How firefighters can manage their anxiety and stay sharp as the COVID-19 pandemic continues
A behavioral health expert breaks down ways responders can cope with the ongoing fear and anxiety they face while responding to and providing care during the pandemic
Sponsored by Cigna
By Sarah Calams for FireRescue1 BrandFocus
There have been more than 10 million confirmed COVID-19 cases and more than a half-million deaths worldwide since the novel coronavirus was first identified late last year.
At a recent news conference, Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, noted that the global pandemic isn’t slowing down – it’s speeding up.
“We all want this to be over. We all want to get on with our lives. But the hard reality is this is not even close to being over,” Ghebreyesus said.
That is a hard pill to swallow, especially for first responders as they continue to serve and take care of patients – even if that means they get exposed and fall ill in the process.
It is important – now more than ever – for first responders to take care of their mental and physical health as this unprecedented pandemic continues.
To help responders learn more about the necessary steps to achieving this goal, I interviewed Laura Magnuson, a behavioral health expert at Cigna, about strategies for coping with the ongoing fear and anxiety faced by responders, including stress management, fatigue and fear of bringing COVID-19 home. Here are excerpts of that conversation, lightly edited for clarity and brevity.
What is your background and expertise?
I have a master’s in forensic psychology. I also have a master’s in marriage and family therapy. In the state of Arizona, I am a licensed associate marriage and family therapist. I have been with Cigna about two and a half years.
Prior to coming to Cigna, I worked on the provider side in a variety of different settings. I have worked for the courts, in inpatient settings and outpatient settings. In the past 10 years, I have also been working more specifically with first responder needs and working as an advocate to make sure their behavioral health needs are met. With police and fire, that means making sure that we can assist and bridge any gaps that might be there for their services.
What are some of the unique stressors that firefighters, EMS providers and other first responders are facing as the COVID-19 pandemic continues?
First – first responders are human beings, right? They still have all of the same stressors that non-first responders have. They have anxiety and fears that the general public would, but they’re also being faced with fears and concerns of potentially being exposed to and contracting COVID-19 at an increased rate due to their interactions while they’re on the job. They also have the added stress of possibly working extra hours if there are staffing shortages due to any kind of quarantine situation that their coworkers might be facing.
They are having fears of potentially bringing home the illness to their families. I have even heard that some have chosen to separate themselves from their families to avoid any kind of exposure. That means that they are losing that support that they would usually have from their primary support system.
We are seeing also just fatigue in general. First responders generally will respond to a situation that is short-term in duration, but this is not a short-term situation that we are all in together.
What are some of the key mental health signs and symptoms associated with the COVID-19 crisis? How do these affect physical health and responder readiness?
Some of the signs that would wave a red flag would be some unexplained physical symptoms, maybe some confused thinking, maybe an increase in feelings of anger or having some extreme highs and lows. Maybe you find that you are worrying a lot more than you ever did and it’s really taking over your behaviors.
Extreme sadness and substance use are some things to be on the lookout for. We know just across the general population that substance use has really increased. Also, social withdrawal would be something that we would want to pay attention to. We know that if first responders aren’t paying attention to these pieces, they’re not taking care of themselves, and that could lead to slower reaction times on the job.
How are stress and anxiety different? How can they affect a person?
Oftentimes, stress and anxiety can be positive. Sometimes stress can motivate us to get things done. It’s important to know that “stress” is not always a negative term to use. There are positive pieces related to stress and anxiety. We might have anxiety over getting a new car, knowing that the car payment is more, but we can also have excitement knowing that we’re not going to be in the repair shop every month. Stressors affect everyone differently, but it’s really how we cope and respond that determines the outcome.
Anxiety is more characterized by fear or worry that we might have about an event or an outcome. For many, there was anxiety about contracting the virus, and there are some other symptoms that you could experience related to the pandemic. It’s this roller coaster that we go in and out of. We could have apathy or numbness, anger, hopelessness, denial – even feelings about being calm.
