1. The first and most important step in decreasing your symptoms is to realize that PTSD is a common response to trauma. You are not going crazy, although you may feel as though you are. Talk to other rescue workers who have had the same experiences that you have had. Discover, for yourself, that other workers have had similar reactions. Finding that others have had similar intense feelings and a distorted sense of time, vision, and hearing, can help to reassure you.
2. Talk, talk, talk. The more you talk about the trauma and your reactions, the less power they seem to have over you. Being able to talk about the reactions helps alleviate the guilt and allows you to “let go” of the intense feelings you may be experiencing. This is often difficult, since talking may cause flashbacks. It is also difficult, because most workers do not want to traumatize family members by letting them know the horror experienced in the rescue work. Research indicates that talking about traumatic events increases the immune functioning of your body. Create support groups with other rescue workers. Debriefing was created as an avenue to help law enforcement officers and fire fighters and other rescue personnel to talk about the traumatic incidents encountered on the job. Have your peer support officer use the Level One questions, listed on this website, to help you and your group process the traumatic memories of your rescue work.
3. It may help to avoid the “anchors” or “triggers” that automatically remind you of the trauma. An anchor can be a smell, something you see, hear, or feel. An anchor can be positive, such as the smell of baking homemade bread reminding you of a loving mother. Anchors into trauma, however, can increase the symptoms of PTSD. It will be very difficult for many workers, especially those working in New York and near the Pentagon, to avoid the skyline changes that may trigger traumatic memories. However, avoiding reminders of the trauma of the rescue work, as much as possible, can help to reduce symptoms. Some rescue workers may become obsessed with information about the terrorist attacks (this was common in OkBomb). Becoming so obsessed that the only subject the rescue worker wants to talk about, read about, and think about, is the terrorist attacks, is a symptom of being traumatized and stuck. If someone you work with is stuck, try to get them to recognize their symptoms and to do something about them.
4. It is common for a rescue worker, who has had a close call with death, to think seriously about quitting their job or retiring. Before the terrorist attacks, their job may have been their whole life. It is important that the rescue worker deal with the symptoms of PTSD, through the newer therapies (and/or repeatedly listening to the CD), before making a final decision on leaving a job they used to love. Many rescue workers, law enforcement officers and fire fighters, have left their jobs because they were in PTSD, believing that their symptoms would then go away. Most found that this was not true; symptoms of PTSD are a result of brain changes caused by the stress hormones that increased dramatically during critical events. They require specific therapeutic techniques to change them, like the alternating stimulation on the CD review of memories of the rescue work or seeing a therapist trained in EMDR. Since many rescue workers find the relationships at work to be one of the primary reasons that they like their jobs, leaving deprives them of these relationships. There are few jobs that have the close comradery common in fire fighters and law enforcement officers. Before you leave a job that you used to love, find a way to eliminate your symptoms of PTSD.
5. Exercise has been found to be valuable in helping to lift depression and symptoms of PTSD. The blood flow through the brain in aerobic exercise (such as jogging) may help to change chemicals in the brain which are causing symptoms, especially depression. Exercise will not eliminate PTSD, but may help with the intense feelings associated with it. Form a running or exercise club with other rescue workers so that you can encourage one another to exercise.
6. Touch has been shown to be the one of the most important factor in re-regulating a body after trauma. Tell the important people in your life that you need hugs and touch, during this time. Reach out to others and pat their back, touch their arm. Nothing makes someone feel more alone, that having no one that cares enough about them to touch them. Do not be embarrassed to get massages; research has shown that they can help to reduce the stress responses in your body. Go to a church or religious group where hugs are common. If you have children, make sure you find ways to hug them and pet your dogs, too.
7. Consider medication. There are a variety of medications which can reduce the symptoms of PTSD, because they quiet down the part of the brain which is over-stimulated. These medications can be taken for short periods (3-9 months) or until a particularly difficult period has passed — such as the remaining work on the World Trade Center (such events keep the memories alive in the mind and can increase symptoms). Prozac, Zoloft, Effexor and, some of the newer anti-depressants that work on the over stimulated part of the brain, may be helpful. Xanex is not recommended because of research that indicates it can increase anxiety to a higher than original level when it is terminated. Caffeine or other stimulants can also, increase the symptoms of PTSD.
