Eight evidence-based approaches to beat burnout
Two years into coping with the pandemic, evidence-based tools and techniques to beat burnout are vital for our mental health.
The COVID-19 pandemic changed life as we know it. On January 9th 2020 the WHO announced Coronavirus-related pneumonia in Wuhan, China. Two years later, the new Omicron variant of COVID-19 continues in circulation. How ever much we want it to be so, a clean ending to the pandemic looks unlikely. By this point, fatigue has set in. Burnout combines exhaustion with cynicism and a reduced sense of competence. It can result in serious physical and mental health consequences, including substance addiction, Type 2 diabetes, and insomnia (difficulty falling asleep or staying asleep). Unfortunately, as well as the health consequences, professionals experiencing burnout may be unable to return to work, depleting the workforce further, and in turn, the economy. This is a double blow, given that some of the workforce is already absent due to contracting or exposure to the virus. Recently, Charlie Massey, Chief Executive of the General Medical Council stated: “The danger is that, unless action is taken, workloads and wellbeing will continue to suffer, and future burnout rates could get even worse. As we move on from the pandemic, it is vital that doctors’ training and wellbeing needs are central to service recovery plans.” Burnout in healthcare workers is a global phenomenon. Stressors include a high workload, insufficient Personal Protective Equipment (PPE), lack of knowledge, long working hours, and direct exposure with patients. A study among 3,100 nurses and 992 physicians working in Asian intensive care units in 16 countries in Asia found that nurses and physicians had high levels of burnout, 52 and 50.3%, respectively. Whilst healthcare workers are particularly affected, the pandemic affects us all and workers in other types of industries are also at risk of burnout. Because burnout was already a major issue in healthcare jobs before the pandemic, a lot of the evidence of what works draws on studies with health care providers. In general, for all professionals, if you have a heavy workload and work long hours, have difficulties maintaining work life balance, you work in a helping profession and you have limited control over your work, you are at increased risk of burnout. This blog is the final piece in a 3-part series on the topic of burnout for digital magazine, Inspire the Mind. As a recap, part one offered up an introduction to the science of burnout. Part 2 looked at the effects of Zoom in relation to burnout. In this final blog, I’ll share 8 evidence-based ways to prevent or recover from burnout. As a researcher at the Evidence Based Practice Unit, I’m passionate about projects that are based on evidence of what actually works. I think that it’s important we refer to the evidence base before testing out programmes that sound great but might not actually work. Most of us wouldn’t take a drug if it had not been scientifically tested, so perhaps it’s important to exercise a degree of caution with our mental health. First, a quick recap on how psychologists define burnout. Researchers, Maslach, Schaufel & Leiter, describe the concept of burnout as having 3 parts, that include:
Emotional exhaustion, this means feelings of being emotionally overextended and depleted of emotional resources
Depersonalization, refers to workers’ negative, callous, or excessively detached feelings towards their clients/customers
Reduced personal accomplishment and equates to feelings of incompetence and lack of achievement at work (Maslach, Schaufeli, & Leiter, 2001).
Why is it important to draw on evidence-based interventions to tackle burnout? It takes a lot of resources and time to deliver a programme across a whole organisation, or even within one department. Before embarking on solutions, checking existing research for evidence of if a program works in other settings increases the chances that it will “work” for employees in the organisation. Evidence that a programme is really effective is most reliable when a trial has been conducted with a control group (a more or less identical group of people that have not received the programme to compare with the group that had the programme), and there are a number of different peer reviewed studies (subject to critical examination by specialists in the field). Evidence based programmes to burn out have ideally been tested on a large group of people, multiple times. Other factors that inform evidence-based interventions (and if a program might work) include a clinicians perspective and an individual’s values. Disclaimer: this blog is only a rapid overview and a full systematic review is needed on this topic.
8 EVIDENCE BASED STRATEGIES
ONE. Cognitive Behavioural Therapy (CBT) to Reduce Stress The good news is that there is lots of evidence that CBT can reduce stress, burnout and promote wellbeing. CBT is one of the most widely used approaches to treat depression, anxiety and stress, here in the UK it’s available from the NHS for a range of mental health difficulties. CBT involves a technique that can be quickly applied to change thinking patterns that in turn have an effect on behaviour. CBT may be learned via a pre-recorded video or taught by a facilitator or therapist. CBT programmes often include:
Recognising unhelpful automatic thoughts and unhelpful beliefs. Automatic thoughts are those that just pop into our heads unfiltered that may not be based on facts. For example, “I’m terrible at choosing gifts”. Recognising them is like conducting “quality control” where we check that our thoughts are warranted. Unhelpful beliefs are things that we tell ourselves all the time but may not be true.
