Placeholder Content Image

Stuck in fight-or-flight mode? 5 ways to complete the ‘stress cycle’ and avoid burnout or depression

<div class="theconversation-article-body"> <p>Can you remember a time when you felt stressed leading up to a big life event and then afterwards felt like a weight had been lifted? This process – the ramping up of the stress response and then feeling this settle back down – shows completion of the “stress cycle”.</p> <p>Some stress in daily life is unavoidable. But remaining stressed is unhealthy. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2568977/">Chronic stress</a> increases <a href="https://pubmed.ncbi.nlm.nih.gov/32886587/">chronic health conditions</a>, including heart disease and stroke and diabetes. It can also lead to <a href="https://theconversation.com/were-all-exhausted-but-are-you-experiencing-burnout-heres-what-to-look-out-for-164393">burnout</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5137920/">depression</a>.</p> <p>Exercise, cognitive, creative, social and self-soothing activities help us process stress in healthier ways and complete the stress cycle.</p> <h2>What does the stress cycle look like?</h2> <p>Scientists and researchers refer to the “stress response”, often with a focus on the fight-or-flight reactions. The phrase the “stress cycle” has been made popular by <a href="https://www.penguin.co.uk/articles/2019/03/complete-stress-cycle-emotional-exhaustion-burnout">self-help experts</a> but it does have a scientific basis.</p> <p>The <a href="https://www.ncbi.nlm.nih.gov/books/NBK541120/">stress cycle</a> is our body’s response to a stressful event, whether real or perceived, physical or psychological. It could be being chased by a vicious dog, an upcoming exam or a difficult conversation.</p> <p>The stress cycle has three stages:</p> <ul> <li> <p><strong>stage 1</strong> is perceiving the threat</p> </li> <li> <p><strong>stage 2</strong> is the fight-or-flight response, driven by our stress hormones: adrenaline and cortisol</p> </li> <li> <p><strong>stage 3</strong> is relief, including physiological and psychological relief. This completes the stress cycle.</p> </li> </ul> <p>Different people will respond to stress differently based on their life experiences and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181835/#:%7E:text=The%20major%20findings%20regarding%20the,renin%2Dangiotensin%2Daldosterone%20system%20or">genetics</a>.</p> <p>Unfortunately, many people experience <a href="https://www.weforum.org/agenda/2023/01/polycrisis-global-risks-report-cost-of-living/">multiple and ongoing stressors</a> out of their control, including the cost-of-living crisis, extreme weather events and <a href="https://www.aihw.gov.au/family-domestic-and-sexual-violence/types-of-violence/family-domestic-violence">domestic violence</a>.</p> <p>Remaining in stage 2 (the flight-or-flight response), can lead to chronic stress. <a href="https://theconversation.com/how-chronic-stress-changes-the-brain-and-what-you-can-do-to-reverse-the-damage-133194">Chronic stress</a> and high cortisol can increase <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476783/">inflammation</a>, which damages our brain and other organs.</p> <p>When you are stuck in chronic fight-or-flight mode, you don’t think clearly and are more easily distracted. Activities that provide temporary pleasure, such as eating junk food or drinking alcohol are <a href="https://onlinelibrary.wiley.com/doi/10.1111/acer.14518">unhelpful strategies</a> that do not reduce the stress effects on our brain and body. Scrolling through social media is also not an effective way to complete the stress cycle. In fact, this is associated with an <a href="https://www.apa.org/monitor/2022/11/strain-media-overload">increased stress response</a>.</p> <h2>Stress and the brain</h2> <p>In the brain, chronic high cortisol can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561403/">shrink the hippocampus</a>. This can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1557684/#:%7E:text=The%20hippocampal%20formation%20plays%20a,%2C%20memory%2C%20motivation%20and%20emotion.&amp;text=Therefore%2C%20reduced%20hippocampal%20volumes%20should,in%20patients%20with%20major%20depression">impair a person’s memory</a> and their capacity to think and concentrate.</p> <p>Chronic high cortisol also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907136/#:%7E:text=The%20prefrontal%20cortex%20(PFC)%20intelligently,brain%20regions%20(BOX%201).">reduces activity</a> in the prefrontal cortex but <a href="https://www.sciencedirect.com/science/article/pii/S2352289514000101">increases activity</a> in the amygdala.</p> <p>The prefrontal cortex is responsible for higher-order control of our thoughts, behaviours and emotions, and is <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2014.00761/full">goal-directed</a> and rational. The amygdala is involved in reflexive and emotional responses. Higher amygdala activity and lower prefrontal cortex activity explains why we are less rational and more emotional and reactive when we are stressed.</p> <p>There are five <a href="https://www.penguin.co.uk/articles/2019/03/complete-stress-cycle-emotional-exhaustion-burnout">types of activities</a> that can help our brains complete the stress cycle.</p> <figure><iframe src="https://www.youtube.com/embed/eD1wliuHxHI?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">It can help to understand how the brain encounters stress.</span></figcaption></figure> <h2>1. Exercise – its own complete stress cycle</h2> <p>When we exercise we get a short-term spike in cortisol, followed by a <a href="https://www.health.harvard.edu/staying-healthy/exercising-to-relax">healthy reduction</a> in cortisol and adrenaline.</p> <p>Exercise also <a href="https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/exercise-and-stress/art-20044469#:%7E:text=Exercise%20in%20almost%20any%20form,distract%20you%20from%20daily%20worries.&amp;text=You%20know%20that%20exercise%20does,fit%20it%20into%20your%20routine.">increases endorphins and serotonin</a>, which improve mood. Endorphins cause an elated feeling often called “runner’s high” and have <a href="https://pubmed.ncbi.nlm.nih.gov/33396962/">anti-inflammatory effects</a>.</p> <p>When you exercise, there is more blood flow to the brain and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6721405/">higher activity</a> in the prefrontal cortex. This is why you can often think more clearly after a walk or run. Exercise can be a helpful way to <a href="https://www.healthline.com/health/heart-disease/exercise-stress-relief">relieve feelings of stress</a>.