Changing Beliefs

Changing 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

Identifying and challenging unhelpful beliefs and expectations may be valuable in improving a sense of personal accomplishment and in reducing emotional exhaustion.

Changing Coping Strategies

Using 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 ideas^59-62

The strategies above are recommended over strategies that have been related to higher levels of burnout, such as:^63,64

• 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

Psychologists who rated the following coping strategies as highly important reported less emotional exhaustion and cynicism or depersonalization regarding clients:³⁸

• 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

Additionally, it may be more adaptive to be flexible in the timing of coping strategies. For example, in a study of first responders, those who could flexibly switch between distraction when under high stress and positive reappraisal of emotional information when less stressed were less likely to exhibit symptoms of PTSD.⁵² Flexible coping is also associated with the ability to see multiple perspectives and to perceive trade-offs between alternatives.^57,58

Perspective Taking and Letting Go

Perspective 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

Letting go is a strategy that has been shown to be helpful when the stress of completing tasks, fulfilling requirements, and meeting deadlines starts to feel overwhelming.³⁶ In the work setting, effectively letting go can include both targeting (identifying which tasks to let go of) and timing (determining when to let go).

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?

Timing can help you determine when to let go. For instance, you can ask yourself:

• 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?

Self-Monitoring

Regular 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

Additional Training

Gaining 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