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Psychological Safety During Uncertain Times

Psychological safety is central to mental health, well-being, and recovery.

Key points

  • Psychological safety is central to mental health and well-being.
  • People often seek therapy because they struggle to feel safe and are overwhelmed by anxiety, panic, and low mood.
  • Being raised in a challenging environment can narrow our window to feeling safe. Our bodies tune to meet adversity.
  • Practicing mindfulness, meditation, grounding, yoga, relaxation, breathing techniques, and spending time out of doors can help.
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co-authored by Dr Nicola Cogan and Prof Stephen W. Porges

Psychological Safety

Psychological safety is central to mental health, well-being, and recovery. People often seek therapy because they are struggling to feel safe. Overwhelmed by anxiety, panic, and low mood, they wish to feel safe again or yearn to for the first time. Feeling psychologically safe is so important that it is one of the main goals of our bodies.

The polyvagal theory describes our subconscious scanning of our environment as "neuroception," a process that actively uses the sensory stream of information to adjust the state of our brains and bodies between three levels of threat response.

When we feel safe, we feel calm, connected, and engaged with others, and our world allows our bodies to support health, growth, and restoration. Whereas when we sense a threat, our "fight-flight response" activates. We feel anxious (flight) or angry (fight) and surging energy toward self-defence. Our sensations heighten, and we become hypervigilant, searching for danger cues (real or imagined). Our bodies prepare us to react to challenges at the temporary cost of supporting stability and nurturance. Stress hormones trigger increased breathing, blood pressure, and heart rate, disrupted digestion, and muscle tension to prepare us for action.

A panic attack is a "false alarm," the same response when we don’t need (or want) it. Our "freeze system" activates if the threat seems more serious. At such times, we "play dead" and experience slowed thinking, withdrawal, and numbness, termed dissociation. While these defence modes are normal in the short term (e.g., we want to react quickly if we accidentally step in front of a car), they can potentially lead to health risks over time.

Unresolved trauma can cause us to respond to past threats as if they are current. When we are raised in a challenging environment, our window for feeling safe can be narrowed, and our minds and bodies can be tuned to meet adversity. This can negatively impact our mental health, trust in relationships, and sense of self.

Creating a safe space is an essential ingredient for psychological therapy, while therapeutic interventions for people who have experienced trauma prioritise a phase of safety and stabilisation in treatment, supporting people to feel safe before traumatic memories are addressed.

Measuring Psychological Safety

To enhance clinical work and research in this growing field, we have developed a standardised measure of psychological safety in partnership with an international team of psychologists and researchers with expertise in trauma and scale development.

The Neuroception of Psychological Safety Scale (NPSS), grounded in the polyvagal theory, comprises 29 statement items with three key sub-scales: Social Engagement (e.g., "I felt accepted by others"), Compassion (e.g., "I felt like I could comfort a loved one") and Bodily Sensations (e.g., "My stomach felt settled"). The NPSS can potentially be used in a wide range of settings, such as in psychological therapy/counselling.

The legacy of the pandemic means that levels of stress, anxiety, and trauma have increased among the general population. This is even more marked among key workers, people with underlying health conditions, and pre-existing mental health problems, leading to moral injury, burnout, and compromised resilience.

Global financial recessions, the rising cost of living, insecure work, climate change, a turbulent political landscape, and the recent war in Ukraine all contribute to modern life seemingly being 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 promote feelings of safety. Organisations that encourage psychological safety have been found to cultivate adaptive learning, creativity, and nourishing relationships with measurable improvements in people's health and well-being. While most of the research on ‘psychological safety’ has focused on safety in the workplace, its applicability is far wider.

This improved understanding of the importance of feeling safe has led to an approach termed psychologically informed medicine which aims to foster feelings of safety to improve mental health outcomes for people requiring medical care. Examples include allowing the soothing presence of loved ones during hospital stays (often prevented by COVID-19), compassionate communication, promoting a healing environment, and challenging disempowering aspects of healthcare such as clinical holding and backless hospital gowns.

How to Enhance Feelings 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 out of doors can help.

Coping statements and practicing self-compassion can also work.

For children, a cuddly toy, a favourite blanket, or being held, sung to, or gently rocked may evoke feelings of safety.

Similar strategies can help us in adulthood, such as reassuring touch (hugs), a comfy pillow, a weighted blanket, listening to soothing sounds, songs, or smells, patting a pet, hearing a familiar voice, seeking out trusted others and switching off from things that challenge feelings of safety (e.g., news or social media).

It is understandable that we may be feeling more on edge just now. We may need to proactively seek strategies to enhance feelings of psychological safety to protect our mental health. If these strategies are not enough, please remember that you are not alone and seek professional support.

Nicola Cogan is a Clinical Psychologist/Senior Lecturer at the School of Psychological Sciences and Health, 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 the Psychology Today Therapy Directory.

References

Morton, L., Cogan, N., Kolacz, J., Calderwood, C., Nikolic, M., Bacon, T., Pathe, E., Williams, D., & Porges, S. W. (2022). A new measure of feeling safe: Developing psychometric properties of the Neuroception of Psychological Safety Scale (NPSS). Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0001313

Cogan N, Kennedy C, Beck Z, McInnes L, MacIntyre G, Morton L, Tanner G, Kolacz J. ENACT study: What has helped health and social care workers maintain their mental well-being during the COVID-19 pandemic? Health Soc Care Community. 2022 Sep 6:10.1111/hsc.13992. doi: 10.1111/hsc.13992. Epub ahead of print. PMID: 36068667; PMCID: PMC9539329.

Morton L, Calderwood C, Cogan N, Murphy C, Nix E, Kolacz J. An exploration of psychological trauma and positive adaptation in adults with congenital heart disease during the COVID-19 pandemic. Patient Experience Journal. 2022; 9(1):82-94. doi: 10.35680/2372-0247.1638.

Morton, L., Cogan, N., Kornfält, S., Porter, Z. and Georgiadis, E. (2020), Baring all: The impact of the hospital gown on patient well-being. Br J Health Psychol, 25: 452-473. https://doi.org/10.1111/bjhp.12416

Morton L. Using psychologically informed care to improve mental health and wellbeing for people living with a heart condition from birth: A statement paper. Journal of Health Psychology. 2020;25(2):197-206. doi:10.1177/1359105319826354

Getting It Right First Time and Every Time; Re-Thinking Children's Rights when They Have a Clinical Procedure, Journal of Pediatric Nursing: Nursing Care of Children and Families, Volume 61, A10 - A12

Tracy Livecchi and Liza Morton (in Press) Healing Hearts and Minds: A Holistic Approach to Coping Well with Congenital Heart Disease, Oxford University Press

Porges, S. W. Polyvagal Theory: A Science of Safety (2022) Frontiers in Integrative Neuroscience, 16, 10.3389/fnint.2022.871227

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