Firefighter Emotional Wellness PDF

Fire ghter Emotional Wellness How to reconnect with yourself and others Juda Hudson What it Means to be Emotionally Well - ch 1 - Lack of balance will show up as mental or physical crisis...

Fire ghter Emotional Wellness How to reconnect with yourself and others Juda Hudson What it Means to be Emotionally Well - ch 1 - Lack of balance will show up as mental or physical crisis - Fire ghters push needs aside to focus on achievement - What really is my motivation for high achievement: - Childhood abuse and neglect - Bullying from peers - Whispers subtle lie “your not good enough, you need to prove yourself” - Bullied children = highly busy proven adults - Feel worthy or lovable - Achievement is like a drug and doing nothing makes you feel odd, antsy and uncomfortable What is Connected? - Connected = emotionally well - Face a tough call with resiliency - Opposite of “suck it up buttercup” - Connected people choose to heal, resolve pain and thrive - Emotionally Well - dealing with di culties in a healthy, intentional way, thinking clearly without lies or burdens and bouncing back in the face of adversity - 3 signs of connected people: (Benedek/ NIH Study) 1. Positive emotions and fewer negative 2. Resident among stress and change 3. Keep perspective and appreciate the good things in life - Emotion Wellness - aware and accepting of feelings without denying them, optimistic approach to life despite occasional disappointments and frustration - Actions of Balanced People: - Sleep 7-9 hrs - Stress reduce with friends - Balanced exercise - Self-care - take breaks, outdoors - Deal with loss in a healthy way - Surround with community (friends, church, social events, sports) fi fi ffi  - Make new friends, keep long term friends - Decisions based on personnel values and advice - Seek help or work independently - Enjoy reciprocal relationships - Con dent trying new things - Comfortable when challenged by personnel growth - Responsible for actions - Reconnecting: - Utilize an emotional support web - 7 Dimensions of Wellness: 1. Physical Wellness - Adequate sleep, physical activity, hydration and nutrition 2. Emotional Wellness - Identify feeling, address it properly and become more balanced - Positive outlet and resiliency contribute to emotional wellness 3. Intellectual Wellness - Doing things that are creative, stimulating, open minded, willing to improve knowledge and skills 4. Social Wellness - Communicating in healthy ways, intimate connections in safe relationships, support network, respecting self and others, taking part in community events 5. Spiritual Wellness - Choose, faith hope and commitment as a belief system while connecting with a higher power 6. Environmental Wellness - Connecting with nature and the world around you - Promotes positive mental health and creates a “domino e ect in others areas of life” - Possible reason for our lack of emotional wellness - surrounded by concrete with less than 10% of our day outside - Being by water or oil from trees rejuvenates the brain 7. Occupational Wellness - Bring your best to the table - Those who use there skills at home, work and for hobbies will feel more accomplished in life fi ff  Rescuer’s Depression - ch 2 - First responders are masters of compartmentalization pushing emotions to the back burner with ashes of anger - In quiet moments 1st responders feel symptoms of depression, anxiety, sadness, no joy in activities… - Anger feels like a way to ght instead of being vulnerable and victimized - signs of depression and PTSD in crisis Unique 1st Responder Depression - 2 Factors: 8. Negative childhood 9. Trauma - Creates a sub conscious sense the world is dark place - Equates to rescuers depression - “hidden depression” - Being a good provider = love with absence due to working Avoiding Emotion in First Responder Jobs - Survival tactic - Makes it hard to connect with self and others - Masculinity complex leads to increased PTSD risk - Compensate with exaggerated stereotypical behavior or self medicating Fire ghters - Hero mentality - Instrumental Personality - fascinated with things and how they work - Less emotionally expressive and self su cient - causes trouble reaching out for help (more men) - Competitive, past athletes - Generations of family in some type of service - Emotion seen as weak - Show anger instead of sadness Self Medicating - Adrenaline - Adrenaline seeking “veteran dilemma” or “ rst responder dilemma” - Intense calls adrenaline release raises what re ghters call “alive” and - afterwards they feel bored, depressed and cope in bad ways: - Workaholics, Alcohol, Porn, Excessive Working Out - Lack of Emotional Vocabulary as children only increases isolation (more seen in men) fi fi fl ffi fi fi fi  - Have to reprogram ability to have emotional conversations and requires internal action - People Self Medicate because they just want to “feel something” anything - Depression causes numbness and rather then feel numb they use