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PEER SUPPORT:We are here to listen, refer, and support you through your mental health needs!

Welcome to the Firestrong Peer Support Team.

The members of this team have been trained to guide and support you through your situation. They themselves are not professional counselors.

They have been through extensive training to listen, refer, and support you through your mental health needs. Each peer team member can be contacted directly and anonymously.

Find A Peer

Assessment option:
Be informed

Alcohol Abuse

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Alcohol Dependence

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ANXIETY & DISTRESS

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DEPRESSION

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DRUG ABUSE

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PTSD

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Mental Health
Each therapist is different. But all are trained to help you with your issue. First find one that will fit. Look them up using your insurance, this will also ensure they are a licensed therapist.
What to expect when going to see a therapist.
Tell them what you think your issue is and see if they would be able to help. If you don't get a good sense on the phone, move on. You may want to decide if you are more comfortable
... read more
When picking a counselor:
3 Common Types of Talk Therapy
Cognitive
Interpersonal Emotional Based
Behavioral
What is the Difference?
Counselor and Therapist are interchangeable classifications of a person who has a Master's level degree in a counseling field
... read more
also reference:
Psychologist
Psychiatrists

SUICIDE: Thinking About Suicide? What you need to know! ... read more

Call today 1-844-525-3473
Thinking about Suicide? You are not alone!

15%

of adults in the United States seriously consider suicide in their lifetime

If you suspect someone is contemplating suicide, don't hesitate to act.

SIGNS AND SYMPTOMS

According to the American Association of Suicidology, the following are signs and symptoms of suicide.

Although it is not necessary for all of these risk factors to be present for someone to commit suicide, they should be used to raise your index of suspicion.

They are listed under the acronym IS PATH WARM These signs and symptoms may not all be present for someone to commit suicide but should raise you index of suspician. If you suspect someone is contemplating suicide, don't hesitate to act! Intervention - Know, Ask, Listen, Connect
  • I Ideation- Having suicidal thoughts or ideations
  • S Substance abuse- excessive or increased amount of substance use/li>
  • P Purposelessness- feeling no reason for living
  • A Anxiety - anxiety or agitated with insomnia or excessive sleep
  • T Trapped- feeling no way out of the situation they are in
  • H Hoplessness
  • W Withdrawal - Withdrawal from friends, family, or society
  • A Anger- Uncontrolled anger or rage
  • R Recklessness - Acting or engaging in risky or reckless behaviors
  • M Mood - Dramatic mood changes

Intervention starts by Knowing the signs and symptoms of suicide. Once you suspect someone may be contemplating suicide, it is important to know what questions to Ask and what actions to take.

You can remember these actions through KNOW, ASK, LISTEN, CONNECT. DO NOT AT ANY TIME PUT YOURSELF IN DANGER. IF THE PERSON IN CRISIS HAS A WEAPON OR IS AN IMMEDIATE DANGER TO SELF AND/OR OTHERS, CALL 911 RIGHT AWAY.

Assessment option:Be informed

Alcohol Abuse

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Alcohol Dependence

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ANXIETY & DISTRESS

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DEPRESSION

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DRUG ABUSE

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PTSD

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DRUG AND ALCOHOL ADDICTION

Drug Abuse

Many people use drugs in order to escape physical and emotional discomfort. Some start using drugs to numb feelings of depression. Others self medicate to deal with stress coming from home. Short term use of sleeping pills to cope with sleep deprivation or taking prescription painkillers to relieve chronic pain can easily lead to long term dependence and abuse.

Alcohol Abuse

Alcoholism is when you have signs of physical addiction to alcohol and CANNOT control consumption, despite the fact that problems with physical health, mental health, relationships and responsibilities have suffered. Alcohol begins to or is controlling your life and relationships.

Drug Abuse learn more
learn more Alcohol Abuse

Pain Relief for Mind & Body

Have you heard of the Mind-Body Connection?

It is a term used to describe the interconnectedness between our emotions and our physical health.

When you are emotionally stressed or anxious, especially for a prolonged period of time, it often has a negative impact on your health. Numerous research studies have shown that stress can cause and/or worsen physical conditions such as:

  • High blood pressure
  • Chest pain
  • Back pain "physical injury, illness, or pain can impact your mood"
  • Headaches
  • Sleep problems (e.g. insomnia)
  • Sexual difficulties
  • Gastro-intestinal problems
  • A weakened immune system

Likewise, you may have experienced first hand how a physical injury, illness, or pain can impact your mood. If our bodies are "sick", we worry about a number of things including:

  • How long it will take to get better?
  • Will I have to go on light duty?
  • Will I have to stop working out or limit my physical activity?
  • Will I be a burden to those around me?

You get the picture. Our bodies and minds are linked together.

The Good News

The following case represents a not so uncommon occurrence: read more

The good news is that there are several things we can do to improve our mental and physical health when it comes to these matters. Relaxation techniques always help. With that in mind try using this linkSedona Skies

First, if you're feeling stressed or anxious you can contact Phoenix Fire's Member Assistance Program (MAP), talk to your private physician or the doctors at the Health Center about it. Their job is to figure out if your physical symptoms are caused by stress factors.

If you want to hear more about how can work for you, follow this link to a podcast that explains the Mind-Body connection, and some strategies to calm your body and mind to prevent or eliminate physical symptoms. Autonomic Podcast

Next, the link below is to the American Psychological Association website that cites some fascinating research about the Mind-Body Connection. For instance, did you know:

Stress is linked to the six leading causes of death - heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide. ("The Stress Solution: An Active Plan to Manage the Stress in Your Life," Lyle H. Miller, Ph.D. and Alma Dell Smith, Ph.D.)

