135. Calming The Chaos: Simple Tools To Regulate Anxiety

Anxiety is just a normal human response to uncertainty, to things that are scary. And it's not a weakness, it's really us being human. So normalize it that it could just be a very normal response that we need at times.

Are you a woman in medicine, feeling overwhelmed and disconnected from the personal fulfillment that you desire? You're in the right place. Join doctors Joanne and Erin as they rewrite the rules for women in medicine. Let's begin.

In today's episode, we're going to be talking about anxiety in an uncertain world. We have had many things happen in the world since we launched this podcast back in June of 2024. And we've brought up some of those things that have happened. Some scariness, some uncertain times. And with Dr. Joanne Sotelo's expertise, not only as a psychiatrist, but also as a physician coach, she has a wealth of information that I'm hoping our listener can find help and solace in and support. And Joanne, I'm so excited to have you here to be providing some support in. We're going through some uncertain times again as we are recording this. Some unfortunate events with violence in our own country. And it seems like it's one thing after another after another. And from your perspective, why is anxiety so common right now?

Thank you, Erin And I want to start by defining terms because we use the word anxiety so commonly. And as a psychiatrist, I like to think that this is our bodies and mind's natural response to perceive the real threat or uncertainty. It's a very simple definition and it includes physical symptoms like our hearts going faster, our breathing changes, we might be restless. It also involves changes in the way that we think. Like we might worry more things might get stuck in our head and we might. It's like a big word, but catastrophize. Like we kind of expect the worst outcome. And then of course, the emotional tension, which is that unease, sense of fear and dread. And to get to your question, we're feeling that more often first because of what you said. There's so many things going on in the world and there's so many changes, technology, expectations. I think that because of the great thing of having the Internet and so many sources of information, news and media, 24, seven, there's this cycles of crisis and we're constantly bombarded. Sometimes I'll open my phone, I just need a break, and like some other recent event, I open my Instagram just to take a breather. And then it's like news of this horrible event that happened, and then it's like Whoa. And quite graphic without necessarily my permission. And that's constantly. There's also so many things that we believe feel very unstable. And you can think of some of the things that we go through. Stressors at work and relationship tension, economic pressures, so much uncertainty and again so much information. And it can get overwhelming very quickly. And it's not always our fault. Sometimes it's that part of our brain that we talk about of that activates that fight or flight. And when that gets activated, it kind of hijacks the part of our brain that can calm us down and that can think more thoroughly and has options and can question. But rather than we stay in that super hyper kind of high alert, which triggers a lot of the, the physiological response to the anxiety, which can then trigger also some of the cognitive and the emotional response to anxiety.

And this theme. We've talked about this before. I remember during our interview with Diane Loosney back in January, I could go way back to what episode that was. And one of the topics I've learned from her is that we spend, I think she quoted about 80% of our time in the sympathetics, in our cortisol drenched so state now and maybe 20% in our parasympathetics. And for physicians, that may be even more skewed when our bodies were meant for Those opposite ratios, 80% in parasympathetics and 20% in our parasympathetics and our brains. Can't you. You talk about hijacking, which is such a powerful word and gets your attention when you're in that constant stress from understanding not only what's going on in your own physical world, in the little bubble around you which is how our brains were created, what are we seeing, what are we hearing in our own environment? And now, as you said, 24, 7, bombarded with what's not just in our environment, but what's going on around the world. And no wonder it's too much. It's frightening. And when we can understand that, oh, your brain is just doing what it's supposed to to keep you safe. And it wasn't wired in 2025. Our brain was wired a long time ago, before the Internet. So I wonder, you know, even different from the lay public, why is it so important for women physicians to be aware of this?

Several reasons why this is important, particularly for women in medicine. So we have high responsibility roles. We're responsible for patients, our families, our teams. And when things feel very uncertain, it's even kind of like a bigger weight that we Feel and, and it's hard to tolerate and that's our constant. But it feels a lot worse when there's a lot going on and, and we're feeling that anxiety. There's also what we talked about, that second shift or the double standards that we're physicians and we do all the things that work and we have to keep up. And then there's home and, and not that it's always traditional, but we, even when there's shared responsibilities, we might still feel a big sense of responsibility. And it adds layers of pressures. Some of the things that we've talked about in the past also interfere with our. And that sense of anxiety, like perfectionism and control, right? Like some of the things that can make us a really good, precise physician. But then we don't know how to turn it off. And then we're obsessed with details and the comparison and doing things a certain way. And we don't give ourselves permission to have it be a little bit more laid back. And that's backfires and it fuels the anxiety. It's also important for us as women in medicine because chronic anxiety affects our overall wellbeing. It'll affect our sleep, it affects our mood. We might be a little bit more cranky. Other physical health problems, right? Like we might be getting more headaches, stomach upset, all those things. And it can also then affect our cognition, interfering with our concentration, and then some of the bigger things that we've talked about that can lead to burnout and depression, anxiety. So definitely that's a really important one. And then also the ripple effect is that the anxiety doesn't just impact the physician. It affects your relationships with loved ones, but then also with patients and team. So the same way that we talked a, a lot about how things can be better and the ripple effect, we know that we, we're not taking care of the anxiety that everyone around us will get impacted.

