© Suzanne Matson, MA, PHR, LPC, NCC Team Care: 4 Top Management Challenges Coping with Conflict,...

© Suzanne Matson, MA, PHR, LPC, NCC

Team Care: 4 Top Management ChallengesCoping with Conflict, Burnout, Compassion Fatigue and Depression in Animal Caregivers

Matson Practice Management & Consulting, LLC

Suzanne Matson, MA, PHR, LPC, NCCPractice Management Consultant

Professional in Human Resources

Licensed Professional Counselor


Team Care:Coping with Conflict, Burnout, Compassion Fatigue and Depression in Animal Caregivers

IntroductionWelcome

Bathrooms

Breaks

Lunch

Evaluation


Overview of Today

ConflictThe Emotional BrainNeuropsychology of Conflict

BurnoutSymptomsStress and the BrainNeuropsychology of Burnout

Compassion FatigueSymptomsCoping Strategies

DepressionSymptomsTreatment Strategies for Depression


My BackgroundExperience

Charles Schwab - 6 YearsStock BrokerTraining in Leadership & Management

– Schwab University - Leadership Development, Finance & Management– “Six Sigma” Management of Productivity

Tuition Reimbursement Program – Master’s In Counseling PsychologyMA with Honors, in Counseling Psychology and Pastoral Care from Denver SeminaryTraining Department – Training ManagersHuman ResourcesMaster’s Certificate in Human Resource Management, Villanova UniversityDesignation of Professional in Human Resources (PHR)

Practice Manager/Consultant – 3 YearsConifer Veterinary Hospital Platte Canyon Animal Hospital

Practice Management Consultant – Professional in Human Resources (PHR) – 4 YearsMountain Paws Veterinary PracticeCoal Ridge Animal HospitalDenver SeminaryOther Small Businesses & Churches

Licensed Professional Counselor – 7 YearsPastoral Care & Counseling – Pastoral Connections Counseling MinistriesMountain Community Counseling Associates


Let’s Talk Conflict!

What are the Top 3 things about Conflict that you hate?

What are the Top 5 Conflicts that arise in your workplace?


The Sources of Conflict

Most Difficult People Characteristics and Problems to Manage in Veterinary Medicine – Animal Welfare?

Time ManagementInefficiencyPosition of Non-responsibilityFailure to Think/Failure to CommunicateConflict & EmotionsRefusal to Share KnowledgeUnprofessionalismEmployee Simply Doesn’t CareResistant to Change

Each of these are a direct result of… How the Brain Processes Conflict andHow the Brain Processes Emotion


The Science of Conflict and Emotion: “The Emotional Brain”

The Limbic System A group of interconnected structures that mediate emotions, learning and memory.

People with Problems & Problem People•Seem to be disconnected from what is going on around them•Display Negative Emotions or is often times “Over Emotional.•Frequently Slow to Learn new things.

Why is this?•Let’s look to a scientific understanding of how the brain works. •I think you’ll be surprised at how much sense there is to the nonsense of conflict in the workplace.


How the Brain Works Under Stress

Function of Three Main Understandings:

First: The Anatomy of the Brain’s “Limbic System”

– The Limbic System is a Contained, Circular Structure

– There is a reason for this structure…

Second: Designed for Fight-Flight-or-Freeze Survival Response

– Fight-Flight-or-Freeze – Explains the standard reactions of

many employees: » Argumentative (Fight)» Unavailable (Flight)» Zombie/Unresponsive

(Freeze)


How the Brain Works Under Stress

Function of Three Main Understandings:

First, Limbic System StructureSecond, Fight-Flight-or-Freeze

Third:Neurotransmitters – “Toxic Fumes” of the Workplace“Stress Hormones”

Increase in stress-related neurotransmitters/hormones

– Result: Increase in Limbic System Activity (emotion/respiratory) and

– Decrease in Neocortal (thinking) Activity

Then it makes sense that Good Thinking becomes impaired when working under stress.

It also makes sense that Emotions begin to run high.

What part of the brain is responsible for this?


How Does the Brain Process Emotion?

Amygdala – Emotion Center/Pleasure-Pain Center

Structure involved in many brain functions including emotion, learning and memory. Part of a brain system that processes “reflexive” emotions and responses.

