Dr. Nick Dewan shares tips on how to cope with stress.
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Coping with Stress
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He is a member of the physician leadership team within the BayCare Health System providing input to the hospitals, medical group, accountable care organization, and insurance-based initiatives. He has the respect of national hospital, managed behavioral health, community mental health, and consumer advocacy groups, and sits on the Council of Healthcare Systems and Finance of the American Psychiatric Association. Dr. Dewan is also a member of the Board of the Positive Coaching Alliance of Tampa Bay. He is a graduate of the Medical College of Ohio, and completed his residency in psychiatry at Los Angeles County-USC Medical Center and UCSD School of Medicine. He is a Diplomate of the American Board of Psychiatry and Neurology and the American Board of Addiction Medicine. He is also a board certified physician executive and a former collegiate tennis player and coach.
Nick Dewan, MD
Dr. Nick Dewan is a pioneer and an accomplished physician leader and sports psychiatrist with a nationally respected track record in health care value improvement and information technology. Currently, he serves as Chief Medical Officer for the Behavioral Health Division of the BayCare Health System. In 2015, he published his third book on information technology “Mental Health Practice in a Digital World: A Clinicians Guide”. His clinical experience includes work in emergency, hospital, outpatient, addiction medicine, and sports medicine settings. He is a sought after speaker and is interviewed by local and national media on behavioral health issues and sports performance topics. His work on clinical guidelines, performance bonuses for quality, efficient use of healthcare, best practice adoption, and patient empowerment and technology positions him as a leading expert in an era of accountable healthcare.He is a member of the physician leadership team within the BayCare Health System providing input to the hospitals, medical group, accountable care organization, and insurance-based initiatives. He has the respect of national hospital, managed behavioral health, community mental health, and consumer advocacy groups, and sits on the Council of Healthcare Systems and Finance of the American Psychiatric Association. Dr. Dewan is also a member of the Board of the Positive Coaching Alliance of Tampa Bay. He is a graduate of the Medical College of Ohio, and completed his residency in psychiatry at Los Angeles County-USC Medical Center and UCSD School of Medicine. He is a Diplomate of the American Board of Psychiatry and Neurology and the American Board of Addiction Medicine. He is also a board certified physician executive and a former collegiate tennis player and coach.
Transcription:
Coping with Stress
Introduction: This is BayCare HealthChat, another podcast from BayCare Health System. Here's Melanie Cole.
Melanie Cole: Welcome. We're discussing coping with stress in a variety of situations. Joining me is Dr. Nick Dewan. He's the Chief Medical Officer in the Behavioral Health Division of BayCare. Dr. Dewan, first I'd like sort of a working definition between chronic stress and acute stress. Tell us the difference.
Dr. Dewan: So acute stress is a medical way of saying short term stress, something that has a defined period of time or is very recent and then it goes away. Chronic stress is when you have an ongoing burden or ongoing situation that requires continual adaptation, continual vigilance, continual sort of heightened alert levels. And those are those kinds of things where whether it's being in the midst of a six month kind of event, sometimes people go to war and they have six month tours of duty or there's this ongoing sort of demand on your own psychological or physical strength or capacity. So that's the real difference between what we term medically as acute versus chronic and acute as something that just recently happened. And chronic is something that's just always there and always sort of a sense of burden.
Host: So then which one is harder for people to deal with? Which one is harder to kind of get past? Something really drastic that happens in your life or that ongoing one that kind of keeps ticking away at ya?
Dr. Dewan: Well, I hate to say this but it really does depend on for the short term how really bad is it? Short term things can be things like tornadoes or hurricanes or some other recent sort of what I would call traumatic stressors versus I've got a new situation or got an exam coming up or I've got a deadline at work, you know where it's time limited. The research tells us the chronic is always worse because when there's chronic stress it really can attack your internal biological resilience capabilities, and your internal psychological resilience capabilities. Usually people recover from short term stressors pretty well, unless it's just a god awful stressor. So chronic is always worse than short term unless the short term is just horrific.
Host: Well. Then Dr. Dewan, how do we, if we're under stress, whether it's financial or someone is ill, there are so many stressors in our lives today. How do we compartmentalize our fears, separate reality from what's actually occurring in our lives? How can we help ourselves?
