The Effect of COVID 19 Pandemic on the Mental Health of First Responders

First responder who are having mental instability due to the pandemic, the shift in our
society because of this, not being able to cope with a pandemic.
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The Effect of COVID 19 Pandemic on the Mental Health of First Responders

Table of Contents



    2.1 Effects of Trauma on Psychology 4
    2.2 Borderline Personality Disorder and Trauma 5
    2.3 Post-Traumatic Stress Disorder (PTSD) 6
    4.1 Results 7
    1.2 Discussion 9
    1.3 Strengths and Weaknesses of the Findings 11
    1.4 Ethical Concerns 12
    5.0 Recommendations 12
    5.2 Conclusion 17


The study examines the effect of the coronavirus pandemic on the mental health of first
responders. To enable this examination, the study engages in a systematic review of past studies
that focus on psychological issues that first responders encounter. The review reveals that first
responders are most susceptible to PTSD. Based on this finding, it is recommended that first
responders should be subjective to integrative therapy as it would help them and their families
cope with the current situation.


The Effect of Covid-19 Pandemic on Mental Health of First Responders


The Coronavirus pandemic has shown the vital role played by first responders during
emergencies. While stress is an unavoidable part of an emergency responder’s work, the
pandemic has exaggerated the level l of stress the first responders; this makes them susceptible to
mental illness. First responders encounter constant threats to their lives and witness harm to other
people. Also, they work long hours and are not well-compensated to accommodate their needs.
On that note, stress management is essential for responders to prevent the onset of mental illness.
Stress management is a broad scope of psychotherapies and techniques aimed at controlling an
individual’s level of stress, particularly chronic stress, typically for the objective of improving
daily functioning.
First responders typically encounter three levels of stress. The first is acute stress. Acute
stress is typically brief and is caused by reactive thinking and negative thoughts about adverse
situations (Walker et al., 2016). The second is episodic acute stress. Since the first responders
face frequent stress, they are at risk of acute episodic stress. These typically result from living a
life of crisis chaos and are always under pressure. The last form is chronic stress. This is the most
severe type of stress and can have permanent psychological damage. The vulnerable populations
include the front-line workers who encounter stressful situations daily in their work
environments (Szeto, Dobson, & Knaak, 2019). The first responders include emergency medical
technicians, firefighters, law enforcement officers, and rescuers.
The study is useful due to several purposes. First, is to form meaningful interventions for
first responders encountering the three levels of stress. Second is to identify the stressors within
the work environment to mitigate them. The third is to devise ways to cheer up and motivate first

responders. The last objective is to create a safe and open work environment. To effectively
maintain the well-being of first-responders, the study will acknowledge the effect of stress from
various sources, like organizational factors. Moreover, it approaches stress prevention in a
comprehensive and multi-phased way, focusing on primary phase interventions. The study will
take a holistic view of stress management to enable significant improvements among first


The onset of COVID-19 has been followed by traumatic events whereby first responders
have been highly exposed to these events. The body of literature examined for this study reveals
how traumatic events affect the psychology of these workers. The review is arranged according
to themes to enable straightforward interpretation.
2.1 Effects of Trauma on Psychology

Severe and prolonged trauma, like the one caused by the coronavirus pandemic, tends to
lead to a chronic inability to moderate feelings. When this occurs, an individual can mobilize a
variety of behaviors that can be understood to attempt to soothe themselves (Carleton et al.,
2018). Carleton et al. (2018) state that these attempts range from indiscriminate relationships
with other people, clinging, and behaviors directed at themselves, such as substance abuse,
eating disorders, and self-mutilation. In extreme cases, the ailing first responder may attempt
suicide numerous times or engage in self-destructive behavior.

