WHAT ARE OPERATIONAL STRESS INJURIES?
A potentially traumatic event (PTE) typically describes an event involving direct or indirect experiences of actual or threatened death, serious injury, or sexual violence. We use "potentially" because whether an event is perceived as traumatic or not depends heavily on individual and contextual variables; in addition, those individual and contextual variables can and do change substantially over time. In some cases, exposure to a PTE may cause post-traumatic stress (PTS).read more
Post-traumatic stress (PTS) refers to the highly variable symptoms of stress or distress that may be experienced after exposure to a potentially traumatic event (PTE).
A person exposed to one or more potentially traumatic events (PTEs) who experiences post-traumatic stress (PTS) may develop persistent psychological difficulties that are consistent with symptoms of a post-traumatic stress injury (PTSI). If any of the exposures were the result of work, operational duties, or service deployment, the PTSI may instead be referred to as an operational stress injury (OSI).
In some cases, post-traumatic stress injuries (PTSIs) may be severe enough that the symptoms are consistent with the diagnostic criteria for one or more mental health disorders, including but not limited to, post-traumatic stress disorder (PTSD), major depressive disorder (i.e., depression), generalized anxiety disorder, panic disorder, adjustment disorder, or substance abuse and dependence.
Public safety personnel (PSP) include, but are not necessarily limited to, Canadian Border Services, Canadian Security Intelligence Service, Correctional Officers, Correctional Workers, Dispatchers, Emergency Call Centre Operators, Emergency Medical Technicians, Firefighters (including volunteers), Municipal Police Officers, Paramedics (including Emergency Medical Responders), Provincial Police Officers, and Royal Canadian Mounted Police (RCMP), as well as the team members who support all front-line efforts.
Not all mental health concerns are post-traumatic stress injuries (PTSIs) or operational stress injuries (OSIs). People who are involved in public safety careers can develop symptoms consistent with a mental health disorder without an identifiable PTE. People involved in public safety careers can develop symptoms consistent with a mental health disorder that are not related to their service. For example, a PTSI could develop following a PTE that occurs while off-duty in your personal life.
Not every person who serves in public safety will develop an operational stress injury (OSI), but OSIs may be more common among public safety personnel (PSP) than previously thought. A recent Canadian survey found that up to 44.5% of participating public safety personnel reported symptoms consistent with one or more mental health concerns based on established screening questionnaires.
On this website you will find information about some OSIs, including PTSD. Click through to learn about what PTSD is, how it is treated, and how to access resources if you or someone you know needs help.
References and Further Reading
WHAT IS POST-TRAUMATIC STRESS DISORDER?
Post-traumatic Stress Disorder (PTSD) is a group of symptoms people might develop after experiencing a potentially traumatic event.read more
WHAT IS A POTENTIALLY TRAUMATIC EVENT?
When a mental health professional is evaluating whether someone has PTSD, they often consider the experience or situation thought to have triggered the symptoms. A traumatic event is different than normal daily stress or pressure. Potential traumas usually involve experiencing or witnessing severe injury, feeling that your life or somebody else’s life is in danger, or witnessing an intentional or accidental death. Events such as natural disasters can also be traumatic.
The kinds of potentially traumatic events that can lead to PTSD are often experienced in person, but not always. For example, some work involves repeated exposure to stories of injury or death – like being a call centre operator for 911 or a crime scene photo developer for a police unit.
Not everybody who experiences a traumatic event develops PTSD. Indeed, in the North American general population most people (i.e., 50-90%) will experience one or more potentially traumatic events during their lifetime; however, relatively few (i.e., 5-10%) will develop PTSD. Even people who are in careers where exposure to potentially traumatic events may be more common, like public safety personnel, are not necessarily going to develop PTSD. There are responses to potentially traumatic events that can be considered fairly normal. For example, you might feel unsettled or uncomfortable at first, but most people recover and return to normal within a few days; however, some people do go on to have longer-lasting challenges after experiencing a potentially traumatic event.
PTSD SYMPTOMS AFTER TRAUMA
There are four types of PTSD symptoms a person might experience after being exposed to a potentially traumatic event.
- Re-experiencing symptoms
A hallmark symptom of PTSD involves re-experiencing the traumatic event. This may occur in the form of unwanted and upsetting memories of the event, or repeated and distressing nightmares. Some people have more intense re-experiencing events called “flashbacks,” where they might feel like they are actually experiencing the trauma again.
- Avoidance symptoms
Avoidance symptoms include a strong urge to stay away from reminders of a potentially traumatic event. These reminders might include people, places, objects, or activities which are related to the trauma in some way. Some people also go out of their way to avoid thinking or talking about the event.
