As the first responder community’s recognition of the value of mental health steadily grows, so does the availability of treatment options for those struggling with post-traumatic stress symptoms. While there are a variety of effective treatments to explore, one in particular demonstrates great success in helping individuals improve their quality of life: Accelerated Resolution Therapy (ART), an evidence-based psychotherapy designed to relieve the emotional and physiological reactions triggered by traumatic memories.
“Most people are dealing with complex levels of trauma. Anxiety, depression, substance abuse and risky behaviors are all comorbid conditions people are unable to tie together until they've gone through therapy,” says Kelly Breeding, a licensed clinical social worker and executive director with ART International Training and Research, Inc., a nonprofit based in Tampa, Fla. dedicated to making ART more widely available to anyone dealing with trauma (about half of ART clients consists of first responders and military veterans while the rest are civilians). “I don't think any human being on this planet was born with the ability to process severe trauma, in my opinion, everybody needs assistance with that.”
One Step at a Time
While practicing EMDR in 2008, a similar form of psychotherapy, Laney Rosenzweig, MS LMFT, developed ART, its more streamlined offshoot. The crux of ART is the use of bilateral eye movements to help process memories, similarly to what happens naturally during the REM stage of sleep, which helps your body process its reactions to daily experiences.
Unfortunately for EMS personnel and firefighters, lack of sleep is a normal occurrence. Coupled with managing distressing calls on a regular basis, it’s a recipe for post-traumatic stress.
“When you have people who are functioning at this level for days and weeks and months at a time without processing their daily experiences, they are continuing to carry those experiences into their daily living,” Breeding says. “The eye movements allow people to move through that process naturally.” During a session, the clinician guides a client by having them visualize one memory at a time. The first step is to process that memory in a way that resolves the physiological reactions accompanying it.
“The clinician is going to keep them focused on working through and processing that one memory to successfully rescript it in their mind before they move to the next one,” says Breeding, who says ART was pursued by some of the first responders on scene of the Pulse night club shooting in Orlando. “Say we’re working with one of the SWAT members [visualizing] walking into the scene. That memory is triggering other things in their lives after the event causing them anxiety, depression or keeping them from being successful in their job.”
Breeding says once a client has successfully worked through one distressing image or memory, it provides new space for them to process the next one. Working through scenes one at a time rather than talking about all of their traumas simultaneously prevents them from feeling overwhelmed. “The client feels a tremendous amount of relief after each session,” she says. “With ART it usually takes about three to five sessions. It's incredible to watch, because when a client comes into a session, you can see when they’re distressed by their physical appearance.”
To further reduce discomfort, clinicians simply ask clients to visualize scenes rather than explain them out loud, as this “can often re-traumatize people […] so there's very little talk therapy,” says Breeding.
After being asked to recall their memory, the client is brought through a series of eye movements which evokes the physiological reactions people experience when thinking of their trauma. Tachycardia, nausea and uncontrollable crying are not uncommon, but ART helps eliminate those feelings.
“ART utilizes metaphors to allow the person to process out the physiological responses first,” says Breeding. For example, if someone is sweating profusely, they could “imagine a cool breeze blowing followed by more sets of eye movements until all those physiological responses are processed out.”
Rewriting the Past
ART clinicians also use memory reconsolidation, a tactic which utilizes eye movements to attach new imagery to old images. Once the client runs through this new imagery a few times with the eye movements, “the new scripting takes precedence over the last part” of that memory. This makes it increasingly harder for the client to recall the old memory and instead recall the new images, empowering them to recognize that they can take control of their memories.
Breeding likens this to becoming “the director of their own memory and allowing them to re- script it,” because the individual is able to recall the memory without experiencing “physiological, physical or emotional responses to it anymore. They can say, ‘I'm in control of this memory now, it's not controlling me.’”
“This is where it's really important when you're working with first responders and military people who have lost their brothers and sisters in combat or in an emergency situation because they feel that they can honor them by maintaining this memory of them,” she says. “But if that memory is affecting their daily quality of life, that's not a way for them to continue on.”
Breeding says rescripting helps people think of the memory differently. For example, a clinician might help a group of military individuals who lost some of their men on a call or firefighters who couldn’t save a child from a fire change the endings of those memories to more positive ones. “Letting them go in and change how that scene ended in their memory allows them to take that memory and process it much more successfully.”
Improving Mental Health Improves Job Performance
Arguably one of the hardest parts of achieving this emotional relief is convincing a first responder to seek out this kind of support in the first place. While it is slowly letting up with mental health awareness campaigns gaining traction, the “suck it up” culture is still deeply engrained in the first responder and military worlds. Because of this, ART clinicians make it clear with their clients that this therapy is the catalyst to helping them become better performers in their line of work.
“In their opinion, admitting that they're struggling could be a sign of weakness,” Breeding says. “When working with the military and first responders, it's very important that we use a language that’s much more structured as a performance enhancement.”
Due to the stigma against mental health discussions, ART clinicians know it’s difficult for first responders to be open and honest about their struggles, which is why Breeding is diligent about referring first responders to clinicians who have experience in the field themselves, who can better understand what they are going through.
“Everybody here knows that they are better performers when they are not struggling,” she says. “That's the important piece—it needs to come from the top down where these types of services are offered and individuals are not in fear of being stigmatized.”
Accounting for the frequency and growing scale of mass casualty incidents, ART International’s goal for 2019 is to reach more first responders.
“Accelerated Resolution Therapy is something that's available for first responders,” she says. “It's something that can change their lives. It can help improve their performance within their jobs. Our organization's mission is to expand the therapy so that all individuals who are experiencing any form of trauma or symptoms of trauma can get the help that they need.
“Our first responders [must be] functioning well and healthy. They're the people that we rely on in the scariest situations,” says Breeding. “I think it really comes from the leadership setting a precedence of how important it is to take care of themselves and continuing to work nationwide toward removing this negative stigma of mental health.”