Cabin Crew Startle and Surprise: Occurrence and Impact

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In the past years research has focused on developing strategies to help pilots mitigate startle and surprise responses to unexpected situations. However, no equivalent research exists for cabin crew. Objective This study investigates the prevalence, impact on crew performance, and emotional consequences of startle and surprise among cabin crew, as well as the way in which it is currently trained. Method A survey was conducted among 348 European-based cabin crew to gather data on in-flight events that provoked startle, surprise, or both. Objective measures included stress ratings, perceived impact on performance, perceived emotional control, training exposure, and lasting anxiety. Qualitative data were also collected to assess crew responses and coping mechanisms. Results Out of 348 respondents, 79.3% reported having experienced startle, surprise or both. High stress levels were significantly correlated with perceived performance impairments and lasting anxiety. Current startle and surprise training improved perceived preparedness but did not reduce perceived stress or anxiety. Emotional control was deemed a key protective factor. Conclusion Startle and surprise can cause operationally significant impact on cabin crew performance. Training that includes simple, effective emotional regulation strategies, such as those developed for pilots, is currently lacking and may help improve both immediate performance and long-term psychological resilience in the cabin environment, as may increased peer-support access. startle surprise cabin crew aviation psychology stress management cognitive performance self-efficacy non-technical skills peer support Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 1. Introduction Research into startle and surprise (S&S) on the flight deck has revealed that it can cause distraction, attention tunnelling, and disruption of cognitive processes, negatively impacting performance of critical non-technical skills such as decision-making and communication (Landman et al., 2017; Martin et al., 2016 ). In recent years techniques and procedures have been established in major airlines to help pilots manage their stress response and facilitate recovery of situation awareness during in-flight emergencies or adverse events (Field et al., 2018 ; Landman et al., 2020 ; Vlaskamp et al., 2025). To our knowledge, such S&S management techniques have not yet been made available for cabin crew, which is remarkable because of their central role in safety-critical tasks. Also, scientific literature on startle and surprise management in cabin crew seems lacking. Startle is defined as a sudden involuntary reaction to an intense stimulus, such as a sudden loud noise (Koch, 1999 ). The initial startle reflex occurs very fast, and includes contraction of face and neck muscles, arrest of ongoing behaviour and physiological arousal (Koch, 1999 ). If a persistent threat is perceived, a sustained stress response will result. Surprise can occur together with, or in the absence of, startle. Surprise is an emotional and cognitive response to unexpected events that cause a mismatch between expectations and what is perceived (Meyer et al., 1997 ) 2017). The combination of stress and surprise can cause “cognitive lockup”, as stress impairs the cognitive processes required for making sense of the surprising situation, and the inability to make sense of the situation can, in turn, increase stress (Landman et al., 2017a ). This state of cognitive lockup, instead of the initial startle reflex, is what is often designated as “startle” or S&S in operational practice (Rivera et al., 2014 ). Both startle and surprise can lead to rushed and incorrect actions and have been shown to impair pilot performance in simulator research (Martin et al., 2016 ; Landman et al., 2017b ). Although the impact of S&S on cabin crew has received little or no attention in the scientific literature, it is likely that emergency or non-normal situations can be equally disruptive for cabin crew as they can be for pilots. Accident and incident reports show that breakdowns of communication between the cabin and cockpit crew may impede effective action in scenarios such as aircraft evacuations (Zhu & Ma, 2015 ; Chute & Weiner, 1995 ). For example, the initial report of a landing accident at Tokyo’s Haneda airport in January 2024 involving a high-speed collision between two aircraft on the runway illustrates how cabin crew can find themselves leading an emergency evacuation with little forewarning. (JTSB, 2024). According to the report, the evacuation of Japan Airlines’ Airbus A350 was complicated by smoke, a collapsed nose landing gear (which prevented use of some of the exit slides), and a failed intercom and public address system (which left the captain unable to communicate his intentions to passengers and crew). This incident shows the importance of cabin crew having sufficient emotional and cognitive control to take the initiative and make independent decisions in dynamic and unpredictable circumstances. Regulatory bodies expect operators to train cabin crew in the behavioural skills needed to manage emergencies under conditions of acute stress: for example, ICAO’s Cabin Crew Safety Training Manual says training should build recognition and response skills for all possible emergencies, be both practical and scenario-based, and develop the ability to take correct action under time pressure and stress (ICAO, 2020). However, minimal guidance material exists, stating how that should be achieved in practice. This is normally integrated into Crew Resource Management (CRM) training, which is the only place S&S is explicitly mentioned in regulation (EASA, 2025). Consequently, the breadth and depth of current training provided is likely to vary between companies in both content and quality. The range of potential safety incidents faced by cabin crew is extensive. Aviation website SkyBrary lists over 100 examples of cabin safety incidents from 1983–2024, including planned and unplanned evacuations, fire and smoke, turbulence and stowage injuries, cabin decompression, air contamination, and medical emergencies (SkyBrary, n.d.). Unlike flight crew, whose cognitive focus in most emergency situations is technical, the cognitive orientation of cabin crew in many of these incidents is social and deals with the management of people (Chute & Weiner, 1995 ). Thus, for cabin crew, maintaining emotional control in high stress situations is not just about sustaining cognitive clarity, but also about being able to demonstrate calm, public-facing leadership. This can play a critical role in scenarios such as the handling of disruptive passengers, which is a frequent problem for cabin crew (EASA,n.d.). The longer-term effect of these incidents is not limited to operational safety but could also impact upon the personal wellbeing of those involved. A study into fear of flying among crew (Dyregrov et al., 1992 ) found that experiencing critical events and emergencies can lead to flight anxiety. Dyregrov et al. ( 1992 ) recommend teaching relaxation procedures and cognitive coping skills in the aftermath of incidents to mitigate their effects. This is key, as research on cabin crews’ experience of disruptive passenger behaviour has shown that it negatively impacts crew wellbeing (Rösch et al., 2024 ), sometimes with long term effects, even precipitating a career change. Based on these findings it can be assumed that cabin crew can benefit from S&S management training, not only to improve performance during the incidents, but possibly also to prevent subsequent mental health issues. Multiple studies (Davis et al., 2000 ; Field et al., 2018 ) have highlighted how training in aviation can develop self-efficacy across technical, cognitive, and social skills. Self-efficacy is a foundational concept in cognitive psychology and refers to belief in one’s own ability to successfully perform complex tasks or handle situations characterized by uncertainty (Bandura, 1977 ). Self-efficacy helps to regulate cognitive processing and emotional arousal, counteracting rumination, catastrophizing, and other negative emotional responses such as panic or helplessness (Bandura, 1997 ). Research shows that individuals with higher self-efficacy tend to perceive threats as more manageable, cope more actively with stress and recover more quickly from traumatic experiences (Benight et al., 2015 ; Lynch & Kaplan, 2025 ). This also reduces long-term mental health effects (Benight & Bandura, 2004 ). Mental health has, in recent years, become an important focus area in aviation. Peer support programs have been mandated by authorities for airlines since the Germanwings tragedy (Hazrati & Grant, 2025 ), but research into their effectiveness is still limited (Bråstad et al., 2024 ), especially for cabin crew. Peer support is positively regarded by cabin crew and is one tool available to mitigate the long-term effects of operational stress and support cabin crew mental health more generally (Hazrati & Grant, 2025 ). However, one contemporary study into disruptive passenger behaviour suggests these programs are often not used (Rösch et al., 2024 ). A review by Adler et al. ( 2024 ) examined peer-delivered interventions in multiple military contexts and found they assist in maintaining operational capacity and resilience among teams, suggesting that real-time peer support could mitigate the kind of acute stress effects initially triggered by startle and surprise incidents. Peer-to-peer support programmes are aimed at proactively contacting crew members after an incident (EASA, 2019). This study examines the occurrence and consequences of startle and surprise (S&S) events in the cabin crew task environment, as well as the factors that shape short- and long-term responses. A survey was distributed among cabin crew with the following main research questions: What is the prevalence of S&S in the cabin crew task environment and which types of events provoke them? What is the perceived impact of S&S incidents on cabin crew acute stress, long-term stress and task performance? What specific S&S training do cabin crew receive and what is its perceived influence on their feeling of preparedness and the impact on their response to incidents in flight? How does perceived emotional control (self-efficacy) affect stress levels and long-term emotional outcomes following startle and surprise events? What is the level of uptake of peer-support and how does it affect long-term emotional outcomes? 