Stress, Burnout, and Secondary Trauma (PDF)

Module 1: Principles and Perspectives 1 Stress, Burnout, & Secondary Trauma Aileen Pascual, MD, FPAFP | August 8, 2023 | Online - Asynchronous Joyce Ann N. Maglaque, MD, MBA, DSBPP | August 8, 2023 | Online - Asynchronous...

Module 1: Principles and Perspectives 1 Stress, Burnout, & Secondary Trauma Aileen Pascual, MD, FPAFP | August 8, 2023 | Online - Asynchronous Joyce Ann N. Maglaque, MD, MBA, DSBPP | August 8, 2023 | Online - Asynchronous → This allostatic reaction is a way for the body to maintain TABLE OF CONTENTS balance/homeostasis by attending to its increased demands Learning Objectives III. Burnout, Secondary → Stress response and allostasis are automatic, and trigger the Summary of Terms Trauma, and Summary brain’s alarm system, which manifests through anxiety I. Biological Perspective of A. Interaction of Biological, Stress Psychological, and Social A. Biological Aspects of Factors Stress B. Allostatic Overload and B. Modern World Stressors the Effects of Chronic Levels C. Allostatic Changes in our of High Stress Brain C. Summary D. Psychosocial Factors of IV. Stress Management Stress A. Garden Metaphor for E. An Invalidating Social Health Environment B. Bio-Psycho-Social II. Psychological and Social Approach to Mental Health Factors that Contribute to C. The R-A-I-N Method Stress Summary & Keypoints A. Biosocial Theory in Review Questions Adulthood: Psychosocial Rationale Figure 1. Pathway of response to stressor Factors Affecting Adults References Emotions - sensations of the mind B. Social Sources of Stress → Emotionality is biological - how people are born and made C. Psychological Sources of up Stress ▪ Emotions cannot be simply equated to feelings - they LEARNING OBJECTIVES occur with specific patterns of thoughts, memories, body 1. To understand the features of stress, burnout, and secondary sensations and/or action urges (impulses) trauma Anxiety - ominous feeling which has life-saving characteristics 2. To enumerate and explain the factors that contribute to stress → Initiates the body’s stress reaction as it believes that there 3. To describe how burnout is observed in patients and its effects must be a threat → Can be pathological SUMMARY OF TERMS ▪ Similar occurrence to dysregulation of bowel movements Physiological changes triggered by stress that aid the leading to diarrhea Allostasis body to meet increased demands, while maintaining homeostasis Homeostasis Self-regulating process to maintain internal stability MH Mental Health Happens with chronic stress; state of complete, Burnout mental, physical, and emotional exhaustion The emotional duress that results when an individual Secondary hears about or witnesses first hand trauma Trauma experiences of another HCW Healthcare worker PNS Parasympathetic Nervous System SNS Sympathetic Nervous System I. BIOLOGICAL PERSPECTIVE OF STRESS A. BIOLOGICAL ASPECTS OF STRESS Stress - natural biological response when perceiving something that is distressing, unknown, or something that the person has a Figure 2. Stress and its effects on homeostasis theory of Primitive Reflex - life-saving reflexes developed through → This is what helped primitive humans to survive evolution that helped our ancestors survive Given a stressor: → Evolution did not erase the caveman mind/stress reactivity → The amygdala will sound the alarm and tell the adrenal ▪ The caveman mind = default mode of survival glands to release the stress hormone “cortisol” The caveman mind (amygdala) is nearer to the brainstem; → Then the stress hormones will trigger body-wide changes hence, its signals will reach the body faster Allostasis ▪ This leads to reactions, emotions, body sensations, and → Whenever there is a perception of a trigger, the brain will action urges sound the alarm called stress → Stress will deliver the message chemically to the adrenal B. MODERN WORLD STRESSORS glands and to the rest of the body to amp up the usual bodily Natural stress should ideally go down functions TG2 | Calderon, Carmona, Chua, Cepeda, Dy, Gorospe, Legaspi, Mathay, Mina, Narvasa, Profeta P&P - T02 1 of 9 CG11 | Borbe, Butcon, Halasan, Kho, La Torre, Lota, Manalo, Martin, Morada, Pizarra, Ricafort, Sabate  and cortisol response system adjusts its baseline → mild stress would appear to be severe Figure 5. Dopamine Response to Stress If the body is not given time to pause/rest, the allostatic change