Stress Reduction – Sutherland Emergency

Breathing for Stress Reduction

Emergency department staff are highly flexible and adaptable people, and resiliency is one of our strengths.

Working in Emergency is undeniably stressful. We work in a noisy, brightly-lit, high stimulus environment. We work with a high degree of autonomy – but “with great power comes great responsibility”. While we have little control over what comes our way on any given day, we are under pressure to perform consistently regardless of the variation in workload.

Our resiliency means we can cope with a high level of stress at work, but almost inevitably, there come times when the stress builds up. When this stress gets to a point where our innate coping mechanisms are over-whelmed, we are vulnerable to burnout.

A conscious approach to managing stress levels is one way to reduce your risk of becoming burnt out, and to maximise your chances of flourishing in the emergency department.

One of the quickest and easiest ways to access stress relief is by breathing.

Breathing techniques to use at work

Breathing can down-regulate our parasympathetic nervous systems rapidly.

To get the best effect from breath work, it is first useful to explore how are you are currently breathing:

Sit with your feet firmly planted on the ground and your back supported by the chair.
Without changing your breathing, bring your attention to how it feels:
- Notice how your chest and/or abdomen move in and out with each breath.
- Notice if you are breathing in through your nose or mouth.

Now focus on using your diaphragm to breathe:

Ideally, with inhalation, the midsection of the torso around the lower rib cage should expand first, followed by expansion of the upper chest. With exhalation, the chest releases first, and then the abdomen.
When you use the diaphragm efficiently, you take the stress off the accessory muscles of respiration.

In addition, the diaphragm stimulates the vagus nerve and has a calming, parasympathetic effect.

Next focus on breathing through your nose:

Nasal breathing helps us take fuller breaths and warms the air. Also, it mixes the air with nitric oxide (a pulmonary vascular vasodilator) from the paranasal sinuses.

While the mouth is sympathetic toned, nose breathing induces the parasympathetic nervous system and is calming.

Now take a few deep breaths focusing on bringing your breath into your diaphragm, in and out through your nose.

Chest Breathing:
Many people are vertical or chest breathers

Chest-breathers underutilise the lower part of the lungs and the diaphragm. They have a reverse breath wave, where their chest rises out and up and their belly collapses in when they inhale.

Chest breathing taxes the secondary breathing muscles in the neck and shoulders and can contribute to chronic musculoskeletal pain.

People who rely on this type of breathing breathe shallow and more often. This creates more work for the respiratory system.

The next step is to add a breath exercise

Box Breathing is an easy one to learn and remember. It is a regulating breath that can help you to turn a stressed state into a state of focus, or a sluggish state into a state of energy. It is used by navy SEALS, and is also known as tactical breathing.

Inhale for 4 seconds
Hold your lungs full for 4 seconds
Exhale for 4 seconds
Hold your lungs empty for 4 seconds

Repeating this 4 times takes around 1 minute, but can be repeated as many times as you need to feel ready for your next task.

Finally, allow your breathing to return to its usual pattern.

Take a moment to feel how your mental and physical state has changed.

In total, this exercise can take as little as 2 minutes. Try it following a stressful interaction, or to prepare yourself for a difficult task. You can do it while sitting at a computer or even on the toilet!

And if you are interested in how breathing can help you regulate stress levels, this podcast by ED physician Rob Orman is a great introduction.

There are also many different apps available to help with guided breathing, also known as breathwork. Try State: Breathing if you have an iPhone, or Breathwrk.

There are many other apps such as Calm, Smiling Mind and Headspace which incorporate breath work exercises with meditations and other relaxation and sleeping strategies.