The Key to Sustainable Change

The Key to Sustainable Change

Peer Coaching for physicians has been shown to be an effective wellness tool, and has many different variations.  One particular coaching strategy is that of showing clients how to strengthen their mental fitness.

This powerful technique allows one to gain control over thoughts, and shift mindset from negative to positive.  Based on the program “Positive Intelligence” by Shirzad Chamine, the idea is that through the use of mindfulness exercises, one is able to command themselves to shift from defeatist, cynical thoughts to those of optimism and enthusiasm.  

This concept is based on research in areas of positive and cognitive psychology, performance science (think elite athletes), and neuroscience (neuroplasticity).  For physicians, the concept of neuroplasticity is very compelling;  the ability to modify neural pathways with repeated thought processes is how we can strengthen our positive thought patterns while simultaneously weakening the negative patterns.  

At the cellular level, our thought patterns are a group of neural pathways, and the “Positive Intelligence” model of mental fitness personifies these thought patterns by referring to the “saboteurs” (negative) and the “sage” (positive). The saboteurs consist of our judge (which is universal; our inner critic), and a host of accomplice saboteurs, whose strength is based on our personality.  

For those of us in medicine, the predominant saboteurs are often  “hyper-achiever”, “controller”, hyper-rational”, “hyper-vigilant”, “stickler”, and “pleaser”.  

These characters generate all the stress, anxiety, frustration, anger, and sadness that we feel.  Conversely, we all have a sage.  This character represents our authentic self; this is one’s pure, inner, true essence. Our sage is the origin of all the sensations of love, calm, creativity, passion, and optimism that we feel.

The saboteurs reside in areas of the brain stem, limbic system, amygdala, and parts of the left brain, while the sage is found in the middle prefrontal cortex and areas of the right brain. Through the years, we have come to rely on our saboteurs to guide our decisions and actions (as part of our survival mechanism), and consequently our sage has been overshadowed and buried by these overbearing negative thought patterns.  

By strengthening mental fitness, we cause atrophy of the saboteur pathway and hypertrophy of the sage pathway.  The “muscles” of mental fitness that we build with this process are self-command, saboteur interceptor, and sage.  The process is as follows:  recognize when a negative thought (saboteur) is happening, STOP, do 10-20 seconds of some kind of mindfulness exercise in the moment, then commit to moving forward in a positive (sage) manner.  

The sage perspective is that every circumstance and interaction  can be seen as a gift and opportunity, therefore allowing us to reframe and see the positivity in all situations.  Furthermore, our sage possesses 5 powers— empathy, curiosity, innovation, navigation, and activation.  

In particular, the power of empathy is vital for those of us in medicine; not only does this refer to empathy for others and circumstances, but also empathy for OURSELVES. 

Physicians are notorious for being hard on themselves, thinking they should be perfect and infallible (all thoughts of our judge and accomplice saboteurs).  Being able to recruit the power of empathy instills compassion, both for ourselves and others.

Developing mental fitness allows for growth and strength in many areas of life.  Indeed, there are multiple applications for this work, both personally and professionally.  When we think of our roles as physicians, we often think about the challenges of work/life balance, job satisfaction, and burnout.  In addition, issues around communication skills, leadership, and self-actualization are important areas for improvement.

As an example, I want to highlight a physician client of mine, and his use of mental fitness training to overcome challenges in his work environment.  The client is an EM physician who was motivated to improve his interpersonal skills, both with colleagues and patients.  After discussing the concept of mental fitness, he committed to this work, and went so far as to have a “pause button” tattooed on his wrist. The client got into a routine at work wherein he identified when a negative thought was about to hijack him.  He would STOP, look at his tattoo for 10-20 seconds, then proceed in the situation with his sage mentality.   

Practicing this routine faithfully led to improved interactions, both with patients and staff, and not only did he feel much happier, but his colleagues noticed a difference in his attitude and behavior. He was now able to reframe challenging situations, and see the opportunity to recruit his sage powers, whether that be empathy, curiosity, or innovation.  

Medicine today brings with it many issues; we all are familiar with the challenges that make this profession so difficult.  Physicians need to be in touch with self-care strategies that mitigate the stress; coaching is a perfect wellness tool to accomplish this goal. Similar to having a personal trainer at the gym for physical fitness, a peer coach serves as a personal trainer for mental fitness.  Maximizing mental fitness is not about changing who you are, but getting back in touch with who you REALLY are.  This is the way to sustainable change!


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