Introduction

For most of us as continuing medical education/continuing professional development (CME/CPD) professionals, the demands of everyday life are fast, furious and full-on. In the year's wheel of perpetual activity, many of us are constantly on high alert and have forgotten how to relax. Presence is a distant horizon in the scurry to locate, purchase, giftwrap and distribute presents.

In short, most of us probably feel stressed.

Stress is the body’s reaction to any changes that require some type of adjustment from us and involves a physiological shift to prepare the body to respond to what is happening in front of us. While stress seems like an inevitable part of life, especially for those juggling multiple roles as workers, parents, caregivers and more, when we do not intentionally manage stress, we can remain in a heightened state of alert that can lead to a range of somatic issues. This article offers practical techniques to manage everyday stress and help us maintain presence as we sprint to the end of the year.

What Happens When We Are Under Pressure?

The brain is constantly scanning the horizon for stressors that pose potential threats to survival or physiological well-being. Most of us experience changes in routine, expectations or environment as positive (eustress) or negative (distress) stressors. However, stressors are different for everyone, and we all respond to stressors in different ways. Depending on the patterns and habits we acquire over time, our exposure to trauma or our experience of acute childhood events.

When we are faced with stressors, the sympathetic nervous system (SNS) activates a physiological response so that our bodies can quickly ramp up to respond to the stressful moment, experience or event. The stress showrunner, the amygdala, seizes control any time our brains perceive threat or danger and immediately tells us: “Don’t just sit there, do something!” This little almond-shaped cluster of nuclei in the brain releases stress hormones, like adrenaline, that trigger fight, flight or freeze — the stress response. Our bodies prepare to react to perceived threats by increasing heart rate, altering blood flow and slowing digestion. In these stressful moments, many of us feel those physiological reactions in the chest, gut or throat. You might also experience depleting emotions like frustration and overwhelm. 

Practice. Take a moment to recall the last time you felt stressed or overwhelmed. Can you pinpoint the exact place in your body where you felt that stress?

Effects of Stress on our Physical and Mental Health

We just experienced the end-of-year rush projects, tying up loose program threads and juggling the ever-expanding to-do list that comes with holiday gifting, family obligations and social activities. Many of us are likely stuck in this stress response. We are always revved up, always on. While short-term stress makes us get out of bed in the morning, can be motivating (deadlines!) and can even be performance-enhancing, the effects of sustained SNS engagement depletes our inner resilience and drains our energy. Staying stuck in a chronic stress response can show up through somatic issues like fatigue, headache, digestive issues, depression and emotional reactivity to events and people. The body is not designed to be stuck in fight, flight or freeze. It wants to be calm.[1]

Restoring Balance

The good news is that we can rebalance the physiological shift that occurs in response to stress by activating the parasympathetic nervous system (PNS). The PNS is the rest-and-digest and tend-and-befriend power pack that helps us hit the brakes on the amygdala and return us to feeling calm, engaged and alert. While mindfulness practices build awareness of and help us to appraise thoughts, feelings and perceived threats, “bottom up” and focused attention practices use breath, touch, movement and visualization to stimulate the vagus nerve. This long, wandering cranial nerve touches just about every bodily organ and sends information about organ function back to the brain, telling it that we are calm and capable of making deliberate choices. We can work with the vagus nerve to slow heart rate and signal relaxation to our brains.[2]

Here are a few of my favorite “bottom up” and focused attention practices to restore equanimity and support presence. They are simple yet effective. You can sprinkle them throughout the day and call on them in those moments when you feel the heat rising, your throat constricting and your gut churning. Follow the written instructions below or pop in your earbuds and listen to my voice as I guide you through each practice.

Even Breath

Even breath helps to slow your heart rate and signal relaxation to your brain. Think of it as a balancing or grounding breath to use in those moments when perhaps you just need to recalibrate or take a moment. Listen and practice here.

1. Set a timer for three minutes.
2. Make yourself comfortable in a seated or lying position.
3. Close your eyes if you like or keep them softly open.
4. Inhale through your nose, counting to 3, 4 or 5, then sigh your breath out through your mouth.
5. Now close your mouth.
6. Notice your breath as it moves in and out through your nose.
7. Count the length of each inhale and exhale. The number doesn't matter. Attention to the length of each breath is what matters.
8. Without forcing your breath, try to make each inhale and exhale the same length.
9. Keep this pattern going until your timer sounds.

Body Scan

If you practice yoga or some forms of meditation, you are probably familiar with body scans. This version of a body scan technique involves focused attention to mentally scan through your body and bring awareness to physical sensations. Listen and practice here.

Heart-Focused Breathing^TM

HeartMath uses breath awareness as a way to improve heart rate variability. Heart-Focused Breathing^TM is a simple to use, energy-saving, self-regulation technique that helps us reduce the intensity of a stress reaction and establish a calm, but alert, state. Heart-Focused Breathing^TM uses conscious breathing to help us take a “time out” where we can step back, neutralize depleting emotions, and shift into a more balanced state. Listen and practice here.

1. Set a timer for three minutes.
2. Sit or stand in a comfortable position.
3. Focus your attention on the area of the heart.
4. Imagine your breath is flowing in and out of your heart or chest area, breathing a little slower and deeper than usual.
5. Find an easy rhythm that is comfortable.
6. Keep this pattern going until your timer sounds.

Hands on Heart

This practice is adapted from Linda Graham’s book “Resilience.” I personally used this practice a lot in the first two years of the COVID-19 pandemic and shared it with participants in Breathing Space, a twice weekly breathing and meditation group I hosted from 2020 to 2023. It is a breath-based practice with the added benefit of touch, which releases oxytocin, the feel-good hormone. Listen and practice here.

Conclusion

As we enter winter in the northern hemisphere and welcome the lengthening of the days, take some time to stand still — like the sun at solstice — and embrace the time for rest, reflection and recalibration. As the holiday season fades away and a new year comes racing toward us, it is the perfect time to relish presence over presents.

References

1. Mednick SC. The Power of the Downstate. Recharge your life using your body’s own restorative systems. New York, NY: Hatchette Books. 2022.
2. Dana D. Anchored. How to befriend your body using polyvagal theory. Boulder, CO: Sounds True. 2021.

A former trauma operating room nurse and academic, Alexandra Howson Ph.D., CHCP, FACEHP, has contributed to CME/CPD as a writer, educator and qualitative researcher since 2010. A frequent presenter at the Alliance Annual Conference, Alex was Chair of the Alliance Research Committee 2018-2021 and served as faculty for the CHCP prep course in 2020. She teaches Fundamentals of Medical Writing Ethics on the Professional Medical Writing Certificate program at the University of Chicago and provides specialist CME/CPD training and professional development for medical writers. Alex is host of Write Medicine, a weekly podcast that explores best practices in creating education content for health professionals. She is also a yoga teacher.