An underutilized way to relieve stress [PODCAST]

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“As a former hospitalist who transitioned out of clinical practice in 2015, I’ve been deep in the physician wellness space for years. Far and away, the most effective way I’ve supported health care professionals during this time (often in my role as a founding board member of the mindful health care collective) is with a tool called tapping, otherwise known as the emotional freedom technique or EFT. Tapping is a powerful, evidence-based stress-reduction and healing technique that uses the same meridians as acupuncture (without the needles). By tapping on these meridians, you can induce profound changes in the brain and nervous system, which send calming signals to the stress center of the brain (the amygdala and hippocampus) in the face of stress. The results are astonishing.”

Jill Wener is an internal medicine physician and can be reached at her self-titled site, Jill Wener, MD.

She shares her story and discusses her KevinMD article, “Tap — yes, tap — to relieve stress.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Jill Wener. She is an internal medicine physician, and she wrote the KevinMD article “Tap, yes, tap, to relieve stress.” Jill, welcome to the show.

Jill Wener: Thanks for having me. It’s great to be here.

Kevin Pho: So we’ll get to the article in a little bit, but first off, can you share your story and journey to where you are today?

Jill Wener: Sure. I had a pretty typical journey. I went straight through medical school, did my residency at the University of Washington in internal medicine, and got a hospitalist job that I actually loved in Chicago at Rush. I got super burnt out in 2011. I was never the type of person who would meditate or do anything like that, but I was in a bad enough spot that I learned to meditate. It totally changed my life. It made me happy at work.

I worked for several more years in my job and then ultimately decided I wanted to do a three-month meditation teacher training in India, to teach what I had been practicing, and I also had a great opportunity to move overseas in addition to that. So I left my job before that. Once I was out for about six months or so, I recognized that I didn’t want to go back, and I’d rather spend my time helping other doctors not get to the point where I had gotten. So I’ve been doing work in the physician wellness space since 2016.

Kevin Pho: Now, tell me some of the issues and factors that led you to being burnt out.

Jill Wener: So many things happened. All these life things converged. The residency work hours changed in 2011, for anyone listening. I’m aging myself, I guess; now I’m old. But the residency work hours changed in 2011, and so a lot of the work fell to the attendings. We had a brand new wing, or actually a building, of our hospital open up, so that increased our workload. And I had been dealing with my second medical malpractice suit. Of course, as many of them are, it was not something that I had done personally or incorrectly, but it was still quite stressful. And just a few other things in life converged to lead to this burnout.

I remember thinking, maybe I’ll go work at Northwestern, or maybe I’ll get a job at a different hospital. But for me, I knew that the answer wasn’t where I was working; it was me. It was something within me, and I had gone through my life without really learning a lot of great ways to take care of myself. So for me, the meditation just blew open all the boundaries of what I thought my life could look like. And then I was much, much happier at work and actually quite successful and productive and doing academic stuff. So for me, that was an internal thing for the most part, an internal response to the external things that were happening.

Kevin Pho: Now, this happened about five to 10 years ago, and you’ve been coaching in the physician wellness space since. Over those years, have you noticed any change in the physician clients that you’re seeing, in terms of the stresses that they’re facing?

Jill Wener: I think there’s a sense of lack of autonomy. I think people are feeling like no one’s listening to them and they’re a cog in the wheel, as a lot more practices and hospitals get sold over to, or are run by, nonclinical people. So I think there’s a lot of that. But I’m also seeing a lot more openness to trying stuff that is not traditional, not what we’re taught in Western medicine as the only way to do things. A lot of people are exploring yoga, exploring meditation, and even things like Reiki and tapping, which I talk about in my article, and just looking for something different. And I also see a ton of coaching. I’m not a certified coach, but through tapping, I do some coaching, and I’ve seen a lot of coaching and people really benefiting from that.

Kevin Pho: All right, so let’s go ahead and talk about one of those methods in the KevinMD article that you wrote. It’s titled “Tap, yes, tap, to relieve stress.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to write it?

Jill Wener: Sure. I’ve been out of clinical medicine since 2015. And when COVID started, I was working with whatever tools I had to be of service to physicians who were on the front lines in such a time of uncertainty, particularly at the beginning. Even though I’m a meditation teacher, I’ve also been a tapping practitioner. Tapping is called the emotional freedom technique, or EFT, and it’s evidence-based. It’s actually a really great technique.

