Motivation and emotion/Book/2019/Thai cave rescue motivation and emotion

Overview
On 23 June 2018, 12 young boys and their soccer coach entered the Tham Luang cave system in Thailand. Shortly after entering the cave, early monsoon rains flooded the cave system and made it impossible for the boys and their coach to make their own way out. Stranded some 2.6km underground, with completely flooded sections of cave preventing their exit and placing risk on their lives, their escape was only possible by being sedated and removed from the cave by a rescue team including experienced police and military divers, cave divers and medical professionals. For specific details of the wider mission, see Tham Luang Cave Rescue.

This book chapter focuses on the efforts of Dr Richard Harris, an Anesthetist from South Australia who had significant experience as a cave diver. In particular, we seek to understand the motivation and emotion that might have been experienced by Dr Harris during the rescue mission.

Dr Harris was engaged by members of the rescue team on July 5 2018. He traveled to Thailand to participate in the mission, however he had no expectations of the mission being a success. This expectation remained until the first group of children were successfully evacuated from the cave, and all of the children and their coach were successfully extricated from the cave. With that in mind, what aspects of human motivation might have prompted him to engage with the rescue team, plan and eventually execute the mission? And what different aspects of human emotion Dr Harris might have experienced?

Interaction between motivation and emotions and their role in the Thai Cave Rescue
Motivation in this high-risk situation is also driven by emotion. While Dr Harris appears to be calm and measured before, during and after the event, there is indeed a significant role played by emotions in the initial engagement and ongoing participation in the rescue attempt.

As noted by Reeve (2018, p. 290), emotions are one type of motive, and can energize, direct and sustain behaviour. To explain why Richard Harris participated in a rescue mission with expectation of failure, we look to the emotions of interest, joy and hope. We also look at the role of empathy and compassion, and unpack the concept of empathy a little deeper to understand how Dr Harris may have been able to feel empathy in a cognitive way and use this as a motivator, as opposed to an emotion that may have hampered rescue efforts.

The emotion of interest would have played an overarching motivational role throughout the entire event. Interest is not so much activated as it is redirected in response to changes in the environment  (Reeve, 2018, pp.347-348). These changes can include stimulus change, novelty, uncertainty, complexity, curiosities, challenges and discoveries. Key to this is the opportunity to gain new information and develop a greater understanding and learn. With each step of the way the environmental complexities changed. Each of these changes would bring on renewed and morphing interest, curiosities, challenges and experiential learning opportunities.

About the Thai cave rescue
The following information is extracted from personal recounts of the event by Dr Richard Harris (2018 & 2019).

The cave system comprises of approx. 10km of caves of varying size, terrain and depth. The persons who were trapped in the cave had entered with the aim of reaching a certain point in the cave, and it was on their way back out that they became trapped by rapidly rising floodwater. The alarm was raised when parents had notified various people that they had not yet returned, and a ranger at the caves found the children’s belongings, signaling that they were indeed within the cave system.

Upon consideration of the barriers to the mission, it was quickly established experienced cave divers would be required to act swiftly before the entire cave system flooded. These barriers included the location of the children, some 2.6km into the caves. Over 1km of that distance was completely flooded and the water had very strong currents and zero visibility. This required a ‘through water cave rescue’ with children who had no diving experience and in fact could not swim. Parts of the cave were restricted, with tight spaces to navigate through. Certainly not a mission for an inexperienced and unqualified diver.

The boys were trapped for 9 days before they were located. This discovery was only possible due to a break in the monsoonal rain, as well as the hard work of locals further north who had dug and sandbagged the area in order to divert as much of the incoming floodwater as possible. There were also thousands of litres of water being pumped out from the cave system in an effort to reduce existing water levels.

After much deliberation, there were 2 clear options:

1) Leave the children in place, and support their life as long as possible. While ever divers could access the group, they could continue to provide food, water and medicine. However, due to the impending monsoon rains, it was expected that the cave system would be completely flooded within days, and remain inaccessible for up to about 4 months. This would mean provisions would not be able to be brought to the group. They would either die of starvation and infection, or through drowning. This was a certainty.

2) Sedate the children and dive them out. Using a full face oxygen mask, and strapping the children into ‘streamlined packages’ to the front of a single cave diver, they would be sedated and would be transported over 3 hours out of the cave. When not under water, they would be transported by stretcher across sand, rocks and chest-deep water. When under water, their diver would be required to navigate through zero visibility, fast flowing water and very restricted spaces (maximum water depth was 5 meters). This meant that at any time they could knock the full face mask out of place and this would result in drowning. Due to the positioning of the child and the diver, the mask dislodging would not be known until surfacing in the next chamber, by which time there would be little or no chance of reviving the child.

