“Your concentration is very complete. Your mind isn’t wandering. You are not thinking of something else. You are totally involved in what you are doing … You feel relaxed, comfortable and energetic.”
These were the words of Mihaly Csikszentmihalyi, a Hungarian-American psychologist known as the world’s leading expert on positive psychology, creativity and focus. In Flow: The Psychology of Optimal Experience, his seminal work, he called this a state where people are so involved in an activity that nothing else seems to matter. They are, using the vernacular: in the zone, getting into the groove, going with the flow.
Published in 1990, Flow became a part of popular culture. Several years later, Dallas Cowboys head coach Jimmy Johnson credited the book for his team’s Super Bowl victory. According to Csikszentmihalyi’s recent obituary in The New York Times, he showed “how everyone from artists to assembly-line workers can be transported to a state of focused content by getting caught in the ‘flow.’”
And, hopefully, emergency medicine teams can as well.
Drs. Joshua Schwarzbaum and Jeffrey Lazar from SBH’s Department of Emergency Medicine had this in mind when they scheduled a half-day workshop this past summer for their attendings, residents, nurses and mental health professionals. They teamed up with Greater New York Hospital Association and a Colorado-based organization called Veteran’s Path that specializes in optimizing performance under stressful situations.
“In the E.R. you can feel overwhelmed and out of control and not be at your best at times, which was particularly the case during the height of the pandemic,” says Dr. Schwarzbaum, the department’s assistant medical director. “We wanted to give our people a resource they can use to slow down things, reset, regain control over themselves and the situation. We wanted to give our staff tools to help regain peace of mind and stability when everything around is chaotic.”
Veteran’s Path provides mindfulness training to active duty military, helicopter pilots, police departments, and Olympic athletes, among others. The SBH workshop stopped considerably short of their day-and-ahalf adrenaline stress training sessions that put clients through simulated prisoner of war camp scenarios. According to the organization’s program director, this intense in-your-face feature provides situations “to teach the techniques that will allow you to survive a prisoner of war camp.” This may help a police officer, for example, handle an intense moment in a more desired manner “so they think about their problem rather than jump into survival mode and reach for their gun.”
The mindfulness training workshop at SBH focused on the first module taught in these classes and was led by Mark Williams, the aforementioned program director. The swashbuckling Williams, a one-time combat pilot during Operations Desert Shield and Desert Storm, mixes his military background with an expertise in martial arts. According to his bio, he has created programs “combining mindfulness and military skills that help develop and maintain resilience, situational awareness and peak performance.” He was personally involved in some of the military’s early studies on mindfulness training.
For SBH, the training session brought together two dozen or so clinicians, who on a July morning gathered, somewhat apprehensively, across the table in the Braker Boardroom. The plan is for these individuals to act in the months ahead as “champions” for the rest of the emergency department. After a short introduction from Williams, the workshop consisted primarily of deep breathing exercises that, according to Williams, will locate the part of one’s body that accumulates stress and “helps drain the bathtub.”
“The point of these exercises is for people to tune into their own stress,” he says. “How do I identify when my mind and body is moving out of whack? How do I recognize this ahead of time so I can prevent it? In a team environment, if emotional sensors are not out there, emotional behavior starts happening.”
The deep breathing exercises – “full inflation of the belly and chest and then let it all go,” he says, enables the individual to “take an internal selfie.” He has the class sit, their feet planted firmly on the ground, palms facing up in their laps, as they breathe deeply into their abdomen and chest, and then exhale. This progresses to having them repeat the breathing with their hands, jaw and forehead tightly clenched.
“Sleep is the most important thing for stress relief,” Williams tells the class. “Then physical exercise and body breathing. You want a little stress. You need to be ready for the show with adrenalin, but this relieving helps you be at the top of your game. It’s about recognize, reset, recover. Your goal is to be in your optimum zone.”
Studies have shown that mindfulness intervention works in terms of performance and cognitive functions and in reducing stress response, whether it be for athletes or helicopter pilots. Mindfulness has also been tied to heart health, immune response, reduction in cognitive decline, and one’s ability to cope with pain, anxiety and depression.
For now, the Department of Emergency Medicine plans to incorporate daily five minute breathing exercises. According to Schwarzbaum, “It will give staff the ability to decompress, permission to take a time out and get into a peak performance state.