Episode 30 An effective and practical framework for managing stress by Dr. Nina Ahuja

Sep 29, 2021

How can medical professionals turn unhealthy competition into healthy collaboration? What is the significance of emotional intelligence to leadership and stress management? Which frameworks can therapists use to help them overcome self-doubt and negative self-talk?

MEET DR. NINA AHUJA

Dr. Nina Ahuja is a surgeon, award-winning medical educator, senior academic leader, certified emotional intelligence facilitator, founder of Docs in Leadership, an organization established to promote and deliver leadership education to health professionals, and author of the bestselling book “Stress in Medicine: Lessons Learned Through My Years as a surgeon, from Med School to Residency, and Beyond“. She is an advocate for emotionally intelligent leadership, mental health, wellness, equity, diversity, and inclusion.

Visit her website. Connect with her on Facebook, Twitter, or Instagram.

IN THIS PODCAST:

  • Dr. Ahuja’s ADMIT framework
  • Benefits of frameworks for therapists
  • The importance of emotional intelligence

DR. AHUJA’S ADMIT FRAMEWORK

The ADMIT framework is something that I feel is a very powerful tool to help organize that jumble of emotion and feeling of overwhelm that we experience when we are in high-stress situations. (Dr. Nina Ahuja)

ADMIT is an acronym that stands for five phases of experience which are common sources of stress:

  • A: adapting to new ways
  • D: doing the work
  • M: measuring success
  • I: introspection
  • T: transformation

You can use the ADMIT framework when you are feeling overwhelmed to help you understand which phase of experience in stress you are currently struggling with. Once you have identified which phase, you can dive deeper into it.

I’ve seen success with [ADMIT] implemented with individuals as well as in teams … this could be applied personally and professionally. It can be applied to a personal goal or a team goal. (Dr. Nina Ahuja)

The ADMIT framework helps to uncover the psychological barriers around what we do and what we do not do. It is a tool that you can use to increase:

  • Emotional intelligence
  • Awareness around our reactions to situations

BENEFITS OF FRAMEWORKS FOR THERAPISTS

You can couple the ADMIT framework with the Smart Goals framework so that you can uncover those underlying stressors and reasons, and create actionable change to implement a shift that is aligned with your goals.

Combine the ADMIT framework for understanding your stressors better with the Smart Goals framework to make meaningful change in your personal life, and to move through any difficulties in your professional one.

It’s reframing our perspectives and then reprogramming our self-talk when it comes to those things and recognizing that there’s success in everything we do but it depends on how you look at it, and how you’re going to measure it. (Dr. Nina Ahuja)

Use the framework to pull yourself out of the rabbit hole of comparing yourself to other medical professionals.

As much as success in the medical field is objective, it needs to be met with personal strength and growth as well. Nurture a healthy internal dialogue to reframe how you view yourself to others because your journey is different from someone else’s journey.

THE IMPORTANCE OF EMOTIONAL INTELLIGENCE

Emotional intelligence is the foundation of being able to cultivate positive and healthy relationships.

It is about being aware of your emotional response and providing yourself with the ability to choose how to react in any given moment, versus being at the mercy of your unchecked emotions.

The more aware we are … the more effective we can be in managing them… instead of having a maladaptive response … so I believe that emotional intelligence is a key factor in relationships and because of that I think it’s essential for everyone to develop it. (Dr. Nina Ahuja)

Your emotional intelligence is what you depend on when you are reacting and responding to your colleagues, your family, and strangers. You exponentially broaden your capacity to create a positive impact in the world when you work on expanding your emotional intelligence.

Emotional intelligence is important for:

  • Leadership, because it encourages empathy
  • Managing stress, because it allows you to shift emotional responses to situations

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Resources Mentioned And Useful Links:

Find Out What’s Possible Through A Positive Mindset with Elizabeth Meyer

BOOK | Dr. Nina Ahuja – Stress in Medicine: Lessons Learned Through My Years as a surgeon, from Med School to Residency, and Beyond

Free 8 Week Email Course with Lisa Lewis

Practice of the Practice Podcast Network

Transcript

[CHRIS McDONALD]

The Holistic Counseling Podcast is part of the Practice of the Practice network, a network of podcasts seeking to help you market and grow your business and yourself. To hear other podcasts like Behind the Bite, Full of Shift and Impact Driven Leader, go to www.practiceofthepractice.com/network.