substances or a stimulant (porn, gambling) - Substances and stimulants provide the cover up for rescuers depression - Male Depression - Symptom of the pursuit of Independence - Clinical vs Hidden Depression - Clinical - acute, unable to function, avoid doping things they formerly loved - Hidden - state of depression, motivated to medicate through action - “Faking good” action keeps them disconnected from feelings - Depression and Anger - “Real man” rather than feel emotions leads to anger - Anger can turn inward to self and lead to suicide if left unchecked - Men are 4x more likely to commit suicide - Depression and Sleep - Insomnia and nightmares strongly impacted a re ghters ability to regulate emotions - Sleep disturbances increase likelihood of depression - Greater and more frequent the sleep disturbances the higher the likelihood of depression and suicide - Lack of sleep maybe the root of epidemic - Sleep disturbances make become lifelong doe to cortisol surges - First Responders Staying Busy - Busy life = connection, empowered and needed - Busy life creates a “high” from the release of endorphins and is an e ective source of self-esteem and identity - Down Side to Busy - Take time to step back, create space - Space is where self awareness grows and contributes to resilience in a stressful job - Self re ecting releases noradrenaline, produces gray matter and gives use mental strength to solve problems - Un-Busy ff fl fi fi  - Down time = healing - Emotional wellness start by protecting your time - Trauma on and o the job - Start healing by talking about traumatic injury - Healing - Leaders share stories with others creating a culture of vulnerability rather than current toxic environment - Critical for wellness of the department - Connect with family, friends… and have space to begin healing - Healing lives in connection Substance Abuse and Addiction ch 4 - Addiction is a physiological and physiological dependence on something. - Productive activities become excessive/obsessive and become like drugs because they provide social approval - no such thing as “good addictions” - Addiction is an attempt to solve a problem and secondarily acts like a disease - Less about what the addiction is to and more about why - Addiction cycle - craving, high, consequences of use and di culty giving up the substance - Leaving people exhausted, trapped and still unhappy - Humans not addicts that need to relearn how to meet there needs in appropriate ways - What Addiction Does For You - Provides comfort, stress relief, pleasure, stress relief, connection and distraction from pain - Relapse happens when individuals do not relearn how to stress relief or calm down addiction is “Only Outlet” - Relapse Risk Factors: 1. Boredom 2. Illness 3. Major Life Change 4. Anger 5. Impulsive Sex ff ffi  6. High Stress - Resentment from family or others - Self Critical/ Criticism - Triggers - Addiction is the primary relationship rather than one with individuals - Signs of Relapse: - Emotional (anger, isolation, mood swings…) - Mental (war in head, thinking of past, glamorizing past, lying, planning) - Sobriety results in unintentional isolation due to social norms like alcohol - Development of an Addiction - Intense calls leave residual cortisol (stress hormone) and adrenaline in the body causing lingering stress and anxiety that may cause shaking - Alcohol used to “chill out” - brain rewires for an alcohol- assisted to chill out - Drinking before bed interferes with Rapid Eye Movement (REM) the period the body truly rests - 7 Common Factors of Addiction 1. Compulsive Behavior 2. Craving 3. Temporary Pleasure or Relief 4. Negative Consequences 5. Denial 6. Shame 7. Brain Circuits (Dopamine Release) - Drugs and Alcohol trigger Dopamine releases = “high feeling” - More use leads to a tolerance and then “Chasing the High” - Leads brain to not feeling normal without substance or behavior and begin to believe they cannot live without it - Addiction Risk Factors - Trauma - Negative in uences - Insecurity - Di culty with positive emotions - love, joy, intimacy… - Childhood Emotional Neglect (CEN) ffi fl  - Connection/ Community with people is away to move toward/ live in freedom from addiction - Connection “Key Ingredient” - Thirst for addiction is actually a thirst for connection - Building “Emotional Vocabulary” as adult will help you Connect with others and yourself - Steps to Freedom: 1. Talking to someone about addiction (friend or consoler) - Emotional Vocabulary 2. Begin taking steps, Remove addictive behavior or substance with help - Self Care - Addicts: - “masters of self neglect” and must learn consistent self care - Have complete inability to relax or enjoy themselves - Self critical/ criticism reduces ability to change - Recovery - Consistent and safe home foundation - Healthy ways to relax - Include: Home, Health, Community and Purpose - Support - O er help - Validate feelings and experiences - Assist with goals - Celebrate accomplishments - Share recovery stories - Be a part of recovery team - Treatment - Withdrawal happens Pediatric Death ch 6 - Self blame caused by inability to nd a reason for death - First responders can’t rationalize or make light of the death of child - Feel powerless because training didn’t save the child - Factors that make pediatric death harder - Can relate to death (race, past, same age child, loss of child) - “Safe Place”, neighborhood becomes a crime scene ff fi  - Accelerated Resolution Therapy (ART) - non-talking traumatic memories relief, used for invasion memories - Processing Pediatric Death - Adult Death (doesn’t work for peds.) - Humor - Blaming Victim - Magical Thinking - rst responders blame pediatric death on self - Pediatric Death Becomes More Than You Can Bear - Don’t go at alone talk to someone - It’s okay to feel sad, rest and process - Introverts take longer to process and need alone time Stress And Trauma CH 7 - Stress and trauma are close brothers - Stress is milder version of trauma with similar physiological response - Stress releases hormones (Adrenaline) are based on situation, causing ght or ight - Stress - e ect of anything in life to which people must adjust - Stressors - e ects that cause stress - Stress capacity - amount a person can tolerate - Stress Load - amount of stress - If stress rules it leads to mental health issues - Chronic Stress - See with First responders - Stress chemicals are released but never reduce to baseline leaving you susceptible to disease, outbursts and break ups - Must allow time to return to baseline - Trauma - Memories are more harmful and harder heal from - Causes mental, physiological and physical health issues - Trauma release greater amounts of hormones - Signs of trauma can be immediate or delayed recognized by aftershocks the individual experiences - Late Onset Stress Symptomatology (LOSS) - aftershocks after you retired fi fl ff ff fi  - It is normal not to remember a traumatic event perfectly - Helplessness and horror are not enough to predict PTSD - Avoidance causes PTSD, individual avoids thinking about or dealing with trauma - Acute Stress Disorder (ASD)- similar to PTSD but less severe - PTSD - overwhelming anxiety and shatter perception of world - Trauma and the Brain ( page 1380) - 3 parts of memory 1. Prefrontal Cortex - ght or ight, hormone release 2. Hippocampus 3. Amygdala - fear present, hormones (nor-epinephrine/ dopamine) that counter act ght or ight - Frontal lobes may not have accurate time line of event but your 5 senses will - Mirror Neurons - causes us to adopt emotions state of those around you - Emergency State 1. Fight 2. Flight 3. Freeze Response - traumatic event causes you to freeze - Tonic Immobility - 3x more likely to get PTSD after Tonic Immobility incident and 3.5x more likely to be severely depressed - Must have time to “let go” or “Thaw out” - Movement releases cortisol - in a freeze moment slow breathing down to down shift the bodies stress hormones - Mind Body Intervention (MBX) - Physical activity leads to the reduction of cortisol serum in PTSD su ers (Stretching and Breathing) allowing return to baseline - Disconnected After Trauma - Brain disassociates during trauma and continues after “missing roommate” physically there but not mentally and if prolonged can lead to PTSD - After trauma the individual must work to stay connected in whatever way possible - Nervous System - Sympathetic nervous system responsible for ght or ight ff fi fl fi fl fi fl  - Stress causes us to live with sympathetic nervous system operating (heart in overdrive slowing digestion) instead of parasympathetic nervous system and homeostasis - Misdiagnosed Bipolar - First responders remain “revved up” even though they are aware and must intentionally keep this feeling in check - All body systems are a ected by stress - Fight or ight responses can mimic manic episodes of bipolar disorder - Mania only lasts for the duration of the incident - Seem to have in ated self esteem do to huge release of hormones and decreased need for sleep - Becomes chatty before, during and after to ensure perfection - Stress Response is the natural, normal response to an emergency - First responders must intentionally activate the parasympathetic nervous system to bring body to baseline after an event and recognize when body is governed by sympathetic nervous system - Relax, control 5 senses, do yoga - Bipolar diagnosis in rst responders should get a second opinion PTSD - Ch 8 - Illness caused by experiencing signi cant traumatic events - 5 Criteria For PTSD 1. Life Threatening Incident 2. Intrusion - recurrent event post incident (memories, ashbacks, nightmares, aftershocks…) 3. Avoidance - Intentionally avoids triggers/ conversations fl fl fi ff fi fl  4. Negative Thoughts And Feelings - ranging emotions and isolation 5. Hyper-arousal - behave di erently at traumatic events - PTSD Symptoms - Physical, cognitive/ emotional, behavioral - Hyper alert, detached and withdrawn - Brains