Report on
TRAININGS PROVIDED BY
PSYCHOSOCIAL ASSISTANCE WITHOUT BORDERS
DECEMBER 20-26, 2005
Idara-e-Taleem-o-Aagahi Center for Education & Consciousness
Cricket House, 2nd floor, 20 Jail Road, Lahore
Tel: (92-42) 7535270 Fax: (92-42) 7535271
Website: www.itacec.org
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
REPORT on
TRAININGS PROVIDED BY PSYCHOSOCIAL ASSISTANCE WITHOUT
BORDERS FROM DECEMBER 20-26, 2005
Background
Several occupations expose its personnel to victimized individuals or traumatized
communities. Primary traumatic stress is designated in individuals who experience,
witness or confront a traumatic event, and respond with intense fear, helplessness or
horror. Secondary traumatic stress [STS] occurs as a result of indirect exposure to
trauma through a firsthand account or narrative of a traumatic event (Zimering, Munroe,
& Gulliver, 2003). For the purposes of this report, humanitarian aid workers [HAW] are
non-clinician employees or volunteers that may 1) ask details of, or 2) provide care for
those exposed to severe physical or psychological trauma. The professional literature
shows that clinicians who listen to survivors’ stories of fear, pain, and suffering
frequently develop deleterious emotional, cognitive, and physical consequences (Salston
& Figley, 2003; Collins & Long, 2003; Carbonell, 1996; Danieli, 1996; Pearlman, 1995b;
McCann, 1990). Workers like HAW, who are not trained clinically but do this work
anyway, have not been served adequately.
The adverse psychological impact of working directly with people who have
experienced trauma has been discussed in the nursing, emergency staff, and
psychotherapist literature (Melchior, 1997; Wall, 1997; Alexander, 1996; Carson, 1995;
Hodgkinson, 1991). Whether it is disaster work in the field or clinical work in
professional settings, the occupational consequences of such work may include episodes
of nightmares, sleeplessness, hopelessness, and other forms STS that appear to be linked
to working with psychological trauma (Figley, 1995). The fact that STS can occur
indirectly is consistent with DSM-IV’s criteria A for post-traumatic stress disorder
[PTSD] that asserts traumatization is possible without being personally harmed or
threatened with harm.
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
Traumatization can occur through contact with narratives of primary traumatic
stress. Like clinicians, HAW come within close contact with such narratives of traumatic
exposure.
The adverse psychological consequences of working with primarily traumatized
individuals have been described in various ways: secondary traumatic stress disorder
[STSD], compassion fatigue, compassion stress, and vicarious traumatization (McCann,
1990; Pearlman, 1995a). A worker can experience negative changes in professional
functioning, self and worldview, sense of security, self-capacities, and psychological
needs (Saakvitne, 1996). This psychological morbidity often goes unnoticed until people
decompensate with more serious consequences such as clinical depression, anxiety
problems, substance dependence, burnout or post-traumatic stress disorder. Frequent,
numerous interactions with survivors of trauma might increase the likelihood of
developing STSD (Figley, 1999).
Burnout is a related, but conceptually distinct concept with features that can
overlap with STS (Figley, 1999; Maslach, 1982 & 1986). It is characterized by “a state of
physical, emotional, and mental exhaustion caused by long term involvement in
emotionally demanding situations” (Miller, 1998; Pines, 1981). Burnout is not strictly
based on psychiatric diagnostic criteria for traumatic event or traumatic symptoms. One
study documents how HAW may underestimate both how much stress they would
experience and the extent to which they would use less adaptive coping mechanisms such
as alcohol and cigarette consumption (Britt, 1999).
Psychosocial Assistance Without Borders [PAWB] Mission
Psychosocial Assistance Without Borders (PAWB) is an organization with a
mission to provide relief workers with definitive training for psychosocial assistance.
PAWB gives therapists and healers from different nations and traditions a platform to
bolster the efforts of relief workers. PAWB’s goal is to provide integrated trainings that
encourage a sustainable model of psychosocial health in the face of societal trauma.
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
Native service providers have legitimacy and capacities (those not reproducible by
international relief organizations) that help heal environments that are tinged with grief,
insecurity, and anxiety. PAWB trains local providers who can best translate the trainings
to fit their circumstances.
Why PAWB? Why Now?
Tremors, aftershocks, violence, war, genocide, displacement, flooding waters.
Survivors having symptoms like “mini-heart attacks” and not able to return to
productivity because of their losses and apprehension. Relief workers wishing to give
psychosocial first aid, but not knowing how to go about it. With the weight of human
tragedies of 2005, there is an unseen burden on society. Compassion fatigue, burnout,
vicarious traumatization – they all refer to the emotional costs borne by mental health
service-providers or care-givers of devastated people. Most people with compassion
fatigue experience isolation because it is a condition that causes shame, even though it is
a product of caring. Thus, they rarely acknowledge that they need help -- unless offered
assistance directly in educational programs or outreach trainings that are
endorsed/provided by their respective organization.
PAWB TRAINING SERVICES
1) Basic information on psychosocial trauma and psychosocial first aid from a crosscultural perspective. When to refer, when to provide additional community support, how
to intervene, and more.
2) Self-care through mind-body techniques, marshalling one's spiritual tradition, and
group cohesion. Burnout and compassion fatigue detection, prevention, and
interventions.
3) Promoting models to integrate local healers, community strength, and faith traditions
into the Western model of psychotherapy and psychiatry.
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
(see Annexures #1 & #2)
Training Objectives

