PRACTICAL APPROACHES TO PRACTICAL APPROACHES TO WORKING AS A HEALTH CARE WORKING AS A HEALTH CARE

PROFESSIONAL:PROFESSIONAL:Building ResistanceBuilding Resistance

Staying MindfulStaying MindfulAdding FlexibilityAdding Flexibility

Taking Charge of Your HealthTaking Charge of Your Health(OR…How to Prevent Burnout!)(OR…How to Prevent Burnout!)

Kate M. Hathaway, Ph.D.,L.P.Kate M. Hathaway, Ph.D.,L.P.

Clinical Health PsychologistClinical Health Psychologist

BEHAVIORAL HEALTH BEHAVIORAL HEALTH LEARNING OBJECTIVESLEARNING OBJECTIVES

DPT 7100DPT 7100 Identify physical, cognitive and emotional Identify physical, cognitive and emotional

ways to cope with stressways to cope with stress Consider your view of yourself as a person Consider your view of yourself as a person

independent of your work and also as a independent of your work and also as a health care professionalhealth care professional

GOALSGOALS

Identify the factors that influence stress Identify the factors that influence stress levels in humanslevels in humans

Identify the physical, cognitive and Identify the physical, cognitive and emotional components of stress and emotional components of stress and burnout symptomsburnout symptoms

Identify physical, cognitive and emotional Identify physical, cognitive and emotional ways to cope with stressways to cope with stress

Learn how to take care of your own healthLearn how to take care of your own health Consider your view of self as a health care Consider your view of self as a health care

providerprovider

REVIEW: COMPONENTS OF REVIEW: COMPONENTS OF STRESS RESPONSESSTRESS RESPONSES

PHYSICALPHYSICAL Heart rate, breathing, muscleHeart rate, breathing, muscle

COGNITIVECOGNITIVE Intense concentration on stressorIntense concentration on stressor

EMOTIONALEMOTIONAL Less access to emotional reactionsLess access to emotional reactions

SOCIALSOCIAL More inward-focused, withdrawal from social More inward-focused, withdrawal from social

interactionsinteractions

LOOKING AT “STRESS”LOOKING AT “STRESS”

Stress Is Adaptive (Survival of fittest)Stress Is Adaptive (Survival of fittest) Can We Re-define Stress as A Learning Can We Re-define Stress as A Learning

Tool? – A Positive ExperienceTool? – A Positive Experience Acceptance: Life Cannot Be Stress-freeAcceptance: Life Cannot Be Stress-free

See Noble Truth #1, Buddhism!See Noble Truth #1, Buddhism!• There has never been a time in history without There has never been a time in history without

war, disease, abuse, sufferingwar, disease, abuse, suffering• Our colleagues are not perfect either!Our colleagues are not perfect either!• Life is busy, distracting and confusingLife is busy, distracting and confusing

Re-Defining: SEEING THE Re-Defining: SEEING THE POSITIVES OF STRESSPOSITIVES OF STRESS

POSITIVES OF STRESS:POSITIVES OF STRESS: AlertnessAlertness Challenge-based – increases self-confidenceChallenge-based – increases self-confidence Learning occurs and coping improvesLearning occurs and coping improves Interpersonal problem-solvingInterpersonal problem-solving

……AND THE NEGATIVE AND THE NEGATIVE EFFECTS OF PROLONGED EFFECTS OF PROLONGED

STRESS?STRESS? Morbidity: Unhappiness, anxiety, strained Morbidity: Unhappiness, anxiety, strained

relationships with others, “burnout”relationships with others, “burnout” Mortality: Yep – you probably won’t live as Mortality: Yep – you probably won’t live as

long!long!

