|
| A) | stress. | ||
| B) | fatigue. | ||
| C) | burnout. | ||
| D) | stress-induced burnout. |
According to the American Psychological Association, stress is the "physiological or psychological response to internal or external stressors. Stress involves changing nearly every system of the body, influencing how people feel and behave" [1]. On the other hand, burnout is defined as [1]:
Physical, emotional, or mental exhaustion accompanied by decreased motivation, lowered performance, and negative attitudes towards oneself and others. It results from performing at a high level until stress and tension, especially from extreme and prolonged physical or mental exertion or an overburdening workload, take their toll.
| A) | Miners | ||
| B) | Firemen | ||
| C) | Medical professionals | ||
| D) | Human services professionals |
According to the American Psychological Association, stress is the "physiological or psychological response to internal or external stressors. Stress involves changing nearly every system of the body, influencing how people feel and behave" [1]. On the other hand, burnout is defined as [1]:
Physical, emotional, or mental exhaustion accompanied by decreased motivation, lowered performance, and negative attitudes towards oneself and others. It results from performing at a high level until stress and tension, especially from extreme and prolonged physical or mental exertion or an overburdening workload, take their toll.
Interestingly, the word burnout, as described in this passage, was first used by an American psychologist to describe the phenomenon that he observed in human service professionals with unmanageable numbers in their caseloads [3].
| A) | True | ||
| B) | False |
As discussed, stress involves too much: too many pressures that demand too much physically and psychologically. But, stressed individuals have hope that if everything were under control, they would feel better. Burnout, on the other hand, is characterized by exhaustion (feeling depleted, overextended, and fatigued), depersonalization (being detached, withdrawing, having negative/cynical feelings toward one's job), and feelings of inefficacy (reduced feelings of accomplishment or productivity). Professionals experiencing burnout often do not see any hope of positive change in their situations [8]. It is clear that stress is not the same as burnout. The essential difference is that stress involves too much and burnout implies nothing at all and no hope of improvement.
| A) | nothing at all. | ||
| B) | way too much. | ||
| C) | stress exemplified. | ||
| D) | unethical behavior. |
As discussed, stress involves too much: too many pressures that demand too much physically and psychologically. But, stressed individuals have hope that if everything were under control, they would feel better. Burnout, on the other hand, is characterized by exhaustion (feeling depleted, overextended, and fatigued), depersonalization (being detached, withdrawing, having negative/cynical feelings toward one's job), and feelings of inefficacy (reduced feelings of accomplishment or productivity). Professionals experiencing burnout often do not see any hope of positive change in their situations [8]. It is clear that stress is not the same as burnout. The essential difference is that stress involves too much and burnout implies nothing at all and no hope of improvement.
| A) | Family-friendly policies | ||
| B) | Utilization of an employee's skills | ||
| C) | Vague or uncertain job responsibilities | ||
| D) | Constant requirement to complete meaningful duties |
Burnout is typically preceded by the mounting effects of stress that have accumulated and gone unaddressed. For some people, this stress builds over many years. For others, the breaking point can come much more rapidly. However, learning to prevent and to deal with stress now can help prevent burnout, which is a much more difficult condition that should be addressed with professionals. In its publication Addressing Burnout in the Behavioral Health Workforce Through Organizational Strategies, the Substance Abuse and Mental Health Services Administration (SAMHSA) identifies six root causes of burnout at the organizational level [8]:
Workload: Includes quantity and type of workload. Quantity of workload that contributes to burnout may be characterized by chronic excessive workload, working overtime, excessive hours, infrequent breaks, or time pressures. Burnout may also occur due to the type of work, including work perceived to be in addition to usual work (such as administrative tasks), work in which skills are lacking due to insufficient training or support, feeling vague or uncertain about job responsibilities, and/or underutilization of an employee's skills and abilities. Understaffing also contributes to workload pressures and increases burnout.
Control: Relates to an employee's capacity to influence their workload and/or work environment, maintain professional autonomy, and have access to resources that support their work. A lack of control in any of these areas may contribute to job disengagement, and eventually burnout. Burnout due to perceived lack of control is especially seen in providers who work in fast-paced, highly demanding environments, such as inpatient settings.