People with high levels of anxiety can have between two to seven times the risk of heart disease. ("Emotional Longevity: What Really Determines How Long You Live," Norman B. Anderson and Elizabeth P. Anderson, 2003)

Two-thirds of all office visits to family physicians are due to stress-related symptoms (American Academy of Family Physicians)

Learn more about this research at http://www.apa.org/helpcenter/mind-body.aspx
  • Stay Strong - Be smart about your body and your mind!
  • Chances are high that this will directly affect you or a loved one during your lifetime !
  • Sources:

    The Mindability Group at www.mindability.com
    The American Psychological Association at www.apa.org

    POST TRAUMATIC STRESS DISORDER (PSTD)

    Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after someone experiences a traumatic event that caused intense fear, helplessness, or horror. PTSD can result from personally experienced traumas (e.g., rape, war, natural disasters, abuse, serious accidents, and captivity) or from the witnessing or learning of a violent or tragic event.

    • While it is common to experience a brief state of anxiety or depression after such occurrences, people with PTSD continually re-experience the traumatic event; avoid individuals, thoughts, or situations associated with the event; and have symptoms of excessive emotions.
    • People with this disorder have these symptoms for longer than one month and cannot function as well as they did before the traumatic event.
    • PTSD symptoms usually appear within three months of the traumatic experience; however, they sometimes occur months or even years later.

    Although the symptoms for individuals with PTSD can vary considerably, they generally fall into three categories:

    • Re-experience

      - Individuals with PTSD often experience recurrent and intrusive recollections of and/or nightmares about the stressful event. Some may experience flashbacks, hallucinations, or other vivid feelings of the event happening again. Others experience great psychological or physiological distress when certain things (objects, situations, etc.) remind them of the event.
    • Avoidance

      - Many with PTSD will persistently avoid things that remind them of the traumatic event. This can result in avoiding everything from thoughts, feelings, or conversations associated with the incident to activities, places, or people that cause them to recall the event. In others there may be a general lack of responsiveness signaled by an inability to recall aspects of the trauma, a decreased interest in formerly important activities, a feeling of detachment from others, a limited range of emotion, and/or feelings of hopelessness about the future.
    • Increased arousal

      - Symptoms in this area may include difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, becoming very alert or watchful, and/or jumpiness or being easily startled.

    It is important to note that those with PTSD often use alcohol or other drugs in an attempt to self-medicate. Individuals with this disorder may also be at an increased risk for suicide.

    • There are a variety of treatments for PTSD, and individuals respond to treatments differently. PTSD often can be treated effectively with psychotherapy or medication or both.
    • Behavior therapy focuses on learning relaxation and coping techniques. This therapy often increases the patient's exposure to a feared situation as a way of making him or her gradually less sensitive to it.
    • Cognitive therapy is therapy that helps people with PTSD take a close look at their thought patterns and learn to do less negative and nonproductive thinking. Group therapy helps for many people with PTSD by having them get to know others who have had similar situations and learning that their fears and feelings are not uncommon.
    • One study of United States firefighters looked at the type of traumatic events experienced. High rates of traumatic exposure were found. For example, many had been exposed to crime victim incidents, people who were "dead on arrival" (where the death was not due to natural causes), accidents where there were serious injuries, and some also reported that they had experienced stress associated with giving medical aid to children and infants.
    • Another study found that firefighters generally reported that medical emergencies and motor vehicle accidents were the most upsetting types of calls that they received.

    A few studies have also looked at what factors might put firefighters at greater risk for the development of PTSD. A number of risk factors for PTSD among firefighters have been identified. These include:

    • Being previously in treatment for another disorder.
    • Starting work as a firefighter at a younger age.
    • Being unmarried
    • Holding a supervisory rank in the fire service.
    • Proximity to death during a traumatic event.
    • Experiencing feelings of fear and horror during a traumatic event.
    • Experiencing another stressful event (for example, loss of a loved one) after a traumatic event.
    • Holding negative beliefs about oneself (for example, feeling as though you are inadequate or weak).
    • Feeling as though you have little control over your life.
    • Even though firefighters might be at high risk for stress as a result of their jobs, it is important to point out that most firefighters will not develop PTSD. In fact, several factors have been identified that may reduce the likelihood of developing PTSD among firefighters after the experience of multiple traumatic events.
    • One of the most important protective factors found was having social support available either at home or through work.
    • In addition, it has also been found that having effective coping strategies available may lessen the impact of experiencing multiple traumatic events.
    • This is not surprising in that, among people in general, the availability of social support and effective coping strategies have consistently been found to reduce the risk for developing PTSD following a traumatic event.

    Criterion A

    • A person must have experienced a traumatic event where both of the following occurred:
    • The person experienced, witnessed, or was confronted with an event where there was the threat of or actual death or serious injury. The event may also have involved a threat to the person's physical well-being or the physical well-being of another person.
    • The person responded to the event with strong feelings of fear, helplessness, or horror.

    Criterion B

    • The person experiences at least one of the following re-experiencing symptoms of PTSD:
    • Frequently having upsetting thoughts or memories about a traumatic event.
    • Having recurrent nightmares.
    • Acting or feeling as though the traumatic event were happening again, sometimes called a "flashback."
    • Having very strong feelings of distress when reminded of the traumatic event.
    • Being physically responsive, such as experiencing a surge in your heart rate or sweating, to reminders of the traumatic event.

