burn out recognize avoid - the aids institute...work) brings an urgency to our responses to...

“Burn Out: How to Recognize, Prevent or Recover”

© 2011 Skills4, Inc.

(c) 2011 Stephen J. Fallon, Skills4

Burn Out Recognizing, Avoiding, Recovering

Stephen J. Fallon, Ph.D.

March 2011 update

For handouts: www.skills4.org Click on Fact Sheets •  Go to Current workshops, then Links •  Click on Burn Out: Recognize and Avoid (c) 2011 Stephen J. Fallon, Skills4

Our Training Objectives

By the end of this brief workshop you will be able to

1.  Describe why HIV prevention outreach, Ryan White service, and HIV care professionals are especially susceptible to burn out.

2.  Recognize signs of burn out. 3.  Take steps to prevent or recover

from burn out.


•  Burn out is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. •  It occurs when you feel overwhelmed and unable to meet constant demands. •  As the stress continues, you begin to lose the interest or motivation that led you to take on a certain role in the first place.

Defining Burn Out


Why Do Case Managers Burn Out? •  Caregivers are vulnerable to “heart fatigue.” •  “We may be better at addressing our clients’ needs than our own. … The life and death nature of (HIV work) brings an urgency to our responses to clients’ needs.”

Kitsy Shoen. “Caring for Ourselves: Understanding and Minimizing the Stresses of HIV Caregiving.” In Shelby, Aronstein, and Thompson. HIV and Social Work: A Practitioner’s Guide, Haworth Press, 1998, p. 527.

•  If case manager is also HIV+ “These providers may be particularly affected by cumulative loss due to their stronger identification with their patients.” Jay R. Warren. “Meeting the Needs of Health Care Providers.” In Shelby, p. 538.




Is Stress = Burn Out? •  Burn out can come from unrelenting stress. •  Duration and control matter more than severity. •  High stress from too many pressures and demands doesn’t lead to burn out … if an end is in sight, or imaginable.

•  If you can still imagine that you can eventually get everything under control, you’ll feel better. •  Burn out means feeling empty, devoid of motivation, and beyond caring. You don’t see any hope of positive change. •  Key warning: while you’re usually aware of being under a lot of stress, you don’t always notice burnout when it happens.


Do a “Self Check” •  How is the world looking to you this morning? Are you

  Hopeful?   Anxious?   Excited?   Worried?   Content?

•  Are you aware of sights, scents, sounds, and tastes today? •  Let’s look at how your HIV work affects life, and how you affect your life.


How Stress Can to Burn Out

•  The majority of your day is spent on tasks you find either mind-numbingly dull or overwhelming.

•  You feel like nothing you do makes a difference or is appreciated.

•  You’re exhausted all the time.

•  You find yourself doing more with less •  You have plenty of responsibility but not enough authority, •  You are juggling an unmanageable schedule.


Physical Warning Signs

•  Feeling tired and drained most of the time. •  Lowered immunity, feeling sick a lot. •  Frequent headaches, back pain, muscle aches, acid stomach. •  Change in appetite or sleep habits (too much or too little).




Emotional Warning Signs •  Sense of failure and self-doubt. •  Feeling helpless, trapped, and

defeated. •  Detachment, feeling alone in the

world. •  Loss of motivation. •  Increasingly cynical and negative

outlook. •  Decreased satisfaction and sense of

accomplishment.


Behavioral Warning Signs •  Withdrawing from responsibilities •  Isolating yourself from others. •  Procrastinating, taking longer to get things done. •  Using food, drugs, or alcohol to cope. •  Taking out your frustrations on others. •  Skipping work or coming in late and leaving early.


Work Related Factors

•  Feeling like you have little or no control over your work. •  Lack of recognition or rewards for good work. •  Unclear or overly demanding job expectations. •  Doing work that’s monotonous or unchallenging. •  Working in a chaotic or high-pressure environment


Lifestyle Factors

•  Working too much, without enough time for relaxing and socializing. •  Being expected to be too many things to too many people. •  Taking on too many responsibilities, without enough help from others. •  Not getting enough sleep. •  Lack of close, supportive relationships.




Personality Trait Factors

•  Perfectionist tendencies; nothing is ever good enough.

•  Pessimistic view of yourself and the world

•  The need to be in control; reluctance to delegate to others

•  High-achieving, Type A personality.