Welcome to the Holistic Counseling Podcast, where you discover diverse wellness modalities, advice on growing your integrative practice, and grow confidence in being your unique self. I'm your host, Chris McDonald. I'm so glad you're here for the journey.

Welcome to today's episode of the Holistic Counseling Podcast. I'm your host, Chris McDonald. I can't wait for you to hear from today's guest. Her name is Dr. Nina Ahuja. She is a surgeon, award-winning medical educator, senior academic leader, certified emotional intelligence facilitator, founder of an organization established to promote and develop leadership education to help professionals, and author of bestselling book Stress in Medicine: Lessons Learned Through My Years as a surgeon, from Med School to Residency, and Beyond. She is an advocate for emotionally intelligent leadership, mental health and wellness, equity, diversity, and inclusion. Welcome to the podcast Dr. Ahuja.

[DR. NINA AHUJA]

Thank you so much, Chris, for having me.

[CHRIS]

Can you tell my listeners a little bit more about yourself and your work?

[NINA]

Hamilton, Ontario, Canada in:

[CHRIS]

That sounds great. Yes.

[NINA]

, which came out in December,:

[CHRIS]

So have you always been interested in the mental health side and mental wellness?

[NINA]

That's something that I've always been very aware of and very attuned to. When you're in medicine, you're meeting people from all backgrounds, all experiences. And my drive to be in medicine was very much wanting to help people. With that I've always been someone who's noticed, how are people around me feeling? What is their energy like? Are they happy? Do they seem sad? I was always interested in learning more about that. So even in medical school, the area of mental health was something I was very drawn to. I ended up in a surgical specialty, but certainly that's something that has stayed with me and I carry through in all my interactions, even with patients.

[CHRIS]

I know you mentioned in your book that you hesitated to share your struggles with colleagues due to the culture of silence. Can you share more what that is and the impact this has on providers?

[NINA]

Certainly. Medicine, like many professions is one that is made up of high achievers. So when you enter every stage of that profession, whether it be medical school applications or residency applications, and then looking for jobs, everyone around you has accomplished a significant amount, at least the same as you, perhaps even more than you. So it's one of those things where if you're struggling, there's a hesitation to share you're struggling. The reason for that is that in a competitive environment, it's always about judgment and we're comparing ourselves against other people and how competitive is my application compared to that person's application. And when you're reared in that sort of culture, it's very difficult to be able to take a step back and openly admit to someone that I'm struggling with this.

And I think that's impactful on multiple levels. Personally, of course, it's a strong burden to bear when you're feeling so much stress and you feel like you can't seek support, but that in turn also impacts how we interact with others, be it with our family members, our friends, our patients, where if we're at a heightened state of stress, which has not been managed effectively, that actually translates into how we speak with other people, what our body language is like, how much patience we have, how willing we to take that extra time to explain or answer a question that a patient may have, for example. So there are lots of impacts on professional level in the examples that I just shared, but also on a personal level. So if your child comes to you and is really struggling or not completely listening to what you want them to do, the level of patients you have does correlate to how much energy reserve you have, if you you're finding that you're spending it all dealing with stress.

[CHRIS]

I would think too, that could lead to a big sense of isolation if you're keeping everything inside, almost like pushing those feelings down, but they don't go away when we push 'em down.

[NINA]

Very true. And then that can translate into other manifestations of that pressure and isolation, be it aches and pains, headaches, joint pains, rashes for no reason, difficulty eating and digesting and multiple ways of manifesting those sorts of feelings.

[CHRIS]

And I know our listeners are mental health therapists, and I think sometimes this culture of silence can even be a us. Like we're afraid to admit that we're having a hard time because as mental health professionals, we should have it all together and we shouldn't have our own struggles, but it's so helpful to be able to open that up and be like, look, I'm having a difficult time. Because we all do we're human.

[NINA]

I think part of the challenge that we have in our profession is that we deal in the objective. So we have structured true tools, frameworks, the knowledge that we all have approaches to asking patients about how they're feeling and then having those algorithms and formulas and experiences that we bring to the table at a professional level to be able to help people. But it's hard to recognize, first of all, we can't apply that to ourselves, I think effectively, most times. I think there needs to be that objectivity to offer guidance, but also to be able to move ourselves into the subjective, let me just feel what I'm feeling and take the mind out of it becomes a very difficult when we do the type of work that we do every day.