2.2 Borderline Personality Disorder and Trauma


Shepherd, D., McBride, and Lovelock (2017) reveal that the trauma experienced by first
responders also leaves them susceptible to borderline personality disorder. Characteristics of
Borderline Personality Disorder involve specific behavioral patterns, including self-image,
interpersonal relationships, and impulse control. This leads to weaknesses in achieving goals,
self-management, as well as less social interactions (Shepherd, McBride, & Lovelock, 2017).
Many theories come up in an attempt to explain its possible causes in first responders due to the
disorder’s high prevalence and the sociocultural factors linked to it. Childhood trauma can bring
about devastating psychological problems later in life.
Psychiatric disorders and social challenges can both result from trauma. Drug abuse,
depression, eating disorders, panic disorder, and post-traumatic stress disorder can all come up as
a result of childhood trauma. Trauma can be in the form of violence in the family, for instance,
an individual who was physically and emotionally abused, disease, and experiencing war
(Shepherd, McBride, & Lovelock, 2017). Antisocial, paranoid, borderline, schizotypal, and
avoidant are all personality disorders that are also associated with trauma. Parental rejection,
being ignored, and devaluation all have an impact on a child’s identity. Ill-treatment of a child by
parents also affects the development of a safe attachment. Attachment anxiety and avoiding
attachment may both be a result of ill-treatment in childhood. According to Chopko, Papazoglou,
& Schwartz (2018), many people suffering from BPD were sexually abused as children.
However, sexual abuse in childhood is not the only practice of ill-treatment that has been
associated with BPD. Neglect, emotional, and physical abuse are linked to the disorder’s

2.3 Post-Traumatic Stress Disorder (PTSD)

Bergen et al. (2015) assert that the most common disorder among first responders is
PTSD. A psychological condition, Post-Traumatic Stress Disorder develops after an individual
has been exposed to danger or experienced harm in one way or another and has not been in a
position to protect themselves. The disorder has a higher chance of developing when a person
experiences helplessness, powerlessness, and fear, features that are common in child abuse.
Three main symptoms characterize PTSD:

 Hyperarousal- This can be experienced as irritability, agitation, or anxiety.
 Intrusions – occur when past traumatic experiences break into a person’s
consciousness. One experiences these events as though they are happening in the
 Avoidance occurs when one tries to defend oneself from danger by limiting the
contact they have with the outside world. This can be by limiting the range of
feelings and thoughts the person chooses to acknowledge or withdrawing from
other people (Bergen et al., 2015). Avoidance can be in the form of repression
(where one blocks out a traumatic event’s memory), dissociation (where
perception is altered), amnesia, or denial (a refusal to acknowledge that a past
event happened).
Panic attacks occur when a person experiences fear when there is no logical reason to feel
that way, and their anxiety escalates. People who have a history of childhood abuse have a higher
likelihood of experiencing panic attacks or frequent anxiety than those who have not experienced
childhood abuse (Boyd et al., 2018). Depression is also linked to traumatic experiences and often

occurs in response to current and past losses. People going through depression isolate themselves
from others, feel unfulfilled in life, and are not positive about what the future holds for them
(Boyd et al., 2018). They often do not have the energy to do things for themselves, lack
concentration, and are unable to sleep or eat normally. Boyd and colleagues (2018) suggest that
Major Depressive Disorder occurs when depression signs such as worthlessness, loss of interest
in friends and family, and lethargy last for two weeks or longer for no reason. All these influence
people’s personalities in a negative way.


The study applies a qualitative methodology. In particular, it uses a case study approach
since it enables an in-depth consideration of psychological disorders that face first responders.
The review involved a meta-analysis of past studies on the issue. The primary technique applied
in highlighting and selecting the relevant and suitable sources involved an electronic search on
trustworthy databases like peer-reviewed journal articles, books, and publications from reputable
magazines. The search was confined to material published from 2010 onwards to ensure the
sources are current. Another search stricture entailed scanning the credentials of an author to
ensure scholarly authority for the papers selected. The search terms used included first
responders, psychological disorders, mental issues facing first responders.


