MANAGING STRESS AT WORK AND HOME

BY MIKE McEVOY, Ph.D., REMT-P, RN, CCRN

The same personality characteristics that attract firefighters to the fire service, such as the ability to perform under pressure, and that help them to be effective firefighters also have a negative side. They increase stress on the job and can ruin relationships at home.

We all know someone who consistently seems happy and cheerful. Have you ever wondered how it is that such people maintain such a positive outlook on life? The answer is very simple: Happy people choose to be happy. They recognize stress in their lives and control their response to it. In the same way, miserable people choose to be miserable. Explanations for how and why people make these choices are rooted in the definition of stress.

WHAT IS STRESS?

The first obstacle in effectively dealing with stress is a lack of understanding of exactly what stresses us. Hans Selye, a researcher considered by many to be the father of stress management, defined stress as a response from our bodies to any demand for change.¹ This response is both physical and psychological, leading to Selye’s theory that continued high levels of stress lead to illness, then to disease, and eventually to death.

The American Psychological Association reports that stress costs American industry $300 billion each year in absenteeism and lost productivity.² Overstressed individuals take sick days at work more frequently, have trouble sleeping, tend to abuse drugs or alcohol, overeat more often, have increased relationship troubles (including fighting with others), suffer more depression, and often exhibit avoidance behaviors such as quitting jobs or job hopping. If you see these symptoms in yourself or others, they may well be stress related. (2)

Some level of stress is necessary for people to be productive. People with no stress whatsoever are dead. Preventing very high levels of stress is the art and science of stress management.

The second challenge when dealing with stress is to recognize that stress is not an event but rather our reaction to an event. This concept is important and explains why different people experience different levels of stress from the same event. Your spouse, dog, boss, child, or car is not a stressor. Stress is your reaction to these people and objects and the happenings they bring into your life.

None of us react to a situation in the same way; therefore, the level of stress each experiences is different. An interesting study of self-reported stress levels in skydivers showed that veteran skydivers experienced nearly opposite levels of stress than novices beginning the night before a planned jump through parachute deployment and landing.³ Although it has never been studied, I am confident that similar observations could be found in a comparison of probationary and seasoned firefighters as well.

If you think about events that cause you to react with stress, you typically think only of negative happenings. This leads you to exclude a number of life events that are equally stress producing. All of us would consider such things as being fired from a job, getting a pay cut, suffering the death of a friend, or being involved in a motor vehicle crash as life events that lead to stress. In fact, getting married, buying a new home, retiring, having a new baby, going on vacation, and even ensuring the holidays can have an equally significant impact on our lives in terms of stress.

Firefighters have a stress management opportunity here. All of us have some internal stress limit beyond which we would not be able to function psychologically. At the same time, firefighting is an occupation that has a tremendously variable and totally unpredictable pattern of responses. You can never predict when you may be called to a motor vehicle crash with multiple fatalities or when you may see a person burned to death. It is important that you recognize this “on-the-job potential for stress” and leave some room in your life for accommodating a sudden surge in your stress level. Consider the life events mentioned earlier. Which could you predict or even control? It would be unwise for any emergency services worker to plan a wedding, move to a new home, buy a new car, and take a vacation all in the same week. Take advantage of the life events you can plan; schedule them so that you leave some room for unpredictable events that might occur on the job. You’ll find that you will be much better able to deal with the unplanned occurrences in your life.

ARE FIREFIGHTERS DIFFERENT?

Jeff Mitchell, a psychologist known for his work in developing critical incident stress debriefing (CISD) programs, once speculated that firefighters have a personality different from that of the ordinary citizen.⁴ Mitchell’s research on this topic has never been scientifically validated,^5-6 but it has been consistently recognized as a personality framework for numerous high-stress occupations. Table 1 lists some of the personality characteristics that Mitchell attributed specifically to rescue workers. To highlight what I consider to be the overall difference in personality between a firefighter and an ordinary citizen, I have labeled this personality the “adrenaline junkie.”

Firefighters tend to enjoy most those experiences that get their adrenaline flowing. Inter-estingly, it would appear that 90 percent of the population has an opposite point of view: They do not like high-stress experiences.

Often, individuals in high-stress occupations are not aware that the average citizen doesn’t enjoy the same adrenaline rushes they do. If you’ve ever had a friend or neighbor tell you that he admires your ability to deal with danger or blood and guts and is certain he could never be a firefighter, he is telling you the truth. It is quite likely that 90 percent of the population I categorize as ordinary citizens would be completely unable to function as a firefighter or in any other high-stress occupation.

