Choosing Hope and Gratitude

By: Pete Volkmann, MSW

As the year 2023 (can you believe…2023!!!) ends, I have found the end of every year and beginning of the new year creates a time of reflection. Maybe that is why there are so many different holidays for many different cultures around the world.  This is a major upcoming holiday season for so many of us worldwide. Holidays are designed as celebrations with time for reflection and connection. Many of us have taken time off from responsibilities, which is a choice in the way we celebrate our holidays. We have a choice on how we share that day. We have a choice of who we share our celebration with and where we celebrate this time of the year. We have a choice to limit our distractions and reflect upon ourselves and our circumstances from the previous year. We have a choice in how we process our thoughts and feelings for the new year. No wonder the end of the year holidays seems, at times, to be too stressful. It is a time of choices of how we filter our memories and interpret the meaning of those memories. This holiday season of reflection may be wonderful for some and yet this time of reflection may be painful for others. And others may experience a little of both. I must confess certain years in my life. I remember I just wanted the holiday season to end because of all the “distractions” and “responsibilities” the holiday season created. It was a time I chose not to reflect and think and feel about my life. I also chose not to be thankful in any way at all. I wanted nothing from the holiday season. I am sure I am not the only person that has had such holiday experiences.

Through all the years in CISM, I have learned through so many people the importance of the end of the year and the beginning of the year. The new year offers a chance for reset or a course correction in life. This is the time to think about who you are and examine your purpose. My own critical incidents have changed my life, sometimes for the better and sometimes for the worse. I do attest my life has changed. The choices I have made in dealing with the good in life and the bad in life have made all the difference in my personal identity and my life destiny. It was my ICISF experiences that taught me two important back pocket skills in life. Gratitude and hope. You cannot have one without the other. Gratitude is a recovery strength that sparks hope to provide us with direction when we struggle in life. You cannot have hope without having some form of gratitude in your life. You cannot have gratitude without acknowledging some form of hope.

Gratitude encompasses your mind-body-spirit (MBS) in wellness. Gratitude is the quality of being thankful; readiness to show appreciation for and to return kindness. Gratitude is both giving and taking of appreciation and kindness. Gratitude is utilized in the present moment in our lives yet acknowledges our past and our future in our lives. Gratitude is reality based and places our self-identity and our life purpose in perspective. Gratitude can be the result of experiences with others (man-made), or it can be spiritual in nature.  Man-made gratitude is a result of our human experiences and/or our human relationships with each other.   This man-made gratitude can also come from self-appreciation of who we are.  The other type of gratitude to recognize may be “spiritual.”  This spiritual sense of gratitude is something our human experiences cannot prove through just our senses. Spirituality is a sense of something cosmic or divine in nature in which we have a relationship. Let us not forget the “body” aspect of wellness that we sometimes do not recognize. “Body” wellness is the gratitude and self-kindness of what our bodies offer to us in our lives. Our bodies provide us with information through our senses that gives us proper interpretations of who we are and the world around us.

Gratitude is being thankful for what we have in our lives and what we do not have in our lives. Past struggles that have been overcome is a powerful appreciation anchor that promotes strength and hope for our present moment and future. Sometimes others’ hardship experiences provide personal gratitude for not being in such a personal life situation.

Gratitude always expands into some kind of “thankful kindness” experience that can be spiritual and/or man-made. It encompasses and results in kindness, compassion, understanding, and even forgiveness. Gratitude is a simple yet powerful conscious action that activates recovery in anything in life. No matter how bad your life is and how hard the struggle is, thankful appreciation sets a focus of kindness that can jump start your recovery. The present moment of gratitude may not change the circumstance in your life at that moment, but it can change what you focus on within your life and change your self-identity of who you are. Gratitude is a simple action that is a precursor to creating hope. Gratitude is not hope but it is the spark that can create hope.

Hope is a concept that is so important in CISM. Whether it is with an individual or with a group, hope is a major component in beginning the process of healing after a critical incident. Hope can be created through others (man-made) or spiritually created. What we do in CISM generates man-made hope through our training and our individual character. We also have the skills to expand spiritual hope beyond what our senses can detect. Spiritual hope may come from connecting with other humans or from a divine influence.

