This is the Drive Time Debrief, episode 208.
Hey guys. Welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And today is part two of our series on emotional intelligence. Today we'll be talking about self-regulation, and this is something that. I don't know. I never learned anything about this in my medical training. Maybe you guys did, but, certainly emotional regulation or self-regulation wasn't modeled by any of my leaders, as an intentional practice.
And a question we have for you guys is, if you've ever thought, I know I shouldn't react like that. Then reacted exactly like that. Anyway, this is the episode for you. This is our second episode in our series on emotional intelligence for physicians, and I think we referenced in the previous episode, physicians are highly intellectually intelligent.
And what that often means is that our emotional intelligence bucket is a little bit on the low side, and research shows that over time during training, our emotional intelligence actually decreases. So that's why we want to have a little refresher on what it means to be emotionally intelligent. In that first episode, we talked about self-awareness, which is the skill of noticing, noticing what's happening inside you in real time, and if that sounds foreign, you are not alone.
Most of us become alexithymic, which means basically blind to our emotions during our training and in practice of medicine. And we have to regain our emotional intelligence, we have to redevelop that skill of being self-aware. So we're going to build on that self-awareness. Because just being aware is really, really important.
It's not enough. We've got to be able to learn how to manage ourselves. And when we notice that we're stressed, irritated, anxious, or overwhelmed. We still snap or we shut down or start over-functioning or over-explaining or spiraling. That is where the self-regulation skill comes in. Self-regulation is the ability to stay present when you're activated or when you're feeling yourself going into fight or flight.
It's the ability to choose a response instead of defaulting to whatever reaction is your go-to, whether that be anger, shutting down, withdrawing, or whatever your flavor of reactivity is. It helps us recover faster when we do get dysregulated. So here's the key point for physicians. Self-regulation is not about being calm all the time.
It's about choosing our responses and learning to recover efficiently when we are triggered.
Let's clear up a misconception right away. Self-regulation is not suppressing emotion. Staying stoic, being unbothered. Or like we hear all the time, keeping it all together at all costs.
Any of this sound familiar? I feel like I'm living in training. Again, most physicians are already excellent at all of these. We compartmentalize. We shove and we stuff. And we stay stoic, right? Because we have to show up and we're going from patient to patient.
But suppression is not regulation. Let's talk about what each one of these look like. So suppression looks like the clenching your jaw, powering through, telling yourself it's fine, I'm fine, everything's fine. It's our mascot, right? The dumpster fire, mm-hmm. The puppy in the dumpster fire or whatever.
Pushing emotion down so you can function is not regulation. This is suppression. Regulation, on the other hand, looks like noticing activation. So while I said, clenching your jaw or maybe a knot in your stomach. When that happens, you notice it right away. You notice, oh, what is that? Or you notice you feel it in your body and instead of avoiding or ignoring it, you're like, something's coming up.
So you allow it, but you don't have to amplify it. And noticing is powerful because you're noticing it, you're allowing it, but it's not getting the best of you or not being the captain of the ship this time, like telling you what to do.
Suppression keeps stress in the body, but regulation helps it just keep on moving through, and that's where the power comes back.
That's where you regain your footing where you get your power back. Medicine trains you to stay sharp under pressure, override your bodily signals and function in that fight or flight all the time, right?
It's a constant stress response and you're required to operate through that, and that is adaptive at work. However, if you don't downshift, at some point you are going to live in this chronic stress state all the time, even when you're not at work. And so we're not calling you out saying that you're bad at regulating.
You're just overtrained to stay activated. So a quick nervous system reset looks like this. It has two primary modes: activated and settled. Activated is the alert, mobilized, task focused, and settled is rested. Connected, and reflective. Medicine keeps you activated. Self-regulation is the skill of helping your system come back down without needing hours of scrolling.
Few bottles of wine, sleeping pills, whatever you wanna say. That is an artificial deactivation. That's numbing. Okay, so this is noticing, allowing and then helping you get back to baseline and you can do this yourself. And this is extremely empowering.
It sounds kind of shocking because becoming stuffers has become so much of our identity and the idea of experiencing emotions and learning to process them is so foreign and emotions really are kind of frowned upon.
And expressing them certainly during our training and what I would offer is that emotions really are messengers. They're signals to us about what is happening in our environment and how it relates to our identity. Things that have happened in our past, how we experience safety. It is just information.
