The Downsides to Good Training (Part Two)

In Part One of this series (my previous newsletter) I discussed the Yerkes-Dodson Stress-Performance curve, being the empirical relationship between stress and performance that takes the shape of an “inverted U”. Basically, performance increases with stress to a certain point and then beyond that point, further increases in stress cause a decrease in performance. It is diagrammatically represented in Figure 1.

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This is a particularly useful model to be aware of for a variety of discussions relevant to military members and first responders. The relationship between stress and performance holds true for physical and psychological stress, as well as for acute and chronic stress.

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The point of optimal performance is found at the very top of the inverted-U graph, where the amount of stress of the situation is enough to prime the individual for peak performance, while not pushing them past this point and into a state of overload where performance starts to dip. Naturally, this point can be difficult to pinpoint precisely for any given acute situation and it is equally difficult to know how much cumulative stress, or “allostatic load” is optimal for an individual chronically to keep them stimulated and engaged in work and life without starting to burn them out.

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Regarding acute stress, Yerkes and Dodson observed that repeated exposures to the same stress allowed for better, and eventually reliable, performance under increasing stress levels. This adaptation to stress is referred to by a variety of names including fear conditioning, stress inoculation, or simply the training effect.

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Done correctly through graduated Reality Based Training, an individual can deliberately be pushed into overload in a controlled training environment and then brought back down to the optimal stress level for a debrief to consolidate learnings, reinforce positive actions, and discuss negative actions with a view to improving them in the next training evolution.

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Over time, the individual can perform at a higher and higher level under increasing acute stress loads due to this stress inoculation. This process is roughly diagrammatically represented in Figure 2. Naturally, this relationship is unlikely to be as linear as depicted in Figure 2, however the principle holds true.

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The phases of stress inoculation marked on Figure 2 are arbitrary but might represent the levels achieved after completion of initial induction training in a military or first responder training pipeline for any given requisite skill (Phase 1) and then a secondary point after the individual has had a period of time in their role and consolidated their skills in more complex real-life situations (Phase 2).

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When it comes to performance in the acute high-stress situations that a military member or first responder might find themselves in, stress inoculation is a good thing. The catch is that despite stress inoculation allowing for better performance outcomes in the acute setting, it doesn’t negate the fact that the individual is being exposed to more and more stress on a chronic timeline.

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Here we need to look at two different Yerkes-Dodson stress performance curves for the same individual based on acute and chronic timelines. On the acute timeline, on the job day-to-day, the individual might find themselves at the optimal point during short-term encounters however, on a chronic timeline, those exposures are causing an insidious accumulation of stress that often goes consciously unrecognised.

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Subconsciously, a chronic stress bucket is slowly but surely being filled without the individual’s conscious awareness. The first time that they are often become aware of the bucket being filled is when it overflows and they suffer from a stress event such as a panic attack or overt signs of a mental health injury such as anxiety, depression, or Post-Traumatic Stress.

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Subjective and Objective Stress

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What occurs in a stress inoculated individual is a disconnect between their subjective (conscious) and objective (subconscious) experience of stress.

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In a non-stress inoculated person, subjective and objective stress are closely linked. If they have a stressful encounter, such as being first on scene to a car crash, they feel stressed and they are aware of the physical reactions of the associated adrenaline dump causing their hearts to race and maybe their hands to shake.

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With stress inoculation, an uncoupling of subjective and objective stress occurs. The stress inoculated individual will not feel consciously stressed when they turn up to the car crash however, they are still releasing pulses of stress chemicals including adrenaline and cortisol to pep up their brains and bodies to respond. This disconnect is represented at the bottom of Figure 3.

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Regular exposures to stressful encounters leads to the chronically elevated stress hormone levels that are well documented in military members and first responders, and that we know are contributory to the high rates of mental health injuries that we see in these populations[i][ii].

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In Figure 3, I’ve used the term Objective Stress Threshold to illustrate when cumulative stress (allostatic load) reaches the point where the individual experiences an overt stress response. This is the point at which their stress bucket overflows.

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This often comes as a surprise to the individual who, due to their stress inoculation, is not consciously aware of being particularly stressed and yet there is no denying that they are experiencing a stress reaction. I’ve used the term traumatic dissonance to describe the delta between subjective and objective stress that leads to confusion and often feelings of shame and guilt. Up until this point, the individual will generally have held a belief that they are immune to the impact of the stress of their exposures and their very identity is that of someone who can function and even thrive in the worst of situations without it affecting them.

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Study after study concludes that military members and first responders are at significant risk of mental health injury from the unique stressors and exposures of their work however, at an individual level, there is a near universal denial of the potential to develop a stress injury until it happens.

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Minimising the chance of stress injury from the exposures of military and first responder roles involves attention to resilience and wellbeing practices before a stress injury occurs. The difficulty in influencing individuals to adopt these practices prior to a stress injury is a perceived lack of relevance. I know, because I was that young, testosterone-fuelled army guy who honestly believed I was immune to stress injury… right up until the point when it happened!

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The hope of this newsletter is to raise awareness of a second potential downside to good training, being stress inoculation causing a disconnect between subjective and objective stress, allowing for chronic stress to insidiously accumulate to the point of mental health injury without the individual’s awareness until it is too late.

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For a comprehensive overview of strategies to mitigate stress and build and maintain resilience in high stress, high consequence, roles, check out The Resilience Shield or www.resilienceshield.com

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As always, comments and questions are welcome. If you feel this newsletter might resonate with others in your community, please share it widely.?

Until next time, stay safe, and don’t forget to have some fun!

Cheers,

Dr Dan Pronk?

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References

[i] Corrigan, S.L., Roberts, S., Warmington, S.?et al.?Monitoring stress and allostatic load in first responders and tactical operators using heart rate variability: a systematic review.BMC Public Health?21, 1701 (2021).

[ii] Steudte-Schmiedgen,S, et al. Hair cortisol concentrations and cortisol stress reactivity predict PTSD symptom increase after trauma exposure during military deployment. Psychoneuroendocrinology, 59 (2021)

P.S.

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