How Humans Cope: Resilience

•  Find sense of safety in recognized routines •  Get useful information and resources •  Resolve stressors •  Maintain positive emotions and creativity •  Reestablish sense of control / sense that there are choices to be made, no matter how small •  Seek and provide mutually supportive relationships •  Identify meaning in the event -- may be related to spirituality •  Gain an appreciation of newfound strengths, or an affirmation of life. Greene, R; Graham, S. “Role of Resilience Among Nazi Holocaust Survivors: A Strength-based Paradigm for Understanding Survivorship.” Family & Community Health January/March 2009.



Too Preoccupied to See the World? •  Famous violinist, Joshua Bell. People pay hundreds to see him in concert.

•  Experiment: he performed incognito, for free, outside a DC Metro subway station.

•  Most everyone walked right by, without listening. •  Why? One possibility: so preoccupied with “concerns” that we miss opportunities right in front of us.


Getting Out of a Rut Can you read this?

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•  Attractors can lock you in bad moods, or spur good moods. Thomas Lewis, MD et al. "A General Theory of Love." New York: Vintage Books, 2000.

•  “Feed the animal”-- a good meal, a good workout, some good music, a good hug can all reset your mood.

C T •  “Neural attractors” help us to recognize unfamiliar things, by relating to the familiar.




Stress / Happiness Often in Senses •  One volunteer each: please share a description of   a sight that took your breath away   a sound that lifted your spirits   a smell that brought you back to a happy moment.   a taste that seemed to light up your whole world. •  Why do we have senses? Why do you think powerful sensations are “rewarded”? •  Neurobiology of sense perception: was for survival and propagation; still controls mood.


Developing Your Self-Help Skills Taking stock of oneself

  Sensory stimuli to shake off gray moods.

  Feeling better through nutrition and exercise.

  Learning to ask for support--don’t go it alone.

  The psychological bank account, and reframing.


Re-Framing •  Locked into a discouraging

day ahead? •  Dig out the one good thing

you can make of the day. •  Re-framing is not denial; it’s

about remembering context.

•  Skips those neural attractors off a negative track. •  Put another way, you’re checking your balance in your

psychological bank account.


Human “Needs”

A.H. Maslow, “A Theory of Human Motivation.” Psychological Review 50 (1943):370-96.




Bonds are Vital for Survival

.

•  Babies and their mothers are emotionally synchronized. Blind infants smile back when the mothers smile while talking.

Darwin C. The Expressions of the Emotions of Man and Animals. Ekman P (editor), Third Edition. New York: Oxford University Press, 1998.

•  Deprivation of this link is dangerous. •  Frederick II, a 13th C Roman Emperor and King of Southern

Italy: discover “innate” language, ordered “suckle and bathe and wash the children, but in no wise prattle or speak with them.”

•  All children died. “Could not live without clapping of hands, and gestures, and gladness of countenance, and blandishments.”

Coulton G.G. St. Francis to Dante. London: David Nutt Press, 1906, p. 242-243. Cited in Lewis T, et al. A General Theory of Love. New York: Vintage Books, 2000, p. 68-69.


Bonds are Vital for Survival (cont’d) •  Babies raised in orphanages or

separated from mothers in prison were given proper food/shelter.

•  Well-intentioned institutions tried to protect babies by keeping them isolated (germ theory).

•  Measles: typical mortality rate, 0.5%. In sterile institutions, 40%. Among most sterile: 75%-100%. That is, the most sterile nurseries experienced the highest deaths.

•  Conclusion? “A lack of human interaction--handling, cooing, stroking, baby talk, and play--is fatal to infants.”

Spitz R. “Hospitalism: An Inquiry into the Genius of Psychiatric Conditions in Early Childhood.” Psychoanalytic Study of the Child 1945; I:53-74.


Danger of Social Isolation

•  Following a heart attack, risk of death is 3x among socially isolated people.

Berkman L.F. et al. “Emotional Support and Survival After Myocardial Infarction: A Prospective, Population-Based Study of the Elderly.” Annals of Internal Medicine 1992; 117(12):1003-1009.

•  Overall, risk of premature death is 3x - 5x higher for people who lack ties to a caring spouse, family, or community.

Ornish D. Love and Survival: The Scientific Basis for the Healing Power of Intimacy. New York: Harper Collins, 1998.


Danger of Social Isolation (cont’d)

•  Why? UCLA study: rejection or relationship loss processed by the same brain areas as are physical pains.

Eisenberger N, Lieberman M, and Williams K. “Does Rejection Hurt? An fMRI Study of Social Exclusion. Science, October 10, 2003, 302: 290-296.

•  Men without spouse or intimate friends had higher levels of inflammatory chemical markers in their system (C-reactive protein, interleukin-6, and fibrinogen).

•  Did not directly harm the men, but excess drug, tobacco or alcohol use.

