Why Therapy is Essential for First Responders

First responders are the unsung heroes who put their lives on the line day in and day out to protect and serve their communities. Firefighters, police officers and paramedics, doctors and nurses are the first to the scenes of peoples’ worst days; when others run away, they run toward. And in addition to the dangerous and extreme demands of their jobs, they also contend with other factors that impact their overall wellbeing, including shift work and often having to be away from their families or miss important family days and traditions because of the nature of that shift work. Their mental and physical health often takes a backseat to the duty of their work and their ability to perform. With higher-than-average rates of PTSD, anxiety, depression and burnout, therapy is not just beneficial – it is essential for the overall well-being of the first responder.

In this post, we will explore why therapy is crucial for first responders in coping with the mental health challenges they face, and the benefits that therapy can provide to both them and their partners or families.

Mental Health Crises in First Responders

First responders are some of the most resilient individuals, trained to handle chaotic, dynamic, and high-pressure situations with courage, skill and focus. However, the nature of their work – constantly being exposed to life-threatening emergencies, horrific scenes, and human suffering – can take a significant toll on their mental health. It’s important to understand some of the psychological challenges that first responders face to fully appreciate the necessity of therapy.

PTSD (Post-Traumatic Stress Disorder

One of the most well-known or thought of mental health issues that first responders face, PTSD occurs when an individual is exposed to traumatic events that overwhelms their ability to cope with the emotional aftermath. First responders are exposed to various traumatic situations and scenes, such as car accidents, violent crimes, natural disasters and life-threatening medical emergencies. Typically, at the scene, they are tasked with having to focus in incredibly stressful situations on patient care. After they leave a traumatic call, and particularly when they experience the compounding effects of many traumatic calls, they are at higher risk of developing PTSD symptomology.

The symptoms of PTSD include flashbacks (suddenly feeling like you are back in the traumatic event), nightmares related to the event(s), anxiety, and emotional numbness. These experiences can be debilitating and affect an individual’s ability to function at their normal level of functioning in their personal and professional lives. They may also have difficulty sleeping, irritability and anger, and struggle with hypervigilance, meaning feeling on edge or constantly alert, even when they do not need to. A lot of first responders report feeling that even when they are at home, and should theoretically be able to relax, they continue to feel on edge, waiting for the next call to come in, as if they were still at work. Without intervention, PTSD can lead to long-term mental health consequences, affecting both their job performance and their relationships.

Burnout

Burnout can result from the accumulation over long hours, or sometimes multiple day shifts, of intense work. It can manifest as physical, emotional, and mental exhaustion, leading to feelings of helplessness, detachment, and frustration. The constant exposure to traumatic situations can cause individuals to become emotionally fatigued, diminishing their ability to feel empathy or effectively perform their duties. Burnout can also lead to poor decision-making in the moment, lack of motivation, and a decrease in overall job satisfaction. As first responders continue to face high-stress situations without addressing their mental health, burnout has a tendency sometimes to spiral into more series mental health condition, including depression and substance abuse.

Burnout can definitely impact a first responder’s experience of home life as well. If not attended to, the same ramifications of burnout experienced on the job (detachment, empathy fatigue, exhaustion, irritability, and a loss of interest in usual activities) can also begin to manifest in the home environment as well. This not only impacts the first responder, but can have effects on the whole family unit.

Anxiety and Depression

First responders may also experience anxiety and depression due to a number of job-related factors: the demands and very real pressures of their jobs, some of which are life and death, the unpredictability of their work day and schedules (hello, forced overtimes or recalls), the exposure to dangerous situations, and interruptions to their protective factors such as having to spend less time with their families, can all lead to feelings of constant worry, ruminating thoughts, stress and emotional exhaustion. Anxiety can manifest as constant restlessness, physical tension, a sense of impending doom, and often involves irritability. Depression can cause individuals to feel hopeless, withdrawn and disconnected from themselves, others, and the activities in their lives that they typically enjoy. These mental health challenges can severely impact first responders’ relationships, work performance, and overall quality of life. Without proper support, these issues can escalate to become chronic, affecting every area of their lives. It is important to note, just as was noted in the discussion of PTSD above, that the symptoms related to anxiety depression cause a marked difference in the person’s level of functioning. While one may have been engaged in their every day lives and hobbies, engaged in healthy relationships, and focused at work, they are now experiencing a loss of some degree in their ability to function in their lives.

