SURGEON GENERAL’S RX FOR STRESS IN AMERICA

The National Institutes of Health (NIH) has put itself firmly on record as being deeply concerned about our national epidemic of stress at the individual, organizational and societal levels. NIH’s National Center for Complementary and Integrative Health (NCCIH) broadcast on September 7th its annual Stephen E. Straus Distinguished Lecture in the Science of Complementary Therapies. The lecture was titled A Nation Under Pressure: The Public Health Consequences of Stress in America.

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PROMOTING RESILIENCE WITH OPTIMISM AND MINDFULNESS

The American Psychological Association (APA) recently documented a worrisome increase in stress in the U.S. population (Stress in America https://www.apa.org/news/press/releases/stress). Uncontrolled stress can cause or worsen anxiety, depression, PTSD and a wide range of clinical conditions affecting every organ system. Medical students, residents and practicing physicians experience higher levels of stress than their age-matched counterparts at all levels of medical training....

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ALLOWING AWE IN MEDICINE

Of all the sciences, medicine uniquely combines all domains of the human condition-biological, cognitive, emotional, environmental, interpersonal and transpersonal. The more we learn about the benefits of the interpersonal and transpersonal dimensions of health, disease and medical practice, the more we seek to populate medical schools with well-rounded students and humanize medical training and the healthcare workplace.

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You may find it helpful to say to yourself “in” on the inbreath and “out” on the outbreath. Use your breath as an anchor to bring you into the present moment and help you tune intentionally into your natural state of calm awareness and restful alertness.


“O” is for “Open” and “Observe”

Expand the field of your awareness beyond your breathing, including a sense of the body as a whole, your posture, your facial expression and the sensations on your skin. Notice all your sense perceptions- touch, sight, sounds, smells and tastes. Expanding your awareness beyond your body, connect to the trees and all the green growing things you depend on for oxygen. Notice your thoughts and their fleeting, impermanent nature. Notice that thoughts are not always facts and not necessarily true. Notice that you can intentionally choose to think your thoughts or let them go. Allow your emotions to surface, recognizing and naming them without judgment- ‘this is anger’- ‘this is joy’- ‘this is grief ’- ‘this is happiness’- ‘this is anxiety’- ‘this is depression’- ‘I know you. I am experiencing you but you do not define me.’


Naming your emotions without self judgment helps to cultivate emotional intelligence, magnifying the benefits of uplifting emotions and reducing the power of distressing emotions. Opening your heart to your own stress, difficult emotions and suffering can nurture your natural capacity for human affiliation and social support and your capacity to help relieve the stress and suffering of other people and all living things. Your own self-healing is the core foundation of your patient care.


“P” is for “Proceed”/new “Possibilities”

After this intentional slowing down, stepping off the treadmill and out of the rat race, take the benefits of this practice into the next moment, the next task, the next meeting, the next conversation, the next relationship- informing ordinary daily activity with the physiological benefits of mindful self-care.


Notice the world around you, experiencing how things really are, tapping into your intuitive inner wisdom for what you need right now- a chat with a colleague, a call or text to a friend, a quiet moment alone, a bite of chocolate, a cup of tea. Then proceed with more clarity, from a place of choice and skillful responding rather than reactive, habitual auto-pilot.


Proceed without any expectation of how others will act or speak or behave. Be realistic about your inability to control the pace at which other people are moving. Know with increasing confidence that you can consciously choose the pace of your own mind and body, where you place your attention and whether you perceive your cup as half empty or half full. Feel your inner relaxation response naturally balancing your stress response. With an open, curious mind, experiment with the S.T.O.P. practice several times a day, anywhere, anytime- as you enter the exam room, while listening to your patients, before each meal, before starting the car, turning on the computer, bathing, brushing your teeth, taking out the trash, during conversation, going to bed, waking up in the morning- anytime, anywhere.


