Author: Judy Gurfein

Post Traumatic Stress Disorder: Understanding the Diagnostic Criteria

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Post Traumatic Stress Disorder: Understanding the Diagnostic Criteria

By: Abby Erasmus

Post- traumatic stress disorder is a psychiatric disorder that individuals can develop after experiencing a traumatic event. Traumatic events are defined by incidents that have the capacity to provoke fear, helplessness, or horror in response to the threat of injury or death. Further, as stated in the Diagnostic and Statistical Manual of Mental Disorders (5th ed; DSM- 5; American Psychiatric Association, 2013), one must display 4 types of symptoms to be diagnosed with post- traumatic stress disorder.

The first type is symptoms of re-experiencing the event in which the individual has unwanted recollections of the event (i.e. nightmares). The second type is symptoms of avoidance that include avoiding thoughts and feelings in regard to the incident as well as external reminders of the event (i.e. people, places). The next type of symptoms is symptoms of negative alterations in cognition and mood associated with the traumatic event (i.e. exaggerated negative beliefs/ expectations about oneself). Lastly, individuals will experience marked alterations in arousal and reactivity associated with the event (i.e. exaggerated startle response). Additional criteria includes length of symptoms in which symptoms should persist for longer than one month, severity of symptoms in which they should cause significant clinical distress, and cause of disorder such that symptoms should not be linked to the effects of drugs or substances.

It is also important to note that individuals can have a “delayed expression” of post-traumatic stress disorder (PTSD), which, according to the DSM-5, occurs when the “full diagnostic criteria [of PTSD] are not met until at least 6 months after the event” (APA, 2013). To restate, symptoms can manifest long after this 6 month window. The DSM-5 also states that having had a prior psychiatric disorder such as depression, and emotional problems such as anxiety problems, serve as risk factors in developing PTSD after one experiences a traumatic event. This relationship also works in reverse; experiencing a traumatic puts one at an increased risk for developing other psychiatric disorders such as generalized anxiety disorder (GAD), and at risk for the worsening of GAD symptoms if they had been diagnosed prior to the PTSD diagnosis.

If you or someone you know is seeking therapy for post- traumatic stress disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/          

Sources:

https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/

https://www.nejm.org/doi/full/10.1056/NEJMra012941

Eating Disorders Part 5: Eating Disorders among Latina Women

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Eating Disorders Part 5: Eating Disorders among Latina Women

By: Abby Erasmus

Latina women are caught between two cultures and are therefore at risk of experiencing acculturative stress (a term discussed in “Eating Disorders: Part 4”). As mentioned previously, increased acculturative stress is linked to an increase in eating- related pathology, thus disordered eating patterns are not uncommon among Latina women. The rate of occurrence of eating disorders among Latina women is equivalent to the rate of the general population of U.S. females; however, anorexia nervosa (AN) is rarely noted in Eating Disorder (ED) studies in regard to Latina women. This does not mean AN does not exist among Latina Women, AN is just thought to be the least prevalent in the community. Researchers have found that bulimia nervosa (BN) and binge eating disorder (BED) are the most common, with lifetime prevalence rates of 2% to 2.3-2.7% respectively. Further, researchers have identified key differences in the presentation of both dietary restriction and drive for thinness in comparison to European- American white women. Latina women are less likely to engage in dietary restriction, and if they do, it is often followed by a binge- eating episode. Latina women also find themselves caught between the thin ideal belonging to Western culture and the curvy but flat- stomached ideal belonging to the Latinx community, and these conflicting body image ideals can result in disordered eating behaviors. Additionally, and quite similarly to Asian American culture, food is the love language of the Latinx community, yet, similarly to Asian American women, these women will be scrutinized for gaining weight. Latina women also experience the paradox, and providers should keep this paradox in mind to understand root causes of EDs within the Latinx community.

Binge eating within the Latinx community is associated with significant levels of distress as well as psychopathology, and is often accompanied by obesity. Despite reporting significant levels of distress, the majority of Latina women do not seek treatment, and when they do, they often refer to primary care doctors in which obesity is the only thing that gets identified. Their ED goes unnoticed. In order to correctly diagnose EDs among Latina women, providers must understand the high prevalence rates of BED, BN, and binge- eating behaviors within the population which, in turn, can result in obesity. Once the ED is addressed, obesity can be addressed. Again, with cultural competency added into the equation of treatment, Latina women’s EDs will be correctly diagnosed and they will receive proper treatment.