Both anxiety and depression have diagnostic criteria related to physical signs of health. If you are noticing a change in your appetite or your sleep, for example, it is a good idea to check in on your mental health overall. Sometimes, when we are the one in the anxiety or the depression, it can be easy to try to get through the day-to-day, and we may not recognize it right away; being mindful of your energy, your appetite and sleep habits (i.e., if you are sleeping too little, cannot sleep, or are sleeping more than usual), and your motivation to engage in regular activities can help you or your loved ones assess overall mental health.

Substance Abuse

Individuals dealing with things like overwhelming stress and trauma can be more likely to turn to substances as a means of coping, particularly if they don’t have coping skills already built up. What is insidious about substance abuse is that it can provide temporary relief from the emotional toll of the work. This is what can often put someone on a damaging and self-destructive path with substance abuse – it can work, for a time. However, it ultimately greatly worsens one’s mental health and leads to additional physical and psychological complications as well as worsening job performance and negative impacts on interpersonal relationships.

Again, while some feel that substances can have the initial effect of helping them forget about their current problems, they often over time greatly exacerbate these symptoms, creating a vicious cycle that is difficult to break without intervention.  Therapy plays a critical role in processing job-related trauma, addressing self-destructive behaviors and providing healthier coping mechanisms.

Relationship Strain

The emotional toll and burnout associated with being a first responder not only affects that singular person but can also have undulating effects in the person’s interpersonal relationships. They may find it difficult to talk about their experiences or may withdraw from loved ones as part of their mental health symptomology.  Furthermore, first responders often struggle with maintaining a work-life balance, particularly when they experience the emotional weight of their job.

Over time, these issues can strain relationships, leading to communication breakdowns, conflicts, or even separation. Individual therapy and couples counseling can help first responders and their partners develop a deeper understanding of one another, allowing them to more easily navigate these challenges by improving their emotional awareness, communication skills, and overall relationship dynamics. Therapy can also help the first responder (and potentially their partner in couples counseling) implement effective systems into their daily lives that helps everyone find balance between time apart from one another, time to themselves, and quality time together to maintain their relationship.

Overcoming the Stigma of Mental Health Treatment

Societally, we have made huge strides in reducing the stigma surrounding therapy. However, some may still avoid seeking help, believing that asking for help or talking about emotional challenges is a sign of weakness. Some fear about the limits of confidentiality and have concerns that seeking help could even harm one’s career, or that private information could be shared with their department. Therapists are bound by legal and ethical obligations to hold material discussed in therapy sessions in the utmost confidence; there are only a few exceptions to this for the safety of individuals involved, i.e., if someone expresses they are a danger to themselves or others. In these professions, where emotional fortitude and focus is often prioritized over emotional well-being, we want to continue to do the work to make sure individuals are aware of the resources available to them and that we continue to decrease the stigma around utilizing those resources.

Seeking therapy is a sign of strength and self-awareness. Just as first responders train to handle physical stress and danger, to treat patients in the field, to find the mental focus needed to navigate highly chaotic and dynamic calls and environments, therapy helps them train to cope with the emotional and psychological stress of their profession. By encouraging first responders to prioritize their mental health, we can foster a culture where therapy is seen as a valuable tool to ensure the longevity and well-being of those who serve the public.

Therapy is not just about addressing acute mental health crises. It’s also a proactive approach to maintaining overall mental well-being and healthy relationships, learning how to manage ongoing stress, and enhancing emotional resilience. Here’s how therapy can make a difference in the lives of our first responders:

Processing Trauma

Therapy provides a safe and supportive space where individuals can process the memories and effects of their past traumatic experiences and learn coping skills to manage ongoing triggers related to trauma. There are a number of therapeutic modalities, i.e., EMDR (Eye Movement Desensitization and Reprocessing), CBT (Cognitive Behavioral Therapy), somatic therapies that are designed to help individuals heal from the emotional and psychological effects of trauma. These therapies help individuals reframe negative thoughts, reduce anxiety, gain a better sense of their mind-body connection, and process difficult memories of their traumatic events.

