Here is some valuable information providing a differentiation of services available to Firefighters. Is there a difference between counseling and therapy? Is a Psychologist the same as a psychiatrist? How do I know which on I need? What can I expect? FireStrong provides the answers to your questions… here.
What is Counseling?
Each therapist is different, but they all are trained to help you with your issue. Look up different therapists using your insurance to ensure they are a licensed therapist. In order to find the right therapist for you read reviews online.
The initial thought of therapy can be intimidating, especially for those who have never really been into talking about their “feelings.” Finding a therapist that you mesh well with is a major key to success in getting the help you need. While searching for a therapist it is important to have a conversation with them beforehand. A phone call can help you determine if they are able to help you with your personal issues. If the conversation is awkward or does not feel natural at all, then that therapist might not be the best fit. It is completely normal for people to contact a couple of different therapists before picking the best one for them!
Therapy sessions are all about making sure you are comfortable with sharing your thoughts and feelings in a safe, protected, and relaxed environment. The ultimate goal of a therapy session is to have you leaving feeling more at ease every time prior to your previous session. While you won’t be lying down on a couch like you often see in commercials, you can often expect to be sitting on a comfy couch in a warm and inviting room.
What to expect when going to see a therapist:
Each therapist has a unique style, and a large part of therapy is the rapport between you and the therapist. If you don’t feel you can achieve this with the counselor you are seeing, you can always try out a new one. Most therapy can help and start to improve your life in less than 10 sessions (you have 30 sessions to work with!) The process of talking to a stranger about our issues/problems is foreign to many of us, but once you reach your comfort zone and start express yourself you can feel the weight of anxiety being lifted off your shoulders!
One therapy session won’t cure all of your problems overnight. Often in life we have to remind ourselves that good things take time! When first starting therapy, it is okay to feel lost or not even realize what some of your issues are. Once you start opening up about your hardships in life it will be easier to connect with your therapist and pin-point some events that might have triggered some personal issues. Sit back and be patient with this new experience.
3 Common Types of Talk Therapy:
•A therapist will help you change harmful ways of thinking. If you tend to see things negatively, it teaches you how to look at the world more clearly.
•Example: You drop by to see a friend, but he says he doesn’t have time to talk. Your first thought is that he’s angry with you. This makes you feel worried and anxious. Soon you are trapped in a flood of negative thinking.
•Cognitive therapy can help you focus on your reaction to your friend’s behavior. Perhaps what he said has nothing to do with you. Maybe he was having a bad day. Perhaps he was late for an appointment. Thinking of other reasons for his actions help you see the event in a more positive and accurate way.
•Helps you learn to relate better with others. You’ll focus on how to express your feelings, and how to develop better people skills. Might be helpful with strengthening relationships.
•Example: You and your wife are not getting along. The fighting seems to be getting worse, but you can’t break the cycle.
•Interpersonal Talk therapy can help you see your wife’s point of view and vice versa. Perhaps she feels you don’t spend time with her anymore. Finding new ways of talking to your wife may help you both feel better.
•Remember that talk therapy doesn’t have to be difficult. The simple act of discussing your feelings allows you to gain new insight and perspective. Talk therapy can also help to enrich your life by bringing the people that you love closer to you.
•Helps you change harmful ways of acting. The goal is to get control over behavior that is causing problems for you.
•Example: You were on a pediatric drowning, and now you are terrified of taking your family to the pool. This paranoia starts to affect your family life.
•Behavioral Talk therapy can help you to face your fears. Discussing your problems with a trusted person can help you to begin to overcome those fears and take control of your life.
What is the difference between a Counselor, a Therapist, Psychologist, and Psychiatrist?
A counselor is a person who is a master level licensed clinician who has completed a counseling focused program. They are trained to assess, diagnose, and treat numerous issues that people face. They cannot prescribe medication, however they work closey with physicians who can.
A Therapist is a person who has a Master’s or doctoral level degree in a counseling field and a license from a Board of Behavioral Health. Both the degree and license take years to achieve, so rest assure that the person should experience in talk therapy. They can’t prescribe medications, however they work closely with physicians who can.
