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Healthcare Burnout and PTSD with Dr. James Zender

by Jen Barna MD, Physician Coaching, Physician Wellness, Podcast

In this episode, Dr. Barna speaks with clinical psychologist, certified brain injury specialist and certified traumatologist Dr. James Zender about healthcare burnout and PTSD. He and Dr. Barna discuss the effects of stress and trauma on physicians and what can be done about it. You will also hear about the benefits of group coaching and group therapy. 

“The impact of stress on the body is well known going back to the research of Hans Selye and the general adaptation syndrome, that when organisms are under prolonged stress and inescapable stress, the body begins to break down in predictable ways.” -Dr. James F. Zender

In today’s episode, Dr. Jen Barna welcomes Dr. James F. Zender to the podcast. Dr. Zender is a clinical psychologist, certified brain injury specialist and certified traumatologist. Dr. Zender shares about his childhood and how it led him to the field of psychology. He and Dr. Barna discuss the effects of stress and trauma on physicians and what can be done about it. They also discuss the significant benefits of professional coaching in a group setting. Dr. Zender has created a burnout inventory and he shares with us some of the questions from it that may be helpful in assessing where you are on the burnout scale. He also has a trauma toolkit for healthcare professionals available on his website. If you would like to learn more about Dr. Zender, visit https://drjameszender.com

Dr. Zender is the author of  “Recovering From Your Car Accident: The Complete Guide to Reclaiming Your Life” (2020, Rowman & Littlefield). His Psychology Today blog, The New Normal, made Heathline’s List of best traumatic brain injury blogs of 2019. Zender was the founding director of The Center for the Prevention and Treatment of Psychological Trauma at Detroit Receiving Hospital and University Health Center and was a full time Affiliate Instructor in Psychiatry at The Wayne State University School of Medicine. For the past 15 years, his private practice in the Detroit Metro area has focused on vehicular trauma injury recovery. He has lectured at the The World Psychiatric Association, Harvard Medical School, The International Society of Traumatic Stress Studies, and The American Psychological Association.

Links to Podcast episodes mentioned:

– Episode 163: Part 1: Emotional Awareness & Expression Therapy for You & Your Patients with Dr. David Clarke

– Episode 164: Part 2: Emotional Awareness & Expression Therapy for You & Your Patients with Dr. David Clarke

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Podcast produced by: Amanda Taran

 

Please enjoy the full transcript below

 

Dr. Zender: The impact of stress on the body is well known, going back to the research of Hans Selye and the general adaptation syndrome, that when organisms are under prolonged stress and inescapable stress, the body begins to break down in predictable ways.

 

[DocWorking theme]

 

Jen: Welcome to DocWorking: The Whole Physician Podcast. I’m Dr. Jen Barna, founder and CEO of DocWorking and cohost of the podcast. I’m so happy that you’re here with me today. Thank you for joining us. We really appreciate you being part of our listening audience, and we’d love to hear from you, and hear about what you’re enjoying on the podcast. What do you want to hear more of? And I’m especially thrilled to have you here with me today to hear this conversation with expert Dr. James Zender. The author of Recovering From Your Car Accident: The Complete Guide to Reclaiming Your Life, published in 2020.

 

Dr. Zender is a clinical psychologist, certified brain injury specialist, and certified traumatologist. His Psychology Today blog, The New Normal, made Healthline’s list of best traumatic brain injury blogs of 2019. Dr. Zender was the founding director of The Center for the Prevention and Treatment of Psychological Trauma at Detroit Receiving Hospital and University Health Center and was a full time Affiliate Instructor in Psychiatry at The Wayne State University School of Medicine. For the past 15 years, his private practice in the Detroit Metro area has focused on vehicular trauma, injury, and recovery. He has lectured at The World Psychiatric Association, Harvard Medical School, The International Society of Traumatic Stress Studies, and The American Psychological Association.

 

Dr. James Zender has also recently put together a healthcare provider burnout inventory and I’m excited to have him here today with me on the podcast to talk about that and the impact of burnout on healthcare workers and what can be done about it. We’re going to be talking about some of the newest types of treatments that can really impact the lives of people with chronic pain, and other chronic injuries, and somatic illnesses that can be stress induced. Dr. James Zender, welcome to DocWorking: The Whole Physician Podcast.

 

Dr. Zender: Thank you, Dr. Barna. I’m thrilled to be here with you.

