NAMI is partnering with #FirstRespondersFirst to raise awareness about the importance of mental health in frontline health care and public safety professionals. In today’s blog, Alexandra Hayes writes about identifying signs of stress and simple strategies to help reduce stress before burnout takes over.
As a first responder — whether you’re a home health aide, social worker, community health worker, nurse, or physician — you know that stress is a part of the job, and you likely have some strategies to keep yours at bay. But in the face of today’s unprecedented health crisis, your stress levels may reach new heights as you take on the responsibility of helping at the front lines.
When left unmanaged, chronic stress can weaken your immune system, lead to burnout, and rob you of the reason you wanted to do this critical work in the first place. You can’t control a lot when it comes to this virus, like the exposure you have to other people’s suffering, or how many patients you may need to treat with the resources you have, but with the right strategies, you can change how you respond to these distressing situations.
What is Burnout? Burnout is defined as exhaustion and depersonalization, that is when you feel an increased mental distance from your job or are negative/cynical about it. It’s important to know that burnout is a syndrome, not a disease, that causes problems for the person, work team and family. Some common signs include the inability to relax when off duty, irritability, and argumentativeness, and increased social conflicts, like blaming others, or withdrawal.
Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.
_______________________________________________________________________ The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. SAMHSA’s 2020 National Survey on Drug Use and Health reports that approximately 19.3 million people aged 18 or older had a substance use disorder in the past year.
Substance use disorder (SUD) is a complex condition in which there is uncontrolled use of a substance despite harmful consequences. People with SUD have an intense focus on using a certain substance(s) such as alcohol, tobacco, or illicit drugs, to the point where the person’s ability to function in day-to-day life becomes impaired.
The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with more than 37,400 physician members specializing in the diagnosis, treatment, prevention and research of mental illnesses. APA’s vision is to ensure access to quality psychiatric diagnosis and treatment. For more information, please visit www.psychiatry.org.
As with many other physicians, recommending physical activity to patients was just a doctor chore for me – until a few years ago. That was because I myself was not very active. Over the years, as I picked up boxing and became more active, I got firsthand experience of positive impacts on my mind. I also started researching the effects of dance and movement therapies on trauma and anxiety in refugee children, and I learned a lot more about the neurobiology of exercise.
I am a psychiatrist and neuroscientist researching the neurobiology of anxiety and how our interventions change the brain. I have begun to think of prescribing exercise as telling patients to take their “exercise pills.” Now knowing the importance of exercising, almost all my patients commit to some level of exercise, and I have seen how it benefits several areas of their life and livelihood.
We all have heard details on how exercise improves musculoskeletal, cardiovascular, metabolic and other aspects of health. What you may not know is how this happens within the brain.
How exercise improves the brain.
Brain biology and growth
Working out regularly really does change the brain biology, and it is not just “go walk and you will just feel better.” Regular exercise, especially cardio, does change the brain. Contrary to what some may think, the brain is a very plastic organ. Not only are new neuronal connections formed every day, but also new cells are generated in important areas of the brain. One key area is the hippocampus, which is involved in learning and memory and regulating negative emotions.
A molecule called brain-derived neurotrophic factor helps the brain produce neurons, or brain cells. A variety of aerobic and high-intensity interval training exercises significantly increase BDNF levels. There is evidence from animal research that these changes are at epigenetic level, which means these behaviors affect how genes are expressed, leading to changes in the neuronal connections and function.
Finally, there is evidence for the positive effects of exercise on the neurotransmitters – brain chemicals that send signals between neurons – dopamine and endorphins. Both of these are involved in positive mood and motivation.
Exercise improves clinical symptoms of anxiety and depression
Exercise could even potentially desensitize people to physical symptoms of anxiety. That is because of the similarity between bodily effects of exercise, specifically high-intensity exercise, and those of anxiety, including shortness of breath, heart palpitation and chest tightness. Also, by reducing baseline heart rate, exercise might lead to signaling of a calmer internal physical environment to the brain.
It is important to note that the majority of studies examined the effects of exercise in isolation and not in combination with other effective treatments of clinical anxiety and depression, such as psychotherapy and medication. For the same reason, I am not suggesting exercise as a replacement for necessary mental health care of depression or anxiety, but as part of it, and for prevention.
Many people have created outdoor gyms during the pandemic. Richard Baker/In Pictures via Getty Images, CC BY-SA
There are other perks besides the neurobiological impacts of exercise. When going out for a walk, one gets more exposure to sunlight, fresh air and nature. One of my patients befriended a neighbor during her regular walks, leading to regular taco Tuesdays with that new friend. I have made some great friends at my boxing gym, who are not only my motivators, but also a great supporting social network. One might pick a dog as their running mate, and another might meet a new date, or enjoy the high energy at the gym. Exercise can also function as a mindfulness practice and a respite from common daily stressors, and from our electronic devices and TV.
So how can you find time to exercise, especially with all the additional time demands of the pandemic, and the limitations imposed by the pandemic such as limited access to the gyms?
Pick something you can love. Not all of us have to run on a treadmill (I actually hate it). What works for one person might not work for another. Try a diverse group of activities and see which one you will like more: running, walking, dancing, biking, kayaking, boxing, weights, swimming. You can even rotate between some or make seasonal changes to avoid boredom. It does not even have to be called an exercise. Whatever ups your heartbeat, even dancing with the TV ads or playing with the kids.
