Ep 188 The prolonged stress cycle
Summary
Dr. Amy Vertrees, the host, introduces the episode focusing on the prolonged stress cycle, a topic relevant to many, especially female surgeons, given the various stressors in medicine and the world . She notes that this topic arose from discussions within the female boss surgeons group, emphasizing its importance and broad applicability . The group, which meets weekly and twice monthly on Sundays, covers topics not typically addressed in residency but crucial for career and mental health .
Dr. Vertrees shares her background as a general surgeon and certified coach, highlighting her experiences in military and civilian settings, as well as private practice, which led her to create the Boss Business and Surgery series . She details the program's structure, including three-month modules on dealing with difficult colleagues and managing the impact of complications . The discussion emphasizes the pervasive nature of stress, exacerbated by global events and the demands of being a surgeon .
The prolonged stress cycle often begins in training, with experiences that may have been hostile or malignant, impacting future stress responses . Dr. Vertrees references the book "What Happened to You?" by Bruce Perry and Oprah Winfrey, explaining how prolonged stress can dysregulate the nervous system, hindering rational thinking . She differentiates between regulated stress, which builds resilience, and dysregulated stress, which results from extreme, prolonged, and unpredictable situations .
Dr. Vertrees explains the stress cycle, involving a trigger, a stress response (fight, flight, freeze, or fawn), and a physiological reaction . Recognizing one's physiological stress response is crucial, as it serves as a red flag indicating excessive stress . She provides an example of a stressful surgical scenario, emphasizing that recognizing a stress response is a sign of awareness, not a personal failing . Finding a colleague in such situations can provide stability and prevent potentially harmful actions .
The discussion covers the importance of emotional regulation, especially for new attendings, and the impact of decision fatigue . Impaired coping mechanisms, such as doom scrolling or overeating, can worsen the stress cycle . Confidence is defined as the ability to manage any emotion, including fear and uncertainty, while still acting effectively . Practical techniques to interrupt the stress cycle include deep breathing exercises, focusing on the next best step, and box breathing .
Dr.Vertrees stresses that emotional and physiological regulation is crucial for surgeons, who are leaders of their teams and responsible for their patients . She advises on communicating with families during stressful events, emphasizing the importance of reassuring them that their loved one is okay . The value of having a second set of skilled eyes, such as residents, is highlighted, as they can prevent potentially devastating mistakes .
Strategies to manage the stress cycle include awareness and tracking, physiological regulation, emotional processing, cognitive reframing, and setting boundaries . Purpose and value alignment, along with gratitude, are also important . Dr. Vertings recommends finding a challenge network, a group of supportive individuals who can be relied upon during difficult times . She concludes by promoting the Boss Female Surgeons Group Coaching Program and other resources available at bosssurgery.com .
Chapter
Introduction to Prolonged Stress Cycle
Dr. AmyVertrees introduces the episode's focus on the prolonged stress cycle, a topic of significant relevance, particularly for female surgeons, given the multitude of stressors present in both medicine and the broader world. She highlights that this subject emerged from discussions within the female boss surgeons group, underscoring its importance and widespread applicability.
The Female Boss Surgeons Group
Dr. V describes the group of female surgeons who meet weekly, Wednesdays at 6 p.m. Central, and twice a month on Sundays, to discuss topics often overlooked in residency but essential for career advancement and mental well-being.
Dr. Vertings' Background and the Boss Business and Surgery Series
Dr. V shares her background as a general surgeon and certified coach, emphasizing her experiences in military and civilian settings, as well as in private practice, which inspired her to create the Boss Business and Surgery series. She notes that the business was reinvigorated in 2020 to address new challenges faced by surgeons.
Program Structure: Difficult Colleagues and Complications
Dr. V details the program's structure, which includes three-month modules dedicated to addressing difficult colleagues and managing the impact of complications. She emphasizes that the program teaches strategies to improve relationships and positively influence workplace dynamics.
Pervasive Nature of Stress
The discussion emphasizes the pervasive nature of stress, which is exacerbated by global events and the inherent demands of being a surgeon. Dr. V mentions theories suggesting that the high level of stress in the world may be intentional, designed to keep people off balance and disengaged.
