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BOS – BEFORE OPERATIONAL STRESS

BOS HELP/INFORMATION

Be the BOS of your mental health.

Public service personnel are exposed to operational stress every day. But the effects of operational stress don’t have to last a lifetime. BOS is about empowering public service employees to be in charge of the effects of operational stress, versus the effects of operational stress being in charge of them. This program has been designed to serve and protect public service personnel as they serve and protect us all.

 

Introducing BOS

Dr. Megan McElheran
CEO & Chief Clinician
WGM Psychological Services Ltd.

BOS Can Help

For the first time in our history, governments and communities are coming together to acknowledge the psychological impacts of those we rely on every day to serve and protect us.

We are gaining important insights in just how public service personnel—our military, police, firefighters, paramedics and others suffer psychological effects merely by doing their jobs in service to all of us.

I have seen in my clinical practice how psychological injuries, if left unaddressed, can change the lives of our public service personnel in profoundly negative ways. We are now better positioned to do more as a society to help these populations from suffering the effects of on-the-job psychological injuries.

Let me introduce the BOS program (Before Operational Stress). This program has been carefully designed to provide public service personnel with theoretical, practical and experiential learning to enhance their resilience and mental health as they continue to operate within their public service positions. It is a unique program that brings together cutting-edge clinical approaches with recognized scientific expertise to support psychological health and wellness of public service personnel over the course of their operational careers.

It is intended to empower public service personnel to take charge of their mental health by giving them specific knowledge and techniques to do so. It is one way we are helping to serve and protect those who serve and protect us.

I have seen in my clinical practice how psychological injuries, if left unaddressed, can change the lives of our public service personnel in profoundly negative ways.

Why BOS?

BOS uniquely combines theoretical and experiential learning procedures to mitigate the effects of operational stress.

 

Growing awareness

Our national awareness regarding the impact of operational stress on public service personnel in Canada has grown substantially in the last several years. Influenced by the experiences of soldiers returning from Afghanistan in the late 2000s, we have come to understand the far-reaching and long-standing negative effects operational stress can have. The gathering of epidemiological data of the public service personnel experience in Canada continues. A recent study of Canadian public service personnel determined that almost 45% of those surveyed reported symptoms consistent with an operational stress injury.1

Operational stress injuries alter the personalities of public service employees. They render employees vulnerable to persistent anxiety, anger and irritability. Nightmares and intrusive reactions develop, which make it increasingly difficult for public service employees to leave their houses, or to feel a sense of safety anywhere within their environments. Relationships are impacted. When the effects of operational stress begin, social isolation and emotional disengagement become the norm. Spouses and children suffer as a result. If the effects of operational stress continue, functional impairment becomes commonplace, and a common effect is that public service personnel are rendered unable to work. And that does not have to be the only story.

A recent study… determined that almost 45% of those surveyed reported symptoms consistent with an operational stress injury.

 

What is BOS?

Our evidence tells us there are things we can do to mitigate the impact of operational stress so that public service personnel can do their jobs, be exposed to operational stress without it resulting in tragic consequences. Will public service employees be exposed to operational stress? The answer is ‘yes.’ Will they need to take precautions and do some work to address operational stress when it occurs? The answer is also ‘yes.’ But public service employees are not destined to have their lives ruined by the effects of operational stress.

BOS empowers public service employees to be in charge of their mental health. We know that there is information these employees need to protect themselves from the effects of  operational stress. We know there are experiences these employees need to better protect themselves from operational stress. And we know they need practice and support to incorporate  this knowledge and these experiences into their operational roles. BOS delivers on these three objectives.

 

 

 

 

 

 

 

 

 

How BOS works

BOS is a group-based intervention that provides participants the opportunity to receive and offer support in the context of the group as issues related to operational stress are processed.  Different than classroom-based learning, a key feature of BOS is the care that will be given to developing the group. Therapeutic change is enhanced when group members are supported  to know each other in a more in-depth and supportive fashion. We set rules of engagement for the group that allow it to be a safe place for issues to be processed. Once the group is  established, specific information relevant to operational stress can be provided and its relevance explored by group participants. The group dynamic is a powerful change mechanism in  and of itself.

BOS also uniquely combines theoretical and experiential learning procedures to enhance understanding of how to mitigate the effects of operational stress. Within each module,  participants will receive education and the content of that module and its impact on participants will then be discussed and processed within the group.

Another important component of BOS is embedded peer support. A public service employee who is in the latter stages of recovering from an operational stress injury will provide peer  leadership within the context of the group. A vast research base has consistently highlighted over and over again the importance of peer support in terms of protection and recovery from the effects of operational stress.

Once the group is established, and the rules of engagement have been determined to support safe and effective function of the group, the next phase of work within BOS can begin.

By The Numbers

BOS is a 16-hour program divided into eight modules delivered to groups of up to 12 public service personnel.

 

BOS Program Structure

Different from classroom based instruction, BOS is a 16-hour program divided into eight modules, all delivered in a group setting of up to 12 participants.

The ideal dosage of BOS is over eight consecutive weeks which allows participants opportunities between group sessions to incorporate the learning from week to week. This can, however,  be modified to meet the unique organizational demands of public service agencies.

