Dr Michael Moseley recently confessed on television that he was concerned with increasing anxiety and problems sleeping. I was not surprised by this confession as I am finding an increasing number of people who are suffering from generalised anxiety. This manifests as an unpleasant emotional state where you increasingly imagine the worst possible outcome rather than adopting a positive/confident outlook. A generalised anxiety state can be caused by stress especially repeated episodes of stress. Trauma and excess alcohol can also trigger generalised anxiety. The state is often described to me as worrying about everything together with increasing difficulty in relaxing. In order to avoid drifting into this state i get clients to focus on identifying times and techniques for relaxation. Exercise has always been recognised as an effective way of reducing stress and recently group exercise has been found to boost endorphin levels to a greater extent than solo exercise. Increased endorphin and serotonin levels are associated with making you feel good and providing an antidote to stress. I have always thought that having a sense of humour is useful for lowering stress levels and we now have laughter therapy as well as talking therapies and other psychological techniques. It is absolutely critical that time is spent identifying the most effective method of relaxation for each individual. Music can be very effective for some people and often they suddenly remember how important music was in their life and getting back into the habit can have an immediate stress lowering effect. Another common finding is that repeated stress or anxiety can lead to snacking on convenience and processed foods rather than taking care to eat a healthy diet. i read recently that adopting a Mediterranean diet after a heart attack is almost three times as powerful in reducing mortality as taking a statin. That made me think of my diet as a method of improving health and wellbeing. It is a mistake to only visit our GP when we are really ill, our GP can refer us for Cognitive Behaviour Therapy which helps us to respond more positively to potentially stressful situations or prescribe medication such as Selective Serotonin Reuptake Inhibitors. Talking Therapies have received good publicity and are available on the NHS but talking to partners, friends, colleagues etc can also be helpful. Finally remember to take holidays and activity holidays can be great if you find it difficult to sit still and sunshine is an added bonus as it boosts your vitamin D level.
“Stay Healthy’
Bill Clinton who used famously to get only five hours sleep,once admitted,”Every important mistake I’ve made in my life,I’ve made because I was too tired. It seems obvious that we will tend to make bad decisions when we are tired yet some people seem to make a fetish of not getting enough sleep. There seems to be a macho/virility attitude that I can do with five hours sleep and how early do you want to arrange the breakfast meeting. A skin care company has reported that women who get a poor night’s sleep on a Monday (a third of women,according to the study),reach a low point by Wednesday when they will look their oldest,have the lowest energy levels and feel the most stressed.Do we not realise that creativity, ingenuity,confidence,leadership,decision-making can all be enhanced by simply sleeping more? It is claimed that lack of sleep was a “Significant Factor” in the Exxon Valdez wreck,the explosion of the Challenger Space Shuttle,and the nuclear accidents at Chernobyl and Three Mile island.We seem to want to treat sleep as a stand alone issue. Sleep is something that encompasses many aspects of our lives,from technology and leadership,to our relationships,careers,creativity and stress.My solution is a short nap in the afternoon and I even used this technique at work. I cleared everyone from the office,locked the door and gave instructions not to be disturbed.I always felt revived after my nap and was able to recall information faster,come up with better ideas and make more considered decisions.I am in good company as Leonardo da Vinci,John F.Kennedy and Winston Churchill all advocated naps during the day.Churchill stated in his usual oratorical fashion “You must sleep sometime between lunch and dinner and don”t think you will be doing less work because you sleep during the day. That’s a foolish notion held by people who have no imagination. This blog was inspired by Arianna Huffington founder of the Huffington Post.
My interest in stress started when I was teaching undergraduate dental students. Observing their contorted positions when treating patients, I thought this is not the appropriate way to start their clinical career. When in Practice they could be maintaining these awkward postures for several hours per day. This commonly results in muscle and joint problems but trapped nerves and headaches are also possible outcomes. Many older dentists suffer from backache, neckache and shoulder problems to prove this point. Former students have contacted me to inform me that the best tip I ever gave them was to roll their head in order to release neck muscles when taking an impression. The “message” is do not maintain an uncomfortable position for any length of time-alter position, stretch and release, stand up and walk around if possible. Most dental teams would benefit from a course on assisted operating techniques and the bonus is that there is a team building aspect included. This article was prompted by the latest information on the physical problems being caused by laptop computers. People sitting on a chair twisting round to view a laptop balanced on the edge of the chair or similar contorted positions. Dr Karen Jacobs has produced an app to remind users to take a break from the screen every fifteen minutes. The author Lionel Shriver ( We Need to Talk about Kevin ) now stands up to type and is feeling the benefit having been sedentary since the 1980s. An eleven year old has evidently been treated for chronic neck pain as a result of doing his homework on a laptop while watching the television. There is no doubt that prolonged physical pain and discomfort can cause mental stress and so the take home message is deal with physical ailments promptly to prevent them becoming chronic.
Go out for a walk as it is marvellous exercise and costs nothing!
Resilience
I recently read an article in the British Medical Journal by Diann Eley from University of Queensland in Australia (d.eley@uq.edu.au)
Resilience is an attribute which helps individuals to bounce back from encounters and allows them to endure and flourish in their work environment. Resilient individuals are better equipped to meet challenges, learn from them and further develop their resilience.
Assessments of General Practitioners showed strong correlations between personality traits and resilience.
Self Directedness. Self directed individuals are conscientious and goal oriented. They accept responsibility for mistakes, learn from them and move on.
Cooperativeness. Cooperative individuals accept the opinions and behaviours of colleagues even when they are contrary to their own.
They don’t lose sight of their own principles but work out solutions to achieve the best outcome for everyone. Consciously becoming more tolerant and accepting the behaviours and points of view of others lowers levels of frustration.
Harm Avoidance. Clinicians who are low in harm avoidance are decisive and less anxious. Their ability to accept uncertainty and a degree of risk generates confidence for decision making in clinical dilemmas and emergencies. High harm avoidance levels reflect a tendency towards anxiety and pessimism.
Persistence. Persistence reflects a bias towards maintaining behaviour with stamina despite frustration, fatigue or discouragement. This trait can be associated with perfectionism and this risk can be avoided by accepting your limitations setting realistic goals.
To enhance your resilience you should know which personality traits are associated with high resilience and be aware of your own traits.
Reflecting on the realities of your working life is a good way to start becoming more self aware. It will be necessary to ask yourself questions about your expectations of yourself and others. Are these expectations realistic ? Reflect on why you are often dissatisfied. It may be that you are not as cooperative and tolerant as you think.
One exercise is to recognise the positive outcomes of your day. Do this on a daily basis even if these positive outcomes seem small.
Another is to take control over some part of your day and allow for “time outs” no matter how short, over which you have control.
This is a useful method to help dentists to regain control of their appointment system when it is controlling them.
A third exercise is to share an experience or problem with colleagues, friends or family. Often just talking about a challenging event can be a powerful way to put your situation in perspective, learn from it and move on.
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