Transcription:
Managing Anxiety Before Surgery

Melanie Cole (Host):  Do you have to go into the hospital for a procedure? It can be scary and you might feel more anxiety than you need to. My guest today is Barbara Hopperstad. She's an integrative health and wellness coach who works with patients preparing for surgery at Abbott Northwestern Hospital. Welcome to the show, Barbara. Does everyone experience pre-surgical anxiety?

Barbara Hopperstad (Guest):  Well, thanks for having me, Melanie, and that's a good question. I would say that anxiety is a natural, human response to the idea of having surgery performed on your body; however, the intensity and the reasons for the anxiety vary widely from person to person. Some of that is due to the personality of the individual and some of that is due to the specific situation related to their surgery.

Melanie:  So, what do you tell people about that anxiety when they come to you? Do they relay it to you? Do they let you know that they're that anxious or do they try to hide it a bit?

Barbara:  Oh, some people really literally say that they don't have any anxiety. That's a very small percentage, and other people, it's all they can talk about. What I like to tell people is that there are actually many parts to each of us, and as a person preparing for surgery, most likely, a part of you is going to be anxious.  But, another part of you made the decision to have that surgery, most likely because that part of you knows that this is really the best course of action for you to take. So, for example, if you're having surgery to deal with chronic pain, I'm sure there's a part of you that really can't wait to get relief from that pain and if you're having surgery to remove cancer, you really, really want to get that cancer removed from your body. So, when we think about these very parts that all come together in this experience of planning for surgery, it's important to understand that each part of us is simply trying to protect us and keep us safe. So, the part of you that's anxious before surgery is trying to alert you to the fact that you're preparing to face some danger. While there's risk associated with surgery, we now know something about anxiety. Feeling anxious is part of our "fight or flight" response which also known as the "stress response". If you can think of the stress response like a light switch that's flipped on, it causes all sorts of physiological reactions and all of them are designed to allow us to run faster--flight--or punch harder--fight. When the light switch is turned off, our body's in the opposite response and this is called the "relaxation response". The body becomes a better healing environment when we're in the relaxation response. So, for the science behind this, the research shows a couple of really powerful things about the relaxation response. When we're in that response, our immune system functions at its peak. The reason that matters to someone coming in for surgery is you do not want to get an infection, catch a cold, or the flu that will complicate your recovery process. There's also evidence that medications that we take work better, more effectively, when we're in the relaxation response. So, I like to tell people that one of their jobs as the patient undergoing surgery is to figure out how they're going to relax as much as possible heading into and following their surgery because this is something they can do to have as quick and easy a recovery as possible.

Melanie:  What an excellent explanation. That's absolutely fascinating. Now, so what is pre-hospital coaching?

Barbara:  So what we focus on in our prehospital coaching program is, we want patients to walk into this hospital, on the day of their surgery, consciously aware of their own strengths, abilities and the resources that they're going to call on to get them to their surgery and their recovery. We also teach tools and techniques that are going to complement the conventional medicine tools that are going to help them manage their pain, anxiety, nausea and those kinds of things. We do some education, including what I just described to you, about understanding anxiety and the relaxation response. It just helps them kind of have the context for why doing the things that we're suggesting they do will be effective and help them have that quick and easy recovery.

Melanie:  So, can family members also get in on this pre-hospital coaching and  be helped with surgical anxiety, because sometimes, they're worse than the actual patient?

Barbara:  Yes, that's a great question. We always encourage family members to attend, as well as the patient if they are so inclined. It's important for them to get this education about how powerful the relaxation response in helping their loved ones have that quick and easy recovery.  Medications work better, their immune system is boosted, and so, one of the things we talk about with family members is having a handle on their own anxiety and managing it when they are around their loved ones. One of the things that happens--it's a natural thing--it's actually called "entrainment" and it's a fancy word for what happens, but when we're around another person, we tend to match their breathing pattern. So, if, as a family member, you're with your loved one in the hospital room and you're breathing in an anxious way, it's probably going to ratchet up your family member's breathing to that same quick and shallow breathing that we do when we are anxious, and the anxiety in the room is going to get bigger. So, a family member needs to work on their own breathing pattern and making it calm and slow when they're around their loved ones. Now, how do we do this? How do we address that in a bigger sense? If someone in the family, or the patient themselves, is really focusing, as they're preparing for surgery, on all the things that could go wrong, we call this "awfulizing". You're thinking about every awful thing that can happen.

Melanie:  You sure are.

Barbara:  Sometimes, people need to go through that process, so what I suggest they do is that they write down a list of every single thing that could possibly go wrong and then they choose a point in time prior to heading into the pre-op area of the hospital when they're going to somehow get rid of that list. They can decide at what time point. It could be the night before surgery; it could be right as they're heading out of the garage in the car; it could be walking into the hospital. So, pick a time that you're going to get rid of this list. You could do it in a ritualistic way:  burn the list, you can tear it up into little pieces and put it in the trash can in that garage before you get in the car, throw it in the first trashcan you see in the hospital. At that point, you make the decision that from now on, you're going to focus on a successful surgery and a quick and easy recovery.

Melanie:  Wow. That is such great advice. So, what do you want people to know, also, about before they go in and what they can expect after?

Barbara:  Okay. So, what I want them to know before they go in is, again, to become consciously aware of their own strengths and abilities. We might talk about, for example, if people have a meditation practice, a prayer practice; if they have some information and wisdom about their breathing. Breathing in a calm, slow fashion is the simplest entry point we have into the relaxation response. So, before heading into the surgery, if they've got some information about calm, slow breathing, I want them to practice that maybe every night before they go to sleep in bed. Practice calm, slow breathing.

Melanie:  So, in just the last minute, Barbara, give your best advice for people that are going into surgery and their families, and how they can manage that anxiety and how you can help them.

Barbara:  Okay. I like to remind people that even though their surgical experience is new to them, the people taking care of them chose this as their profession and they do this every day. So, if they can ask the part of them that's anxious to step back, to allow them to relax as much as they can, they are doing their part as the patient, and as the family members, to allow the patient to have a quick and easy recovery.  I also just really encourage the personal support system to spread that message far and wide that the best thing they can do for that patient is to help them relax as much as possible during their recovery.

Melanie:  What great information, and I applaud all the great work that you do. You sound like you are very, very good at your job. You're listening to The WELLcast with Allina Health. For more information, you can go to allinahealth.org. That's allinahealth.org. This is Melanie Cole. Thanks so much for listening.