4.1 Results

The searches identified 500 potentially eligible articles. A total of 100 articles published
between the years 1990 and 2019 were used in the review. Most of the articles excluded did not

match the inclusion criteria of reporting psychological disorders, or other relevant disorders
about first responders. Other studies used to pilot or feasibility studies that were not meant as
services were also excluded.
The studies highlight that PTSD is the most prevalent and most risky disorder among first
responders; hence it is essential to place particular focus on it. The critical issue being addressed
in the articles is the reason why post-traumatic stress disorder is evident in first responders. The
studies provide various pieces of evidence regarding homeless veterans who are suffering from
post-traumatic stress disorder. On that note, the studies show that almost two-thirds of first
responders are suffering from post-traumatic disorder.
The evidence gathered showed that first responders had a higher rate of suffering from
PTSD when compared to war veterans. The PTSD rates for first responders fell between 8-13%
(Skogstad, Fjetland, & Ekeberg. 2019). According to the evidence presented in the articles, first
responders had higher rates when compared to the war veterans when it came to PTSD because
they had witnessed more traumas during their daily duties (Crowe et al., 2015). One of the
articles delves deeper into a study which had been carried out by one of the psychologists, Jack
Tsai, who stated that the higher rates which had been recorded were as a result of awareness and
various assessments which had been carried out by clinicians.
The information obtained by Jack Tsai and his team relied on data that had been analyzed
and derived from a program that had been carried out between 2008 and 2011. The data was also
based on 994 veterans who had been deployed in Afghanistan and Iraq and had entered the
program, Housing, and Urban Development-Veterans Affairs Supportive Housing program. The
articles also provide information on the previous reports based on past studies that had been
carried out, which showed that this particular sample of veterans was either homeless or at risk

of being so. The program provided that in 2010, the estimated number of homeless veterans of
the Afghanistan and Iraq wars was at 12,700 (Papazoglou, 2017). The program also provided
that 7.7% of the male veterans had PTSD (Papazoglou, 2017). However, the findings also
included information that the disorder was as a result of previous traumas which occurred before
they had been deployed
The same program managed to provide information which revolved around 15% of male
veterans and 34.1% female first responders from the specified sample who had reported that they
had PTSD that was related to their duties as well as PTSD which was associated with the past
traumas (Geronazzo-Alman et al., 2017). When it came to the rates of substance abuse and
psychotic disorders, the specific sample showed that only a few of the first responders were
suffering from the two disorders (Patton, Smith, & Lilienfeld, 2018). Hence, the conclusion
presented by the information gathered shows the reasons as to why PTSD is more common in
first responders. The main reason as to why it was common in this sample is because of the
trauma they had witnessed in their job that had not been encountered by the war veterans who
had been deployed to different wars.
1.2 Discussion

PTSD will typically develop after specific experiences that traumatize a first responder.
The encounters are related to traumatic events (Heyman, Dill, & Douglas, 2018). In this case, the
traumatic event is the coronavirus pandemic. A worker suffering from the disorder will be
extremely fearful of the events recurring. PTSD has been brought to the spotlight by first
responders since it is quite familiar to them since they will have seen someone injured during
combat (Lewis-Schroeder et al., 2018). However, various traumatic incidents will also lead to the

development of PTSD. Following the coronavirus pandemic, it is most likely that most first
responders will have PTSD. After the pandemic, they will have difficulties attempting to readjust
their lives. Sadly, most of them will live in seclusion and emotionally cut off people who are
close to them.
One cause of PTSD when it comes to first responders, mainly, would be the traumatic
events encountered while performing their duties. The events which occur during work will
further result in work stress (Jones et al., 2018). As noted earlier, first responders face a higher
risk of suffering from PTSD when compared to the war veterans. The increased level of exposure
is a result of the frequency of traumatic experiences (Jones et al., 2018). First responders
experience traumatic events daily, and this increases the risk of getting PTSD. The events
witnessed during such events, like friends being killed, being exposed to harm, and seeing
people’s deaths contribute to the development of PTSD among the first responders (Kaplan et al.,
2017). Based on these findings, there are various forms of therapies that are suggested for first
responders with psychological disorders in the context of the coronavirus pandemic
Cognitive Approaches
The cognitive approaches for psychiatric nursing are evidence-based techniques to
transform behaviors, feelings, and thoughts of patients. They include approaches like cognitive
restricting techniques, grand exposure assignments, successive approximations, and dynamic
scheduling. Aside from changing the thought patterns of patients, they are applied by psychiatric
nurses to enhance functioning and enhance the quality of life (DeRubeis, Keefe, & Beck, 2019).
The approaches are based on recent psychology research and have continuously been one of the
most effective interventions for psychological issues and mood disorders (Crane, 2017). The