[CHRIS]

And I know you created the ADMIT Framework. Can you help listeners understand this approach to stress?

[NINA]

Sure. So the ADMIT Framework is something that I feel is a very powerful tool to help organize that jumble of emotion and feeling of overwhelm that we experience when we're in high stress situations. ADMIT is an acronym. It stands for five phases of experience, which are common sources of stress, A being adapting to new ways, D is doing the work, M is measuring success, I is introspection and T is transformation. So the idea is that when we're feeling overwhelmed to take a step back and to look at what phase of experience am I really struggling with, and then once you've identified that one phase, you can delve deeper into it. So for example, if it's adapting to a new learning style or say you've proposed a new routine to a patient and they're having trouble adjusting or adapting or accepting that idea, the idea is what is it about that that's preventing them from adapting to that new way?

What can be used as a motivating trigger for them that allows them to connect to that new idea, to then encourage them to want to follow that routine or that recommendation that you've made? Then it moves on to, okay, in terms of the doing phase, are they struggling with actually doing those suggested approaches? So what is it about that? Do they need more support? Do they need something in their physical environment? Do they need an accommodation at work, for example, where they have a 15-minute break to allow opportunity to do that exercise that you've suggested? So you can move through the framework in that way, then identifying what is that measure of success? If they get it done X number of times, is that a measure of success? Is it the internal effort that they've put in that they're really connecting with?

And that is the measure of success that finally they've now realized that they're willing to accept that new idea. Then the introspection of course allows for that time to process what is that feeling that I'm experiencing? How is that impacting my ability to accept something new, my ability to commit to doing the work? What does that measure of success mean to me and how can I make it feel important enough that it then transforms the person into wanting to actually follow through with the routine and then bring about that change that you're trying to bring them to.

[CHRIS]

I saw hat you had done some trainings, I think about the ADMIT Framework. So I'm guessing that you've seen some success with this implementing?

[NINA]

Yes, absolutely. I've seen success with it implemented in individuals as well as in teams. So for example, this can be applied personally and professionally. It can be applied to a personal goal or a team goal. We had a couple of initiatives that I've been working with equity, diversity, and inclusion, and also with some of the residents in dealing with some of their issues they have in their programs. I've been able to teach them, particularly the residents, how to work through the framework so that if they're dealing with issues, for example, in optimizing their schedules, balancing work and home, what are those factors that are impeding that ability to create balance intentionally? So having them work through each step of the framework saying that, okay, these are the issues that we need to address personally. These are the logistics we need to address at the program level. How do we motivate ourselves? How do we motivate others and then drive the change within the system? So it's actually been quite helpful and quite useful.

[CHRIS]

Are you having another training coming up?

[NINA]

Right now I'm putting together an online leadership course, which is a seven-module program that looks at essentials of leadership in healthcare. But actually the principles are universal when it comes to leadership, but it's just anchored in healthcare because that's the perspective I'm coming from. And within that, the ADMIT Framework draws through and is presented within that curriculum as a tool to you use for conflict management, change management and in communications, for example.

[CHRIS]

So do you think this could be something too that could benefit mental health care providers?

[NINA]

I do. I believe it definitely can because the intention is to help, the ADMIT Framework helps to uncover the psychological barriers of what we do and what we don't do. So I usually recommend that the ADMIT Framework is a tool to use to help increase emotional intelligence, our awareness of our reactions and trying to understand what's behind those responses. And then to couple that with JT Doran's smart goals framework, which is a really good approach to goal setting, as you, I'm sure you're familiar with are specific, measurable, achievable, relevant, and time-bound so that if you're able to know what the barriers are from a psychological aspect and what the strengths are from a psychological aspect that can then translate into setting goals effectively and definitively using the smart framework. So I like coupling the two together. I think it works really effectively in mental health for patients helping them adapt to your recommendations or to carry through with certain commitments and set their own goals. I think that it's a very nice tool to help explore those different areas and to help teach people to explore as moments for themselves as well.

