Book Reviews

Flourishing in Demanding Environments

Stress and Trauma Handbook: Strategies for Flourishing in Demanding Environments edited by John Fawcett. World Vision International, Monrovia, CA, 2003. 277 pages, paperback; ISBN 1-887983-52-X; $29.95 at

Reviewed by Steve Spinella

World Vision’s Stress and Trauma Handbook describes the impact of stress and trauma on aid workers, reviews relevant professional literature, and recommends proactive strategies for addressing stress and trauma within World Vision. It is an outcome of a five-year project to study stress and trauma organizationally by World Vision using internal and external resources. It aims to provide strategies for flourishing in demanding environments. (Note: While published in the US, this book largely uses British English.)

Facing Stress and Trauma

The first half of this book defines the challenge and summarizes the research that formed the basis for World Vision’s approach to sharpening their strategies for flourishing in demanding environments. The second half elaborates six recommendations:

  • Strengthen relationships
  • Deepen your faith journey
  • Rest and refresh yourself
  • Enhance organizational care
  • Respect and care for local staff
  • Plan for traumatic stress as a certainty, not just a possibility

Quick Take

  • If we view stress and trauma as a normal, predictable aspect of our work, we can look more deliberately at strategies that will help us to flourish in demanding environments.
  • We keep ourselves and those we care for safe whenever possible.
  • We prepare for trauma by strengthening resiliency in our personal and organizational lives. This includes healing old wounds, putting aside optional stressors and building positive mental and physical capacity.
  • We address the impact of trauma throughout our personal and work processes. This includes taking time to rest and replenish, making room for our own and each other’s arousal under stress and caring for one another in difficult conditions.
  • We accept traumatic stress and its consequences as part of our family and organizational lives.

The Challenge

“Stress is a state of psychological and physical arousal [resulting from] a threat, challenge or change in one’s environment (p.15.)” Distress is “a psychological and physical arousal for which routine stress management is inadequate over time (p.16.)” Stress management refers to all efforts to reduce daily, chronic, cumulative, traumatic and caregiver (“secondary”) stress.

Physiological reactions to stressful incidents and environments are normal and automatic (not moderated consciously.) Crisis physiology provides short term benefits at long term costs. Cortisone speeds up healing but depletes the immune system. Adrenaline enhances immediate performance but promotes heart disease. Endorphin relieves pain but is arousing and addictive. Sex hormones are depleted.

The increased sensual acuity of crisis physiology helps explain persistent arousal, heightened functioning and vivid dreams, flashbacks and memories, as well as memory lapses, lack of peripheral awareness and ineffective activity. Burnout, flameout, acute stress reactions and post-traumatic stress disorder (PTSD) reactions are common sequels to overwhelming stress.


The research section includes three fairly independent chapters with listed authors. Graham Fawcett (John’s brother) presents a behavioral model, Cynthia Eriksson et al present a research model, and Graham Fawcett presents the research project design with some summarized conclusions.

The second half of the Handbook elaborates six strategies in response to the realities of stress and trauma impacting international aid workers.

  1. Strengthen relationships: Strengthen relationships because social support is even more strategic than individual healthy behaviors for ameliorating stress. Build, maintain, and use caring friends, family and coworkers for support. Strengthen team cohesion; develop consultative leadership styles; set clear and limited objectives.
  2. Deepen faith: Deepen your faith journey because spiritual faith is a central element in coping with situations that challenge our previously held assumptions and beliefs. Increasing frequency, fervency and rigidity of religious behaviors may indicate that faith is under stress. Unresolved, this may lead to withdrawal to a safer environment, formation of a reactive affinity group, and/or emotional and physical distress symptoms. Effectively processed, faith in crisis may lead to more integrative, nuanced affirmations and resilient spirituality.
  3. Rest and refresh: Rest and refresh yourself. Take restful vacations and other breaks, especially when stress is high. In actual practice, workers, teams and supervisors all undervalue rest when under stress. This is congruent with the physiology of stress discussed earlier. Monitor and modify exercise, diet, sleep and relaxation. Use meditation and other relaxation techniques. Monitor and limit use of psychoactive chemicals, including caffeine.
  4. Enhance the organization: Enhance organizational care. In recruitment and staff placement, recognize that poor fit or selection will be more disastrous, not less, in high stress conditions. In personnel development, recognize that increased training, coaching, consulting, and team building can lower arousal levels both through behavioral conditioning and through increased social support. In assessment and management, recognize that rest, relief from frustrating requirements or structures and access to care will preserve and enhance your organization’s most valuable resource—your experienced and deployed front line personnel.
  5. Respect and care for locals: Respect and care for local staff. Historically, perceived differences in meeting needs of local and international staff have been a besetting problem of international aid efforts. Practices cannot be universally coherent when cultures and nations intersect, though principles should be universally applied. Furthermore, when facing stress and trauma, cultures and communities differ in their assessments, histories, structures and resources, just as individuals within them also differ.
  6.  Plan for traumatic stress: Anticipate traumatic stress as a certainty, not just a possibility. World Vision’s Trauma and Emergency Support Service (TESS) seeks to (1) reduce the likelihood of exposure to traumatic events; (2) maximize the likelihood of survival when trauma comes; (3) provide immediate and follow-up services to minimize damage and reduce longer-term consequences.


This is not a handbook in the sense of being a practical “how to” manual. Instead, it is the summary of the outcomes from a major effort by World Vision to better handle the impact of trauma on their international aid organization. If your organization wanted to do a comprehensive study on stress and trauma on your staff, you would probably get something much like what World Vision has already done. Your action plan would probably look a lot like that of World Vision. So, why not start with what they have done and then go on from there?

Because this book presents methodology, studies and applications, it also allows those of us with field experience to question their conclusions. For me, perhaps the weakest link was that of causality—for instance, is poor social support for front line workers a corollary of intense traumatic stress, or is it an independently contributing factor? Is it contradictory to assert that both collaborative leadership styles and clear direction for a team ameliorate stress, or does intense stress expose the flaws in every leadership style?

Final Note

As one who deals with stress and trauma both personally and in my work with others, I cannot even write a review like this without being personally aroused by this material. For me, the automatic arousal that stress brings is an ongoing and recurring reality. Fawcett suggests, though, that there are two other groups of people among stress responders who are reportedly unaffected (p.25.) The first is those who have little awareness of their own stress responses. He suggests these will greatly benefit from stress management education. The second group is those who were once aware of their own stress responses, but now “feel nothing” over the longer term. This he suggests is more serious, because the links between our physical awareness and our body function may be compromised. This group, he suggests, will benefit from professional mental health care. I share this to suggest that an awareness that we are deeply impacted when we face stress and trauma is not such a bad thing compared to the alternatives. Intentionally asking ourselves, each other, and our Father what we can do about our stress is a very practical next step. 

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Steve Spinella

Steven P Spinella, DMin, is director of the Center for Counseling and Growth in Taichung, Taiwan, and an AAMFT approved supervisor for marriage and family therapists. He has spent the last ten years based in Taiwan. His personal list of traumatic events includes the loss of twin babies in 1986 …View Full Bio