Making Meditation relevant to Warriors

The importance of relevance in driving behavioural change was drilled home to me at a tactical medical conference I attended in 2010 in Belgium. The organisation running the conference was the NATO Special Operations Forces Medical Expert Panel, and I was lucky enough to be one of the Australian representatives that year. The topic of focus was simulation in tactical medical training, and it was during one of the presentations looking at different fidelity training modalities that a German presenter made a comment that really resonated with me. It was:

“Relevance is far more important than realism”.

It was the key learning point that I took away from the conference, and one that I employed in all the training that I was responsible for organising subsequently in my military career and since.?

I have seen some of the most expensive, highest possible fidelity training be completely wasted on disinterested students because they have failed to see the relevance of it to them.?

Likewise, on the flipside of that coin, I have seen students engaging to the point of sweating and shaking over super-low-fidelity training, where wounds had been drawn on a simulated casualty with a red pen, because they could see that the training was highly relevant to them and might actually save a life one day.?

Looking back on my failure to embrace mindfulness and meditation prior to when I eventually did in my 40s, I can see that the issue was related to relevance.?

As a younger man I failed to see any relevance of mindfulness or meditation in the life that I aspired to live. I now know clearly that it was highly relevant to the younger me, and I wish I had have embraced it decades sooner. At the time of my military service, despite having the practices presented to me on several occasions, I was the perfect storm of formal medical education and ignorance to never even open my mind to the practices.?

Firstly, I was medically trained in an evidence-based manner, where if there weren’t studies done on thousands of people that proved beyond any reasonable doubt that a certain intervention or medication made a difference, then the intervention was not credible. The evidence for the benefits of meditation is now unquestionably there, and if I hadn’t had been so dismissive of the concept and bothered to look it up, I probably would have found some compelling studies 20 years ago.?

Secondly, I had mistakenly assumed that mindfulness was synonymous with passivity, and I saw myself as a special forces soldier, indoctrinated into the warrior culture, and heading to war. In my na?ve opinion at the time, mindfulness was a practice for the weed-smoking hippie mung beans protesting the war, not for those heading off to fight it.?

My primary goal in this newsletter is to attempt to convince you, the reader (and especially you – the testosterone-fuelled, 20-something, bulletproof bloke) that mindfulness is a superpower and you should embrace it today.?

When I further consider why I was so dismissive of mindfulness and meditation earlier in my life I can identify several reasons. No one had ever bothered to ask me my perceptions of the practices, which might have facilitated a discussion leading to me mentally challenging my somewhat fixed preconceived ideas. The people who had presented mindfulness and meditation to me, while nice folk, were not people I had any prior relationship or rapport with, so my trust for them and what they were telling me was superficial at best. They certainly hadn’t spent time in the space that I was operating in at the time, which probably reduced their credibility in my mind at the time.?

My first real exposure to meditation was on the Acute Mental Health On Operations (AHMOO) course, which I had been forced to do prior to one of my deployments and had no interest in at all. In my mind at the time, that course was nothing more than an inconvenience that was taking up two days of our pre-deployment training that I felt could be better used in honing tactical medical skills that we would certainly need on the battlefield, rather than learning some mental health skills that I felt unlikely to need. With hindsight, I had gone into that training with a terrible mindset and was destined to get nothing from it.?

What had been happening on the AHMOO course was an attempt to drive behavioural change in us without an understanding of our perceptions of mindfulness and meditation or any attempt to educate us and build relevance of the practices to our individual circumstances. That approach almost never works.

To drive behavioural change against someone’s will usually requires extreme circumstances or the use of force.?

For example, in my medical practice I see plenty of people who continue to smoke right up until the point of their first heart attack, stroke, or cancer diagnosis before kicking the habit.?

They’ve known all along that smoking was bad for their health, but it takes the extreme circumstances of a life-threatening event to jolt them into the behavioural change of quitting smoking. To some degree, this was me with mindfulness and meditation in that it took the symptoms of Post-Traumatic Stress and the failure of my maladaptive attempts to manage them before I turned to the practices.?

In my former military role, this same principle was seen in the counter terrorist (CT) space. One of the CT capabilities held by the units I served with was hostage rescue. When all other measures had failed and a peaceful solution was no longer on the table, a team of special operators would blow in and recover the hostages with force.?

While this looks rad in the movies it is never the preferred option in a hostage situation and it is always a better outcome when the situation can be resolved without the use of force. The hostage negotiators know this fact well and arguably no one does it better than the FBI, whose Behavioral Change Stairway Model (Figure 1) is considered the gold standard for approaching hostage situations.?

As seen in the Behavioral Change Stairway Model, there are four important stages before reaching behavioural change.?

1. ?Active listening – being the act of truly listening to someone and not just thinking about what you’re going to say next and eagerly waiting for their lips to stop moving so you can blurt in. One of the key tactics in active listening is taking the main points in what the other person has said to you and paraphrasing them back to them to confirm understanding.?

2. ?Empathy – this is a step up from active listening and involves a demonstration that you understand the emotions behind what the person is saying. A great way to build empathy is through what’s known as emotional labelling. Emotional labelling involves latching on to key words the person is saying and deciphering the emotions that they are experiencing. For example, when exploring someone’s reluctance to embrace meditation, you might interpret a degree of frustration at their inability to quieten their mind as a factor contributing to their inability to continue with the practice. Pointing this observation out to the person helps to build empathy through making them see that you can understand how they feel.?

3. ?Rapport – Through the use of active listening to confirm understanding and building of empathy to confirm you understand the emotions underpinning how someone feels, rapport is generated.?

4. ?Influence – It is only after building rapport that influence is generated. Any attempt to influence without establishing rapport is likely to fail.?

