First responders face numerous physical and chemical hazards when they respond to disasters, in their own communities and further afield. Their susceptibility to trauma is less well understood, according to Adam Gonzalez, Ph.D., founding director of the Mind-Body Clinical Research Center at Stony Brook University in New York.
Gonzalez and colleagues study post-traumatic stress disorder (PTSD), respiratory health, and stress management in responders to the September 11, 2001 World Trade Center (WTC) disaster and Hurricane Sandy. He discussed research underway at the Stony Brook University WTC Wellness Program and the Mind-Body Clinical Research Center during a July 25 talk for the NIEHS Keystone Lecture Seminar Series.
"The potential psychological and mental health effects that disaster responders experience is oftentimes neglected," Gonzalez said. The WTC Wellness Program, one of five clinical centers funded by the National Institute for Occupational Safety and Health, monitors more than 8,000 disaster responders who reside in Long Island, New York.
"Dr. Gonzalez's work demonstrates the importance of our mission to train and ensure the health and safety of workers, especially those engaged in disaster response," said NIEHS Worker Training Program (WTP) Director Joseph "Chip" Hughes, who hosted the seminar. "We are delighted to have him on board."
Respiratory health and PTSD
Respiratory problems and PTSD have been found to occur together, known as comorbidity, among WTC survivors and responders, yet the reason is unknown.
Gonzalez and colleagues published findings in February that suggest anxiety sensitivity may play a role in the connection between these health effects. The authors explained that anxiety sensitivity is a clinical term for the tendency to misinterpret as dangerous the sensations associated with anxiety, such as dizziness, heart pounding, and difficulty concentrating.
Studies led by Gonzalez’s colleague, Benjamin Luft, M.D., may shed light on epigenetic mechanisms associated with PTSD and with the relationship between PTSD and respiratory problems in WTC responders. Epigenetics refers to changes to DNA that affect its activity without changing the underlying sequence of amino acids.
Mental health risks from later disaster exposure
In April, Gonzalez and colleagues reported a significant association between PTSD in WTC responders and exposure to traumatic events related to Hurricane Sandy, such as damage to home and possessions, and lack of gasoline.
He said the results suggest that programs tracking the health of responders should look at personal history when evaluating health risks and assessing the impacts of later disasters.
Training for resiliency
Managing mental health of responders after a disaster with immediate, or acute, interventions — such as debriefing and referrals to care — is important. But some aspects of these acute interventions may lead to more problems and interfere with the recovery process, according to Gonzalez.
To better equip disaster responders to handle the stress and trauma of their experiences, he and his colleagues use resources from the Disaster Worker Resiliency Training program, which helps responders to recognize symptoms of stress related to disaster work, obtain support, and build resilience. The program is offered jointly by WTP and the U.S. Substance Abuse and Mental Health Services Administration.
"Resiliency training is needed to help responders build their body's ability to adapt to stress," Gonzalez said. "This can be achieved through a number of stress management and relaxation response techniques."
To determine efficacy, Gonzalez and colleagues conducted a randomized clinical trial among Hurricane Sandy responders to explore changes in mental health and health-promoting behaviors before and after resiliency training. Data analysis is underway.
Mahaffey BL, Gonzalez A, Farris SG, Zvolensky MJ, Bromet EJ, Luft BJ, Kotov R. 2017. Understanding the connection between posttraumatic stress symptoms and respiratory problems: Contributions of anxiety sensitivity. J Trauma Stress 30(1):71−79.
Bromet EJ, Clouston S, Gonzalez A, Kotov R, Guerrera KM, Luft BJ. 2017. Hurricane Sandy exposure and the mental health of World Trade Center responders. J Trauma Stress 30(2):107−114.
(Kenda Freeman is a research and communication specialist for MDB, Inc., a contractor for the NIEHS Division of Extramural Research and Training.)