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Unprocessed trauma

Topics: Couples, Family, Mental Health

What is unprocessed trauma?

PSP are frequently exposed to trauma and may need time to process events that occur during a shift. When PSP transition from work to family life without adequate exit and recovery time to process their experience, they may carry unprocessed trauma. This unprocessed trauma can make it difficult to relax and engage in family activities. The PSP is sometimes unable to leave work behind and may be emotionally distant or irritable. This can impact couple and family relationships. PSP can be physically present but grappling with events from work which interfere with their ability to fully participate in family life.

Signs that PSP might have unprocessed trauma

 

The effects of unprocessed trauma on PSP families

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References for this page (click to expand)

Anderson, L. (2019). The impact of paramedic shift work on the family system: a literature review. British Paramedic Journal, 3(4), 43-43. https://doi.org/10.29045/14784726.2019.03.3.4.43

Beks, T. (2016). Walking on eggshells: the lived experience of partners of Veterans with PTSD. The Qualitative Report 21(4):645-660. https://doi.org/10.46743/2160-3715/2016.2269

Cox, M., Norris, D., Cramm, H., Richmond, R., & Anderson, G. S. (2022). Public safety personnel family resilience: a narrative review. International Journal of Environmental Research and Public Health, 19(9), 5224. https://doi.org/10.3390/ijerph19095224

O’Toole, M., Mulhall, C., & Eppich, W. (2022). Breaking down barriers to help-seeking: preparing first responders’ families for psychological first aid. European Journal of Psychotraumatology, 13(1), 2065430-2065430. https://doi.org/10.1080/20008198.2022.2065430

Porter, K. L., & Henriksen, R. C. (2016). The phenomenological experience of first responder spouses. The Family Journal (Alexandria, Va.), 24(1), 44-51. https://doi.org/10.1177/1066480715615651

Regehr, C., Dimitropoulos, G., Bright, E., George, S., & Henderson, J. (2005). Behind the brotherhood: Rewards and challenges for wives of firefighters. Family Relations, 54(3), 423-435. https://doi.org/10.1111/j.1741-3729.2005.00328.x

Tuttle, B. M., Giano, Z., & Merten, M. J. (2018). Stress spillover in policing and negative relationship functioning for law enforcement marriages. The Family Journal (Alexandria, Va.), 26(2), 246-252. https://doi.org/10.1177/1066480718775739


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Proactive versus reactive behaviours

Topics: Couples, Family, Mental Health

Proactive versus reactive behaviours

How do negative affect and reactivity influence home life?

There are consequences when the impact of work stress spills over into family life. Negative affect can impact how someone engages in family life. It can reduce the quality of family interactions, relationships, and communication.

Withdrawal

If a negative affect leads to withdrawal and disengagement, family members might feel lonely or uncared for. There can be a feeling of loss when the PSP is mentally and emotionally withdrawn from the family. They may be physically present but not actively engaging with the family. This can lead to a loss of intimacy, a loss of relationship, and feelings of frustration and disappointment (see ambiguous loss).

Reactivity

Families may experience reactivity if the PSP family member ‘acts out,’ showing a response that is too ‘over the top’ and not what one would typically expect. Families might feel that the PSP family member loses their temper easily, overreacts to simple things, or makes unreasonable demands. This can lead to emotional fatigue, particularly for spouses and significant others (SSOs).

How do positive affect and engagement influence home life?

Positive affect can support healthy engagement in family/couple life. Relationships and social interactions are enhanced when a PSP family member returns home with a positive outlook. The whole family benefits when all members are able to contribute to complete household tasks and enjoy leisure time together. Engagement and positive interactions build relationships and support the wellbeing of the family. When individuals can show each other respect and kindness, they feel that they are valued members of the family.

