Overview

Our best bet in preventing suicide is to get in front of it.

Way in front.

Promoting protective factors will not only reduce the risk of suicide — it also is a great way to build a life worth living. In this podcast, I interview Captain Dena Ali about what we have learned about wellness at work from the fire service and about the mitigating effects of social support, mindfulness and sleep. We also talk about the power of peer support to promote these buffering factors and how small interventions can go a long way. As you listen to Captain Ali, ask yourself, “How can these protective factors of the fire service be translated to other industries and workplaces?

Social Support

A strong support network is the most powerful buffer against PTSD, stress, and suicide. True social connection is based on trust, empathy and vulnerability. We can see at the brain science level how simply talking to others allows us to “know and understand what is going on with us while also processing the memories of the trauma.” According to Dr. Van der Kolk, the body keeps score, "As long as you keep secrets and suppress information, you are fundamentally at war with yourself. Hiding your core feelings takes an enormous amount of energy; it saps your motivation to pursue worthwhile goals, and it leaves you feeling bored and shut down. Meanwhile, stress hormones keep flooding your body, leading to headaches, muscle aches, and irrational behaviors that may embarrass you and hurt the people around you.”

We are hardwired to connect. According to Ali, “Social support is not just being in the presence of other; it requires meaningful connection and a visceral feeling of safety. You have to feel safe to share your thoughts and know that you are understood.”

The fire service has important protectors when it comes to social support like a feeling of camaraderie, familial support, and a communal sense of purpose. Workers pull together around the kitchen table to process the day and check in with one another in meaningful ways.

How can we help workers build out their “A-Team”?

Mindfulness

Ali states, “Mindfulness is the super power that allows humans the opportunity to own the space between a stimulus and the response.” Mindfulness works because it increases activation of the neocortex while decreasing activation of the emotional centers of the brain, which can help mitigate the impact of trauma. Several smartphone applications like Headspace and Calm or the Navy Seal’s Breathing Technique called “box breathing” work to promote resilience.

According to Ali, mindfulness for emotional survival is based on where you put your attention. Victims focus on what they can’t control. Survivors focus on what they can control.

How can skills of mindfulness be used in workplaces to mitigate experiences of overwhelm and other forms of workplace trauma?

Sleep

Sleep disruption is a key contributor to our emotional well-being. The sleeping brain prunes information to let emotionally relevant information stay present while letting irrelevant information fade away. It also helps traumatic events turn into memories experienced from an emotional distance rather than stuck in the reliving part of the brain. Sleep disruption can lead to emotional reactivity — anger, impulsivity and aggression.

When it comes to shift work, employers need to get creative to help workers prioritize quality sleep. Teaching workers about “sleep hygiene” can be a place to start.

What can be done to help workers sleep better?

About Captain Dena Ali

Dena Ali is a captain with the Raleigh (NC) Fire Department. Ali has a degree from North Carolina State University and an MPA from the University of North Carolina—Pembroke, where her research focused on firefighter suicide. As a graduate student, she was awarded the 2018 MPA student of the year. She has also received several awards throughout her career. One that she is most proud of is the NC Office of State Fire Marshal Honor, Courage, and Valor award that she earned in 2018 for her steadfast effort to bring awareness to firefighter mental health through her vulnerability.

Dena has also served as a subject matter expert at the National Fire Academy where she assisted in curriculum review for their health and wellness curriculum. Dena is an advocate of awareness, education, and understanding of mental health disorders and suicide. She speaks locally and nationally on these topics and is a QPR Suicide Prevention Gatekeeper Instructor. She has written several articles on topics such as suicide prevention, peer support, wellness, and post-traumatic stress. Dena is the founder and director of North Carolina Peer Support where she helped to develop their statewide curriculum.

Show Notes

Resources

National Guidelines for Workplace Suicide Prevention www.WorkplaceSuicidePrevention.com

Matthew Walker “Why We Sleep”: https://youtu.be/5MuIMqhT8DM

Sleep Hygiene Information: https://www.sleepfoundation.org/articles/sleep-hygiene

Denver Fire Department “Total Wellness” https://youtu.be/SskSfiMLxl8

Now Matters Now — Skill Building in Emotional Regulation (including mindfulness of current emotions) www.NowMattersNow.org

Calm https://www.calm.com/

Headspace https://www.headspace.com/headspace-meditation-app

Books

Hines, K. (2013) Cracked, not broken: surviving and thriving after a suicide attempt. Lanham: Rowman & Littlefield.