Dr. Dewan: Whether it's a financial stressor, a healthcare stressor, I mean, let's face it these days, there are usually predictable stressors in life. You either have financial, you either have relationship or you have something going on with your health or healthcare stressors. That's usually the three biggest sort of stressors. The real solution for, regardless of what it is, is step one, you've got to have what I would call me time or selfish, peaceful time. That's true. If it's a chronic stress, it's not going away. It's going to be there. So you got to protect yourself from it. So taking mini breaks and quiet time and me-time, step one is very important. The second thing is thinking through the stressful event, whether it's financial, whether it's health related, whether it's relationship related. You have to think through what's really going on here. Do I have another strategy? Am I overvaluing the stressor, and maybe the word we use is we use what's called catastrophic thinking. Am I thinking of this in a catastrophic way when it really isn't? Let me take a step back. Let me see what's really happening. Now, sometimes we have unknown stressors.
What's really going to happen financially? What's really going to happen to us health wise? What's really going to happen? And when things are unknown is when you have to tell yourself, you know what, this is really not that known, but here's what I do know and here's what I can do to address a situation. So there's the me time. There's the thinking through it rationally way. And the third way is the typical, what I would call ways that you should be doing this every day of your life, or at least thinking about this, keeping yourself emotionally healthy, whether it's talking to a friend, whether it's trying to enjoy a movie, whether it's maybe taking a walk or doing some type of exercise. These are what I would call those inner protective things that you should be doing, whether you're under stress or not under stress. And oftentimes when people are under stress they forget to do what you should do anyway to keep yourself healthy. So those are the three kinds of approaches that you got to think through. And the me time, what I would call the thinking time, and the doing activity time are all sorts of ways of compartmentalizing ways of not thinking about that chronic stressor.
Host: So interesting. I love how you compartmentalize it for us into those three ways and what if we feel, because stress as you said can eat away at you and it can also cause panic attacks. What if we feel like we are having a panic attack or losing it, just losing it? Does breathing really help? What do we do to calm ourselves down in the case where we start to really worry and go, I'm going to lose it right now?
Dr. Dewan: Yeah. I think when those things happen you said the right word. Step one is saying, okay this is happening and accepting it. It's happening. It's going to last for a little bit. I'm going to just be silent and I understand why it's happening and I'm going to let this take its course. Because oftentimes when you fight against it and you try to battle against it, you're just throwing, you know, fluid on a fire. The heart is racing and then you're like, Oh, I got to, I'm going to adrenaline through this. And that's the worst thing that one can do is adrenaline through a already existing heightened adrenaline panic state. You let the fire slowly come down, you let it sort of reduce in intensity. And then while it's reducing is when you sort of count your breaths, you think about the thoughts that led you there, but you kind of dial it down from 10 to nine, to eight to seven to six and you do it nice and slow. And by the time you do that you're like, okay, boy, that's over. And instead of lasting 20 minutes, it only lasted two.
Host: What a great bit of advice, Dr. Dewan. You are such a great guest as always. What if sleep problems are contributing to our stress? And conversely, what if our stress is keeping us from sleeping, which I think is so common, especially for moms.
Dr. Dewan: Absolutely. Stress really changes what I would call our sleep wake cycles. It really does disrupt them. And there are three psychological things you can do. Number one, if you're trying to get to sleep and you can't sleep, you leave the room that you were trying to sleep because the longer you stay in that setting you associate being awake with being in that room. And that just sort of reprograms the brain not to sleep when you're in that room. So you leave the setting and when you leave the setting, you don't watch TV or go on your phone and look at stuff and then get your brain all energized. The real goal is to quiet the brain down and anything you can do to sit away from that room, quiet the brain down. And then when you're really tired again, go back to the room where you want to sleep, close your eyes, do some breathing. And that usually helps a lot of people.
But it is something that, of course I can say this, but then actually doing it obviously is much more difficult. That's the one thing I hear people do. They're in their beds, they're trying to sleep and I can't go to sleep, so they turn on the TV, bad mistake, or they get their phone out and they're looking at their most recent messages or they're tweeting or whatever. It's like, no, you want to reduce stimulation. You want to get away from that room and then come back when you're ready. You might have a couple of nights where the sleep is not doing well, but that's okay. You just have to have good habits and in the morning you got to make sure you expose yourself to sunshine because exposing yourself to light resets the sleep wake clock in your brain. And that's the other thing a lot of people don't do is they don't reset their clock or maybe they drink too much caffeine at night and that just messes things up. So there's a lot of things you can do to sort of get your sleep back.
Host: Wow, I didn't know that. I've never heard that before and that is excellent advice, Dr. Dewan, before we wrap up, help us put our stress into perspective and manage our expectations for what we as super humans can accomplish, what we can get past, especially for us women, Dr. Dewan, because we do feel like we are expected to be superhuman and always hold the family together and make sure everything gets done and the house is clean, and the meals are cooked, and our jobs are perfect, and our kids are taken care of. We all have stress. Help us to manage them. What would you like us to know? Give us your best advice.
