Calming the State of Fear: Using Stress Inoculation Training and  Aerobic Exercise to Reduce the Amygdalar Response to Stress

The training wasn’t meant to be excessively nerve-wracking or fear-inducing; yet, the teachers were visibly nervous. This was largely due to their fear of the unknown, since they were unaccustomed to exposure to realistic scenario training. Moreover, I was having each of them run through the scenario as individuals—without the support of a colleague for assistance if they froze while not knowing what to do.

 

What is most interesting about this group of teachers is that they asked for this. Several weeks prior to this training event, I had provided classroom instruction and school-mandated realistic scenario training to all school staff members during teacher in-service training before the start of the school year. Several teachers approached the staff coordinator and said, “We want more—we want to receive training at the next level.” I am always willing and eager to provide training to an enthusiastic and engaged audience, so I agreed to provide advanced scenario training on a Saturday to these teachers and staff members. For each of them the training was doubly beneficial—they received additional required continuing education credits as well as strengthening neural pathways which would be needed for encountering a potentially threatening event.

 

Realistic scenario-based training exercises have become the gold-standard for law enforcement agencies and the U.S. military for training members to effectively respond to various threats. In fact, the use of simulated munitions—known as “simunitions”—has taught police, federal agents, and soldiers to win gunfights. In the past, use of training vests which would sound a tone when a laser contacted one of their sensors would—in effect—train our soldiers to die, rather than live. Opposing forces would fire cartridges with gunpowder but no projectile—often referred to as “blanks.” The force of the gunpowder explosion would trigger a laser to be “fired” in the direction which the firearm was aimed. If the aim was in contact with a participant’s vest, the sensor would sound the tone and the participant was “dead.” Simunition training does the very opposite—even when a participant is struck with a simulated munition, they remain in the fight. This reinforces the essential lesson that even if you are struck with a bullet in an actual gunfight, you are able to continue fighting and win as long as you are conscious.

 

However, on this teacher training day, we certainly were not using simulated munitions. Nor were the teachers being exposed to any form of physical contact with my role-player. Yet, they were still visibly nervous. This was intentional on my part; as a federal tactics instructor, I know that learning comes when you step outside of your comfort zone. My goal was to drive them to their individual growth edges; remaining well within their comfort zones leaves them bored and pushing them too far overwhelms them. I was seeking the “Goldilocks zone”—if you will—for stress exposure for individuals unacquainted with violence.

 

Known as “stress inoculation training”—or SIT—the concept involves exposure to a particular stressor in a controlled environment under the supervision of an expert instructor. A comparison may be made to physiological inoculation against a disease provided by a specific vaccine—exposure to the virus in non-living form causes the body to produce antibodies to combat and defeat the virus when exposed to the living form. Similarly, limited exposure to a stressor over time dampens the fear response in the part of the brain known as the amygdala. As a key component of the limbic system, the amygdala plays a large role in detecting and responding non-consciously to threats (LeDoux, 2015).

 

Developed by Donald Meichenbaum and Jerry Deffenbacher, SIT consists of three phases. The first stage involves the conceptualization of the problem or source of stress (Meichenbaum & Deffenbacher, 1988). The second phase consists of acquiring and rehearsing skills which will serve to reduce the anxiety associated with the source of stress (Meichenbaum & Deffenbacher, 1988). In phase three, coping skills are applied which are designed to transfer to the actual stressor in the individual’s life (Meichenbaum & Deffenbacher, 1988). The law enforcement application of SIT involves the use of the aforementioned simulated munitions to train officers and agents to know when to use deadly force—as well as how to continue to fight a deadly threat even if the law enforcement officer has been struck by enemy fire (Lawler, 2016).

 

The goal of my scenario training conducted for the teachers wasn’t to teach them to engage in a gunfight, but rather to develop cognitive markers for behavioral adaptation and recognition of potentially violent situations. Mental models guide our behaviors across a wide spectrum of events—from the way you brush your teeth in the morning, to the route you take to work, to the way you prepare to give a presentation at work. Each of us is guided throughout the day by the mental models we have formed through life experience. However, what happens when we encounter a situation for which we have no prior experience? Moreover, what if this situation involves a violent encounter or a life-threatening event? We have become accustomed to think of our reactions as putting us in what is commonly referred to as the “fight-or-flight” mode. Research indicates that the most common behavior under great stress is actually freezing (Leach, 1994). While freezing behavior may be beneficial for an animal to evade detection by a predator in the animal world, such maladaptive behavior may lead to fatalities when humans encounter a violent situation or life-threatening event.

