As a therapist who works with individuals who experience panic attacks, here are my top 10 things friends, family and concerned others should do (and not do) when someone is having a panic attack. – Charlotte Johnson, MA, LPCC
Police officers have high rates of heart disease and suicide and shorter life expectancy. Some might also suffer from what researchers call ‘compassion fatigue.’
Plymouth police Sgt. Jeff Dorfsman remembers he was eating dinner when a homicide call came through dispatch in the typically quiet western Twin Cities suburb. He and other officers on duty rushed to the scene.
Some officers provided cover while Dorfmsan administered first aid to the gunshot victim. He died anyway. Dorfsman said officers always have the potential stress of these sort of calls in the back of their minds. These are the calls that can jar him.
“It could be a sick child or a terminally ill patient or car crashes, it could be violence, and sometimes it’s just things you can’t unsee,” Dorfsman said. “Over time, that can be a difficult thing for some officers to process.”
Police work can be stressful and unpredictable. An officer never knows when something routine like a traffic stop can escalate into something traumatic. It’s a side of the job that not many civilians see or think about.
There’s growing concern in law enforcement that responding to traumatic calls over and over without mental health support can take a toll on officers’ well-being, and that built-up trauma can make it more challenging for officers and community members to rebuild trust between them.
Plymouth police officer Steve Thomas said cops traditionally have bottled up their feelings. After responding to calls about suicides, murders or child abuse, they’d be expected to suck it up and move on. But the Plymouth Police Department is at the forefront of providing support for officer wellness, and to giving officers tools to deal with that stress.
Thomas, who is one of the department’s designated wellness officers, said it’s typical now in Plymouth for officers to work through these calls after they happen.
“If there’s a traumatic incident, we always have debriefings of just the people involved in that incident. Nobody else can come in,” Thomas said. “Just so they can decompress and talk.”
Plymouth Police Chief Mike Goldstein remembers the first experience as a cop that really stuck with him. It was three decades ago, late in the afternoon. He was a rookie cop, patrolling alone for one of the first times, when he got a medical call.
Goldstein was the first to arrive at the home, which he says he can still pick out on the street.
“I was led to the crib and I started to try to resuscitate the infant,” Golstein said. “Then I felt a tap on my shoulder from a senior officer who, you know, was shaking his head. It was obvious that the child had passed.”
It was because of these sort of incidents, and the strain they put on career officers, that spurred Goldstein to launch the department’s officer wellness programs in 2012. The department now has four police trained as wellness officers and a part-time officer who’s a physician who mentors other officers. They’ve even got an in-house chaplain.
”We’ve done a lot to look at physical health, to look at behavioral health and to look at spiritual health,” Goldstein said. “We have programs from the time you walk into this department as a brand-new officer to the time you choose to retire.”
The department also now requires officers to meet with a behavioral health counselor at least once a year. Goldstein made that change after some officers had to take leaves of absence because of post-traumatic stress disorder.
“I really don’t care when you go in to talk to the provider what you discuss. You could stare at them for an hour, you could talk about the Minnesota Twins,” Goldstein said. “I just want them to establish a connection so that if something does trigger an emotional response and they need to talk to someone, they have a comfort level going in and they’re not starting from scratch.”
Before becoming a police officer, Mitch Martinson served in the military, where these sort of wellness services have been long established to help soldiers cope with trauma. He said the programs have helped his fellow officers understand that talking about trauma isn’t a sign of weakness.
“We would urge each other to seek help if needed,” Martinson said.
Wellness isn’t just about mental health. In recent years, the department has also built out a free gym for officers to use in the basement of the police station.
Plymouth police Detective Amy Goodwin was in the gym dead-lifting 205 pounds on a recent afternoon. She said the on-site gym gives officers an opportunity to blow off steam and talk about things other than their police work.
“It’s just a great way for officers to come down here, relieve stress and to be able to take the uniform off for a while,” Goodwin said. “We all do workouts together, so it also builds that team-building for us down here.”
This is something Goldstein emphasizes, too: Officers need to interact with people outside the profession and outside the sometimes stressful 911 calls.
“Try not to live, breathe, sleep and eat law enforcement. It’s unhealthy,” he said. “Remember: Most people are good.”