American Heart Association, Scientific Sessions 2003: Abstract 3378. Presented Nov. 11, 2003.




The Power of Connection •  “Limbic resonance”: mammals feel /

match one another’s physiology. •  Grieving together in a cave may have

tended to protect against threats. •  An adapted survival advantage, staying

close to the clan. Diamond J. Guns, Germs, and Steel: The Fate of Human Societies. New

York: W.W. Norton, 1997.

•  Female friends start to menstruate at same times.

•  Making certain facial expressions triggers the emotions they typically represent. Can trigger them in other people, too. Ehrlich P. Human Natures: Genes, Cultures, and the Human Prospect. Shearwater Books, Washington DC, 2000.


The Power of Connection •  “Limbic regulation”: primary

partners balance each other’s moods (and inflammatory chemical markers).

•  That’s why people who are married outlive those who are single.

Money, J. Love and Sickness: The Science of Sex, Gender Difference, and Pair-Bonding. 1980, Baltimore: Johns Hopkins University Press.

•  Best between people, though any mammal helps. After a loved one’s death, people with dogs or cats double survival.

Lewis, Thomas, et al. A General Theory of Love. New York: Random House, 2000.


Work = Surrogate Family

•  Think of the helpful qualities of many family interactions. •  Then think about the ways that connectedness leads to challenges, too. •  In what ways do you have too many eggs in the basket of work?


Stages of Burn Out 1.  Physical, Mental and Emotional

Exhaustion: seen in “crashing” once home, comfort food, withdrawal.

2.  Shame and Doubt: still projecting confidence, but feeling conflicted. Want to retreat when new challenges or opportunities come up.

3.  Cynicism and Callousness: adopting an abrasive, looking out for #1 exterior. Often adopted defensively by people who couldn’t say no before. Intended armor.

4.  Failure, Helplessness and Crisis: a slight or an emotional bump can set off an overly sensitive and personal reaction.

Marc Gorkin, LCSW, a.k.a. “The Stress Doc”




Prevent / Recover from Burn Out •  Start the day with a relaxing ritual: meditate, write in your journal, stretch, or read something that inspires you. •  Take a break from technology: disconnect from phone, web, and e-mail. •  Set boundaries. Don’t overextend yourself. Learn how to say “no”.

•  Adopt healthy eating, exercising, and sleeping habits. •  To reduce work stress, try to engage in “re-framing.” Look for the positive aspects of any situation, or ways to turn it positive.


•  Be playful and creative: try something new, start a fun project, or resume a favorite hobby (should have nothing to do with work). •  Learn how to manage stress. Recognize triggers, re-fill your “psychological bank account.” •  My mantra: Feed the animal! •  Smell, see, taste, hear, feel. •  Varied sensory pleasures, try to avoid pre-packaged. (Not just cheesecake breaks!)

Prevent / Recover (cont’d)


The Tools to Address Burn Out •  Actively address problems: Take a proactive

approach – rather than a passive one – to issues in your workplace.

•  Clarify your job description: Point out things you’ve expected to do that are not part of your job description and gain a little leverage.

•  Ask for new duties: Ask to try something new: a different grade level, a different sales territory, a different machine.

•  Take time off: Go on vacation, use up your sick days, ask for a temporary leave-of-absence—anything to remove yourself from the situation. Re-charge.


Recovering from Burn Out

The "Three R" Approach •  Recognize – Watch for the warning signs of burnout. •  Reverse – Undo the damage by managing stress and seeking support. •  Resilience – Build your resilience to stress by taking care of your physical and emotional health.




Recovering from Burn Out (cont’d)

•  Slow down: Force yourself to slow down or take a break. Give yourself time to rest, reflect, and heal.

•  Get support: natural tendency is to protect what little energy you have left by isolating yourself. But friends and family are best cure. Share your feelings with another person can relieve some of the burden.


Recovering from Burn Out (cont’d) •  Reevaluate goals and priorities:

take time to re-assess your hopes, goals, and dreams. Rediscover what really makes you happy and to change course accordingly.

•  Acknowledge losses: Don’t deny losses. Suppression creates a heavy burden. Recognize and allow yourself to grieve losses. You’ll release that trapped energy and open yourself to healing.

•  Re-create!


1.  Something you play an active role in creating.

2.  Something that plays a role in your past, present, and future.

3.  Something you share with another person.

•  For me: plan, explore, then remember. •  Take a trip with me ….

The Cure for Burn Out Thank You for Making a Difference! Contact information: Stephen J. Fallon, Ph.D. Skills4, Inc. 1712 N. Victoria Park Road Ft. Lauderdale, FL 33305 [email protected]

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