</p> <p>Exercise can also increase the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041121/">volume</a> of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915811/">hippocampus</a>. This is linked to better short-term and long-term memory processing, as well as reduced stress, depression and anxiety.</p> <h2>2. Cognitive activities – reduce negative thinking</h2> <p>Overly negative thinking can trigger or extend the stress response. In our 2019 research, we found the relationship between stress and cortisol was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987429/">stronger in people with more negative thinking</a>.</p> <p>Higher amygdala activity and less rational thinking when you are stressed can lead to <a href="https://pubmed.ncbi.nlm.nih.gov/18628348/">distorted thinking</a> such as focusing on negatives and rigid “black-and-white” thinking.</p> <p>Activities to reduce negative thinking and promote a more realistic view can reduce the stress response. In clinical settings this is usually called <a href="https://www.healthdirect.gov.au/cognitive-behaviour-therapy-cbt">cognitive behaviour therapy</a>.</p> <p>At home, this could be journalling or writing down worries. This engages the logical and rational parts of our brain and helps us think more realistically. Finding evidence to challenge negative thoughts (“I’ve prepared well for the exam, so I can do my best”) can help to complete the stress cycle.</p> <h2>3. Getting creative – a pathway out of ‘flight or fight’</h2> <p>Creative activities can be art, craft, gardening, cooking or <a href="https://heartmindonline.org/resources/10-exercises-for-your-prefrontal-cortex">other activities</a> such as doing a puzzle, juggling, music, theatre, dancing or simply being absorbed in enjoyable work.</p> <p>Such pursuits increase <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2014.00761/full">prefrontal cortex activity</a> and promote flow and focus.</p> <p>Flow is a <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.645498/full">state of full engagement</a> in an activity you enjoy. It lowers high-stress levels of noradrenaline, the brain’s adrenaline. When you are focussed like this, the brain only processes information relevant to the task and ignores non-relevant information, including stresses.</p> <h2>4. Getting social and releasing feel-good hormones</h2> <p>Talking with someone else, physical affection with a person or pet and laughing can all <a href="https://theconversation.com/what-happens-in-our-brain-and-body-when-were-in-love-198885">increase oxytocin</a>. This is a chemical messenger in the brain that increases social bonding and makes us feel connected and safe.</p> <p>Laughing is also a social activity that <a href="https://neurosciencenews.com/laughter-physical-mental-psychology-17339/">activates parts</a> of the limbic system – the part of the brain involved in emotional and behavioural responses. This increases <a href="https://www.jneurosci.org/content/37/36/8581">endorphins</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/27439375/">serotonin</a> and improves our mood.</p> <h2>5. Self-soothing</h2> <p>Breathing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189422/">exercises</a> and meditation stimulate the parasympathetic nervous system (which calms down our stress responses so we can “reset”) via the <a href="https://theconversation.com/our-vagus-nerves-help-us-rest-digest-and-restore-can-you-really-reset-them-to-feel-better-210469">vagus nerves</a>, and <a href="https://www.tandfonline.com/doi/full/10.1080/17437199.2020.1760727">reduce cortisol</a>.</p> <p>A good <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035568/#:%7E:text=We%20conclude%20that%2C%20in%20addition,self%2Dsoothing%20effects%20of%20crying.">cry can help too</a> by releasing stress energy and increasing oxytocin and endorphins.</p> <p><a href="https://www.medicalnewstoday.com/articles/319631#:%7E:text=Possible%20benefits%20of%20crying%20include,of%201.9%20times%20a%20month.">Emotional tears</a> also remove cortisol and the hormone prolactin from the body. Our prior research showed <a href="https://pubmed.ncbi.nlm.nih.gov/29096223/">cortisol</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9216608/">prolactin</a> were associated with depression, anxiety and hostility.<em><a href="https://theconversation.com/profiles/theresa-larkin-952095">Theresa Larkin</a>, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> and <a href="https://theconversation.com/profiles/susan-j-thomas-1293985">Susan J. Thomas</a>, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a></em></p> <h2>Action beats distraction</h2> <p>Whether it’s watching a funny or sad movie, exercising, journalling, gardening or doing a puzzle, there is science behind why you should complete the stress cycle.</p> <p>Doing at least one positive activity every day can also reduce our baseline stress level and is beneficial for good mental health and wellbeing.</p> <p>Importantly, chronic stress and <a href="https://theconversation.com/are-you-burnt-out-at-work-ask-yourself-these-4-questions-118128">burnout</a> can also indicate the need for change, <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20311">such as in our workplaces</a>. However, not all stressful circumstances can be easily changed. Remember help is always available.</p> <p>If you have concerns about your stress or health, please talk to a doctor.</p> <p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call <a href="https://www.lifeline.org.au/">Lifeline</a> on 13 11 14 or <a href="https://kidshelpline.com.au/">Kids Helpline</a> on 1800 55 1800.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/218599/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/theresa-larkin-952095">Theresa Larkin</a>, Associate professor of Medical Sciences, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a> and <a href="https://theconversation.com/profiles/susan-j-thomas-1293985">Susan J. Thomas</a>, Associate professor in Mental Health and Behavioural Science, <a href="https://theconversation.com/institutions/university-of-wollongong-711">University of Wollongong</a></em></p> <p><em>Image </em><em>credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/stuck-in-fight-or-flight-mode-5-ways-to-complete-the-stress-cycle-and-avoid-burnout-or-depression-218599">original article</a>.</em></p> </div>

