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Development of Middle Adulthood -

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Navigating the Rapids:Completing the Journey throughMedical School
PresentedbyAlan Korinek, Ph.D.Director, Program of Assistance for HSC StudentsThe Counseling Center at TTUHSCJanuary 14, 2019
When We Hit “Rapids”
“Rapids” are stressful events (e.g., Step 1) that can dysregulate us emotionallyHyper-arousal and/or hypo-arousal are experiencedHyper-arousal – feeling panicked, angry, overwhelmedHypo-arousal – feeling numb, disconnected, no energyCatastrophic thinking can resultOverestimating the probability of bad things happening (aka, “worse case scenario” thinking)“Fight or flight” impulses can occur, including thoughts of suicide
Impact of Stress onBrain Functioning
Our Two-Tiered Brain:Upstairs/RationalBrain(the Rider)“Thinking Cap” used to problem solve, create, innovate, and imagineManages the downstairs brain, but only if engagedDownstairs/ReptilianBrain(the Horse)Emotionally reactive and always on; goal is survivalAmygdala is our “sentry”
High stress causes“emotional flooding” (flash flood or rising waters); when that happens:Survival instinctunseats good intentions and “amygdala hijackings” (fight or flight) may occurCognitive difficulties result; cannot process information or make necessary neural connections (i.e., learn and consolidate critical concepts); memory and recall are compromised
ManagedStress Benefits Us
Benefits ofmanaged stressinclude increased alertness, heightened focus, andenhancedcognitiveperformanceGood stress management prevents flooding, or allows us to get back into our upstairs brain if flooding begins
Keys to Navigating the Rapids
Practice self-careProper diet; exercise; mindfulness* and relaxation; smiles and laughter; practicing gratitude(*apps: Headspace, Calm)Be self-aware and emotionally intelligentRecognize the signs of emotional dysregulation and activate coping to get the “rider” back in control of the “horse”Keep your self-talk positive, encouraging, and hopefulAvoid ruminating about the past or worrying excessively about the future; check out“The Single Most Important Thing You Can Do to Manage Your Stress”:
Keysto Navigating the Rapids
Avoid “flight” behaviors, such as:IsolatingAbusing or misusing substancesEscaping into video games or online activitiesOr any other unhealthy “emotionally-driven” behaviorsSeek support,especiallyif you are having any suicidal thoughtsPAS counseling and support isfreeandfully confidentialSeeking support isnota sign of weakness; it’s a sign of emotional intelligence!
Keys to Navigating the Rapids
Get adequate restAdequate sleep strengthens the nerve circuits underlying learning and memory, allowing the brain to make and consolidatenew and essential neural connectionsDistribute your time wisely by using effective time-management strategiesIdentify your “time bandits”and avoid or managethemSet and keep a schedule and/or track how you use your timeEmploy effective study techniquesFor example, thePomodoroTechnique (25 minutes studying, 5-minute break)
One Final Appeal
As you care for yourself, care also for one anotherYou are all having to navigate the same “rapids”, though in your own way, so encourage one another and support one anotheras you haveopportunityBe especially sensitive to any signs that a classmate is really struggling and may be having suicidal thoughts(e.g., isolating themselves, becoming emotionally dysregulated, appearing depressed or behaving differently)Remember the QPR training you all received:Question,Persuade, andRefer
Tips for Better Sleep(aka “Sleep Hygiene”)
Dim the lights one hour before sleeping; use only soft, warm lighting (no “blue light” from electronics)Adopt a regular sleep schedule, even weekends, to reset circadian rhythms and increase melatonin productionDon’t engage in “brain work”, have emotional discussions, or make complex decisions, 2-3 hours priorCurb your appetite: no heavy meals 4 hours before sleeping or light snacks 2 hours before sleepingCurb caffeine use in the evening





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Development of Middle Adulthood -