Funding Request

To those who share our concern for the mental health and wellbeing of our military members, veterans, first responders, and front-line health care workers,

As you are likely aware, we are seeing an escalation in the need for mental health care for our emergency and front-line responders. Those we rely on to keep us safe and healthy are facing significant new challenges in today’s world. There are increasing numbers of calls for service, the pandemic has made delivering care riskier, and professionals are working overtime and short-staffed due to colleague burnout and budgetary cuts. In addition to this, some first responders, especially police officers, are facing criticism and condemnation from the public more than ever. Media reporting of the performance of emergency service providers is increasingly negative.

Project Trauma Support (PTS) has developed a six-day residential experiential program that helps our uniformed professionals and our front-line medical personnel process their painful experiences so that they may remain actively engaged in service. Since 2016, we have had over 600 graduates of our program. Many have indicated that their experience with us was life changing and even life saving. Many have either returned to work or have been able to stay at work as a result of completing the PTS program. Families have reported that they have seen lasting positive changes in their loved ones returning from the program.

Our physician led, peer mentor driven program has the advantage that effective, targeted treatment can be delivered in a short time frame, limiting both the cost and the length of time a participant is away from work and their families. We too, have been adversely affected by media reporting and the lessons we have learned have allowed us to be even more able to help those who reach out to us.

We wish to ensure that we remain adequately funded so that we may continue to offer the benefits of our work to many who are suffering and have not been able to access effective care. We are receiving increasing numbers of referrals from not only past participants who want to send their colleagues, but also from their mental health providers who have seen the benefits. To be able to continue, we need your financial support. As Project Trauma Support is a registered charity in Canada, all donations receive a tax receipt.

We wish to continue to develop the PTS programming, backed by sound research, to demonstrate that the work we are doing is safe, effective and ground-breaking. As we announced at our September 17th conference, we are making a documentary about the healing journey that our participants embark upon at PTS with the famous documentary maker and investigational journalist John Russel Feist (producer of “Survivor” and “The Royal Tours”). We hope that through this full length feature documentary we will be able to inspire others to embark on a healing journey of their own. John’s skill at engaging the human spirit in his documentaries is unsurpassed.

Our goal is to scale up our work by teaching our findings and our methods to other physicians and mental health providers across Canada. We believe that we can be part of an effective and affordable solution and that our work can contribute to establishing the standard of care for ensuring the mental health and resilience of those who hold the front lines and are the first and last defense of our country.

Donations can be made through our website: www.projecttraumasupport.com or through searching for Project Trauma Support on the Canada Helps website: www.canadahelps.org

For more information, please contact us at info@projecttraumasupport.com

Sincerely,

Manuela Joannou M.D. CCFP(EM) FCFP
Medical Director, Project Trauma Support

You Cannot Heal From PTSD Alone

How does one regain peace of mind and joy for living when Post Traumatic Stress and Moral Injury have set in?

We cannot go back in time and rewrite our histories. We cannot wipe out the fact that we have seen horrific things and witnessed the unfolding of events that are just plain wrong. We cannot pretend that we didn’t do things that continue to give us a jolt of shame and guilt whenever the memory sneaks in.

The only way to return to a path of equanimity and hope is to reprocess the way we have judged ourselves, others and the world that has allowed atrocities to occur. We must find an attitude about our experiences, our observations, and our choices that we can live with, in peace.

This may sound simple, but it is far from being easy. This is generally not work we can do on our own.
When our most predominant emotions are fear, shame and disillusionment, our tendency is to isolate. But we need the companionship, support and love of our family and our comrades to restore order in our world. We also need to feel that we can reciprocate and show up and be useful in the lives of those we love.

When we are yearning for forgiveness, we need atonement.

We can try to convince ourselves that we can be absolved of guilt but the arguments ring hollow without the acknowledgement and support of others whose opinions we value.

We may be battle-scarred and battle-scared, but our new assignment is to gain wisdom from our experiences that can be shared with others. We are also called to find new meaning in our life stories, that can energize and direct us to more purposeful lives.

We can be the change we wish to see in the world.

We can direct or energies to making our world a safer place in both physical and emotional terms for those we love, and even perfect strangers.

The symptoms of PTSD are often devastating and crippling. We most likely need professional help to overcome them.

If we could gain command over intrusive, painful thoughts, the other symptoms would dissipate. We could calm our hyper-vigilance. We could sleep without our psyche being hijacked by senseless terrors. We could boldly step out of our homes to run errands or socialize. We would have lots of patience to be supportive of our friends and families. We could happily dream and plan for our futures and look forward to a fulfilling life of work and leisure.