[CHRIS]

I appreciate you sharing that because I think that would be helpful because I do find that I'm a therapist as well and sometimes we get stuck with clients and trying to figure out how to help them. I could see how this framework could really be an added bonus and then add it in with a smart goal as well to really kind of get things going, help clients to move from that stuck place to move forward with their goals. Definitely.

[NINA]

I think it's a nice pairing from a subjective spot to an objective plan, right?

[CHRIS]

Yes, definitely. And I think too, this framework could be used for therapists personally and not just to ---

[NINA]

Hundred percent.

[CHRIS]

Sharing with clients because we need that too?

[NINA]

Absolutely. And in fact, because there's that culture of silence, I think that this at least offers something too, for us to use individually that hopefully we can change the culture. And part of the reason of the book at being so transparent is to break that culture of silence and share a lot of the challenges that I went through myself. But until we hit that point where the entire culture has shifted enough that we feel comfortable talking about our concerns and challenges, this at least offers something that we can use as individuals for ourselves and then in turn for other people.

[CHRIS]

So I wonder if behind some of the distress that providers feel could there be some of that imposter syndrome and comparing to others. Because I know you said in medicine too, it's a very competitive field and, "Oh my God, look what they've done and I'm not even close to that. Who am I? Do I know what I'm doing?"

[NINA]

Absolutely. And that's something I talk about in the book as well, having experienced that myself, yes.

[CHRIS]

I hear that. And that can be hard it too, and actually be open with that.

[NINA]

Yes. And part of it is the professions that we're in, we're expected to have all the answers and it's an expectation that we put on ourselves and it's an expectation that society puts on us as well, which is good because they need to have faith in our abilities and what we can contribute. But at the same time, when you do have that sense of responsibility of knowing that we don't know everything, which is good because that helps us develop, grow and maintain our expertise by learning all the time, it can still be something that is difficult to deal with ourselves.

[CHRIS]

So what are your thoughts on comparing to other people in your field? Do you have any ideas of how therapists can manage that?

[NINA]

Yes. So I think the biggest thing that I struggled with because I went through that a couple of times in my career where I definitely had an sense of imposter syndrome. What really helps me is to draw inward. I found that we are reared in that competitive culture, as I mentioned before, where so much of our success is rooted in how many degrees you have, what your marks were, how many awards you've earned, what grants you've gotten. It's completely rooted in objective, which is good and there's a place for that because we need to make sure that certain standards are met. However, I think the piece that I was missing is that I was losing the internal effort that I was putting in, in terms of I'm doing the best that I can, I'm doing this as sincerely as I possibly can.

[CHRIS]

So that internal dialogue?

[NINA]

Exactly. So it's all about the self talk and then recognizing that other people around us may be more accomplished than we are, or perhaps less, but that every where there's a lesson and we can learn from each other in terms of what people have done more or what people have done less, which really translates to doing things differently, ultimately, if there really is no more or less. It's just, our experiences are different. So it's reframing all of those thoughts. So yes, exactly, it's reframing our perspectives and then reprogramming our self-talk when it comes to those things and recognizing that there's success in everything we do. It depends on how you look at it and how you're going to measure it.

[CHRIS]

For sure. And I think reminding yourself, and I try to do this to myself too, to say, "This is their journey. This is not my journey," and to kind of separate that. That's for sure.

[NINA[:

And we're all here to do our path and to contribute along our own path. And everybody's path looks different when we don't know what everybody's path looks like, but there is, we are on our own paths and our own journeys.

[CHRIS]

I recently listened to a podcast for therapist too, about the comparison. And they did say too, to think about it another way to look like how can I call collaborate with other people then if they're more successful? And I think you mentioned learning. It's a learning process. Why not try to learn from them?

[NINA]

Yes, and it's a funny thing you say that because there have been a few projects where I've been working on recently that are a fair impact and they have been truly collaborative projects. I've led them be because of my approach and experience with Docs in Leadership in driving different initiatives and having different facilitated workshops to help people work through different projects or challenges towards an outcome. However, this was truly collaborative. I remember there were points where there was opportunity to share the work before it had been published and I kind of debated that because felt that competitive spirit come back in me because early on in my career, when you're applying for different things and doing different things, it's you want to be the first to get that material out there in a published form. And my mindset has shifted where it's really about, let's just get the work done.