    Criterion C

    • The person experiences at least three of the following avoidance symptoms of PTSD:
    • Making an effort to avoid thoughts, feelings, or conversations about the traumatic event.
    • Making an effort to avoid places or people that remind you of the traumatic event.
    • Having a difficult time remembering important parts of the traumatic event.
    • A loss of interest in important, once positive, activities.
    • Feeling distant from others.
    • Corneil, W., Beaton, R., Murphy, S., Johnson, C., & Pike, K. (1999). Exposure to traumatic incidents and prevalence of posttraumatic stress symptomatology in urban firefighters in two countries. Journal of Occupational Health Psychology, 4, 131-141.
    • Del Ben, K.S., Scotti, J.R., Chen, Y., & Fortson, B.L. (2006). Prevalence of posttraumatic stress disorder symptoms in firefighters. Work and Stress, 20, 37-48.
    • Haslam, C., & Mallon, K. (2003). A preliminary investigation of posttraumatic stress symptoms among firefighters. Work and Stress, 17, 277-285.
    • Heinrichs, M., Wagner, D., Schoch, W., Soravia, L.M., Hellhammer, D.H., & Ehlert, U. (2005). Predicting posttraumatic stress symptoms from pretraumatic risk factors: A 2-year prospective follow-up study in firefighters. American Journal of Psychiatry, 162, 2276-2286.
    • http://ptsd.about.com/od/prevalence/a/Firefighters.html
    • www.nami.org

    Assessment option:Be informed

    Alcohol Abuse

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    Alcohol Dependence

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    ANXIETY & DISTRESS

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    DEPRESSION

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    DRUG ABUSE

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    PTSD

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    resilience:

    Though some of our resiliency is genetic, many important resiliency skills are learnable. And, when put into regular practice the benefits begin quickly.

    Definition of resilience

    Ability to bounce back from setbacks is a common definition for one of the most important aspects of a firefighter's life and mental health resiliency!

    Resiliency is so important to us all because no one is immune from stress, ranging from minor daily irritants to life-altering events.

    A great deal of scientific research has shown that firefighters with better resiliency skills are more likely to:

    • Live much longer
    • Have less or survive better from heart attacks (your number one killer!)
    • Have a lower risk of developing alcohol or drug problems
    • Have higher job satisfaction and productivity
    • Get along better with others
    • Do better financially

    Firefighters are no exception, and are considered a "high risk" occupation due to the nature of your work.

    This predisposes you to significantly higher mental and physical challenges ranging from heart disease to depression and PTSD, families are affect too.

    TACTICAL BREATHING

    Tactical breathing is used to gain control over physical and psychological responses to stress. Through practice one can gain control over heart rate, oxygen intake and emotions to increase concentration in various situation. Please see the link below for more information.

    http://onresilience.com/2011/06/02/tactical-breathing-can-stop-stress-on-the-spot/

    PositivityRatio.com - Self Test PositivityRatio.com is Barbara Fredrickson's companion website for her new book Positivity.

    CRISIS INTERVENTION

    As much as we like to think of ourselves as unbreakable, we break, and when we do it's usually hard and fast. If this feeling of being in crisis comes we may not feel comfortable to reach out for support. It's embedded in our DNA that we are firefighters and we are supposed to fix problems.

    Our exposures to high stress calls and events have given us the ability to overcome our feelings and work through them. Over time we store up our issues until they may overflow into other parts of our life. Sure, we may use dark humor or sarcastic remarks to move past our own feelings and continue to do our jobs but what happens when the floor falls out from under us, and we or a friend needs help.

    If we finally do decide to accept help we will need somebody we can trust. We will need to know what the help will look like. So if you or somebody you know is in crisis and you decide to ACCESS RESOURCES to get help. What can you expect to happen next?

    'What will a crisis intervention look like?'

    Each program is different, but all professional licensed counselors adhere to regulations when it comes to crisis intervention. Crisis Intervention should not be confused with traditional Therapy or Counseling. Crisis Intervention is used in acute situations to assist those who are in urgent need of help.

    • Their behavior constitutes a danger of inflicting serious physical harm upon oneself, including attempted suicide or the serious threat thereof, or if the threat is expected that it will be carried out.
    • There is potential that the continued behavior can reasonably be expected to result in serious physical harm to others.
      Behavior in which a person is likely to come to serious physical harm or serious illness because he/she is unable to provide for his basic physical needs.
    • They are showing signs that they are suffering severe and abnormal mental, and emotional issues and that these issues are significantly impairing judgment, reason, behavior or capacity to recognize part of reality.

    These four guidelines are reasons for a Crisis Intervention. It is after intervention and when the person is back to more stable that they would benefit from therapy or Counseling in hopes of creating a new healthy baseline.