will persist With each new introduced baseline, the threshold for stress becomes lower Figure 3. Effect of exceeding stress resistance Symptoms of Stress However, this is not the case in the modern world Table 1. Initial Biological Signs of Stress → Our current stressors are not as black and white as in ancient Aspect Signs times; the end is not clear, resulting in chronic stress Examples of modern world stressors: Physical Back and shoulder stiffness and pain → Pandemic Headaches → Adulting Stomach upset Heart palpitations → Existential crisis Chest tightness → Emotional pain Fast breathing Allostatic Overload Sleep problems → Chronic stress leads to repeated allostasis, especially when Restlessness stressors have no end Behavior Drug or alcohol use ▪ E.g. repeatedly staying up overnight can still lead to increased smoking feelings of being tired even after a night of restful sleep Social withdrawal → Stress is a buildup, it is not episodic Relationship conflicts → Resetting the allostatic load is necessary Poor adherence to treatment regimen if with ▪ When the body is pushed without resetting the allostatic medical illness High-risk sexual behavior load, the baseline of stress response is pushed ▪ This eventually leads to a point of no return or distress Emotional Irritability because intervention is already necessary Anxiety → Distress or burnout makes people more vulnerable to Sadness Anger physical, emotional, behavioral, and cognitive changes Frustration → Allostatic overload leads our bodies to severe fatigue, Impatience increasing our susceptibility to MH problems Urge to cry or run and hide Cognitive Lack of focus Difficulty making decisions Low self-esteem ↑ Allostatic load we put = ↑ Changes in the body Other effects on the body: → Weaken the immune system, making it less able to fight off infection → More sensitive to pain → Dysregulated hormones → Missed menstrual periods → Skin and pH changes → Sugar metabolism dysregulation → Increased BP Figure 4. Stress-distress relationship C. ALLOSTATIC CHANGES IN OUR BRAIN Self-care is not self-indulgence. Hyper-sensitivity and over-stimulation of the amygdala → Sometimes we cope through distractions such as: → Results in more sensitivity to stress ▪ Eating sweet/salty/greasy food ▪ Leads to anxiety becoming pathological as stress affects ▪ Drinking up to the DNA level of the amygdala ▪ Smoking → Prolonged stress will condition your brain negatively leading ▪ Venting on social media to anxiety disorders/depression Coping through distractions can lengthen allostasis Hippocampus decreases in function and then in size → Normally, the initial basal stress reaction will be steady even in → Hippocampus - responsible for controlling emotions, mild stress concentration, and learning → In severe stress, there will be spikes in the dopamine released → Why brain fog occurs, can also lead to dysregulated serotonin → However, prolonged distractions/allostatic change (e.g. Decrease / dysregulated serotonin drinking) introduces a new stimuli to the body → the dopamine → Serotonin (neurotransmitter) is important for neurogenesis ▪ Neurogenesis - growth of brain cells P&P - T02 Stress, Burnout & Secondary Trauma 2 of 9  ▪ Dysregulated serotonin leads to low neurogenesis ACTIVE RECALL BOX → Serotonin promotes the release of BDNF 1. Which of the following does not indicate an allostatic change ▪ BDNF, or brain derived neurotrophic factor ensures that that occurs in the brain due to stress? the brain is happy, well, and performing its normal a. Hyper-sensitivity of the amygdala b. Lower levels of neurogenesis due to lower serotonin functions c. Increased control over emotions ▪ This is associated with the pathophysiology of clinical d. Increased susceptibility to depression and anxiety depression and pathological anxiety 2. T/F: Through drinking alcohol and smoking, the allostatic load D. PSYCHOSOCIAL FACTORS OF STRESS gets reset. 