A rustling of leaves was heard in the deep underbrush. The hunter froze in place, his fingers stiffening around his bow, poised for attack or flight. He bolted, leaping across the rocks as the cougar emerged, just missing its prey. Not stopping until he reached his destination, the hunter collapsed by the fire and fell asleep. This analogy showcases the survival response and a natural, rapid recovery.
The sharpening of the senses to danger and, subsequently, what we know to be the “fight or flight” response, can save our lives. Typically, once danger passes, we’re able to return to homeostasis. The survival response to stressors is not the problem. In the presence of persistent stressors and a state of “high alert,” the human brain triggers thoughts, feelings, actions, and physical responses that either escalate, or in the more resilient brain, de-escalate the action of the amygdala in triggering and sustaining the body’s cortisol levels and a complex cascade of psycho-physiological reactions.
Such reactions to perceived threats, when frequent and sustained, are well understood to be associated with compromised cognitive functioning, reduced life and job satisfaction, and a wide range of adverse health conditions – all of which contribute to symptoms of burnout. The human and organizational costs are immense. Thus, there is an imperative for protecting psychological resilience in the complex jungle of stressors within health care communities.
The dilemma for providers and health care communities
The dilemma of how to protect health care workers’ stress resilience lies not just with individual clinicians, but also with the organization. The pressures, challenges, and unpredictability of health care delivery have greatly increased in the 21st century and are further heightened more recently because of the COVID-19 pandemic. There are too many “virtual cougars” in health care’s underbrush (exhaustive administrative burdens, EHR frustrations, government regulations, payer struggles, financial strain, infection fears, liability risks, work-home balance issues, etc.).
As a group, physicians and other health care workers are inherently above average in stress resilience. However, where system-level stressors are persistent, the brain’s activation of stress-triggered thoughts, feelings, behaviors, and physical responses, can erode psychological flexibility and resilience, exacerbating a vicious cycle wherein burnout symptoms emerge. Higher than average resilience levels may be protective of, but are not impervious to, highly adverse, pressured environments. Laying by the fire at night or listening to a meditation app may provide short term relief, but it is no longer enough to restore homeostasis. As weariness and frustration increase, the capacity to navigate complex situations may seem overwhelming for all health care stakeholders.
In the sea of regulatory, technological, financial, and pandemic-related obstacles, how can health leadership navigate towards creating a culture with fewer virtual “cougars” that support clinical team wellness and resilience? Concurrently, while this daunting process is underway, what practical, science-based cognitive and behavioral intervention strategies can the health care community adopt, advocate and immediately make available to individuals in its community to strengthen psychological flexibility and resilience?
Psychological flexibility as an asset in altering the landscape and the beasts in the jungle
In this extraordinarily pressured environment, protecting stress resilience, a complex phenomenon in the brain, requires mindful, self-applied intervention strategies in the “heat of the moment.” Arguably, the goal in retraining a more resilient brain is not merely to better weather the storm or fight off the cougars, but, importantly, to more effectively work as equal partners – administrators and clinicians – in decisions affecting care, in the allocation of resources, and in promoting the individual team member’s valued path, purpose, and wellbeing.
The capacity for psychological flexibility is a cornerstone of resilience. A more resilient brain is associated with improved vitality, clarity, problem-solving, decision making, better communication, working memory, reduced errors, life and job satisfaction, and better physical health. Thus, a new way forward begins with an awareness that strengthening the capacity for psychological flexibility and resilience, both in management leadership and clinicians, optimizes the possibility for clarity and adaptability in working together to make effective change in system-wide issues – the proverbial beasts in the health care jungle – as well as benefiting the individual more immediately.
Among mindfulness approaches, the methodology developed in Acceptance and Commitment Therapy (ACT) fosters levels of awareness beyond present moment awareness (of one’s stress-triggered thoughts, feelings, behaviors, and physical responses), to cultivating the capacity for self-assessment of the usefulness of one’s stress-triggered responses; and importantly, a commitment to being flexible and open to more workable strategies that align with one’s valued directions. Peer-reviewed research demonstrates that integrating resilience-promoting interventions – ACT, mindfulness-based therapies, and cognitive behavioral strategies – leads to more durable outcomes, while also substantially reducing health care utilization. Through a community-wide approach to facilitation of the brain’s neuroplasticity capacity, individuals are allowed to re-navigate their minds towards directions of flexibility, valued actions, psychological and physical well-being, and be more effective partners in proactive system advocacy.
Health care delivery will always be inherently unpredictable and challenging. Those drawn to medicine are among our most resilient, but the current landscape reveals acutely a rise in burnout that exceeded acceptable levels even before the COVID-19 outbreak. Such innate resilience in clinicians and clinical care teams is an individual and strategic asset worthy of recognition, protection, and system-wide approaches that nurture and potentiate it. Such system-wide advocacy serves to proactively promote the vitality of health care delivery, quality of care, individual and group purpose, life-work satisfaction, and balance. Ultimately, these all are recognized as antidotes to burnout.
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