Surfing stress: A practical and paradigm changing approach to improving personal resilience

Introduction

Each of us is unique with unique life situations, perspectives and stressors. Common stressors include money, sleep, health, family, work, and society.¹ Much like surfers floating on the ups and downs of an ever changing ocean, we need skills to be able to read and respond well to the waves of stress.²

Working in healthcare has inherently unpredictable events, analogous to rapidly changing weather. So in a single day life can feel calm one moment, then intense or even overwhelming in the next. Modernity also presents some challenges, such as globalisation, social evolution, technological transformations, economic, ecological and existential uncertainties, which like tides subtly shift our personal and professional lives.

‘Dad what are you doing today’ - 4 year old son.

‘I'm hoping to help people… through a computer screen!’ - Surprised GP.

Combined these factors can have significant implications for our health, performance and ability to care. For example the British Medical Association reported that 41% of doctors who responded to their COVID tracker survey in February 2021 said they were suffering from depression, anxiety or another mental health condition. The June 2021 report from the House of Commons Health and Social Care Committee concluded that burnout is a widespread reality in today's NHS.^3,4

The importance of identifying challenges, adapting to uncertainty and working with stress has long been recognised.⁵ There have been many admirable attempts to optimise our response to stress and nurture our wellbeing.^4,6 Despite this there remains a `pervasive sense of stress' amongst healthcare workers. So unfortunately our wellbeing endeavours may seem at best ineffective and at worst imposed and disingenuous.<sup>7</sup> These undercurrents of impotence then become an additional challenge. So much so that sadly `wellbeing' may have become a tarnished term. Understandably trainees and seasoned practitioners may look into the future, anticipating rough seas ahead; feeling fearful, underprepared, reticent and perhaps even resentful. According to a BMA survey four in 10 junior doctors are actively planning to leave the NHS as soon as they can find another job.⁸

Perhaps I can help?

I endeavour to help bring out our best, working as a GP (which means ‘Gentle Presence’ to me), medical educator and founder of an organisation called Humble. Combining humility and science, (which I define as the art of making better mistakes), I tentatively share hope because I have seen that profound change is possible.⁹ I have witnessed that once stressful challenges can transform into opportunities for flourishing and that even small personal shifts can ripple out systemically, to nurture ‘Healthy Care’ (healthy for people, practitioners, practice and planet).

Would you like to learn how to surf stress?

The aim of this article is to empower you with practical skills to surf stress. Whilst learning, we may fall off and need rest, but with help get back on and enjoy the ride.

We shall begin by redefining stress. Then undertake six surfing lessons (Fig. 1): Balancing your 1. Breath (basics), 2. Bodies (physical factors), 3. Brains (emotional-mindset factors), 4. Boards/boundaries (situational factors), 5. Buddies (relational factors) and 6. Beyond (spiritual factors). Finally I will offer ways of tracking and improving your own surfing skills.

Fig. 1.

Surfing the ups and downs of life.

The science is complex, nuanced and evolving, however my expertise is limited. So this presentation of the principles will be simple, practical, personal and include quite a few acronyms, which you are welcome to ignore or try with a spirit of curiosity.

The skills progress in sequence, however because they are interconnected it's fine to adapt them to suit you and do what's EASY (Easy, Appealing, Supported and authentically Yours). Also before learning to surf it's important to recognise that it can get rough out there, so I suggest starting with small waves first and if in doubt talk with your GP before trying these skills.

Redefining stress and rest

What does stress mean to you? Culturally it has had many negative connotations for example, `I'm stressed out!'. So psychologically is can be defined 'a state of worry or mental tension caused by a difficult situation'¹⁰

Mechanical stress can be felt as a force experienced by an object and strain is the degree of deformity before the material resiliently recovers integrity when rested (the stress is removed). Many systems are able to adapt to stress however at extremes of intensity and duration of stress the object may functionally fail. Failure could be defined when strain damages the object or the system such that effective recovery or adaptation is not possible.

Biological stress could be considered as the body's response to prepare for action, in processes that are mostly unconscious and modulated through multiple physiological systems.^11,12 For example the Hypothalamic-pituitary-axis modulates stress with adrenaline and noradrenaline generating alertness and agitation, alongside cortisol mobilising energy and redirecting resources. This stress drive is much like a surfer leaning forwards to keep up with a breaking wave. Balance is required because too much or prolonged stress can be unpleasant, unhelpful and generate disease.^4,6,7,10 Fortunately combinations of neuromodulators harmonise to create different effects, for example adding acetylcholine (meaning and perseverance), and dopamine (drive and development).^11,12 Thus stress evolved to be adaptive and be counterbalanced by factors that enable states of rest (Fig. 2).

