In Tibet, Bhutan, Nepal for Three Weeks--Back on May 17

Research trip, vacation, pilgrimage--I can look at my trip in many different ways because it means all of the above to me.





Finally, today is the day! I am headed for Tibet.





The first leg of the trip is flying from Los Angeles to Kathmandu--about 20 hours travel time.





From there, there will be a three day drive to Lhasa over the passes (16,000 feet some of them) across the South-Western region of the Tibetan High Plateau--The Roof of The World.





I will visit Bhutan and Nepal as well in one big sweep of the region.





We have the Diamox ready, to prevent the altitude sickness, as well as sun glasses and sun screen because it seems that altitude and sun light are the two biggest hazards for tourists in that part of the world.





We will stay mostly at Tibetan equivalent of bed and breakfasts, own by Tibetans, to learn as much as we can about how is like to live there and about their culture and customs. We will visit many Hindu and Buddhist monasteries and meet with gurus and Buddhist Lamas and monks.



I don't know how well equipped the places I will stay at will be with Internet access. As often as I will get a chance, I will make sure I will "tweet." You can follow me on Tweeter and stay in touch.





I will resume my regular posts after I get back on May 17, so stay tuned.


So long for now.

STRESSED? WHAT TO DO ABOUT IT (PART 2: Access and Use Your Deeper Inner Resources

BETTER THAN CURED INTERVENTION, Applied to Stress Management--A 10 stage Healing Process (cont.)


STAGE 3:


SOUL SEARCHING:

Tap into your deeper inner resources!

Creativity
Compassion
Wisdom and Common Sense
Intuition
Emotional intelligence
The power to choose your path
Gut feeling
Sense of wonder
Sense of humor

And the list goes on. These are the skills we do not learn only through training. They are part of the very fabric of our souls. Someone may be very intuitive while another may have the gift of instinctively understanding his feelings or those of others--emotional intelligence--while yet another may have an unbeatable sense of humor that helps him through hard times. We all have a special gift. Many of us may have not discovered what it is. In stressful times, when we need to mobilize all the outer and inner resources--all we've got--to overcome an obstacle, we will find our own strength.

But it would be helpful to know ourselves better before a crisis strikes, so that we will be better prepared to cope with it.

Here are a few examples:








Cultivate your Emotional Intelligence (EI)!

High EQ (Emotional Quotient)=
low insecurity=more openness

More openness leads to more flexibility to explore new solutions to a problem and more ease in dealing with other's emotions, denials and fears.


The essential premise of EI: to be successful requires the effective awareness, control and management of one’s own emotions, and sensitivity towards those of other people.


Learning to work with our EI at different levels, managing our own emotions, knowing how to motivate ourselves, acknowledging other people’s emotions, can help us and our teams become more productive and less stressed out while keeping a sense of balance, continuity and harmony.



Discover and use your creativity!

Creativity does not apply only to artistic endeavors. Teachers use their creativity to teach students knowledge.
Doctors use their creativity to combine different intervention and treatment options in the best possible way for each patient. The CEO uses creativity to manage the difficult economic situations of his company.

"Thinking out of the box" is an overused expression but its value remains: allow yourself enough freedom to think! You then may come up with a beautiful and completely unexpected plan to get yourself out of trouble.








Maintain a Sense of Wonder and a Healthy Curiosity!


Healthy curiosity is the mental process that makes the world go around. It jolts us out of the boring routine and propels us into the unknown. What can we discover there? New avenues for the future.

Einstein, when asked what character trait most led him to his discoveries, said it was his creativity.

The first hominid who broke a round stone into sharp pieces and then used them as tools must have had the same trait.

Todd Kashdan, clinical psychologist, psychology professor at George Mason University and a strong advocate of Positive Psychology, has written a whole book in which he explains how staying curious about life can make us happier and less jaded. His book is called CURIOUS? Discover the Missing Ingredient to a Fulfilling Life and it is a very interesting read.

"The greatest advantage of curiosity," he writes, "is that by spending time and energy with the new, increased neurological connections are made possible. Facts and experiences are synthesized into a web, paving the way for greater intelligence and wisdom."