– Fear and Anxiety– Size of an Almond– Pleasure vs. Pain –

» Simple “reflexive” responses vs. Complex Processing

» Neuro-pathways are “Reflexive”


How Does the Brain Process Emotion?

Cingulate gyrus – Required for more Complex ProcessingPlays a role in processing conscious emotional experience.

The distance between the amygdala and cingulate gyrus, the structures in between, and the presence of stress hormones explain how it is that emotional employees can’t see the impact of their emotions on others. Without building the Neuro-pathway…the (thinking) destination can’t be reached.

Explains StagnationResistance to Change

But, How do negative emotions permeate the workplace?


What about the Emotional Escalation and Deterioration of the Workplace?

Physiology of the Group

Emotion and anger become contagious in the workplace for the same reason that Women’s Menstrual Cycles Synchronize….

The Amygdala and Neurotransmitters play a role, and the “intelligence of the primitive brain.”

The Limbic System along with the Primitive Structures of the Brain Regulate or Excite the Central Nervous System.

How?Our Sympathetic Nervous Systems detect other people’s hormonal levels and respond with either synchronization and/or dis-regulation.Unconscious Process – Olfactory/Visual/Auditory Synchronization – to another person’s level of distress/excitement. Disregulation – swing between two or more states of stress.

Parasympathetic Nervous System is responsible for calming us down.This requires the conscious activity of the Cingulate Gyrus.


Review

ConflictControlled by the Brain

Structures involved?– LS– A– FFF– CG– AC– CNS– SNS– PSNS– NT– SH


Activity

The Color of Words Exercise


The Human Brain and Conflict

Recognized Styles of ConflictAvoidance – “I’ll think about it tomorrow”

Accommodate – “It would be my pleasure”

Compromise – “Let’s make a deal”

Collaborate – “Two heads are better than one”

Compete – “My way or the highway”


Break

See you back in 5 Minutes


Burnout & Compassion Fatigue in Animal Care-giving

Let’s Talk Burnout, First!


Burnout: What you will learn…

What is Burnout?

How Stress is Processed by the brain

Neuro-endocrine dysfunction

Role of Dopamine in the Brain

How Dopamine influences Thinking and Behavior

Symptoms of Burnout

What creates burnout in animal caregivers

Relationship between Burnout and Compassion Fatigue


Burnout

What is Burnout?

Burnout is the state of extreme dissatisfaction with one’s work.

Symptoms – Five Categories

Poor MotivationWorkplace DreadSense of AlienationAgitation or AggressionHealth Problems

When we understand the impact of stress on the brain, we understand where these symptoms originate from…


Burnout

Self Reflection Exercise…Symptoms – Five Categories

Do I have Poor Motivation?– In What Areas

Workplace Dread?– In general– Specific people I dread being around

Sense of Alienation– Conscious choice to alienate self– Avoidance of others?

Agitation or Aggression– In general, directed inward– In general, directed outward– Directed at specific people

Health Problems– Changes in sleep, appetite, weight, energy– Muscle soreness– Headaches– Slow to recover from illness, sick more often


Burnout, Stress & The Brain

The Brain

Stress Response Neurotransmitters (brain chemicals) activate the HPA-Axis

Hypothalamic Pituitary Adrenal Axis = HPA AxisHPA-Axis: Assesses threat & Triggers a Behavioral ResponseCatecholamines (FFF Hormones) activate the Hypothalamus as the result of Stress.When stimulated, the Hypothalamus secretes CRF (corticotrophin releasing factor)



The Brain

CRF effects brain functioning in several waysIncreases Arousal, Alertness, Attention and ReadinessStimulates the Pituitary Gland to release ACTH (Adrenocorticotropic Hormone)

ACTHStimulates the Adrenal Glands to produce two glucocorticoids: cortisol, and corticosterone.Increase cortisol production helps individual to initiate their behavioral response to the stress or threat by increasing stimulatory glucose to lower fear responseOver time, cortisol lowers immune response, resulting in health problems



The Brain

Neural Endocrine Dys-regulationHPA-Axis should stop cortisol production when the stressor is removed.This does not always happen.