approaches are dynamic nature since their application hinges on the needs of the patient and the
desired outcomes.
Formal and Informal Support Systems and Social Distancing
Formal support is comprised of the services provided by trained and professional workers
in the field of psychiatry. For instance, a cognitive therapy offered by a nurse in a clinical setting
is formal support based on evidence-based practice. On the other hand, informal support includes
the support of a patient’s community and social network, like family and friends (Kellner et al.,
2019). They help a patient cope with the condition and adjust to a new way of living. The recent
call for social distancing due to the COVID-19 pandemic has complicated the provision of
support systems for psychiatric patients. Mostly, the support systems are set in place so that
patients can have interactions with other human beings to help them cope with the disorder.
Indeed, the interactions form a vital part of intervention since they help the patient gain a sense
of normalcy by giving them reinforcement. Therefore, the need for social distancing will limit
the efficacy of interventions of psychiatric patients. Formal support systems can be offered
through electronic methods, and informal support requires face to face interactions for
1.3 Strengths and Weaknesses of the Findings

One of the strengths of the findings provided in the articles is the accurate information
gathered from the various studies which had been conducted regarding PTSD and first
responders. The information contained in the articles is precise since other peer-reviewed articles
provide information on the number of first responders who were suffering from the disorder. The
data also accurately offered the reasons as to why first responders involved in the coronavirus

pandemic have PTSD and provides various recommendations which will help with the treatment
of the disorder among the selected sample.
One weakness of the findings is that they fail to provide more information on the reasons
as to why first responders are more likely than war veterans to suffer from PTSD. The authors
should have provided adequate findings that focus on combat and war that further led to the
development of PTSD and compare it to the daily traumatic experiences of first responders.
1.4 Ethical Concerns

Based on the information provided, there are hardly any ethical concerns that can be
identified. Moreover, in the studies reviewed, the authors managed to show respect for
anonymity since they have not produced the names of individuals in the sample who were
suffering from PTSD because of previous traumatic events, which included rape, childhood
abuse, and assaults. This shows that the authors maintained confidentiality when carrying out the
research. However, informed consent was not gathered from the sample used for the study which
would indicate that they were willing to participate in the study being carried out by the housing


5.0 Recommendations
Since the psychological disorders that first responders encounter due to the coronavirus
pandemic are bound to affect the entire family system, it is recommended that they use
integrative therapy for these workers and their families. Integrative therapy is a type of
psychotherapy that interweaves different therapeutic approaches and tools to fit the needs of first
responders and their families. With a comprehension of healthy human development, a counselor

that uses this approach adjusts standard treatment to plug the development gaps that affect
families in different ways. By interweaving elements from different disciplines of psychological,
research, and theory, integrative therapy can become a more inclusive and dynamic approach to
the treatment of families than the more singular, conventional forms of therapy.
The rationale for Using Integrative Family Therapy
Integrated therapy is a practical approach since families deal with many issues about
substance abuse, sexual abuse, finances, and gender roles. Besides, the therapy is suited to
handle the discrete issues that face children and adolescents from adverse family environments
and help them make decisions concerning their future (Wesselmann, Armstrong, Schweitzer,
Davidson, & Potter, 2018). The approach is well suited to the issues that fir responders face since
it is not only focused on adult relationships but also the at-risk youth within the family set up.
These youth face a higher risk of not succeeding later in life than those that live in a considerably
stable environment, and most of them also have behavioral and emotional problems. Integrative
family therapy is based on the idea that by changing ways of thinking, family members can
dramatically improve their health, both emotional and behavioral (Wesselmann et al., 2018). The
approach is successful since it is not mainly focused on assisting families to air their emotions
and bitterness. Instead, it shows them how they can truly improve, and lead happier lives focused
on self-actualization. The approach focuses mostly on helping family members realize their real
value and importance, both in the family set up and in society.
The need for using integrative therapy on families is necessitated by the fact that those
other approaches are lacking, especially considering the effect of coronavirus on first responders.
The other approaches are more focused on individual factors rather than the entire family system.
Therefore, integrative therapy builds on its strengths to create a wide-ranging approach. The

