KATHY DERVIN, PSY.D. SGU Psychological services center Preventing Burnout KATHY DERVIN, PSY.D. SGU Psychological services center

What is burnout? A state of mental and/or physical exhaustion caused by excessive and prolonged stress1 Burnout syndromes characterized by: Emotional exhaustion Depersonalization (cynicism) Diminished sense of personal accomplishment Burnout is defined as a psychological syndrome in response to chronic interpersonal stressors on the job, which creates of feeling of being emotionally exhausted, depersonalized (ie, feeling emotionally detached), and diminished sense of personal accomplishment

Types of stressors Physical Financial Psychological Spiritual Familial Social Academic Physical- can result from internal physical symptoms and external physical conditions Psych- can arise from time pressures or unrealistic expectations we place on ourselves or allow to be placed on us by others; “you must know everything” or “you must suppress feelings at all costs” “physicians don’t have anxiety, depression, etc.” Family- med students face competing time demands for family and education; family problems can tax resources such as time or money Financial-common for med students; loans, not being able to work while in school; decision-making about amount of loans to take Spiritual-arises when basic spiritual beliefs are being challenged, questioned, reformulated, disregarded, or when time constraints impede on spiritual growth or attendance at services Social- can arise in any context where interpersonal relationships exist; loss of contact with friends/family due to time constraints can lead to feelings of loneliness; stress can also result from continued contact with indivudals who don’t share values and beliefs Academic- change with progression through school; first two years, students face competition and fear of failure,

Stressors in Medical School Dramatic lifestyle changes Heavy academic workload/clinical caseload Perceived need to excel at all costs Lack of control/autonomy Limited support systems Time pressure and demands Disillusionment Frenetic, intense pace of training Responsibility for patients Death and dying

What causes burnout? Individual traits may factor as risks but situational factors play a predominant role Potential situational causes: Heavy workloads Limited control New moral and ethical dilemmas Unsatisfactory elements of learning environment + feeling one’s efforts are meaningless or irrelevant

Risk factors for burnout Perfectionism and control Sense that to reveal emotions equals weakness Overachievers/Type A personality Reluctance to ask for help Belief that physicians should not have needs Pressure that patients should always come first Same qualities that make physicians excel in their work can also place them at risk for burnout, such as perfectionism, Type A, and workaholism; culture of medicine has created unrealistic expectation of doctors to always put patients first, don’t have needs; in role as “healer” hard for doctors to accept help or admit when having challenges

Stress Process

Stages of Burnout2 1. Stress Arousal 2. Energy Conservation 3. Exhaustion Usually occur sequentially, progresses. Interventions can be made during any stage

Stage 1 – Stress Arousal Irritability, anxiety Bruxism Insomnia Forgetfulness/poor concentration Gastrointestinal disorders Headaches Self-medication As you can see, stress arousal includes physiological and psychological responses. With the presence of any two of these, one may be experiencing stage 1-stress arousal

Stage 2 – Energy Conservation Lateness, procrastination Excessive time off Decreased sex drive Fatigue Social withdrawal Increased substance abuse Energy conservation attempts to compensate for stress. If those strategies fail, it can result in above in addition to increased cynicism and resentment, and excessive apathy. Again, any two of these symptoms can indicate one is in stage 2-energy conservation

Stage 3 - Exhaustion Chronic sadness or depression Suicidal ideation Chronic GI problems and/or headaches Social isolation Substance Use Disorders Unethical behaviors Where most people finally get the sense that something is wrong. Remember that burnout is usually a sequential, progressive process so there is the opportunity to recognize symptoms early on and take steps to address before it progresses. Again any two symptoms can indicate one is in stage 3-exhaustion

Negative Outcomes Addictive behaviors Relationship distress Emotional/behavioral problems Loss/lack of spirituality Academic consequences Death/suicide Addictive bx- increased use of substances to cope with stress places an individual at much greater risk for developing substance use disorders Relationship distress- depersonalization may arise as a protective mechanism in healthcare professionals in order to minimize emotional involvement that can interfere with fx in crisis situations; in moderation, “detached concern” toward patients is appropriate and necessary, but when excessive can lead to callousness and cynicism with subsequent negative effects on physician-patient relationship Emotional/bx conseq- emotional exhaustion is caused by the excessive demands made on people helping people, which can lead to low morale, reduced effectiveness, burnout, and health probs Academic conseq- feelings of diminished personal accomplishment are reflected in symptoms of stress, depression, and sense of inefficiency and diminished competence; with such feelings, an individual can feel that his/her actions no longer can or do make a difference, which can in turn affect physician-patient rel’ship, patient satisfaction. Burnout can become so severe can adversely affect health or unaddressed depression, etc. can lead to suicide

Preventing Burnout Maintain a sense of optimism Work on friendships and support systems Self-care/not overextending Exercise/eating habits Sleep habits Leisure time Hobbies Sense of humor Choose specialty wisely Seek help Cannot avoid stress altogether, rather it’s about recognizing and managing stress such that we can avoid the negative consequences of stress We all have at least a tiny little kernel of optimism, and can take steps to cultivate it. Optimistic role models, mentors, peers; staying connected to reasons for being in medicine Not just on maintaining friendships and supports, but on utilizing them! Hear very often that students don’t want to talk about it if having problems because don’t think others will understand or be burdened- remember that people are there to support, don’t have to do it on your own! Exercise obviously great way to release stress and enhance health, relieve anxiety, elevate mood; sleep obviously important; leisure time also important-helps with dealing with stress, increasing productivity, enhancing contentment Nurturing other aspects of personality (e.g., creativity) important for overall well-being; maintaining a sense of balance can help on feel more optimistic and as a result, able to study and comprehend the work being asked of you more effectively and efficiently Sense of humor- helps with keeping stresses in perspective,

If you need more help… Psychological Services Center (PSC) 439-2277 Campeche Building (behind Bourne, above Accounts department) www.sgu.edu/psc - presentation slides available on website

References 1. Hurd, C.L., Monaghan, O., Patel, M.R., Phuoc, V., & Sapp, J.H. (2013). Medical student stress and burnout. Committee on Physician Health and Rehabilitation. 2. Girdano, D.A., Everly, G.S., & Dusek, D.E. (1996). Controlling stress and tension: A holistic approach. Needham Heights, MA: Allyn & Bacon. Burnout defined as psychological syndrome