Dr. Dewan: What you've just described is what I would call role diffusion or role disruption or too many roles. And I think the most important thing you can do is, although you might be superhuman, having six roles really is a burden and I think that's when a person has to say, I'm doing these six things. I'm not having the balance. I'm going to need help. So it's important to say, here's the six things. Let's divvy up this work or today I'm only going to do these three things because I'm not really superhuman and if I try to be superhuman for the next few weeks or months, I'm going to burn out and I'm going to be stressed, and I know chronic stress is not good for me. So on any given day I'm doing three roles, I'm not doing six, or if there are six things to get done, I'm going to ask for help because that's the only way I can continue doing what I do. So that's my advice. It's that role diffusion and role strain and having a strategy to address the role strain is the best way to go.
Host: Well, I am certainly going to work on just that when we're finished today. That's excellent information, Dr. Dewan, thank you so much for coming on and helping us learn to manage our stress because it's so important that we all hear that. And that concludes this episode of BayCare HealthChat. Please visit our website at baycarebehavioralhealth.org for more information. And to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. Share this show with your friends and family on social media. That way we can all learn how to manage our stress from the experts at BayCare together. I'm Melanie Cole.
Coping with Stress
Introduction: This is BayCare HealthChat, another podcast from BayCare Health System. Here's Melanie Cole.
Melanie Cole: Welcome. We're discussing coping with stress in a variety of situations. Joining me is Dr. Nick Dewan. He's the Chief Medical Officer in the Behavioral Health Division of BayCare. Dr. Dewan, first I'd like sort of a working definition between chronic stress and acute stress. Tell us the difference.
Dr. Dewan: So acute stress is a medical way of saying short term stress, something that has a defined period of time or is very recent and then it goes away. Chronic stress is when you have an ongoing burden or ongoing situation that requires continual adaptation, continual vigilance, continual sort of heightened alert levels. And those are those kinds of things where whether it's being in the midst of a six month kind of event, sometimes people go to war and they have six month tours of duty or there's this ongoing sort of demand on your own psychological or physical strength or capacity. So that's the real difference between what we term medically as acute versus chronic and acute as something that just recently happened. And chronic is something that's just always there and always sort of a sense of burden.
Host: So then which one is harder for people to deal with? Which one is harder to kind of get past? Something really drastic that happens in your life or that ongoing one that kind of keeps ticking away at ya?
Dr. Dewan: Well, I hate to say this but it really does depend on for the short term how really bad is it? Short term things can be things like tornadoes or hurricanes or some other recent sort of what I would call traumatic stressors versus I've got a new situation or got an exam coming up or I've got a deadline at work, you know where it's time limited. The research tells us the chronic is always worse because when there's chronic stress it really can attack your internal biological resilience capabilities, and your internal psychological resilience capabilities. Usually people recover from short term stressors pretty well, unless it's just a god awful stressor. So chronic is always worse than short term unless the short term is just horrific.
Host: Well. Then Dr. Dewan, how do we, if we're under stress, whether it's financial or someone is ill, there are so many stressors in our lives today. How do we compartmentalize our fears, separate reality from what's actually occurring in our lives? How can we help ourselves?
Dr. Dewan: Whether it's a financial stressor, a healthcare stressor, I mean, let's face it these days, there are usually predictable stressors in life. You either have financial, you either have relationship or you have something going on with your health or healthcare stressors. That's usually the three biggest sort of stressors. The real solution for, regardless of what it is, is step one, you've got to have what I would call me time or selfish, peaceful time. That's true. If it's a chronic stress, it's not going away. It's going to be there. So you got to protect yourself from it. So taking mini breaks and quiet time and me-time, step one is very important. The second thing is thinking through the stressful event, whether it's financial, whether it's health related, whether it's relationship related. You have to think through what's really going on here. Do I have another strategy? Am I overvaluing the stressor, and maybe the word we use is we use what's called catastrophic thinking. Am I thinking of this in a catastrophic way when it really isn't? Let me take a step back. Let me see what's really happening. Now, sometimes we have unknown stressors.
What's really going to happen financially? What's really going to happen to us health wise? What's really going to happen? And when things are unknown is when you have to tell yourself, you know what, this is really not that known, but here's what I do know and here's what I can do to address a situation. So there's the me time. There's the thinking through it rationally way. And the third way is the typical, what I would call ways that you should be doing this every day of your life, or at least thinking about this, keeping yourself emotionally healthy, whether it's talking to a friend, whether it's trying to enjoy a movie, whether it's maybe taking a walk or doing some type of exercise. These are what I would call those inner protective things that you should be doing, whether you're under stress or not under stress. And oftentimes when people are under stress they forget to do what you should do anyway to keep yourself healthy. So those are the three kinds of approaches that you got to think through. And the me time, what I would call the thinking time, and the doing activity time are all sorts of ways of compartmentalizing ways of not thinking about that chronic stressor.
