Therapeutic Operations: Integrating PACE Planning with Modern Mental Health Practices

By: Nichole Oliver LPC, NCC, DAAETS

As a psychotherapist, I often encounter clients who are overwhelmed by life's unpredictability. Whether it's coping with daily stressors, managing significant life transitions, or dealing with mental health challenges, the need for a structured approach to resilience is universal. One powerful framework that can be adapted from the military to civilian life is the PACE plan. Originally designed for mission-critical operations, PACE stands for Primary, Alternate, Contingency, and Emergency. It provides a methodical approach to planning, preparation, and adaptability ensuring that individuals have a comprehensive strategy to handle various scenarios. Let’s explore how PACE can be integrated with therapeutic techniques such as memory reconsolidation, cognitive shifting, interoception, exteroception, proprioception, attunement, hypervigilance, and awareness. We'll also consider how brain functions like the amygdala and hippocampus, subconscious programming, and instinctual actions play a role in this model, drawing comparisons with Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and conditioning.

Primary: Establishing Your Main Support System In the military, the primary plan is the first line of action. Similarly, in therapy, primary support systems and coping mechanisms are crucial for maintaining stability and well-being. The "Primary" plan represents your first line of defense—your most reliable and preferred method of support and self-care. This could be your go-to coping mechanisms, routines, or support networks that you rely on during challenging times.

 Therapeutic Comparison: 

• Memory Reconsolidation: This involves recalling and modifying existing memories to reduce their emotional impact. Primary support in therapy might involve initial sessions focused on memory reconsolidation to address traumatic memories, stabilizing the client’s emotional state.
• Attunement and Awareness: Developing a strong connection with oneself and others forms the foundation of primary support. Regular therapeutic sessions foster this attunement, enhancing awareness of one’s emotions and thoughts.
• Proprioception and Interoception: These bodily awareness skills help clients stay grounded. Activities like yoga or mindfulness, incorporated into regular therapy, form part of this primary support.

Example: For Ryan, a veteran, his primary support system includes weekly therapy focusing on memory reconsolidation to process trauma, daily mindfulness exercises to enhance interoception, and regular physical activities to maintain proprioception. 

Therapeutic Application: Identify and solidify your primary sources of support. This may include regular therapy sessions, chiropractic, and other services to maintain health and wellness, a consistent exercise routine, a close-knit group of friends or family, or engaging in hobbies that bring you joy and relaxation. The goal is to have a strong foundation that you can lean on when things are going well and when challenges arise. Remembering and opening positive neural networks, I have done this before, I have come through worse, what was helpful and what skills do I have and resources to manage in a positive productive way so I can work towards helping and serving others. As one has to first move through and master things personal before sharing and teaching others. 

Example: Ryan, considers weekly lifting classes and bi-weekly calls with friends/lunch, shooting matches, etc. as his primary support system. These activities help him maintain a sense of balance and connection in his nervous system “Polyvagal Theory”-social engagement. 

Alternate: Having Backup Options Alternate plans are essential when primary methods are unavailable or insufficient. Therapy often involves having multiple strategies to manage mental health. Develop alternative strategies and support systems that can step in when your primary ones are compromised. This could involve having a secondary therapist, joining an online support group, or exploring new hobbies that can be done from home. The "Contingency" plan is for less likely but still possible scenarios. It involves thinking ahead and preparing for situations where both primary and alternate plans might fail. Anticipatory helps us plan and move through barriers to entry, habits, blocks to keep up from achieving our goals or plans.  Some of these things are self-sabotage, subconscious we are unaware and other are displaced and out of fear of failing, disappointing, feeling embarrassed, inadequate and even fear of success are the common factors within the experience of the human condition. 

