‘The brain says it’s had enough’

Probably all high-demand industries – in aviation, not just the engineers, but also the pilots – are suffering from chronic stress. They are under pressure to perform every day. Being stressed is the first part; chronic stress is the next. So it’s hard to say, but there’s nobody who isn’t stressed in some aspect of their life. We can’t forget it’s work, and then also their private life, which is sort of a work/life integration, where we are stressed in our industries. For my patients, they are all high-performing professionals; they are working in high-performing jobs, and they are most known to suffer from chronic stress.

AA: What factors contribute to chronic stress in aviation?

AK: Well, one is the shift work, the unpredictability, and then the pressure – having passengers on board, being reliable for the crew, navigating weather, everything else that’s not predictable. We now know that, over the last 10 years, when I did my research into that, safety measures around the technology have dramatically improved in aviation, but the human-factor side has only dropped 10 per cent, roughly 10 per cent. So, there is something we’re missing here to keep our pilots, our workers in aviation really safe, and on the ground as well. They have the capability to inspect and check all the aircraft as well to keep them safe.

AA: What are some of the symptoms you see?

AK: What they have is when you can’t sleep anymore, you stay awake, you have brain fog, you have memory loss, you walk in a room and forget things – then it can progress to shaking of the hands, facial paralysis, imitation of a stroke. And in a worst-case scenario, they’re locked into their body. It’s no fault of their own; it’s just the measure of the brain saying, “I’ve had enough; you ignored all my small warning signs, it’s maybe back pain or migraines got worse, and you didn’t listen, and now it got worse and worse”. That’s when I see them in my practice, when they have neurological symptoms. That doesn’t mean they can’t have chest pain or other symptoms, which are also from chronic stress.

It’s traumatic for us as clinicians to see, because we do every test, we do the brain scan, we do the brain waves – this is sort of my specialty – for epilepsy, and you would think they are having an epileptic seizure, but they are not. It’s all normal; everything comes back normal, and then only with going deeper into the history of the patient’s situation, they have no chance, no support at home or at work. Altogether, it will just tip it over, and the brain says it’s had enough. And it’s only when it really gets worse, the symptoms, when they are shaking, or actually can’t do their job anymore, that they come to the practice and see us.

AA: What impact could this be having on safety?

AK: What we see is that when we talk about it, and when I go and speak, and I talk about these symptoms, people come back and say, “Oh, I had that”, and describe all these symptoms. What they’re really good at, the high-performing people, is hiding distress. We all know we’re stressed, we’re coping, but we’re pushing through because we have to, and this is what we learn, and we’re strong, and that’s when the safety is compromised – when they know, or there was a near miss, which was maybe not reported. The situation awareness is there’s bad weather, or you’re on a runway, and something else comes from right or left. You’re not 100 per cent with it.

And then emotional regulation: you’re a bit snappy, or you’re a bit more teary, and people notice, but you push through. Then, if there’s a situation, you have to react really quickly in your decision making. That’s when the safety is compromised. Otherwise, if everything goes well, you can go through for quite a long time without anyone seeing. I’m sure there are many of us out there who are hiding this quite perfectly.

AA: Do you think there is a stigma in aviation about admitting to chronic stress?

AK: I think there is. We are really good at saying we’re burned out, we can’t cope anymore, but if you are going on leave or sick leave, you take six weeks off, and after this you want to be back for full time, and you think you’ll be spot on – it’s not really true. Most of these professionals will have a WorkCover claim and then never come back or go part-time, so it’s really sad to see. That was my intention when I saw these high-performing people suffering so much; that is when I did the research to see what we could do. Because medicine has nothing to offer to actually alleviate this. So, there is a stigma, I think, but we also are really trained to push through. We are busy, we are really good, which is all good, because we have to, and we love it, but we also need to be aware of the signs early on.

We are really good at knowing we need to exercise, have good nutrition, and sleep; we know all of that. But when I see the signs and see my patient cohort, which I have in my clinic, there’s something missing – and this is what I was looking at, and this is when I went back researching in my own time after hours to really find what we did, what we have learned in neuroscience and chronic stress both together, and what the brain actually does when we are stressed. What we see is changing early on, and I think that’s the missing link from the program I developed after my 25 years of experience and the research I did to understand the science behind it. Yes, you need to sleep, but understanding why you need to sleep, why you need to eat, and why you can’t exercise too much, even if you’re stressed.