Host: So interesting. I love how you compartmentalize it for us into those three ways and what if we feel, because stress as you said can eat away at you and it can also cause panic attacks. What if we feel like we are having a panic attack or losing it, just losing it? Does breathing really help? What do we do to calm ourselves down in the case where we start to really worry and go, I'm going to lose it right now?
Dr. Dewan: Yeah. I think when those things happen you said the right word. Step one is saying, okay this is happening and accepting it. It's happening. It's going to last for a little bit. I'm going to just be silent and I understand why it's happening and I'm going to let this take its course. Because oftentimes when you fight against it and you try to battle against it, you're just throwing, you know, fluid on a fire. The heart is racing and then you're like, Oh, I got to, I'm going to adrenaline through this. And that's the worst thing that one can do is adrenaline through a already existing heightened adrenaline panic state. You let the fire slowly come down, you let it sort of reduce in intensity. And then while it's reducing is when you sort of count your breaths, you think about the thoughts that led you there, but you kind of dial it down from 10 to nine, to eight to seven to six and you do it nice and slow. And by the time you do that you're like, okay, boy, that's over. And instead of lasting 20 minutes, it only lasted two.
Host: What a great bit of advice, Dr. Dewan. You are such a great guest as always. What if sleep problems are contributing to our stress? And conversely, what if our stress is keeping us from sleeping, which I think is so common, especially for moms.
Dr. Dewan: Absolutely. Stress really changes what I would call our sleep wake cycles. It really does disrupt them. And there are three psychological things you can do. Number one, if you're trying to get to sleep and you can't sleep, you leave the room that you were trying to sleep because the longer you stay in that setting you associate being awake with being in that room. And that just sort of reprograms the brain not to sleep when you're in that room. So you leave the setting and when you leave the setting, you don't watch TV or go on your phone and look at stuff and then get your brain all energized. The real goal is to quiet the brain down and anything you can do to sit away from that room, quiet the brain down. And then when you're really tired again, go back to the room where you want to sleep, close your eyes, do some breathing. And that usually helps a lot of people.
But it is something that, of course I can say this, but then actually doing it obviously is much more difficult. That's the one thing I hear people do. They're in their beds, they're trying to sleep and I can't go to sleep, so they turn on the TV, bad mistake, or they get their phone out and they're looking at their most recent messages or they're tweeting or whatever. It's like, no, you want to reduce stimulation. You want to get away from that room and then come back when you're ready. You might have a couple of nights where the sleep is not doing well, but that's okay. You just have to have good habits and in the morning you got to make sure you expose yourself to sunshine because exposing yourself to light resets the sleep wake clock in your brain. And that's the other thing a lot of people don't do is they don't reset their clock or maybe they drink too much caffeine at night and that just messes things up. So there's a lot of things you can do to sort of get your sleep back.
Host: Wow, I didn't know that. I've never heard that before and that is excellent advice, Dr. Dewan, before we wrap up, help us put our stress into perspective and manage our expectations for what we as super humans can accomplish, what we can get past, especially for us women, Dr. Dewan, because we do feel like we are expected to be superhuman and always hold the family together and make sure everything gets done and the house is clean, and the meals are cooked, and our jobs are perfect, and our kids are taken care of. We all have stress. Help us to manage them. What would you like us to know? Give us your best advice.
Dr. Dewan: What you've just described is what I would call role diffusion or role disruption or too many roles. And I think the most important thing you can do is, although you might be superhuman, having six roles really is a burden and I think that's when a person has to say, I'm doing these six things. I'm not having the balance. I'm going to need help. So it's important to say, here's the six things. Let's divvy up this work or today I'm only going to do these three things because I'm not really superhuman and if I try to be superhuman for the next few weeks or months, I'm going to burn out and I'm going to be stressed, and I know chronic stress is not good for me. So on any given day I'm doing three roles, I'm not doing six, or if there are six things to get done, I'm going to ask for help because that's the only way I can continue doing what I do. So that's my advice. It's that role diffusion and role strain and having a strategy to address the role strain is the best way to go.
Host: Well, I am certainly going to work on just that when we're finished today. That's excellent information, Dr. Dewan, thank you so much for coming on and helping us learn to manage our stress because it's so important that we all hear that. And that concludes this episode of BayCare HealthChat. Please visit our website at baycarebehavioralhealth.org for more information. And to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. Share this show with your friends and family on social media. That way we can all learn how to manage our stress from the experts at BayCare together. I'm Melanie Cole.