1. Copyright 2013 Ungvarsky and Trivette Resiliency and First Responders Jim Ungvarsky, PsyD, LMFT Sharon Trivette, PsyD, LPC Regis UniversityEl Paso County Sheriff’s Office

2. Question In a study 1 of hospitalized survivors of motor vehicle accidents, approximately what percentage did not develop PTSD? a. 95%c. 40% b. 80%d. 17% 1 Bryant, R.A., Harvey, A.G., Guthrie, R.M., & Moulds, M.L. (2000). A prospective study of psychophysiological arousal, acute stress disorder, and posttraumatic stress disorder. Journal of Abnormal Psychology, 109, 341-344.

3. Question In a study of PTSD among veterans serving in Iraq 2, approximately what percentage had no psychological distress when examined within one year of their return to the U.S.? a. 73%c. 40% b. 63%d. 3% 2 Sutker, P.B., Davis, J.M., Uddo, M., & Ditta, S.R. (1995). War zone stress, personal resources, and PTSD in Persian Gulf War returnees, Journal of Abnormal Psychology, 59, 444-452.

4. Question A 2002 study conducted by Resnick and others found that what percentage of Manhattan residents did not report having a single PTSD symptom the in the year following 9/11? a. 60%c. 20% b. 40%d. 10%

5. Learning Objectives Differentiate between reactive vs. proactive models of mental health Distinguish the subtleties between prevention of illness and promotion of health Gain skills to promote resiliency in the face of traumatic events Identify the components of resiliency Copyright 2013 Ungvarsky and Trivette

6. Research Questions What can we learn from first responders? What differentiates those who get PTSD from those who don’t? How do we enhance factors that promote resiliency in adults? Copyright 2013 Ungvarsky and Trivette

7. Why focus on Law Enforcement? “Research suggests that police work is among the most stressful occupations in the world and officers typically suffer a variety of physiological, psychological, and behavioral effects and symptoms.” McCraty, Atikson, Global Advances in Health and Medicine, Copyright 2013 Ungvarsky and Trivette

8. Why Study Law Enforcement? Officers are exposed to numerous Potentially Traumatic Events (PTEs) Keeping Law Enforcement Officers healthy is in the best interest of the communities that they serve. Copyright 2013 Ungvarsky and Trivette

9. Why Study Law Enforcement? Stress among police has the potential to affect society directly and in more critical ways than other occupations. Those in the occupation of law enforcement may be encouraged to detach from others and disassociate from their feelings. Copyright 2013 Ungvarsky and Trivette McCraty, Atikson, Global Advances in Health and Medicine

10. Copyright 2013 Ungvarsky and Trivette

11. Operational Sources of Stress for Law Enforcement Officers Major disasters Traffic incidents Shooting incidents Interpersonal violence, including domestic violence calls Negative or confrontational interactions with individuals Sense of personal endangerment Fear of revenge/retaliation from criminals Subservience to an ambivalent, watchful public Copyright 2013 Ungvarsky and Trivette

12. Non-Operational Sources of Stress for the Law Enforcement Officer Shift schedules Authoritarian management styles Poor interpersonal relationships with supervisors Interdepartmental politics Lack of adequate planning and resources Lack of promotion and transfer opportunities Excessive paperwork Lack of autonomy in performing duties Lack of recognition for work accomplishments Copyright 2013 Ungvarsky and Trivette

13. Predictors of PTSD Reactions Lack of social support Low intelligence Lack of education Family background Prior psychiatric history Dissociative reactions Copyright 2013 Ungvarsky and Trivette

14. Predictors of Symptoms* among 1 st Responders to a Potentially Traumatic Event Proximity Duration Intensity of Exposure Copyright 2013 Ungvarsky and Trivette

15. Ease Adaptive state Resilience Dis-ease Maladaptive state Vulnerability

16. How do we conceptualize functioning following a potentially traumatic event? Copyright 2013 Ungvarsky and Trivette

17. Time Event Disruptions in normal functioning Mild Moderate Severe CHRONIC DELAYED RECOVERY RESILIENT

18. Research 50%-60% of the US population is exposed to traumatic stress Only 5%-10% develop PTSD (Ozer at al., 2003) Est. chronic PTSD range from 6.6% to 17.8% of those exposed to PTE Copyright 2013 Ungvarsky and Trivette

20. Pathogenic or Negative Responses Traumatic stress symptoms Secondary traumatic stress Compassion fatigue Burnout Copyright 2013 Ungvarsky and Trivette

