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Psychological First Aid - Part One: Keeping your cool

Updated: Aug 11, 2023

It's all too easy to get complacent in familiar terrain. But when things go wrong it can be hard to switch out of the default setting and take control of the situation. This is why having some psychological first aid tools in the toolbox are important to help you keep a cool head under pressure. It's great to see so many people out in the wild, particularly after Lockdown-fever. But with this comes increased precedence of mountain and sea rescue call outs as people don't realise they are operating in high risk environments and unexpected turn of events occurs. We can attempt to release the strain on our emergency services by being better equipped mentally to deal with stressful situations - on the mountainside and in daily life...Engaging our executive functions when they are most needed.




I champion an Adventure Neuropsychology approach to inspire and motivate others in the face of adversity and the challenges of life. This draws on escapades I have experienced as well as observing those who prevail in adventurous predicaments to provide insight into the mindset necessary to thrive under stress. As well as a basis in cutting-edge neuroscientific research into how the brain operates in extreme environments to optimise performance.

“The higher cognitive processes that can shut down under stress we refer to as executive functions. That is the mental operations that evolution bequeathed to us to allow flexible thinking, strategic planning, seizing opportunities and innovating solutions to problems. These are the first to go out the window when you feel the sense of rising panic. In order to protect these functions from stress we need to intervene in the stress response and prevent it from putting us in a reactive mode"

Mentally equipped


“Have you ever had to use your first aid skills in a real situation?”


Hands go up.


It’s the usual round of paper cuts, a bump on the head, slips, trips, falls. First Aid at Work 101.


I put my hand up hesitatingly.


“Err. 6 helicopter rescues and counting.”


“And does evacuation by snow mobile count?”


It’s not that I am accident prone. Far from it. It’s mostly been about other people. Except the snowmobile.


When you spend time in extreme environments, hanging around with extreme (sports) people, or even just being in the mountains a lot, sometimes accidents happen.

Whilst I am a firm advocate of the benefits of adventure, challenge and risk, we need to address the flip side of this: what happens when things go wrong. With the exponential increase in people taking to the hills, indulging in pursuits in the great outdoors, especially since being released from Lockdown, comes the inevitable upswing in accidents. This means more and more call outs for the Search and Rescue services. Those tasked with responding to incidents in high risk environments where recreational activities are pursued, including the mountains, at sea, are also overstretched. The services are populated by volunteers as well as specialist paramedics.


There are so many accounts of the unprepared and ill-equipped being retrieved from hazardous locations. They might be caught out in storm, crag-fast, going down with exposure due to the weather, and so on. The point of this article is not so much to lecture about having the right clothing, rations, equipment. It's about being psychologically equipped to deal with situations that might occur even to those who did everything right and have the requisite kit.


The bottom line is if we are to benefit from embracing challenge and being more adventurous, we need to have some tools in the mental toolbox that acknowledge and are ready to deal with the downside of risk.


If you step into the unknown, by definition unforeseen things can occur.


The first point to appreciate is that we might not realise that we have stepped into the unknown. Maybe we have been up Snowdon many times before. It seems so familiar. The weather has been accommodating. We have a (false) sense of security.


Events can conspire against us.


I was leading a party in the Glyders range in Snowdonia. We were heading gradually up a ridge with the intention to scramble the last section, building up to the more challenging part of the route.


We stopped for a rest, having taken a slow and steady pace so as to be fresh for the increased challenge.


I was alerted by one of the party – someone had collapsed. I rushed over and sought a diagnosis. Events unfolded rapidly. Symptoms pointed to a suspected heart attack. A coordinated response was required to triage the casualty and organise the party.

The Mountain Rescue service was contacted and a Coastguard SAR helicopter scrambled.


In summary, a rescue was implemented, the casualty airlifted to the nearest hospital, the party led safely back down and a debrief took place. Fortunately, the casualty recovered from the incident after a few days in hospital.


The principle outcome from this was how well the party worked together. It was stressful, we were on a mountain ridge, it can affect people in different ways – at the time and in the aftermath.


One thing I do when I lead parties in the mountains, and which I did on this occasion, was to give a briefing on psychological first aid and stress management at the start and at various points along the way to refresh the principles and get people practicing some techniques that can come in useful when anxiety arises.


Telling someone to ‘calm down’ and do this or that when the sh!t hits the fan is all well and good, but when the stress-response is provoked, the higher brain centres shut down and instinctive behavioural patterns are triggered. This isn’t exactly conducive to taking instruction, or incorporating new ways of thinking or acting and the rationale behind them.


But if we weave elements of this in at junctures along the route, when people are more relaxed and receptive, the techniques and concepts can be seeded in mind and muscle memory. When things go wrong it is easier to gain access to some of this information and practice.


The higher cognitive processes that can shut down under stress we refer to as executive functions. That is the mental operations that evolution bequeathed to us to allow flexible thinking, strategic planning, seizing opportunities and innovating solutions to problems.


These are the first to go out the window when you feel the sense of rising panic.

In order to protect these functions from stress we need to intervene in the stress response and prevent it from putting us in a reactive mode. I’ve talked at length about how the sympathetic nervous system activity can dominate, putting us in a state of high arousal. By taking control over our breathing, slowing the pace and prolonging the exhale we can balance out the nervous system with increased parasympathetic activity. Introducing some calm into proceedings.


This helps quieten the inner voice which otherwise can go haywire, flooding us with self doubt and negative thoughts, switching us out of a default setting which conflicts with a more appropriate task-focused, state. A state in which we exhibit executive control.

Being in executive control does what it says on the tin. Like the leadership of a business conglomerate navigating the turbulent waters of high finance (I’m tempted to reference the Monty Python skit “The Crimson Permanent Assurance” for those who would get it), the executive board takes the helm and sets a decisive course to safer waters.

In the next part I will unpack some of the executive functions so we can appreciate what they do for us and why they are useful in a crisis.


Whether that crisis is an actual emergency scenario, or an everyday situation in which you feel immense pressure to do the right thing. The brain often doesn't seem to know the difference.


Helicopters notwithstanding.


References


DeHais, F., Roy, R. and Fairclough, S. (2020). A Neuroergonomics Approach to Mental Workload, Engagement and Human Performance. Frontiers in Neuroscience (14), Article 268


DeHais, F., Hodgetts, H.M., Causse, M., Behrend, J., Durantin, G. and Tremblay, S. (2019). Momentary lapse of control: A cognitive continuum approach to understanding and mitigating perseveration in human error. Neuroscience & Biobehavioral Reviews, (100), 252-262


Miyagi, T., Oishi, N., Kobayashi, K., Ueno T.,Yoshimura, S., Murai, T. & Fujiwara, H. (2020). Psychological resilience is correlated with dynamic changes in functional connectivity within the default mode network during a cognitive task. Scientific Reports. 10:17760


Zhang, Y., Daic, Z., Hud, J. Qine, S., Yuf, R. and Suna, Y. (2020). Stress-induced changes in modular organizations of human brain functional networks. Neurobiology of Stress 13 (2020) 100231





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