Mind

Placeholder Content Image

It’s beginning to look a lot like burnout. How to take care of yourself before the holidays start

<p><em><a href="https://theconversation.com/profiles/sophie-scott-1462197">Sophie Scott</a>, <a href="https://theconversation.com/institutions/university-of-notre-dame-australia-852">University of Notre Dame Australia</a> and <a href="https://theconversation.com/profiles/gordon-parker-94386">Gordon Parker</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p>It’s getting towards the time of the year when you might feel more overwhelmed than usual. There are work projects to finish and perhaps exams in the family. Not to mention the pressures of organising holidays or gifts. Burnout is a real possibility.</p> <p>Burnout is defined by the <a href="https://www.who.int/standards/classifications/frequently-asked-questions/burn-out-an-occupational-phenomenon#:%7E:text=Burn%2Dout%20is%20defined%20in,has%20not%20been%20successfully%20managed.">World Health Organization</a> (WHO) as having three main symptoms – exhaustion, loss of empathy and reduced performance at work.</p> <p>Australian <a href="https://pubmed.ncbi.nlm.nih.gov/34052460/">research</a> argues for a broader model, particularly as the WHO’s third symptom may simply be a consequence of the first two.</p> <p>So what is burnout really? And how can you avoid it before the holidays hit?</p> <h2>More than being really tired</h2> <p>The Australian research model endorsed exhaustion as the primary burnout symptom but emphasised burnout should not be simply equated with exhaustion.</p> <p>The second symptom is loss of empathy (or “compassion fatigue”), which can also be experienced as uncharacteristic cynicism or a general loss of feeling. Nothing much provides pleasure and <em>joie de vivre</em> is only a memory.</p> <p>The third symptom (cognitive impairment) means sufferers find it <a href="https://www.abc.net.au/news/2023-02-13/gordon-parker-says-the-burnout-definition-needs-to-broaden/101920366">difficult to focus</a> and retain information when reading. They tend to scan material – with some women reporting it as akin to “baby brain”.</p> <p>Research <a href="https://pubmed.ncbi.nlm.nih.gov/34052460/">suggests</a> a fourth symptom: insularity. When someone is burnt out, they tend to keep to themselves, not only socialising less but also obtaining little pleasure from interactions.</p> <p>A potential fifth key feature is an unsettled mood.</p> <p>And despite feeling exhausted, most individuals report insomnia when they’re burnt out. In severe cases, immune functioning can be compromised (so that the person may report an increase in infections), blood pressure may drop and it may be difficult or impossible to get out of bed.</p> <p>Predictably, such features (especially exhaustion and cognitive impairment) do lead to compromised work performance.</p> <p>Defining burnout is important, as rates have <a href="https://dspace.library.uu.nl/bitstream/handle/1874/420608/Burnout_Fatigue_Exhaustion.pdf?sequence=1&amp;isAllowed=y">increased</a> in the last few decades.</p> <h2>‘Tis the season</h2> <p>For many, the demands of the holidays cause exhaustion and risk burnout. People might feel compelled to shop, cook, entertain and socialise more than at other times of year. While burnout was initially defined in those in formal employment, we now recognise the same pattern can be experienced by those meeting the needs of children and/or elderly parents – with such needs typically increasing over Christmas.</p> <p>Burnout is generally viewed according to a simple stress-response model. Excessive demands lead to burnout, without the individual bringing anything of themselves to its onset and development. But the Australian <a href="https://pubmed.ncbi.nlm.nih.gov/34052460/">research</a> has identified a richer model and emphasised how much personality contributes.</p> <p>Formal carers, be they health workers, teachers, veterinarians and clergy or parents – are <a href="https://www.taylorfrancis.com/books/mono/10.4324/9781003333722/burnout-gordon-parker-gabriela-tavella-kerrie-eyers">more likely</a> to experience burnout. But some other professional groups – such as lawyers – are also at high risk.