To create awareness about compassion fatigue and burnout among relief workers

To identify signs of stress and trauma and to help them use self-help techniques.

To enable participants to develop skills to help people undergoing psychological
trauma due to disaster

To emphasize the community approach to healing by empowering the community
members through training

Psychosocial intervention – Do’s and don’ts

To identify people who need specialized help

To promote models to integrate local healers, community strength, and faith
traditions into the Western model of psychotherapy and psychiatry.

To provide relevant handout materials for immediate support and further study
Methodology
Each training group was divided into subgroups that rotated among the 3 trainers
(specific areas can be found in Annexure #1). These smaller settings allowed for closer
interaction, more trust-building, and more engaged learning. Each session maintained
time for questions, discussion, and interaction. Feedback forms (Annexure #3) were
specifically devised to determine whether individuals felt that their needs were met and
for further need assessment for future trainings.
Methodology -- Review of Services provided
PAWB provided Idara-e-Taleem-o-Aagahi (ITA) and other groups with 4 full day
trainings between the dates of Dec 20-28. PAWB appreciates the leadership role that
ITA is taking with regard to relief worker training. We hope that our content and style
gave ITA and other beneficiaries a rewarding and worthwhile experience.
Over a period of four days, several organizations from Islamabad, Lahore, Kashmir, and
Northwest Frontier province participated and benefited from PAWB trainings.
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
Organisations included, among others, ITA, Sahil and World Vision. The dates &
locations of the trainings were as follows:
Dec 20
Islamabad
Dec 22 Muzaffarabad
Dec 24
Mansehra
Dec 26 Islamabad
Training Outcomes

Trained nearly 200 relief workers at 3 different sites – Islamabad, Muzzafarabad and
Mansehra.

Participants (HAW) developed a better understanding of the psychological
implications of the disaster (refer to Testimonials)

Participants learned basic principles of psychosocial intervention (adequate handouts
also given for reference)

Relief workers trained to take care of their own stress through yoga therapy, breathing
exercises, and guided imagery and relaxation techniques. A special audio CD was
produced in response to requests from trainees who experienced benefits during the
training and wanted to use it regularly for self and others.

Increased productivity of relief workers; and enhanced HAW ability to reach out to
the survivors of the earthquake.

