The first thing to say is that some stress and anxiety are completely normal reactions to everyday life. It is incredibly common for us to struggle sometimes. In particular, when we have a busy, stressful and potentially isolated job, with multiple demands and decisions to make, it is natural and understandable to find it emotionally challenging. Importantly, that doesn’t make you weak or a failure. It certainly doesn’t make you bad at your job or not as good as your colleagues. That makes you human. Some of the time it might even make you better at your job – because it shows that you care and want to do well for yourself and your patients and motivates you to do better.
Sometimes, these feelings can shift into something a little bit more significant, where short-term stress that motivates you to perform becomes longer-term stress and anxiety that begins to have a detrimental impact on your wellbeing. Maybe you are so busy you feel out of control at work. Maybe you’ve had a tricky interaction with a patient or feel you have made a mistake at work. You’re exhausted, you’re stressed, maybe you don’t feel you have the support or someone to talk to that you need. Of course your tired mind is going to make you focus on the negative.
An evolutionary hangover
Unfortunately, our human brain has evolved to be hyper-vigilant to mistakes. It’s what kept our ancestors safe from threats of danger. Whilst the threats we face now aren’t life-threatening in the same way, our minds still approach our challenges as if they are. Our threats now are often internal, psychological. They are thoughts (‘I’ve made a mistake!’), worries about the future (‘What if I make a mistake?’), self-criticisms (‘I am such a terrible dentist for making that mistake!’) … ruminations (‘I’m not good enough to do this’, ‘I can’t cope’, ‘I’m a failure’) ….
Particularly when we feel anxious and stressed, we focus our attention and energy towards the perceived threats. They play on our minds and affect how we feel about ourselves, our abilities, our work. We fixate, dwell, beat ourselves up. We blame ourselves. We can lose confidence. We might want to avoid certain challenges at work, to protect ourselves from anxiety. This is when our supposedly helpful ability to notice the things that are perceived as a threat can spiral, triggering negative thoughts and painful feelings of stress and anxiety, and stopping us from doing things that we might like to be able to do.
Fight, flight, freeze
Many of you probably already know about the fight, flight or freeze response. You might even see it at work all the time, in your patients. As evolved, our body evolved to prepare for perceived danger by releasing adrenaline, a hormone that triggers certain bodily sensations: a racing heart, breathlessness, nausea, butterflies, shaking or trembling, sweating, light-headedness. This adrenaline was released to help us to prepare to fight the threat, run away from it or hide from it – it was useful.
But now? Because many of our threats are internal, the adrenaline has nowhere to go, nothing to fight or flee from. So the adrenaline builds up in our system and can feel completely paralysing. These experiences can be different for each individual. For some, it might cause short-term stress in response to a specific trigger, but it can also develop into something more long-term and a generalised feeling of anxiety with a consistent feeling of unease and dread. For others, the symptoms might present in the form of panic attacks, when a specific trigger causes a sudden surge in the physical symptoms. Either way, we might find it hard to relax or be unable to concentrate, feel tearful or be irritable, or even more mistake-prone – with knock-on effects on our work, home and interactions with others.
The good thing, however, is that there is much that we can do ourselves to understand and manage our anxiety, using self-help and different therapies, such as Cognitive Behavioural Therapy, that have a proven evidence-base suggesting that they are effective for stress and anxiety.