But not everyone was on board with the wellness programs right away. There was skepticism from older officers and the police union, Goldstein said. But over time, the wellness programs have become part of the culture of the department.
”They know it’s not going away. They know that it’s a benefit to them. If they don’t see it, their families do,” Goldstein said. “And I just want to promote it as effectively as we can so that it becomes contagious.”
Some observers, including Goldstein, see an explosion of interest in police officer wellness programs in Minnesota and across the country. Both the International Association of Chiefs of Police and the Department of Justice COPS program have launched programs promoting officer wellness in recent years.
At a time when fewer young people are being drawn to work in law enforcement, Goldstein, who’s 52, sees the wellness programs as a perk that may help recruit a younger generation of officers who have different expectations and fewer stigmas around issues of mental health.
“The curmudgeons that are out there, the crusty old guys,” Goldstein said, “I think that if they had an honest conversation, they would say, ‘I really wish we were doing this stuff 30 years ago because I would have benefited from it.’”
Researchers have found that police officers’ health is worse than many other professions. They have high rates of heart disease and suicide and a shorter life expectancy.
That’s partly due to the routine stresses of the job, said Daniel Blumberg, a professor of psychology at Alliant International University
“Some officers never even draw their weapon,” Blumberg said. “But all officers are going to be going to child abuse, domestic violence, fatal traffic accidents and just seeing some of the challenges of society.”
It’s not uncommon for large departments to have counseling available for officers. Blumberg said it’s about more than just supporting traumatized officers — but about city leaders appointing chiefs who put wellness at the core of their missions.
”It’s about everything from who you’re hiring, to how you train, to how you supervise implementing preventive measures,” Blumberg said.
The personal impact of stress on officers is well established. But there may also be a broader public interest in ensuring that officers mental health is taken care of. Blumberg said another thing clinicians see in police officers is what they refer to as “compassion fatigue,” which can also affect other first responders.
“It’s essentially the emotional toll taken by routinely trying to assist victims of trauma, and additionally for police officers, the futility that they often feel when it comes to preventing a crime or stopping criminals from hurting people,” Blumberg said.
“Compassion fatigue” can happen to police officers partly because of the demands of the job. Imagine an officer going from a call where a child was brutalized to a call where someone’s bike was stolen, he said.
”When you’re suffering significantly from compassion fatigue, the last thing that you want to do is connect with someone who’s in a lot of emotional pain,” Blumberg said. “So, that person comes to the scene, and is not being as helpful or supportive as that victim may need in the moment.”
Police and community relations are in the headlines all the time. Protests broke out across the country in recent years after police officers shot and killed civilians on the job.
That’s led to a climate where officers can feel like their actions are being closely scrutinized, said Jillian Peterson, a professor of criminology and criminal justice at Hamline University. She said providing mental and physical support for officers could be one way to start to rebuild trust between police and the communities they serve.
“We talk a lot about trauma that is sometimes caused by police interaction, which is a really important conversation. But I think we don’t talk as much about the trauma that police are being exposed to and how that’s impacting every interaction that they have,” Peterson said. “It’s to the public’s benefit, I think, to have these conversations.”
Mike Goldstein, the Plymouth police chief, said his goal is to make sure his officers stay healthy, so they can do a good job for their citizens.
“If I give them everything they need, they’re the ones that are then going to serve the community, they’re going to carry out our mission, and then everybody wins,” Goldstein said. “But if they’re broken, if they’re sick, if they’re not focused, if they’re stressed, then nobody wins.”
When we’ve survived an extremely upsetting event, it can be painful to revisit the memory. Many of us would prefer not to talk about it, whether it was a car accident, fire, assault, medical emergency, or something else.
However, our trauma memories can continue to haunt us, even — or especially — if we try to avoid them. The more we push away the memory, the more the thoughts tend to intrude on our minds, as many research studies have shown.
If and how we decide to share our trauma memories is a very personal choice, and we have to choose carefully those we entrust with this part of ourselves. When we do choose to tell our story to someone we trust, the following benefits may await. (Please note that additional considerations are often necessary for those with severe and prolonged experiences of trauma or abuse, as noted below.)