</p> <p>In essence, “good” people - who are dutiful, diligent, reliable, conscientious and perfectionistic (either by nature or work nurture) – are at the <a href="https://journals.lww.com/jonmd/Abstract/2020/06000/A_Qualitative_Reexamination_of_the_Key_Features_of.4.aspx">greatest risk</a> of burnout.</p> <h2>6 tips for avoiding seasonal burnout</h2> <p>You may not be able to change your personality, but you can change the way you allow it to “shape” activities. Prioritising, avoiding procrastination, decluttering and focusing on the “big picture” are all good things to keep in mind.</p> <p>Managing your time helps you regain a sense of control, enhances your efficiency, and reduces the likelihood of feeling overwhelmed by responsibilities.</p> <p><strong>1. Prioritise tasks</strong></p> <p>Rank tasks based on urgency and importance. The Eisenhower Matrix, <a href="https://www.amazon.com.au/7-Habits-Highly-Effective-People/dp/0743269519">popularised</a> by author Stephen R Covey, puts jobs into one of four categories:</p> <ul> <li> <p>urgent and important</p> </li> <li> <p>important but not urgent</p> </li> <li> <p>urgent but not important</p> </li> <li> <p>neither urgent nor important.</p> </li> </ul> <p>This helps you see what needs to be top priority and helps overcome the illusion that everything is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10159458/">urgent</a>.</p> <p><strong>2. Set realistic goals</strong></p> <p>Break down large goals into smaller, manageable tasks to be achieved each day, week, or month – to prevent feeling overwhelmed. This could mean writing a gift list in a day or shopping for a festive meal over a week. Use tools such as calendars, planners or digital apps to schedule tasks, deadlines and appointments.</p> <p><strong>3. Manage distractions</strong></p> <p>Minimise <a href="https://psycnet.apa.org/record/2023-66900-001">distractions</a> that hinder productivity and time management. <a href="https://www.journals.uchicago.edu/doi/full/10.1086/691462">Research</a> finds people complete cognitive tasks better with their phones in another room rather than in their pockets. People with phones on their desks performed the worst.</p> <p>Setting specific work hours and website blockers can limit distractions.</p> <p><strong>4. Chunk your time</strong></p> <p>Group similar tasks together and allocate specific time blocks to focus on them. For example, respond to all outstanding emails in one stint, rather than writing one, then task-switching to making a phone call.</p> <p>This approach <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075496/">increases efficiency</a> and reduces the time spent transitioning between different activities.</p> <p><strong>5. Take breaks</strong></p> <p>A <a href="https://psycnet.apa.org/record/2022-90592-001">2022 systematic review</a> of workplace breaks found taking breaks throughout the day improves focus, wellbeing and helps get more work done.</p> <p><strong>6. Delegate</strong></p> <p>Whether at home or work, you don’t have to do it all! Identify tasks that can be effectively delegated to others or automated.</p> <p>To finish the year feeling good, try putting one or more of these techniques into practice and prepare for a restful break.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/216175/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/sophie-scott-1462197"><em>Sophie Scott</em></a><em>, Associate Professor (Adjunct), Science Communication, <a href="https://theconversation.com/institutions/university-of-notre-dame-australia-852">University of Notre Dame Australia</a> and <a href="https://theconversation.com/profiles/gordon-parker-94386">Gordon Parker</a>, Scientia Professor, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/its-beginning-to-look-a-lot-like-burnout-how-to-take-care-of-yourself-before-the-holidays-start-216175">original article</a>.</em></p>

