Five Antidotes to Stress

There are five non-physical threats or stressors that cause illness in primates. They are described by Robert Sapolksy, Ph.D. in his book, Why Zebras Don’t Get Ulcers. These primal threats are the essential ingredients of any horror movie: 1) No control over circumstances; 2) Cannot predict what will happen next; 3) Facing it alone; 4) No escape; and 5) No hope of it getting better.

If you can reduce any one of these factors, especially the one that is threatening you most, your stress and the damage it does to your body is reduced considerably. The following strategies are recognized as best practices because they directly counteract these primal threats, by adding resources that help you to see the threats differently—as challenges. This creates a more confident motivational state and less wear and tear on your body.

  1. CONTROL – Choose more consciously your schedule, work, and lifestyle. Exercise self-governance in the things you can control. Less chaos means less stress.
Get in the driver’s seat
  • Self-Care: Cover the basics that everyone knows: sleep, diet, exercise. Customize your own self-care action items in ways that are realistic, make sense, and put you in the driver’s seat.
  • Work/Life Balance: Improve your work, play, and rest balance. The number of hours per week spent with traumatized people is the primary predictor of vicarious trauma.
  • Commitment: Commit to a one percent change—the one small significant change you will implement. Build the habit of successfully taking small yet pivotal steps. This is not about impressive accomplishments; it’s about your capacity to gradually improve your well-being repeatedly.

2. FORESIGHT – Be better able to predict where stress will come from.

Look ahead
  • Occupational Hazards: Understand what is happening to you. Know the occupational stress hazards, the risk factors, of your profession.
  • Warning Signs: Recognize them early. Know your habits, vulnerabilities, and blind spots. Notice your stressors at home and work.
  • Training: Get more training on the aspects of your job in which you have least training. Build your skills, understanding, and contacts in all your areas of responsibility—you will be most stressed where you know the least.
  • Narrative Medicine: Learn to write and tell your stories; they will help you make sense of your experiences and recognize the themes, patterns, and lessons in your life.

3. CONNECTIONS – Stay in touch with those who bring out the best in you. Don’t face stress alone.

Get together
  • Social support: Create and restore your social supports at home, at work, and in your community (chronic stress will isolate you). Find strategic allies.
  • Empower co-workers, family, and friends; the more disempowered people are, the more they turn on each other.
  • Stay away from toxic people, chronic complainers (the BMW’s who bitch, moan, or whine) and those who bully and commit “horizontal violence” in the workplace.
  • Good Company: Spend time with people who inspire, ennoble, and are role models for you. Belong to a group where you feel a sense of camaraderie and purpose.

4. OUTLETS – Always have a safety valve to let off steam or a way to escape from stress.

Find breathing room
  • Debriefing: Know what to do with all of the traumatic stories you hear. Regularly practice low-impact debriefing (but share your stories without traumatizing others).
  • Contingency Plan: Know who will be your go-to person. Then ask for help before it’s a crisis. Don’t be intimidated by stigma. Seeking help from friends or professionals is not a sign of personal failure—it’s the smart thing to do.
  • Sanctuary: Find a safe place and set aside time regularly where you can be quiet and find peace.

5. HOPE – Always have something to look forward to, something to hold onto, a sense of progress, and the skills to know that you can bounce back.

Look forward
  • Resilience: Build resiliency with regular training in self-awareness, relaxation, and in moderating empathic hyper-arousal. Stay in touch with what is most meaningful, inspiring, and joyful in your life, and have daily exposure to wiser perspectives. Develop the capacity to find peace whenever necessary through daily practice. The ABC’s of resilience are Awareness, Balance, and Connectedness.
  • Inner Work: No matter how much we exercise or eat right, how skillful our stress management, how good our intentions, how educated we are, or what we believe in, there is no substitute for doing our own interior self-care. Happiness is an inside job.
  • Faith: Believe you can choose a brighter future and change your life for the better. Beneficial changes are always possible with good people, perspectives, and practices in your life.

—Simon Fox

Simon Fox is Executive Director of the Adventures in Caring Foundation and author of Oxygen for Caregivers: Our Toolkit to Guard Against Burnout, Build Resilience and Sustain Compassion, an interdisciplinary team-learning program for health care and emergency service professionals.

Seven Things Everyone in Health Care Should Know about Self-Care

1. Self-care is a choice. “The key to healing” says Gabor Maté in his book, When the Body Says No, “is the individual’s free, active, and informed choice.” It is also the key to quality self-care. Unfortunately making such choices doesn’t come naturally to a lot of us, and few have been taught how to consciously choose, evaluate those choices, and then make the necessary choice adjustments to get where we want to go. Learning this art of making better and better self-care choices is the key to resilience and quality of life.

2. Self-care is personal. There is no one-size-fits-all universal answer. It’s not about the method, it’s about the person. You. The answer is, to use Carl Jung’s phrase, in the secrets of your own private experience. Your life, your choices, your commitment. You are the only person who knows what is most meaningful and motivating for you, and self-care must be meaningful and self-motivating, otherwise it doesn’t last. Perhaps you’ve noticed that. Only you can discover your best path to wellness. No one else can do it for you.

3. Self-care protects you. There are occupational hazards in caregiving. No, you don’t usually need a hard hat, but… at some point, as a caregiver, you will find yourself going down a dark hole to rescue someone. Someone who is in physical, emotional, mental, social, or spiritual darkness. You need strong lifelines anchored in place ahead of time, so that we don’t end up with two of you down that hole. Burnout, compassion fatigue, vicarious trauma, and moral distress are not personal failings, they are some of the all-to-real hazards that come with the territory. Good self-care is your protective gear. In her Compassion Fatigue Workbook, Françoise Mathieu describes these hazards as equivalent to the physical dangers of working on an Arctic fishing boat.

