The Difference between High Stakes Performance and High Stakes Jobs

Current research suggests that first responders and protective service personnel are under more distress and suffering from higher rates of potential trauma, PTSD, and secondary trauma than ever before. If we want to continue to be able to rely on them to rescue us when we need them, we should be providing them with the latest research-based training and support available.

Disasters, both man-made and natural, are a worldwide and increasing phenomenon (Federal Emergency Management Act [FEMA], 2011; Johnson, Ronan, Johnston, & Peace, 2014; Saul, 2013), and more of the population will become vulnerable to natural disasters over the next several decades (Johnson et al., 2014). As stated in an executive summary report to Congress by FEMA and the Department of Homeland Security (2013), “we are facing increasing risks and mounting costs from disasters in the near- and long-term future” (p. iii), and “the worldwide loss of life and economic disruption caused by disasters is an increasing focus of attention” (p. 2). While there are calls for an increase in the focus of attention on disasters which, are driven by the increase in the frequency, intensity of, and human vulnerability to natural disasters (FEMA, 2011; Johnson, and Ronan, 2014; Saul, 2013), there does not seem to be an equal focus on an increase in training and support for first responders.

Current research suggests that first responders and protective service personnel are under more distress and suffering from higher rates of potential trauma, PTSD, and secondary trauma than ever before. If we want to continue to be able to rely on them to rescue us when we need them, we should be providing them with the latest research-based training and support available.


Federal Emergency Management Agency (2011). A whole community approach to emergency management: Principles, themes, and pathways for action. Retrieved from

Johnson, V. A., & Ronan, K. R. (2014). Classroom responses of New Zealand school teachers following the 2011 Christchurch earthquake. Natural Hazards72(2), 1075-1092.

Johnson, V. A., Ronan, K. R., Johnston, D. M., & Peace, R. (2014). Evaluations of disaster education programs for children: A methodological review. International Journal of Disaster Risk Reduction9, 107-123.

Saul, J. (2013). Collective trauma, collective healing: Promoting community resilience in the aftermath of disaster (Vol. 48). London, UK: Routledge.

Thapa, A., Cohen, J., Guffey, S., & Higgins-D’Alessandro, A. (2013). A review of school climate research. Review of Educational Research83(3), 357-385.

Increasing First Responder Suicide Rates Spark Concern. Retrieved from:

Basic Science (emphasis on basic) behind Trauma Informed Work


Western science generally separates the human mind into two broad categories; the conscious mind and the subconscious mind. The conscious mind is responsible for things like short-term memory, logical and analytical thinking, and decision making (as in thinking on one’s feet); it is the part of our mind of which we are aware. The subconscious mind holds long-term memory, belief systems, associations, perceptions (and a whole lot more) and is the part of our mind that is, well, not so accessible. The conscious mind is able to process about 40 bits of information per second while the subconscious mind is believed to process upwards of 40 million bits per second. The take away here is not how many “bits” of information an average conscious or subconscious mind can process per second (after all, what constitutes a “bit” of information  depends on an operational definition). The take away is the phrase “a whole lot.” The unconscious mind processes information a whole lot faster than the conscious mind (see “emphasis on basic” in above title).

“Why should I care about my subconscious mind and what does it have to do with trauma?”

Our conscious and subconscious minds process information very differently and without training, do not communicate with one another effectively. When we are stressed, our subconscious minds take over and we lose partial (or complete) access to our more conscious processes. This is how our subconscious mind doing its job.

Our subconscious mind has evolved to keep us safe. When we feel unsafe (and it is largely our unconscious mind that makes this determination) we transition into a more defensive state of consciousness that can feel like wariness on one end of a spectrum to a state of complete overwhelm known as fight or flight, on the other. The degree to which we our subconscious mind takes over and we move to the fight/flight end of the continuum is commensurate with access to our conscious mind – the more we transition into fight/flight, the less access we have to our conscious processes.




Living a Life by Design Instead of by Default 

Some days, or maybe most days, you might feel like a passenger in the backseat of your own car. You are being driven to destinations you don’t want to go by a driver you didn’t pick. You feel stretched too thin. You are exhausted. You feel overwhelmed. You are attending events you’d rather not attend. Your to-do list is filled with tasks you don’t want to do. And the things you do want to do? Somehow those aren’t on the list. This might mean that you’re living life by default, not by design. Thankfully, this is something you can change. In his eye-opening book Essentialism: The Disciplined Pursuit of Less author Greg McKeown shares valuable tips on how we can start living (and working) by design. Essentialism is pursuing less and better (versus trying to get everything done). It is constantly asking the question: “Am I investing in the right activities?” And by “right,” he means whatever is essential to you. It is being deliberate and thoughtful about our days. Below are several tips

Source: Living a Life by Design Instead of by Default | World of Psychology

Caregivers of ICU survivors at high risk of developing depression, emotional distress — ScienceDaily


A new Canadian study focusing on caregiver outcomes of critically ill patients reveals that caregivers of intensive care unit (ICU) survivors, who have received mechanical ventilation for a minimum of seven days, are at a high risk of developing clinical depression persisting up to one year after discharge.