Caring

Placeholder Content Image

Stress and burnout should never be ignored

<p>Every day it seems we learn of another suicide. Given that every 40 seconds someone in the world takes their own life, it's not surprising our news feeds – however you get them – are full of bad news. Recently reading about a Brisbane gastroenterologist and father-of-four committing suicide shows what we have known for a long time: It can strike from the shadows at any time and at anyone.</p> <p>In my experience, there are a number of reasons people commit suicide. Mental illness, depression and burnout can all affect the brain's electrical circuits, which can result in making irrational decisions. An Antarctic storm rages in your head and you can never imagine the sun shining again. But the sun can come out again – if you seek help, get treatment and treat the causes.</p> <p>One of the main causes can be an excessive workload and a lack of sleep. In my view, other causes of suicide include the loss of a relationship, a business, health and, sometimes, social status.</p> <p>The wife of the Brisbane doctor wrote an open email stating that she didn't want his suicide to be a secret. The family photos of him with his four children made you feel some of their pain and horror.</p> <p>Despite the fact both his parents were psychiatrists, he was surrounded by doctors (and was a doctor himself), he still took his own life. His wife writes, although no one had seen it coming, they knew he had been working a lot. She described a very rough weekend of call-outs, and how he had missed his son's birthday party. From reading the article, it suggests the doctor was extremely burnt out and had some financial problems at his practice.</p> <p>Burnout is when the brain becomes so exhausted, the mind can't take it anymore. You can lose faith in yourself, and everything can become a lot harder. It's the feeling you get when you have no time to do the things you enjoy, feel constantly under pressure, and do not even have the time to properly rest. Self-doubt can rage like an Antarctic storm and is just as frightening if you have never experienced either.</p> <p>Doctors and vets have alarmingly high suicide rates, for a number of reasons. Being up constantly in the middle of the night, being so emotionally involved with patients and their lives and death, then having to run a business during the day with financial pressures all take their toll.</p> <p>The mantra that we need to look after ourselves before we can look after others, has never been truer. We all need help when depression and burnout strike from the shadows. They are just as fatal as heart attacks and cancer, but just as treatable if you have the tools and support to do so.</p> <p>What seems insurmountable in the dead of night can be solved. There are no problems, only solutions. Accountants can help with the finances; psychologists and doctors with the mind and the brain. Family and friends can offer the reassurance and support needed to navigate through the storm.</p> <p>Like any storm, it will pass – the wind will drop and the sun will shine again. People can't help if you don't tell them. The first step is to ask for help. We would all rather help than read about another tragic case that could have been prevented and the ongoing hurt it can cause.</p> <p><em>Written by Dr Tom Mulholland. First appeared on <a href="http://www.stuff.co.nz/" target="_blank" rel="noopener"><strong><span style="text-decoration: underline;">Stuff.co.nz</span></strong></a>.</em></p> <p><em>Image: Getty</em></p>

Mind

Placeholder Content Image

Moral injury: what happens when exhausted health workers can no longer provide the care they want for their patients

