PTSD: National Center for PTSD
Self Help Cognitive
Provider PTSD Toolkit
Changing BeliefsChanging or reframing beliefs can be a helpful way to reduce burnout and STS reactions. Interventions that include a cognitive-behavioral approach have been shown to be effective in reducing burnout, anxiety, stress, and general symptoms in healthcare workers, and there is some evidence that interventions which contain cognitive elements coupled with behavioral elements yield better results than those with behavioral elements alone.23
A number of beliefs have been linked to elements of provider burnout, including: 25
- Low tolerance of distress, related both to distress experienced by the therapist (e.g., 'If I allow my clients to cause me distress, I'm a failure') and distress experienced by the client (e.g., 'I must protect my client from reliving painful events')
- Inflexibility with respect to the application of therapeutic models, reflecting the belief that only one treatment model or protocol should be used in therapy
- Need to feel in control of the therapy setting with strong perfectionistic tendencies
Changing Coping Strategies
Changing Coping StrategiesUsing multiple coping strategies related to working through one's emotions and focusing on goals have been shown to reduce psychological distress.56 The following strategies have been shown to lower stress and depersonalization, and improve personal accomplishment:
- Emotion-focused strategies such as humor and acceptance
- Problem-focused coping such as planning, maintaining work balance with family and leisure activities, positive reinterpretation, and use of innovative ideas59-62
- Escape-avoidance coping strategies such as wishing the situation would go away or going on as if nothing happened
- Negative emotion-focused coping strategies such as denial and alcohol use
- Maintaining a sense of control
- Reflecting on satisfying experiences of work
- Maintaining self-awareness/self-monitoring
- Maintaining a balance between personal and professional lives
- Maintaining professional identity/values
Perspective Taking and Letting Go
Perspective Taking and Letting GoPerspective taking and letting go are two simple strategies for managing stress. Perspective taking is the ability to understand or relate to an experience from different and varied points of view. Changing your perspective can take many forms. For instance, in one study it was shown that taking a broader perspective allowed providers to get in touch with the larger goals of their work and gave them a more balanced view of what was happening.63 Being able to suspend your personal point of view gives you the opportunity to view the situation from another perspective and decide how to respond based on a fuller appreciation of the situation.64 This kind of flexibility can be helpful in a number of ways, including:
- Promoting a shift in behavior and attitudes
- Assisting in maintaining balance among important life domains
- Promoting recognition of and adaptation to a variety of situational demands
- Assisting in remaining open to experience while maintaining the capacity to choose personal values-based actions.65
To target your priorities, ask yourself:
- What about this task is important to me?
- Am I attached to this task in some way that I need not be?
- How much control do I truly have in this situation?
- Is my attachment to the task in line with my broader work goals?
- How can I create time during the workday (e.g., lunch, break, taking a walk) to get some distance from my work stress?
- How can I manage time during my workday to leave my work at the office, so it doesn't weigh on me after hours?
MindfulnessMindfulness involves paying attention to the present moment, in a non-judgmental way.66 It has been shown to be helpful for work-related stress by reducing burnout and improving mood among primary care physicians and mental health providers,67 Mindfulness-based interventions (MBIs) have been found to be well-received and effective in a number of studies. MBIs reduce negative psychological effects of the work environment and promote mental health among employees, similar to the results shown with other stress management approaches such as relaxation and yoga. Additionally, mindfulness practices may be helpful in reducing inflexible emotional suppression, which has been associated with low levels of positive affect and life satisfaction, and is thought to contribute to greater depression, anxiety, and negative emotions, as well as posttraumatic stress.29,36,50,51,67-72
Mindfulness interventions don't have to take a lot of time. For instance, a 5-week course of daily 15-minute interventions proved to be helpful in increasing employees' level of mindfulness, and significantly reducing psychological distress.73 Mindfulness interventions can also be augmented with online support, which has been shown to be particularly helpful for those with more pronounced symptoms.74
Mindfulness CoachThe Mindfulness Coach mobile app will help you practice mindfulness meditation. The app offers strategies to help overcome challenges to mindfulness practice, reminders, exercises, and a log to track your progress.
Self-MonitoringRegular self-monitoring is a useful technique for making behavioral changes. Self-awareness and self-monitoring have emerged as highly rated strategies and have been discussed at length in the literature on self-care and prevention of burnout.46,54,75 The abilities to realistically self-assess strengths and vulnerabilities and to be sensitive to signs of difficulties are critical to making good choices about work activities and taking constructive action to avoid excessive stress and burnout. Finally, self-monitoring can help you remain aware of your own possible triggers for distress in personal, professional, and environmental domains.11,39
HumorHumor is commonly used as an effective coping skill among mental health providers.2,76 When used appropriately, it can elevate mood and increase social connections, release tension, and create muscle relaxation.77 Maintaining a sense of humor is a strategy that has been highly endorsed in burnout studies, and has been associated with less emotional exhaustion at work.54,59 The positive side of humor, the non-hostile efforts intended to build feelings of affinity between people, appears to enhance coping effectiveness, increase workplace cohesion, and reduce burnout. 76,78 Even when controlling for bonds between coworkers and the use of social support, darker gallows humor has been linked to higher STS scores, whereas lighthearted humor is related to lower STS scores.76
Additional TrainingGaining an increased sense of professional efficacy and accomplishment is another strategy that has been shown to be helpful for burnout and STS.79 Professional self-efficacy is negatively correlated with both PTSD and vicarious traumatization (VT) symptoms in providers; and, compared to other burnout components, personal accomplishments form the strongest associations with self-efficacy. A lack of specific training, use of unstructured treatments, and insufficient knowledge can complicate the experiences of burnout and STS.80-83
One solution that many therapists have found helpful is to seek additional training opportunities. For instance, using evidence-based practices (EBPs) was the most reliable predictor of health, resilience, and compassion satisfaction among trauma providers in a study of social workers and psychologists.86
Engaging in additional training opportunities can improve your confidence and competence in working with your patients. Work self-efficacy is associated with better quality of life, lower levels of secondary traumatic stress, and beliefs about one's ability to deal with challenges related to secondary trauma.84,85 It is comprised of beliefs regarding how capable one is to deal with one's own emotions, thoughts and fears, to find meaning in the work, and to more effectively give and receive help from others. Enhancing self-efficacy appears to benefit a long-term adaptational process by facilitating social support, which in turn reduces a negative resource loss spiral, and fosters secondary traumatic growth.80