I will survive!
Building resilience and minimizing
burnout in school-based practice
Pam Stephenson OTD, OTR/L & Carolyn Moore DPT, PT
Murphy Deming College of Health Sciences
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Objectives
• Recognize and describe the features of burnout
• Recognize and describe the features of resilience
• Identify practical strategies for building personal and professional
resilience
• Build a resilience tool kit
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Burnout
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What is burnout?
• Physiological syndrome that results from chronic occupational stress
• Physical & emotional components
• Feeling over-extended (Hurt et al., 2013)
• Develops slowly over time (Crow, 2015)
• Frequently seen in human service professions
– Lack of clarity regarding roles & purpose
– Internal and external factors (Paleksic et al., 2015)
• Impacts staff turnover, job satisfaction & quality (Scanlan & Still, 2013)
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What is burnout?
• Maslach Burnout Inventory identifies 3 components:
– Emotional & physical exhaustion
– Cynicism & depersonalization
– Reduction in professional efficacy/personal achievement
• Personality may play a role:
– Extroverts tend to have fewer symptoms of burnout
– Neuroticism may be a risk factor (Hurt et al., 2013)
– OT practitioners have “significant levels of burnout” (Luken & Sammons,
2016)
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Why are we at risk?
• “Helping” professions
• Caseload size and mix
• Workload
• Conflicting or unclear roles
• Resources – personal & professional
• Practice contexts: e.g. legislative demands; working in isolation etc
• Work environment
• Locus of control
• Cost of therapeutic use of self (Luken & Sammons, 2016)
• Compassion fatigue (Smart et al., 2013)
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Why are we at risk?
• “In many ways, the heavy workload in itself in not so much the
issue as the consequences of heavy workloads, in that they
fragment teams and prevent members from being ‘present’ to
one another” (Napier, 2015, p.19)
• Have you experienced this?
• How and why does it happen?
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All too real
• Here is a first-hand account of what burnout may look like
– The thoughts and behaviors that we may experience as therapists
– The effort of being therapeutic in the face of clients’ needs and
behaviors
– The impact on self-efficacy
• http://theanonymousot.com/2013/06/21/therapist-burnout/
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I love my job sometimes!
You are at risk of burnout:
• If you identify so strongly at work you lack a work-life balance
– If your work takes up so much of your time and effort that you
don't have the energy to spend time with your family and friends,
you might burn out quickly
• Extremes of activity
– When a job is monotonous or chaotic, you need constant energy
to remain focused — which can lead to fatigue and job burnout
Risks of burnout
• You try to be everything to everyone
• You work in a helping profession such as health care, counseling
or teaching
• You feel you have little or no control over your work
– An inability to influence decisions that affect your job — such as
your schedule, assignments or workload — could lead to job
burnout
– So could a lack of the resources you need to do your work
Risks of burnout
• Unclear job expectations
– If you're unclear about the degree of authority you have or what
your supervisor or others expect from you, you're not likely to
feel comfortable at work
• Mismatch in values
– If your values differ from the way your employer does business
or handles grievances, the mismatch can eventually take a toll
Could you be experiencing job burnout?
Ask yourself the following questions:
• Have you become cynical or critical at work?
• Do you drag yourself to work and have trouble getting
started once you arrive?
• Have you become irritable or impatient with co-workers or
clients?
Could you be experiencing job burnout?
• Do you lack the energy to be consistently productive?
• Do you lack satisfaction from your achievements?
• Do you feel disillusioned about your job?
Could you be experiencing job burnout?
• Have your sleep habits or appetite changed?
• Are you using food, drugs or alcohol to feel better or to
simply not feel?
• Are you troubled by unexplained headaches, backaches or
other physical complaints?
Consequences of job burnout
• Excessive stress
• Fatigue
• Insomnia
• A negative spillover into personal relationships or home life
• Depression
• Anxiety
• Alcohol or substance abuse
• Heart disease
• High cholesterol
• Type 2 diabetes, especially in women
• Stroke
• Obesity
• Vulnerability to illnesses
Could you be experiencing job burnout?
