Dr. Liana Lianov is the chair of the Happiness Science and Positive Health Committee of the American College of Lifestyle Medicine and President of the Positive Health and Wellness Division of the International Positive Psychology Association. She serves as a consultant to ACPM and previously also served on the ACPM board of regents.

The surreal circumstances to which we have awakened day after day over the past weeks is taking a toll on our mental and emotional well-being. As preventive medicine and public health physicians, we work in a large variety of settings, experiencing a spectrum of additional stressors related to the COVID-19 pandemic. Whether we are working long hours on the public health emergency preparedness frontlines, managing an overwhelming volume of extremely sick patients, mustering the courage to show up to clinical care in the face of obvious danger, experiencing the heart-wrenching events of patients taking their last breath without loved ones to hold them, feeling the potential threat of losing a job (in the case of “non-essential” work), suddenly shifting clinical, programmatic and academic work to video conferencing, helping children with distance learning while also working, or other major shifts…we are collectively experiencing extraordinary stress, anxiety, uncertainly, and loss—loss of our normal lives. Some of us may also be dealing with personal illness, loss of a loved one, survivor’s guilt, guilt for not being able to assist on the frontlines, and more. And we have additional cognitive load for heightened attention to meticulous handwashing and cleanliness, physical distancing and wearing masks/PPEs. That’s a lot!

Before I go on further, I need to emphasize that if you do find yourself feeling completely overwhelmed or concerned about your mental well-being, please reach out to a mental health professional. A number of resources are now available, including the National Suicide Prevention Lifeline (1-800-273-8255) and the Physician Support Line (1 (888) 409-0141) offered by our psychiatry colleagues.

Physician burn-out was on the rise before the pandemic due to a myriad of health system changes and challenges, but now the pandemic has rocked our world swiftly and unexpectedly. What can we do to take care of ourselves physically, mentally and emotionally? Scientific data strikingly suggest that a total healthy lifestyle plays a pivotal role in boosting our immunity, as well as improving our mood. Even as preventive medicine leaders, we need to remind ourselves and make a concerted effort, despite circumstances, to practice the six major pillars of lifestyle medicine: eating a predominantly whole food, plant-based diet, engaging in plenty of physical activity, getting enough sleep, avoiding risky substances, doing activities to calm and manage our stress levels, and enjoying positive psychology activities, including social connection. All of these pillars of lifestyle medicine improve both physical and mental health.

I’d like to especially highlight emotional well-being and positive psychology interventions that can serve as crucial underpinnings to surviving and even thriving throughout these challenging times. Some approaches are common sense. For example, while staying well-informed of developments, we need to make sure to limit exposure to bad news. These thoughts and images are “sticky” and can be haunting for many hours or days even beyond our cognitive awareness. For most of us, we are looking to manage these difficult times with simple, practical and effective actions. How can we promote our emotional self-care? Firstly we can be gentle with ourselves and practice self-compassion. Oftentimes, physicians feel the extra pressure that they should be role models for colleagues, family and patients by being “strong” and in control. Yet, we are human, and it is natural to experience the full range of emotions. Self-compassion requires that we embrace all of our feelings, instead of fighting them back. Then we can gently shift to see the situation as a third party observer. If your best friend was experiencing what you are experiencing, what would you say to your friend? Be your best friend.

When negative emotions swell up, cognitive-behavioral techniques may help. Pay attention to your thoughts and reframe them into something realistic and authentic, yet more supportive. In very anxious or sad moments, breathing exercises, movement, and diverting attention can break the cycle of emotions quickly. Other positive mood shifters can be as simple as looking out of the window, playing some music or going outside to soak in a little sunshine or grasp the green beauty of a tree. Such actions are easily available to all of us…and can bolster other stress management practices, including mindfulness and meditation. Well-regarded free resources and apps are now accessible to physicians to help with this.

Beyond countering our stress, we can each make a concerted effort to activate our thriving. The foundation of our well-being relies on effective positive activities, some of which do not take much time. The father of positive psychology, Martin Seligman developed a framework that makes it easy to keep in mind the essential elements of this field for boosting happiness and emotional well-being: PERMA, positive emotions, engagement, relationships, meaning, and accomplishment.

  • Positive emotions can be triggered through brief attention to what is good in your life. A few moments, once a week, to identify three things for which you are grateful can make a big difference. Altruism is another powerful evidence-based tool. For example, offer assistance to people in your life on several consecutive days. Studies suggest acts of kindness, when bunched together, can positively impact mood. Of course, these activities may not be appropriate for everyone, e.g. frontline practitioners who are already giving much.
  • Engagement in activities that are challenging, but seem within reach can lead to a sense of well-being, while losing track of time and tuning out the world. Examples of these “flow” activities include running, gardening, creating art, and playing musical instruments. Regularly doing such activities, even for a few minutes at a time, can incite a type of mindfulness and a sense of healing.
  • Relationships comprise the most important pillar of the PERMA framework. We are social creatures. What we need now, more than ever, is physical distancing, but social closeness. Not only do positive interactions (these days, mainly on video chats) feel good emotionally, but they have the potential to rev up our parasympathetic nervous system, the “tend and befriend” response with all of the associated physiologic benefits. And yes, we do need to make extra effort to connect while wearing masks, through our tone of voice and gestures.
  • Finding meaning in what we do is a crucial element to our well-being. Even as we suffer through major challenges, we can survive and thrive if we can connect our experience to a sense of everyday meaning or life purpose. Meaning can be found in the medical and public health work we do, in small everyday family events or in the way we use our individual strengths to advance what feels personally important. Logotherapy, as outlined in Viktor Frankel’s Search for Meaning, the famous book he wrote soon after being released from a World War II concentration camp, offers a timeless approach for addressing this pillar.
  • Having a sense of accomplishment, by witnessing step-be-step progress towards our goals is essential to our well-being. Humans, and especially well-accomplished physicians, are driven to achieve. Sometimes we may lose track of what we are achieving in different areas of our lives. This pandemic may be propelling you to a different set of professional and/or personal achievements. Notice and celebrate them.

For more information and practical action steps, I highly recommend the Greater Good Science Center at greatergood.berkeley.edu and Greater Good in Action at ggia.berkeley.edu. In recent years, I have become an active champion for integrating these science-based positive psychology techniques into health care. Now, more than ever, let’s harness their power to boost well-being for ourselves, our colleagues, our family and friends, as well as our patients.

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