How do we gain command of our thoughts? The evolving field of metacognition, or noticing what you’re noticing, guides us on this path. To gain mastery over our minds, we must become aware of the specific sorts of thoughts and thought patterns that tend to take up residence in our brains. Very often, they are strong enough to dictate how we live our very lives.

It can be useful to take a step back and become a witness to our exact thoughts, as a passive observer. With a detached curiosity, we can inspect what notions our troubled psyches are thrusting in the forefront of our awareness, without attaching any emotion or reacting to them. This is the practice of mindfulness and it does take practice.

When we recognize intrusive thought patterns, we can start to challenge them by replacing them with new attitudes we have decided to adopt through our reprocessing of our experiences. We can displace fears and limiting beliefs by taking on new challenges that are driven by the resolve that comes from new meaning we attach to our histories.

Sitting at the unintended crossroad imposed by PTSD, we have a choice.

We can become victims of our traumas and our automatic thoughts that come from them, or we can realize we did not go through all this for nothing and do the work to push through to new vistas of post traumatic growth.

The other dragons to slay on the path to recovery may include depression, loneliness and relationship issues, health considerations, financial and insurance concerns and general life challenges.

All of these can and should be addressed by a professional team along with peer support guides. As Joseph Campbell stated, there is a psychic unity of mankind. We heal from our traumas that are part of our human condition by tapping into this human connection.

Project Trauma Support: Addressing Moral Injury in First Responders

Download the research paper
Download the research paper

Abstract

Post-traumatic Stress Disorder (PTSD) amongst military, police, Royal Canadian Mounted Police and first responder personnel often includes a moral injury component. The Project Trauma Support (PTS) program is designed to address moral injury in the emergency service personnel population. The Kessler scale of psychological distress (K6) and a new Life Challenges survey (LCS) were administered pre-and post-course to three cohorts undergoing the PTS program, providing a within-subject design examining 8 males and 8 female emergency services personnel, in 2016. All participants were above K6 threshold for distress upon entry into program. Positive improvement was noted in both instruments, and
across all K6 subdomains (p < .001) and across 8 of the 10 LCS subdomains. The results indicate that the PTS course shows promise to provide a holistic therapy for military veterans,
police, Royal Canadian Mounted Police and other emergency personnel suffering from PTSD.

Introduction

There has been an increase in prevalence of Post-Traumatic Stress Disorder (PTSD) in military personnel returning from Afghanistan [1-3]. Studies have shown that PTSD is a major risk factor for suicide in the military veteran population [1,4]. Police and paramedics encounter similar traumatic events as the military population, and studies have shown the emergency services have an elevated risk of suicide [5-7].

Moral injury has been implicated in PTSD outcome [8], and includes anger, shame, inappropriate guilt and social alienation that manifests after witnessing or engaging in traumatic events that defy a person’s sense of humanity [9]. Project Trauma Support (PTS) is a new initiative started in Canada that seeks to address moral injury associated with PTSD in Military/Veterans and First Responders (police officers, firefighters, paramedics). Moral injury is difficult to treat and also a more likely component to drive those suffering from PTSD to suicide [10-12].

Prolonged exposure therapy and cognitive processing therapy have been studied as the favoured treatments for PTSD in military veterans by Veteran Affairs in USA. These modalities have shown only modest benefits, perhaps because they do not address the physiological, psychological and sociological disintegration arising from PTSD [13]. Recently some complementary holistic approaches such as yoga, equine therapy, music, and art therapy have shown promise in the treatment of PTSD [14-16]. It has been our belief and experience that combining traditional therapeutic modalities with some of the more experiential therapies in an intense, brief residential treatment program can have significant positive outcomes. Furthermore, shared experiences and group psychotherapy stemming from shared experiences may be invaluable when it comes to reprocessing the memories (cognitive and physical) and lasting impact of trauma, thus helping to alleviate or minimize the symptoms of PTSD [13-16].

The Project Trauma Support (PTS) program is designed to address moral injury in the emergency service personnel population. The focus of the PTS program is to provide a safe environment where defences may be dropped and authentic emotions may be processed in the presence of supportive comrades who provide unconditional positive regard through
shared experiences.

This paper reports on the results of a pilot investigation of the PTS program on three cohorts of participants in 2016. Results from this project will help inform healthcare providers
of potential complementary therapies to aid in the rehabilitation process.

Download and read the research paper.