- Changes in your thoughts and mood
Potentially traumatic events can change how people think about themselves, other people, and their world. The changes can include feeling hopeless, detached from loved ones, or difficulty experiencing positive emotions – or sometimes any emotions – at all. Such changes might indicate PTSD, especially for people who were ‘positive’ or ‘realistic’ person but have become increasingly ‘negative’ after a potentially traumatic event.
- Changes in physical and emotional reactions
Potentially traumatic events can also cause significant distress and physical symptoms. People can become more watchful, on guard, easily startled, or frightened. Difficulties sleeping or trouble concentrating can be caused by diverse stress, up to and including traumatic stress. In addition, potentially traumatic events can cause increased feelings of anger, irritability, shame, or guilt.
Many people can experience some of the above symptoms after a potentially traumatic event; nevertheless, for most people the symptoms fade within a couple weeks.
If someone experiences several of the above symptoms from each of the four groups for longer than a month, and the symptoms are extremely distressing or interfere with work, relationships, or other important areas of life, they may be experiencing PTSD and may benefit from appropriate mental health care.
If you think that you or someone you know might be experiencing these symptoms, click here to take a short, anonymous questionnaire to screen for PTSD.
While PTSD has many negative impacts, there are interventions that can be very effective at treating the symptoms. To learn more about how PTSD can be treated and how you can access resources, read the following section on Understanding PTSD Treatment.
REFERENCES AND FURTHER READING
UNDERSTANDING PTSD TREATMENT
There are many treatments available for PTSD that have been supported by several rigorous peer-reviewed research projects (i.e., empirically-supported treatments). Such therapies, when provided by appropriately trained professionals, can help reduce PTSD symptoms, improve quality of life, and develop skills maintaining good mental health.read more
Cognitive Processing Therapy (CPT)
Traumatic experiences can have ripple effects through many areas of life. Once the effects are identified, a CPT therapist can help a person to work towards solutions and generate a more adaptive way of moving forward. CPT can help a person to think differently about the negative thoughts they have regarding a trauma. Doing so can change how a person feels about and interacts with the trauma, which can reduce the impact of PTSD symptoms in many different parts of a person’s life. CPT involves talking with a therapist about the negative thoughts related to a trauma and doing short writing assignments.
Eye-Movement Desensitization and Reprocessing (EMDR)
Traumatic experiences can be difficult to make sense of and change the way a person thinks about the world. For some people discussing the trauma can be too difficult. Eye-Movement Desensitization and Reprocessing (EMDR) can help a person process and make sense of a trauma, which can help reduce PTSD symptoms. EMDR involves a person recalling a trauma in their own mind while paying attention to a back-and-forth movement or sound (e.g., a finger waving side to side, a light, a tone) produced by a therapist.
Prolonged Exposure (PE)
Imagine a child who is very afraid of swimming – how would you help the child overcome their fear? Perhaps, “start small with a sprinkler, work up to a shallow pool, eventually working up to a deeper pool, and perhaps eventually to a lake or ocean”? Essentially you want to help them gradually develop new skills, confront their fears, and decrease their anxiety. Prolonged Exposure, or PE, helps a person confront difficulties with trauma in a similar fashion. Once a person has identified their challenges, developed their goals, and is comfortable enough with their therapist, they can gradually confront their trauma with help from their therapist. Gradual exposure to the trauma story (starting small and working up slowly) in a safe and therapeutic environment can help to reduce PTSD symptoms. Therapists can help to make sense of traumatic experiences and find ways to move forward towards an improved quality of life.
EMPIRICALLY-SUPPORTED PTSD TREATMENTS
In addition to the above treatments, the American Psychological Association suggests Narrative Therapy and Brief Eclectic Therapy are promising therapies, and researchers are currently exploring how well they work in different settings with different populations. In all cases, persons interested in PTSD treatment should consult with an appropriately trained professional. If you would like more information comparing PTSD therapy options, click here.
REFERENCES AND FURTHER READING
WHAT IS CLINICAL DEPRESSION?
Major depressive disorder (MDD), clinical depression, or simply depression, is a group of symptoms that occur together in time, and that can develop at any point in a person’s life.read more
SYMPTOMS THAT DEFINE DEPRESSION
- Feeling sad, blue, depressed, or down in the dumps
- Losing interest in most things you find enjoyable
- Sleeping too much, or sleeping too little compared to your usual self
- Eating too much, or eating too little compared to your usual self
- Moving or speaking less than you usually do, or the opposite: moving or speaking more than you usually do
- Having low energy, or feeling fatigued
- Having low self-esteem, thoughts that you’re worthless, or feeling guilty about things you may or may have not done
- Having trouble concentrating (e.g., while doing work), or having trouble making even simple day-to-day decisions (e.g., where or what to eat)
- Having thoughts of death or suicide, or thoughts that you may be better off dead
It is normal for most people to experience some or all these symptoms for a relatively brief period, or to experience milder versions of these symptoms. For some people, these symptoms resolve on their own.
