A new measure of psychological safety for patients

Researchers devised the scale, consisting of 29 items, to assess how safe a person feels. It is further divided into three sub-scales of Social Engagement, Compassion and Bodily Sensations.

The items were identified from the responses to a questionnaire, in which participants were asked how strongly they agreed with 107 statements such as: 'I felt understood'; 'I felt compassion for others,' and 'my heart rate felt steady.'

Using statistical methods, the researchers established which statements were most associated with feeling safe, leading to the 29-item scale.

The measure, which has been named the Neuroception of Psychological Safety Scale (NPSS), is the first of its kind, combining psychological, physiological and social components. It has the potential to be used in a broad range of settings, such as tracking progress in psychological therapy or assessing whether a sense of psychological safety enhances learning or improves hospital outcomes.

It can also be applied to psychological safety in the wake of the COVID-19 pandemic.

NPSS is informed by the Polyvagal Theory (PVT), which offers a comprehensive explanation of psychological safety grounded in an evidence base of neurophysiology, psychology and evolutionary theory.

The study has been published in the journal Psychological Trauma: Theory, Research, Practice, and Policy.

Dr Liza Morton, who led the research, was based at Strathclyde during the study and is now a Lecturer in Applied Psychology in Glasgow Caledonian University's Department of Psychology. She said: "The importance of feeling psychologically safe for health and wellbeing is being increasingly recognised. Feeling psychologically safe is essential for protecting us from stress, anxiety and low mood, while promoting post-traumatic growth following adversity.

"When we feel safe, we feel connected and engaged with others and our world and our autonomic nervous system can support the processes of health, growth and restoration. Whereas when we sense threat, our 'fight-flight response' is activated. We feel anxious or angry and a surging energy towards self-defence. Our sensations are heightened and we become vigilant, searching for danger cues, real or imagined.

"This improved understanding of the importance of feeling safe has led to an approach I've termed Psychologically Informed Medicine, which aims to foster feelings of safety to improve mental health outcomes for people requiring medical care. This complements my health advocacy, for people like myself, who depend on livelong medical interventions.

"We have developed this standardised measure of psychological safety to enhance clinical work and research in this growing field."

Dr Nicola Cogan, a Senior Lecturer in Strathclyde's School of Psychological Sciences & Health, is also a co-author of the research. She said: "Clients often seek therapy because they are struggling to feel safe, blighted by anxiety, stress and low mood. They often wish to feel safe again, or indeed yearn to for the first time.

"Early adversity and repeated exposure to adverse life events can bias us towards sensing threat, which can significantly challenge feelings of safety and compromise our physical and psychological wellbeing.

"Organisations that encourage psychological safety have been found to cultivate adaptive learning, creativity and nourishing relationships, with measurable improvements in peoples' health and wellbeing."

The study also involved: partners from the Traumatic Stress Research Consortium at Indiana University's Kinsey Institute, including Professor Stephen Porges, the founder of Polyvagal Theory, and Dr Jacek Kolacz; Strathclyde Teaching Associate Dr Damien Williams and MSc students Calum Calderwood and Marek Nikolac. Dr Thomas Bacon, Clinical Psychologist with NHS Fife, and Dr Emily Pathe, Counselling Psychologist with NHS Lanarkshire, contributed to item development.