• Complete this burnout questionnaire
• Are you showing signs of burnout?
http://enrichmentjournal.ag.org/200603/200603_020_burnout_sb_test.cf
m
Dimensions of Wellness
Beazner JR, Promoting Health and Wellness ; Implications for physical therapist practice. PHYS THER. 2015;95:1433-1444.
• EMOTIONAL
– Possession of a secure sense of self-identity and a positive sense
of self-regard
• INTELLECTUAL
– Perception that one is positively energized by intellectually
stimulating tasks
• PHYSICAL
– Positive perceptions and expectancies of physical health
• SOCIAL
– Perception that family and friends are available in times of need,
and the perception that one is a valued support provider
• SPIRITUAL
– Positive sense of meaning an purpose in life
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www.vanderbilt.edu/recreationandwellnesscenter/wellness/wellness-wheel
Resilience
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What is Resilience?
• From the Latin “resilire”, “to recoil”
• Elasticity, rebound, spring back…..
• What does resilience mean to you?
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Other perspectives on resilience
• Ability to endure and recover from difficulties (Taormina, 2015)
• Ability to bounce back from adversity (Glasberg et al., 2007)
• Ability to adapt to stress and adversity (Spencer 2015)
• Dynamic process
• Context-dependent (Napier, 2015)
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Other perspectives on resilience
• Multi-dimensional concept that includes exposure to a source of
stress or adversity AND our positive adaptation to it
• It is more than coping:
– It is our “opportunity and capacity” to navigate our way to the
resources we need to sustain ourselves (Spencer, 2015)
– Those resources may be psychological, physical, social, cultural
• Resilience can be learned, developed and strengthened
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Connectedness
• Social support may help to develop resilience
• “The more connected we are in our social networks both within
and outside of work, the more resilient we become” (Napier, 2015)
– Connections to people, purpose and meaning
• Need to maintain or develop personal resilience and connection to
ourselves as well as external social supports
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Personal resilience: 4 key components
• “Personal resilience….includes a person’s ability to endure, adapt, and
recover from adversity” (Taormina, 2015)
• Determination
– Willpower, decision to persevere, “firmness of purpose” while being
conscious of the difficulty of the task
• Endurance
– Personal strength, fortitude, withstanding difficult situations
without giving up, physical and mental
• Adaptability
– Flexibility, resourcefulness, adjusting self to fit changing conditions
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Personal resilience: 4 key components
• Recuperability
– ability to recover physically and mentally from setbacks and
difficulties “in order to return to and re-establish one’s usual
condition” (Taormina, 2015, p.37)
• How do you recover?
• How long does it take?
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Resilience and coping skills
• Resilience has been associated with productive coping strategies,
including optimism, effective self-care skills
• It offers a “buffer” to protect against psychological and physical health
consequences (Padesky & Money, 2102)
• Younger health professionals (under age 25) experience higher levels
of psychological distress and lower resilience when faced with
pediatric trauma (McGarry et al., 2013)
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Building resilience
• Promoting Adult Resilience (PAR) program (Liossis et al., 2009)
• 7-week workplace program to promote resilience
– Understanding personal strengths & resilience
– Understanding & managing stress
– Challenging & changing negative self-talk
– Practicing changing negative self-talk
– Promoting positive relationships
– Problem-solving work-life problems & managing conflict
– Bringing it all together
– How can we use these ideas to build our own resiliency?
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4-step CBT model
• Strengths-based CBT model to build resilience
• Views resilience as a process, not a trait
• 4 steps:
– Search for strengths
– Strategies, beliefs, personal assets
– Construct personal model of resilience (PMR)
– Identify individual episodes of resilience and build them into more
generalizable strategies
– Apply PMR to areas of difficulty
– Practice resilience
(Padesky & Mooney, 2012)
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Building Your
Resiliency Toolbox
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Building a resiliency toolbox
• Our tools could include:
– Mindfulness
– Meditation, spirituality
– Physical wellbeing
– Cognitive behavior therapy
– Happiness, optimism
– Reflective practice
– Mentoring
– Supervision/Stress management skills
– Cycle of change
– Conversations (Napier, 2015)
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Skills & strategies for handling
burnout
• Evaluate your options
• Adjust your attitude
• Seek support
• Get some sleep
• Assess your interests, skills & passions
• Get some exercise- take a “booster break”
Definition of Health & Wellness
HEALTH
• A state of complete mental, physical and social well being
and not merely the absence of disease (WHO)
• More to health than the physical side (Bezner 2015)
WELLNESS
• Sense that one is living in a manner that permits the
experience of consistent balanced growth in the physical,
spiritual, emotional, intellectual and psychological
dimensions of human existence (Bezner, 2015)
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Aerobic Activity
• The World Health
Organization recommends
that adults participate in at
least 150 minutes of
moderate-intensity or 75 min.
