Cognitive Appraisal and Stress Performance: The Threat/Challenge Matrix and Its Implications on Performance

Stress has the potential to improve performance through increased focus and strength or negatively impact performance through distraction and decreased fine motor control. The first step in the distinction between success or failure in a stressful situation is making the decision to engage in the process or withdraw. Cognitive appraisal describes the process of evaluating a stimulus as either a challenge to be met or an overwhelming obstacle from which to retreat.

Providers in the air medical community are required to perform in inherently stressful and unpredictable situations that may threaten to devastate personal resources. This paper is a literary meta-analysis of existing literature on stress performance, threat assessment, and cognitive appraisal in the medical environment.

Preparing for stressful situations is not only accomplished through the practice of skills and rehearsal of knowledge, but also cognitive readiness, mindfulness, and encouragement of team members. Positive cognitive appraisals is practiced through simulation, case study, and purposeful mental practice. Deciding to actively engage in problem solving through the lens of overcoming obstacles and meeting challenges with confidence provides the mental framework that recruits the inevitable sympathetic surge for benefit rather than impairment.

Cognitive appraisal describes the decision to focus on the challenge rather than threat of the situation based on the skills, knowledge, and experience of the team. Establishing a positive narrative and actively engaging in challenges increased confidence and improves performance of medical providers.