What makes hope…hope? There are six dimensions of hope that align with the five areas of distress in CISM. Check out the ICISF Podcast “Quick Tip Series” on the dimensions of hope.

Let us start with a definition. Robert Mills in 1979 provided different perspectives of a definition of hope.

• Hope is an attitude or state of being. Hope is the intuitive read of our conscious being that connects our whole selves, both conscious and unconscious, with the fullness of transcendent relationship that unites past and future as well as oneself with another.
• Hope implies participation in that which is hoped for. It is neither expansion nor reduction of self. It is transcendence of self. It is the “state of being” in which one exists in a true relationship with others.
• Hope, like love, is giving of self beyond oneself. Hope is peace beyond magical thinking or stoic acceptance that provides a glimpse of light. Hope opens the possibility of achieving a sacred sense of comfort, whether confronted by joy or overwhelmed by sorrow.

These definitions can run deep which makes grasping the understanding of hope challenging.

A colleague of mine, Brian Flynn, from Binghamton, N.Y. described hope beautifully as,

“Hope is who we want to be and how we interact with the world in which we want to live.”

Defining hope with universal concepts and a universal definition is difficult because it is a personal experience.

Hope is a complex concept that has different dimensions that cannot be seen through one lens. I have experienced two types of hope…

• Man-made hope (focuses on a valued outcome, goodness, or state of being. It preserves and restores the meaning of life. It clarifies, prioritizes, and affirms what a hoped person perceives as most important in life).
• Spiritual hope (generalized hope like a protective umbrella that is a pinhole of a positive glow that extends beyond time and matter).

Spirituality is a belief of something greater than self, something more in being human than just sensory experience, something greater that we are part of that is cosmic or divine in nature. It shifts from finding a certain way to live towards accepting and living in the experience.

I have compared the six dimensions of hope from the work of Karen Dufault and Benita Martocchio with the comparison of the five areas of distress in CISM training.

The five areas of distress include: Cognitive, Affective, Behavioral, Physical, Spiritual. Compare that with the six dimensions of hope: Cognitive, Affective, Behavioral, Affiliative, Temporal, and Contextual.

Comparing the five areas of distress (CISM) with six dimensions of hope.

    6 Dimensions of Hope                     5 Areas of Distress (CISM)

• Cognitive                                               Cognitive
• Affective                                                Affective
• Behavioral                                             Behavioral
• Affiliative                                               Physical
• Temporal                                               Spiritual
• Contextual

Cognitive dimensions: Hope is reality based and not a wish. The cognitive dimensions make it reality based through a rational examination of personal resources and limitations at that present moment. It is not magical thinking. This dimension is “cerebrally based” through some kind analytical thinking.

Affective dimensions: Hope creates sensations and emotions that result in a confident feeling of an outcome with feelings of uncertainty with the necessary waiting for the outcome. Hope brings confident feelings for the future yet needs to have that uncertainty in waiting to ascertain if it will work. Hope is full of different feelings at the same time as a human being that are necessary in all hope concepts.

Behavioral dimensions: There are four realms of behavioral actions to energize feelings and attitudes to directly affect hope that include:

• Psychologic realms are those mental activities like organizing ideas, planning strategies, making decisions, and thinking of resolutions to create hope.
• Physical realms are personal acts we take such as proper eating habits, exercise, or even resting.
• Social realms are actions involving reaching out to others creating caring attachments.
• Religious realms contribute to religious functions such as charities, reading sacred scriptures, praying, and meditation.

Affiliative dimensions: are all about a sense of belonging beyond self. It is how we identify relationships with other people, other living things, and a higher power. There is an expression of hope objects that include a relationship with or concern for others. It could be a reliance on others through their skill and/or influence to create your hope.

Temporal dimensions focus on experiencing time in the past, present, and future into generating the hoping process. Past experiences may have helped you previously but can now be utilized again for your need to create new hope presently. Creating hope in the “now moment” using the other dimensions creates your future hope.

Contextual dimensions are hope components brought to the forefront of conscious awareness and experience within the context of life (life situations that surround and influence hope). This usually comes with loss resulting in hopelessness through stress and crisis. Hopelessness is NOT the absence of hope. Hopelessness is not the opposite of hope. Each concept activates a need for an outcome.

