James K. Abshire, M.D.

Author of Live Love & Let Go

Combating Stress: You Have Power!

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“Calling Dr. Howard, Dr. Fine, Dr. Howard”

“Calling Dr. Howard, Dr. Fine, Dr. Howard”

The hospital loudspeaker blared away while the three doctors ran through the hospital with patient’s lives on the line. Mayhem everywhere.  Fortunately, it was just a Three Stooges movie short. Nyuk, Nyuk, Nyuk.

But I remember experiencing those types of days in real life (although with slightly less pies flying through the air). Working for 20-plus hours and then just getting to sleep right before being called for a code blue and have to run straight from bed to a patient’s room to perform CPR with a life on the line. Trying to save patients who are septic, throwing up blood, having a heart attack, a stroke, or pneumonia, and all of that on the same day (I really hate Mondays).

Yes, I think being a doctor is stressful. A soldier in wartime is probably the most stressful occupation, but law enforcement, firefighters, and airline pilots would also rank high. But all jobs can be stressful: all it takes is a hard boss, demanding customers or a troublesome coworker. However, the level of stress can be greatly influenced by how we perceive and manage it.

There are several suggestions to lower stress levels:

  • Prayer and meditation
  • Exercise. Target 30-60 minutes a day, most days of the week
  • Relaxing music, most likely not something from Metallica
  • Hobbies and crafts. One idea is adult coloring books. Be careful with these, though, because someone recently gave me one of these to do and I got more stressed out when I realized there were no numbers to tell me what colors to use (like they have in the kids coloring books)
  • Try and get a good night’s sleep
  • Massage and warm baths
  • Don’t turn to alcohol and street drugs. Any perceived short term benefit will be offset by worsened problems down the line.
  • Talk to family, friends, a counselor or a clergy member
  • Forgiveness. If you hold anger or a grudge towards someone, then find a way to forgive them. It will benefit you (by lowering your internal stress levels) far more than whoever you are forgiving. For instance, injured patients who have a worker’s compensation claim or lawsuit against whoever injured them seem to not recover as well. I don’t think this is because the patient is ‘faking it’ or ‘malingering’, but rather because of increased stress over the issue.  Of note, I did not originate this idea. It’s based on what other physicians have told me of their observations.
  • Cognitive Behavioral Therapy (CBT- see Blogs 8 and 9). If you have any negative self-talk, then you need to stop it as it only ramps up your stress levels. In fact, negative self-talk may be a big source of your stress.
  • Find short term goals. It helps you get through stressful times. There have been plenty of tough days where the idea grows in my mind that I can’t manage to do this for the next ‘X’ number of years. At these times I tell myself that I just need to get through that day and then I can go home and relax a bit. Thirty years later I’m still going strong.
  • Don’t forget to find humor in the situation….. “Calling Dr. Howard, Dr. Fine, Dr. Howard”.  Don’t forget to duck when things are flying at you, and don’t forget to block when you see a two-finger eye poke coming your way. Nyuk, Nyuk, Nyuk.

Next time: Using the concepts of attitude, focus, and perspective to control stress.

Stress

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Today you decided to take a nice walk in the forest after you got home from work. It’s a good way to unwind after a long day. As you walk down the trail, enjoying the beauty around you, you hear some strange rattling in the nearby bushes. You step closer to see what’s causing it, and suddenly realize it’s a mama grizzly and her cub. She lets out a loud roar. Before you have time to even think, you’re darting 20 feet in the opposite direction. This is the most stress you’ve ever felt in your life. But what is stress?

Stress is our reaction to a force or event that adversely affects us. We can be stressed by a wide variety of potential forces.  Some examples:

* Being chased by a bear. (I chose a bear here because bears are the funniest animal exceeding even the lobster.  Hopefully choosing a funny bear will make this blog less scary for you, and less likely to stress you out. You can even imagine it’s a teddy bear if that helps.)

* Personal illness or injury.

* Illness or death of a family member or friend.

* Being robbed or assaulted. (Also, I’m told robbing or assaulting someone is also stressful.)

* Getting a new job, or promotion.

* Birth of a child. (Especially Sam)

* A troublesome boss, coworker, or employee.

* Moving place of residence, church, or school.

*  A graduation or retirement.

* A new relationship or breakup of a relationship.

* Thinking about who our next president might be. Where’s that bear when you need it?

* Financial or legal problems.

* Winning the lottery. Yes, people who win the lottery tend to get stressed out and not do well.

* Going to see the doctor, or in my case, going to see the patient.

* Loss of a pet.

* A child leaving home. (Unless it’s Sam)

* Being a caregiver.

* Preparing for a vacation, reunion, or party.

* Performing a task. Deadlines. Writing a blog.

We can spend all day thinking of stressors, but as you can see, not all stressors are bad, but they still put stress on us because we have to adjust to a new situation. Stress can even be a good thing by helping us to escape a bad situation, like being chased by a bear.

When put under stress, our bodies undergo changes which can be good and even improve our chance of survival. The classic example of this is the ‘fight or flight’ response which happens when you are being chased by a bear. Under these stressful circumstances, your body’s sympathetic nervous system releases adrenaline causing your heart rate to increase, you’ll breathe faster, muscles will tense up and receive more oxygen, and the liver will release stored up energy (in the form of fatty acids and glycogen). All of this is to help you be more alert and run faster, or even fight the bear (don’t take it personally, but I have $50 on the bear). Other changes also occur…for instance our blood will clot easier so we don’t bleed as much and endorphins are released which decrease pain, and that’s important for when the bear catches us.