3. This manifests when allostasis and stress responses are Emotions are biological sensations of the brain that are also generated by a person resulting in an alarm in the brain. affected by psychosocial factors Answers: 1C, 2F, 3 Anxiety → These factors come in the form of social transactions that II. PSYCHOLOGICAL AND SOCIAL ASPECTS OF STRESS affect how you regulate your emotion → Much of our misgivings about emotions are coming from A. BIOSOCIAL THEORY IN ADULTHOOD: society PSYCHOSOCIAL FACTORS AFFECTING ADULTS ▪ Emotions are important for learning The Biosocial Theory in Adulthood ▪ But we have been taught to push them aside as if it is → Frustration Tolerance something we control → Coping Strategies The Glass Metaphor - transactions matter! → Mental and physical health → Empty - How we all start out → How we relate with life (perception) → Initial filling of the glass - Implicit and explicit environmental Stress threshold/frustration tolerance is affected by coping cues (initially from one’s family) influence you heavily during strategies, mental and physical health, prior experiences, and your formative years until you can generally form your beliefs modeling → Glass is filled - Beliefs are formed when influence is either ▪ Frustration tolerance is impossible to preserve today due to challenged or reinforced increased convenience brought by technology → Hand over the glass - One’s identity develops when beliefs ▪ Minor inefficiencies in our daily lives trigger shorter are reinforced patience and a lower frustration tolerance ▪ Typically occurs during the teenage years onwards (after Trauma encountered during formative years affects the formative years) sensitivity to stress response and coping strategies ▪ Beliefs can be reinforced to an adolescent via group Self-perception - stress affects how we relate with life identification → In one’s formative years (forming the bio-psychological → Stirring the glass - An established identity is susceptible to aspect), an encounter with a stressful environment impacts judgment and thus, creates tension the biological development of the threshold of stress and how we understand certain environmental factors ▪ This affects how we perceive ourselves ▪ In dealing with future stressors we go back to these self-perceptions and perform accordingly B. SOCIAL SOURCES OF STRESS Stress occurs when needs are not met at each level which leads to certain degree of distress Figure 6. The glass metaphor When a new transaction looks like a past transaction, we resort to our existing beliefs which are intertwined with our identity → Our perception of stress is affected by these past transactions and our social environment E. AN INVALIDATING SOCIAL ENVIRONMENT Invalidating social environment Figure 7. Maslow’s Hierarchy of Needs → Makes it hard to regulate emotions → Maslow’s Hierarchy of Needs → Does not understand your emotions and/or incurs ▪ Self-actualization (highest) communication errors (such as labeling them as invalid, weird, ▪ Self-esteem wrong or bad) in the proper validation of one’s emotions ▪ Love and belonging → Reinforces out out-of-control emotions and actions which is ▪ Safety and security difficult to regulate ▪ Physiological needs (lowest) ▪ When you get accustomed to people adapting to you when External Sources of Stress you get out of control = difficulty encountered when you try to practice control Some external sources of stress include: ▪ When you are instructed to change without proper → Perception that tasks are never done guidelines and explanations = difficulty encountered when ▪ Imbalance: Excessive work demands VS individual’s you try to adapt this change inability to meet demands in a timely manner → Multiple complex roles to fulfill/role overload P&P - T02 Stress, Burnout & Secondary Trauma 3 of 9  ▪ Roles as a daughter/son, student, friend, sibling, leader, → Putting pressure on someone already pressured → anxiety group member, etc III. BURNOUT, SECONDARY TRAUMA, AND SUMMARY → Physical distance from family and/or friends A. INTERACTION OF BIOLOGICAL, PSYCHOLOGICAL, & → Lack of support and conflict within the work space SOCIAL FACTORS ▪ Possible issues with peers, bullying and presence of “tsismis” Psychology influences our perception of our environment -> Digital Fatigue (“Zoom Fatigue”) Environment affects our biology -> Biology influences our → A new external source of stress that emerged recently psychosocial response to stress → Found to have increased with more people using zoom → Psychology refers to what we have learned growing up ▪ There are more than 300 million users of Zoom every day (assumptions, etc.) ▪ A person’s average screen time currently: 10 hours a day The brain is a dam → Ideal screen time: 2 hours a day → The valley represents the mind; water represents our Positive association between screen time and poor mental health thoughts, emotions, and actions can be attributed to: → A dam can efficiently have enough water -> Our mind needs → Lack of perceived reward thoughts, emotions, and actions to survive ▪ Face-to-face interactions have greater activation regions → With every allostatic load, the dam fatigues involved with reward → Fatigue prevents the dam from optimally regulating the flow of → Increased cognitive effort or cost water ▪ Learning new platform and navigating it → As we grow older and experience more stress, our mind ▪ Must be more conscious on how to communicate fatigues -> It can no longer regulate our thoughts, emotions, → Over-constant external self-awareness and actions ▪ Hyper-aware of your look, mannerisms, etc. Eventually, overload would occur and our minds would be → Sedentary pandemic rhythm flooded ▪ Being immobile leads your body and brain to fatigue → What usually occurs in burnout and secondary trauma ▪ Movement reduces risk of fatigue by 40% B. ALLOSTATIC OVERLOAD & THE EFFECTS OF CHRONIC → Blue Light LEVELS OF HIGH STRESS ▪ Stimulant for the brain causing poor or disrupted sleep pattern Allostatic Overload ▪ Extended exposure to screens (stimulus) -> strains the → One of the theories of pathology such as the development of eyes -> sends brain into overdrive -> leading to sleeping cancers, etc. difficulties → Occurs when the body’s stress or fatigue levels reach a Psychosocial factors of digital fatigue breaking point → Work from home/distance learning Burnout ▪ Blurred boundaries between work and home Happens with chronic stress → Extended working hours → Different from stress (a physiological reaction) → Multiple responsibilities → Buildup of stress, nearing the edge ▪ Studies, house chores, etc. Associated with: → Increased demand → High workload, high work ▪ Same or more output demanded amidst changing set-ups → Stress, high work → Inability of businesses and society to evolve with the times → Expectations ▪ Indicators of success are not appropriate for the current → Cynicism, indifference situation → Despair, helplessness, aversion ▪ Negative perception of stress (stress as a weakness rather → Diminished sense of personal accomplishment than a signal of the need for improvement of well-being) → Demoralization Internal Sources of Stress Characterized by: Difference between (idealistic) expectations vs reality → Absenteeism → Sometimes the expectation becomes how reality should be ▪ Literally being absent which is psychologically distressing ▪ Intentional or habitual absence at work Externalized source of validation and motivation → Presenteeism → External source of validation vs internal source of validation ▪ Physically there but checked out mentally ▪ Internal: personally drives you (ex. emotions) ▪ Lost productivity that occurs when employees come to ▪ External: taking cues from the environment (ex. grades) work ill and perform below par → Feeling unappreciated The impacts of poor MH on individuals: → Self-esteem issues → Burnout is responsible for a lot of health effects → Majority of Comparison with peers/friends/relatives those who seek doctor consults have burnout-related medical → Normal human instinct to compare with groups to know how problems to survive Nice! → What ifs → Jealousy over perceived success of others → Cost associated with poor employee MH is at least 2-3 → Not being contented with what you have times greater than direct health care expenses (chronic Perceived lack of support or perceived pressure illnesses) → Sources of stress can be perceived → In 2014, the British economy faced a recession because of ▪ Implicit (e.g. actions or culture of people) burnout ▪ Explicit (e.g. assumptions, past experiences) a. Absenteeism caused a 39% reduction → Issues with peers, bullying, “tsismis” b. Presenteeism caused a 64.2% reduction P&P - T02 Stress, Burnout & Secondary Trauma 4 of 9  Now an ICD diagnosis and pertains to a significant source of → Changes in the brain hamper the more reflective parts of our stress brain, leading to an “amygdala hijack” making us susceptible → Usually the prequel to the development of MH problems, to: especially depression ▪ Burnout Secondary Trauma ▪ Secondary Trauma ▪ MH problems Helping professions and frontline responders are vulnerable to These biological changes are the body’s reaction to prolonged secondary traumatic stress exposure to cortisol → May not simply hear about trauma, but also witness it first-hand When To Seek Help? → Specifically, repeatedly