4. Talking to Fear

Jason Brooks, PhD is a performance coach who works with physicians, athletes, and the military, helping them develop the cognitive skills not only to operate at the highest level, but to thrive no matter what the task. During the COVID-19 pandemic, Jason has been working with frontline clinicians, helping and guiding them through the cognitive and emotional aspects of what’s happening. This episode will give us strategies to mentally prepare for each day. It will show us how to find an anchor to ground us so that rather than feeling like we’re constantly running defense, we’re actually on offense.

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We discuss:

How pandemic medicine may be more dangerous to the healthcare provider than battlefield medicine, from the Happy MD blog [02:24];

In a war, the danger is the enemy. In a pandemic, the danger is the patient.
In a war, you have skilled, trained, and equipped people to protect you. In a pandemic, just being in the same room with the patient can be fatal.
In a war, the act of caring for patients is usually not dangerous to you. In a pandemic, you (and your family) are in danger.
Most clinicians did not sign up to fight something that could kill them.

Two big emotions experienced by people on the frontline of the COVID-19 pandemic: the fear of uncertainty and the lack of control [05:42];

We have no answers to many questions. When will this end? When will it peak? Am I safe? Is my family safe?
When we don’t have answers, we feel loss of control.
We’re left hoping the answers will reveal themselves in time, but hope is not a strategy that feels grounding in a crisis.
There are things we can do to manage our fear. And there are ways we can focus our efforts to find the control we need.

How we should keep our focus small and put our attention on the things that we feel some degree of certainty about [07:25];

This is a way to deal with uncertainty while adding as much certainty as we can.
Things we can be certain about: staying together, bringing good energy, having a good attitude, being empathetic, being good leaders, encouraging one another.
Small things we can focus on: making sure we’re prepared, communicating well, getting the latest updates, showing up and doing our job.
If you focus on the things you can’t control, it will make it difficult to focus effectively on the tasks at hand or to sustain emotional stamina for what’s ahead.

Ways people have created leadership and command centers to handle information overload [09:40];

Some sites have designated one person to triage and summarize all updated hospital emails. Other people have been tasked to compile the latest research information.
The idea is that not everyone in a large group of physicians needs to spend their free time duplicating the work, but can be kept informed by reading only a couple emails each day.
By keeping the focus small, you can conserve mental and emotional energy.

Strategies for managing the stress, anxiety, and fear that comes with working in the COVID-19 environment [11:55];

Accept your fears.
Talk to your fears.
Give fear what it needs to quiet it down. Examples: reassurance, humor, good leadership, contingency plans.
Specific things you might do if you feel fear before an ED procedure: take a pause, step back, remind yourself to not be rushed, be mindful of your technique.

The 2 things fear needs to know: that you hear it and that you have a plan to keep yourself safe [14:35];

Fear is a signal that’s there to help us. It informs us that there’s danger.
If there’s a plan that we can bring into a situation, it will allow fear to temporarily subside.

The tipping point between being scared and feeling panic [15:35];

Panic is a heightened reactive state which prevents you from being able to access the prefrontal cortex where the important cognitive skills and capacities reside. In this state you can’t think clearly, rationalize, or make effective decisions.
Being scared means you’re heightened, but you can still think and articulate yourself clearly.
If you can appreciate the difference between being heightened (scared) and impaired (panicked), you can develop tools to de-escalate so you can operate at the level you need to be.

The importance of flipping your perspective from being on the defense to being on the offense [17:45];

When you’re in a state of defense, you tend to feel like you don’t have control over anything. When in that state for extended periods of time, you eventually burn out.
A psychological shift to being on offense can occur if you give your fear what it needs. For many, that’s turning your focus to the things over which you DO have control. What things can you do right here and now that will make a difference in this moment?
Being on offense helps you recover emotionally and conserve energy.
A healthy, offensive perspective is to believe that COVID-19 will be the challenge of a lifetime, but knowing with confidence that we’re going to get through it.

The value of adding purpose where there is uncertainty and fear [19:00];

If you have purpose, you will find the strength to persevere.
Purpose can come from small things you can do to help your patients and your team.
A sense of purpose helps shift the mindset from being powerless and defensive to being back on offense.

Tools for handling moments of stress, panic or fear [22:30];

Don’t resist or fight it. Just observe what’s happening and find out what you need right now to de-escalate.

Anti-fragility and how it compares with resilience [23:52];

Anti-fragility is the notion that certain systems need stress, strain, failure, and challenge in order to grow and actualize. Examples are the immune and musculoskeletal systems.
The human mind is anti-fragile as well. We learn and get better by pushing ourselves to the edge of discomfort. When we adapt to challenges, we improve by result.
Resilience is the ability to bounce back to form. The more times you jump back up after being kicked down, the better you become at withstanding shock.
Tragedies such as the Las Vegas shooting or the COVID-19 pandemic show us the importance of collective resilience. These shared experiences teach us that we must help one another by being kind and showing encouragement.

How some people perform better as the favorite, but others prefer being the underdog [29:00];

People who are more timid or fearful often prefer to think of themselves as the underdog. It takes off some of the pressure and helps them focus
Others draw energy from being the one expected to save the day.
The important thing is knowing which is more effective for YOU.

Ways to “pregame” before entering the COVID-19 environment, and how your pre-performance plan can be thought of as a prayer [31:30];

Face the fear. Take a few minutes to check in with yourself about what you’re experiencing at that moment. Pause. Observe your feelings. Take a deep breath if you need it, to bring your arousal down by a small percentage.
Determine your purpose and the reason you will persevere. Reconnect to a perspective on why your presence has value and significance. What is your sense of meaning and purpose? Why is it that you’re choosing to step in, in spite of how scared you are?
What do you need? Figure out what you need from others, and then make a plan for how you can get it. It might just be that you need words of encouragement from a colleague.
Get ready to go. Anchor your sense of conviction and purpose on a phrase or mantra that tells your mind that it’s time for the emotional switch that gets you into the state where you perform at your best. This anchor allows you to feel a little bit more at peace. It assures you that you’re okay at this moment.

Why showing compassion to your fear and embracing it as a part of you is far better than resisting it [42:00];

In much the same way that PPE is vital and precious as a resource, so is the mental and emotional energy of the frontline personnel.
Every moment that is NOT entrenched in an extreme sense of fear is an opportunity to feel peace and to conserve emotional energy.

How the aftermath of COVID-19 will need space for healing, processing, and recovery [44:10];

When you go through this type of unprecedented experience, there’s great potential for becoming stronger. But this is not by virtue of the experience itself.
Instead, it hinges upon what you do to apply the lessons you’ve learned and to grow. It comes from being conscious with regards to how you choose to engage with the experience itself and your feelings about it.

Shownotes by Melissa Orman, MD