Back in April, when the COVID-19 pandemic was in its first month of claiming lives in the U.S., I wrote an article about how it could quickly become a moral injury pandemic for healthcare workers. Ever since, while the moral injury issue has received some attention in research (e.g. see recent articles here and here), discussions about burnout in healthcare in general, and the mental health sphere in particular, have been abundant.
On November 17th, a week before Thanksgiving—a very different one from those of years past—the American Psychological Association issued a press release in which they noted marked changes in the demand for and delivery of mental health care since March. Notable findings include that:
- 74 percent of psychologist reported an increase in demand for treatment of anxiety disorders
- 60 percent reported an increase in demand for treatment of depression
- About half report increases in demand for treatment of post-traumatic stress disorder (48 percent) and sleep-wake disorders (51 percent)
- 41 percent of psychologists admitted to feeling burned out
- 30 percent reported not being able to meet the demands for treatment expressed by their patients
In a profession where our primary sense of self-worth and fulfillment is derived from feeling effective in using our skills to help others, these numbers point to a grim reality—one in which burnout, if not already pervasive, is certainly lurking behind the corner.
Below, I outline five signs of burnout that go beyond the well-known fatigue, anger, and increased physical illness, and which, if allowed to become more chronic and pervasive, may lead to more serious psychological (and medical) problems necessitating professional care.
1. Feeling unempathic or absorbing the trauma or emotional pain of your patients.
You may have heard the term compassion fatigue (CF). There is a well-documented inverse relationship between empathy and burnout (cf. Wilkinson, Whittington, Perry, & Eames, 2017). When we are so chronically inundated with requests for help by patients in distress, we may feel like we start drowning in their pain, unable to maintain healthy emotional boundaries.
CF may be a result of that, manifesting itself as thoughts and feelings of inadequacy (e.g. “I don’t even know how to help anyone anymore”), depletion (e.g. “I have nothing to give”), or reduced ability to experience empathy and, consequently, detachment. When left unattended, these can grow into cynicism and ultimately into burnout or vicarious traumatization.
2. Escape fantasies.
This one is less talked about, yet I find it particularly relevant and important today, when we have already seen a number of physicians commit suicide as a result of COVID-19 related stress. (Of course, we cannot necessarily attribute taking one’s life solely to burnout, and other factors such as moral injury may contribute.)
However, escape fantasies can also take a less drastic form. Quitting our job immediately, changing our profession, moving to another state, country, or continent are all examples of ideas that I have heard my colleagues discuss—yes, somewhat jokingly, but the gravity of such remarks should not be underestimated.
Any impulsive decision making (e.g. “Must buy a new house now!”) and larger life decisions made in a haste may constitute an escape from the present reality as well. Some means of escaping reality, like taking a weekend off for excessive TV watching, may not be detrimental and, in fact, can be helpful in resetting but are nevertheless worth noticing.
3. Healthy routines are slipping.
Snoozing the alarm clock too much, not eating properly, or delaying exercise, meditation, or connecting with loved ones can also be signs of burnout. Changing our routines may be a result of pushing ourselves too hard to accommodate an ever-increasing flow of patients. While stretching our schedule occasionally to take a new referral is not in and of itself problematic, infringing upon our personal time too much or too frequently can lead to feeling like our boundaries are being violated. Keeping healthy routines is, metaphorically, the scaffolding that keeps us upright and able to remain stable throughout times of crisis.
4. Anhedonia (i.e. difficulty feeling positive emotions).
Burnout can manifest itself as feeling unmotivated and unable to feel joy or excitement. The to-do list feels too overwhelming and even the thought of activities that may have excited us in the past is now too much of a burden. This may also be related to the fact that we derive positive emotions from job positives like being helpful, impacting lives in a positive way, and seeing the results of our work.
In a pandemic, the stressors our patients are experiencing are constant and chronic. They also exacerbate already existing mental health conditions. We may see a resurgence of already discharged patients return to treatment. Treatment duration may be extended for patients, with no end in sight due to the pandemic and related stressors. This, in turn, creates a vacuum in which there is little positive reinforcement for the work we do. In other words, using Demerouti and Sanz’s (2014) demand resource model—currently, job demands far exceed job positives.
So, speaking of burnout, I could not have said it better than Gold and Zerwas (2020): “As mental health professionals, we simply have to stop setting ourselves on fire just to keep everyone else warm.”
To find help near you, visit the Psychology Today Therapy Directory.
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Wilkinson H., Whittington R., Perry L., Eames C. (2017). Examining the relationship between burnout and empathy in healthcare professionals: A systematic review. Burnout Research, 6, 18–29. doi:10.1016/j.burn.2017.06.003
Demerouti E., Sanz A. Burnout and work engagement: the JD-R approach. Annu. Rev. Organ. Psychol. Organ. Behav. 2014;1 doi: 10.1146/annurev-orgpsych-031413-091235.
Gold, J. & Zerwas, S. (2020). We are therapists. After 6 months of lockdown, we’re almost at breaking point. Newsweek. Retrieved from https://www.newsweek.com/we-are-therapists-we-need-therapy-ourselves-1528311?amp=1&fbclid=IwAR0TA6p4U1qCPl5TEE02Y3QmvPGAqULQRq_NqH695kMGcI03xYV01wFvyE8&__twitter_impression=true&s=04