MHM Magazine

professional is exposed to an increased risk for burnout. However, by not establishing and enforcing appropriate professional boundaries, the healthcare professional fails to meet the legal and ethical mandate to do so, whilst also exposing themselves to an increased risk of burnout. The answer to this dilemma is perhaps found in meta-analytic studies of burnout, which indicate a moderate correlation between chronic exposure to stressors and burnout. Such moderate correlations indicate that moderators are likely present in the relationship between chronic stress and burnout. Research identifies several moderators in the stressor-burnout relationship, which include meaningful coping strategies, job resources, personal resources, and post-work recovery from stress. Whilst it might be difficult to entirely avoid the aspects which can result in frustration of enabling and enforcing professional boundaries, the healthcare professional can aid their well-being through the meaningful application of personal boundaries in promotion of recovery and self-preservation. However, to establish meaningful and impactful personal boundaries which support the ability to sustain professional boundaries, delineation of the factors that promote personal recovery from burnout and its antecedents is warranted. Research indicates the following aspects are key in recovering from, or warding off the onset of psychological burnout: • Psychological detachment from work This means refraining from work-related activities after work hours, whilst also actively relinquishing work-related thoughts, that is to say; to ‘switch off’. Psychological detachment fromwork further speaks to being mentally involved in other areas, such as sports, hobbies and activities with other people. A key aspect in creating psychological detachment fromwork is by setting non-negotiable personal boundaries between work and non-work time. Individuals who can psychologically detach fromwork hold more positive associations with work, enjoy increased life satisfaction, positive affect, work engagement and increased professional efficacy. • Opportunities for recovery: Taking shorter planned and more frequent periods of respite fromwork is more effective than taking longer, yet more infrequent periods of respite. Secondly, the period of respite should be bolstered by planned experiences for relaxation, and active detachment fromwork (such as switching off one’s work phone, and not having access to work related emails). Thirdly, periods of respite which occur over weekends are associated with lower burnout, and higher workplace vigour levels than compared to taking off two days in the work week. Furthermore, having clearly defined start and end times for the workday, opportunities to take regular breaks and capacity to adjust workload in accordance with one’s need for recovery are important in warding off sleep disturbances and health complaints commonly associated with burnout. • Physical activity and related leisure time activities Physical activity enables biological changes which reduce the physiological sensitivity to stress, whilst also acting as a behavioural distraction which alleviates the psychological impact of experienced stressors. Higher engagement with active leisure activities, hobbies, and exercise – are linked to better sleep, improved recovery, and lower incidence of maladaptive fatigue related symptomology. Furthermore, research indicates that when time is spent on physical activity, a positive effect occurs for burnt-out employees, irrespective of the initial level of burnout. Many healthcare professionals often aspire toward increased exercise, leisure, and recovery time; however, the realities of medical practice and life often make this difficult to initiate and sustain. To meaningfully enable and maintain personal boundaries, the following aspects should be considered: • Personal boundaries are more than a mindset: Research indicates that whilst goals can assist in starting with new habit formation, it is the link between the situation and the behaviour which in fact sustains new habit formation. The mindset must shift from the values that prompted the new habit, to the actual mechanics of the new habit, i.e.: o Do you have a clear behaviour to mind? o What occurs just before initiating this new behaviour? o What can enable, or distract from this behaviour? o Is this behaviour rewarding? o How often should this behaviour occur? • Keep it simple: New habits require simple, easily repeatable behaviours. To create long term, complex habit behaviours, one must ‘stack’ discrete, simple behaviours together which enable habitual instigation. • Habit stacking and environmental cues Habit ‘stacking’ is an empirically known means fromwhich new habits are linked into an existing routine. Habit stacking uses the automaticity of the established habit to build a new one. For instance, when putting your keys down upon arriving home, you could also switch your work phone off. • Keep friction in mind: Friction speaks to how fast, convenient, and easy a new habit is. The two keys to building healthy habits and boundaries are by reducing friction in healthy activities and increasing it for the unhealthy ones. • Build in enjoyment: Temptation building, a strategy of pairing a pleasurable experience with a behaviour which provides delayed rewards is an effective means to engage in activities which are less pleasurable yet are needed to build healthy boundaries. For instance, whilst some might not enjoy the treadmill, yet enjoy binge-watching series, a gymwith treadmills that have built in televisions might be the solution. References available on request. MHM | 2024 | Volume 11 | Issue 2 | Crisis Intervention Skills for Doctors MHM 32 | MENTAL HEALTH MATTERS | 2024 | Issue 2 H