They're not anything to be afraid of. So it's really important for us to look at them as friends. I had a client, actually earlier today, he was talking about how he looks at himself, like a, you know, the ruler or king and the emotions coming are like his counsel telling him what's happening.
I was like, I really like that analogy. And so that's a helpful framework I think. Dysregulation is just kind of where our emotions are happening to us, and we are not able to manage ourselves in the face of them many times because we deny that we have them, or we are not aware of what's happening.
So here's a couple of little cases. So case number one, the snap that comes out of nowhere. We had an episode on amygdala hijack, and I think I described a snap that came out of nowhere for me. This is not uncommon and I'm sure we've experienced this or seen it happen in other physicians. So Dr. C has a normal shift, nothing dramatic at home.
A small request from her partner and suddenly she snaps, and later she's thinking, why did I overreact like that?
Slowing it down and really looking at the sequence of events, the words that were said, the sensations felt in the body can really help. Us understand she didn't overreact in that moment and she wasn't poorly controlled at work either. Most of us are extremely controlled at work. Here's what happened is that she stayed activated all day long without downshifting, and then it came out later and maybe you guys have heard stories of kids who like keep it together all day at school and then you know, are the best students and then come home and unleash it on their family. It's kind of a similar situation or like we're trying to hold it together so much in the face of so much pressure and stress and then kind of let it fly out at home.
At work, physicians use tremendous. Top down control. We use parts of our brain to manage the emotions that we're feeling, such that we actually trick ourselves into believing we aren't having emotions sometimes. We're focused. We're overriding our stress responses, overriding biological needs.
Overriding everything so that we can function. So we're not dysregulated. Most of the time at work, we are experiencing over control, and the problem there is that control is not the same thing as regulation. Regulation includes acceptance of the emotions. It includes. Understanding what's happening, and it includes recovery, includes settling ourselves down and completing the stress cycle.
Most physicians are never taught how to do that. In fact, we're taught quite the opposite. We're taught, suck it up, buttercup, move along. Next patient, keep your chin up. It's like we're Elsa in Frozen. You know, don't let it show. Don't let any of your feelings show, make one wrong move and everyone will know.
So our nervous systems just stay completely jacked up all day. We're completely activated, and then we come home and additional demands present themselves in relationships that we feel safer with. And the system is safe enough for us to release things. And it all comes out. And that can look like just being irritable, grouchy, snapping could be exhaustion or emotional withdrawal. For Kay and I it looked like sitting in our car for hours before coming back into the house, like avoiding, it can show itself in lots of different ways, so it doesn't actually come out of nowhere. The nervous system released at home what it had been really trying to hold together at work, and that snap wasn't an overreaction to the moment.
It's really just a delayed discharge and it's a release of more than what's happening in that moment. And this matters because it changes the solution. The answer isn't to try harder to control yourself. The answer is learning how to downshift intentionally before everything spills out onto the people that you really love the most.
Some common dysregulation patterns in physicians show up as follows. That doesn't always look dramatic. Sometimes it just looks like being irritable, withdrawing emotionally, over-explaining. That's one of my favorite adaptations, perfectionism, trying to control not just ourselves, but control others.
Numbing that can look like a variety of different things. Social media, scrolling, alcohol, other substances, food, shopping, lots of different ways to numb. And many physicians try to regulate by working more, thinking harder, staying busy, avoiding stillness and. They don't ever get to where they need to be because those strategies might work short term, but they are not actually dealing with the issue.
They fail long term. Perfectionism as a source of regulation is one that is a pet choice for physicians. It may surprise people that perfectionism is not healthy. Hopefully, if you've been listening to us long enough, you know that it's not, and perfectionism is often not about standards. It's about control.
And when you feel anxious or powerless, when you tighten standards on yourself and on others, it might give you some temporary relief. It keeps your nervous system activated because obviously perfection is not achievable, and so your brain is always on alert for the little places where perfection is not happening.
Another way this may show up in physicians is emotional leakage, when regulation doesn't happen intentionally and kind of as we go, it happens unintentionally. And the stress that we've kind of shoved down all day leaks out in our tone. We might sound condescending or irritable in our tone.
It might again show up as withdrawal. Reduced empathy, more know-it-all-ness, more being right. Usually this is happening towards people who feel the safest, so towards the people that we want to be treating the best, not because we care less about them, but because our systems finally feel safe enough.
