Adjustment Reactions: The Teachable Moment in Crisis Communication

(Traducción en Español )

This is the seventh in a series of risk communication columns I have been asked to write for The Synergist , the journal of the American Industrial Hygiene Association. The columns appear both in the journal and on this web site. This one can be found (more or less identical except for copyediting details) in the January 2005 issue of The Synergist , pp. 47–49.

When someone first learns about a new and potentially serious risk, the natural, healthy, and useful reaction is, in a sense, an over-reaction:

You pause. While you wait to see what’s going to happen, you may stop doing things that suddenly feel dangerous. After 9/11, some people quit flying for a while or stayed away from skyscrapers. During the anthrax attacks, some people hesitated to open their mail. When a U.S. cow was discovered with mad cow disease, some people briefly avoided hamburgers.

You become hyper-vigilant. You watch TV news more than you used to, or check Google News every few hours. You may scrutinize suspicious-looking people in nearby cars, restaurant booths, and airplane seats. You wonder what that white powder might be, and consider whether you should notify the authorities.

You personalize the risk. You imagine what it would be like if it were you – if a risk that is already hurting others and may be coming your way were actually here now. You may even imagine that it is actually here now.

You take extra precautions – precautions that are probably unnecessary, or at least premature. You go out for Mexican food instead of Chinese food if you’re worried about SARS , or Chinese food instead of Mexican food if you’re worried about hepatitis.

These responses are signs of what psychiatrists call an adjustment reaction. They are part of the process of adjusting to the new risk. Here are the key characteristics of the adjustment reaction to crisis.

It is automatic. That is, it’s not entirely under your conscious control. Critics may seize on this characteristic, ridiculing the adjustment reaction as “knee-jerk.” But notice, please, that knee-jerk reactions are sometimes preferable to conscious ones in crisis situations, because they’re quicker. When your doctor checks your reflexes during a medical exam, the doctor is hoping they’re working, knee jerk and all. It is healthy to pull back automatically after touching a hot stove or almost falling into a hole; you don’t want to think about it first. It comes early. We may be in the early moments of a crisis that hasn’t yet gotten big or gotten here. We may be experiencing a precursor event, a potential crisis that either will or will not turn into an actual crisis this time. Obviously it may be a false alarm … or the real thing. That’s when it’s most useful to adjust! A newspaper headline that “Fear Is Spreading Faster than SARS” missed the point. The last thing we want is a crisis that spreads faster than people’s concern about it. It is a survival trait to take a risk seriously before it engulfs you. It is temporary. The adjustment reaction is a temporary phenomenon that eases the transition to whatever is next. Very few people get stuck in a long-term over-reaction. Those who do are said by psychiatrists to have an “adjustment disorder,” and may need clinical help. The rest of us “over-react” only briefly. Then the threat passes and we stop taking precautions; or we settle into the New Normal, a longer-term state of preparedness; or the growing crisis makes our early reaction appropriate. It is a small over-reaction. The adjustment reaction is excessive mostly because it is technically premature, not because it’s disproportionate. If and when the actual crisis arrives, this level of reaction – and more – may well become standard, even mandatory. If the adjustment reaction is way out of proportion not just to what is happening so far but also to what could happen, it is an adjustment disorder. But it may be a little out of proportion. When you pull back from accidentally touching a hot stove, your reflex briefly moves you farther from the stove than is actually needed to avoid getting burned. It may need guidance. Adjustment reactions shouldn’t be disproportionate, but that doesn’t mean they are necessarily well-informed and well-chosen. People who decide to wear a mask because of a SARS outbreak or a chemical release not only tend to put it on sooner than they need it – they may also be wearing the wrong mask or wearing it incorrectly. They may need guidance on how best to act on their fear, on which precautions are wisest. It serves as a rehearsal. The adjustment reaction is an emotional rehearsal, getting you psychologically ready to cope if you have to. It is also a logistical rehearsal; it’s how you start figuring out what to do and how to do it. The value of rehearsing, emotionally and logistically, explains why “premature” isn’t such a devastating criticism. You can’t rehearse after the show starts. People who have gone through a successful adjustment reaction are better prepared to cope with the crisis when it comes. It reduces the probability of later over-reaction. This is the most paradoxical payoff. Because they have rehearsed, because they are better prepared and feel better prepared, people who have gone through a successful adjustment reaction are less likely to over-react to an actual crisis that follows. In this sense an adjustment reaction functions a little like an inoculation. Just as important, people who have gone through a successful adjustment reaction tend to notice more quickly, and recover more quickly, when the crisis is over – or when a threatened crisis has failed to materialize.

This is the teachable moment! Instead of criticizing or ridiculing people’s adjustment reactions to emerging crises, smart crisis communicators encourage the adjustment reactions, legitimize them, ally with them, and guide them.

It’s okay to tell people that they’re jumping the gun a little – that there is still time and you advise them to hold off on particular precautions until the risk gets closer, bigger, or clearer. It’s okay to recommend substitute precautions – precautions that are more useful or less burdensome or less likely to backfire than the ones they’re attracted to. It’s okay to remind them that nobody knows yet whether the situation will worsen or blow over, that they should try to stay poised to ramp up or ramp down their level of concern. That’s all part of guiding the adjustment reaction.

What isn’t okay is to suggest that people shouldn’t be worried yet, that they shouldn’t take any precautions or even think about what precautions they want to take until you give the word. It isn’t okay to tell people that their normal and useful impulse to rehearse is irrational or panicky. Healthy people are going to rehearse. They are going to imagine the worst before it happens and before we know for sure if it’s coming. They are going to take premature precautions. An adjustment reaction is a big improvement over being caught unawares. Don’t try to tell people not to have one. Help them have a good one.

NOTE: My wife and colleague Jody Lanard M.D. introduced me to the psychiatric concept of adjustment reactions. Most of this column is adapted from previous writing by both of us.

Copyright © 2005 by Peter M. Sandman