Developing Healthy Coping Mechanisms

Therapy can teach clients effective coping strategies to deal with general stress, depression and the triggers of a past traumatic event. Instead of turning to unhealthy coping mechanisms like substance abuse or emotional numbing, therapy can help people find healthier and individual ways to manage difficult emotions and experiences. Techniques such as mindfulness, relaxation exercises and deep breathing can help individuals regulate their stress levels and remain calm in high-pressure situations. Regular physical exercise can make a significant impact in terms of reducing stress and helping an individual cope with the demands placed on them. There likely will be specialized individual coping strategies depending on the individual that they can uncover with their therapist.  Therapy helps build emotional resilience by equipping first responders with the tools they need to bounce back from difficult experiences. This emotional resilience not only helps them cope with the demands of the job, but also ensures that they remain effective and compassionate in their working roles.

Improving Relationships

Job-related stress that the first responder experiences, and copes with, can also have a significant impact on their personal relationships. Therapy can help first responders communicate more effectively with their loved ones, express their emotions in a healthy and productive way, and navigate finding balance between work life and personal life. By strengthening their emotional intelligence and self-awareness, therapy can help first responders build stronger, more supportive relationships both at home and in the workplace.

Preventing or Treating Burnout

Burnout is a serious concern for first responders. Therapy can serve as a preventative measure, helping individuals recognize the early signs of burnout and develop strategies to manage stress before it becomes overwhelming. This proactive approach can help them maintain their mental and physical health over the long term. Therapy can also help an individual learn how to mitigate burnout after it’s begun by helping them to become more mindful and aware of their emotions and when stress levels are rising, and by helping the individual learn coping skills as well as systems to implement in their working and personal lives that help set them up for improved success.

How Departments Can Support the Mental Health Needs of Their First Responders

It can make a world of a difference in terms of whether someone with a need for mental health services actually seeks out and obtains those services if their departments create a supportive environment that encourages this. Here are a few ways that departments can foster a culture of mental health support:

Providing Access to Therapy

Departments can – and many do – offer access to confidential therapy services for it’s employees, either through Employee Assistance Programs (EAPs), by building up a network of available resources to share with their employees, and by partnering with local mental health professionals to link the supply to the demand. Ensuring that first responders have easy access to therapy removes significant barriers to care and improves the overall culture of the department by helping to reduce the stigma surrounding mental health services.

Promoting Mental Health Awareness

Departments can prioritize mental health education and awareness by holding workshops, offering targeted resources, and encouraging open conversations about mental health. In particular, departmental personnel skilled at crisis intervention and processing can come into local divisions of the department after particularly difficult and traumatic calls the employees have been on. Sometimes we can all use a refresher or reminder of the services that are available to us when we are in the thick of it. This also helps to reduce stigma and encourages first responders to seek help when needed.

Offering Peer Support Programs

Peer support (individuals that are themselves within or connected to the department that offer emotional support to the employees) allow first responders to talk to colleagues who have had similar experiences, who “get it”, creating a safe space for them to share their feelings and struggles. Peer support can complement therapy by offering a supporting, non-judgmental community of individuals who uniquely and intimately understand the challenges of the profession.

Normalizing Mental Health Care

Departments should take an active role in normalizing mental health care by showing that seeking therapy is not only acceptable, its encouraged and at times absolutely necessary. When leaders model healthy mental health practices, and normalize addressing one’s own mental and emotional health, it sends a powerful message to all employees that taking care of one’s well-being is a priority. This is not just for the benefit of that individual, but so that individual can maintain their ability to continue to serve others.

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First responders are critical to the safety and security of our communities, but their mental health often goes overlooked. The emotional toll of their work can have lasting effects on their well-being. Therapy can be an invaluable tool for first responders, helping them to manage the psychological challenges they face, build emotional resilience, ensure their relationships with loved ones and support individuals remains healthy, and maintain an appropriate work-life balance.

By breaking the stigma surrounding mental health, promoting therapy as a tool for strength, and creating a culture of support within departments, we can help first responders not only survive but thrive in their demanding roles. Therapy is often a lifeline that can help first-responders improve their overall well-being, ensuring that they can continue to serve their communities with strength, clarity and compassion. If you’ve been thinking about trying therapy, do yourself a favor, and make the call today. Give it a try, you don’t have much to lose.