2. Method 2.1 Participants A total of 348 European participants provided valid responses to the survey. Respondents were required to be active cabin crew or have been so in the last five years. All participants provided informed consent, and the study was approved by the ethics committee of Cranfield University under number 25723/2025. Table 1 shows a full breakdown of the demographic data from the sample. Table 1 Demographic characteristics of the participants (n = 348). Experience (flight hours) n % 0-999 21 6.0 1000–1999 34 9.8 2000–4999 48 15.8 5000+ 225 29.6 Rank Purser 148 42.5 Cabin Attendant 196 56.3 Other 4 1.2 Gender Male 75 21.6 Female 270 77.6 Other 1 0.6 Prefer not to say 2 0.3 Type of operations (multiple answers possible) Airline (short-haul/regional) 196 56.3 Airline (medium-haul) 207 59.5 Airline (long-haul) 317 91.1 Charter 1 0.3 Business aviation 7 2.0 Other 4 1.1 Age range (years) 18–29 30 8.6 30–39 59 17.0 40–49 100 28.7 50–59 120 34.5 60–69 39 11.2 2.2 Survey content and procedure An electronic survey for cabin crew was designed using Qualtrics software based on a format previously used to investigate the prevalence and effects of startle and surprise in airline and helicopter pilots (Vlaskamp et al., 2025b ). The survey was distributed through the authors’ network of airline contacts and promoted on LinkedIn. The first questions requested consent and confirmed that respondents were employed as cabin crew within the past five years. Demographic information was gathered (see Table 1 ). Because of the range of interpretations in aviation, participants were then presented with the following definitions of startle and surprise: Startle is defined as the response to a sudden, intense stimulus, such as a loud bang or a flash. It triggers an involuntary physiological reflex, such as blinking of the eyes, an increased heart rate and an increased tension of the muscles, preparing the body for flight or fight. Examples are sudden severe turbulence or a loud engine explosion. Surprise results from the mismatch between expectation and reality. The effects of surprise are comparable to those of startle, such as increased heart rate and blood pressure, confusion and loss of situational awareness. Examples are an unexpected fire that cannot be located immediately, or a technical fault that is unclear. The main body of the survey focused on questions that were developed to elicit information about experiences that had triggered S&S in participants This included types of events, their effect, and the respondents’ emotional response. If participants had experienced more than one S&S incident, they were asked to reflect on the event that they remembered best. Table 2 presents a full list of the survey questions. The survey was activated online on June 27th, and closed on July 15th 2025, when response data were downloaded. Table 2 Survey questions and response options. Question Response options Research question (RQ) Demographics Multiple choice, see Table 1 Prevalence of S&S, RQ1 Have you ever experienced an event during your flight where you were startled and/or surprised? Yes, only startle Yes, only surprise Yes, S&S combined No ->survey ends Prevalence of S&S, RQ1 How would you best describe the event? Fourteen options were given, based on common occurrences. If “other abnormal event” was chosen, participants were asked to describe the event in an open question. These events were: • dangerous goods incident • evacuation required (premeditated) • evacuation required (sudden) • decompression • emergency landing ("brace for impact") • bomb threat • emergency on ground (incl. rejected take off) • go around • premeditated emergency landing • other abnormal event • sudden turbulence, unruly passenger smoke/fire/fumes • medical emergency (pax/crew) Prevalence of S&S, RQ1 On a scale from 0-100, how stressed did it make you feel? 0-100, based on Houtman & Bakker’s (1989) anxiety scale. Participants rated their level of anxiety on a continuous scale from 0 to 100, with higher scores indicating greater anxiety. No verbal anchors were provided at intermediate points. Impact of S&S, RQ2 What was the effect of the startle and/or surprise reaction and the resulting stress on your performance? 5-point Likert scale: (“very negative”, “negative”, “somewhat negative”, “no effect”, “positive”) Impact of S&S, RQ2 Please elaborate on the experienced effects of startle and surprise (positive or negative) Open question Impact of S&S, RQ2 How in control of your emotions did you feel while dealing with the event? 5-point Likert scale (“no control at all”, “very little control”, “moderate control”, “substantial control”, “complete control” Impact of S&S, RQ2 and self-efficacy, RQ4 Does your training include startle and surprise management? Yes/no Current training, RQ3 How well prepared to manage the startle and/or surprise event did you feel your training made you? 5-point Likert scale (“not at all”, “very little”, “moderately”, “substantially”, “completely”) Current training, RQ3 After the event, did you feel a lasting increase in anxiety as a consequence of the experience? 5-point Likert scale (“no increase in anxiety”, “small increase in anxiety”, “moderate increase in anxiety”, “substantial increase in anxiety”, “very large increase in anxiety”) Long-term effects, RQ5 Did you receive any help from a peer-to-peer (or other, e.g. psychologist) support system after the event? Yes/no Long-term effects, RQ5 2.3 Data Analysis Non-parametric tests were used due to the ordinal or categorical nature of the survey items (see Table 3 ). SPSS version 29.0.2.0 was used for analysis., with p < 0.05 as the threshold for significance. Table 3 Statistical tests used for analysis. Test Variables H₀ (Null Hypothesis) Chi square Startle experienced (Y/N) vs. experience level No association between experience level and having experienced a S&S event in flight Kruskal–Wallis Event type vs. stress score (0-100)_ Stress scores do not differ across event types Spearman ρ S&S effect on performance (1–5) vs. stress score (0-100) No correlation between S&S performance effect and stress scores Mann–Whitney U S&S training (Yes/No) vs. perceived preparedness due training (1–5) No difference in preparedness ratings Kruskal-Wallis Emotional control vs. event type No difference in emotional control across event types Spearman’s ρ Perceived control over emotions (1–5) vs. stress score (0-100) No correlation between perceived control and stress scores Spearman’s ρ Lasting anxiety (1–5) vs. stress score (0-100) No correlation between lasting anxiety and stress scores Spearman’s ρ Perceived control (1–5) vs. lasting anxiety (1–5) There is no monotonic relationship between perceived control and lasting anxiety Mann–Whitney U Received peer support help (Yes/No) vs. lasting anxiety (1–5) No difference in lasting anxiety between groups Mann-Whitney U S&S training vs. preparedness No difference in preparedness between the group that received current S&S training against the group that did not Mann–Whitney U S&S training (Yes/No) vs. lasting anxiety effects (1–5) No difference in lasting anxiety 3. Results 3.1 Prevalence of S&S among cabin crew In total 79.3% (276) of respondents ( n = 348) reported having experienced startle and/or surprise. “Startle only” was experienced by 12.9% (45) of all respondents. “Surprise only”, was experienced by 10.6% (37). “Startle and surprise combined” was reported by 55.7% (194). The remaining 20.7% (72) of respondents reported not having experienced either. Only one event per participant was evaluated, the one they recalled best. A chi-square test of independence examined the relation between total flying hours (0–999, 1000–1999, 2000–4999, 5000+) and experience of startle or surprise (yes vs no). The association was not significant, χ ²(3, n = 348) = 7.07, p = .070. 3.2 Categories of event types The most frequently reported startle or surprise event by cabin crew ( n = 78, 27.7%) was experiencing a medical emergency onboard. Other notably high-frequency events affecting the cabin were: smoke/fire/fumes (18.3%), unruly passengers (13.3%) and sudden turbulence (12.5%). All the reported event frequencies are displayed in Fig. 1 . Under “other abnormal events”, 11.4% (30) of respondents selected this option. Participants offered details of these events in a corresponding open-answer question. Here, almost half ( n = 14) of answers represented the experience of a lightning strike. Consequentially, “lightning strike” was added as its own S&S event category. The remaining “other abnormal events” ( n = 16) represented miscellaneous events that fitted none of the categories provided and included, for example, engine failures, an unidentified loud bang or a traffic warning from the Traffic Collision Avoidance System (TCAS) while in the cockpit. No evacuation was reported. 3.3 Reported impact on acute stress Figure 2 shows the event mean stress scores and their spread. A Kruskal-Wallis H test indicated that there was no statistically significant difference in perceived acute stress between the 12 reported event categories, H(11) = 7.99, p = .714. Figure 2. Ratings of acute stress experienced during the reported S&S event, separated for event category (total n = 263). 3.4 Reported impact on performance Figure 5 shows the results of the reported impact of acute stress on the performance during the incident. On average, this rating amounted to M = 3.64, SD = 1.10, on a 1–5 scale. A Spearman’s rank-order correlation revealed a small significant negative correlation between the reported perceived stress rating and impact on performance, ρ (251) = -0.18, p = 0.004, indicating that events with high reported stress levels were associated with a negative perceived impact on task performance, while lower stress events reported more positive effects on performance. Figure 3 shows that 54 respondents reported positive effects of stress on their performance. According to a follow-up question in free text the arousal felt from the stress response led to an increased focus and ability to concentrate. Example comments included, “ it helped me perform because of the adrenaline” and “it made me awake and alert”. Other explanations for positive ratings in the comments referred to the way individuals felt they had overcome the S&S effects leading to a positive resolution of the incident, rather than the immediate impact on their performance. The most commented factor contributing to this (17.9% − 38 participants) was the role of SOPs and training in overcoming the initial surprise: “ It calmed me that I realised I had procedures ”. 8.5% (18 participants) said that they had believed in themselves to take action and had done so appropriately, for example “we immediately knew what to do” . Others commented that they had taken a deep breath before acting and managed to remain calm. The most mentioned reaction associated with negative performance effects described by 11.8% of respondents was a freeze prior to taking action. Typical comments shared were: “ I was so overwhelmed I didn’t know what to do” and “I went into freeze mode. Other mentioned effects included high stress (10.4%), becoming emotional (8%), feeling confusion (7.5%), and shock (1.9%). The reported reactions were coded into categories. These are listed along with their prevalence in Table 4 . Table 4 Reactions to startle and surprise experienced by respondents (n = 202). (Note that some respondents described more than one reaction type). Reaction to startle & surprise Frequency of description Percentage Relied on training/teamwork/procedures 38 17.9 Increased focus/concentration 28 13.2 Freeze 25 11.8 High stress 22 10.4 Acted and trusted in self-efficacy 18 8.5 Emotional 17 8.0 Confusion 16 7.5 Delayed reaction (post event) 12 5.7 Calm 8 3.8 Await explanation from flight crew 8 3.8 Physical (heart rate, adrenaline) 7 3.3 Take deep breaths 5 2.4 Shock 4 1.9 Rushed action 4 1.9 TOTALS 212 100. 3.5 Reported emotional control Mean levels of perceived emotional control during the reported S&S event were 3.70 ( SD = 0.87); between moderate control (3) and substantial control (4), Mdn = 4, IQR = 1. Results are shown in Fig. 4 . Although 90% of respondents said they felt moderately to completely in control during the incident they reported, only 5% elaborated on this in the follow-up free text question. A Kruskal–Wallis H test was conducted to examine differences in perceived emotional control (0–5 scale) across 12 event categories that were reported at least once. The test showed no statistically significant differences between groups, H (11, n = 250) = 14.60, p = 0.201. A Spearman’s rank-order analysis showed a significant negative correlation, ρ (249) = -0.24, p < .001, (effect size small to medium) indicating that those who reported higher emotional control tended to report lower levels of stress. The boxplots (Fig. 5 ) illustrate that while median control levels were generally high across events, distributions varied in spread. Events such as Bomb Threat, Unruly Passenger and Lightning Strike showed a wider range of responses, whereas Decompression and Go Around were more tightly clustered. These results suggest that although participants typically felt in control during in-flight incidents, the type of event may influence the consistency (rather than the central level) of perceived control. 