Reward: Insufficient recognition and/or reward can make employees feel undervalued, leading to withdrawal and burnout. Low salaries and limited career advancement opportunities are common across behavioral health settings, contributing to feelings of underappreciation.
Community: Relationships within the workplace can be a cause of stress when the employee feels there is insufficient support, trust, or assistance from coworkers or supervisors, or when the general environment of the workplace is negative. Supervisory skills also play a role in stress and burnout; encouraging effective communication, conflict resolution, and team building are essential in building a sense of community within a workgroup.
Fairness: Decision-making that is not transparent or does not engage employees at all levels can contribute to feelings of unfairness or disrespect. Inequitable procedures can lead to cynicism toward one's job, which can result in burnout.
Values: A mismatch between an individual's and an organization's values can contribute to burnout as employees may experience less job satisfaction when their work or the organizational culture is not aligned with their personal goals or motivations. Work environments that are diverse and inclusive affect staff's feelings of value and sense of belonging.
| A) | True | ||
| B) | False |
Burnout is typically preceded by the mounting effects of stress that have accumulated and gone unaddressed. For some people, this stress builds over many years. For others, the breaking point can come much more rapidly. However, learning to prevent and to deal with stress now can help prevent burnout, which is a much more difficult condition that should be addressed with professionals. In its publication Addressing Burnout in the Behavioral Health Workforce Through Organizational Strategies, the Substance Abuse and Mental Health Services Administration (SAMHSA) identifies six root causes of burnout at the organizational level [8]:
Workload: Includes quantity and type of workload. Quantity of workload that contributes to burnout may be characterized by chronic excessive workload, working overtime, excessive hours, infrequent breaks, or time pressures. Burnout may also occur due to the type of work, including work perceived to be in addition to usual work (such as administrative tasks), work in which skills are lacking due to insufficient training or support, feeling vague or uncertain about job responsibilities, and/or underutilization of an employee's skills and abilities. Understaffing also contributes to workload pressures and increases burnout.
Control: Relates to an employee's capacity to influence their workload and/or work environment, maintain professional autonomy, and have access to resources that support their work. A lack of control in any of these areas may contribute to job disengagement, and eventually burnout. Burnout due to perceived lack of control is especially seen in providers who work in fast-paced, highly demanding environments, such as inpatient settings.
Reward: Insufficient recognition and/or reward can make employees feel undervalued, leading to withdrawal and burnout. Low salaries and limited career advancement opportunities are common across behavioral health settings, contributing to feelings of underappreciation.
Community: Relationships within the workplace can be a cause of stress when the employee feels there is insufficient support, trust, or assistance from coworkers or supervisors, or when the general environment of the workplace is negative. Supervisory skills also play a role in stress and burnout; encouraging effective communication, conflict resolution, and team building are essential in building a sense of community within a workgroup.
Fairness: Decision-making that is not transparent or does not engage employees at all levels can contribute to feelings of unfairness or disrespect. Inequitable procedures can lead to cynicism toward one's job, which can result in burnout.
Values: A mismatch between an individual's and an organization's values can contribute to burnout as employees may experience less job satisfaction when their work or the organizational culture is not aligned with their personal goals or motivations. Work environments that are diverse and inclusive affect staff's feelings of value and sense of belonging.
| A) | Values | ||
| B) | Control | ||
| C) | Workload | ||
| D) | Community |
Burnout is typically preceded by the mounting effects of stress that have accumulated and gone unaddressed. For some people, this stress builds over many years. For others, the breaking point can come much more rapidly. However, learning to prevent and to deal with stress now can help prevent burnout, which is a much more difficult condition that should be addressed with professionals. In its publication Addressing Burnout in the Behavioral Health Workforce Through Organizational Strategies, the Substance Abuse and Mental Health Services Administration (SAMHSA) identifies six root causes of burnout at the organizational level [8]:
Workload: Includes quantity and type of workload. Quantity of workload that contributes to burnout may be characterized by chronic excessive workload, working overtime, excessive hours, infrequent breaks, or time pressures. Burnout may also occur due to the type of work, including work perceived to be in addition to usual work (such as administrative tasks), work in which skills are lacking due to insufficient training or support, feeling vague or uncertain about job responsibilities, and/or underutilization of an employee's skills and abilities. Understaffing also contributes to workload pressures and increases burnout.