A Psychologist is a person who has their Ph.D. in a counseling related field. Psychologists have more training and schooling than a therapist. They provide counseling, support, perform psychological tests. Psychologists cannot prescribe medication but work closely with psychiatrists and physicians if prescribed medication becomes necessary.
Psychiatrists are physicians who had to do a residency in the area they specialized, ie child psychology, neuropsychology. They can prescribe medication (prozac, ativan). Some provide talk therapy. Some will prescribe and provide both.
Secret Signs of Hidden Depression
People who suffer from secret or concealed depression usually do not want to acknowledge how serious their feelings are. They often put on a “happy face” for others so they do not feel judged. Click HERE to find out what the six signs of concealed depression are.
Depression is a mood disorder that causes a constant feeling of sadness, hopelessness, anger, and loss of interest in everyday life for a long period of time. The exact cause of depression is unknown, however, many researchers believe that depression is caused by chemical imbalances in the brain. Norepinephrine, seratonin and dopamine are neurotransmitters (chemical messengers that transmit electrical signals between brain cells) thought to be involved with major depression. It is believed that there is an increased risk for developing depression if there is a family history of the illness. However, people who do not have a family history of depression can still develop this mood disorder.
About 19 million Americans battle depression annually. Depression is estimated to contribute to half of all suicides. About 5%-10% of women and 2%-5% of men will experience at least one major depressive episode during their adult life. Depression affects people of all races, incomes, ages, and ethnic and religious backgrounds, but it is three to five times more common in the elderly than in young people.
“Some types of depression seem to run in families”
Causes, incidence, and risk factors:
Certain personality traits such as low self-esteem, physical or sexual abuse, financial issues, and the death of a loved one can often times trigger depression in some people. While it has long been believed that depression caused people to misuse alcohol and drugs in an attempt to make themselves feel better (self-medication), it is now thought that substance abuse can actually cause depression. Some illnesses such as heart disease, cancer, and certain medications may also trigger depressive episodes. It is also important to note that many depressive episodes occur spontaneously and are not triggered by a life crisis, physical illness or other risks.
There is no single cause of major depression. Psychological, biological and environmental factors may all contribute to its development. Whatever the specific causes of depression, scientific research has firmly established that major depression is a biological, medical illness.
A number of factors can play a role in depression:
- Life events or situations, such as: Breaking up with a significant other, illness or death in the family, or parents divorcing (for adolescents)
- Repetitive traumatic calls
- Childhood events, such as abuse or neglect
- Divorce, death of a friend or relative, or loss of a job (for adults)
- Social isolation (common in the elderly)
- Medical conditions such as hypothyroidism (underactive thyroid), medications (such as sedatives and high blood pressure medications), cancer, major illness, or prolonged pain
- Sleeping problems, Sleep deprivation
- Alcohol or drug abuse
- Agitation, restlessness, and irritability
- Dramatic change in appetite, often with weight gain or loss
- Extreme difficulty concentrating
- Fatigue and lack of energy
- Feelings of hopelessness and helplessness
- Feelings of worthlessness, self-hate, and inappropriate guilt
- Inactivity and withdrawal from usual activities, a loss of interest or pleasure in activities that were once enjoyed (such as sex)
- Thoughts of death or suicide
- Trouble sleeping or excessive sleeping
- Depression can appear as anger and discouragement, rather than as feelings of hopelessness and helplessness. Use of alcohol or illegal substances may be more likely to occur.
- Even Medicines that you take for other problems could cause or worsen depression, check with your doctor.
- Medicines that you take for other problems could cause or worsen depression. You may need to change them. DO NOT change or stop taking any of your medications without consulting your doctor.
- People who are so severely depressed that they are unable to function, or who are suicidal and cannot be safely cared for in the community may need to be treated in a psychiatric hospital.
- Most people benefit from antidepressant drug therapy, along with psychotherapy. As treatment takes effect, negative thinking diminishes. It takes time to feel better, but there are usually day-to-day improvements.
