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The danger of “nobody else can understand”

If you are in public safety or the military, as well as some other fields, you know that some people insist that there it is pointless to talk about work to any “outsider.” Often, big agencies have this attitude toward smaller, less busy, ones –  “We are the only REAL firefighters, police, medics, etc., around here.” So they close themselves off from  support by people who otherwise might be peers.

The walls even go up within agencies – specialized, elite teams form a “tribe” mentality that says if you haven’t been part of a similar unit, there’s no point in talking to you about stresses and challenges, even if do the same kind of job.

No doubt, there is some truth to this. Working at a big, busy, urban agency certainly is different from smaller ones. Combat experience absolutely has unique aspects. Being part of an elite or specialized team really is different. People who haven’t walked the walk truly cannot understand. Experience is the only instructor – words quickly fail if we were to try to fully communicate it, especially the emotions around high-stress events (which can directly impact the brain’s speech center).

For a number of years, I have suspected that organizational isolation – that’s this is about – could be as toxic as individual isolation. We know that social support is the most important factor in resilience under stress or recovery from trauma; isolation aggravates stress. In fact, almost any trauma expert will agree that people will continue to suffer as long as they remain isolated –  connections with others give us strength and healing.

I recently began reading Ellen Kirschman’s book, I Love a Fire Fighter: What the Family Needs to Know, which has been sitting on my nightstand for a while. Dr. Kirschman, a well-regarded therapist in public safety, is also regularly involved in the West Coast Post-Trauma Retreat, where I have volunteered and learned.

Here’s the light bulb that went off as I read Kirshman’s introduction – the “nobody else can understand” attitude cuts us off from our friends and family. If you are certain that even a co-worker who isn’t part of your elite unit can’t support you because “they don’t understand,” then how can your friends and family who are civilians, possibly support you?

Here’s one of Kirschman’s observations about going through a fire academy (emphasis mine).

No one acknowledged how the emotional courage fire fighter families need or the independence that is forced on them contributes to the fire service mission. This is extremely puzzling in light of the many studies that confirm how family and friends are the heart of a fire fighter’s emotional support system.

Her books (she wrote a similar one for law enforcement) are for families, but the message to public safety is just as important. Your social support outside of work is also critical to your strength and resilience in the face of occupational stresses, and recovery from critical incidents and other injuries that aren’t physical.

The following words are why it does not matter that outsiders can’t understand the job.

Empathy does not require understanding.

It’s true – if you are an outsider, you will not understand. If you’ve never been there, I can’t explain what it was like to talk to a patient one minute and then do CPR on him, unsuccessfully, the next. You won’t understand how difficult it was to walk past his wife in the ER waiting room, seeing her comforting another wife, not knowing her own husband was just pronounced dead. If you’ve never done anything like helping a family bury their dogs who couldn’t escape a wildfire, nothing I can say will make you understand. If you haven’t been part of a rescue that went all wrong and killed the victim, I don’t have words for the emotions. If you haven’t done shift work, you don’t know the toll it can take.

Even if you cannot understand, that doesn’t have to stop you from supporting a responder if you are a trusted friend – because empathy does not require understanding. They may spare you details. They probably won’t repeat the sick jokes that helps many get through the day. But if you are willing to simply walk beside them, your presence can be healing.

You don’t need to understand responder experiences to know that they are painful. You don’t have to work shifts to that it is hard to be exhausted and miss family events. Everyone has experienced pain and frustration, he stress of an event or life going out of control. Co-workers can appreciate it more than outsiders, so co-workers are an essential part of any responder’s network of social support. So are spouses, friends with completely different careers, pastors and may others.

Camaraderie is powerful. Every agency – and groups within them – benefits from friendships, mutual support and teamwork. However, the idea that only our co-workers or people like them can support us is a misguided obstacle to wellness. We should not want anyone, from new recruits to  seasoned veterans, to believe that their friends and family have little to contribute. As Ellen Kirschman says, that idea cuts t them off from the heart of their social support system.

Paramedics with social support sleep better

An article in the Journal of Occupational Health Psychology earlier this year described a one-week study of paramedics’ sleep and their social support. Those who saw themselves as having more social support reported better sleep. The researchers also observed that the sleep quality of paramedics who perceive more support isn’t as impacted by job stress.  On the other hand, they reported “Those with low levels of support displayed poor sleep quality in the face of high occupational stress.”

In recent years, it has become quite clear that good, deep sleep is vital for coping with stress – poor sleep is associated with increased risk of developing PTSD.  The correlation between social support and coping with stress has also been observed repeatedly in studies. It’s unsurprising to find a link between social support and sleep quality – this reinforces the importance of both.

News report: Meditation reduces stress, changes your brain

Many studies have shown that meditation can be a powerful way to reduce anxiety and raise the body systems that calm us down after exposure to stress. The Washington Post last May reported findings of Sara Lazar, a neuroscientist at Massachusetts General from brain scans that showed that some parts of the brain expanded and others became smaller after sustained meditation.

