Phoebe Sneddon, Sarah Broadhead
What I’ve learned from racing bikes and performing under pressure at work
I have raced bikes for a number of years. I have spent my time, when not at work, sweating away training and practising all different aspects of cycling. I worked hard on my physical strength and fitness. But that wasn’t all that I needed to be a successful racer – your mental strength is as important. Most of us ignore that aspect but in recent years more emphasis has been placed on training our minds to help us perform at our best in sport. To handle the gut wrenching nerves, to think fast under pressure with adrenaline levels sky high and my heart beat pumping in my ears needs mental strength. I explored my fears, I repeated the mantras required to give me confidence and I improved. I started to wonder; could I apply these techniques to other aspects of my life?
Training the mind
Why on earth when I turn up to work – and perform under far greater pressure – do I not train and prepare my mind? When my palms are sweaty and my own heart beat is ringing in my ears as I stand at the end of the bed leading the cardiac arrest, why do I not prepare my mind to work with me? I learn the medical knowledge, I practise the clinic skills – but do any of us spend time training our minds to support us rather than work against us in those high pressure moments?
I looked into this further and tasked a friend of mind Sarah Broadhead (of Broadhead Performance) to explain what I would need to do. Sarah is a performance psychologist working with Olympic athletes, supporting them and teaching them to ensure their mind allows them to perform at the highest level.
We used a psychological framework to breakdown the different areas of the mind that affect our work and our relationships. Understanding these areas allows us to refine them, making our minds more efficient, meaning that we in turn are less likely to suffer from the dreaded burn out.
This is the area of the mind responsible for fight, flight or freeze. It is that sinking feeling in the bottom of your stomach or the cold sweat dripping down your neck. In medicine this area can have many triggers, from the most obvious; fear of getting it wrong, fear of the patient dying to the more mundane; presenting on ward round. If you think about your day at work there will be multiple micro moments where you sense the threat, from difficult consultations to tricky referrals to doubts about your ability . These can build up over time. We as humans have the ability to ruminate and often each of these threats can play on our mind, even once we are removed from that particular situation. This can leave you in a permanent state of threat. With stress hormones running high and the body constantly on high alert. This is what leaves us more exhausted, more emotional and more miserable than we ever imagined we could feel. Obviously some threat is good, it’s what keeps us safe at a basic human level, it gives us adrenaline to help us perform at our best. But where we once came across a single threat in a day, we are now being bombarded with constant threats in a never ending torrent of stress.
Drive is what makes us doctors. None of us would have achieved what we have achieved without it. Drive gives us motivation. Drive is a fine balance. We need it to get where we want. Too much Drive can be all consuming and some use this as a way of ignoring the overwhelming threat state. Too little drive leaves us feeling lethargic and lacking in empathy. Once the threat state has overwhelmed you, drive is often one of the first things to be affected leaving you deplete in enthusiasm for the job and fantasising about a little broken leg or some other fairly mild but incapacitating ailment that would leave you able to lie in bed, watch Netflix and avoid the outside world.
This is the wonderful part of our minds that is so good at giving out advice or working out medical problems. This is the part of our minds that when your friend comes to you in a tricky situation you can give them clear calm sensible advice. However, our wonderful logical minds tend not to give ourselves good advice. They are taken over by the threat and the catastrophic thinking that often ensues. In order to get your logical mind to work for you, you need to sit down and vocalise your concerns, your worries, the thoughts keeping you awake at 4am. You need a sensible and trusted soundboard to bounce those ideas off. Then you can use your calm and logical mind to problem solve. This takes practise and this takes concentration. This cannot be done when under stress, or when tired and hungry. This part of our mind needs optimal conditions to perform.
This is the key player in helping us perform in those tasks at work we find more difficult. The various aspects of the job that each of us find tricky is entirely individual and a great deal of that is based on our experiences. Experiences and training make up the vast bulk of our reference system. Good and bad experiences get logged in the system and subconsciously affect our judgement, mood and feelings. References work in medicine clinically and a good example of this is the A to E assessment of the sick patient. Most of us have done this so many times it is subconscious, a reflex action, “Airway, are they maintaining their own airway?” we do it without thought. This in itself helps reduce the threat state initiated by our immediate response to a sick patient. We can work on and improve our referencing system with simulation and rehearsal for the acute situations. We can improve our reference system by reflection and debrief, focusing on the things that we did well, that we were pleased with. Giving ourselves the positive affirmation to create and cement positive references in our minds. We as medics are so good at critique, so good at seeing the negative. If all our references are negative that will drive the threat state and increase the stress levels. Now is the chance to acknowledge that inner monologue, and challenge what it is saying. Are your thoughts predominantly negative? How can you change them so that your subconscious is giving you positive references regarding your job, your working relationships, your ability as a doctor. Taking the time to invest in your reference system will allow you to reduce the threat state and cope with the demands of the job.
This is the fun bit. This is the part of your mind that pushes you to do all the things you enjoy. This bit diminishes as the threat and drive grow. This takes a conscious effort to embrace. Many of us feel too tired, too short on time, too guilty to spend time on ourselves. This does not make us good doctors. You cannot pour from an empty cup. Renewal counteracts the stress we feel. Look at your life, your work life balance, ask yourself what am I doing for fun? For relaxation? When have I given myself time to decompress? Actively allowing yourself that time to recover will work wonders for your ability to deal with the demands of not only the job but of life’s many stressors.
So now you know all this, how can you best make use of your time preparing your mind? Most professional athletes have the gift of time on their hands – there’s lots of down time between training sessions to work on these different areas. We on the other hand struggle. Thankfully most of the exercises explained below can be done on those quiet moments you might be able to snatch throughout the day.
1. Consider your threat level. Pick a day at work and consciously acknowledge each time you feel stress. Jot it down in your phone if you can. Then at a time when you are more relaxed look back at those moments and use your logical mind to work out why you felt threatened. Consider if you feel your threat level is overwhelming your day to day life.
2. Each day draw out on a piece of paper how big you think your threat, drive and renewal areas are. Is your threat overwhelming your drive and renewal or are you feeling good, is you renewal the largest circle? This can be done over days/weeks to see patterns. Are there particular shifts or tasks that affect these? Once they have been identified you can work on improving how you feel about them.
3. Once you have identified the things that make you feel stressed or affects your threat level consider how you can make positive references that will improve how you feel about those stressors.
4. Renewal is so important. Take time in your day, each day to do something for you. That may be 20 mins reading a book before bed, or a hot bath or an exercise class. Whatever it is you enjoy in life, make time for it.
Phoebe Sneddon, Paediatric Registrar (and one of the One Hundred Women in Cycling 2018); Sarah Broadhead, Performance Psychologist, Director at Broadhead Performance