The Rest Activity Dance

The mental health of Australia's HCPs has been under the microscope more than ever recently. Dr Steven Sommer addresses the nature of stress in the medical sphere, and offers some insight on how he deals with the stresses of work and life.

  My pet cats are great teachers; they know how to chill. If I observe my cats over a period of a day a clear pattern emerges. Bursts of activity are followed by periods of quiet alert times, then periods of deep rest from which they can quickly become alert again. Can we learn something from this? Are there reasons to become copycats? In our 24-hour-news-cycle-on-mobile-lifestyles can we make room for our own rest activity dance?

  Most of us are familiar with the fight/flight or stress response, a response that can play a useful role as a short-term motivator, and be especially important if we want to jump out of the way of an oncoming bus. In this case, blood flow is directed to muscles that tighten, heart and breathing rates as well as BP increase and we are ready for action. The response is switched on and then switched off and no harm is done, assuming we got out of the way of the bus! But when it is regularly switched on by getting fed up with waiting on the telephone, or worrying about a difficult patient, finances, work or home, or replaying a less than satisfactory consultation in our mind, it can become a problem.

  In our modern world, the stress response is typically activated when we find ourselves overtaxed or feeling overwhelmed. It can also be triggered by negative thoughts we may not even realise we are having; fear of litigation for instance. Key factors here are: whether we perceive our ability to cope is being exceeded, whether the demands placed upon us exceed our resources, or whether we lack a sense of control over the demands placed upon us. With some patients, for instance, we may be taking on more than we can handle on our own.

  Unchecked, in time, stress can become habitual, developing its own momentum and this can lead to chronic stress. In this situation, we can become so used to its presence, that we live life in its shadow. It tires us, undermines our health and happiness, disturbs our concentration and impacts on our relationships. We stop taking time to smell the ‘roses’ of life.

 How do we improve our situation? The obvious first step is to identify any problems that might be causing distress and if possible, address them. Problem-solving alone or with the assistance of a friend or counsellor may be enough to resolve the situation.

 My own experience is that admitting one needs help and seeking assistance can be the most difficult step. In time I’ve come to see that reaching out can remind us of our common humanity (we are all vulnerable) and ultimately build resilience, confidence and new skills. When I had to stop work due to chronic ill-health (ulcerative colitis and Parkinson’s disease) I was confronted by many challenges. One of the greatest problems I identified was no longer feeling useful. I had chosen medicine as a way of helping people so how was I going to do this now? Ultimately the answer came from realising I could find meaning and purpose in sharing my experiences and knowledge through writing. Some days I was only well enough to spend 30 minutes on my computer, but at least it felt like a contribution that would ultimately end up achieving my long-term goal of publishing a book. Six years later I achieved that goal. But perhaps the bigger achievement was maintaining my sense of self-worth and mental state over this six-year period.

  In addition to problem solving it is worth developing other skills that help us to regain perspective and build a safety net, because even if we solve all of our problems today the chances are there will be more stressful situations queuing up for us tomorrow. One proven preventive and treatment technique is to take a tutorial from our feline friends and regularly trigger a less well-known response, the relaxation response.

  In the late 1960’s Harvard University cardiologist, Dr Herbert Benson, became interested in researching the effects of Eastern meditation techniques arriving in the U.S at the time. He even took his equipment to the East to study meditating monks. In time, he researched a variety of meditation and relaxation techniques and he identified a bodily response, mediated by the parasympathetic nervous system, which they all had in common. He called this response the ‘relaxation response’ and published a book with this title in 1975. During the relaxation response, heart and breathing rates slow, blood pressure lowers, muscles relax and the body receives a deeper restorative rest than at any time during sleep. We are happily relaxed while at the same time clearly awake. Our concentration improves and we function well in this state of restful alertness. Athletes describe this experience as being in the ‘zone.’ Subsequent research has shown that it can be triggered in a variety of ways. Deep breathing, meditation, progressive muscle relaxation, visualisation, repetitive prayer, jogging, tai chi, yoga, knitting… the list goes on. Personal preference plays a part. Knitting may not be for everyone!

  Significantly, all of these activities require our active participation and give our minds something to focus upon. In other words, while the stress response is often triggered without us knowing, perhaps paradoxically, the relaxation response requires our conscious attention. Furthermore, Dr Benson’s research found that if someone practised a focused relaxation technique for as little as 10 minutes a day, after just one month their quality of life and ability to cope with stress had all improved. Learning how to invoke this response with techniques that can be used anywhere and anytime is a wonderful life skill and I believe an essential antidote to modern living. Importantly, it is a technique that can also be used to identify unexpressed feelings which can then be acknowledged and if necessary addressed (a topic beyond the scope of this blog).

  My suggestion then is to become a copycat. Punctuate your day with some physical bursts of exercise interspersed with brief centering moments (for example taking three mindful, slow deep breaths between consultations). This can be complemented by a longer more formal ‘catnap’meditation or relaxation exercise of at least five-minutes duration once or twice a day. This can refresh our minds, help us regain perspective and identify problems or feelings which need to be addressed, which in our modern world, are all a part of maintaining a healthy life.

Jow KosterichDr Steven Sommer
Dr. Steven Sommer graduated from Monash Medical School in 1984 and became a Fellow of the RACGP in 1991. He has worked as a GP, stress management consultant and lecturer at Monash’s Department of General Practice and Deakin’s Medical School. Steven recently published his first book, Finding Hope. He lives in Geelong with his wife, Tori, and their two cats, Pip and Claude.