Enhance Your Compassion!

"Compassion is the ultimate and most meaningful embodiment of emotional maturity. It is through compassion that a person achieves the highest peak and deepest reach in his or her search for self-fulfillment." --Arthur Jersild.

Why do we need compassion to better manage stress?



Because through compassion we can relate to ourselves and others with more kindness; we can more easily see that we are all beings engaged in a common quest for happiness. No mater what happens and no matter where we go, we will be surrounded by other people who have this trait in common with us. Tapping into what we have in common with others, rather than what we have different, will help us understand deeply our connection with others and relate to anyone from a common place.






Find and Trust the Wisdom of Common Sense
in Everything You Do!


Who says that in the current society as it changes at a fastest pace in history, common sense lost its value? It has become even more important. Yes we have new ways of communicating. We have virtual neighborhoods and shoot "tweets" and instant messages all day.
But everything I've read about "on-line etiquette" is exactly the same way my grandmother used to lecture me years before all this technology was available: be polite, answer nicely, find good ways of saying "no" but don't hesitate to do it if you strongly feel the need to, and so on.

In every profession, if you don't obey the "common sense rule" you will be lost for sure.
Everyday in my medical practice I am faced with many different answers for the same problem. How can I choose? I always try to pick the answer that "makes more sense." For example, an anxious patient may tell me that he is trying to find a solution to feeling "like drowning" every time he takes a shower. In addition to exploring his hydrophobia, I also told him to turn his back toward the shower. That way the jet of water will no longer come directly at him, hitting him in the face and making him hold his breath. He would then be able to breathe freely and his association between water and inability to breathe will greatly diminish.



This was a common sense solution. Hearing it, my patient was not only able to easily embrace it, but he laughed aloud at "how silly of me not to think of doing this for all the long years I had this problem and was ashamed to even discuss it with anybody." For those of you who don't know yet, laughter in psychiatry is a very good thing. It means a healthy emotional defense mechanism. It indicates one's ability to "rise above" a problem to better control it.

Talking About Stuff Helps!

This is another example of a common sense solution for when we feel overwhelmed. It's not scientifically explained yet, but we all know that when we feel heavy, upset and stressed out, we feel a great deal of relief by sharing our feelings with someone we trust. It may have to do with establishing a comforting basic human connection or with finding compassion in someone else when we lost, for a moment, our ability to be compassionate with ourselves. Done right, it always works.

It is a good idea to build around you a social circle where you can find understanding, acceptance, love and warmth. Try it! It will be worth your effort. You can create a support group from people who work in the same profession or from people who are going through the same challenges you are. There will always be someone out there, in cyberspace if not in person, that has gone at some point in his life through something similar to what you are going through right now and is willing to listen and hear you out. Reach out and find that person!

IListen

Like IPhone or IGoogle, a device should be invented to make us better listeners. It could be called IListen and it could save us the pain of miscommunicating with others.

While being able to verbalize and share your problems with people who will understand you is a very helpful skill to manage stress, so is being a good listener. Knowing how to listen to the underlying message in what you hear, will give you a warning about what to expect from the person talking to you. Only if you really listen to someone will you be able to understand his intentions.

Listen not just to the words but also to the tone in the other's voice; register his gaze and his body language; take him/her into account completely not just superficially. Becoming a good listener takes mindfulness and practice. Try to listen and really pay attention to what your girlfriend or your boss or your secretary is saying to you in your next conversation.

People do not like to go around saying negative things or talking about themselves directly. They will say generic things but in many different ways, leaving it up to you to get the true meaning of what they actually meant to say. When your girlfriend, for example, invites you to choose a restaurant for dinner by saying "I am happy to go anywhere. Where would you like to go?" means that she wants you to be happy, not that she doesn't know where she would rather have dinner that night.

Are You a Good Listener?

Try this little questionnaire. Don't just automatically say "yes." You may be surprised by your own answers.