To let some of this stuff out. So if we want to show up as our best for the people who mean the most, it is a skill worth learning to notice our emotions as they come and regulate throughout the day, and not take home this big shoved-down pile of emotional stress and unleash it on our family members. Nice.
So let's transition then into some tools that you can start to use for self-regulation. So the first thing is regulate your body. First, it turns out that you can't think your way out of your nervous system activation. And this is. This. And I try so hard. I know. Why isn't it, why can't I think my way out?
We like to joke that physicians tend to be cut off at the neck. Like we ask people, how does that make you feel? And it's like, well, I think that. This is a stupid rule or whatever. Nope. Still thinking. That's not feeling. A feeling is literally in your body. That's why it's called a feeling.
So cognitive tools that we keep trying to use over and over, that's step two after physiologic regulation. So your first question shouldn't be, what should I do? It's something more like. Hey, I'm noticing something. I'm noticing some sensations in my body. What does my body need to settle down right now?
That also I think is a beautiful question to ask. What does my body need right now? Because I used to be real critical of myself if I were having like negative emotions, what's wrong with me? No, there's nothing wrong. I've been going all day instead, like pushing it down under the surface.
My body's doing what it's supposed to. So what does it need right now? Hey, we're on the same team instead of, you know, in conflict. So try a 30-second physiologic reset. Like, dropping your shoulders and unclenching your jaw. Exhaling longer than the inhale is particularly good for like, slowing down your system.
Just do it for 30 seconds. Everybody has 30 seconds. You're probably waiting for a phone call to come back from your consultant or for a result from a lab or something. That's enough to signal safety in the nervous system. That's a good one. I've noticed too that when I notice something come up, and especially if I can't leave the room right away, I will finish.
I just. Actually just listen to the patient, and I say, okay, we're gonna do some stuff. I'll be back. And I take the scenic route back to the fishbowl or my desk where I was working and I find taking the scenic route, yes, I'm getting my steps in, but I really am intentional about like box breathing or having that extra long exhale.
Because I'm like, okay, I'm noticing something. I need to take the scenic route back to my desk. Yeah. When we had Dr. Alvarez on the podcast, he said like, he'll go get a blanket for a patient. Like nobody ever is sad about getting a blanket for a patient and it looks like you're doing something, but really you're giving yourself those few moments to resettle and like the discharge valve, you know, the release valve.
You're letting some of that kind of blow off instead of keeping it all for your unsuspecting family. Okay, tool number two. Containment, which is not the same as venting. Venting. Turns out, you know, what you focus on, amplifies. So sometimes when you're just complaining without solutions.
It can feel like connection. It can feel like we're all in the same, you know. Foxhole together. Sometimes that actually backfires and amplifies your emotions. So containing means naming the emotion, acknowledging it without attaching to it so much, and then choosing not to spread it everywhere. So you might say internally like, Ooh, I'm starting to get irritated.
I'll deal with this later. That's not regulation, that's actually stuffing it down, which I think most of us anyway are quite excellent at. What we wanna do is, you know, give it a safe space, without suppressing, but also not amplifying it. So that would be containment. I think a good example of that would be like, if you get home and there's really some stuff that you need to process, maybe a lot of people will set a 10 minute timer or a 15 minute timer where you just let yourself feel the stuff.
But you don't have to dwell in it. You like, you process it, you feel the feelings and then you move on after that. A second example here, a patient encounter that you can't stop replaying. Hi, my name is Amanda. I am a chronic ruminator. So yeah, let's say hi Amanda. Join me in my processing of this situation.
So let's say I had an uncomfortable interaction, not necessarily a complaint, no error, but I keep replaying it over and over and over. So instead of spiraling like used to be my tendency, regulation looks more like, something about that interaction activated me and I'll revisit it when I'm regulated.
That's not avoiding it, that is a more appropriate use of our excellent containment. You're not stuffing it to never revisit it later. You are containing it so that you're able to pace yourself and deal with it when you are safe, but you do actually deal with it. And then tool number three, a pause. A pause doesn't get enough credit because it can be a superpower to learn how to pause before responding before whatever it is. So when you feel the urge to fire off that email, oh good lord. Please don't, this is aside. Don't hit send. Please don't do it after you've had adult beverages. Let's just please never log back into your computer after that.