- Antidepressant medications work by increasing the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemical messengers.
- Take medications correctly and learn how to manage side effects.
- Learn to watch for early signs that depression is becoming worse and know how to react when it does.
- Try to exercise more, seek out other activities that bring you pleasure, and maintain good sleep habits.
- Avoid alcohol and illegal drugs. These substances can make the depression worse over time, and may also impair your judgment about suicide.
- When struggling with your depression, talk to someone you trust about how you are feeling. Try to be around people who are caring and positive.
- Try volunteering or getting involved in group activities.
“therapy teaches depressed people ways of fighting negative thoughts”
Types of help (See also Types of Counseling)
- Cognitive behavioral therapy teaches depressed people ways of fighting negative thoughts. People can learn to be more aware of their symptoms, learn what seems to make depression worse, and learn problem-solving skills.
- Psychotherapy can help someone with depression understand the issues that may be behind their behaviors, thoughts, and feelings.
- Joining a support group of people who are experiencing problems like yours can also help. Ask your therapist or doctor for a recommendation.
You can take a personal assessment here.
What is anxiety?
Anxiety can come from any situation or thought that makes you feel frustrated, angry, or during a time you feel you have no control of the situation. Anxiety is a feeling of apprehension, nervousness, or fear. The source of this uneasiness is not always known or recognized, which can add to the distress you feel. People with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations.
Having anxiety is a normal part of life. However, too much is harmful. It can be debilitating and get in the way of everyday life. Continued high levels of anxiety can set you up for general poor health, as well as physical and psychological illnesses like infection, heart disease, and depression. It can lead to unhealthy behaviors to help self medicate like overeating and abuse of alcohol or drugs.
What are the symptoms?
- Abdominal pain (this may be the only symptom of anxiety, especially in a child)
- Diarrhea or frequent need to urinate
- Dry mouth or difficulty swallowing
- Muscle tension
- Rapid breathing
- Rapid or irregular heart rate
- Twitching or trembling
- Sometimes other symptoms occur with anxiety:
- Decreased concentration
- Irritability, including loss of your temper
- Sexual problems
- Sleeping difficulties, including nightmares
More severe symptoms that may need immediate treatment:
- You have crushing chest pain, especially with shortness of breath, dizziness, or sweating.
- These symptoms might be caused by a heart attack, which can also cause feelings of anxiety.
- You have thoughts of suicide.
- Call your health care provider if you have dizziness, rapid breathing, or a racing heartbeat for the first time, or if it is worse than usual.
- You are unable to work or function properly at home because of anxiety or other symptoms.
- You do not know the source or cause of your anxiety.
- You have a sudden feeling of panic.
- You have an uncontrollable fear — for example, of getting infected and sick if you are out, or a fear of heights.
- Your anxiety is triggered by the memory of a traumatic event (See PTSD).
- You have tried self care for several weeks without success, or you feel that your anxiety will not go away without professional help.
- Changes to you environment or day to day life
- Both positive and negative changes can cause anxiety
- Relationship issues
- Certain drugs, both recreational and medicinal, can lead to symptoms of anxiety due to either side effects or withdrawal from the drug.
Such drugs include:
- ADHD medications, especially amphetamines
- Benzodiazepines (during withdrawal)
- Bronchodilators (for asthma and certain other breathing disorders)
- Cold remedies
- Diet pills
- Thyroid medications
- A poor diet — for example, low levels of vitamin B12 — can also contribute to stress or anxiety. In very rare cases, a tumor of the adrenal gland (pheochromocytoma) may cause anxiety or stress-like symptoms. The symptoms are caused by an overproduction of hormones responsible for the feelings of anxiety.
The most effective solution is to find and address the source of your stress or anxiety. This can be difficult, because the cause of the anxiety may not be conscious. A first step is to take an inventory of what you think might be making you “stressed out,” trying to be as honest with yourself as possible:
- What do you worry about most?
- Is something constantly on your mind?
- Is there something that you fear will happen?
- Does anything in particular make you sad or depressed?
