Can the way we train our military, first responders, paramedics, and firefighters reduce the effects of post-traumatic stress (PTS)?
I have been asking myself this question as I reflect on nearly 20-years of being in the military, integrating what I have learned through my Master's program at Boise State University, and what I have discovered in my own research on training and PTS. What I have discovered is that I think that we can.
I know that this is a hot-button, often emotional issue. This topic can be very inflammatory for some and it is not my intent to ignite anything. However, we can’t learn to do things better, unless we talk about them. With that being said, let me put out a disclaimer first.
DISCLIAMER
First, I am not a medical professional. I do not claim to be one nor do I want you to seek me out for that type of advice. The thoughts here are my own that are derived from my own experiences and research. Next is that I do not intent to offend anyone who may be suffering from varying degrees of PTS. Our men and women in these fields are asked to do the unspeakable for the, often times, undeserved. I appreciate each and every one of them. I am just a curious personality and always want to learn something new while also helping teach people along the way.
Finally, let’s define what we are talking about. When I say debilitating PTS (again reference that I am not a medical professional, I am talking about a severe case. This could be described as one in which the person ceases to function in everyday activities. We are talking about complete avoidance, loss of conscious thought, total confusion, and a loss of a sense of reality. This is an important delineation that I think needs to be made here and now. I am not going to write an article that claims we can simply solve PTS by making sure you are trained properly. In fact, what I want to make sure that everyone knows, is that you may still have symptoms of PTS after a traumatic experience. However, with the right tools in your tool kit, a person may be able to move past that experience faster or find healthy ways to deal with their symptoms.
What am I talking about?
In short, what I believe that we should be looking at with regards to our training programs for these professionals are ones that effect the way their subconscious reacts to their environments. You may be reading right now and asking yourself what I am talking about. You may also be questioning reading this entire article after a statement like that. However, I think that our training programs for these professions should lean towards an experience-based learning system. That system should systemically achieve a required performance level while simultaneously motivating an individual to conceptualize, analyze, and socialize their lessons learned to their peers, subordinates, and even superiors. This type of environment would lead to a better understanding of their profession and increase the performance of those around them as well.
Spoiler alert, I am not the first one to think about this. Malcolm Gladwell, Daniel Kahneman, and Gary Klein all have literature that provide some methodologies, theories, and concepts that we could adopt to achieve this level of training. The core of what we are talking about here revolves around teaching someone to solve problems. Now you’re probably thinking to yourself, “really John, all we need to do is teach critical thinking and that will solve debilitating PTS?” If that was your question, the answer is no. That is the core, and to every core, there must be something surrounding it. Those things are our experiences. Yeah, I know it sounds cliché, but imagine if instead of thinking about training someone, you thought of it as giving them an experience.
Would that change the paradigm?
My research has taught me that our brains link together every sense that you experience during a monumental event during trivial events. In fact, the synaptic pathways between the brains neurons are proven to be strengthened over multiple experiences through a process known as synaptic plasticity. Synaptic plasticity basically means that our memories can change over time based on our experiences. In short, it is how we learn and form memories.
What does that mean? That actually means that the more times you experience something that is similar to an already formed memory, your knowledge of that event can change based on the experience surrounding it. Are you catching on yet?
Now, some of you will stop there and think that this is a quantity conversation. However, from what I have found in my research, there is not enough data to state how many times you have to experience something to commit it to memory. Instead of thinking about that question, I want you to think about experiences in your life that you do remember? How much detail from those experiences can you recall? Think about your first love. Can you still smell their perfume? What about your grandma’s house, can you still smell it? When that one Blink 182 song comes blaring over the radio, can you remember a moment that takes you back and does it make you happy or does it make you sad? For my generation, the easiest one is asking where you were on September 11, 2001. For me, I was sitting at McGavock High School in Nashville, Tennessee in Chemistry class. While sitting there, the teacher turned the TV on and it was the news reporting on the second plane hitting the tower. I remember the sounds of the classroom, the feelings of rage and the fear that I had at the moment I saw it. Those experiences are synaptic pathways between neurons that are linking those feelings together. Those pathways are strengthened over repeated like experiences and can be changed over time.
