Tag: response

Posted in Life & Happiness

Reactive Versus Proactive

Posted on by Jinavie

The world functions on a cause-and-effect basis, where actions result in reactions. A relevant example for us is how a stimulus will prompt us to respond with an emotion. The stimulus could be physical, such as a hug making us feel loved or pain making us sad, or situational, such as feeling frustrated and angry when things do not go as planned. Our monkey brains are wired to rely on emotional reactions to guide our behaviour.

Emotional reactions can be useful as they are very fast and powerful. Fear activates the fight-or-flight response, letting us flee from danger or prepare us to fight. Disgust teaches us to avoid things that cause us to become unwell. Happiness and love give us energy to carry on through hard times.

However, as powerful as they can be, emotional reactions can also be deleterious. Being overly reactive makes us slaves to our emotions or can result in unhealthy behaviours. For example, reacting with rage, frustration and hysteria builds stress and makes us toxic to people around us. Our monkey brains were crucial to our survival as a species in prehistoric times, but in the modern world, it can cause more harm than good.

The problem with being reactive is that we are not acting, but being acted upon. When we are reactive, we cannot control our response or use rational thinking to solve problems. Instead, we are controlled by circumstances and conditions.

So how can we combat our tendencies to be reactive? The answer is to be proactive instead of reactive. Viktor Frankl wrote in his book, Man’s Search For Meaning:

“Between stimulus and response there is a space. In that space is our power to choose our response.”

The secret to being proactive is understanding that between the stimulus and our response, we have the freedom to choose how we react.

Being proactive is an effective strategy in many aspects of life. Proactivity allows us to plan ahead and prepare for stress and challenges, letting us cope better when hardships strike. In sports and competitive games (or war), the concept of “offence is the best defence” is a fundamental tactic. One of the key concepts of resuscitation is having a plan and preparing for the worst, so that you are not caught off guard when the unexpected happens. This kind of preparedness and flexibility allow us to navigate through this uncertain, ever-changing world.

In a world full of hot takes where we are expected to respond immediately to everything from messages to tweets to headlines, pausing to think in that little space between stimulus and response allows us to access the power of higher order thinking, while letting us be calmer in anxiety-provoking situations. Overall, it helps reduce the stress and frustrations that build up in the background as we constantly encounter unpredictable changes that affect our lives, letting us be more present and content.

There are many ways to train ourselves in utilising this space to take back control of how we respond.

The first step, as mentioned above, is being aware and mindful. What emotion are you starting to feel, why might you be feeling it and do you think your reaction is justified?

Next, determine whether you have the power to change the situation, to remove or weaken the stimulus. Can you remove yourself from the situation? Can you break the vicious cycle by taking a time-out, or change your approach or perspective? Remember that our brains can easily magnify the perception of a threat, distorting our objective view of reality. If possible, take action to modulate the stimulus or your perception of it, so you don’t react as strongly.

If not, then shift your focus to how you can optimise and de-escalate the situation. Think of the consequences of your reaction, if there are any alternate ways to defuse your reaction, if you can think of a positive side or a silver lining, or if there is anything else you can do to help yourself. Instead of thinking “why is this happening to me?“, try to reframe it as “how can I solve this situation?“.

If you find that the fiery emotional reaction is still building despite this, then draw from the wisdom of the Serenity Prayer and accept that there are things outside of your control. Focussing on what you have control over and accepting that you cannot control everything empowers you to take charge of the situation. This lets you be the agent of your own response and story. Meditation is another powerful tool that helps train this approach to facing a problem.

Failing all of that, it is okay to respond with emotion. After all, we are only human and emotions are part of what makes us human. The important part is that you took action and you chose to feel that emotion, instead of being acted upon by the emotion. Indulge in catharsis and let your emotions out. Sometimes, the drunk elephant that is your emotional side just needs to vent and that is a perfectly healthy thing to do (in moderate amounts).

Don’t waste emotional energy to reactivity: be proactive and empower yourself.

Posted in Psychology & Medicine

Bystander Effect

Posted on by Jinavie

March 13, 1964 – Queens, New York. A young woman called Kitty Genovese was running from a man chasing her across the parking lot. She screamed for help as she ran from the attacker but not a single person came to her rescue. The attacker stabbed her repeatedly but the police were never alerted to the incident. The astonishing fact is that not only was there someone watching the whole attack – completely able to call the police or intervene – but there were no less than 38 bystanders.

This case sparked a question in social psychology: what prevented those 38 people from stopping a murder happening in front of them? Was it fear of attracting the assaulter’s attention? The bystanders were all watching from their apartment and calling the police would have been simple and discreet, so this was not the reason. Psychologists designed an experiment to study the natural human response as a bystander in an emergency situation.

The experiment was simple: have participants fill a survey in a room and have the helper leave the room. The helper would then stage a collapse with a yell. The participants’ response would then be observed (particularly their response time).
What they found was fascinating. When only one person was in the room, it was very likely he or she would check to see what happened. But with a group (even three would suffice), the response time would dramatically increase, if they responded at all. Simply put: the more bystanders there are, the less likely someone will step in to do something.

The reason is actually simpler than people think. It is not that people are naturally evil and wish to see others suffer; the bystander effect is a consequence of the basic human psyche.
Firstly, people constantly observe others’ responses in a social situation. This creates a paradox where everyone assumes that since no one is doing anything, they themselves do not act either.
Secondly, there is a shared sense of delusion where people think “others will do it”. This is known as “responsibility splitting” and explains why more people lead to less response.
These two factors combined with cognitive dissonance reduce the guilt and burden of the bystander as they consider it alright to not respond as long as no one else does (or if they do, good for them).

