# DTD 189
This is the Drive Time Debrief, episode 189.
Hey guys. Welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And last time we talked about dorsal vagal shutdown, which gave words to something many of us have felt—that numbness, that disconnection that so many physicians feel, particularly after working. But today we are focusing on hope because there are ways to get back up on the ladder.
We're gonna just talk about a few things that we can do to help get us out of this dorsal vagal shutdown. Sometimes when we get so far out of our zone of resilience, and that zone of resilience is really where we can regulate our emotions, even just by talking to ourselves. But sometimes when we get out of that zone of resilience, we can't outthink that and we have to do something with our body.
Sometimes medication is what needs to happen with an SSRI or SNRI to help stabilize our mood and increase our arousal. Sometimes we can do things to stimulate the vagus nerve, meaning the ventral vagus nerve to enhance vagal tone, and there's several things that we can do to do that. Sometimes it's deep breathing, sometimes it's actually humming or singing. We can do that. We can go to therapy.
We work in an extremely stressful job. We have very complex lives as physicians. I'm going to freely tell you, I go to therapy. I love my therapist. It makes my life so much better that I feel like we need to normalize because while we're treated like we should be superhuman, and acting like we can take on all this stress and all this secondary trauma that we do on no sleep and no self-care, it really is a recipe for hitting the wall and for disaster.
So going to therapy helps, and there are therapists who specialize in somatic therapy and that means that they, you use your body during therapy and a lot of times those therapists are polyvagal informed therapists, so that could be something to look for when you are looking for your therapist.
Somatic therapies, as I mentioned, use the body to help release stored stress through body awareness and gentle movement. And I find that yoga is this kind of like what yoga with the breathing and moving your body to your breath, I find that helps ground me. That's why I love yoga.
Yeah, yoga is fantastic. And you know, we always say that yoga is not the answer to the physician burnout crisis. And yoga does help. It does help. Even within yoga though, there's different forms of breathing. Like some are activating breathing and some are more relaxing. So just being with an experienced practitioner who can lead you through what it is that you're trying to accomplish would be a good thing.
Yoga is helpful because it gets you back into your body where you can actually do some of these things like reconnect. And it is calming. It can be very, very calming. And I think that's different than dorsal vagal state. I think it's the more ventral vagal state. I am curious if there has been any research done on the neurophysiology of yoga. I'm sure there has been really.
But when working with clients who are adamant that they can't do exercise, they absolutely can't because they're too exhausted when they get home from work, I will often suggest, okay, we can do one yoga pose for 30 seconds, and doing that actually does help break them out of that frozen state and remind them that exercise is our friend. Doesn't always feel like it, but it is.
Biofeedback and heart rate variability training. I have not tried this myself and I'm very, very curious. I do know that there are places where you can go and do biofeedback therapy. Mm-hmm. Have either of you guys ever tried that?
So that was kind of a thing that was a popular topic in the integrative medicine fellowship. Like you can get your own little, it's called HeartMath. It's almost like a pulse ox, but you can mm-hmm, literally watch your own heart rate variability as you move through exercises and stuff. So it's just same thing like we spin around in our head all day and we're not paying attention to what's going on in our body very often. Mm-hmm. But it teaches you how to do that.
And there's also one called neurofeedback where they've got almost like EEG probes. Mm-hmm. My dad did that 'cause it was post-op one time, there had been a couple complications and he was having terrible anxiety about it. Mm-hmm. And with that, it can tell when you're getting revved up so the TV show that you're watching or the movie that you're watching will go black. So it's like to get it going again, it teaches you how to calm yourself down.
Fascinating stuff out there. No meds, but you're learning to like, this is probably what you should have learned to self-regulate as a kid, but we don't. We don't do that, so—
That's amazing. So it was actually connected to his TV so he was at a place, so that one's obviously gonna be a lot more expensive than your little pulse ox machine that gets shipped to your house. Yeah. He needed something at that time, so, and it worked. Yeah. Wow. That's awesome. Mm-hmm.
