By Michael Coupland, RPsych (AB), CEO, Network Medical Director - IMCS Group
Social isolation is one of the classic symptoms of Post-Traumatic Stress Disorder (PTSD). It’s not necessarily that those affected have no interest in engaging in their normal activities, but the fear of persistent flashbacks and panic attacks that seem to arise with no apparent reason often prevents sufferers from leaving their homes – sometimes even their beds.
Understanding how the brain processes traumatic events helps explain the physiological responses and what is needed to move beyond them. One of the most important and effective strategies for someone with PTSD is socialization with others who understand and are supportive. This is especially true for First Responders.
In working with First Responders in both the U.S. and Canada, I know that appropriate treatment that includes a strong socialization component can prevent or mitigate incidents of PTSD. Departments that utilize peer counseling have seen dramatic reductions in needless suffering and lost workdays among First Responders.
The Brain in Trauma
From the time humans first existed, our bodies have been poised to protect us in any way possible. When faced with danger our brains tell us how to respond; we can choose to fight the bear or whatever is ready to attack, or we can take flight. Additionally, there is the freeze reaction, where we become immobilized. This act of playing possum, or pretending to be asleep, unconscious or dead, might just trick the bear into ignoring us and moving along.
The freeze response is a failsafe survival mechanism. It kicks in when neither fighting nor fleeing is possible. The freeze response is a product of the vagus nerve, one of the largest nerves in the body.
The vagus nerve typically helps us maintain a smooth psychological balance between arousal and relaxation. It helps control the lungs, heart, and stomach. But when we are faced with a threat the vagus nerve becomes dysfunctional and essentially shuts down these systems. The result can range from a slight inability to think clearly to actually fainting.
As humans have evolved, a new branch of the vagus nerve has emerged. It is partially responsible for our expressions and is active in social engagement. When this part of the vagus nerve is active we seek social engagement as a means to calm us and lessen the need for oxygen and food.
Some people who are faced with trauma have a freeze response, indicating their vagus nerve is not functioning properly. When the vagus nerve is out of whack, the gut, heart and brain don’t function properly. Interestingly, we technically have three brains, since the gut and heart are predominantly made up of neurotransmitter cells and the vagus nerve is the communication pathways for synchronization between the three organs.
Adding to this is the fact that experiencing a traumatic event can result in memories getting filed in the wrong places in the brain. So a thought or stimuli that occurred just before the trauma can become jumbled together with the horrific event and trigger a flashback in which the person feels as if he is reliving the event.
A police officer looking at paperwork shortly before he is called to a mass shooting may subsequently re-experience the trauma whenever he sees something that was on the paperwork. Even though the two events are unrelated, his brain has intertwined the memories. It explains why people with PTSD have panic attacks for no apparent reason.
Regulating the vagus nerve settles down these various responses. It calms the stomach, heart and brain, and gets memories filed correctly. Engaging in social interaction is one of the steps to get the vagus nerve back on track and regulate that psychological balance again. Socialization among peers is one of, if not the most important steps to help First Responders recover from PTSD.
PTSD installs feelings of loss of control and safety. Others with a clear understanding of that can help them recoup that trust. Debriefing – a process of helping the PTSD sufferer sort out which facts are related and which are unrelated to the trauma – is most successful when done in groups of peers.
A study of police officers in Canada revealed that a lack of social support from colleagues during and immediately after a traumatic event was a strong risk factor for developing PTSD. Also, a perception of negative social interactions after a trauma was cited as another risk factor. A workplace with a stressful, unsupportive atmosphere is more likely to have PTSD cases than one with a supportive environment.
The Toronto Transit Company implemented a peer counseling group in 2015 to help workers who witnessed suicides on subway tracks. The organization has since seen a reduction of 45 percent in related lost-time injuries following such incidents. It has also received a National Corporate Leadership Award from a trade association for the Canadian urban transit industry.
In Chicago, the Gatekeepers Peer Support Network is described as one of the most effective aspects of the Fire Department’s Employee Assistance Program. Earlier this year, Georgia lawmakers considered a proposal to create a state-run program of peer counseling for First Responders at all levels of government. Florida has enacted legislation to mandate mental health awareness training for First Responders.
Organizations that work with First Responders are increasingly warming up to the idea of formalized peer support. We know that social interaction is imperative to help calm the vagus nerve and aid recovery from PTSD. Socializing with others who have been through the same or similar traumas is the most effective way to do that, especially for First Responders. The camaraderie of their professions is one of the protective factors against developing PTSD. Sharing similar experiences with a peer engenders mutual trust that does not exist easily with a counselor outside the group. Formalized peer counseling programs go a long way in helping First Responders with PTSD – if they are created and implemented correctly.
Elements of Peer Counseling Programs
The Toronto Transit Company’s program is comprised of 14 employees, many of whom have experienced traumas on the job. They receive training for 3 days on how to support and encourage colleagues who have witnessed tragedies. The program is a model for those that are most effective.
Training for peer counselors typical involves critical incident stress support – or crisis intervention, ethics and guidelines for the peer supporter. Those who volunteer to be involved must be recovered enough from any traumas they‘ve experienced to be able to support someone else.
They may work with colleagues in a number of ways:
• One-on-one support, such as mentoring and befriending
• Reaching out to colleagues who have recently been exposed to a traumatic event
• Participate in support groups that meet on a regular basis to provide mutual support
• Community resource and professional intervention referral
• Assistance with goal setting
The idea of a peer counselor is not to replace a trained clinician or to try to fix a fellow employee. Instead, it is to help by relating to other workers in a way no one else can. They provide empathy and encouragement to help the colleague face difficult situations in a safe, nonthreatening manner.
The role of the peer counselor is to help and observe colleagues who have been through traumas. A person who seems to be withdrawn and isolating himself may need assistance.
The peer counselor can approach the worker and see how he can help. That may require the counselor to refer the worker to the EAP program or more professional counseling, for example.
One additional benefit of peer counseling programs is the support they can provide to the families of First Responders with PTSD. Engaging in normal family activities is a big step in helping the worker recover. Peer counselors can stress this to family members and provide resources that may help them better cope.
Workers who elect to become peer counselors are often those who have been through traumatic events themselves and either have had the benefit of working with other peer counselors, or see the benefit of doing so.
Integrated Medical Case Solutions (IMCS) is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.
Please join our LinkedIn group, COPE with Pain at https://www.linkedin.com/groups/8540640.
Michael Coupland is a Charter Psychologist, Registered Psychologist and was a Certified Rehabilitation Counselor (inactive as of 3/31/16). He co-founded three national Disability Evaluations companies that have performed over 250,000 evaluations. He is the developer of the Assess Ability Functional Medicine Evaluation and Functional Psychological Evaluation systems. He is author of the COPE with Pain program and Supervised Withdrawal of Opioids Program (SWOP) for chronic pain intervention and national practice leader for a national network of psychologists and addiction medicine providers for the COPE and SWOP programs. He is a chapter author of the AMA 6th Ed. Guidelines companion text Guides to the Evaluation of Functional Ability and author of Psychosocial Interventions for Chronic Pain Management, The International Journal of Industrial Accident Boards and Commissions; Fall 2009. He was honored in 2014 with the Top 50 People in Workers Compensation award from the SEAK organization.
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