approach expands the current ideas of mental health treatment outside just a behavioral approach
emphasizing the unconscious to one that emphasizes the conscious and people’s rational abilities.
Integrative Therapy Formula and Application
Integrative therapy uses the ABC formula to reinforce the notion that irrational beliefs
bring about negative feelings. The acronym has been developed to increase awareness of how to
overcome negative behaviors and cognition (Daley, Miller, Bean, & Oka, 2018). The ‘A’ denotes
adversity. This can mean the daily challenges everyone has to deal with purely as a result of
interacting with others. The ‘B’ is for belief. It has to do with whether or not a particular
individual believes that they can get a positive outcome, or whether or not they can overcome the
challenges. The ‘C’ stands for the consequences that follow a specific belief. For a person
undertaking some kind of rational therapy, the teaching here is that harboring negative beliefs
eventually leads to negative results and that by practicing more positive thinking on confronting
challenges, there would be positive outcomes (Daley et al., 2018). Hence, the ABC formula
translates to mean: Actions lead to Beliefs which in turn produce Consequences. In most cases, it
is not the action that produces the responsive consequence; it is the belief one has concerning the
action that does. This is positive teaching for families as it helps them see that while they cannot
stop negative things from happening to them, they can change the direction their thoughts take,
which changes how they are affected by the different challenges in their lives.
The integrative approach teaches that dysfunctional beliefs lead to a dysfunctional family
system. A dysfunctional belief system is active and needs maintenance. This implies that it is
susceptible to the opposition through methods like rational examination and other psychoanalysis
methods (Rodríguez-González, Martins, Bell, Lafontaine, & Costa, 2019). Therefore, the aim of
a profound change in philosophy is a change of dysfunctional beliefs that impact families

negatively. When a person changes long-held beliefs, there is a philosophical change that results
because dysfunctional beliefs that do the most damage consist of a pattern of pondering about
one’s identity or life (Rodríguez-González et al., 2019). Scientific thinking is involved because,
just like in science, patients are taught how to test their thoughts in the same way a scientist
would test a theory. This is applied to patients of all ranges, whether gifted or psychotic. The
approach will be suitable to respond to the psychological needs of first responders and their
Advantages of Integrative Therapy in Treating Families
First responders often have suicidal thoughts. Suicide is among the leading causes of
death among people with depression, and integrative therapy could be beneficial when applied in
such cases because of its simplicity (Gutierrez et al., 2019). It is especially crucial in intervening
for first responders. In a way, integrative therapy may not feel like psychotherapy to the teenager
because of its direct approach and reliance on practicality (Gutierrez et al., 2019). Other forms of
therapy often appear intimidating and mysterious to first responders, but integrative therapy is
the opposite, making it a beneficial therapy form for the youth.
Integrative therapy for Addiction Treatment
Drug and alcohol addiction is a serious issue that many first responders face. Many first
responders turn to drug and alcohol abuse to cope with traumatic experiences. In this case,
integrative therapy is used to free family members from addiction that has been passed down
between generations. The goal is to make the family members accept the reality, even though it
might be unpleasant, and develop a healthy way to react to the situation.
Most people suffer due to developing unhealthy beliefs, and that the suffering continues
if they hold onto these irrational beliefs. According to Pitta and Datchi (2019), people stop

