Stress Management Stress Management for Medical Studentsfor Medical Students

Med School is not easy; Med School is not easy; it it isis rewarding, yet stressful. rewarding, yet stressful.

• Stress can be:Stress can be:– Useful and adaptive, orUseful and adaptive, or– Detrimental and maladaptiveDetrimental and maladaptive

DEFINITIONDEFINITION• ““Stress is the bodily responses to Stress is the bodily responses to

pressures, challenges, problems”pressures, challenges, problems”

• A stressor is anything that speeds up, keys A stressor is anything that speeds up, keys up, or tenses your body; anything that up, or tenses your body; anything that pushes you or worries you.pushes you or worries you.

• Stress is unavoidable; one can learn to Stress is unavoidable; one can learn to minimize its negative effectsminimize its negative effects

StressStress– Stress occurs with ANY new event in your Stress occurs with ANY new event in your

life:life:•The death of a loved one,The death of a loved one,•The birth of a child, The birth of a child, •A job promotion,A job promotion,•A new relationship, A new relationship, •Starting Med school...Starting Med school...•Taking exams.Taking exams.

– Stress will help you or hinder you, Stress will help you or hinder you, depending on how perceive the stress, and depending on how perceive the stress, and how you react.how you react.

INTERPERSONAL INTERPERSONAL RELATIONSHIPSRELATIONSHIPS• Can add to the stress of medical schoolCan add to the stress of medical school• This is especially true when we function This is especially true when we function

in one of the 3 roles of the STRESS in one of the 3 roles of the STRESS TRIANGLETRIANGLE

• These roles are: Persecutor, Caregiver These roles are: Persecutor, Caregiver and Victimand Victim

• Often these patterns are deeply Often these patterns are deeply ingrained and outside ones awarenessingrained and outside ones awareness

Stress Producing RolesStress Producing Roles• Persecutors: dictatorial, controlling, Persecutors: dictatorial, controlling,

critical, blaming (undermining others’ self critical, blaming (undermining others’ self esteem)esteem)

• Caregivers: overprotective, too helpful, Caregivers: overprotective, too helpful, and seek to please others to detriment of and seek to please others to detriment of self; take care of others’ feelings, ignoring self; take care of others’ feelings, ignoring their owntheir own

• Victims: act helpless, pity themselves and Victims: act helpless, pity themselves and are nonassertiveare nonassertive

Stress TriangleStress TrianglePersecutor

Caregiver Victim

StressStress• POSITIVE EFFECTS:POSITIVE EFFECTS:

– Compel you to action (Hmmm, maybe I should Compel you to action (Hmmm, maybe I should start NOW to study for that test in two weeks).start NOW to study for that test in two weeks).

– NEGATIVE EFFECTS:NEGATIVE EFFECTS:– It can result in feelings of distrust, rejection, It can result in feelings of distrust, rejection,

and anger.and anger.– It can lead to health problems such as anxiety, It can lead to health problems such as anxiety,

depression, headaches, upset stomach, rashes, depression, headaches, upset stomach, rashes, insomnia, ulcers, high blood pressure, heart insomnia, ulcers, high blood pressure, heart disease, and stroke.disease, and stroke.

– Can result in a vicious cycle of feeling Can result in a vicious cycle of feeling overwhelmed then procrastinating…etc. overwhelmed then procrastinating…etc.

Stress-BustersStress-Busters

• Believe in yourself.Believe in yourself. – You are here today because you CAN do this.You are here today because you CAN do this.– If you prepare properly you should do fine.If you prepare properly you should do fine.

• Don't try to be perfect.Don't try to be perfect. – If you think that "less than AIf you think that "less than A++ = failure" then = failure" then

you will be you will be wayway overstressed. Med school is overstressed. Med school is not that easy. not that easy.

– Aim to do your best, but realize that you will Aim to do your best, but realize that you will not get a perfect grade all the time. not get a perfect grade all the time.