Setting goals — setting goals can help us to achieve what we want from life and work and from the therapy itself and provide greater meaning and a sense of achievement.
Understanding your attributional style — how we understand the meaning of events and what causes them.
Identifying thinking patterns such as — catastrophising, the tendency assume that the worst outcome might follow from a small event.
The challenge is that, whilst effects are seen after the intervention, these changes are not always maintained months after the intervention.
TWO. Coping interventions Coping is key to managing stress. Programs that teach coping strategies have found to be effective, for example, coping and support groups for nurses to increase coping with difficult situations and encourage positive coping strategies. Lee’s review of a range of studies found that coping interventions for 6 month to a year led to a reduction in emotional exhaustion, depression, and ultimately burnout among nurses. Coping can involve confronting a problem head on, while avoidance is an aspect of burnout. A range of coping strategies may be used in a given situation that include confrontation, distancing, self-control, seeking social support from others, accepting responsibility, putting our head in the sand, avoidance, problem solving, and positive reappraisal (viewing the problem in different terms). Coping interventions often enable people to consider some of the disadvantages of their current range of coping strategies (e.g., watching Netflix) and provide them with new ones, (such as seeking support, exercise and meditation).
THREE. Novel approaches There’s some evidence for novel approaches that are less widely researched. A study of Qi jong for physiotherapists found that emotional exhaustion decreased amongst participants that engaged in “White ball exercises”. Massage and touch therapy has had mixed results with some studies finding it effective and others not. Workplace appreciation events were found to have a significant effect in increasing performance and reducing depression and burnout among nurses and physicians.
FOUR. Learning and skills training and professional identity development
Learning and training can reduce burnout in mental health care workers. Interestingly, these types of interventions also increase employee performance. The pandemic has been a huge learning curve and those organisations that have learned and adapted have succeeded. Professional identity development programs have also been found to reduce burnout of the nurses.
FIVE. Taking a holiday
Taking a holiday may not change the organisation, but there is some evidence from an Israeli study led by Etzion and colleagues that it can reduce burnout in the short term, but it’s not maintained upon return to work. With lockdowns and shortages of staff, there may have been much less opportunities for staff to take holidays and to take holidays that fit with our ideas of holidays (covid testing pre, during and post trips can change our notion of what a short get away looks and feels like).
SIX. Practice Psychological Flexibility
Researchers have found that people that are psychologically flexible, are better able to cope with setbacks in a work environment and studies show effectiveness at reducing burnout. Psychological flexibility refers to being aware of the situation you are in and taking action based on your own values.
SEVEN. Learn mindfulness
Mindfulness involves observing one’s thoughts and feelings from a noncontrolling, nonelaborative, and non-judgmental perspective: A way of thinking commonly described as mindful.
Mindfulness is a skill that can be learned as outlined in this blog. Researchers Luken and Sammons (2016) ran a systematic review of mindfulness practices for reducing job burnout in health care professionals and teachers. They found evidence that mindfulness practices effectively reduced job burnout. Other reviews find evidence of mindfulness reducing related conditions of anxiety and depression. Inspire the Mind has previously published blogs on what mindfulness is and on its scientific basis.
Guidance for improved sleep includes: aim to get 7–9 hours per night, avoid drinking before bed, only use beds for sleep or sex, keep the bedroom quiet and relaxing, limit bright light exposure in the evenings, be careful of naps disrupting sleep patterns. Light from both lamps and screens can potentially disrupt circadian rhythms.
In summary, 8 evidence based strategies have been briefly proposed:
1) Cognitive behavioural therapy
2) Coping interventions
3) Learning and skills training
4) Novel interventions
5) Taking a holiday
6) Psychological flexibility
These approaches can be pursued through self-help books, online videos, apps, joining a mindfulness course online or in person, or seeking support from a licensed therapist or coach.
Hopefully, employers will also be seeking to assess risk of burn out in their organisations and put strategies in place to maintain the wellbeing of their employees.
Finally, there are other strategies, from talking to your employer about your mental health, to employers practicing better communication with staff to forming a support group for working parents. It is not that these other strategies do not work, they are just less studied in the literature.
Many thanks, valued readers, for reading.