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Healing the Healers

June 2, 2019

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Healing the Healers

June 2, 2019

 

It is Thursday afternoon, my favourite time of the week. I am about to host the next session of my Yoga of Stress Resilience program. In this session, we discuss the topic that has brought us all together – Burnout. This group is made up  entirely of helping professionals - Social Workers, Nurses, Physicians and even members of Clergy. They were referred to me for yoga therapy by their family physicians, who recognized their issues were secondary to the build-up of stress.

 

As we come together, we meet others who also work in helping society’s most vulnerable – veterans, homeless, those suffering addiction or those experiencing intimate partner violence (IPV). We also learn we are not alone in the feelings of exhaustion, fatigue and even bodily pain. We are amongst colleagues who “get it” and are no longer isolated in our common experience. In connecting with each other, our pain eases and we can begin to heal.[1]

 

Burnout has recently been recognized as a diagnosis by the World Health Organization (WHO).[2] As described by Dr. Christina Maslach, burnout is a syndrome characterized by emotional exhaustion and involving depersonalization (inability to feel empathy for the people with whom we work, the development of negative, cynical attitudes and feelings towards our work, clients, or surroundings) and reduced personal accomplishment (where we tend to evaluate ourselves negatively in regards to our work with clients and may even feel like we are no longer effective at our job). [3]  Recent statistics show increasing prevalence of burnout of almost 40% in our frontline helping professions, including first responders, teachers, social workers, nurses and physicians. There is also increasing prevalence of suicide amongst paramedics and physicians.[4],[5],[6],[7],[8],[9][10]

 

Brain scans shows that when we experience the pain of others, areas of our own brain lights up in the areas corresponding to the other person’s pain.[11]

Emotional resonance can easily become emotion contagion, and we too can become equally stressed. When it becomes too much, we become overwhelmed and experience empathic distress. Our thalamus, the brain’s relay station, blocks the signals to our cortex. We shut down our ability to feel, we go numb, and reduce our capability to empathize.[12]  Unfortunately, our bodies still hold the stress of the experience and what goes in must come out.

 

Often our distress lashes out when we least expect it, affecting our family, friends, and often our clients and patients. Maybe it creeps up slowly, and we may subconsciously attempt to drown the feeling in food, alcohol or another soothing addiction, in detriment to ourselves. Maybe it comes up in our own body experience of pain or helplessness. In our group, we all agree that we have all seen it happen in our co-workers, and admittedly, in ourselves.

 

In the program, we give a name to the other things we may experience. Secondary Trauma occurs when we bear witness to the trauma of others. Our empathic neurons in our limbic system experience the trauma it as if it is happening to ourselves. Repeated exposure to secondary trauma can lead to Vicarious Traumatization. When we experience traumatic events first hand, it can lead to Post-Traumatic Stress, and Occupational Stress Injuries. We also name Moral Distress and Injury – the feeling of being helpless, knowing what you need to do, but not being able or supported by the system you work in to do it. The participants agree - it is more often these systemic issues and being micromanaged that causes us stress and the feeling of being unable to provide the care we want to provide. As one participant says, wiping tears from her eyes. “Yes! This is it! I just didn’t know how to express it.” Recognizing that others have also had this experience is validating. We are not alone. 

 

There is also hope. There are skills we learn to practice for these moments. In being mindful of our experience of resonating with the suffering of others, we can name and hold that experience as empathic resonance. We can then offer ourselves compassion for the empathic stress we may be experiencing. Compassion and empathy work on different neural networks, and research shows that as we practice compassion, we can soothe our own empathic distress, buffering it, and helping us to restore calmness, and the ability to tolerate discomfort.[13],[14] As emotions can be contagious, the other may resonate with the compassion we are generating and hopefully some of their distress will calm. It is not always an easy practice, and it might not be a bullet proof method. But it may offer us some resilience in bearing the trauma of others.

