Two ways to beat stress

The daily frustrations of medical practice take their toll on body and mind. These stress-reduction methods can put you back in control.

By Deborah A. Grandinetti
Senior Editor

You know the damage stress can do. Every doctor does; but not every doctor follows his own advice to cut down on stressors. If you haven’t yet developed a good system to manage the pressure and anxiety you face every day, here are two strategies that physicians endorse. Each has a short version that can be done in minutes, and a longer one that can make you less vulnerable to stress in the first place, provided you practice it regularly.

Although the goals of both systems are similar, the methods aren’t. The Institute of HeartMath, in Boulder Creek, CA, takes a step-by-step, straightforward approach in its Freeze-Frame and Heart Lock-In techniques.

If you’re more interested in self-exploration, the system taught by The Focusing Institute of Spring Valley, NY, may serve you better.

Here’s a closer look at each.

HeartMath: useful in the heat of the moment

When an anesthesiologist told vascular surgeon Joseph F. McCaffrey that he wouldn’t give his high-risk patient anesthesia because the patient hadn’t been evaluated properly, McCaffrey almost lost it. This was the second such incident in less than a week. "I was ready to blow up. I just about had my finger on the anesthesiologist’s chest," he says.

But then McCaffrey made himself do the Freeze-Frame technique, an exercise designed to restore calm in less than a minute. Using a specific sequence of steps, McCaffrey "froze" his anger. He imagined himself breathing through his heart. Then he conjured a good memory strong enough to evoke feelings of love and appreciation.

According to the folks at HeartMath who teach this technique, shifting to these feelings dramatically affects the heart’s rhythm. In fact, if McCaffrey had been hooked up to an ECG at the time of this episode, he’d have seen the frequent, jagged peaks in his heart rhythm smooth out as the anger gave way to more positive feelings.

HeartMath Research Director Rollin McCraty says that smoothing out the heart rhythm changes the nature of the signals the heart sends to the brain, effectively stopping the body’s stress cascade and facilitating clearer thinking.

As McCaffrey’s agitation cleared, he asked himself–still following the technique–"What would be a more productive response to this situation?" That’s when he realized that the anesthesiologist was "as interested in taking good care of the patient as I was."

Keeping that common ground in mind, McCaffrey was able to bring the anesthesiologist around to his point of view–without exploding. "I could have been the typical obnoxious surgeon," he said, "but that wouldn’t have made for a very collegial relationship."

The Freeze-Frame is one of three main exercises HeartMath teaches. It’s designed for use at the moment stress flares up. The other two–Cut Thru and Heart Lock-In–are meant for regular use to prevent stress.

Cut-Thru, which takes five to 10 minutes, was created to help people free themselves from the emotional loops that cause anxiety and depression. Heart Lock-In, which HeartMath recommends doing at least five times a week for 15 minutes at a stretch, was designed to help stabilize emotions.

Internist Lee Lipsenthal, medical director for Lifestyle Advantage, the consulting arm of Dean Ornish’s Preventive Medicine Research Institute, says the Heart Lock-In exercise offers a range of benefits. It has been shown, for instance, to lower blood pressure and improve sugar regulation in diabetics.

According to Lipsenthal, research suggests that the technique increases the speed at which the brain processes thought. In other words, you can think more clearly–and perhaps more creatively–when you aren’t consumed by rage and anxiety.

HeartMath’s McCraty says that regular practice helps people maintain optimal heart rhythm for longer periods, making it easier for the Freeze-Frame technique to shift them back to this rhythm when an immediate stressor surfaces.

McCaffrey, who uses Heart Lock-In regularly, concurs. It helped him quickly clear his mind when he found himself in a tight spot during carotid surgery on a frail elderly woman.

Twenty minutes after the procedure, she began to bleed. He remembers thinking, "I’ve got one shot to get a secure suture, and if it gets away from me, I’m going to have to open her chest quickly–which she may not survive." So he stopped for a moment to do the Freeze-Frame, then successfully completed his work.

New Providence, NJ, internist Richard N. Podell appreciates the technique’s in-the-moment applicability. "If you’re feeling stressed while you’re talking to someone, you can’t go off into a corner and meditate."

The HeartMath approach is finding its way into the broader physician community, too. Physician groups that have sponsored the training include The Permanente Medical Group in Northern California, ThedaCare in Wisconsin, and Sentara Healthcare in Norfolk, VA.

Focusing: engaging the wisdom of the body

The second approach to stress management is taught by The Focusing Institute, and it centers on, obviously, focusing–a process that asks you to look inside yourself, determine what’s bothering you, and put those concerns aside.

A full session can take anywhere from 20 minutes to more than an hour, but you can do a short version in just a few minutes. A technique called "clearing a space," which is often the first step in the full focusing process, takes about five minutes and can be used as a quick stress reliever during the day.

Here’s a variation of that technique from Boston psychologist Joan Klagsbrun, who has used focusing in her behavioral medicine practice for 25 years:

•Set aside at least five minutes when you know you won’t be disturbed.

•Remember a time when you felt a deep sense of calm and well-being. Try to use as many of your senses as you can, recalling the sights, smells, and sounds, as well as what you felt.

•Ask yourself: "What is getting in the way of that?"

•Touch on each of the concerns or problems you uncover. Don’t probe deeply; just get a sense of how each concern feels in the body. Then imagine that you’re putting down the concern, at the right distance, outside of you.

•Continue until you have put down three or four of your most pressing concerns. Then ask yourself, "What do I still sense in the background?" It could be a feeling of being constantly pressured, rushed, overwhelmed, or a little depressed.