Therapeutic Comparison: 

• Cognitive Shifting (Putting Thoughts on Trial): This technique helps clients reframe negative thoughts. When primary coping mechanisms fail, cognitive shifting offers an alternative way to manage stress.
• Interoception and Exteroception: Developing these skills allows clients to shift focus between internal bodily sensations and external surroundings, providing alternative coping mechanisms.
• Hypervigilance Management (Workout/Lifting/Movement): Learning to modulate hypervigilance ensures that clients can switch to different alertness levels as needed.
• Example: When Ryan's primary therapist is unavailable, he uses cognitive shifting techniques and practices interoceptive awareness to manage anxiety, completing tasks, connecting to friends, family, building his skills sets mentally, physically and spiritually ensuring continuity in his coping strategies. 
• Contingency: Planning for Less Likely Scenarios Contingency planning prepares for less likely but possible scenarios, ensuring readiness for unexpected situations. If that happens, then ____, having a backup plan and shifting thoughts and energy to not fixate or become overwhelmed. Using Stoicism, character building, mind mapping, creating something new, making plans, finding meaning n things, connecting and serving something greater than self, exploring new purposes and ways to utilize skills or expand them in the future…. It is a process of BEING…. Not just doing and thinking. 
• Therapeutic Comparison: TF-CBT and Conditioning: These methods help clients build resilience by reinforcing positive behaviors and coping mechanisms that can be utilized when primary and alternate plans fail. Narrative and deconstructive non-factual events, thoughts or assumptions, noticing and honoring “gut instincts they kept you alive are they helpful or useful here and now? Compare and contrast context and situations to retrain your amygdala like a new puppy.
  
  
• Subconscious Programming and Instinctual Actions: Therapy often involves reprogramming subconscious responses to stress, ensuring that clients have contingency plans based on conditioned positive reactions, discussing, processing, speaking out loud shifting mind and body states “updating software.” How was that helpful, necessary, what did I learn, gain, lose, understand because of or in despite of the situation… existential exploration and evaluation for personal growth and resilience.  “ I am not what happened to me but what I choose to become”

Example: Ryan’s contingency plan includes engaging in TF-CBT techniques to reinforce positive behaviors and using conditioned responses like deep breathing (2 breaths in or diaphragmatic breathing) or visualization exercises when faced with unexpected triggers. 

Emergency: Immediate Action Plans for Crisis Situations Emergency plans are designed for immediate, critical situations. In therapy, having a clear, actionable strategy for crises is crucial. (988 Emergency line, call a friend or family member when therapist is not available, find ways to stay safe…) “Code Red” 

Therapeutic Comparison: 

• Amygdala and Hippocampus Regulation: Understanding how these brain regions influence fear and memory helps in creating emergency action plans. Techniques to calm the amygdala (like deep breathing) and engage the hippocampus (like grounding exercises), challenging core beliefs and assumptions are vital to mental, physical and spiritual health.
• Neuroplasticity: Emergency plans often involve rapid deployment of coping strategies that clients have practiced, leveraging the brain’s ability to adapt and form new neural connections. Our ability to learn, shift and grow throughout the lifespan!!!!

Example: In a crisis, Ryan uses his emergency plan, which includes immediate grounding techniques to engage the hippocampus and regulate the amygdala, and contacting an emergency support network for immediate assistance. 

Integrating PACE with Therapeutic Modalities Adapting the PACE framework for therapy involves integrating it with various therapeutic techniques, ensuring a comprehensive, flexible approach to mental health: for personal use requires introspection and planning. Here’s a step-by-step guide to get you started: 

1. Primary Support: Establish strong foundational practices (e.g., regular therapy, mindfulness) focusing on memory reconsolidation, attunement, and bodily awareness. Reflect on what currently happening “present moment over perfection” helps you manage stress and maintain well-being.
2. Alternate Strategies: Develop backup options such as cognitive shifting and interoception techniques to manage stress when primary methods are unavailable. Identify Gaps and Develop Alternatives: Think about what you can rely on if your primary methods are unavailable. (Circle of control what I can and cannot control”)
3. Contingency Planning: Prepare for less likely scenarios with TF-CBT, conditioning, and subconscious programming to ensure readiness for unexpected challenges and how you would handle them. (three concise questions and shift your mind)
4. Emergency Actions: Create clear, immediate action plans using brain-based techniques and neuroplasticity principles to manage crises effectively. Establish clear, immediate steps for crisis situations, speak them out or write them down if necessary.

By incorporating the PACE framework into your life, you can build a robust, adaptable strategy for managing stress and enhancing resilience. Remember, the key to effective planning is flexibility and the willingness to adapt. Life is full of uncertainties, but with a well-thought-out PACE plan, you can navigate challenges with greater confidence and peace of mind.