1. Feelings of shame subside.
Keeping trauma a secret can reinforce the feeling that there’s something shameful about what happened — or even about oneself on a more fundamental level. We might believe that others will think less of us if we tell them about our traumatic experience.
When we tell our story and find support instead of shame or criticism, we discover we have nothing to hide. You might even notice a shift in your posture over time — that thinking about or describing your trauma no longer makes you feel like cowering physically and emotionally. Instead, you can hold your head high, both literally and figuratively.
2. Unhelpful beliefs about the event are corrected.
Many people experience shifts in their beliefs about themselves, other people, and the world following a traumatic event. For example, a person might think they’re weak because of what happened, or that other people can never be trusted. When we keep the story inside, we tend to focus on the parts that are most frightening or that make us feel self-critical.
I’ve often been struck during my work with trauma survivors by the power of simply telling one’s story to shift these unhelpful beliefs. These shifts typically don’t require heavy lifting by the therapist to help the trauma survivor recognize the distorted beliefs. Instead, there’s something about opening the book of one’s trauma memory and reading it aloud, “from cover to cover,” that exposes false beliefs.
For example, a person who was assaulted might believe they were targeted, because they look like easy prey; through recounting what actually happened, they may come to see that it was due to situational factors (“wrong place, wrong time”), rather than something personal and enduring about themselves.
Telling the trauma story to a supportive therapist is one of the key components of Cognitive Behavioral Therapy (CBT), which is one of the most effective treatments for post-traumatic stress disorder (PTSD). I recently explored the latest findings on PTSD treatment research with psychologist Dr. Mark Powers, Director of Trauma Research at Baylor Scott and White Health. As we discussed, effective CBT typically doesn’t require an intensive examination of the survivor’s beliefs and evidence for those beliefs, as is often done in CBT for other conditions. Instead, insights about the truth of what happened emerge just through talking about what happened and what it means.
3. The memory becomes less triggering.
Revisiting a trauma memory can be very upsetting, triggering strong emotional and physical reactions and even flashbacks to the event. Those reactions can stay in place for years if we have unprocessed trauma memories, especially when we’re trying to avoid thinking about the trauma.
Through retelling the story of what happened, we find that our distress about it goes down. The first time, it’s likely to be very upsetting, even overwhelming, and we might think we’ll never be able to tolerate the memory. With repeated retelling to people who love and care about us, though, we find the opposite — that the memory no longer grips us. As Dr. Powers noted, we find that the memory no longer controls us. It will never be a pleasant memory, of course, but it won’t have the same raw intensity that it once had.
4. You find a sense of mastery.
As we talk about our trauma, we find that we’re not broken. In fact, as Dr. Powers pointed out, we can come to see that our reactions to trauma actually make sense. For example, it’s understandable that our nervous systems are on high alert, since they’re working to protect us from similar danger in the future.
Many trauma survivors I’ve worked with described the strength they found as they faced their trauma and told their story. They said they felt like they could face anything, as they saw their fear lessen and found greater freedom in their lives. It takes courage to tell your story, and witnessing your own courage shows you that you’re not only strong, but also whole.
5. The trauma memory becomes more organized.
Trauma memories tends to be somewhat disorganized compared to other types of memories. They’re often stored in fragments, disconnected from a clear narrative and a broader context. Existing research suggests that these differences are detectable in the brain, with unprocessed trauma memories showing less involvement of areas like the hippocampus that provide context to our experience.
Recounting the trauma begins to organize the memory into a story of what happened. We can see that it has a beginning, a middle, and an end, and that it happened at a specific place and a specific time. We can better understand the events that led up to it, and our own reactions at the time and in the aftermath. By putting a narrative frame around it, the memory can become more manageable and less threatening.
6. You begin to make sense of the trauma.
The biggest benefit from sharing our trauma stories may come from starting to make sense of a senseless event. “As humans we gravitate toward processing and trying to make sense of our experience,” Dr. Powers said, and that need is especially pronounced following a trauma. “That’s why treatment is often geared toward finding a sense of meaning.”