And I also want to share one of the trends that I've noticed as I'm working with individuals and groups of individuals in medical clinics is the additional role that if you're the only medical person in your family and many of the individuals we work with are in that sandwich generation, so they not only are taking care of themselves and maybe a partner, and they've got kids, they've got aging parents or extended family members, and if you're the only healthcare person in your family like I am, then you are it. So you may also be having a really heavy burden for your family and many family members if they're dealing with Health and aging issues, and that's a lot. And I met with someone recently and the list of things they were dealing with, I'm looking at this individual going, how are you even standing with all of the responsibilities you're dealing with, let alone showing up every day at work to see your patients? You have such fortitude and strength and it, it made me feel almost sick to my stomach knowing how much they were having to dig in to show up every day for themselves, for their patients, for their staff, for their family, for their extended family, for the in laws, because they were the strong, intelligent, knowledgeable person that knew how to problem solve. And because of all of those strengths that got them into medicine and through medicine is also further complicating their life because they think I'm the best one to do it. So I guess I have to. And maybe not even delegating what might be able to be delegated to others and not asking for help. You know, one of the things I was like, are you getting a housekeeper? What about a landscaper? Can you get help for the kids? You know, you're doing so much work, how can you pour back into yourself so you can even survive and take care of yourself to get through this time?

Yeah, that's a perfect example of that high responsibility roles that we have. And part of us likes to be in that role and the fact that we can serve, but it cannot be to the expense of our own health and well being.

Absolutely. And, and just like we have been talking on previous episodes when we interviewed Corey Feist and Dr. Stephanie Simmons from the Dr. Lorna Breen Heroes foundation, in episodes 133 and 134, we're. We are seeing some grave impact, negative impact on the healthcare workers. So Joanne, I'd love to hear from your perspective, what can we do about it? Let's have some hope here.

Yes, my goodness. And I would love to for our audience to refer back to those episodes because so much information of things that we can do individually and as a system, but what can we do right now? So here are some steps of things that you can do right now. So the first one, which will not be new to you, as if you're a regular listener to our podcast, is first that awareness and then acknowledge it and normalize it. No, anxiety is just a normal human response to uncertainty, to things that are scary. And it's not a weakness, it's really us being human. And I can say this over and over again because it's part of the trickle effect of then us like we talked in this previous episodes of not seeking help or the stigma. Right. And the shame and all the things. So first normalize it that. That it could just be a very normal response that we need at times. So that's the first one. The second one is that we need to calm our nervous system, especially if you feel it, if you feel very activated, another word, it's triggered. We talk in. Erin and I talk so much about coaching tools and psychotherapy tools that we can use. But sometimes we can have all the tools to change how we're thinking. So we have a different approach. And if we don't calm our central nervous system first, those things are. Will not work as well. And calming our nervous system can be as easy as doing breath work. And I don't mean it easy in a minimized way of just breathe better and your anxiety will go away. Believe me, I'm a psychiatrist. I treat anxiety all the time. There's no easy switch. And there's still things that we can do to at least, like I say, lower the volume of the intensity of the anxiety. So breath work. There's different techniques, but if just the intention of taking deep belly breaths where you are extending your exhale more than your inhale and you're breathing from. It's almost like when you're like you're gonna blow out a candle like that, like you really extend your exhale activates our parasympathetic nervous system, which is the one that slows things down and gets calmer. So that's one. We've also talked about meditation things. One of my favorite grounding techniques is the 5. 4, 3, 2, 1. So you can name five things that you see and like really go detailed. And then four you feel, you go through the senses. Four you can. Three you can hear, two you can smell, and one you can taste. And you don't have to worry about the numbers. Just even if you just do the five things that you can see and you. And you're breathing while you're doing that, it can be very grounding and really get you out of that fight or flight. This is one of my favorites. I'll talk about it forever. Movement is the fastest way to. When we change our physiology, we change how we feel. And it doesn't need to be go crazy. Literally just a couple of minutes of a good stretch walking, a yoga movement. Those are things that we can control. So it's our responsibility. And then other things that we talk about, of course, like sleeping better, eating better, staying well hydrated all Those things. So that's a, that was a huge step too. Other things that we can do particularly for anxiety and you know yourself the best, so you know what activates you, you know what are the things that can trigger you. You might know what are the things that are making you feel overwhelmed. And again, not that you can just snap your fingers and it goes away, but have boundaries, especially for the external things that are feeding your anxiety like social media or media in general. So limit your exposure to the news and any of those social media cycles. And then in terms of work and personally, not as easy, but we can still reset, reset expectations, especially the part that we, the pressure that we put on, on ourselves and that perfectionism and that we don't have to always be on like we believe. And then of course another step would be cultivate safety and support. We talk so much about rituals like the meditation, journaling, connecting with a trusted person. And then part of why Erin and I do this work is to create community and that deeper connection and having more purpose and finding meaning on our day to day, that sense of fulfillment for your overall mood in general. So that's a, a long answer to your question, but hopefully if you can find one little detail out of all those things that I just said that could be beneficial, you will start to feel better.

