Developing Greater Stress Resiliency in Medical Practice

We previously focused on becoming more aware of the sources of stress in your life and then identifying ways to either change the stressor and/or change your reaction to it. The more aware you are of what is causing stress and what you are prepared to do about it, the greater sense of control you will feel. The key is putting those stress reduction strategies into practice - nothing changes until you make changes. Be intentional and specific about how you will change and then practice, practice, practice. With the brain’s neuroplasticity capability, developing new habits is achievable. Neurons that fire together, wire together.

Now let’s focus on a couple of other key strategies for minimizing stress and developing greater resiliency:

Lifestyle Factors: Research in this area of brain resiliency has shed light on various factors that enhance brain health and improve cognitive functioning. As mentioned in the previous article, exercise appears to increase brain derived neurotropic factor expression in the hippocampus - an important brain structure related to learning and memory. Additionally, various foods have shown to improve brain health, such as leafy greens, blueberries, green tea, and my favorite, dark chocolate. Sleep plays a critical role in stress resiliency - and, when experiencing acute or chronic levels of stress - sleep quality and quantity can be significantly impacted.

Another key factor for developing stress resiliency is mindfulness practice. In medical practice this is defined as “…the capacity for moment-to-moment self-awareness, self-monitoring, and self-regulation in the service of safe, effective, and compassionate health care.” (Ronald Epstein, 2014). Research examining the impact of mindfulness practices on mental resiliency is compelling. For example, one study found that mindfulness practices actually decreased grey matter in the amygdala during times of stress (“MBSR Decreases Gray Matter in Amygdala During Stress;” Hölzel, et al Soc Cog Neuro, 2010).

Another neurological effect is strengthening of the brain’s “breaking system” in the prefrontal cortex: the implications of this are greater emotional regulation during times of stress. Epstein reviews the evidence that links mindful practices to improved caregiver well-being and resiliency and improved patient care. With as little as one hour per week of mindfulness practice, sleep quality is improved (Wolever et al., 2012); twice a day for 10 days resulted in reduced emotional exhaustion and improved job satisfaction (Hulsheger et al., 2013); and 2.5 hours per week resulted in reduced burnout (Krasner et al., 2009). The Internet is replete with strategies and instructions (from beginner to advanced) on various forms of mindfulness practices.

Minimizing the “negativity bias”: The brain is naturally inclined to pay greater attention to, remember more, and experience more of the effects of negative information and events than positive ones. Stress, such as that experienced by negative events, causes the release of cortisol, which lasts longer in the brain than do the effects of “feel-good” chemicals, such as dopamine and oxytocin which are associated with rewarding events. Thus, our negative bias is a key factor in producing stress - we tend to be more self-critical than self-appreciating, and we tend to pay more attention to negative interactions with others than the positive ones. One way to help minimize this bias is to intentionally focus on our successes and what we are appreciative of.

During the course of each day, stop and acknowledge what you have done well, positive experiences you have had, and things you are grateful for. This will not only reduce your stress, it will also cause you to begin paying more attention to the positive in others.

In summary, here are some strategies you can easily implement to develop a more resilient brain, and thus, a more stress-free life:

• Exercise every day.

• Eat a healthy diet, especially foods rich in antioxidants.

• Focus on getting quality sleep - avoid excess caffeine, using the bed for thinking about problems, and using sleep aids

• Develop a mindfulness practice - for example, take at least 10 minutes a day to focus on your breathing and quieting the mind

• On a daily basis, pay attention to and list your accomplishments, positive experiences, and things for which you are grateful

Remember, the less stress you experience, the greater your ability to provide compassionate care to your patients, engage in positive interactions with your staff, and improve decision-making. With a little intentional practice, you too can develop a more resilient brain.