Like clearly my 80-year-old dad, I was in my integrative medicine era because Uhhuh, he would've never did that otherwise. He's your average engineer. But he did like the idea of him being able to control his own physiologic responses, like for a control enthusiast like that, it was appealing rather than meds or whatever for him to figure out how to do it himself. Yeah. I don't know any other control enthusiasts. Yeah, but definitely not. I didn't hear that. If you know it, that would be a good approach to dealing with some of these issues.
Some other thoughts are lifestyle supports. Obviously eating healthy food, sleep. Sleep is so crucial. We discount the importance of sleep, but that's gonna help all of these things as well. Doing some exercise, meditation again helps us get out of that dorsal vagal state and into our prefrontal cortex so that we can be more present, be more intentional in our lives, and not just at the whim of our autonomic nervous system. And again, it doesn't have to be 30 minutes, it can be one minute, it can be a one or two minute. Oh, I promise you're not gonna regret doing a small meditation. That will create a lot of positive change in most of our lives if we could do that.
Co-regulation. Have you ever been around someone that you just really felt safe around? Like you just love being around that person? That is called co-regulation. You just, if you both know that when you're together, you laugh, you calm down, you know that you're perfectly safe with them. Those are good people to seek out in these situations.
Physical touch, hugs, snuggles, all of that's great. Music, especially singing. You are a singer in the car like me. Great news—that is really good for you. That really increases that ventral vagus tone and just makes us feel better.
And laughter. Obviously, if you don't have a comedic strategy for getting yourself out of a funk, I invite you to create a file of memes. Make a list of your favorite funny movies. Make a list of funny topics you like to search on Instagram or happy topics, pet videos. There's one guy that I really like, he does voiceovers for pets. I think his name is Rockstar, but it is hysterical the way he makes the pets talk. So make sure you have that handy so when you're feeling terrible, that's something that you can pull up and remind yourself that there's hilarious stuff in the world, and life is worth living and you're not gonna be stuck in your dorsal vagal state forever.
You know, some of this sounds kind of, maybe woo, or I mean, they are soft skills, but they're not. They're essential skills is, I guess what I'm trying to say. These are biological recalibrations, so if you identify as a control freak, this is a great way to gain control over your autonomic nervous system.
I definitely will enjoy the Instagram reels that are usually like kids saying sassy things. I laugh a lot at the expense of small kids doing super funny things. Yeah. Yeah. So that's just good to know. What cracks you up? I chuckle at my son. Mm-hmm. Mm-hmm. My son, anytime I ask him to do something, does the, "I'm just a baby."
Oh yeah. I love that one. I do really like that one, but no. I watch Daily Dose of Internet with my teen boys. Like, that's one of our little rituals. That one also that will get you out of it too, if you need a tip—Daily Dose of Internet. It's amazing. Yeah. I also appreciate all the healthcare workers, like nurses, everything that make fun of our work. Yeah. Especially the ones that work in the ER, man, those hit home and I laugh till I cry about those like, preaches.
So climbing up the ladder like we've been talking about actually can be gentle and simple. We just gave you a few examples, but really to get started is naming it and name it, but drop the shame guys. Just drop it. This is not something that is supposed to bring anything but awareness and allowing for you to understand and feel empowered because we've given you the language. And so even saying like, "This is my dorsal reset. This is my biological recalibration. Not me failing, not me falling short, not me." Whatever you can think of that, you know, you've said to yourself, allow it to happen and feel empowered because you're able to name it now.
Low and slow breathing. We talk about breathing a lot, really engaging that exhale because that is when you turn on those parasympathetics, and this is what we really need to activate. It's the low and slow. It's focusing on the exhale. It's really entering in and understanding the purpose behind it.
And then like we talked about, gentle movement. You know, even just holding a stretch. You know, we talked about yoga, but that's less cringey than just stretching. Just laying there. You know, one of the things, I used to take a barre Pilates class, and then we ended the class. She turned off all the lights, we laid on the mat and she brought attention to every body region. I mean, it just really got you out of your head. And she's just like, "We're gonna relax. We're gonna start at the head and go all the way down to our toes," and it took probably five minutes, but just laying there with your eyes closed, just focusing. She was like, "relax your scalp, relax your eyebrows." I mean, it was like by the end, I think I was asleep, but it was very relaxing just to focus on the body region.
