 The Sore Spot 111 Emotionally Challenging Tasks and Collective Crises 112 The Worst Moments 112 Model 6: The Strain Square Strategies 113 Moved, Affected, and Shaken 113 Model 7: Moved, Affected, Shaken 113 References 114 15 The TIC Model and the Powerlessness-Power Pendulum 115 ''Just Being'' with the Other Person 115 The TIC Model 116 Model 8: The TIC Model 116 The Powerlessness-Power Pendulum 118 Model 9: The Powerlessness-Power Pendulum 119 References 120 16 The Big WHY? 121 Meaning and Compassion Satisfaction 122 Personal Experiences 122 The Professional WHY and the Personal WHY 123 Hope 124 IGLO-E 125 Model 10: The IGLO-E Model 126 References 126 17 Educational Institutions, Organisations, and Leaders: Roles and Responsibilities 128 Educational Institutions: Roles and Responsibilities 129 From Preparation to Practice 130 Organisations: Roles and Responsibilities 130 New Hires 130 Role Models 132 Responsibility for Your Own and Other Managers'' Well-being 133 Physical Security 134 Contingency Plans for Emergency Situations 134 Terms and Conditions of Employment 135 Systematic Learning and Development 135 Fostering a Learning Culture Also Means Acknowledging Moral Impact 136 Managers: Roles and Responsibilities 137 Recruitment 138 Trauma Training and Supervision 138 Clarity About the Task and Defined Roles and Frameworks 139 Professional Language Use 139 Professional Leadership and Development 140 Strategic Planning 140 Leadership Duties for Temporary and External Staff 142 Responsibility for Your Own and Your Employees'' Well-being 143 References 144 18 Groups: Roles and Responsibilities 146 Emotional Support 147 The Principle of ''On Equal Terms'' 147 The Principle of Sharing 150 The Principle of Dark Humour 151 The Principle of Not Overburdening One Another 152 End-of-day Defusing Duty 153 The Principle of Taking Good Care of E.