3.6 Reported effects on lasting anxiety Of a total of 251 participants that experienced S&S and answered this question, 62.9% (158) reported a long-term increase in anxiety following the event. Participants reported a median response of “a slight increase in anxiety” following the event. The interquartile range (IQR) spanned from “no increase in anxiety” to “a moderate increase in anxiety” ( n = 251). The distribution is shown in Fig. 6 . Examples of reported effects included: “ For more than 2 years [afterwards] I experienced a very high stress level while opening an airplane door ,” and “ Since then, my biggest fear is any kind of fire or smoke. Sounds in the cabin may trigger me .” One commented “[Afterwards] I realised what could have happened in flight, which made me very nervous .” The Spearman’s rank-order correlation analysis between reported acute stress and lasting anxiety revealed a moderate, statistically significant positive correlation, ρ (249) = 0.355, p < .001. This indicates that participants who reported higher acute stress levels during the event also reported higher lasting anxiety after the event. Figure 7 displays a scatter plot of the data. The Spearman’s rank-order correlation between lasting anxiety and perceived emotional control showed a significant negative correlation, ρ (251) = -0.28, p < 0.001. This indicates that participants who felt more in control of their emotions during the event were less likely to report lasting increases in anxiety afterward. 3.7 Peer support Of all respondents that experienced a S&S event and answered the question on long term effects, 35.1% (88) received help from a peer-support program and 64.9% (163) did not. A Mann–Whitney U test indicated that participants who received peer-to-peer or professional support (Mdn = 2, IQR = 1–4, n = 88) reported a significantly greater lasting increase in anxiety than those who did not receive support ( Mdn = 2, IQR = 1–3, n = 163), U = 6023.0, z = − 2.19, p = 0.029, r = 0.14. Effect size was small. General practice in most airlines is that crew members are actively offered peer support in the more severe events, whereas in other cases the crew member will have to contact peer support themselves. The impact of some of the more severe experiences shared by participants are worthy of note and highlight the importance of peer and psychological support. One respondent commented: “[ I was] shocked and [suffered] a breakdown two days after the attack. [I felt] the urge to find help with the Critical Support Team .” 3.8 Current S&S management training Of the total of 348 participants, 64.4% (224) reported having S&S management training while 35.6% (124) had not. Responses to the open question where they described their training were coded into categories by two authors, and triangulation was carried out until agreement was reached. Six categories emerged from the data describing the types of S&S training and methods taught recalled by participants. (Only replies that did not mention other techniques were placed in category 2). The emerging categories were: 1) Scenario-based training, including simulator and role-play with an actor (mentioned by 49%) 2) General classroom or training discussion (mentioned by 35%) 3) To ‘take a deep breath’, or other breathing technique (mentioned by 3%) 4) To take a pause before acting (mentioned by (7%) 5) To refer to SOP or follow procedures (mentioned by 3%) 6) The use of mental rehearsal (mentioned by 3%) Participants rated how well they felt their training prepared them for managing S&S events on average at Mdn = 4, IQR = 1, on a 1–5 scale. A Mann–Whitney U test indicated that participants whose training included startle and surprise training rated themselves as significantly better prepared, ( Mdn = 4, IQR = 1), compared to those without such training, ( Mdn = 3, IQR = 1), U = 5221.50, z = − 3.88, p < 0.001, r = 0.25. A Mann–Whitney U test indicated no significant difference in reported lasting anxiety between participants whose training included startle and surprise training and those whose training did not, U = 7186.0, z = − 0.04, p = 0.965, r < 0.01. 4. Discussion The study examined the prevalence and triggers of startle and surprise among cabin crew, their impact on stress and performance, the effectiveness of existing training, and the role of emotional control in mitigating their effects The results show that 79.3% of the respondents experienced an S&S event during their duties, which confirms our assumption that these reactions are not limited to the cockpit. Cabin crew reported a range of serious operational events that had provoked S&S. The events that participants reported the most often were medical emergencies, fire/smoke and unruly passengers. The results of the performance impacts of startle and surprise were nuanced. 21.3% of respondents answered that the stress induced by the incident they reported had a positive effect on their subsequent performance. Examples of negative effects reported were impairments such as freezing, confusion, shock, becoming emotional when they did not want to be, or acting too slow or too fast. Results showed that events provoking the highest levels of stress were significantly correlated with negative performance effects. A subset of crew appeared to channel the stress response into focused action and attributed this to confidence in their training, team support, or personal efficacy. This suggests that emotional and cognitive resilience, rather than the absence of stress, also has an important role to play in preserving performance during high-pressure situations. Previous research shows that people with higher self-efficacy manage threats better, cope better with stress, and recover more easily from traumatic experiences (Benight et al., 2015 ; Lynch & Kaplan, 2025 ). In our study, having received specific training in startle and surprise was found to significantly increase perceived ability to cope with an incident, suggesting that crew training had a role in increasing self-efficacy. However, current S&S training had no statistically significant effect on the reported acute stress, or on lasting anxiety after the event. S&S training is unlikely to be able to prevent initial acute stress provoked by incidents suggesting that future training should focus more on mitigating their effects. Only 6% of participants reported having discussed specific techniques such as a breathing technique to manage these effects, which suggests that there is scope for including evidence-based interventions as part of training that are integrated with existing procedures, as have been introduced for flight crew. A number of participants (62.9%) described that they suffered from lasting anxiety after experiencing an S&S event. This is in line with Rösch et al. ( 2024 ) who described that stressful passenger interactions can have lasting consequences Our findings show that the stressfulness of the event was moderately correlated with lasting anxiety, suggesting that acute stress caused by S&S during operations can lead to meaningful psychological consequences. However, participants who reported a higher perception of emotional control during an incident had a significantly reduced likelihood of lasting anxiety. This is in line with previous findings from Bandura ( 1997 ) and Benight & Bandura ( 2004 ) on the protective role of self-efficacy and emotional regulation in traumatic or high-stress environments, although the correlation found in our study could also be confounded by seriousness of the S&S event. Despite these suggested long-term effects, only one-third of affected participants received peer or psychological support after their incident. Those that did receive support reported slightly but significantly more lasting anxiety. This is likely because only the more severe cases receive or seek peer support. A growing body of literature on peer support in aviation shows positive effects (Bråstad et al., 2024 ; McCall, 2023 ). The low percentage of peer support uptake might reflect the fact that only a proportion of the incidents reported were severe enough to warrant this kind of follow up, however, it could also suggest either that access to such programs is limited, or their importance is not widely recognized. Given the increasing awareness of occupational mental health in the aviation, this finding could support calls for more systematic peer support and structured debriefing processes following critical incidents (EPPSI, 2019 ). 5. Limitations and further research. This study has several limitations. Participants were asked to describe their experiences during and after one S&S event (they best remembered). This means that the answers are unlikely to reflect average experiences during S&S events, as more negative experiences are more likely to be recalled (Hamann, 2001 ). Additionally, several correlations between aspects of experiences and responses could be moderated or confounded by differences in seriousness between reported events, limiting the possibilities to draw conclusions on causal connections. The data were self-reported and retrospective, individual differences in reporting, and variability in stress perception may have influenced the results. Although the sample was broad and diverse in experience, it was restricted to European-based participants, employed at a few large EASA-based airlines, meaning the respondents were drawn from a homogeneous background in terms of regulation, training and operational cultures. Future research into the impact of stress provoked by startle and surprise could incorporate more objective physiological measures (e.g., heart rate/cortisol), real-time scenario simulation, or longitudinal follow-up to real events to assess the longer-term effects in greater depth. Practical measures to manage and mitigate the effects of S&S in cabin crew would benefit from further development and operational assessment of a standardised and tailored and practical management method, possibly similar to those that have been adopted for flight crew in recent years. Introducing simple, context-appropriate methods may help cabin crew sustain performance during high-pressure events, particularly those requiring leadership and calm in passenger-facing roles. 6. Conclusion The findings from this study suggest that startle and surprise present significant cognitive and emotional challenges for cabin crew, similar to what has been reported in the literature for pilots. These events can disrupt task performance, trigger strong emotional responses, and, for some, lead to lasting anxiety with longer-term implications. Our results also show that the stress perceived during S&S can sometimes be beneficial for cabin crew performance. Informing cabin crew of this during S&S training could possibly facilitate a positive appraisal of one’s own stress response and increase self-efficacy. The results also show that current training approaches for cabin crew are diverse, and in some cases lack effective strategies to help the crew cope with these events. For pilots, formal techniques have been developed and introduced operationally to mitigate these effects. These techniques can possibly be adapted for the cabin crew context and could possibly mitigate performance impairments and stress and thereby prevent or reduce lasting anxiety after the event. Further research is needed to compare if a structured S&S management method provides additional benefits for cabin crew. Peer-support uptake shows room for improvement and will remain a valuable tool to mitigate mental health effects. Declarations Competing interests The authors declare that they have no competing interests. Funding No funds, grants, or other support was received for conducting this study. Author Contribution D.V. and A.P. wrote the manuscriptD.V. performed statistical analysis and created all figuresD.V., A.L., A.P. and J.B. conceptualized the research all authors reviewed the manuscript and provided supervision Data Availability Data is available from the corresponding author on request. References Adler AB, Gutierrez IA, McCuaig EH, Nordstrand AE, Simms A, Willmund GD (2024) Peer-based intervention for acute stress reaction: Adaptations by five militaries. BMJ Military Health 170(5):425–429. https://doi.org/10.1136/military-2022-002344 Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84(2):191–215 Bandura A (1997) Self-efficacy: The exercise of control, vol 11. Freeman Benight CC, Bandura A (2004) Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. 