Stressed? Who me? Yes, You!
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Transcript Stressed? Who me? Yes, You!
Suzanne Kunkle, PhD., H.S.P.P.
Imbalanced
Work
Partner
Family
Friends
Personal
Household
Spiritual
Recreation
Health
Exercise
Work
Assess burnout symptoms
Define burnout
Describe early warning signs
Discuss contributing factors
Discuss resolution and resilience
Identify resources
A maladaptive response to stress
Emotional exhaustion
Depersonalization
Reduced sense of personal
accomplishment
Maslach C, Jackson SE. (1986). Maslach Burnout Inventory, 2nd ed. Palo Alto, CA:
Consulting Psychologists Press.
High
Moderate
Low
Emotional
exhaustion
27 or over
17-26
0-16
Depersonalization
13 or over
7-12
0-6
Personal
accomplishment
0-31
32-28
39 or over
Stage 1: Emotional Exhaustion
Stage 2: Depersonalization and cynicism
Traditionally support others in numerous roles areas
Finite energy to give
Immediately helpful
Long-term ineffective against exhaustion
Cynicism for women maintain before stage 3 starts
Stage 3: Reduced Accomplishment
Doubting the quality of work and difference in
patients’ lives
Stage 1: Depersonalization and cynicism
Stage 2: Emotional exhaustion
Worsens until unable to cope
Stage 3: Absent! (sense accomplishment).
Less likely to think impacts quality of care
Leads to a cynical, exhausted caregiver who keeps
going despite burnout
Burnout ranges 27% - 75%
U.S.: Indiana 39th in depression
Suicide:
2nd & 3rd cause death physicians
11th cause of death in U.S.
Physicians: 2-300 /year: Female nurses and physicians 4
times greater then general population
U. S.: Indiana 21st
History: family/self:
anxiety
depressive
substance use
suicide/doing self harm
Pre-existing or undiagnosed:
learning disability
attention deficit disorder
Perfectionism greater than “normative” in
medicine
Introversion & pre-existing self-doubt
System
Legal
Developmental:
relationship, children
Personality
Finances
Other responsibilities
Adopting negative
medical cultural
mindset
Fearing stigma
More critical self
Pushed vs. pulled to
goal
Self attack: unmet goals
Fear failure/disappointing
Procrastinate
Defensiveness
Low self esteem
Unrealistic goals
Results focused vs.
journey
All-nothing
Overgeneralization
Filter: dwell negative
Discount positive and
attribute to luck
Jump conclusions
no data
mind reading
fortune telling
Shoulds, must, have
to
Magnify/minimize
Emotional reasoning:
“I feel like an idiot
thus I am”
emotions = reality
Labeling
mistake vs. jerk, loser
Blame self, others
vs. contributions &
solutions
Concentration: details
decisions
Fatigue
Guilt, unworthy,
helplessness
Hopelessness and
pessimism
Disturbed sleep
Irritability, restlessness
Interest loss: hobbies,
activity, sex
Appetite
Persistent aches/pain
headache, GI
Persistent sadness,
anxiety, emptiness
Suicidal ideation,
doing self harm
Increased:
Physical symptoms &
illness
Relationship
difficulties
Negative thoughts
Eating, spending,
smoking, drinking,
gambling,
unprotected sex
Decreased:
Pleasure with
relationship &
activities
Exercise, nutrition,
socializing, laughing
Inability to push
yourself
Impaired performance
Relationship difficulty
Poorer patient care
Physical problems
Professional
problems:
Addictions
Lawsuits
Suspensions
License revocation
Leave profession
Anxiety, depression,
suicide
Mood Disorder
Substance use/abuse
Physical/emotional
abuse
Hopeless/helpless
Gender: age &
profession
esp. Untreated
Past attempts
Plan
Means–Esp. firearms
Anxiety, agitation, or
enraged behavior
Isolation
Neglecting
self care
treatment of general
medical & mental
wellness
Absenteeism/
isolation
Irritability
Depressing
themes
Dishonesty/
declining
performance
Erratic behavior
Day sleeping
Moodiness
Physical symptoms
Self-destructive
behavior
Threats-active
passive death
WELLNESS
Professional
Spiritual
Emotional
Intellectual
Physical
Social
Work
Partner
Family
Friends
Personal
Household
Spiritual
Recreation
Health
Exercise
Self
Amount
Reaction
Connect to others
Flexibility
Making & executing
realistic plans
Communication to
problem solve
Emotional regulation
Self confidence
Purpose & meaning
See big picture
Appropriate humor
Self care
Care for othersphysically &
emotionally
Important
Urgent
Not Urgent
I
(Manage)-Necessity
II
(Focus)-Quality &
Leadership
Crisis
Some calls
