Are You Managing Stress? Or is Stress Managing You?

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When considering how to best manage yourself and your stress, it’s worth asking yourself whether stress is the problem, or whether there is something else underlying the difficulty you’re experiencing.

We are all familiar with what stress looks like from a physiological standpoint—increased heart and respiratory rates, altered appetite and agitation. While not necessarily pleasant, these physiological alterations can help us cope with stressors. However, in the long term, these responses can be detrimental to our health. Ongoing or extreme stress can cross the line into distress, with signs such as headaches, fatigue, nausea, problems sleeping, mood changes and altered eating habits.

It can be difficult to determine when this happens, often because the increases in stress or responsibility happen incrementally. Let’s think of stress like water in a river. Be proactive in managing this unavoidable part of veterinary life. There’s a threshold past which the river floods the surrounding area, but below that threshold, the river can change level without incident. Once the stress threshold is exceeded, there are consequences; but below a certain threshold, we function fine with the stressors in our lives.

Typically, we’re comfortable sharing with others that we’re stressed. We hear phrases such as “I’m so stressed,” and “That last case really stressed me out” from colleagues and friends. In general, we don’t attribute shame or embarrassment to being stressed. This contrasts with mental health issues we might face as vets, such as compassion fatigue, burnout, depression or anxiety, which some in the industry consider taboo to discuss.

When considering how to best manage yourself and your stress, it’s worth asking yourself whether stress is the problem, or whether there is something else underlying the difficulty you’re experiencing.

Keeping Your Balance

Overall, the best way to manage stress is to strive to have good work-life balance and to create time for self-care activities. The most fundamental of these include eating well, sleeping normally and exercising on a daily or weekly basis. The degree of success you have with those things will set the stage for how resilient you are to the daily stresses and strains of practice.

That being said, stress is ubiquitous and unavoidable. Whether it is work stress, life stress or the stress we put on ourselves, learning how to thrive in the face of it is an essential life skill.

Let’s start by discussing how to minimize stress on a daily basis.

Daily Balance

An effective preventative stress management strategy is to have habits and a routine that decrease the daily burden of decision making and facilitate your needs being met. Why is this important? Because of willpower depletion.

Research suggests that we have a finite amount of willpower in a given day, and if we expend it early, say, in dealing with minor life stresses, then we won’t have any left with which to persevere when the going gets really tough.

“Routine” doesn’t have to equal “boring,” and it doesn’t have to be rigid. In fact, flexible routines are probably the most appropriate, given the unpredictability of equine medicine. Any regular activity, errands or chores can and should be slotted into a routine; it’s also important to set aside time for self-care activities and unstructured time.

Routines and habits help to minimize the stress that comes from the predictable items on our to-do list; this will give you more capacity to deal with the unexpected stressors and strains that arise on a given day. Many of these are out of our control, and that in itself can cause stress.

An important step in dealing with unexpected and uncontrollable stressors is to acknowledge them as such. Once you’ve recognized that you are feeling stressed or overwhelmed, take a moment to scan your body and acknowledge the physical sensations occurring—is your heart racing? Is your face flushed? Are you holding your breath? Noticing these sensations will help you connect your mind with your body, which in itself is calming. Here are several exercises you can try:

• Square breathing—2-second inhale, 2-second hold, 2-second exhale, 2-second pause

• Focused exhale—2-second inhale, 8- to 10-second exhale; this allows for optimal gas exchange and requires attention to sustain.

• Breathe with your tongue on the roof of your mouth, right behind your upper incisors.

• Belly breathing—place one hand on your abdomen and focus on the rise and fall as you inhale and exhale.

• “Brain massage”—breath 4-second inhale with abdomen rising, 4-second hold, 8-second exhale with abdomen becoming flat (repeat three times). This breath combines several breathing techniques. It includes a conscious diaphragmatic breath with increased oxygen levels that support calming and a long exhale that helps you to perceive space and freedom in your life.