Fig. 2.

Balancing rest and stress. Examples of endogenous and exogenous stimulants and sedatives.

Often overlooked are neuromodulators such as GABA (gamma-aminobutyric acid), which enable the balance to shift between states of stress and rest by creating pauses in the release of neuromodulators. This capacity to pause is essential in adapting our stress response to external circumstances and also for making time for transitions in internal biological rhythms such as the 90 min ultradian cycles of sleep. Indeed ‘pausing and breathing’ (described later) is a technique that I teach in sleep support groups because of its GABAnergic calming effects, and enhancement of the ‘wake-sleep switch’, which helps improve their insomnia.^13,14

Recovering integrity from the extremes of stress (distress) and rest (disrest) can be challenging, feel overwhelming or sluggish (Fig. 3). However the judicious practice of deliberate distress (eg 30 s of cold showering) and deep rest (eg 10 min non sleep deep rest) have been shown to widen the range of the wave we can comfortably ride, thus making us more resilient.¹²

Fig. 3.

Balancing stress and performance.

In summary we float in a sea of experiences and emotions that are mostly unconscious (below the surface). Stress is like a wave of energy getting us somewhere (toward a desire, away from undesired states) and rest is the absence of stress. We need all in balance, including extremes of deep rest and distress and time for transitions, therefore it helps to be able to feel the wave and have the skills to move across it. So stress is great when you can surf it.

Six lessons in surfing stress

• 1.Pause and breathe

If there was just one technique to take home it would be how to pause and breathe. Also known as a Physiological sigh15, 16 it is an evidence based breath practice that can help you feel calm and centred in as little as 30 s. Taking three calm breaths helps you rebalance your brain and body because it enhances the release of brain chemicals (Nitric oxide and GABA) which act like a pause button for your mind. By breathing deeper we get more alert, and by breathing more slowly through our nose we calm. Combining the two can help us feel relaxed and ready. If you would like, you can try it.

First focus on your breathing through your nose.

Then Breathe deep In-2-3, Pause, then out slowly and pause.

Repeat this cycle two more times and then relax with a gentle shake.

Well done! Click here for a guided animation.

How was that for you? With practice you can pause & breathe to feel calm and flow with emotions. I suggest practising this at the same time twice a day (eg after you brush your teeth) for 1 week, because habits are easier to sustain when small and prompted.^16, Also as simple as it sounds, the effects of practising at these prime times is profound for surfing stress because it helps you, set up your day and reinforce your ability to induce neuroplastic states and rewire your own mind overnight.¹² Then once skilled you can apply the technique to recover balance in bigger stress waves.

• 2.Bolster your body

A bit like preparing before getting in the ocean, everybody needs to sleep, nourish, move and soothe well to function.¹⁷ These lifestyle factors are well recognised but what is often overlooked is the importance of context, priming and timing because our chronobiology (body clocks), life situations and mindset matters too. Working in a way that harmonises with these is essential, so our wellbeing doesn't become a stress generating chore. Mastering these essential living skills can be correlated to six physiological factors that easily fit into a day. I call these getting our LEFTSS right, (Light, Exercise, Food (and fluids), Temperature, Soothing and Sleep spaces).

Fig. 4 below suggests a sequence for the LEFTSS that can be collected a bit like a treasure hunt. If you would like to try this using a fun way to design your day that I teach in schools here is video link.

• 3.Boost your brains

Fig. 4.

Physiological factors.

Our experiences emerge through the interactions of our many brains, including overlapping connectomes in our nervous systems, as well as immuno-humoral, guts, microbial, technological, epi/genetic, ecological, quantum biological and social systems.¹⁹ Although mostly unconscious, we can influence these interactions through cognitive, behavioural and environmental processes. Methods such as meditation, mindset, gratitude journaling and mindfulness are not new, but have found favour with mounting research refining and supporting their practice.^13,17, 18, 19 So even a few minutes of meditation practice a day can create the capacity to invite deep states of peace and physiological restoration amidst challenges. Feeling curious? perhaps try pausing and breathing (Fig. 5) as described above when you next see the circle of doom on your computer screen.

Fig. 5.

The power of pausing and breathing.

For more courageous surfers I have developed a CALM process. CALM stands for four skills: Connect, Allow, Learn and Move on which help surfers ride with transitioning neuromodulators occurring in four stages of an emotional wave (see below).