AA: What are the remedies for chronic stress?

AK: If they’re already at the practice, we’ll assess them, take the history, and then we’ll do the tests, and it’s really important that whichever symptoms you have, you have to go to the doctor and check it out, so to know if then if it comes back negative and they say everything is fine with you, but you are still shaking or you still can’t move your arm or you have really bad migraines, then doesn’t mean it’s not there. It’s not in your head, and you are not imagining this.

What I see, then, is the 30 per cent who are still in denial because we do want the tablet that relieves it, and we can move on. Another 30 per cent are not ready to talk about it, and then 40 per cent of the cohort are really grateful if you can offer them the program, saying you can alleviate their symptoms and, over time, reverse them. So what I do then with the person individually is look at their life, what they’re having in work life and personal life, and see how we can enhance and modify the things they are doing – the exercise, the sleeping pattern, what’s good.

How can we regain and reconnect with purpose and connection outside? As soon as you’re stressed, you are withdrawing from your family and your friends, so it’s all part of it. Your brain is changing. When you understand it’s stressful, we’re going in looking at what you have as a basis, and then we really look at the three pillars: restore, regain, and reconnect. The last thing we want is to take three weeks off, wait for the weekend. You have to integrate it into your day-to-day life.

Just as an example, if you are the pilot and you’re going on a long flight and you know you’re sleep deprived already, don’t have your phone when you have your coffee in the morning – just put your phone away and have it on silent, so you actually have five minutes, 10 minutes to yourself and reconnect with yourself and the task you have, and just enjoy the coffee, and then go, “OK, now I’m ready for the day, turn my phone on and go on a flight and be ready for work”. Just small things during the day will already help the brain to change again.

AA: Can you give us more detail on the “three pillars”?

AK: What we see normally is just if you’re stressed, go exercise, and you get endorphins, and you feel good, and you’ll be fine. What we have also seen is this: when you’re chronically stressed, it’s not enough, and that’s really the key. So, the first pillar is restoring it, where we have looked at nutrition, exercise, and sleep, so our brain has a basis to cope with stress. Then, two, regain control. We make micro-decisions about our lives, where we’re not just pushed in our work and just going through the motions where we have to be, but taking active control. The last pillar is reconnecting with your personal self and with the people around you and your friends – even the Friday drinks. When we think we’re really stressed, we will never be arriving there, because it’s all too much, it’s too noisy, it’s everything. So, these three pillars together have shown that you can alleviate stress symptoms and, over time, reverse them by understanding where they’re actually coming from and what the brain does under chronic stress.

AA: What industry-wide or policy changes are needed to help reduce the incidence of chronic stress?

AK: They have excellent training programs for safety, for human factors. I think the missing point, from my experience in neuroscience, is understanding that the brain changes so much earlier than we see the real stress symptoms. We have to connect with and train people, and understand and educate them early on about what the brain does in the workplace, before symptoms arise and before we become fatigued. That, I think, is the clue to moving forward into a healthier profession.

The people who have done the program felt empowered because all of a sudden they knew, “My back pain is the weakest part of my body; if I’m really stressed, I get these symptoms again”. Because they can put it together now – stress and this pain – they will know exactly. Then it’s, “Did I do my exercise? Did I reconnect? What didn’t I do? What did I let slip in my day-to-day life?” So, they go back and really can focus on what they have learned, and can alleviate immediately the pain in that case, and then they are more satisfied at work, they feel more empowered actually to do their job and do a good job. They do want to do a good job, and don’t want to be fatigued – nobody wants to be chronically stressed and have symptoms. We want to go through our lives feeling really strong and empowered.

I’m a neuroscientist, I’m not a policy maker, but what I do think is if a forward-thinking airline pilot association would take the program on, and to see if this really empowers the pilots to bring less stress into their jobs, and the incident rates can come down more than the 10 per cent over the last 10 years, then we have won – and even if we have one less incident, then we have saved someone’s life.