Strategies to Help Physicians Build Stress Resiliency

The world of medical practice and healthcare has become increasingly complex, complicated, and uncertain - a perfect recipe for inducing stress. Stress not only activates our sympathetic nervous system with all its myriad physiologic responses, it also activates a threat response in the brain, triggering limbic system arousal. Specifically, stress can impair decision making, cognitive flexibility, memory, and attention; it causes neurotransmitter changes that negatively affect mood and motivation; and it causes an increased fear response and overall emotional reactivity. There are three key factors that determine how stress will affect you:

• How much of it (intensity)

• How long it lasts (duration)

• And how you interpret the situation (perception)

Much of the stress we experience is due to perceived threat versus an actual physical threat.

Not all stress is bad: Acute, low levels of stress stimulates neuron production and primes the brain for improved cognitive performance, and primes the body for improved physical performance. So for example, when a physician is faced with a patient crisis, her prefrontal cortex (PFC) is activated and she is able to manage the situation effectively and efficiently. There is an optimal arousal curve (that varies from person to person) whereby both physical and cognitive performance is enhanced as stress increases. Once stress reaches a critical level, performance begins to decline and continues to do so the higher the level of stress. What can really exacerbate the situation is when stress becomes chronic - causing deleterious changes in key brain structures that impair memory and cause hyper-reactivity in the amygdala (not to mention the physical effects in the body). Chronic stress actually suppresses the production of new neurons.

Building stress resiliency (defined as an ability to adapt and cope in threatening or challenging situations, and then return to your normal levels of function) is a key preventative practice that will serve you well both in your practice and in your life. Here is the prescription to optimize brain and body health:

1. Get an adequate amount of sleep.

This cannot be over-emphasized as sleep plays a pivotal role in how the body deals with stress (lack of sleep is in itself a stressor).

2. Get an adequate amount of daily exercise.

Exercise reduces anxiety, improves memory, and increases the production of neuro-protective chemicals in the brain

3. Eat a healthy diet that includes a variety of plant-based foods.

4. Increase your positivity.

There is a link between sleep, stress, and positivity (the latter being the easiest to influence).

5. Practice mindfulness.

Research demonstrates that spending time in a calm, relaxed, and focused state builds the brain's ability to thrive in stressful situations. Additionally, it helps us gain greater self-control in threatening (real or perceived) situations. An easy way to learn mindfulness is by taking a few minutes to focus on our breath (which will also activate the parasympathetic nervous system).

6. Learn how to reframe and label distressing situations.

There is a direct link between our thoughts and our feelings. Much of the stress we experience is due to stressful thoughts, often causing a learned helpless and/or fearful response to certain triggers. Examples of stress-inducing thinking are: over-generalizing, black-and-white thinking, seeing things as worse than they are, making assumptions about what other people think about us, and believing we are helpless or powerless.  

7. Plan ahead.

Much of stress is self-induced. Practice time management and priority setting to avoid procrastination and a buildup of stress.

8. Inoculate yourself!

Much like an athlete engages in interval training to build their athletic ability, you can challenge yourself with small doses of stress to help the brain adapt. Do not avoid situations that cause low levels of time-limited stress. Imagery has been shown to be an effective stress inoculator - simply imagining yourself coping in a challenging or threatening situation allows the brain to build resiliency, while also enhancing self-confidence, motivation, and a belief in one's ability to cope.

Building stress resiliency grows one's ability to cope in challenging situations, improves life satisfaction, increases feelings of self-confidence, and stimulates the generation of neurons in the brain (neuroplasticity).

Doctor's advice: Know your triggers, be aware of signs that you are experiencing stress (so you can intervene quickly), and practice the eight strategies above. You will notice the difference - and so will others.