Don't Burn Out- Resilience At Work

‘Being in control of your life and having realistic expectations about your day-to-day challenges are the keys to stress management, which is perhaps the most important ingredient to living a happy, healthy and rewarding life.’                                                               

                                                                                         Marilu Henner (Actress and producer)

Although work can greatly contribute to our well-being by giving us financial independence, as well as an opportunity for goal pursuit/accomplishment, personal growth and socializing it can also have a negative side: work-related stress. In some instances, chronic occupational stress can have a significant impact on our personal lives, resulting in anxiety, depression, burnout or compassion fatigue. Some professions have a particularly high risk of negative impacts of work-related stress, which include health care workers and veterinary professionals.

Importantly though, high levels of work-related stress do not necessarily result in burnout or other negative outcomes.¹ Once again resilience is the key factor, which determines whether or not we can cope. But resilience does not only prevent the potential negative mental impacts of our professional life- it can also lead to better quality and quantity of our work, making us more productive, successful and less likely to make errors.^2,3

About occupational stress

• We tend to become stressed when we think that we cannot cope with demands made on us, and/or if we perceive the demands as a threat to our well-being.¹ If we do not manage to recover from individual stressful episodes, we may experience chronic stress.^2,3
• Stress can also be understood as an equilibrium between demands put on us and the resources that we have available (including time, energy/motivation, problem-solving ability, interpersonal skills and emotional stability, working conditions such as organizational structure, team members and equipment). For example, if we are motivated, enthusiastic, adequately trained, have a positive and supportive work environment and sufficient time to rest outside of work, we tend to regard the work demands as a challenge and can cope even with highly challenging work. We also experience job-related satisfaction and feel rewarded by professional accomplishment, positive work relationships and/or the satisfaction to help others through our work. If, on the other hand, work demands exceed our resources, we tend experience negative stress.¹
• Apart from having a significant negative impact on our emotional/mental and physical well-being, excessive stress reduces our work performance by decreasing our resources even further:^2,3
• It reduces our cognitive ability (we start thinking more slowly and lose sound judgment).
• It decreases our interpersonal skills so that we are finding it more difficult to interact and communicate well with others, e.g. colleagues, clients/customers/patients (we become less empathic, more unfriendly and less communicative).

About burnout

• Burnout is a phenomenon where significant stress accumulates over a longer time period. It arises when we lose the ability to recover and ‘recharge our batteries’ in the time off work, and repeatedly feel that we are unable to achieve our goals, resulting in frustration and a sense of loss of control.^1-4 Burnout makes us feel emotionally and physically exhausted, we become cynical and have a sense of reduced professional accomplishment.^1,2
• Common causes for burnout are:^1,3,4
• Excessive job demands: Chronic work overload and time pressure.
• Unsupportive work environment: Lack of support from colleagues and management; feeling unfairly treated; lack of feedback, participation and autonomy.
• The feeling that we are expected to give more in regards to time, effort, skill or flexibility than was originally expected or agreed with the employer, while at the same time not feeling adequately looked after or compensated.
• Individual factors: These include vulnerability to stress (for example through the personality trait of ‘neuroticism’), perfectionism, a low sense of control and autonomy, low openness to change, avoidant coping style (becoming withdrawn and/or escaping into alcohol/drug abuse rather than actively seeking a solution to problems), unrealistic expectations regarding the type of work and likelihood of achieving success.

About compassion fatigue and compassion satisfaction

• In caring professions (e.g. health care workers, veterinarians or psychotherapists) it is also possible that occupational stress can result in compassion fatigue. This may occur when we are exposed to significant physical and/or emotional suffering of our clients or patients, in addition to experiencing burnout.⁴
• However, the experience of being able to help others in distress can also have a very positive effect on us by being a source of motivation and giving us a sense of meaning, which can actually help to prevent burnout. This effect is called compassion satisfaction.⁴
• Both, compassion fatigue and compassion satisfaction, tend to occur in people with a high potential for empathy (the ability to detect and understand the internal mental state of others). Although people in health care professions learn to ‘distance’ themselves somewhat from the pain and emotions of patients during their training in order to perform their work appropriately,² there is evidence that empathy not only enables them to benefit from compassion satisfaction, but that this can also lead to better patient outcome.^2,4 The concept of empathy and compassion is very complex, but also essential for our private interpersonal relationships and well-being, and will therefore be discussed in a separate post.

What influences resilience?