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Retrieved August 5, from https://skybrary.aero/articles/accident-and-serious-incident-reports-cs Vlaskamp D, Landman A, van Rooij JM, Li W-C, Blundell J (2024) Airline pilots’ perceived operational benefit of a startle and surprise management method: A qualitative study. In Proceedings of the 2nd International Conference on Cognitive Aircraft Systems (ICCAS 2024) (pp. 29–34). SciTePress. https://doi.org/10.5220/0012927800004562 Vlaskamp D, Landman A, van Rooij J, Blundell J (2025a) Recovery from startle and surprise: A survey of airline pilots' operational experience using a startle and surprise management method. Int J Ind Ergon 107:103733. https://doi.org/10.1016/j.ergon.2025.103733 Vlaskamp D, Pollitt A, Blundell J, Landman A, Groen EL, van Paassen MR, Mulder M (2025b) Startle and surprise in helicopter operations: reported prevalence and application of mitigation strategies. Cogn Technol Work 1–12. https://doi.org/10.1007/s10111-025-00811-y Zhu S, Ma W (2015), January Cockpit/cabin crew communication: Problems and countermeasures. In International Conference on Education, Management, Commerce and Society (EMCS-15) (pp. 500–504). Atlantis Press. https://doi.org/10.2991/emcs-15.2015.103 Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":101695,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eNumber of respondents reporting each S\u0026amp;S event category (total n = 263). Thirteen respondents did not specify the event.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8158472/v1/bbd86eba629cfa7a54787a53.png"},{"id":97427209,"identity":"8bf09ffb-c712-449c-b526-fb58f15acb09","added_by":"auto","created_at":"2025-12-04 09:24:49","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":59944,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eRatings of acute stress experienced during the reported S\u0026amp;S event, separated for event category (total n =263).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8158472/v1/802e9d5c13c35ddbe4189564.png"},{"id":97427211,"identity":"25dacecf-3da2-4951-864c-aafb9546605a","added_by":"auto","created_at":"2025-12-04 09:24:49","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":62909,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePerceived impact of acute stress on performance during the incident (total n = 253).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8158472/v1/595d77aa462643f0430de552.png"},{"id":97427213,"identity":"0245652e-4822-426d-a6ee-6a36639f0a01","added_by":"auto","created_at":"2025-12-04 09:24:49","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":46201,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePerceived level of emotional control in dealing with the event (n = 251).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-8158472/v1/0cc6e76d8a43bebecfc2b7a1.png"},{"id":97668213,"identity":"55a347b0-290b-4d80-810c-f1faf70cc737","added_by":"auto","created_at":"2025-12-08 09:25:03","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":52954,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePerceived emotional control by event type.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-8158472/v1/140e767c29674eed4cc8ebf4.png"},{"id":97427216,"identity":"0d87922f-6ecd-4e6a-ba56-144e048e2c13","added_by":"auto","created_at":"2025-12-04 09:24:49","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":68277,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eReported effects of the S\u0026amp;S event on lasting anxiety (n = 251).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-8158472/v1/734b83b53407ef87a1d629f7.png"},{"id":97666328,"identity":"3987ad29-53e9-4936-89a6-ed51cb6b3c30","added_by":"auto","created_at":"2025-12-08 09:21:00","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":38559,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eScatterplot of acute stress levels and lasting anxiety scores.\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-8158472/v1/222a9caa5338ab7ded624b98.png"},{"id":105754888,"identity":"def436bd-ca87-49f0-82fc-2806b502f7af","added_by":"auto","created_at":"2026-03-30 16:22:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1461987,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8158472/v1/9628f0a2-3243-49cd-9b7a-b40f5db245ff.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cabin Crew Startle and Surprise: Occurrence and Impact","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eResearch into startle and surprise (S\u0026amp;S) on the flight deck has revealed that it can cause distraction, attention tunnelling, and disruption of cognitive processes, negatively impacting performance of critical non-technical skills such as decision-making and communication (Landman et al., 2017; Martin et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). In recent years techniques and procedures have been established in major airlines to help pilots manage their stress response and facilitate recovery of situation awareness during in-flight emergencies or adverse events (Field et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Landman et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Vlaskamp et al., 2025). To our knowledge, such S\u0026amp;S management techniques have not yet been made available for cabin crew, which is remarkable because of their central role in safety-critical tasks. Also, scientific literature on startle and surprise management in cabin crew seems lacking.\u003c/p\u003e\u003cp\u003eStartle is defined as a sudden involuntary reaction to an intense stimulus, such as a sudden loud noise (Koch, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). The initial startle reflex occurs very fast, and includes contraction of face and neck muscles, arrest of ongoing behaviour and physiological arousal (Koch, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). If a persistent threat is perceived, a sustained stress response will result. Surprise can occur together with, or in the absence of, startle. Surprise is an emotional and cognitive response to unexpected events that cause a mismatch between expectations and what is perceived (Meyer et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1997\u003c/span\u003e) 2017). The combination of stress and surprise can cause \u0026ldquo;cognitive lockup\u0026rdquo;, as stress impairs the cognitive processes required for making sense of the surprising situation, and the inability to make sense of the situation can, in turn, increase stress (Landman et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2017a\u003c/span\u003e). This state of cognitive lockup, instead of the initial startle reflex, is what is often designated as \u0026ldquo;startle\u0026rdquo; or S\u0026amp;S in operational practice (Rivera et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Both startle and surprise can lead to rushed and incorrect actions and have been shown to impair pilot performance in simulator research (Martin et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Landman et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017b\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough the impact of S\u0026amp;S on cabin crew has received little or no attention in the scientific literature, it is likely that emergency or non-normal situations can be equally disruptive for cabin crew as they can be for pilots. Accident and incident reports show that breakdowns of communication between the cabin and cockpit crew may impede effective action in scenarios such as aircraft evacuations (Zhu \u0026amp; Ma, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Chute \u0026amp; Weiner, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e1995\u003c/span\u003e). For example, the initial report of a landing accident at Tokyo\u0026rsquo;s Haneda airport in January 2024 involving a high-speed collision between two aircraft on the runway illustrates how cabin crew can find themselves leading an emergency evacuation with little forewarning. (JTSB, 2024). According to the report, the evacuation of Japan Airlines\u0026rsquo; Airbus A350 was complicated by smoke, a collapsed nose landing gear (which prevented use of some of the exit slides), and a failed intercom and public address system (which left the captain unable to communicate his intentions to passengers and crew). This incident shows the importance of cabin crew having sufficient emotional and cognitive control to take the initiative and make independent decisions in dynamic and unpredictable circumstances.\u003c/p\u003e\u003cp\u003eRegulatory bodies expect operators to train cabin crew in the behavioural skills needed to manage emergencies under conditions of acute stress: for example, ICAO\u0026rsquo;s Cabin Crew Safety Training Manual says training should build recognition and response skills for all possible emergencies, be both practical and scenario-based, and develop the ability to take correct action under time pressure and stress (ICAO, 2020). However, minimal guidance material exists, stating how that should be achieved in practice. This is normally integrated into Crew Resource Management (CRM) training, which is the only place S\u0026amp;S is explicitly mentioned in regulation (EASA, 2025). Consequently, the breadth and depth of current training provided is likely to vary between companies in both content and quality.\u003c/p\u003e\u003cp\u003eThe range of potential safety incidents faced by cabin crew is extensive. Aviation website SkyBrary lists over 100 examples of cabin safety incidents from 1983\u0026ndash;2024, including planned and unplanned evacuations, fire and smoke, turbulence and stowage injuries, cabin decompression, air contamination, and medical emergencies (SkyBrary, n.d.). Unlike flight crew, whose cognitive focus in most emergency situations is technical, the cognitive orientation of cabin crew in many of these incidents is social and deals with the management of people (Chute \u0026amp; Weiner, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e1995\u003c/span\u003e). Thus, for cabin crew, maintaining emotional control in high stress situations is not just about sustaining cognitive clarity, but also about being able to demonstrate calm, public-facing leadership. This can play a critical role in scenarios such as the handling of disruptive passengers, which is a frequent problem for cabin crew (EASA,n.d.).\u003c/p\u003e\u003cp\u003eThe longer-term effect of these incidents is not limited to operational safety but could also impact upon the personal wellbeing of those involved. A study into fear of flying among crew (Dyregrov et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e1992\u003c/span\u003e) found that experiencing critical events and emergencies can lead to flight anxiety. Dyregrov et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e1992\u003c/span\u003e) recommend teaching relaxation procedures and cognitive coping skills in the aftermath of incidents to mitigate their effects. This is key, as research on cabin crews\u0026rsquo; experience of disruptive passenger behaviour has shown that it negatively impacts crew wellbeing (R\u0026ouml;sch et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), sometimes with long term effects, even precipitating a career change.