tree from below
Source: Liza Morton
Co-written with Nicola Cogan and Stephen W. Porges
Psychological safety is essential to mental health, well-being and recovery. People often seek therapy because they have trouble feeling safe. Overwhelmed by anxiety, panic and bad mood, they wish to feel safe again or long for it for the first time. Feeling psychologically safe is so important that it is one of our body’s main goals.
Polyvagal Theory describes our subconscious analysis of our environment as “neuroception,” a process that actively uses sensory information flow to adjust the state of our brain and body between three levels of threat response.
When we feel safe, we feel calm, connected, and engaged with others, and our world enables our bodies to support health, growth, and restoration. Whereas when we sense a threat, our “fight-flight response” activates. We feel anxiety (flight) or anger (fight) and a surge of energy towards self-defense. Our sensations intensify and we become hypervigilant, looking for signs of danger (real or imagined). Our bodies prepare us to respond to challenges at the temporary cost of supporting stability and caring. Stress hormones trigger increased breathing, blood pressure and heart rate, upset digestion and muscle tension to prepare us for action.
A panic attack is a “false alarm”, the same response when we don’t need it (or want it). Our “freeze system” activates if the threat seems more serious. At such times, we “play dead” and experience a slowing of thought, withdrawal, and numbness, called dissociation. While these modes of defense are normal in the short term (for example, we want to react quickly if we accidentally run over a car), they can potentially lead to health risks over time.
Unresolved trauma can cause us to react to past threats as if they were current. When we are raised in a harsh environment, our window to feel safe can be reduced, and our minds and bodies can be tuned to deal with adversity. It can negatively impact our mental health, confidence in relationships, and self-esteem.
Creating a safe space is an essential ingredient of psychological therapy, while therapeutic interventions for people who have experienced trauma prioritize a phase of safety and stabilization in treatment, helping people feel secure. safety before traumatic memories are addressed.
Measuring psychological safety
To enhance clinical work and research in this growing field, we have developed a standardized measure of psychological safety in partnership with an international team of psychologists and researchers specializing in the development of trauma and scales.
The Neuroceptive Psychological Safety Scale (NPSS), based on polyvagal theory, comprises 29 items with three key subscales: social engagement (e.g., “I felt accepted by others”), compassion (eg, “I felt like I could comfort a loved one”) and bodily sensations (eg, “my stomach calmed down”). NPSS can potentially be used in a wide range of contexts, such as psychological therapy/counseling.
The legacy of the pandemic means that levels of stress, anxiety and trauma have increased in the general population. This is even more pronounced among key workers, people with underlying health conditions and pre-existing mental health issues, leading to moral injury, burnout and compromised resilience.
Global financial recessions, the rising cost of living, precarious work, climate change, a turbulent political landscape and the recent war in Ukraine all contribute to modern life seemingly surrounded by constant psychological threats. Perhaps more than ever, we could benefit from a focus on enhancing feelings of psychological safety to facilitate our collective recovery.
Building safer societies
Our hospitals, schools and workplaces could be better designed to foster a sense of safety. Organizations that promote psychological safety have been found to cultivate adaptive learning, creativity, and nurturing relationships with measurable improvements in people’s health and well-being. While most research on “psychological safety” has focused on workplace safety, its applicability is much broader.
This better understanding of the importance of feeling safe has led to an approach called psychologically informed medicine that aims to promote feelings of safety to improve mental health outcomes for people requiring medical care. Examples include allowing the calming presence of loved ones during hospital stays (often prevented by COVID-19), compassionate communication, promoting a healing environment, and questioning aspects disempowering health care such as clinical attire and backless hospital gowns.
How to improve the feeling of psychological safety
There are many ways to enhance feelings of psychological safety. Different strategies work for different people. Practicing mindfulness, meditation, grounding, yoga, relaxation, breathing techniques, and spending time outdoors can help.
Dealing with statements and practicing self-compassion can also work.
For children, a stuffed toy, a favorite blanket, or being gently held, sung, or rocked can evoke feelings of security.
Similar strategies can help us as adults, such as a reassuring touch (cuddling), a comfortable pillow, a weighted blanket, listening to soothing sounds, songs or smells, petting a pet, hearing a familiar voice, seek out people you trust and turn off things that challenge feelings of safety (eg, the news or social media).
It’s understandable that we might be feeling more nervous right now. We may need to proactively seek out strategies to enhance feelings of psychological safety to protect our mental health. If these strategies are not enough, remember that you are not alone and seek professional support.
Nicola Cogan is a Clinical Psychologist/Lecturer in the School of Psychological and Health Sciences, University of Strathclyde, Glasgow, Scotland, UK.
Stephen Porges is a Distinguished University Scientist at Indiana University/Founding Director of the Traumatic Stress Research Consortium, Kinsey Institute.
To find a therapist near you, visit Psychology Today’s Directory of Therapies.
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