21. Resilient Responses Compassion satisfaction (Stamm) – Positive feelings about helping others, finding meaning in one’s effort and challenges, fulfilling one’s potential, contributing to the work setting and even to the greater good of society, and the overall pleasure derived from being able to do one’s work well. Copyright 2013 Ungvarsky and Trivette

22. What is Resilience “ability of adults in otherwise normal circumstances who are exposed to an isolated and potentially highly disruptive event, such as the death of a close relation or a violent or life-threatening situation, to maintain relatively stable, healthy levels of psychological and physical functioning” Bonanno Copyright 2013 Ungvarsky and Trivette

23. What is Resilience The process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress – such as family and relationship problems, serious health problems, or workplace and financial stressors. (American Psychological Association) It refers to the ability of “bouncing back” from difficult experiences Copyright 2013 Ungvarsky and Trivette

24. Ordinary vs Extraordinary Research supports that we all commonly demonstrate resilient behavior Being resilient does not mean a person doesn’t experience sadness or distress – these feelings are ordinary. Resilient people have an extraordinary trait to survive such experiences without it holding them back Copyright 2013 Ungvarsky and Trivette

25. Common Questions Where does resilience come from? Do some people have more of it than others? Is there some unique quality only special people have? What role does the environment and culture play in hindering or helping one’s resilience? Copyright 2013 Ungvarsky and Trivette

26. The Simple Answer Resilience is not a trait people either have or do not have; regardless of race, age, gender, creed, etc. It involves behaviors, thought, and actions that can be learned and developed by anyone. In fact, those we would define as resilient often have the skill thanks to action learning through life experiences that involve considerable emotional distress. Copyright 2013 Ungvarsky and Trivette

27. Building a Scaffold of Resiliency

28. Standard One Connections & Community Forge positive relations with others helps increase one’s emotional strength Feelings of belonging and emotional connection to a community Perceived influence over the community Perceived opportunities for fulfilling one’s needs (including need for belonging) Copyright 2013 Ungvarsky and Trivette

29. Standard Two Collective Efficacy What people choose to do as a group, the effort they put into it, and the perception of the group’s ability to accomplish its major tasks Copyright 2013 Ungvarsky and Trivette

30. Standard Three Coping & Appropriate Perspective See Crisis Events as They Are – Crisis events are not viewed as insurmountable problems – You can not change what has happened. You can however control how you respond to that event – Don’t make mountains out of molehills – When confronting mountains, view them in perspective of the greater challenge ahead – Appraise PTEs as being less threatening Copyright 2013 Ungvarsky and Trivette

31. Standard Four Accept Challenge Surrender yourself to the fact that change is part of life Accept that from time-to-time certain goals may no longer be attainable as a result of adverse situations beyond your control Copyright 2013 Ungvarsky and Trivette

32. Standard Five Contribution Take Action – Do something about achieving your goals – If you don’t have any, get some! – Set achievable goals rather than wasting time on “learning to fly without any wings.” Copyright 2013 Ungvarsky and Trivette

33. Standard Six Control Be Decisive – Do not avoid facing adversity – confront the problem head-on and take decisive action to improve the situation or ensure it does not repeat itself in your life Copyright 2013 Ungvarsky and Trivette

34. Standard Seven Competence Self Improve – Be active in finding ways to improve yourself and don’t be frightened to get to know yourself better – Find reasons to have a strong sense of self-worth and value to the world Copyright 2013 Ungvarsky and Trivette

35. Standard Eight Confidence Develop an Ego – Take the time to find reasons why you are important and focus energy on developing confidence – Trust yourself and your instincts so that they can better help you and your world to problem solve Copyright 2013 Ungvarsky and Trivette

36. Standard Eight Confidence Self-Efficacy – The individual beliefs that one holds regarding one’s own capability to exercise some measure of control over in how one functions and of environmental events Copyright 2013 Ungvarsky and Trivette

37. Standard Nine Optimism Be Hopeful – Find the optimistic outlook for even the most devastating event – Learn to see what you want rather than worrying about what you fear – which is what we often confuse as what we see. Copyright 2013 Ungvarsky and Trivette

38. Standard Ten Character & Self-Care Take Care of Yourself – Pay attention to your own needs and feelings – but don’t be self-centered – Keep yourself healthy, fit, and well. Invest energy into eating well, gentle exercise, and maintaining a positive frame of mind Hardiness Copyright 2013 Ungvarsky and Trivette

39. PhysicalEmotionalMentalSpiritualRelationships Dimensions of Resilience

40. Next Steps Resiliency training – Heart Math – Biofeedback Efficacious use of resources Utilizing the law enforcement community as a support system Copyright 2013 Ungvarsky and Trivette

41. Thank you