The next thing my research brought me to was that our memories can help us recognize current situations or interactions subconsciously. Because of those pathways being built, our subconscious can actually free up some of the processing power for our conscious thought processes. This is not science fiction, however, it is science. Do you think about breathing? Not unless you are specifically working on a breathing technique to lower your blood pressure or calm your senses right? How about walking? Do you think about where you are placing your feet now as you walk down a hallway? The simple answer should be no. That is because your brain has taken this motor-skill and it has become second nature now. This is something that the we naturally do (outside of specific disabilities) so that our brain is not over inundated with these “mundane and everyday” tasks. Instead, it can focus on what is going on around you. It can take those senses in a little more and help inform your next moves. That was another clue…
So why does that matter?
Imagine for a moment that I could give a police officer an experience, or rather several experiences, with a hostile individual, in a realistic scenario, that felt as close as possible to a real-world situation as we possibly could. When that scenario was done, we would get to re-live it to see what we did right and what we did wrong. We would then get to give that same officer another shot at that experience to see if we had worked through any of the issues or if we could learn anything new. We would be reenforcing those and strengthening those synaptic pathways for that individual as well as others involved in the process. Through those experiences, and synaptic plasticity, we are essentially training their brain, conscious and subconscious, to react to various situations.
What if we could give a paramedic an experience of treating multiple victims with realistic patients, vitals, blood, and reactions? Would that be useful for that paramedic in training? Most of you are probably nodding your heads yes at this point. However, the vast majority of you are probably also thinking that we already do this type of training. We already have cadavers for paramedics. We have scenarios for police officers that they can accomplish threat reactions in training simulators. So, what are we missing John?
Change the Focus.
It is my belief that we are focused too much on two distinct things that lead to a possible root cause. First, we have a hyper focus on moving training to simulators now. Don’t get me wrong, I think that simulators are a great tool. I just don’t think that we are executing simulator events appropriately to give this set of professionals the experiences they need.
Our second issue is the reliance on what I call “part-task training.” This is a training method that does not allow the student to use all the tools in their tool-kits to solve a problem during their training iteration. That type of training, if used improperly (which I believe is still happening) leads to a student only thinking that there is one tool for a specific job.
Now, I will also do you the favor of countering both of my points by countering them myself here. To my first point, simulators are not always the sole focus of training and with the emerging technology it is only going to get better. This is something that I believe to be true as well. The technology is going to get better. However, if we do not change the way we design our training within the simulated environments, we will get the same, underwhelming, results from our simulated training. There is room for improvement here is all I am getting at. We can chat about simulators and the trends at a later date.
For the second issue I will tell you that part-task training is a requirement for the adult learner. This is where you build tools to use in larger scenarios. However, the majority of our training programs (this is VERY TRUE in the military) focus on a currency-based training model instead of a performance-based training model. When we focus on the currency (read that as quantity) our systems are usually designed to ignore the quality of the training.
So what is the answer?
The easiest answer is designing training programs that give these professionals the tools to conceptualize, analyze, and socialize situations where they are expected to perform their duties.
What does that actually mean John?
That means that our training programs need to give our professionals the tools to be successful AND THEN challenge those same professionals in realistic scenarios that give them a chance to conceptualize which tool to use, analyze if that tool was the most effective for the situation, and the socialize their lessons learned to others.
Okay, but why?
If we only throw a student into a situation once (read that as a “culminating event”) we have only given them a single chance to experience what it will be like to do their job in the “real world environment” before they actually need to perform under high stress. Does that make any sense? It sure doesn’t to me.
I would much rather see us progressively build a tool kit out for these professionals. Refer to figure 1 where we start at the top left with a wrench, then we progress to ratchets, and finally power drills on the top right side. What we see is that we are building out our tool box right? Along the bottom you can see that we have a small tool box at first with only a few tools and then we slowly build out to a full tool chest. This can only happen with experience!
Figure 1. The Importance of Tools and Tool Chests
So why is the focus on experiences then?
