Amanda: Hey guys. Welcome back to the podcast. I'm Amanda.
Laura: I'm Laura.
Kendra: And I'm Kendra.
Amanda: And today we are going to continue our little mini study on emotions. The goal of which is to increase all of our emotional granularity. We find with a lot of our physician clients that we spend so much time in our head and not a whole lot of time acknowledging, processing, feeling feelings, and so having the ability to name what it is that is going on in your body and what it is that you're feeling gives you an advantage and ownership over it and makes it much more pleasant to choose the outcome that you want. When you know what it is and are able to label it, it just lets you process it much better. It's just a much healthier emotional intelligence when you can be in touch with your feelings and know what it is that's happening. Again, her example is that with her thousands and thousands of surveys, people could accurately identify like three: anger, sadness, and happy. I guess. I can't remember, but anyway. Yeah, not good. It wasn't good. Yeah. So we're gonna become emotionally literate and it really does help. It's so funny when you ask a physician like, what, so how did that make you feel? I'd say like, 90% of the time they answer with another thought, like, well, I thought that they were stupid. You know, like, no, that's not a feeling. That's a thought. And so it's for myself, too, as a professional bufferer. Like my default is to avoid emotions. And so this is actually for me to reattach with that part of the human experience. So let's get into it. It is from, again, Brene Brown’s, Atlas of the Heart, which is basically a directory of what emotions are, what they mean, and how you can use them.
Kendra: So when we start to talk about the feelings of anxiety, worry, dread, the American Psychological Association actually defines anxiety as an emotion characterized by feelings of tension, worried thoughts, and physical changes. So we already know that when you have a feeling of anxiety, if we were to ask you to put a word to that or like, what does it actually feel? So we know emotions and feelings are actually just the vibrations in the body. So it's manifesting in the body somewhere. So we have to drop out of our brain. You know, all of us are supratentorial. As physicians, as professionals, we love to stay up here. It's safe, but we actually gotta drop down. We gotta get under the jaw, under the neck and get down in our body and how it feels. So, even if, just as we speak, you know about this today, if we say the word “anxiety”. Like already. Maybe some people just already feel like, “Ooh, I got a little palpitation”.”I got a little knot in my throat”. I know anxiety for me, my stomach is like a pit. It's almost like, I imagine it being like, you know, the fight or flight when your body physiologically shunts the blood to brain and heart, because that's like, that's survival. So I like to just even picture my gut, just having no blood flow, it just gets shunted away. And so my gut's just like, “HEY!” But that's kind of what it feels like to me. But when we start to describe what these feelings and emotions are, we have to figure out where it is in the body. But I like how she divides it up. Brene Brown says there's trait and there's state. And so a trait is like something that is part of an individual's personality. So some people say, “I am a confident person”, or “I am an anxious person”. And basically it's just stating I have this personality attribute. A state on the other hand is a temporary condition that someone is experiencing for a short period of time. So it's like saying, I am feeling quite confident about this interview, or I am feeling nervous about taking care of these types of patients. So it's describing a state, so it's temporary, just meaning because of something that's happening, maybe a circumstance. In the ER, I mean, I know it gets turned on if I hear “pediatric code in progress" I just do not love to hear that. And as soon as I hear that and I know I'm up for the next patient, ooh, that dread sets in. And it's a state, it's a state of anxiety that starts to well up because lots of things I don't wanna do that. That's a kid, like that's just not supposed to be that way in my mind, and I'm a mom and I’m ultra sensitive to that. So that's just a state of anxiety that starts to rise up in me because of the situation that's getting ready to happen. But I walk into the room and it does serve me because I'm very efficient in there, like I am focused and I use it for that time. It's just when it stays with you for days, weeks, and months. Then we start to get into some of the more like diagnosis traits, like general anxiety disorder, and that's when you start to get into that excessive worry about everyday issues. So it's like, okay, I was triggered by the pediatric code in progress, but then now it's overflowing into everyday issue situations. And usually when you get a medical diagnosis or a mental health diagnosis, you have to have the anxiety for somewhere around six months. And it also has to manifest in some sort of physical symptoms like fatigue, trouble concentrating, decreased appetite, increased muscle tension, so some kind of somatic complaints that go with that. And if that is what's happening to you, if you find yourself just not ever able to turn it off or let it go or work through it, that's the time when you really need to seek out your primary care provider or the mental health professionals in your area. I like how Brene Brown, though, she's talking about all types of anxiety. The big picture here is basically our intolerance for uncertainty. Like we just do not do well with the uncertain. I mean, that just brings up so much anxiety. And one of the things in her book that she quotes this Elizabeth Gilbert writer, she made a comment.
“You are afraid of surrender because you don't want to lose control, but you've never actually had control. All you had was anxiety”.
