As I coach physicians and healthcare leaders from across North America, I’m noticing that themes are shifting. In March, it was lack of PPE and fear of contagion for themselves and their families. In April, it was concern about when the surge would hit and, for many, the burden and frustrations of having kids at home 24/7. Now, the focus is shifting to grief and sadness for losses, and trepidation about what healthcare and healthcare employment are going to look like moving forward. What these all have in common is the difficult emotions many in healthcare are experiencing right now. Fear, sadness, anger, grief, loneliness, frustration, guilt, and others are all normal aspects of the pandemic experience.
All of these emotions are part of the spectrum of what we can experience in a difficult time like this. Like it or not, emotions are part of what it means to be human. We all have them, yet most of us don’t learn how to manage them. Yet, learning to do so is part of what helps us dealwith uncertainty and change—in other words, resilience in healthcare.
We may have seen anger handled poorly in our families, with parents erupting in late-night arguments when we were supposed to be asleep. We learn that sadness is for a character like Eeyore, unbecoming when we experience more than the tiniest amount. In medical training, physicians learn to push away all emotions as we’re supposed to be strong, all-knowing, and always the captain of the team. And in almost every male physician I’ve coached, it’s become clear that what’s reinforced is not showing any emotion whatsoever. If you do, you’ll be labeled a sissy, or worse.
Our emotions are regulated by several areas in the brain. While the neuroscience of emotions is not yet definitive, we know that the amygdala, hypothalamus, and insula are key regions. These are the same brain regions that fuel our fight/flight/freeze instinct and that helps us appreciate the intensity our emotions can generate! Just like with fight/flight/freeze, emotions like anger, sadness, guilt, and grief lead to a cascade of sympathetic hormones being released leading to an elevated heart rate, facial flushing, and even that sense that our head might explode if the emotion stays too long. But when we engage our prefrontal cortex (PFC,) we can ‘cool down’ our emotions, bringing executive function to bear, engaging the parasympathetic nervous system, and steadying ourselves from the storm.
All of this leaves us struggling in a time like this where such a wide array of emotions can be present. Because we don’t learn how to manage them, we may find our emotions managing us! At times we can even feel like we’re a slave to them. But it doesn’t have to be this way. With emotional intelligence, we can build our mastery and resilience over our emotions, gaining comfort with them.
Resilience and Emotional Intelligence in Healthcare
When we think of emotional intelligence, there are five components: self-awareness, social skills, motivation, empathy, and self-regulation. While all are important and interrelated, the key components are self-awareness and self-regulation. Self-awareness starts with the recognition that an emotion is present, even if we can’t exactly pinpoint what it is. Simply having this awareness engages the PFC and helps us see our experience more clearly. We can then remind ourselves of something like:
“Wow, my sympathetic system is active right now! Let me take a moment to calm myself down.”
In a sense, this takes us out of the thick of an emotion and creates just enough space to keep us from being swept away by the intensity. And that’s self-regulation—being able to work with the emotion so that we stay present and grounded. It is definitely easier said than done! Here are four strategies that will help:
Get to Know Your Emotional Weather System
Just as there are patterns to the weather, we all have patterns to our emotions. There are sunny days when the weather systems of our emotions are in balance and we’re calm and at ease. There are also days when it’s stormy, and we’re bombarded by a variety of emotions. Just 2 weeks ago, I found out that my father died. He was a very bad actor in my life and I hadn’t seen him in 20 years. To say that I experienced a storm of emotions around his death would be an understatement.
But I was able to recognize that a storm of emotions was par for the course. I anticipated having some bumps along the road, which made it that much easier to cope and be gentle with myself when emotions arose.
With the pandemic, for any of us, difficult emotions are to be expected! Understanding our patterns of emotional response and anticipating what reactions are likely to occur during a time like this can help us be more resilient.
Further, our emotions can be likened to clouds in the sky: arising, passing through, and dissipating. With self-awareness, we can become the observer of our emotions, and thus less swayed by them. When we engage our PFC, we can train our minds to stay steady no matter what cloudy emotions pass through.
Learn Your Triggers
A key strategy in resilience and emotional intelligence is beginning to understand what triggers strong emotional reactions in us. This can be a host of things, but for many of us, there are a few common triggers. Top of the list are a sense that someone is not respecting us, that we’re not being listened to, or that our needs are not being taken into account. Another big one is seeing someone else being treated unfairly. For a cardiologist I was coaching recently, the trigger during COVID was feeling disrespected by his administrator when he said he needed better PPE. When he asked her repetitively to provide an N95 mask, he saw her roll her eyes. He immediately felt disrespected and it was such a strong trigger for him that he lost his temper and started yelling with patients and staff overhearing his lapse.
