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Stress Management on the Olympic Frontline

Abi Walker is an ENT Surgeon at Lewisham and Greenwich Trust. She is a former International hockey goalkeeper. During her career she made 65 appearances for Scotland and won 17 caps for Great Britain. She retired in 2013 to concentrate on adding complex cases to my Friday afternoon lists!

A famous Italian football manager once mused that sport is “the most important of the unimportant things in life”.

And he’s right: when the world brought to a standstill by COVID, sports events were quickly postponed, rescheduled, and cancelled in the name of public safety.Whilst clearly of miniscule importance compared to the health and wellbeing of a population, sport is an outlet for many (including myself) who love getting caught up in the highs and lows of competition.

Sport was the biggest part of my life for nearly a decade as I put my medical training on hold to play international hockey, leading up to selection for the Great Britain team in London 2012. I can confidently say that while the general population like to characterise doctors as demigods who fight back the dark forces of death on a daily basis (and as a surgeon, I wouldn’t entirely resist this characterisation), my life as a doctor is comparatively less stressful compared to life as an athlete. Why? Not because life as a doctor is stress-free, but because I found life as an athlete so incredibly stressful.

Sporting outcomes are so binary and objective, and when your whole environment is geared towards placing value on those outcomes then it becomes easy to equate them with your personal value. I did not win; so I am a loser. I wasn’t selected for the team; so I am useless. Of course, there are positive outcomes that counterbalance those feelings – I won! I am a great person! – but the nature of sport is that the next event is just round the corner and your balloon doesn’t stay unpopped for long.

One of the most useful strategies I found to manage stress was described to me by a sports psychologist who brought me to understand the flow between rational thoughts, emotions, and behaviours. And specifically, that emotions should always be sandwiched between thoughts and behaviours. Its easy to think of numerous examples on the sports field where emotions overtake an athlete and feed directly into behaviours – “This referee is useless! I’m going to scream swear words in his ear to make him understand how useless he is!”. And although its less obvious, emotions will often play on an athlete’s mind and interfere with their rational thinking. That internal narrative is sometimes called “self-talk”, and when the narrative of self-talk is a stream of negativity then it is easy to see how that leads to a spiral of loss of confidence, poor performance, and reinforcement of those negative thoughts.

Recognising that flow between thoughts, emotions, and behaviours allowed me to work with the psychologist on a set of strategies to get a healthier balance. You can influence both your thoughts and your behaviours, and in turn, master your emotions to be kinder to yourself. For example, I would make a list of behaviours – both conscious and unconscious – that I recognised in myself in times of stress: tight shoulders, clenched teeth, fidgeting. As soon as I noticed them in myself, I would question: what is the emotion that’s making me do this? Fear of failure? Time pressure? Anger?

Using your rational brain to question the motivations behind an emotion will often be enough to defuse the negative feelings in it. “This referee is useless! I can’t change that. We’d better keep the ball out of contact to make sure he doesn’t have to make any decisions”.

As helpful as this was, the biggest game changer for me was finding strategies to work in the opposite direction and use behaviours to influence thoughts. Making a simple list of behaviours like deep centring breaths, stretching, standing tall would alter my physiology and allow me to return to a state that I associate with calm. Lower heart rate, slowed respiratory rate, balanced posture. From that physiological state I could take a mental step back and re-examine any negative emotions swirling about my mind, and then address them with a more helpful rational thought.

High pressure moments like the last few minutes of a game or a penalty shoot out are almost invariably won by the team who is thinking clearest; using behaviours that positively influence your physiology is a great way of activating your rational mind and accessing emotions that work for you rather than against you.

Although hopefully we don’t shout and scream whilst in the hospital, I encounter similar stressful scenarios in medical workplaces all the time – frustration at a difficult patient, anger at a rude referring doctor, fears for my own health and for others. Of course I can’t claim to be a model citizen and it is not infrequent that I’ll reflect on my behaviour and resolve to be better. But at least now I feel I have the tools to analyse and understand how to change for the better, and many of those strategies come from my time on the sports field.

Action points:

· What behaviours do you recognise in yourself when stressed?

· What positive behaviours are you proud of and would like to do more of?

· Have you had any negative thoughts today? Are you able to step back and understand if that thought is from your rational brain or emotional brain?

· Have you taken the time to talk to yourself in a positive way today? What effect did that have on your physiology?

· Take three deep breaths, stand evenly on both feet, and stretch your arms as wide as you can. What emotion do you feel?

Please add your own views and experiences in the comments section

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