Self Compassion Correlates with Burnout

I have talked a lot on this blog about the need for systemic changes in health care that would promote implementation of compassionate care. Research shows that compassion education doesn’t stick if institutions don’t adopt and foster compassionate actions and policies. Research also shows that providers are suffering from high levels of burnout due to strains on the health care system and the ways that business people try to regulate health care from a financial standpoint rather than from a human connection standpoint. My personal opinion, and that of researchers, is that serious changes need to be made in the structure of health care delivery and payment in the United States, and that these changes would be beneficial to the health and wellbeing of both patients AND providers.

However, many providers make compassionate choices every day, even in the face of all these obstacles. About 50% of patients feel that their providers care about them, and it’s almost astounding that so many providers are able to demonstrate that level of loving kindness toward their patients each day when workforce optimization policies attempt to eliminate every moment not devoted to a billable procedure. We all go into healing professions in order to help people, but it’s so easy to get jaded along the way. I came across a study recently that explains why some people suffer more from compassion fatigue and burnout[1]. In this study, researchers gave primary care physicians different burnout inventories (but primarily used a 36 item burnout inventory for their results) and determined that low levels of self-compassion result in higher levels of burnout. Additionally, the study showed that the lowest score of the three elements of self-compassion predicted differing presentations of burnout in these clinicians.

Self-compassion is defined by Dr. Kirstin Neff as “being open to and moved by one’s own suffering, experiencing feelings of caring and kindness toward oneself.” She breaks down self-compassion into three elements, each of which has a positive presentation and a negative presentation[2]:

1) one’s emotional reaction to suffering: self-kindness vs. self-judgment

2) one’s perception of suffering as a human event: connection vs. isolation

3) one’s response to suffering: mindful awareness vs. over-identification

People with high levels of self-compassion and other focused compassion typically demonstrate kindness, connection, and mindful awareness. A low score in any of these elements of self-compassion correlates with expression of a specific subtype of burnout.

The “frenetic” subtype of burnout is characterized by ambition, overload, and involvement (meaning people in this category increase efforts to cope with difficulties only because that's necessary to produce results). They use active problem solving as a coping mechanism. In this subtype, clinicians are so highly motivated that they aren’t able to recognize their own limitations and feel guilty when their goals are unmet. The main element of self-compassion associated with this frenetic subtype is the negative presentation self-judgment. This means that the antidote to this type of burnout is the self-kindness. These providers need to learn to approach themselves with the same grace and understanding with which they would approach a colleague, and seriously cut down on the negative self talk when things (inevitably) don’t go as planned.

The “under challenged” subtype of burnout is characterized by indifference, lack of development, and boredom. They use escapist cognitive avoidance as a coping mechanism. In this subtype, clinicians experience the absence of personal growth and feel guilty about their ambivalent attitude toward work (or about their desire for change). The main element of self-compassion associated with this under challenged subtype is isolation. These providers need to connect with other providers and share stories about the ways in which they feel disconnected or stagnant in the work in order to understand that they aren’t alone in their suffering. By sharing and connecting with others, these providers can become inspired to make changes in their jobs or their personal lives to decrease their own personal discomfort/distress.

The “worn out” subtype of burnout is characterized by lack of acknowledgement for jobs performed, lack of control, and neglect. They use behavioral disengagement as a coping mechanism. In this subtype, clinicians are more likely to experience the mental or physical health changes associated with burnout syndrome, and they feel guilty about not fulfilling their job responsibilities. The main element of self-compassion associated with this worn out subtype is over-identification. This means that providers get stuck in a cycle of underperforming on job duties because they know that their efforts will go unnoticed (or be taken for granted). This perceived lack of control over workplace scenarios leaves providers feeling victimized by a health care system that takes advantage of individuals'' altruism. These providers need to detach from their identification as a victim of the system in order to gain the mental distance necessary to approach their workplace complaints with curiosity and creativity. Change is always possible, whether its changing an existing workplace or leaving to find something more suitable.

It would be instructional and insightful for health care companies to give this self-compassion survey to employees, possibly at an annual review time, in order to gauge the mental state of employees and to figure out what types of changes they could make at an organizational level to decrease employee burnout. It may also be helpful to give this self-compassion survey to medical or other health professional students. One recent study[3] demonstrated that DPT students have much lower levels of self-compassion than clinical instructors or DPT faculty, and therefore may be more susceptible to burnout during therapy education and the first few years of clinical practice. By identifying areas for improvement and personal development in school, it’s possible that mindfulness education and practice geared toward each of the three self-compassion elements could protect future health professionals and equip them with better coping skills when out in the harsh medical world. Risk for burnout is higher when the gap between self-compassion and other focused compassion is wider, so helping students and clinicians to narrow this gap, through personally targeted techniques, would be beneficial for workforce retention and for the provision of compassionate care. People who are in burnout are not capable of acting compassionately, and therefore patient outcomes suffer when worker self-compassion is low.

In the Research tab of this website, I have uploaded a copy of the Burnout Clinical Subtype Questionnaire used in the first study I cited in this article. I have also uploaded a link to Neff’s Self-Compassion Scale. The correlation held true for my personal results on both scales, although I can identify times of my life when I have experienced each different subtype of burnout. I'd love to hear from anyone who takes both assessments to see if the correlation held true for you as well!

[1] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157499#sec023 [2] Self Compassion. Kirstin Neff.

[3] https://www.researchgate.net/publication/330162970_Self-compassion_and_Compassion_for_others_in_Physical_Therapy_Students_Faculty_and_Clinical_Instructors