That just really resonated with me cuz it's like, are you really in control here? Because there's one sovereign God and that's not me. So when we realize that, that we just never really had control, all we did was have dread or anxiety or fear for whatever the uncertainty was. That gives a pretty good perspective and allows you to maybe just take a deep breath and say, “Actually, I'm not in control here. I'm gonna let it go”.
Laura: Yeah. And when we're anxious, we often choose one of two paths and she talks about worry and avoidance. And really neither of these is very useful. Brene talks about worry saying that it is not an emotion, it's the thinking part of anxiety. It's a chain of negative thoughts about bad things that might happen in the future. And we're humans and many of us worry and feel like it's a productive use of our time, but really it's not. We might believe it's a helpful coping mechanism. It's not. We might believe it's uncontrollable, and so we don't even try to stop it. We might try to suppress worry instead of allowing it and allowing it to pass through, and then it gets bigger. My daughter shared with me this quote from one of her professors: that when we don't process our emotions, they go down to the basement and lift weights and get bigger and stronger and come back later.
Amanda: Oh, I like that. Yeah. Yeah, I do like that. That's exactly what happens. A good visual.
Laura: Avoidance is not showing up and often spinning a lot of energies zigzagging around and away from the thing that already feels like it's consuming us. So we may have difficult conversations we need to have or we may have…This happens a lot for those of us who procrastinate. If there's something that we don't want to do and it worries us, we are worried either that we won't be able to do it well or that there will be some bad outcome. Maybe we worry about what's in the email inbox, and don't even go to the email. We've actually heard of this being a problem with residents at times where they're just so afraid to go to their email box because they think there's gonna be some bad feedback or some bad news. We avoid these things and that doesn't help. And we're pre-living things oftentimes that either may or may not come to pass, but we're having suffering from it right now when we don't have to. Dr. Harriet Lerner writes "In the Dance of Fear, “It is not fear that stops you from doing the brave and true thing in your daily life. Rather, the problem is avoidance. You want to feel comfortable, which is completely natural and normal. Of course, we want to feel comfortable, so you avoid doing or saying the thing that will evoke fear and other difficult emotions. Avoidance will make you feel less vulnerable in the short run, but it will never make you less afraid”. So the only way to get rid of that feeling of fear is really just to face it and do the thing that we know we need to do, have the conversation we need to have, and not just sit there and worry about it and try to avoid it.
Amanda: You know? That's interesting because anxiety is kind of an energizing sort of emotion, like definitely, as opposed to contentment, there's energy in there. Right? And so maybe the anxiety could serve you in a way to give you the energy to do the thing that you're supposed to do. Instead of, I like how she says zigzagging, like yeah, I've done that. I've gone every single direction except for the one that I knew I should go in. Okay. So a little subsection of anxiety is dread, and Kendra, this reminds me of the pediatric code in progress. Dread is specifically when a negative event is very likely to occur. Like, regardless of what happens there's a high likelihood that something negative is going to happen. And with dread, the magnitude increases as the event draws nearer. Like you hear, the thing called overhead. Then it’s five minutes out, then it's two minutes out, then it's one minute out. It's getting bigger and bigger and bigger. We also call this future tripping, like, you're going to the future and already pre-living bad situations. It's problematic because even if things turn out all right, you're already exhausted from all the energy you put into that dread. We talked about last podcast that was me with my night shift. I had very powerful dread about my shifts and sometimes they were totally fine. But do you think I felt good after? No! I was exhausted from all my pre-living of the awful situations.
Laura: That used to be me with all shifts. Like it did not matter. Like all of 'em, especially if I had time in the morning to really think about it.
