In a post not so long ago in a galaxy very near here, we discussed neuroception and the hierarchy of needs. In it, I described how the nervous system’s subconscious evaluation of threat determines one’s ability to engage with, or disengage from, the environment. 

This ultimately shapes the resting tone of the nervous system across a spectrum of open and engaging vs closed and disengaged which I described here. Those who do not feel at risk (whether physically or psychologically – if there’s even a difference) are more likely to pay attention, learn, and adjust to the environment. In other words, they are more successful at the tasks they are asked to perform whether in sport or function. 

Which leads to the following question: What are we really doing when rehabilitating and training? Are we getting stronger and more endurant? Less stressed? 

In my opinion, we are developing new brain pathways and improving the efficiency of established ones in order to systematically decrease the perception of threat. This allows our bodies to better develop and express strength, endurance, power, etc. All that is to say, essentially, that we are learning and changing our perception. 

So how can we set up a proper environment for all these mad gainz to occur?

Consistency and Security

In April of this year, I was fortunate to hear psychiatrist Todd Stull, MD speak at the PRI Annual Symposium. One of my biggest takeaways from his excellent talk was the concept of developing consistency and security in coaching and relationships. He described how consistency thru interactions affects how the brain generates behavior. Expanding upon this, I feel that these two variables also influence the ability to pay attention and learn. 

My working definitions:
Consistency is a predictable set of circumstances, or context, that allows one to form patterns.
Security is the neural assessment of the environment as relatively safe or non-threatening. This includes other people within the environment as well as their perceived expectations. 

The nervous system depends on consistent patterning in a non-threatening environment in order to best learn and perform. Patterns create security (though these patterns may not always be ideal). Security allows for one to pay attention and integrate sensory cues with minimal internal noise or distraction. 

When we are functioning in this state we are better able to acquire and develop skill thru trial and error because it comes from a place of security. The brain is able to pick up and process signals with minimal, transient noise making the response to errors more effective. Think of it as a non-scummy rich guy playing the stock market: he can afford to take more risks because he has financial security – allowing him to learn from his risks and ultimately make more money.

Being secure in a situation also allows us to best access the brain’s attentional resources, namely the nucleus basalis, needed to learn and to have the psychosomatic “flexibility” to perform.

So what happens when these two needs are not met:
Loss of Security: Too much threat and the brain loses prefrontal regulation – we revert to our reptilian brainstem, becoming reactive and rigid. This is paralleled in Stephen Porges’ The Polyvagal Theory and in Robert Sapolsky’s Why Zebras Don’t Get Ulcers with extensive evidence that those who are raised or function in stressful environments are less able to self-regulate, make good decisions, and recall information. Dopamine is still released under stress but it acts to reward outputs that could be considered suboptimal – such as solidifying automatic, reflexive movements.

Loss of Consistency: Perform a task that is way too complex or difficult as compared to prior tasks and the brain is unable to adapt with new patterns. Perform a task that is much too easy or boring, like that which you would probably see in a traditional therapy setting, and attention is lost. Loss of attention is the bane of effective learning. A loss of consistency can also be a loss of security as too much unpredictability gives the sense of having no control – this is why your dog freaks out when you come home late and break routine.

If consistency and security are lacking, then the brain gets overly busy and cannot properly process and integrate the information it is receiving. The signals coming into the brain cannot compete against the background noise caused by the brain being tied up with stress – the brain is unable to focus. “Muddy signals in, muddy signals out”. 

Setting the Stage

So here a few ideas for clinicians and coaches to create a consistent and secure environment:

  • Avoid threatening language and ultimatums 
  • Carefully modulate vocal intonations and facial expressions. Avoid mismatches as I see this often: physio/coach says one thing but their tone and expression says the opposite. You can’t say “everything is gonna be alright” while your face says “you’re so screwed, I have no clue what’s going on”. As my mother always said, “it’s not what you said, it’s the way you said it”
  • Avoid pathoanatomic explanations
  • Build trust thru a series of positive interactions in which your behavior is predictable regardless of the client’s mindset or behavior – this is the consistency piece.
  • Find out what drives the client. What is their passion? This bumps the security and trust factor up big time and it helps figure out the underlying pattern that likely brought them in in the first place
  • Develop a semi-standardized routine – too much routine and it becomes boring and redundant with minimal stimulus for growth. Too little routine and there is a sense of loss of control and trust (“does this guy know what he’s doing?”) as well as a lack of consistent stimuli for adaptation
  • Be clear with expectations and timelines and follow-thru on them
  • Maintain eye contact where appropriate to cultivate a connection
  • Be fully present – actually listen and observe
  • Apply calculated stressors that you know the client will perform well in, even if they are skeptical. This recovery from an acute stressor engenders an anti-fragile mindset. Though this is much easier said than done as it may be one of the most fundamental keys to being an excellent physio or coach.

seems like a good guy…

Now this is not to say that everything we do should be warm, cozy, and stay the same in order for us to learn. Far from it. Improving function requires that we gradually stress and challenge the organism following the principle of minimizing danger and maximizing reward. Acute, moderate stress with the opportunity to recover is necessary for growth and adaptation – it just needs to be manageable and in a safe environment. We will discuss this more in future writings.

Without setting up a proper environment, using the principles of consistency and security, our goals of improving resilience and efficiency while mitigating the stress response – all thru the formation of neural patterns – are sabotaged.

– Seth
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