That’s what I was using the most during the pandemic to help doctors, because the meditation that I teach is not guided. It’s not an app or a visualization, so I have to teach it, of course. People have to come for eight hours and learn a technique, or they take my online course. But with tapping, you can show up and benefit from it if you’ve never done it before, and you can get the same benefits as if you do it every day. You can tap once a week or once a month. You can tap in a group setting, and even if I’m not the one directly working with the person in the group, the people who are in the group with us can also benefit if they tap along with us. So it’s been a really, really great tool that I think has helped a lot of folks process the difficult emotions, the fear and the uncertainty, the anger, the guilt, all these things that have come up around COVID.

So the purpose of the article was to introduce people to tapping. But also, there’s been such a backlash against personal resilience-building strategies, I feel, in the past few years, in terms of burnout being caused by the system. And yes, the system is for sure broken. But what I’m suggesting in the article is that we offer these tools that help people manage stress and trauma, because tapping is also really, really great at managing trauma and PTSD. We offer these to our physicians not as an obligation, “Oh, you have to do this, yet another thing,” but as a gift: “We care about you, and we know you’ve been through this hell. These are tools that you can use to actually feel better. How can we help facilitate you trying them and potentially benefiting from them?” So it’s trying to shift some of the perspective back to the individual, but not as a responsibility, just as an ability to take a breath and pause and heal from all that physicians have been through. And not just physicians, but everyone in the health care system, and of course, all essential workers.

Kevin Pho: Now, can you take me through a typical tapping workflow? How exactly would you utilize it in a session? Perhaps give an example, and even a typical case study.

Jill Wener: Sure, sure. I do tapping in several formats. I tap with people one-on-one, and that’s much more like an accelerated therapy session, where we talk about very deep, specific issues. We can talk about childhood traumas or anything, a breakup, anything like that. And I also tap in a group setting, and I have a tapping club. So there are different ways that people can interact with the practice.

But basically, what it entails is using acupressure, so tapping with your fingers on different points on the face and chest that are the same energy meridians used in acupuncture. What you do is, as you’re saying out loud whatever negative things you’re feeling, you tap on these points, and I do it like call and response. So if you’re telling me, “Jill, I am so anxious about this big talk I have to give. It’s the biggest audience I’ve ever been in front of, and I’m so anxious,” and I get a little bit more about that, then we would be tapping, and I’d say, “I’m so anxious,” and you’d repeat back, “I’m so anxious,” and you go through the tapping points, really naming and diving into these negative emotions, which most of us are not used to.

We’re used to this kind of positivity bias where we have to say the positive things, but tapping really helps us process the negative. It actually sends calming signals to the hippocampus and amygdala and changes the way the stress center of our brain processes these stressors. So by saying these negative things and acknowledging them and facing them, we’re able to change the way our brain perceives them. We could do a 15-minute session in a group, and then I say, “OK, who’s the next volunteer?” Or it could be an hour-long session, and I work with people, generally once a week, who do tapping sessions with me.

Kevin Pho: How many sessions would a clinician have to go through to notice an effect?

Jill Wener: You could tap for 15 minutes and notice an effect. I mean, it’s that powerful, and it’s that immediate. The work that I do in groups is more symptom management, and the work that I do one-on-one is more getting into the much deeper issues, so processing the death of a loved one or processing abuse or trauma. That’s not going to really work in the group setting, because that’s not going to feel better in 15 minutes. But if someone’s angry at their spouse for something, or mad at their boss, or processing potentially a bad patient outcome, that’s something that can be done relatively quickly, depending on how traumatizing it was. If it was very deeply traumatizing for the doctor, it may take some more deep work. My packages are eight, 12, and 16 sessions, so it just depends on the level of intensity.

Kevin Pho: Now, for the clinicians that you see in your practice and that you suggest tapping for, what are some common scenarios? Is it simply seeing too many patients at work, or is it conflict with an administrator? What are some typical examples that clinicians come to you for tapping?

Jill Wener: I’ve seen a lot of things: issues with coworkers. I work with a lot of women, so a lot of processing of maybe mistreatment or microaggressions at work based on gender identity. Also feeling a lot of guilt about, “I don’t want to be in the COVID clinic. I feel like I should be wanting to step out and be a warrior, but I don’t feel like a warrior.” A lot of anxiety, so much anxiety. And then a lot of grief as well, about losing patients. Processing the grief of bad patient outcomes is huge, and those are things people carry around with them for a long time. So tapping is a really great way to work through what’s called second victim syndrome, if you’ve heard of that before or had other guests talk about that.

