BY TAMARA LORENSEN
Recently, I asked a senior firefighter to review a paper I was writing on mental health within the fire service. I felt that the personal and extensive experience of this decorated firefighter would assist in clarifying the issues raised. The fire officer did have some questions; one was related to the quote below, which is from the paper.1 The passage discusses the personal and individual factors that may influence the development of post-traumatic stress disorder (PTSD) symptoms.
“Another personal mediator is that of self-efficacy—that belief in one’s ability to succeed in a specific situation or accomplish a task. Whealin, et al (2008)2 state that higher levels of self-efficacy increase the perception of controllability of a situation and is related to decreased symptoms of PTSD. This concept lends itself to the importance of training and preparation to reduce risk and vulnerability to psychological distress. (Heinrichs, et al 2005)” 3
Psycho-Education and Operational Training
The firefighter asked whether the “importance of training” was mental health training or operational training. I responded it was operational training with the addition of psycho-education. A hearty discussion ensued. The concept may seem simple on the surface; however, with consistent training and practice, research shows we improve our efficiency in accomplishing a task, almost automatically, at times. This contributes to our self-efficacy and, therefore, our sense of controllability (the sense that we are in control of a situation) and, according to research, this decreases our vulnerability to PTSD symptoms.
Bandura and Locke4 state that self-efficacy affects the ability to think in self-enhancing or self-debilitating ways; consequently, it impacts how well motivated an individual is, his ability to persevere in the face of difficulties, and what choices he makes at important decision points. Importantly, these researchers also indicate that this affects his emotional well-being and vulnerability to stress and depression.
Learning to do tasks efficiently raises many issues. When responding to a call, firefighters follow a set of operational guidelines and begin rescue, recovery, firefighting, or any other operational tasks. Efficiently conducted operations can free cognitive capacities to improve situational assessment and can promote novel creative thinking and problem solving. This occurs regardless of whether the incident involves someone’s beloved cat stuck up a tree or when considering how to perform a rescue at a mangled wreck without further injuring the victim or others.
Firefighters must be creative problem solvers. A team needs to be confident and competent in how it goes about its business, which is why it needs ongoing operational training. Senior, experienced firefighters are as valuable as gold in developing training scenarios for junior colleagues.
The Possible Downside
Is there a flip side to the benefits of freeing cognitive capacity? Some research indicates there is, but the scientific jury is out often because of the different research approaches. The ability to “attend” or pay attention may also mean that some individuals have the capacity to consider the distress of the situation they are facing, the possibility of distraction, persistence in an endeavour when it isn’t working, or even task complacency. In my experience with firefighters, however, I am always agog at their commitment and persistent efforts to save lives, even at the risk of their own. In interviews, these firefighters often explain that stopping to think about the risk to themselves would prove the bigger risk—they would hesitate, question themselves, or in some way falter. They consider this inconceivable when working in a team; it puts everyone at risk.
What has been described above is a biological stress response with a difference. It is automatic: Instead of fighting or fleeing from a threat, the firefighter is experiencing the same physical responses because of the conditions of heightened arousal while doing the job.
Research has also shown that anticipation will initiate this biological response; for a firefighter, that can occur at the station when an emergency call comes in. The heart rate increases, the blood flow redirects to the muscles to galvanize for action, hunger is supressed, and numerous physical changes occur. For example, the thinking about the home improvement job planned for next week ceases and automatic mechanisms and a complete focus on the task take precedence—action takes over. Operational training can promote the maintenance of rational capacity under heightened arousal circumstances. This is likely to build self-efficacy—the belief in one’s ability to accomplish the task but do so with improved chances of maintaining safety for all concerned.
Rescue vs. Recovery
Another question is whether these experiences differ depending on whether a response is to a rescue vs. a recovery. The self-efficacy research has made some progress here, although I have yet to find it applied to firefighters. In discussions with my trusty firefighter about this question, he declared that the mindset is different when attending a call for rescue vs. a recovery. Recent research has shown that when the rewards are high, self-efficacy is positive; when the rewards are low, self-efficacy is negative.5 Worthy of further research, could this be applied to rescue (positive and rewarding) vs. recovery (negative and low reward)?