 

When teachers are exposed to a realistic scenario, they develop a new mental model which their brain’s prefrontal cortex then associates with the situation just encountered. Expose them to enough variety of scenarios and they will develop a wide array of mental models to fit those encounters. These learned behavioral responses are known as “secondary emotional bookmarks”—in other words, they are bookmarked “programs” which the brain will resort to when it encounters a similar event (Gonzales, 2003). These programs are “emotional” due to the fact that they lie deeply ingrained within the brain’s limbic system—that structural entourage of the brain which, when aroused by fear or excitement, responds with a particular action—often automatically without conscious thought. Primary emotions are those survival mechanisms which are innate and often present at birth—the need for social companionship or using a hand to break a fall, for example (Gonzales, 2003). However, secondary emotions are learned survival mechanisms which may not come naturally. These secondary responses are then bookmarked into memory, awaiting the brain’s recognition of a situation in which they will be needed. Here lies the essence of why realistic scenario training works—in a moment of crisis, individuals without prior life experience need to have been exposed to something which is similar and which provided an automatic behavioral response which will avoid freezing and lead to survival.

 

Now, research has demonstrated that there may be a powerful ancillary to stress inoculation training—aerobic exercise. Through the release of neurochemicals and growth factors, this form of exercise makes the brain function at its optimal level (Ratey, 2008). The brain responds by releasing, balancing, and producing more serotonin, dopamine, and norepinephrine—among many others—which are regulatory neurotransmitters that reverse the negative effects of chronic stress (Ratey, 2008).

 

When the amygdala senses a threat, it initiates the flow of a cascade of chemicals within the body. Norepinephrine is released which then causes the sympathetic nervous system to activate the adrenal glands, which, in turn, release epinephrine (adrenaline) into the bloodstream (Ratey, 2008). The immediate effects of this are sharp increases in heartrate, respiratory rate, and blood pressure. Aerobic exercise also increases heart and respiratory rates; however, the brain can be trained to associate these physiological effects in a positive manner when caused by exercise. Accordingly, the mere sensation of an increase in heart rate or breathing will not necessarily automatically lead to feelings of anxiety or dread. Additionally, aerobic exercise causes heart muscle tissues to produce a chemical known as atrial natriuretic peptide—ANP for short—which plays a direct role in reducing the body’s response to stress (Ratey, 2008). ANP reduces the level of stress by slowing the HPA (hypothalamus—pituitary—adrenal) axis, which plays a regulatory role in the body’s reaction to stress.

 

Perhaps an even more important benefit of aerobic exercise is that it causes the production of a protein called brain derived neurotropic factor (BDNF) which Harvard Psychiatry Professor John Ratey describes as “Miracle-Gro” for the brain (2008). The reason Professor Ratey likens BDNF to fertilizer is that this protein nourishes neurons and causes them to grow new dendrite “branches”—an indispensable factor in learning (2008). In fact, Professor Ratey cites a program conducted in Naperville, Illinois in which students began a regimented program of aerobic exercise prior to the start of the school day. This program greatly improved student fitness levels, but the most impressive—and unexpected—result was the improvement on academic performance. Students from Naperville District 203 took an international academic test known as the Trends in International Mathematics and Science Study (TIMSS), designed to compare performance levels of students in a variety of countries in these two key areas (Ratey, 2008). In 1999, 230,000 students from 38 countries took the TIMSS (Ratey, 2008). Incredibly—and unbelievably—Naperville students scored sixth in math and number one in the world in science [emphasis added] (Ratey, 2008).

 

Moreover, aerobic exercise is also a key ingredient in neurogenesis—the production of new neuron stem cells. As Ratey notes, the greatest increase in neurogenesis occurs when skill acquisition is combined with aerobic exercise (2008). In addition to creating new cells, exercise elevates the levels of neurotransmitters and creates new blood vessels through which these proteins and other beneficial growth factors are pumped throughout the body and into the brain (Ratey, 2008). Complex activities expand the networks of cells, as well as thickening the myelin sheath around neurons; thus increasing the speed and quality of the signals being transmitted among neurons (Ratey, 2008).

 

This is where aerobic exercise may prove to be a beneficial addition to teacher scenario training drills. First, a small amount of exercise prior to running a realistic scenario training drill will serve to lower teachers’ perception of stress. A 10-15 minute routine of exercise to increase heart and respiratory rates will calm the action of the HPA axes of teachers participating in the drill. Second, aerobic exercise will optimize teacher’s brains ability to create new neuronal circuits to learn and remember the behavioral skills acquired during the scenario. It is the production of these appropriate secondary emotional bookmarks which will provide teachers with the automatic behavioral responses which will lead to survival if they ever experience a similar violent encounter. In order to acquire these bookmarks, teachers simply must be pushed outside of their comfort zone—without going too far outside (this is why expert coaching is a crucial element in the entire process). This surely is to become the new gold standard of training: enable educators to learn to cope with stressful encounters through limited exposure to similar stressors in a controlled environment, while using aerobic exercise to both dampen the body’s stress response while optimizing cognitive functionality and learning. The stress inoculation/aerobic exercise methodology is the antidote to the maladaptive freezing response in the face of a violent encounter or other life-threatening event.

