It seems there is still much to be done to create a post-pandemic world. The calendar has turned the page, but the infection rates and death toll continue to rise, especially in California. The vaccine provides hope that we will be beyond the grip of the pandemic, but we can't really be sure when that will be. Even when the pandemic eases its impact on each of us will be felt for years to come, including some that are unimaginable now. COVID-19 has become synonymous with stress, axiety, and burnout. So let's talk about pushing back against stress, axiety and burnout by creating and improving resilience.
Key Concepts of Burnout
Burnout, a psychological syndrome, was originally defined by Christina Maslach and Susan Jackson in 1981 as something that happens in the workplace. Put simply, it’s the often the result of too many demands and not enough resources to succeed (or the perception of such). This work led to the development of the Maslach Burnout Inventory (MBI). Today there are several versions of the MBI tailored to specific professional populations including medical personnel, educators and students. For a complete list of MBI versions check out this resource.
If you think you are feeling burned out it might be time to complete the MBI and get your baseline. Here’s a free online stress test that is very similar to the copyrighted MBI. The results can help you determine where to start with developing improved resilience. Not sure if you’re burned out?
Have you felt overexhausted or emotionally drained by any of these?
- Listening to people complain about the same thing
- Doing your best with little appreciation for your work
- Dispensing advice to people who don’t value your feedback
- Unhealthy dialogue with unhealthy people
- Doing things that don’t spark joy
- Lack of balance/harmony in your roles and duties
- High expectations at work, home, or in relationships
- Having a strong urge to control situations out of your control (source)
These examples highlight the three dimensions of burnout. Read the definitions below and ask yourself, which example(s) above corresponds with each dimension below. This will help you recognize where you may be struggling the most and corraborate your MBI results if you have them.
Emotional Exhaustion (EE) – A feeling of being emotionally overextended and/or exhausted as a result of chronic stress and personal and/or professional demands that exceed your available resources. When completing the inventory, the higher the score the more burnout is present.
Depersonalization (DP) – A sense of unfeeling and/or an impersonal response toward your co-workers, patients or other recipients of your services, attention or expertise. When completing the inventory, the higher the score the more burnout is present.
Personal Accomplishment (PA) – A sense of achievement or success in one’s work. When completing the inventory, the lower the score the more burnout is present.
For those of you in healthcare, you should also be aware of something called compassion fatigue and second victim syndrome. These are specific challenges for those of us in healthcare/patient care that can lead to burnout and in severe cases post traumatic stress disorder (PTSD) which is beyond the scope of this blog.
Compassion fatigue (CF) - Stress resulting from exposure to a traumatized individual. A convergence of secondary traumatic stress and cumulative burnout. A state of physical and mental exhaustion caused by a depleted ability to cope with one’s everyday environment. Professionals regularly exposed to the traumatic experience of people they service are particularly susceptible. (source)
Second Victim Syndrome (SVS) – Healthcare providers who commit an error (or witness an error) and are traumatized by the event manifesting psychological (guilt, shame, anxiety, grief, depression), cognitive (compassion, dissatisfaction, burnout secondary traumatic stress), and/or physical reactions that have a personal negative impact. (source)
Once you recognize your burnout and how you got here you can take steps to reduce it and improve your ability to feel engaged in your work, life or relationships. You will have the resources you need to meet the daily challenges you face (or delegate) and be able recognize and celebrate your successes. There are many ways to stave off burnout and lessen it as it creeps in, including social support, professional support, clarifying your priorities and delegating, and prioritizing self-care (sleep, exercise, and eating well). Resiliency training is one option among many.
Resiliency training, a.k.a. mental resiliency training, is often compared to physical strength training – it’s lifting weights for the mind. Here is a great introduction from the American Academy of Family Physicians (AAFP). The article discusses the resiliency tools reframing, self-compassion, appreciation and gratitude, self-awareness, and self-care. Consider the resiliency triangle (image below). Remember, resilient people have similar stresses in their lives as those seen as less resilient, it’s just that they have the coping skills and strength to address the stress(es) head on. Here are a few tips and resources for you to begin your own resiliency training routine.
Positive reframing is the ability to take something negative and view it from another perspective and make it a positive – to find the silver lining. You ever hear a story where two people experience the same event and while one walks away from the situation saying, “I’ll never do that again”, the other may say, “Next time I try this I need to remember…” Another way to think of reframing is, it is not what happens to you, but how you respond to it. This article walks through the basics of reframing and provides examples of how reframing works.
The AAFP takes the next step and looks at reframing in patient care/healthcare situations. For example, how can you reframe each of these situations? Reflect on your own experiences with each of these and then check out this AAFP article for their perspective.
The rude patient?
The non-compliant patient?
The talkative patient?
Paperwork and documentation?
These techniques can also be transitioned to your personal life and non-patient relationships. For those of you who work with athletes, teaching them positive reframing could help them improve their performance.
The opportunity for self-care seems to be the first thing to go when the stress gets high, but this is one of the most important things we can do to maintain and increase our resilience. Many of you reading this are probably frayed, tired, and wondering when things are going to get back to normal – COVID-19 has challenged us all. It’s important, even when other things seem more important, to continue to take care of yourself even if you feel like you don’t have time. Check out this article from Mental Health First Aid USA who reminds us self-care doesn’t have to cost anything and can happen in 10 minutes or less. Use that mindfulness app to breathe and focus between patients, or while waiting for your groceries to come to your car. There are also muscle relaxation videos out there to help get rid of the physical manifestations of your stress. Get out for a walk in the sun, the earlier in the day is better – the science shows that bright light kick starts our circadian rhythm and improves our mood for the day. Walking is a great way to make sure to have some sort of exercise routine and can be great for taking quick breaks from our daily stresses. Have something that you really enjoy that relaxes you and can integrate into your workday? Perfect. Add it to your routine and see your resiliency strengthen.
Resources for self-care:
- Exercise – 10 tips from Harvard University
- Nutrition – Tips for eating with a busy schedule from Cal - Berkeley
- Sleep – 17 Tips for Getting Good Sleep
- Relaxation – 17 Ways to Create a Relaxed Workday
Gratitude is the concept of being thankful for what you have and/or appreciating the goodness in your life (source). The concept of gratitude has been discussed repeatedly in recent years. It is a powerful tool for building resilience, positivity, happiness, and health. There are also a wide range of strategies and techniques that you can utilize to express gratitude. Gratitude can also be a part of your reframing practice – focusing on what you have as opposed to what you don’t. The science is still mixed on many of the potential physical impacts of gratitude, but there is potential to improve your sleep, reduce headaches, stomach pain and symptoms of depression. The psychological impact is clearer with people reporting increased optimism, improved relationships, happiness and a sense of calm across various studies.
Ways to practice gratitude include daily gratitude journals, sending thank you cards, volunteering, and practicing mindfulness to suggest a few. For those who prefer, praying is also a form of showing gratitude. We each have a lot to be grateful for, even in these challenging times – just remember to look around and share your gratitude with others.
Resources for gratitude:
- Online gratitude journal – Thnx4
- At work – 5 tips for cultivating gratitude
- At home – 6 ways to infuse gratitude
- For happiness – 20 ways to practice
Let the resiliency training begin, one step at a time. In the meantime, stay safe, take care of yourself and your families. Most of all, thank you for all you do.
Disclosure: The content contained in this blog is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician, athletic trainer, or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately.
Image Credit: Photo by American Academy of Family Physicians (AAFP)