Dealing with Stress in Medical Practice

& Academia

“If you want to help your patients deal with their stress, you’re
going to have to learn to handle your own.”
— Dr. Matthew Budd, Harvard University

Andrew L. Parker, Ph.D.

Faculty & Staff Assistance Program
 The Hard Truth:

Medical Practice
Is a
Stress Machine
 Why Don’t We Choose To Manage Our
Stress Even When We Know What To Do?

Stress
Common Stressors of Medical
Practice at UCSF

1. Overworked & underpaid

2. Too much to do & too little time
3. More criticism than praise
4. Patient health & life at stake
5. Personal life often neglected
6. Competition for status & tenure
 Understanding Stress
“Stress is the nonspecific response of the body to any demand made
upon it” — Hans Selye, MD

 The concept of Stress entered psychological

& medical vocabularies from engineering with
Hans Selye's work in 1950's 
 Stress is an environmental pressure, strain is
its effect on something or someone
 Understanding Stress
“Man should not try to avoid stress any more than he would shun
food, love or exercise." — Hans Selye, MD

 Stress is a fact of life, a universal

condition, and therefore unavoidable
 If we cannot eliminate stress, how can we
come to terms with it?
 The Continuum of Stress
 Stress occurs along a continuum:
 No stress: promotes Stagnation — no challenge, no

spur to action, no adaptation

 Prostress (or “Eustress”): promotes Growth —

pleasant, challenging exciting conditions that offer

fulfillment and arousal without the harmful
consequences of negative stress.
 Distress: Negatively perceived event or trigger that

promotes upset, suffering, illness — at the extreme it

can lead to psychosis, even death
 The Continuum of Stress
Stress runs along a continuum from None to Total — neither
extreme is healthy

Stagnation Growth Death

 Understanding Stress
The Distress Reaction

1. Outpouring of adrenaline and other hormones

2. "Fight or flight" response
3. Impacts health by modulating rate of cellular aging
4. Increase in heart rate & blood pressure
5. Faster breathing
6. Muscle tension
7. Increased alertness and sensory sensitivity
8. Increased blood flow to brain, heart and muscles
9. Decreased blood flow to skin, digestive tract, kidneys and liver
10. Increase in blood sugar, fats and cholesterol
 Understanding Stress
Symptoms of Distress
 Physical:
 Fatigue, headaches, insomnia, muscle aches/stiffness, heart
palpitations, chest pains, abdominal cramps, nausea, trembling,
flushing, sweating, frequent colds
 Mental:

Decreased concentration and memory, indecisiveness, racing
thoughts, confusion, loss of humor
 Emotional:
 Anger (short temper, irritability, impatience), Anxiety (nervousness,
worry, fear), Sadness (grief, anguish, depression)
 Behavioral:
 Pacing, fidgeting, nervous habits, increased eating, smoking,
drinking or drug abuse, crying, yelling, swearing, throwing things
 Understanding Stress
Sources of Distress
 External:
 Physical Environment: noise, heat, bright lights, traffic
 Social: rudeness, bossiness, aggression
 Organizational: rules/regulations, red tape, deadlines, dysfunction
 Major life events: births, deaths, weddings, job loss, promotion
 Daily hassles: commuting, mechanical breakdowns, misplaced keys

 Internal:

Lifestyle choices: caffeine, lack of sleep, overloaded schedule
 Negative self-talk: pessimistic thinking, self-criticism, over-analyzing
 Mind traps: unrealistic expectations, black-or-white thinking, over-
personalizing, rigid standards
 Personality traits: perfectionism, workaholism, people-pleaser,
“Type A”
 The Generic Model of Stress

(Stimulus) Stressor  (Response) Strain

 This model assumes that all stimuli or stressors are the same
and more or less affect everybody equally.

 The problem with this model is that one situation can be quite
stressful for one person and not at all for another.

 How you respond is determined in part by the personal

meaning you give to the stressor. Example: a crisis can be
experienced by one person as a breakdown and by another as
a breakthrough.
 Individualized  Model of Stress
Environmental Individual: beliefs, Stress
frustrations, losses, personality, values, Reactions:
and uncertainties personal and prostress /
medical history, distress
threats, challenges, (physical)
goals, coping, (cognitive)
relationships, (behavioral)
habits, sense of
control, self-esteem,
intelligence, and
physical
predispositions
 The Goal is Stress Optimization

 Optimizing stress has two aspects:

1. Managing External and Internal stress levels in order to stay
within the Prostress range
2. Expanding the Prostress range by increasing tolerance for
stress — through improved stamina, proactive (“wellness”)
measures, mindfulness, etc.

 The body’s physical activation in response to optimal stress is

actually beneficial — Selye called this the “general adaptation
syndrome”.

 If the stress continues unrelieved, what happens is that the initially

adaptive response begins to takes its toll, leading to what Selye
calls the “wear and tear of stress.”

 If you interpret stress positively and handle it “actively,” you won’t

have the long-term, particularly harmful physical activation that
coincides with negative stress — i.e., distress.
 Stress Management Strategies
Lifestyle Changes

1. Decrease or discontinue caffeine

2. Regular exercise
3. Relaxation/Meditation
4. Sufficient Sleep
5. Time-outs and Leisure (pacing & work/leisure balance)
6. Realistic expectations
7. Reframing/Reinterpreting stressful situations
8. Belief/Value systems
9. Ventilation/Support system
10. Humor
11. Balanced diet
Stress Management Strategies
Situational Changes

1. Time and money management

2. Practicing healthy assertiveness in social
relationships
3. Creative Problem-solving
4. Consider leaving a job or relationship that
has become unsustainable or destructive
Stress Management Strategies
Cognitive Changes

1. See problems as opportunities

2. Refute negative thoughts
3. Focus on the positives
4. Take the long-term view
 Being “Stress-Wise” 

    Being “Stress-Wise” is being open to

interpreting difficult situations as positive
and growth-promoting opportunities and
actively seeking out such situations,
while consciously monitoring oneself for
signs of slipping into distress and actively
working to ensure they don’t become too
prolonged and harmful