– Neural pathways have been set in childhood– And, our initial conscious management of stress reinforces

these neural pathways and the levels of cortisol in the brain.

Conscious Management of Stress is Critical and Essential to Coping and Changing our Lives

Prefrontal Cortex (PFC)Controls attention, working memory, sorts out sensory inputs, regulates inhibitory responses.PFC has a high concentration of dopamine receptors.



Role of Dopamine in the BrainHelps to Regulate…

Movement as a crucial part of the basal ganglia motor loop in the brain

– Fatigue– Depression

Emotion, Motivation and Feelings of Pleasure (Limbic System)– Fatigue– Depression

Stabilizes brain activity – facilitates brain activity– “brain fog”– Regulates the flow of information to other parts of the brain

(Neuro-cognitive functioning)

Acts on our sympathetic nervous system (blood pressure, heart rate)

– Fatigue– Depression



Role of Dopamine in the Brain

Excessive Levels of Dopamine Deficient Levels of Dopamine Normal Levels of Dopamine

Addictions Addictions (food) Healthy bonding

Anxiety Depression Feelings of well-being, satisfaction

Compulsions Anhedonia – no pleasure Pleasure, feelings of reward in accomplishments

Sexual Addiction Lack of Ambition Healthy libido

Unhealthy Risk-taking Inability to ‘love’ Good feelings toward others

Gambling Low libido Motivated

Compulsive Activities Erectile Dysfunction Healthy risk taking

Aggression No remorse about personal behavior

Sound choices and decisions

Psychosis ADHD Realistic expectations and thinking

Schizophrenia Social Anxiety Disorder Parent-Child Bonding

Sexual Fetishes Sleep Disturbance & Restless Leg Syndrome

Contentment in the ‘little’ things


The Balance Between…Too much or Too Little?

Martha Stewart

Tiger Woods

1st Date but no 2nd?

“It’s not you, it’s me”

Chocolate cravings?

Cocaine?

Indifferent to your partner/spouse?

Prone to Addiction/Not Prone to Addiction


The Balance Between…Too much or Too Little?

Oxytocin & ProlactinOxytocin

Encourages Closeness & AttachmentTrust hormoneDrops in Dopamine & Oxytocin result in increased levels of prolactin.The more oxytocin you produce, the more receptive nerve cells are to oxytocin. The more dopamine you produce, nerve cells shut down to protect themselves from overstimulation and are not as receptive to dopamine the next time. Therefore it takes more dopamine to stimulate them.Calming effect on other individuals (pheremonal quality)

Prolactin (excessive)Increases hostility and anxietyIncrease of testosterone levelsAssociated with despairIncreases desire for one’s own space



The Brain

Under-Communication by the PFC to the HPA Axis and Amygdala– Amygdala continues to assign high emotional valence to the stressor– Setting the entire process back in motion – negative feedback loop.

Long Term Effects of Stress

Pre-Frontal Asymmetry – Left Frontal Brain Impairment– Increased levels of cortisol cause

» damage to the hippocampus» PFC to shrink

– Neuro-chemical Dysregulation – Maladaptive Feedback Cycle– The frontal brain is the last area of the brain to develop, as an individual develops.

Limbic System– Structures: Thalamus, Hypothalamus, Amygdala and Hippocampus– Threat stimulates the locus coeruleus to produce noradrenaline (primary stimulatory

neurotransmitter of the Limbic System.– Amygdala responds to stress by releasing CRF– Prolonged elevated cortisol levels burn out neurons in the hippocampus and

amygdala and these areas have been shown to be smaller in individuals impacted by long-term stress, and traumatic stress.


Burnout in Animal Caregivers

Revisit Symptoms and Characteristics of Burnout in Animal Caregivers in light of the Brain…

Excessive distancing from ClientsImpaired competenciesLow energy and dissatisfaction Increased irritability with othersDepression resulting from individual, social, and work environmental factors


Burnout in Animal CaregiversBurnout is Cumulative over Time

Gradual build-up of dissatisfaction often related to several competing external factors

Demands of the jobDealing with Clients and the PublicDemands of Time Pressures in Medicine Line of Responsibilities Clearly Defined

– Lack of clarity around responsibilities– Responsibility Overload

Relationship Stress– Poor Relationships– Personality Incompatibility– Lack of Respect, Displays of Disrespect

Stress caused by Management– Bullying Bosses – Supervisors


Burnout

Questions…?

