Good news : We can change our mindsets by viewing one video on how stress can be Enhancing . 6 I highly recommend the paper and Shawn Achor ’ s TED Talk . The “ stress-is-enhancing ” mindset works synergistically with reappraisal . We can view stress as overwhelming and debilitating or challenging and energizing . Avoidance of stress means avoidance of challenges that will not just go away if ignored . By removing the fear of stress , we are more likely to confront obstacles . Many scientific studies have established that this “ benefit finding ” mindset correlates with decreased morbidity and mortality . 7 Observe your family , friends , patients and coworkers to discern who has a stress-is-debilitating mindset and how damaging it can be . Once you begin to look , you will see it everywhere . If you are not careful , you will experience “ secondhand stress ” from emotional contagion . Seeing it in others helps you detect it in yourself , allowing you to overcome “ mindset blindness .”
OK , the scientific evidence says stress can be enhancing , but why does this sound like total BS ? Because only acute stress can be healthy , and we humans have more experience now with chronic stress . Robert Sapolsky wrote a whole book about our ability to ruminate on non-life-threatening chronic stressors so intensely that we develop disease . 8 Whether or not Mark Twain said it ( probably not ), we can all relate : “ I have been through some terrible things in my life , some which actually happened .”
Chronic stress is bad , but acute stress can be good if we allow ourselves to recover . Isn ’ t the definition of chronic stress basically continuous stress without reprieve ? We move from worrying about getting the kids to school , to worrying about the unsigned notes and unverified labs , to worrying about the patient who might sue , to worrying about our unhealthy lunch , to worrying about getting home in time , to worrying about our aging parents . This sequence of acute worries adds up to one long train of perpetual angst . Stress cannot enhance if we never get a break from it . Many people even become addicted to stress , seeking that familiar surge of hormones and neurotransmitters .
Jim Loehr has coached elite athletes and business professionals for decades , pointing out that while athletes perform at high intensity for maybe four hours a day , professionals in high-stress careers work 12 , 16 , 24 + hours in a row . A life of nonstop action at work followed by household duties is excessively linear . Too much energy expenditure without any rest leads to exhaustion , just as too much recovery without any stress leads to atrophy . That unicorn of work-life balance is actually a proper oscillation between energy expenditure and recovery . The natural world has inherent rhythms : tides , seasons , the Earth ’ s rotation . These phenomena synchronized our internal rhythms : breathing , heart rate , brain waves , body temperature , hormone and blood pressure . “ We are oscillatory beings in an oscillatory universe , rhythmicity is our inheritance .” 9 When we try to escape this rhythm , we burn out . “ It is not stress that causes burnout , but the failure to periodically seek relief .” Speaking about any career , not specifically medicine , Loehr says , “ Burnout is nature ’ s
MENTAL HEALTH way of forcing you to oscillate .” Some have even proposed that most chronic disease results directly from altered ( ultradian ) rhythm . 10
How can a busy professional oscillate ? Loehr says to add rituals into your life . Meditation , breathing , a nap , a walk , device-free time with family . Daily “ micro-oscillations ” may make more difference than macro-ones like vacations , where we continue the linear push to accomplish many things in a limited amount of time . These entirely achievable rituals pull at you , forcing attention to the present . Loehr has coached a bunch of tennis greats , in whom he instills the ritual use of “ time between points ” to find presence . If you have ever played a solo sport like tennis or golf , you know the powerful effect of one ’ s internal monologue on performance . Dr . Dike Drummond ( theHappyMD ) recommends a ritual in the time between patients – the Squeegee breath . Even if you can ’ t spare a few quiet moments between patients , you can at least stop at the door and take one mindful , relaxed breath .
Attention to recovery and insertion of rituals can break the cycle , transforming chronic , debilitating stress into acute , enhancing stress . This requires intentional reflection , presence and self-compassion . James Pennebaker has spent decades solidifying the impressive evidence on one method of reflection - expressive writing . 11 Writing ( or typing , speaking to a person or even a tape recorder ) about experiences names the stressful internal state , making it something external and controllable . By creating a narrative of personal adequacy , the writer transforms stress or other troubling emotions into growth and even triumph . Write about personal strengths you brought to a patient encounter , about parts of your life for which you are grateful , about your core values , or about how you connected with a patient or coworker . We all know that the sympathetic nervous system can initiate the fight-or-flight response , but few have heard of “ tend-andbefriend .” 12 When patients or coworkers cause you stress , connect with them . In an initiative at the Transit Authority of River City ( TARC ) in Louisville , bus drivers were instructed to reframe their role to become “ safety ambassadors ” – connecting with passengers by offering a safe place while helping them reach their destinations . Drivers felt a greater sense of meaning and reported less burnout .
As the teaching goes , physicians should be careful in the quest for connection with patients . Empathy generally means feeling what the other person feels : sadness , fear , anger , anxiety . But we can practice compassion ( warmth , concern and care for the other with a strong motivation to improve their well-being ) without actually feeling the other person ’ s emotion ( see Dr . Adam ’ s fantastic essay in this issue ). 13 Unlike empathy , compassion does not deplete resources , it amplifies them . 14 This is even true when we are having our own struggles . “ When you help someone [ else ] in the middle of your own distress , you counter the downward spiral of defeat .” 1 Active community involvement can prevent medical diagnoses and even death . “ Stress did not predict mortality risk among individuals who provided help to others in the past year ( HR = 0.96 ; 95 % CI = 0.79 , 1.18 ), but stress did predict mortality among those who did not ( continued on page 14 )
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