<p>Healthcare workers in New Zealand already face life-and-death decisions daily. But as multiple winter illnesses add pressure to a system already stretched by COVID, staff now also have to deal with <a href="https://www.stuff.co.nz/national/politics/local-democracy-reporting/300534812/covid19-union-and-frontline-worker-say-staff-at-middlemore-hospital-facing-increasing-abuse" target="_blank" rel="noopener">daily abuse</a>, acute <a href="https://www.newshub.co.nz/home/new-zealand/2022/05/christchurch-hospital-cancels-surgeries-as-it-hits-112-pct-capacity.html" target="_blank" rel="noopener">staff shortages</a> and <a href="https://www.1news.co.nz/2022/06/17/dhb-clashes-with-union-over-stretched-palmerston-north-ed/" target="_blank" rel="noopener">unsafe working conditions</a>. At times, they cannot provide the care they would like for their patients.</p> <p>The impact on health workers is often described as <a href="https://www.nzherald.co.nz/rotorua-daily-post/news/great-minds-health-workers-on-covid-19-frontlines-burnt-and-bled-by-two-years-of-virus/T7JXOXGXEKKCICUNOMUJYT4QWM/" target="_blank" rel="noopener">stress and burnout</a>. The consequences of this prolonged pressure can be seen in the number of <a href="https://www.nzdoctor.co.nz/article/undoctored/acem-welcomes-111b-health-nz-budget-urges-fixes-health-workforce-crisis" target="_blank" rel="noopener">doctors</a>, <a href="https://www.nzherald.co.nz/nz/nursing-shortage-nurses-broken-while-sector-faces-thousands-of-vacancies/L7NUXOPG4AB472OKXOH5QJSUMU/" target="_blank" rel="noopener">nurses</a> and other <a href="https://capsulenz.com/be/therapist-shortage-nz/" target="_blank" rel="noopener">health professionals</a> leaving their jobs for overseas positions and the private sector, or being lost to their professions completely.</p> <p>Many of these healthcare workers may well be suffering from a more serious form of psychological distress than burnout: moral injury.</p> <p><a href="https://www.phoenixaustralia.org/wp-content/uploads/2020/07/Moral-Stress-Healthcare-Workers-COVID-19-Guide-to-Moral-Injury.pdf" target="_blank" rel="noopener">Moral injury</a> refers to the psychological, social and spiritual impact of events on a person who holds strong values (such as caring for patients) and operates in high-stakes situations (hospital emergency care), but has to act in a way inconsistent with those values.</p> <p>Examples include having to turn patients away despite them being in pain or discomfort; being unable to provide adequate care due to staff shortages; having to care for a dying patient isolated from their loved ones while wearing full protective gear.</p> <p>Symptoms of moral injury can include strong feelings of guilt and shame (about not being able to uphold healthcare values, for example) as well as high levels of anger and contempt towards the system that prevents proper care.</p> <p>High levels of self-criticism, loss of trust in people and organisations and a weakening of personal relationships are further <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00113-9/fulltext" target="_blank" rel="noopener">symptoms</a> of moral injury.</p> <p>It can be viewed as a <a href="https://www.afta.org/wp-content/uploads/2019/07/Physicians-aren%E2%80%99t-%E2%80%98burning-out.%E2%80%99-They%E2%80%99re-suffering-from-moral-injury..pdf" target="_blank" rel="noopener">more severe form of burnout</a>. But while burnout can happen in most workplaces, moral injury requires the three core components listed above.</p> <p><strong>From war to the operating table</strong></p> <p>The term moral injury arose in <a href="https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp" target="_blank" rel="noopener">military psychology</a> to refer to situations where, for example, soldiers were unable to intervene to save lives in case they risked breaching the rules of engagement. More recently, the term has been adapted to apply to healthcare.</p> <p>Viewing the experiences of health workers through this lens can help us understand why they may experience a seesawing emotional state and the confusing conflict of simultaneously wanting to be at work while wishing they were anywhere but.</p> <p>For healthcare workers, understanding the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752815/#:%7E:text=Over%20time%2C%20these%20repetitive%20insults,is%20in%20some%20way%20deficient" target="_blank" rel="noopener">concept of moral injury</a> may help reframe it as something that is happening to them rather than because they don’t have the skills to cope. The latter can sometimes be a mistaken implication of the term burnout.</p> <figure class="align-center "><img src="https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" alt="Exhausted nurse" /><figcaption><span class="caption">Staff shortages can take health workers beyond exhaustion and burnout.</span> <span class="attribution">Getty Images</span></figcaption></figure> <p>While healthcare workers are largely at the mercy of the organisations they work for, there are some steps individuals can take to alleviate moral injury. Firstly, simply recognising they may be suffering from this condition can reduce confusion and validate their experiences.</p> <p>Secondly, reconnecting back to an individual’s values and beliefs can help refocus and re-energise, at least temporarily. Reminding themselves why they got into this job in the first place is a useful place to start.</p> <p><strong>Organisational responses</strong></p> <p>Organisations and businesses must play a lead role in preventing and treating moral injury. Many of the factors leading to it (lack of resources or staff, a pandemic or peak flu season) are outside the control of individuals.</p> <p>Most modern businesses will be aware they have a legal responsibility under the 2015 <a href="https://www.legislation.govt.nz/act/public/2015/0070/latest/DLM5976660.html" target="_blank" rel="noopener">Health and Safety at Work Act</a> to look after their employees’ mental and physical well-being.</p> <p>At a high level, organisations can advocate for systemic change and increases in funding and resourcing, where needed. But these higher-level changes take time to achieve. In the meantime, it is important healthcare workers are protected and supported.</p> <p>Broad steps an organisation can take to prevent or reduce moral injury include removing the burden of difficult ethical decisions from frontline workers and instead adopting evidence-based policies to guide an organisation-wide response. Where possible, rotating staff between high and low-stress environments may help.</p> <p>Providing funding for workers to access professional psychological supervision is another practical step businesses can consider. At a team level, it can be helpful to have leaders who are visible, validating and can help make sense of the moral conflict. Leaders can also play a role in keeping alive professional values and modelling their own struggles with the situation.</p> <p>The general public also has a role to play in supporting healthcare workers. Any steps we can take to protect our own health and thereby reduce pressure on the system can have a cumulative effect on the well-being of doctors, nurses and allied health clinicians. The health of our nation rests with those who work in this field and it is in all our interest that their health is protected and prioritised.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/185485/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/dougal-sutherland-747623" target="_blank" rel="noopener">Dougal Sutherland</a>, Clinical Psychologist, <a href="https://theconversation.com/institutions/te-herenga-waka-victoria-university-of-wellington-1200" target="_blank" rel="noopener">Te Herenga Waka — Victoria University of Wellington</a></em></p> <p><em>This article is republished from <a href="https://theconversation.com" target="_blank" rel="noopener">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/moral-injury-what-happens-when-exhausted-health-workers-can-no-longer-provide-the-care-they-want-for-their-patients-185485" target="_blank" rel="noopener">original article</a>.</em></p> <p><em>Image: Getty Images</em></p>