Use positive peer pressure to your advantage. I have created a group messaging for the boxing gym because at 5:30 p.m., after a busy day at the clinic, I might have trouble finding the motivation to go to the gym or do an online workout. It is easier when friends send a message they are going and motivate you. And even if you do not feel comfortable going to a gym during the pandemic, you can join an online workout together.
Do not see it as all or none. It does not have to be a one-hour drive to and from the gym or biking trail for a one-hour workout vs. staying on the couch. I always say to my patients: “One more step is better than none, and three squats are better than no squats.” When less motivated, or in the beginning, just be nice to yourself. Do as much as possible. Three minutes of dancing with your favorite music still counts.
Merge it with other activities: 15 minutes of walking while on the phone with a friend, even around the house, is still being active.
When hesitant or low on motivation, ask yourself: “When was the last time I regretted doing it?”
Although it can help, exercise is not the ultimate weight loss strategy; diet is. One large brownie might be more calories than one hour of running. Don’t give up on exercise if you are not losing weight. It is still providing all the benefits we discussed.
Even if you do not feel anxious or depressed, still take the exercise pills. Use them for protecting your brain.
Arash Javanbakht, M.D., is a psychiatrist and associate professor at Wayne State University. He serves as the director of the Stress, Trauma, and Anxiety Research Clinic (STARC). His clinical work is mainly focused on anxiety and trauma related disorders, and PTSD in civilians, first responders, law enforcement, and refugees and victims of torture and human trafficking. His clinic utilizes pharmacotherapy (medication), psychotherapy, exercise, and lifestyle modification to help patients achieve their full capacity for a fulfilling life.
His research is also focused on anxiety disorders and trauma. Several research studies at the STARC examine the impact of exposure to war trauma in adults and children Syrian and Iraqi refugees in the US, and biological and psychological factors of risk and resilience. This research examines genetic, environmental, and inflammation correlates of trauma as well. Also, use of art, dance and movement, and yoga and mindfulness in helping refugee families overcome stress.
STARC also researches neurobiology of psychotherapy, and utilization of augmented reality and telemedicine technologies for providing in vivo treatment for anxiety disorders and PTSD. Dr Javanbakht has a special interest in the “personal meaning” of trauma: how does personal interpretation of a traumatic experience affect the way an individual is affected by it.
Dr Javanbakht’s work has been frequently featured on the CNN, Aljazeera, NPR, Washington Post, Smithsonian, PBS, American Psychiatric Association Press Briefing, Anxiety and Depression Association of America, American Academy of Child and Adolescent Psychiatry, and tens of other media outlets.
Keeping correctional staff safe begins with how we prepare to respond to correctional emergencies. This preparation is usually dealt with under the umbrella of emergency preparedness planning. It is important to note that correctional personnel respond to emergencies as first responders.
Staff members initially respond to these emergencies, determine what type of specialized emergency response is needed, then assist with handling the problem while the appropriate specialized response teams are called to the scene, such as correctional emergency response teams, EMS, fire department or maintenance department.
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While Emergency Medical Responder (EMR) does not provide state licensure or certification as an Emergency Medical Responder, this course is ideal for high school and college-aged students to receive training similar to the training EMS professionals receive as they look to enter careers in healthcare, public safety, or law enforcement.
Firefighters and EMS personnel routinely witness horrific events that ordinary people don’t. These experiences can lead to mental health issues, including PTSD and depression—even suicide. Here you can view the latest findings, policies and procedures that can help first responders and their leaders recognize behavioral health problems and take action before they put themselves and those around them at risk.
Recognizing emerging or existing mental health issues is critical to keeping first responders safe.
Like most emergency responders, firefighters are expected to be calm, level-headed and able to face even the most challenging situations with courage. They have long been expected to contain their emotions and approach their jobs with logic and reason, with the understanding that only those who have the ability to successfully manage the stress and emotional aspects of the job are cut out for success.
As a result, many firefighters have suppressed their feelings, with devastating consequences to their mental health. Research indicates that a large number have experienced mental health issues such as PTSD, anxiety, depression and suicidal thoughts. For example, one study of 7,000 firefighters found that 65% of the respondents struggle with memories of difficult calls, while 59% have had family or relationship problems as a result of their jobs. Substance abuse issues were experienced by 27%, while 19% have had thoughts of suicide.
In this article, we explore why mental health is critical for firefighters and what resources are available to help departments raise awareness within their teams.
Being an Emergency Dispatcher is difficult for a multitude of reasons. Firstly, the job is incredibly intense and stressful; at any moment you could answer the phone to a panicked caller and alter the course of their lives depending on your actions. To top it all off, this is done at a lower salary level compared to other first responders.
Those that quit during dispatcher training cite not being able to handle the “rapid pace of the job and the responsibility of having someone’s lives in their hands.” The hours are long, and there is mandatory overtime; working during emergencies and on holidays is often required as dispatchers are needed 365 days out of the year, 24 hours a day. In small towns, dispatchers must often take calls from people that they know.
