Post-traumatic Growth

May 17, 2017

The Positive Side of Post-traumatic Stress

Exposure to trauma is commonplace for men and women in the fire and rescue service. Prior to becoming official fire and rescue personnel, they undergo a recruitment and selection process followed by rigorous training and development to help them navigate through dangerous situations with as few fatalities and injuries as possible. Despite this, constantly being exposed to large fires and health hazards, and at the same time dealing with burn victims and injured comrades, can take its toll, making them susceptible to post-traumatic stress.

People who suffer from post-traumatic stress disorder (PTSD) find it more difficult to deal with subsequent stressors that they may encounter at work or in their personal lives compared to peers who don’t have PTSD. This negatively impacts job performance, work-life balance, and personal relationships.

Researchers and positive psychologists, however, have identified that, despite being exposed to highly traumatic situations and experiencing post-traumatic stress, some individuals demonstrate a positive outcome and appear not only to have psychologically and emotionally ‘bounced back,’ but have actually improved their psychological state compared to how they were prior to experiencing traumatic situations.

This positive outcome was first officially observed in detail back in 1995 by University of North Carolina at Charlotte Professors of Psychology, Richard Tedeschi and Lawrence Calhoun, who called it ‘post-traumatic growth’ (PTG).

According to Lynn Hulse, a Psychologist and Researcher at the University of Greenwich in the UK and leading expert in this field, “Post-traumatic growth is the positive psychological change resulting from a traumatic or stressful experience. PTG may manifest in firefighters in various ways such as a greater sense of personal strength, a greater appreciation for life, and developing new priorities in life.”

Studies have demonstrated that some people are naturally better equipped to handle, cope with, and grow from trauma and stress. They are not in the majority, however, and it is clear that a better understanding of the research on PTG can offer insight into how different responses can be predicted and promoted among fire and rescue service personnel.

Factors Associated with PTG
Calhoun and Tedeschi identified five potential beneficial impacts of PTG: closer relationships; greater appreciation of life; identification of new possibilities; positive spiritual change; and increased personal strength. The premise is that after experiencing highly traumatic and stressful events, emergency responders can potentially learn to rise above day-to-day troubles and develop a greater sense of gratitude for things they might previously have taken for granted. These could include time with family, health, sports, hobbies and other interests.

However, despite experiencing these positive affects, a person may still exhibit symptoms of PTSD. A 2014 study conducted by David Sattler looked into the relationships between post-traumatic stress and the growth factor, resource availability, and the critical incident stress debriefing experience. He found that PTG is negatively associated with PTS, and therefore any reduction of PTS factors facilitates growth. Risk factors associated with PTS include burnout, number of years in the emergency response service, and using a style of coping that constitutes disengagement.

Along with PTG, Sattler also found that high levels of social support and personal characteristic resources were negatively associated with PTS. The availability of external and personal ‘resources,’ or factors that help a person cope and deal with stressors, can facilitate PTG and resilience among firefighters. Personal resources pertain to internal coping characteristics, such as self-esteem, inner strength and self discipline.

According to Calhoun and Tedeschi, “Persons with average levels of psychological adjustment might be fit enough to consider constructively changes that trauma has introduced into their lives. Persons with few psychological resources may be poorly equipped to do so.” They highlight the importance of differentiating between individuals who demonstrate coping flexibility, which allows them to internally process trauma and stress better than others. They suggest that psychologically healthy people may produce less illusion and more wisdom from their experience of highly emotional events.

External resources, on the other hand, can pertain to status, material possessions, and, critically, the availability of support from family members and co-workers. Sattler identified critical incidence stress debriefing and occupational support as external resources that facilitate positive growth. He identified other protective factors that enhance PTG, such as: occupational satisfaction, problem-focused coping skills (where the aim is to reduce the cause of the stress), and emotion-focused coping skills (aimed at reducing the negative emotions associated with stress). These factors imply that organizations play a crucial role in providing debriefing sessions, ensuring attendance at these sessions, providing support, reminding firefighters of the meaning and significance of their occupation, and actively guiding the coping strategies used by firefighters.

A recent 2015 study by Doris Kehl identified some additional predictors of PTS. They included subjective incident features (such as perceived life-threat), and objective features (such as the type of incident, number of fatalities and time since the incident). “In our study, PTG was greater when a firefighter had experienced a natural disaster, and when they had experienced greater emotional distress and perceived life-threat during the event,” she wrote. However, Lynn Hulse believes the findings indicate that cultural factors might influence PTG more, and that further studies are still needed in this area.

