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PTSD treatments for firefighters

Summarizing the primary treatments currently being used to treat firefighters experiencing PTSD


Current counseling treatments for PTSD provide skills for dealing with various symptoms that evidence the disorder, promote self-esteem needed to successfully apply these learned skills, and develop personalized methods for effectively managing any ongoing symptoms.

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The origins of post-traumatic stress disorder (PTSD) in a firefighter’s life are clearly defined. You have experienced a traumatic event or a series of events that is affecting your behavior in a negative way. You were witness to a traumatic event, and the experience is redefining your reaction to life’s challenges. And while you as a firefighter may not have experienced a traumatic event or their culmination, you know likely someone who has.

The result of such direct or indirect involvement surrounding traumatic incidents might be a repetition of graphic details. Such repetition can debilitate a firefighter, with the resulting behavior or impact reflected in diminishing health, experiencing nightmares, or inappropriate conduct.

Current counseling treatments for PTSD provide skills for dealing with various symptoms that evidence the disorder, promote self-esteem needed to successfully apply these learned skills, and develop personalized methods for effectively managing any ongoing symptoms. It is important to recognize that treatment is a process and not a product.

Following are overviews of some of the current treatment options.

Cognitive behavior therapy (CBT): Connecting mind and body

In the medical world of psychotherapy, excluding drug and electrical intervention, there is an umbrella treatment known as cognitive behavior therapy (CBT). In session visits, firefighters are open to various therapies moving toward a common goal. In straightforward terms, the objective of self-help through self-realization is accomplished by a direct visceral exposure to the problem (exposure therapy, or ET) or by mental reasoning, understanding and acceptance of what has transpired and why (cognitive restructuring, or CR).

These two approaches can be further divided by length and type of treatment and emphasis areas, as well as different methods of providing mental and physical coping mechanisms. For firefighters, it boils down to basic therapies of mind and body, and their resulting strategies necessary to cope with PTSD.

Exposure therapy: Direct contact with the event

Exposure therapy (ET) focuses on the specific traumatic event or events that are affecting behavior. A firefighter takes small steps in facing their reactive fears in a safe environment. There is honest identification of personal suffering due to the acknowledged events. A firefighter begins to believe in how such feelings debilitate, why they are so prevalent, and exactly what triggers their repetitive dysfunctional reactions. Firefighters can use recollection, writing commentary or visits to persons or places associated with the trauma-induced stress.

Prolonged exposure therapy: Deeper contact

Prolonged exposure therapy (PE) is an advanced form of ET relying on extreme repetition and a direct confrontational approach to trauma. While severely emotional in some cases, research is providing clear evidence of tangible success in myriad PTSD cases.

Additionally, virtual reality technology is now being introduced into PE, as it creates vivid and real-time exposure to events.

The basic premise of these various methods of exposure is that by acknowledged repetition of trauma in a safe and controlled environment, the firefighter will become desensitized over time, allowing for the opportunity to develop coping skills.


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Cognitive restructuring: Remembering the event

Cognitive restructuring (CR) relies on memories of past traumatic events that are affecting a firefighter’s behavior. Recollection is a less threatening technique to acquire behavioral change with no judgement or conditions – just solutions. As Elizabeth Hoge, MD, and PTSD specialist so accurately describes, “Remembrances are stored in the brain differently.”

CR begins with how a firefighter views the world and how it has changed since the traumatic event was experienced. Memories are often disconnected and misinterpreted to a point where the firefighter feels guilt and shame with no tangible causation. CR attempts to put a realistic perspective on the actual event and apply such insight to an individual’s beliefs and values with regards to the current world.

Relying heavily on memories and emotions associated with a traumatic event, CR supports confrontation and resolution over a long period of recovery.

Cognitive processing therapy: Changing your mind

Cognitive processing therapy (CPT), another form of mental therapy, takes a firefighter’s thought process one step further, utilizing techniques that attempt to change the entire thought process from beginning to end. By exposing inaccurate thoughts and incorrect views of the entire body of recollections associated with an event, a firefighter creates a more helpful and productive review and subsequent conclusion relating to the actual trauma.


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Eye movement desensitization and reprocessing: Physical effects of PTSD

Eye movement desensitization and reprocessing (EMDR) is a form of therapy that recognizes the physical toll PTSD takes on a firefighter and its subsequent reflection on the body. Headaches, chronic fatigue, organ failure and acute illness can be traced to the inability to process a traumatic event or events. Such physical signs and symptoms are reflected in the medical markers associated with poor health.

The latest research is connecting the actual chemistry of the body as a code to the mind and spirit of an individual. Tremors, eye movements and inappropriate body chemistry can be leading indicators of PTSD. Medical researchers in the Netherlands are exploring this concept of organic stressors leading to social dysfunction or PTSD.

Utilizing a series of analytical benchmarks and associated therapeutic skills, firefighters experience sustainable improvement in their health while lowering their PTSD symptoms.

Stress inoculation training: Understanding coping skills

Digging deeper into the idea that the body reflects PTSD, stress inoculation training (SIT) introduces the firefighter to techniques that directly influence the effects of the disorder producing a positive outcome. Breathing techniques, muscle relaxation, meditation, assertive training and an overall development of self-control and confidence serve to reduce the anxiety of trauma by commitment and repetition.

While it is recognized that people react differently to traumatic events, focused skills central to improved attitude and behavior can be effectively applied in a wide range of cases.


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Present-centered therapy: Trauma in perspective

Not technically in the CBT family, but widely acknowledged as an effective approach to PTSD, is present centered therapy (PCT). PCT deals with individual trauma by focusing on current events and issues in an effort to place the incident in context with daily living. By examining contemporary matters, the intensity of any past trauma is eventually diminished. The primary goal of PCT is to understand an individual’s trauma and place it in the proper perspective, all within a productive and proactive life.

Thank you to the Anxiety and Depression Association of America and the Mayo Clinic for their insights into PTSD.

This article, which was originally published on May 27, 2019, has been updated.

Jim Spell spent 33 years as a professional firefighter with Vail (Colorado) Fire & Emergency Services, the last 20 years as a captain. He helped create the first student/resident fire science program west of the continental divide, formed the first countywide hazmat response unit and was on the original Colorado Governor’s Safety Committee. As founder of HAZPRO Consulting, LLC, Spell advised businesses on subjects ranging from hazard analysis and safety response to personnel development and organization. His writing won six IAFF Media Awards. Many of Spell’s articles are available by podcast at His last book was titled “Boot Basics: A Firefighter’s Guide to the Service.” Spell passed away in April 2024 after a short battle with cancer. His last four articles detailed his cancer journey.