Two tools to use when dealing with people we don't like

Ever have a difficult relationship result in clouded judgment?

Do you have trouble deciding on the next right thing to do when working with clients, animals, or staff that you don't like?

 I get so focused on what the jerk did that I can't see clearly what I should do in response. I get offended and can't properly think.

First I need to realize this is a natural process and step away from blaming others and myself. What I mean is that when I'm offended my autonomic nervous system cranks up the sympathetic branch; cortisol and adrenalin levels rise; the blood flow, oxygenation, and energy to my brain stem and major muscle groups increases, while my frontal lobes and amygdala get starved; and I’m physiologically in great shape to react, to confront others or stick my head in the sand, but in crummy shape to think through the situation and respond with compassion.

In the heat of the moment I’ve found softening my belly and focusing on my breath while feeling my belly expand when I inhale tips the scale a bit toward the parasympathetic, toward rational, compassionate thought. I take a deep breath. I give myself a moment. I pay attention to what my body and emotions are telling me. I take another deep breath.

For growth over the long term I’ve found meditation essential to train my brain; to give me some control over repetitive, obsessive, and negative thought processes; to rein in that wild foal of a brain stem. I’ve found lovingkindness meditation most helpful. The essence follows. First, I acknowledge that I want to be happy, useful, healthy, and at peace. Next I do the same for someone who is easy to love; a child, pet, spouse, or close friend may come to mind. Then I repeat the acknowledgment of the same for an acquaintance, like the clerk at the store I know, but not well. Finally I repeat this for whoever is on the top of my list of irritants. This has nothing to do with what anyone deserves. I just realize and affirm that they probably want to be happy, useful, healthy, and at peace. This tool helps me realize the oneness of humans and animals in life. As a result I am better able to deal with irritating people and animals.

There are many tools available to address burnout, which is what you described, a mismatch of ethics accompanied by not being part of the same team as this irritating individual. If you are new to meditation I encourage you to check out Insight Timer - https://insighttimer.com/. It is the top free meditation phone application.

I’ve described two tools that work for me. I hope you find some tools that work for you, too.

Burnout and Compassion Fatigue Terminology and Assessment Tools

 

Burnout

Herbert J. Freudenberger conceived the term “burnout” and first used it as a medical term in 1974 to describe a syndrome of “exhaustion, disillusionment, and withdrawal resulting from intense devotion to a cause that failed to produce the expected result.”^1,2 The German born, New York psychologist wrote from personal experience. He described the symptoms he had at the time. Although he was in a thriving practice, he suffered from perfectionism and had a self-imposed missionary zeal to help addicts. He worked from 8 AM to 7 PM in a ritzy area on the Upper East Side and then went to a free clinic in the Bowery and worked with the indigent until 2 AM.³  

The Maslach Burnout Inventory (MBI) was constructed to measure the syndrome.⁴ The MBI was designed to assess three components of burnout: emotional exhaustion, depersonalization, and reduced personal achievement. Burnout was found to be the result of mismatches in at least one of six areas: workload, control, reward, community, fairness, or values.⁵ The MBI is not free, but is available online.

Compassion Fatigue

The term “compassion fatigue” (CF) was first coined as a medical term in 1992 when Joinson described a unique form of burnout that affected caregivers and resulted in a, “loss of the ability to nurture.”^6,7 This form of burnout: a) was related to a variety of stressors including long hours, heavy workload, and needing to respond to complex patient needs such as pain, trauma, and emotional distress, b) resulted in nurses feeling tired, depressed, angry, and detached, and c) was associated with ineffective performance.⁷ Over time the terminology describing CF has not been precise. It is common for authors to define terms to clarify what they mean within specific studies.

 

In an extensively researched 2015 graduate thesis on CF, Amanda Depippo states the term secondary traumatic stress (STS) was originally used by Charles Figley to describe CF.^8,9 Figley states compassion stress, CF, STS, and secondary traumatic stress disorder (STSD) are equivalent terms.⁹ He considers the condition that CF, STS, and STSD describe to be nearly equivalent to posttraumatic stress disorder (PTSD), “except that exposure to a traumatizing event by one person becomes a traumatizing event for the second person.”⁹   

 

Figley suggests that, “perhaps PTSD should stand for Primary Traumatic Stress Disorder, rather than Post Traumatic Stress Disorder since every stress reaction is ‘post’ by definition.”⁹ 

“Caring people sometimes experience pain as a direct result of their exposure to other’s traumatic material… This situation -- call it Compassion Fatigue, Compassion Stress, or Secondary Traumatic Stress – is the natural, predictable, treatable, and preventable unwanted consequence of working with suffering people,” Figley wrote.⁹

 

ProQOL

The most common measurement tool for compassion fatigue, the Professional Quality of Life (ProQOL), was developed by Beth Stamm.^10,11 The ProQOL describes CF as being comprised of burnout and secondary trauma and gives scores for each along with a score for compassion satisfaction.