Acquiring Personal ‘Resources’ to Facilitate PTG
Studies consistently point to the positive association between pre-event personal characteristics and PTG.

Sattler wrote, “The findings show that the maintenance and acquisition of resources can offset losses and facilitate resilience and post-traumatic growth.” In other words, individuals with a healthy psychological and emotional state, prior to exposure to traumatic events, are better equipped to confront stress and deal with any trauma that may linger after an event.

It is therefore necessary for fire departments to measure and evaluate the default psychological state of fire and rescue service personnel in order to determine which personal characteristics can be enhanced through training interventions and personal development programs.

More importantly, firefighters can be exposed to different styles of coping mechanisms and practice their flexibility in choosing the style best suited to certain traumatic situations.

Coping styles come in many forms, including emotion-focused, problem-focused and self-care focused approaches. Personal characteristics, such as positivity and optimism, must also be developed among firefighters in order to counter post-traumatic symptoms, such as depression and other self-destructive behaviour.

Support from Fire Departments
Research suggests that social support plays a critical role in facilitating post-traumatic growth among firefighters. Calhoun and Tedeschi wrote that despite possessing healthy personal characteristics that facilitate PTG, a firefighter might still fail to experience significant PTG when family members, peers and colleagues don’t provide the right kind of psychological or emotional support after a traumatic event.

Hulse, on the other hand, emphasizes the importance of providing crisis responders with the necessary resources for disclosure. “We surmise in our paper that disclosure may be one factor that aids PTG among firefighters,” she says. “If services were to help firefighters identify and access resources for disclosure, this might help promote PTG.”

Retired career firefighter and National Fire Academy Instructor, Linda Willing, makes a similar suggestion: “Firefighters should have access to support systems for behavioural health. These can exist on several levels – trained peer support team members, formal education for all members on behavioural health issues, and access to skilled counseling and intervention services.” Anonymous hotlines can also be set up for firefighters who aren’t comfortable speaking with someone face-to-face.

Indeed, Willing points out that there is still a stigma attached to asking for help among firefighters. She emphasizes the need, in these circumstances, for unwavering support from fire department leaders for intervention programs. “Fire departments have the responsibility to educate their members about expectations and resources related to stress, psychological problems, substance abuse, and related issues,” she says. “Company officers should be enlisted in this effort since they are the ones who tend to notice significant changes in an individual at the earliest point in time.”

Another form of disclosure that must be encouraged is post-event debriefing. As highlighted in Sattler’s study, attendance at critical incident stress debriefing sessions is positively associated with PTG. It is an opportunity for firefighters to go through their experience calmly, highlight the good decisions that were taken and results achieved, as well as identifying mistakes, potential risks and areas where there is room for improvement. Debriefing and talking about shared traumatic experiences can bring colleagues together and build closer relationships while also enhancing psychological well-being.

Support from Family members and Friends
Social support shouldn’t be limited to what can be provided by fire departments and work colleagues, but must also come from family members and friends. According to Willing, “Stress can extend to families and it is important to involve and orient them on their role in promoting PTG.”

She explains that people outside the fire and rescue service may find it difficult to understand the demands and hazards of the occupation. She therefore encourages the creation of programs that orient and involve family members and friends. “Some departments have created programs for the families of recruit firefighters to give them insight into what the job entails. I think these programs can be beneficial if done well,” she says.

Fire and rescue service personnel are constantly exposed to highly traumatic and stressful situations. Fire departments should recruit and select individuals with healthy and positive pre-event psychological conditions, because they may be more emotionally equipped to deal with stress and trauma. However, incidents that are perceived to be life-threatening can still lead to post-traumatic stress, even among personnel who receive the best technical and tactical training.

To facilitate post-traumatic growth, fire organizations must provide programs and resources that develop personal characteristics such as resilience, promote psychological health, and teach different coping styles.

There is huge potential to promote renewed personal strength, spiritual change and an appreciation for new opportunities in life. To provide the best opportunities for growth, firefighters must be provided with access to social support systems, where they can share thoughts, feelings and experiences about traumatic experiences.

An effective support system requires positive contact with peers, department leaders, family members, friends – and sometimes fire victims themselves – allowing fire/rescue personnel a chance to develop closer professional and personal relationships and a greater appreciation for life.

Dr Nicola Davies is a Psychologist and writer with an interest in the psychology behind frontline work.