I’d like to take a few minutes to highlight some information I hope will be helpful to those who are currently experiencing a prolonged period of increased stress. As a physician I have been watching as my fellow physicians mentally and logistically prepare for what we expect to be a very difficult time. I liked the Washington Post article by Alison Block titled “Doctors and nurses are already feeling the psychic shock of treating the coronavirus.” The medical community is preparing for unprecedented measures in the United States. In the midst of this, we are also making decisions about who will care for our children, how much contact we will have with spouses and children, and how to plan for childcare without exposing our elderly parents. In today’s world of living apart from close family many have to find support from friends and neighbors. In the article Dr. Block refers to this as “pre-trauma.”
This concept is very similar to the concept of secondary post-traumatic stress, which is something healthcare workers also frequently experience. Secondary traumatic stress is the emotional duress that results when an individual hears about the firsthand trauma experiences of another. The essential act of listening to trauma stories may take an emotional toll that compromises professional functioning and diminishes quality of life. When you couple this with the stress of the work environment in healthcare settings right now you can expect that your body is putting out a surge of cortisol. Cortisol is useful for short periods of time under stress. It works to raise blood pressure, shunts blood to essential organs, raises blood sugar, and temporarily suppresses immune system function. Normally a period of intense stress should be short and then over, allowing the body to get back to normal functioning. But when you have a job or life situation that involves frequent traumatic events or hyper-vigilance to danger, cortisol remains high for long periods of time or indefinitely. As you can imagine, this would result in persistent high blood pressure, high blood sugar, immune system suppression, and the resulting organ damage over time.
The good news is there are some things we can do to proactively lower our physiologic stress and cortisol levels on a daily basis. Here is a list of activities you can incorporate into your daily schedule right now to give your body a pause.
2. Mindfulness/Meditation - apps like YouTube, Calm, Headspace, MoodTools, Abide
4. Grounding exercises – sitting with eyes closed and focus on your other senses – feeling the floor, your chair, smells, sounds, breathing, etc.
5. Tactical breathing – breathe in while counting to four, hold for four, breathe out for four, hold for four,etc.
6. Spend time with family
7. Spend time with pets or animals
9. Gardening, hiking, spend time in nature
10. Journaling - If you don't like to write a lot, you can write 3 things you are grateful for, 3 good things that happened today, and 3 things you are looking forward to tomorrow.
11. Connecting with faith communities
12. Talk to a colleague who understands
13. Humor, comedy
14. Create something – draw, paint, craft, knit, carpentry, write, sort photos, etc.
It’s a great idea to schedule a few of these throughout your day even at this difficult time. This is called making a coping strategy.
Morning – prayer or mindfulness app
Work – stop and do tactical breathing for one minute twice during your shift, talk to a colleague about your day at the end of shift, call a friend
Evening – go for a walk/run, spend time with family/pets
Bedtime- prayer, do stretches or yoga, listen to a sleep story on a mindfullness app
I also like the idea of combining these as much as possible. Exercising outside is better than indoors. I like to walk outside while listening to a book or podcast that lowers stress. Walking with a pet, watching a comedy with your kids, or working on a project or hobby outdoors or with family are some ways you can think about combining them.
Being intentional to lower our stress is the best way we have available to function at our best and get through this without adverse consequences to our health. As you begin to use these, share with your colleagues and create a culture of intentional coping strategies.
Laura Shamblin, MD