If you or someone you know is seeking therapy for an eating disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources:

https://yourlatinanutritionist.com/blog/eating-disorders-among-latinas

Identifying Eating Disorders in Latinas

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680162/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078895/

Eating Disorders Part 4: Eating Disorders among Asian- American Women

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Eating Disorders Part 4: Eating Disorders among Asian American Women

By: Abby Erasmus

Unique cultural values and experiences of Asian Americans can lead to the development of an eating disorder for individuals in the community. Similar to Western culture, Asian American (AA) culture idealizes the thin body and individuals face scrutiny from family members if they don’t meet this ideal; paradoxically, food is said to be the love language of Asian culture. Many AAs report being “force fed” by the same family members who criticize their weight. This creates pressure and anxiety around food, and due to this paradox, the complex relationship between food, love, and weight, bulimia nervosa (BN) tends to be the most pervasive ED in the AA community. Furthermore, AAs have to go through the process of acculturation: they must adapt to the practices and values of the dominant culture while maintaining their own. This can result in acculturative stress which is a positive predictor of disordered eating. In turn, research shows that AA college students report higher rates of restrictive eating, purging, and muscle building in comparison to their white counterparts. Also, second generation AA women report more ED behaviors than first and third generation women. This gives us insight into who is more likely to be affected within the community and what the ED behaviors are.

Different cultural values in the AA community such as interdependency, a complete reliance on the family for help rather than a stranger (therapist), and stigma surrounding mental health in general, contribute to the lack of help seeking. Further, some mental health providers are unable to recognize ED- like behaviors in the AA community as they are an under researched group when it comes to this pathology; lack of diagnosis and treatment can thus lead to poor prognosis. Once EDs are officially seen as a disorder that affects all ethnic and demographic groups at similar rates, stigma can be lessened and providers will recognize ED symptoms in this community. Again, cultural competency must be encouraged. Providers should understand the unique stressors AAs face like acculturative stress, as well as the complex relationship between food, showing love, and the idealization of the thin body. Although anorexia nervosa is prominent in the AA community, BN and binge- eating behaviors are the most common in the community; 1.50% are diagnosed with BN and 4.74% experience binge eating behaviors (See Eating Disorders Part 1 for DSM definitions). Once providers are more familiar with BED and BN, as well as the unique factors AAs face, they will be able to have culturally appropriate treatment for AAs with EDs.

If you or someone you know is seeking therapy for an eating disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources

https://www.eater.com/2019/11/19/20955556/my-discomfort-with-comfort-food

https://centerfordiscovery.com/blog/eating-disorders-and-the-api-community/

Eating Disorders in the Asian American Community: A Call for Cultural Consciousness

https://www.nationaleatingdisorders.org/blog/anorexia-for-an-asian-american-a-recovery-story

https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01950/full

https://anad.org/get-informed/about-eating-disorders/eating-disorders-statistics/

https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2014.6b4

How Social Media Affects Mental Health

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By Jillian Hoff

In a world where most individuals are obsessively using social media, it can be detrimental to a person’s mental health.  Some of the most common symptoms that come from excessive use of social media include an increase in anxiety, depression, isolation, and fear of missing out (FOMO). Humans need social interaction, which can be given through social media but only to an extent. Humans need an in person social interaction with the people around them to feel connected. There is a reliance on social media to be able to connect with others now, especially during the pandemic. The convenience that comes from using social media may seem like it is beneficial but it the overuse of it can be the reason for your decline in mental health.

How to know when social media is affecting your mental health:

  • You start spending more time on social media than with your friends in person.
  • You compare yourself to others on social media.
  • You find yourself being distracted while you are at work or school.
  • Using social media is disrupting you sleep.

Ways to improve on mental health after a social media addiction:

  • Turn off your phone at certain times of the day.
  • Keep your phone or tablet in a different room when you are completing a task or going to bed.
  • Use social media in an active way instead of passively. This means you are using social media for a purpose.
  • Take on a new hobby or adventure to new places as a means of meeting new people and getting off of your phone.
  • Interact with others when you go somewhere instead of sitting on your phone.

