Hope Out of Darkness: A Guide to First Responder Mental Wellness - Softcover

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Dena Ali is a battalion chief with the Raleigh (NC) Fire Department, where she has worked her way up the ranks. She also serves as the program manager for behavioral health for the First Responder Center for Excellence. She holds a degree from North Carolina State University and a Masters of Public Administration from the University of North Carolina at Pembroke, where her research focused on firefighter suicide. She is an Executive Fire Officer Program graduate through the National Fire Academy.Ali’s passion for mental health awareness stems from her personal and professional experiences, which have led her to become a vocal advocate for the mental health and resilience of firefighters and other emergency personnel. She has conducted extensive research on the mental health challenges faced by first responders, including the impact of trauma and stress.As a sought-after speaker, Ali has delivered numerous presentations and workshops on mental health, resilience, and leadership, sharing her expertise with fire departments, conferences, and organizations nationwide. Her efforts have contributed significantly to developing supportive resources and programs to reduce stigma and promote mental wellness within the fire service.Her work has been recognized with various awards and honors, reflecting her dedication to her profession and her unwavering commitment to the well-being of her colleagues. Her leadership, compassion, and advocacy inspired positive change and support within the firefighting community. Ali has also served as a subject matter expert at the National Fire Academy, where she assisted in reviewing the health and wellness curriculum. Additionally, she is the founder and director of North Carolina Peer Support, where she played a key role in developing the statewide curriculum.

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“Hope Out of Darkness is a must-read for anyone who is a first responder, who loves a first responder, or who works with first responders.” —Brooke Bartlett, CEO of The Center for Trauma, Anxiety, and Stress

“By digging into this book, you will be well on your way to becoming a more effective fire officer in dealing with what you and we have always claimed: our people are our most important asset. Now prove it.” —Billy Goldfeder, deputy fire chief. E.F.O., Loveland-Symmes Fire Department, Ohio

“Hope out of Darkness seamlessly blends science and lived experience in a way that will inspire organizations, communities, and individuals to confidently address mental wellness.” —Thomas Joiner, Robert O. Lawton Professor of Psychology at Florida State University

In Hope Out of Darkness: A Guide to First Responder Mental Wellness, Dena Ali, battalion chief with the Raleigh, NC, Fire Department and sought-after speaker, delivers a comprehensive exploration of the mental health issues facing first responders. Combining powerful personal experience with intensively researched insights and data from subject matter experts, Ali dispels mental health myths, outlines a range of resources for support and treatment, and skillfully employs both her vulnerability and wisdom to offer hope to first responders in need.

Features:

• Frank and honest discussion of suicide in the emergency services

• A nonjudgmental focus on substance-use disorder among first responders

• Resources for social and professional support

• Overview of the importance of sleep and other aspects of physical health

• Methods for helping yourself and your peers in need

About the Author

Dena Ali is a battalion chief with the Raleigh (NC) Fire Department, where she has worked her way up the ranks. She also serves as the program manager for the First Responder Center for Excellence. She holds a degree from North Carolina State University and an MPA from the University of North Carolina—Pembroke, where her research focused on firefighter suicide. She is an Executive Fire Officer Program graduate through the National Fire Academy.

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Defining Trauma

There is a lot of confusion surrounding what constitutes trauma, and this confusion is more complicated by first responders who focus solely on exposure to violence and pain. However, trauma is ubiquitous and is experienced by all people. At the most basic understanding, trauma is any physical or emotional threat that overcomes our coping mechanism. As can be seen from the definition, our coping mechanisms play a huge role in our response to trauma. Bolstering our protective factors and coping mechanisms is the key to resilience.

There are two types of trauma exposure, “big T” trauma and “small t” trauma. According to the American Psychiatric Association, “big T” trauma is an exposure to actual or threatened death, serious injury, or sexual violence. Big “T” trauma can be directly experienced or experienced through indirect or vicarious exposure through learning about the experience from a friend or family member. “Small t” trauma, while not inherently threatening to life, involves highly distressing events that affect people personally. “Small t” trauma can exacerbate the effects of “big T” trauma over time. “Small t” trauma includes divorce, bullying, death of a loved one or a pet, loss of a job, illness resulting in disability, and psychologically unsafe workplaces. Nearly everyone will experience “small t” trauma in their lifetime.