An additional unique feature of BOS is that following the delivery the 16-hour program, scheduled monthly follow-ups will occur to enhance consolidation of the learning and experience of the program.

Module 1: Operational service cultures

Public service organizations have been influenced by an historical approach to public protection that encourages stoicism as a fundamental attribute required as part of their work. BOS  will begin with an exploration of operational service cultures and how valued attributes of stoicism, which continue to be important, must be understood in the context of public service protection.

A visual media tool will be used to enhance understanding of this concept and the dissemination of the knowledge within this module will then be discussed within the group to explore relevance of the information to group participants.

What participants will take away from this module is an enhanced understanding of stoicism and how these cultural attributes can interfere with processing natural reactions to human suffering.

Module 2: Neural effects

What we know about operational stress injuries, and particularly the injury of Post-Traumatic Stress Disorder (PTSD), is that pathological disruption of specific neural pathways occurs.  In essence, exposure to chronic, unprocessed operational stress results in changes to the brain.

This module serves to enhance participants’ understanding of natural responses to stress and the importance of supporting the finishing of a limbic response to stress when it occurs. That is, participants will learn the importance of, and techniques, to facilitate the processing of natural responses to stress so as to mitigate pathological disruption to the neural circuitry implicated in PTSD.

Module 3: Markers

We are normalizing the understanding that public service personnel are going to be exposed to operational stress. This module serves to help participants’ understand and recognize the  cognitive, emotional and behavioral markers of operational stress within themselves. The objective of this module is to enhance participants’ ability to engage in self-monitoring to  increase their ability to recognize when intervention is required.

BOS can enhance participants’ ability to engage in selfmonitoring to increase their ability to recognize when intervention is required.

Module 4: Cognitive impacts

This module will focus on understanding how operational stress can negatively impact cognition. For the purposes of this module, cognition implies thoughts about ourselves, others and  about the world as a whole. It also incorporates understanding of operational stress and its impact on information processing. Participants will be supported to understand the  relationship between operational stress and cognitive change, and they will be provided with specific techniques to intervene on patterns of cognition. Operational stress causes fiery  thinking. This module gives participants techniques to calm their thinking.

Module 5: Emotions

Human beings all come into this world with a basic, universal set of emotions. One need only spend time with a small child to understand what those emotions are. In the context of stoic  service cultures, public service personnel are often socialized to treat some emotions as more acceptable than others, leading to suppression of emotions deemed unacceptable. When  certain emotional experiences are denied or avoided, the risks of intensifying operational stress effects are increased. This module will focus on the nature and purpose of the basic human  emotions. Participants will be supported to understand the role of each emotional experience and will be encouraged to relate to all emotional experience differently than what  stoic service cultures would encourage.

Module 6: Behaviour change

One of the most common effects of operational stress is negative behavioral change. When stress intensifies, public service personnel commonly change their daily activities, often losing  interest in activities they once enjoyed as well as to become more avoidant of situations that remind them of operational experiences. This module will focus on the importance of behavioral activation and how participants can utilize graded behavioral exposure to maintain regulated and valued daily activity. Public service personnel remain healthy when they  have a personal life that they value. It remains essential for public service personnel to be able to disconnect from their operational role and having valued personal activities supports  their ability to do so. This module addresses this objective.

Public service personnel remain healthy when they have a personal life that they value. It remains essential for public service personnel to be able to disconnect from their operational role and having valued personal activities supports their ability to do so.

Module 7: Communication

Those under operational stress commonly become less outwardly expressive. Sometimes public service personnel struggle to know what it is they’re thinking and feeling, and struggle  putting those thoughts and feelings into words. This creates fertile ground for communication and relational breakdown because those suffering the effects of operational stress are  vulnerable to misinterpreting the intentions and experiences of others. The downstream effects of this are social isolation and loss of relationships, whether personal or occupational. This  module focuses on the understanding and practice of three specific communication skills that support effective communication. These three skills are: paraphrasing, perception check,  and clarification. While seemingly simple, these are robust communication interventions to enhance interpersonal understanding.

Module 8: Empathy

There is a beautiful paradox that is implicated in a disorder like PTSD. That is, in order to suffer the effects of being exposed to human suffering, one must have an inherent empathic response to the human being to whom suffering occurs. However, having an empathetic response inherently renders one more vulnerable to that very exposure.

This module serves to help participants understand that their capacity for empathy in the face of human suffering will help them to be good at their job. Yet it is that capacity for empathetic response that will render them more vulnerable to the effects of human suffering. It is this vulnerability that, if managed appropriately, will insulate them from the negative  effects of operational stress.

At the conclusion of this discussion, the group will be brought to a close and participants will be given the opportunity to engage in a process of saying goodbye to group members in this  format. The nature of the work of public service personnel often does not allow for a sense of closure.

Bringing the group to a deliberate and thoughtful close provides participants with the experience of bringing a sense of closure to something that’s been meaningful. This is therapeutically powerful.

Paradox of Empathy

The capacity for empathy will render personnel more vulnerable to the effects of human suffering. Yet it is this vulnerability that will insulate them from the effects.


1 Carleton, NR., et., al. Mental Disorder Symptoms among Public Safety Personnel in Canada. Canadian Journal of Psychiatry. 2018; 63; 54 – 64.

 

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