The ProQOL is a 30-question, 5-point Likert scale assessment. This tool is available for AVMA members online in a self-scoring format that is quite easy to use. Those who are not AVMA members can download the ProQOL to take it.

Ownership of the ProQOL was transferred to the Center for Victims of Torture (CVT) in 2017. CVT is a mental health and human rights nongovernmental organization operating in several countries around the world. The CVT plans on keeping the ProQOL free and available for use.

 

Provider Resilience App

The ProQOL is also available as part of an interesting, useful, free phone application, Provider Resilience, which was developed by the National Center for Telehealth & Technology to help healthcare providers guard against burnout and compassion fatigue when helping veterans. The app has many features that apply to any healthcare professional. The ProQOL is a 5-minute test on the app. It also has quick surveys that provide data displayed on a dashboard to show one's resilience rating and time since last vacation. The dashboard's Resilience Rating gauge is based on completion of a Resilience Builders/Killers quiz that is recommended daily, a Burnout toggle chart recommended weekly, and the ProQOL test that is recommended monthly. For an in-depth YouTube review of the app view the bottom of my website resources page.

References

1. Freudenberger HJ, Richelson G. Burn-out : the high cost of high achievement. Toronto : Bantam Books,; 1980.

2. Coles TB. The solution to burnout. Vet Forum 2003;20:26–31.

3. Anon. Planet Money Episode 740: Burnout, Dec 7, 2016. Available at: http://www.npr.org/sections/money/2016/12/07/504734219/episode-740-burnout. Accessed March 22, 2017.

4. Maslach C, Jackson SE. The measurement of experienced burnout. J Occup Behav 1981;2:99–113.

5. Maslach C, Jackson SE, Leiter M. The Maslach Burnout Inventory Manual: Third Edition. In: Zalaquett CP, Wood RJ, eds. Evaluating Stress: A Book of Resources. The Scarecrow Press; 1997:191–218.

6. Joinson C. Coping with compassion fatigue. Nursing (Lond) 1992;22:116, 118–119, 120.

7. Boyle DA. Countering compassion fatigue: a requisite nursing agenda. Online J Issues Nurs 2011;16.

8. Depippo A. Compassion Fatigue and Self-Care Strategies among Addiction Professionals: A Qualitative Study. 2015. Available at: http://scholarcommons.usf.edu/cgi/viewcontent.cgi?article=6875&context=etd. Accessed June 16, 2016.

9. Figley CR. Compassion Fatigue: Toward a New Understanding of the Costs of Caring. In: Stamm BH, ed. Secondary Traumatic Stress: Self-Care Issues for Clinicians, Researchers, and Educators. Lutherville, MD: Sidran Press; 1995.

10. Stamm BH. Professional Quality of Life Scale (proQOL): Compassion Satisfaction and Compassion Fatigue. 2009. Available at: http://proqol.org/uploads/ProQOL_5_English_Self-Score_3-2012.pdf. Accessed January 11, 2016.

11. Stamm BH. The Concise ProQOL Manual. 2nd ed. Pocatello, ID: ProQOL.org; 2010. Available at: http://www.proqol.org/uploads/ProQOL_Concise_2ndEd_12-2010.pdf.

Five Free Apps That Can Improve Wellbeing

High Tech Wellbeing Tools 

Aren’t we all looking for ways to improve our wellbeing? Well, there’s an app for that! In fact, there are quite a few apps for that. I’ve used the free elements of the following phone applications (available for iPhone and Android smartphones) and solidly endorse them: 

• Way of Life
• Headspace
• Calm 
• Insight Timer
• Provider Resilience

Way of Life

Improving wellbeing always involves making a change. Need help establishing a new routine, reinforcing a new wellbeing plan? Way of Life is billed as the ultimate habit builder and breaker! 

You can setup a reminder for weekdays, weekends, or specific days of the week; add a custom message and choose whether the reminder includes an alarm. You can also view charts to see how you are doing over time. Tracking change is an important reinforcement and takes less than a minute a day to accomplish with this handy app. 

A few months ago I used the app to track how I was doing at practicing yoga before bed, getting to bed on time, and establishing a morning walking exercise program. With two out of three of those behaviors I’ve dramatically improved, in fact I have established a new routine regarding my bedtime and walking in the morning. The yoga in the evening didn’t take, but two out of three isn’t bad! 

