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PTSD Prevention in First Responders
Presenter: Dr. Dawn-Elise Snipes

Counseling CEUs can be earned for this presentation at
~ What is PTSD and Cumulative PTSD?
~ Prevention: Why and When?
~ HPA-Axis AKA Threat Response System
~ Prevention: How?
~ Destination
~ Mindfulness
~ Vulnerabilities
~ Cognitions
~ Interventions
~ Specific Interventions


~ Exposure to a traumatic event that involved actual or the potential for death or serious injury in which there was a sense of helplessness and horror.
~ 3 Types
~ Single Exposure (The straw that broke the camel’s back)
~ Chronic Exposure
~ Secondary Exposure (Think… Spouses of people working Twin towers)
~ Spouses – When Mama ain’t happy…
~ Children
~ For the vast majority of the population, the psychological trauma is limited to an acute, transient disturbance.
~ The signs and symptoms of PTSD reflect a persistent, abnormal adaptation of neurobiological systems to the witnessed trauma.
~ For more information (psychobabble) about the exact brain changes that take place in people with PTSD, view the video on our YouTube Channel: Neurobiological Impact of Psychological Trauma on the HPA-Axis
PTSD Symptoms & Functions
~ Re-Experieincing: Flashbacks, nightmares
~ Avoidance: Avoiding any triggers for re-experiencing
~ Sight, Smell, Sound, Taste, Touch, Place, Time, Objects…
~ Arousal or Reactivity
~ Hypervigilance /Easy startle
~ Difficulty Sleeping
~ Angry outbursts
~ Cognition/Mood
~ Trouble remembering key features of the traumatic event
~ Negative thoughts about oneself or the world (Us-Them)
~ Distorted feelings like guilt or blame
~ Loss of interest in enjoyable activities

Burnout –Not Quite PTSD, but Just as Bad
~ Physical, Mental, Emotional Exhaustion: Rookie
~ Frustration, Guilt, Loss of a sense of purpose
~ Nothing I do makes a difference.
~ There’s just too many of them
~ Self-consciousness about their sense of vulnerability, emotional reactions
~ Cynicism and callousness: In response to prolonged feelings of helplessness some people put on heavy armor hey develop an
~ “Look out for # 1.” “Cover your ass.” “Not a Social Worker.”
~ Failure, helplessness and crisis: R.O.D Deputy
Risk Factors
~ The response of an individual to trauma depends not only on stressor characteristics, but also on factors specific to the individual.
~ Perception of stressor
~ Proximity to safe zones
~ Similarity to victim
~ Degree of helplessness
~ Prior traumatic experiences (1+1=5)
~ Amount of stress in the preceding months (Including family, personal and organizational)
~ Current mental health or addiction issues
~ Availability of social support 4/24
Prevention Whys
~ It is easier (and cheaper) to intervene early
~ Activity—identify someone who has developed burnout. What are the impacts
~ Emotionally (anger, anxiety, moodiness, withdrawn, depressed)
~ Mentally (outlook, concentration, hope, screw it attitude, gets behind on paperwork)
~ Physically (illness, exhaustion, weight gain, increased drinking)
~ Socially (relationships with family, friends, ability to get along with team, draws complaints, “lost puppies”)
Prevention Whens
~ NOW!
~ Prevention mitigates vulnerabilities and strengthens the force
~ A vulnerable officer is more likely to:
~ Draw a complaint
~ Make a mistake
~ Get hurt
~ Develop stress related illnesses and mood issues
The HPA Axis: Threat Response System
~ Hypothalamic-Pituitary-Adrenal Axis
~ Controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure


HPA-Axis Dysfunction
~ Dysfunctional HPA axis activation will result in
~ Abnormal immune system activation (illness)
~ Increased inflammation and allergic reactions (pain)
~ IBS symptoms such as constipation and diarrhea
~ Reduced tolerance to physical and mental stresses (including pain)
~ Altered levels of sex hormones (low libido)
~ Increased anxiety and/or depression
What Triggers the HPA-Axis
~ Anything your brain thinks makes you vulnerable to injury or attack to your person (If your HR goes up you are likely stimulating the HPA Axis)
~ Going to calls
~ Getting reprimanded
~ Pain / discomfort
~ Lack of quality sleep
~ Overtraining
~ Watching the news

Activity: What triggers your HPA Axis (Anger, Stress, Worry). A dozen little things add up!
Prevention Basics: Have a Destination in Mind
Prevention Basics: Mindfulness
~ Get your head in the game!
~ Anchored mindfulness
~ Mindfulness helps people become aware of what they are feeling and needing in the present moment to help them work towards their goals
~ Mindfulness helps people become aware of and work with their vulnerabilities. (Ex. Hypoglycemia)
~ Emotionally
~ Mentally
~ Physically
~ Environmentally
~ Socially

Prevention Basics: Vulnerabilities
~ Sleep
~ Rebalances and restores
~ Lack of sleep is bad mojo (makes you vulnerable)
~ Slows reaction time
~ Impairs judgement
~ Triggers the Threat Response System / HPA-Axis
~ Average adult needs 6-7 hours with 1.5 hours of “deep sleep”

Prevention Basics: Vulnerabilities
~ Sleep
~ Get enough rest (SHADES)
~ Sleep Routine
~ Hydration (Reduce 3 hours before bed)
~ Alcohol (Avoid. Have a BAC of 0.00 at bedtime)
~ Decompress (Guided imagery, progressive muscle relaxation, stretching)
~ Ergonomics and Environment (blue light filters, sleep timers, ear plugs, blackout curtains)
~ Stimulants (Avoid)