- Keep a diary of the experiences and thoughts that seem to be related to your anxiety. Are your thoughts adding to your anxietyin these situations?
Then, find someone you trust (friend, family member, neighbor, clergy) who will listen to you. Often, just talking to a friend or loved one is all that you need to relieve anxiety.
Contacting on of the Peer Support Team members is always an option. Also, most communities also have support groups and hotlines that can help. Social workers, psychologists, and psychiatrists can be very effective in helping you reduce anxiety through therapy or medication.
Also, find healthy lifestyle choices to help you cope with the stress and anxiety. For example:
- Eat a well-balanced, healthy diet. Don’t overeat.
- Exercise regularly.
- Find self-help books at your local library or bookstore.
- Get enough sleep.
- Learn and practice relaxation techniques like guided imagery, progressive muscle relaxation, yoga, tai chi, or meditation.
- Limit caffeine and alcohol.
- Take breaks from work. Make sure to balance fun activities with your responsibilities. Spend time with people you enjoy.
- Pick up a hobby that you used to enjoy.
What to expect your doctor to ask:
- When did your feelings of stress, tension, or anxiety begin? Do you attribute the feelings to anything in particular, like an event in your life or a circumstance that scares you?
- Do you have physical symptoms along with your feelings of anxiety? What are they?
- Does anything make your anxiety better?
- Does anything make your anxiety worse?
- What medications are you taking?
- Do you use alcohol or drugs?
Anxiety and Distress
Use the following personal assessments to determine your risk for anxiety and distress.
What is resiliency?
One of the most important aspects of a firefighter’s life and mental health is resiliency. Resilience is often defined as one’s ability to bounce back from setbacks and to properly adapt to stressful situations. Resiliency is so important to us all because no one is immune to stress whether it’s daily irritants or major life-altering events.
Building resilience takes time. In order to help improve resiliency make sure to get enough sleep, exercise, and practice on thought awareness. Being more optimistic and seeing the glass half full in the long run will help change the way you think about negative or stressful events. If we improve the health and happiness in our individuals and workforce as a whole, then we will produce a higher performance overall.
Building resiliency is important for the following reasons:
- It protects against heart disease (the #1 killer of firefighters!)
- Potentially increase life expectancy by up to a decade
- Inoculates against daily hassles and life altering events
- Improves job satisfaction and productivity
- Boosts your immune response
- You’re at lower risk for injuries and pain, including headaches
- Lowers risk of alcohol and dependency
Four pillars of resilience:
- Mental toughness
- Social connectivity
- Mind body “muscle memory”
- sparking positive emotions
Tactical breathing is used to gain control over physical and psychological responses to stress. Through practice one can gain control over heart rate, oxygen intake and emotions to increase concentration in various situation. Please see the link below for more information.
THE BIOLOGY OF SLEEP
Every person needs a different amount of sleep to awaken feeling refreshed. Individual sleep requirements are genetic and may be hereditary. Scientists consider six to 10 hours of sleep a normal range, with most people requiring 7.5 to 8.5 hours of sleep in a 24-hour period. At least four to five hours of uninterrupted core sleep is necessary to maintain minimum performance levels. Sleep requirements may change slightly with age and can be affected by general health. Illness, stress, and depression cause the body to require more sleep to heal and recuperate.
WHAT IS SLEEP DEPRIVATION?
Sleep deprivation occurs when a person does not get sufficient amounts of quality sleep. Work demands, family life, and lifestyle choices may cause a person to sleep fewer hours than his body needs to maintain wakefulness and energy levels. In the Fire Service most of us to Shift work and have to interrupt the body’s natural wake/sleep cycle. Over time deprivation of sleep can have both an acute and cumulative effect on our bodies and minds.
