1. Burnout Syndrome What is BurnOut? Emotional Exhaustion
Depersonalization (or distancing)
Reduced personal accomplishment (inefficacy)
One conceptualization of exhaustion includes: Physical, emotional and mental exhaustion (Maslach et al. 2001; Pines 2005).
2nd conceptualization- burnout consists of physical and psychological fatigue plus exhaustion ( Kirstensen et al. 2005)
3rd conceptualization – burnout consists of physical, emotional energy and cognitive exhaustion which may result in depletion of coping resources (Shirom and Melamed, 2006)
4th conceptualization – burnout consists of exhaustion and disengagement (distancing oneself from work and a negative attitude toward work related to objects and tasks (Demerouti et al. 2003)
The concept of burnout is related to the construct of compassion fatigue and secondary traumatization and some authors have concluded that burnout can be viewed within a compassion fatigue framework.
This enables us to go beyond only paying attention to exhaustion and delve into the other symptoms which arise, that is, those “associated with feelings of hopelessness and difficulties in dealing with work or in doing your job effectively” (Stamm, 2010)
Professionals who experience trauma indirectly may experience symptoms similar to PTSD- this has been called Secondary Traumatic Stress. These symptoms can include: 1) intrusive re-experiencing of the traumatic material, 2) avoidance of trauma triggers and emotions, 3) increased physiological arousal, 4) cognitive negative shift in world view and cognitive shift with difficulties with safety, esteem, intimacy and control in reference to oneself and others (Pearlman and Saakvitne, 1995).
Maslach, C. (2003) Burnout: The Cost of Caring. Los Altos, California, ISHK.
Information from notes: Cieslak, R., Shoji, K., Douglas, A., Melville, E., Luszczynska A., Benight, C. (2014) A Meta-
Anaysis of the Relationship Between Job Burnout and Secondary Traumatic Stress Among Workers with Indirect Exposure to Trauma. Psychological Services, Vol. 11,No.1, 75-86

2. Who is at risk for Burnout Syndrome
*Caregivers
*Doctors, nurses, hospital and health workers
*Teachers and other professionals
* Over achievers

3. High levels of responsibility Working with advanced technology
“ I consider burnout a highly personal happening inside the nurse—the literal collapse of the human spirit. It would be more useful and certainly more compassionate to ask what goes on in a professional nurse that transforms caring into apathy, involvement into distance, openness into self-protection, and trust into suspicion. The ICU nurse must protect herself from grief, anxiety, guilt, hostility and physical and emotional exhaustion.” (Storlie, 1979)
Stems from:
High patient acuity
High levels of responsibility
Working with advanced technology
Caring for families in crisis
Being involved in morally distressing situations
Not enough input into moral decisions and physicians not asking for or valuing their viewpoint and expertise (Gutierrez, 2005 as cited by Epp,2012).
Work stress such as: physical labor, human suffering, work hours, staffing and interpersonal relationships (Jennings, B. 2008)
Storlie, F.J. (1979). Burnout: The elaboration of a concept. American Journal of Nursing. 79,
Epp, K. (2012) Burnout in critical care nurses: A literature review. Dynamics: The Official Journal of Canadian Association of Nurses, 23(4),
Jennings, B.M. (2008) Work Stress and Burnout Among Nurses: role of the work environment and working conditions. Patient Safety and Quality: An Evidenced based handbook for Nurses. Rockville, MD; Agency for Healthcare Research and Quality (US).

4. Crisis in Physician Burnout
“The prevalence of burnout of US physicians is at an alarming rate…
burnout can have serious personal repercussions for physicians”
30 -40% experience burnout
Stems from:
Work related stress
Excessive work loads
Difficulty balancing personal and professional life
Deterioration in work control/autonomy
Meaning in work
Results in:
Medical errors
Scores lower on empathy measures
Retire early
Higher job dissatisfaction
Reduced patient satisfaction
Reduced adherence to treatment plans
45.8 % report at least one symptom of burnout
Highest risk- front line of care access-
family medicine
general internal medicine
emergency medicine
Loss enthusiasm for work
Feelings of cynicism
Loss sense of personal accomplishment
Adverse personal consequences:
Broken relationships
problematic alcohol use
suicidal ideation.
(left slide) Dyrbye, L.N., Shanafelt, T. (2011) Physician Burnout: A Potential Threat to Successful Health Care Reform. JAMA 305(19):
(right slide) Shanafelt, T., Boone, S., Litjen, T. (2012) Burnout and Satisfaction with work life balance among US physicians relative to the general US population. Archives of Internal Medicine, 172(18):