Medical emergencies
Some other emergencies
Pressing problems
Deadline driven projects
Last minute prep
Not Important
III
(Avoid)-Deception
Some calls, emails, texts
Some mail, reports
Some meetings
Many pressing problems
Many popular activities
Preparation/planning
Prevention
Values clarification
Exercise
Relationship building
True Recreation/relax
IV
(Avoid)-Wasters
Trivia
Junk mail
Time wasters
Escape activities
Excessive, mindless TV
computer games
Replace catastrophic
thinking
Meaningful/useful
Best case scenarios
Weigh evidence
Develop realistic
plan
Avoid pessimism
Examine
explanation life
events
Temporary
Self blame
Pervasiveness
Do cost benefit
analysis
Awareness of
tendency
Look for positive
Alter self-talk
Practice enjoying
the process
Learn to handle
criticism
Proactive self
care/health care
Regular consults and
supervision
Interdisciplinary
approach
Professional
organization
Ethical risk
management
Sound practice
management
Continuing education
Warn family, friends
of professional hazards
Analyze your practice
situation
What makes you feel
empowered and
ready for success?
Find meaning in your
work and set limits
Identify and routinely
meet with a mentor
Develop adequate
administrative
support systems
1. How can I build and strengthen my connections, support
network?
2. How can I change my thinking to create more optimism,
see more gray, more flexibility, solution focused, less
blame while accountable and that situations are
temporary?
3. How can I improve planning & decision-making skills, be
more decisive?
4. How can I improve my daily self care: diet, exercise, $,
etc.
5. What can I do to feel more confident and self-assured?
7. What are my goals for the future?
SPECT scans show differences in brains before
and after focusing on gratitudes
Daily: List 5 things for which you are grateful
Builds psychological capital
www.amenclinics.com
Shift pathological to adaption
Assess areas of influence & control
Balance & prioritize: ensure self care
Time management
Assertiveness: no without unhealthy guilt
Foster supportive relationships
Practice management
Employee Assistant Program
Specialty State Associations
Behavioral Health Insurance Providers
Spiritual advisors
Emergency rooms
Websites
IUSM Wellness Website:
http://msa.medicine.iu.edu/wellness
Resilience Program
http://www.library.scarborough.me.us/resili
ency/index.html
Positive Psychology
http://www.pursuit-of-
happiness.org/history-of-happiness/martinseligman/
References
Amen, Daniel G. www.amenclinics.com
Barclay, L. (2003). Confronting Physician Depression & Suicide: A newsmaker interview with Morton M.
Silverman, M.D.
Medscape Medical News: http://www.medscape.com/viewarticle/457429
Brody, D. & Brody, P. (2003). Virtual Mentor Ethics. Journal of the American Medical Association. September.
http://virtualmentor.ama-assn.org/
Breazealle, R. http://www.library.scarborough.me.us/resiliency/index.html;
http://abilitycoach.com/disability/ch02.html
Caiati, M. E. Depression and Suicide Among Physicians. Newsletter of the Colorado Physician Health Program.
http://www.cphp.org/documents/depression-suicide.pdf; 17
Coping with Stress in the Practice of Medicine: http://texmed.org/Template.aspx?id=4460
DeMaso, D. R. Stress Management for Physicians.
http://docs.google.com/viewer?a=v&q=cache:W1DNftcBpH8J:www.childrenshospital.org/cfapp
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Girdino, D., Everly, G., & Dusek, D., (1996). Controlling Stress and Tension. Needham Heights, MA: Allyn &
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Gottman, J. (1994). Why Marriages Succeed or Fail.. New York: Fireside.
Gunderson, L. (2001). Physician Burnout. Annals of Internal Medicine, 135: 145-148.
Drug Abuse and Addiction.
http://www.helpguide.org/mental/drug_substance_abuse_addiction_signs_effects_treatmen
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Hart, A. Differences between burnout and stress.
http://www.mayoclinic.com/health/stresshttp://www.churchlink.com.au/churchlink/forum/r_croucher/str
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Katie, Byron (2002). Loving what is. New York: Random House
Mayo Clinic Staff (2006). Stress: Unhealthy response to the pressures of life. http://www.mayoclinic.
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