Unfortunately, this effect is so powerful that they occur in about 70% of assault cases and also other emergencies such as a person collapsing from a heart attack (i.e. no one rushes to perform CPR). The same effect is seen in cases of suicides (where the person publicly announces their intentions with no one responding) and classrooms (when the teacher asks the class a question).

This is why one of the greatest tips for emergency response is to pick a single person out and instruct them to do something. For example, “You there, in the red jacket, call the ambulance” is much more effective than “Somebody do something”.

Posted in Psychology & Medicine

CPR

Posted on by Jinavie

CPR stands for cardiopulmonary resuscitation – or in plain English, artificially (and partially) restoring the function of the heart and lungs of an unconscious, pulseless person. As blood flow (perfusion) is critical in the survival of major organs such as the brain, this procedure can save lives by prolonging a victim’s life until the paramedics arrive to provide professional medical care.

When the heart stops beating, or becomes inefficient due to erratic beating, blood flow stops. In the case of the brain, this means that the cells will start dying after 4~5 minutes if perfusion is not restored. CPR can restore about 30% of perfusion, delaying the onset of brain death.

This may be critical when someone suffers a heart attack (myocardial infarction) and paramedics will not arrive for over 10 minutes. Ergo, this is one of the most important emergency skills one should know to help people in need as soon as possible.

There are different guidelines for CPR in many countries, but here is a standard procedure guideline (NZ).
It is summarised into the acronym: DR’S ABCD (doctor’s ABCD), and is a flowchart that goes from one step to the next (detailed explanation after summary).

  1. Danger: check that area is safe and risk-free
  2. Response: check for patient response by shouting, shaking, pain
  3. Send for help: pick one person to call emergency services
  4. Airway: check airway, remove obstruction, tilt head back and lift chin
  5. Breathing: check for breathing, go to CPR if no breathing
  6. Circulation: check for pulse if breathing, if no pulse, start CPR (30 chest compressions : 2 breaths)
  7. (Defibrillation): follow AED instructions

The first rule of first aid is that you must not put yourself in danger. For example, if the patient is on the road, pull them to a safe area to minimise the risk to your own health.

Then, check for a response. The easiest way is to call loudly to them such as “Can you hear me”, and inflicting pain (such as rapping on their chest or shaking their shoulders) and see if they become conscious.

If they remain unconscious, immediately designate a person around you by pointing to them (otherwise they will be less likely to be responsible) to call the emergency service (111, 911, 119 etc.), alerting them the location and state of the patient.

This is the point when clinical skills come in.

Airway: An unconscious person may have their airway obstructed by vomit or their own tongue (which falls back by gravity into the throat). You must secure the airway by scooping out any material, and clearing the tongue out of the way. This is done by tilting the head back far (as if they are looking up), then using one hand to pull their chin out. This opens the airway up so that mouth-to-mouth becomes effective.

Breathing: Put one ear right next to the person’s nose and mouth and check for any breathing sounds or air flow. If they are breathing, check the pulse to see if they are pumping blood. If not, go straight to CPR.

Circulation: It is best to check the central pulses such as the carotid (side of neck, next to the Adam’s apple), brachial (squeeze inner side of biceps) or femoral pulses. The carotid is often the easiest as most people know how to take it. If you feel a pulse, put the patient in recovery position as they are just unconscious, breathing and has blood flowing. If not, proceed to CPR (as you do with when the patient is not breathing).

CPR is composed of two actions: chest compressions and mouth-to-mouth breathing. The former is the strong compression of the chest wall to squeeze blood in and out of the heart; the latter is breathing air into the patient’s lungs and letting exhalation come out naturally.

Chest compressions are often misrepresented in medical dramas, and is extremely important that you do it correctly. First find where the sternum is (centre of ribcage, between the nipples) and place the heel of your left palm on it, then spread your fingers out. Put your right hand over your left and close your fingers around it for a good grip. If the patient is lying flat on the ground (with head tilted back), kneel beside them and stoop over their chest with straight, locked arms (bent arms exert much less pressure).

You are now ready to begin chest compressions. Press down hard, until the chest wall is compressed to about 1/3~½ depth (the chest wall is a springy structure, and do not worry about broken ribs, as being alive is more important for the person), then ease pressure to let it bounce back up. Ideally the time pushing and the time letting it bounce back should be the same, giving a good rhythm. Repeat this 30 times at the beat of 100/min, or in easier terms: to the beats of the Bee Gee’s song Stayin’ Alive (scientifically proven).

After 30 compressions, tilt the patient’s head back, lift their chin up, and lock your mouth over their mouth and nose to make an airtight seal. It is crucial that you use a face shield to prevent the spread of disease. Be aware that breaths are less important than the compressions, so if you do not have a face shield, let someone else do the breathing and focus on chest compressions. Pinch the nose closed to ensure air does not escape.
Forcefully breathe into them and look for the chest rising. Let go of the nose and pull away so that they can breathe out. Repeat once, then return to chest compressions.

After 2 minutes of CPR (30 compressions : 2 breaths, repeat 4 times), change places with another person capable of CPR, as otherwise you will tire out and become inefficient.

Defibrillation is only possible if you are near an AED (automated external defibrillator). Nowadays, AEDs are designed to be completely user-friendly so simply follow the instructions on the machine.

It is important to note that not all abnormal heart rhythms are “shockable” (see Flatline). Follow the AED’s instruction, as it will state whether shock is advised or not. Make sure that CPR is still happening continuously.

Repeat until help arrives.

As a final note, remember that the patient is dead whether you do CPR or not, so there is nothing to lose. Believe it or not, this will be of incredible help in calming your mind when struck with such an emergency. Even with CPR, there is a maximum 30% chance the patient will survive, 10% if it occurs outside the hospital. But if you do nothing, their survival chance will be 0%, so put all your energy into resuscitating them, and you may just save a life.