 

 

References

Gonzales, L. (2003). Deep survival: Who lives, who dies, and why. New York, NY: W.W. Norton & Company.

Lawler, S. M. (2016). Strategies for disruption of an active shooter or terrorist attack on American schools: An exploratory qualitative study (Doctoral dissertation). Colorado Technical University, Colorado Springs, CO.

Leach, J. (1994). Survival psychology. London, UK: Palgrave.

LeDoux, J. (2015). Anxious: Using the brain to understand and treat fear and anxiety. New York, NY: Penguin Books.

Meichenbaum, D. H. & Deffenbacher, J. L. (1988). Stress inoculation training. The Counseling Psychologist 16(1), 69-90. doi: 10.1177/0011000088161005

 

Ratey, J. (2008). Spark: The revolutionary new science of exercise and the brain. New York, NY: Hachette Book Group.

Toward a more effective survival model: Why “Run, Hide, Fight” isn’t the answer.

We tend to think that under extreme stress, we will exhibit the oft-touted “fight-or-flight” response–immediately fighting or fleeing from a threat. However, evidence indicates that the vast majority of the population will do neither immediately. Rather, the most common immediate response to a life-threatening event is behavioral impairment exhibited as “freezing” (Tiara, n.d.). In fact, cognitive paralysis in the face of extreme danger is so common that Leach suggests the stress response should be renamed the “fight, flight, or freeze” response (2004).

Freezing often leads to fatalities. Therefore, our central research question should be “Why do so many people perish in what should be a survivable event?” In the face of an imminent threat, moving often leads to survival (Lawler, 2019). Moving may have saved more lives in the terrorist attack on the World Trade Center on September 11th, the Boston Marathon bombing, the Las Vegas mass shooting attack, and the Columbine massacre (Lawler, 2019). Moving did lead to survival for several children during the attack at Sandy Hook Elementary School (Lawler, 2019).

“Run, Hide, Fight” cannot be our nation’s “go-to” response for disaster events or terrorist attacks. Certainly, teachers cannot simply run and hide, leaving their students behind. Neither can parents or spouses when they are with their families. Running and hiding promotes a victim-oriented conceptual framework for examining violent encounters. When the threat is very near–whether it be a gunman, bomb blast, or building fire–moving is the priority. However, moving may mean evacuating from the area–or going on the offensive against an armed attacker in close proximity to you. If an armed attacker is very near or your escape path is blocked, fighting must be the behavior of first resort–not the last resort. Training in this manner promotes a survivor’s mindset–which is the opposite of that elicited by “running and hiding.” After all, possessing a warrior mindset may be the most crucial element of all in surviving a violent encounter (Lawler, 2019).

A more effective, research-driven model, is “Move, Fight, Evacuate” (Lawler, 2019). Details to follow…

References:

Lawler, S. (2019). “Revealing the secrets of surviving life-threatening events”. 2nd National Student Safety & Security Conference and Workshop. Las Vegas, NV.

Leach, J. (2004). Why people ‘freeze’ in an emergency: Temporal and cognitive constraints on survival responses. Aviation, Space & Environmental Medicine, 75, 539-542.

Tiara, S. (n.d.). Safety & Survival Training. Retrieved from: http://www.samson-tiara.co.id

New Research Links Marijuana Use with Psychosis–Part 1

Clinicians have long known that marijuana use–especially in the teenage years while the brain is still developing–causes degraded cognitive capacity, loss of motivation, memory loss, and paranoia. However, researchers are now discovering further evidence that marijuana use leads to an increased risk of developing psychotic disorders–including schizophrenia (Robertson & Swartz, 2019). Moreover, it’s not only youth who are at greater risk. The May 2017 edition of the journal Psychiatric Services reported that there is an increase in adults over the age of 30 in the U.S. being diagnosed with psychotic disorders (as cited by Berenson, 2019).

Why the increases in diagnoses of psychosis? At least part of the answer is likely due to the combined effects of the presence of more potent marijuana, legalization of marijuana use at the state level in many regions, and a prevailing national attitude that “marijuana is simply not that bad.” The science on this topic provides strong evidence to the contrary. [It’s important to note that marijuana possession and distribution remains illegal at the federal level, and this applies to all 50 states.]

The psychoactive component of the marijuana plant is the chemical delta-9-tetrahydrocannabinol–commonly known as THC (Berenson, 2019). Although marijuana has been utilized for thousands of years, it’s usage in the U.S. increased in the 1960s and 1970s. However, the THC content of marijuana at that time was commonly less that two percent (Berenson, 2019). Today, the THC content of marijuana purchased in “legal” dispensaries is routinely 25% (Berenson, 2019). It is difficult to overstate the negative effects and danger which this increase in THC content poses to today’s marijuana consumers.