BURNOUTBURNOUT

Results from excessive/prolonged stressResults from excessive/prolonged stress Stress can be adaptive; burnout is notStress can be adaptive; burnout is not Results in decreased productivity, feelings Results in decreased productivity, feelings

of powerlessness, isolationof powerlessness, isolation Signs: Extreme frustration, irritability, Signs: Extreme frustration, irritability,

sadness, difficulty with colleaguessadness, difficulty with colleagues

NOTE: Stress and burnout are defined by NOTE: Stress and burnout are defined by the the personperson, not only by the situation, not only by the situation

GENERAL WORK-RELATED GENERAL WORK-RELATED FACTORS THAT INFLUENCE FACTORS THAT INFLUENCE

BURNOUTBURNOUT

Too many responsibilities/demandsToo many responsibilities/demands Too few responsibilities/demandsToo few responsibilities/demands Role ambiguityRole ambiguity Lack of control (perceived or real)Lack of control (perceived or real) Lack of new challenge or diversity in work Lack of new challenge or diversity in work

contentcontent

OTHER FACTORS: HEALTH OTHER FACTORS: HEALTH CARE PROVIDER CHALLENGESCARE PROVIDER CHALLENGES

Focus on pathology (seeing the negative)Focus on pathology (seeing the negative) Looking to technique as solutionLooking to technique as solution Focus on treating disease, illness and Focus on treating disease, illness and

pathology versus building healthpathology versus building health

HEALTH CARE PROVIDER HEALTH CARE PROVIDER ISSUES THAT INFLUENCE ISSUES THAT INFLUENCE

BURNOUTBURNOUT Health care perspectivesHealth care perspectives

Beliefs about the roles of health care Beliefs about the roles of health care professionalsprofessionals

Beliefs about the roles of patientsBeliefs about the roles of patients Beliefs about our ability to influence outcome Beliefs about our ability to influence outcome

with patients (ego-based)with patients (ego-based) There is a “right” and “wrong” way to provide There is a “right” and “wrong” way to provide

health carehealth care Struggles with the health care systemsStruggles with the health care systems

ADDITIONAL CHALLENGES FOR ADDITIONAL CHALLENGES FOR PHYSICAL THERAPISTSPHYSICAL THERAPISTS

Natural progression of work skills: Early focus on Natural progression of work skills: Early focus on techniquetechnique

Natural progression of work relationships and Natural progression of work relationships and habits of interactinghabits of interacting

Tendency to become or be seen as the authority Tendency to become or be seen as the authority on matters of rehabilitationon matters of rehabilitation

Tendency to tire of emotional work and avoid it in Tendency to tire of emotional work and avoid it in working with difficult patientsworking with difficult patients

Tendency to care-take others and forget oneselfTendency to care-take others and forget oneself Less desire to listen or care-take at home? Less desire to listen or care-take at home?

FALLACY-REALITYFALLACY-REALITY

““We are the experts; patients are the We are the experts; patients are the consumers”consumers”

““We know how the brain and body work; We know how the brain and body work; we can offer fixes”we can offer fixes”

REALITYREALITY

Only 25% of health care is provided by the Only 25% of health care is provided by the professional; 75% (or more?) is provided professional; 75% (or more?) is provided by the patient to him/herselfby the patient to him/herself

Humans do not like to focus on fear or Humans do not like to focus on fear or negativity (pathology)negativity (pathology)

We know really very little about the brain We know really very little about the brain or body and how they work, although we or body and how they work, although we know more than many othersknow more than many others

TO CONSIDER…TO CONSIDER…

““I believe that every person knows I believe that every person knows more about him/herself than more about him/herself than anyone else will ever know….”anyone else will ever know….”

- Physically- Physically

- Cognitively- Cognitively

- Emotionally- Emotionally

-Interpersonally-Interpersonally

Stress management, then, is an Stress management, then, is an individual individual challengechallenge

No one solution works for everyoneNo one solution works for everyone The environment may supply the The environment may supply the stressor;stressor;

the individual supplies the the individual supplies the copingcoping

COPING: BUILDING COPING: BUILDING PHYSICAL RESISTANCEPHYSICAL RESISTANCE

Increase physical strengthIncrease physical strength Increase physical adaptabilityIncrease physical adaptability Increase energyIncrease energy Decrease toxinsDecrease toxins Build antitoxinsBuild antitoxins Decrease heart rate, GI distressDecrease heart rate, GI distress