of vigorous aerobic physical
activity throughout the week
to reduce the risk of chronic
disease, including
cardiovascular disease, type 2
diabetes mellitus
• Breaking Studies Arem H et.al.
(JAMA Intern. Med.)
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Find ways to sneak in exercise
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In Summary - Stretching for Job
Satisfaction?
• During the day take a break for aerobics (walking, stairs, etc.)
• Minimize sitting (Healy GN et.al 2008)
• Strength training (yes moving children around should qualify)Make sure that you have set your core stability by knowing
where your neutral spine is before lifting
• Stretch breaks- If no other ex done during the day make sure
that you are taking stretch breaks
– Stretching increases flexibility as well as increased selfperception and self-worth (McGillis 2015)
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Exercise Break!-SUN SALUTATION
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Dan Gilbert: The surprising science of
happiness
http://www.ted.com/playlists/171/the_most_popular_talks_of_all?gclid=
CKWtypaR-MoCFUEehgodgeQHvg
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What are the barriers we face when
trying to build resilience through happiness?
Internal• Surprisingly our brains can be our own worst enemies
• Per Dr Amit Sood a Mayo Clinic physician and researcher, our
brains are not designed for peace and happiness but to
constantly scan the environment for what could harm us
• Constantly looking out for what will harm us or what is “out of
place”
• Created a 4 step plan to gift ourselves with joy, positivity,
resilience and productivity
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4 Step Plan
• ONE: Train your attention
– HOW? Before you get out of bed, before you think about
all of things that must get done, stop and think about 2-3
people in your life that make you happy and picture them
in your mind one by one.
– When you come home for the day and greet your family
don’t start improving them. Praise them and focus on
their novelty
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4 Step Plan
• TWO:
• Cultivate emotional resilience.
• Practice holding positive thoughts (Keep practicing!)
• Theme for the day=
– Monday-Gratitude
– Tuesday-Compassion
– Wednesday-Acceptance (be open to possibilities)
– Thursday- Meaning (why are you here?)
– Friday-Forgiveness
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4 Step Plan
• Three: Incorporate a mind-body practice
– Practice relaxation, imagery
– Use of biofeedback
• Four: Once your mind is in better control, make dietary
and physical changes
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Dr Sood
https://www.youtube.com/watch?v=GZZ0zpUQhBQ
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Track Your Happiness
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Mindfulness
• “Awareness, without judgment, of life as it is, yourself as you are,
other people as they are, in the here and now, via direct and
immediate experience” (Sanderson, 2006, p.1 in Brown & Stoffel, 2011,
p.351)
• “The awareness that emerges through paying attention, on purpose
and nonjudgmentally, to the unfolding of experience moment by
moment” (Kabat-Zinn, 2003, p.145)
Effective in reducing job burnout (Luken & Sammons, 2016)
Mindfulness
• Being present in the moment
• Noticing without judgment
• Let go of the thoughts that pop into your head
• STOP technique: 5 seconds, 4 steps! (Smalley & Winston,2010, in Elliott,
2013):
1. Stop
2. Take a breath
3. Observe
4. Proceed
• Dr. Jon Kabat-Zinn http://www.mindfulnesscds.com
Flow
http://www.ted.com/talks/mihaly_csikszentmihalyi_on_flow?language=en
Mihaly Csikszentmihalyi What makes life worth living?
