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ResiliencyinResearchDevelopment:ToolstoReduceStressandFindBalance
ANORDPPresentationMay9,2018
byJoannaDowner,PhD,
AssociateDeanforResearchDevelopment,DukeUniversitySchoolofMedicine
LearningObjectives
1. Understandstressandburnoutandtheircontributors.2. Explorearobust“tool-kit”forreducingstress,preventing
burnout,andimprovingbalance.3. Begindevelopingyourownspecificplanofaction–
immediate,short-term,andlong-termgoalsandsteps.
"GodgrantmetheserenitytoacceptthethingsIcannotchange,thecouragetochangethethingsIcan,andthewisdomtoknowthedifference.“
–ReinholdNiebuhr
Stress
• A stateofstrainortensionresultingfromadverseorverydemandingcircumstancesthatresultsinapredictablesetofbiochemical,physiologicalandbehavioralchanges.
• Untreatedchronicstressà seriousphysicalandpsychologicaldifficulties
• “Stressisnotafunctionofevents;it’safunctionoftheviewyoutakeofevents.”
http://www.apa.org/helpcenter/understanding-chronic-stress.aspxMindfulnessintheAgeofComplexity(aninterviewwithEllenLanger),HarvardBusinessReview,March2014.https://hbr.org/2014/03/mindfulness-in-the-age-of-complexity
Burnout
• Physicalormentalcollapsecausedbyoverworkorstress(APA).
• Work-relatedhopelessnessandfeelingsofinefficacy(ProQOL.org).
• Burnoutistotheextreme,asensethatthereisnoendandthatanypurportedcontrolisjustanillusion;itisoftenpastthe“pointofnoreturn”.
MovingfromStresstoBurnout• Personalcharacteristics&tendencies:
– Areyouaperfectionist?– Doyousetandsticktoboundaries?Areyouanaturalhelper?– Doyoueffectivelymanageothers’expectations?Yourown?– Doyourespondtostressorsappropriately?– Doyouprioritizeeffectively?Doyoueverprioritizeyourself?– Doyouseekandthriveonchallenge?– Areyouaprocrastinator?
• Burnoutrisks:– Lackofcontrol;Unclearjobexpectations– Dysfunctionalworkplacedynamics;Mismatchinvalues;Poorjobfit– Extremesofactivity– Lackofsocialsupport(atworkand/orhome);Poorwork-lifebalance
• Avalidatedmeasure:― TheProfessionalQualityofLifeScale– CompassionSatisfactionand
CompassionFatigueProQOL Version5(2009)©B.Hudnall Stamm,2009;seewww.proqol.org formoreinformation.(In2017,ownershiptransferredtotheCenterforVictimsofTorture,whichwillcontinuetomakethetoolfreeandavailableforuse.)
― Scores“CompassionSatisfaction”and“Burnout”.
Whereonthespectrumofstressedtoburned-outareyou?
Let’stakeamomenttobreatheandrebuild….
Mindfulness:AFewPractices
• Moment-to-moment,non-judgmentalawareness.– Balanceour“planning”brainandcreativebrain,andimprove
ourresponsetostressors.– Allowsusto“reset”&recovereachdayorthroughouttheday.
• “MindfulnessBasedStressReduction”(MBSR)– AwarenessofBreathPractice– 20BreathsPractice– BodyScanPractice– WalkingMindfulness– MindfulCommunication– Loving-Kindness
• FindMBSRtraining.Adaptedinpartfrom Benson,H.“TheRelaxationResponse”,1975;Kabat-Zinn,J.“FullCatastropheLiving”,2013.
Exerciseactuallyhelpsyourbrainrebuild
• Enduranceaerobicexerciseleadstogreaterneurogeneration inthehippocampusthaneitherstrengthtrainingorhighintensityintervaltraining (inrodents).
• Be(more)active.– 150 min/wk ofmoderate-to-vigorousphysicalactivity– Evensegmentsof2minutesaddup!(humans)
• Getasit-standworkstation.
Nokiaetal.,J.Physiology2016;594(7):1855-73;Saint-Mauriceetal.,JAmer HeartAssoc 2018;7:e007678
Toolstocontrolstressors
• Anticipateandplanforstressfulperiods.– Justbecauseit’s“life”doesn’tmeanit’shelpful.– Consideryourentireself.– Takesometimetorecover.
• Manageinterruptions.– Ittakesdoubleortriplethetimetoregainfull
concentration.– Checkemailsonasetschedule;checkinglaterallows
youtofocusfirstonyourpriorities.– Scheduleyourcalendarinawaythatsuitsyou;leave
yourselfbreathingroom.
Adaptedinpartfromhttp://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/work-life-balance/art-20048134
Toolstocontrolstressors(cont.)
• Leaveworkatwork.– Consciouslyseparateworktimefrompersonaltime.