hearing about an event or hearing → Increase substance (alcohol or drug) use about it from the source itself → Feeling or expressing that there is no reason for living; no HCW’s vulnerability to secondary trauma increases with physical sense of purpose in life fatigue → Anxiety, agitation, difficulty sleeping, or sleeping all the time → Example: Physical exhaustion can easily lead to emotional → Feeling trapped, like there’s no way out exhaustion (as seen in HCW during the pandemic) → Hopelessness → Proves that the brain and body are connected → Withdrawal from friends, family and society → Rage, uncontrolled anger, seeking revenge → Acting reckless or engaging in risky activities, seemingly without thinking → Mood changes → Threatening or talking about self-harm and/or suicide → Looking for ways to kill oneself by seeking access to firearms, pills or other means → Talking or writing about death, dying or suicide when these actions are unusual for the person → Patient is severely delusional or depressed over a long time → Patient has substance abuse or dependence problem → Patient is suicidal → Patient’s social function is seriously impaired although depressive disorder is mild Figure 8. The perils of physician fatigue → Patient develops symptoms (i.e depression) while taking a Perils of physician fatigue can cause precursors of MH problems particular medication to manifest in individuals: → Burnout IV. STRESS MANAGEMENT ▪ Increases suicide risk A. GARDEN METAPHOR FOR HEALTH → Compassion fatigue We can think of our health as a garden, with our biology as the ▪ Results from secondary trauma soil and health as the plant that emerges from it. ▪ Makes HCW less empathetic with the patient → Soil → These are factors outside of our control ▪ Service suffers → Plant → This can be thought of as our health that grows from → STSD the soil. ▪ Secondary trauma symptoms are akin to symptoms of B. BIO-PSYCHO-SOCIAL APPROACH TO MENTAL HEALTH hyperarousal in PTSD ▪ Can develop further into vicarious trauma → Vicarious Trauma ▪ Develops from symptoms of hyperarousal in PTSD ▪ Cognitively and spiritually being checked out of humanity ▪ Disillusionment of humanity ▪ Difficulty relating to or trusting others C. SUMMARY Stress is a normal, bodily reaction to a stimuli to help our bodies be more reactive for survival → Signal that stress reaction works -> the feeling of anxiety Stress response is intrinsic in our brains and we are still using it now Figure 9. Health as Bio-Psycho-Social There are some situations in the present day that do not need further activation of stress response (we haven't really been For instance, in the case of brushing teeth: taught how to manage this) → Biological Everytime your body reacts to a stressor, it goes through ▪ Prevents cavities, plaques, bacteria, toothaches. chemical changes to deal with the stimuli in an event we call: → Social “allostasis” ▪ We have to as we were taught that this is important from a → When allostasis is chronic and we do not get to take pauses, young age. our bodies will overload leading to chronic changes → Psychological ▪ This is something that may affect our security/confidence (i.e. feeling uncomfortable if we have bad breath) P&P - T02 Stress, Burnout & Secondary Trauma 5 of 9  Instead of reacting, take a pause and breathe. → S.T.O.P. = Stop, Take a breath, Observe, Proceed There is a proper way of breathing → Inhale through your nose for 4 seconds → Hold your breath for 2 seconds → Exhale through your mouth for 6 seconds Benefits of slow, intentional, diaphragmatic breathing → PNS is activated through the vagus nerve, deactivating the SNS which is responsible for perpetuating the stress Figure 10. Relationship Between Biological, Social, and Psychological Aspects of reaction Mental Health → DMN (default mode, the caveman mind) deactivation Biological, social, and psychological factors must be taken into leads to improvements in cognition consideration when thinking about stress management ▪ DMN puts us in a state of hyperalertness (amygdala) The goal in stress management is NOT to live a life without stress ▪ Breathing allows one to be grounded in the present, → There is no quick fix to stress management allowing for tapping of higher brain processes → What your mind wants to forget, your body will remember → Vagal activation The best way to manage stress is to prevent it from building up in ▪ Improves the