Kate M. Hathaway, Ph.D.,L.P . Clinical Health Psychologist

1. PRACTICAL APPROACHES TO WORKING AS A HEALTH CARE PROFESSIONAL:Building ResistanceStaying MindfulAdding FlexibilityTaking Charge of Your Health(OR…How to Prevent Burnout!) Kate M. Hathaway, Ph.D.,L.P. Clinical Health Psychologist

2. BEHAVIORAL HEALTH LEARNING OBJECTIVESDPT 7100 • Identify physical, cognitive and emotional ways to cope with stress • Consider your view of yourself as a person independent of your work and also as a health care professional

3. GOALS • Identify the factors that influence stress levels in humans • Identify the physical, cognitive and emotional components of stress and burnout symptoms • Identify physical, cognitive and emotional ways to cope with stress • Learn how to take care of your own health • Consider your view of self as a health care provider

4. REVIEW: COMPONENTS OF STRESS RESPONSES • PHYSICAL • Heart rate, breathing, muscle • COGNITIVE • Intense concentration on stressor • EMOTIONAL • Less access to emotional reactions • SOCIAL • More inward-focused, withdrawal from social interactions

5. LOOKING AT “STRESS” • Stress Is Adaptive (Survival of fittest) • Can We Re-define Stress as A Learning Tool? – A Positive Experience • Acceptance: Life Cannot Be Stress-free • See Noble Truth #1, Buddhism! • There has never been a time in history without war, disease, abuse, suffering • Our colleagues are not perfect either! • Life is busy, distracting and confusing

6. Re-Defining: SEEING THE POSITIVES OF STRESS • POSITIVES OF STRESS: • Alertness • Challenge-based – increases self-confidence • Learning occurs and coping improves • Interpersonal problem-solving

7. …AND THE NEGATIVE EFFECTS OF PROLONGED STRESS? • Morbidity: Unhappiness, anxiety, strained relationships with others, “burnout” • Mortality: Yep – you probably won’t live as long!

8. BURNOUT • Results from excessive/prolonged stress • Stress can be adaptive; burnout is not • Results in decreased productivity, feelings of powerlessness, isolation • Signs: Extreme frustration, irritability, sadness, difficulty with colleagues • NOTE: Stress and burnout are defined by the person, not only by the situation

9. GENERAL WORK-RELATED FACTORS THAT INFLUENCE BURNOUT • Too many responsibilities/demands • Too few responsibilities/demands • Role ambiguity • Lack of control (perceived or real) • Lack of new challenge or diversity in work content

10. OTHER FACTORS: HEALTH CARE PROVIDER CHALLENGES • Focus on pathology (seeing the negative) • Looking to technique as solution • Focus on treating disease, illness and pathology versus building health

11. HEALTH CARE PROVIDER ISSUES THAT INFLUENCE BURNOUT • Health care perspectives • Beliefs about the roles of health care professionals • Beliefs about the roles of patients • Beliefs about our ability to influence outcome with patients (ego-based) • There is a “right” and “wrong” way to provide health care • Struggles with the health care systems

12. ADDITIONAL CHALLENGES FOR PHYSICAL THERAPISTS • Natural progression of work skills: Early focus on technique • Natural progression of work relationships and habits of interacting • Tendency to become or be seen as the authority on matters of rehabilitation • Tendency to tire of emotional work and avoid it in working with difficult patients • Tendency to care-take others and forget oneself • Less desire to listen or care-take at home?

13. FALLACY-REALITY • “We are the experts; patients are the consumers” • “We know how the brain and body work; we can offer fixes”

14. REALITY • Only 25% of health care is provided by the professional; 75% (or more?) is provided by the patient to him/herself • Humans do not like to focus on fear or negativity (pathology) • We know really very little about the brain or body and how they work, although we know more than many others

15. TO CONSIDER… “I believe that every person knows more about him/herself than anyone else will ever know….” - Physically - Cognitively - Emotionally -Interpersonally

16. Stress management, then, is an individual challenge • No one solution works for everyone • The environment may supply the stressor; the individual supplies the coping

17. COPING: BUILDING PHYSICAL RESISTANCE • Increase physical strength • Increase physical adaptability • Increase energy • Decrease toxins • Build antitoxins • Decrease heart rate, GI distress

18. PHYSICAL: At Your Desk • STRETCH! • POSTURE CORRECTION • FACIAL MUSCLE RELAXATION • BREATHING • LIGHTING • SOUND • AROMATHERAPY • NUTRITION, WATER

19. PHYSICAL: Anywhere • EXERCISE • Walk at breaks? Lunch? • Less sedentary activity (decrease TV/computer?) • SLEEP • 8 hours? naps? • GET OUTSIDE • Fresh air, new visual stimuli • NUTRITION • 4-6 times per day, nutritionally sound • Vitamins?