This is part of a big change in thinking about our brains, which until recently were assumed to be fixed, unchangeable. Now we we have a word for the brain’s ability to change – neuroplasticity – as well as increasing evidence about what kinds of attitudes and activities encourage positive changes.

Don’t take that bite! Dogs, diets and heart rate variability

Two new reports related to heart rate variability (HRV) reveal more about its significance as a measure of our physical and emotional health. Higher HRV is associated with better stress management. It is a way to peek into the state of a person’s nervous system, particularly the vagus nerve, the mind-body information superhighway. The more active your vagus is, the better you are at coping with stress. It is the neural path through which your “rest and digest” system signals your “fight or flight” system to calm down.

One new article reports that people with high HRV can more easily resist temptation when dieting. Greater self-control of that kind is also linked to better psychosocial and physical health.

HRV is similar in other mammals, so another researcher looked at the relationship between HRV and aggression in dogs, hoping that HRV might predict how aggressive a dog is likely to be. Just as humans with high are better at resisting that extra slice of cake, perhaps dogs with higher HRV would be better able to resist taking a different kind of bite.

The resulting article reports that indeed, less aggressive dogs had higher HRV.  “Dogs with bite histories had significantly lower HRV” and owners who reported that their dogs were aggressive also had lower HRV. The researcher’s work suggested that HRV could be an objective way to measure the effectiveness of dog training that is intended to reduce aggressiveness.

Paper: Psychological First Aid: Rapid proliferation and the search for evidence

Psychological First Aid (PFA) – there are many different protocols, great confusion about its relationship to Critical Incident Stress Management (PFA is part of it), and it is increasingly recommended by people and organizations who often don’t seem to recognize that PFA has multiple meanings, is limited in scope and hasn’t yet been confirmed as effective in field evaluations.

I’m not a PFA skeptic – I use it and teach it – but it needs more, careful investigation.

A recent report took a look at PFA’s popularity and lack of field evaluation. The authors are from  two academic centers focused on emergencies and mental health:

The authors give a nod to the down-to-earth nature of PFA guidelines, which are “evidence-informed,” meaning that they are based on related research:

[PFA is] documenting and operationalizing good common sense – those activities that sensible, caring human beings would do for each other anyway.

As the authors observe, the lack of proof that PFA works doesn’t mean it is ineffective. It means that PFA’s effectiveness hasn’t been demonstrated.

They identified forty-eight PFA courses and materials! Yet, oddly, they failed to include one that has been around for quite a while, the SAFER-R model developed by George Everly and incorporated in ICISF CISM training.

Now the bad news.

PFA’s popularity, promotion, and proliferation have not been matched with a commensurate pursuit of evidence demonstrating its effectiveness. Not only is there a dearth of data regarding the benefits of PFA, but there is limited demonstration of widespread commitment to generate such data.

However, like other kinds of crisis intervention, PFA is difficult to study. With nearly 50 different approaches, it is hard for researchers to know exactly what care is being given. There is no way to create control groups – they have to be observed, which is daunting.

The writers offer five recommendations.

  1. Evaluating PFA with first responders, rather than disaster survivors, “may be a good place to start.”
  2. Hospital emergency rooms or other controlled settings might be good places to begin to evaluate PFA for civilians.
  3. We need to figure out how to test its effectiveness for civilians in real disasters. “Predictable disasters” such as annual flooding might create opportunities.
  4. International coordination will make evaluation most effective – agreement on methods and techniques.
  5. PFA should be adapted as the field of trauma evolves. The authors are working on an approach that suggests that early intervention can be tailored to the nature of an incident.

A similar report, by an international group of researchers for the Belgian Red Cross-Flanders, reviewed literature the literature on PFA and came to essentially the same conclusion:

The scientific literature on psychological first aid available to date, does not provide any evidence about the effectiveness of PFA interventions. Currently it is impossible to make evidence-based guidelines about which practices in psychosocial support are most effective to help disaster and trauma victims.

Paper: Psychological First Aid training helps EMS workers

Star of LIfe

A dissertation , Community-based psychological first aid for emergency medical service providers: Mental health stigma, resilience, and social support, published at the University of South Dakota took a look at the effect of Psychological First Aid (PFA) training on EMS workers. Although the study did not confirm the researcher’s hypotheses about why there is stigma in EMS around asking for psychological help, there were two positive findings. Knowledge of PFA gave EMS workers a greater sense that they are supported and a decrease in the self-stigma of getting help.

Results are supportive of PFA as a practical and effective psychosocial support method for EMS providers. The present study contributes to the limited literature on psychological support for EMS providers and invites further research on the topic.