Know when to put down your phone, it will make all the difference in your mental health!

If you or someone you know is seeking therapy, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources

https://www.riseservices.org/the-impact-of-social-media-on-mental-health/

https://www.helpguide.org/articles/mental-health/social-media-and-mental-health.htm

Eating Disorders Part 3: Eating Disorders in the LGBTQ Community

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By: Abby Erasmus

Members of the LGBTQ community experience an array of challenges that pose as risk factors in developing an eating disorder. Many members of the community experience fear of rejection from individuals they are close with and those outside their immediate circle; they often experience verbal or non- verbal violence, PTSD, discrimination, inability to meet the body image ideals within some LGBTQ contexts, internalized homophobia or transphobia, and more. These negative experiences can lead to depression or anxiety, which in turn can result in unhealthy coping mechanisms like an eating disorder. Past research indicates that about 54% of LGBT adolescents have been diagnosed with a full blown eating disorder (ED), and an additional 21% of LGBT adolescents reported they suspected having had an ED at some point in their lives. Further, about 61% of LGBT adolescents in one study reported that they had engaged in at least one disordered eating behavior in the past year. These statistics emphasize the importance of learning about the diverse, root causes of EDs within the community and how they manifest.

EDs manifest differently in the sub- groups of the LGBTQ community, and are experienced at higher rates compared to their straight or cis- gendered counterparts. In one study, adult and adolescent lesbians reported more binge eating, purging, and laxative use than their heterosexual counterparts, as well as the highest rate of binge- eating compared to any other sexual orientation. Lesbian women also report the highest rates of weight- based self- worth, while bisexual women have been found to report the highest levels of eating pathology compared to lesbian and gay men. Further, gay men report a higher likelihood of engaging in exercise with the intention of losing weight, restrictive eating, fasting, bingeing, purging, and diet pill use compared to their heterosexual counterparts. Lastly, transgender and gender- nonconforming youth seem to be at particular risk for developing an ED; this is due to all risk factors mentioned above, as well as conflicting gender identity and being dissatisfied with their body.

Despite these findings and the clear prevalence rate of such pathology within the community, and increased rates in relation to their straight/ cis- gendered counterparts, many members do not seek help. Many LGBTQ individuals fear their therapist or doctor won’t understand the unique problems within their community. In order to increase rates of treatment, we need to strive for cultural competency in which providers understand the unique experiences of LGBTQ individuals that can lead to EDs, and what EDs look like within the subgroups of the community.

If you or someone you know is seeking therapy for an eating disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources:

https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-020-00327-y

https://toledocenter.com/eating-disorders/why-are-eating-disorders-more-common-in-the-lgbtq-community/

https://www.nationaleatingdisorders.org/learn/general-information/lgbtq

https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-020-00327-y

https://onlinelibrary.wiley.com/doi/full/10.1002/eat.23257

Unexpected and Unwanted Pregnancy: The Psychological Effects of a Pregnancy One is Not Ready For

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By: Rebecca Fernandez

Unexpected and unwanted pregnancies can end in one of three ways. The first: The pregnant woman carries the fetus to term and keeps the child, putting her previous life on hold to raise a child into a life that is not ready for them. The second: the pregnant woman carries the fetus to term and gives the child up for adoption after birth – at which point she may have grown extremely attached to them. Finally, the third: the pregnant woman undergoes an abortion.

While none of the above options are desirable, it is important to note that none of them are any more emotionally destructive than the others. Thus, contrary to many pro-life arguments, abortion isn’t a particular source of trauma. Rather, abortion is a solution to the broader traumatic issue of unexpected and unwanted pregnancy.

The impossible choice can leave a woman feeling helpless and alone. All of the options can be painful and traumatic. Whether the specific thoughts and feelings revolve around the woman losing her previous life and anticipated future to take care of a child, losing a child that she grew attached to throughout her pregnancy, or undergoing an abortion and losing the opportunity to raise a child because she isn’t ready, the lasting effects – grief and otherwise – can remain for a very long time. The different regrets – what-ifs, guilt, sorrow, grief, self-hatred, self-doubt, etc. – stemming from any of these choices all have the potential to linger for the rest of the woman’s life.