Amanda: Well, yeah, and that's funny that you say that. Even mornings for some reason early morning ones kind of just hit me in the face, so I didn't have as much time cuz I was asleep. But I would wake up every hour thinking that I missed my alarm, you know? Maybe that's what I was doing. It was a sleeping dread. Okay, so that's dread. And then fear is a short-lasting, negative feeling, high alert emotions. All of these are energizing, you know, you have a buzzing in your body with these or I don't know what it is for you, but for me it is like that. There's definitely pent up energy in there. Fear, though, is in response to a perceived threat. And like anxiety, it can also be a state or trait. We would ask is this useful or not? But you can consider yourself a fearful person or just have fear in the moment. Whereas this is an important difference, anxiety and dread are about the future. It's that future tripping. Fear is in the now, and it can be so rapid fire that it's almost automatic. Like I think of a deep tendon reflex where the thing happens before you even are aware of it. Fear can be so primal that it bypasses all the circuits and you are in a fearful state without ever having a conscious thought about it. This is common with fear that it kind of short circuits. It's an amygdala hijack, I believe what the psychiatrists call it. There's tons of different fears and phobias. But one common one is fear of social rejection, and she points out that a social pain, lights up the same areas of the brain as a physical pain. It is something that we're all hardwired to avoid. Whereas back in the day when you were in a clan and might get kicked out and literally die, situations are different. But in your body it feels exactly the same whenever there is a social pain, as a physical pain. The whole point of this though is that fear, anxiety, and dread can serve a purpose. If you can allow it, that is the best option because it can pass through you that way. Dr. Harriet Lerner says, in her book, “Throughout evolutionary history, anxiety and fear have helped every species to be wary and to survive. Fear can signal us to act or alternatively to resist the impulse to act. It can help us to make wise, self-protective choices in and out of relationships where we might otherwise sail mindlessly along, ignoring signs of trouble”. If we can get into a space of metacognition where we are watching our earth suit in its anxiety, fear, or dread. It's so much easier to me when I think of it like, “oh, my earth suit is experiencing some fear right now. I wonder what that's about”. It's probably there to tell you something. We need to go this way. We need to not go that way. We need to face this head on and that's why I'm giving you the energy to do this. Like let's go. Let's freaking go! So, the other thing to do is the physical sensation of anxiety can be the exact same sensation as excitement. It's how you're labeling it. You know, excitement seems a lot better than anxiety. So if you can, like, is this really something bad or am I looking forward to something? It's just interesting and you're much better able to do that when you're stepping out and looking at it, witnessing it, without judgment from a place of the observer. So it's important to invite the anxiety, fear, or dread in, not be scared of it. I like to tell my anxious patients, you know, when you get panic attacks, do you ever find yourself having anxiety that you're about to have a panic attack? And does that help? You know, or does that send you off into a spiral? You know what I mean? What if it's okay? What if it's not a problem to have this? In your body. What if it's not a problem to have a little anxiety? What if it could serve you in some sort of way? It's just interesting to think about. But for most of our emotions, they are here to tell us something. And so if we can get to a place where we can start allowing them and be like, hi, anxiety, what is it that you want to tell me today? Like, that's just a much different place from, oh my God. Oh, oh boy. Here it comes.
Kendra: And I think one of the things, yeah, one of the things that she goes on to talk about in that chapter is vulnerability. And I think all of these feelings, these emotions come from places where you feel vulnerable. And I think that's why it's so easy to try to zig-zag and avoid because people, I'm not comfortable with vulnerability. I'm not comfortable with that. Just circumstances in my past, situations that have happened, vulnerability has never been easy for me. So I think also when you sit with them, it allows you to accept in a non-judgment way that it's happening. And then what it's trying to tell me, and maybe it's okay to do that with yourself and in yourself and in your own way. But you can't help but show it when it's in response to something that's happening at work right then or whatever. And so I know at times that vulnerability maybe is the place I didn't wanna go in public or I don't wanna go on the outside. But then I never would come back home and sit with that vulnerability and say, okay, that was rough. Like, I'm exhausted. I was so high anxiety my whole shift just cuz I had badness after badness after badness. So that was the part that I never came full circle around. Like it was no problem to feel fear, anxiety, or dread. But it was just then later after I used that high energy to get through my shift. I never figured out, “okay, why was I so easily triggered? What was happening there?” And even just be vulnerable with myself. It’s an awareness.
Amanda: Yeah, and maybe they go back and revisit, you know, Caroline Leaf's stuff that sometimes you're having these emotions and if you can sit with it you realize, “oh my gosh, this is reminding me of that memory. And no wonder I'm feeling that:. Like, just being able to dissect it and having compassion and grace for yourself. A lot of times when people start in coaching, they're like, I can't believe I'm having this emotion. And like then piling shame on them, that is the opposite of what it is intended to do. It is just to raise awareness and have, “oh, that makes so much sense. No wonder”. I mean, we do it! I've done it to myself like, I can't believe I don't have a handle on this yet. Instead of like, “okay, let's calm down. Hello perfectionism”. Like let's join me and let's just examine this in a non-judgmental way.
Kendra: Did we get the coagulation cascade on the very first try when we became aware of it. So we had the awareness of the coagulation cascade. And we didn't get it the first time. We were made aware that it happened, and then we had to go and learn it and apply it and do all the things.
Laura: Why don't we allow it? And we still have to go look it up. Yeah. We still have to for sure. Like we still have to remind ourselves of this stuff. No matter what we learn. I think that's an important thing for everyone to know is that even the coaches. Oh gosh, like we're not, we're still dumpster fires, people, like we're still getting all this stuff figured out ourselves.
Kendra: Awesome. Well, this has been a fun conversation and it's always nice to talk about fear, anxiety, and dread. But hopefully we've put a little bit of a humorous spin on it and allowed you to not only become aware, but feel comfortable sitting with it, naming it, allowing it, and using it to work for you. We had such a fun time doing our webinar recently. “What's the ICD 10 Code for Injuries Sustained in a Dumpster Fire?” If you missed it, scroll down to the bottom of the show notes and click on the link to watch the replay and stay tuned because our next free class is coming up on May 10th at 12:00 PM central standard time on Time Management. Stay tuned for the details.
So until next time, you are whole. You are a gift to medicine and the work you do matters.