5. The Compassionate Journey
Compassion Fatigue and vicarious traumatization are unique forms of BOS that affect individuals in caregiving roles bearing the responsibility, emotional and physically for the life and wellbeing of a patient, partner, child or parent.
Compassion is that feeling that arises when you are confronted with another’s suffering and feel motivated to relieve that suffering.
Caregivers in a health setting understand that pain and its acute or chronic relief is their task. Constant exposure to pain and suffering may make it difficult to sustain compassion over time. When compassion is denied, one feels rage.
Caregivers lose their ability to process their emotions when they find themselves unable to care for their patients in the way that they would want to and in the way they know is right.
Gahles, Nancy, Burnout Syndrome & Compassion Fatigue: A Self Care Guide for Integrative Practitioners. Integrative practitioner.com

6. Your Issues Are In Your Tissues
1) One study found a correlation between burnout and physical illness:
Cardiovascular diseases in men and musculoskeletal disorders in women were correlated with the severity of all three dimensions of burnout even “when adjusted for age, marital status, education, socioeconomic status, physical strenuousness of work, smoking, physical activity, alcohol consumption, body mass index, and depressive symptoms”( Honkonen et al., 2006)
2) 2nd literature review-
burnout and vital exhaustion can influence ill health, “including the metabolic syndrome, dyregulation of the HPA axis along with sympathetic nervous system activation, sleep disturbance, systemic inflammation, impaired immunity functions, blood coagulation and fibrinolysis, and poor health behaviors (Melamed et al. 2006)

7. Body Scan
Begin by placing your feet on the floor. Place your hands on your knees or comfortably in your lap. Assume a position that is upright, dignified and worthy of respect. Invite your breath to drop into your body. Imagine that your body is a vessel that you fill with breath. Use your breath to progressively relax each body part that I name. Lovingly attend to each part. Even if it is causing you pain or discomfort, even if it is damaged in some way. Refresh and restore it with your breath.
Notice thoughts, feelings associated with each part if it arises. Simply notice. No attachment, no judgement. Let the thoughts float away like clouds.
Each breath balances you. The inbreath isn your sympathetic nervous system, the accelerator. The outbreath is your parasympathetic nervous system, the decelerator, the brakes.Innervating the parasympathetic system with a longer outbreath activates the vagus nerve. Grace under pressure. The nobility of the vagus nerve.
Breath awareness calms the body.
Breathing in, I calm my body.
Breathing out, I smile.
Activating the orbicularis oculus induces endorphins, your happy, ffeel good chemicals.
Dwelling in the present moment,
I know this is a wonderful moment.

8. Harmony
Balance
Skillful solutions include finding balance within the chaos of daily, even moment to moment life. Discover and create harmony by interconnecting the pieces of emotional, spiritual, environmental and social dimensions of your life.

9. The Essential Journey for Providers
“And the leaves of the trees are for the healing of the nations”~Rev 22:2
Essentially, what we know today as essential oils are highly advanced distillations of the resins such as Frankincense and Myrrh that were the well known Gifts of the Magi.
Nature provides us with a powerful & diverse material media of healing plants.
There are more than 300 essential oils in general use today by professional practitioners.
Professional use of healing oils derives from the holy anointing first directed to Moses from God. The “flowing” myrrh, sweet cinnamon, calamus, cassia & olive oil is a powerful antiviral & antibiotic mixture meant to confer protection and treatment.
Hippocrates, in the 4th Century recognized that burning certain aromatic substances offered protection against contagious diseases.
Egyptian priests used aromatics for embalming their pharaohs & for treating psychiatric conditions such as depression, nervousness and the manias of the day.
Clay tablets from Babylonia circa 1800 BC detail orders for the aromatics cedarwood, myrrh and cypress, all still used today as therapeutic oils,