Participants were provided handouts on relevant topics for future reference.
Testimonials
“Sessions were very useful. I like the first session with Arvinder -- particularly useful
based on trauma conditions. The workshops conducted today, and method used in that, I
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
will try my best to implement. I will train other people so that they could use with others
as well.”
“I found training on alternative healing very helpful. The discussions we had, and the
exercises we learnt were very simple but beneficial”.
“Being in emergency work, I forgot myself as a human, it made me realized to make my
efforts more productive, not only in field work, but also to myself” [One of the effects of
compassion fatigue is that relief workers lose touch with their own selves.]
“Such workshops should be conducted on a large scale, so other could learn more useful
techniques and implement them”
“As a special education teacher, I can use these skills in my school, and especially for
myself, because self-care is also a very important factor”
“What I have learnt today will help me to provide psychosocial support to survivors of
earth quake, and provide training”
“Training should be extended up to three or four days, and cover more topics”
RECOMMENDATIONS
 Organisations are recommended to promote healthy environments to ensure that
workers can continue to make significant contributions while maintaining high
job satisfaction and quality of life. Team leaders, managers, and agencies can
integrate into their work culture the significance of work stress, ways to identify
and alleviate stress, and resources for professional help.
 Organisations must take responsibility for 1) psychosocial criteria by which their
workers are recruited; 2) worker training and awareness-raising programs; 3)
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
increased encouragements to rest and relaxation; 4) planned and readily available
counseling.
 Follow up trainings are essential for the learning to be internalized.
 Follow up assessments are recommended to determine the degree of learning, the
current application, and further unmet needs.
 These trainings should be extended to more organizations that work with
psychosocial difficulties.
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
Annexure #1 -- PAWB Training Outline
Training #1 “Working with Survivors/Victims”
 Working with psychosocial trauma
 Beyond Mental Health Do’s and Don’ts -- Psychosocial First Aid
 How to recognize people who will benefit from referral to
psychologist/psychiatrist
 Using Mind-Body-Spirit approaches with your clients
Training #2 “Working with Worker Stress”
 Understanding Compassion Fatigue and Burnout
 Managing stress within humanitarian workers
 Boundary-setting for humanitarian workers
 Using Mind-Body-Spirit approaches for oneself and in groups
Training #3 “Working with Alternative Healers”
 Integrative Relief Work -- Utilizing local and alternative healing practices
 How to evaluate alternative treaters – quacks, placebo, and healers
 How to refer people to alternative treatments
 Understanding the power of Western psychiatry and its limitations
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
Annexure #2 – Time Schedule
PROPOSED SCHEDULE
7:30am-8:30am
Optional Yoga relaxation class with Dr. Siddharth Shah
8:30 – 9am
Registration & Break for Snack
9 - 9:20am
Mandatory Orientation to Training
9:30 - 11am
Trainings #1-3 with PAWB staff in breakout groups
11am - 12noon
Break for lunch, and rotate to next training
12 - 1:30pm
Trainings#1-3 with PAWB staff in breakout groups
1:30 - 2pm
Break, and rotate to next training
2pm - 3:30
Trainings#1-3 with PAWB staff in breakout groups
3:30 - 4pm
De-briefing & Further Questions
4pm - 4:30pm Optional Question & Answer Session
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
Annexure #3 – Feedback Form
1. Was this a good learning environment?
Yes
2. Did the day meet your expectations?
3. Would you recommend this training to others?
4. Did this training energize you
No
Yes
Yes
No
No
Yes
No
for more work ahead?
5. What did you find most useful?
6. What did you find least useful?
7. In what way are you going to use the skills learned today?
8. Suggestions for further workshops:
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
Annex 4
Participants List
Second Islamabad training
http://pawb.cfsites.org/
This is a photo of Siddharth Shah doing the second Islamabad training (Dec 26th). That day we
had more teachers and special education specialists who wanted to understand psychological
difficulties among children. The earthquake and its aftermath have caused serious concerns, but at
the same time we had a very empowering training session that elicited a can-do attitude.
Some people travelled from Kashmir (where we trained Dec 22) to get a second round of PAWB
training. It was not a total repeat for them because we adapt our training material depending on
the needs of the trainee composition.
posted by Siddharth A. Shah, MD @ 10:10 PM 2 comments