 

Jen: It’s so good to have a conversation with you. I’m really excited to hear about the work you’ve been doing, and also how it relates to healthcare workers currently. And so, just letting people get to know you a little bit, I’m hoping that you would be willing to share with us your own background story and what has brought you to this important work.

 

Dr. Zender: Sure, glad to. My story begins in my childhood. I grew up in a wonderful family, but it was a traumatized family. I grew up living on a farm with my mother and father. My mother had been severely traumatized as a child in a burning accident and that continued to haunt her for the rest of her life to some degree or another. One of the ways that it haunted her was in expressions of posttraumatic stress. She would have anniversary reactions on the anniversary of the accident. She was four years old when it happened and it happened to coincide with my birthday. So, often, she would have a severe regression that coincided with that and that left me quite confused as a child. At a very young age, I was desperate to find out what was going on, to try to make sense of my world, and my mother’s reactions, and my confusion about what was happening in the family. I suppose that’s what propelled me into the study of psychology.

 

Jen: I really appreciate you sharing that with me because it sounds like such a difficult situation for everyone in your family. Not just your mother, but obviously, it really affected you and probably your father. Did you have siblings as well?

 

Dr. Zender: No, I didn’t. But you make a really good point that trauma affects the whole family unit. It affects the community, it really spreads out from the nucleus of the traumatic incident, and it’s amazing how it reverberates over the decades throughout lifetimes.

 

Jen: And that can be so true and it can manifest itself in somatic or physical symptoms that can be very difficult to diagnose with patients. It seems relatively, commonly present with physical symptoms that are very real, but don’t have an obvious etiology. And that’s an area of research and treatment that has made huge progress in the last, I would say, the last even couple of years. It’s at least finally coming to the forefront. And that also is part of the body of work that you are involved in. So, can you explain to us some of the changes that have happened and how treatment in that type of scenario has evolved?

 

Dr. Zender: Yes. It was just last year I attended, I think it was the second annual conference, of the American Psychophysiologic Association. It was a wonderful conference. It’s really looking at what’s known about the connection between mind and body. We have a number of terms now. I think the most accepted is psychophysiologic disorder, which fits more neatly into the medical model. Other terms are the mind-body syndrome, or stress illnesses, or psychosomatic illnesses, or somatization disorders. But I do like psychophysiologic disorders.

 

Jen: Yeah, I’m glad that you mentioned that. Actually, we just recently had Dr. David Clarke as a guest, I believe it was episodes 163 and 164. He’s President of the Psychophysiologic Disorders Association. And so, I’m very excited to hear from you about how this area has evolved and continues to evolve even as we speak, and how it has impacted your work.

 

Dr. Zender: Yeah, it’s huge. It’s a huge impact. It really goes back to the beginning of the diagnosis of posttraumatic stress disorder in some ways, which was in the early 80s, when I was really just entering the profession. It’s hard to imagine in the early 80s. I think it was 1982, the diagnosis first appeared in the DSM. Before that we didn’t really have a term for how trauma was affecting people. So, what a huge revolution that was to now have a way of thinking and researching how external traumatic events can impact someone’s psychological functioning.

 

Jen: Yes. And how in addition to psychological functioning, I think, if I understand correctly, it can impact the physical functioning as well or it can present as physical symptoms as opposed to psychological symptoms?

 

Dr. Zender: Absolutely. It really goes back to, I think Hippocrates said that “When the mind is ill at ease, the body is ill at ease and conversely.” Yes, a lot of times when there’s a lot of stress or tension, people will start to develop different kinds of pains and aches, and these can become chronic, and then they can manifest in actual physiological disorders within the body, and contribute to, I think, all physical illness to some extent. The impact of stress on the body is well known going back to the research of Hans Selye and the general adaptation syndrome that when organisms are under prolonged stress and inescapable stress, the body begins to break down in predictable ways.

 

Jen: And that brings us, of course, to the question of how the healthcare workforce could be impacted by stress-induced illness. And what you see as the effects of that. One thing that you and I talked about in a previous conversation was what percentage of healthcare workers have PTSD from the work itself? What are your thoughts about that?

 

Dr. Zender: I think that healthcare workers develop PTSD from their work being exposed to high levels of other people’s traumas and human suffering. We have the concept of vicarious traumatization and it’s well known that being exposed to other people’s traumatic stress can create traumatic stress within you. So, definitely over the last couple years, it’s been really rampant. I think we’ve done poorly as a society addressing mental health needs in the world. But I think the pandemic, one of the blessings from it, is that mental health issues have become more salient for everybody.