 

Paper: Oxytocin shows promise in meth addiction (in rats)

Neuroscientists looking at meth-addicted rats found that higher levels of oxytocin, the much-studied hormone associated with social behavior and stress, decreases their demand for the drug, an article in Biological Psychiatry reports. They found that the effects are changed by actions in the part of the brain associated with aversion, motivation and rewards.

This study echoes findings in a 2014 report by some of the same researchers, which found that oxytocin decreases cocaine usage in addicted rats.

Paper: Mindfulness helps elementary students with stress

Researchers at the University of Colorado taught mindfulness techniques to a class of Denver 4th graders, who practiced it daily during homeroom check-in for 10 weeks. After comparing those students to a similar class without mindfulness, they reported improvements in pro-social behavior, emotional regulation and academic performance for those who practiced it. Their conclusion?

Mindfulness in urban classroom settings as a feasible option for students to help with personal stress and coping, as well as emotional and behavior regulation in schools and at home.

The methods came from two sources of mindfulness curricula for children:

  • MindUp, from the Hawn (as in Goldie Hawn) Foundation
  • Mindful Schools, which came out of a project in Oakland, California

Related: Mindfulness Goes to School: Things Learned (So Far) from Research and Real-World Experiences.

Article: Actually, Let’s Not Be in the Moment

Ruth Whippman takes on mindfulness in the New York Times: Actually, Let’s Not Be in the Moment

Mindfulness is supposed to be a defense against the pressures of modern life, but it’s starting to feel suspiciously like it’s actually adding to them. It’s a special circle of self-improvement hell, striving not just for a Pinterest-worthy home, but a Pinterest-worthy mind.

Mindfulness is a $4 billion market, she reports.

As much as I believe that mindfulness is good, her skepticism is on point. It applies to every relaxation practice – yoga, deep breathing and all the rest. Coping with stress is much more than just learning to relax. As I’ve repeated many times, social support has the strongest correlation to our psychological resiliency. Spirituality – in the sense of having values and bigger-than-self purposes – also matters.

Whippman cites a U.S. Agency for Healthcare Research and Quality report, Meditation Programs for Psychological Stress and Well-Being, which surveyed almost 18,000 journal citations covering 41 trials with about 3,000 participants. Its conclusion was that these practices are helpful, but more study is needed:

Meditation programs, in particular mindfulness programs, reduce multiple negative dimensions of psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health as well as stress-related behavioral outcomes.

We should stop teaching “eustress and distress”

Stress management often teaches that there are two kinds of stress – distress, which is what we usually think of as stress, and “eustress” – stress that is good for you. The idea of eustress – the word itself – came from Hans Selye, a pioneer in understanding how our bodies respond to challenges. Selye was an endocrinologist, focusing on hormones and the systems that regulate them.

One of Selye’s great insights is that when we experience a change or other challenge, we will have a physical stress reaction, whether we see it as positive or negative. For example, graduation from high school or college – an event the graduate certainly considers positive – is stressful. And of course it is – a fresh graduate faces uncertainty about what will happen next. Their social support network, a key source of resiliency,  is disrupted as they lose touch with classmates.

Selye’s fundamental insight, that both positive and negative events are stressful, has been demonstrated to be true in many, many research projects. Cognitive neuroscience is unveiling more of the mechanisms and complexities of our physical and emotional responses to stress.

Talking about “distress” and “eustress” is confusing. Psychologists use them because in casual talk, ee use the word “stress” to refer to both the cause and our reaction. “Graduation is stressful” and “I’m stressed about graduation” are both reasonable sentences, but they are saying two different things. The first is about what happened, the second is the graduate’s reaction to it.

Let’s swap in the other words. “Graduation is distressing me” sounds reasonable, but means the same thing as “Graduation is stressing me.” Let’s try the other one. “Graduation is eustressing me” not only sounds awkward, it doesn’t make any sense, since “eustress” is about the graduate’s reaction.  The accurate way to use the word would be “I am having a eustressful reaction to graduation” – a sentence that could only be pleasing to a psychologist.

Using these words was been based on the belief that the difference between eustress and distress is the intensity of our reaction.  We taught people that too much stress is bad for their health, so we should reduce and avoid stress in order to avoid crossing the line from eustress into distress. Now we know that there is no such line.

In recent years, convincing evidence shows that our perception makes a big difference in how our body reacts to stress. If we see a threat, our bodies react in ways that probably will cause illness in the long run. If we see a challenge, stress becomes our friend, we perform better and don’t undergo the physical reactions that cause health problems.

Our perceptions of whether we are facing a threat or a challenge are influenced by how much social support we have. When we are alone, almost anything will look like a threat. Isolation is toxic to our health. Values and spiritual beliefs also make a difference in whether we perceive stressful occasions as threats or challenges.

Instead of talking about distress and eustress, we should be teaching people that they can handle enormous amounts of stress and thrive, then give them tools – attitudes and actions – that transform how they think and react to life’s challenges.

 

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