\u003c/p\u003e\u003cp\u003eBased on these findings it can be assumed that cabin crew can benefit from S\u0026amp;S management training, not only to improve performance during the incidents, but possibly also to prevent subsequent mental health issues. Multiple studies (Davis et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Field et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) have highlighted how training in aviation can develop self-efficacy across technical, cognitive, and social skills. Self-efficacy is a foundational concept in cognitive psychology and refers to belief in one\u0026rsquo;s own ability to successfully perform complex tasks or handle situations characterized by uncertainty (Bandura, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e1977\u003c/span\u003e). Self-efficacy helps to regulate cognitive processing and emotional arousal, counteracting rumination, catastrophizing, and other negative emotional responses such as panic or helplessness (Bandura, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e1997\u003c/span\u003e). Research shows that individuals with higher self-efficacy tend to perceive threats as more manageable, cope more actively with stress and recover more quickly from traumatic experiences (Benight et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Lynch \u0026amp; Kaplan, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). This also reduces long-term mental health effects (Benight \u0026amp; Bandura, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMental health has, in recent years, become an important focus area in aviation. Peer support programs have been mandated by authorities for airlines since the Germanwings tragedy (Hazrati \u0026amp; Grant, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), but research into their effectiveness is still limited (Br\u0026aring;stad et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), especially for cabin crew. Peer support is positively regarded by cabin crew and is one tool available to mitigate the long-term effects of operational stress and support cabin crew mental health more generally (Hazrati \u0026amp; Grant, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). However, one contemporary study into disruptive passenger behaviour suggests these programs are often not used (R\u0026ouml;sch et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). A review by Adler et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) examined peer-delivered interventions in multiple military contexts and found they assist in maintaining operational capacity and resilience among teams, suggesting that real-time peer support could mitigate the kind of acute stress effects initially triggered by startle and surprise incidents. Peer-to-peer support programmes are aimed at proactively contacting crew members after an incident (EASA, 2019).\u003c/p\u003e\u003cp\u003eThis study examines the occurrence and consequences of startle and surprise (S\u0026amp;S) events in the cabin crew task environment, as well as the factors that shape short- and long-term responses. A survey was distributed among cabin crew with the following main research questions:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat is the prevalence of S\u0026amp;S in the cabin crew task environment and which types of events provoke them?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat is the perceived impact of S\u0026amp;S incidents on cabin crew acute stress, long-term stress and task performance?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat specific S\u0026amp;S training do cabin crew receive and what is its perceived influence on their feeling of preparedness and the impact on their response to incidents in flight?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHow does perceived emotional control (self-efficacy) affect stress levels and long-term emotional outcomes following startle and surprise events?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat is the level of uptake of peer-support and how does it affect long-term emotional outcomes?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"2. Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Participants\u003c/h2\u003e\u003cp\u003eA total of 348 European participants provided valid responses to the survey. Respondents were required to be active cabin crew or have been so in the last five years. All participants provided informed consent, and the study was approved by the ethics committee of Cranfield University under number 25723/2025. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows a full breakdown of the demographic data from the sample.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eDemographic characteristics of the participants (n\u0026thinsp;=\u0026thinsp;348).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExperience (flight hours)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0-999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1000\u0026ndash;1999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2000\u0026ndash;4999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5000+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRank\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePurser\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCabin Attendant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e270\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrefer not to say\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eType of operations (multiple answers possible)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAirline (short-haul/regional)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAirline (medium-haul)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAirline (long-haul)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e317\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e91.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBusiness aviation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge range (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50\u0026ndash;59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u0026ndash;69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Survey content and procedure\u003c/h2\u003e\u003cp\u003eAn electronic survey for cabin crew was designed using Qualtrics software based on a format previously used to investigate the prevalence and effects of startle and surprise in airline and helicopter pilots (Vlaskamp et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2025b\u003c/span\u003e). The survey was distributed through the authors\u0026rsquo; network of airline contacts and promoted on LinkedIn.\u003c/p\u003e\u003cp\u003eThe first questions requested consent and confirmed that respondents were employed as cabin crew within the past five years. Demographic information was gathered (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Because of the range of interpretations in aviation, participants were then presented with the following definitions of startle and surprise:\u003c/p\u003e\u003cp\u003e\u003cb\u003eStartle\u003c/b\u003e is defined as the response to a sudden, intense stimulus, such as a loud bang or a flash. It triggers an involuntary physiological reflex, such as blinking of the eyes, an increased heart rate and an increased tension of the muscles, preparing the body for flight or fight. Examples are sudden severe turbulence or a loud engine explosion.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSurprise\u003c/b\u003e results from the mismatch between expectation and reality. The effects of surprise are comparable to those of startle, such as increased heart rate and blood pressure, confusion and loss of situational awareness. Examples are an unexpected fire that cannot be located immediately, or a technical fault that is unclear.\u003c/p\u003e\u003cp\u003eThe main body of the survey focused on questions that were developed to elicit information about experiences that had triggered S\u0026amp;S in participants This included types of events, their effect, and the respondents\u0026rsquo; emotional response. If participants had experienced more than one S\u0026amp;S incident, they were asked to reflect on the event that they remembered best. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents a full list of the survey questions.\u003c/p\u003e\u003cp\u003eThe survey was activated online on June 27th, and closed on July 15th 2025, when response data were downloaded.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eSurvey questions and response options.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResponse options\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eResearch question (RQ)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDemographics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMultiple choice, see Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePrevalence of S\u0026amp;S, RQ1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHave you ever experienced an event during your flight where you were startled and/or surprised?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes, only startle\u003c/p\u003e\u003cp\u003eYes, only surprise\u003c/p\u003e\u003cp\u003eYes, S\u0026amp;S combined\u003c/p\u003e\u003cp\u003eNo -\u0026gt;survey ends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePrevalence of S\u0026amp;S, RQ1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow would you best describe the event?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFourteen options were given, based on common occurrences. If \u0026ldquo;other abnormal event\u0026rdquo; was chosen, participants were asked to describe the event in an open question. These events were:\u003c/p\u003e\u003cp\u003e\u0026bull; dangerous goods incident\u003c/p\u003e\u003cp\u003e\u0026bull; evacuation required (premeditated)\u003c/p\u003e\u003cp\u003e\u0026bull; evacuation required (sudden)\u003c/p\u003e\u003cp\u003e\u0026bull; decompression\u003c/p\u003e\u003cp\u003e\u0026bull; emergency landing (\"brace for impact\")\u003c/p\u003e\u003cp\u003e\u0026bull; bomb threat\u003c/p\u003e\u003cp\u003e\u0026bull; emergency on ground (incl. rejected take off)\u003c/p\u003e\u003cp\u003e\u0026bull; go around\u003c/p\u003e\u003cp\u003e\u0026bull; premeditated emergency landing\u003c/p\u003e\u003cp\u003e\u0026bull; other abnormal event\u003c/p\u003e\u003cp\u003e\u0026bull; sudden turbulence, unruly passenger smoke/fire/fumes\u003c/p\u003e\u003cp\u003e\u0026bull; medical emergency (pax/crew)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePrevalence of S\u0026amp;S, RQ1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOn a scale from 0-100, how stressed did it make you feel?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0-100, based on Houtman \u0026amp; Bakker\u0026rsquo;s (1989) anxiety scale. Participants rated their level of anxiety on a continuous scale from 0 to 100, with higher scores indicating greater anxiety. No verbal anchors were provided at intermediate points.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eImpact of S\u0026amp;S, RQ2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhat was the effect of the startle and/or surprise reaction and the resulting stress on your performance?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5-point Likert scale: (\u0026ldquo;very negative\u0026rdquo;, \u0026ldquo;negative\u0026rdquo;, \u0026ldquo;somewhat negative\u0026rdquo;, \u0026ldquo;no effect\u0026rdquo;, \u0026ldquo;positive\u0026rdquo;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eImpact of S\u0026amp;S, RQ2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlease elaborate on the experienced effects of startle and surprise (positive or negative)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOpen question\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eImpact of S\u0026amp;S, RQ2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow in control of your emotions did you feel while dealing with the event?