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Living and Leading with Resilience, by Adam Perlman, MD

Duke Integrative, Todays Practitioner, Adam Perlman

By Adam Perlman, MD, MPH / Leaders in healthcare, as in all industries, have the responsibility to support Duke Integrative, Todays Practitioner, Adam Perlmanemployees’ physical, mental, and emotional well-being. This support can take many forms, but there is one challenge in particular that affects every corner of the workforce: stress. The Centers for Disease Control and Prevention defines workplace stress as “the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the workers.” [1]

It is now well established that stress has reached epidemic status in the United States and across the world—and the workforce is feeling its impact. When we empower our employees, teams, managers, and co-workers  to better deal with the stressors of their work environment, responsibilities at home, and other corners of their lives, they are happier, healthier, and more engaged—in other words, they are better able to thrive. [2]

The concept of dealing with stress more effectively is one that opens opportunities for Integrative Health leaders with expertise in concepts such as mindfulness, meditation, and progressive relaxation, to name a few. Demonstrating effective stress management is crucial for anyone interested in shifting their team, department, or organization towards a culture of optimized well-being and productivity.

The answer is not to eliminate stress. Even if we could, we wouldn’t want to: stress, in and of itself, is not inherently bad. Some chronic stressors—such as unrealistic expectations, habitual miscommunication, or schedule chaos—create an unnecessary burden that can and should be removed from our personal lives and work environment. However, others serve us well, such as getting us out of the bed in the morning and driving us to succeed. [3] The answer lies in changing the way we respond to, and therefore experience, stressful events. Key to this shift is the concept of resilience.

Resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress­—such as family and relationship problems, serious health problems, or workplace and financial stressors. It means ‘bouncing back’ from difficult experiences.” [4] Having resilience is the difference between coping and thriving; the difference between enduring a setback and growing from it. Perhaps most importantly, resilience is not an intrinsic trait that one either has or does not have—it is a set of competencies that can be learned and strengthened.  The concept of resilience is an integrative, whole-person and preventative approach to stress management and human performance.

Just as stress affects all areas of our lives, so does resilience. This transcends the work environment, because we, and our teams, bring our whole selves to work. Imagine that you have been up all night, dealing with a sick child or worrying about your mortgage. Chances are that you will not be at your best at work the next day. Likewise, if you had a particularly difficult conversation with your team, it is more than likely that you bring that stress home with you. [2] The more resilient you are, the better your performance and higher your satisfaction at home, at work, and with everything in between. Published with permission from meQuilibrium.  © New Life Solution, Inc. 2017

These benefits are not limited to the individual. At the core of resilience is the ability to be agile and adaptable, traits that can be cultivated in an individual, fostered in a team, and woven into the fabric of an organization. With 40 percent of workers reporting their jobs to be very or extremely stressful, resilience on an organizational level is not just a nice to have, it is a need to have. Workplace stress does not just affect job performance (over half of workers admit to calling in sick because of stress), but mental and physical health as well, with 73 percent of workers regularly experiencing psychological symptoms and 77 percent regularly encountering physical symptoms. The result is an estimated $300 billion spent on workplace stress each year. [2]

A study of workplace stress noted that the companies who had policies that specifically set out to lower their employees’ stress levels experience a range of benefits. They had a remarkably low turnover rate of 6 percent compared to the national average of 38 percent. The number of their employees reporting chronic work stress was 19 percent, nearly half of the national average of 35 percent. Their employees were also less likely to want to find a new job and had much higher employee satisfaction than their less-resilient counterparts. [2] Few industries nowadays are more “stressed out” than healthcare—and as leaders, we can and should take action.

Whether you are starting a program from the ground up or trying to transform an existing initiative, the way to begin cultivating resilience is to first focus on one’s own resilience. Resilient individuals, especially leaders, are the foundation of resilient organizations. It is a win/win: by cultivating resilience, we are stronger at work and happier at home, while also contributing to a resilient work culture that leads to positive business outcomes. So how does one build resilience? There are a few simple steps that leaders can take:

  • Examine our thoughts and thinking styles
  • Practice informed mindfulness
  • Seek out gratitude

Examine Thoughts and Thinking Styles

A basic tenet of cognitive behavioral psychology (CBT) is that our thoughts drive our emotions, which then drive our behavior. To change our behavior and better handle stress, we should start at the source: our thoughts. Just as we develop habits in our outer lives, we develop habits in the way we think. Our minds take mental shortcuts to save time and energy, and while there is nothing inherently “wrong” with that, the issue is that these shortcuts often lead us to draw inaccurate conclusions.