As you take control of where you place your attention, you will understand why ‘mindfulness’ is also translated as ‘heartfulness.’ Refining your ability to slow down and S.T.O.P. can help you promote resilience, manage stress, prevent burnout and cultivate compassion. Keeping a log of your practice can be extremely helpful. The following questions are taken from the S.T.O.P. practice log (3) below.


What was the situation? What was going on with you when you thought to S.T.O.P.? (body, mind, emotion) What did you notice WHILE you were practicing? (body, mind, emotion) What did you notice AFTER your practice? (body, mind, emotion, action) What did you learn?


Resources


1. U Mass Medical Center for Mindfulness in Medicine, Health Care and Society  

2. Downloadable basic S.T.O.P. instruction summary

3. Downloadable detailed 1 week S.T.O.P. practice log       

Modern life is taking its toll on our nation’s mental and physical health. Physicians and their patients both suffer from stress-related conditions and burnout. Multiple national surveys in the last year have documented an alarming increase in perceived stress, anxiety, depression and suicide. Our health and our very lives depend on our ability to manage stress in healthy ways at home, at work, in traffic, in relationships- and simply inside our own skin. We need simple tools that we can use personally and also prescribe to bring some calm to the chaos- some peace to the frenzy- some kindness to the aggression and competition. S.T.O.P. is one such tool taken from the Mindfulness-Based Stress Reduction curriculum (1). This practice can take as little time as 1 breath or as long as you like.


“S” is for “Stop” and take Stock

Aren’t there times when you just need a break- even for a minute- even for a breath? Make yourself a promise to recognize several times each day when you need some self-care and rejuvenation and simply stop. Step out of the unskillful, habitual reactivity of automatic pilot mode and step into the present moment.


Step out of the doing mode and into the being mode. Reconnect with yourself and your natural inner resources of resilience, relaxation, peacefulness, compassion and wisdom. Really tune in- paying attention to what is happening right now, right here, without expectation, without an agenda other than a curious, open inquiry into what is actually happening inside you and around you.   

BY JOHN A. PATTERSON MD, MSPH, FAAFP


Even if you don’t remember this entire sequence, just remember the word stop. Have the intention to truly inquire into the three primary domains of your experience- 1) Body- sense perceptions and physical sensations , 2) Mind- thoughts, images, plans, memories and 3) Emotions and feelings. Bring some well- deserved self-compassion and kindness to yourself, especially if your experience is unpleasant, stressful or painful.


Alternatively, you might ask, ‘What is absent from my experience right now- what have I forgotten about myself, my work, my colleagues, my family.’ Allow experiences of kindness, compassion, generosity, awe and beauty and smell the roses along the way.


“T” is for “Take” a Breath

Take a normal, natural breath, directing your full attention to breathing. Even one breath experienced with your full, unhurried attention can counteract the stress response. Feel the physical sensations of each inbreath and each outbreath- sensations in the nostrils as the air moves in and out- sensations as the air moves back and forth across the upper lip- sensations as the air moves in and out of the back of the throat- sensations as the chest expands and contracts- and sensations as the belly expands and contracts.

JOHN A. PATTERSON MD, MSPH, FAAFP

Dr Patterson chairs the Lexington Medical

Senator Alvarado earned his bachelor's degree in biology from Loma Linda University (California) in 1990, and then went on to receive his Doctorate in Medicine in 1994. He completed his medical residency in Internal Medicine and Pediatrics at the University of Kentucky in 1998. Society's Physician Wellness Commission and is certified in Physician Coaching. He is on the family practice faculty UK College of Medicine and teaches nationally for Saybrook School of Integrative Medicine and Health Sciences (San Francisco) and the Center for Mind Body Medicine (Washington, DC). After 30 years in private family practice in Irvine KY, he now operates the Mind Body Studio in Lexington, where he offers integrative mind-body medicine consultations specializing in mindfulness-based approaches to stress-related chronic conditions and burnout prevention for helping professionals. He can be reached through his website at www.mindbodystudio.org