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5-point Likert scale (\u0026ldquo;no control at all\u0026rdquo;, \u0026ldquo;very little control\u0026rdquo;, \u0026ldquo;moderate control\u0026rdquo;, \u0026ldquo;substantial control\u0026rdquo;, \u0026ldquo;complete control\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eImpact of S\u0026amp;S, RQ2 and self-efficacy, RQ4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDoes your training include startle and surprise management?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes/no\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCurrent training, RQ3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow well prepared to manage the startle and/or surprise event did you feel your training made you?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5-point Likert scale (\u0026ldquo;not at all\u0026rdquo;, \u0026ldquo;very little\u0026rdquo;, \u0026ldquo;moderately\u0026rdquo;, \u0026ldquo;substantially\u0026rdquo;, \u0026ldquo;completely\u0026rdquo;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCurrent training, RQ3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAfter the event, did you feel a lasting increase in anxiety as a consequence of the experience?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5-point Likert scale (\u0026ldquo;no increase in anxiety\u0026rdquo;, \u0026ldquo;small increase in anxiety\u0026rdquo;, \u0026ldquo;moderate increase in anxiety\u0026rdquo;, \u0026ldquo;substantial increase in anxiety\u0026rdquo;, \u0026ldquo;very large increase in anxiety\u0026rdquo;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLong-term effects, RQ5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDid you receive any help from a peer-to-peer (or other, e.g. psychologist) support system after the event?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes/no\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLong-term effects, RQ5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Data Analysis\u003c/h2\u003e\u003cp\u003eNon-parametric tests were used due to the ordinal or categorical nature of the survey items (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). SPSS version 29.0.2.0 was used for analysis., with \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 as the threshold for significance.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eStatistical tests used for analysis.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eH₀ (Null Hypothesis)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChi square\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStartle experienced (Y/N) vs. experience level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo association between experience level and having experienced a S\u0026amp;S event in flight\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKruskal\u0026ndash;Wallis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEvent type vs. stress score (0-100)_\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStress scores do not differ across event types\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpearman ρ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u0026amp;S effect on performance (1\u0026ndash;5) vs. stress score (0-100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo correlation between S\u0026amp;S performance effect and stress scores\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMann\u0026ndash;Whitney U\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u0026amp;S training (Yes/No) vs. perceived preparedness due training (1\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo difference in preparedness ratings\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKruskal-Wallis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmotional control vs. event type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo difference in emotional control across event types\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpearman\u0026rsquo;s ρ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerceived control over emotions (1\u0026ndash;5) vs. stress score (0-100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo correlation between perceived control and stress scores\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpearman\u0026rsquo;s ρ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLasting anxiety (1\u0026ndash;5) vs. stress score (0-100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo correlation between lasting anxiety and stress scores\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpearman\u0026rsquo;s ρ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerceived control (1\u0026ndash;5) vs. lasting anxiety (1\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThere is no monotonic relationship between perceived control and lasting anxiety\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMann\u0026ndash;Whitney U\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReceived peer support help (Yes/No) vs. lasting anxiety (1\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo difference in lasting anxiety between groups\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMann-Whitney U\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u0026amp;S training vs. preparedness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo difference in preparedness between the group that received current S\u0026amp;S training against the group that did not\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMann\u0026ndash;Whitney U\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u0026amp;S training (Yes/No) vs. lasting anxiety effects (1\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo difference in lasting anxiety\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Prevalence of S\u0026amp;S among cabin crew\u003c/h2\u003e\u003cp\u003eIn total 79.3% (276) of respondents (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;348) reported having experienced startle and/or surprise. \u0026ldquo;Startle only\u0026rdquo; was experienced by 12.9% (45) of all respondents. \u0026ldquo;Surprise only\u0026rdquo;, was experienced by 10.6% (37). \u0026ldquo;Startle and surprise combined\u0026rdquo; was reported by 55.7% (194). The remaining 20.7% (72) of respondents reported not having experienced either. Only one event per participant was evaluated, the one they recalled best.\u003c/p\u003e\u003cp\u003eA chi-square test of independence examined the relation between total flying hours (0\u0026ndash;999, 1000\u0026ndash;1999, 2000\u0026ndash;4999, 5000+) and experience of startle or surprise (yes vs no). The association was not significant, \u003cem\u003eχ\u003c/em\u003e\u0026sup2;(3, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;348)\u0026thinsp;=\u0026thinsp;7.07, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.070.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Categories of event types\u003c/h2\u003e\u003cp\u003eThe most frequently reported startle or surprise event by cabin crew (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;78, 27.7%) was experiencing a medical emergency onboard. Other notably high-frequency events affecting the cabin were: smoke/fire/fumes (18.3%), unruly passengers (13.3%) and sudden turbulence (12.5%). All the reported event frequencies are displayed in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Under \u0026ldquo;other abnormal events\u0026rdquo;, 11.4% (30) of respondents selected this option. Participants offered details of these events in a corresponding open-answer question. Here, almost half (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;14) of answers represented the experience of a lightning strike. Consequentially, \u0026ldquo;lightning strike\u0026rdquo; was added as its own S\u0026amp;S event category. The remaining \u0026ldquo;other abnormal events\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16) represented miscellaneous events that fitted none of the categories provided and included, for example, engine failures, an unidentified loud bang or a traffic warning from the Traffic Collision Avoidance System (TCAS) while in the cockpit. No evacuation was reported.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Reported impact on acute stress\u003c/h2\u003e\u003cp\u003eFigure 2 shows the event mean stress scores and their spread. A Kruskal-Wallis H test indicated that there was no statistically significant difference in perceived acute stress between the 12 reported event categories, \u003cem\u003eH(11)\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.99, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.714.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFigure 2.\u003c/b\u003e \u003cem\u003eRatings of acute stress experienced during the reported S\u0026amp;S event, separated for event category (total n\u0026thinsp;=\u0026thinsp;263).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Reported impact on performance\u003c/h2\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the results of the reported impact of acute stress on the performance during the incident. On average, this rating amounted to \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.64, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.10, on a 1\u0026ndash;5 scale.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eA Spearman\u0026rsquo;s rank-order correlation revealed a small significant negative correlation between the reported perceived stress rating and impact on performance, \u003cem\u003eρ\u003c/em\u003e(251) = -0.18, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004, indicating that events with high reported stress levels were associated with a negative perceived impact on task performance, while lower stress events reported more positive effects on performance.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that 54 respondents reported positive effects of stress on their performance. According to a follow-up question in free text the arousal felt from the stress response led to an increased focus and ability to concentrate. Example comments included, \u0026ldquo;\u003cem\u003eit helped me perform because of the adrenaline\u0026rdquo; and \u0026ldquo;it made me awake and alert\u0026rdquo;.\u003c/em\u003e Other explanations for positive ratings in the comments referred to the way individuals felt they had overcome the S\u0026amp;S effects leading to a positive resolution of the incident, rather than the immediate impact on their performance. The most commented factor contributing to this (17.9% \u0026minus;\u0026thinsp;38 participants) was the role of SOPs and training in overcoming the initial surprise: \u0026ldquo;\u003cem\u003eIt calmed me that I realised I had procedures\u003c/em\u003e\u0026rdquo;. 8.5% (18 participants) said that they had believed in themselves to take action and had done so appropriately, for example \u003cem\u003e\u0026ldquo;we immediately knew what to do\u0026rdquo;\u003c/em\u003e. Others commented that they had taken a deep breath before acting and managed to remain calm.\u003c/p\u003e\u003cp\u003eThe most mentioned reaction associated with negative performance effects described by 11.8% of respondents was a freeze prior to taking action. Typical comments shared were: \u0026ldquo;\u003cem\u003eI was so overwhelmed I didn\u0026rsquo;t know what to do\u0026rdquo; and \u0026ldquo;I went into freeze mode.\u003c/em\u003e Other mentioned effects included high stress (10.4%), becoming emotional (8%), feeling confusion (7.5%), and shock (1.9%). The reported reactions were coded into categories. These are listed along with their prevalence in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eReactions to startle and surprise experienced by respondents (n\u0026thinsp;=\u0026thinsp;202). (Note that some respondents described more than one reaction type).