I don’t rush to judge before I hear what the other has to say.
I don’t “zone out” while the other is talking to me.
I understand the other’s point of view.
I don’t start formulating the answer before I understand what the other is saying.
I hear what the other meant to say.

If you didn't truthfully answer "yes" to all the above questions, don't panic. Just begin training yourself immediately to become better at really hearing people. It takes some practice but you will be greatly rewarded.

Try it tomorrow at work. At the end of the day, take a moment and see how it went--how did you feel through the day and how did others reacted to your change in attitude.



The journey continues in the next post. Stay tuned. I would love your comments on what you have read so far.

STRESSED? What To Do About It (Part 1: Awareness of Stress and Basic Self-Intervention)

These are excerpts from my recent workshop on stress management, which I presented to a group of 50-60 health care workers.

There are many ways to manage stress and stressful situations. Better Than Cured intervention suggests its own. It is structured in 10 stages, progressing in complexity from the awareness of stress and basic self-help measures, to more complex interventions: psychotherapy, medication, life coaching. Buddhist psychology is present in almost all stages because it deals with awareness, compassion, the quest for peace of mind and happiness--basic human needs. Buddhism deals with these issues from a pragmatic perspective. I have always found myself attracted to the Buddhist point of view in this regard. Buddhist principles make a lot of sense to me personally, but also to the hundreds of patients I have worked with and watched heal using these guiding ideas and principles.

Let's begin by understanding some basics about stress:

You may be surprised to realize that stress is not always bad.

Under a reasonable degree of stress, we may feel at first energized by it--stimulated and excited. It is a healthy reaction to a manageable, productive degree of stress. This type of stress is called Eustress. As soon as we learn how to manage it, we reach a comfort zone dealing with it.

But if the intensity of stress continues to rise, we reach a point where our coping mechanisms are exhausted. That point varies for different people, but everyone has a stress point at which his ability to cope is overwhelmed. Ideally, we do not push ourselves that far. But occasionally that happens. One of the first symptoms of stress becoming unmanageable is fatigue. Once we reach that point, we suddenly feel tired even doing our usual tasks. Taking a break and resting can reverse the toxic effect of stress at this point, and can help us regroup and return to our normal level of functioning.

But if we can't take a break from stress and the intensity keeps rising, we will soon reach the burnout stage. From there, if the process continues, we will become severely anxious, depressed and even suicidal, going into a crisis mode. At that point, something has to drastically change, however costly that may be, to recover our strength and return to our normal level of functioning.

Better Than Cured: 10 Stages To Stress Management:

Stage 1: The Awareness of Stress
(awakening to the problem at hand)

“Oh, my God! I have a stress problem!”

Stress awareness exercise:

"I know I am stressed out every time I…"

This was a phrase completion exercise I presented during the workshop. Feel free to do it too. It is useful to increase your awareness of how stress manifests in you. You yourself may be surprised with your answer. Some people say that they know when they are stressed out when their voice becomes high pitched, others when they feel tension in their neck and shoulders. Try to identify what your signal of being stressed out is. You probably have more than one such signal.

Another exercise:

Identify and balance the stress with the rewards for each difficult situation you find yourself in.

Thinking of the possible stressors and rewards you will likely encounter today, how does your balance look?
Thinking of long term stressors and rewards, is the balance between them steady? If not, can you add more to the rewards side or decrease the stress? Would that create an acceptable situation for you?

Feel free to try it!

STAGE 2: BASIC SELF-HELP:
Examples of immediate actions to ease stress.

SLOW DOWN THE BUSYNESS

TURN OFF THE NOISE!


We all do innumerable things that add to the constant “chatter" in our heads or in our lives. Turning the volume down by eliminating some of the redundant or obsessive dialogues we carry on with ourselves will have a relaxing effect. Try it!


DETACH AND OBSERVE
(gain a bird’s eye view)


















Rise above a stressful situation. Imagine you are above it looking down. What do you see? Do you see different patterns of interaction between participants? Can you distinguish details that escaped your attention when you were deeply entrenched in it?