When we focus on experiences we are essentially focusing on quality with a tip of the hat to quantity. The quality of the experience will matter. I had an old instructor that used to say “practice makes perfect right?” and then you would answer him with “yes” and he would say “NO! Perfect practice makes perfect. Practice makes proficient.” Thinking back on that, he wasn’t far off. If you consistently practice doing something incorrectly, you will inevitably be proficient in doing that task incorrectly. Essentially, you cannot simply focus on the number of times you practice a task, you have to focus on the quality of the practice.
Hopefully we are starting to understand why experiences matter. However, why do I think that this can help with decreasing the effects of debilitating PTS? If I can give an individual the experiences in training that they can expect to see in the real world, in the most realistic conditions possible, with the same levels of stress that is expected in performance of the task we are helping to expose them to potentially traumatic situations in a controlled environment. We are then allowing our synaptic plasticity to inform future iterations of the same experience. In theory, we would be reducing the probability that the same experience is as traumatic over time. We are also, allowing the professional to solve problems by using the tools they have been trained with. We are also encouraging them to modify those tools so they can make their own when it is warranted. We are doing all of this in a training environment, where IT IS OKAY TO FAIL. That culture must be cultivated so that it fosters learning.
The training experiences should allow the student to work through a conceptual process where they can predict behavior, model results, experiment with solutions and evaluate their potential solution. The experience should then allow for an analytic process that allows the student to diagnose the results, plan for future iterations, and then apply causation and judgement. Finally, the social aspect cannot be forgotten. The student should be allowed to teach their lessons through a description of their problem set or scenario in order to influence their peers. This should then provide an opportunity to work and communicate as a team to become better each other through negotiation.
Experiences train your conscious and subconscious processes.
If we allow each of our training iterations to focus on these processes we are giving our brains a chance to build the experience out and relate specific tools to specific situations. This process allows our memories to have synapses related to the specific experience in training that are informed, post exercise, with lessons learned. That process then allows us to strengthen those synaptic bonds in practice. That process, repeated over time, could result in training our subconsciousness to work for us and not against us. It allows our subconscious to inherent some of what is currently conscious thought processes.
As described by Gary Klein in his book “Strangers to Ourselves” that can look like a fire fighter entering a house with their team to extinguish a fire. Upon entering, getting a “weird feeling” and immediately pushing his team out before the entire first floor collapses. Through some post-event analysis, he discovered that he was unconsciously processing information about the environment based on other experiences that he had. Some of those things were “the fire was colder than I expected upon entering” or “it was quiet, way more quiet than it should have been for a kitchen fire” and even the fact that “the floor felt soft under my feet.” Each of those pieces of information were discovered through analysis after the fact over a several month period. What do we learn from that?
We learned that in the 10-20 seconds he and his team were in the house he was processing this data without having an immediate conscious thought of the knowledge. He actually described it initially as a “sixth sense” from all of his experience fighting fires. While that is a noble cause to think that we have gained superhero like qualities, what it boils down to most of the time is that you are operating with a tool chest worth of tools for a single problem set. You quickly, with more experience, know what tool to use without even thinking about it. You only were able to do this with experience and quality experiences.
Some final thoughts.
The final thought here is that when we expose our professionals to these environments and scenarios in training with the appropriate support during and after the training event, we allow them to further train themselves and their brains on how to react to the high-stress situations. We have time to teach them how they reacted and work to teach them better ways to react in the future with newly developed tools.
Hopefully, through this type of training, we can provide these professionals with the experiences necessary to prepare them mentally and physically for the environment they are expected to work in. Again, this is not to say that we are going to prevent PTS with this type of training at all. In fact, there are going to be some experiences that are so traumatic for them, no “new training” will be able to combat the side effects. However, what we should be attempting, is exhausting all of our efforts in training to hopefully provide all of the tools necessary to be successful in the moment and thrive post-mission.
I am interested in your thoughts on this topic. Please feel free to leave me some comments or shoot me a message. As always, stay humble in your knowledge, approachable in your teaching, credible in your thoughts, and aggressive in your passion to teach others!
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