– Doworkatwork– don’t“spite”it.
• Setboundaries(inwriting!)andsticktothem.– Giveyourselfpermissiontosay“no”,ortosay“yes”undercircumstancesofyourchoosing.
Adaptedinpartfromhttp://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/work-life-balance/art-20048134
Toolstocontrolstressors(cont.)
• Manageothers’expectations,aswellasyourown.– Keepyourexpectationsasrealisticaspossible.– Acceptwhatyoucannotchange.– Givetherationaleandconsequence,andthenaccepttheirdecision.
– “Itiswhatitis.”
Toolstocontrolstressors(cont.)
• Organizeandplan.– Sticktoyourownpriorities!– Ratherthan“biglists”,createeffectiveproject-specific“nextstep”to-doliststhatgatherALLto-dos.
– PRIORITIZEANDUSETHESELISTS!
Makeabetterto-dolist
• DavidAllen’sfive-stageprocess:1) CollectALLofthethingsthatareinyourbrainand
puteachonitsownpieceofpaper;2) Processwhattheymeanandwhattodoabout
them(theexactnextstepforeach);3) Organizetheresults;and4) Reviewthemasoptionsforwhatyouchooseto5) Do.
• Asinglelocationforacomplete“to-do”listallowsyourbraintostopremindingyou!
• Get DavidAllen’sbookoranotherofyourchoosingandimplement it.
DavidAllen.GettingThingsDone:TheArtofStress-FreeProductivity. NewYork:PenguinBooks,2001.
• Prioritizeeffectively.– Usethe“EisenhowerMatrix”to“do,
decidewhentodo,delegate,ordelete”.
– Howmuchtimeareyoureallyspendingonvariousactivities?
– Evaluatenotjustsinglerequests,butongoingefforts.(Don’tconfuse“busy”with“productive”!)
– “Don’twaste100%ofyourenergyona5%issue.”http://pas.duke.edu/stress.php
Toolstocontrolstressors(cont.)
Adaptedinpartfromhttp://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/work-life-balance/art-20048134 andhttp://waitbutwhy.com/2015/03/procrastination-matrix.html &https://waitbutwhy.com/2013/10/why-procrastinators-procrastinate.html
The“DarkPlayground”(waitbutwhy blog)
ToolstocontrolYOU
• Prioritizeyourself.– Prioritizeyourownneedssometimes.– Takesometimetorecover.
• Eatahealthydiet.– Freshfruits,vegetables,leanprotein,wholegrains,andcomplexcarbohydrates.
– Caffeine,alcohol,andrefinedsugarsinmoderation.– Stayhydrated(dehydrated=irritable!)
Adaptedinpartfromhttp://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/work-life-balance/art-20048134
ToolstocontrolYOU(cont.)
• Getenoughsleep.– Sleepinterruptedbyyourbrainrunningwild?Buildthatcomprehensiveto-dolist;putanotepadandpenbyyourbed.
– Troublefallingasleep?Putawayyourphone;breatheslowly&countbackwards;identifytensionandrelaxit.Toocoldorhot?Achy?
– Adjustyoursleepingenvironment(bed,curtains,orientation,etc.).
– Exercise!
• Seekprofessionalhelp.– Employer-providedcounselingservices?CareerorExecutiveCoach?
• Connectwithotherpeople.– Moretimewith“nourishing”friends.– Ventyourfrustrations?Treadcarefully!
• Re-discoverafavoritepastimeoruncoveranewone.– Volunteeringcanboostsenseofwork-lifebalance.– Chooseanactivitythatfillsinwhat’smissingforyou.– Caution:Youractivitymayneedtobeasdemandingaswork.– Listfivethingsyoulovetodoandthendooneofthem!
ToolstocontrolYOU(cont.)
Adaptedinpartfromhttp://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/work-life-balance/art-20048134andhttp://pas.duke.edu/stress.php
• Identify&evaluateworkandpersonalresponsibilities.
• Whatisnegotiable?WhatCANyoucontrol?– Drop(decidenottodothem)and/orre-prioritizethem.– Seekreassignmentof(punt!)drainingresponsibilities.– Askforanddeployadditionalresourcesatworkand/orathome.Whodoyouneedtotalkto?Whatshouldyousay?
• Lookforchancestoaddresponsibilitiesthatstimulateyou.(Bolles,R.N.,WhatColorIsYourParachute?)
• SignupforMindfulnessorothertraining
Sowhatcanyoudo?
Adaptedinpartfromhttp://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/work-life-balance/art-20048134
Conclusion
• Stressfuleventsandstressorsareonlypartoftheequation– howyoureactto,dealwith,process,orpursuethosestressorsisequallyifnotmoreimportant.
• WhatwillYOUdo?Identifyimmediate,short-term,andlongertermgoalsforreducingyourstress.