    A Crisis Specialist will ask a series of questions to identify relevant safety issues, and to assess if the person meets the criteria above. Some of these questions may seem intrusive when asked, but regulations dictate that the level of safety is assessed. Here are some sample questions to expect:

    Safety Assessment Questions

    • Have you had any thoughts or actions, now or in the past, to do anything to hurt yourself?
    • Are you concerned about your ability to maintain your own safety?
    • Is anyone else concerned about your ability to maintain your safety?
    • What, exactly, are any thoughts you have had or are having to hurt yourself?
    • Do you have a plan on what you would actually do to hurt yourself?
    • Have you ever acted on these thoughts? What did you do?
    • Regarding any past actions to hurt yourself, was your intention to hurt yourself, die, let someone know how bad things are?
    • What were you trying to get away from or are you trying to get away from, by doing something to hurt yourself?
    • How are you hoping hurting yourself/killing yourself will solve your problems?
    • Do you have the means to hurt yourself? Do you have access to weapons or drugs?
    • Has anyone in your family ever hurt themselves/committed suicide?
    • What level of support do you have in your life?
    • Are you willing to make a no-harm contract with me?
    Steps in Crisis Intervention:
    • Define the Problem. Explore and define the problem from the patient's point of view. Use active listening, including open-ended questions. Attend to both verbal and nonverbal communications.
    • Ensure Personal Safety. Assess lethality, criticality, immobility and seriousness of threat to patient's physical, emotional and psychological safety. Assess internal impact as well as environmental situation.
    • Provide Support. Communicate (by words, voice, and body language) a caring, positive, non-possessive, nonjudgmental, acceptant, personal involvement with the one in crisis and the family.
    • Examine Alternatives. Assist in brainstorming choices available now. Search for immediate supports. These supports might include hospitalization or rehabilitation facility
    • Plan. Develop a plan with your patient which: provides something concrete and positive for the patient to do now with definite action steps which the patient can own and comprehend.
    Before leaving
    • Ask the patient to verbally summarize the plan and commitment.
    • Demonstrate your part of the commitment if you collaborate.
    • Follow up on the patient's performance or in obtaining assistance.

    Click Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) to receive a FREE digital copy of suicide assessment guidelines put out by the Substance Abuse and Mental Health Services Administration (SAMHSA).

    FINANCIAL FITNESS

    We all need a plan for our money. Financial Peace University (FPU) can be that plan! It consists of weekly classes on how to foster ways of handling money. Through video teaching, class discussion and interactive small group activities, FPU presents practical steps to get from where you are to where you would like to be. This plan will show members how to get rid of debt, manage money, spend and save wisely, and much more.

    To order your kit, go to http://www.daveramsey.com/fpu/home/?snid=classes.fpu-a For departments in Arizona, the 100 Club of Arizona has graciously offered Arizona members and their spouses an opportunity to purchase Dave Ramsey's Financial Peace University Membership Kits at a discounted rate of $25. These kits are now available by contacting the 100 Club of Arizona at 602.485.0100

    It is our hope that our members use the links below as an educational tool for the Financial Advisors that may come to the firehouse to ask for your business. You have worked really hard at saving for your retirement and it is important that you take an active interest in your savings account. Simple word of mouth referrals can be costly if you don't do your own investigation into the backgrounds of who you are working with. Just like you would check on a Doctor's or Psychologists license, there are FREE websites that will do an extensive background check of a Financial Advisor or Broker. Please take the time to enter their name and make an educated decision in the links below.

    http://brokercheck.finra.org/Search/Search.aspx

    http://www.adviserinfo.sec.gov/IAPD/Content/Search/iapd_Search.aspx

    Click on this Link above for more info.

    American Financial Solutions 1 (800) 892-4604 is a non-profit educational company that has qualified counselors available to talk with you on a wide range of financial issues and budgeting. They guarantee that you have access to the same counselor from beginning to end. All financial counseling is done over the phone because when dealing with debt solutions, it sometimes takes more than a few phone calls from home to be able to gather all the documents so that they can best assist you with your situation. This is all confidential and free. Some of the issues they can assist with are:

    Credit card, medical bills and other forms of debt becoming unmanageable. Experiencing financial distress in the wake of a major illness or life event such as divorce or job loss. Threatened mortgage foreclosure. You can free yourself from the anxiety and stress of financial problems. Get free unbiased information and assistance through American Financial Solutions a nonprofit agency offering:

    Taking action in the face of overwhelming financial worries can be hard. Getting advice, direction and encouragement from someone you trust can make all the difference. Talk to a Certified Credit Counselor for a confidential personalized consultation and address your most urgent concerns. Get the advice you can trust and set the goals that you can achieve.

    Start your personal financial assessment with powerful financial tools to make strategic decisions about credit card debt, spending and debt management. Check out the following calculators:

    • Budget Planning
    • Credit Card Minimum Payment & Interest Calculator
    • Mortgage Refinancing Calculator
    • Car Cost Comparison Calculator
    • Name Brands versus Generic Brands Savings

    Access free on-line financial education in the ?Investing in Yourself? curriculum:

    • Setting Financial Goals and Creating a Budget
    • Your Banking Relationship
    • Understanding Credit and Credit Reports
    • Introduction to Borrowing
    • Introduction to Investing
    • Identity Theft and Predatory Lending

    Upon completion of the series you may submit a copy of your certification of completion to the three credit reporting agencies and request that they note it on your credit profile.

    STRESS AND ANXIETY

    • Stress can come from any situation or thought that makes you feel frustrated, angry, or anxious. What is stressful to one person is not necessarily stressful to another.
    • Anxiety is a feeling of apprehension, nervousness, or fear. The source of this uneasiness is not always known or recognized, which can add to the distress you feel.

