A career as a first responder is a unique, intense job that has high reward but also high risk. Many first responders have the opportunity to change lives and make a huge difference in their communities. On the down side, the job leads to being exposed to traumatic situations nearly every working day. A plethora of recent research has been done on first responders and exposure to trauma and the results are showing that dire mental health consequences are happening to first responders who have long-term exposure to trauma and remain untreated.
One of the biggest barriers in addressing mental health concerns is that the culture surrounding law enforcement, paramedics, fire departments and other emergency professions, where it can be difficult to discuss a mental health issue, emotions or personal struggles from a traumatic incident amongst peers. There is a culture of shaming for having a natural human reaction to trauma exposure and a real fear of losing one’s job if one is not seen as mentally fit. The culture and workplace is running off of old ideas that are not backed by scientific research. The fact is, we are all human and that at some point trauma exposure will affect us.
As a first responder, the requirements of dealing with intense, traumatic situations on a daily basis is expected, but that doesn’t mean these traumatic events won’t cause anger, pain and sadness. The problem is most first responders are responding to the culture of shame surrounding showing emotions or a mental health issue. The idea of exposing a crack in the armor to colleagues could mean losing a job. First responders are being punished for being human and being punished for have a nervous system response --- this is basic biology. The job of dealing with intense and often traumatic situations does wear down on the nervous system in all people.
On the positive, research on mental health and first responders is growing and efforts are being made to break down the culture of not expressing stressors amongst peers, not receiving support from peers, not seeking mental help or realizing that long term exposure to trauma causes problems for all people and that you are not weak if you have PTSD from vicarious trauma.
RECONIZING THE SIGNS OF PTSD
As the discussion on mental health is normalized and more people help remove the stigma around mental health and first responder work, the better the chances of getting treatment are for first responders. Many fire departments, police stations, and medical facilities are paving the way for better mental health awareness, check-ins and services for employees who work in a high intensity environment.
Learning to recognize the signs of trauma and PTSD is the first step.
Emotional
· Nightmares
· Flashbacks
· Unwanted memories that intrude thoughts
· Emotional distress (feeling uneasy, strong feelings of anxiety)
· Unprovoked emotional outbursts
· Risky taking behavior (alcohol, drugs, placing oneself is risky situations – drunk driving, getting injured in accidents)
· Destructive behavior (having affairs, carelessly having unprotected sex, not caring about life, behaviors at work may end up costing job)
· Increased use of alcohol or drugs (numbing behaviors)
· Mood swings
· Detaching emotionally from others
· Relationship issues with partners or family
· Suicidal thoughts
Avoidance
· Avoiding location of traumatic situation
· Avoiding thoughts and emotions related to the trauma ( shutting down)
· Can’t recall parts of a traumatic event
· Avoidance of work
Negative thoughts
· Negative thoughts about oneself ( maybe thinking he/she could have done better in a situation)
· Negative mood and assumptions about world
· Exaggerated blame of others or self
· Feeling alone or isolating oneself
· Decreased interested in favorite activities
Body/nervous system reactions
· Sleep issues (problems falling asleep or staying asleep)
· Hypervigilance
· Heightened startle response
· Difficulty concentrating
· Dissociation symptoms
depersonalization -- experience of being an observer of oneself ( outside the body, feeling detached from the body
derealization – feeling like things are not real, feeling separate and distant from surrounding.
It’s important to know that all of these symptoms are completely normal reactions to witness and experiencing trauma. It does not mean someone is weak or unfit for a job as a first responder. At some point nearly all first responders experience PTSD. A recent study found that 86% of first responders reported one or more symptoms of PTSD. The hurdle is talking about PTSD and trauma and creating a non-shaming safe environment for first responders to tell the truth about what they are experiencing. The end of this stigma on mental health and shaming is the barrier that needs the most change.
FINDING THE RIGHT CLINICIAN
We have a problem in this country where we are not looking at mental health issues the same as physical issues. If you break your arm you go to a doctor and he/she will reset the bone, clean any wounds and make sure that the arm heals correctly. Mental health is no different, literally something is injured in the brain and we need to set it correctly, clean the wound and make sure it heals properly. Finding a licensed therapist is a great place to start but for something specialized liked PTSD and trauma treatment is is important to find a clinician who specializes in trauma. Think of it like going to a orthopedic surgeon for a knee issues versus a general practice doctor.
Trauma-informed clinicians generally express their specialties on their websites, but it is also important to look for a clinician show understand the culture and sensitive nature of the first responder’s job. The specialized treatment can make a huge difference in recovery. It is also important to note that if you go to a therapist and don’t feel that you connect or even like their style it is ok to find a different clinician.
TRAUMA-INFORMED THERAPY TECHNIQUES THAT CLINCIANS USE
Eye movement desensitization and reprocessing (EMDR). Excellent outcomes can come from EMDR therapy, which is a body-based therapy that utilizes bilateral stimulation and thought reprocessing. A trained EMDR therapist will be able to assess and determine if EMDR works for you. EMDR is a great choice for first responders because the emotional charge can be dampened in a traumatic memory.
Somatic experiencing therapy (SE). This therapy was developed based on the biology of the brain and nervous system. Working with the nervous system, SE regulates and soothes emotions, thoughts and bodily sensations that are associated with a traumatic experience. SE can increase bodily and emotional awareness and allow for more daily mindfulness.
Trauma-focused cognitive behavioral therapy (TF-CBT). CBT is generally threaded in with other trauma therapy modalities. Be aware that just focusing on the thoughts surrounding a trauma may never get to the emotional underbelly or physically stored parts of the trauma where the real work needs to happen.
Developmental trauma therapies. It may be necessary to dig further beyond a single trauma incident to discover related trauma that needs to be cleared from the system. Looking at early traumatic situations can help reduce a present-day reaction to a trauma and free up space to process traumatic incidences that can happen daily to first responders.
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