suffering when they change these beliefs, which takes a lot of time and practice. The person can
change these irrational beliefs by adopting three kinds of acceptance; completely accepting
themselves, accepting others for who they are, and accepting the challenges that they encounter
in life. Concerning addiction, the integrative approach articulates that people take part in
unhealthy behaviors due to having irrational beliefs. The main reason why people turn to
substance abuse could be a shame, depression, or guilt. Once a person can stop harboring the
irrational beliefs driving the substance abuse by becoming more accepting of their
circumstances, it becomes a lot easier to get over their dependence and helps them focus more on
bettering their lives. The aim of the therapy is not merely to get the person to stop the unhealthy
behavior, but to get rid of the beliefs that resulted in them taking up such habits, to begin with.
Integrative therapy would be valuable to a family set up in helping them become more
satisfied with their lives, reduce disorder symptoms, and avoid negative thoughts that could
increase the chances of a relapse or addiction. The therapy used in treating addiction to help
individuals recognize how they can control their negative emotions (Pauzé, Cook-Darzens,
Villeneuve, Chateauneuf, Petitpas, & Côté, 2017). It teaches them recovery methods applicable
in real-life circumstances that increase life fulfillment, and in so doing, the odds of relapse are
minimal. A counselor using the approach would teach the family members that they are
primarily responsible for their fulfillment in life and that their beliefs have an impact on their
well-being much more than outside influences do. While some may argue that telling people to
change their beliefs equates to indoctrination, a therapist using the integrative approach only asks
patients to change the negative and irrational beliefs that may be contributing to their
dissatisfaction with life. People that come from difficult backgrounds struggle with acceptance in
their families and society at large. They are more likely to suffer from sexual abuse and display

disruptive behavior. They find it hard to fit in, especially among their peers. Integrative therapy
effectively teaches these people that while not everyone will accept them; it does not make them
lesser individuals.
Integrative family therapy is a practical approach since it combines different theories and
concepts to create a systematic way of dealing with family issues. This focus makes it ideal for
troubled families founded on the tenets of positive transformation by reinforcing positive beliefs.
Its approach is realistic in that it does not try to help people change the harmful environments
they may be in, but instead teaches patients to develop an acceptance of themselves and the
world around them. By applying this approach, integrative has a significant impact on reducing
disruptive behavior in first responders and their families.
5.2 Conclusion
First responders play a vital role in society, especially in times of disaster. Indeed, the
importance of these workers has been demonstrated during the coronavirus pandemic. The first
responders attend to the needs of patients while helping families to cope with grief and loss.
While performing these duties, the first responders’ witness adverse events, are exposed to harm
and face the prospect of being isolated from their families. Due to these traumatic events, first
responders are at risk of psychological issues. The review reveals that PTSD is the most common
disorder in first responders. It is recommended that integrated therapy be provided to first
responders and their families to help them cope with the harmful effects of the job, particularly
amid this pandemic.



Bergen-Cico, D., Lane, S., Thompson, M., Wozny, S., Zajdel, M., Barduhn, M., & Noce, J.
(2015). The impact of post-traumatic stress on first responders: analysis of cortisol,
anxiety, depression, sleep impairment, and pain. International Paramedic Practice, 5(3),
Boyd, J. E., Protopopescu, A., O’Connor, C., Neufeld, R. W., Jetly, R., Hood, H. K., &
McKinnon, M. C. (2018). Dissociative symptoms mediate the relation between PTSD
symptoms and functional impairment in a sample of military members, veterans, and first
responders with PTSD. European journal of psychotraumatology, 9(1), 1463794.
Carleton, R. N., Afifi, T. O., Turner, S., Taillieu, T., Duranceau, S., LeBouthillier, D. M., &
Hozempa, K. (2018). Mental disorder symptoms among public safety personnel in
Canada. The Canadian Journal of Psychiatry, 63(1), 54-64.
Chopko, B. A., Papazoglou, K., & Schwartz, R. C. (2018). Mindfulness-based psychotherapy
approaches for first responders: From research to clinical practice. American journal of
psychotherapy, 71(2), 55-64.
Crane, R. (2017). Mindfulness-based cognitive therapy: Distinctive features. Routledge.
Crowe, A., Glass, J. S., Raines, J., Lancaster, M., & Waggy, M. (2015). Mental illness stigma
among first responders and the general population. Journal of Military and Government
Counseling, 3(3), 132-149.
Daley, L. P., Miller, R. B., Bean, R. A., & Oka, M. (2018). Family System Play Therapy: An
Integrative Approach. The American Journal of Family Therapy, 46(5), 421-436.
DeRubeis, R. J., Keefe, J. R., & Beck, A. T. (2019). Cognitive Therapy