    Considerations

    • Stress is a normal part of life. In small quantities, stress is helpful -- it can motivate you and help you be more productive.
    • Too much stress, or a strong response to stress, is harmful. It can set you up for general poor health, as well as physical and psychological illnesses like infection, heart disease, and depression. Ongoing stress can lead to anxiety and unhealthy behaviors like overeating and abuse of alcohol or drugs.
    • Emotional states like grief or depression, and health conditions like an overactive thyroid, low blood sugar, or heart attack can also cause stress-like symptoms.
    • Abdominal pain (this may be the only symptom of anxiety, especially in a child)
    • Diarrhea or frequent need to urinate
    • Dizziness
    • Dry mouth or difficulty swallowing
    • Headaches
    • Muscle tension
    • Rapid breathing
    • Rapid or irregular heart rate
    • Sweating
    • Twitching or trembling
    • Sometimes other symptoms occur with anxiety:
    • Decreased concentration
    • Fatigue
    • Irritability, including loss of your temper
    • Sexual problems
    • Sleeping difficulties, including nightmares

     More severe symptoms that may need immediate treatment:

    • You have crushing chest pain, especially with shortness of breath, dizziness, or sweating. These symptoms might be caused by a heart attack, which can also cause feelings of anxiety.
    • You have thoughts of suicide.
    • Call your health care provider if you have dizziness, rapid breathing, or a racing heartbeat for the first time, or if it is worse than usual.
    • You are unable to work or function properly at home because of anxiety or other symptoms.
    • You do not know the source or cause of your anxiety.
    • You have a sudden feeling of panic.
    • You have an uncontrollable fear -- for example, of getting infected and sick if you are out, or a fear of heights.
    • Your anxiety is triggered by the memory of a traumatic event.
    • You have tried self care for several weeks without success, or you feel that your anxiety will not go away without professional help.
    • Certain drugs, both recreational and medicinal, can lead to symptoms of anxiety due to either side effects or withdrawal from the drug.
      • Such drugs include:
        • ADHD medications, especially amphetamines
        • Alcohol
        • Benzodiazepines (during withdrawal)
        • Bronchodilators (for asthma and certain other breathing disorders)
        • Caffeine
        • Cocaine
        • Cold remedies
        • Decongestants
        • Diet pills
        • Marijuana
        • Nicotine
        • Thyroid medications
        • A poor diet -- for example, low levels of vitamin B12 -- can also contribute to stress or anxiety. In very rare cases, a tumor of the adrenal gland (pheochromocytoma) may cause anxiety or stress-like symptoms. The symptoms are caused by an overproduction of hormones responsible for the feelings of anxiety.
    • The most effective solution is to find and address the source of your stress or anxiety. This can be difficult, because the cause of the anxiety may not be conscious. A first step is to take an inventory of what you think might be making you "stressed out," trying to be as honest with yourself as possible:
      • What do you worry about most?
      • Is something constantly on your mind?
      • Is there something that you fear will happen?
      • Does anything in particular make you sad or depressed?
      • Keep a diary of the experiences and thoughts that seem to be related to your anxiety. Are your thoughts adding to your anxietyin these situations?
      • Then, find someone you trust (friend, family member, neighbor, clergy) who will listen to you. Often, just talking to a friendor loved one is all that you need to relieve anxiety. Most communities also have support groups and hotlines that can help. Social workers, psychologists, and psychiatrists can be very effective in helping you reduce anxiety through therapy or medication.
      • Also, find healthy lifestyle choices to help you cope with stress. For example:
      • Don't use nicotine, cocaine, or other recreational drugs.
      • Eat a well-balanced, healthy diet. Don't overeat.
      • Exercise regularly.
      • Find self-help books at your local library or bookstore.
      • Get enough sleep.
      • Learn and practice relaxation techniques like guided imagery, progressive muscle relaxation, yoga, tai chi, or meditation.
      • Limit caffeine and alcohol.
      • Take breaks from work. Make sure to balance fun activities with your responsibilities. Spend time with people you enjoy.
    • When did your feelings of stress, tension, or anxiety begin? Do you attribute the feelings to anything in particular, like an event in your life or a circumstance that scares you?
    • Do you have physical symptoms along with your feelings of anxiety? What are they?
    • Does anything make your anxiety better?
    • Does anything make your anxiety worse?
    • What medications are you taking?
    • Do you use alcohol or drugs?

    Cognitive-behavioral therapy (CBT) has been shown to significantly decrease anxiety.
    Also Mindability (Road Map to Peace at Mind) can help you decrease and cope with the amount of anxiety and stress you carry. Please see the Mindability Tab for more information.

      Anxiety may occur as part of an anxiety disorder. Anxiety disorders are a group of psychiatric conditions that involve excessive anxiety. They include:

    • Generalized anxiety disorder
    • Obsessive-compulsive disorder
    • Panic disorder
    • Post-traumatic stress disorder (PTSD)
    • Social anxiety disorder
    • Specific phobias

    References

    • Larzelere MM, Jones GN. Stress and health. Prim Care. 2008;35:839-856. [PubMed: 18928833]
    • Ahmed SM, Lemkau JP. Psychosocial influences on health. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 4.
    • PubMed Health [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2011 Jan 1; cited 2011 Jan 6]. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/.

    SLEEP DEPRIVATION

    Every person needs a different amount of sleep to awaken feeling refreshed. Individual sleep requirements are genetic and may be hereditary. Scientists consider six to 10 hours of sleep a normal range, with most people requiring 7.5 to 8.5 hours of sleep in a 24-hour period. At least four to five hours of uninterrupted core sleep is necessary to maintain minimum performance levels. Sleep requirements may change slightly with age and can be affected by general health. Illness, stress, and depression cause the body to require more sleep to heal and recuperate

    Sleep deprivation occurs when a person does not get sufficient amounts of quality sleep. Work demands, family life, and lifestyle choices may cause a person to sleep fewer hours than his body needs to maintain wakefulness and energy levels. In the Fire Service most of us to Shift work and have to interrupt the body's natural wake/sleep cycle. Over time deprivation of sleep can have both an acute and cumulative effect on our bodies and minds.