PHYSICAL: At Your DeskPHYSICAL: At Your Desk

STRETCH!STRETCH! POSTURE CORRECTIONPOSTURE CORRECTION FACIAL MUSCLE RELAXATIONFACIAL MUSCLE RELAXATION BREATHINGBREATHING LIGHTINGLIGHTING SOUNDSOUND AROMATHERAPYAROMATHERAPY NUTRITION, WATERNUTRITION, WATER

PHYSICAL: AnywherePHYSICAL: Anywhere

EXERCISEEXERCISE Walk at breaks? Lunch?Walk at breaks? Lunch? Less sedentary activity (decrease TV/computer?)Less sedentary activity (decrease TV/computer?)

SLEEPSLEEP 8 hours? naps?8 hours? naps?

GET OUTSIDEGET OUTSIDE Fresh air, new visual stimuliFresh air, new visual stimuli

NUTRITIONNUTRITION 4-6 times per day, nutritionally sound4-6 times per day, nutritionally sound Vitamins?Vitamins?

COPING: BUILDING COPING: BUILDING COGNITIVE RESISTANCECOGNITIVE RESISTANCE

Increase sense of controlIncrease sense of control Increase permission for optionsIncrease permission for options Increase plasticity in thinkingIncrease plasticity in thinking Decrease all or nothingDecrease all or nothing Eliminate the word “but”Eliminate the word “but”

COGNITIVE: At Your DeskCOGNITIVE: At Your Desk

INCREASE “I CAN” SENSE OF CONTROL; INCREASE “I CAN” SENSE OF CONTROL; DECREASE “I CAN’T” STATEMENTSDECREASE “I CAN’T” STATEMENTS

DECREASE “WOULD’VE,” “COULD’VE,” DECREASE “WOULD’VE,” “COULD’VE,” “SHOULD’VE”“SHOULD’VE”

PLAN, RE-ORGANIZE, PRIORITIZEPLAN, RE-ORGANIZE, PRIORITIZE INCREASE MINDFULNESSINCREASE MINDFULNESS DECREASE JUDGMENT, INCREASE DECREASE JUDGMENT, INCREASE

ACCEPTANCEACCEPTANCE MAKE MAKE VALUE-BASEDVALUE-BASED DECISIONS DECISIONS

COGNITIVE: AnywhereCOGNITIVE: Anywhere

MAKE MAKE VALUE-BASEDVALUE-BASED DECISIONS DECISIONS INCREASE ACCEPTANCEINCREASE ACCEPTANCE ADMIT OWN INFLUENCEADMIT OWN INFLUENCE ADD CREATIVITY TO YOUR ADD CREATIVITY TO YOUR

PROBLEM-SOLVINGPROBLEM-SOLVING REMAIN FLEXIBLEREMAIN FLEXIBLE

FLEXIBILITYFLEXIBILITY

““For a mind burdened with fear, with For a mind burdened with fear, with conformity, with the thinker, there can be conformity, with the thinker, there can be no understanding of that which may be no understanding of that which may be called the original…”called the original…”

• J. Krishnamurti, J. Krishnamurti, On FearOn Fear

COPING: BUILDING COPING: BUILDING EMOTIONAL RESISTANCE EMOTIONAL RESISTANCE

Be mindful Be mindful Practice staying in the momentPractice staying in the moment Identify feelings without judgmentIdentify feelings without judgment Practice joyPractice joy

““We consider bibles and religions divine…; I say they have We consider bibles and religions divine…; I say they have all grown out of you, and may grow out of you still;all grown out of you, and may grow out of you still;

It is not they who give the life – it is you who give the life.It is not they who give the life – it is you who give the life.Will you seek afar off? You surely come back at last, in Will you seek afar off? You surely come back at last, in

things best known to you, finding the best, or as good as things best known to you, finding the best, or as good as the best –the best –