References for this page (click to expand)

American Psychological Association. (2022). APA Dictionary of Psychology. American Psychological Association. Retrieved July 18, 2022, from https://dictionary.apa.org/ 

Bateman, T. S., & Crant, J. M. (1999). Proactive behavior: Meaning, impact, recommendations. Business Horizons, 42(3), 63–70. https://doi.org/10.1016/S0007-6813(99)80023-8 

Brandt, A. (2018). How reactive behavior damages your relationships. Psychology Today. Retrieved August 10, 2022 from https://www.psychologytoday.com/ca/blog/mindful-anger/201810/how-reactive-behavior-damages-your-relationships  

Porter, K. L., & Henriksen, R. C. (2016). The phenomenological experience of first responder spouses. The Family Journal (Alexandria, Va.), 24(1), 44-51. https://doi.org/10.1177/1066480715615651  

Regehr, C. (2005). Bringing the trauma home: Spouses of paramedics. Journal of Loss & Trauma, 10(2), 97-114. https://doi.org/10.1080/15325020590908812  

Regehr, C., Dimitropoulos, G., Bright, E., George, S., & Henderson, J. (2005). Behind the brotherhood: Rewards and challenges for wives of firefighters. Family Relations, 54(3), 423-435. https://doi.org/10.1111/j.1741-3729.2005.00328.x 

Sonnentag, S., & Binnewies, C. (2013). Daily affect spillover from work to home: Detachment from work and sleep as moderators. Journal of Vocational Behavior, 83(2), 198-208. https://doi.org/10.1016/j.jvb.2013.03.008  

Tuttle, B. M., Giano, Z., & Merten, M. J. (2018). Stress spillover in policing and negative relationship functioning for law enforcement marriages. The Family Journal (Alexandria, Va.), 26(2), 246-252. https://doi.org/10.1177/1066480718775739 

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Indirect trauma

Topics: Couples, Family, Mental Health

Indirect trauma exposure

PSP and PSP families can experience direct exposure to trauma by experiencing, witnessing, confronting, or being involved in a traumatic event. Over time, repeated exposure to details of a traumatic event can also impact PSP families. This is called indirect exposure and is sometimes referred to as vicarious trauma and/or secondary trauma.

 

Vicarious trauma happens when a person takes on the emotional experiences of another. It can affect an empathetic family member of a PSP trauma survivor. While empathy can shape good social behaviours, it also can lead to an SSO taking on a PSP’s distress. The likelihood of developing vicarious trauma may also be influenced by coping strategies, personal trauma history, stress, low levels of social support, etc. Vicarious trauma can develop over time after hearing about several traumas rather than all at once because of a single event.

Secondary trauma is trauma that can cross over from one person to another; the non-exposed person develops posttraumatic stress symptoms. Secondary trauma may occur through exposure to a PSP who has been exposed to trauma, but it does not always develop. Any family member can develop PTSD symptoms, including children.

There are some differences between vicarious and secondary trauma. Vicarious trauma occurs over time and can change how a person sees the world. The person with secondary trauma experiences trauma-related symptoms in response to another person’s trauma.

Difference between vicarious and secondary trauma

Vicarious trauma

  • comes with a lasting change in worldview through an empathic relationship
  • can develop as an accumulation of hearing about several trauma over time
  • can include affective and cognitive changes, such as alterations in self-identity and mental health

Secondary trauma

  • involves experiencing trauma-related symptoms in response to another’s trauma
  • can happen as a response to a single event
  • can lead to manifestation of PTSD symptoms among contacts of traumatized individuals, including family members
Did you know?

Research has found that SSOs of PSP feel directly responsible for helping relieve the PSP partner’s stress, and for encouraging them.1 Many sectors, such as paramedics, have identified that their PSP partners often debriefed with them after a shift. These SSOs identified that they experienced feelings of distress related to what their partners shared with them.2

Effects of indirect trauma on family members

SSOs and other family members who are indirectly exposed to details about serious traumatic events can be affected. When SSOs and family members become “sounding boards” and learn about traumatic events through PSP family member, they are at risk of indirect trauma.

How might indirect trauma affect me and/or my family positively?

Exposure to PSP’s trauma may also result in:

Postraumatic growth

Posttraumatic growth (PTG) occurs when an individual experiences a positive psychological change after exposure to major trauma or life crisis.

Hearing about someone else’s trauma can lead an individual to develop more positive views on human resilience, including amazement at the human spirit.

This can result in positive changes, including learning to be more compassionate, becoming more accepting of others, and gaining a greater appreciation for life itself.

 

Vicarious resilience

Vicarious resilience occurs when those indirectly affected by trauma are positively influenced by the resilience of someone who was directly affected. Resilience is often demonstrated through that person’s journey and recovery process.

