First Responders, National Holidays, and Couples Therapy

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We frequently hear ambulance sirens in our neighborhood, as the sound echoes throughout the streets of our Boston suburb and into our second-floor apartment, but they generally pass by, directed toward a hospital, fire station, or in a worst case, a scene of an emergency.

One afternoon this summer, the siren wails grew nearer to our house, nearer, until the flashing lights of ambulance vans and a fire truck parked outside our front door. I watched the following scene from the second floor, a la Jimmy Stewart: two men carefully yet efficiently strapping my landlord onto a gurney, a woman negotiating calmness to the landlord’s hysterical wife and direction to her even-tempered daughter. A team of paramedics receiving the gurney in the back of an ambulance van and quickly attaching my landlord to a number of monitoring devices, gauging his heart rate and blood pressure. Within about 10 minutes, they drove away, sirens blazing through our often impassable streets, where they dropped him off, whisked him into care of emergency room, and sped toward the next emergency, where I only imagine this stressful process of quick resuscitation and calming of family members got repeated dozens of times throughout an 8-12 hour shift.

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On Saturday, September 27th, communities throughout the nation shared end-of-summer picnics and gatherings in honor of First Responder Appreciation Day.

We’ll cut you some slack if you missed it. Only 19 states (including Massachusetts, but not including bigger states like California, Texas, New York, and Florida) have passed legislation identifying September 27th as a state holiday, signifying the overlooked, often thankless tasks of law enforcement officials, firefighters, EMTs, and others that arrive to scenes of emergency and tragedy offering order, support, and compassion to immobilized victims and communities.

Currently, the House of Representatives has a bill, sponsored by Massachusetts’ own Michael Capuano, that would require the President to designate 9/27 as National First Responders Day. This bill was introduced into the House at the end of February, where it has remained in the Committee on Oversight and Government Reform for the last seven months. Some legislators and civilians, including Andrew Collier, brother of Sean Collier, the MIT police officer who was killed on duty while tracking the Tsarnaev brothers following the Boston Marathon bombings last April, have attempted to press the House into moving this bill along. Andrew Collier writes on change.org, a site that invites citizens to support legislative petitions:

“We ask that our elected officials designate a national holiday to honor the brave professionals in the emergency response fields, including Police, Firefighters, and EMS. We’ve witnessed the bravery and heroism of these men and women time and again – running into the Twin Towers on 9/11; heading toward the sound of gunfire in Colorado, Connecticut, and too many other recent tragedies; and facing danger for our protection in every community, every day. We are now reminded of their bravery again after the tragic events that took place in Boston, Cambridge, and Watertown, MA.”

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Researchers at Johns Hopkins report that first responders who are exposed to traumatic events increase their possibility of experiencing post-traumatic stress symptoms, including physical ailments, avoidance, and flashbacks. First responders are also more likely to develop substance use addictions as they attempt to wash away the memories of seeing someone severely injured, having one of their colleagues killed, or seeing a dead body.

Too often, our first responders suffer in silence. Unfortunately, a stigma around receiving professional help exists in many first responder communities, as some risk losing their job or ranking following a PTSD diagnosis. Global News, a Canadian news source, reports that 23 Canadian first responders have committed suicide since April, a disturbing trend amongst many nations.

Anita DeLongis and David King, professors of psychology at the University of British Columbia, recently explored the internal suffering of first responders in the context of intimate relationships. In “When Couples Disconnect: Rumination and Withdrawal as Maladaptive Responses to Everyday Stress”, an article published in August’s Journal of Family Psychology, DeLongis and King evaluated the interactions patterns of 87 intimate relationships involving paramedics. The authors identify the term “rumination” as the passive, internal process of repetitive thinking about problems, and label burnout, the depletion of emotional and social resources, as the end result of perpetual rumination. Many first responders avoid burdening their partners with the stressors and chaos of their job, but still struggle to truly leave work at work.

DeLongis and King asked these couples to keep journals of their conversations at three points during the day: one hour after waking up, immediately after work, and before bed. They discovered days with greater work stress also involving greater levels of rumination during times before bed. Rumination seldom involved discussions explicitly about work, but carried over into worries about other areas of life, including finances and social obligations. Partners attempted to assuage the increase of worry in one of two ways: either by pursuing and trying to find solutions to eliminate the worry, often through criticism, or by distancing completely. DeLongis and King also discovered that paramedics struggling with burnout had a greater tendency to withdraw entirely, creating an impenetrable wall around their anxiety, exhaustion, and feelings of worthlessness. Partners’ responses, regardless of whether they pursued or distanced from their partners, seemed to exacerbate the process.

Working with emergencies creates an inordinate amount of stress for first responders, particularly when an outlet to discuss occupational stressors in a supportive environment fails to exist. DeLongis and King remind us, in line with other research, that first responders who found that safe outlet in the context of their intimate relationship reported a significant higher quality of intimacy, connectedness, and empathy from their partners.

Couples therapy can provide an opportunity to improve connectedness and intimacy by providing a space to share stories of stress, burdens, disappointment, and heroism. First responders experiencing high levels of stress and burnout may perceive that they have limited emotional energy to engage with their partner, or that if they do engage, their partner will share some of their negative self-thoughts and distance or not understand them. We’ve discovered, through creating a safe space to share experiences, that partners often move closer to their first responder when learning of their anxieties and vulnerabilities, providing compassion, empathy, and support for their significant other.

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