10. Essential Oils for Self Care
Stress and BurnOut Relief: Helichrysum (H.italicum), in a blend with peppermint and basil, was randomized to participants via personal inhaler in a double blind placebo controlled study to determine the effects of a mixture of essential oils on mental exhaustion and moderate burnout.The results published in The Journal of Alternative and Complementary Medicine , Jan showed that the aromatherapy group had a much greater reduction in the level of mental fatigue/burnout.
Irritable Bowel Syndrome:Peppermint. Essential oils can be taken internally with professional guidance. A 2014 systematic review and meta-analysis revealed that IBS is a common disorder and that medical interventions are limited with focus on symptom control only. Conclusions were that enteric coated peppermint oil is a safe and effective short-term treatment for IBS.
Khanna R, et al. J Clinical Gastroenterol.2014 Peppermint Oil for the treatment of irritable bowel syndrome: a systemic review and meta- analysis
Varney E, et al, J Altern Complement Med. 2013, Effect of inhaled essential oils on mental exhaustion and moderate burnout: a small pilot study.

11. Essential Oils for Self Care
Musculoskeletal: Lavendar was studied for its effect on neck pain in The oil, added to a cream was massaged into the painful area daily. The lavender EO cream was shown to be more effective at reducing pain levels than the non-EO control.
Peppermint in a systematic review of oils used in aromatherapy demonstrated effectiveness for its analgesic and antispasmodic properties for to tight muscles.
Pain and Inflammation: Frankincense leads the way with a 2014 study that tested frankincense essential oil and extracts to validate its traditional use in Omani culture for muscle pain, intestinal discomfort and arthritic pain compared with aspirin. Frankincense oil showed the strongest pain inhibiting results with over 50% in both early and late phase pain.
M.-C.Ou et al., "The Effectiveness of Essential Oils for Patients with Neck Pain:A Randomized Controlled Study.” Journal of Alternative Complementary Medicine 20, no.10(2014)
A.Babar, "Essential Oils used in Aromatherapy:A Systemic Review," Asian Pacific Journal of Topical Biomedicine 5, no.8 (2015)
Al-Harrasi A, et al. ‘Analgesic effects of crude extracts and fractions of Omani frankincense obtained from traditional medicinal Boswellia sacra on animal models. Asian Pac J Trop Med 2014

12. Essential Oils for Self Care
Depression:Clary Sage, in one study, was tested for anti-depressant abilities and demonstrated potential as a stand-alone treatment due to its dopamine regulation.
Rose,by any other name, the essential oil of Rose does indeed cheer women up. In clinical tests, postpartum depression and a lowered occurrence of anxiety was noted. Hormonal relationships to mood disorders anywhere on the spectrum of life should be noted in cases of anxiety or depression.
Mental Clarity: Mental clarity, lack of concentration, focus, brain fog, difficulties remembering are all symptoms that can be firstly addressed by restorative self care measures. ROSEMARY is my top favorite. One study found that “rosemary produced a significant enhancement of performance for overall quality of memory and secondary memory factors.”
Seol GH, et al. Antidepressant-like effect of Salvia scalier is explained by modulation of dopamine activities in rats/.J Ethnopharmacol.2010
Conrad P, et al. The effects of clinical aromatherapy and depression in high risk postpartum woman-a pilot study. Complement Ther Clin Pract. 2012
Moss M, et al. Aromas of rosemary and lavender essential oils differentially affect cognition and mood in healthy adults . J Neurosci. 2003