immune system the first place ▪ Decreases intensity of bodily response during stressful → Taking control of the way we respond to stress situations C. THE R.A.I.N. METHOD Taking a pause should take 60-90 seconds STEP 1. Recognize → Brain only takes 1 minute to go through stress reactivity → Brain experiences a longer period of stress reactivity when 1) At any point within a day, there is a fluctuation away from our we don’t take a pause, or 2) we indulge it too much window of tolerance → The window of tolerance is the state in which we can STEP 3. Investigate optimally function (Learn new information, Explore, Investigating the present with kindness and no judgement; Experience, etc.) understanding our own limitations and knowing how to work with We start each day refreshed, but as the day progresses we begin the body to feel fatigued—fluctuation away from the window of tolerance With kindness, you want to investigate: → What is OUT of your control ▪ Limited brain economy ▪ Traumatic learning vs true learning ▪ Salience and memory ▪ Fatigue of the brain ▪ The brain and body's need for rest and sleep ▪ The nature of med school → What is IN your control Figure 11. Window of Tolerance This fluctuation may be a result of getting caught up in one’s own thoughts → This may occur when there is a debate between the reasonable and emotional mind. When you are in distress, you regress → When you are fatigued, your functional IQ is diminished. Figure 13. Circles of control, influence and concern ▪ People who focus on what they can control or influence are more resilient, live better lives, and create more meaningful action. ▪ People who focus on how things should be are the opposite. They are more reactive, easily stressed, and at Figure 12. Functional IQ as a function of one’s mental state greater risk for MH problems. → Learning becomes traumatic learning For example, adjusting from F2F to online learning at home will ▪ Traumatic learning: amygdala does the learning, you require investigating the present with kindness and no remember the emotion over the information judgement. Recognition is always the first step → As a creature of habit, the brain has difficulty reorienting itself → When we recognize, we are able to expand our point of view immediately to being as productive and efficient in a setting to become an observer, and instead of debating, we are able that is very relaxed. to find balance → We can counter this by taking advantage of the habitual brain, → This state of balance between the reasonable and emotional and doing things the brain has associated with working (i.e. mind is referred to as the wise mind looking the part by wearing work clothes) STEP 2. Accept & Allow We suffer when we judge ourselves and do not accept things; this furthers our allostatic overload. P&P - T02 Stress, Burnout & Secondary Trauma 6 of 9  → Determine what’s appealing about the assignment or what you really want to accomplish from it ▪ Take into account factors of anxiety and overthinking → Swiss Cheese It ▪ Dedicating short time segments for a big task and doing as much as possible with few expectations on what you’ll do. − After getting used to this, you’ll have some progress and momentum, thus less work needed to complete it − A task won't seem so big because you've punched holes in it (like Swiss cheese) and it'll be easier because you've already begun and eliminated some obstacles. ▪ E.g. Spend 10 minutes to get just the main ideas by jotting Figure 14. Cortices of the Brain down anything on the topic or skimming over a long → We must understand that in order to survive, we must allow reading the brain to sleep. Some tips to improve sleep hygiene: Commit ▪ Stop using gadgets to help you sleep, as blue light → Start small and when you’re done, reward yourself stimulates the brain. Have an hour without gadgets before Check your Surroundings going to bed. → Be wise with where and with whom you’re working with ▪ Commit to a sleeping ritual. → A kind of procrastination: repeatedly getting into not doing ▪ Have a lukewarm bath before sleeping. much work (e.g. working on your bed) ▪ Play white noise/delta waves to help initiate sleep. Set Goals ▪ Make your room very dark. → Focus on doing and not avoiding ▪ Designate sleeping clothes. → Make your goals concrete, meaningful learning and ▪ No coffee 8 hours before you sleep. achievement ones ▪ Don’t sleep with your problems. Be