Your Least Favorite Emotion, and What to Do with It...

TLDR at bottom*

The Challenge of Emotions in Medicine

As physicians, we encounter a LOT of interesting situations and can experience a LOT of emotions. We often distance ourselves from emotions to stay focused in emergencies or maintain professionalism with patients or in power differential situations in training. While one strategy is to remove yourself from the immediate situation to regroup, as the physician, that's not always safe or appropriate. 

Immediate regulation often happens by default because we are so hyperalert to the emergent situation. Sometimes though our sympathetic response goes on overdrive and we need grounding or centering techniques. "Take your own pulse..." My favorite is to take a couple of deep breaths, focusing on exhalation longer than inhalation. This activates the parasympathetic system to balance the fight/flight. Or tune into one of my senses for just a few seconds (rubbing my fingers together tyring to feel my finger tips or listening to what is close and what is in the distance). This brings me into the present instead of in the immediate future or past and is calming and focusing. (Shirzad Charmaine's book Positive Intelligence can give more information). 

While emotional regulation is essential in the moment, unresolved or unprocessed emotions can build up and lead to negative consequences over time. Essentially we learn to emotionally regulate in the moment. 

Cy Wakeman, a drama researcher with a therapist lens, once addressed an audience of physicians I was in. She said something along the lines of - 'Look therapsist and physicians all get Lesson 1 - You have to emotionally regulate in the moments of stressful patient situations. However, it seems like physicians didn't get Lesson 2 that therapists get. You have to deal with those emotions at somepoint!'

Let's look at the typical options of dealing with emotions - other than adaptive responding: 

The Four Ways to Respond to an Emotion

1. React – As covered previously, emotions drive actions. Responding to an emotion is normal and often functional. However, reacting to an emotion  - Yelling when angry, quitting when disgruntled, or making an excuse or blaming when embarrassed, are examples of reacting. often impulsively. This is when "The emotion has you, rather than you having an emotion," as someone once described it. We often end up regretting our actions from reacting. 
2. Resist - Resisting can come in 2 forms: 
   1. White-knuckling through the emotion, suppressing feelings - like holding a beach ball underwater, isn't effective for the longterm. Will-power is finite. Eventually, that ball bursts back up in the air getting everyone soaked. A great descriptor of what happens when we ignore emotions comes from Brooke Castillo. It's like a toddler, pullling on your pants leg trying to get your attention. They will get louder and more animated, until you give them attention and listen.
   2. Ignore - you can become good at just ignoring your emotions. The downside is that you cannot selectively ignore emotions. You will dull the pleasant along with the unpleasant. Just like an aperature on a camera - if you open it up fully to feel the good, you will experience the unpleasant. And if you shrink the aperature, you feel less emotions overall.
3. Avoid – Numbing, or buffering emotions,  through overeating, overdrinking, excess gaming, social media, or even things like cleaning. Not that there is anything inherently wrong with any of those, but when we do them to avoid unpleasant emotions, they are often to our dedriment as well. 
4. Allow & Process – Recognizing, naming, and metabolizing the emotion to let it pass naturally. 

So, what they heck does it really mean to process an emotion?

This is a great question. I didn't learn this until one day as core faculty, my BH team recommended that we allow a resident to grow in her ability to "sit" with her emotions. And that, "She was lacking the skill to process them." Hmmm, well - I honestly didn't really know what the heck they were talking about, but nodded my head. (I was reacting to my own emotion of confusion or insecurity - thinking I should already know what it meant). 

Eventually, though I learned what that meant and what it looked like - partially from the term "sit with " and observing the recommendations to the resident and truly, practically in my formal coach training several years later. 

How to Process an Emotion

1. First Tune In  You have to intentioanlly become aware of your emotions. This takes practice, intentionality and patientce to notice them earllier. 
2. Name the Emotion

Physicians, like most people, have a fairly limited vocabulary around feelings. Using a list of feeling words can help with affect-labeling, which alone can reduce emotional intensity by disarming the amydala - that threat detection center we all have. Use a resource such as the Feeling Wheel, Mood Meter app for your phone, or if you want to really dig deep - Brené Brown's Atlas of the Heart. Accuracy in the label of the emotion is more effective. And keep in mind to not label yourself but the feeling. I'm feeling embarassement, not I'm embarassed. (I like to add, "and that's okay" when I name it to help decrease the common self-judgment of any given emotion.)

3. Allow It to Be Present

Instead of avoiding, lean into the feeling.  They are just sensations in the body. We willingly experience emotions when reading books, watching movies, or riding roller coasters (even unpleasant ones)—why not allow them in real life? You've survived everyone of your unpleasant emotions. 