As we provide hope for others in our CISM skills, we are really utilizing at least one of the dimensions of hope. Tapping into these dimensions is what creates hope. Over the decades of CISM experiences and being part of ICISF, I have gratitude I would like to share publicly.

I am personally grateful for:

Dr. Jeff Mitchell, who created the CISD model that has changed my life for the better. You gave me the skills I did not know I had to have influence on those in their worst moments.

Dr. George Everly, who co-founded ICISF with Dr. Mitchell and expanded ICISF to become the largest crisis intervention organization in the world. You gave me the confidence to challenge the old world first responder system and bring CISM into an accepted standard of care with your wisdom you provided.

The ICISF staff who have always placed the CISM mission before their needs. I have been and will be inspired by your faithfulness through the years in all you do every day for ICISF. I genuinely love each and every one of you.

The ICISF faculty, who have dedicated the passing of their knowledge and personal experiences through course creations and provided support to every CISM student.  It was not just your efforts in front of the class, but the side conversations to students providing compassion and confidence one soul at a time.

To the approved instructors who understood the trust Jeff and George gave us to be able to teach their CISM content. You all understood the responsibility to train properly and be ICISF ambassadors throughout the years. Every instructor has made a difference in keeping to our mission.

To every person who I trained in CISM, I am honored to be part of your CISM development and thankful for your time and efforts in the trenches in dealing with critical incidents worldwide.

To every person and every group who allowed me to become part of their recovery story through CISM. You have given me more than I could ever give to you…the power of human spirit and strength of hope in recovery.

To those individuals who have been there for me to keep me sober and sane throughout my many critical experiences in my life. You have saved my life again and again with no expectation for me to return the favor.  Your unconditional love for me and consistent life skills you provided to me have been passed to others by me. That is the least I can do in appreciation. You know who you are. Thank you.

Through the gratitude I always realize how blessed I am in my life with ICISF…through all the good and all the bad. May I learn your personal ICISF gratitude when I see you in the future. Until then, may your gratitude in 2024 be abundant and your hopes for the new year be attained.

Never discount what hope can do when hope is all that counts. – Peter Volkmann

Giving Thanks – Growing Hope

By: Chaplain Ron Harvell, USAF BG (ret), D.Min.

Happy Thanksgiving to you all.  Specifically, thank you to the International Critical Incident Stress Foundation (ICISF) for asking me to write a blog about giving thanks and growing hope.  I pray this blog gives you ideas and tools for caring-for-the-caregiver and caring for others.  I want you to take away 3 distinct things:

1. Become a More Thankful Person
2. Add Human Flourishing Research to Your Skills Toolkit
3. Build an Infrastructure to Produce Hope and Resiliency

 

1. Become a More Thankful Person – The Value of Gratitude and Thankfulness

I worked for a Four-Star General named Phillip Breedlove who would become the Supreme Allied Commander for Europe and NATO.  He was famous for noticing people, hearing their stories, and treating them with great respect.  General Breedlove grew up in a humble family of hard-working people.  The qualities of kindness, gratefulness, and thankfulness would be evidenced in his positive treatment of others.  I observed these qualities at a video shoot for a United Services Organizations (USO) advertisement. He said thank you to even the smallest kindness.   He ensured everyone was greeted and acknowledged.  When he left the USO to continue his schedule, several of the USO team said, “Did you see that?  He treated all of us as if we were the most important person here.” The General’s staff replied, “He is always that way.”

In your life how can you become more intentional in your gratitude and thankfulness?

I was asked by some of Charleston Southern University’s counseling students this question: “What is the goal of counseling?”  I thought about the skills and answers that counselors need to help people in crisis.  My answer to the students was however different.  I said, “Being thankful is the greatest milestone of recovery.”

2. Add Human Flourishing Research to your Skills Toolkit

I had the privilege of meeting Dr. Tyler VanderWeele, of the Harvard T. H. Chan School of Public Health, several years ago when the Air Force was learning about the value of faith practiced with others.  He is the world’s premier public health research professor.  Since that time his team has launched a large research model entitled “12 Points of Human Flourishing.”  I encourage you to look into his research and skills training for expanding your scale of knowledge.

Harvard Activities for Flourishing:  An Evidence-Based Guide

Tyler VanderWeele’s research shows that gratitude has significant positive personal outcomes, resulting in:

• increased personal well-being
• increased personal behaviors
• better feelings about life
• fewer physical symptom complaints
• better sleep
• higher levels of happiness
• lower levels of depressive symptoms.[1]

When you think of Thanksgiving this year, think about these values of gratitude and thankfulness.

