Resilience, Stress and Burnout Steve Blades, GP Tutor, Appraiser and Executive Coach

Aims Appraisers will be more able to Promote resilience in doctors Recognise signs of stress and burnout Help doctors to understand the causes of their stress Promote change to reduce stress

What is Resilience? A set of flexible cognitive, behavioural and emotional responses to acute or chronic adversities which can be unusual or commonplace These responses can be learnt Coming back from adversity (not bouncing back) (Neenan, 2009)

Coping with pressure Thinking Behaviour Health related activities

The Power of Thinking “Man is disturbed not by things but by the views he takes of them” (Epictetus, AD ) “My life has been full of terrible misfortunes most of which have never happened” (Michael de Montaigne)

Strengths underpinning resilience High frustration tolerance Self acceptance Self belief Humour Perspective Curiosity Adaptability Meaning

Behaviour Support networks Reflection Assertiveness Avoid procrastination Develop goals Time management Work – life balance

Health Issues Alcohol Caffeine Exercise Nutrition Smoking Relaxation

What is Stress? “Stress occurs when pressure exceeds your perceived ability to cope” (Palmer and Cooper, 2007) “The adverse reaction people have to excessive pressures or other types of demand placed on them” (Health and Safety Executive)

Model of Stress External pressure or life event Perceived as stressful Stress response: psychological, behavioural and physiological Reappraisal of the situation Stress responses fail to remove or modify causal factor Physical and/or psychological illness Palmer and Cooper, 2007

Stress Arousal Curve Performance Pressure

Causes of Stress Work Relationships Health Housing issues Financial issues Bereavement Carer issues etc. etc.

Stress and Doctors Excessive workload Dealing with suffering and constant demands Dealing with uncertainty Dealing with one’s own mistakes or fear of them Lack of professional support Externally imposed change Boredom Reluctance to seek help

Causes of Stress at Work 1. Demands 2. Control 3. Support (Manager and Colleagues) 4. Relationships 5. Role 6. Change Health and Safety Executive Management Standards

Stimulus and Response Stimulus Response Gap = Choice Response-ability

The ABC Model A – Activating event or situation B - Beliefs about the event C – Consequences emotional, such as anxiety or anger behavioural such as aggression or avoidance physiological such as palpitations, shaking

Unhelpful thinking patterns All or nothing thinking Labelling Overgeneralisation Disqualifying the positive or focusing on the negative Magnification or minimisation Thoughts and feelings equalling reality Using should, must or ought statements Use of dramatic language Personalisation Mind reading or predicting the worst

Perfectionism High standards and conscientiousness Self criticism Chronic doubt and guilt Exaggerated sense of responsibility High demands of others and difficulty delegating Procrastination Frustration with inefficiencies

Mindset (Carol Dweck) Fixed mindset Growth mindset Implications for feedback

Burnout Maslach’s triad of burnout Emotional exhaustion Depersonalisation Reduced accomplishment

Role of Appraisers Listening ear External view Promote resilience Recognise stress and help identify causes Develop action plan Signpost to other resources Recognise sick doctors

Problem or Puzzle?

Advice giving doesn’t work - Suggests one is wise and sensible and the other is weak and needy Undermines partnership ‘Why don’t you …? …Yes, but …? It discourages person taking responsibility for themselves If advice is taken, goes wrong – it’s your fault! Unlikely you tell them anything they didn’t know

PUSH PULL solving someone’s problem for them helping someone solve their own problem NON-DIRECTIVE DIRECTIVE LISTENING TO UNDERSTAND ASKING QUESTIONS THAT RAISE AWARENESS MAKING SUGGESTIONS GIVING FEEDBACK OFFERING GUIDANCE GIVING ADVICE INSTRUCTING TELLING REFLECTING PARAPHRASING SUMMARISING The Coaching Spectrum M Downey, Effective Coaching 2003

Further Reading Developing Resilience by Michael Neenan How to deal with stress by Stephen Palmer and Cary Cooper Mindset by Carol Dweck The Chimp Paradox by Steve Peters

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