So if we have to share it now, because they're starting a similar initiative that we can build off of each other's work and really drive that change we're looking for. That seems to be coming my overall goal and objective at this point as compared to being the first one to publish something. So it's an interesting thing when you look at collaboration and if you can get everyone in that spirit of collaboration. You can really get a lot of work done in a really timely manner as well with everyone engaged and connected to the greater purpose. Competition, I think is valuable where it brings the best out of us. It brings out the skills that we can optimize or that potential that we know we have within ourselves. That can be an inward competition but I think that when you're dealing with people who are respectful and who are all committed to a greater vision, there's much more value in collaboration than competition, or at least if you're going to be competitive. It's a productive competitiveness where you're all on the same team, working towards getting to that goal as fast as you can.

Whether or not a other people are doing it doesn't matter. But we ourselves are going to do this the best way that we can in the best time that we can and as comprehensively as we can. I think if that is done in a collaborative spirit, within the entire team, that type of competition can be very constructive, but it's hard to move away from that when we're just used to, like you said, comparing to everybody all the time.

[CHRIS]

Yes. But that's perfect what you said, I think to really look at it a different way and that how we can work together in that spirit and not be that internal dialogue, really looking at that and changing that. It really is going to push you through because I think that just is going to cause more negative feelings if you're really getting on yourself, "I haven't done this. I haven't done that to frame that." It's really, what's going to start the internal work that's going to make a difference.

[NINA]

I agree.

[CHRIS]

So what are your thoughts on why emotional intelligence is so important?

[NINA]

Emotional intelligence to me is really the foundation of having positive relationships around us, whether they be personal or professional, whether they be in individual or on a group level. As you know emotional intelligence is really about being aware of our emotional responses, how we then in turn respond to them in terms of how we speak to one another, what our behaviors are, what our decisions are so that the more aware we are of how we react to things in different scenarios, the more effective we can be in managing them in the sense that instead of having a maladaptive response, for example, if we're aware that in this context, I feel really irritable and I tend to snap at people. If I'm aware of that, the next time that scenario comes up, I feel that irritability, I can say, "Okay, I know this is my tendency. I'm going to choose to do something differently."

So I believe that emotional intelligence is a key factor in relationships and because of that, I think that it's essential for everyone to develop it. That comes into play in our personal lives when we're dealing with our own internal dialogue, as we were talking about before, but also in terms of how we relate to the people around us, whether it be family or colleagues and how we relate to strangers. So if we come across someone, I mean, racism's a huge issue right now. Discrimination is definitely such a major problem. If people understood well, why is it that if I see someone who looks differently than me, I react the way that I do, there may be some work that can be done in terms of saying, oh, that's an emotional response. I can't find the reason behind it, or maybe I can. And how can I reframe that so that I don't respond in that same way? Again, there is so much potential for impact through developing emotional intelligence throughout society that I think it's really something that needs to be a driven home for everyone.

[CHRIS]

So it impacts everything, doesn't it, personal and professional? Because I know you mentioned how important it is for leadership. So why would it be really important for leadership?

[NINA]

For leadership it's really important because you're working with other people who have multiple responsibilities of their own and if we don't have the ability as lead leaders to have empathy for that, it's very hard to keep people connected and motivated towards the mission of what you're doing professionally as a collective. So for example, if I've got someone on my team, who's got four kids at home, their spouse is sick or say they're a single parent and they're trying to juggle all their responsibilities at home with all of their responsibilities at work and they aren't able to perform the way they want to for the team, if I don't take that time to speak to that person and try to understand where they're coming from, I don't have the opportunity to offer support or to modify expectations and delegate tasks in different ways so that it brings the best instead of that person still.

The reason that links to emotional intelligence is I need to have that awareness within myself that, okay, I'm feeling irritable this person didn't get the work done. Rather than stick with that and emote whatever I do in response to that, if I can stop myself and say, there may be another reason. Let me speak to this person, see what's happening and then I can choose to be empathetic or compassionate, or if I need to be a little bit more directive about things, then I can choose that too. But at least there's an awareness there of what's happening on the table at an emotional level and then that could be linked back to practicality and dealt accordingly. So that's where I think for leadership to really bring everyone together in a way that works for them, from the perspective they bring to the team, emotional intelligence becomes really critical.