Happiness, knowledge, not another place, but this place – Happiness, knowledge, not another place, but this place – not for another hour, but for this hour”not for another hour, but for this hour”

Walt WhitmanWalt Whitman

EMOTIONAL: At Your DeskEMOTIONAL: At Your Desk

PRACTICE OPTIMISMPRACTICE OPTIMISM FIND SMALL WAYS TO INCREASE JOY FIND SMALL WAYS TO INCREASE JOY

(PICTURES, TEAS, ETC.)(PICTURES, TEAS, ETC.) ACCESS MEMORIES – ESPECIALLY OF ACCESS MEMORIES – ESPECIALLY OF

TIME IN NATURETIME IN NATURE PRACTICE GRATITUDEPRACTICE GRATITUDE PRACTICE KINDNESS AND PRACTICE KINDNESS AND

GENEROSITYGENEROSITY

EMOTIONAL: AnywhereEMOTIONAL: Anywhere

IMAGINE PEACEIMAGINE PEACE Remember that the body and the spirit do not know the Remember that the body and the spirit do not know the

difference between what is imagined and what is difference between what is imagined and what is real….real….

FOCUS MORE ON CREATIVITY, LESS ON FOCUS MORE ON CREATIVITY, LESS ON PRODUCTIVITYPRODUCTIVITY

INCREASE SOCIAL SUPPORTINCREASE SOCIAL SUPPORT PRACTICE KINDNESS AND GENEROSITYPRACTICE KINDNESS AND GENEROSITY HAVE MORE FUN!!!!! LAUGHTER IS A GREAT HAVE MORE FUN!!!!! LAUGHTER IS A GREAT

STRESS REDUCERSTRESS REDUCER

REVIEW: COMPONENTS OF REVIEW: COMPONENTS OF STRESS REDUCTION STRESS REDUCTION

PHYSICALPHYSICAL Relaxation, BREATHINGRelaxation, BREATHING Build healthBuild health

COGNITIVECOGNITIVE Re-framing, re-interpretingRe-framing, re-interpreting Staying “in the moment”Staying “in the moment”

EMOTIONALEMOTIONAL Peace-givingPeace-giving

SOCIALSOCIAL Support of friends, family Support of friends, family

COMBINATION OPTIONSCOMBINATION OPTIONS

MUST HAVE A MUST HAVE A PHYSICAL, COGNITIVE AND PHYSICAL, COGNITIVE AND EMOTIONALEMOTIONAL COMPONENT COMPONENT Bonus points for breathing!Bonus points for breathing!

NO TIME PARAMETERSNO TIME PARAMETERS VARIETY IS THE SPICE OF LIFEVARIETY IS THE SPICE OF LIFE BE MINDFUL, BE PRESENT IN THIS MOMENT BE MINDFUL, BE PRESENT IN THIS MOMENT

AND TIME…AND TIME…

NOTE: There are likely gender, cultural and age NOTE: There are likely gender, cultural and age differences in coping…differences in coping…

OPTIONS FOR BUILDING OPTIONS FOR BUILDING EMOTIONAL AND COGNITIVE EMOTIONAL AND COGNITIVE

HEALTHHEALTH Relaxation exerciseRelaxation exercise Yoga, tai chi, qi gongYoga, tai chi, qi gong MeditationMeditation Self-hypnosisSelf-hypnosis Warm bath, hot tubWarm bath, hot tub Daily rituals: Prayer, Daily rituals: Prayer,

candle-lighting, water candle-lighting, water ritualsrituals

Music, sound, dancing, Music, sound, dancing, woohoo!woohoo!

