Cancelled-Saving Blue Lives

Posttraumatic Stress Disorder (PTSD), Suicide, and Peer Support Workshop

Curriculum Outline

DAY ONE

8a – 10a

1. Introductions
   1. Introduction of instructors and background
   2. Input using Poll Everywhere
      1. What are you most hoping to get out of this?
      2. What concerns you about this workshop?
      3. Do you know someone (keep name anonymous) that you think struggles with PTSD or symptoms of PTSD? 
      4. What about depression or substance abuse?
2. Overview of workshop content, tasks, and exercises, and review of learning objectives
3. What is PTSD?
   1. Symptom clusters
      1. Reexperiencing as the hallmark symptom
      2. Avoidance as the maintaining symptom
      3. Hyperarousal as a result of avoidance symptoms
      4. Negative mood and cognitions resulting from the event and subsequent struggles
   2. FEAR – false evidence appearing real
      1. Triggers become generalized
      2. Triggers can come in several forms: anniversaries, noises/sounds, locations, similar events, inactivity (i.e., boredom, weekends/days off)
   3. Requirements for diagnosis, versus subthreshold symptoms
   4. Understanding delayed onset cases as resulting from subsequent triggers, cumulative exposure, or removal of avoidance (like retirement)
   5. Importance of seeking a professional for diagnosis
      1. Dangers of incorrect self-diagnosis
      2. Implications for treatment
4. Discussion and short break

10:15a – 11:45a

5. Brief overview of literature on PTSD prevalence among emergency responders
   1. Why might emergency responders be at particular risk
      1. Cumulative nature of exposure
      2. Confronted with betrayal, depravity, injustice – difficult emotions and cognitions with which to struggle
      3. May not know the outcome of the incident, which can enhance reexperiencing and hyperarousal symptoms
      4. Culture of stoicism that often reinforces the use of avoidance as the primary coping method
      5. Moral injury: definition and connections with mental health
   2. What other conditions commonly co-occur with PTSD, or are seen in lieu of PTSD?
      1. Depression
         1. Most commonly comorbid diagnosis with PTSD
         2. Research has shown that it is often the result of PTSD-related impairment
      2. Substance abuse
         1. Using alcohol to cope with reexperiencing and hyperarousal symptoms
         2. Form of avoidance that worsens PTSD symptoms over time
      3. Though not a condition, working to excess if often seen among those suffering from PTSD, and is seen as a form of avoidance

Break for lunch (11:45a – 12:45p)

12:45p – 2:45p

6. Suicide
   1. Why might emergency responders be at heightened risk for suicide?
      1. Cumulative exposure alters our beliefs about the benevolence of people and the world, and our beliefs about our own self-worth and culpability
      2. Link between PTSD and suicide, as well as links between suicide, depression, and substance abuse
         1. Isolation
         2. Lack of understanding / awareness
         3. Fatigue / exhaustion
         4. Impulsivity and lack of inhibition associated with substance abuse
      3. Emergency responding is characterized by a work environment in which the work becomes part of your identity
         1. Difficulty with that position when work is causing stress/distress
         2. Difficulty with that position if you are reprimanded, placed on leave, considered unfit for duty
         3. Difficulty with that position given today’s media
         4. Moral injury revisited
   2. Biggest predictors of suicide
      1. Hopelessness (with or without concurrent depression)
      2. Rigidity in thinking, pessimism, use of the four-letter word “only”
      3. Major life changes or stressors, particularly those that impact on important pieces of our identity
         1. Divorce
         2. Unemployment
         3. Retirement
         4. Difficulties with kids / family / friends
         5. Loss of loved ones
   3. Getting help
      1. Re-engage in activities to reduce depressive symptoms
      2. Stop substance abuse
         1. Recognize that removing that avoidance strategy may make things worse in the immediate future
         2. In cases of severe use, consult with physician and psychologist/psychiatrist
      3. Immediate help:
         1. PATH crisis hotline – description of their services
         2. Safecallnow
         3. First Responders Suicide Prevention Act
         4. CrewCare
   4. Strategies to find help in the community or statewide services

3p – 4p

7. Recognition and Intervention
   1. Arm yourself with knowledge and recognize when others may be suffering. What will you see in struggling colleagues or friends?
      1. Avoidance of certain activities, people, places, things, duties at work
      2. Isolation / withdrawal
      3. Change in attitude about the world and people
      4. Agitation or anger
      5. Family problems, which often present when someone is struggling with PTSD or related conditions
   2. Ultimately, we are trying to get people to approach rather than avoid, even in the absence of professional help
      1. Stigma associated with approaching the event
      2. Approach behaviors lead to the best outcomes
      3. People are often shocked by their ability to handle talking about the event
   3. If and when someone talks to you, it’s important to:
      1. Recognize their struggle without personalizing it (i.e., getting more upset or angry than the person talking)
      2. Avoid co-rumination
      3. Focus on what you or the other person are experiencing now, rather than retelling details of past events (which is not typically helpful)
   4. Seek assistance if you’re struggling
      1. Co-worker / peer support is powerful
      2. Family or friends – focus on experience, not retelling the exact narrative
      3. Professional options (revisited later)
   5. Recognize that talking about it once may be all that you need.  In cases of PTSD, that is often not enough.
   6. Professional options
      1. Veterans Administration endorses three approaches based on research
         1. Cognitive processing therapy – brief description and video
         2. Prolonged exposure – brief description and video
         3. Eye Movement Desensitization and Reprocessing – brief description and video
      2. What do these approaches have in common?  
      3. Are there other options?
   7. How do you find a good therapist in the community?  Establishing a connection with someone who has experience with police or fire.