In VanderWeele’s work on Human Flourishing, these other positive behaviors resulted in positive outcomes:

• forgiveness
• character
• kindness
• imagining
• connectedness
• volunteering
• marriage
• work
• worship

Human Flourishing research on weekly religious participation:

• 30-50% less likely to die over the next 20 years
• 50% less likely to divorce
• 5 times less likely to commit suicide

3. Build an Infrastructure to Produce Hope and Resiliency

When I was stationed in Germany, 2010-2013, I had the honor of being on the staff of 4-Star General Mark Welsh and subsequently General Phillip Breedlove.  They were the Commanders of Air Forces in Europe and Africa.  General Mark Welsh was very concerned about the importance of Airmen and their families having the personal qualities that build character, hope, and faith.

In order to answer his concerns, a multidisciplined resiliency committee worked together to design a program called “Core Groups.” Based on the Air Forces Core Values, this program provided an opportunity for Airmen to increase their resiliency by participating in a simple tool to make them better Airmen.  They would gather monthly in groups of 10 or less and follow a prescribed lesson.  The lesson had a discussion on a particular theme.  Every Airman had to speak in the group.  They had the opportunity to reflect on their own lives, share their ideas, and build their character and sense of community.

In the first month, 45,000 Airmen met in 5,000 groups across Europe and some in Africa.  We designed 20 months’ worth of Core Groups.  The groups made the Airmen more professional, part of a greater community, and able to have inputs that resulted in an increase in purpose, belonging, and value.

The abbreviation “O.P.R.” stands for Office of Personal Responsibility.  The Air Force chaplains were the O.P.R. of Hope.  It was our job to help build hope in individuals.  Where there is hope, there are not suicides. In our programing we used community, faith, purpose, value, and meaning to build hope.

We began a campaign to marry up with Harvard and Duke’s research on the value of faith and community.  People can Belong, Believe, and Become. When a person Belongs with others in community, it increases their social fitness.  When a person Believes with some type of faith, they increase their spiritual fitness.  When combined, they Become a person with greater hope and resiliency.

Hope is the strategy.  We must build people’s lives on a solid foundation.  They need meaning, purpose, worth, value, and community.  From these come God’s gift of Hope.  It is Hope that gets us through each day.

Look to discover how you can help build hope!

Fill your tool chest with Harvard’s Flourishing Tools

Enjoy a great big grateful and thankful Thanksgiving!

References:

[1] VanderWeele, Tyler., Harvard University, United States; http://journalppw.com ISSN 2587-0130, Journal of Positive Psychology & Wellbeing 2020, Vol. 4, No. 1, 79 –91

Ibid.  “On the Promotion of Human Flourishing.” Harvard T. H. Chan School of Public Health, Boston, MA 02115, Program on Integrated Knowledge and Human Flourishing, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, 02138.  PNAS, 1 August 2017, Vol. 114, no. 31; www.pnas.org/cgi/doi/10.1073/pnas.1702996114.

[1] VanderWeele, Tyler., Harvard University, United States; http://journalppw.com ISSN 2587-0130, Journal of Positive Psychology & Wellbeing  2020, Vol. 4, No. 1, 79 –91

Destigmatizing the Conversation: The Crucial Role of Critical Incident Stress Management for First Responders

By: John Hunt, MA, CHEC, CCISM, CAAIS

Chief Operations Officer, Crisis Response Canines

October marks the National Depression and Mental Health Awareness and Screening Month.  While depression can affect anyone, it has a particularly profound impact on First Responders. Now more than ever, we have a call to action to raise awareness, and address the mental health needs of our heroic first responders. Critical Incident Stress Management plays a crucial role in supporting their mental health and general wellbeing.

It is widely known that First Responders have exceedingly dangerous and stressful jobs. The daily exposure to traumatic events and the cumulative effects of Post-Traumatic Stress Injuries (PTSIs) takes a toll on physical and mental health. First responders are often regarded as heroes, yet are not immune to the struggles of depression. The unique challenges they face in their line of duty can contribute to the development and exacerbation of stress and depression symptoms. Constant exposure to traumatic events, long hours, shift work, and the pressure to make life-altering decisions can create a perfect storm for mental health issues.

