How does understanding the human survival response to trauma, peoples values and the link to human behaviour assist us to help people recover and RTW?
This is a huge topic - so much to consider and discuss - so i will break my article into 2 parts!
This is PART ONE
Why do we have a survival response if it doesn’t always help us?
Many clients ask me this when I am coaching them about trauma, recovery and return to work – the answer is that it does help us on many occasions – but sometimes it can also lead us astray – the secret lies in being able to determine when its helpful and when its not – and recognising how its negative impact translates to unhelpful behaviours and outcomes for us.
Lets be clear – ANYONE that has experienced ANY trauma in life has experienced the survival response – and no doubt all of us have experienced one or more of these symptoms (or others) at some point
Increased breathing rate – sweating – increased heart rate – goosebumps – upset stomach – foggy thinking – forgetting simple things – muscle tension – clammy hands – sensitised hearing – intense emotional reactions – increased pain – clenched jaw or fists – irrational thoughts…….
These are all common symptoms of the survival response – nothing to be worried about in and of themselves - completely normal response in the face of threat!
When a real danger confronts us (like a stranger jumping out in front of you in a dark alley) – this bodily survival response is helpful – it readies our body to respond to the danger – usually in the form of fleeing from it, or fighting it.
When the situation confronting us overwhelms our coping capacities - when we can neither defeat the frightening opponent confronting us nor safely run from it we become paralysed with fear.
Problem is – that the brain – based on stored memories in the limbic system (emotional brain) will govern how we respond to a perceived threat. The thinking brain (rational brain) is slower and doesn’t engage in time to modulate our behaviour response.
As we are neurobiologically wired to seek safety and avoid danger, once the brain PERCEIVES threat, the survival response is triggered, the body’s systems are engaged and a survival behaviour will play out.
So what determines the response choice our brain makes?
Of fundamental importance – is to appreciate that for the most part – what we fear or see as a threat is learned through experience, as are our coping abilities - “what we don’t know, we don’t know”. We cant respond to something with skills we haven’t learnt or been taught. I can’t speak French because I have never learnt it – so people cant respond with coping skills they don’t have – hence its NOT helpful to ask a traumatised person “why didn’t you fight back”, “why didn’t you run away”, "why didn't you leave"? Their response wasn’t a conscious choice they made – the survival brain takes over and in a matter of milliseconds it has determined our best chance of survival in the current situation and it directs our behaviour. On many occasions this is beneficial to our survival – but occasionally the outcome may not beneficial to us, especially if we are triggered by a threat that may not actually be present (and that’s a whole discussion on its own for another time).
So what does this all mean to our clients and their ability to recover?
I can best exemplify this by way of a case study (all names changed)
John was managing a shop alone when 3 customers entered. These people were known to John as being people who were drug takers and had previously committed theft within the shopping centre. Hence, he already began to experience feelings of concern (aka threat) as soon as they entered the shop. The customers looked around for a few minutes, and John observed one of them slip something into their bag. They went to exit the shop, John asked them to stop and he requested to look in their bag before they left. It was clear to John that they were drug affected, the customers became loud and aggressive and eventually the situation escalated into John being attacked and badly bashed by one of the customers. John did not fight back or run away, he froze and took the beating.
By the time John came to me to do the THRIVE program he had seen a Psychiatrist, a Psychologist and a Mental Health Nurse for 2 years. He was not close to a return to work or deciding on a future job goal. John was plagued by ONE very significant question that was debilitating to his recovery – “why didn’t I fight back”? John stated “I’m big and strong and they were smaller, I probably could have beaten them”. John had also been asked this question by his partner and well meaning friends on many occasions. Its easy to ask yourself that rational question, and evaluate yourself negatively when you are not activated by the survival response and the rational brain has a fighting chance to engage.
At this point – I asked John a couple of simple questions – “Have you ever been in a fight before”? Have you had self defence lessons or been taught how to fight”? His response was “NO” to all of these.
I then explained to John that his survival brain had no stored memories of him ever fighting, let alone winning a fight – so why would his survival brain decide in that millisecond it has to determine a course of action for his survival – that he should fight this person?
We cant call on stored memories, or coping capacities that we don’t have. HE did NOT make a conscious decision not to fight (his rational brain was not engaged at this time) – his survival brain made that decision for him and chose to freeze. The fact he is alive today may indicate that it was the best decision for his survival – if he had engaged in fight there is a chance the outcome may have been worse for him – that we will never know. Freezing is a common defence mechanism in nature, “playing dead” to an aggressor may result in them losing interest in continuing their attack against you. What we do know, is that John is alive today, and able to move forward with his family.
In that instant – John experienced a profound understanding of what happened when he was attacked and was able to let go of the shame and embarrassment he felt about not fighting his assailant. It freed him of the guilt he had been carrying for 2 long years, and he was able to focus on moving forward. In that moment John was able to “forgive himself” for not fighting back (not that he had anything to forgive – but that’s not what his rational brain had been telling him after the event). He could now move forward and focus his attention on determining job goals and a new path. He was also able to explain to his partner and friends why he didn’t fight back; this helped to improve their understanding of him and his response, resulting in John restoring his self-respect.
At that point he understood enough about his own reaction to let go of the past and now focus on the future. As a practitioner who believes in the health benefits of good work for people, the reward of assisting someone to achieve that moment of clarity so they can move forward and normalise their life is beyond profound.
Everyone's story of trauma is different - but all injured workers are in a fight for survival in one way or another, the brain and body's response to a perceived threat is generally the same(with some individual differences). Taking the time to understand a person's individual battle, and responding to that in an empathic, personalised and practical way is what will help them to recover - and RTW - no computerised or cookie cutter response can achieve that. The workers compensation system that enables that sort of individualised and flexible response is the one that will rise above the rest, both for employment outcomes, worker satisfaction and a reduction to claims costs and employers premiums.
By the way - I can hear some people screaming one question though..........why didn’t John run?
Hmmm – I will save that discussion for part two……………..