Control: Relates to an employee's capacity to influence their workload and/or work environment, maintain professional autonomy, and have access to resources that support their work. A lack of control in any of these areas may contribute to job disengagement, and eventually burnout. Burnout due to perceived lack of control is especially seen in providers who work in fast-paced, highly demanding environments, such as inpatient settings.
Reward: Insufficient recognition and/or reward can make employees feel undervalued, leading to withdrawal and burnout. Low salaries and limited career advancement opportunities are common across behavioral health settings, contributing to feelings of underappreciation.
Community: Relationships within the workplace can be a cause of stress when the employee feels there is insufficient support, trust, or assistance from coworkers or supervisors, or when the general environment of the workplace is negative. Supervisory skills also play a role in stress and burnout; encouraging effective communication, conflict resolution, and team building are essential in building a sense of community within a workgroup.
Fairness: Decision-making that is not transparent or does not engage employees at all levels can contribute to feelings of unfairness or disrespect. Inequitable procedures can lead to cynicism toward one's job, which can result in burnout.
Values: A mismatch between an individual's and an organization's values can contribute to burnout as employees may experience less job satisfaction when their work or the organizational culture is not aligned with their personal goals or motivations. Work environments that are diverse and inclusive affect staff's feelings of value and sense of belonging.
| A) | Low self-esteem | ||
| B) | Positive worldview | ||
| C) | Working too few hours | ||
| D) | Acknowledgement from management |
Individual-level factors that contribute to burnout include [4,8]:
Low level of hardiness: Lacking a sense of power over events, disengaging from life activities, resisting change
External locus of control: Attributing achievements to others or chance versus attributing achievements to oneself (an internal locus of control)
Poor self-esteem: Lacking confidence in one's abilities
Avoidant coping style: Responding to stressful situations passively rather than actively
| A) | Robust workforce | ||
| B) | Budgetary considerations | ||
| C) | Decreased need for behavioral health in the general population | ||
| D) | All of the above |
In addition to organizational and individual level factors, SAMHSA has identified systemic issues in the behavioral health landscape that compound the risk for burnout. These factors include a workforce shortage, an increased need for behavioral health in the general population, budgetary considerations, systemic inequities, and shifts in service delivery and policies (e.g., telehealth, transparency laws) [8].
| A) | True | ||
| B) | False |
Some professionals are more vulnerable to experiencing stress and burnout than others. Although work stress and burnout are present in every occupation, human service professionals, who spend their work lives attending to the needs of others, are at the highest risk, especially if their work puts them in frequent contact with the dark or tragic side of human experience. This heightened risk is exacerbated if professionals feel underpaid, underappreciated, or criticized for matters beyond their control [5].
| A) | Anxiety | ||
| B) | Social isolation | ||
| C) | Gastrointestinal problems | ||
| D) | All of the above |
There is a clear connection between workplace stress and physical and emotional issues. Signs of stress and burnout in an individual may include [8,9]:
Headache
Sleep disturbance
Difficulty concentrating
Fatigue
Irritability
Depression
Anxiety
Suicidal ideation
Feelings of hopelessness, futility, despair, boredom, cynicism
Withdrawal
Loss of morale
Isolation
Negative self-concept
Social withdrawal
Inability to regulate emotions
Gastrointestinal problems
Excessive weight gain or loss
| A) | Heart disease | ||
| B) | Musculoskeletal conditions | ||
| C) | Substance use disorder | ||
| D) | All of the above |
Evidence indicates that workplace stress plays an important role in several types of chronic health conditions, especially heart disease, musculoskeletal conditions (e.g., back pain, muscle tension), psychological conditions, and substance use disorders [9].
| A) | Smoking | ||
| B) | Overeating or undereating | ||
| C) | Self-medicating with alcohol or drugs | ||
| D) | All of the above |
Compassion fatigue, or vicarious or secondary trauma, is a term used to describe the emotional exhaustion associated with caregiving. It is relatively common among those in the helping professions, particularly those who care for trauma victims [15,16]. While related to stress and burnout, compassion fatigue is generally brought on by a specific situation [17,18]. Furthermore, those experiencing compassion fatigue retain the capacity for caring, unlike those with burnout. However, an accumulation of stressors can lead to a progression from compassion fatigue to burnout if symptoms are not adequately addressed. On the opposite end of the spectrum, compassion satisfaction refers to the positive feelings associated with helping others through one's work. Assessment of these dimensions can give important insight into one's risk for (or resilience to) burnout.