Work-related resilience can be broadly divided into three categories:^1,2

• Individual factors: Apart from our problem-solving ability and professional skills, differences include our personality, our drive to achieve and self-motivation, persistence, our energy levels, and degree of emotion regulation and emotional intelligence to name just a few. It is really important to realize that we are all different! Just because your colleague can cope with a 16-hour day this does not mean that this is the right thing for you; we all need to get our own individual balance between work demands/accomplishments and our resources right, if we want to have a satisfying and successful professional career in the long run.
• Social/Interpersonal factors: As you may know from personal experience, this can make all the difference. Having a team of reliable and understanding colleagues can help you through very challenging times at work. On the other hand of the spectrum, interpersonal conflicts with colleagues can undermine our ability to cope with high work-demands.
• Organizational factors: A supportive management and organizational structure has a significant impact on our ability to cope with work challenges. Even a resilient person may succumb to stress in an unsupportive or poorly organized work environment.

How to increase resilience at work

This post will focus on individual factors of resilience, as this is the factor we have the most influence on (unless you are in a management role of course). The following discussion builds on increasing your general resilience, which was the topic of last week’s post. Have a look at Can You Face The Storm: About Resilience- Part 2, if you have not already read it. So, looking more specifically at the work setting, we have three strategies available to cope with excessive occupational stress:¹

1. Manage the balance between our work and private life.

2. Increase our own resources where possible and learn to manage limited resources by changing specific thought patterns and behaviours.

3. Change our job characteristics so that the job is less demanding and more motivating.

1. Work-life balance

This includes making sure that you have an appropriate time off work and that you make good use of this time to relax, spending time with family and friends, and making time for physical activity/sport and hobbies. How much time we need outside work and how we use it depends largely on individual factors- for some people this needs to be more than for others.

2. Increasing and managing our resources

One central feature is that resilient people tend to learn from set-backs, failures and frustrations and use this knowledge to cope more effectively. This means that they see themselves able to learn from difficult situations.¹ Practically this means that we should try and learn from difficult situations in which we coped, as this directly increases our resilience. If we encounter a negative experience in which we did not cope well or made a mistake, we need to learn to deal with the anxiety and regret this can trigger and identify the things we may do differently should we come into a similar situation in future.¹ Once again, emotional intelligence and associated self-supportive mindsets and behaviours have been identified as the main factors in occupational resilience:

• Emotional self-awareness and emotion regulation: Being aware of our own emotions, understanding, managing and expressing them appropriately, and identifying our own stress triggers are key factors in the prevention of burnout and compassion fatigue.^1,4,5 Emotion regulation allows you to stay calm and control impulses under stress, while enabling you to act appropriately and stay effective. However, emotion regulation can be difficult to learn and is energy consuming. As previously mentioned, mindfulness practices may be greatly helpful to learn this skill (see also Dealing with the Darker Days: Emergency Measures and Emotional Intelligence and Staying in the Moment: Mindfulness and Conscious Appreciation).
• Knowing your own limitations: Closely associated with self-awareness, it is important that you know your limits and having realistic expectations regarding your energy levels, areas of expertise and levels of demands that you can cope with- this is not a sign of weakness but an attribute of resilient people.¹ This includes setting boundaries (saying no if necessary) and asking others for help when necessary. Knowing your own limitations also prompts you to look after yourself appropriately (self-care).
• Address any tendencies of perfectionism and of the personality trait neuroticism: While perfectionism and neuroticism can be great motivators as well as making us pay attention to detail and consider our decisions carefully, they also reduce our ability to cope with stress and can make us less efficient and productive.^1,3 Try to learn applying your high standards only in situations where it really matters and which require a high degree of attention. In other situations try to accept that good is good enough and that nobody – including you – can be perfect. Perfectionism and neuroticism are often associated with a fear of making mistakes/fear of failure and fostering self-compassion can be an effective way of dealing with these fears³ (see also Taming Your Inner Critic: About Self-Compassion and Self-Acceptance).
• Try to be open to change and cultivate an attitude of optimism: Adaptability/openness for change and optimism has been identified as a factor which protects from burnout.¹
• Cultivate active coping strategies: When problems arise at work then try to address them constructively rather than withdrawing or remaining passive. Burnout is associated with using ineffective emotion-focused coping strategies,¹ and a problem-focused approach should therefore be preferred wherever possible. However, if the problem is outside of our control then emotional intelligence helps us to identify a more effective emotion-focused approach.
• Empathy has a central role in stress-management and prevention of burnout/compassion fatigue. However, as mentioned above, we also need to be aware that we automatically become less empathic when we are stressed, which ironically decreases our ability to deal with stress even more.² Empathy is important for several reasons:
• It is a central attribute of emotional intelligence, allows us directly to have a more positive response to stress and promotes creative problem solving.^1,5
• Being aware and acknowledging the feelings of others helps to de-escalate tensions.¹
• Empathy also helps to have an outward (rather than self-centered) focus, which supports well-being and makes us happier.^1,2
• As mentioned above, empathy can have two opposite effects: it can make us vulnerable to compassion fatigue but it can also make us more likely to achieve a sense of meaning and reward through our work in the way of compassion satisfaction. It has been found that if we have the ability to recognize and express our own emotions appropriately, and are able to take perspective (i.e. recognizing that the suffering that we are witnessing is not our own but that of someone else) we are likely to experience predominantly compassion satisfaction rather than compassion fatigue.⁵
• Motivation and meaning:^3,6 We generally find work more enjoyable and less draining if we are intrinsically motivated. This means having a passion for our work and experiencing it as meaningful and worthwhile. For this, we need to have a genuine interest in our work and it needs to be in line with our values.    
• Increase your self-efficacy: Self-efficacy means that you believe in your abilities to cope with work demands and that you have control over your environment.¹ This attribute has been associated with work-related resilience, as it is important for self-motivation, and influences individual goals, effort, and coping. People with a high sense of self-efficacy tend to perceive difficult goals as a challenge rather than a threat. Self-efficacy can be nurtured in several ways:¹
• Mastery experience- achieving success at work is the best way to achieve self-efficacy.
• Physical activity- this decreases our stress-levels and negative emotional tendencies thereby increasing the trust in ourselves.
• Social modeling- observing other people who are similar to us can make us realize that we can achieve similar results.
• Verbal persuasion- others can convince us that we are able to achieve something.
• Be a team player: This is our contribution to having a positive and supportive team at work, which pays off because our team can support us in times of stress:¹
• Offer support to others and encourage their cooperation and input.
• Learn effective conflict management: Address significant conflicts by openly talking about disagreements with the people involved. By having good emotion regulation and not taking things personally, you can de-escalate and resolve conflicts.
• Other helpful skills, which help with the management of limited resources are good time management and self-organisation (including the ability to prioritize). We will come back to these skills and the interesting topic of motivation theory another day.