So many different things. Any negative emotion that comes up in your life, personal or professional, you can tap on it. Overwhelm is something that you can tap on, and just feeling not heard. So the sky’s the limit, really.

Kevin Pho: Now, you mentioned that there was some evidence behind tapping. Can you just walk me through some of the studies and the evidence?

Jill Wener: Sure. No, I am not an expert in the evidence. I’m an expert in being a practitioner. But there’s one study I know of, where Dawson Church is the author, that showed that, comparing a tapping session to a standard therapy session to a control, tapping decreased cortisol levels by 24 percent compared to the therapy. And there are other studies. They’ve done functional MRIs trying to delineate the pathway and how the tapping actually works.

For anyone interested in the literature, you want to look for emotional freedom technique, not for tapping, because tapping will not come up with anything. It’s more technically called emotional freedom technique. And there’s a bunch of other articles, but that cortisol one you’ll see quoted the most often.

Kevin Pho: We’re talking to Jill Wener. She is an internal medicine physician, and she wrote the KevinMD article “Tap, yes, tap, to relieve stress.” Jill, a lot of clinicians who are out there may not be versed in these nontraditional techniques in the exam room to treat things like anxiety and stress, but of course, we see a lot of patients with anxiety and stress. Now, are there any techniques that you could just quickly share during this podcast that internal medicine physicians like myself can perhaps utilize in the exam room?

Jill Wener: Yes. I mean, tapping is one of those things. Tapping can be used to help patients manage their anxiety or pain. It is really great for acute and chronic pain. I can’t teach it right now. It would take too long; it’s more complex than that. But one of the things I love about it is that you don’t need to train forever in order to work with people using tapping. I’ve done my training, and I used tapping myself as a client for a year and a half before I became a practitioner.

But you can watch it. You can Google. You can go to YouTube and type “tapping for anxiety” or “tapping in patient care,” and that would come up, and you can guide your patients. You can refer your patients to those resources: “Wow, you’re having a lot of back pain. Go to YouTube and type in ‘tapping for back pain’ and see what comes up.” And these are things that can be used at the bedside in five or 10 minutes, or in the exam room, and can really help people.

That’s another thing that I love about it: It is experiential, and it’s got an algorithm. It’s kind of foolproof, I guess. So you can help guide people through it without having all the complexities of a more nuanced, multi-package way of working with somebody. You can do it in a much less nuanced way and still get really good benefits.

Kevin Pho: Now, are there any specific resources or organizations that clinicians can go to if they want to learn tapping, other than just Googling it?

Jill Wener: Sure. To learn how to, yes, ACEP is the Association for Comprehensive Energy Psychology, ACEP, and they offer clinical EFT courses. It’s for clinicians, and it’s actually CME-accredited. They have level one and level two, so clinicians could go and do that, and it’s quite a bit of CME. It’s a multi-week course, but I think you get 17 or 20 hours of CME by doing it. And it’s only open to clinicians of some sort. So that’s probably what I would recommend to start, because it’s very clinically oriented, and it appealed to my doctor brain sense.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Jill Wener: It doesn’t have to be this way. The system is the system, and it does not care about the individual and how we, as individual organisms floating through this world, experience the world. The system isn’t going to fix that necessarily. The system can fix things that make us feel stressed, but there’s no shame, and there’s nothing wrong. In fact, it’s a beautiful thing to take time and interest in ourselves and do practices that maybe we didn’t think were traditional, acceptable things, but that actually can be quite helpful and really improve our quality of life.

Going through life in constant stress and constant anger toward the system, it might be true, but it is not a pleasant way to go through life. And there’s so much more that can enhance our experiences, clinicians.

Kevin Pho: And how can people reach you?

Jill Wener: My website, jillwener.com, J-I-L-L-W-E-N-E-R.com. I host lots of events, and a lot of them are for health care professionals, including a retreat coming up in October. So there’s lots of great stuff on my website. You can check it all out there.

Kevin Pho: Jill, thank you so much for your time and insight, and thanks again for being on the show.

Jill Wener: Thanks.

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