With Way of Life you can track 3 habits at no charge; more will cost you a one-time fee of about 5 bucks. That premium gets you multiple reminders, backup capability, and no ads.

Meditation Apps

If you’ve never meditated, want some help getting started, or you're an experienced meditator looking to try something new, then Headspace, Calm, and Insight Timer are excellent apps to try. 

Headspace

Headspace has made its founder, former Buddhist monk Andy Puddicombe, into a multimillionaire. Andy’s catchphrase, "We all need to get a little head space,” has become a mantra of sorts for millions of meditators. 

You can try Headspace daily for 10 days for free and go back those free introductory meditations over and over again. I have! There are other free single sessions such as their sleep and fear of flying exercises, which are 10 minutes each. 

Every few days there is an animated video that you’ll likely enjoy. They’re really cute and insightful. They’ll stimulate your motivation. 

If you want to get their sleep, stress, focus, and other series packs you’ll need to become a member and it will cost ~$13 monthly, $95 annually ($8/mo), or $420 for an eternal membership. To see everything they offer it is best to login to their website. As an example, with subscription you can also access an in depth meditation section for kids ages 5 and under, 6-8, and 9-12 years of age on calm, focus, kindness, sleep, and wake up.

Calm 

Calm is a free phone app with three main sections: breathe, meditate, and sleep. The breathe bubble guides you to mindful breathing with options like holding your breath between inhale and exhale or not. This is another really good app for beginners or those of us who have been meditating for a long time. 

Try out its free options, which you can reuse over and over again. There is a free 7 days of calm program that introduces meditation with sessions that are about 10 minutes each. There are also free guided meditations (body scan, lovingkindness, calm light, forgiveness, and newly released sleep stories) in which you can select duration from 3 to 30 minutes. 

If you like it and want to become a member so you can access their 7-day programs on managing stress, focus, calming anxiety, sleep, happiness, gratitude, and self-esteem, it will cost ~$13 monthly, $60 annually ($5/mo), or $300 for a lifetime membership. With membership you can also access their suite of guided meditations including their calm kids program and a number of other programs on sleep, walking meditation, returning to now, non-judgement, etc.

Insight Timer

Insight Timer is available on your computer via the Internet or on your smartphone. It is rated as the top free meditation phone app. As of today it offers several bell and duration options for silent meditation and over 4000 free guided meditations, music tracks, talks and courses by over 1000 teachers in over 20 languages, with offerings increasing steadily. 

You can see how the various offerings are rated and bookmark your favorites. There is also a social networking component in that you can join groups, read posts, and make comments. I have especially enjoyed the Healing the Healer and the Healthcare Professionals groups. 

I highly recommend this app for guided meditations on lovingkindness. Lovingkindness meditation involves acknowledging or praying that you, a loved one, an acquaintance, and a person you find irritating all want to be happy, healthy, useful, and at peace. I have found this type of meditation improves my self esteem, compassion for others, awareness of unity, ability to stand up for myself in a loving manner, ability to maintain boundaries without rancor, and achieving a feeling of being on the an equal footing, rather than feeling superior or inferior to others. There are a plethora of guided Insight Timer meditations on lovingkindness in a variety of durations from a few minutes to over an hour. 

In addition, I have found many of the sleep meditations quite helpful when I wake up in the middle of the night and am trying to settle down and get some rest.  

Provider Resilience

Last, but not least, is Provider Resilience. It is the one best app I’ve found for monitoring compassion fatigue and burnout. It was developed by the National Center for Telehealth & Technology (T2). 

The main screen is a dashboard with a Resilience Rating gauge to show you how you are doing regarding your  resilience to compassion fatigue and burnout. It is based upon the data you input via: 

• Resilience Builders/Killers quiz - recommended daily

• Burnout toggle chart - recommended weekly

• Professional Quality of Life (ProQOL) test - recommended monthly, which is a 30-question, 5-point-Likert-scale test that takes about 5-minutes

You can keep track of how you’ve done by checking on charts that display your burnout and ProQOL scores over time. 

This is a very functional, well thought out app with lots of features. There are cartoon jokes to help you keep your sense of humor, simple physical exercises that can be done in the office, and alphabetically sorted "value cards" for contemplation or use as a daily devotional. 

To find out more about Provider Resilience check out my in-depth video review of it.  

Improving your personal wellbeing is good for you and it will improve your relationships with family, friends, co-workers, clients, and patients. Guaranteed!