For anyone presented with this impossible crossroads, the most important thing to remember is that whatever decision you make is valid. There is no magic solution, and the best one of the three options varies with each individual woman’s situation. All of the options can lead to pain and trauma. To move forward with life after this point, it is important to work through your feelings by talking to friends or loved ones. Speaking with a therapist can be extremely beneficial as well. You are not alone – help is out there.

If you or someone you know is struggling with mental health after an unexpected or unwanted pregnancy, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

https://www.psychologytoday.com/us/articles/199707/the-effects-abortion

https://www.psychologytoday.com/us/articles/200811/abortion-and-the-emotions-it-brings

https://www.guttmacher.org/gpr/2006/08/abortion-and-mental-health-myths-and-realities#

Vaping; Vaping Addiction is Becoming More Prevalent in Teenagers and Young Adults

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Vaping; Vaping Addiction is Becoming More Prevalent in Teenagers and Young Adults

By: Priya Desai

Vaping has risen tremendously in the past couple of years, especially within the teenage population.  Patients as young as 13 years old were reported to either get sick or die after they vaped. Products that are harmful to your body would be e-cigarettes that include nicotine, THC, and even vitamin E acetate. Many users started using vapes that contain vitamin E to help them reduce their use or contain their use, but these were recently found to be harmful too. People’s lungs end up looking like popcorn lungs due to vaping. Vaping is linked to EVALI which stands for e-cigarette or vaping use-associated lung injury. Symptoms for this disease include shortness of breath, coughing, vomiting, fever and chills, chest pain, dizziness, headache, and diarrhea. To diagnose this, doctors evaluate the patient’s history of vaping devices and take an X-ray of the chest or a CT scan of the lungs. This disease is newer, and among the cases reported, about 96% of patients have needed to be hospitalized.

Vaping is extremely addictive and many teens smoke this to fit in, but this is also why many of them enter early adulthood with a nicotine addiction. Teenager’s vape out of curiosity. There are a variety of different flavors these products provide, and so the teens often do tricks with the device. Normal cigarette smoking has gone down within the teenage population, but e-cigarettes have gone up because they are “easier” to get away with since there is no odor and they are easier to hide. People are also attracted to the different flavors that stores sell. Although e-cigarettes might not seem that harmful, one pod of liquid nicotine is equivalent to smoking one pack of cigarettes.

If you or someone you know is seeking therapy for a vaping addiction, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Citations: https://www.psychologytoday.com/us/blog/mind-matters-menninger/202001/vaping-teens-are-dying-be-cool-and-collected

https://www.lung.org/lung-health-diseases/lung-disease-lookup/evali

https://www.rallyhealth.com/quit-smoking/why-do-so-many-teens-vape

Image Citation: https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.ochd.org%2F2020%2F09%2F18%2Fcdc-study-reveals-teen-vaping-use-down-in 2020%2F&psig=AOvVaw1NH06SDRcHM5tWOL_daimc&ust=1631802234262000&source=images&cd=vfe&ved=0CAsQjRxqFwoTCIDMk6uXgfMCFQAAAAAdAAAAABAM

ADHD in Girls: Suffering in Silence

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ADHD in Girls: Suffering in Silence

By: Stacey Rodriguez

Generally thought to be a disorder specific to school-aged boys, attention deficit disorder (ADHD) has shown to be relatively prevalent in girls as well. The disorder includes 3 subtypes: hyperactive and impulsive  (HI), inattentive, and combination. ADHD is commonly associated with the HI subtype, which is most commonly exhibited by boys. Contrastingly, girls tend to exhibit the inattentive subtype. By nature, inattentive features are not as overtly obstructive as that of hyperactivity and impulsivity, often causing them to go unnoticed. In fact, studies estimate that 75% of girls with attention deficit disorder never get diagnosed. Additionally, it is theorized that societal norms, such as gender roles, might also be a factor in this disparity; since many overt characteristics of ADHD do not align with female gender norms, such as the tendency to be disorganized or interrupt others speaking, girls with the disorder tend to suppress the tell tale signs. 

