Robert C. Ciampi, LCSW -                                               Psychotherapist
Burnout: The Dangers of Acute and Chronic Secondary Stress
 
This essay was first presented to a group of social workers at a major medical center in northern New Jersey entitled, “Burnout: The Dangers of Acute and Chronic Secondary Stress.” (information presented in this article was taken from The Resilient Clinician by Robert J. Wicks and other clinical works). As we will see, burnout, as opposed to normal stress, can have major negative consequences to our health and well-being the longer it persists. I will outline how burnout develops, the physical and psychological signs to look for, the danger it presents to us, and ways to recognize and treat this debilitating condition.

The term burnout was first coined by psychologist Herbert Freudenberger in 1974 as “a depletion or exhaustion of a persons mental and physical resources attributed to his or her prolonged, yet unsuccessful striving toward unrealistic expectations, internally and externally derived.” And later, in 1980, psychologists Edelwich and Brodsky defined burnout as “a progressive loss of idealism, energy, and purpose experienced by people in the helping professions.” We can already begin to see from the quotes above that burnout is about “loss”, “depletion”, and “unrealistic expectations” of those who suffer from it.
 
What is the difference between stress and burnout? Stress is the response our bodies and minds have to the demands placed on them and the interpretations we assign to those demands. Stress involves too much: too many pressures that demand too much of one physically and emotionally. One may think, “I know I will feel better when the work is completed.” Burnout is a state of emotional and physical exhaustion caused by excessive and prolonged stress. Burnout is about not enough; being burned out means feeling empty, devoid of motivation, hopeless, and beyond caring. The thought may be, “I 
know it will never get better.” 
 
What are some causes of burnout? And how can we recognize it?
 
  • Vague criteria for judging success and/or inadequate positive feedback on our work
  • Guilt over perceived “failures” 
  • Using sick time or personal time to recharge ones “batteries”
  • Unrealistic goals that are daunting rather than motivating
  • Working with others who are also burned out
  • Lack of appreciation by superiors, coworkers, patients and their families
  • Trying to cope with our own issues while treating patients for the same problem
  • Having a “savior complex” – an inability to recognize what we can and cannot do in helping others in need

The above list outlines some of the causes of burnout that we, along with others around us, can add to and perpetuate over time. As we learned
in the above paragraph, stress involves too much, but once we have completed the tasks that stressed us out we can begin to breathe a sigh of relief. Burnout is continual stress over long periods of time in which we can never get out from under the constant pressure to perform. And once we become burned out, it becomes like a “dark hole” we fall into without any break in sight.

Who are most vulnerable to Burnout? Those who:
 
  • Work exclusively and intensely with distressed or demanding people
  • Are charged with the responsibility for too many individuals
  • “Personalize” their work
  • Have an inordinate need to save people
  • Are overly perfectionistic and idealistic
  • Feel guilty about not attending to their own needs
  • Like to fight for the underdogs
  • Experience “vicarious” PTSD – being traumatized by the clients trauma

Concerning “Vicarious” PTSD (being traumatized by the patients trauma) some questions to ask are:

  • Are you experiencing a blunting of affect, numbing, loss of feelings, or a tendency to avoid reminders of a past traumatic event?
  • Do you have a heightened sense or exaggerated sense of being startled?
  • Do you experience dramatic alterations in your outlook or world view?
  • Have you begun to demonstrate signs of antisocial behavior that was not present before working with your patients trauma?
  • Do you find that you are re-experiencing (your own) past traumatic events?
  • Are your basic interpersonal relationships becoming dramatically affected?

The answers to the above questions can be helpful in gaining insight toward signs of burnout in ourselves that we are often not aware of but perhaps others can see. We will next take an in-depth look, through additional questions, at ways to begin to develop a self-care protocol. By answering the questions below honestly, we may prevent or gain the strength to get physically and emotionally stronger in order to manage our lives in a healthier way:

  • How important and realistic is a self-care plan for you?
  • How have your past experiences set habits in motion that make self-care a challenge?
  • What is the ideal balance between work and leisure for you? Have you ever thought about this before?
  • How much exercise do you get a week? How much sleep? And how are your nutritional practices?
  • Do you use alcohol or drugs as a way to relax? 
  • How and with whom do you spend your leisure time?
  • How much quiet time do you set aside for yourself each day?
  • Do we follow our own advice we give to others? 

