seX & whY Episode 5 Part 3: Stress Response

Jeannette WolfePodcast Episodes

Show Notes for Podcast Five of Sex & Why

Host: Jeannette Wolfe
Guest Host: Justin Morgenstern

Topic: Stress Response – Part 3

Tricks for optimizing performance under stress


  • Over train and begin to focus on how to recover from mistakes
  • Invest in mindfulness
    • Meditate
      • Increases your awareness of your own physiological stress response
      • Can help you train to go back and forth from narrow to broad focus
    • Be Awed
      • Have gratitude for what is going right
    • Use a transition mantra as you walk into work and move from your personal to your professional life
    • Appreciate the power of emotional contagion
      • Your mood influences your team’s performance
      • Acknowledge and celebrate team’s saves and successes
    • Create safe communities in which you can talk and walk through difficult cases without shame or judgement
  • Maximize environmental advantages
    • Have the right equipment and know where it is

In the moment

  • When you are becoming aware of stress- acknowledge its presence and recognize that you can face it as a threat or a challenge and then deliberately and emphatically choose challenge
  • Chunk down overwhelming situations into immediate next actions, when in doubt go to the head of the bed and check oxygen connections and monitor leads
  • Access mental crutches- simple pneumonics, resource cards, or a favorite app to jumpstart your thinking until your frontal lobe comes back on line
  • Consider cognitive reframing and brief emotional detachment
  • Keep a talisman in your pocket- use for either spiritual strength or physical distraction
  • Use Mike Lauria’s pneumonic BTSF (Beat The Stress Fool)
    • Breath
      • Tactical breathing and controlling the breath
    • Talk
      • Positive self-talk
    • See
      • Visualize successful completion of the task
    • Focus
      • Use a trigger word
    • Tips for breathing
      • Consciously slow your exhalation
      • Belly breath in which your abdomen expands with inhalation
    • Armor for negative thoughts
      • Thank your brain for trying to keep you safe
        • “Thank you brain for trying to watch my back, but I’ve got this”
      • Recognize your thoughts as being “just thoughts”
        • Change “I can’t do this” to “I’m having a thought that I can’t do this and fortunately most of my thoughts don’t equate actual reality”
      • Identify and label your patterns
        • “oh yay, I do this sometimes when I get stuck, but I can choose to do X, Y or Z instead” (repeating if needed.)
      • Internally shout at yourself (to snap out of an internal loop) and then remind yourself that you are trained and capable
      • Repeat a repetitive negative thought in a strange accent
      • Sing a repetitive negative thought
      • Refer to yourself as a third person
      • Touch something in front of you and describe its shape/temperature and texture
      • Acknowledge that you are stressed but decide to just do it anyways
    • Tricks for focus words
      • Consider single word describing next critical action (“drape”, “needle”)
    • After the stressful event
      • Anticipate parasympathetic backlash
      • Consider cognitive offloading
        • Have a check list
        • Use time outs
          • Creates a shared mental model of critical actions
          • Allows for information exchange
          • Reinforces value of team
        • Appreciate that cortisol spiking may subtly shift your tolerance for risk and could potentially impact clinical decision making
        • Take a break
          • Eat and drink something (preferably without caffeine)
          • Emotionally recharge
        • After the shift
          • Work Out
          • Play Tetras- (this was a new one for me and I’ve attached a reference below)

Selected Resources

Meditation App- Insight Timer

Justin Morgenstern’s Performance Under Pressure blog:

Adrian Plunkett’s SMACC talk

Recent Tetra study: Horsch A, et al: Reducing intrusive traumatic memories after emergency caesarean section: A proof-of-principle randomized controlled study. Behaviour Research and Therapy, 2017

Lauria, M. J., Gallo, I. A., Rush, S., Brooks, J., Spiegel, R., & Weingart, S. D. (2017). Psychological Skills to Improve Emergency Care Providers’ Performance Under Stress. Annals of Emergency Medicine.

Parkin, B. L., Warriner, K., & Walsh, V. (2017). Gunslingers, poker players, and chickens1 :Decision making under physical performance pressure in elite athletes. Progress in Brain Research (1st ed., Vol. 234). Elsevier B.V.

Markway B, Stop Fighting your Negative Thoughts, Psychology Today May 7 2013