This month we spoke to Life Works' Clinical and Therapy Services Manager, Steve Clarke (fdSc, MSc), about burnout - an increasingly worrying issue in GPs as well as patients. He offers advice on the best ways to manage this condition, seek burnout treatment, the importance of supporting yourself as well as your patients, and spotting the signs and symptoms.
Steve specialises in burnout, stress and other mood disorders at Life Works, a Priory site which offers burnout treatment as a co-occurring mental health condition to addictions or eating disorders.
Clinical burnout is best described as a state of severe emotional, physical, and mental exhaustion, which is often defined by “excessive and prolonged periods of stress”. The condition causes individuals to experience enormous amounts of distress when attempting to meet the constant demands of life.
What is the difference between stress and burnout?
Stress implies an adaptive response to any kind of demand created by adverse circumstances. Burnout however, refers to a state of mental or emotional tiredness, which occurs in response to continuous exposure to that stress.
Someone with work-related stress for example, may feel a lack of motivation and a sense of dissatisfaction in their job. However, someone with burnout may well experience physical energy loss, an inability to function, and no motivation to do anything, even things they once enjoyed. Whilst stress may instil a loss of hope, burnout would cause frustration, disruption and extreme cynicism about everything associated with the job.
Recent statistics related to stress and burnout emphasise the importance of treating such conditions as promptly and efficiently as possible, in order to improve the lives of those struggling to cope. In the past year alone, a reported 74% of people surveyed had felt so stressed at some point, that they had been too overwhelmed to cope with everyday tasks.
In the UK, 12.5 million working days are lost each year due to work-related stress, depression or anxiety and in 2016/17, stress, depression or anxiety accounted for 40% of all work-related ill health cases and 49% of all working days lost due to ill health. In fact, these UK anxiety statistics show that mixed depression and anxiety affects 8 in 100 adults, so it's no surprise that many need time off work to help manage their conditions.
The signs and symptoms of burnout
So how can you tell if a patient attending your GP surgery is suffering from burnout? Below, we offer some common signs and symptoms:
- Fatigue – initially, a patient may feel tired most days, low in energy and lethargic. Progressively though they will become physically and emotionally exhausted and depleted of resources
- Insomnia – initially, a patient may struggle to fall asleep or stay asleep. This however can turn into insomnia and become much more troublesome. Despite increasing levels of exhaustion, it becomes even more difficult to sleep
- Forgetfulness / lack of concentration – initially, there may be a loss in focus, or some forgetfulness. Later on, work becomes unmanageable and everything begins to pile up
- More susceptible to illness – as the body’s natural resources become depleted, a patient’s immune system weakens. They may find that illness strikes more frequently, ranging from a cold to flu-like symptoms
- Loss of appetite – initially, hunger levels may drop as a result of stress. However, this can lead to one’s appetite being lost altogether, leading to noticeable levels of weight loss
- Physical symptoms – these can take place in a number of increasingly severe ways. Physical symptoms may include a shortness of breath, or even persistent chest pains. Some may feel heart palpitations, dizziness, headaches and stomach problems including diarrhoea
- Anxiety – initially, experiences may include tension, worry or negative projection. The longer this continues, the closer a patient becomes to burning out entirely. Anxiety can interfere in our personal lives, and can affect our work, to the point that we may actually fear or dread attending
- Depression – initially, a person may feel sad and possibly hopeless. There may be some feelings of guilt and worthlessness as a result of missing deadlines for example. At its worst, patients may feel shame, trapped and severely depressed. One may then begin to feel that everyone will be better off without you. If a patient’s depression has reached this point, you can guide them to specialist support
- Anger – initially, this may present as irritability and frustration. Eventually, this may turn into resentment, leading to angry outbursts. There could be serious arguments at home and a feeling that no-one actually appreciates you for anything that you do. If anger gets to the point where it turns to thoughts or acts of violence toward family or colleagues, a patient should be offered immediate professional assistance
- Isolation – as anger intensifies, the patient may feel that they just want to avoid everyone as they feel too frustrated and too busy to form and maintain friendships, leading to spending more time alone and losing social interaction
What can GPs do to support and manage a patient experiencing burnout?
Encourage talking therapy
It’s always good to talk. There are many trained psychotherapists and counsellors, trained in recognising the symptoms of burnout, who are able to offer support along with a plan for recovery. Talking therapies can include cognitive behavioural therapy (CBT), dialectical behaviour therapy (DBT) and group therapy.
Encourage rest
Get enough rest – napping for just 20 minutes can improve cognitive functioning and processing of information. Rest encourages greater tolerance for the tasks that may lead to burnout.
Encourage ‘good enough’, not ‘perfection’
Perfectionism can actually hinder success, and may be a large cause for burnout. We can often measure ourselves against impossibly high standards and striving to achieve these standards. Setting the bar too high is dangerous as we will never consistently be able to deliver.
Encourage taking regular breaks
A great way to begin to recover from burnout is to encourage time away from work, which in turn gives the distance and time needed to relax and de-stress. Of course, the stress, issues and problems that you're experiencing at work may still be there when you get back, however, taking time off is essential for getting the rest you need to come up with long-term solutions to burnout.
Encourage learning to say “no”
Encourage learning to say “no” to a task without feeling guilty
Supporting GPs with burnout
It’s important to remember that GPs can also struggle with burnout, which means that you need to look after yourself as well as your patients. GP burnout was recently described in an article by the British Medical Journal as having reached an “epidemic level”. Now, more than ever, you should be supporting your own mental wellbeing with this advice and guidance.
Priory is passionate about supporting GPs and professionals, and on October 30th 2018, Dr Ed Burns (MBChB, MRCPsych, MSc) and Dr Samantha Cobb (DPsych, CPsychol) will be exploring the impact of burnout on GPs. This educational session will provide advice to help you to manage your own mental health and wellbeing, in turn enabling you to better support your patients.
Treatment at Priory – what benefit does this have for someone with burnout?
A residential inpatient treatment programme would predominantly be recommended in order to avoid burnout, or a return to burnout. This allows a break from everyday life, whilst re-assessing what is contributing to the burnout.
Priory approaches treatment for burnout in a similar way to that of any other mental health issue or addiction. We use intervention techniques such as CBT and DBT but also work on re-evaluating lifestyle and work-related priorities, nutritional wellbeing, exercise and sleep hygiene. One important part of a burnout programme that will be important in recovery, is for patients to see the importance of ‘down time’ and the need to experience pleasure in a healthy way.
During treatment for burnout, we focus on the underlying causes, which may be related to a whole host of things including:
- A lack of exercise goals
- Poor nutritional health
- A general absence of boundaries
We initiate talking therapy for patients to help them to begin to understand why they feel the need to do the things that may contribute to burnout, whether this is an inability to say “no”, a desire for perfection, or a yearning for success. We re-evaluate what is likely to happen if and when certain lifestyle goals are re-established.
We will also work jointly on identifying coping strategies in order to investigate how to do things differently in future. We focus on the underlying anxiety that manifests, generally as a contributing factor in burnout.
All patients have the opportunity to work to a daily treatment schedule, which also delivers a balanced programme of:
- Psychotherapy
- Complementary therapies
- Healthy nutrition
Patients will be given therapeutic assignments based on issues that are identified as part of their treatment and present these back to their therapist, or the group as a whole. As patients come to the end of their treatment, they will work with the therapy team to produce a relapse prevention plan, to ensure there is no return to old behavioural patterns.