This option also posed other risks, including lack of medical support (the guide divers were a retired fireman and IT specialist). In Should the sedation wear off, there was a risk the child would panic, dislodge their own mask and drown. This also posed a risk to the rescuers trying to manage a flailing child in a completely submerged and restricted space. There was also no provision for responding to any medical emergency or adverse reaction that arose.

There was also the risk of hypothermia, with both a drop in core body temperature as physiological response to anesthesia as well as the cool temperature of the floodwaters. Should the child’s head fall forward while they were sedated there was also a risk of choking from an obstructed airway.

Motivation
The initial engagement with Dr Harris was to pose the question about sedating the children. Harris responded that this was absolutely not an option, however he offered to travel to Thailand to assist.

This initial motivation was likely drawn from a number of factors, the first of which is self-efficacy beliefs (Reeve, 2018, p. 231). As Dr Harris’ considered participating, he would have drawn on his sense of self-efficacy for both cave diving and for practicing medicine. He had been in many varied situations that allow for the observing and practicing of both skill sets and effective performance in difficult circumstances. This allows for an understanding personal behaviour history and vicarious experience, albeit for each skill set separately, but not together (Reeve, 2018, p.231, 233). He also noted being ‘up for the challenge’ which suggests he drew a sense of self-efficacy from his physiological state.

We have seen beliefs of self-efficacy play a role in motivating other health professionals before, as documented by Nishigori et.al. in the case of the Japanese Tsunami in 2011 (Nishigori, 2019, pp.2 4-32). In this research it was self-efficacy beliefs that prompted what was titled the ‘duty of the capable’, where medical professionals felt obliged to support because they were competent to do so.

This same research also showed a testing of self-efficacy beliefs, where the participants reported a motivation to apply their skills in new and difficult situations, to find out ‘what they were capable of under exceptional circumstances’. It is possible that Dr Harris was implicitly motivated by achievement, and therefore strives to experience situations to test and demonstrate high achievement (Reeve, 2018, pp. 158-159). The sense of a difficult challenge immediately had his interest and when the opportunity arose to support the mission, he immediately offered to help. Even with significant experience in both cave diving and anesthesiology, this was a new combination of both and likely was a tantalizing opportunity to test personal competence.

Emotion
During this stage of the mission, the emotion labelled as Interest would have played the main emotional role. At this point, it may have been a combination of a new cave diving challenge, combined with a potential to broadly use his skills and knowledge in medicine to assist in any way.

Motivation
After diving the cave to gain an intimate understanding of the situation, and after much deliberation with the rescue team, there emerged 2 clear options, but in Dr Harris’ mind there was only 1 expected outcome. What motivated Dr Harris and his peers to commit to, and execute the plan, even though it came at great risk to them personally?

If we consider the concept of mindset and the resultant motivating forces, an rationale can be found in the sequential patterns of thought that are deliberative and implemental mindsets (Reeve, 2018, pp. 204-206). Upon arriving at the scene, considering all available options and deciding on a plan, Dr Harris and his peers were exercising a deliberative mindset. This is in contrast to the local authorities, who were having difficulty making decisions and had no solid plan to recover the children (Harris, 2018, np). Harris notes this was likely due to the cultural and political environment of the local community.

Once a plan was decided on, testing began with local children in a pool. Once this was considered successful, the deliberative mindset switched to implemental, and the focus was then solely on extricating the children, and all other peripheral information not pertaining to the task at hand was shut out. Reeves (2018, p.206) notes a key facet of an implementation mindset is demonstration of cognitive tuning towards a step-by-step way of thinking and problem solving. This is evidenced by Dr Harris talking of a ‘recipe’; a step-by-step plan that he introduced to the trapped boys to inform them of the steps in attaining the goal – getting them out alive.

Considering a second mindset theory, that of promotion vs prevention, it would appear that Dr Harris was employing a promotion mindset, and this is evident in the way the mission is discussed. A promotion mindset is gain-framed; and motivated people to achieve or gain, whereas a prevention mindset motivates for action that avoids loss (Reeves, 2018, pp.207-208). This warrants thought of how the situation was framed. In either of the 2 scenarios, the expectation was that all lives would be lost. So proceeding with the mission, and failing, would not be a ‘loss’ scenario, rather a faster and more controlled outcome. Also, as raised by Dr Harris (2019, np.), in the case of diving the children out, if lives were lost they would ‘be asleep when it happened’. This would have motivated Dr Harris to ‘just do it’, with the potential gain in this case being a faster and more humane outcome for both the boys and their families.

One such paper that supports this framing is that of Nygren (1998, pp.73-98), where it was noted that in high-risk situations there is often enhanced sensitivity to losses, which leads to risk-averse behavior. But when a situation is seen as being low risk, a reversal occurs and positive affect will often result in more risk seeking behavior. It is possible that by framing the situation as low risk (loss expected either way), the rescue team were more inclined to engage in the option that had higher risk to more persons, than for the rescue team to remove themselves from the high risk situation and allow the situation to reach its inevitable outcome.