This may manifest in anxiety disorders, relationship issues, substance abuse, depression, and suicidal ideation. Rates of depression among these professions approaches 5 times that of civilians. There is up to a 54% increase in suicide risk as compared to others. More first responders die by their own hand than in the line of duty (and this is likely underreported as the suicides occur among retirees, are sometimes covered up to protect the image of the lost loved one, or attributed to other causes). Unfortunately, there is no shortage of stories of lives lost of heroes who thought there was no other alternative. Also unfortunate is the fact that depression and suicide remain topics few want to discuss.

Critical Incident Stress Management (CISM) is a comprehensive, evidence-based approach aimed at helping first responders cope with the psychological effects of their challenging work. It involves a range of interventions and support systems designed to mitigate the impact of critical incidents and promote resilience.  Studies into the effectiveness of these interventions indicate that when utilized by trained operatives, the positive outcomes include reduced depression, alcohol dependence, anxiety and mitigation of PTSIs.

The concept of accepting the consequences of the daily exposure as a “Burden of the Badge” needs to be dispelled. First Responders have shared that if they seek help, they will be labeled “unfit for duty” or seen as weak. When suicides among colleagues do occur, shame and stigma often lead to silence or secrecy about the event, thus preventing an opportunity to process the event.  It is during these Critical Incident Stress Debriefings that trained peers openly discuss events, and the physical and emotional aftermath. It is imperative that these debriefings are integrated into standard operations when critical incidents occur. This proactive approach helps to normalize these heretofore difficult conversations.

There is an opportunity to take this month to collectively focus on educating the first responder community and the public about the mental health struggles of first responders. It is a time to destigmatize the conversations that must be had.  We have a unique opportunity to share stories, statistics, and resources to increase awareness. We can promote education and training to increase the number of available CISM teams who can provide peer support.

Mental Health Awareness Month is a crucial reminder of the need to prioritize mental well-being for everyone, including our dedicated first responders. As we acknowledge their unwavering commitment to our safety, we must also recognize the toll their duties can take on their mental health. By promoting Critical Incident Stress Management and supporting initiatives that aim to reduce the stigma around mental health, we can help ensure that those who risk their lives for our communities receive the care and support they deserve. This May, let’s make mental health a priority for our first responders, so they can continue to serve and protect us with strength and resilience.

References:

Boscarino JA, Adams RE, Foa EB, Landrigan P. J. (2006). A propensity score analysis of brief worksite crisis interventions after the World Trade Center disaster: implications for intervention and research. Medical Care, 44(5), 454–462.

Everly, G. S., Jr., & Boyle, S. H. (1999). Critical Incident Stress Debriefing (CISD): A meta-analysis. International Journal of Emergency Mental Health, 1(3), 165–168.

Everly, G.S. & Mitchell, J.T. (1997). Critical incident stress management (CISM):A new era and standard of care in crisis intervention. Chevron.

Everly G. S., Jr., & Mitchell J. T. (1999). Critical incident stress management, (2nd ed.). Chevron.

Heyman, M., Dill, J., & Douglas, R. (2018) The ruderman white paper on mental health and suicide of FRs. Ruderman Family Foundation. https://dir.nv.gov/uploadedFiles/dirnvgov/content/WCS/TrainingDocs/First%20Responder%20White%20Paper_Final%20(2).pdf

National Institute of Mental Health, U.S. Department of Health and Human Services. (2021)Suicide. https://www.nimh.nih.gov/health/statistics/suicide.

International Association of Chiefs of Police. (2020) Preventing Suicide among Law Enforcement Officers: An Issue Brief. Education Development Center, https://edc.org/sites/default/files/uploads/NOSI-Issue-Brief.pdf.

September 26, 2023

Police Organization Providing Peer Assistance (POPPA) Reflects on 9/11 and

Introduces its Suicide Awareness for Emergency Responders (S.A.F.E.R.) Training

By Jennifer Taylor, Ph.D., Clinical Advisor, POPPA, Inc.

POPPA is a confidential, independent, non-departmental, peer-based assistance program for the NYPD, designed to respond to the psychological and mental health needs of NYPD officers.  All services within POPPA are provided to NYC police officers free-of-charge. 