    In a study at the University of Chicago, rats kept from sleeping became sick and died after two and a half weeks. Sleep-deprived rats that became ill but were then allowed to sleep recuperated fully.

    Sleep loss is cumulative and creates a sleep debt. Larger sleep debts require greater amounts of restorative sleep to return the body and mind to normal, rested levels. Sleep deprivation affects mental processes and intellectual abilities. It reduces performance on challenging tasks and negatively affects psychomotor skills. Mood, productivity, and communication skills suffer. Extended periods without sleep may cause hallucinations and paranoia.
    Physical and mental performances are not the only casualties of sleep deprivation. Even a minimal loss of sleep impacts general health. Chronic lack of sleep can contribute to serious health problems and even shortened lifespan. In a 1983 study at the University of Chicago, rats kept from sleeping became sick and died after two and a half weeks. Sleep-deprived rats that became ill but were then allowed to sleep recuperated fully.
    Lack of sleep may slow glucose metabolism by 30 to 40 percent and increase levels of the stress hormone cortisol. Sleep deprivation has also been linked to inadequate levels of the hormone leptin. Leptin signals the body to stop eating when it's full. Decreased levels of leptin lead to increased carbohydrate cravings and eating.
    Other effects of chronic sleep deprivation include:

    • Depression and mood swings
    • Gastrointestinal dysfunction
    •  Adult-onset diabetes
    • Menstrual and infertility problems
    • Increased use of drugs and alcohol
    • Impaired sexual function
    • Less satisfaction in personal and domestic pursuits
    • Increased appetite and weight gain
    • Personality changes, particularly loss of humor and increased ill temper.

    "Firefighters need to get an adequate amount of uninterrupted sleep every off-duty night"
    Quality sleep is the primary weapon in the battle against sleep deprivation. Firefighters must take advantage of opportunities for sleep, both on and off duty. Sleeping areas at home and at the fire station should be quiet and dark, and the room temperature should be cool. A comfortable, good-quality mattress is a must. Invest in comfortable bedding and pillows as well. Good sleep habits are essential. Firefighters need to get an adequate amount of uninterrupted sleep every off-duty night. Going to sleep and waking up at the same times every day, even on weekends, is important for maintaining the body's natural rhythms.
    Other tips for quality sleep include the following:
    Avoid eating, reading, and watching TV in bed.
    Restrict caffeine intake, and avoid caffeinated drinks at least six hours before bedtime.
    Eat healthful foods. Do not eat large meals within four to five hours of sleeping.
    Do not use alcohol to induce sleep. The effects of alcohol-induced drowsiness last only a few hours and cause poor-quality sleep.
    Avoid long-term use of over-the-counter sleeping pills. Habitual use can reduce effectiveness and lead to addiction.
    Reduce life stress as much as possible.
    Use relaxation techniques to relieve stress and invite sleep.
    Exercise, but not more than four hours before bedtime. For 24-hour shift workers, outdoor exercise during daylight hours can help the body maintain natural biological rhythms and increase sleep quality off-duty.
    "Napping is an effective coping strategy"

    Daytime sleep after a night shift is essential to staying well rested, but trying to sleep when the rest of the world is awake can be challenging at best. The shift worker must emphasize to friends and family the importance of restorative sleep. Go as far as having daytime sleep scheduled on the family calendar along with ballgames, school meetings, and other activities.
    Napping is an effective coping strategy that can be used in anticipation of a long night or during extended operations. Naps as short as 20 minutes can be effective. Two-hour naps during around-the-clock operations are highly restorative.
    Melatonin may help promote better sleep, particularly during the day. However, this supplement is not FDA-approved, and current research is contradictory on short-term and long-term effects.
    People who are regularly unable to sleep should consult their physicians to rule out underlying health problems. Doctors may also be able to prescribe medication to help with sleep. Sleep disorders can be aggravated by shift work. Shift workers with diagnosed sleep disorders need to work closely with their physicians to effectively manage their disorder.

    References:
    Koester, Robert J. Fatigue: Sleep Management During Disasters and Sustained Operations. DbS Productions, 1997.
    Maas, Dr. James B. Power Sleep. HarperPerennial, 1998.
    Moore-Ede, Martin, M.D., Ph.D. The Twenty-Four Hour Society. Addison-Wesley Publishing Company, 1993.
    NIOSH.Publication 97-145. "Plain Language About Shiftwork." 1977

    Retirement

    If you are approaching retirement age, there are a number of things you can do to prepare for an emotionally healthy retirement. 

    • First, begin by talking to someone, a spouse, significant other, children, or all of the above about how you feel regarding the impending change in your life.  Look at all the aspects, but particularly the emotional part.
    • Begin now to think about what you are passionate about.  Is it politics, sports, finance, art or music?  Many possibilities are available, but you need to focus on what excites you.
    • Get an emotional checkup.  Many couples consult a marriage therapist before taking the big step.  In a similar perspective, retirees may want to talk to a therapist about their situation and gain insights.
    • Don't make other big decisions during this transition time.  For example, people who retire and immediately move to another state may wind up suffering two major losses -- the loss of their work-related identity, and the loss of their relationship network.

    Achieving a successful retirement is a process that takes planning, time, and experimentation.  Retirees who achieve emotional integration learn to know themselves and what will make the coming years satisfying.  They are confident in their ability to cope, and they can appreciate the possibilities within themselves.  Retirement can then become a passage to new opportunity and self-fulfillment.

