Wellness Champion Retreat #2 GME Wellness Steering Committee April 11, 2018

Agenda Mindfulness exercise Group discussion Resilience: chapters 1-3 Visual imagery exercise

Are You Burned Out? American Psychiatric Association Wellness Oldenburg Burnout Inventory www.psychiatry.org/psychiatrists/ practice/well-being-and- burnout/assess-yourself Oldenburg Burnout Inventory is validated for evaluation of academic burnout. Available for free on APA website under wellness and burnout.

What is Resilience? “The forces of fate that bear down on man and threaten to break him also have the capacity to enoble him” -Elisabeth Lukas 90% will experience 1 serious traumatic event in our lives. Picture Victor Frankl, Man’s Search for Meaning, a must read for all, especially residents.

APA Definition “the process of adapting well in the face of adversity, trauma, tragedy, threats and even significant sources of stress—such as family and relationship problems, serious health problems, or workplace and financial stresses” American Psychological Association 2009

How Can We Measure Resilience? Connor-Davison Resilience Scale Response to Stressful Experiences Scale Connor Davison Resilience Scale 2, 10, or 25 questions. Not free. $1/usage

Real-life Resilience What can we learn from Jimmy Dunne’s story? Crucial decisions: 1. “do right by the families” 2. find a way to carry on with business. Rebuilding became a moral imperative. He acknowledged that at quiet times, he was upset, staying busy with a purpose helped.

Resilience Factors Realistic optimism Facing fear Moral Compass Spirituality/Religion Social Support Role models Exercise Cognitive & Emotional training Cognitive & Emotional Flexibility Find your purpose the ability of a substance or object to spring back into shape; elasticity. Resilience: The Science of Mastering Life’s Greatest Challenges. 2016. Drs. Southwick and Charney

Resilience Factor #1: Optimism "Optimism is a fuel for resilience, provides the energy to power the other resilience factors" Definition = future oriented attitude, hope and confidence things will turn out well.

Optimism Measure How optimistic are you? Life Orientation Test - Revised

Styles of Optimism Dispositional optimism = trait type, that pervades one's overall outlook Situational optimism = one is hopeful for a favorable outcome in one situation but not another.  Deborah in the book born with the spinal lipoma, becomes a Paralympics swimmer and Yale grad. 

Realistic Optimism A realistic optimist pays attention to negative information relevant to the problem, but do not focus on the negative. They disengage from problems that seem unsolvable, and turn their energy to problems they believe they can solve. 

How Does Optimism Influence Resilience? Positive emotion  Increase attention/ behavior responses Increased creativity, flexibility 3 positive coping skills from this: Positive reappraisal Goal oriented, problem based coping Infusion of meaning into everyday events Broadened attention leads to 3 positive coping skills: 1. positive reappraisal 2. Goal directed, problem focused coping 3. infusion of meaning into everyday events

Case Presentation A pediatric resident is at the end of a stressful overnight call in the ICU.  She is ruminating about her decisions with a very difficult case, when a nurse approaches her with a list of negative feedback about her handling of that patient in front of her senior resident.  The resident feels like a failure and wonders if she is even cut out to be a physician.  You are the attending/senior resident that overheard this interaction.  1. Identify the "pessimistic" thinking. 2. As the supervisor, how can you bring some optimistic coping skills to this tired resident? 

Case Reflection Pessimistic Thinking? Negative cognitive distortions Permanence (negative consequences will last forever) Universality  Optimistic Approach? Positive reappraisal, cognitive reframing Consequences are temporary and limited in scope Internal locus of control – what I can I learn from this for next call? 

Enhancing Optimism Refute negative thinking Increase positive thinking

When Something Bad Happens This will not last forever Keep the negative event right where it is, not pervading other areas of life Have positive people or actions you can do  Notice acts of kindness even in a tough time

When Something Good Happens Let yourself feel good about your part Be grateful for the others that helped the good thing happen Get the most out of it: remember this good thing, share it with yourself in a journal, with a close support, etc. 

Enhancing Optimism: Gratitude Practice 1. Positive Reflection Exercise Start the morning with an intention for the day End the day with 3 specific events/interactions of the day you are grateful for. Recall these in the morning. 2. Gratitude Journal Write 1-3/week for 10-15min, 5 things you are grateful for from the day with very specific details. See handout. Emmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well- being in daily life. Journal of Personality and Social Psychology, 84(2), 377- 389.

Resilience #2: Facing Fear 1. View fear as a guide 2. Fear can be an opportunity 3. Examine the fear 4. Learn and practice skills to master fear 5. face fear with friends and colleagues 6. Use spiritual support to face fear "To conquer fear, one must face fear. That's what resilient people do" "I am fearful about this procedure, but how exciting if I can be one of the few people who can practice it and master it" 

Case #2: Facing Fear A psychiatry intern is assaulted by a psychotic patient on the unit.  It was not her patient, and she had not seen the patient heading toward her.  She calls the chief resident and program director, and leaves early for the day.  How do you guide this resident on facing her fear of returning to work? 

CBT Resources EAP Dawn & St. Louis Behavioral Medicine Institute CBT podcast 5 conversations on anxiety  https://cbtradio.libsyn.com/ Overcome anxiety and worry, Mark Reinecke

Thank you, and be well!