Supporting your Injured First Responder

When the first responder you love has been psychologically injured as a result of his or her service, you need to be prepared to weather the storm. Because the impact of their injury is going to affect your entire family. It’s going to change the dynamics in your household as well as within your relationships. It will change the balance of workload and rearrange your priorities. You might have financial implications. You may find that you look back and realize that your life has been divided into the time before and the time after this thing they call PTSD came to stay.

When the first responder you love has been psychologically injured as a result of his or her service, you need to be prepared to weather the storm.

The person you loved and were so proud of, your invincible rock, might suddenly become a fearful shadow of who they used to be. He or she may have a hard time leaving the house. They may have a lot of anxiety and constantly worry about what terrible things could happen. You will find yourself worried, confused, and unsure of how to respond to them. You will look to the doctors and therapists for some understanding of what is going on. They may not always be as helpful as you wish, and you might need to go through a few clinicians before you find someone who includes you in the treatment plan.

What is important to understand is that your partner is struggling with powerful emotions that are lurking deep down. These might include overwhelming sadness, heartbreaking loss, despairing loneliness, and relentless guilt and shame. It is likely that they are grappling with an identity crisis, as they are concerned that they are not the resilient person they believed themselves to be. These emotions can surface and grip your husband or wife with ferocious intensity at seemingly random times. They live in fear of having more of the deep searing pain they have endured. They try to avoid feeling this pain in various ways. Pain, fear, and sadness may be their true underlying emotions, but what you see and what is portrayed to the world may be only varying shades of anger.

Their hurt might show up as attack and accusation. The loss is expressed as suspicion. The loneliness shows up as isolating from others and pushing people who love them away. Guilt and shame can manifest as negativity, irritability, and reckless behaviour.

You never know when some innocent comment will bring a cascade of hurtful comments, a barrage of insults or a suddenly disrupted conversation.

Your partner quite likely has sleep disturbance as part of their new life challenges. You won’t be able to predict when a nightmare will set the tone for the whole day, railroading well established plans you may have had. Your own sleep might get disrupted by their restlessness, insomnia, or strange behaviours at night.

You may be shocked and concerned when you watch your partner drink too much, start using drugs, gamble or engage in risky behaviour that is so unlike the person they used to be. These are attempts at self-distraction or self-medication but you will worry that any of these could suddenly take them away from you and your children.

You will find yourself being very careful about how much you ask of your partner. The request for help with simple chores can result in a discussion of how demanding you’ve suddenly become and how overwhelming his or her life has become.

Be ready for unfinished projects. There will be times when short lived enthusiasm will prompt your loved one to engage in new hobbies or start attending to tasks. But the inability to follow through might mean that the new equipment or toy will sit in the garage or that someone else will have to finish what was started.

Be prepared that any situation or statement can be interpreted in a way that is far from your assessment of what is happening or what you intended to say. Your loved one’s own perception of what happened or what was said becomes coloured by their own painful experiences or fears.

There may be a reaction or response that you find surprising. Sarcasm, attack, and irritability may be what you get when you said some simple thing you believed to be straight forward and kind.

If you take this personally, you are liable to be hurt and maybe even want to strike back, but you will never find this to be a good move.

Addictions are common and add another element of complexity. When your loved one’s focus is on where they will get their next drink or dose, anything that gets in the way is seen as cause for irritation and resentment. This will include you, your children, extended family, special events. appointments, chores and promises they have made.

Be prepared to feel like you are walking on eggshells. In spite of being very careful about how you choose your words, you will still end up feeling like you’ve said and done the wrong things.

Your loved one’s mind can be hijacked by sudden intrusive inner thoughts, and you will not understand why he or she is instantly in a bad mood.

You might find yourself in an argument and you won’t know why. You may be blamed for starting it. You may be accused of something odd, but there might be just enough of a hint of possible truth in it so you will begin to doubt your own sanity.

Your heart will break as you try to struggle for the right words to say, recognizing that your loved one is coming from a place of pain, but you will realize there is no right thing to say or do, so sometimes you may just go to bed and cry yourself to sleep.

And then sometimes he will cry too and hold on to you and you will realize that he or she needs you and you know that somehow you must find the strength to keep it together, for their sake and for the sake of the family.

There will be rare times of clarity and passion. These times will make you fervently want to believe that things are getting better and that he or she is really trying to work on your relationship. But then they will turn around and angrily hurl insults and make outlandish damaging statements that will crush your soul and make you want to run far away.

You may find that the hopes and dreams you had for your future together seem to be slowly eroding away. You might find that you no longer dream of holidays or special occasions because the joyful anticipation you used to have tends to turn to disappointment and frustration. The idea of “happily ever after” can become a far-off fairy tale.