| A) | True | ||
| B) | False |
Compassion fatigue, or vicarious or secondary trauma, is a term used to describe the emotional exhaustion associated with caregiving. It is relatively common among those in the helping professions, particularly those who care for trauma victims [15,16]. While related to stress and burnout, compassion fatigue is generally brought on by a specific situation [17,18]. Furthermore, those experiencing compassion fatigue retain the capacity for caring, unlike those with burnout. However, an accumulation of stressors can lead to a progression from compassion fatigue to burnout if symptoms are not adequately addressed. On the opposite end of the spectrum, compassion satisfaction refers to the positive feelings associated with helping others through one's work. Assessment of these dimensions can give important insight into one's risk for (or resilience to) burnout.
| A) | Requesting a transfer | ||
| B) | A relaxed and positive outlook | ||
| C) | A support network of friends and coworkers | ||
| D) | Balance between work and family or personal life |
NIOSH has identified the three essential components of a self-care plan [4,8]:
Balance between work and family or personal life
A support network of friends and coworkers
A relaxed and positive outlook
| A) | Resist perfectionism | ||
| B) | Recommit to the job | ||
| C) | Be less willing to compromise | ||
| D) | Surrender control of your environment |
While this is a good overall framework, many professionals require more specific strategies that will bring the framework to life. The following actions can be taken at work to address feelings of stress and/or burnout; some may be more realistic or applicable than others, depending upon the situation [5]:
Clarify your job description
Request a transfer
Ask for new duties
Take time off
Resist perfectionism
Flip negative thinking and look for the positive
Take a time out
Talk about perceived problems or issues
Recognize sources of support at work
Find humor in the situation
Learn how to say "no"
Avoid people who add stress
Take control of your environment
Avoid hot-button topics
Pare down your to-do list
Express and share your feelings
Be willing to compromise
Be more assertive
Manage your time better
Do not try to control the uncontrollable
Learn to forgive
Reframe problems
Look at the big picture
Do something you enjoy every day
| A) | Reading | ||
| B) | Exercising regularly | ||
| C) | Eating a healthy diet | ||
| D) | Taking a tranquilizer to relax |
While these suggestions may improve a work situation or environment, it is also vital to address stressors in one's personal life. One way to do this is to adopt a healthy lifestyle. Take time to engage in activities that nourish the body and/or mind in a positive way, such as [5]:
Exercising regularly
Eating a healthy diet
Sleeping seven to eight hours per night
Spending time in nature
Talking to a supportive friend
Writing in a journal
Taking a long bath
Playing with a pet
Getting a massage
Reading
Listening to music
| A) | stress. | ||
| B) | anxiety. | ||
| C) | depression. | ||
| D) | All of the above |
Breathing is something most people take for granted. However, not taking the time to really breathe can have serious ramifications on health and wellness. Some have suggested that slow, rhythmic breathing may be the basis of the mechanism synchronizing the brain and the autonomic response. Furthermore, studies have shown a positive relationship between yogic breathing and alleviation of stress, anxiety, and depression [10,11].
| A) | an endorphin producer. | ||
| B) | a gateway to guided imagery. | ||
| C) | the mechanical miracle of respiration. | ||
| D) | a life force, the connection between physical and spiritual. |
The Western medical definition of breath is the air inhaled and exhaled in respiration. Clearly, the absence of breath is typically equated with the absence of life. Those who practice yoga or other Eastern philosophies view breath as even more significant. In Eastern conceptualizations, breath is a life force, the link between the physical and the spiritual. Because most people have not taken the time to notice their breathing patterns, starting breathing exercises can be difficult. Good breathing takes discipline and deliberate practice, but the effects on self-awareness and coping can be considerable.