Sadly, that type of reaction is what had landed him in coaching in the first place. We’ve all had the experience of our emotions taking us from 0 to 100 in nanoseconds, and the subsequent sense of being out of control is never a good one. But we don’t want to let this emotional escalation translate to hostile actions in the workplace! I helped this client pay attention to his triggers and pretty rapidly he was able to see them in action. Once he did, he could remind himself that he was being triggered and that reminder alone helped quiet the emotional storm.
Build Resilience by Building Self-Compassion
How many times have you experienced an emotion and then judged yourself for it? We can be fairly harsh with ourselves with self-questioning such as:
“Why am I feeling this? What’s wrong with me?”
“Everyone else seems so happy, why on earth am I feeling sad?”
“I don’t know why I get so angry with my kids. If I were a good parent, I would be patient all the time.”
It’s challenging enough to experience the emotion in the first place. This pile-on of judgment can then escalate things to the point where we’ve dug ourselves into quite a bleak hole. But where does all this self-judgment get us, anyway? With my father’s death, I could see how judging myself for feeling both angry and sad just made me feel worse for having the emotions I had. And for the hundreds of physicians I’ve coached, I’ve seen that this kind of self-flagellation just makes them feel worse and worse.
It’s important for us to understand that these emotions are coming up for a reason. We can’t control the emotions that arise in stressful situations; we can only control our response. So why respond with more tension, negativity, and judgment?
To build resilience, a different approach is self-compassion. It’s very challenging when strong emotions visit us. Is it possible that applying compassion to ourselves may actually make it easier to manage the experience? For the cardiologist who was triggered by his administrator, part of his initial experience was berating himself for letting her get under his skin. As he became more aware of his triggers, however, he was also able to remind himself that his emotional reactions were a normal experience. As he shed the self-judgment, he found that the emotions passed more rapidly.
Remind Yourself that all Emotions Pass
What an emotion hits, it’s often overwhelming. We’ve all had those moments with sadness, anger, and grief. These can be powerful emotions, and it can feel like we are going to be overwhelmed by them. But in truth, our emotions typically dissipate after a couple of minutes. If we can pause and remind ourselves of this fact, we heighten a sense of safety in being with the emotion. While they can feel so powerful that we wonder if we can survive, if we stay grounded, we can watch our emotions arise, pass through us, and fade away. Just like clouds in the sky.
The irony is that the harder we try to push emotions away, the more they stick around. Thus, the adage: “What you resist will persist!” The more we push challenging emotions away, the more they can dog us, sometimes erupting when we least expect them. The more we accept the emotions that come up, the more quickly they subside. Emotional intelligence involves letting our emotions be, as this is the way they most readily pass through.
The Purposeful Pause for Building Resilience and Emotional Intelligence
When strong emotions take hold, we need tools to remain in the here and now. I’ve written in the past about what’s called a purposeful pause and how it can build healthcare resilience. Here’s a simple protocol for pausing that can help you stay grounded when emotions hit. It goes by the acronym S. T. O. P.:
S: STOP everything you’re doing; hit the pause button and still yourself. Freeze the frame.
T: TAKE three slow, deep breaths. Focus on the sensations of breathing, and feel your body slowing down.
O: OBSERVE yourself and whatever generated your emotional response. Imagine that you’ve stepped out of yourself, and are observing the situation from the stance of a neutral third party. Now, imagine that this observer has full compassion for you and what you’re experiencing. From the vantage point of this compassion is observer, what do you see?
P: PRAISE yourself in any way you can, small or large. Remind yourself of your strengths. Congratulate yourself for choosing to de-escalate this situation. Then think about what your next step should be, now that your mind is clearer.
The key to developing greater emotional intelligence and resilience is self-awareness and self-regulation. This is particularly important in the setting of this pandemic when uncertainty challenges us all to maintain emotional balance.
See if you can get to know your emotional weather patterns and triggers. Remind yourself that all emotions pass. Instead of self-judgment, utilize the S.T.O.P. protocol, and try a strong dose of self-compassion. I suspect you’ll find more calm, steadiness, and ease.
Recent COVID-19 related well-being and resilience posts and resources
If you’ve missed any previous posts in our popular Mindfulness In Medicine Series, here’s a list of them for your convenience.
- Managing the difficult co-worker
- Patient satisfaction in healthcare and mindfulness
- Mindful parenting
- Self compassion mindfulness for physicians
- Mindfulness and non-physician healthcare administrators
- The top 10 common myths about meditation
- Doctor stress, overwhelm and physician burnout
- Being present with patients
- Mindfulness leadership for physicians
- How to prevent medical errors causes and physician burnout
- Beat imposter syndrome anxiety symptoms with mindfulness