You may find yourself constantly trying to be the referee, mediator and peacekeeper between your spouse and your children. You will want to protect your children from their anger. You will try to soothe your child’s hurt feelings and try to convince them that Daddy or Mommy still loves them. You will do your best to explain your partner’s behaviour to your child in age-appropriate ways, but never feel that you have been very convincing. You will feel the strain in the relationship fed between your spouse and your children, but you will know that there is only so much you can do about it.

You may feel like there is an unpredictable stranger in your house who randomly disrupts the peace in your home, and it is no longer a haven for you and your children. There might be times that you wonder if it would be better for you and your children if you were to just pack up and leave. But you struggle with guilt when you think about breaking up the family and abandoning your spouse, knowing he or she is in pain.

It would be so complicated. There are financial implications, logistical considerations. Even though you might already have taken on most of the family responsibilities, the work required to move out with the children seems like a huge chore.

Besides, you think, what would become of your loved one? In the back of your mind, you may always be worried that their despair may one day become too great, and they might end their life. What if taking the kids and moving out may just be the last straw? If this happens, you know you will feel the guilt forever, and your children will be forever impacted.

At times, the reality of your own situation will flatten you. You might feel a deep loneliness of your own. You may have stress and worry as your constant companion. The spouse who used to be your rock, the man or woman who supported you and soothed your hurt no longer exists. Instead, you have a stranger who is needy, unpredictable, and sometimes explosive.

Living with a partner with PTSD may turn out to be the greatest challenge of your life. The good news is that there is hope that things can improve. With a little bit of understanding of what is actually going on with your partner, and knowledge of the nature of their psychological injury, you will not only feel empowered to help, but you will become aware that you are likely the most important person to walk beside them in their healing journey.

Your loved one has been impacted by things they have seen and done in the course of their service. It may be one incident that has rocked their world, or it may be an accumulation of events. Sometimes, the final event that leads to a psychological crash might seem fairly mild, but it is the fact that all the other incidents coming before have chipped away at their psychological defense mechanisms and this final one led to their undoing.

After a difficult call, your partner might be experiencing post-traumatic stress. The symptoms of this might include having recurring thoughts about the event, ruminating about the details, reviewing and questioning their role in what happened. They may have increased anxiety and worry that the same terrible thing could happen to them or their loved ones. They may start to worry that they are not up to handling their job anymore, or that they are losing their nerve. The anxiety can cause heart palpitations, headaches, chest or back pains, indigestion, and loss of appetite. It can cause insomnia or nightmares. It can make them snappy and irritable, distracted and fidgety. It might lead them to drinking more alcohol or using other substances to calm them down. They might not want to talk to you about the incident. This could be because they are thinking that they are protecting you, that you don’t need to hear how dangerous their job is, how scary the world is, or how guilty they feel about their role in the incident. You might just sense that something bad happened that impacted them greatly, and you are forced to guess what that might be.

Post-traumatic stress disorder cannot formally be diagnosed until the symptoms of post-traumatic stress have become quite severe and have lasted at least one month. This is because many people will learn how to process what happened and make peace with the incident so that it no longer consumes their attention.

This means there is an opportunity to help your loved one and support them to find the attitudes about the incident that they can live with, in peace. This of course would mean that they have to be willing to talk to you about it. It is always astounding to us that many first responders coming through our program have been suffering with the aftermath of traumatic incidents for years and never shared their stories with their intimate partners. To encourage your partner to speak to you about what happened and how they have been impacted, you might first want to acknowledge the concerns they have about confiding in you.

They need to know that:

  • You can handle hearing the story without being traumatized.
  • That you can keep things confidential
  • That you will not judge them or think less of them because of their part in their story
  • That there may be some things they cannot tell you because of security considerations or confidentiality.
  • You might ask them to tell you the general theme of the event without including all the nasty details.

If you can allow your partner to open up to you about their incident or incidents, you must be prepared to listen. Ask questions to help your partner clarify their emotions and feelings about what happened. Remember you cannot argue with someone’s feelings, regardless of how unreasonable they may seem to you. Their feelings are their feelings. Ask questions to help them clarify why the feel like they do about it.

Remember that critical incidents cause a person to lose the belief that the world is a safe place. Years of being on the job has likely already eroded your loved one’s faith in humanity, sense of safety and how much they can actually control. They could already have been just this one incident away from total loss of a sense in themselves, others, and the world in general.

Your calm, reassuring, unconditionally loving presence is most important. You provide a safe haven, a soft place to land where your spouse or partner can rationally work through and process their experiences.