are structurally and functioning di erently than those without PTSD - Personality changes, short term/ remote memory weakened and learning challenges - 5 Quali ers of PTSD Diagnosis 1. Duration 2. Functional Signi cance 3. Exclusion 4. Disassociation 5. Delayed Expression - Big gap between the idea of what re ghters feel (shocked, overwhelmed, fearful) and they are supposed feel (emotionless, unshaken) - Complex PTSD (CPTSD) - Di culty regulating emotions in a situation - Feel negatively about self/ self criticism - Feel disconnected - Not caused by a single event, slower onset - Moral Injury - Occurs when deep down inside one does something or witnesses something he knows isn’t right (break trust, upset moral values) - Horrible acts others have committed - Most triggering part of memory - Causes depression, PTSD, suicidal ideation - PTSD and Moral Injury combined a person is more likely to experience suicidal ideation/ behavior - Su er moral injury due to the regular proximity to traumatic incidences ffi ff fi ff fi fi fi ff  Resiliency Ch 9 - Anyone can develop resilience because it comes from your thoughts - Resilience - adapting well in the face of adversity, trauma, tragedy, treats or signi cant sources of stress - Ability to rebound and have personal growth from hardship - Act when necessary to nd a new vision for the future (victim to survivor) - Coping - taking action to deal with life situations vs resiliency is leveraging new internal/ external resources so the demands of situation don’t impede your ability to thrive - If you under a microscope treat every shift as if your on probation - Appraise it as a challenge enabling your mind and body to respond more e ectively instead of a threat to your wellbeing causing you to shut down 2 things happen when experiencing adversity 1. Struggle - haunted by event - What doesn’t kill you makes you weaker 2. Grow - nd meaning and work through hardship - 90% of trauma survivors report having a new outlook on life - What doesn’t kill you makes you stronger – post traumatic growth Daily thinking: optimism versus pessimism - Resiliency begins whether you view situation as challenge (opportunity) or threat (problem) - Optimists - blame bad events on causes outside of themselves - Proactive language can help you complete a task - Self E ciency - belief in your own ability to complete a task - Gratitude - being thankful/ expressing thanks for what you have - Causes release of dopamine”feel good” and oxytocin “cuddle and calm” from limbic system - The more you practice gratitude, the more emotionally well you become - Con rmation bias - brain searches for cues in the world around you to con rm the ideas you have in your head - The brain will act negatively or positively in this way - Pessimist - skeptical that own actions can lead to good results How to stay on top of your thoughts - Deep breathing helps you stay sharp and in control of your thoughts allowing you to think logically (Frontal lobe - helps you think logically and clearly) fi ffi ff fi fi fi fi  - Drinking water forces, intentional breathing, helps with maintaining thought or tactical breathing - breathing in six seconds and breathing out eight seconds - “ Slow is smooth and smooth is fast” - Slow movement with deep breathing actually allows you to be fast and smooth - Post event allow your mind to rest, “say goodbye” to negative emotions not serving you and begin the process of resiliency - Yoga, physical activity, a massage… might help “drain o ” excess cortisol The Seven Resiliencies 1. Insight - ask yourself di cult questions and answer honestly 2. Independence - Choosing to go forward and do something you haven't done before ( not drinking at a barbecue, attending peer support… ) 3. Relationships - connection, social support changes our outlook on the world and our ability to thrive amidst diversity - This bene t is best received from the support of a spouse 4. Initiative - step up, take control and o er a solution - Taking charge of life builds resilience 5. Creativity - thinking outside the box and problem-solving 6. Humor - laughing is a great way to keep perspective and teach yourself to be resilient 7. Morality - Knowing the di erence between right and wrong helps build resilience Marks of resilient people - Speaking up for their own needs in a healthy way allows you to self-respect of setting boundaries - Select quality, friends, a person who you choose to con de in - Three types of friendships 1. Friendships of utility - Both people bene t, but can be short-lived 2. Friendships of pleasure - More about fun of friendship, then longevity 3. Friendship of the good - based on unconditional love, take a long time to build - Men have the most di culty maintaining long-term relationships, and starting new friendships - Friends from outside the rst responder world are a great way to keep perspective of the world fi ffi ffi fi ff ff fi f fi  - People do not succeed in isolation. You need connection. - Comfortable