How can health professionals avoid burnout by recognising and cultivating emotional awareness and self-compassion?

Health professionals deal with pain, suffering and disease every day. We diagnose disease, make a treatment plan and implement therapeutic measures. We deal with others’ difficult emotions mostly by translating them into prescribed action plans. Making sense of the difficulties by transforming them into action plans, diagnostic procedures, treatment steps, and so on, is foundation to the medical professional. We alleviate patients suffering by acting in a knowledgeable and skilful way. We are experts of creating actions out of emotions.

Many of us start our professional journey stressed by the wealth and the depth of the emotions of our patients, and our own emotions. Fear, anxiety, pain, shame, guilt, frustration, anger, irritation, repulse, worry, concern, annoyance, guilt, frustration, and even arrogance… Almost never do we pause in our medical journey to ask ourselves the questions:

What do I feel?

How that feels in my body?

Why do I feel certain way?

How can I alleviate the suffering and the burden of my current emotion?

How can I be kind with myself?

Very often we are not even aware of emotionally charged stress, we are all wrestling with, in those early days of our professional careers.

We learn very quickly to deal with those difficult emotions similarly to how we deal with our patients’ emotions; by avoiding, ignoring, and “fixing them” – by quickly acting on them in various ways. We almost never give emotions sufficient attention and processing time. We rapidly translate them into manageable action plans. We quickly learn the management plans for a long list of medical conditions that our patients suffer from. Likewise, we learn new patterns of behaviour to cover-up and estrange our own emotions. We are trained to act and fix by acting. Very soon, we even start developing pride as a result of our increasing mastery over quickly learned new skills of healing the human body.

Somewhere along that journey we start disconnecting ourselves from our own fragile humanity and start divorcing our cognitive brains from our emotions. Even when our own bodies start sending signals for attention, we are quick to intellectualise and medicalise those signals. We treat ourselves the same way that we treat our patients: with careful knowledge-focused precision and management plans. We operate in “doing, fixing mode”.

We master our newly learned skills of healing and find comfort and joy in belonging to our medical group of respected health professionals. When we struggle with some new disease or problem, we know where to turn to, and who to ask. The medical profession is a very well organised trade with lots of safety barriers, mentoring and educational programs.

We slowly develop a sense of competency, relatedness and autonomy1 building blocks of wellbeing and progress. This is the classical trajectory of a medical student on the road to become a competent medical professional. This serves the medical professional and the community at large. When one fulfills these three basic needs, they feel good, capable and resilient. They function well and the whole medical system functions well.

However, we need to ask ourselves what happens when the rules of the game change? When a situation becomes unpredictable and we lose that sense of control, competency and autonomy. What happens when we feel that our knowledge and our mastery of medicine is not enough to alleviate our patient’s suffering. We experience a growing sensation of stress, which if not resolved threatens to develop state of burnout2. Prolonged and inappropriately addressed stress, or not addressed stress, leads to a burnout.

The recent COVID-19 pandemic imposed a prolonged situation of stress, whereby many medical professionals felt a loss of control, competency, autonomy and relatedness. All three of the foundational blocks of wellbeing disappeared, almost overnight. Collectively, we lost our known support structure. In a short period of time all the prerequisite elements of wellbeing and successful functioning were replaced with burnout. Essentially, medical professionals globally are facing an enormous new challenge. The burnout pandemic lies in the shadows of the COVID-19 viral pandemic.

Do we know how to protect ourselves? Do we know how to deal with our own emotions? How can we alleviate our own chronic stress and avoid burnout? Do we know where and how to start that journey of prevention and healing, without using the old model of action and translation? Can we learn to reverse the old model: “How can I fix this new situation by not paying attention to my feelings and quickly intellectualising a new action plan and management system?” into “What do I feel; Why; How can I accept with care and compassion my own feelings of suffering?”. In a nutshell, how can we still use our cognitive and knowledgeable brains while also making room for our emotions and compassion? To begin answering these questions we must first consider three central sub-questions:

What is chronic stress?

What is burnout?

How are chronic stress and burnout related, and how can we alleviate chronic stress and simultaneously prevent burnout?