So what of the caveat mentioned at the beginning? Extensive psycho-education should be considered a vital part of operational training and not just implemented after a difficult operation or an experience of trauma.
In my experience, knowingness—improving one’s base of knowledge about the biological underpinnings of behavior, particularly from a biological perspective—provides an opportunity to decrease the misery of not understanding “what is wrong with me” and to improve colleagues’ ability to recognize distress in each other. During those exposures to trauma, the brain still has the capacity to imprint the personal lived experience, whether it is fear, helplessness, or outright risk to life. The more we consider post-trauma stress a real alteration of brain and physical circuitry and less a weakness or flaw, the better we can deal with this and other mental health issues.
This article is by no means a comprehensive view of this extremely broad topic. Rather, it is intended to stimulate critical thinking about operational training and to incorporate mental health training to improve or build self-efficacy. Self-efficacy inpacts human endeavor, motivation, and a person’s belief in his power to affect situations; it influences the power a person has to competently face challenges and the choices the person is most likely to make.6
The cost of training may be high, but the cost of not training can be higher. Consider feeling helpless or not confident about an operation and how that can cascade into more chronic anxiety, particularly under low self-efficacy and low ability or high self-efficacy and low ability circumstances. The performance anxiety and worries become the focus of attention, and the thinking becomes internal. Listening to the internal dialogue—“What do I do now?”—is when negative thoughts can hijack your attention from the task. This is when it is important to talk to the chain of command or a senior colleague about further training and support.
The methods of building self-efficacy7 listed below are all related to operational training:
- Achieve operational training success through increased mastery of a task and in accomplished performance, which can increase feelings of confidence and competence.
- Observe colleagues who are good at handling certain situations.
- Encourage trainees that they can achieve the task, and provide constructive feedback to help them overcome self-doubt in a challenging task.
- Maintain awareness of your physiological state during operational training. How you interpret and evaluate emotional states is important for how you construct your belief in yourself. If you are feeling confident, you are more likely to have a sense of excitement that fosters self-efficacy; learn how to manage worries or anxiety.
Peak performance athletes train extensively in honing their physical skills; however, they also engage in mental training to optimize their chances of winning. Mental performance and physical performance make the difference in winning.
Author’s note: Many thanks to the firefighter who in his passion for his occupation freely contributed his thoughts and time in the preparation of this article.
References
1. Lorensen, T. (2017). Unpublished paper.
2. Whealin, JM, Ruzek, JI, & Southwick, S. (2008). “Cognitive-behavioural theory and preparation for professionals at risk for trauma exposure.” Trauma, Violence & Abuse, 9 (2),100-113. doi: 10.1177/1524838008315869.
3. Heinrichs, M, Wagner, D, Schoch, W, Soravia, LM, Hellhammer, DH, & Ehlert, U. (2005). “Predicting posttraumatic stress symptoms from pretraumatic risk factors: A 2-year prospective follow-up study in firefighters.” American Journal of Psychiatry, 162 (12), 2276-2286. doi: 10.1176/appi.ajp.162.12.2276.
4. Bandura, A, & Locke, EA. (2003). “Negative self-efficacy and goal effects revisited.” Journal of Applied Psychology. 88 (1), 87-99.
5. Tzur, KS, Ganzach, Y, & Pazy, A. (2016). “On the positive and negative effects of self-efficacy on performance: Reward as a moderator.” Human Performance. 29 (5), 362-377.
6. Luszczynska, A, & Schwarzer, R. (2005). Social cognitive theory. In M. Conner & P. Norman (Eds.), Predicting health behaviour (2nd ed. rev.). Buckingham, England: Open University Press, pp. 127–169.
7. Moesgaard, S. (2014). “4 ways to develop self-efficacy beliefs.” http://bit.ly/1WGyMfU. Accessed 13/01/2017.
TAMARA LORENSEN has been a private practicing psychologist in Queensland, Australia, for more than 20 years and is also a psychologist with the Australian Defence Force. She specializes in using neurofeedback in treating stress, anxiety disorders, and post-traumatic stress disorder.
