If you are a doctor, nurse, nurse practitioner or other medical professional, you are exposed to stress on a daily basis. This doesn't have to be conscious stress. You may not be aware of it or feel particularly uncomfortable. Stress can be subliminal and gradually accumulate in your body, drop by drop, without you ever noticing until you find out you can't sleep and you overreact to trivial events.

What is Your Stress Level?

To get you started, here’s a quick self-test. It assesses your underlying sources of stress reactivity and stress resilience, some of which have been linked to telomere length.

 

TEST YOURSELF

Think of a situation that bothers you a great deal and that is ongoing in your life. (If you cannot think of a current situation, think of your most recent difficult problem.) Circle your numerical response to each question.

1. When you think about dealing with this situation, how much do you feel hope and confidence vs. feelings of fear and anxiety?

             0                          1                           2                           3                           4

hopeful, confident                      same amount of each                            fearful, anxious

2. Do you feel you have whatever it takes to cope effectively with this situation?

             4                          3                           2                            1                           0

      not at all                                          somewhat                                          extremely

3. How much are you caught up in repetitive thoughts about this situation?

             0                  1                                   2                            3                            4

      not at all                                          somewhat                                          extremely

4. How much do you avoid thinking about the situation or try not to express negative emotions?

             0                  1                                   2                            3                            4

      not at all                                          somewhat                                          extremely

5. How much does this situation make you feel bad about yourself?

             0                  1                                   2                            3                            4

      not at all                                          somewhat                                          extremely

6. How much do you think about this situation in a positive way, seeing some good that could come from it, or telling yourself statements that feel comforting or helpful, such as that you are doing the best you can?

 

             0                  1                                   2                            3                            4

      not at all                                          somewhat                                          extremely

TOTAL SCORE (Add up the numbers; notice questions 2 and 6 are positive responses so the scale is reversed.)

The point of this informal test is to raise awareness of your own tendencies to respond in a certain way to chronic stress. Also know that if you’re dealing with a severe situation, your response style score will naturally shift to be higher. This is not a pure measure of response style, because our situations and our responses inevitably get a bit mixed together.

Total score of 11 or under: Your stress style tends to be healthy. Instead of feeling threatened by stress, you tend to feel challenged by it, and you limit the degree to which the situation spills over into the rest of your life. You recover quickly after an event. This stress resilience is positive news for your health.

Total score of 12 or over: You’re like most of us. When you’re in a stressful situation, the power of that threat is magnified by your own habits of thinking. Those habits are linked, either directly or indirectly, to poor health.

……………………..

Here’s a closer look at the habits of mind associated with each question:

Questions 1 and 2: These questions gauge how threatened you feel by stress. High fear combined with low coping resources turn on a strong hormonal and inflammatory stress response. Threat stress involves a set of mental and physiological responses that can, over time, endanger your telomeres. Fortunately, there are ways to convert threat stress into a feeling of challenge, which is healthier and more productive.

Question 3: This item assesses your level of rumination. Rumination is a loop of repetitive, unproductive thoughts about something that’s bothering you. If you’re not sure how often you ruminate, now you can start to notice. Most stress triggers are short-lived, but we humans have the remarkable ability to give them a vivid and extended life in the mind, letting them fill our headspace long after the event has passed. Rumination, also known as brooding, can slip into a more serious state known as depressive rumination, which includes negative thoughts about oneself and one’s future. Those thoughts can be toxic.

Question 4: This one’s about avoidance and emotion suppression. Do you avoid thinking about the stressful situation or avoid sharing feelings about it? Is it so emotionally loaded that the thought of it makes your stomach clench? It’s natural to try to push difficult feelings away, but although this strategy may work in the short term, it doesn’t tend to help when the situation is chronic.

Question 5: This question addresses “ego threat.” Does it feel as if your pride and personal identity could be damaged if the stressful situation doesn’t go well? Does the stress trigger negative thoughts about yourself, even to the extent that you feel worthless? It’s normal to have these self-critical thoughts sometimes, but when they are frequent, they throw the body into an overly sensitive, reactive state characterized by high levels of the stress hormone cortisol.

Question 6: This question asks whether you’re able to engage in positive reappraisal, which is the ability to rethink stressful situations in a positive light. Positive reappraisal lets you take a less than ideal situation and turn it to your benefit or at least take the sting out of it. This question also measures whether you tend to offer yourself some healthy self-compassion.