Stress Cycle in Training and Early Career
The prolonged stress cycle often begins during training, with experiences that may have been hostile or malignant, significantly impacting future stress responses. Dr. V reflects on her own training, initially downplaying its hostility but later recognizing its challenging aspects.
"What Happened to You?" and Dysregulated Nervous System
Dr. V references the book "What Happened to You?" by Bruce Perry and Oprah Winfrey, explaining how prolonged stress can dysregulate the nervous system, hindering rational thinking. She explains that stress can overwhelm the primitive brain, preventing signals from reaching the smart part of the brain.
Regulated vs. Dysregulated Stress
Dr. V differentiates between regulated stress, which builds tolerance and resilience, and dysregulated stress, which results from extreme, prolonged, and unpredictable situations. She notes that predictable, moderate, and controllable stress can lead to productive stress responses.
The Stress Cycle: Trigger, Response, and Physiological Reaction
Dr. V explains the stress cycle, which involves a trigger, a stress response (fight, flight, freeze, or fawn), and a physiological reaction. She emphasizes that recognizing these responses is crucial for managing stress effectively.
Recognizing Physiological Stress Response
Recognizing one's physiological stress response is crucial, as it serves as a red flag indicating excessive stress. Dr. V provides examples such as increased heart rate, muscle tension, and poor sleep.
Surgical Scenario and Stress Response
Dr. V provides an example of a stressful surgical scenario, emphasizing that recognizing a stress response is a sign of awareness, not a personal failing. She notes that in high-stress situations, the primitive brain can take over, hindering clear thinking.
Finding a Colleague for Stability
Finding a colleague in stressful situations can provide stability and prevent potentially harmful actions. Dr. V likens this to grabbing onto a stable object during a tornado.
Emotional Regulation and Decision Fatigue
The discussion covers the importance of emotional regulation, especially for new attendings, and the impact of decision fatigue. Dr. Vertings notes that making numerous decisions can impair one's ability to make further decisions effectively.
Impaired Coping Mechanisms
Impaired coping mechanisms, such as doom scrolling or overeating, can worsen the stress cycle. Dr. V explains that these behaviors are often attempts to avoid negative feelings but ultimately lead to increased vulnerability.
Confidence as Emotional Regulation
Confidence is defined as the ability to manage any emotion, including fear and uncertainty, while still acting effectively. Dr. V emphasizes that courage is acting despite feeling fear.
Techniques to Interrupt the Stress Cycle
Practical techniques to interrupt the stress cycle include deep breathing exercises, focusing on the next best step, and box breathing. Dr. V mentions Dr. Robin Tiger's advice on using deep breathing for both surgeons and patients.
Importance of Emotional and Physiological Regulation
Dr. V stresses that emotional and physiological regulation is crucial for surgeons, who are leaders of their teams and responsible for their patients. She notes that a calm leader can help the team remain calm and effective.
Communicating with Families During Stressful Events
Dr. V advises on communicating with families during stressful events, emphasizing the importance of reassuring them that their loved one is okay. She suggests leading with the assurance that the patient is fine before explaining the details.
Value of a Second Set of Skilled Eyes
The value of having a second set of skilled eyes, such as residents, is highlighted, as they can prevent potentially devastating mistakes. Dr. Vertings shares a personal experience where a resident prevented her from making a significant error.
Strategies to Manage the Stress Cycle
Strategies to manage the stress cycle include awareness and tracking, physiological regulation, emotional processing, cognitive reframing, and setting boundaries. Dr. V emphasizes the importance of naming and owning feelings.
Purpose, Value Alignment, and Gratitude
Purpose and value alignment, along with gratitude, are also important. Dr. V suggests reflecting on past experiences to identify one's values and aligning actions with those values.
Finding a Challenge Network
Dr. V recommends finding a challenge network, a group of supportive individuals who can be relied upon during difficult times. She credits Dr. Jill Clark for this concept.
Promotion of Boss Female Surgeons Group Coaching Program
Dr. V concludes by promoting the Boss Female Surgeons Group Coaching Program and other resources available at bosssurgery.com. She mentions upcoming topics such as power and negotiating, as well as strategies for managing clinic and developing a CEO self-concept.