For example, we may have a tendency to constantly scan the world for imminent threats. This scanning creates anxiety, and this anxiety can lead us to jump to the worst-case scenario when something relatively minor goes wrong.  For example, it could manifest as difficulty sleeping, worrying about our job when the boss calls for an impromptu meeting the next day, only to find out that he was excited about your latest proposal and wants your team to make it a priority.

Though protective in nature, these ruminations do not serve us well; instead, these disproportionate responses sap our resilience, create unnecessary stress, and get in the way of problem solving. [5]

We balance out these problematic shortcuts by practicing mindfulness, which increases our ability to experience and respond to the spectrum of human emotion in a way that is proportionate to the trigger. With mindfulness, we are able to make clear-headed decisions, become more efficient problem solvers, and better manage our stress. They key is to catch yourself “in” the emotion before it gets the best of you by recognizing the thoughts and physical sensations that accompany it.

Practice Informed Mindfulness

As we have written about previously, true mindfulness is much more complex than simple self-awareness. Informed mindfulness connects mindful self-awareness with self-regulation and educated decision-making. A mindful person is tuned in to the current moment without judgment and can see that how they respond is up to them. A person practicing informed mindfulness will see each situation in its larger context and make an informed choice based on a clear set of values and adequate information. Informed mindfulness, in a way, is knowledge in action. [6]

Informed mindfulness protects us from mental fatigue and empowers us to become more resilient individuals and leaders. Each day is a series of choices, and each choice we make informs the next one. It is helpful to know, for example, when you are angry and when that anger is not warranted. But if you do not know how to properly manage that anger, the awareness is not sufficient enough to bring about change. With informed mindfulness, you can sense that anger and then use your values and knowledge to diffuse it before it derails your day. Perhaps for you that means doing a deep breathing technique, stepping outside for a walk, or repeating a soothing self-affirmation. Whatever your solution is, informed mindfulness can help support your journey to resilience.

Seek Out Gratitude

Resilience, like integrative healthcare, is about more than getting to a neutral state—it is about thriving. While informed mindfulness is crucial for stress management, to truly optimize our mental and emotional wellbeing, we must seek out gratitude and make positivity a habit.

Focusing on the negative is an evolutionary impulse—but in today’s world, we do not need to be constantly stuck in survival mode. By actively seeking out moments of gratitude, we can train the neurotransmitters in our brain to more easily find and hold onto these moments of joy. Make it a habit to think of (and write down) at least three things you are grateful for each day. Nothing is too small to qualify.

This simple task can literally transform your life—and your brain. [7] In Integrative Healthcare, we know this, but do we do it?  As we seek moments of gratitude, we can not only strengthen our own sense of well-being and resilience, but impact the individuals and by extension the organizations of which we are a part.  That is true leadership.

[1] “STRESS…At Work.” Centers for Disease Control and Prevention. The National Institute for Occupational Safety and Health. Web. Accessed 9 June 2017.
[2] “Work Related Stress on Employees Health.” Eastern Kentucky University. Web. Accessed 9 June 2017.
[3] “Eustress vs. Distress.” Brock University. Web. Accessed 10 June 2017.
[4] “The Road to Resilience.” American Psychological Association. Web. Accessed 13 June 2017.
[5]  Accessed 20 June 2017.
[6] The Pebble in the Pond.  The Leadership Program in Integrative Medicine at Duke University.
[7] Kini, P., J. Wong, S. McInnis, N. Gabana, and J. W. Brown. “The Effects of Gratitude Expression on Neural Activity.” Neuroimage (2016) U.S. National Library of Medicine. Web. Accessed 13 June 2017.
Adam Perlman, MD, MPH, FACP, is CEO for Synchronicity and Program Director for the Leadership Program in Integrative Healthcare at Duke University


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