Caring

Placeholder Content Image

Think you're burnt out? Here are the signs and symptoms

<p><span>It’s a word that has become increasingly commonplace in today’s world. Now, the term has been further legitimated as the World Health Organization (WHO) included “burnout” in its International Classification of Diseases and Related Health Problems handbook.</span></p> <p><span>The WHO acknowledged burnout as one of the factors influencing health in the book that guides medical providers in diagnosing diseases. </span></p> <p><span>The phenomenon is included in the latest version of the handbook following a review by <a href="https://10daily.com.au/lifestyle/health/a190528nbwvd/burnout-has-been-recognised-as-a-medical-condition-20190528">the 194 member states to the World Health Assembly</a>.</span></p> <p><span>Burnout itself is described as “a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed”. The WHO also noted, “Burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”</span></p> <p><span>According to the handbook, doctors can diagnose someone with burnout if they have the symptoms of:</span></p> <ul> <li>feelings of energy depletion or exhaustion;</li> <li>increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and</li> <li>reduced professional efficacy.</li> </ul> <p><span>Burnout is not exactly a new problem – it has been the subject of scientific studies for more than 40 years, according to a <a href="https://redirect.viglink.com/?format=go&amp;jsonp=vglnk_156317378883710&amp;key=a426d7531bff1ca375d5930dea560b93&amp;libId=jy40ee320102i8oq000DLb793poek&amp;loc=https%3A%2F%2Fedition.cnn.com%2F2019%2F05%2F27%2Fhealth%2Fwho-burnout-disease-trnd%2Findex.html&amp;v=1&amp;out=https%3A%2F%2Fjournals.sagepub.com%2Fdoi%2Fpdf%2F10.1177%2F2158244017697154&amp;ref=https%3A%2F%2Fwww.google.com%2F&amp;title=Burnout%20is%20an%20official%20medical%20diagnosis%2C%20World%20Health%20Organization%20says%20-%20CNN&amp;txt=state%20of%20burnout">2017 literature review</a>. Researchers found in as early as the <a href="http://www.emeraldinsight.com/doi/full/10.1108/13620430910966406">1970s</a> that people could experience burnout from a chronically stressful work environment.</span></p> <p><em><span>If you are experiencing a personal crisis or thinking about suicide, you can call Lifeline 131 114 or beyondblue 1300 224 636 or visit </span></em><span><a href="https://www.lifeline.org.au/"><em>lifeline.org.au</em></a><em> or </em><a href="https://www.beyondblue.org.au/get-support/national-help-lines-and-websites"><em>beyondblue.org.au</em></a><em>.</em></span></p>

Mind

Placeholder Content Image

How to deal with emotional burnout

<p>If you’ve been lacking in energy and motivation, feeling numb, or have had trouble enjoying previously pleasing things in your life, you could be experiencing emotional burnout.</p> <p>In years gone by, burnout was something experienced by social workers or police offers. But these days, people from all professions and walks of life seem to be affected by it.</p> <p>It appears that modern life could be the cause, with social media and mass consumerism noted as just part of the puzzle.</p> <p>Well-known Austrian psychologist Alfried Längle has presented his ideas for coping with it.</p> <p>Most of us have felt burned out before, whether it was at the end of some personal trauma, working too hard, caring for a loved one, or living in a difficult relationship.</p> <p>While we can cope with smaller periods of tension such as these, it’s when they are ongoing that further issues can arise. This is when the burnout turns from mild to chronic. Taking a holiday, getting some support, or changing jobs are all ways to cope.</p> <p>In order to deal with (or ideally prevent) burnout, much research supports the idea that we need to live a life with meaning. If you value what you do, and feel as though you are helping others and getting recognition for it, the long hours seem to cause less friction. We need to determine what motivates and fulfills us, be it money, career progression, status, popularity and recognition.</p> <p>Secondly it’s important to reduce your workload if you are experiencing burnout. Delegate some tasks, change unrealistic deadlines, or even take some time off if possible to relax and gain some perspective.</p> <p>The third step is to ensure that the causes of the emotional burnout don’t have a chance to creep back in. This could mean changing jobs or even taking a step down to a less stressful role.</p> <p>Have you ever experienced burnout? What strategies did you use to cope? We would love to hear your story in the comments.</p> <p><strong>Related links:</strong></p> <p><a href="http://www.oversixty.com.au/health/mind/2016/07/how-to-stop-dwelling-on-negative/"><span style="text-decoration: underline;"><em><strong>Why we dwell on the negative and how to stop</strong></em></span></a></p> <p><a href="http://www.oversixty.com.au/health/mind/2016/07/secret-to-quieting-a-frazzled-mind/"><em><span style="text-decoration: underline;"><strong>The secret to quieting a frazzled mind</strong></span></em></a></p> <p><a href="http://www.oversixty.com.au/health/mind/2016/07/benefits-of-believing-in-yourself/"><span style="text-decoration: underline;"><em><strong>5 wonderful things that happen when you start to believe in yourself</strong></em></span></a></p>

