Most physicians experience a great deal of stress on a daily basis. This comes in many forms – pagers, phone calls, bad outcomes, administrative hassles, dealing with insurance companies, malpractice threats, family problems, health problems... the list goes on and on. No one is immune and no one escapes from these hardships. And yet some people seem to be better able to roll with the punches. How does one become resilient and learn to manage stress?
We know a great deal about what causes stress and how the mind/body reacts to stress. Disorders linked to stress, including depression and anxiety, are widespread and the most commonly used medications in the United States are used to treat problems directly related to stress (including antidepressants, anxiolytics, and sleeping pills). Stress is thought to pose a more serious risk factor for mortality than tobacco.
Psychotherapy can be extremely helpful for people to process their beliefs and assumptions regarding their life stressors, but this takes time and requires developing a relationship with a therapist, something many physicians are reluctant to seek out on their own. Psychotropic medication can be helpful, but the benefits of medications often stop after treatment is discontinued and it is clear that antidepressants and anti-anxiety medications do not “cure” in the sense that antibiotics cure infection. Because anti-anxiety agents like benzodiazepines give immediate relief, even if temporarily, people taking these tend to not put effort into learning coping mechanisms for managing stress and anxiety. Then when used for longer than a few months, the medications can cause unintended side effects such as dependence, sleep disruption and cognitive problems which can ultimately result in a vicious cycle of more stress. Traditional western medicine has become more aware of the power of non-traditional treatments that may be equally effective as medication or psychotherapy. David Servan-Schreiber, MD, PhD, a psychiatrist, cognitive neuroscientist and NIH psychopharmacological researcher, has written a book entitled The Instinct to Heal - Curing Stress, Anxiety, and Depression without Drugs and without Talk Therapy.1 Working with Tibetan refugees while with Doctors Without Borders, he observed traditional Tibetan medical practitioners using only acupuncture, traditional herbs and the instruction to meditate while treating chronic illnesses as effectively as western medicine practitioners with remarkably fewer side effects and significantly less cost. Dr. Servan-Schreiber rejoined the University of Pittsburgh Medical Center where he is the cofounder of their Center for Complementary Medicine. He returned to the institution where he has studied and written on the science behind several of these natural methods of treatments for depression, anxiety and stress including acupuncture, exercise, nutrition, eye movement desensitization and reprocessing (EMDR), synchronization of chronobiological rhythms with artificial dawn and heart rate coherence training. The latter is the focus of this article.
Heart rate coherence training is a biofeedback technique in which one can learn to manage stress and become resilient. It is based on heart rate variability and the relationship between the emotional brain in the head and the “brain” in the heart, a diffuse two-way communication that occurs via the autonomic nervous system. The two branches of the autonomic nervous system, sympathetic and parasympathetic, are in constant equilibrium and are continually in the process of speeding up and slowing down the heart. The interval between successive heartbeats is never identical, which results in heart rate variability. This is considered healthy and indicates the heart is responding to both the “accelerator” and the “brake” as needed. However, in states of stress, anxiety, depression or anger it has been discovered that the variability between consecutive heartbeats becomes irregular or “chaotic”. While in states of well-being, compassion or gratitude this variability becomes “coherent”—the heart rate alternates regularly between speeding up and slowing down, in a smooth sine wave pattern. This can be visualized on a computer screen utilizing software from various sources and a sensor to detect heart rate.2
The term “autonomic nervous system” has implied that this is beyond our conscious control; however, we are finding that we can learn to exert control over this system. The HeartMath Institute in Boulder Creek, California has done a great deal of research on ways of managing stress by achieving cardiac coherence.3 Coherence is not a state of relaxation in the conventional sense of the word but an inner calm that can be achieved both at rest or when working out with a heart rate of 140 bpm. The practice of heart coherence melds techniques found in yoga, mindfulness, meditation and relaxation and enables the brain to work faster and more accurately, when fully coherent with the heart.
To begin, take two deep, slow breaths, focusing on the breath, breathing in, pausing and breathing out and pausing. This immediately stimulates the parasympathetic system, applying a physiological brake. Once your breathing stabilizes, draw the focus of your attention to the region of your heart and imagine you are breathing in and out through your heart. Finally, while breathing through your heart, bring your mind to a pleasant or happy memory, or focus on a positive emotion such as joy, gratitude or love. Pracice this for five minutes and you will achieve cardiac coherence. The more you practice, the easier it becomes to induce coherence, which can then facilitate your ability to deal with any situation. Research on this technique has demonstrated it can aid in the ability to control symptoms of anxiety and depression, lower blood pressure, increase the hormone DHEA and stimulate the immune system. You do not need the software program to do this but it is a powerful tool to be able to see how the heart instantly reacts to one’s emotional state.
1. David Servan-Schreiber, The Instinct to Heal – Curing Stress, Anxiety, and Depression without Drugs and without Talk Therapy, (Paris, Rodale Books, 2003).
2. www.heartmath.com, www.wilddivine.com (relaxing rhythms)
3. www.heartmath.org Re-printed with permission by Dr. Stuyt