THE EFFECTS OF SLEEP DEPRIVATION
Sleep loss is cumulative and creates a sleep debt. Larger sleep debts require greater amounts of restorative sleep to return the body and mind to normal, rested levels. Sleep deprivation affects mental processes and intellectual abilities. It reduces performance on challenging tasks and negatively affects psychomotor skills. Mood, productivity, and communication skills suffer. Extended periods without sleep may cause hallucinations and paranoia. Lack of sleep may slow glucose metabolism by 30 to 40 percent and increase levels of the stress hormone cortisol. Sleep deprivation has also been linked to inadequate levels of the hormone leptin. Leptin signals the body to stop eating when it’s full. Decreased levels of leptin lead to increased carbohydrate cravings and eating.
“Physical and mental performances are not the only casualties of sleep deprivation. Even a minimal loss of sleep impacts general health. Chronic lack of sleep can contribute to serious health problems and even shortened lifespan. In a 1983 study at the University of Chicago, rats kept from sleeping became sick and died after two and a half weeks. Sleep-deprived rats that became ill but were then allowed to sleep, recuperated fully.”
Other effects of chronic sleep deprivation include:
• Adult-onset diabetes
•Menstrual and infertility problems
•Increased use of drugs and alcohol
•Impaired sexual function
•Less satisfaction in personal and domestic pursuits
•Increased appetite and weight gain
•Personality changes, particularly loss of humor and increased ill temper.
COUNTERMEASURES AND COPING STRATEGIES
“Firefighters need to get an adequate amount of uninterrupted sleep every off-duty night”
Quality sleep is the primary weapon in the battle against sleep deprivation. Firefighters must take advantage of opportunities for sleep, both on and off duty. Sleeping areas at home and at the fire station should be quiet and dark, and the room temperature should be cool. A comfortable, good-quality mattress is a must. Invest in comfortable bedding and pillows as well. Good sleep habits are essential. Firefighters need to get an adequate amount of uninterrupted sleep every off-duty night. Going to sleep and waking up at the same times every day, even on weekends, is important for maintaining the body’s natural rhythms.
Other tips for quality sleep include the following:
- Avoid eating, reading, and watching TV in bed.
- Restrict caffeine intake, and avoid caffeinated drinks at least six hours before bedtime.
- Eat healthful foods. Do not eat large meals within four to five hours of sleeping.
- Do not use alcohol to induce sleep. The effects of alcohol-induced drowsiness last only a few hours and cause poor-quality sleep.
- Avoid long-term use of over-the-counter sleeping pills. Habitual use can reduce effectiveness and lead to addiction.
- Reduce life stress as much as possible.
- Use relaxation techniques to relieve stress and invite sleep.
- Exercise, but not more than four hours before bedtime. For 24-hour shift workers, outdoor exercise during daylight hours can help the body maintain natural biological rhythms and increase sleep quality off-duty.
- Napping is an effective coping strategy that can be used in anticipation of a long night or during extended operations. Naps as short as 20 minutes can be effective. Two-hour naps during around-the-clock operations are highly restorative.
- Daytime sleep after a night shift is essential to staying well rested, but trying to sleep when the rest of the world is awake can be challenging at best. The shift worker must emphasize to friends and family the importance of restorative sleep. Go as far as having daytime sleep scheduled on the family calendar along with ballgames, school meetings, and other activities.
- Melatonin may help promote better sleep, particularly during the day. However, this supplement is not FDA-approved, and current research is contradictory on short-term and long-term effects.
- People who are regularly unable to sleep should consult their physicians to rule out underlying health problems. Doctors may also be able to prescribe medication to help with sleep. Sleep disorders can be aggravated by shift work. Shift workers with diagnosed sleep disorders need to work closely with their physicians to effectively manage their disorder.
A great insomnia program is available through Mindability. Please click on the link to learn more.
This article is provided as a service by FireStrong.org
Causes, incidence, and risk factors
How much you drink
can influence your chances
of becoming dependent
There is no known cause of alcohol abuse or alcoholism. Research suggests that certain genes may increase the risk of alcoholism, but which genes and how they work are not known. How much you drink can influence your chances of becoming dependent. Those at risk for developing alcoholism include:
- Men who have 15 or more drinks a week.
- Women who have 12 or more drinks a week.
- Anyone who has five or more drinks per occasion at least once a week.
