As a licensed trauma therapist, I've had the privilege of working closely with first responders and I've seen how overlooked one element of the profession is: cumulative stress. It's something that all first responders should be aware of as they're starting out their service as it's an unavoidable part of the job. I've seen the stigma around mental health getting in the way of individuals who are struggling seeking support within the first responder community. In addition to being a therapist who specializes in trauma, I'm also a first responder spouse, so I'll share a few things that may be helpful for partners and families to look out for.
What is Cumulative Stress?
Cumulative stress, also known as cumulative trauma, refers to the gradual build-up of stress over time due to the repeated exposure to traumatic events or high-stress situations. We all have a normal stress response to situations like this, however, over time the stress from witnessing accidents and deaths, responding to emergencies, hearing the details of people's worst moments, or experiencing violence firsthand accumulates over the months and years. This stress can build and present in ways that we may not notice or name as 'stress'.
A normal stress response happens when a healthy adult experiences a single-incident traumatic event. If they have adequate support and most areas of their life are healthy, they will more than likely experience difficult memories, wanting to isolate or be alone, and some emotional avoidance that should resolve itself in several weeks. This is a normative response to a one-time trauma. Our brains are meant to keep us surviving, so having the space and support to process one traumatic moment typically won't result in longer term changes. However, the more we're exposed to, the more our neurophysiology shifts as a result of these experiences.
An acute stress response is more common when an adult has experienced more than one exposure to a traumatic event. These symptoms tend to last from three days up to a month. You may notice feeling irritable, agitation, anger, fear, panic, sadness, feeling numb, shakiness, nausea, and dizziness.
Post Traumatic Stress happens when things go beyond that first month. Some of the signs are intrusive memories and sensations, avoiding internal or external reminders of the traumatic event(s), negative thoughts and mood, and hyperarousal.
Complex Post Traumatic Stress happens when there is repeated, prolonged exposure to traumatic events. Complex trauma can also happen when adults have experienced developmental trauma (or chronic stressors or abuse in their childhoods). Some of the signs are intrusive memories and sensations, emotion dysregulation, avoidance, dissociation, problems in interpersonal relationships, inaccurate or negative beliefs, and health issues.
Impacts of Cumulative Stress on First Responders
This buildup of stress overtime due to the nature of the job can create a wide range of mental health difficulties. In addition to the progression of trauma symptoms, cumulative stress can also lead to anxiety, depression, and burnout. The constant exposure to trauma overtime can erode one's resilience and coping strategies, making it increasingly difficult to manage stress effectively.
The toll of cumulative stress isn't just limited to mental health, it can also manifest physically. First responders may experiences symptoms like headaches, insomnia, gastrointestinal problems, and cardiovascular issues due to the prolonged activation of the body's stress response system.
This emotional burden carried by first responders can also impact personal relationships. It can make it difficult to communication effectively, whether that's reactivity or withdrawal, and increase conflict within relationships. The impacts on social relationships can also create it's own issues, as our support systems are one of the tools to deal with stress.
High levels of cumulative stress can also impair cognitive function, decision-making abilities, and job performance among first responders. This is all the more reason for cumulative stress to be talked about and planned for early on, so that when the signs show up, first responders can have the space that they need to process the buildup of traumatic events.
Managing Cumulative Stress
Take a moment to think about what you typically do for yourself when you're stressed, ways that you can manage that stress without involving anyone but yourself. We all need to have ways to cope with stress and care for ourselves that we can do entirely on our own. It's beneficial for first responders to find both short and long term stress relievers. Short term stress relievers are things that can be done in a moments notice, like breathing techniques. Long term stress relievers require a bit more time and planning, like workouts or travel. Building a self-care plan with activities that provide relaxation and enjoyment can help mitigate the effects of cumulative stress.
A sense of community and connectedness is another way to combat cumulative stress. This can consist of your family relationships and close friendships, as well as the first responder community. Peer support programs through departments and buddy systems in other organizations can be ways to create a safe space for first responders to share their experiences, seek guidance, and receive support from colleagues who understand what it's like. Building a strong support network can foster resilience and reduce feelings of isolation.
Looking for trauma therapy and working with a licensed therapist who specializes in working with trauma and first responders can be another way to decrease the cumulative stress. Therapy can provide first responders with the tools to regulate their nervous systems and the resources to do trauma focused counseling to reprocess the difficult calls and traumatic moments that first responders witness. Brainspotting is a tool that I use with my first responders to allow them to decrease the intensity of emotions, thoughts, or beliefs associated with the buildup of stressors so that they can actually reduce the amount of accumulation.
Warning Signs of Cumulate Stress
So aside from the symptoms of traumatic stress that I mentioned above, what else might be helpful to look out for? Whether you are a first responder yourself or you love a first responder, these are some helpful signs that it may be time to increase your stress management and support:
Irritability
Less interest in things that you typically enjoy (hobbies, exercise, etc.)
Lashing out or shutting down more easily
Changes and difficulties with sleep
Appetite changes
Wanting to be alone or around other people less
A negative perspective that feels hard to shake (i.e. seeing the worst in others)
Feeling like you get 'set off' easily
Physiological changes when a stressor isn't present (increased heart rate, rapid or shallow breathing)
Difficulties with situations where you don't have as much control (i.e. large crowds)
The earlier first responders are able to start unpacking the buildup of stress, the more sustainable their careers are. There is nothing wrong with anyone who starts to have a difficulty with the accumulation of stress, it creates changes in our minds and bodies which are a normal reaction to the stress. There's also nothing wrong with taking care of ourselves so that we can continue to enjoy and participate fully in our lives.
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If you're interested in dealing with the buildup of stress, looking for trauma therapy in San Diego or throughout California, reach out today to schedule a free 15-minute consultation call. I would be happy to see if I would be a good fit for you, and if not, I would love to help find you the person who is.
Take care out there.
Hi there. I’m Gabrielle Kawashima, a Licensed Clinical Professional Counselor and Brainspotting Therapist. I have a passion for working with childhood and complex trauma, people who've learned to prioritize others over themselves (helpers), and working with emergency and first responders. If you’re interested in working with me, click below to set up a free consultation (:
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