Chronic Stress, Burnout, and Self-Compassion

There are two types of stress: acute stress and chronic stress. Chronic stress occurs when the body experiences stressors with such frequency or intensity that the autonomic nervous system does not have an adequate chance to activate the recovery response on a regular basis. This means that the body remains in a constant state of physiological arousal3.

Acute stress is often not harmful. It can even be beneficial, as it activates the sympathetic nervous system into a mode of action in order to correct for and remove threatening environmental stimuli. The best way to manage stress is to create a behaviour that can effectively resolve the newly threatening situation. This requires cognitive planning and behavioural adaptation. This chain of events reinforces sensations of competency and autonomy. We health professional are good at that. Cognitive planning and action plans are our ‘bread and butter’. Unfortunately, this new pandemic is lasting too long without a clear resolution and is rapidly changing, thus not allowing us to use this strategy of acute stress resolution. Instead, we are all dealing with chronic stress.

When stress lasts for prolonged period, without an effective response in a form of cognitive planning and behavioural action, it becomes chronic stress. Chronic stress carries with it interoceptive perceptions of hopelessness, helplessness, lack of competency, and lack of autonomy. The autonomic nervous system cannot relay its sympathetic branch to resolve the situation. It activates its dorsal vagal branch, which puts us in a freeze or faint reaction – the exact state one is in when they are experiencing the burnout3.Chronic stress without adequate resolution leads to burnout.

Healthcare workers are effective at caring for others but less effective at recognising and attending to their inner emotional needs. There are possibly many reasons for that. One potential reason is a lack of education in emotional awareness. Another potential reason is a lack of learned skills in self-compassion. Chronic stress often leads to burnout, “a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed”2. Burnout results when the autonomic nervous system changes gears from the sympathetic branch to the dorsal vagal parasympathetic branch3. According to the WHO2, burnout can be defined across three critical dimensions: “(1) feelings of energy depletion or exhaustion; (2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and (3) reduced professional efficacy.” In short, burnout can be conceptualised as stress running out of fuel.

Maybe emotional awareness and self-compassion are the basic grammar that we health professionals need to learn and implement in order to avoid chronic stress and burnout? For us to be able to help ourselves and our patients we might need to start developing a new knowledge of our emotions. Essentially, emotional awareness constitutes being aware of our transient and internal emotional states with patience, repetition and focused attention. Self-compassion, on the other hand, requires us to have the courage to gently accept these emotions (both pleasant and unpleasant). While emotional awareness builds our capacity to interoceptively gauge our inner emotional worlds, self-compassion enables us to approach this world with curiosity and kindness. Together, they provide us with essential countermeasures against the growing phenomena of chronic stress and burnout in the medical profession. There are likely many reasons underlying chronic stress and burnout that are not related to emotional awareness and self-compassion, but these two mental tools are worth addressing as they can be learned and cultivated4. And they are in big demand as prevention tools for imminent personal and collective burnout5. Learning skills of emotional intelligence with self-compassion could potentially be the new way of unravelling some of the accumulated chronic stress of the medical profession that the current COVID-19 pandemic has unearthed.

My proposition to all of us in the health profession is this: let’s start learning these essential human skills that somehow most of us have learned to neglect throughout our professional journey. We possibly need them now more than ever before.

References

1. Ng, J. Y. Y., Ntoumanis, N., Thøgersen-Ntoumani, C., Deci, E. L., Ryan, R. M., Duda, J. L., & Williams, G. C. (2012). Self-Determination Theory Applied to Health Contexts. Perspectives on Psychological Science, 7(4), 325–340. https://doi.org/10.1177/1745691612447309

2. World Health Organization. (2019, May 28). Burn-out an “occupational phenomenon”: International Classification of Diseases. Www.who.int. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases

3. Porges, S. W. (2001). The polyvagal theory: phylogenetic substrates of a social nervous system. International Journal of Psychophysiology, 42(2), 123–146. https://doi.org/10.1016/s0167-8760(01)00162-3

4. Paul Gillbert. (2014).” The origins and nature of Compassion focused therapy”. British Journal of Clinical Psychology. https://doi.org/10.1111/bjc.12043

5. Ioannidou, F., & Konstantikaki, V. (2008). Empathy and emotional intelligence: What is it really about? International Journal of Caring Sciences, 1(3), 118–123.