- One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor.
- You have an increased risk for alcohol abuse and dependence if you have a parent with alcoholism.
Signs and Symptoms of Alcohol Abuse
- Continue to drink, even when health, work, or family are being harmed.
- Become violent when drinking.
- Are not able to control drinking — being unable to stop or reduce alcohol intake.
- Make excuses to drink.
- Miss work or school, or have a decrease in performance because of drinking.
- Stop taking part in activities because of alcohol.
- Need to use alcohol on most days to get through the day.
- Try to hide alcohol use.
- Memory lapses after heavy drinking.
- Needing more and more alcohol to feel “drunk”.
- Alcohol withdrawal symptoms when you haven’t had a drink for a while.
The following questions are used by the National Institute on Alcohol Abuse and Alcoholism to screen for alcohol abuse or dependence:
- Do you ever drive when you have been drinking?
- Do you have to drink more than before to get drunk or feel the desired effect?
- Have you felt that you should cut down on your drinking?
- Have you ever had any blackouts after drinking?
- Have you ever missed work or lost a job because of drinking?
- Is someone in your family worried about your drinking?
If you or somebody close to you is feeling the effects of alcohol abuse there are plenty of resources available. Please feel free to take one of the confidential and completely anonymous ASSESSMENTS to help you gauge where you may be in you use.
- ACCESS RESOURCES has many programs available.
- You can call also call our FIRE support crisis line for more resources.
- In addition, your medical insurance covers rehab and detox facilities.
- You can also access many substance abuse therapists to aid you along the way to recovery.
Suicide Risk Factors
Many have pointed out that the risk factors for suicide mirror the population of the fire service. Importantly, it has also been noted that thousands of signs, symptoms and risk factors have been reported by various organizations. Using those risk factors to try and predict who will attempt or commit suicide has thus far proven to be challenging even for professionals. The Center For Disease Control has listed the following prominent characteristics as some of the possible contributing factor for increased risk of suicide:
- family history of suicide and/or child maltreatment.
- previous suicide attempt.
- history of mental disorders and/or alcohol/substance abuse.
- feelings of hopelessness.
- impulsive or aggressive tendencies.
- local epidemics of suicide.
- isolation from others.
- barriers to treatment including stigma.
- loss (relational, social, work, or financial).
- physical illness.
- access to lethal means.
Although it is not necessary for all of these risk factors to be present for someone to commit suicide, they should be used to raise your index of suspicion. If you suspect someone is contemplating suicide, don’t hesitate to act.
- I Ideation– Having suicidal thoughts or ideations
- P Purposelessness– feeling no reason for living
- A Anxiety – anxiety or agitated with insomnia or excessive sleep
- T Trapped– feeling no way out of the situation they are in
- W Withdrawal – Withdrawal from friends, family, or society
- A Anger– Uncontrolled anger or rage
- R Recklessness – Acting or engaging in risky or reckless behaviors
- M Mood – Dramatic mood changes
You can remember these actions through KNOW, ASK, LISTEN, CONNECT. DO NOT AT ANY TIME PUT YOURSELF IN DANGER. IF THE PERSON IN CRISIS HAS A WEAPON OR IS AN IMMEDIATE DANGER TO SELF AND/OR OTHERS, CALL 911 RIGHT AWAY.
Have you heard of the Mind-Body Connection?
It is a term used to describe the interconnectedness between our emotions and our physical health.
When you are emotionally stressed or anxious, especially for a prolonged period of time, it often has a negative impact on your health. Numerous research studies have shown that stress can cause and/or worsen physical conditions such as:
- High blood pressure
- Chest pain
- Back pain “physical injury, illness, or pain can impact your mood”
- Sleep problems (e.g. insomnia)
- Sexual difficulties
- Gastro-intestinal problems
- A weakened immune system
Likewise, you may have experienced first hand how a physical injury, illness, or pain can impact your mood. If our bodies are “sick”, we worry about a number of things including:
- How long it will take to get better?
- Will I have to go on light duty?
- Will I have to stop working out or limit my physical activity?