Vicarious resilience can include positive meaning making and growth through the vicarious experience of someone else’s journey through trauma.

 

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References for this page (click to expand)

1Porter, K. L., & Henriksen, R. C. (2016). The phenomenological experience of first responder spouses. The Family Journal (Alexandria, Va.), 24(1), 44-51. https://doi.org/10.1177/1066480715615651

2Regehr, C. (2005). Bringing the trauma home: Spouses of paramedics. Journal of Loss & Trauma, 10(2), 97-114. https://doi.org/10.1080/15325020590908812

3Cramm, H., Tam-Seto, L., Norris, D., Eichler, M., & Smith-Evans, K. (2016). The impact of parental operational stress injury on child mental health and well-being: A scoping review. Military Behavioral Health, 4(4), 334-344. https://doi.org/10.1080/21635781.2016.1181582

4Dinshtein, Y., Dekel, R., & Polliack, M. (2011). Secondary traumatization among adult children of ptsd veterans: The role of mother-child relationships. Journal of Family Social Work, 14(2), 109-124. https://doi.org/10.1080/10522158.2011.544021

5Kishon, R., Geronazzo-Alman, L., Teichman, M., Teichman, Y., Cheslack-Postava, K., Fan, B., Duarte, C. S., Wicks, J., Musa, G. J., Djalovski, A., Tadmor, B., Moreno, D. R., Cycowicz, Y., Amsel, L., Bresnahan, M., & Hoven, C. W. (2020). Parental occupational exposure is associated with their childrenʼs psychopathology: A study of families of Israeli first responders. Journal of Occupational and Environmental Medicine, 62(11), 904-915. https://doi.org/10.1097/JOM.0000000000001971

Alrutz, A. S., Buetow, S., Cameron, L. D., & Huggard, P. K. (2020). What happens at work comes home. Healthcare (Basel), 8(3), 350. https://doi.org/10.3390/healthcare8030350

Cohen, K., & Collens, P. (2013). The impact of trauma work on trauma workers: A metasynthesis on vicarious trauma and vicarious posttraumatic growth. Psychological Trauma, 5(6), 570-580. https://doi.org/10.1037/a0030388

Duarte, C. S., Eisenberg, R., Musa, G. J., Addolorato, A., Shen, S., & Hoven, C. W. (2017). Children’s knowledge about parental exposure to trauma. Journal of Child & Adolescent Trauma, 12(1), 31-35. https://doi.org/10.1007/s40653-017-0159-7

Friese, K. M. (2020). Cuffed together: A study on how law enforcement work impacts the officer’s spouse. International Journal of Police Science & Management, 22(4), 407-418. https://doi.org/10.1177/1461355720962527

Hernandez-Wolfe, P., Killian, K., Engstrom, D., & Gangsei, D. (2015). Vicarious resilience, vicarious trauma, and awareness of equity in trauma work. The Journal of Humanistic Psychology, 55(2), 153-172. https://doi.org/10.1177/0022167814534322

Hoven, C. W., Duarte, C. S., Wu, P., Doan, T., Singh, N., Mandell, D. J., Bin, F., Teichman, Y., Teichman, M., Wicks, J., Musa, G., & Cohen, P. (2009). Parental exposure to mass violence and child mental health: The first responder and WTC evacuee study. Clinical Child and Family Psychology Review, 12(2), 95-112. https://doi.org/10.1007/s10567-009-0047-2

Landers, A. L., Dimitropoulos, G., Mendenhall, T. J., Kennedy, A., & Zemanek, L. (2020). Backing the blue: Trauma in law enforcement spouses and couples. Family Relations, 69(2), 308-319. https://doi.org/10.1111/fare.12393

Meffert, S. M., Henn-Haase, C., Metzler, T. J., Qian, M., Best, S., Hirschfeld, A., McCaslin, S., Inslicht, S., Neylan, T. C., & Marmar, C. R. (2014). Prospective study of police officer spouse/partners: A new pathway to secondary trauma and relationship violence? PloS One, 9(7), e100663-e100663. https://doi.org/10.1371/journal.pone.0100663


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Anticipatory Vigilance: Posttraumatic Stress Injury (PTSI)

Posttraumatic Stress Injury (PTSI)

When a person does not have a diagnosis of Posttraumatic Stress Syndrome (PTSD), but does have symptoms of a mental health injury (anxiety, depression, etc.) it is called a Posttraumatic Stress Injury (PTSI). For PSP, PTSI can happen at any time, but is more common later in a career due to a buildup of exposures over time.  PSP family members can be heavily impacted by their own traumatic exposures as well as those of their PSP member.