Hoge, Charles (2010). Once a Warrior Always a Warrior. Guilford, Connecticut: Lyons Press

Joiner, T. E. (2011). Myths about suicide. Cambridge, MA: Harvard University Press.

Junger, Sebastian (2016). Tribe, on Homecoming and belonging. New York: Twelve

Marks, M., Callahan, P., Grill, M., (2019) A community of one; building social resilience. Tulsa, OK: PennWell

Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking

Van Heeringen, K. (2018). The Neuroscience of Suicidal Behavior (Cambridge Fundamentals of Neuroscience in Psychology). Cambridge: Cambridge University Press.

Articles

Antonellis, P Jr & Thompson, D. (2012, Dec. 1). “A Firefighters silent killer: Suicide,” Fire Engineering; 165(12):1-10.

Bryan, C. J., Jennings, K. W., Jobes, D. A., & Bradley, J. C. (2012). Understanding and Preventing Military Suicide. Archives of Suicide Research,16(2), 95-110.

DeGryse, D. (2015, November 30). Chicago Fire Department Suicide Study. Retrieved from http://www.rosecrance.org/chicago-fire-department-suicide-study/.

Dhingra, K., Klonsky, E. D., & Tapola, V. (2018). An Empirical Test of the Three-Step Theory of Suicide. Suicide and Life-Threatening Behavior.

Emet, M., Uzkeser, M., Guclu, S., Ergin, M., & Aslan, S. (2016). Sleep Disorders in Shift Workers in the Emergency Department and Efficacy of Melatonin. Eurasian Journal of Emergency Medicine,15(1), 48-53. doi:10.5152/eajem.2016.84758.

Hedegaard, H., Curtin, S., & Warner, M. (2018, October 03). Suicide Mortality in the United States, 1999-2017. Retrieved from https://222.cdc.gov/nchs/products/databreifs/db330.htm.

Joiner, T.E., Buchman-Schmitt, J.M., Chu, C. (2017). Do Undiagnosed Suicide Decedents Have Symptoms of a Mental Disorder? Journal of Clinical Psyhology. 73(12), 1-17.

Joiner, T. E., Van Orden, K. A., Witte, T., & Rudd, D. (2009). Interpersonal Theory of Suicide: Guidance for Working with Suicidal Clients. Washington: American Psychological Association.

Martin et al., (2017) Alcohol use and suicidality in firefighters: Associations with depressive symptoms and posttraumatic stress. Comprehensive Psychiatry.

O’Connor, R. C., & Kirtley, O. J. (2018). The Integrated Motivational-Volitional Model of Suicidal Behavior. Philosophical Transactions B,373, 1-10.

Stanley, I. H., Hom, M.A., Joiner, T.E., (2015) A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and Paramedics. Clinical Psychology Review

Stanley, I. H., Hom, M. A., Spencer-Thomas, S., & Joiner, T. E. (2017). Suicidal thoughts and behaviors among women firefighters: An examination of associated features and comparison of pre-career and career prevalence rates. Journal of Affective Disorders,221, 107-114. doi:10.1016/j.jad.2017.06.016

Stanley, I. H., Boffa, J. W., Smith, L. J., Tran, J. K., Schmidt, N. B., Joiner, T. E., & Vujanovic, A. A. (2018). Occupational stress and suicidality among firefighters: Examining the buffering role of distress tolerance. Psychiatry Research,266, 90-96.

Storr, W. (2015, May). The male suicides: How social perfectionism kills. Retrieved from https://mosaicscience.com/story/male-suicide/.

Sullivan, J., O'Brien, C., Barger, L., Rajaranam, S., Czeisler, C., & Lockley, S. (2017). Randomized, Prospective Study of the Impact of a Sleep Health Program on Firefighter Injury and Disability. Sleep, 40(1), 1-10. doi:10.1093/sleep/zsw001.

Turecki, G. & DA Brent. Suicide and suicidal behavior. (2016) The Lancet.

Van Orden, K. A., & Conner, K. R., You, S. (2011). Social connections and suicidal thoughts and behavior. Psychology of Addictive Behaviors, 25(1), 180-184.

Vyas, K.J. (2016). Preventing PTSD and Depression and Reducing Health Care Costs in the Military: A Call for building Resilience Among Service Members. Military Medicine (181) 1240-1247

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