However, if someone is experiencing at least five of these symptoms, with the experience at least one of the first two on the list, for two weeks or longer, and these symptoms are interfering significantly with work, school, or relationships, he or she may be experiencing depression.
People may experience one episode of depression, or two or more episodes (recurrent) in a lifetime. People may also experience conditions closely related to clinical depression, such as Persistent Depressive Disorder, formerly known as dysthymia, where less symptoms of depression are experienced, but over a long period of time (over two years).
If you think that you or someone you know might be experiencing these symptoms, click here to take a short, anonymous questionnaire to screen for depression.
The good news is that depression is treatable. To learn more about how depression can be treated and how you can access resources, read the following section on Understanding Depression Treatment.
REFERENCES AND FURTHER READING
UNDERSTANDING DEPRESSION TREATMENT
You may wonder, “what comes next” after a diagnosis of depression. Fortunately, there are many high-quality treatments available for depression! The experience of depression is very difficult, but therapy with a trained professional can help you reduce your symptoms and suffering, reconnect with the people and activities you miss, and develop skills for keeping mentally healthy. Many people who access an empirically supported treatment for depression go on to recover and return to their normal lives.read more
An empirically supported treatment – also called evidence based treatment – refers to a treatment that has been tested in several rigorous research studies conducted by scientists and medical professionals. Clinical research studies might include:
- Initial work looking at whether a new course of treatment helps a small group of people.
- Larger studies looking at how the treatment compares to other treatments, or to no treatment, with a more diverse group of people.
- The gold standard, Randomized Controlled Trials, where a large group of people are randomly assigned to receive the new treatment or not. Random assignment means that other factors, such as personality or how long ago the trauma was, should be spread out between the two groups. If the people who receive the treatment become healthier than the people who don’t receive the treatment, we can be confident that the new treatment is the reason why they improved.
EMPIRICALLY-SUPPORTED TREATMENTS FOR DEPRESSION
Anti-Depressant Medications (ADMs)
Certain medicines, called anti-depressant medications (ADMs), have research evidence indicating they reduce symptoms of depression. There are several different anti-depressant medications including Prozac, Zoloft, Paxil, Celexa, Cymbalta, and Effexor. Anti-depressant medications may work by changing the chemicals in the brain that affect emotions, like intense sadness or depression. The goals of ADMs are to relief symptoms of depression and improve patients’ quality of life. ADMs are often prescribed by a family physician or psychiatrist and can be obtained from a pharmacy. Pharmacists may provide patients with education on how the anti-depressant medications work, as well as on common side effects. Depressed patients are typically prescribed anti-depressant medications for 16 weeks, but the majority of patients stay on these treatments for longer. The dosage may be small in the beginning of treatment but is gradually increased each week to a maximum daily dose. The physician or psychiatrist may then decrease the dosage if patients had difficulty with side effects. Common side effects included feeling tired and experiencing reduced sexual functioning, problems sleeping, sweating, and headaches.
Cognitive Therapy or Cognitive Behavioural Therapy (CBT)
Cognitive behavioural therapy (CBT) are a group of therapies focused on the relationships between the ways we think, feel, and act. Accordingly, CBT for depression focuses on helping patients understand how certain thoughts and actions affect emotions, like intense sadness or depression. Patients with depression may have thoughts that they are not loved or wanted, or that they are worthless. In terms of behaviours, patients with depression may withdraw from the world around them, or neglect important tasks like their health and hygiene. Patients may also stop doing pleasurable or enjoyable activities. The goal of CBT is to help patients change thoughts and behaviours in ways that will help reduce depression. CBT often happens in a therapist’s office, but patients are often expected to do between-session “homework” to bring about lasting change. The treatment typically consists of 12 to 20 face-to-face sessions, wherein a depressed patient meets on a weekly basis with a qualified cognitive-behavioural therapist. However, this form of treatment can also be done successfully via remote technology (online; mobile apps), with little involvement from a therapist.
Interpersonal Psychotherapy (IPT)
Interpersonal psychotherapy is a type of treatment for depression that helps patients understand how relationships in their lives affect their mood and behaviours. With the help of a qualified psychotherapist, patients begin to evaluate their relationship patterns and their capacity for intimacy. Further, patients may learn how recent interpersonal changes (e.g., being let go at work; losing a loved one) are impacting their mood, and ways to successfully cope with these changes. The treatment typically consists of 12 to 20 face-to-face sessions, wherein the patient meets with the therapist on a weekly basis.
In addition to the above treatments, the American Psychological Association, the National Institute for Health and Clinical Excellence, and other organizations suggest the following therapies are promising, and researchers are currently exploring how well they work in different settings with different populations: Behaviour Therapy, Supportive or Client-centered Psychotherapy, and Short-Term Psychodynamic Psychotherapy.