Psychological Flexibility on the Front Line
NICOLA DAVIES
© 2018 FrontLine Defence (Vol 15, No 5)

A recent Johnson and Johnson survey revealed that 81% of first responders and military members suffer from some form of mental distress.

According to Mental Health First Aid (MHFA) Canada, mental disorders or syndromes are believed to be the third most common cause of short-term disability. In this article, we explore psychological flexibility and how it can help ease the psychological impact of frontline work.

There are many pathways to psychological flexibility, and building resilience is one of them.

Psychological Flexibility
According to Stephen Hawking, human intelligence gives us the ability to adapt to change. Such adaptability, or psychological flexibility, gives us the ability to remain in any given moment – even difficult or negative moments. In other words, you can remain flexible to the ever-changing moment without trying to avoid or change it. Psychologist Dr. Jennifer Barbera says psychological flexibility is extremely important for “building resiliency in response to stress and recovering from stressful or traumatic experiences.” It is also known to facilitate decision-making and is seen as a good indicator of job performance. Having mental flexibility is closely related to emotional intelligence, with high emotional intelligence being linked to greater psychological flexibility and, in turn, better work performance under pressure.

Experiential Avoidance
On the opposite end of the spectrum is experiential avoidance – the need to avoid negative thoughts and emotions, and the triggers associated with them. This can lead a person to resist the present moment or circumstances. In other words, they become rigid rather than flexible to their changing circumstances. This type of reaction is associated with increased levels of stress, anxiety, depression, poor work performance, and substance abuse.

Experiential avoidance is a common and natural ‘coping’ method for anyone in an occupation that involves coming face-to-face with negative or traumatic experiences. However, this approach can have negative long-term consequences. While we can’t completely stop this human response, by being aware of it, we can choose to override it when the urge to avoid an experience emerges.

Improving your Psychological Flexibility
At the core of most programmes designed to promote or improve psychological flexibility are mindfulness and acceptance strategies. Research has found that mindfulness practices can increase psychological flexibility in first responders while also decreasing incidence of work-related conditions such as burnout.

Through applying mindfulness techniques, such as controlled breathing exercises and meditation, first responders learn to live in the present moment instead of letting the past and fears for the future affect them. In one study, both mindfulness and psychological flexibility were found to be interrelated, and helpful in understanding and managing the psychological effects of stressful situations.

Mindfulness encourages psychological flexibility by teaching individuals to examine any given moment with a sense of curiosity rather than anxious aversion, enabling them to accept situations for what they are both during and after an event.

A frontline worker who has practiced mindfulness techniques may be better equipped to deal with an emergency than one who has not. For example, when called to the scene of a heart attack or motor vehicle accident, a paramedic who has mindfulness skills is likely to respond in a calm and objective manner. This is not to say that there is a disassociation from the event but rather a sense of acceptance, enabling the person to overcome any feelings of being overwhelmed by negative emotions that might prevent them from concentrating on saving lives.

The core values of Acceptance and Commitment Therapy (ACT) are designed to improve psychological flexibility by helping us recognize how attempts to suppress negative thoughts and emotions can lead to long-term consequences.

With ACT, a person is taught to disassociate the self from experiences, as a person is substantially more than whatever trauma may have been faced. Acceptance of the past is one of the core processes of ACT – the premise being: if you have accepted past work-related events, you will be ready for the next one.

Acceptance encourages a person to relive negative or stressful experiences, allowing both positive and negative reactions to occur without the need for action. This improves psychological flexibility by deactivating stress triggers, which are the natural human psychobiological drive to protect ourselves from trauma with fear- and avoidance-based behaviours.

If we can override the emotional part of the brain (the amygdala) and engage the rational part of the brain (the cortex), then emotions can be noted and named, fears can be calmed, and attitudes and behaviours can be chosen. This creates greater psychological flexibility when faced with emotionally-charged situations.

Programs for improving psychological flexibility
Psychological flexibility encompasses a wide range of human abilities that include recognizing and adapting to various situational demands and being able to shift mindsets or behaviours that compromise our ability to function. To this end, Langara College in Vancouver had been offering the Strategic Resilience for First Responders course. The 104-hour Continuing Education Certificate Program looks at managing the nervous system, learning brain and body-oriented strategies, and empathetically engaging with the self and others through a blend of Eastern traditions and Western scientific research.

Ruth Lamb (PhD), the Program Coordinator at Langara College, mentions in the course outline that students are taught to examine the “toxic power of trauma and stress and the healing potential that comes with strategic resilience practices.” Unfortunately that program was cancelled.

Another program, run by J Marlin & Associates, specifically deals with Acceptance and Commitment Therapy for First Responders. Students are trained to embrace practices related to psychological flexibility and learn the dangers of experiential avoidance. Attendees are also taught skills to cope and adapt to the stress caused by the nature of their work. The training is conducted in a group setting to encourage a social support network and reduce the stigma of reacting to stress openly. The goal of the training is to prevent mental disorders that can result from experiential avoidance and lack of psychological flexibility, especially from Post-Traumatic Stress Disorder (PTSD).

A Continuous Journey
Building psychological flexibility is a lifelong process. Individuals must make a conscious effort to commit to actions that promote their psychological well-being and be consistent in carrying out those actions. As Dr. Barbera states, “At times, people may waver in their psychological flexibility in the face of higher stress or loss of personal awareness. Psychological flexibility skills can be actively trained, but just like with exercise, if people want to maintain their skills they must continue to practice.”

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Dr Nicola Davies is a psychologist who focuses on issues related to first responders.

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