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
Sunday, December 25, 2005
Role of Systematic Relaxation Techniques in Relief Work
What you see here is a series of pics in which trainees are learning relaxation techniques for
themselves as well as their beneficiaries (clients): deep abdominal breathing, Muraqba “Noor”
Meditation, and alternate nostril breathing.
Trainees in the heavily affected areas of Muzzafarabad and Mansehra spoke glowingly about the
emphasis PAWB lays on self-care. Here are their words:
“In our work we really forget our self…”
“This was a very very good learning environment”
“…doctors we needs more workshops…”
And excerpted from a letter written by a field coordinator after the training: “During relief work
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
due to continuous work I was so much tired mentally and physically but after today training I am
feeling now very well and become so much easier through breathing and murakabah exercises.”
posted by Siddharth A. Shah, MD @ 10:43 AM 0 comments
Dedication of the Trainees
The dedication of the trainees is mind-boggling to me. They do and say things that are unheard
of. For our Muzaffarabad training on Dec 22nd, one group of young relief workers from Bagh
started their day at 2:30am. They walked in the bitter cold in order to meet up with other
colleagues at 3:30. They caught transport at 4am and finally arrived at the training camp site at
7:30am. In light of such dedication, I felt that I could at least put in a little work on my 'day of
rest.'
posted by Siddharth A. Shah, MD @ 10:38 AM 0 comments
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
Advocating for our Children -- Idara-e-Taleem-o-Aagahi
Children attend open-air schools in the Northern Areas as many
of their schools have been left looking like the one on the right.
Idara-e-Taleem-o-Aagahi is a well-established and highly respected organization that prioritizes
the education of Pakistan's children. For the PAWB trainings, ITA has been able to marshal the
support of the Gov't of Pakistan, UNICEF, and several key NGOs. PAWB has been blessed by
ITA's hosting of our Pakistan trainings in a way that can only be called extraordinary and
prescient. They anticipated all of our personal needs and exceeded all of our expectations.
posted by Siddharth A. Shah, MD @ 10:26 AM 0 comments
Wednesday, December 21, 2005
TESTIMONIALS from the first training day
Arvinder is our deeply committed trainer and therapist from New
Delhi. She is wearing the cream colored dupatta here.
“Sessions were very useful. I like the first session with Arvinder -- particularly useful based on
trauma conditions. The workshops conducted today, and method used in that, I will try my best to
implement. I will train other people so that they could use with others as well.”
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
“I found training on alternative healing very helpful. The discussions we had, and the exercises
we learnt were very simple but beneficial”.
[One of the effects of compassion fatigue is that relief workers lose touch with their own selves.]
“Being in emergency work, I forgot myself as a human, it made me realized to make my efforts
more productive, not only in field work, but also to myself”
“Such workshops should be conducted on a large scale, so other could learn more useful
techniques and implement them”
“As a special education teacher, I can use these skills in my school, and especially for myself,
because self-care is also a very important factor”
“What I have learnt today will help me to provide psychosocial support to survivors of earth
quake, and provide training”
“Training should be extended up to three or four days, and cover more topics”
posted by Siddharth A. Shah, MD @ 12:48 PM 1 comments
First Day of training -- getting started with yoga
Dec 20, 2005
Islamabad
Today at 8am Siddharth began by teaching a hatha yoga class in Islamabad. Two people came on
time. We got started with Suryanamaskar, about 5 of them; and then we sat in meditation. After a
body scan revealing whether we should work on upper body opening (upper back, shoulders,
neck) or lower body (lower back, hips, thighs), we got into a routine designed to bring focal relief
and teach body awareness. This caught the imagination of the group that had since gathered. We
were up to about 10 people, more than our small room could accommodate. People basically took
turns using the same space to stretch out. As is often said among desis, “you have to adjust.”
posted by Siddharth A. Shah, MD @ 12:44 PM 0 comments
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH
Ms. Khalida Sheikh -- One of our trainers
Khalida Sheikh is a talented psychotherapist from the UK who works
with a diverse population of Muslims in Bradford as part of the National Health Service.
Specializing in transcultural mental health training, she manages a team of therapists.
posted by Siddharth A. Shah, MD @ 12:38 PM 0 comments
nnex 5 About the Trainers
Report submitted by PAWB – Arvinder Singh & Siddharth Shah, MD., MPH