The Roots of Trauma

At the 2019 Fire Department Instructors Conference International classroom session “Lead from the Front: Fireground Tactics and Leadership,” Deputy District Chief (Ret.) Steve Chikerotis from the Chicago (IL) Fire Department displayed the slide, “Don’t move next to an airport and complain about the airplane noise: Why PTSD?” This slide piqued my interest because post-traumatic stress disorder (PTSD) is a complex condition that develops in response to one’s coping skills, early life experiences, mental health, and social support before and after the event. Thus, two people can experience the same trauma and have drastically different outcomes. Neuroscience demonstrates that just as flexibility and fitness mitigate fireground injuries, mindfulness and social support mitigate the effects of trauma and stress.

It Is Time to Change Our Focus

With this information on PTSD in mind, why is there so much focus on renaming PTSD to PTSI (post-traumatic stress injury) and providing benefits to victims after they sustain injury or disability instead of addressing prevention and understanding that the disorder is far more complex than a singular injury?

At a recent Behavioral Health Symposium conference in Indianapolis, presenter Dr. Kerry Ramella, clinical director of the PSCS (Public Safety Crisis Solutions) Wellness Center in Phoenix, Arizona, urged, “Stop spending so much time fighting for presumptive PTSD benefits and direct your focus on prevention by addressing trauma early through treatment and resource preload.”

I support the treatment of PTSD and the benefits provided through legislation, but I believe it is just as critical, if not more critical, to place emphasis on prevention. It is not enough to accept that our first responders are exposed to trauma and will be impacted. We must also recognize that we can arm our first responders with tools that can prevent the manifestation of PTSD, PTSI, or whatever you want to call it.

Post-traumatic stress symptoms are normal responses to trauma that will resolve and even lead to post-traumatic growth for most people. The lack of support after an event is more predictive of PTSD than the trauma itself; when recovery is inhibited, post-traumatic stress can lead to PTSD. For this reason, we must train our leaders to create supportive environments that facilitate growth through adversity and trauma.

Sebastian Junger describes PTSD as a “disorder of recovery.” He explains that our responses to trauma are normal and protective, but if we don’t process trauma and don’t feel safe or supported, the symptoms become destructive. Lack of support, specifically organizational support, is the greatest predictor of PTSD for firefighters. Our organizations must recognize the importance of smart, caring leaders who have the courage to build support into every facet of the work environment. They must have open-door policies, encourage help-seeking behavior, and model vulnerability among other positive coping skills such as getting adequate rest and sleep, practicing mindfulness and gratitude, seeking professional support, and maintaining healthy relationships. Dr. Bessel van der Kolk takes this one step further by explaining that safety and trauma are incompatible and the greatest form of safety comes from the support of others.

A 2015 review found a dearth of population-specific intervention studies relative to the cause, prevention, and treatment of PTSD among first responders. This has led to difficulty in understanding and addressing population-specific protective factors. Fortunately, information that has emerged in the past several years has the potential to guide firefighters and other emergency responders in moving successfully through trauma and grief.

For example, stating the trauma aloud is necessary for processing and leads to positive outcomes. Conversely, failing to resolve trauma and using maladaptive coping, such as avoidance, alcohol, or both, lead to negative patterns and outcomes. Thoughtfully emphasizing positive coping skills not only protects individuals from PTSD but also reduces symptomology and alters the path from addiction, depression, and suicide. These skills include, but are not limited to, seeking positive social support, practicing mindfulness, and prioritizing restorative sleep. As a whole, the fire service has not placed enough emphasis on teaching members the critical importance of learning coping skills and continuously practicing these skills. Fortunately, these skills are easy to implement and understand and are the foundation of Part II of this book.

This chapter combines evidence-based research and life lessons from those who have grown from trauma to demonstrate that we can manage our responses to trauma and adversity. The greatest lesson is that first responders equipped with coping skills and who practice these skills are much more likely to experience growth from adversity and trauma instead of suffering from PTSD.

PTSD

New branches of neuroscience have led to an explosion of knowledge surrounding the effects of trauma. They provide an understanding of how the brain supports mental processes, the dangerous effects of adverse early life experiences, and how our emotions influence our behavior. Surprisingly, the negative long-term effects of trauma are all positive short-term responses to stress. When not processed, these adaptations can become destructive. As explained by van der Kolk, “[M]ost human suffering is related to love and loss, and the greatest sources of our suffering are the lies we tell ourselves.”

The truth is often subconsciously avoided when it coexists with shame, powerlessness, betrayal, or guilt. When stressful memories are ignored or avoided, automatic shortcuts develop, which become seemingly uncontrollable negative thoughts. These shortcuts include trauma symptoms such as hypervigilance, numbing, and confusion.

One of the most surprising findings by van der Kolk was that the parts of the frontal lobe near the expressive motor language area of the brain went offline whenever a flashback was triggered, demonstrating that the effects of trauma can overlap with physical ailments such as stroke. Brain scans also discovered that traumatic...