[CHRIS]

I could see that too, because I talk to clients about that, not jumping to conclusions. Could there be another reason that you didn't hear from your friend on the text? That's a big thing.

[NINA]

Yes, I know.

[CHRIS]

Or you jump into conclusions about, I didn't hear from them. They must be mad at me. They hate me. The internal dialogue, but I can see that from a leadership role too, that if somebody's not doing their work, having that empathy could be so important and keeping the team together and really understanding, well, let's stop a second. Let's look at this and could there be something else going on and maybe they're having health issues or something else at home and really understanding that it's not necessarily that they don't want to do the work or they're just unmotivated, that something else could be going on. And keeping that in mind, I guess that makes a lot of sense. Being tuned in isn't it to the emotional intelligence. So what's a holistic strategy or technique that you like to use as part of a daily practice?

[NINA]

For me, I always like to take part of the day, this sounds kind of funny, but to listen to the silence around me. I find that my mind often gets so busy because I'm often working on multiple things at a time as most of us or many of us do. I find that the busyness is due difficult to step away from, just the mental busyness. So if I intentionally try to listen to the sounds around me, it actually centers me so that if you stop for a moment, you'll hear the traffic and you'll hear the buzz of the computer and you'll hear everything else. But below all of that, there's just a quiet and if I focus on that, close my eyes and focus on that for a few minutes, it just brings this sense of calm for me that I can do anywhere at any time and nobody needs to know. I can do it with my eyes open as well, so if I really didn't want people to know, but it's something you can really do anywhere. And I find that, like I said, it centers me, it brings me a sense of calm then I do some deep breathing along with that and then I get back into it. But you can do that as many times a day as you need to really, but intentionally I do try to do it, my routine is usually before bedtime, but through the day I'll often do it as well if I'm just feeling like I need a break.

[CHRIS]

Sounds like that could be a very centering activity, grounding experience to really just tune in that mindfulness component. Very nice. Thank you for sharing that. So is there anything else I missed that you want to share?

[NINA]

No, I appreciate the opportunity to be on your show. Thank you so much for that and I just hope that over time, you know we've gone through such a stressful period with this pandemic, that the lessons that we've learned through it, I hope that people feel willing to be open and share and be vulnerable and help one another through because we've been through the heat of the pandemic, but there's lots of residual stuff going on. And I think stress is going to be high for many people for a very long time still. So I just hope that people feel encouraged to be open, be vulnerable and help support one another through.

[CHRIS]

Yes, definitely. Because I think I had heard too, that they don't even know the long-term mental health of the pandemic.

[NINA]

No they don't. And I mean the range is so wide as you know of what the impact has had on people's personal lives, people's careers, professional circumstances, working styles. There's been so much change and so much need for adaptation at such a quick pace across so many domains of that I could see this, there's going to be impacts for a while. So we're going to need each other.

[CHRIS]

Yes. I was going to say, we need to support each other and really be in that vulnerable place to help each other out and to take care of yourself. And that's part of this podcast too, is not just the holistic counseling piece, but also that self-care because we have to be good place too in order to fully support and help our clients.

[NINA]

Absolutely.

[CHRIS]

What's the best way for listeners to find you and learn more about you?

[NINA]

I am on social media. My Instagram and Twitter handle is @docsleadership, D-O-C-S L-E-A-D-E-R-S-H-I-P. I do have a website as well, which is www.docsinleadership.org.

[CHRIS]

And that will be in the show notes as well on the webpage. I want to thank you so much for coming onto the Holistic Counseling Podcast.

[NINA]

Thank you so much, Chris, for having me.

[CHRIS]

I appreciate it Nina. And I want to thank you my listeners for continuing to support the show. Don't forget to subscribe, rate and review wherever you get your podcast. And this is Chris McDonald sending each one of you much light and love. Until next time, take care.

If you're loving the show, will you rate review and subscribe on your favorite podcast platform? We just started this and that helps other people find this show. Also, if you're feeling uncertain about your modalities and you want to build your confidence to be your unique self, why don't you to join my free email course, Becoming a Holistic Counselor over at holisticcounselingpodcast.com.

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