Is Burnout a Predictable and Foreseeable Process?


Burnout – Thinking Question?

What is the difference between…A frog placed into a pot of boiling water

And a frog in a pot of cold water that is gradually brought up to a boil?


Burnout

Burnout is often a “Solvable Problem”Actions can be taken to prevent

Taking a vacation usually restores

Change of job is often beneficial, if necessary

Changes in Work-Life Balance are helpful

Level of external support and connections has been shown to impact burnout.


Working Lunch Together

Enjoy!!!


Compassion Fatigue…

What you will learn…

The difference between Burnout and Compassion FatigueWhat is Compassion FatigueThe context of Compassion Fatigue: Traumatic Stress DisordersHow to think about How Compassion Fatigue may be Impacting your life or those you work with.Your Potential for Compassion SatisfactionYour Potential for Compassion FatigueYour risk for Burnout


Burnout & Compassion Fatigue

Burnout

A state of extreme dissatisfaction with one’s work.

Not necessarily associated with manifestations of trauma.

Compassion Fatigue

A prolonged state of tension and preoccupation with the cumulative traumatic aspects of working in animal-care and veterinary medicine.

Natural consequence of stress resulting from caring and helping traumatized or suffering animals or people.


Compassion Fatigue

Compassion Fatigue

Display of outward signs and stress resulting from giving care to others.Secondary Traumatic Stress Disorder (STSD vs. PTSD)

“The Stress of Caring….too Much”Beyond what is healthyNot just Emotional, Physical, but characterized by Trauma Responses

Manifestations– Re-experiencing the traumatic events– Avoidance/numbing or reminders of traumatic experiences– Persistent Arousal - Hyperarousal

Internal Emotional Conflict (CF) vs. External Conflicts (BO)– Set of Symptoms – Not a disease.– Prolonged exposure can result in Clinical Depression


Compassion

“a feeling of deep sympathy and sorrow for another who is stricken by suffering or misfortune, accompanied by a strong desire to alleviate the pain or remove its cause”

“To suffer with…”


Compassion Fatigue

Field of TraumatologyPrimary Traumatic Stress

PTSD – Post Traumatic Stress Disorder

Secondary Traumatic Stress“the cost of caring…”Being witness to

Other TermsVicarious Trauma (VT)Emotional ContagionCumulative Trauma Compassion StressRepetitive Stress InjuryRepetitive Emotional Self Injury – Repetition Compulsion


Compassion Fatigue Self-Test


Compassion Fatigue Facts…

Compassion Fatigue, Burnout and Compassion Satisfaction are not significantly different for male and female veterinary professionals.

Compassion Fatigue, Burnout and Compassion Satisfaction are not significantly different for those who are involved in performing Euthanasia and those who are not.

Scores for all members of veterinary practice teams are similar, although veterinarians and office staff reported different sources of stress and satisfaction.

Healing animals and the opportunity to work as a team are major sources of satisfaction for all staff.


Compassion Fatigue

Primary Traumatic StressThe traumatic event is persistently re-experienced in one (or more) of the following ways:

Recurrent and intrusive distressing recollections of event, including thoughts, images or perceptions *Recurrent distressing dreams *Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). *Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. *Physiological reactivity on exposure to trauma cues. *


Compassion

Primary Traumatic StressPersistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) as indicated by three or more of the following:

Efforts to avoid thoughts, feelings, or conversations associated with the trauma.Efforts to avoid activities, places, or people that arouse recollections of the trauma.Inability to recall an important aspect of the traumaMarkedly diminished interest of participation in significant activities.Feeling of detachment or estrangement from othersRestricted range of affect/emotions (unable to feel one’s own emotions.Sense of foreshortened future (cannot feel a sense of the future, uncertainty).


