Show Notes for Podcast Five of Sex & Why

Host: Jeannette Wolfe Guest Host: Justin Morgenstern

Topic: Stress Response - Part 3

Tricks for optimizing performance under stress

Preloading

• Over train and begin to focus on how to recover from mistakes
• Invest in mindfulness
  • Meditate
    • Increases your awareness of your own physiological stress response
    • Can help you train to go back and forth from narrow to broad focus
  • Be Awed
    • Have gratitude for what is going right
  • Use a transition mantra as you walk into work and move from your personal to your professional life
  • Appreciate the power of emotional contagion
    • Your mood influences your team's performance
    • Acknowledge and celebrate team's saves and successes
  • Create safe communities in which you can talk and walk through difficult cases without shame or judgement
• Maximize environmental advantages
  • Have the right equipment and know where it is

In the moment

• When you are becoming aware of stress- acknowledge its presence and recognize that you can face it as a threat or a challenge and then deliberately and emphatically choose challenge
• Chunk down overwhelming situations into immediate next actions, when in doubt go to the head of the bed and check oxygen connections and monitor leads
• Access mental crutches- simple pneumonics, resource cards, or a favorite app to jumpstart your thinking until your frontal lobe comes back on line
• Consider cognitive reframing and brief emotional detachment
• Keep a talisman in your pocket- use for either spiritual strength or physical distraction
• Use Mike Lauria's pneumonic BTSF (Beat The Stress Fool)
  • Breath
    • Tactical breathing and controlling the breath
  • Talk
    • Positive self-talk
  • See
    • Visualize successful completion of the task
  • Focus
    • Use a trigger word
  • Tips for breathing
    • Consciously slow your exhalation
    • Belly breath in which your abdomen expands with inhalation
  • Armor for negative thoughts
    • Thank your brain for trying to keep you safe
      • "Thank you brain for trying to watch my back, but I've got this"
    • Recognize your thoughts as being "just thoughts"
      • Change "I can't do this" to "I'm having a thought that I can't do this and fortunately most of my thoughts don't equate actual reality"
    • Identify and label your patterns
      • "oh yay, I do this sometimes when I get stuck, but I can choose to do X, Y or Z instead" (repeating if needed.)
    • Internally shout at yourself (to snap out of an internal loop) and then remind yourself that you are trained and capable
    • Repeat a repetitive negative thought in a strange accent
    • Sing a repetitive negative thought
    • Refer to yourself as a third person
    • Touch something in front of you and describe its shape/temperature and texture
    • Acknowledge that you are stressed but decide to just do it anyways
  • Tricks for focus words
    • Consider single word describing next critical action ("drape", "needle")
  • After the stressful event
    • Anticipate parasympathetic backlash
    • Consider cognitive offloading
      • Have a check list
      • Use time outs
        • Creates a shared mental model of critical actions
        • Allows for information exchange
        • Reinforces value of team
      • Appreciate that cortisol spiking may subtly shift your tolerance for risk and could potentially impact clinical decision making
      • Take a break
        • Eat and drink something (preferably without caffeine)
        • Emotionally recharge
      • After the shift
        • Work Out
        • Play Tetras- (this was a new one for me and I've attached a reference below)

Selected Resources

Meditation App- Insight Timer

Justin Morgenstern's Performance Under Pressure blog: https://first10em.com/2017/03/13/performance-under-pressure/

Adrian Plunkett's SMACC talk https://www.smacc.net.au/2017/02/learning-from-excellence/

Recent Tetra study: Horsch A, et al: Reducing intrusive traumatic memories after emergency caesarean section: A proof-of-principle randomized controlled study. Behaviour Research and Therapy, 2017 https://doi.org/10.1016/j.brat.2017.03.018

Lauria, M. J., Gallo, I. A., Rush, S., Brooks, J., Spiegel, R., & Weingart, S. D. (2017). Psychological Skills to Improve Emergency Care Providers' Performance Under Stress. Annals of Emergency Medicine. https://doi.org/10.1016/j.annemergmed.2017.03.018

Parkin, B. L., Warriner, K., & Walsh, V. (2017). Gunslingers, poker players, and chickens1 :Decision making under physical performance pressure in elite athletes. Progress in Brain Research (1st ed., Vol. 234). Elsevier B.V. https://doi.org/10.1016/bs.pbr.2017.08.001

Markway B, Stop Fighting your Negative Thoughts, Psychology Today May 7 2013 https://www.psychologytoday.com/blog/shyness-is-nice/201305/stop-fighting-your-negative-thoughts