- Will I be a burden to those around me?
The Good News
The good news is that there are several things we can do to improve our mental and physical health when it comes to these matters. Relaxation techniques always help.
First, if you’re feeling stressed or anxious you can contact FireStrong.org Crisis Support Line 1-844-525-FIRE (3473).
If you want to hear more about how can work for you, follow this link to a podcast that explains the Mind-Body connection, and some strategies to calm your body and mind to prevent or eliminate physical symptoms. Autonomic Podcast
Next, the link below is to the American Psychological Association website that cites some fascinating research about the Mind-Body Connection. For instance, did you know:
- Stress is linked to the six leading causes of death – heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide. (“The Stress Solution: An Active Plan to Manage the Stress in Your Life,” Lyle H. Miller, Ph.D. and Alma Dell Smith, Ph.D.)
- People with high levels of anxiety can have between two to seven times the risk of heart disease. (“Emotional Longevity: What Really Determines How Long You Live,” Norman B. Anderson and Elizabeth P. Anderson, 2003)
- Two-thirds of all office visits to family physicians are due to stress-related symptoms (American Academy of Family Physicians)
Learn more about this research at http://www.apa.org/helpcenter/mind-body.aspx
- Stay Strong – Be smart about your body and your mind!
- Chances are high that this will directly affect you or a loved one during your lifetime !
As much as we like to think of ourselves as unbreakable, we break, and when we do it’s usually hard and fast. If this feeling of being in crisis comes we may not feel comfortable to reach out for support. It’s embedded in our DNA that we are firefighters and we are supposed to fix problems.
Our exposures to high stress calls and events have given us the ability to overcome our feelings and work through them. Over time we store up our issues until they may overflow into other parts of our life. Sure, we may use dark humor or sarcastic remarks to move past our own feelings and continue to do our jobs but what happens when the floor falls out from under us, and we or a friend needs help.
If we finally do decide to accept help we will need somebody we can trust. We will need to know what the help will look like. So if you or somebody you know is in crisis and you decide to ACCESS RESOURCES to get help. What can you expect to happen next?
‘What will a crisis intervention look like?’
Each program is different, but all professional licensed counselors adhere to regulations when it comes to crisis intervention. Crisis Intervention should not be confused with traditional Therapy or Counseling. Crisis Intervention is used in acute situations to assist those who are in urgent need of help.
- Their behavior constitutes a danger of inflicting serious physical harm upon oneself, including attempted suicide or the serious threat thereof, or if the threat is expected that it will be carried out.
- There is potential that the continued behavior can reasonably be expected to result in serious physical harm to others.
Behavior in which a person is likely to come to serious physical harm or serious illness because he/she is unable to provide for his basic physical needs.
- They are showing signs that they are suffering severe and abnormal mental, and emotional issues and that these issues are significantly impairing judgment, reason, behavior or capacity to recognize part of reality.
These four guidelines are reasons for a Crisis Intervention. It is after intervention and when the person is back to more stable that they would benefit from therapy or Counseling in hopes of creating a new healthy baseline.
A Crisis Specialist will ask a series of questions to identify relevant safety issues, and to assess if the person meets the criteria above. Some of these questions may seem intrusive when asked, but regulations dictate that the level of safety is assessed. Here are some sample questions to expect:
Safety Assessment Questions
- Have you had any thoughts or actions, now or in the past, to do anything to hurt yourself?
- Are you concerned about your ability to maintain your own safety?
- Is anyone else concerned about your ability to maintain your safety?
- What, exactly, are any thoughts you have had or are having to hurt yourself?
- Do you have a plan on what you would actually do to hurt yourself?
- Have you ever acted on these thoughts? What did you do?
- Regarding any past actions to hurt yourself, was your intention to hurt yourself, die, let someone know how bad things are?
- What were you trying to get away from or are you trying to get away from, by doing something to hurt yourself?
- How are you hoping hurting yourself/killing yourself will solve your problems?
- Do you have the means to hurt yourself? Do you have access to weapons or drugs?