    Is Not About Money
    It's About Play and Purpose  

     "The happiest retirees were more likely to answer by giving specific examples of rewarding or creative activities"
    Research has found that, in addition to a happy marriage and a sense of purpose, the most important factor in a happy retirement was learning how to "play" again. The scientists define play as engaging in activities that are highly gratifying. These activities can lack any economic significance, and do not necessarily need to lead to praise or recognition from others. In other words, many of the factors that allow happiness in retirement appear to be quite different from those that assure a contented and economically secure middle age.The researchers found that happiness in retirement depended neither on being free from physical disability nor on having a large income. Instead, the answers to two questions were most important:

     "What are your most enjoyable activities…

    Men who found retirement satisfying were more than twice as likely to report enjoying relationships, volunteering, and having hobbies. The happiest men were more likely to answer by giving specific examples of rewarding or creative activities: "watching my grandchildren," "writing my memoirs" and "playing the piano" were typical responses.

    what the researchers call "autistic activities" like "watching
     "happy retirement involves taking the time to find activities that stimulate us"
    television" or "gambling" or "caring for myself." For example, 43 percent of the happiest retirees said they found purpose in community service, while only 7 percent of those who found retirement unsatisfying did.
    A lot of what one can do to assure a happy retirement involves taking the time to find activities that stimulate us, making us broader and deeper and more complex, and activities that involve others, and which in many cases the only obvious benefit is to others. It has a lot less to do with income.
    From the American Journal of Psychiatry

    DEPRESSION

    • Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods.
    • True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for a long period of time.
    • Depression affects about 19 million Americans annually. It is estimated to contribute to half of all suicides. About 5%-10% of women and 2%-5% of men will experience at least one major depressive episode during their adult life. Depression affects people of all races, incomes, ages, and ethnic and religious backgrounds, but it is three to five times more common in the elderly than in young people.

    "Some types of depression seem to run in families"

    • The exact cause of depression is not known. Many researchers believe it is caused by chemical imbalances in the brain, which may be hereditary or caused by events in a person's life.
    • Some types of depression seem to run in families, but depression can also occur in people who have no family history of the illness. Stressful life changes or events can trigger depression in some people. Usually, a combination of factors is involved.
    • Substance abuse: While it has long been believed that depression caused people to misuse alcohol and drugs in an attempt to make themselves feel better (self-medication), it is now thought that the reverse can also be the case; substance abuse can actually cause depression.
    • There is no single cause of major depression. Psychological, biological and environmental factors may all contribute to its development. Whatever the specific causes of depression, scientific research has firmly established that major depression is a biological, medical illness.
    • Norepinephrine, serotonin and dopamine are three neurotransmitters (chemical messengers that transmit electrical signals between brain cells) thought to be involved with major depression.
    • "Scientists have also found evidence of a genetic predisposition to major depression"Scientists believe that if there is a chemical imbalance in these neurotransmitters, then clinical states of depression result. Antidepressant medications work by increasing the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemical messengers.
    • Scientists have also found evidence of a genetic predisposition to major depression. There is an increased risk for developing depression when there is a family history of the illness. Not everyone with a genetic predisposition develops depression, but some people probably have a biological make-up that leaves them particularly vulnerable to developing depression.
    • Some illnesses such as heart disease and cancer and some medications may also trigger depressive episodes.
    • It is also important to note that many depressive episodes occur spontaneously and are not triggered by a life crisis, physical illness or other risks.
    • Alcohol or drug abuse
    • Life events or situations, such as:
    • Breaking up with a significant other, illness or death in the family, or parents divorcing (for adolescents)
    • Repetitive traumatic calls
    • Childhood events, such as abuse or neglect
    • Divorce, death of a friend or relative, or loss of a job (for adults)
    • Social isolation (common in the elderly)
    • Medical conditions such as hypothyroidism (underactive thyroid), medications (such as sedatives and high blood pressure medications), cancer, major illness, or prolonged pain
    • Sleeping problems, Sleep deprivation
    • Agitation, restlessness, and irritability
    • Dramatic change in appetite, often with weight gain or loss
    • Extreme difficulty concentrating
    • Fatigue and lack of energy
    • Feelings of hopelessness and helplessness
    • Feelings of worthlessness, self-hate, and inappropriate guilt
    • Inactivity and withdrawal from usual activities, a loss of interest or pleasure in activities that were once enjoyed (such as sex)
    • Thoughts of death or suicide
    • Trouble sleeping or excessive sleeping
    • Depression can appear as anger and discouragement, rather than as feelings of hopelessness and helplessness. Use of alcohol or illegal substances may be more likely to occur.

    "Medicines that you take for other problems could cause or worsen depression"

    • Medicines that you take for other problems could cause or worsen depression. You may need to change them. DO NOT change or stop taking any of your medications without consulting your doctor.
    • People who are so severely depressed that they are unable to function, or who are suicidal and cannot be safely cared for in the community may need to be treated in a psychiatric hospital.
    • Most people benefit from antidepressant drug therapy, along with psychotherapy. As treatment takes effect, negative thinking diminishes. It takes time to feel better, but there are usually day-to-day improvements.
    • Take medications correctly and learn how to manage side effects.
    • Learn to watch for early signs that depression is becoming worse and know how to react when it does.
    • Try to exercise more, seek out other activities that bring you pleasure, and maintain good sleep habits.
    • Avoid alcohol and illegal drugs. These substances can make the depression worse over time, and may also impair your judgment about suicide.
    • When struggling with your depression, talk to someone you trust about how you are feeling. Try to be around people who are caring and positive.
    • Try volunteering or getting involved in group activities.

