Vigilance Or Hypervigilance? Proactive Protection Or Mental Health Concern?

STAY VIGILANT!

This a common directive in military and first responder cultures. Many heroes in these cultures seem to be hardwired to protect with vigilance coming naturally. Combine a personality that naturally leans this direction with specific training to refine this protective awareness, and the result is a highly trained soldier or first responder ready to step into danger at a moment’s notice.

When working with the military and first responders in therapy how do we distinguish between vigilance characterized by proactive protection and the mental health concern of hypervigilance? I offer that not all vigilance is hypervigilance, and it is important to not mistake one for the other. This is a complex discussion, but here are a couple thoughts to consider.

Impairment

How are the proactive protective measures impacting life? Some of these behaviors may be present even when not “on the job,” but how are they impairing your client’s life? Transitioning from training, deployment, or shift work in a bad part of town to home life may make it difficult to switch vigilance on and off. A certain level of vigilance on and off the job may be appropriate considering the difficult work these professionals do. This vigilance may not be hypervigilance, and addressing it as such may alienate the client. However, if this vigilance moves into impaired functioning in life perhaps hypervigilance is present and attention here is warranted.

Self of the Therapist

Here are a few questions to explore when working with these heroes, especially if military and first responder cultures seem a bit foreign. These questions can be used for personal reflection, for a peer consult group, or clinical supervision. How is the vigilance presented by your client impacting you? What happens for you when your client describes their vigilance on and off the job? How familiar are you with your client’s military or first responder culture? How foreign do these behaviors seem to you? It may be helpful to consider that what may be vigilance for your client may be hypervigilance for you. What may be normal everyday behaviors that do not impair your client’s life may be very disruptive if these behaviors were present in your own life.

What is important to you when making the distinction between vigilance and hypervigilance with your military and first responder clients?