Geronazzo-Alman, L., Eisenberg, R., Shen, S., Duarte, C. S., Musa, G. J., Wicks, J., & Hoven,
C. W. (2017). Cumulative exposure to work-related traumatic events and current post-
traumatic stress disorder in New York City’s first responders. Comprehensive
Psychiatry, 74, 134-143.
Gutierrez, D., Carlson, R. G., Daire, A. P., & Young, M. E. (2017). Evaluating treatment
outcomes using the integrative model of brief couples counseling: A pilot study. The
Family Journal, 25(1), 5-12.
Heyman, M., Dill, J., & Douglas, R. (2018). The Ruderman white paper on mental health and
suicide of first responders. Ruderman Family Foundation.
Jones, S., Nagel, C., McSweeney, J., & Curran, G. (2018). Prevalence and correlates of
psychiatric symptoms among first responders in a Southern State. Archives of psychiatric
nursing, 32(6), 828-835.
Kaplan, J. B., Bergman, A. L., Christopher, M., Bowen, S., & Hunsinger, M. (2017). Role of
resilience in mindfulness training for first responders. Mindfulness, 8(5), 1373-1380.
Kellner, A., Townsend, K., Loudoun, R., Dao-Tran, T. H., & Wilkinson, A. (2019). 16 Balancing
Formal and Informal Support for Psychological Health in Emergency Services. Critical
Perspectives on the Management and Organization of Emergency Services, 232.
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.
Patton, C. L., Smith, S. F., & Lilienfeld, S. O. (2018). Psychopathy and heroism in first
responders: Traits cut from the same cloth?. Personality Disorders: Theory, Research,
and Treatment, 9(4), 354.

Papazoglou, K. (2017). Examining the psychophysiological efficacy of CBT treatment for first
responders diagnosed with PTSD: An understudied topic. Sage Open, 7(3),
Pauzé, R., Cook-Darzens, S., Villeneuve, M. P., Chateauneuf, D., Petitpas, J., & Côté, J. (2017).
The evaluation of family functioning: A proposal for an integrative model to support
clinical practice and research. Thérapie Familiale, 38(3), 295-328.
Shepherd, D., McBride, D., & Lovelock, K. (2017). First responder well-being following the
2011 Canterbury earthquake. Disaster Prevention and Management: An International
Skogstad, L., Fjetland, A. M., & Ekeberg, Ø. (2015). Exposure and posttraumatic stress
symptoms among first responders working in proximity to the terror sites in Norway on
July 22, 2011–a cross-sectional study. Scandinavian journal of trauma, resuscitation, and
emergency medicine, 23(1), 23.
Szeto, A., Dobson, K. S., & Knaak, S. (2019). The road to mental readiness for first responders:
a meta-analysis of program outcomes. The Canadian Journal of Psychiatry, 64(1_suppl),
Walker, A., McKune, A., Ferguson, S., Pyne, D. B., & Rattray, B. (2016). Chronic occupational
exposures can influence the rate of PTSD and depressive disorders in first responders and
military personnel. Extreme physiology & medicine, 5(1), 8.
Rodríguez-González, M., Martins, M. V., Bell, C. A., Lafontaine, M. F., & Costa, M. E. (2019).
Differentiation of Self, Psychological Distress, and Dyadic Adjustment: Exploring an
Integrative Model Through an Actor–Partner Analysis. Contemporary Family
Therapy, 41(3), 293-303.

Wesselmann, D., Armstrong, S., Schweitzer, C., Davidson, M., & Potter, A. (2018). An
integrative EMDR and family therapy model for treating attachment trauma in children:
A case series. Journal of EMDR Practice and Research, 12(4), 196-207.