A few other changes accompany the ‘fight or flight’ response. For instance: the pupils dilate (making our eyes look big), hairs on the skin stand up, sweating, and relaxation of the urinary bladder sphincter muscle – which may cause you to wet yourself. This is important so that the bear can see that you’re really scared and may have pity on you and let you go, which is your last chance for survival when a bear is chasing you.

The ‘fight or flight’ response is a short term response to stress. There are numerous long term responses to stress which are harmful. They include1:

* Release of cortisol into the blood stream which weakens the immune system and makes us more predisposed to illness.

* Increased blood pressure and predisposition to arrhythmia, coronary disease, and heart failure.

* Increased headache, neck, shoulder, and back pain.

* Worsened irritable bowel and acid reflux digestive problems.

* Worsened asthma and chronic bronchitis.

* Dysfunction of the reproductive system such as infertility, erectile dysfunction, and painful menstrual cycles.

* Worsened acne and psoriasis.

* Elevated blood sugars in diabetics.

* Psychological effects such as irritability, anger, depression, anxiety, fatigue, sleep problems.

The big problem with chronic stress is that life itself is inherently stressful. The above list of potential life stressors are almost all typical life events (except for being chased by a bear and winning the lottery). In fact, I have personally experienced almost all of them. However, many of these stressors are internally generated…in other words; the stress is increased by how you deal with the problem. This gives us a chance to reduce stress, which is our goal.

Next time: Ways to decrease stress

1. Stress Management – Effects of stress, Web MD, 2016.

Self-Talk… Don’t Loose the Argument

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Man talking to a clone of himself

We all have self-talk. This is our inner talk…what we say to ourselves, usually quietly unless we look around first to make sure no one else is there. We all do it…well, maybe not all of us, but almost all of us. I’m not sure how the famous Marcel Marceau (the pantomime artist) talks to himself. Maybe he just pictures rooms with invisible walls in his mind. It must be weird to think in terms of clownish cartoons, with people in white painted faces moving very slowly and bumping into obstacles that aren’t really there.

But maybe Marcel Marceau is the lucky one with comical inner thoughts, while the rest of us are left dealing with reality, often with accompanying negative self-talk.

Negative self-talk is bad. It can worsen our mood, causing more depression and anxiety. It decreases self-confidence, making it harder for us to perform. This is why athletes try to build themselves up. As boxing champion, Mohammed Ali would say, ‘I am the greatest’, not ‘I’m champ because I got a lucky punch in.’

David Snowden at the University of Kentucky led a research study on aging known as the Nun Study. They followed 678 nuns over time. By choosing nuns to study, they eliminated lifestyle variables such as diet, living conditions, not smoking/drinking etc., as they were all almost identical. They reviewed their life journals that they started writing in the 1930’s at the age of roughly 20. Use of key positive words in the journals showed that some had much more positive thoughts. They found that:blog 8 happy nuns

  • The nuns with positive thoughts had a roughly 10 year longer lifespan on average. TEN YEARS…that is huge.
  • The nuns with positive thoughts had no Alzheimer’s. The negative thinking nuns had a significant incidence of Alzheimer’s.
  • Almost all of the nuns are now deceased. They did autopsies and they did find that one nun with positive thoughts had significant Alzheimer’s disease in her brain. However, that nun showed no signs of Alzheimer’s dementia while alive.

Clearly the ones with positive thoughts have healthier bodies and healthier brains. Like the healthier nuns, we need to get ‘into the habit’ of positive self-talk.

Positive self-talk will be key to recovery if you are battling depression or anxiety. Positive self-talk is also helpful if you are having stress in your life (which is all of us have really as life is inherently stressful).

Positive self-talk can be fostered and increased. Here are some of the ways:

  • Strengthening your faith
  • Building supportive relationships
  • Cultivating gratitude
  • Seeking laughter
  • Prayer and meditation
  • Considering situations from a different perspective (i.e. how will things be in 1, 5, 10, 100 years?)
  • Finding a positive purpose to your life
  • Exercise (to burn off inner anxieties, stress, and negative thoughts)
  • Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy is a type of psychological therapy which has been shown to be very effective in treating problems such as depression, anxiety, and post-traumatic stress. CBT has been shown in studies to be as effective as antidepressant medications. The combination of CBT with antidepressants is even more powerful. Similarly, a combination of all of the above ideas is the best way to keep positive.

CBT relies on your thoughts, behaviors or actions, and emotions all being interrelated. You can improve your emotions (such as decreasing depression and anxiety) by altering your thoughts and behaviors. In other words, a positive activity or thought can improve your mood.

cbtNow I have heard some doctors say that CBT and faith are not really compatible. The reasoning was that faith relies on the spiritual belief while CBT relies on western scientific deduction. They felt CBT was what people should turn to when faith was not working to solve the problem.

Actually, CBT can be used with faith to build the strongest emotional support. Borrowing on reasoning from St. Augustine, CBT fits in quite nicely with God’s plan. Augustine asserted that God exists as a Holy Trinity – Father, Son, and Holy Spirit. God also created man in His own image, and so our essence can be broken down into 3 parts which can be viewed in different ways:

  • Consciousness of self, knowledge, love
  • Memory, understanding, and will
  • Our soul seeks eternity, truth, and love
  • We exist, we know we exist, and we are glad for that

Similarly, we can be thought of as:

  • Behaviors, thoughts, and emotions, which is the basis of CBT. So Augustine would argue that CBT is based in God’s plan and design for us. If we add thoughts of God into that mix, it will obviously be much more powerful.

 

Next time we’ll look more at how we can use CBT in conjunction with faith to overcome negative thoughts and emotions.