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReaction to startle \u0026amp; surprise\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency of description\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelied on training/teamwork/procedures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncreased focus/concentration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFreeze\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActed and trusted in self-efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotional\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConfusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDelayed reaction (post event)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCalm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAwait explanation from flight crew\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical (heart rate, adrenaline)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTake deep breaths\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShock\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRushed action\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTOTALS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Reported emotional control\u003c/h2\u003e\u003cp\u003eMean levels of perceived emotional control during the reported S\u0026amp;S event were 3.70 (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.87); between moderate control (3) and substantial control (4), \u003cem\u003eMdn\u0026thinsp;=\u003c/em\u003e\u0026thinsp;4, \u003cem\u003eIQR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1. Results are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Although 90% of respondents said they felt moderately to completely in control during the incident they reported, only 5% elaborated on this in the follow-up free text question. A Kruskal\u0026ndash;Wallis H test was conducted to examine differences in perceived emotional control (0\u0026ndash;5 scale) across 12 event categories that were reported at least once. The test showed no statistically significant differences between groups, \u003cem\u003eH\u003c/em\u003e(11, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;250)\u0026thinsp;=\u0026thinsp;14.60, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.201.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eA Spearman\u0026rsquo;s rank-order analysis showed a significant negative correlation, \u003cem\u003eρ\u003c/em\u003e(249) = -0.24, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, (effect size small to medium) indicating that those who reported higher emotional control tended to report lower levels of stress.\u003c/p\u003e\u003cp\u003eThe boxplots (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e) illustrate that while median control levels were generally high across events, distributions varied in spread. Events such as \u003cem\u003eBomb Threat, Unruly Passenger\u003c/em\u003e and \u003cem\u003eLightning Strike\u003c/em\u003e showed a wider range of responses, whereas \u003cem\u003eDecompression\u003c/em\u003e and \u003cem\u003eGo Around\u003c/em\u003e were more tightly clustered. These results suggest that although participants typically felt in control during in-flight incidents, the type of event may influence the consistency (rather than the central level) of perceived control.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.6 Reported effects on lasting anxiety\u003c/h2\u003e\u003cp\u003eOf a total of 251 participants that experienced S\u0026amp;S and answered this question, 62.9% (158) reported a long-term increase in anxiety following the event. Participants reported a median response of \u003cem\u003e\u0026ldquo;a slight increase in anxiety\u0026rdquo;\u003c/em\u003e following the event. The interquartile range (IQR) spanned from \u003cem\u003e\u0026ldquo;no increase in anxiety\u0026rdquo;\u003c/em\u003e to \u003cem\u003e\u0026ldquo;a moderate increase in anxiety\u0026rdquo;\u003c/em\u003e (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;251). The distribution is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e6\u003c/span\u003e. Examples of reported effects included: \u0026ldquo;\u003cem\u003eFor more than 2 years [afterwards] I experienced a very high stress level while opening an airplane door\u003c/em\u003e,\u0026rdquo; and \u0026ldquo;\u003cem\u003eSince then, my biggest fear is any kind of fire or smoke. Sounds in the cabin may trigger me\u003c/em\u003e.\u0026rdquo; One commented \u003cem\u003e\u0026ldquo;[Afterwards] I realised what could have happened in flight, which made me very nervous\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe Spearman\u0026rsquo;s rank-order correlation analysis between reported acute stress and lasting anxiety revealed a moderate, statistically significant positive correlation, \u003cem\u003eρ\u003c/em\u003e(249)\u0026thinsp;=\u0026thinsp;0.355, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001. This indicates that participants who reported higher acute stress levels during the event also reported higher lasting anxiety after the event. Figure\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e7\u003c/span\u003e displays a scatter plot of the data.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe Spearman\u0026rsquo;s rank-order correlation between lasting anxiety and perceived emotional control showed a significant negative correlation, \u003cem\u003eρ\u003c/em\u003e(251) = -0.28, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001. This indicates that participants who felt more in control of their emotions during the event were less likely to report lasting increases in anxiety afterward.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.7 Peer support\u003c/h2\u003e\u003cp\u003eOf all respondents that experienced a S\u0026amp;S event and answered the question on long term effects, 35.1% (88) received help from a peer-support program and 64.9% (163) did not. A Mann\u0026ndash;Whitney U test indicated that participants who received peer-to-peer or professional support (Mdn\u0026thinsp;=\u0026thinsp;2, IQR\u0026thinsp;=\u0026thinsp;1\u0026ndash;4, n\u0026thinsp;=\u0026thinsp;88) reported a significantly greater lasting increase in anxiety than those who did not receive support (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2, \u003cem\u003eIQR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1\u0026ndash;3, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;163), \u003cem\u003eU\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6023.0, \u003cem\u003ez\u003c/em\u003e = \u0026minus;\u0026thinsp;2.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.029, \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.14. Effect size was small. General practice in most airlines is that crew members are actively offered peer support in the more severe events, whereas in other cases the crew member will have to contact peer support themselves.\u003c/p\u003e\u003cp\u003eThe impact of some of the more severe experiences shared by participants are worthy of note and highlight the importance of peer and psychological support. One respondent commented: \u0026ldquo;[\u003cem\u003eI was] shocked and [suffered] a breakdown two days after the attack. [I felt] the urge to find help with the Critical Support Team\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.8 Current S\u0026amp;S management training\u003c/h2\u003e\u003cp\u003eOf the total of 348 participants, 64.4% (224) reported having S\u0026amp;S management training while 35.6% (124) had not. Responses to the open question where they described their training were coded into categories by two authors, and triangulation was carried out until agreement was reached. Six categories emerged from the data describing the types of S\u0026amp;S training and methods taught recalled by participants. (Only replies that did not mention other techniques were placed in category 2). The emerging categories were:\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003e1) Scenario-based training, including simulator and role-play with an actor (mentioned by 49%)\u003c/h3\u003e\n\n\u003ch3\u003e2) General classroom or training discussion (mentioned by 35%)\u003c/h3\u003e\n\n\u003ch3\u003e3) To ‘take a deep breath’, or other breathing technique (mentioned by 3%)\u003c/h3\u003e\n\n\u003ch3\u003e4) To take a pause before acting (mentioned by (7%)\u003c/h3\u003e\n\n\u003ch3\u003e5) To refer to SOP or follow procedures (mentioned by 3%)\u003c/h3\u003e\n\n\u003ch3\u003e6) The use of mental rehearsal (mentioned by 3%)\u003c/h3\u003e\n\u003cp\u003eParticipants rated how well they felt their training prepared them for managing S\u0026amp;S events on average at \u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4, \u003cem\u003eIQR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1, on a 1\u0026ndash;5 scale. A Mann\u0026ndash;Whitney U test indicated that participants whose training included startle and surprise training rated themselves as significantly better prepared, (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4, \u003cem\u003eIQR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1), compared to those without such training, (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3, \u003cem\u003eIQR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1), \u003cem\u003eU\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5221.50, \u003cem\u003ez\u003c/em\u003e = \u0026minus;\u0026thinsp;3.88, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.25.\u003c/p\u003e\u003cp\u003eA Mann\u0026ndash;Whitney U test indicated no significant difference in reported lasting anxiety between participants whose training included startle and surprise training and those whose training did not, \u003cem\u003eU\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7186.0, \u003cem\u003ez\u003c/em\u003e = \u0026minus;\u0026thinsp;0.04, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.965, \u003cem\u003er\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe study examined the prevalence and triggers of startle and surprise among cabin crew, their impact on stress and performance, the effectiveness of existing training, and the role of emotional control in mitigating their effects\u003c/p\u003e\u003cp\u003eThe results show that 79.3% of the respondents experienced an S\u0026amp;S event during their duties, which confirms our assumption that these reactions are not limited to the cockpit. Cabin crew reported a range of serious operational events that had provoked S\u0026amp;S. The events that participants reported the most often were medical emergencies, fire/smoke and unruly passengers.\u003c/p\u003e\u003cp\u003eThe results of the performance impacts of startle and surprise were nuanced. 21.3% of respondents answered that the stress induced by the incident they reported had a positive effect on their subsequent performance. Examples of negative effects reported were impairments such as freezing, confusion, shock, becoming emotional when they did not want to be, or acting too slow or too fast.\u003c/p\u003e\u003cp\u003eResults showed that events provoking the highest levels of stress were significantly correlated with negative performance effects. A subset of crew appeared to channel the stress response into focused action and attributed this to confidence in their training, team support, or personal efficacy. This suggests that emotional and cognitive resilience, rather than the absence of stress, also has an important role to play in preserving performance during high-pressure situations.