The stress and anxiety could really affect everybody differently. It’s just as important to be self-aware that this is a difficult time and to have compassion for these feelings and monitor them. And when you feel like you’re feeling so overwhelmed that your behaviors are changing, then it might be time to reach out for help.
We are wired in a way that when we are experiencing high levels of stress, we’re thinking about survival. When we think about this pandemic, oftentimes our responses are our body’s way of trying to say, “How do I survive in this moment?” And our minds and bodies don’t know how to survive in a pandemic, because we probably haven’t experienced a pandemic before. That’s why we might be seeing all of these roller coaster emotions and reactions, because our body is trying to figure out, “How can we be successful during this time?”
Why is self-care and wellness important for first responders? And what can first responders do to prioritize their own mental and emotional well-being, as well as ensure they support one another?
Certain self-care measures that are sometimes adopted during those normal stress times have been taken away from this population. Those social gatherings, sporting events, the gym, church, family celebrations – all those self-care pieces have been taken away. It’s important for first responders to try to figure out things that they still can do so that they’re not experiencing additional fatigue.
Most departments still have their peer support network in place. That is always a great place to start, as well as any kind of employee assistance program. This is something that’s free to employees and any household members. At Cigna, we have doubled the amount of EAP sessions up to a maximum of 10, because we know that the stress can really be heightened at this time in our lives.
There are also so many different virtual resources that are available. You don’t even need to leave your home. At Cigna, we have Happify and iPrevail that are available to members. We have a variety of different therapists and psychiatrists that are available now virtually through our own network, Talkspace and other different providers.
We’ve also made several resources available not just to our members, but the community. We have podcasts, webinars and guided mindfulness meditations. There really are quite a few different pieces available out there. It’s just putting forth that time and effort to make self-care a priority.
“Mindfulness” and “self-care” are common terms, but what do those terms mean? What are some practical strategies to accomplish those on an individual level?
If we were to rely on Jon Kabat-Zinn’s definition of mindfulness, it’s really that we’re paying attention on purpose in the present moment, non-judgmentally, as if your life depends on it.
Self-care is a practice of taking an active role in protecting your own well-being and happiness. And we talk about it during periods of stress.
Mindfulness can be a part of self-care, but self-care can include other activities that make you feel better, like healthy eating, getting good sleep, exercising, expressing gratitude – whatever it is that is the good fit for you. Self-care is more of a broader umbrella, and mindfulness can be a piece of self-care, but really it’s trying to be present.
What resources are available to help? What can individuals and organizations do to promote stress relief?
It’s important that all agencies are sharing these resources in this stressful time, that these messages really come from the top and that the resources are supported. Whether it is an employee assistance program or other resources that might be available, it’s important that the messaging is clear that these resources are there to be supportive to employees.
We know that everybody is having heightened levels of stress. That’s one important piece, but when we talk about different resources that can be available, draw on EAP, peer support, some of the resources that were already in play, and make sure that there’s an awareness about all these different virtual providers as well. Find what is going to be beneficial to individuals and encourage that as well.
We know that if you’re taking care of your emotional health, then you’re taking care of your physical health at the same time. We really want to make sure that we have this holistic approach to managing the whole person, and behavioral health is a huge component of that.
Back when we were flying, you started your flight with, “If something happens, make sure you put your mask on yourself before you put it on others or your children.” That’s really important to remember – that we can’t care for others if we’re not taking care of ourselves.
To help improve resiliency during COVID-19, Cigna is providing supportive resources for customers, clients, and communities in regard to managing anxiety, fear and stress. Visit Cigna for resources and information to help you navigate this time of uncertainty at Cigna.com/coronavirus ( for individuals) or Cigna.com/coronavirus/employers (for organizations). For additional information, visit Cigna’s COVID-19 resource center.
Cigna products and services are offered by Cigna Health and Life Insurance Company or its affiliates. This article is not intended for residents of New Mexico.