So if you feel the urge to fire off that email, to defend yourself, to overexplain, to correct somebody immediately, notice there's something going on in your body that's not from just your prefrontal cortex. You're a little activated at this moment. Pause. Even a brief pause interrupts your reactivity and regulation lives in that space.
I really think that that's important to highlight. If you're feeling in fight or flight, that is your clue that you are not in the best space. Like trying to solve problems with your partner, trying to send off emails. When you are in that spot, you're not using the best part of your brain, right?
Then. You're gonna cause damage to relationships and possibly your career. So wait, wait until you're calm. Yeah. I learned this the hard way. All of our tests in medical school were in the same week, so guess what happens to me as a procrastinator? I haven't slept in five to seven days legitimately, and it is so wild how many arguments I would get in with now my husband.
Yep. The first time that it happened, he said, you might need a nap. And let's just say that I absolutely lost my mind, but then I did take a nap and slept and was like, wow, I do feel a lot better. A lot of those things I was upset about, like, really are not bothersome to me now. That's actually a thing now where I'm like, I think I just need to sleep before I respond to what's going on. I can tell that in myself now, this is probably not when the conversation should be happening.
Tool number four, a post-shift downshifting ritual. Like just schedule it. Just be ready to do this every day. Most of us work in places where maybe there's beeping all the time.
Our nervous systems are totally activated, you know, you're not just sitting there in a nice— I did work in a library one time and that was so nice. It was quiet. Nothing was like super stressful. I just had to file things and put books away. That's not our working conditions now.
So the working conditions that we work in now probably do require a planned downshifting ritual. So it can be something like two minutes of stillness or a walk outside is always a good idea. Some music that you particularly love that is settling or even fun for you, and breathing is always something that you can come back to, box breathing or 4-7-8 breathing.
You're not doing it for entertainment, you're not doing it for distraction. This is an on-purpose sort of transition back into your real life. The goal isn't calm necessarily. It's recovery. It's proactive downshifting. So let me be clear. The goal of self-regulation is not to be calm all the time. The goal is faster recovery, less spillover, less ruminating, less taking work and letting it spill out in the rest of your life.
More choice, more intentionality about how you are spending your time. Highly regulated people still get activated. Listen, just because it happens doesn't mean you're doing it wrong. They just don't stay there as long. They don't engage in the like six-month rumination that I can do. This episode builds directly on what we talked about in episode one, which is self-awareness.
You have to be aware that this is happening within you, before you can do something about it. So both self-awareness and regulation are core skills in emotional intelligence. Both are learnable. Self-regulation is not a personality trait. It is a skill, and like any skill, it improves with practice.
Don't be perfectionistic about this. This is not the time or the place for that. You don't need to regulate everything. You don't need to do it perfectly. You just need to start practicing it sometimes on purpose. The next episode in this series, we're gonna talk about motivation. Why so many high achieving physicians feel stuck, empty, or disconnected despite their objective success.
Until then, try this one day. What does my body need right now to settle? That's where regulation starts. Yeah, this is a great conversation. You know that reset, that's probably the best thing you could do for yourself. So choose this week. Choose one shift or one day when you come home from work. And just practice, right? Because you don't need energy for this. You just need intentionality. So thank you for listening today, and if you found this conversation helpful, the best way to support us is to subscribe.
So click that button now and leave us a five star review and comment in there because it helps other physicians find us and it moves us up on the list. And if you've had experience with this, or if you practice this week and you're like, wow, that was impactful, shoot us an email at [email protected].
We'd love to hear these experiences and we love to talk about them on air. So share it with us. And don't forget to follow us on the socials at The Whole Physician because we love connecting with you. And before we go, just a quick invite. We have a first exclusive physician only wellness retreat in the lovely Nosara, Costa Rica.
Coming up, we are collaborating with MedTreks International to offer a one week retreat at Bodhi Tree Yoga Resort. It is amazing. This sanctuary is built for renewal and restoration. We'll be bringing the content, you just bring flip flops and a t-shirt and maybe some swim shorts. And you are set. So easy to sign up, go to the show notes, click the link and sign up. We would love to spend a week with you in this lovely, lovely jungle paradise.
So thank you for spending time with us today. Until next time, you are whole. You are a gift to medicine and the work you do matters.