"Focusing can bring enormous physical relief," says Klagsbrun. "The more we place the background content outside of ourselves, the more we can feel like ourselves."

Emergency physician Bruce E. Nayowith, who has been a fan of the method since 1988, says the technique has helped make him less frantic. "Even when I have lots of things to do, I can put them ‘out in space’ so they’re not all trying to run my body at once."

The full focusing process employs five other basic steps. Because there are subtleties involved, you’ll need personal instruction to master it. Here’s a brief description to help you determine whether it appeals to you.

Begin by bringing your attention to the solar plexus. As you follow the process, your attention might shift to other areas of the body. These areas are keys to related stress. Let’s say your attention turns to your stomach. Focus there. How would you describe the way it feels? Is there a word, phrase, or image that captures it exactly? It may take a couple of tries. Sometimes just hitting on the right word or image is enough to bring relief.

As you continue to pay attention to what that feeling is like, you may discover that you are carrying other feelings you’re not consciously aware of. Maybe you notice anger over your need to rush all day just to keep on top of your schedule, or grief about a patient who died. Acknowledging the unacknowledged–simply by spending time paying attention–can lighten those feelings considerably.

"Focusing is really about making the implicit explicit," says Klagsbrun. "We carry what’s implicit at the body level. If we were to look at problems only from an intellectual perspective, we wouldn’t have access to the ones that we don’t yet have words for, but are weighing us down."

This is the point in the process when focusers use specific questions, such as, "What is it about this whole situation that I don’t know that creates this body state?" This is the key to focusing–to explore the meaning that is emerging from the body. The method’s philosophy is that everyone has innate wisdom, and that the best solutions for stress unfold from within.

Nayowith, for instance, used focusing to understand why his stomach tightened intensely during certain work activities, despite his twice daily relaxation exercises. At the root of it all, he discovered, was a fear that he wouldn’t be accepted for the quality of his work. Once he acknowledged the fear, the abdominal distress and anxiety eased. That session also ended a cycle of sore throats and fevers, which he found himself getting every couple of weeks for more than a year.

The final step in focusing explores the best way to resolve the problem. You can do the whole process alone, or by taking turns with a partner. The partner is there to reflect your words, without giving advice.

Focusers say they use "focusing moments" throughout the day. Nayowith says he’s found it particularly helpful when he needs to "settle down" after intense patient encounters, like when he suspects the patient is lying to him to gain access to drugs.

"I hate this type of confrontation and can feel myself start to shake," he says. So after he discharges the patient, he takes a few minutes to "be with how my body is feeling. It helps just to acknowledge that something I don’t like is happening. Otherwise, it might take me a couple of hours to settle down. This way, I don’t take that tension with me when I see my next patient."

To learn more ...

...About HeartMath, call 800-450-9111, or visit www.heartmath.com. This nonprofit organization runs workshops around the country; some are day-long, others are more intensive. You can also purchase private instruction by phone or teach yourself using an interactive software program that allows you to watch how the techniques change your heart rate variability pattern.

... About The Focusing Institute, call 800-799-7418, or visit www.focusing.org. The nonprofit organization offers two books, Focusing (Bantam Books, 1981) by Eugene T. Gendlin and The Power of Focusing: A Practical Guide to Emotional Self-Healing (New Harbinger, 1996) by Anne Weiser Cornell, as well as audio and videotapes and a series of workshops.

A Medical Economics Web Exclusive

When the whole office is on edge

What do you do when the pressure at the office builds to the point where you’re afraid you’re going to lose your best employees? That was the dilemma faced by Plantation, FL, gastroenterologist Gary S. Luckman and his two partners.

Luckman’s practice caters mostly to older patients, many of whom are also under the care of specialists. As the practice took on more managed care contracts, the paperwork, records management, and phone calls increased exponentially.

To make matters worse, new patients who joined the practice simply because it was under contract with their health plan were more abusive toward doctors and staff than longtime patients. That set everyone on edge.

Enter Jack Singer, a psychologist and physician stress-reduction specialist Luckman brought onboard. Singer held two two-hour meetings for the staff where he elicited their frustrations, helped them find solutions, and taught them stress management techniques.

He also asked them to write comments on the character and personality of everyone in the practice, including the doctors. Then he shared the information. "You had to read how everyone else saw you," says Sherlyn O’Neil, who has been with the practice for almost 20 years. She says that helped a lot. Everyone got a chance to air their complaints, and they also saw what they needed to change in their own behavior so they didn’t continue to create conflicts with other staff members.

At a third session, Singer included the doctors. "That’s when the staff got to yell at us," quips Luckman. At that meeting, Singer showed staff and physicians how to confront each other–productively–to resolve interoffice problems. He also taught the group how to handle demanding or disrespectful patients so that it didn’t wear them down.

What did the group’s doctors and staff learn from the experience? "Jack reminded us that we need to talk about problems as soon as they come up, instead of letting the resentment build," says Luckman. "With 18 staff members, there are always little fires. Now we try to snuff them out as quickly as possible."

The other lesson, says Luckman, is how important it is for everyone to take a lunch break every day. "If we get overly stressed and don’t take care of ourselves, we’re not going to be very effective."

Since their work with Singer, the doctors and staff continue to meet every month or two to keep things on an even keel. Luckman says he has also hired a physician assistant to take some of the pressure off the doctors.

The practice has recently started to "fire" problematic managed care companies. "We choose ones that are giving us the most hassles and the lowest pay," says Luckman. On the day they end the contract, staff and physicians hold a mini-celebration.

Deborah Grandinetti. Two ways to beat stress.

Medical Economics

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