    "therapy teaches depressed people ways of fighting negative thoughts"

    • Cognitive behavioral therapy teaches depressed people ways of fighting negative thoughts. People can learn to be more aware of their symptoms, learn what seems to make depression worse, and learn problem-solving skills.
    • Psychotherapy can help someone with depression understand the issues that may be behind their behaviors, thoughts, and feelings.
    • Joining a support group of people who are experiencing problems like yours can also help. Ask your therapist or doctor for a recommendation.
    • Fava M, Cassano P. Mood disorders: Major depressive disorder and dysthymic disorder. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusette General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 29.
    • American Psychiatric Association. Practice guidelines for the treatment of patients with major depressive disorder. 2nd ed. September 2007. Accessed January 22, 2010.
    • Little A. Treatment-resistant depression. Am Fam Physician. 2009;80:167-172. [PubMed: 19621857]
    • PubMed Health [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2011 Jan 1; cited 2011 Jan 6]. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/.
    • www.NAMI.org

    RELATIONSHIPS

    Most of us have some kind of idea in our minds about how a "good" or "correct" relationship is supposed to be. We can cause ourselves needless distress by comparing our own relationships with such an idea of what a relationship "should be like" and then concluding that our own is defective by comparison. Psychologists may imply something of that sort when they formulate criteria for a "healthy relationship" which few real couples ever meet. There is no right way of having a relationship, and no easy answer to maintaining a health one. However if you find yourself questioning yours, therapy can often help."A therapist will try to improve a couple\'s communication"

    You may meet once a week, and sessions are 50 minutes in length. In a first session together, you will learn as much as possible about your marriage or relationship, including how you met, how you got to where you are now, and anything else you think is important.

    A therapist will try to improve a couple's communication so that they can move from "gridlock" or an unhealthy communication pattern to healthy dialogue about key issues. In later sessions you may discuss things about handling conflict, rebuilding the friendship (if necessary), bringing romance back, and finally, discussing long-term goals and dreams

    Yes, couple counseling works very well. In an article published in The Journal of Marital and Family Therapy, clients of 526 marriage counselors were surveyed, and 91.2% of the clients said they were satisfied with the amount of help they received.

    "...couples counseling will help you illicit new changes you want in your relationship"

    You and your partner have learned many things during your lives. And during your time together you have both grown and changed and the relationship has evolved. If you want to, you can also learn new ways of being with your partner, and there is an excellent chance that couples counseling will help you illicit new changes you want in your relationship.

    If you think you might need counseling, you probably do! Marriage counseling is under-utilized. Marriage counselors should be consulted sooner, rather than later! Studies show that the average couple doesn't seek professional help until six to seven years have passed since the relationship started to go downhill. Starting early can help strengthen the relationship so that when trouble does occur you will have the tools to make the problem a small bump in the road rather than a mountain to climb.

    That's unlikely! Up to 70% of couple conflict, even in stable couples, is about "perpetual" issues. One goal in dealing with perpetual problems is not to decide who gets their way and who doesn't, but instead to avoid gridlock and going back to the same old patterns of communication by establishing healthy dialogue about the issue, in which each partner communicates acceptance of the other's position.

    "A fractured relationship can cause significant stress in an individual"

    On average, therapy can take anywhere from 6 to 12 sessions. The first few sessions should be weekly, and after that sessions can be either weekly or bi-weekly. Couples are always free to come back on an "as needed" basis.

    No, it's never too late. Marriage counselors agree that if both husband and wife are open to change and willing to do some work, love can be rekindled and a happy and satisfying marriage can be restored.

    Marriage counselors will tell you that a fractured relationship can cause significant stress in an individual, and that stress can contribute to a variety of physical ailments that can have serious physical effects. Recent studies also show that when a fight begins with a "harsh startup" (referring to how the problem is initially presented by one partner to the other) adrenaline and cortisone levels rise significantly, just as they do in the "fight or flight" response. Repetition of this cycle can be physically draining.

    Yes. When one partner makes some positive changes and shares what has been learned, the other partner frequently becomes motivated to make his/her own positive changes. Hopefully the reluctant partner then becomes willing to attend counseling.

    No, infidelity doesn't have to mean the end of the marriage. Many couples have survived infidelity. It's traumatic, it hurts terribly, but you can get through it with professional help. Therapists have found that the crisis brought on by an unfaithful spouse is frequently the trigger for the couple to seek the counseling they have needed for a long time.

    Acknowledgement for donating his time to help write this section:

    Jay Slupesky, M.A., MFT
    Licensed Marriage & Family Therapist
    http://eastbaycouples.com

    Chaplaincy Program

    Spirituality has a lot to do with how we understand the world around us. Our beliefs influence how we live and how we react to situations.  A faith-based connection is often associated with better mental health and increased resiliency.  It can provide excellent support to help you cope. The Chaplains on Firestrong come from diverse backgrounds of ministry, social work, education, and past experience. They have come to know the fire service and are willing to help make a difference in the lives of those who may need guidance during challenging times.  You may find that you may want to reach out to others that hold a similar faith and belief.  A Chaplain can be a great starting point to helping with interpreting individual faith-based views and helping problem solve various matters.  Please look through the Chaplain section of this website.  Read their individual bios and feel free to contact them directly and confidentially.

    Contact us today:Please reach out to us for any questions you may have. Every conversation is extremely confidential.

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