Sunday, April 6, 2014

One way to prevent burnout in life and sports

As 4th year medical students, we are required to take a course called TRIPLE: transition to residency and internship and preparation for life. We had an interesting conversation the other day about physician burnout. Burnout is quite common among residents and doctors, and is associated with job-related stress and poor coping mechanisms when faced with significant pressure. In recent years, burnout has also been a hot topic in sports medical journals as kids become more and more focused on athletic performance and on early sport specialization. But burnout can affect anyone, athlete or non-athlete, physician or not, and I think there are some interesting ways to cope with stress to prevent burnout in any aspect of your life.

The burnout syndrome in work or in sports is characterized by losing enthusiasm (emotional exhaustion), having a negative attitude towards people or sports (depersonalization or devaluation), and having a sense that work or racing is no longer meaningful (low personal accomplishment).

There are several factors that can lead to burnout. The most obvious one is excessive working or training with too much monotony and little time for recovery. Other factors associated with burnout include low autonomy and involvement in decision making, having multiple stressors outside of work or sports, such as financial obligations or balancing family life, feeling pressure from peers or coaches to perform up to inappropriate expectations, and feeling trapped by work or sports because to leave would mean giving up one's identity and years of preparation. There are also perfectionist or anxious personality characteristics can make certain individuals more prone to burnout.

But burnout is not inevitable. People can be doctors or athletes for years without feeling distressed about their jobs or races. While there are multiple ways to prevent burnout, such as emphasizing recovery time, varying daily routine and surrounding yourself with a strong and supportive social network, recent studies have also shown that mindfullness training can have a positive impact on individual well-being and burnout prevention.

What exactly is mindfullness? That was my first question when I heard about these studies. It sounded a lot like soft fluffy psychology with no real scientific basis to back it up. However, after reading some more about mindfullness and talking with my classmates and mentors in small group sessions over the past 2 weeks, I have a new appreciation for what it means.

Anyone who has taken a yoga class or tried meditation has practiced mindfullness, which is the the ability to pay attention in a particular way: on purpose, in the present moment, and nonjudgmentally. It includes the capacity for lowering one’s own reactivity to challenging experiences; the ability to notice, observe, and experience bodily sensations, thoughts, and feelings even though they may be unpleasant; acting with awareness and attention (not being on autopilot); and focusing on experience, not on the labels or judgments applied to them.

When I am working in the hospital or sometimes even in a race, I find myself daydreaming a lot of the time and thinking about the many tasks I have to get done before the day ends, my plans for the next weekend, how tired I am, everything and anything except on what is going on in front of me.

Being pulled in multiple directions and multi-tasking is part of any career or athletic pursuit. As a result, living mindfully is something you have to consciously practice and cultivate. It doesn't just happen on its own. Below are some techniques that can help you become more self-aware and more in-tune with your personal well-being. Interestingly, in the process of learning about yourself, studies have shown that individuals who practice mindfullness training become more emotionally stable and better able to manage stress, more empathetic and open towards others and new ideas, and have improved relationships with the people around them - all qualities which are important in work and sports. Being mindful doesn't require a big time investment. Many of these techniques can be done in 5 minutes or less.

Meditation: The purpose of mediation is to become aware of your sensory, emotional and cognitive reactions that you experience on a daily basis. These can include: 
  • Body scan: start at the top of your head or the bottom of your feet and notice bodily sensations and the cognitive and emotional reactions you have without attempting to change the sensations themselves. Alternatively, you can practice being aware of each muscle in your body and work from head to toe contracting muscles and then relaxing them.
  • Sitting or walking mediation: Bring awareness to the thoughts, feelings and sensations experienced while sitting or walking
  • Mindful movement: yoga-type exercises that allow you to use movement and breaths to bring awareness to your body
  • I really like these free, short, guided mediation audioclips:
Reflective Narrative Exercises: By writing brief stories about personal experiences and sharing them with friends or peers, you can explore challenges you faced, recognize ways you successfully worked through difficult situations, and identify personal qualities that promoted success or failure.

Appreciative Inquiry: Listening to others share their stories can be equally as beneficial as being the storyteller. Listeners practice avoiding interruptions and judgments, resist comparing their own experience with that of the storyteller, and try to truly understand the situation from the storyteller's point of view by thinking of focused questions to deepen understanding of the storyteller's experience.

One part of me still thinks that mindfullness training is a bit of nonsense. But another part of me hopes that by spending a few minutes a day living more mindfully, I will be able to balance the demands of 80 hr residency work weeks and still fit in some racing (and all the other things important in life) without getting too stressed or burned out. Since I won't have much time for rest and relaxation, I am hoping that through mindfullness training, I can find meaning and a sense of well-being in the moment to moment experiences in my daily routine.

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