\u003c/p\u003e\u003cp\u003ePrevious research shows that people with higher self-efficacy manage threats better, cope better with stress, and recover more easily from traumatic experiences (Benight et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Lynch \u0026amp; Kaplan, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). In our study, having received specific training in startle and surprise was found to significantly increase perceived ability to cope with an incident, suggesting that crew training had a role in increasing self-efficacy. However, current S\u0026amp;S training had no statistically significant effect on the reported acute stress, or on lasting anxiety after the event. S\u0026amp;S training is unlikely to be able to prevent initial acute stress provoked by incidents suggesting that future training should focus more on mitigating their effects. Only 6% of participants reported having discussed specific techniques such as a breathing technique to manage these effects, which suggests that there is scope for including evidence-based interventions as part of training that are integrated with existing procedures, as have been introduced for flight crew.\u003c/p\u003e\u003cp\u003eA number of participants (62.9%) described that they suffered from lasting anxiety after experiencing an S\u0026amp;S event. This is in line with R\u0026ouml;sch et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) who described that stressful passenger interactions can have lasting consequences Our findings show that the stressfulness of the event was moderately correlated with lasting anxiety, suggesting that acute stress caused by S\u0026amp;S during operations can lead to meaningful psychological consequences. However, participants who reported a higher perception of emotional control during an incident had a significantly reduced likelihood of lasting anxiety. This is in line with previous findings from Bandura (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e1997\u003c/span\u003e) and Benight \u0026amp; Bandura (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2004\u003c/span\u003e) on the protective role of self-efficacy and emotional regulation in traumatic or high-stress environments, although the correlation found in our study could also be confounded by seriousness of the S\u0026amp;S event.\u003c/p\u003e\u003cp\u003eDespite these suggested long-term effects, only one-third of affected participants received peer or psychological support after their incident. Those that did receive support reported slightly but significantly more lasting anxiety. This is likely because only the more severe cases receive or seek peer support. A growing body of literature on peer support in aviation shows positive effects (Br\u0026aring;stad et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; McCall, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The low percentage of peer support uptake might reflect the fact that only a proportion of the incidents reported were severe enough to warrant this kind of follow up, however, it could also suggest either that access to such programs is limited, or their importance is not widely recognized. Given the increasing awareness of occupational mental health in the aviation, this finding could support calls for more systematic peer support and structured debriefing processes following critical incidents (EPPSI, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e"},{"header":"5. Limitations and further research.","content":"\u003cp\u003eThis study has several limitations. Participants were asked to describe their experiences during and after one S\u0026amp;S event (they best remembered). This means that the answers are unlikely to reflect average experiences during S\u0026amp;S events, as more negative experiences are more likely to be recalled (Hamann, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). Additionally, several correlations between aspects of experiences and responses could be moderated or confounded by differences in seriousness between reported events, limiting the possibilities to draw conclusions on causal connections. The data were self-reported and retrospective, individual differences in reporting, and variability in stress perception may have influenced the results.\u003c/p\u003e\u003cp\u003eAlthough the sample was broad and diverse in experience, it was restricted to European-based participants, employed at a few large EASA-based airlines, meaning the respondents were drawn from a homogeneous background in terms of regulation, training and operational cultures. Future research into the impact of stress provoked by startle and surprise could incorporate more objective physiological measures (e.g., heart rate/cortisol), real-time scenario simulation, or longitudinal follow-up to real events to assess the longer-term effects in greater depth.\u003c/p\u003e\u003cp\u003ePractical measures to manage and mitigate the effects of S\u0026amp;S in cabin crew would benefit from further development and operational assessment of a standardised and tailored and practical management method, possibly similar to those that have been adopted for flight crew in recent years. Introducing simple, context-appropriate methods may help cabin crew sustain performance during high-pressure events, particularly those requiring leadership and calm in passenger-facing roles.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eThe findings from this study suggest that startle and surprise present significant cognitive and emotional challenges for cabin crew, similar to what has been reported in the literature for pilots. These events can disrupt task performance, trigger strong emotional responses, and, for some, lead to lasting anxiety with longer-term implications. Our results also show that the stress perceived during S\u0026amp;S can sometimes be beneficial for cabin crew performance. Informing cabin crew of this during S\u0026amp;S training could possibly facilitate a positive appraisal of one\u0026rsquo;s own stress response and increase self-efficacy.\u003c/p\u003e\u003cp\u003eThe results also show that current training approaches for cabin crew are diverse, and in some cases lack effective strategies to help the crew cope with these events. For pilots, formal techniques have been developed and introduced operationally to mitigate these effects. These techniques can possibly be adapted for the cabin crew context and could possibly mitigate performance impairments and stress and thereby prevent or reduce lasting anxiety after the event. Further research is needed to compare if a structured S\u0026amp;S management method provides additional benefits for cabin crew. Peer-support uptake shows room for improvement and will remain a valuable tool to mitigate mental health effects.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNo funds, grants, or other support was received for conducting this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eD.V. and A.P. wrote the manuscriptD.V. performed statistical analysis and created all figuresD.V., A.L., A.P. and J.B. conceptualized the research all authors reviewed the manuscript and provided supervision\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is available from the corresponding author on request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdler AB, Gutierrez IA, McCuaig EH, Nordstrand AE, Simms A, Willmund GD (2024) Peer-based intervention for acute stress reaction: Adaptations by five militaries. 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Atlantis Press. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2991/emcs-15.2015.103\u003c/span\u003e\u003cspan address=\"10.2991/emcs-15.2015.103\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"cognition-technology-and-work","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ctwo","sideBox":"Learn more about [Cognition, Technology \u0026 Work](http://link.springer.com/journal/10111)","snPcode":"10111","submissionUrl":"https://submission.nature.com/new-submission/10111/3","title":"Cognition, Technology \u0026 Work","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"startle, surprise, cabin crew, aviation psychology, stress management, cognitive performance, self-efficacy, non-technical skills, peer support","lastPublishedDoi":"10.21203/rs.3.rs-8158472/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8158472/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eStartle and surprise are known to impair pilot performance during non-normal flight conditions. In the past years research has focused on developing strategies to help pilots mitigate startle and surprise responses to unexpected situations. However, no equivalent research exists for cabin crew.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study investigates the prevalence, impact on crew performance, and emotional consequences of startle and surprise among cabin crew, as well as the way in which it is currently trained.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eA survey was conducted among 348 European-based cabin crew to gather data on in-flight events that provoked startle, surprise, or both. Objective measures included stress ratings, perceived impact on performance, perceived emotional control, training exposure, and lasting anxiety. Qualitative data were also collected to assess crew responses and coping mechanisms.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOut of 348 respondents, 79.3% reported having experienced startle, surprise or both. High stress levels were significantly correlated with perceived performance impairments and lasting anxiety. Current startle and surprise training improved perceived preparedness but did not reduce perceived stress or anxiety. Emotional control was deemed a key protective factor.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eStartle and surprise can cause operationally significant impact on cabin crew performance. Training that includes simple, effective emotional regulation strategies, such as those developed for pilots, is currently lacking and may help improve both immediate performance and long-term psychological resilience in the cabin environment, as may increased peer-support access.\u003c/p\u003e","manuscriptTitle":"Cabin Crew Startle and Surprise: Occurrence and Impact","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-04 09:24:44","doi":"10.21203/rs.3.rs-8158472/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-17T11:12:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-17T10:25:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-16T23:59:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-15T21:17:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"319068304328364307341520455995875351865","date":"2025-12-03T12:49:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97962191555064986742783156207348195923","date":"2025-12-03T10:40:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97138911442189987804525926243989926584","date":"2025-12-01T17:06:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-01T10:29:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-20T07:53:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-20T07:52:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"Cognition, Technology \u0026 Work","date":"2025-11-19T20:12:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cognition-technology-and-work","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ctwo","sideBox":"Learn more about [Cognition, Technology \u0026 Work](http://link.springer.com/journal/10111)","snPcode":"10111","submissionUrl":"https://submission.nature.com/new-submission/10111/3","title":"Cognition, Technology \u0026 Work","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3e242659-2d72-4b8b-ab77-9f50651d957b","owner":[],"postedDate":"December 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:18:25+00:00","versionOfRecord":{"articleIdentity":"rs-8158472","link":"https://doi.org/10.1007/s10111-026-00866-5","journal":{"identity":"cognition-technology-and-work","isVorOnly":false,"title":"Cognition, Technology \u0026 Work"},"publishedOn":"2026-03-28 16:10:34","publishedOnDateReadable":"March 28th, 2026"},"versionCreatedAt":"2025-12-04 09:24:44","video":"","vorDoi":"10.1007/s10111-026-00866-5","vorDoiUrl":"https://doi.org/10.1007/s10111-026-00866-5","workflowStages":[]},"version":"v1","identity":"rs-8158472","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8158472","identity":"rs-8158472","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}