This article originally appeared in the Spring 2025 issue. View the full issue here.

The fire service has done a tremendous job over the past 10 or so years in making mental health and post-traumatic stress injury part of the normal conversation. Yet, many still harbor fears that receiving treatment makes them look inferior, weak, or damaged.

I know these fears all too well. I was diagnosed with PTSD and compassion fatigue in 2019. I saw a counselor regularly and had a perfect friend I would speak with from time to time. However, I knew I needed help with PTSI, nightmares, and insomnia, but did nothing about it. That was mainly out of fear, shame, and the notion I would lose being the glue that held my family together.

An Unexpected Opportunity

Fast-forward to spring 2023. Dr. Sara Jahnke called to ask if I would send a flyer to my contact list regarding a FEMA-funded trial on accelerated treatment for PTSI, insomnia, and nightmares. I said yes.

This was hitting close to home, and I was a little nervous about reading the material. Dr. Jahnke must have sensed my nervousness, and she was aware of my history in public safety. She offered me a spot in the trial if I qualified. I thanked her and said I was doing OK (yes, I lied). I told her that if there was a last-minute opening, I would attend to ensure this pilot program would continue.

Dr. Jahnke called me the first week in October. “It’s your lucky day; there is one spot left,” she said. My heart skipped a beat, and I tried to think of every excuse under the sun to get out of this. But I could not break my word.

Program Structure and Onboarding

The program takes anywhere from two to seven firefighters, the typical group size being four. To be admitted, a participant must have PTSD and sleep disorder symptoms. Ultimately, admission is left to the assessor’s discretion and the context of the trauma.

The onboarding process started with a lengthy sleep, stress, and PTSI survey. Once a clinician evaluated the results and deemed me qualified for the program, I had a virtual session with the clinician. That clinician used the survey questions to dig deeper into the underlying issues I was dealing with. At this point, I was no longer nervous; I was scared to attend the program. After all, I had just disclosed history and events that I had only discussed with one other person.

Next was the accelerated brain camp in St. Louis. I was a bundle of nerves in the days leading up to the dreaded flight there.

  • What if this didn’t help?
  • What if I knew other people who were attending?
  • What if my wife thought I was nuts and wouldn’t be there when I got home?

The day arrived, and I was so scared I could not even ask my wife of 24 years to take me to the airport. I was nervous I would not be able to get on that plane; it was yet another stressor for my wife.

So, I asked a dear friend who is more like a little sister. She would not cave in to my excuses and would ensure I got on the plane. As we got my suitcase out of the car, I told her I was scared and unsure this was a good idea.

“What do you have to lose?” she asked. “What you are doing now isn’t working.” I finally had a flicker of hope. I hugged her, and off I went to do the unknown.

The Treatment Approach

This treatment has been effective in a sample of veterans and is being tailored to the fire service. It uses a combination of written exposure therapy and cognitive behavior therapy for insomnia and nightmares (or CBTi+n). Written exposure therapy aims to desensitize individuals to their traumatic experiences. CBTi+n is a structured approach to improve sleep quality and reduce nightmares.

The pilot workshop program ended in autumn 2024. Organizers are trying to obtain Federal Emergency Management Agency funding to make it a viable program that can be implemented on a much larger scale.

Day 1 was full of emotions, but everything seemed soothing once I landed in St. Louis. The program coordinator met me at baggage claim and drove me to the workshop location. She ensured I got settled in my room and introduced the other attendees in an informal yet meaningful way. I realized I was not alone. I felt comfortable with this group and hopeful for the first time in years.

Ground Rules and Relief

We met the clinicians the next day and started the program as a cohort. We started with ground rules. The one I remember was: “This is not story time; we will not ask you to describe your traumatic events.” I instantly thought, “Holy cow, you mean I don’t have to relive it again? Win for me.”

Over the next few days, we had multiple writing sessions. The clinicians gave specific directions on picking one event, and we built upon the story in writing how we felt during that section of the event. The story would never be spoken aloud. The writing was confidential between me and the assigned clinician.

In the next portion of the writing, we were taught how to re-describe the story through a different lens. This aided in softening some edges to make the feelings and memories less damaging.

Over the four-day session, we also dove into these topics:

  • Sleep hygiene
  • Selecting a support person
  • The connection between nightmares, stress and sleep
  • Trauma processing and targeting nightmares
  • Relaxation techniques

Lastly, we built a support system and discussed what would happen if insomnia, nightmares and additional symptoms returned. Additionally, we worked through the perception of stigma and communication.

The Return Home

On the last day of what I like to call “brain camp,” I felt odd, like the party was slowing down, but no one wanted to leave. Regardless, we had to go.

Once I arrived home, the previous four days hit me, and an emotional dump started. It was a mix of feelings, but I was hopeful and looking forward. The lessons we went through, the tools we learned, and the habits we created were working and continue to work to this day.

Of course, it doesn’t end there. There are take-home exercises and follow-ups. We had a check-in with the therapists one week after the workshop to ensure we could implement what we learned. There are assessments completed at the one-month mark with independent assessors that review the individual’s scores on certain scales, as well as review their sleep diaries. We also sent online self-report surveys completed at the 30- and 90-day mark.

PTSI workshop is not a one-size-fits-all program; it worked well for me and, I suspect, for the others in attendance. There’s a chance it won’t work for everyone. But don’t let the symphony of irrational fears playing in your head keep you from taking this or other steps toward recovery.

This article originally appeared within the Spring 2025 issue. View the full issue here, or browse all back issues in theCRACKYL Library.