| A) | presence of spiritual images. | ||
| B) | expression of a vision for overall well-being. | ||
| C) | extended thought, reflection, or contemplation for the purpose of restoring balance. | ||
| D) | cognitive generation of sensory input recalled from experiences or self-generated from non-experienced form. |
Like breath work, imagery and meditation are also valuable, cost-effective skills that can be used to increase coping and resilience, but they also take practice and discipline. The technical definition of imagery is the "cognitive generation of sensory input from the five senses, individually or collectively, which is recalled from experience or self-generated in a non-experienced form" [1]. Imagery is often conceptualized as putting the imagination to work. Of course, imagery in therapy can be a positive activity used to enhance relaxation or build positive coping skills, or it can be used to promote catharsis of negative, traumatic memories. Imagery, also called visualization, is a powerful tool. Although the concept of meditation often has spiritual connotations, it can simply be viewed as extended thought, reflection, or contemplation for the purpose of restoring a sense of balance. Clearly, imagery and meditation can go hand-in-hand. Whether used together or independently, both can help restore a professional balance.
| A) | discipline. | ||
| B) | meditation. | ||
| C) | visualization. | ||
| D) | coping skills. |
Like breath work, imagery and meditation are also valuable, cost-effective skills that can be used to increase coping and resilience, but they also take practice and discipline. The technical definition of imagery is the "cognitive generation of sensory input from the five senses, individually or collectively, which is recalled from experience or self-generated in a non-experienced form" [1]. Imagery is often conceptualized as putting the imagination to work. Of course, imagery in therapy can be a positive activity used to enhance relaxation or build positive coping skills, or it can be used to promote catharsis of negative, traumatic memories. Imagery, also called visualization, is a powerful tool. Although the concept of meditation often has spiritual connotations, it can simply be viewed as extended thought, reflection, or contemplation for the purpose of restoring a sense of balance. Clearly, imagery and meditation can go hand-in-hand. Whether used together or independently, both can help restore a professional balance.
| A) | lack of time. | ||
| B) | embarrassment. | ||
| C) | feeling that self-care is unimportant. | ||
| D) | discouragement from colleagues or employers. |
Lack of time is possibly the most common excuse professionals give when they are not engaging in self-care activities. In the modern era, when productivity equals survival, it can be too easy to justify not having the time or resources to take care of oneself. However, it is important for individuals who are experiencing symptoms of stress and/or burnout to consider the costs of not making time to reduce stress. Persons who are burned out have difficulty engaging in all aspects of their lives and being there for family and friends. As discussed, stress and burnout also negatively impact productivity. This is particularly important for professionals whose relentless quest to complete tasks is affecting their work and personal lives.
| A) | Accept, cope, eliminate | ||
| B) | Accept, change, enhance | ||
| C) | Accept, change, eliminate | ||
| D) | Accentuate, capture, enhance |
The acronym ACE (accept, change, or eliminate) can help one explore available options when feeling stuck or overwhelmed. These options are available in any situation in which one is feeling trapped or stressed. The situation can either be accepted for what it is, changed to the extent possible (which generally means changing something about oneself), or eliminated (e.g., leaving a toxic work environment). After the option has been selected, it should not be revisited until it either continues to add stress or may be addressed more completely.
| A) | I can do this. | ||
| B) | I am capable. | ||
| C) | I can handle whatever comes. | ||
| D) | All of the above |
Examples of positive affirmations include:
I can do this.
I am capable.
I have dealt with this before; I can do it again.
I can handle whatever comes.
Challenges bring opportunities.
| A) | they should never disclose their recovery to work supervisors. | ||
| B) | mental illness is no longer an issue when you become a counselor. | ||
| C) | being healthy as a professional is contingent on being healthy as a person. | ||
| D) | working with patients on recovery can replace your own recovery program. |
Many behavioral health professionals enter their chosen field because they have had their own experiences with recovery from an addiction, a mental health issue, or a medical issue. The desire to help others often stems from their gratitude that someone once helped them. Recovering professionals may offer important insights into what clients and patients experience. However, it is important to remember that working with recovering patients is not a way to ensure your own personal wellness and recovery. Being healthy as a professional is contingent upon being healthy as a person. Professionals who are in recovery may have to be especially attentive to their own plans of recovery in order to meet the emotional demands of their profession.