8. Be very careful about using alcohol to decrease your symptoms. Alcohol will numb parts of the brain which are over-stimulated. This will temporarily make you feel better. However, alcohol will soon become its own problem, because it will take a good deal of alcohol to keep symptoms of PTSD numbed all day and night. If you are having symptoms of PTSD, adding alcoholism to them will make them (and all the problems in your life) much worse. Don’t do it.
9. Because the symptoms of PTSD will often cause an individual to feel dead inside, to withdraw from family members, and to stop wanting to do anything that is fun, relationships with significant others, can easily get into trouble. It may be that trauma increases the levels of testosterone in a male; as a result, he is thinking about sex much more than before the rescue work. Divorces in law enforcement are extremely common, perhaps for this reason. The pulling away from those you care about at the same time you are thinking much more about sex, can lead to affairs and sexual activity that can destroy relationships which were important to you, in the past. The loss of the people you care about can make your problems even worse. Take care of the symptoms related to being traumatized; having affairs will not get rid of your symptoms. Just as alcohol abuse will make your problems worse, so will affairs.
10. If you lost co-workers, friends, family members in the terrorist attacks, you will be experiencing grief, along with any symptoms of PTSD that you may have. Grief and PTSD have very similar symptoms in the beginning. Grief is a normal reaction to the loss of someone who helps to define who you are. Grief commonly takes at least two years before it begins to decrease. However, if you are having symptoms of PTSD related to the loss of those you care about, your grief will not process; it will become frozen. It is important that you find ways to let go of the traumatic images and flashbacks related to the loss of those you cared about, so that your grief can process and you can retrieve the positive memories of these relationships.
11. There are a variety of new techniques which research has proven often quickly decrease or eliminate symptoms. Eyemovement Desensitization and Reprocessing (EMDR), Touch Field Therapy, Traumatic Incident Reduction and Neurolinguistic Programing (NLP) are three of them. Dr. Charles Figley, a researcher with the University of Florida, has recently tested these methods and found EMDR to be the most effective, of these three, for quick reduction in symptoms. EMDR is followed in effectiveness by the other three. These techniques may take as little as one long session to eliminate trauma symptoms and flashbacks from your rescue work. It is unclear how these therapies work, although there are several theories. You may locate therapists in your area trained in EMDR through the EMDR Institute website. The other three therapeutic techniques and names of therapists may also be located through websites.
12. If, in addition to being a rescue worker, as a child or adolescent, you experienced long-term physical, sexual and/or emotional abuse, the death of a parent or other very significant traumas, therapy that combines the newer techniques to reduce symptoms of trauma with Cognitive Therapy (or talking) is extremely helpful in reducing the impact of future traumas. Remember that unresolved traumas can piggyback onto present traumas, causing symptoms to be much more extreme than those of someone who did not experience trauma when growing up. Resolving past traumas is a way of preventing extreme symptoms related to future traumas.
13. Especially for the rescue workers from New York City, it is important to recognize that spouses and family members of lost co-workers will probably have symptoms of PTSD. Most watched the buildings collapse on their television sets. These images and others surrounding the death of their loved ones will be frozen, as flashbacks, in their memory. They will continually replay them, and this will keep their grief from processing, as well. Have your professional organization locate the best therapists in dealing with grief and PTSD to help these survivors. Make sure they get to therapy. One of the best things you can do for them is to encourage them to find ways to get out of PTSD. The emotional functioning of the children of your co-workers will be directly related to how well the remaining parent deals with the loss. If you want to help the children, start by helping the parent. It will also help to take the children to your family gatherings, and work with them in sports, home work and other activities. Grief will pull the spouse of the co-worker who died, into him/herself. When this happens, their children will feel like they have lost both parents. Be there for these kids until the parent begins to come out of their grief (usually two years or more).
14. Although this has to be extremely difficult, try to find something that you learned from this experience that was positive, something that will make you stronger or feel better about your fellow human beings or the United States. Helping other traumatized rescue workers, and the families who lost a loved one, has often been healing for both parties.
Remember that Post Traumatic Stress Disorder is a common reaction to trauma. PTSD is common in rescue workers who work in horrific and traumatic scenes where many people died, where there are body parts, where they know some of the people who died and where the conditions are extremely difficult. Trying to deal with these common biological reactions by pretending they don’t exist and not talking about them, is one of the primary reasons that the symptoms persist or even grow more severe. The more techniques you use to lessen the reactions to your trauma, the quicker these reactions will disappear.