Compassion

Primary Traumatic StressPersistent symptoms of increased arousal (not present before the trauma) as indicated by two or more of the following:

Difficulty falling or staying asleep * Irritability or outbursts of anger *Difficulty concentrating *Hyper-vigilance *Exaggerated Startle Response *30 days of ongoing duration, or more *Disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning: Evidenced by increase in family conflict, sexual dysfunction, poor interpersonal communication, less loving, more dependent, reduced social support, poor stress-coping methods. *


Examples of Compassion Fatigue Symptoms

Seven Categories of FunctioningCognitive

Emotional

Behavioral

Spiritual

Inter-personal Relationships

Somatic

Work Performance


Examples of Compassion Fatigue Burnout Symptoms

Seven Categories of FunctioningCognitive

Lowered Concentration

Decreased self-esteem

Apathy

Rigidity

Disorientation

Perfectionism

Minimization

Preoccupation with Trauma

Thoughts of self harm or harm to others



Seven Categories of FunctioningEmotional

PowerlessnessAnxietyGuiltAnger or rageSurvivor guiltShutdownNumbnessFearHelplessnessSadnessDepressionEmotional instabilityDepletedOverly sensitiveSelf Esteem



Seven Categories of FunctioningBehavioral

Self-EsteemInpatientIrritableWithdrawnMoodyRegressionSleep disturbanceNightmaresAppetite ChangesHyper-vigilanceElevated Startle ResponseAccident pronenessLosing things



Seven Categories of FunctioningSpiritual

Questioning the meaning of life.Loss of purpose.Lack of self-satisfaction.Pervasive hopelessness.Anger at God.Questioning of prior religious beliefs.Loss of faith in GodGreater skepticism about life and God.



Seven Categories of FunctioningInter-Personal Relations

WithdrawalDecreased interest in emotional intimacy, physical intimacy, or sexual intimacy.MistrustIsolation from othersOverprotection as a parentProjection of anger or blameIntoleranceLonelinessIncreased interpersonal conflicts



Seven Categories of FunctioningSomatic Symptoms

Shock

Sweating

Rapid heartbeat

Breathing difficulties

Aches and pains

Dizziness

Increased number and intensity of medical maladies

Other somatic complaints

Impaired immune system



Seven Categories of FunctioningWork Performance

Low moraleLow motivationAvoiding tasksObsession with detailsApathyNegativityLack of appreciationDetachmentPoor Work commitmentsStaff conflictsAbsenteeismExhaustionIrritabilityWithdrawal from Colleagues


Break

See you back in 5 Minutes


Depression…

Presence of 2 or more of the following…

Poor Appetite or Over EatingInsomnia or Hyper-somniaLow Energy or FatigueLow Self-EsteemPoor Concentration or Difficulty Making DecisionsFeelings of Hopelessness


Coping with…” it all…”

MASTERS Process of Wellness Transformation

MotivationAssessmentSelf-ReflectionTransformationEvaluatingReviewingStudying

•Knowing

•Being

•Doing




MotivationIntention is setting your mind to a specific task. Motivation is the force necessary or needed to actually carry out the task.

AssessmentGathering factual and objective information that informs us about where we are now, and where we want to be. And, which may lead us to being happier and healthier.




Self-ReflectionRequires honesty, concentration, commitment, and forward reaching vision.

TransformationThe process of shifting from one mind-set that lacks wellness to one that embraces and moves toward wellness.Developing strategies and plans for change.



MASTERS Process of Wellness TransformationEvaluating

Seeking, finding, and learning about those life skills or practices that are tools for achieving success in our Life Plan.

ReviewingReviewing one’s life up to the present.

– Learning from experiences, mistakes, the pastReviewing one’s future life plan for

– Added wellness– New life skills– Desired outcomes for change

Redefining success and failureStudying

Study new thingsStudy your Life Plan Regularly


Activity

Beck Depression Inventory

MASTER’s Review

Team Handcuffs


Activity

Team Handcuffs Debrief…

A Metaphor for Remembering what We’ve Learned Today…


Conclusion…


References & Credits

Compassion Fatigue in the Animal Care Community

Charles Figley, Ph.D.Robert Roop, Ph.D.

Healthy Caregiving: A Guide to Recognizing & Managing Compassion Fatigue

Patricia Smith, Founder, Compassion Fatigue Awareness Project


Compassion Fatigue

Primary Traumatic StressDirect experience of an event outside the range of usual human experience that would be markedly distressing to almost anyone.

Car Accident

September 11, 2001

Family violence

Combat

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