1. Stress Management for Medical Students

2. Med School is not easy; it is rewarding, yet stressful. Stress can be: Stress can be: –Useful and adaptive, or –Detrimental and maladaptive

3. DEFINITION “Stress is the bodily responses to pressures, challenges, problems” “Stress is the bodily responses to pressures, challenges, problems” A stressor is anything that speeds up, keys up, or tenses your body; anything that pushes you or worries you. A stressor is anything that speeds up, keys up, or tenses your body; anything that pushes you or worries you. Stress is unavoidable; one can learn to minimize its negative effects Stress is unavoidable; one can learn to minimize its negative effects

4. Stress –Stress occurs with ANY new event in your 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, depending on how perceive the stress, and how you react.

5. INTERPERSONAL RELATIONSHIPS Can add to the stress of medical school Can add to the stress of medical school This is especially true when we function in one of the 3 roles of the STRESS TRIANGLE This is especially true when we function in one of the 3 roles of the STRESS TRIANGLE These roles are: Persecutor, Caregiver and Victim These roles are: Persecutor, Caregiver and Victim Often these patterns are deeply ingrained and outside ones awareness Often these patterns are deeply ingrained and outside ones awareness

6. Stress Producing Roles Persecutors: dictatorial, controlling, critical, blaming (undermining others’ self esteem) Persecutors: dictatorial, controlling, critical, blaming (undermining others’ self esteem) Caregivers: overprotective, too helpful, and seek to please others to detriment of self; take care of others’ feelings, ignoring their own Caregivers: overprotective, too helpful, and seek to please others to detriment of self; take care of others’ feelings, ignoring their own Victims: act helpless, pity themselves and are nonassertive Victims: act helpless, pity themselves and are nonassertive

7. Stress Triangle Persecutor Caregiver Victim

8. Stress POSITIVE EFFECTS: POSITIVE EFFECTS: –Compel you to action (Hmmm, maybe I should start NOW to study for that test in two weeks). –NEGATIVE EFFECTS: –It can result in feelings of distrust, rejection, and anger. –It can lead to health problems such as anxiety, depression, headaches, upset stomach, rashes, insomnia, ulcers, high blood pressure, heart disease, and stroke. –Can result in a vicious cycle of feeling overwhelmed then procrastinating…etc.

9. Stress-Busters Believe in yourself. Believe in yourself. –You are here today because you CAN do this. –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 A + = failure" then you will be way overstressed. Med school is not that easy. –Aim to do your best, but realize that you will not get a perfect grade all the time.

10. Be aware of your reaction to stress Notice your distress, don't ignore it. Notice your distress, don't ignore it. Determine what distresses you and how you react, e.g., the role you take with self/others Determine what distresses you and how you react, e.g., the role you take with self/others Determine how your body responds to the stress, e.g., where you hold your tension Determine how your body responds to the stress, e.g., where you hold your tension Do you become nervous or physically upset? If so, in what specific ways? Do you become nervous or physically upset? If so, in what specific ways? Pay attention to these Distress Signals! Pay attention to these Distress Signals!

11. Recognize what you can change Can you avoid the stressor? Can you avoid the stressor? –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. Can you shorten your exposure to stress? Can you shorten your exposure to stress? –Give yourself time to relax, as well. Practice positive self-talk. Visualize yourself as confident/successful Can you change your behavior? Can you change your behavior? –Set goals, manage time effectively, reward yourself for jobs well done. Practice positive self-talk. Plan. –Take care of yourself!

12. Stress-Busters Take steps to overcome problems. Take steps to overcome problems. –If you have problems, get help, not stressed out. Course tutors, classmates, teachers, SMH Course tutors, classmates, teachers, SMH Don't keep things bottled up. Don't keep things bottled up. –Talking to someone you trust who will be 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 in the big picture. –Remember that you have a life!

13. Diminish emotional reactions to stress The stress reaction is triggered by your perception of danger. The stress reaction is triggered by your perception of danger. –Do you overestimate stressors? Do you overreact and view things as absolutely 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.

14. Maintain emotional reserves Develop supportive friendships and relationships. Develop supportive friendships and relationships. Pursue your goals, not goals others have for you. Pursue your goals, not goals others have for 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.

15. Diminish physical reactions to stress Slow, deep breathing will decrease heart rate and respiration. Slow, deep breathing will decrease heart rate and respiration. RELAXATION TECHNIQUES: RELAXATION TECHNIQUES: –can reduce muscle tension, increase energy and productivity, and reduce insomnia and fatigue –can improve memory and concentration –can prevent or reduce psychosomatic symptoms –can prevent stress from becoming cumulative –can increase self-confidence and decrease self-blame

16. Aids to relaxation Abdominal breathing Abdominal breathing Progressive muscle relaxation Progressive muscle relaxation Visualizing: a peaceful scene; success Visualizing: a peaceful scene; success Remembering past successes Remembering past successes Positive self-talk Positive self-talk Using audio and visual aids Using audio and visual aids Meditation – even for 2-5 minutes per day Meditation – even for 2-5 minutes per day

17. Maintain 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 alcohol. Avoid nicotine, caffeine, stimulants, and alcohol. Mix leisure with work. Take breaks. Mix leisure with work. Take breaks. Get enough sleep. Get enough sleep.

18. More Stress-Busters Leave plenty of time for study, so you don't have to cram. Leave plenty of time for study, so you don't have to cram. Create a timetable so you can track your progress. Create a timetable so you can track your progress. Make sure you allow time for fun and relaxation so you don’t burn out. Make sure you allow time for fun and relaxation so you don’t burn out. As soon as you notice your mind is losing concentration, take a short break. You will then come back to your study refreshed. As soon as you notice your mind is losing concentration, take a short break. You will then come back to your study refreshed.

19. Tips for the exam itself: Don’t panic! Don’t panic! It's natural to feel some anxiety before you start the exam, but too much is detrimental. It's natural to feel some anxiety before you start the exam, but too much is detrimental. Avoid negative, anxious pre-exam interactions Avoid negative, anxious pre-exam interactions The best way to calm down: The best way to calm down: –Close your eyes –Take several long, slow deep breaths. –Visualize yourself feeling confident and successful –Silently repeat: "I am calm and relaxed" or "I know I will do fine“, while you are deep-breathing.

20. Tips for the exam itself: If your mind goes blank: If your mind goes blank: –Don't panic! –Focus on slow, deep breathing for one minute. –If you still can't remember, move on, and return if you have time. After the exam: After the exam: –Don't criticize yourself for stuff you think you got wrong. –Often, your own self assessment is far too harsh. –Congratulate yourself for the things you did right, learn from the stuff you did wrong, and move on.

21. Student Mental Health (SMH) If you begin to feel overwhelmed, you do have resources If you begin to feel overwhelmed, you do have resources It is NOT a sign of strength to go it alone! It takes courage to ask for help! SMH sees 1/3 of the students in each class, as well as a number of house- staff and faculty

22. Student Mental Health If you begin to feel overwhelmed, you do have resources, and you are not alone. If you begin to feel overwhelmed, you do have resources, and you are not alone.