So we commit to our practice, setting an intention for self-care. We begin with a gentle breath focused restorative Asana (movement) practice, to release all the stress built up in in our bodies, followed by Pranayama (breathing exercises) to prepare for meditation, and Metta/Maitri (Loving Kindness) Karuna (Compassion) based meditation. We practice giving loving-kindness and compassion back to ourselves, as we hold another person’s suffering, so we can maintain compassion for the person who is suffering. We know there is more that needs to happen to fix our broken systems, but taking care of ourselves must be our primary aim. We must put on our own oxygen mask first.

 

 

For more information on upcoming programs, please sign up for my mailing list!

 

 

Shailla Vaidya. MD MPH CCFP(EM) E-RYT-500 C-IAYT practices Mind-Body Medicine in Toronto, Canada. Her current focus is on Helping Professionals and Caregivers cope with stress and burnout. She offers the Yoga of Stress Resilience Program to Helping Professionals with burnout in Toronto, and will be launching it online soon! For more information on the program and upcoming retreats, sign up for her mailing list! 

 

 

References

 

[1] Eisenberger NI. The neural bases of social pain: evidence for shared representations with physical pain. Psychosom Med. 2012;74(2):126-35. https://www.ncbi.nlm.nih.gov/pubmed/22286852

 

[2] https://www.who.int/mental_health/evidence/burn-out/en/

 

[3] Maslach, Christina, Schaufeli WB, Leiter MP. JobBurnout. Annual Review of Psychology 2001 52:1, 397-422 http://www.annualreviews.org/doi/abs/10.1146/annurev.psych.52.1.397

 

[4] Shanafelt TD, Boone S, Tan L, et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 2012;172(18):1377–1385. doi:10.1001/archinternmed.2012.3199 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1351351

 

[5] Monsalve-Reyes CS, San Luis-Costas C, Gómez-Urquiza JL, Albendín-García L, Aguayo R, Cañadas-De la Fuente GA. Burnout syndrome and its prevalence in primary care nursing: a systematic review and meta-analysis. BMC Fam Pract. 2018;19(1):59. Published 2018 May 10. doi:10.1186/s12875-018-0748-z https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-018-0748-z

 

[6] https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-may2018.pdf

 

[7] https://www.psychologytoday.com/ca/blog/much-more-common-core/201611/the-teacher-burnout-epidemic-part-1-2

 

[8]https://scholarworks.lib.csusb.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=1452&context=etd

 

[9] https://www.washingtonpost.com/national/health-science/what-ive-learned-from-my-tally-of-757-doctor-suicides/2018/01/12/b0ea9126-eb50-11e7-9f92-10a2203f6c8d_story.html?noredirect=on&utm_term=.d232bb7b7c27

 

[10] Carleton, R. N., Afifi, T. O., Turner, S., Taillieu, T., LeBouthillier, D. M., Duranceau, S., . . . Asmundson, G. J. G. (2018). Suicidal ideation, plans, and attempts among public safety personnel in Canada. Canadian Psychology/Psychologie canadienne, 59(3), 220-231. http://dx.doi.org/10.1037/cap0000136

 

[11] Lamm, C, Decety, J, and Singer, T. (2010). Meta-analytic evidence for common and distinct neural networks associated with directly experienced pain and empathy for pain. NeuroImage. 54. 2492-502. 10.1016/j.neuroimage.2010.10.014. https://www.ncbi.nlm.nih.gov/pubmed/20946964

 

[12] Ashar YK13,Andrews-HannaJR, 2SonaDimidjian1Wager TD12, Empathic Care and Distress: Predictive Brain Markers and Dissociable Brain Systems, Volume 94, Issue 6, 21 June 2017, Pages 1263-1273.e4 https://www.sciencedirect.com/science/article/pii/S0896627317304154

 

[13] Klimecki, O, et al  (2013)Functional Neural Plasticity and associated changes in positive affect after compassion training. Cereb Cortex 23. 1552-1561 https://academic.oup.com/cercor/article/23/7/1552/288473

 

[14] Klimecki, O  et al  (2014)Differential Patterns of Function brain plasticity after compassion and empathy training. Soc Cogn Affect. Neurosci.9, 873-879 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4040103/

 

 

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