Tag: social support

The danger of “nobody else can understand”

December 21, 2016 / Nick Arnett

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

December 19, 2016 / Nick Arnett

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.

Building Gratefulness

September 23, 2016 / Nick Arnett

A few years ago, my spiritual director challenged me to list three things I was grateful for, daily, for 30 days. There were a couple of other parts to this exercise, but it was aimed at helping build an “attitude of gratitude.” I’m happy to report that it stuck with me. One of the instructions that helped overcome my perfectionist and self-criticism tendencies was the instruction to not worry about missing a day – just pick it up again. The 30 days didn’t have to be consecutive.

Psychologists have only recently begun to look into the benefits of cultivating gratitude, but early findings are encouraging, confirming traditional teachings. In two long-term studies of college students and gratitude, researchers in England found that the more often and intensely people feel grateful, the more social support and lowered stress and depression they believe they have. This makes sense because anything that builds social support will almost surely help us cope with stress and do better overall.

Rejoice always, pray continuously, give thanks in all circumstances – 1 Thessalonians 5:16-18.

When we are more grateful, we tend to see the world in a more positive light, which protects against stress and depression. We also make our own world better by thanking helpful people – expressing gratitude – because they become more likely to offer us more support.

Does making gratefulness lists work? Yes, says a recent study titled, “Counting Blessings Versus Burdens.” Across three groups who either kept lists of hassles, things they were grateful for or ways in which they were better off than others, the people who tracked gratitude ended up with a more positive outlook. The gratitude list-makers were also more likely to offer emotional support to others – another example of gratitude encouraging social support. They also spent more time exercising, slept better, had fewer physical complaints and were more optimistic. Daily gratitude tracking was more powerful than weekly.

I will not be afraid, Lord, for you are with me – Psalm 23:4

Another study, on religious involvement and gratitude, showed that attending church more often leads to more gratefulness. The increase was greater for people who believed that God works with them to overcome difficulties and challenges. This makes perfect sense through the lens of stress as a threat or challenge. When we feel ill-equipped to deal with a situation, our bodies have a “threat” stress response, raising the levels of hormones and neural pathways that cause long-term health problems. On the other hand, if we see the same situation as a challenge – because, in this study, we believe God is with us – our bodies react differently, in a way that doesn’t jeopardize long-term health.

Some other studies on the effects of greater gratitude:

Daily well-being increased with daily gratitude practices for Vietnam veterans with PTSD.
Gratefulness helps people stick with self-directed interventions to improve their body image.
Gratitude in children was related to positive functioning after the 9/11 attacks.
People who are more grateful tend to recall more positive life events, which helps make them more positive.
Writing about how a good thing, such as finding a romantic partner, might never have happened, increased their positive outlook – to the surprise of the writers.
Writing a letter of gratitude, about a time you were at your person best, identifying character strengths all contributed to happiness and positivity, while reducing depression.

Bibliography

Algoe, S. B., & Way, B. M. (2014). Evidence for a role of the oxytocin system, indexed by genetic variation in CD38, in the social bonding effects of expressed gratitude. Social Cognitive and Affective Neuroscience, 9(12), 1855–1861. http://doi.org/10.1093/scan/nst182

Emmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377–389. http://doi.org/10.1037/0022-3514.84.2.377

Fredrickson, B. L., Tugade, M. M., Waugh, C. E., & Larkin, G. R. (2003). What Good Are Positive Emotions in Crises? A Prospective Study of Resilience and Emotions Following the Terrorist Attacks on the United States on September 11th, 2001. Journal of Personality and Social Psychology, 84(2), 365–376.

Geraghty, A. W. A., Wood, A. M., & Hyland, M. E. (2010). Attrition from self-directed interventions: Investigating the relationship between psychological predictors, intervention content and dropout from a body dissatisfaction intervention. Social Science & Medicine, 71(1), 30–37. http://doi.org/10.1016/j.socscimed.2010.03.007

Gordon, A. K., Musher-Eizenman, D. R., Holub, S. C., & Dalrymple, J. (2004). What are children thankful for? An archival analysis of gratitude before and after the attacks of September 11. Journal of Applied Developmental Psychology, 25(5), 541–553. http://doi.org/10.1016/j.appdev.2004.08.004

Kashdan, T. B., Uswatte, G., & Julian, T. (2006). Gratitude and hedonic and eudaimonic well-being in Vietnam war veterans. Behaviour Research and Therapy, 44(2), 177–199. http://doi.org/10.1016/j.brat.2005.01.005

Koo, M., Algoe, S. B., Wilson, T. D., & Gilbert, D. T. (2008). It’s a Wonderful Life: Mentally Subtracting Positive Events Improves People’s Affective States, Contrary to Their Affective Forecasts. Journal of Personality and Social Psychology, 95(5), 1217–1224. http://doi.org/10.1037/a0013316

Krause, N. (2009). Religious Involvement, Gratitude, and Change in Depressive Symptoms Over Time. The International Journal for the Psychology of Religion, 19(3), 155–172. http://doi.org/10.1080/10508610902880204

Park, N., & Peterson, C. (n.d.). Positive Psychology Progress: Empirical Validation of Interventions Martin EP Seligman & Tracy A. Steen University of Pennsylvania. Retrieved from http://guardianlv.com/wp-content/uploads/2013/09/happiness01.pdf

Watkins, P. C., Grimm, D. L., & Kolts, R. (2004). Counting your blessings: Positive memories among grateful persons. Current Psychology, 23(1), 52–67.