And Joanne, one of the ways I close out my coaching sessions is I ask em for an aha moment. What was your aha moment? Did the light bulb go off? And, and then I ask for a commitment. And as you were sharing about the power of cultivating safety and support in your community, I have a, an example. Just from this morning, I got a text from a client just listing out all the ways that their day was falling apart. And she said I just need to vent. And I was able to quickly respond and, and say here's my little cheerleading for you. And you know how I know them and I'm gonna, I'm here to support you. What do you need? And just her knowing that she can reach out to me as her coach to say I got you. How can I support you? And not only, you know, with that the group that she's involved in because she's a one on one client, gets access to the group and she knows she's got solidarity in another group of women healthcare providers who understand how life can get so complicated can be game changing as opposed to so many women in medicine thinking I'm on my own. Nobody has these problems, nobody will understand. And as you said on this podcast, our wish is that we give permission to start talking about the hard stuff. We give permission to take down that facade and. And get rid of that perfectionism and say, I'm not a robot. I'm human. And then the next person next to you is like, oh, my gosh, I'm human, too. And, you know, my kitchen is a mess right now. I don't have. I talked to a group about, you know, sometimes you're not going to have time to put the laundry away. And one of them's like, that's so true right now. And I'm like, let's not judge each other for it. So when you have the right people in your community, Joanne, and I want to help you build that you don't have to further berate yourself. And that one tiny shift can really make a huge difference when you're not feeling alone, when things feel so heavy. So, Joanne, I'm so grateful for your wisdom that you're willing to talk so freely and openly about these hard topics about anxiety that I think is so prevalent these days. And hopefully this will be an episode that our listener can come back to when they're feeling anxious and go, okay, what were those things? And for our listener, I would love for you to think about what's my aha moment that I learned from Joanne? And can you make one commitment and think about, what are you going to do? And to raise your likelihood of doing it, where are you going to do it? And what time and location those are going to raise your likelihood from maybe 20% to over 90%. What are you going to do from today? Are you going to meditate? Are you going to do breath work? Do the 5, 4, 3, 2, 1. Do some movement, as Joanne said, so powerful to quickly shift your circumstances. How can you feel grounded? And then the basics of sleeping. How are you fueling yourself? How are you hydrating? And so often, as intelligent as we are, we forget those basics. And Joanne, is there one more piece of information you'd like to share with our listener on this topic of anxiety?

I'd like to share something personal because I've had to give myself this reminder over and over in the knowing that a lot of what we do is from our wiring in our brain and our programming as physicians. And as I've shared in here, I'm going through a transition from. From working at this institution I've been working at for 18 years of, you know, like a lot of us, you just. You show up and you see patients all day, and. And it's externally structured and Now I am going to be opening my own private practice in psychiatry. But I have this setup time. So it's not, but it's not structured even though I have a lot to do to get things started. But I, it's the day I start, it's arbitrary, like I set it up and it's a very restless place to be. And, and you know, I'm sure that you went through something similar a while back. And it's, I have to remind myself like, it's okay, take your time, prioritize. You don't have to do it all. But it's interesting because I feel restless as if I have done nothing because I haven't been seeing patients. And that's kind of of how I've structured my days for so long anyway. So all that to say that it's my compassion to myself, which is such an important piece of all of this too, is, it's okay. We're, this is a process. You're going through a transition and this is, you're setting it up the way you want it to be. And that's another permission that we need to give ourselves for where we are now in our future.

And I want to say witnessing you, my beautiful friend Joanne, is that you are doing it so gracefully because you've poured so much into yourself through your own coaching journey, from working with world renowned experts, from being in masterminds, you have done so much work on yourself and that allows you then that ability to self coach even during big transitions. And I'm just so proud of all you've been doing. It's like the duck with a really fast paddling legs under the water and you make it look smooth on the surface and it's just very beautiful to witness. So I am so appreciative that I see you role modeling that you can get through really big transitions gracefully when you have the right support. And thank you for role modeling that for me and our listeners. And with that, we would love for you to stay tuned to our next episode because it's coming right up.

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