20. COPING: BUILDING COGNITIVE RESISTANCE • Increase sense of control • Increase permission for options • Increase plasticity in thinking • Decrease all or nothing • Eliminate the word “but”

21. COGNITIVE: At Your Desk • INCREASE “I CAN” SENSE OF CONTROL; DECREASE “I CAN’T” STATEMENTS • DECREASE “WOULD’VE,” “COULD’VE,” “SHOULD’VE” • PLAN, RE-ORGANIZE, PRIORITIZE • INCREASE MINDFULNESS • DECREASE JUDGMENT, INCREASE ACCEPTANCE • MAKE VALUE-BASED DECISIONS

22. COGNITIVE: Anywhere • MAKE VALUE-BASED DECISIONS • INCREASE ACCEPTANCE • ADMIT OWN INFLUENCE • ADD CREATIVITY TO YOUR PROBLEM-SOLVING • REMAIN FLEXIBLE

23. FLEXIBILITY • “For a mind burdened with fear, with conformity, with the thinker, there can be no understanding of that which may be called the original…” • J. Krishnamurti, On Fear

24. COPING: BUILDING EMOTIONAL RESISTANCE • Be mindful • Practice staying in the moment • Identify feelings without judgment • Practice joy

25. “We consider bibles and religions divine…; I say they have 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. Will you seek afar off? You surely come back at last, in things best known to you, finding the best, or as good as the best – Happiness, knowledge, not another place, but this place – not for another hour, but for this hour” Walt Whitman

26. EMOTIONAL: At Your Desk • PRACTICE OPTIMISM • FIND SMALL WAYS TO INCREASE JOY (PICTURES, TEAS, ETC.) • ACCESS MEMORIES – ESPECIALLY OF TIME IN NATURE • PRACTICE GRATITUDE • PRACTICE KINDNESS AND GENEROSITY

27. EMOTIONAL: Anywhere • IMAGINE PEACE • Remember that the body and the spirit do not know the difference between what is imagined and what is real…. • FOCUS MORE ON CREATIVITY, LESS ON PRODUCTIVITY • INCREASE SOCIAL SUPPORT • PRACTICE KINDNESS AND GENEROSITY • HAVE MORE FUN!!!!! LAUGHTER IS A GREAT STRESS REDUCER

28. REVIEW: COMPONENTS OF STRESS REDUCTION • PHYSICAL • Relaxation, BREATHING • Build health • COGNITIVE • Re-framing, re-interpreting • Staying “in the moment” • EMOTIONAL • Peace-giving • SOCIAL • Support of friends, family

29. COMBINATION OPTIONS • MUST HAVE A PHYSICAL, COGNITIVE AND EMOTIONAL COMPONENT • Bonus points for breathing! • NO TIME PARAMETERS • VARIETY IS THE SPICE OF LIFE • BE MINDFUL, BE PRESENT IN THIS MOMENT AND TIME… • NOTE: There are likely gender, cultural and age differences in coping…

30. Relaxation exercise Yoga, tai chi, qi gong Meditation Self-hypnosis Warm bath, hot tub Daily rituals: Prayer, candle-lighting, water rituals Music, sound, dancing, woohoo! Laughter Massage Light treatments, Time in nature – nature images Story-telling or story-listening Mindfulness Social support Animals, children Attention to the present moment… See CSH offerings, U of MN (www.csh.umn.edu) OPTIONS FOR BUILDING EMOTIONAL AND COGNITIVE HEALTH

31. NOTICE…Trends in health utilization • Increased utilization of CAM • Increased attention in psychological literature on “mindfulness,” mind-body interactions, cultural proficiency, optimism, gratitude and generosity • DBT -- Herbal remedies • Meditation -- Buddhist philosophy • Yoga -- Intercultural respect

32. CHANGES IN HEALTH CARE THAT BENEFIT ALL • View health holistically • Connect body and mind (EXERCISE) • Increase positive view of experiences • View experience as way of learning • We learn fastest from our mistakes • Increase attention to acceptance • Increase attention to patient perspective

33. APPLICATION TO SELF: Looking at Ways to Reduce Burnout • View your own health holistically • Connect body and mind (EXERCISE) • Increase positive view of experiences • View experience as way of learning • Note that we learn fastest from our mistakes • Increase attention to acceptance • Practice mindfulness: Attention and Intention • Increase attention to the other’s perspective

34. THOUGHTS FOR HEALTH CARE PROFESSIONALS • Control schedule • Add “transition” time to clear head and help with preparation for next interaction (work and home) • Schedule work around family? Mental health days? • Practice mindfulness: Stay in the moment when with patients and when with family and friends • Ask for significant other’s wisdom, emotional support • Peer review • Build spiritual practice • Practice non-emotional generosity • Schedule breaks with purpose • Walk, nap, meditate, yoga, stretch, eat

35. TAKE CHARGE OF YOUR HEALTH DOMAINS:LIFE LONG LEARNINGSEE TCOYH at www.csh.umn.edu • Life purpose • Self-care and prevention • Stress mastery • Emotional health • Physical activity and fitness • Diet and nutrition • Relationships • Environment

36. SUMMARY • Stress is adaptive; burnout is not • Our responses to life challenges are influenced by our perspectives (cognitive), our emotional reactions and our habits • To build personal health and resistance (and reduce burnout) address all aspects of health

37. ASSIGNMENT • Look at the eight domains of health • Self-assess • Designate a plan for yourself to build health in EACH of these domains