Be aware of your reaction to Be aware of your reaction to stressstress

• Notice your distress, don't ignore it.Notice your distress, don't ignore it.• Determine what distresses you and how you Determine what distresses you and how you

react, e.g., the role you take with self/others react, e.g., the role you take with self/others • Determine how your body responds to the Determine how your body responds to the

stress, e.g., where you hold your tension stress, e.g., where you hold your tension • Do you become nervous or physically Do you become nervous or physically

upset? If so, in what specific ways? upset? If so, in what specific ways? • Pay attention to these Distress Signals!Pay attention to these Distress Signals!

Recognize what you can Recognize what you can changechange • Can you avoid the stressor?Can you avoid the stressor?

– Don’t study in noisy places if it disturbs you. Don’t study in noisy places if it disturbs you. • Can you decrease the stress?Can you decrease the stress?

– Give yourself plenty of time to study for tests.Give yourself plenty of time to study for tests.• Can you shorten your exposure to stress?Can you shorten your exposure to stress?

– Give yourself time to relax, as well. Practice positive Give yourself time to relax, as well. Practice positive self-talk. Visualize yourself as confident/successfulself-talk. Visualize yourself as confident/successful

• Can you change your behavior?Can you change your behavior?– Set goals, manage time effectively, reward yourself for Set goals, manage time effectively, reward yourself for

jobs well done. Practice positive self-talk. Plan.jobs well done. Practice positive self-talk. Plan.– Take care of yourself!Take care of yourself!

Stress-BustersStress-Busters• Take steps to overcome problems.Take steps to overcome problems.

– If you have problems, get help, not stressed If you have problems, get help, not stressed out. out. •Course tutors, classmates, teachers, SMHCourse tutors, classmates, teachers, SMH

• Don't keep things bottled up.Don't keep things bottled up. – Talking to someone you trust who will be Talking to someone you trust who will be

supportive is a great way to decrease stress.supportive is a great way to decrease stress.• Keep things in perspective.Keep things in perspective.

– Tests are only a small part of your whole life Tests are only a small part of your whole life in the big picture. in the big picture.

– Remember that you have a life!Remember that you have a life!

Diminish emotional reactions to Diminish emotional reactions to stressstress• The stress reaction is triggered by your The stress reaction is triggered by your

perception of danger.perception of danger.– Do you overestimate stressors? Do you Do you overestimate stressors? Do you

overreact and view things as absolutely overreact and view things as absolutely critical? critical?

• Stop and think before you react.Stop and think before you react.• Try a less extreme view.Try a less extreme view.• Temper your emotional responses. Temper your emotional responses. • Put the situation in perspective. Put the situation in perspective. • Don’t dwell on negative aspects. Don’t dwell on negative aspects.

Maintain emotional Maintain emotional reservesreserves• Develop supportive friendships and Develop supportive friendships and

relationships. relationships. • Pursue your goals, not goals others have for Pursue your goals, not goals others have for

you.you.• Expect some frustrations, failures, and sorrows.Expect some frustrations, failures, and sorrows.• Try yoga, tai-chi or other relaxation techniques. Try yoga, tai-chi or other relaxation techniques. • Maintain a spiritual role in your life.Maintain a spiritual role in your life.• Plan. Plan alternatives. Plan ahead. Prepare.Plan. Plan alternatives. Plan ahead. Prepare.

Diminish physical reactions to Diminish physical reactions to stressstress

• Slow, deep breathing will decrease heart Slow, deep breathing will decrease heart rate and respiration. rate and respiration.

