When a serious situation happens at work, such as our current COVID-19 pandemic, it is easy to panic. Unfortunately, stress and anxiety will lower any chance of your ability to perform well. Moreover, it can have short and long term effects on your personal health and well-being.
Yes, we should be vigilant and do everything in our power to keep yourself, your staff, your patients, and your family safe but, I also want to prepare you and your mind on some ways to handle stress amid a crisis.
What is Stress?
Stress is a normal biologic response to a high-pressure situation. We know from medical school that cortisol and adrenaline are released during these events. These hormones are meant to be short-lived–to prepare the body to take action during a stressful event.
However, amid a crisis, when we are constantly in this heightened state, chronic stress occurs. As physicians, we are not immune from the effects of stress, nor are we adept at even identifying the stress that we face. Keep reading for some specific ways to ease stress.
Research has shown that chronic stress can develop into significant illnesses such as heart disease, obesity, and a weakened immune system. Additionally, it can affect our psychological well-being, causing anxiety, depression, and insomnia.
Strategies to Control Stress
Slow Down and Breath
With days like these–when you feel you are losing control–slow down and remember to breathe. It’s a great way to ease stress.
The body can survive weeks without eating and days without drinking, but without nourishing breaths, we have only minutes to live. We know this. Yet, have you considered the way you breathe can have a profound impact on your health and well-being.
As easy (and automatic) as breathing is, we likely don’t consider the immense benefits of controlled and focused breathing. This is especially important as we encounter our day-to-day stressors of caring for sick and critical patients.
Choose to breathe better
When we choose to breathe better consciously, we unleash a vast area of benefits toward our health and well-being. With practice, breathing exercises allow you to feel more at ease and less stressed. You will achieve more clarity and become less reactive in high stakes situations.
Box Breathing
Developed by US Navy Seal, Mark Divine, box breathing is a simple and easy way to slow down your breathing and deepen your concentration during stressful events. It is something you can do anywhere and anytime. For me, I have used box breathing just before I begin an intubation or during a cardiac arrest, I am leading.
The Steps:
- Close your eyes and exhale all the air from your lungs to a count of 4 seconds
- Retain and hold for 4 seconds
- Inhale slowly and deeply through your nose for a count of 4 seconds
- Retain the air in your lungs and hold for 4 seconds
- Exhale slowly through your nose
Serenity Prayer
This common prayer, adopted and popularized by Alcoholics Anonymous, written by American theologian Reinhold Niebuhr, helps me gain perspective amid a crisis.
God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And the wisdom to know the difference.
When I find myself worrying, I take a minute and examine the things that I have control or influence over. While I can’t prevent a storm, I can prepare for one in an effort to ease stress. And while I can’t control how someone behaves, I can surely control how I react.
When you begin replaying a conversation in your head or imagining a catastrophe, take a moment and ask yourself, “Is this productive?”. If it is not (and it rarely is), put your energy into something else. As physicians, we are problem-solvers, and that is vital for what we do, but that trait can lead us to wasted time worrying about things we can’t control.
Get Better Sleep
Readers of Medicine Revived know I place a high value on an Evening Ritual and Sleep. My Evening Ritual has single-handedly reduced my stress significantly. It puts closure to the day and prepares me for a good night’s rest.
While my work schedule doesn’t allow me a regular time for sleep every night, I begin engaging in calming activities 1-2 hours before sleep (yes–even after a night shift). I listen to calming music, I read (always) before bed and I journal. Turn the television, computer, and phone off. Don’t worry; those items will be there in the morning.
Let Go of ALL Electronics before Sleep
Technology is all around us, and you may not realize the extent to which these devices have on our bodies. The reality is that electronic devices before bedtime can be physiologically and psychologically stimulating. These devices delay our circadian rhythms, which hinder the release of melatonin, making it more difficult to sleep. This is mostly due to the short-wave blue light that is emitted from these electronics. Over time, this not only delays the onset of REM but reduces the total amount of REM sleep we are in. This compromises our alertness and productivity in the morning.
Initiate an electronic curfew for you and your family. Do whatever is realistic that you can consistently follow—even 30 minutes before bedtime is a start. An excellent substitution for electronics is reading. While print media is a great choice, e-books are incredibly convenient and affordable. I have found that using an e-ink e-reader such as the Kindle Paperwhite (as opposed to iPad or Kindle Fire) doesn’t produce the same type of blue light that delays sleep.
Exercise
Make your health a priority. As physicians, we know the value of this. We have likely seen the physical and emotional transformation that exercise has on our patients, yet many of us struggle with this. I understand that work and family obligations can hinder a regular exercise routine, but I implore you to make “you” a priority.
Schedule your workouts. If it does not get scheduled, it will not happen. Find an exercise routine that works for you. First and foremost, don’t complicate this. There is a mind-boggling array of online and in-person training program that will make you dizzy.
I have found Mike Matthews, bestselling author, and creator of Muscle For Life, a great place to start. His workouts are science-based and straightforward to follow. He has a weight lifting program tailored for men and women. His workouts take no longer than 45-60 minutes to complete and can be done 3, 4, or 5-times a week.
Not interested in weight lifting–no problem. Go for a run. Arguably one of the best internet running coaches is Hal Higdon. He has some free and some paid training programs–from 5K to Marathon distance. Want to add speed to your running, look into Nike’s online training programs.
No Time? No Problem!
Don’t have time to drive to the gym, or is the weather horrible? No problem! Consider buying a spin-bike and join an online spinning class. You can splurge on a Peloton Indoor Exercise Bike, but a more inexpensive option would suffice for most of us. I recently purchased Sunny Health Spin Bike and registered for a Peloton Digital Membership. I, now, workout at home anytime I want. Peloton Digital streams over 20 live classes a day or has 10,000 on-demand workouts.
Are you a medical resident and working a 24-hour shift? Are you required to take in-house call? No problem. I have found the TRX Suspension System a great solution to get in a quick 20-minute workout in the comforts (and space) of a call room. There is a robust and very active online community with plenty of online workouts.
As you can see, there are plenty of options to use to ease stress. Two key points are that it should be fun and convenient. Schedule exercise into your week and hold yourself to it. Your body and mind will thank you.
Journal
As you know, I am a huge advocate for journaling as a means to ease stress. I have found no other tool that has such a substantial return on investment for my mind and soul. It is part of my morning ARISE Ritual as well as my evening SLEEP Ritual.
Journaling allows me time to self-reflect and to clarify my thoughts and feelings. It allows me to solve problems (real or perceived) and to explore solutions. It is such a powerful tool that has been shown to not only reduce stress and anxiety but has been shown that it can improve your cognitive function and strengthen your immune system.
Make this a daily practice
Seek Support
A shared burden is always lighter when looking to ease stress. Seek support from close friends and family. You will be surprised that many of your close friends and colleagues share the same stress. Be open and honest and let them know you are going through a tough time and need some help.
If you continue to feel overwhelmed and helpless and are having trouble even getting through the day, seek the support of a licensed mental health professional. Many hospital systems have physician consulting services. They are typically free of charge and private. and are usually staffed by psychologists or therapists who are specially trained to work with providers. They will be able to help you develop strategies to tackle chronic stress and make recommendations on some behavioral changes that will improve your mental health.
There is no need to face these challenges by yourself. Seek the support that you need.
Friends, my brothers and sisters in medicine, these are undoubtedly uncertain and anxious times but take time for yourself. As we navigate through these uncertain waters together, know that your response to your own stress will be a beacon of light to those around you.
Be good to yourself, give yourself some grace, and let’s walk through this together.
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