A classic example is the following analogy. Consider the reactions of a driver when a deer suddenly darts in front of his car. After swerving several times, nearly running off the road, skidding around in a complete circle, and finally bringing the car to a controlled stop, how might ordinary citizens react? Most would probably shake uncontrollably for several minutes, slowly drive home, and leave the vehicle in the driveway for at least a few days before they get the nerve to drive again.

Many firefighters, on the other hand, would be likely to think the whole escapade was fun and perhaps the most enjoyment they’ve had all week-hence, the label “adrenaline junkie.”

Other unique characteristics seem to accompany this adrenaline-driven personality. Firefighters appear to be particularly attentive to detail in many aspects of their lives. “A place for everything and everything in its place” is a motto that often characterizes firefighters.

Firefighters are control-oriented individuals, seeking to always understand and take charge of their environment, the people, and the things around them. They do not like to be told what to do. In a crisis, control-oriented people provide smooth, effective operations and safe resolution of dangerous situations.

Firefighters are histrionic people: They have a strong need to be needed and take pride in being identified with a department or organization. Histrionic people enjoy seeing themselves in the newspapers and on television.

People in high-stress occupations often recreate in action-oriented ways. Their risk-taking behavior follows them from work into their leisure time. Firefighters tend to have equally dangerous hobbies such as racing cars or motorcycles, mountain climbing, parachuting, and the like.

Firefighters are highly dedicated people and have a strong commitment to their jobs, tasks, and projects. They are also very family oriented, which may seem strange at first. Perhaps you’ve been told that you often ignore your family. In truth, however, firefighting is often a family tradition handed from generation to generation. Compare firefighting with other occupations, such as accounting. If an accountant died on the job, would a huge contingent of brother accountants attend the wake and funeral? The answer is obvious. Firefighters belong to a huge family of fellow firefighters that extends throughout the world.

Having high expectations is another characteristic of firefighters. They expect perfection from themselves and tend to hold those around them to the same high standards. Finally, firefighters are more rescue oriented than ordinary citizens. A firefighter is more inclined to stop and help a stranger in trouble.

TRAITS THAT HELP ALSO HINDER

Different personality characteristics actually help to make you a good firefighter. Having a take-charge attitude, a penchant for doing things in an organized and detailed manner, a certain degree of fearlessness, a high degree of dedication to the job, respect and concern for fellow members of the fire service family, and the highest standards and expectations all combine to produce exactly what the public needs in an emergency response. Although these traits make you helpful to others, they can sometimes be harmful to you on the job and at home.

Being oriented to control and having high expectations are two such traits. As a control-oriented person, you prefer to be in charge and are an independent thinker. You don’t take direction well and are difficult to supervise. Sound familiar? In truth, control-oriented people comprise a significant proportion of people categorized as “difficult people.” Not surprisingly, nearly all troubles at work revolve around issues of control. Control-oriented people can also have problems in their relationships. A relationship problem coupled with job-related stress can lead to isolation. In fact, isolation is the most common cause of stress at home for firefighters. Sadly, being dep-rived of meaningful contact with those we love adds even greater stress to our lives.

Anger, frustration, and burnout are the results of work-related stress, which often begins with problems we seek to control but have no ability to change or affect. It is important that you consciously evaluate which facets of your job and work life you can control and those you cannot control. Let go of those issues that are beyond your control. Doing this will considerably reduce your stress level. This is not to be construed as advice to quit a job that causes you a great deal of anger and frustration.

There are positive and negative ways to handle conflict; withdrawing, quitting, surrendering, and performing acts of hostile aggression are examples of negative, and unhelpful, strategies. All increase rather than decrease stress levels. Examples of positive strategies for handling conflict include persuasion and open dialogue.

Continually expecting to be perfect can lead to poor self-esteem. The constant flawlessness you expect from others makes you quick to criticize. Be constantly vigilant for high expectations. Maintain-ing your self-esteem is critical. Negative thoughts will produce negative results. Fight negative self-talk that creeps into your mind. Recognize that “should have” is a form of negative thinking, as is comparing yourself with others. Learn to say no to such activities. Instead, focus on your assets. Avoid placing blame, being pessimistic, feeling victimized, and striving to be a perfectionist. Remember also that you are not alone in the high-expectation personality group. Negativity is extremely contagious in the fire station. Any outbreak will quickly spread! Keeping a positive outlook in your own mind helps, and helping others to fight negativity will keep your environment more positive.