So if you're like cringey about yoga, just lay down, close your eyes and just start at the top of your head and just begin to focus on every single body part, relaxing it, and really focus on the exhale. When you exhale, you're relaxing something new. And just work all the way down to your toes.
And then the connection we talked about, you know, snuggling, hugging, call a friend, snuggle with your pup. Like my pups are 175 pounds and think they're lap dogs, which yes, it's not too relaxing, but they do appreciate a snuggle or two. And even bringing the thought of somebody safe, your bestie, your significant other, someone that you know, that you can be yourself and lay it all out with, and know that there's no judgment. There's, you know, no harboring anything, that it's just a safe space.
And then, like Laura said, you know, vagus toning can come with a hum, a sing, even a gargle. But even just humming or just reflecting on your favorite song that really brings you—I know we talk about hype music all the time. I particularly love worship music. I will blare it in the car and just being able to let it all go and really like into a time of just like bringing praise into it, bringing worship into it, whatever your favorite song is, you know, just hearing those lyrics that can really just reach down deep into your soul and recenter you.
And then a micro moment of purpose. So this is really an easy way to get out of your head. Texting someone you care about. I know when I have found this helps me a lot when I'm starting to ruminate or worry about something, especially since my kid is off to college, I can really spin out now. Or when she was in the house, but I will just text her or I'll remember somebody that, you know, maybe called me or texted me with like a medical problem. I'll just check back in with them like, "Hey, how you doing? How's mom feeling? How's this?" You know? And it just really gives you purpose and gets you out of your head.
And then interrupt the narrative like we talked about. Speak to yourself with compassion. One of the things that we have talked about multiple times because there's actually research and data—the strongest antidote that we know to burnout or feeling burned out is self-compassion. And Dr. Neff does such a great job with all of the work that she's done, her Center for Mindful Self-Compassion, and remembering that what you say to yourself really is going to determine what part of your brain is activated.
So do you really wanna stay in the activated state? Do you really wanna ignite that sympathetics when that's what's turned on most of your time? Or do you really want to bring yourself down into your parasympathetics, allow yourself to feel it, feel empowered, 'cause you named it, and then doing all of these, you know, little things, tiny things to really recalibrate? Each of these micro steps signal safety, nudging the nervous system upward, bringing that healing, bringing that centering and also allowing for you as you practice this, then you become more aware of the situations, hence more practicing. And then you get to where it is almost your automatic, so.
If somebody listening out there happens to resonate with this, happens to be in their own dorsal vagal state, it's just an era. It's not who you are. Sometimes it does feel like maybe this is just who I am now. No, it's not. Your true self is still in there waiting. It is just, this is a physiologic reaction to the things that have been happening to you, and it's good to know this so that then you can do some of the things that we talked about before to reconnect with that version of you that's still in there waiting.
Your ventral vagal state is your executive brain. It wants to get back online. Your ventral vagal state wants you to connect, reconnect with your empathy, your humor, your creativity, and don't ever think that that's gone, that's not a thing. It's just been buried underneath the things that also have been happening to you or you've been experiencing. Burnout tricks you into thinking that that version of you is gone. That's not true. That's just one of those lies that sometimes our brains tell us, you can find yourself again.
And sometimes it can help to get that tension out—there's something called neurogenic tremor or dancing or stomping, or there's even a lot of people that will like jump up and down and shake out that tension. Sometimes that can complete that cycle to release, you know, the tension and energy that's been in there. Each micro step is like telling your nervous system, "You're safe, you can come back home now."
So here's the takeaway—that feeling of burnout, numbness isn't your fault. That's not who you are, and it isn't permanent. Yeah, and your nervous system is actually doing its best. Remember, it's meant for survival, but with small signals of safety like grounding, pendulation, or even a hum, you can return to connection, vitality, and purpose. So we're here for you. We're here for it, and your nervous system is too.
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