The issue of burnout, particularly amongst healthcare professionals, is greatly impacted by the cognitive impacts of protective and defensive states.
Dr. Darin Davidson partners with Learner+, a CME/CE reflective learning platform for healthcare providers. For the opportunity to reflect on this article and earn CME/CE credits, Launch here. Check out all past articles which are also eligible for reflections and CME/CE credits.
For downloadable, actionable strategies and tactics to leverage biology in the pursuit of health, wellbeing, and sustainable high performance, visit the resource store, Launch here. Chapters are arranged by topic so those of interest can be selected and each are also eligible for reflections and CME/CE credits through Learner+.
The past several articles in this series have focused on the issue of the cognitive impact of protective and defensive states. Specifically, the issues of cognitive distortions and confirmation bias, conformity, and utilization of logical fallacies in the response to opposing ideas and opinions have been described in detail. Ultimately, each of these issues does not exist in isolation but rather frequently coexist to create a negative and synergistic effect.
As noted across these articles, these detrimental traits typically emerge from protective and defensive states. In isolation, and to an even greater degree in combination, they stifle our ability to consider new and emerging information and engage in constructive conversations and debate with others who may have different ideas and opinions. While this issue exists on a widespread basis in many different realms of present day life, the implications specifically within the pursuit of health, wellbeing, and sustainable high performance have been discussed in these past articles.
Within the domain of healthcare, a particularly critical present issue is that of burnout. Over the past several years, there has been a progressive and significant increase in the proportion of healthcare professionals who self-report symptoms and manifestations of burnout. Given that this is self-reported, it is likely that this is under reported and, therefore, the issue may be greater than that which we currently recognize. There are significant impacts to healthcare professional burnout, including to the individual professionals themselves and their families, as well as the colleagues and partners with whom they work and the patients who they treat.
The issue of healthcare professional burnout is significant and is being discussed and addressed by many people across the domain of medicine and healthcare. This topic has been discussed in past articles in this series. Using the perspective of the Practices of the Healthcare Athlete, the biological basis for development of burnout has been described in detail. Ultimately the biological consideration of this issue leads to the understanding that the end result of burnout leads to becoming stuck in overwhelmed and shutdown states. This corresponds to the protective and defensive states noted above.
Furthermore, when the framework of the Practices of the Healthcare Athlete is applied to the understanding of the issue of burnout, we can recognize the many potential sources that lead to the final common pathway of becoming stuck in protective and defensive states. Across each of the three pathways, specifically, internal, external, and relational, cues which would tend to shift our biology towards activated, attacking, anxious, overwhelmed, and shutdown states can lead to burnout when this becomes chronic in nature and persistent over time. The manifestations of burnout which have been discussed in past articles typically emerge from overwhelmed and shutdown states. The early indicators are often associated with attacking and anxious states.
The biological understanding of burnout can lead not only to a greater understanding of the issue, but development of actionable strategies to better address the issue. The biological perspective has not yet received wide spread attention and emphasis. In part, from my vantage point, this is the result of the cognitive impact of protective and defensive states. When we consider the concepts discussed in the previous several articles we can apply the concepts to the issue of healthcare professional burnout. This is the emphasis of the current article.
Typically, when the topic of healthcare professional burnout is discussed, the emphasis is placed on the healthcare system at large and its role in causing burnout. This is typically attributed to issues such as healthcare professionals being overworked, under resourced, and working within a system that places demands which are too great and too persistent. When considered from the perspective of the three pathways, this corresponds to predominantly external cues and to a lesser degree relational cues. While this paradigm no doubt is part of the story, it is not a complete understanding of the issue of burnout as it does not include the important contributions of internal cues. In addition this framework while it does describe the external and relational cues does not provide immediately actionable strategies which an individual can implement in order to address the situation.
As stated above, individuals who become burnt out are typically manifesting a biological state scenario in which they become stuck in protective and defensive states. As a result, there are cognitive impacts which have been discussed in past articles. Importantly, this includes issues such as cognitive distortions and confirmation bias, conformity, and use of logical fallacies. The emergence of these biases will tend to limit the ability of those affected to consider new and emerging information as well as ideas and opinions which may not correspond to preconceived notions, particularly related to the belief that it is the system itself alone which is the cause of burnout. As discussed in past articles, this significantly limits not only our understanding of the issue, but our ability to implement effective strategies and tactics to address it.
Related to the above issue, the topic of conformity becomes important as well. As the prevalence of healthcare professional burnout continues to increase, there is an ever increasing number of individuals who are demonstrating manifestations of burnout. As the prevailing narrative surrounding burnout relates to the external pathway and associated cues, there is a great degree of conformity which can readily occur as individuals only consider these particular cues. While this may provide a degree of belonging amongst the larger group, as a result of sharing similar views, the inability to consider the entirety of the picture becomes very limiting in the understanding of the issue and implementation of effective strategies and tactics.
The final of the three issues related to the cognitive impacts of protective and defensive states relates to the issue of logical fallacies. As discussed in the past article, this particularly focuses on ad hominem attacks and strawman arguments. From my perspective, when individuals attempt to raise the understanding of burnout from the biological perspective by combining both psychologically based paradigms and somatically oriented perspectives, it is often the case that these logical fallacies are employed, often unintentionally, by those who are holding to the external pathway cues as the sole cause of burnout.
For example, a strawman argument is frequently utilized where the entirety of the model for considering burnout from a biological basis is not considered. This leads to a tunnel vision type of consideration in which all of the pertinent factors are not considered. The full and comprehensive framework for understanding burnout from the biological perspective is not considered, indicating use of a strawman argument. Ad hominem attacks are also frequently encountered in which individuals mistakenly accuse those promoting a more comprehensive understanding of burnout as blaming the victims, specifically those who have become burnt out. Nothing could be further from the truth as blame is not being laid upon those who become burnt out, however, developing a full and complete understanding of the issue is necessary if we are to truly address the topic.
As can be seen from the above discussion, there are very practical implications from the cognitive impacts of protective and defensive states. As outlined above, these issues can limit our understanding of the true scope and nature of an important topic, as well as significantly curtail our ability to implement effective strategies and tactics. While it is no means suggested that there is an intentional or deliberate attempt to undermine the true understanding, even when done subconsciously and unintentionally, the end result is the same.
The above discussion serves to illustrate the importance of developing skills, strategies, and tactics to increase our capacity to maintain anchored and grounded states and shift back to these states when we experience the inevitable shifts towards protective and defensive states. There are practical cognitive effects and related implications to becoming stuck in those states, as illustrated in the above examples. If we are to truly enhance our ability to understand complex topics, it is essential that we are able to leverage our biology such that we are optimally positioned to consider new information and engage in constructive debate and conversation. This is based upon an ability to shift towards anchored and grounded states.
To learn more, including about polyvagal informed coaching for healthcare professionals and others in high demand domains, please visit www.darindavidson.com.
Dr. Darin Davidson partners with Learner+, a CME/CE reflective learning platform for healthcare providers. For the opportunity to reflect on this article and earn CME/CE credits, Launch here. Check out all past articles which are also eligible for reflections and CME/CE credits.
For downloadable, actionable strategies and tactics to leverage biology in the pursuit of health, wellbeing, and sustainable high performance, visit the resource store, Launch here. Chapters are arranged by topic so those of interest can be selected and each are also eligible for reflections and CME/CE credits through Learner+.