4. Self-care is the best antidote to stress. The greatest stressors are five primal threats identified by Robert Sapolsky in his book, Why Zebras Don’t Get Ulcers. They are the primary ingredients of horror movies: you have no control over the situation, you can’t predict what will happen next, there’s no escape, you’re facing it alone, and there’s no hope of it getting better. These threats cause most of the stress experienced by all primates—which includes anyone reading this. Once you understand these threats you can recognize where they are coming from in your life. Then you can target them accurately with the self-care resources and strategies that change them from a threat into a challenge. Challenges motivate us in positive rather than negative ways, and this one change—seeing something as a challenge rather than a threat— protects our health in numerous ways. With practice you’ll get better at it, and be able to manage your threat-level with skill even in high-stress situations.

5. Self-care is about wholeness rather than excellence. It’s not about being better than others, its about being better with yourself. Excellence is not the same as strength. Excellence won’t protect you against burnout. It is too brittle, too dependent on your last success. However, a deep, resilient strength comes from addressing your weakest links as well as your strengths. This is a sense of wholeness, balance, and resilience that can be steadily built into your life. It brings with it the capacity to cope with the hard knocks of life and grow wiser from them.

6. Self care is a priority, and priorities compete. Those who work in health care have very meaningful jobs to do—you save lives, restore health, and reduce pain. So the bar for what to do with your time is set very high. You can always be doing something incredibly important for someone else. But… bitter, burned out caregivers are not a source of comfort to anyone, and they make lousy decisions. The only way you can consistently bring your A game to those in your care, is to have already taken care of you. As they say on airplanes in an emergency, put your oxygen mask on first. You make better choices that way.

7. Self-care is a learnable skill, best learned in a team setting. The most insidious thing about burnout is that it is isolating. We are all in this together. In a team we can learn not only from the materials, we can learn from the wisdom in the room. This builds interdisciplinary teamwork where caregivers look out for each other. Burnout is not a medical problem, so it doesn’t have a medical solution. Prescriptions, regimens, best practices, or latest research findings may be helpful, but they are secondary. The primary thing is to support one another in making better self-care choices, and to find the path that leads to a healthier you.

—Simon Fox

Simon Fox is Executive Director of the Adventures in Caring Foundation and author of Oxygen for Caregivers: Our Toolkit to Guard Against Burnout, Build Resilience and Sustain Compassion, an interdisciplinary team-learning program for health care and emergency service professionals.

The Secret Language of Healing

Some gifted doctors and nurses know it, so do some psychologists and other health professionals. But most do not.

This is the language that makes healing possible. It is active in the healing of trauma, illness, and relationships. In patients, families, and caregivers.

It is what we teach at Adventures in Caring (AiC)—to young people who are pursuing careers in health care, and to current professionals in health care and emergency services.

It takes a year to learn this language well enough to remember it for life, and to be fluent enough to alleviate distress and restore well-being. After one year, students are capable of restoring the elements of well-being that make life worth living, even at the end of life. Such elements of well-being are our sense of: identity, connectedness, security/trust, autonomy, hope, meaning, growth, forgiveness, gratitude, and joy.

We are not only made of molecules, we are also made of stories. So the language of healing uses symbolism, paradox, metaphor, and appreciative listening to bring out the stories that lead to healing—of body, mind, heart and soul.

This language causes the universal solvent of compassion to flow, and so to solve, dissolve, and resolve the hard feelings, harsh thoughts, and bitter experiences of illness and injury.

The language can be taught—we have done it successfully for thirty-five years—but it cannot be taught by lecture. It can only be learned in the service of others who are suffering. This may be why it is so rarely taught in academia.

This is the AiC mission: to endow the next generation with this gift of healing—as an all-purpose tool to attend to, and cope with, the trauma, sickness and instability they will face. And, to be a blessing to current generations through their process of learning.

This healing language is crucial to the quality of relationships, not only in health care, but in public. We desperately need conversations that are healing rather than divisive, conversations that produce insight rather than merely affirm the latest fashion in group-think. We need language that leads to conversations that are meaningful, open, honest, and life-affirming, rather than those that are superficial, censored, devious, and corrosive. We need language that unlocks our innate capacity to heal, to grow, to thrive.

AiC undergraduate student volunteers demonstrate their proficiency in this language by engaging in healthy, constructive conversations with people who hold diametrically opposite points of view on politics and religion. They interact with people five times their age, who grew up in different countries, with different cultures and different races, speaking different languages, believing different creeds—and who are also having difficulty hearing, seeing, or speaking, and are in pain—and they still produce deeply meaningful, healing, life-affirming interactions. That is why we call them advanced skills.

So many of problems we face in our society are related to language that is divisive, deceptive, reductionistic, manipulative, mocking, and dismissive. The antidote is this language of healing. Many of our students tell us: “the whole world needs to learn this.” We agree, and with your help we can teach it to the world.

—Simon Fox

Simon Fox is Executive Director of the Adventures in Caring Foundation and author of Oxygen for Caregivers: Our Toolkit to GuardAgainst Burnout, Build Resilience and SustainCompassion, an interdisciplinary team-learning program for health care and emergency service professionals.