• Shareyourtips!
Resources– MindfulnessBasedStressReduction
• http://www.helpguide.org/harvard/benefits-of-mindfulness.htm• JonKabat-Zinn.FullCatastropheLiving:UsingtheWisdomofYourBody
andMindtoFaceStress,Pain,andIllness.NewYork:BantamBooksTradePaperbacks,2013.(ISBN-13:978-0345536938)
• UCSDCenterforMindfulnesswebsitehttps://health.ucsd.edu/specialties/mindfulness/Pages/default.aspx
• UCSDCenterforMindfulnessonlineresources(includinglinkstoaudioandvideoguidance)https://health.ucsd.edu/specialties/mindfulness/resources/Pages/default.aspx
• DukeMBSRProgram(10weeks)https://www.dukeintegrativemedicine.org/programs-training/public/mindfulness-based-stress-reduction/
• DukeDistanceMBSRProgram(8weeks)https://www.dukeintegrativemedicine.org/programs-training/public/mindfulness-based-stressed-reduction-distance-learning/
• LookatyourownornearbyinstitutionsforMBSRormindfulnessprogramsandofferings.
OnlineResources– StressandBurnout• http://waitbutwhy.com/2013/10/why-procrastinators-procrastinate.html• http://waitbutwhy.com/2013/11/how-to-beat-procrastination.html• http://waitbutwhy.com/2015/03/procrastination-matrix.html• https://www.psychologytoday.com/blog/high-octane-women/201104/overcoming-
burnout• http://misplacedbrit.com/depression/recovering-from-burnout-or-depression-an-a-z/• http://www.helpguide.org/articles/stress/preventing-burnout.htm• http://www.helpguide.org/articles/stress/stress-symptoms-causes-and-effects.htm• http://www.health.harvard.edu/staying-healthy/understanding-the-stress-response• https://hbr.org/2016/06/steps-to-take-when-youre-starting-to-feel-burned-out• http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/art-20046642 (job
burnout)• http://www.cnn.com/2017/01/18/health/no-worries-wisdom-project/index.html• http://pas.duke.edu/stress.php• https://www.nimh.nih.gov/health/publications/stress/index.shtml• ProfessionalQualityofLifeElementsTheoryandMeasurement:Compassion
SatisfactionandCompassionFatigue,Burnout, SecondaryTraumaticStress,VicariousTraumatizationandVicariousTransformation– Website:http://www.proqol.org/Home_Page.php– Tool:http://www.proqol.org/uploads/ProQOL_5_English_Self-Score_3-2012.pdf
Resources– Effectsofstressonthebrain
• Dias-FerreiraE,etal.Chronicstresscausesfrontostriatal reorganizationandaffectsdecision-making.Science2009;325:621-625.
• Lucassen PJ,etal.Regulationofadultneurogenesisbystress,sleepdisruption,exerciseandinflammation:Implicationsfordepressionandantidepressantaction.EuropeanNeuropsychopharmacology 2010;20:1-17.
• Lucassen PJ,etal.NeuropathologyofStress.Acta Neuropathol2014;127:109-135.
• McEwenBS,GrayJD,Nasca C.Recognizingresilience:learningfromeffectsofstressonthebrain.NeurobiologyofStress2015;1:1-11.
• McEwenBS,McKittrick CR,TamashiroKLK,Sakai,RR.Thebrainonstress:InsightfromstudiesusingtheVisibleBurrowSystem.Physiology&Behavior2015;146:47-56.
• SandiC,Pinelo-NevaMT.Stressandmemory:behavioraleffectsandneurobiologicalmechanisms.NeuralPlasticity2007;2007:ArticleID78970.
• Schoenfeld TJ,GouldE.Stress,stresshormones,andadultneurogenesis.ExperimentalNeurology2012;233:12-21.
Resourcesonmindfulness&work-lifebalance
• AlexandraMichel,ChristineBosch,MiriamRexroth.Mindfulnessasacognitive-emotionalsegmentationstrategy:Aninterventionpromotingwork-lifebalance.JOccupationalandOrganizationalPsychology.Dec2014;87(4):733–754.http://onlinelibrary.wiley.com/doi/10.1111/joop.12072/full(Univ.Heidelbergstudy)
• KimberlySchaufenbuel.BringingMindfulnesstotheWorkplace(awhitepaper).ExecutiveDevelopment,UNCKenan-FlaglerBusinessSchool,2014.http://www.kenan-flagler.unc.edu/~/media/Files/documents/executive-development/unc-white-paper-bringing-mindfulness-to-the-workplace_final.pdf
• Sonnentag S,FritzC.Recoveryfromjobstress:Thestressor-detachmentmodelasanintegrativeframework.JOrganiz Behav 2015;36:S72-S103.