It sounds a bit geeky but this process is so easy that primary school children and busy doctors can learn how to do it in four breaths. I frequently hear from practitioners that ‘this is life changing’ in helping them honour emotions, integrate memories, translate feelings and transform traumas into empowering experiences. Eg from fear to care, frustration to passion, floundering to endeavouring, sadness to appreciation, resentment to acknowledgement and fatigue to rest.⁹ These skills are best practised with an experienced guide. To find out more visit www.humble.info

• 4.Balance your boundaries

Boundaries can be defined as the limits of an area like the board upon which a surfer balances. These boundaries (actual and perceived) are important as our environments hold our health and wellbeing. For example we can be relatively protected from burn out (chronic workplace stress) if our home or play spaces are preserved.^6,12 This is not a substitute for addressing those challenging situations (eg working conditions) but can give us the space to reflect upon and the resilience to make those changes. The first stage for many is designing a day with clear boundaries and buffer times to transition. This is especially important if you are working from home or with screens as tech use has especially blurred our physiological and psychological boundaries, and contributed to the sense that we are always on call, (Fig. 6).

Fig. 6.

The CALM process.

Interested? Take a moment to clarify the times of your boundaries between work, play, home and away using the definitions in Fig. 7? Could you also decide your healthy times to work with screens and when is a good time to have a digital sunset?

• 5.
  Buddies

  ‘Show me your friends and I'll show you your future’ Jim Rohn

Fig. 7.

Boundaries between work, play, home and away.

Our relationships not only have a huge impact on our lives but it could be argued that they are why we are here?

Like surfers sharing a wave, we may encounter others in states of consideraton, collaboration, competition and combat. As such we need to be adaptive in our approaches to relationships so we can coexist, celebrate each other and also channel conflict when it occurs.

This requires skills in self- and social awareness, regulation, respect and responsiveness. It is worth recognising that quality, quantity, timing and perception are important too. So ‘likes’ from 100 digital friends is no substitute for the connections created by tender touch or caring conversations.^9,17

Please consider how you plan to nurture positive relationships and cultivate a sense of belonging this week ?

‘True belonging doesn't require us to change who we are, it requires us to be who we are ’ Brene Brown

If you would like some support you are welcome to try humble gatherings. These are friendly free online meetings from 1 to 1.30pm on Fridays. To find out more click this link.

• 6.
  Beyond

  ‘Awe is the quiet recognition of the extraordinary woven into the fabric of the ordinary, revealing the profound beauty that often hides in plain sight.’ Unknown

This final factor is perhaps the hardest to write about because it is precisely that which is beyond definition. And yet research into awe (and what else) has shown its remarkable impacts in our lives, (improving our sense of emotional well being, stress response, autonomic regulation, physical resilience to disease, cognitive functioning, sense meaning, and social integration).¹⁹ States of awe can be invited through many portals such as an appreciation of art, beauty, spiritual practices and nature. What is your favourite way ? Could you book an appointment with awe today?

Sometimes trying harder to experience awe may paradoxically push it further away. Having practiced meditation for a year on a mountain (without psychedelics!) and also trying to fit it into a busy GP day, I've discovered this practice consistently works for me. I simply pause and breathe, in the present moment, feeling sensations and FLOAT for 5 min a day, (with Focused Attention, Loving intention and Open Awareness for a defined Time).

It often feels a bit like I'm diving into the sea and surrendering to the water before rising to the surface refreshed and ready. If it feels unpleasant that's fine because I'm simply showing up, and if I forget that’s fine too, because every time I realise that I’ve been lost in thoughts, I'm half way home having leaned my way even better.

Back to shore

As the sun sets on our surfing lesson let's take a moment to reflect. I wonder, what stood out to you?

We learned that stress can be redefined as helpful when you can surf it. We also practised ways to balance your breath, body, brain, boundaries, buddies and beyond. We recognised that humility helps, so something as simple as pausing a breathing when you brush your teeth may be profound in helping you nurture resilience, support recovery and radiate positively to those around you.¹⁶ If you would like to learn to continue to improve your surfing skills, you can track your good stress score using a weekly questionnaire in Fig. 8. You are also welcome to get in touch with us as at www.Humble.info as we’d love to hear from you.

Fig. 8.

How to track your good stress score.

Declaration of competing interest

Ashish Bhatia is the founder and owner of Humble, an organisation that offers resources and services which are both free of charge and paid for.