When the Bells Go Down: Resilience and Vulnerability in Firefighters
Alexander, Lois Elizabeth
Firefighters respond to a wide range of critical incidents in which they face exposure to multiple stressors. Previous studies have reported prevalence rates of various symptomatology and identified some risk factors for firefighters, but accord has not been reached across studies on the extent of vulnerability or resilience and potential predictors of each have not all been identified. Studies with firefighters in the United Kingdom are comparatively rare. The purpose of this series of studies was, therefore, to investigate the prevalence of PTSD symptomatology and that of its associated comorbid conditions (depression, anxiety and alcohol misuse) in UK firefighters. On the basis of a literature review, the role of thought control, counterfactual thinking and humour style in predicting symptoms was examined. Study I examined this together with the demographic, occupational, event-specific and cognitive factors associated with these conditions in a retrospective, cross-sectional analysis of multiple exposure in firefighters. Results indicated that these firefireghters demonstrated high levels of resilience, recording relatively low rates of PTSD, depression, anxiety and alcohol misuse symptomatology. No DSM-IV Criterion A1 exposure variable independently predicted symptomatology of PTSD, but A2 responses of fear and helplessness predicted PTSD symptomatology, and A2 fear predicted alcohol misuse. Individual aspects of A1 exposure did predict symptomatology of depression, anxiety and alcohol misuse; one operating schedule predicted symptomatology of depression and anxiety; and both previous divorce and previous psychiatric diagnosis predicted symptomatology of alcohol misuse. Of the three cognitive predictors, nonreferent counterfactual thinking and self-defeating humour independently predicted higher levels of PTSD symptomatology, whilst self-enhancing humour predicted lower symptomatology of depression. Results were essentially the same in both regression models, indicating no difference between the predictive power of these cognitive constructs between the models where humour was used at work and when used with the person closest to the participant. Study 2 evaluated the same symptomatology in a longitudinal investigation of firefighters exposed to a single critical incident in which the casualty’s life could not be saved, again addressing the cognitive factors of thought control strategies, counterfactual thinking and humour style. Results showed high levels of resilience with firefighters recording relatively low rates of PTSD, depression, anxiety and alcohol misuse symptomatology, although symptomatology of depression, anxiety and alcohol misuse increased over time for a small number. Factors associated with development of symptomatology were firefighter type and rank, A2 horror, body recovery, and the use of thought suppression and “if only” counterfactuals). However, these were not long-lasting. Similarly, associations between depression/anxiety symptomatology and A2 helplessness; anxiety and previous psychiatric diagnosis also had a short term effect on symptoms. Those who were younger and who had not been involved in body handling had higher depression scores at T2 although the sample size was small and these results may be anomalies. Study 3 explored the firefighters’ responses to the same critical incident in greater depth in order to draw out any aspects of it which caused distress and any factors which were found to be helpful in coping with such distress. This qualitative exploration was designed to identify the meaning attached to aspects of critical incidents and how firefighters individually experienced such a critical incident response in comparison with other critical incidents. Results showed positive emotions, professional pride and a strong sense of duty were expressed far more than “negative” emotions, suggesting a high degree of resilience. Identification with the dying or dead is a marker for distress because meaning has been attributed to the event through recognition of the deceased’s humanity. Dissonance arose because of the struggle between this recognition and the desire to protect colleagues and it appears that it is this dissonance which adversely affects those with responsibility for making decisions. Feelings of helplessness arose through operational limitations and are also a marker for distress. Avoidance techniques were utilised, but thought suppression was not identified as such, although the transposition of distressing images through humour was reported. Downward counterfactuals were reported more frequently than upward, and the latter related to decision making and operational difficulties. The type of humour commonly used is banter which includes “taking the piss” out of colleagues and situations although it was not experienced the same way by all firefighters. The purpose of banter is to cope with the stressors inherent in the job of firefighting and to facilitate bonding through its use as a private language. This study identified three “rules of banter”: it is reciprocal, the timing of it is critical, and it has contextual restrictions. Adaptive banter may be expressed as the self-enhancing or affiliative styles of humour and maladaptive as self-defeating, or banter may itself be a separate style of humour. Together, the studies’ findings show that these firefighters were resilient to exposure to a range of stressors but that suffering may be seen on a spectrum. This has implications for theory and further research, and for the development of psychoeducational interventions to increase resilience in those first responders who may be at risk of developing symptoms.