Stigma around Posttraumatic Stress Injury (PTSI) in PSP sectors

Some PSP might find it hard or hesitate to seek help for mental health concerns. This can be because of the ongoing stigma around mental illness, the structure of PSP organizations, and the communities in which they live. Stigma describes the negative attitudes and perceptions around mental illness. In the Global North, much work is being done to dispel the myth that mental illness is a weakness.

Because of their roles, PSP are often presumed to be strong and courageous in all that they do. There might be a feeling that they are letting the team and community down if PSP seek mental health support. Many PSP have reported feeling this expectation of courage and strength, and so fear the labels that might come with seeking support. PSP also fear that this could have an impact on their jobs.

When stigma prevents PSP from seeking out care, it increases the strain placed on other family members. They may have to cope with behavioural changes in the PSP and an increase in household responsibilities because the PSP is unable or unwilling to contribute. The stigma can also lead to isolation for both the PSP and family members. PSP might be afraid that others will not accept or trust them or will think less of them. They may avoid going out and, in turn, reduce chances for their families to socialize with extended family and friends.

Effects of PTSI on PSP Families

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References for this page (click to expand)

Carleton, R. N., Afifi, T. O., Turner, S., Taillieu, T., Duranceau, S., LeBouthillier, D. M., Sareen, J., Ricciardelli, R., MacPhee, R. S., Groll, D., Hozempa, K., Brunet, A., Weekes, J. R., Griffiths, C. T., Abrams, K. J., Jones, N. A., Beshai, S., Cramm, H. A., Dobson, K. S., Hatcher, S., … Asmundson, G. J. G. (2018). Mental disorder symptoms among public safety personnel in Canada. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 63(1), 54–64. https://doi.org/10.1177/0706743717723825  

Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest : A Journal of the American Psychological Society, 15(2), 37–70. https://doi.org/10.1177/1529100614531398 

Jones, S., Agud, K. & McSweeney, J. (2019). Barriers and facilitators to seeking mental health care among first responders: “Removing the Darkness”. Journal of the American Psychiatric Nurses Association 26(1):43-54. https://doi.org/10.1177/1078390319871997 

Lewis-Schroeder, N. F., Kieran, K., Murphy, B. L., Wolff, J. D., Robinson, M. A. & Kaufman, M. L. (2018). Conceptualization, assessment, and treatment of traumatic stress in first responders: A review of critical issues. Harvard review of psychiatry, 26(4), 216–227. https://doi.org/10.1097/HRP.0000000000000176  

McKeon, G., Wells, R., Steel, Z., Moseley, V. & Rosenbaum, S. (2020). Self-reported physical and mental health of informal caregivers of emergency service workers. Journal of Loss and Trauma, 26(6), 507-518. https://doi.org/10.1080/15325024.2020.1845020 

O’Toole, M., Mulhall, C., & Eppich, W. (2022). Breaking down barriers to help-seeking: preparing first responders’ families for psychological first aid. European Journal of Psychotraumatology, 13(1), 2065430-2065430. https://doi.org/10.1080/20008198.2022.2065430  

Porter, K. L., & Henriksen, R. C. (2016). The phenomenological experience of first responder spouses. The Family Journal (Alexandria, Va.), 24(1), 44-51. https://doi.org/10.1177/1066480715615651  

Public Safety Canada. (2022). Supporting Canada’s Public Safety Personnel: An Action Plan on Post-traumatic Stress Injuries. Retrieved August 29, 2022 from https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/2019-ctn-pln-ptsi/index-en.aspx 