• 5-4-3-2-1—Stop and name five things you can see, four things you can touch, three things you can hear, two things you can smell and one thing you can taste. This is an exercise that will help you refocus and decrease the chances of the stress response escalating further.

Once you’ve recognized that you’re stressed and have taken a moment to regain even a small sense of calm, it’s time to make a plan for how to deal with that particular stressor.

Balance and Control

The only things in life that we can control are ourselves. Therefore, if we cannot change the things that are causing us stress, we might choose to change our responses to those things.

Changing our attitudes or perspectives isn’t easy, but deciding to try can have a strong psychological impact. The idea of choosing what you get stressed or riled up about can seem novel or next to impossible. How could you not get upset that your new digital radiography machine is broken? You do have a choice—a choice to give power to uncontrollable and often unavoidable events in your life, or not.

It takes practice not to allow things to manage your responses. The first aspect to keeping your power and balance we’ve already discussed: noticing you’re stressed. Then, instead of allowing the proverbial freight train to keep rolling, ask yourself whether you want to let it. Sometimes you will deem something worth your increased blood pressure and cortisol levels; other times, you could choose to take a deep breath and let it go. Asserting your choice over what is worthy of your stress and what is not will help you feel more in control and help you manage your short-term and long-term stress levels.

Another aspect of changing your attitude is altering your expectations. It’s natural to expect a lot of yourself; however, the pressure that comes from those expectations can cause problems. It’s difficult to meet high expectations in all areas of one’s life simultaneously. If you go the extra mile at work to meet your expectations of being an exceptional vet, it might be difficult to have the energy and time to devote to being the best partner or parent at home. Whereas, if we set more moderate expectations at work—lower the bar just a little—or choose one area at a time on which to improve, it might be possible to meet our expectations of ourselves. When this happens, we increase our feelings of self-efficacy and self-esteem, as well as experience a greater sense of calm and fulfillment.

Delegating or asking for help is a great way to alleviate some sources of stress, although it can be difficult to do. As veterinarians, we are naturally doers and fixers. We are used to being able to do everything ourselves and to having others view us as highly capable, which can sometimes act as a barrier to asking for help or assigning a task to another. There is value in asking for help, not only because it will decrease our stress burden, but it will also remind us and others that we are not superheroes and that receiving help does not indicate that we have failed.

A colleague of mine used to wash his own truck because he thought car washes were overpriced. When he became a practice owner, he priced out how much it cost for him to wash his truck and never did it again. When we offload tasks that do not need our unique skill sets, whether it be washing a truck or hiring domestic help (i.e., cleaning service, nanny), a bookkeeper or a technician, we give ourselves more room for things that demand attention specifically from us, and no one else.

No stress management article is complete without stating the obvious: Use your vacation days and go on a holiday. Taking a break from work and your day-to-day stressors is essential in managing stress in the long term.

Take-Home Message: Quick Stress Busters

• Smile for 30 seconds. Your mind will follow your body’s cues. If you can sustain a smile for 30 seconds, you are likely to feel like smiling when the time is up.

• Laugh out loud. This is another way to use your body to support your mind.

• Spend time with your animals.

• Close your eyes and visualize somewhere that you feel calm or happy.

• Declutter or tidy one small area. This has two benefits. First, it’s a consuming activity to take your mind away from the source of your stress. Second, having less mess will help you feel more organized and together.

References

1. “Is willpower a limited resource?” American Psychological Association website. apa.org/helpcenter/willpowerlimited- resource.pdf. Accessed August, 20, 2016.

2. “A 30-second hack to instantly become more patient with your kids.” Lipsky, L. Mindbodygreen website. mindbodygreen. com/0-26175/a-30-secondhack- to-instantly-become-morepatient- with-your-kids.html. Accessed August 15, 2016.

3. 10 Fast Stress-Busting Pick-Me-Ups. WebMD website. webmd.com/balance/ ss/slideshow-stress. Accessed August 20, 2016. 

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