Source: “The Telomere Effect” by Nobel prize nominee Elizabeth Blackburn, Ph.D. and Elissa Epel, Ph.D.

 

Exercises

 

The good thing about these tools is that they work for everyone in any circumstance. No matter if you are a doctor, nurse, NP, PA or other, the results will be there.

General Instructions:

1 – Use while having a facial mask.

2 – Use during a TENS/EMS massage 

3 – Use when applying a cream

4 – Use when having Alpha-Stim treatment or while lying on your inversion table

5 – Use while having a Perfectio session

EXERCISE 1: Third Person Thinking (1, 2, 4)

Think of an upcoming stressful task in the third person. What makes him/her nervous? This perspective makes feel a fly on the wall and distances you from negative emotions. Research has found that frequent self-referencing, using first person I, me, mine is a sign of being self-focused and is related to feeling more negative emotions. Thinking in the third person has been found to leave people less anxious, threatened and ashamed, and to engage in less rumination. They perform better and are more confident.

EXERCISE 2: Time distancing (1, 2, 4)

You will have a weaker emotional response if you think of the far future vs the near future. Ask yourself, in 10 year, will this event still have impact on me. Studies have found good stress reduction resealed from this exercise. People get over IT faster.

EXERCISE 3: Visual self-distancing or cognitive diffusion (1, 2, 4)

You can do that after the fact. If you have experienced a stressful event that you still feel emotional about, visual distancing allows to process it in a way that will put you to rest. Step back and view the event from afar as if you’re watching a movie. That way you won’t experience it with your emotional brain but more rationally, with separation and clarity. It’s been shown to immediately reduce the brain’s stress response.

EXERCISE 3A: Visual, linguistic and time distancing combined (1, 2, 4)

Close your eyes. Go back to the time and place of the emotional experience and see the scene in your mind’s eye. Now take a few steps back. Move away from the situation to a point where you can watch it from a distance and see yourself in the event, the distant you. Watch the experience happening to the distant you all over again. Observe your distant self. As you continue to watch the situation unfold to your distant self, try to understand his/her feelings. Why did he/she had those feelings. What were the causes, the reasons for them. Ask yourself, will this situation affect me in ten years? If you suffer from retrospective stress (after the event), this is very useful. By mentally stepping outside your body, you can bypass its sense of imminent stress and attack.

Conclusion

We are largely unaware of the mental chatter in our minds and how it affects us. Certain thought patterns seem to be unhealthy. Thought suppression, rumination and negative thinking are the most typical ones. We can’t completely change our automatic thought patterns, some of us are born ruminators or pessimists, but we can learn how to keep them from hurting us. We can be the one in control.

 

Next are a few tested exercises suggested by Dr. Dike Drummond, MD in his course “Stop Physician Burnout”.

EXERCISE 4: Treat yourself like a dog – celebrate all wins (1, 2, 3, 4, 5)

Remember something you have recently achieved, even if it is a small victory, and relive it in your mind whenever you do a self-care activity (massage, facial mask, etc.). See it as a reward for yourself for the good work you’ve done.

EXERCISE 5: Focus on progress (1, 2, 3, 4, 5)

Think of any steps forward you’ve made in your personal or professional life. Notice any improvement you’ve achieved and congratulate yourself for it.

EXERCISE 5A: Notice What is Going Right – The Satisfaction Mind Flip (1, 2, 3, 4, 5)

Focus on one thing that’s going right. Be happy about it and remind yourself that everything is possible when you work from that mindset.

HOW TO GET RID OF NEGATIVE THOUGHT PATTERNS

Negative thought patterns are automatic, exaggerated—and controlling. They take over your mind; it’s as if they tie a blindfold around your brain so that you can’t see what is really going on around you. When your negative thought patterns are in control, you can’t see how exaggerated version of reality is. But when you become more aware of your thoughts, you take off the blindfold. You don’t necessarily stop the thoughts, but you have more clarity. Activities that directly promote better thought awareness include most types of meditation, especially mindfulness meditation, along with most forms of mind-body exercises.

Thought Awareness

Thought awareness promotes stress resilience. Here is an easy meditation exercise that promotes it.