The result of undiagnosed attention deficit disorder can be detrimental, as it can lead to mental health consequences in adulthood. This is largely due to the fact that girls tend to internalize mistakes. This internalization leads to negative internal dialogues, which puts girls with ADHD at higher risk for eating disorders, anxiety disorders, and depression. It is imperative to be aware of the ways in which the disorder manifests differently in girls. For example,

A girl with ADHD might:

-be more more easily irritated, or sensitive to certain sounds/feelings

-talk significantly more than her peers and often interrupt others

-struggle to commit to completing tasks or activities

-often make “careless” errors

-seem to be especially disorganized

-tend to be forgetful

If you or someone you know is seeking therapy for attention deficit disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Source: https://www.cfpsych.org/blog/what-parents-need-to-know-about-adhd-in-girls/

Image Source: https://psychbc.com/blog/adhd-is-different-for-girls-what-families-need-to-know

Mindfulness: Its Effects on Anxiety and Depression

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Mindfulness: Its Effects on Anxiety and Depression

By: Stacey Rodriguez

Mindfulness, derived from Buddhist teachings, is a practice which fosters introspective awareness. It’s main principles consist of actively experiencing the present moment, as well as practicing radical acceptance. Radical acceptance is a distress tolerance skill, which is implemented by openly recognizing thoughts and experiences without the tension of subjective or negative perception. Central facets of radical acceptance include self compassion and validation. This perspective emphasizes defusion, which is the process of separating the mind from its thoughts; the act of perceiving oneself as the observer of one’s thoughts, rather than identifying with them, allows individuals to healthily process emotions while remaining grounded and rational. Mindfulness is a defining feature of several modern therapeutic approaches, such as dialectical behavioral therapy (DBT) and mindfulness based cognitive therapy (MBCT). DBT is a form of cognitive therapy, in which the approach focuses on recognizing maladaptive behavioral patterns and core beliefs. Similarly, MBCT uses cognitive behavioral therapy supplemented by mindfulness meditative practices, in order to help individuals become aware of their thoughts and feelings all while avoiding the loop of negativity. 

Practicing mindfulness has proven to have an abundance of promising effects on the mind and body. Overall, it has shown to significantly reduce anxiety and depression. Methodical data suggests that the practice influences stress pathways, and even modifies structure and activity in regions associated with attention and emotion regulation in the brain. Additionally, studies have found mindfulness to have the same moderate effect on treating depression as does medication, as well as moderate effects on anxiety and pain. 

Some mindful activities include:

  • Journaling
  • Practicing breathing techniques
  • Mediation
  • Yoga

If you or someone you know is seeking therapy for depression or anxiety, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Source:https://www.apa.org/topics/mindfulness/meditation#:~:text=Researchers%20reviewed%20more%20than%20200,%2C%20pain%2C%20smoking%20and%20addiction.

https://www.apa.org/monitor/2015/03/cover-mindfulness

Image source: https://news.harvard.edu/gazette/story/2018/04/harvard-researchers-study-how-mindfulness-may-change-the-brain-in-depressed-patients/

PTSD in First Responders

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By Jillian Hoff

Post-Traumatic Stress Disorder is extremely common among first responders. This is because of their high exposure rate to traumatic incidents. Some of the common signs and symptoms for PTSD include flashbacks or dreams about the incident, losing interest in activities, refusing to talk about the event and sleep disturbances. Most first responders do tend to avoid seeking treatment for their PTSD. This typically is because of the stigma that surrounds mental health in general. These individuals might feel as though people will see them as weak for seeking the help they need, which is not the case. Often times when the individual does not treat their PTSD it will worsen, which since first responders do not get to just stop working makes their symptoms even worse.

Some ways that first responders can help their PTSD would be to have a support system. This especially could be the people who were also there during the traumatic event, this way they can talk about what happened and how it made them feel with an individual who was also there.  To gain positive coping strategies, it could be extremely helpful to engage in Cognitive Behavioral Therapy. This could help the person manage some of their stress that relates to the incident. Most importantly, the person needs to remember why they love being a first responder and all the positives that come from their job. While the negative times within this profession can be hard to handle, it is important to remember all the good that comes from what first responders do.

If you or someone you know is suffering from PTSD, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources

https://eraseptsdnow.org/first-responder/shining-a-light-on-ptsd-among-first-responders

https://www.suicideinfo.ca/resource/first-responders-trauma-intervention-suicide-prevention/

https://www.jems.com/administration-and-leadership/first-responders-and-ptsd-a-literature-review/