Research which correlates marijuana use and psychosis suggests that “adolescent marijuana use raises the risk of schizophrenia between two- and six-fold” (Berenson, 2019, p. xxxiv). This data must be shared with every parent, educator, student, and policy-maker in the nation.

The epidemic isn’t coming–it’s already here. More to follow in part 2.

References:

Berenson, A. (2019). Tell your children: The truth about marijuana, mental illness, and violence. New York, NY: Free Press.

Robertson, A. G., & Swartz, M. S. (2019). Thinking carefully about marijuana legalization: Public health considerations for state policy makers. Psychiatric Services, 00, 1-2. doi: 10.1176/appi.ps.201900124

Getting Adequate Sleep is One of the Most Important Steps You Can Take to Maintain Your General Health and Well-Being–and Recent Neuroscience Proves It

Many Americans are chronically sleep-deprived. Excessive usage of screen technologies–including video games and social media–is now known to be addictive and interfere with normal sleep patterns. This is particularly problematic for younger children whose brains are still undergoing the delicate–and essential–process of myelination. Myelin provides the insulation around neurons which allow for rapid transmission of electrical signals (ie. thoughts) and it is easily disrupted by the hyperactive arousal provided by electronic screens. Accordingly, parents should take proactive steps to limit the screen usage by their children and prevent screen/sleep interference. Unfortunately, “80% of today’s teens say they rarely or never sleep well” (Rosen, 2017). The newly proscribed clinical diagnosis of “problematic screen disorder” has all of the trappings of a national crisis for America’s youth.

When you don’t sleep enough, you can’t think well. We know this from experience, but now recent neuroscience has provided more answers as to why this is so. When you sleep, your brain is literally being cleansed of toxins which accumulate during the waking hours. The less sleep you receive, the less toxic material you are purging from your brain. Two of these proteins are A-beta and tau. According to research by David Holtzman, a neurologist and neuroscientist at Washington University School of Medicine in St. Louis, deficiencies in sleep quality and duration lead to excessive build-up of both A-beta and tau proteins in the brain and cerebrospinal fluid (Cunningham, 2019). Furthermore, excessive build-up of these proteins in the brain is now implicated in the onset and development of Alzheimer’s Disease (Cunningham, 2019).

In 100% of the active shooter mass murder attacks which I have studied, I have found what appears to be addiction to violent media–particularly violent video games. A common trait of addiction is the willingness of the one who is addicted to trade other life patterns in order to accommodate the addiction. This is the case with video game addicts–they will trade sleep, eating, even walking to the restroom–in order to avoid leaving the game. Some will wear diapers or keep jars next to the computer to avoid the short time away to use the restroom. In South Korea, marathon gaming has even resulted in the death of one video game addict. Moreover, screen addiction has become China’s number one public health crisis.

Inadequate sleep not only leads to physiological disease and psychosis, but it can be akin to gasoline thrown on the fire of violence.

References:

Cunningham, A. (February 16, 2019). Lack of sleep again tied to Alzheimer’s: Levels of tau protein go up in people deprived of shut-eye. Science News Magazine 195 (3), 6.

Rosen, L. (October 2017). The distracted student mind–Enhancing its focus and attention. Kappan 99 (2), 12.

Mirror Neurons–The Neurological Basis for the Effectiveness of Experiential Learning and Response Engineering

According to Gilkey and Kilts (2019), neuroscientists have discovered a dedicated neural system which guides experiential learning in the brain. Known as “mirror neurons,” these brain cells mentally simulate objects, people, and actions of our prior experiences which allows for quick recall (Gilkey & Kilts, 2019, p. 93). This means that physical practice of a new skill is not the only way to learn the skill–it may also be learned through observation of the skill being performed (Gilkey & Kilts, 2019, p. 93).

Organizations can use this science in a variety of ways. While it may improve organizational effectiveness in more mundane tasks, it also serves to inform senior leaders of practical methods by which they can train their employees to survive a violent attack against their organization. Law enforcement agencies and the US military have discovered that the use of simulated munitions within the context of force-on-force training serves to train members how to survive lethal combat (ie. gunfights). When stress levels are raised during realistic scenario training exercises, employees–such as teachers, receptionists, nurses, doctors, etc.–can develop these mirror neurons to mentally form images (bookmarks, if you will) for violent, life-threatening events. This is one method for overcoming freezing behavior which is often observed in individuals under extreme stress.

The discovery of this dedicated system of mirror neurons now provides us with a partial window into how the incredible process of experiential learning actually works.

References: Gilkey, R. & Kilts, C. (January 2019). Cognitive fitness: Research in neuroscience shows how to stay sharp by exercising your brain. Harvard Business Review, Special Issue: The Brain Science Behind Business.