13. Essential Oils for Self Care
Sleep Disturbances: Quality of sleep predicts the benefits of restoration of optimal functioning. In a study done in the Dept. of Nursing at Gimcheon Univ., Korea, inhalation of essential oils was shown to increase the quality of sleep in nurses working the night shift. Lavender was the intervention oil demonstrating effectiveness.
Immunity: Immune modulating activity was demonstrated in a study using 15 EO’s, 4 EO fractions and 3 pure compounds. Oils of nutmeg, clove, tea tree, bay laurel, lemon, red thyme and ginger showed mild-moderate inhibition of phagocytosis; thymol (Thyme) showed highest inhibitory activity.
Wonjong Kim, Myung-Haeng Hur, Inhalation Effects of Aroma Essential Oil on Quality of Sleep in Shift Workers after Night Work. J Korean Acad Nurs Dec;46(6): Korean.
Renato Perez-Roses, Esther Risco, et al. Effect of Some Essential Oils on Phagocytosis and Complement System Activity. Journal of Agricultural and Food Chemistry . Vol.63; Issue 5; Pages Pub: Jan, 19, 2015

14. The Workaholic Heart
Compassionate caregivers can become workaholics because their work is their passion.
Florence Nightingale called her work in the Crimean War her “must”.
We MUST do that which we are called to do that fulfills our need for meaning and purpose in life.
We also MUST learn to say No, to draw realistic boundaries, to conserve our energy.
Essential oils that are stimulating without being overstimulating and also have relaxant properties open the doorway for you to be reflective and observant about the facets of your life that are a withdrawal from your health account of vitality and well-being.
Geranium, Lavender, Marjoram, Basil, Neroli, Rose are my favorite Workaholic Oils.

15. Mindfulness
1) A before and after design provided an intensive education program including mindfulness, communication and self awareness training for 8 weeks and then 10 months of maintenance.
Results:
improved mindfulness
decreased emotional exhaustion
depersonalization
increased personal accomplishment
increased empathy
mood disturbance decreased
increased conscientiousness and emotional stability (Krasner et al., 2009)
2) A Systematic Review of Mindfulness Practice for Reducing Job Burnout found that “6 of the 8 studies (that met inclusion criteria) demonstrated statistically significant decreases in job burnout after mindfulness training (Luken and Sammons, 2016).
1) Krasner et al. (2009) Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians. JAMA, September 23/30, Vol.302 No.12, pp
2) Luken, M., & Sammons, A. (2016) Systematic review of mindfulness practice for reducing job burnout. American Journal of Occupational Therapy, 70,

16. CBT- Pos Emo (Cognitive Behavior Therapy and Positive Emotion Induction)

17. The Benefits of Strategically Inducing Positive Emotions
Fredrickson et al., 2003 article states:
Positive emotions put our bodies at ease
Quell or undue lingering cardiovascular effects of negative emotions
Positive emotions allow us to take a “breather” or “psychological break” and replenish us through cardiovascular quiescence (the undoing effect of positive emotions)
Positive Emotions have a broaden and build effect on our cognitions, attention, and behavior that increases flexibility, creativity and integrative, open, efficient problem-solving. Increase broad minded coping.
Negative emotions narrow our range of thinking (escape and avoidance tendencies)
“The theory holds that, over time, the broadening triggered by positive emotions builds a range of personal resources, including physical resources (eg. Physical skills, health longevity), social resources (eg.friendship, social support,networks) intellectual resources (eg. Expert knowledge, intellectual complexity), and psychological resources (eg. Resilience, optimism, creativity)”.
Well-Being
3:1 ratio and above
Notes for left slide-Barbara Fredrickson et al. study
Research on positive emotions
“Open Hearts builds Lives”
Induced positive emotions daily through Loving-Kindness Meditation in ½ subjects
Measured: increase in # of positive emotions experienced over time
increase in physical health
increase in life satisfaction (a measure of well-being)
decrease in depression symptoms
Previous research had shown shortened cardiac reactivity with positive emotions
Positivity ratio: 3:1 for benefits
Adds up
Left slide:Fredrickson, B. L., Cohn, M. A., Coffey, K. A., Pek, J., & Finkel, S. M. (2008). Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Journal of Personality and Social Psychology, 95(5),
Right slide: Fredrickson, B.L., Tugade, M.M., Waugh, C.E., Larkin, G.R.(2003). What good are positive emotions in crises? A prospective study of resilience and emotions following the terrorists attacks on the United States on September 11, Journal of Personality and Social Psychology. 84(2):

18. Positive Emotion Induction