5. ?Behavioural change – The final step of the Stairway Model is behavioural change. This is the point we want to reach, but unless we’ve stepped through the other stages, the only way to achieve it is against the person’s will.?

Along the X-axis of the Stairway is time. It takes time to reach the point of voluntary behavioural change in someone. In the setting of a crisis there is no time to play with and behavioural change needs to be forced. This is the case of a smoker who has had their first heart attack, or a hostage situation that has hit flash point with the hostage taker starting to execute hostages. In those examples, time has run out and influence needs to be decisive and swift to enforce behavioural change. In less urgent scenarios, the steps need to be followed to improve the chance of a change in behaviour.?

Underpinning the Stairway model are other more individual models of behavioural change including the Transtheoretical Model (TTM).?

Transtheoretical Model of Behavioural Change

Developed by researchers Prochaska and DiClemente in the late 1970s, the TTM recognises that individuals move through different stages when modifying their behaviours, outlining five distinct stages of change, each representing different levels of readiness and commitment to behavioural change[1]. The levels are as follows:

1. ?Precontemplation: In this initial stage, individuals may be unaware of their need to change or may be minimising the significance of their behaviours. They are not yet even considering change.?

2. ?Contemplation: In this stage, individuals may still be ambivalent towards committing to change, however they acknowledge the need for change and are contemplating taking action within the next six months.?

3. ?Preparation: Individuals are actively planning to take action in the near future, are gathering resources to help them in the process, and may be taking small steps towards behavioural change.?

4. ?Action: Individuals are making observable and measurable measures in implementing behavioural change. They’ve started doing it!

5. ?Maintenance: This is the final phase when individuals have made a habit of the behavioural change and have been practicing it for over six months. They’ve committed to sustaining the new behaviours and have measures in place to prevent relapse into their old ways.?

Health Belief Model

Another theoretical model that helps explain why I didn’t embrace mindfulness and meditation when I was in the army is The Health Belief Model (HBM). The HBM has its origins in population health observations dating back to the 1950s and is a model developed to predict health-related behaviours[2]. The HBM can be diagrammatically represented as seen in Figure 2.?

As can be seen, whether or not an individual takes action in a health behaviour is determined by a multitude of factors, including demographics, psychological characteristics, their perceived susceptibility and severity of not taking action, their perceived pros and cons of taking action, and finally, specific cues to action.?

A large body of research into health behaviours, such as smoking cessation, consistently shows that only a very small percentage of people at risk (20% or less) are prepared to take any action to change their behaviours.?

Viewing my failure to embrace mindfulness and meditation while I was in the army through the lens of the HBM, I can appreciate why I remained inactive.?

From a demographic perspective, I was a young, testosterone-fuelled man, who honestly believed was immune to the mental stress of my role with special operations. This mindset led to a low perceived susceptibility to mental health issues. While I theoretically understood the potential severity of such issues, they didn’t seem applicable to me at all, certainly not enough to drive any action. The perceived benefits of mindfulness and meditation were infinitesimally small, if any at all, and the perceived barrier to action, even if I had considered it at all, was the time cost of doing such seemingly irrelevant activities when I could be better spending the time training in the skills that I could see direct relevance in, such as tactical medicine.?

Psychologically, I was immersed in a culture that was unreceptive, if not overtly hostile, towards the concepts of mindfulness and meditation and the out-groupswho engaged in those practices. There was a degree of peer group pressure from my own in-group to not practice mindfulness and meditation.?

At that time, there was no cues to action (yet!) which led to no action.?

Decisional Balance Sheet

At the risk of going further down the theoretical rabbit hole, the middle section of the HBM is derived from yet another tool for behavioural change known as the Decisional Balance Sheet [4].

This one is pretty simple and is in essence just looking at the pros and cons of a certain course of action. Most will have used it either formally or informally in their minds when making decisions big and small. Diagrammatically, it appears as in Figure 3.?

While I never formally stepped through this process for mindfulness and meditation back in the day, if I had, I imagine it would have looked something like this:

The goal of my newsletters on the topics of mindfulness and meditation are to change the view of the practices and build relevance for those in the military and first responder roles as ways to optimise performance in high-stress, high-consequence roles, while minimising the risk of mental health consequences from the inevitable exposures of those jobs.?

If you want to check out some of my previous newsletters on the benefits of mindfulness and meditation in high-consequence roles, you can find them here:

The Mindful Sniper

Mindfulness and Machine Guns

Why Snipers and Combat Medics should meditate differently

People in military and first responder roles need to perceive their susceptibility for mental health injury for exactly what it is, that being significantly higher than the general population [5] and hopefully my newsletters will help increase the perceived benefits of mindfulness and meditation to drive action before the point of a mental health injury serving as a cue to action.?

This newsletter is an adaptation of a chapter from a book I'm currently writing, with the working title "The Mindful D**khead". If you're interested in the topic, keep an eye out for that one in the future!

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

References

[1] Prochaska, J.O., & DiClemente, C.C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-5.?

[2] Rosenstock, Irwin (1974). "Historical Origins of the Health Belief Model". Health Education & Behavior. 2 (4): 328–335

· ?[3] Abraham, Charles & Sheeran, Paschal. (2015). The Health Belief Model. In Predicting and Changing Health Behavior. Edition 3. McGraw-Hill.

[4] Janis, Irving L. ; Mann, Leon (1977). Decision making: a psychological analysis of conflict, choice, and commitment . New York: Free Press .

[5] Walker A, McKune A, Ferguson S, Pyne DB, Rattray B. Chronic occupational exposures can influence the rate of PTSD and depressive disorders in first responders and military personnel. Extrem Physiol Med. 2016 Jul 15;5:8.

P.S.?

If you're interested in hearing more from me, you can check out the books below which are available through Amazon and other online book retailers.?