• RELAXATION TECHNIQUES:RELAXATION TECHNIQUES:– can reduce muscle tension, increase energy and can reduce muscle tension, increase energy and

productivity, and reduce insomnia and fatigueproductivity, and reduce insomnia and fatigue– can improve memory and concentrationcan improve memory and concentration– can prevent or reduce psychosomatic symptomscan prevent or reduce psychosomatic symptoms– can prevent stress from becoming cumulativecan prevent stress from becoming cumulative– can increase self-confidence and decrease self-can increase self-confidence and decrease self-

blameblame

Aids to relaxationAids to relaxation• Abdominal breathingAbdominal breathing• Progressive muscle relaxationProgressive muscle relaxation• Visualizing: a peaceful scene; successVisualizing: a peaceful scene; success• Remembering past successesRemembering past successes• Positive self-talkPositive self-talk• Using audio and visual aidsUsing audio and visual aids• Meditation – even for 2-5 minutes per dayMeditation – even for 2-5 minutes per day

Maintain physical reservesMaintain physical reserves

• Exercise 3 to 4 times a week.Exercise 3 to 4 times a week.• Eat well-balanced, nutritious meals. Eat well-balanced, nutritious meals. • Maintain your ideal weight. Maintain your ideal weight. • Avoid nicotine, caffeine, stimulants, and Avoid nicotine, caffeine, stimulants, and

alcohol. alcohol. • Mix leisure with work. Take breaks.Mix leisure with work. Take breaks.• Get enough sleep.Get enough sleep.

More Stress-BustersMore Stress-Busters• Leave plenty of time for study, so you Leave plenty of time for study, so you

don't have to cram. don't have to cram. • Create a timetable so you can track your Create a timetable so you can track your

progress. progress. • Make sure you allow time for fun and Make sure you allow time for fun and

relaxation so you don’t burn out. relaxation so you don’t burn out. • As soon as you notice your mind is losing As soon as you notice your mind is losing

concentration, take a short break. You will concentration, take a short break. You will then come back to your study refreshed. then come back to your study refreshed.

Tips for the exam itself:Tips for the exam itself:• Don’t panic! Don’t panic! • It's natural to feel some anxiety before you It's natural to feel some anxiety before you

start the exam, but too much is detrimental.start the exam, but too much is detrimental.• Avoid negative, anxious pre-exam interactionsAvoid negative, anxious pre-exam interactions• The best way to calm down:The best way to calm down:

– Close your eyesClose your eyes– Take several long, slow deep breaths. Take several long, slow deep breaths. – Visualize yourself feeling confident and successful Visualize yourself feeling confident and successful – Silently repeat: "I am calm and relaxed" or "I know I Silently repeat: "I am calm and relaxed" or "I know I

will do fine“, while you are deep-breathing.will do fine“, while you are deep-breathing.

Tips for the exam itself:Tips for the exam itself:• If your mind goes blank:If your mind goes blank:

– Don't panic! Don't panic! – Focus on slow, deep breathing for one minute. Focus on slow, deep breathing for one minute. – If you still can't remember, move on, and return if If you still can't remember, move on, and return if

you have time. you have time. • After the exam:After the exam:

– Don't criticize yourself for stuff you Don't criticize yourself for stuff you thinkthink you got you got wrong. wrong.

– Often, your own self assessment is far too harsh. Often, your own self assessment is far too harsh. – Congratulate yourself for the things you did right, Congratulate yourself for the things you did right,

learn from the stuff you did wrong, and move on. learn from the stuff you did wrong, and move on.

Student Mental HealthStudent Mental Health(SMH)(SMH) If you begin to feel overwhelmed, If you begin to feel overwhelmed,

you you dodo have resources have resourcesIt is NOT a sign of strength to go it It is NOT a sign of strength to go it

alone!alone!It takes courage to ask for help!It takes courage to ask for help!SMH sees 1/3 of the students in SMH sees 1/3 of the students in each class, as well as a number each class, as well as a number

of house-staff and facultyof house-staff and faculty

Student Mental HealthStudent Mental Health If you begin to feel If you begin to feel

overwhelmed, you overwhelmed, you dodo have have resources, and you are resources, and you are notnot

alone.alone.