While PTSD treatment shares elements with the treatment of anxiety, such as phobias, Dr. Powers pointed out that it focuses more on meaning than does treatment for anxiety. “We don’t see the same type of drive to make sense of one’s fear in panic disorder or spider phobia,” he said. “The person doesn’t tend to say, ‘I really need to understand my fear of spiders.’ But that does seem to happen in PTSD, that our brains need to process what happened.”
Accordingly, effective therapy for PTSD includes not only revisiting the trauma memory, but also exploring its possible meanings. The meaning doesn’t come “off the shelf,” of course, but can only be arrived at by each individual. According to Dr. Powers, “At best we can help guide them through that discovery process.”
Important Considerations
It probably goes without saying that not everyone is the ideal person to share your trauma with. Some people may have a hard time hearing it based on their own trauma history. Others might respond with blame or criticism, or other non-validating responses. Choose carefully so that the person is likely to meet your story with understanding and compassion.
Timing is also important. It may take time before you’re at the point where you’re able to put the trauma into words. Be patient with yourself, recognizing that “not now” doesn’t have to mean “never.” Again, you get to decide when, where, and how you tell your story, which is a crucial part of owning the events of your life.
A Note About Complex PTSD
As noted above, the points raised here are based for the most part on work with discrete types of trauma — for example, a one-time car accident or violent assault. Other considerations may be necessary for those experiencing more complex forms of PTSD, such as those with a history of severe childhood maltreatment. The National Center for PTSD provides additional information on complex PTSD.
When we think about posttraumatic stress disorder (PTSD), it’s typically in the context of active duty service members and veterans—for good reason. Dangerous and potentially traumatic situations are common occurrences in the context of military service. However, it’s important to note that PTSD is not exclusive to this type of trauma.
In the U.S., about eight million people experience PTSD. While any traumatic experience can lead to PTSD, there are a few types of trauma that are the most common. Examples include sexual assault/abuse, natural disasters, accidents/injuries to self or other, or being in a life-threatening situation. When you consider these examples, it’s understandable why people would associate PTSD most frequently with military service members. However, this assumption can be problematic.
If people believe that only service members and veterans can develop PTSD, the recognition of symptoms and treatment can be delayed. The fact is: Anyone can develop PTSD when they experience or witness a traumatic event—adult or child, man or woman. Anyone.
About 50% of all people will go through at least one traumatic experience in their lifetime. But not everyone will develop PTSD. In fact, the majority won’t. However, it can be difficult to distinguish between the typical symptoms that follow a traumatic event and when it has reached the point that a condition like PTSD has developed.
It’s common for people who experience trauma to have nightmares or flashbacks for a few weeks and then gradually improve. It’s when those symptoms don’t improve and begin to interfere with a person’s life that a mental health evaluation should be considered. A person who experiences the following intense symptoms for more than a month may have PTSD:
It’s important to note that PTSD-related symptoms may not occur immediately after the traumatic event; they may not surface until weeks or months afterwards. Another major, key difference between typical reactions and PTSD is that while most will remember the fear they felt during trauma, PTSD can cause a person to actually feel as if they are reliving that fear.
If a person feels supported by friends and family after a traumatic event, it can reduce the risk of developing symptoms of PTSD. It can also be helpful for a person to join a support group, so they can share their thoughts, fears and questions with other people who have also experienced trauma. Using healthy, positive coping strategies—such as exercise, mediation or playing an instrument—can also be helpful.
If symptoms persist, it’s essential to seek treatment. Those with PTSD typically respond better to structured therapies such as:
If you or someone you know is having a difficult time coping with trauma, these interventions can make a huge difference. PTSD is treatable. It’s more effective if treated early, but it’s never too late to get treatment no matter how long ago the trauma occurred.
Trauma is a part of life—it affects most people at some point. But that doesn’t mean it’s a mundane experience that can be ignored or brushed off. The key is to check-in on symptoms and seek care from a mental health professional if they persist.
Whether you’re a military service member, veteran, salesperson or elementary school student, PTSD has the potential to develop in any of us. And if it does, please know that help is available. No one should face PTSD alone.
Laura Greenstein is communications coordinator.
https://www.nami.org/Blogs/NAMI-Blog/November-2017/PTSD-and-Trauma-Not-Just-for-Veterans