The backbone of POPPA is its more than 200 volunteer Peer Support Officers (PSOs) drawn from all ranks of the NYPD.  These officers receive extensive 8-day training by POPPA on peer support and screening for safety issues, substance abuse, and mental health issues such as depression, anxiety, and PTSD.  POPPA also provides ongoing and semi-annual training and self-care support groups for its PSOs.  PSOs work in conjunction with a network of independent mental health clinicians who provide guidance and expertise. 

POPPA has used CISM protocols in several of its programs.  These include our 24-hour Helplines, Trauma Response Teams (TRTs) that conduct diffusings — responding immediately to critical or traumatic incidents, and follow-up critical incident stress debriefings (CISD).  POPPA goes out on hundreds of calls each year.  The debriefings have enhanced our ability to identify signs of distress and to respond by offering services and making appropriate referrals for these officers.  Information that officers share during debriefings have helped guide the expansion of POPPA services.  We now periodically offer our 2-day workshop/seminars.  These events include a debriefing component as well as health and self-care and interpersonal effectiveness strategies designed to bolster officer resiliency.  

POPPA was just in its 5th year when 9/11 happened.  In the immediate aftermath of 9/11, PSOs and clinicians, familiar with CISM, provided coordinated emergency mental health services at Ground Zero and established a temporary crisis center at the nearby Federal Reserve Bank.  Several ICISF-sponsored CISM teams from across the US and around the world came to work with POPPA at Ground Zero.1  Large numbers of officers, arranged in small groups, underwent defusings and debriefings to help process their experiences and by late September 2001, POPPA was providing services to nearly 100 officers daily.2  From December 2002 to December 2003, POPPA screened 28,232 NYPD officers (approximately 73% of the estimated 39,000 NYPD force) for the ongoing impact of the events of 9/11.  Over 68% of officers reported at least one ongoing behavioral, emotional, physical, or cognitive 9/11-related stress symptom 15-27 months after the attacks.3 This demonstrates the importance of responding to the emotional and psychological effects of exposure to traumatic events and the potentially devastating impact of cumulative traumatic exposures on police. 

The impetus for the development of POPPA was the shocking increase in suicides within the NYPD in 1993, 1994 and 1995.  With the exceptions of the deaths of 23 NYPD officers on 9/11, the ever-increasing numbers of 9/11 health-related NYPD deaths, and COVID-19-related NYPD deaths, the rate of suicide among NYPD officers is typically at least 2-3 times that of line-of-duty deaths annually.  This heart-breaking reality – that suicide exceeds line-of-duty deaths nationwide every year has led POPPA to develop its own Suicide Awareness for Emergency Responders (S.A.F.E.R.) program.   

The S.A.F.E.R. program helps to identify warning signs of suicidality and to respond effectively and compassionately to get the officer in distress appropriate professional help.  POPPA has conducted S.A.F.E.R. training for its own PSOs, as well as for NYPD peer support officers, active-duty NYPD officers, and has offered this training to surrounding agencies and police departments beyond the NYC area.  This training, like all POPPA services, is provided free-of-charge.

With gratitude for the work that the ICISF does and the collaboration between ICISF and POPPA, we would like to extend an offer for free S.A.F.E.R. training to emergency responders and clinical personnel as our guests.  If you are interested, please contact John Petrullo at 917 416-6558.

References

1. Levenson RL, Jr. and Acosta JK.  Observations from Ground Zero at the World Trade Center in New York City, Part I.  International Journal of Emergency Mental Health 2001 3(4), pp. 241-244.
2. Silver Award:  The Child and Adolescent Services Program of the World Trade Center Healing Services, Saint Vincent Catholic Medical Centers, New York – Providing Trauma-Related Treatment to Students After the Terrorist Attacks of September 11, 2001, and Other Traumatic Events.  2005 APA Silver Achievement Awards.  Psychiatric Services, October 2005: Vol. 56: No 10.  Pp. 1309-1312.
3. 3. Dowling FG, Moynihan G, Genet B, and Lewis J.  A Peer-Based Assistance Program for Officers with the New York City Police Department:  Report of the Effects of Sept. 11, 2001.  Am J Psychiatry 2006; 163:151-153.

For more information check out their website! https://poppanewyork.org/