3. Changing your job characteristics

This may mean altering our work pattern and/or adjusting our job role within our current job so that we are less exposed to the things we find particularly stressful. The other options are changing our job role, place of work or even our profession completely.

A truly amazing person- What can we learn from…:

This has already been an unusually long post so I do not want to keep your attention for much longer, but I just want to draw your attention to one of the most remarkable (and resilient) people I have come across during my project: Denis Mukwege is a gynaecologist who has been tirelessly helping the huge number of victims of sexual violence associated with the civil conflict in the Democratic Republic of Congo, despite extremely long working hours and attacks on his own life. Please take a few more moments to find out about his work at http://www.panzifoundation.org/dr-denis-mukwege/ and http://www.rightlivelihoodaward.org/laureates/denis-mukwege/, where you can learn how a resilient personality in combination with meaning and empathy can result in a truly outstanding professional and humanitarian achievement.

Preview: We have covered a lot of ground over the last few months. Next week I would like to share some thoughts on happiness and well-being from a slightly more personal and subjective angle, before we approach another larger subject area, which has a huge influence on well-being: interpersonal relationships in all its facets.

References and further evidence-based reading:

1. Wiens KJ. Leading Through Burnout: The Influence Of Emotional Intelligence On The Ability Of Executive Level Physician Leaders To Cope With Occupational Stress And Burnout [Dissertation]. University of Pennsylvania. 2016.

2. Peters D. The neurobiology of resilience. InnovAiT. 2016;9(6):333-341.

3. Seppälä E. The Happiness Track: How to Apply the Science of Happiness to Accelerate Your Success. Piatkus; London, UK. 2016.

4. Cocker F, Joss N. Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. International Journal of Environmental Research and Public Health. 2016;13(6):618.

5. Gleichgerrcht E, Decety J. Empathy in Clinical Practice: How Individual Dispositions, Gender, and Experience Moderate Empathic Concern, Burnout, and Emotional Distress in Physicians. PLoS ONE. 2013;8(4):e61526.

6. Lyubomirsky S. The Myths of Happiness: What should make you happy but doesn’t, what shouldn’t make you happy but does. Penguin Books; New York. 2013.

7. References for the section ‘A truly amazing person’: http://www.panzifoundation.org/dr-denis-mukwege/, http://www.rightlivelihoodaward.org/laureates/denis-mukwege/

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