LaughterLaughter MassageMassage

Light treatments, Light treatments, Time in nature – nature Time in nature – nature

imagesimages Story-telling or story-Story-telling or story-

listeninglistening MindfulnessMindfulness Social supportSocial support Animals, childrenAnimals, children Attention to the present Attention to the present

moment…moment… See CSH offerings, U of See CSH offerings, U of

MN (www.csh.umn.edu)MN (www.csh.umn.edu)

NOTICE…Trends in health NOTICE…Trends in health utilizationutilization

Increased utilization of CAMIncreased utilization of CAM Increased attention in psychological Increased attention in psychological

literature on “mindfulness,” mind-body literature on “mindfulness,” mind-body interactions, cultural proficiency, optimism, interactions, cultural proficiency, optimism, gratitude and generositygratitude and generosity DBTDBT -- Herbal remedies-- Herbal remedies MeditationMeditation -- Buddhist philosophy-- Buddhist philosophy YogaYoga -- Intercultural respect-- Intercultural respect

CHANGES IN HEALTH CARE CHANGES IN HEALTH CARE THAT BENEFIT ALLTHAT BENEFIT ALL

View health holisticallyView health holistically Connect body and mind (EXERCISE)Connect body and mind (EXERCISE)

Increase positive view of experiencesIncrease positive view of experiences View experience as way of learningView experience as way of learning We learn fastest from our mistakesWe learn fastest from our mistakes

Increase attention to Increase attention to acceptanceacceptance Increase attention to patient perspectiveIncrease attention to patient perspective

APPLICATION TO SELF: Looking APPLICATION TO SELF: Looking at Ways to Reduce Burnout at Ways to Reduce Burnout

View your own health holisticallyView your own health holistically Connect body and mind (EXERCISE)Connect body and mind (EXERCISE)

Increase positive view of experiencesIncrease positive view of experiences View experience as way of learningView experience as way of learning Note that we learn fastest from our mistakesNote that we learn fastest from our mistakes

Increase attention to acceptanceIncrease attention to acceptance Practice mindfulness: Attention and IntentionPractice mindfulness: Attention and Intention Increase attention to the other’s perspectiveIncrease attention to the other’s perspective

THOUGHTS FOR HEALTH CARE THOUGHTS FOR HEALTH CARE PROFESSIONALSPROFESSIONALS

Control scheduleControl schedule Add “transition” time to clear head and help with Add “transition” time to clear head and help with

preparation for next interaction (work and home)preparation for next interaction (work and home) Schedule work around family? Mental health days?Schedule work around family? Mental health days?

Practice mindfulness: Stay in the moment when Practice mindfulness: Stay in the moment when with patients and when with family and friendswith patients and when with family and friends

Ask for significant other’s wisdom, emotional Ask for significant other’s wisdom, emotional supportsupport

Peer reviewPeer review Build spiritual practiceBuild spiritual practice Practice non-emotional generosityPractice non-emotional generosity Schedule breaks with purposeSchedule breaks with purpose

Walk, nap, meditate, yoga, stretch, eatWalk, nap, meditate, yoga, stretch, eat

TAKE CHARGE OF YOUR TAKE CHARGE OF YOUR HEALTH DOMAINS:HEALTH DOMAINS:

LIFE LONG LEARNINGLIFE LONG LEARNINGSEE TCOYH at www.csh.umn.eduSEE TCOYH at www.csh.umn.edu

Life purposeLife purpose Self-care and Self-care and

preventionprevention Stress masteryStress mastery Emotional healthEmotional health

Physical activity and Physical activity and fitnessfitness

Diet and nutritionDiet and nutrition RelationshipsRelationships EnvironmentEnvironment

SUMMARYSUMMARY

Stress is adaptive; burnout is notStress is adaptive; burnout is not Our responses to life challenges are influenced Our responses to life challenges are influenced

by our by our perspectivesperspectives (cognitive), our (cognitive), our emotional emotional reactionsreactions and our and our habitshabits

To build personal health and resistance (and To build personal health and resistance (and reduce burnout) address reduce burnout) address allall aspects of health aspects of health

ASSIGNMENTASSIGNMENT

Look at the eight domains of healthLook at the eight domains of health Self-assessSelf-assess Designate a plan for yourself to build Designate a plan for yourself to build

health in EACH of these domainshealth in EACH of these domains