Like members of the military, EMS providers commonly experience repeated exposure to horrific events. Because of this aspect of their jobs, one of the dangers EMTs and paramedics face is developing post-traumatic stress disorder (PTSD).
So it’s fitting that a PTSD treatment program exists that’s specifically designed for first responders and the military—purportedly the only one for this population that uses evidence-based treatments.
Background on Brattleboro
The Brattleboro Retreat, located in Brattleboro, Vt., is a not-for-profit mental health and addictions treatment center. It provides a range of specialized diagnosis and treatments for children, adolescents and adults. Brattleboro’s Uniformed Services Program (USP) was created to help law enforcement officers, firefighters, members of the military, combat veterans, EMS providers and corrections personnel who suffer from PTSD.
Why develop a separate program for this group? Tania Glenn, PsyD, LCSW, CTS, a member of USP’s advisory board and president of a clinical private practice in Austin, Texas, explains, “This is a specialized population. Public safety workers aren’t as open to mental health services as the general population. This group requires a very specific approach, and they also need to ability to talk about events without being judged.”
The therapists and medical staff who work in the USP have public safety or military backgrounds, so they understand the context of what participants have faced. “They put a lot of thoughtful consideration into starting this program,” said USP advisory board member David Williams, Ph.D., chief improvement officer of Positive Eye Consulting. “They looked to existing evidence to remain clinical, rather than jump on the CISD bandwagon. Instead, they built their own evidence-based plan, and brought in experts with backgrounds in public safety and the military.”
The USP is designed to train people in these populations who are suffering from PTSD to face the traumatic experiences and accompanying emotions that overwhelm them and “de-activate” their response. “For people with PSTD, feelings can be the things that are frightening. The fear is of these uncontrollable feelings intruding and causing symptoms,” explains Jennifer Fyler, MD, medical director of USP. “We try to slow down the physiology and allow those feelings to come up, then we notice them and let them go away.”
One of the treatments is Mindfulness Based Stress Reduction (MBSR). “This is a strategy for helping people reduce their level of arousal, how easily they are activated into the fight or flight response,” explains Fyler. “Mindfulness is similar to meditation. We sit, as a group, and try to quiet our minds. While focusing on our breathing we notice the feelings and thoughts that come up while we’re quieting ourselves. We can actually calm ourselves down.”
Other treatments include trauma-informed yoga, used to help participants cultivate a safe, healthy relationship with their bodies; and dialectal behavioral therapy, where participants talk one-on-one with a therapist as well as in a group setting, practicing skills to regulate their emotions. “Telling one’s story gives one mastery over feelings as well,” said Fyler. “It’s important that they’re among other first responders who’ve had other experiences.”
These therapies have a basis in physiology, Dr. Fyler explains. Research shows that one can improve the function of the thought centers of one’s brain, and reduce that of the emotional center—which is overactive in PSTD sufferers. By engaging in these treatments, PTSD sufferers can improve their ability to understand and master emotional responses. “We want to increase their ability to assess their feelings, so those feelings can lose their power,” said Fyler.
Importance of Physical Activity
Brattleboro Retreat incorporates physical activity into its programs, including the USP. The retreat includes a workout facility, basketball courts and nine miles of hiking trails. Participants in the USP start every day with a mandatory workout and are encouraged to use the other facilities.
“For this group, comfort in one’s body is a big issue,” Fyler points out. “A lot of them don’t exercise, so starting to can be very empowering for them. This helps them sleep better, too. Sleep is also very important to restoring brain function.”
Fyler says taking walks and exercising is “like food for the brain.” Data shows that physical activity can actually grow new neurons and neural connections.
Glenn adds, “PSTD is an anxiety disorder and triggers so many biophysical responses in the body. You can get those out of your system by walking, moving, working out. Walking is also a good way to process—for many of these folks, talking while taking a long walk is a lot easier than sitting across from someone in a room.”
After approximately 10 days, participants in the USP are sent back home. “The assumption is that you’ll create a sustainable plan for when you leave,” said Williams.
Each participant leaves with strategies they can use to continue to master their feelings, and they’re encouraged to find effective treatments at home. “Everyone is different,” Fyler said. “Some will go home and revive their spiritual life, or see a therapist, or join a meditation or yoga group. Many of the people we work with have substance abuse issues. They may join a 12-step program. These have a mindfulness component, although they don’t call it that. These are all ways to proceed.”
Glenn, who regularly works with PSTD sufferers in emergency services, said, “When folks recover from PTSD, they are very solid and able to deal with their jobs. I’m not worried about them—they can cope with what they see, and they’re also quick to get help if they feel they need it. I’m more worried about the ‘walking wounded’—the ones who haven’t sought any help.”
Brattleboro Retreat’s USP offers proven, state-of-the-art treatments for public safety workers suffering from PSTD. But it’s not the only option. EMS workers suffering from PSTD should be able to easily find local resources they can use—if they’re willing to take that first step.
“For this group, there are difficulties in asking for help,” said Fyler. “Their role is to be helpers, and it can be shaming or frightening for them to admit they need help. But it can be very freeing when they do admit it.”