EXERCISE 6: Thought awareness (1, 2, 4)

To become aware of your thoughts, close your eyes, take some relaxed breaths, and focus on the movie screen of your mind. Take a mental step back and watch your thoughts go by, as if you’re watching traffic on a busy street. Refrain from judgment. As you become more aware of your thoughts, including the ones that are distressing, you can label them, accept them, and even laugh at them. (“Oh, I’m criticizing myself again. I do that so often it’s funny.”) Instead of pushing your thoughts under the surface or letting them control your behavior, you let the negative thoughts pass by.

Thought awareness can reduce rumination (Querstret and Cropley, 2013). It puts some distance between your instinctive thought and your reaction to it. You realize that you don’t have to follow the story line inside your head because the story line doesn’t usually lead to productive thinking. We have around sixty-five thousand thoughts a day. If we can’t control our mind, it can drive us crazy. With time and practice, you learn to have control over your thoughts. When you encounter your own ruminations or problematic thoughts, you will be able to say, “That’s just a thought. It’ll fade.” That is a secret about the human mind: We don’t need to believe everything our thoughts tell us.

Here is another exercise that creates thought awareness. It overlaps with the mindfulness section and is a form of micro meditation:

EXERCISE 6A: Thought awareness (1, 2, 4)

Close your eyes. Let yourself breathe normally, but pay attention to your breath. When thoughts come into your mind, imagine you are simply a witness to them and watch them gently waft away. Try not to judge the thoughts or yourself for having the thoughts. Bring your attention back to your breath, focusing on the natural feel of it as you breathe in and breathe out.

EXERCISE 7: Deep Breathing  (1, 2, 4, 5)

Recommended by WebMD

Stopping and taking a few deep breaths can take the pressure off you right away. You’ll be surprised how much better you feel once you get good at it. Just follow these 5 steps:

  1.  Sit in a comfortable position with your hands in your lap and your feet on the floor. Or you can lie down.

  2.  Close your eyes.

  3. Imagine yourself in a relaxing place. It can be on the beach, in a beautiful field of grass, or anywhere that gives you a peaceful feeling.

  4.  Slowly take deep breaths in and out.

  5.  Do this for 5 to 10 minutes at a time.

EXERCISE 8: Progressive muscle relaxation (1, 4)

By Cathy Wong

Progressive muscle relaxation is a mind-body technique that involves slowly tensing and then relaxing each muscle group in the body. Typically used to tame stress, progressive muscle relaxation is said to increase your awareness of the sensations associated with tension (and, in turn, help you identify and deal with the physical effects of everyday stress). Indeed, a number of studies show that regular practice of progressive muscle relaxation may help keep your stress in check (as well as treat stress-related health problems like insomnia and anxiety).

How to Practice

Progressive muscle relaxation is best practiced in a comfortable position and in a quiet space free of distractions. To start, tighten the muscles in your face for five seconds by squeezing your eyes shut, wrinkling your forehead, and clenching your jaw. Next, relax your face and breathe deeply as you feel the tension release from your muscles. Moving through the rest of your body (including your hands, arms, shoulders, back, stomach, buttocks, thighs, and feet), repeat the tension-relaxation sequence for each muscle group (one muscle group at a time). If any muscles still feel tense at the end of your progressive muscle relaxation session, tighten and relax that muscle group at least three more times.

Benefits

Several studies show that progressive muscle relaxation may help lessen stress. In a 2000 study from the Journal of Behavioral Medicine, for example, researchers exposed 67 volunteers to a stressful situation and then had them practice progressive muscle relaxation, undergo music therapy, or take part in a control group. Results revealed that members of progressive muscle relaxation group experienced greater relaxation (including a more significant decrease in heart rate) than the rest of the study members. Other research indicates that progressive muscle relaxation may also help soothe stress by reducing levels of cortisol (a hormone released in response to stress).

In addition, a number of studies suggest that progressive muscle relaxation may benefit people with certain health problems. For instance, a 2003 study from the journal Psychooncology found that progressive muscle relaxation helped relieve anxiety and improve quality of life among 29 colorectal cancer patients who had recently received surgery. A 2006 study published in the Journal of Alternative and Complementary Medicine, meanwhile, showed that progressive muscle relaxation improved quality of life and reduced blood pressure among people with heart disease.