Prevention Basics: Vulnerabilities
~ Nutrition
~ Your body repairs using proteins
~ Vitamins are the spark plugs of the system
~ Hydration allows for the chemical reactions (1% –2% dehydration causes anxiety, moodiness, difficulty concentrating and a decline in short-term memory



Prevention Basics: Vulnerabilities
~ Nutrition
~ Decent eating
~ 3 colors at each meal
~ Water bottle
~ Keep a food log for a week to get a baseline on your nutrient intake
~ Eliminate or moderate caffeine and nicotine
~ Healthy snacks in your car
~ Eliminate or moderate simple sugars and high fructose corn syrup
~ Eat mindfully for hunger not self-soothing




Prevention Basics: Cognitions
~ Losses
~ Need to be grieved… Denial, anger, …, depression, acceptance
~ Think of life as a book and you are the author. How do you incorporate this plot twist
~ Types of losses
~ Loss of idealism and sense of purpose
~ Start each day with a focus/quote.
~ What good did they do?
~ How can they make meaning from it? The Secret to Victory

Prevention Basics: Cognitions
~ Losses
~ Types of losses
~ Loss of a sense of personal control
~ What do they have control over?
~ Loss of cognitive flexibility (rigid problem solving and conceptualization)
~ Challenging Questions Worksheet

Prevention Basics: Unhelpful Thoughts
~ AKA Cognitive Distortions
~ Mindreading
~ What is the proof?
~ Personalization (Internalizing to the extreme)
~ What part did the others play?
~ Blaming (Externalizing to the extreme)
~ What was your part, and what can you learn?
~ All-or-None / Dichotomous
~ Find the exceptions
~ Walk the middle path
Prevention Basics: Unhelpful Thoughts
~ AKA Cognitive Distortions
~ Availability Heuristic
~ Show the evidence
~ Magnification/Exaggeration
~ How likely is that to happen?
~ In a month, how much will this matter?
~ Compared to other things, how big of a deal is this?

Intervention Basics: Distress Tolerance
~ Distress Tolerance helps people get through unpleasant feelings and urges which they cannot immediately control
~ Distress Tolerance helps people let go of some of the unpleasant things.
~ Distress tolerance skills can help people avoid acting impulsively on urges
Distract with Wise Mind ACCEPTS
~ Activities (pleasant)
~ Contributing
~ Comparisons
~ Emotions (opposite)
~ Pushing Away
~ Think about something totally different
~ 4 3 2 1
~ What did you used to do on long car trips?
~ Body Scan
~ Meditation
~ Self-Soothing Using the 5 Senses
~ Sight
~ Smell
~ Hearing
~ Touch
~ Taste
IMPROVE the Moment
~ Imagery
~ Safe place
~ Successfully dealing with this
~ Feelings and thoughts are clouds in the sky
~ An unstoppable train
~ Meaning
~ Changing how you think about yourself and your situation
~ Make lemonade. Find the silver lining.
~ Prayer
~ Relaxation

IMPROVE the Moment
~ One thing in the Moment
~ Focus on one thing you are doing right now
~ Sitting in a chair
~ Driving
~ Weeding
~ Vacation
~ Mental vacation
~ Take a short break
~ Leave stress at work
~ Encouragement
~ Be your best friend
~ Create a mental coach

Specific Early Interventions
~ How can you PREVENT:
~ Idealism shattered
~ Loss of a sense of personal control
~ Loss of a sense of purpose
~ “Badge-heavy adrenaline junkie“ obsessed with regaining control (if not on the job, in his/her personal life)
~ Little sleep
~ Lose contact with civilians / withdrawal
~ Sense of hopelessness about the job
~ Rigid in problem-solving and conceptualization

Late Term Interventions
~ Counseling is often appropriate here, but… how can you help:
~ Depersonalization (Labeling, name calling, ‘nother day-’nother dollar)
~ Make it personal
~ Don’t confuse with compartmentalization
~ Increased apathy
~ Okay, what do you care about? What options do you have in this situation to get you closer to your destination?
~ Question the goodness of humanity
~ Find and highlight the exceptions
~ Alienation/ Isolation from peers and family
~ Don’t confuse with introversion
Late Term Interventions
~ Counseling is often appropriate here, but… how can you help:
~ Lack a sense of accomplishment
~ Make a determined effort to praise
~ Beginning of addictions /eating problems/ ulcers
~ Emotional exhaustion
~ Numbing / blind rage
~ Combat breathing
~ Distress tolerance
~ Lack of belongingness
~ What makes you feel you don’t belong?
~ How might you fix or address that?
~ Sense of hopelessness

~ LEO often see people on the worst day of their lives, acting in the worst way of their lives
~ Extreme scrutiny “Damned if I do, damned if I don’t” takes away personal power, motivation to make a difference
~ Prevention of vulnerabilities begins by
~ Developing a physically healthy workforce
~ Ensuring awareness of signs of burnout/distress
~ Ensuring the team is cohesive, feels supported, can find meaning in their jobs, can integrate incidents into their narrative, have a destination.

~ Early Intervention
~ After critical or significant incidents
~ Provides social support (emotional if not factual)
~ Helps the person find meaning and avoid cognitive traps
~ “Shoulda, coulda, woulda.”
~ Us vs. Them
~ Late Intervention
~ Counseling referrals
~ Time off
~ Working with the treatment team to re-integrate