CREATE A SPECIAL,
PEACEFUL PLACE
OF REFUGE
IN YOUR MIND
















You can create in your mind a peaceful, private space where you can relax. It may be a real place or an imaginary one. Whenever you are tired, frustrated or overwhelmed by the realities around you, you can find refuge, even if it is only for a few minutes, in this virtual quiet, peaceful place. When you return to face the same realities, you will feel much more rested and refreshed and better able to deal with the situation.


One of my coaching clients pictured a Japanese tea house because he was in love with Japanese art and culture. Another imagined a meadow she stumbled upon while walking with her mother in the woods as a child. The choices are virtually limitless.


Go ahead and try to create your own place of mental refuge. What does it look like?




SHAKE OFF HELPLESSNESS!

TAKE ACTION AND A LEAP OF FAITH!











Sometimes the only acceptable way to manage a stressful situation is to have the courage to escape it. Often when under intense stress, it is easy to believe that we will never be able to escape it. Feeling hopelessness is a common problem when overwhelmed by stress. But it is a death sentence to allow yourself to listen to that urge. Make a leap of faith and take action!



Like Ulysses who, had he succumbed to the song of the sirens, would have never found the strength to find his way home, so you may get lost in being sad and sorry for yourself and forget to fight your way out of a bad situation. Taking action will save you. Sometimes you need to be brave and take a real leap of faith. It can be scary and risky. But it will jolt you out of the inertia, you will set in motion different factors, and with a little bit of luck you will overcome the stressful situation that seemed, at first, so unmanageable.

I would love to have your feed-back. The journey continues in the next post.

My Newest Ezine Article: Qitting A Bad Job Doesn't Make You A Quitter

While I am preparing for my lecture to health care staff on managing stress, I haven't had much time to keep up with my blog posts. But I have written this article for Ezine that I hope you will find interesting. It was inspired by a very dear patient of mine who, deeply committed to her job, did not register how her desire to make her job worthy of her efforts was blinding her to how the job was changing: her boss had no interest in listening to her suggestions or appreciating her work. Instead of pulling out, she was being even more dedicated, investing even more time in it in the hope that, finally, her work would be acknowledged. It never happened. You can read in the article how she, and thousands of others, could have avoided this ordeal.

Meanwhile, I am preparing for my lecture. It will be held at Nile Hall in Preservation Park, Oakland, and it is organized by Service Employees International Union - United Healthcare Workers West (SEIU-UHW) and the Joint Employer Education Fund. SEIU-UHW in association with Joint Employer Education Fund are committed to increase medical staff's awareness and education about important professional issues like managing stress on the job.

Although it doesn't make newspaper head lines, the type of stress specific to health care-- secondary stress--adds to the usual life stress and creates a faster burnout rates that can lead to depression and even suicide.

Secondary stress is defined as "the pressure that results from reaching out to others in need," according to Robert J. Wicks, the author of Overcoming Secondary Stress in Medical and Nursing Practice: A Guide to Professional and Personal Well-Being. You may not be a professional health care person, but you likely have experienced secondary stress in various manifestations at various times.

There are about 400 physicians who commit suicide every year, an average of one a day. This is a very serious problem that confronts the health care community.

There are many obvious explanations and many hidden, less obvious causes for this. Some obvious causes: pressure to perform; being overwhelmed by the pace and the volume of work; stigma about asking for help from a colleague who is a mental health care provider; the feeling that doctors always have to be in control and admitting a mental illness may ruin his/her credibility and authority in their own eyes and in the eyes of their colleagues; restrictions in getting or renewing medical licenses if there is a history of mental illness. And these are only a few of the causes.

One of the possible solutions is to help the medical staff learn how better to take care of their own needs in order to be able to adequately take care of the needs of their patients. With this idea in mind, I have designed an intervention based on the principles of Better Than Cured, that I hope the audience will find helpful in reducing their stress level and managing the demands in their personal and professional lives.

Are you familiar with secondary stress? How have you managed it? Or, if you haven't, what do you think would be helpful in learning how to manage stress in general and secondary stress in particular?