Shepherd-Banigan, M., Shapiro, B., McDuffie, J. R., Brancu, M., Sperber, N. R., Van Houtven, C. H., Kosinski, A. S., Mehta, N. N., Nagi, A. & Williams, J. W. (2018). Interventions that support or involve caregivers or families of patients with traumatic injury: A systematic review. Journal of General Internal Medicine, 33(7):1177-1186. https://doi.org/10.1007/s11606-018-4417-7   

Thomson, J. L. (2021). PTSD perceptions in the U.S. military members and their families: A qualitative study. SAGE Open, 11(1). https://doi.org/10.1177/21582440211006393 

Wyse, J. J., Ono, S. S., Kabat, M. & True, G. (2020). Supporting family caregivers of Veterans: Participant perceptions of a federally-mandated caregiver support program. Healthcare (Amsterdam, Netherlands), 8(3), 100441. https://doi.org/10.1016/j.hjdsi.2020.100441 

Ambiguous loss: Avoidance and withdrawal

Topics: Couples, Family, Mental Health

Avoidant behaviours

After exposure to a stressful event, those affected may try to avoid related emotions. This is how they cope with trauma. A person might immerse themselves in an activity, shut down, or engage in substance abuse to escape their feelings. These are avoidant behaviours. People affected by trauma might also respond by withdrawing from family and friends. They might spend more time alone and turn down opportunities to socialize. Withdrawal behaviours include irritability, reduced communication, and limited involvement in family life. The give and take of both emotional and practical support are limited when a family member engages in behaviours related to avoidance and withdrawal.


Avoidance + withdrawal = Ambiguous loss


Impacts of avoidance and withdrawal on the family


When substance use, gambling, infidelity, or other vices are used to cope with trauma, SSOs can experience sadness, anger, jealousy, and/or depression. Poor communication can put the couple relationship at risk.

 


When PSP avoid and withdraw from family life, family members, especially SSOs, are burdened with added responsibilities. There may be significantly more demands on their time which can lead to role overload.


Over time, PSP families report that they have learned the signs and symptoms of a ‘bad call’. They know what to pay attention to and adjust their expectations. Sometimes these behaviours are isolated and manageable.

 


Family members can experience feelings of anger and resentment. These feelings arise from lack of intimacy and trust. Both physical and emotional distance and unpredictable involvement in family life strain relationships.

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References for this page (click to expand)

Beks, T. (2016). Walking on eggshells: the lived experience of partners of Veterans with PTSD. The Qualitative Report 21(4):645-660. https://doi.org/10.46743/2160-3715/2016.2269  

Dekel, R., Levinstein, Y., Siegel, A., Fridkin, S., & Svetlitzky, V. (2016). Secondary traumatization of partners of war veterans: the role of boundary ambiguity. Journal of Family Psychology, 30(1), 63-71. https://doi.org/10.1037/fam0000163  

Miller, L. (2007). Police families: Stresses, syndromes, and solutions. The American Journal of Family Therapy, 35(1), 21-40. https://doi.org/10.1080/01926180600698541  

Porter, K. L., & Henriksen, R. C. (2016). The phenomenological experience of first responder spouses. The Family Journal (Alexandria, Va.), 24(1), 44-51. https://doi.org/10.1177/1066480715615651  

Regehr, C., Dimitropoulos, G., Bright, E., George, S., & Henderson, J. (2005). Behind the brotherhood: Rewards and challenges for wives of firefighters. Family Relations, 54(3), 423-435. https://doi.org/10.1111/j.1741-3729.2005.00328.x  

Taft, C. T., Watkins, L. E., Stafford, J., Street, A. E., & Monson, C. M. (2011). Posttraumatic stress disorder and intimate relationship problems: a meta-analysis. Journal of Consulting and Clinical Psychology, 79(1), 22.  

Waddell, E., Lawn, S., Roberts, L., Henderson, J., Venning, A., & Redpath, P. (2020). “Why do you stay?”: The lived‐experience of partners of Australian veterans and first responders with Posttraumatic Stress Disorder. Health & Social Care in the Community, 28(5), 1734-1742. https://doi.org/10.1111/hsc.12998  

Watkins, S. L., Shannon, M. A., Hurtado, D. A., Shea, S. A., & Bowles, N. P. (2021). Interactions between home, work, and sleep among firefighters. American Journal of Industrial Medicine, 64(2), 137-148. https://doi.org/10.1002/ajim.23194  


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