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.
Just mentioning the words Post Traumatic Stress Disorder or PTSD probably has you running for the hills right now but trust me, it doesn’t have to be a scary subject. Every firefighter in this world is willing to take on any risk to save another person’s life. Sometimes that risk means witnessing or engaging in a crisis that would be unthinkable for the average Joe on the street to handle. You jump in on someone’s worst day of his or her life and at times risk your life for the sake of theirs. With that said, sad to say it, but that means you have witnessed a traumatic event. When you witness a traumatic event, it puts you at risk for developing PTSD. It puts you at greater risk to develop PTSD when you continuously witness traumatic events. It probably sounds a lot like your day-to-day life as a firefighter, endlessly witnessing trauma.
There is such limited information out there to let you know what the stats say about PTSD amongst firefighters. The most consistent, predicted number out there says that about 37% of firefighters show signs or symptoms of PTSD. You would think that number would be higher since it is pretty safe to say that 100% of you witness at least one traumatic event throughout the course of your career. You’re probably laughing right now because that number is probably way higher than one.
Whether it was by choice or by chance, the way that a firehouse is set up, and the way that your schedule works is a protective factor that reduces your risk to develop PTSD. Protective factors are a fancy way of saying that there is something in place that helps you reduce the risk of developing PTSD. Psychologists, actually let’s call them head docs; they had to develop a fancy way to say it that sounded smart. It looks better in our field when we sound smart.
So let’s look at what these protective factors are and how you can rely on them to process through any traumatic event that you might come across. Because let’s face it, the next alarm that goes off could lead you right into someone’s worst day and your next call might be the one that is hard to forget. Your next call might be the one that plays over and over in your mind. Your next call might be the one that wakes you up at night in a pool of sweat. You never know what the next call is.
So what about these protective factors makes the risk of PTSD lower for firefighters? The fact that you live in the firehouse with the same people that are going through the same trauma with you, that in itself allows you to process events in a healthy way. You are side by side with the same people day in and day out, and they are someone with whom you can relate. You eat, sleep, shower, and who knows what else goes on in there but regardless, you do this with one another. If you were to experience an incident and then immediately return home to your family, it would make it harder to process it fully and effectively because they didn’t live the incident with you. The other protective factor is your schedule, as much as your wife, girlfriend, partner, might hate your schedule, it is a protective factor. When you work these long hours, it means that your support system is right there with you and that helps.
I know many of you think that you are invincible but even though you aren’t the average Joe, you still breathe and bleed just as they do. So just because these protective factors are in place, doesn’t mean you are invincible to developing PTSD. You should know the warning signs and talk to someone about it. Really quick. Here are some down and dirty signs to look for: If you are experiencing panic attacks, feeling numb towards emotions, difficulty concentrating, frequent nightmares, feeling extra stress or anxiousness, flashbacks to the event that feel real, or even memory loss, you might need to find someone to talk to about it. These are just some quick signs that should trigger you to dig a little deeper and see if everything is alright.
So turning to someone for help doesn’t mean you are weak, it means you are human. If you think things don’t feel right, you should listen to your body and talk to someone. At the end of the day, the world needs you and needs you to take care of yourself.
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.