Mind

Placeholder Content Image

Silent symptoms of caregiver burnout

<p>Caregiving is undoubtedly one of the hardest and most selfless acts you can ever perform for another person, but sadly it can take its toll. If you’re feeling tired, moody or even resentful, it’s time to step back and reassess your situation. Sometimes these emotions can creep up on you without you even knowing until burnout has well and truly set in. Here are five signs you must keep an eye out for when caring for a loved one.</p> <ol> <li><strong>You don’t feel like socialising</strong> – Spending so much time with one person can be a struggle for many people, even if that person is a loved one.</li> <li><strong>You’ve lost interest in your hobbies</strong> – Caregiving is both physically and mentally draining, so it’s natural to feel a lack of energy or desire to engage in your interests.</li> <li><strong>You’re having depressive or suicidal thoughts</strong> – As soon as these thoughts come into your head, it’s time to speak to someone. Whether it’s a loved one or a mental health professional, it’s important to realise that you can overcome these negative thoughts.</li> <li><strong>Your diet has changed</strong> – Has your appetite completely vanished? Perhaps you’re eating much more than you used to? Both extremes are possible as a result of caregiver stress.</li> <li><strong>You have trouble sleeping</strong> – Whether it’s falling asleep, staying asleep or getting up in the morning, sometimes the burden of responsibility can negatively impact your sleeping patterns.</li> <li><strong>Your immune system is weak</strong> – <a href="https://www.psychologytoday.com/blog/how-the-mind-heals-the-body/201411/how-stress-affects-the-immune-system" target="_blank"><strong><span style="text-decoration: underline;">Studies</span></strong></a> have shown that stress can actually wreak havoc on your immunity and could in fact responsible for 90 per cent of all diseases and illness – even cancer.</li> </ol> <p>Do any of these apply to you? If so, you’re not alone. Caregiver stress is incredibly common, especially if you aren’t receiving any help sharing the responsibility with other loved ones. Fortunately, there are ways you can combat caregiver burnout.</p> <ul> <li><strong>Get help for yourself</strong> – Having someone to unload all your worries on can be extremely therapeutic. If you don’t feel comfortable chatting about it to a friend or family member, your doctor can refer you to a mental health professional who can give you practical tips on overcoming these issues.</li> <li><strong>Get help for your loved one</strong> – <a href="/health/caring/2016/02/splitting-the-caring-of-a-loved-one-with-siblings/" target="_blank"><strong><span style="text-decoration: underline;">Splitting the care of your loved one</span></strong></a> with other family members can help ease the burden of looking after them. If you can afford it, consider hiring a professional carer<a href="/health/caring/2016/04/tips-to-for-finding-short-term-carer-help/" target="_blank"></a> or, if you think it’s necessary, moving them to an aged care facility<a href="/health/caring/2016/04/right-time-to-look-at-aged-care/" target="_blank"></a>.</li> <li><strong>Find a way to relax</strong> – it’s always a good idea to have something just for yourself when things are tough. A nice warm bath or solitary stroll could be enough to lower your stress levels. Even <a href="/health/mind/2016/05/5-household-chores-that-reduce-stress/" target="_blank"><strong><span style="text-decoration: underline;">doing chores</span></strong></a> around the house can be relaxing, experts believe.</li> </ul> <p>What tips do you have for other caregivers? Share them with us in the comments below.</p> <p><strong>Related links:</strong></p> <p><a href="/health/caring/2016/05/signs-of-elderly-abuse-and-neglect/"><span style="text-decoration: underline;"><em><strong>Signs your elderly loved one is suffering abuse or neglect</strong></em></span></a></p> <p><a href="/health/caring/2016/05/caring-for-someone-with-depression/"><span style="text-decoration: underline;"><em><strong>How to care for someone with depression</strong></em></span></a></p> <p><a href="/health/caring/2016/05/the-4-negative-feelings-every-caregiver-experiences/"><span style="text-decoration: underline;"><em><strong>The 4 negative feelings every caregiver experiences</strong></em></span></a></p>

Caring