STRESS FROM MAJOR INCIDENTS

A “normal” individual exposed to an extremely unusual event can be expected to develop some psychological symptoms. The mental health profession first saw this constellation of symptoms in soldiers returning from battle and labeled it “post traumatic stress disorder” (PTSD). Firefighters often experience these same symptoms from extremely unsettling runs, which I’ll refer to as “critical incidents.” More recently, the name “acute stress disorder” has been applied to the immediate time period following a critical incident. Its symptoms are virtually the same as those for PTSD. Fire service instructors, mentors, and leaders must educate new members and recruits about the symptoms of PTSD. Without some warning, firefighters may believe that their emotional reaction to a serious incident is abnormal and signifies an inability to handle occupational stress. Nothing could be further from the truth. Any normal person exposed to a significantly upsetting situation can develop symptoms of PTSD; firefighters are no exception. A firefighter may experience symptoms after seeing for the first time a dead body after a particularly gruesome motor vehicle accident. Symptoms may also result following a serious and dangerous fire operation.

No amount of experience prevents a person from developing PTSD symptoms. Experience on the job teaches us that we are all human and that the symptoms we develop following a critical incident normally fade with time. Not every person involved in a critical incident will develop PTSD symptoms for the simple reason that we all react differently to life experiences. What constitutes a critical incident for one firefighter may not be of significance to another. When we are affected by a critical incident, the symptoms typically last from two to three weeks. In addition to educating new members on the symptoms of PTSD, it helps to let them know that veteran members of the department are also affected by serious calls.

Table 2 lists some of the most common PTSD symptoms. Each can be categorized as being part of one of three distinct changes:

• Continual reliving of the critical incident. Sights, sounds, smells, and sensations are more clearly imprinted in the mind of a detail-oriented firefighter than that of the average citizen. Nightmares, flashbacks, and other intrusive images cause the individual to continually reexperience the critical incident, making it difficult to get it out of his mind.
• Feeling numb or detached. Emotions seem disconnected, and it becomes very difficult to enjoy life. Often, the firefighter may feel withdrawn, experience a lack of appetite, and lose interest in sex (decreased libido).
• Experiencing anxiety. The firefighter feels nervous, is jumpy, and has trouble concentrating. Memory is often impaired. Sights, sounds, or smells that bring the event back to mind (symbols) greatly increase the symptoms. Some people become extremely irritable and have angry outbursts with little or no provocation.

There is no magic cure for PTSD or acute stress disorder. It is important to provide support and show concern for firefighters affected by critical incidents. Some departments use CISD teams to help firefighters recover from the effects of critical incidents. The CISD teams consist of several trained peer-support personnel and a mental health professional. They lead a group discussion of the critical incident and its effects on the firefighters. The session is not considered therapy or counseling. It follows a format that encourages participants to discuss the incident and its effects on their lives, acquaints them with the symptoms of critical incident stress, and focuses energy on returning to service emotionally. CISD teams have been in existence for nearly two decades in many areas; their use has placed debriefing skills in the hands of many leaders and fire service officers, who probably debrief informally without the aid of organized teams.

Nonetheless, firefighters with symptoms significant enough to disrupt their ability to work or who experience PTSD symptoms beyond a two- to three-week period should be referred to a mental health professional for evaluation.

RELATIONSHIP STRESSORS

Relationship stressors may result from the firefighters’ personality or the nature of their work. Other high-stress occupations, especially those public health and safety professions that require round-the-clock staffing, share some of these work-related relationship stressors.⁹ The work schedule-variable hours, shift work, on-call rotations, and the inclination to work additional hours because of dedication to the job-is often the first and most significant source of relationship stress for the firefighter.

Loyalty is another relationship stressor. Although most firefighters would say that their loved ones and family come first, their behavior does not always reflect that. A further complication for the firefighter is the extended family of the fire service, which significantly divides loyalty.

Danger, a relationship stressor frequently mentioned by family and loved ones, does not always occur to firefighters. Today, it is recognized that there are new and ever-increasing dangers in all of the public safety professions, particularly firefighting. Even routine responses can suddenly turn sour. There is no longer a relatively safe firefighting job.

Finally, negativity is commonly mentioned as a significant relationship stressor. Negativity can be manifested in two ways. Firefighters carry their high expectations into their personal life and relationships. Negativity results when toxic thoughts and critical analysis of others appear in personal interactions. Emotional stress on the job also causes firefighters to bring negativity into the home. Constantly caring for other people is draining and can leave firefighters tired, irritable, and low on emotional energy.

The word understanding summarizes the major issue in relationships between firefighters and their significant others. Firefighters believe that their loved ones don’t understand them or their firefighting career; their loved ones believe that firefighters do not understand their needs and interests. It seems sensible for firefighters to want to protect those they love from the stresses of public safety work. Unfortunately, attempts to isolate family members from a firefighter’s stress often send the exact opposite message. In relationship counseling, about half of all problem behaviors between couples are found to be caused by a lack of feedback. Without clear feedback and communication, firefighters’ significant others will believe that something they did resulted in the firefighters’ behavior toward them.