3. Tune Into Your Body

We feel emotions in our body (hence the term feelings). Just like butterflies in our stomachs for most of us when we are nervous. Intentionally focus your brain on the somatic. Where do you feel the emotion? Chest, stomach, head? Run it through your HPI questions. Does it feel heavy, tight, fluttery? Is it moving, or still? Is it fast or slow? Fast emotions can be excited or scared. Slow emotions can be depressed or content. Observing, as the compassionate, objective observer - without judgment,  the sensation rather than reacting helps it dissipate naturally. "And, so this is what shocked, feels like to me. Interesting."

4. Let It Pass

As you keep your attention on the bodily part of the emotion, the sensation eases and resolves. Usually within 15seconds to 2 minutes. Recognizing and allowing them without judgment can help them move through. If new thoughts arise, refocus on the body instead of fueling the feeling with additional narratives.

Emotions often come in waves, especially grief. Nothing has gone wrong, recognize, allow, name, tune in to the body, allow it to run its course again. 

But what if the emotion doesn't ease?  

There are couple of things to consider if that happens and a couple of additional things to try.

1. Can we just be honest and say, sometimes the emotions are so intense we need an immediate emotional release? This can be done in a healthy way - choosing time and location to be alone or away from anyone that is not prepared to see you in that state. Having a good cry or screaming into a pillow or in your car - can be the intial step to processing. (Dr. Edith Eger, a holocaust survivor and pscyhologist, talks about her personal experience with this and her client's experience in her books The Gift and The Choice.) You just want to be sure to reflect afterwords and continue the process of processing. This isn't the right approach for everyone or for every intense emotion - you'll want to see how it affects you. 
2. Are you judging the emotion or yourself for having it - that will hinder the process. Remind yourself you are human and will have the full human experience. 
3. Are you allowing more thoughts about the situation to continue thereby distracting your focus from the body? Those thoughts are fuel to the emotional fire. Just notice when they happen - let them go as you tune back in to the somatic sensations.
4. Is the emotion a go-to "indulgent" emotion - worry, overwhelm, confusion - these are often some of the emotions that become familiar and comfortable even though they're unpleasant. These don't need processing - you need to acknowledge they're there. Allow it to be there without any additional attention. Elizabeth Gilbert writes about her anxiety this way (my paraphrase): It's coming along for the ride whereever I go. So I just tell it to take a seat in the back. I'm still driving. It can have a voice but it can't have vote on where I steer. 
5. Can you find a way to close the stress cycle regularly: Stress isn’t a one-time event with a single reaction. It has phases:
   External Stressor --> Internal appraisal - senses, insula, --> amygdala’s emotional processing --> Physiologic response – hypothalamus and pituitary --> sympathetic response -->
   Internalization - full awareness (tachy, sweaty, GI)  --> aware of discomfort of stress -->
   Coping mechanism – actions taken in response to discomfort (positive and maladaptive types). 
   By demonstrating to your system that you are safe, it allows a reset to the system. The Nagoski sisters in their book on burnout highlighted 7 things shown to close the cycle and signal your brain and threat detection system you are safe: 

    

   Physical exercise. Focused breathing exercises. Positive social interactions. Genuine laughter.
   A Hug. A good cry. Creative expression.
6. It may be that you are needing professional help. Physicians often neglect their own mental health for a variety of reasons, tuning in late to the need is just one factor. I like to encourage all physicians to have their own doctor that they could bring this up to for referral to therapist. Take your own PHQ9 or GAD7  periodically - what would you tell a patient with that score? Line that up for yourself. If in crisis, call 988 or the physician/medical student support line (this is staffed by volunteer psychiatrists from across the country so is may not as immediate) 1-888-409-0141

    

The 50/50 of the Human Experience

Life is a balance of pleasant and unpleasant emotions. If we expect only positivity, we’ll constantly resist reality. Disappointment, frustration, and sadness are normal parts of life. The key is to let them exist without fear or avoidance. And remember from last week's blog: Madeleine L'Engle's quote "Joy is not the same thing as pleasure. Indeed, it partakes of difficulties, sadness, sorrow." These are not mutually exclusive.

You can also see them as data. If you feel anger, ask yourself: Is this signaling a crossed boundary? If so, what action should follow? Emotions as data can help guide our next steps.

Final Thoughts

Coping isn’t just about external tools—it’s about embracing emotions without fear. By allowing feelings to be present, noticing them in the body, and letting them pass naturally, we reduce suffering and build emotional resilience.

Reflection Question: What emotion have you been resisting lately, and how could you allow yourself to process it instead?

I'd love to know what you discover! 

Have a joy-filled, emotion-embracing and metabolizing type-of-week!  Tonya

If you're looking to have an external coach involved in your residency program, reach out to discuss options. 

TLDR
- Processing emotions is essential for healthy coping.
- Avoiding, resisting, or reacting to emotions can have negative consequences.
- Allowing and processing emotions helps regulate them effectively.
- Naming emotions, accepting their presence, and noticing physical sensations can ease their intensity.
- This approach promotes healthier emotional responses and forward movement.