The answers to these questions can help bring awareness to what self-care aspects we may have forgotten or practices that may be detrimental to how we care for ourselves. We will now take a look at specific self-care behaviors that we may be lacking in our lives.




Time Management

How many people can admit to having a time management problem? Time management issues can be a sign of Burnout (I don’t want to go to work), control, passive-aggressive behavior, lack of prioritization, or the lack of being assertive. Can we learn to recognize our physical and mental limitations, access others or other resources for help, be better organized, or delegate more? And can we learn to be more assertive, actually say “no” to others or request small favors from them? Making some adjustments in this area can be a start in our self-help protocol.

Self-awareness
 
Self-awareness starts the process in making positive changes in our lives. Can we be aware of how stressed we really are which can lead to burnout? Can we gauge the intensity of a situation accurately, or do we tend to blow even minor issues out of proportion? Can we listen to others when they give us positive feedback or are we always on the defensive ready to bark back at them? And how honest can we be with ourselves regarding what is healthy and unhealthy in our lives? Being self-aware can teach us a lot about ourselves if we choose to look.

Mindfulness
 
Learning to be one-minded and present oriented can help keep us focused on our tasks at hand. How many of us can honestly say that we live our lives in the present moment and not in the past or future? Mindfulness is the opposite of multitasking – something our society praises, but can we really give 100% to any task if we are dividing our time between them? Here are some exercises to try to help to be one-minded throughout the day: 

  • When we wake up in the morning, can we be mindful of the first breaths we take? 
  • Can we try to eat our breakfast without reading the newspaper, watching TV, or checking emails on our computers or smart phones? 
  • On our way to work, can we drive without the radio on and take in the environment around us? 
  • Throughout the day can we be more aware of our breathing? 
  • Can we have in our work environment something that is calming and peaceful? 
  • At the end of the day can we appreciate the work that we accomplished without judgment? 
  • And before bedtime, can we take a few restful breaths before falling asleep? 

To be aware of everything we do throughout the day may not be possible or practical, but the more insight we have into our existence in the present moment will help us appreciate life more and help to decrease any depressive thoughts or anxious moments.

Sometimes we can be overly focused on our problems and we can have a difficult time being grateful for the good things we have in our lives. Positive Psychology is the scientific study of what goes right in our lives – the things that make life worth living. For example, can we draw from our memories of positive past experiences that have brought us joy and happiness as well as our pleasurable and sensual experiences we encounter in the present moment? Can we project positive and constructive thoughts about the future and bring about optimism, hope, and faith? More questions to ponder are:

  • Who/what are the persons or situations that make life more joyful and meaningful for you?
  • How do you enhance these situations and nurture these relationships?
  • As a healthcare professional, what do you consider to be your most important goals?
  • How has your own resiliency as a healthcare professional been enhanced by very challenging clients?
  • What are some ways that you ensure your autonomy as a healthcare professional?
  • In what ways do you ensure your professional and personal life is balanced?
  • What are some of the approaches you use to remove obstacles to your own growth?

Taking some time to ponder these questions can help us “tune in” to what is important in our lives as well as to develop better insight into our own health and personal growth. We will now look at steps we can take to help prevent or remediate burnout once it occurs:

  • Work toward having self-awareness of your thoughts and behaviors in order to recognize when you are exceeding boundaries or personalizing client issues
  • Make it a habit of having some “quiet time” at some point in the day
  • Interact on a regular basis with supportive friends and family
  • Be more assertive!
  • Get proper nourishment, sleep, and exercise
  • Listen to others who are close to you when they voice concerns about your changed mood or behaviors
  • Laugh more
  • Be careful to discern between what you can and cannot control
  • Be aware of alcohol or substance abuse as a way of self-medicating
  • Make sure to give yourself daily mental reminders for the good work that you do
  • Do not become over involved with your patients - keep boundaries in check
  • Take the necessary time away from work to help “recharge” yourself
  • If your work becomes intolerable due to unreasonable expectations or a “toxic” work environment develops, think about making a change to a new job. Your life may depend on it.

As we can see, there are ways we can learn to protect ourselves from the clutches of burnout. Burnout can be debilitating to our health and well-being, our relationships, jobs and careers and can even be life-threatening if we do not recognize it in time. If you feel you are headed for Burnout, contact a mental health professional right away. 





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