IMPROVING FIREFIGHTERS’ RELATIONSHIP SKILLS

Better communication is the key to better relationships and a less stressful home environment. For firefighters, better communication involves improved listening skills and greater self-disclosure. Listening does not always come easily to firefighters, yet they already have the needed skills. The goal is to listen to others with the same attention you listen to your radio at a fire scene. Eye contact, paraphrasing what you think you heard back to the speaker for clarification, and avoiding bias or preconceived notions are all components of good listening. Arguments are clear evidence of failed communication; so are dismissive statements such as “Yes, dear…” Silence is a means of avoiding communication and sends negative feedback to others.

When problems arise, they need to be addressed. Behavior not discussed will never, ever change. The best way to open discussion about a problem would be for you to say what is bothering you and why; explain the feelings involved. Suggest a change or solution, and ask for feedback-for example, “Paging me seven or eight times each day while I’m at work bothers me. I feel out of control, embarrassed, and anxious. I’d like to suggest that I call you twice a day. You could always page me if you have an emergency. How does that sound to you?”

Greater self-disclosure builds better and stronger relationships. It is risky to talk about yourself and share your secrets with others, but this is exactly how bridges are built between people. The tough shell you use at work is not for use at home. Letting your family members know that you need them is an important message to convey. Making sure that you reserve time together is essential to keeping relationships alive and growing.

Improving Relationship Skills for Significant Others

Someone involved in a relationship with a firefighter must understand the basis and nature of the relationship. It may not always be possible to help firefighters deal with stress, but building a supportive and helping relationship that promotes better communication would be very helpful.

Firefighters are control-oriented individuals who tend to be sensitive to criticism. It is helpful for the loved one to show interest in what happens at work, and it is imperative to keep the doors open by listening empathetically, to try to hear the feelings behind the facts and to avoid judging or second-guessing the situation. If there are issues or needs you think need to be addressed, be sure to mention them. Behavior never discussed or confronted will never change.

Supporting the decisions your partner makes and expressing your confidence in his/her ability to solve problems are incredibly helpful. Firefighters’ self-esteem is fragile as a result of the extremely high expectations they apply to themselves and others. They get frequent criticism and probably very little credit for what they do each day. Supportive messages can never be given too often! Reserving time together, regardless of how busy both partners may be, is critical to keeping shared interests and open communication.

As indicated, some of the keys to managing stress include recognizing and letting go of those things you are unable to control, keeping a positive focus, and consciously trying to abandon negative thinking. Also, keep in mind that improved communication leads to better relationships with the people in your life. Making your loved ones aware of the stresses and demands of your job as a firefighter can help you to build bridges and decrease isolation.

References

1. Selye, H. Stress Without Distress. (New York: Harper & Row, 1974).
2. “Stress: How and when to get help,” American Psychological Association, Washington, D.C., 1997.
3. Fenz, W., S. Epstein, “Gradients of physiological arousal in parachutists as a function of an approaching jump,” Psychosomatic Medicine; 1967, 29:33-55.
4. Mitchell, J.T., “Living dangerously: Why some firefighters take risks on the job,” Firehouse; 1986; 11:50-51, 63.
5. Brown, A, Letter to the editor, Journal of Emergency Medical Services, Nov. 1996; 21,10-12.
6. Mitchell, J.T., and G.S. Everly Jr., “The scientific evidence for critical incident stress management,” Journal of Emergency Medical Services; Jan. 1997, 22, 86-93.
7. Adapted from Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision. American Psychiatric Association. Washington, D.C., 2000.
8. Adapted from “Posttraumatic Stress Disorder,” American Psychiatric Association, Washington, D.C., 1997.
9. Shelton, J, J. Kelly, EMS Stress: An Emergency Responder’s Handbook for Living Well. (Carlsbad, Calif.: Mosby, 1995).

MIKE McEVOY, Ph.D., RN, CCRN, REMT-P, is the EMS coordinator for Saratoga County, New York; a paramedic for the Clifton Park-Halfmoon Ambulance Corps; and the medical advisor for West Crescent Fire Department. For the past 13 years, he has worked in the Cardiac Surgical ICU at Albany Medical Center. Previously, he was a forensic psychologist with the Department of Justice. McEvoy is an instructor at Albany Medical College and lectures extensively at hospitals and colleges and at EMS, fire, and police conferences. He is a member of the New York State EMS Council and the State Emergency Medical Advisory Council and chairs the EMS Section of the New York State Association of Fire Chiefs. He presented on the topic of firefighter stress management at FDIC 2002.