As a medical student or resident, there’s a good chance that you’re living in a daunting world. Maybe your week looks something like this: It’s Wednesday afternoon and you’ve got a group project due on Friday. There’s an exam Monday that you’re behind on studying for. It’s your mother’s birthday celebration this weekend, but you are going to be post-call, and can probably sneak in a piece of cake after your mandatory 2 hours of afternoon sleep. Despite the need to accomplish 12 things, you feel the capacity to do nothing.

In times of crisis, simplicity reigns supreme. When a trauma patient comes in and needs resuscitation, we always return to the ABCs – airway, breathing, circulation. The ABCs can also be applied to venues outside the trauma bay. When the strength of life valsalva’s up on you, it’s nice to have a simple framework to return to. Let us have a look at the ABCs of busting out of a rut.

A = Attitude/Gratitude

There is no more powerful tool in changing your mindset than re-framing your situation. In difficult situation, we often receive trite advice like “look on the bright side!” When done systematically, however, there is real power in taking a step back, and approaching your situation from another angle. When work is burning you out, you can always fall back on the fact that you are doing the noblest of deeds for someone in need. Did you blow your IVs and forget to include the obvious diagnosis in your differential? These are learning experiences. Just about any situation you encounter can be re-framed as a positive. Let the rough patches be opportunities to exude virtue and rise above adversity. That is growth.

Remember the words of Marcus Aurelius, stoic philosopher of ancient Rome: “The impediment to action advances action. What stands in the way becomes the way.” By conquering obstacles, your problem-solving muscle grows stronger, and future problems will shrink in comparison.

In addition to having the right attitude and properly framing a situation, expressing gratitude in a systematic way can actually work transform you into a sunnier, more optimistic person. (For the non-believers out there, PubMed is riddled with examples of the positive effects of gratitude training. Check out this 2016 meta-analysis: Thankful for the little things: A meta-analysis of gratitude interventions). The best way to begin this practice is to carve out just a few minutes at some point in the day (e.g. immediately upon waking, just before bed) and think about that which you are grateful for, everyday. Even on days where you are berated by attendings and patients alike, you can still find something to be grateful for.

B = Breathing

Something you and your trauma patient have in common: you like to breathe. And whether you realize it or not, your stressed breathing is likely shallow. Exercise that vital capacity (expiratory reserve volume + tidal volume + inspiratory reserve volume) and take a few enormous deep breaths at whatever speed feels right. Need some extra energy? Do it quickly and call upon your cardiac output to keep up. Trying to relax? Take some nice long slow exhalations to increase that vagal tone and cool out for a bit. The mere focus on your breathing patterns can help pull you out of whatever silly tangents your mind is heading down and pull you back into what is happening right here, right now.

C = Circulation

Sounds familiar?! A big driver of mental stagnation is physical stagnation. It is way easier to feel mentally miserable when you are laying in bed or killing time on the couch. When was the last time you were actively physically exhausting yourself and felt your mind in another place? Go for a hard run, lift some weights, ride your bike. Not only will your body appreciate the catecholamine surge, but your mind will appreciate the change of scenery. If you want to push your circulation to the next level, take a cold shower after your hard workout. The visceral experience will help snap you out of any negative thought loops.

D = Dig for Drive

Aren’t you glad it didn’t stand for disability? After completing A, B, and C, you should be in a much better spot to dig down and rediscover your drive. At face value, anyone reading this blog has a strong drive to succeed. It is known by many names: determination, will, fortitude, desire. Whatever label you give it, drive is something that has gotten you to this point, and still lives inside you. Sure, sometimes it is more occluded by doubt and mental gridlock than a diseased coronary, but it is always there. Think back to a time when you were running on eight cylinders, feeling invincible, and conquering anything that stood in your path. Visualize this situation, really ponder it deeply and feel yourself in that power position. Then remember that this was you—this is you; the very same person.

E = Evacuate

This one works in two ways. If you are still feeling beat down and useless after all of the above, there are some last-ditch effort strategies that can help. Think about all those negative thoughts that might be spiraling around your cerebrum. I recently did this exercise and came up with words like “useless,” “boredom,” and “underperforming.” In this exercise, you are going to take the words and feelings, and put them on a piece of paper. After you write them out, and envision the translation of the negative thought patterns from brain to paper, take the paper, crumple it up, and cathartically dispose of it.

Thereafter, you can physically evacuate. Get to a new spot, and if nothing else, definitely get out of the house. Inertia pours on thick when trapped inside at home. Do what it takes to go anywhere: into a store, into a rainstorm, a friend’s house, a park, a coffee shop, a library… anywhere but home.

We hope that you can employ this simple framework next time your mindspace fills with clutter and your life and work grind to a halt. Remember, everyone feels this way sometimes, and there are ways out — having a systematic plan can help bust you out even sooner.