seX & whY Episode 5 Part 3: Stress Response

Dec 21, 2017

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Show Notes for Podcast Five of Sex & Why

Host: Jeannette Wolfe Guest Host: Justin Morgenstern

Topic: Stress Response - Part 3

Tricks for optimizing performance under stress

Preloading

Over train and begin to focus on how to recover from mistakes
Invest in mindfulness
- Meditate
  - Increases your awareness of your own physiological stress response
  - Can help you train to go back and forth from narrow to broad focus
- Be Awed
  - Have gratitude for what is going right
- Use a transition mantra as you walk into work and move from your personal to your professional life
- Appreciate the power of emotional contagion
  - Your mood influences your team’s performance
  - Acknowledge and celebrate team’s saves and successes
- Create safe communities in which you can talk and walk through difficult cases without shame or judgement
Maximize environmental advantages
- Have the right equipment and know where it is

In the moment

When you are becoming aware of stress- acknowledge its presence and recognize that you can face it as a threat or a challenge and then deliberately and emphatically choose challenge
Chunk down overwhelming situations into immediate next actions, when in doubt go to the head of the bed and check oxygen connections and monitor leads
Access mental crutches- simple pneumonics, resource cards, or a favorite app to jumpstart your thinking until your frontal lobe comes back on line
Consider cognitive reframing and brief emotional detachment
Keep a talisman in your pocket- use for either spiritual strength or physical distraction
Use Mike Lauria’s pneumonic BTSF (Beat The Stress Fool)
- Breath
  - Tactical breathing and controlling the breath
- Talk
  - Positive self-talk
- See
  - Visualize successful completion of the task
- Focus
  - Use a trigger word
- Tips for breathing
  - Consciously slow your exhalation
  - Belly breath in which your abdomen expands with inhalation
- Armor for negative thoughts
  - Thank your brain for trying to keep you safe
    - “Thank you brain for trying to watch my back, but I’ve got this”
  - Recognize your thoughts as being “just thoughts”
    - Change “I can’t do this” to “I’m having a thought that I can’t do this and fortunately most of my thoughts don’t equate actual reality”
  - Identify and label your patterns
    - “oh yay, I do this sometimes when I get stuck, but I can choose to do X, Y or Z instead” (repeating if needed.)
  - Internally shout at yourself (to snap out of an internal loop) and then remind yourself that you are trained and capable
  - Repeat a repetitive negative thought in a strange accent
  - Sing a repetitive negative thought
  - Refer to yourself as a third person
  - Touch something in front of you and describe its shape/temperature and texture
  - Acknowledge that you are stressed but decide to just do it anyways
- Tricks for focus words
  - Consider single word describing next critical action (“drape”, “needle”)
- After the stressful event
  - Anticipate parasympathetic backlash
  - Consider cognitive offloading
    - Have a check list
    - Use time outs
      - Creates a shared mental model of critical actions
      - Allows for information exchange
      - Reinforces value of team
    - Appreciate that cortisol spiking may subtly shift your tolerance for risk and could potentially impact clinical decision making
    - Take a break
      - Eat and drink something (preferably without caffeine)
      - Emotionally recharge
    - After the shift
      - Work Out
      - Play Tetras- (this was a new one for me and I’ve attached a reference below)

Selected Resources

Meditation App- Insight Timer

Justin Morgenstern’s Performance Under Pressure blog: https://first10em.com/2017/03/13/performance-under-pressure/

Adrian Plunkett’s SMACC talk https://www.smacc.net.au/2017/02/learning-from-excellence/

Recent Tetra study: Horsch A, et al: Reducing intrusive traumatic memories after emergency caesarean section: A proof-of-principle randomized controlled study. Behaviour Research and Therapy, 2017 https://doi.org/10.1016/j.brat.2017.03.018

Lauria, M. J., Gallo, I. A., Rush, S., Brooks, J., Spiegel, R., & Weingart, S. D. (2017). Psychological Skills to Improve Emergency Care Providers’ Performance Under Stress. Annals of Emergency Medicine. https://doi.org/10.1016/j.annemergmed.2017.03.018

Parkin, B. L., Warriner, K., & Walsh, V. (2017). Gunslingers, poker players, and chickens1 :Decision making under physical performance pressure in elite athletes. Progress in Brain Research (1st ed., Vol. 234). Elsevier B.V. https://doi.org/10.1016/bs.pbr.2017.08.001

Markway B, Stop Fighting your Negative Thoughts, Psychology Today May 7 2013 https://www.psychologytoday.com/blog/shyness-is-nice/201305/stop-fighting-your-negative-thoughts