Emotions
The emotion of interest continued to play a role at this point. Hope, however, would have supercharged Dr Harris’ persistence. While all knowledge and experience showed the mission to be an expected failure, there was hope that in this unique situation some sort of ‘miracle’ might occur and the group might just make it out alive. This would have been boosted by the series of small successes through the swimming pool tests and eagerness of the rescue team to carry out the plan. These ‘small seeds of progress’ (Reeve, 2018, p.357) would have motivated Dr Harris to continue towards the goal, helping to counteract negative feelings and doubt. This became evident with Dr Harris’ discussion at a later medical conference (2018, np.) where he deliberately omitted information that might negatively affect the emotions of the rescue team or show signs of his continued expectation of mission failure.

Empathy and compassion would have also been felt during and after the first ‘test dive’, when Dr Harris gained a full understanding of the scope of the situation. Empathy is likely to have been felt on seeing the stranded boys in their predicament. Compassion is evident in his later discussion about the expected loss of life, when he commented that when it occurred, they would be asleep.

A successful outcome
As documented by global media coverage, the rescue was a resounding success. All members of the trapped group survived with only minor medical issues. At this point emotions would have been overflowing, and the whole rescue team would have felt much joy. In addition to this, it is possible that Dr Harris continued to experience the emotion of interest, with reflection and further consideration for what this event would mean for modern medicine and for the cave diving community. The unexpected success of the mission would ‘be one for the books’ (Harris, 2018, np.) and will be the subject of further discussion and study, and hypothesizing of the polycontextual transfer of the learnings from this experience to other emergency situations.

One interesting comment that surfaced during the subsequent discussions, was that Dr Harris had ‘false modesty’ (Harris, 2019, np.). Harris’ response to this was that he was simply combining two activities that he loves during that time. This goes a long way to demonstrate that Harris is intrinsically motivated to achieve. As Reeve (2018, p.162) explains this as interest and satisfaction for attaining standards of excellence, but only when the sought achievement is for the individual’s own sake; do not derive intrinsic pleasure and satisfaction from attaining excellence that has been externally set or prescribed by others.



Affective vs cognitive empathy
Empathy usually includes the individual mirroring the feelings of the other party. However, it is interesting to consider how feeling empathy cognitively, did not also result in overwhelming emotional empathy, such that would have potentially hampered the rescue team with feelings of helplessness and doubt.

To answer this, we can look to Newton (2013, p.3) and the discussion around the differences between ‘affective empathy’ (vicarious, innate or emotional empathy), and ‘cognitive empathy’. Newton describes the difference using a ‘high road’ and ‘low road’ approach.

The ‘low road’ corresponds to affective empathy, where an automatic response of empathy. This neural processing uses the AI, mid-cingulate cortex, amygdala, secondary somatosensory cortex, and the IFG, with the AI and mid-cingulate cortex most consistently activated. The ‘high road’ corresponds to neural processing using the temporoparietal junction, superior temporal sulcus, dorsomedial PFC, and posteromedial cortex. In this case, higher order executive functioning allows for an ‘overriding’ of the affective empathic response.

Newton’s paper looks at this variance in a medical context, where doctors can use their executive functioning to feel ‘cognitive empathy’ for their patients as opposed to the ‘emotional empathy’ which can negatively impact patient care and decisions. Given Dr Harris is an experienced physician as well as an experienced cave diver, it is likely that he is also experienced in using his executive functioning to override affective empathy. One such strategy was highlighted in his comments about ‘thinking about the kids as inert patient packages’ making it easier to cope during the rescue. Distancing the human from the task seems to support the separation of cognitive and affective empathy. In this case it likely prevented Harris from feeling negative affect such as fear and sadness while carrying out the goal-directed activities.

Quiz
Here are some example quiz questions - choose the correct answers and click "Submit": {What is the overarching emotion that prompted Dr Harris to engage and persist with the rescue mission? - Hope - Empathy - Fear + Interest - Compassion
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{Which implicit need is most likely a motivator for Dr Harris?. + achievement - affiliation - power
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{What was one of the efficacy expectations that likely contributed to Dr Harris' sense of self-efficacy? + Personal Behaviour History - Verbal Persuasion - Psychological state - Compassion
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Conclusion
While there are many motivating factors to explain Dr Harris' decision to engage in this rescue mission, a key driver was implicit need for achievement. The key emotion appears to be interest, as this was the overarching emotion that promoted both engagement and persistent goal directed behavior. Clearly hope was an important factor also, even though all knowledge and experience pointed towards an unsuccessful outcome, the wishful thinking that is hope provided a motivational force to 'just do it'. Framing also played an important role, with both options expected to end in loss, but one option also featured hope when the other did not.