with themselves, are not constantly busy, can work quietly without the TV or music - Utilize this physical activity and self-care practices regularly - intentionally take care of themselves - Talking about things with perspective - people who speak about adversity with a hint of hope or positivity Recharging your batteries - You cannot keep going inde nitely without taking time to recharge - If you are bringing work home, you are not recharging, checking emails, talking about it, you are away without being away - Internal Recovery - rearranging tasks when you feel maxed out on one or the other - External Recovery - time away from work, vacation nights, and weekends - Stopping, intentionally taking a break from work will help you become more emotionally well and e ective at work and in relationships What can you control? - Sphere of In uence - everything inside the circle you can control - What you believe becomes your reality Resiliency through transition - Be slow and easy on yourself during transitions (divorce, new boss, new shift, death of a parent…) - Transitions require slow, deliberate expenditure of your energy and thoughts - Rest is balancing in nourishing of the soul What to do when you are in transition? - Take time to remember and put memories in the right place cultivating gratitude - Take time to rest and allow your body to repair itself mentally and physically - Take the transition slow - Utilize a support network Adjustment Disorder In First Responders - Adjustment disorder - the development of emotional or behavioral symptoms in response to an identi able stressor occurring within three months of the onset of the stressor - Having a hard time coping with a stressor fl fi fi ff  - Intense spike in stress, mood, depression, anxiety, disturbing conduct, and strong emotions - First responders are trying to focus on the task at hand, disregard emotions, and move forward. This is completely opposite of what needs to happen during life transitions. First responder self-care ch 11 - Self-care must be incorporated in every rst responders life - 4 days physical activity, heart rate up - 1-3 days/ week yoga - restorative yoga, greatest bene t - Consistent bedtime routine - Self-care requires tough mindedness, understanding of priorities, self- respect, and respect for those you live your life with - Self-care is the central responsibility of every rst responder Where does self-care begin? - Paying attention to what rejuvenates your mind, body and soul and what depletes them (write it down, engages your brain deeper) Self-care practices for rst responders 1. Create a good work, life balance 2. Exercise to relieve stress - Movement is the core piece of emotional wellness - Three ways exercise improves performance 1. Physiological toughness - 3 factors to physiological toughness 1. Exposure to a stressful event in a controlled environment 2. Coinciding sense of control over the stressor 3. Adequate recovery time - Passive toughening - happens when you’re running calls - Active toughening - intentionally pushing yourself like with exercise - Help build “stress armor” which prevents you from becoming stressed out - You will perform better during stressors 2. Physical health and longevity fi fi fi fi  - Low intensity exercises like yoga or walking help return you to your baseline operating in your parasympathetic nervous system - Operating in your sympathetic nervous system continuously will cause physical, mental, and many other health problems 3. Emotional wellness - Exercise, stretch and breathe to release toxic hormones - Use anger to motivate positive change by understanding why you’re angry - Use exercise, hobbies, motivate you to make changes to help control anger in a positive way - Western diets can lead to mental disorders, Mediterranean diets do not have the same e ect (eat non-processed foods, natural foods) - Drink one cup of co ee and wait an hour after waking up to drink it - Use of vitamins has proven to help - Ways to boost, dopamine and serotonin 1. Exercise 2. Time with nature 3. Nutrition 4. Meditation 5. Gratitude 6. Essential oils 7. Happy memories 8. Novelty of new things 9. Therapy 10. Flow - when you’re working on something and you lose track of time 3. Meditate daily 4. Have healthy relationships 5. Laugh (humor) 6. Connect with nature 7. Get involved outside of work (hobbies, church..) 8. Meet with a counselor Self-care actions that are also treatments - Moving meditation - walking while meditating is conscious rest - Slow breathing down - 4 count inhale, 6 count exhale - Yoga for PTSD 1. restorative yoga, ff ff  2. trauma-sensitive yoga, 3. yoga nidra - - creates REM like state in the brain “conscious, deep state” - 65% release of dopamine - Yoga signi cantly reduces PTSD symptoms to a similar degree as medications due to the release of cortisol - Yoga increases neuroplasticIty - Mantra meditation - repeating a phrase or belief to reinforce it helps individuals move forward through PT fi