Primary Care Clinician Stress and Psychological flexibility

1. Session # H4a October 18, 2014 Primary Care Clinician Stress and Psychological flexibility Debra A. Gould MD, MPH Central Washington Family Medicine Residency Program deb.gould@chcw.org Michael J. Aquilino MS Central Washington Family Medicine Residency Program maquilino@chcw.org Patricia Robinson PhD MountainviewConsulting Inc. Patti@Mtnviewconsulting.com Collaborative Family Healthcare Association 16th Annual Conference October 16-18, 2014 Washington, DC U.S.A.

2. Faculty Disclosure We currently have or have had the following relevant financial relationships during the past 12 months: • Dr. Gould & Dr. Robinson: Book Royalties - New Harbinger Publications, Inc. • Dr. Robinson: - Mountainview Consulting Group, Inc. • Book Royalties - Springer Science + Business Media, LLC - Behavioral Consultation and Primary Care: A Guide to Integrating Services

3. Learning ObjectivesAt the conclusion of this session, the participant will be able to: • Use tools to self-assess level of burn-out, sources and magnitude of stress, and level of psychological flexibility • Name 6 core psychological processes that support clinician resiliency • Describe specific exercises designed to enhance resilience among PCMH team members • Develop a personal strategy for building resiliency based on cognitive-behavioral therapy model called Acceptance and Commitment Therapy (ACT)

4. Bibliography / Reference Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, ShanafeltTD, Acad Med, 2014 Mar;89(3):443-51. doi:10.1097/ACM.0000000000000134. Identifying psychological mechanisms underpinning a cognitive behavioural therapy Intervention for emotional burnout. Lloyd, J., Bond, F. W. & Flaxman, P. E. Lloyd, Apr-Jun 2013, Vol. 27 Issue 2, p181-199. To be or not to be empathic: the combined role of empathic concern and perspective taking in understanding burnout in general practice. LamotheM, Boujut E, Zenasni F, Sultan S. BMC Family Practice 2014, 15:15 doi:10.1186/1471-2296-15-15.http://www.biomedcentral.com/1471-2296/15/15 Not all coping strategies are created equal: a mixed methods study exploring physicians’ self reported coping strategies. LemaireJB, and Wallace JE, BMC Health Services Research 2010, 10:208, http://www.biomedcentral.com/1472-6963/10/208 Real Behavior in Primary Care; Improving Patient Outcomes and Increasing Job Satisfaction. Robinson PJ, Gould DA, Strosahl KD, New Harbinger Press, Inc., 2010, Oakland California. The Mindful Employee and Effective Employee. Flaxman PE, Bond FW, Livheim F, Hayes SC; New Harbinger Press, Inc., 2013, Oakland California.

5. Learning Assessment • Describe self-assessment tools and use them to determine a. level of burn-out, b. sources and magnitude of stress, and c. level of psychological flexibility • Describe 6 core psychological processes that support clinician resiliency and specific exercises designed to enhance resilience among PCMH team members

6. Primary Care Home “Adaptive Reserve” • Value their role • Self-aware • Balance and prioritize • Manage a practice • Support relationships

7. Resilience Burnout ACT Organizational Individual Wellness

8. Burnout Symptoms: • Emotional Exhaustion • Depersonalization • Personal Accomplishment • Unhealthy coping: • Over-eat, drink, work • Isolation, Depression, Suicide • Leave Profession • Relationship Problems

9. Psychological Flexibility “Learning to be aware and accepting of the pain that comes into our lives and continue to pursue what we value.”

10. Resiliency – Core Processes Be Present Connect with Values Acceptance Psychological flexibility Act on Values Defuse Changing Self Mindfulness Values

11. Tool: PCP Stress Checklist Domains: • Interactions with Patients • Practice Management • Administrative Issues • Education / Learning • Relationships with Colleagues • Balance between Work and the “Rest of Life” Scoring: Higher scores indicates more stress (range 0-100)

12. Tool: Primary Care Provider Acceptance and Action Questionnaire (PCP-AAQ) Measures Psychological Flexibility • 20 Items; sum equals total score (range 0-120) • Higher indicates greater psychological flexibility.

13. Tool: Values Clarification If you were at your own retirement party, what would you like to hear other people say about what you stood for: • Practicing Medicine • Relationships with Colleagues • Relationships with Family/Friends • Personal Health & Well-being

14. Tool: Bulls Eye Values Assessment My work life is totally consistent with my values Studying/Practicing Medicine Relationships with colleagues My work life is totally inconsistentwith my values x x Relationships with Family & Friends Personal Health & Well Being

15. Personal ACTion Plan Value Statement: Action Steps: 1. Practice of Acceptance - 2. Practice of Mindfulness - Practice of Value Consistent Daily Actions -

16. How We’ve Done It! Be Present “EHR billing” Connect with Values “Compassionate Self” Acceptance “Heavy Hitters” Psychological flexibility Act on Values “3 at 3PM on Friday” Defuse “Drug Seeker” Changing Self “A Different Doc”

17. ACT Resources Association for Contextual Behavioral Science www.contextualpsychology.org/ New Harbinger Publications www.newharbinger.com

18. Questions????? Be Present “EHR billing” Connect with Values “Compassionate Self” Acceptance “Heavy Hitters” Psychological flexibility Act on Values “3 at 3PM on Friday” Defuse “Drug Seeker” Changing Self “A Different Doc”

19. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!