Realistic → Allot time and effort to achieve goals The Ivy-Lee Method → Don’t sabotage yourself so set goals that can be met Our usual method of planning: scheduling, making a to-do list Engage in Self-talk → Human nature for us to push ourselves to do more, making → Observe the manner of which you think and talk to yourself our plans somewhat unrealistic → Talk in a way that reinforces your goals and switch to an ▪ Brain becomes pressured, and can see unchecked tasks improved and effective habit of self-talk as mistakes causing stress → Practice saying “I will...” instead of “I wish I hadn’t...” Benefits of the Ivy-Lee Method: Un-schedule → Allows us to prioritize properly → Create a largely unstructured, flexible schedule including only → Takes advantage of the habitual brain necessary tasks Being present-based, it must be done every night before one → To possibly be more satisfied with your work, keep track of goes to sleep time spent in achieving your goals → Write down the 6 most important tasks you need to do for → Reward yourself tomorrow. Do not exceed this number. ▪ They should be of true importance - these are tasks that STEP 4. Non-identification with the Event are BOTH urgent and important. Life is filled with a lot of experiences and opportunities that are → Rank your tasks according to importance. still up to us, like an endless treadmill or a story that is still being written→ a process Non-identification: not taking events personally → A single event is not the end-all and be-all of our self-identity and self-worth → Meaning of living: figuring out how to walk through → There is always something we can do about the future → Promoting growth mindset ▪ Not giving up on yourself Table 2. Fixed vs Growth Mindset Figure 15. Ivy-Lee Method Matrix Fixed-Mindset Growth-Mindset → Do tasks one at a time, do not multitask. Harbors… …a deep need for …a passion for learning → When a task is done, strike it out. The brain becomes more approval motivated when this is done! Sees Risk and Effort… …as actions that will …as necessary for Tips For Procrastinators reveal their change and growth inadequacies Practice Self-Awareness: Self-talk with ourselves like talking to Sees Failure… …as a shameful …as a source of a friend imperfection motivation and → Think of why you procrastinate, your habits, and what led to information doing it → Assess: feelings that led to and behind procrastinating Responds to the …with resentment and …with interest and Success of the need to show inspiration to learn ▪ Identify if positive and productive → Would you change? Others… their own superiority and build on new Change your Outlook strategies → Breaking down a big task into smaller ones is more manageable P&P - T02 Stress, Burnout & Secondary Trauma 7 of 9  REVIEW QUESTIONS #1: Allostatic load increases and builds-up given exposure to stress, and this needs a reset to reduce the chances of being burnt out. Which of the following practices or activities could help in resetting the allostatic load? A. Staying up all night to play online games. B. Doing a consciousness examen for all the good things that occurred for the past few days. C. Biking down the road on a day with heavy traffic and constant formation of smog. Figure 16. Self-Determination Continuum D. Drinking beer and eating pizza on Friday evening. Cultivate a growth mindset by having internal motivation rather #2: Regine has been determined to have tuberculosis. For the than external first three months, she has been attentive and consistent → External motivation: unpredictable and always changing with her medication. However, online classes have been ▪ Outcomes-based quite the impediment for her the following months after that → Internal motivation: already within us which resulted in her refusing to take her medication and ▪ Personal meaning and values upheld constantly crying because of her fear towards her situation. ▪ Making the best of our one and only life by taking Which of the following symptoms of stress is she exhibiting? opportunities and any chance (e.g. studying to become the A. Physical and Cognitive good doctor you believe you’ll be) B. Emotional and Cognitive Cultivate a growth mindset by adopting a beginner’s mind C. Physical and Behavior → Let go of assumptions about how things operate D. Emotional and Behavior ▪ Consider being a student of life, rather than an expert → Free yourself from expectations #3: When is a person’s stress resistance at its highest level? ▪ Deal with things one day at a time A. Immediately after stressor occurs → Become more curious to deeply understand things more B. During Phase 2: Resistance → Open yourself up to new possibilities C. During Phase 3: Exhaustion ▪ Being flexible with habits to keep up with medical school D. Stress resistance is at a same level all throughout ▪ Learn along the way and grow through it #4: Which of the following is NOT an example of a psychosocial → Ask simple questions factor of digital fatigue? SUMMARY & KEY POINTS A. Increased screen time due to online classes/meetings Allostasis is a way for the body to maintain B. Multiple responsibilities balance/homeostasis by attending to its increased demands. It C. Extended working/studying hours is a normal and automatic biological reaction to trigger life D. Increased demand for productivity saving characteristics, and is unhealthy when there is an #5: Which of the following correctly describes the PNS and SNS exposure to chronic stress leading to allostatic overload with during slow, intentional, diaphragmatic breathing? irreversible changes physically, emotionally, behaviorally and A. PNS = activated, SNS = activated cognitively. B. PNS = deactivated, SNS = deactivated Stages of Stress: C. PNS = deactivated, SNS = activated → Phase 1: Alarm Reaction (where stressor occurs + D. PNS = activated, SNS = deactivated mobilization of our resources) → Phase 2: Resistance (body copes with stressor/s) Answer Key → Phase 3: Exhaustion (reserves are depleted and stress 1B, 2D, 3B, 4A, 5D resistance decreases) RATIONALE TO ANSWERS OF REVIEW QUESTIONS Biological Aspect of Stress: you perceive a potential threat -> 1. [B] — Exposure to stressors increases the allostatic load such as brain sounds an alarm -> adrenal glands release stress hormone interacting with negative people or being exposed to pollution. (CORTISOL) -> travels to rest of the body -> undergoes different Self-indulgence fails to reset the allostatic load. While, mindfulness changes in response to stressor -> FIGHT or FLIGHT response practices reduce amygdala activity. Social Sources of Stress: a certain degree of distress will 2. [D] — She is exhibiting poor adherence to treatment during an always be encountered if needs aren’t met at each level of illness and she is showcasing sadness/fear towards her situation. Maslow’s Hierarchy of Needs 3. [B] — The graph shows the peak of stress resistance to be → External sources: (1) Feeling as if tasks are endless, (2) highest during Phase 2 as our bodies are adapting coping activities multiple roles to fulfill, (3) Lack of support/conflict in to accommodate the presence of stressor. As a natural continuum, workplace the stress resistance should be followed by a decline as it reaches Helping professionals and frontline responders are susceptible to Phase 3. Secondary Trauma because they either first-hand witnesses or 4. [A] — Psychosocial factors of digital fatigue include work from hear stories from those with lived experiences home/distance learning, extended working hours, multiple The R.A.I.N. Method can be used to practice mindfulness: responsibilities, increased demand, and inability of businesses to → Recognize - Becoming an observer, using the wise mind evolve with the times. → Accept and Allow - Acknowledge and breathe 5. [D] — The parasympathetic nervous system helps restore → Investigate with Kindness - Apply techniques in what can be calmness to the body, therefore is activated. The sympathetic or cannot be controlled in the present nervous system (SNS, or our “fight or flight”) is responsible for → Non-identification - Focus on a beginner’s mind for growth perpetuating the stress reaction, thus with breathing, this should be deactivated. P&P - T02 Stress, Burnout & Secondary Trauma 8 of 9  REFERENCES REQUIRED RESOURCES Cee, S. (2022, August 7). Part 1 Biological Perspective of Stress [Video]. Youtube. [https://www.youtube.com/watch?v=6lOCMr5tC64] Cee, S. (2022, August 7). Part 2 Psychological and Social Aspects of Stress [Video]. Youtube. [https://youtu.be/EldNN4b4gW0] Cee, S. (2022, August 7). Part 3 Burnout, Secondary Trauma and Summary [Video]. Youtube. [https://www.youtube.com/watch?v=EldNN4b4gW0] FREEDOM SPACE Good luck, Batch 2028 (and future batches who will have access to our Trans)! - TG 2 P&P - T02 Stress, Burnout & Secondary Trauma 9 of 9