If you are becoming concerned about the amount they are drinking, calmly voice your concerns and help them find other ways of de-stressing. Go for a walk with them or go to the gym. Plan an outing or mini holiday that does not involve alcohol. Ask family friends or relatives that don’t drink to spend time with your partner.

If post-traumatic stress does set in, learn as much as you can about the condition. Know that it might be moral injury, and not PTSD that could be causing the majority of their suffering.

Moral injury is an injury to the heart and soul of a person. This happens when feel they did something they wish they didn’t, they didn’t do something they wish they did, and there were dire consequences. The symptoms of this type of moral injury may be overwhelming guilt and shame. This might make your loved one feel that they deserve to be punished. They may feel undeserving. They may become very hard on themselves and believe that they don’t deserve to have their job or have you and your children. The sense of guilt and being undeserving may show up in unusual ways. Shame may translate into not wanting to go out in public or not wanting to socialize with work mates.

Sometimes moral injury occurs when your partner bears witness to something that is unbearably sad and morally wrong. It may involve bad things happening to good people. It may involve loss of innocence or the crushing of the life of someone who had the expectation of a joyful occasion. These types of incidents lead a person to lose faith in humanity. They also can lead to depressive thoughts and even a state of depression.

Sometimes the fallout of a critical incident causes what we call “sanctuary trauma” or “institutional trauma”. This is when the very organization a person has devoted their life to serving, seems to respond to their need for support in a way that causes a sense of betrayal. This could be through a colleague scapegoating them or not protecting them, leadership failure, insurance companies or workman’s compensation boards not taking care of them. The symptoms of this type of injury are anger and a sense of injustice.

If their incident involves an investigation that could lead to discipline or a criminal charge, expect that the stress and suffering will be magnified and will be prolonged, sometimes for years before the matter is settled. In this case, your partner might not be able to talk to anyone about what happened to protect the integrity of the ensuing investigation. You can still find ways to support your partner without questioning him on the details. There will be many mixed emotions: anxiety, disbelief, sometimes guilt, almost always shame, sadness, anger and sense of injustice or betrayal. How can it be that this could happen when all they wanted to do was help people?

When you are supporting your loved one who has issues with PTSD or moral injury, it would be good for you to get some counselling for yourself. It will be very difficult for you to get your own support that you need from your partner. He or she will likely be preoccupied with their own difficult emotions and will need to rely on you.

You will be the sounding board and nurturer one minute, and then possibly the object of their irritation and resentment the next. You will have to learn to keep calm and not instigate or escalate disagreements or arguments. You will need to keep your voice, your words and your body language calm, loving and reassuring. You will need to learn to recognize the subtext in their sometimes inflammatory statements, knowing they are coming from fear and sadness.

You will also need to set some boundaries for yourself and your children. You should not tolerate verbal, physical, or emotional abuse. You have the obligation to speak up and protect your children and others if they are experiencing abusive interactions with your partner. You will have to decide when it’s time to intervene if alcohol or drug use is becoming a problem. You will have to decide how you will gently but firmly broach the subject. If you feel that your partner is imminently suicidal or in danger of harming someone else, you have no choice but to notify the authorities and ask for help. You can work on discussing the situation with your partner after the fact.

PTSD and Moral Injury change the way a first responder views himself, others, and the world. Their best chance for healing is to be enveloped in a loving safe container where they feel validated, respected, and secure. There is good help available, and we have seen many success stories where those with PTSD are able to transform their stories into one of post traumatic growth. It is a well-established fact that those with mental health challenges of any kind do better if they have a loving, supportive family. You and your entire family are along for the journey. The family and close partners will also benefit immensely when they are able to show up for their injured loved one in a solid way. Working through the perceptions, emotions, and behaviours with your loved one who is reprocessing their story of trauma is a gift. It allows a deepening of connection and invites a new level of intimacy that could be beyond what you thought was possible.

Determining the impact of a residential retreat program on PTSD and Moral Injury in active duty personnel and veterans

This poster was presented at the International Society for Traumatic Stress Studies Forum in Boston in 2019. It shows the preliminary results of the University of Alberta’s study funded by the Family and Wellbeing fund of the Canadian Ministry of Veterans Affairs.

Download the original poster

Project Trauma Support (PTS) offers active duty personnel and veterans who have  experienced PTSD and Moral Injury an opportunity to process traumatic events, acquire skills, find meaning & purpose, and both repair damaged relationships and form new ones.

To examine the impact of participation in the PTS program on

  1. Reducing symptoms of OSIs, PTSD, and MI
  2. Facilitating reprocessing of traumatic experiences,
  3. Enhancing well-being and quality of life,
  4. Improving relationships

Source: Download the original poster