Navigating the Rapids: Completing the Journey through Medical School Presented by Alan Korinek, Ph.D. Director, Program of Assistance for HSC Students The Counseling Center at TTUHSC January 14, 2019

When We Hit “Rapids” “Rapids” are stressful events (e.g., Step 1) that can dysregulate us emotionally Hyper-arousal and/or hypo-arousal are experienced Hyper-arousal – feeling panicked, angry, overwhelmed Hypo-arousal – feeling numb, disconnected, no energy Catastrophic thinking can result Overestimating the probability of bad things happening (aka, “worse case scenario” thinking) “Fight or flight” impulses can occur, including thoughts of suicide

Impact of Stress on Brain Functioning Our Two-Tiered Brain: Upstairs/Rational Brain (the Rider) “Thinking Cap” used to problem solve, create, innovate, and imagine Manages the downstairs brain, but only if engaged Downstairs/Reptilian Brain (the Horse) Emotionally reactive and always on; goal is survival Amygdala is our “sentry” High stress causes “emotional flooding” (flash flood or rising waters); when that happens: Survival instinct unseats good intentions and “amygdala hijackings” (fight or flight) may occur Cognitive difficulties result; cannot process information or make necessary neural connections (i.e., learn and consolidate critical concepts); memory and recall are compromised

Managed Stress Benefits Us Benefits of managed stress include increased alertness, heightened focus, and enhanced cognitive performance Good stress management prevents flooding, or allows us to get back into our upstairs brain if flooding begins PERFORMANCE Low STRESS High

Keys to Navigating the Rapids Practice self-care Proper diet; exercise; mindfulness* and relaxation; smiles and laughter; practicing gratitude (*apps: Headspace, Calm) Be self-aware and emotionally intelligent Recognize the signs of emotional dysregulation and activate coping to get the “rider” back in control of the “horse” Keep your self-talk positive, encouraging, and hopeful Avoid ruminating about the past or worrying excessively about the future; check out “The Single Most Important Thing You Can Do to Manage Your Stress”: https://m.youtube.com/watch?v=I6402QJp52M

Keys to Navigating the Rapids Avoid “flight” behaviors, such as: Isolating Abusing or misusing substances Escaping into video games or online activities Or any other unhealthy “emotionally-driven” behaviors Seek support, especially if you are having any suicidal thoughts PAS counseling and support is free and fully confidential Seeking support is not a sign of weakness; it’s a sign of emotional intelligence!

Keys to Navigating the Rapids Get adequate rest Adequate sleep strengthens the nerve circuits underlying learning and memory, allowing the brain to make and consolidate new and essential neural connections Distribute your time wisely by using effective time-management strategies Identify your “time bandits” and avoid or manage them Set and keep a schedule and/or track how you use your time Employ effective study techniques For example, the Pomodoro Technique (25 minutes studying, 5-minute break)

One Final Appeal As you care for yourself, care also for one another You are all having to navigate the same “rapids”, though in your own way, so encourage one another and support one another as you have opportunity Be especially sensitive to any signs that a classmate is really struggling and may be having suicidal thoughts (e.g., isolating themselves, becoming emotionally dysregulated, appearing depressed or behaving differently) Remember the QPR training you all received: Question, Persuade, and Refer

Tips for Better Sleep (aka “Sleep Hygiene”) Dim the lights one hour before sleeping; use only soft, warm lighting (no “blue light” from electronics) Adopt a regular sleep schedule, even weekends, to reset circadian rhythms and increase melatonin production Don’t engage in “brain work”, have emotional discussions, or make complex decisions, 2-3 hours prior Curb your appetite: no heavy meals 4 hours before sleeping or light snacks 2 hours before sleeping Curb caffeine use in the evening