The study, led by Dr. Jill Cameron, Affiliate Scientist at Toronto Rehabilitation Institute-University Health Network (UHN) highlights the need to consider the mental health of caregivers in post-ICU care. While caregiver assistance can be beneficial to patients, such care may have negative consequences for caregivers, including poor health-related quality of life, emotional distress, caregiver burden, and symptoms of post-traumatic stress disorder.

Published in the New England Journal of Medicine on May 12, 2016, the study’s findings suggest patients’ illness severity, functional abilities, cognitive status and neuropsychological wellbeing are not associated with caregiver outcomes. Alternatively, characteristics of the caregiver and individual caregiving situation play a significant role in determining outcomes over the follow-up year.

This study is part of Phase one of the RECOVER Program, a multi-phase project, involving 10 intensive care units across Canada, co-led by Drs. Margaret Herridge, Scientist at the Toronto General Research Institute, and Cameron, in collaboration with the Canadian Critical Care Trials Group. The project aims to identify risk factors for patients and families with the goal of designing rehabilitation models to improve outcomes.

“In the world of critical illness, a lot of research has focused on making sure people survive — and now that people are surviving, we need to ask ourselves, what does quality of life and wellbeing look like afterwards for both patients and caregivers,” says Dr. Cameron, also Associate Professor, Department of Occupational Science & Occupational Therapy and Rehabilitation Sciences Institute, Faculty of Medicine at University of Toronto.

“We need to intervene and support caregivers of all patients, not just the ‘sickest’ patients. Caregivers are not a uniform body of individuals — they have different needs unique to their caregiving situation.”

From 2007-2014, caregivers of patients who received seven or more days of mechanical ventilation in an ICU across 10 Canadian university-affiliated hospitals were given self-administered questionnaires to assess caregiver and patient characteristics, caregiver depression symptoms, psychological wellbeing, health-related quality of life, sense of control over life, and impact of providing care on other activities. Assessments occurred seven days and three, six and 12-months after ICU discharge.

The study found that most caregivers reported high levels of depression symptoms, which commonly persisted up to one year and did not improve in some. Caregiver sense of control, impact on caregivers’ everyday lives, and social support had the largest relationships with the outcomes. Caregivers’ experienced better health outcomes when they were older, caring for a spouse, had higher income, better social support, sense of control, and caregiving had less of a negative impact on their everyday lives.

Poor caregiver outcomes may compromise patients’ rehabilitation potential and sustainability of home care. Identifying risk factors for caregiver distress is an important first step to prevent more suffering and allow ICU survivors and caregivers to regain active and fulfilling lives.

A parallel companion study evaluating patients led by Dr. Herridge, also a Professor of Medicine at University of Toronto has been published in the American Journal of Respiratory and Critical Care Medicine. This project showed that patients who had been on a mechanical ventilator for one-week could be divided into disability risk groups using age and length-of-stay in an intensive care unit and that these groups determine one-year recovery and illuminate the details of functional disability in daily life.

“These findings will help patients and families make vital decisions about embarking on and also continuing treatment in an intensive care unit,” says Dr. Herridge.

“We need to educate patients, families and the public about what we can realistically offer in terms of functional outcome and quality of life for those patients with complex critical illness and who may come to the ICU in a debilitated state or may be older. We want people to understand and make informed choices about their care, given their circumstances.”

The next phase of this research will focus on developing models of rehabilitation to optimize patient recovery and a program for caregivers to better prepare them for their caregiving role, including education and information on community-based resources, access to home care, and how they can draw on social and psychological support.

Story Source:

The above post is reprinted from materials provided by University Health Network. Note: Materials may be edited for content and length.

Journal Reference:

  1. Jill I. Cameron, Leslie M. Chu, Andrea Matte, George Tomlinson, Linda Chan, Claire Thomas, Jan O. Friedrich, Sangeeta Mehta, Francois Lamontagne, Melanie Levasseur, Niall D. Ferguson, Neill K.J. Adhikari, Jill C. Rudkowski, Hilary Meggison, Yoanna Skrobik, John Flannery, Mark Bayley, Jane Batt, Claudia dos Santos, Susan E. Abbey, Adrienne Tan, Vincent Lo, Sunita Mathur, Matteo Parotto, Denise Morris, Linda Flockhart, Eddy Fan, Christie M. Lee, M. Elizabeth Wilcox, Najib Ayas, Karen Choong, Robert Fowler, Damon C. Scales, Tasnim Sinuff, Brian H. Cuthbertson, Louise Rose, Priscila Robles, Stacey Burns, Marcelo Cypel, Lianne Singer, Cecilia Chaparro, Chung-Wai Chow, Shaf Keshavjee, Laurent Brochard, Paul Hébert, Arthur S. Slutsky, John C. Marshall, Deborah Cook, Margaret S. Herridge. One-Year Outcomes in Caregivers of Critically Ill Patients. New England Journal of Medicine, 2016; 374 (19): 1831 DOI: 10.1056/NEJMoa1511160
University Health Network. (2016, May 11). Caregivers of ICU survivors at high risk of developing depression, emotional distress. ScienceDaily. Retrieved May 24, 2016 from

Source: Caregivers of ICU survivors at high risk of developing depression, emotional distress — ScienceDaily