Why Does perception matter?
I’ve written about managing mindset and perception a few times now, and if you’ve ever taken one of my classes you’ve heard me talk about it a lot. But why should we care? If the objectives of the job remain unchanged, does it matter how we see things, ourselves, or the job? We take care of sick and injured patients, so does our perception of ourselves within that situation change anything? Does it change the reality of the trauma we see? Does our mindset shape the way we respond to stressful situations? Can changing our perspective protect us from psychological trauma?
I know, I know, that’s a lot of question marks. The real question is, can changing the way you see yourself and the world around you change the way you respond to it? And the answer to that is, of course, yes!
So let’s break down the cause of the psychological injuries that lead to Post Traumatic Stress Disorders. The psychological injury is usually caused by exposure to critical incident stress.
To define critical incident stress we need to define what a critical incident is. This is rather subjective and challenging even for Critical Incident Stress Management (CISM) teams. We know things like mass casualty incidents, multiple deaths, critical pediatrics, etc. are often considered critical incidents. But why is it that some of us will be completely fine while others are not? Moreover, why are some incidents that may be considered “less critical” become PTSD inducing events for some and not others?
The answer is found in how we respond, and we all respond to the things we see differently.
Critical incident stress is the result of a high threat perception coupled with a high sympathetic nervous system response.
A high threat perception does not necessarily mean one feels physically threatened but rather measures your intrinsic ability to handle a given event and is determined by an automatic process called a Cognitive Assessment.
A Cognitive Assessment is a series of three questions your brain asks itself every time it’s exposed to an event.
- 1: How complex is this problem? Or, how bad is this?
- 2: How well prepared am I to handle this issue?
- 3: What are the consequences if I fail?
Most of us in EMS love the combination of a complex problem with high consequence as long as we feel prepared to handle it confidently. That is the kind of cognitive assessment that will put us into a “flow state,” and those calls are often remembered fondly as good calls. But a complex problem that requires a skill set with lower confidence coupled with high consequences (which could be anything from self or patient death, to a hit to the ego or reputation) will result in a high threat perception, which is how critical incident stress is formed.
The implications of a heightened threat perception go beyond increasing the risk of psychological trauma. It typically leads to over-stimulation of the sympathetic (“fight or flight”) nervous system response which in turn blunts performance when we need to be at our best. This only increases the stress felt.
So really, it has very little to do with any specific event, but rather a specific response we have to it that puts us at risk. We know that specific events (like pediatric fatalities) are likely to cause this response in many of us, but that certainly doesn’t preclude having similar responses to any EMS incidents.
So how does perception play into it all? How we perceive ourselves, our skills, our job, and the patients we treat directly affects the cognitive assessment. “I don’t save lives, I give people a chance to live” is a personal perspective that lightens the consequences. Changing your mindset concerning our role in an incident can change how bad or complex you see the patient, or more accurately assess our own preparation. Adjusting our mindset is our opportunity to change the way we react to our environment.
In EMS we have a distinct advantage when it comes to psychological health. We work in a field where we know we will be exposed to traumatic stress. Every day we walk into work understanding that today we might see something horrific. And that means right now, we have the opportunity to prepare for it. Understanding how we form a threat perception gives us the ability to adjust what that assessment could be. Managing our mindset is just one way we can do that.
For a few examples of how I’ve changed my perspective, check out these articles:
Is what we are called important?
“I am a paramedic but I do not save lives.”