Wood, A. M., Froh, J. J., & Geraghty, A. W. A. (2010). Gratitude and well-being: A review and theoretical integration. Clinical Psychology Review, 30(7), 890–905. http://doi.org/10.1016/j.cpr.2010.03.005

Wood, A. M., Maltby, J., Gillett, R., Linley, P. A., & Joseph, S. (2008). The role of gratitude in the development of social support, stress, and depression: Two longitudinal studies. Journal of Research in Personality, 42(4), 854–871. http://doi.org/10.1016/j.jrp.2007.11.003

LCES for Everybody

July 7, 2016 / Nick Arnett

If you spend time around wildland firefighters, you’ll notice the abbreviation “LCES” quite often. Some people have it on their helmets. It can be a hashtag (#LCES) in social media. You might hear crews calling “LCES!” to one another as they head out to the fireline.

LCES stands for Lookouts, Communications, Escape routes and Safety Zones. Before firefighters engage the fire, they are always supposed to establish LCES – it is the starting point for fireline safety. It can also be a starting point for maintaining your emotional safety.

Lookouts

Lookouts at a fire are in a position where they always can see what the fire and the crew are doing. They should always know where everyone is – if crew members are moving out of view, they let them know. They monitor the weather and maintain communications between the crew and the rest of the world. They stick to their position until the hazards are no longer present.

Who are your emotional lookouts? Are you “visible” to your co-workers and family enough that they’ll be able to notice when you have had a rough time or you’re heading for trouble? Emotional transparency can be difficult in public safety, where there will always be some stigma about appearing “weak.” However, it’s life and death – the same macho attitude that has killed firefighters – by leading them to take on more than they can handle – can also kill you emotionally and spiritually. Do you have lookouts that are independent of your family and job – a support group, religious study or other small group that you can trust? Sometimes strangers are the easiest people to trust.

Are you being a lookout for people around you? Are you paying attention to your co-workers, family and friends, watching for signs that they are struggling or getting into trouble? Are you willing to gently confront and offer to support them when you can see possible danger signs? Look out for people who are drinking, eating, spending or working too much. Watch out for changes such as increasing isolation, depression, anger, anxiety, unfocused, not sleeping enough, having affairs.

Communications

Lookouts are useless without communications. In firefighting, lookouts have to maintain communications with their crew and the outside world. Radios are the most frequent means, but non-verbals are also important. Daily communication starts with briefings – what’s the current situation, other information that’s necessary to going through the day safely. Communications failures have led to firefighter deaths, including the 19 who died in the Yarnell Hill Fire in Arizona in 2013. Only their lookout survived.

Do you have regular and thorough communication about your current emotional situation with the key people in your life? Even if you and your family are lookouts for each other, that won’t do any good unless you communicate regularly and effectively. Effective communication, which is an essential part of any public safety career, has to be a two-way process – clear messages from senders with confirmation and clarification from receivers. The same applies to personal communications – speak and listen well. Do you raise your defenses when your lookouts give you negative feedback? Do you schedule time to talk with family, friends and other sources of support – a spiritual director, small group, counselor or therapist – as needed? Are you willing to give others direct feedback about themselves even though they might perceive it as rude? That’s the kind of communication it takes to stay alive on the fireline. You’ll find that even though it is uncomfortable in daily life, a friend who is fearlessly honest about communicating your blind spots is a friend to hang onto. Psychologists repeatedly report studies demonstrating that our resilience correlates to our social support more than any other factor.

Escape routes

Escape routes are the paths that firefighters will take to leave an area quickly and reach a safety zone. Everyone needs to know at least two escape routes; those routes have to be cleared of barriers.

When we face critical incidents, we need emotional escape routes when the work is done. Does your agency have protocols so that your critical incident “lookouts” – line supervisors – know when to automatically trigger a defusing or other intervention? Is anyone empowered to call for one if they are having a difficult reaction or they are worried about others? Do you have trusted people you can call or meet with to talk about a rough day – peer support team, family, counselor, therapist, sponsor, pastor, rabbi. Are you good at saying “No” to overtime and other extra tasks when you know you need down time?

Safety Zones

In firefighting, a safety zone is a place where you can retreat and not be injured if the fire burns through. It isn’t just a spot where you might survive using all of your safety gear; it is a place where you can be confident that you won’t even need any of that equipment.

Where are your safety zones? Sometimes, the signal that you’re in a safety zone is that it is where you discover that you’re carrying more emotional baggage than you realized. For me, that is often Sunday morning at church during a particularly powerful song. I find that my throat tightens up and it’s hard to get the words out as my mind drifts back to something that happened earlier in the week. If the feelings are strong enough, I’ll seek out our pastor or a friend after the services.

Any 12-step meeting or other support group had better be a safety zone – a place where you can speak freely and honestly – or it’s not doing its job. The same is true, naturally, of critical incident stress defusing, debriefings and individual support. Above all, these interventions need to be safe, which means confidential, supportive rather than critical and low pressure. If the facilitators of these interventions do nothing more than create a safety zone, that’s a win.

Whose Job is LCES?

Just as we are each the primary person responsible for our physical safety at work, we are responsible for our emotional safety – our own lookouts, communications, escape routes and safety zones. A great peer support team facilitates and encourages these, while supplementing them by creating and maintaining agency-wide lookouts and communications. Escape routes and safety zones – mutual aid, support meetings, clinicians and other shared resources – also need to exist at a higher level, so that there is a strong continuum of care available to all.

LCES for everybody!

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