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http://otpotential.com/blog/flow
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Reflective practice
• Change practice through mindful reflection
• Build a structured approach
• Reflect on self, events
• Identify opportunities for change
• Identify personal and professional strengths, areas for growth
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Supervision & mentoring
• Identify a mentor
• Local or distance
• Use professional journaling
• Reflect on experiences
• Use clinical supervision sessions
• Individual, group, peer
• Ask for help
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References
• Arem H, Moore SC et. al. (2015) Leisure time physical activity and
mortality A detailed pooled analysis of the dose-response relationship.
JAMA Intern. Med. 175 (6), 959-967.
• Bak, P. L., Midgley, N., Zhu, J.L., Winstoft, K., & Obel, C. (2015). The
resilience program: Preliminary evaluation of a mentalization-based
education program. Frontiers in Psychology, 6, article 753, 1-6.
• Bezner JR. (2015) Promoting health and wellness: Implications for
physical therapist practice. J Phys Ther. 95, 1433-1444.
• Crow C. (2015). Burnout and self-care considerations for oncology
professionals. J Pain Manage. 8(3), 191-195.
• Elliott, N. (2015). Exploring mindfulness meditation in occupational
therapy: An introduction to basic practice. Occupational Therapy Now,
17(1), 6-8.
• Glasberg, A. L., Eriksson, S., & Norberg, A. (2007). Burnout and ‘stress of
conscience’ among healthcare personnel. Journal of Advanced Nursing,
57(4), 392-403.
• Healy GN et al. (2008) Breaks in sedentary time beneficial associations
with metabolic risk. Diabetes Care, 4, 661-6.
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References
• Hurt, A.A., Grist, C.L., Malesky Jr, L. A., & McCord, D. M. (2013).
Personality traits associated with occupational ‘burnout’ in ABA
therapists. Journal of Applied Research in Intellectual Disabilities, 26, 299308.
• Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past,
present, and future. Clinical Psychology Science and Practice, 10, 144156.
• Liossis, P. L., Schochet, I. M., Millear, P. M., & Biggs, H. (2009). The
Promoting Adult Resilience (PAR) Program: The effectiveness of the
swcond, shorter pilot of a workplace prevention program. Behaviour
Change, 26(2), 97-112.
• Luken, M., * Sammons, A. (2016). Systematic review of mindfulness for
redicing job burnout. American Journal of Occupational Therapy, 70,
7002250020. http://dx.doi.org/10.5014/ajot.2016.016956
• McGillis J. (2015). Worksite stretching programs. OOHNA J,
Spring/Summer 29-30.
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References
• McGarry, S., Girdlar, S., McDonald, A., Valentine, J., Lee-, S-L.,
Blair, E., Wood, F., & Elliott, C. (2013). Paediatric health-care
professionals: Relationships between psychological distress,
resilience, and coping skills. Journal of Paediatrics and Child
Health, 49, 725-732.
• Napier, J. (2015). How we keep sailing. Journal of Holistic
Healthcare 12(1), 18-21.
• Padesky, C. A., & Mooney, K. A. (2012). Strengths-based cognitivebehavioural therapy: A four-step model to build resilience. Clinical
Psychology and Psychotherapy, 19, 283-290.
• Spencer, L. (2015). Psychological resilience. MMJ: Mid Yorks
Medical Journal, Summer, 27-30.
• Taormima, R.J. (2015). Adult personal resilience: A new theory,
new measure, and practical implications. Psychological Thought,
8(1), 35-46.
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References
• Paleksic, V., Ubovic, R., & Popoovic, M. (2015). Personal
characteristics and burnout syndrome among teachers of primary
and secondary schools. Scripta Medica, 46(2), 118-124.
• Scanlon, J. N., & Still, M. (2013). Job satisfaction, burnout and
turnover intention in occupational therapists working in mental
health. Australian Journal of Occupational Therapy, 60, 310-318.
• Stew, G. (2011). Mindfulness training for occupational therapy
students. British Journal of Occupational Therapy, 74(6), 269-276.
• Wilski, M., Chmielewski, B., & Tomczak, M. (2015). Work locus of
control and burnout in Polish physiotherapists: The mediating
effects of coping styles. International Journal of Occupational
Medicine and Environmental Health, 28(5), 875-889.
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