They save skiers and hikers in the wilderness. Here’s how they think about resilience.

Covid-19 and its aftermath has made even the most resilient of us take mental punches as the lives of our nearest & dearest were turned upside down by the pandemic. In such circumstances it is useful to take inspiration from those who face psychological pressures and physical dangers far more intense that what we encounter in our relatively prosaic office jobs. This long read in Vox describes the lives of search-and-rescue responders in the US and how they recover from trauma. The article begins by describing why such people have to deal with Post-Traumatic Stress Disorder: “In June 2018, a hiker fell to his death in the rugged, forested backcountry near Pratt Lake, about 50 miles east of Seattle. A 22-year-old first responder named Alexis Leader helped recover his body, which lay at the bottom of a cliff, wedged in a snow moat — the gap between a rock face and the snowpack. Leader had been a search-and-rescue volunteer for three years, and while she had assisted with recoveries in the past, this was her first time coming face to face with a dead person.

Leader’s team stayed with the body through the wet and snowy night. Leader cried as she drove out of the woods the next morning. Later that summer, Leader was hiking with her fiancé and a friend in Washington’s North Cascades. They rappelled over a rocky ledge, unclipped their rope, and prepared to cross a deep moat, similar to the one where she’d recovered the body. The gap looked nearly bottomless and she froze, envisioning herself trapped, cold, wet, and wedged against the rock like the dead hiker. She eventually managed to speak a few words to her companions, control her breathing, and cross the moat.

Backcountry search-and-rescue responders like Leader experience high rates of stress and trauma in their frequently harrowing work….”
The authors explain that stress impacts these first responders in much the same way that impacts the rest of us – by making us feel that we are on the “edge” and somehow are “holding it together”. That in turn brings substance/alcohol abuse into the picture – alcohol becomes a way numbing out the feeling of perpetually being on the edge. “In the language of psychiatry, we’d say that many search-and-rescue and disaster response workers experience anxiety, depression, or PTSD. Between 11 and 37 percent of first responders experience PTSD, compared to 7 to 10 percent of the general population. But PTSD can come with a stigma, with some people feeling that it’s their fault they “can’t shake it off.””
Leaving aside the human element of helping a first responder overcome PTSD, there is also a very good practical reason to help such professionals: ““You can’t make good decisions if you’re at an elevated stress response,”…“If we figure out ways to lower people’s stress responses, they can do their jobs better.””

So what are the coping and mental resilience techniques used by responders like Alexis Leader? Here is the first technique described in Vox: “…adopted much of their approach from a military model meant to prevent and identify injuries that could lead to PTSD. More than a decade ago, the US Marine Corps put in place a tool called the stress continuum, which was meant to take a snapshot of Marines’ stress levels. A scale ranging from green (“emotionally and physically healthy”) to red (“relationships and work suffer”) aimed to help individuals assess their mental state and track their stress levels over time….
“PTSD is a type of traumatic stress injury, but not the only type,” she told me in an email. She tries to normalize the idea that stress impacts exist on a spectrum, not a binary of either injured or not. When speaking to responder groups, she says, the term “stress injury” removes a stigma and allows stress to be discussed like an occupational hazard, akin to a broken ankle. “Someone should say that the most common injury you’re most likely to experience in your career is stress injury,” McGladrey says. “Not your back, not your knee.”

To complement the self-assessment of the stress continuum, McGladrey recently piloted a system she calls “3-3-3” — basically an informal check-in three days, three weeks, and three months after a significant event. At the three-day mark, the idea is to gauge the mental state of participants at the time of the event and identify some red flags for bad outcomes. These check-ins can also identify people who need more support.”

The second technique described in the piece uses EMDR (Eye Movement Desensitisation and Reprocessing) and is now commonly used by psychologists in India: “One approach, exposure therapy, aims to reduce symptoms by exposing participants to reminders of their trauma, such as an icy slope or a buried victim. The stimuli can be real, imagined in a therapy session, or even simulated by virtual reality. A recent review of randomized trials showed that patients with PTSD treated with prolonged exposure therapy experienced better outcomes than 86 percent of untreated patients. Several responders told me that they had tried EMDR therapy, which combines exposure therapy, cognitive behavioral therapy, and a series of guided eye movements in order to reprocess traumatic events.”
The third approach is a little more “out there” but is fast gaining credibility among psychologists: “A newer approach involves psychedelic drugs. In a 2021 study published in Nature Medicine, patients with severe PTSD who were given doses of MDMA — ecstasy — in conjunction with therapy sessions reported fewer PTSD symptoms, compared with patients who underwent therapy alone. Other psychedelics, like ketamine and psilocybin, could be promising. A randomized trial of ketamine published last year showed that two-thirds of study subjects had at least a 30 percent reduction in PTSD symptoms after two weeks of treatment.”