- Has anyone in your family ever hurt themselves/committed suicide?
- What level of support do you have in your life?
- Are you willing to make a no-harm contract with me?
- Define the Problem. Explore and define the problem from the patient’s point of view. Use active listening, including open-ended questions. Attend to both verbal and nonverbal communications.
- Ensure Personal Safety. Assess lethality, criticality, immobility and seriousness of threat to patient’s physical, emotional and psychological safety. Assess internal impact as well as environmental situation.
- Provide Support. Communicate (by words, voice, and body language) a caring, positive, non-possessive, nonjudgmental, acceptant, personal involvement with the one in crisis and the family.
- Examine Alternatives. Assist in brainstorming choices available now. Search for immediate supports. These supports might include hospitalization or rehabilitation facility
- Plan. Develop a plan with your patient which: provides something concrete and positive for the patient to do now with definite action steps which the patient can own and comprehend.
- Ask the patient to verbally summarize the plan and commitment.
- Demonstrate your part of the commitment if you collaborate.
- Follow up on the patient’s performance or in obtaining assistance.
Click Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) to receive a FREE digital copy of suicide assessment guidelines put out by the Substance Abuse and Mental Health Services Administration (SAMHSA).
For Help or more information on Crisis Intervention please visit FireStrong.org.
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after someone experiences a traumatic event that caused intense fear, helplessness, or horror. PTSD can result from personally experienced traumas (e.g., rape, war, natural disasters, abuse, serious accidents, and captivity) or from the witnessing or learning of a violent or tragic event.
- While it is common to experience a brief state of anxiety or depression after such occurrences, people with PTSD continually re-experience the traumatic event; avoid individuals, thoughts, or situations associated with the event; and have symptoms of excessive emotions.
- People with this disorder have these symptoms for longer than one month and cannot function as well as they did before the traumatic event.
- PTSD symptoms usually appear within three months of the traumatic experience; however, they sometimes occur months or even years later.
Although the symptoms for individuals with PTSD can vary considerably, they generally fall into three categories:
– Individuals with PTSD often experience recurrent and intrusive recollections of and/or nightmares about the stressful event. Some may experience flashbacks, hallucinations, or other vivid feelings of the event happening again. Others experience great psychological or physiological distress when certain things (objects, situations, etc.) remind them of the event.
– Many with PTSD will persistently avoid things that remind them of the traumatic event. This can result in avoiding everything from thoughts, feelings, or conversations associated with the incident to activities, places, or people that cause them to recall the event. In others there may be a general lack of responsiveness signaled by an inability to recall aspects of the trauma, a decreased interest in formerly important activities, a feeling of detachment from others, a limited range of emotion, and/or feelings of hopelessness about the future.
– Symptoms in this area may include difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, becoming very alert or watchful, and/or jumpiness or being easily startled.
Risk Factors for Firefighters
A few studies have also looked at what factors might put firefighters at greater risk for the development of PTSD. A number of risk factors for PTSD among firefighters have been identified. These include:
- Being previously in treatment for another disorder.
- Starting work as a firefighter at a younger age.
- Being unmarried
- Holding a supervisory rank in the fire service.
- Proximity to death during a traumatic event.
- Experiencing feelings of fear and horror during a traumatic event.
- Experiencing another stressful event (for example, loss of a loved one) after a traumatic event.
- Holding negative beliefs about oneself (for example, feeling as though you are inadequate or weak).
- Feeling as though you have little control over your life.
Protective Factors for Firefighters
- Even though firefighters might be at high risk for stress as a result of their jobs, it is important to point out that most firefighters will not develop PTSD. In fact, several factors have been identified that may reduce the likelihood of developing PTSD among firefighters after the experience of multiple traumatic events.
- One of the most important protective factors found was having social support available either at home or through work.
- In addition, it has also been found that having effective coping strategies available may lessen the impact of experiencing multiple traumatic events.
- This is not surprising in that, among people in general, the availability of social support and effective coping strategies have consistently been found to reduce the risk for developing PTSD following a traumatic event.
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