 

Most people were experiencing high levels of anxiety, depression, and particularly for healthcare providers to be dealing with their own level of anxiety, fear, uncertainty, and then to be assisting their patients, dealing with their heavy loads of traumatization, and anxiety. Yeah, it’s like a double whammy for healthcare professionals, particularly ones dealing with severely ill people and dealing with a lot of death and dying. The unusual situation of not being able to participate in the normal grieving processes that we need to be able to move on from loss.

 

Jen: For someone who may be experiencing this type of posttraumatic stress disorder as a healthcare worker, what is the new frontier of therapy that can be so transformational and curative? As far as I know, it’s a relatively new type of treatment that you and some others who are really at the front of the field are seeing huge results with.

 

Dr. Zender: There Are two things here. I think there’s the idea of strictly working with psychophysiologic disorders and the protocols that are being developed to address psychophysiologic disorders, that once they’re identified and diagnosed, there are some really exciting new protocols for approaching stress disorders. Okay, so, there’s that and then there’s the general issue of helping people recover from trauma, helping people to recover from posttraumatic stress. This is where it gets into the issue that I just mentioned about how we’ve not done very well as a culture in dealing with mental health needs of the society of the population. It’s particularly true for healthcare professionals and I think possibly particularly true for physicians that there’s been a culture within the profession that discouraged reaching out to others for help around mental health needs. I think that’s a culture that really needs to change and I believe that you’re really on the forefront of helping change that culture with encouraging coaching and mental health therapy if that’s indicated too. So, that’s a wonderful thing.

 

I think we can’t fill somebody else’s glass if our glass is empty. If we’re not taking care of ourselves, we’re not going to be very good at taking care of other people. This whole issue of burnout is really a huge issue for, I think physicians and healthcare providers in general or any professions that have high demands for production and perfection or striving towards perfection. That is a recipe for burnout. I think burnout does share a lot of features of posttraumatic stress. Once burnout happens, it’s hard to come back from that ,especially if you’re not doing anything different and you keep going deeper and deeper into professional exhaustion, or compassion, fatigue, or vicarious trauma, whatever you want to call it.

 

Jen: Yeah, beautifully said. I really do agree that my goal with DocWorking is to normalize physician and healthcare professional coaching to the extent that it is not something that you need to go and seek when you think you have a problem, it is something that you’re using all along to prevent having a problem. It can help you if you’re having a problem, but the ideal situation is for everyone to have access to it all the time, and then to be putting tools in place that can help to prevent these problems that can develop if everything is neglected, and pushed down, and someone doesn’t give themselves time or space to process. Everything that they’re dealing with, all of the stresses that result with working in this profession. One thing that you admitted to me is that you have created a burnout inventory. I’d love to hear more about that.

 

Dr. Zender: Yes, I think it was last year it was becoming more and more apparent to me that there wasn’t a lot of help for healthcare providers in dealing with all the stress of what was going on in the world. I did a lot of research and put together a course, I called it Trauma Toolkits, for healthcare providers and I also put together a physician traumatic stress burnout inventory. It has just 20 items that I have observed with people that I’ve worked with, that are indicators of burnout and I can read through a few of those items if you’d like. I’ve got it here with me.

 

Jen: That would be fantastic.

 

Dr. Zender: The first one I have is, “I feel emotionally and physically drained after a day of caring for my patients. I feel I’m running on empty. Most nights I have difficulty sleeping. I often feel dissatisfied with my work and wish I had chosen a different profession. I feel unsupported by my administrators, staff, or employer. I often feel hopeless about my future. I feel trapped by my financial debt. I prefer time away from my practice. My professional life is out of balance with my personal life. My spiritual values don’t align with the work I am able to do. As a physician, I do not feel a sense of personal autonomy in my work.” And then there’s eight more, I won’t go through everything. But that gives you an idea of the kinds of stressors that I believe physicians often encounter in their personal lives.

 

Jen: Yeah, absolutely. We’re currently putting together a burnout quiz that will be on our website as well. There is, of course, some overlap, but you do have some more specific things about the work itself that sadly, I think, ring true for a lot of us. So, I’d love to know from the physicians and other healthcare providers that you work with, what percentage would you say are burned out based on your inventory and then what’s next in terms of what can be offered to them to help them move through that to get to the other side.

 

Dr. Zender: Well, it’s not a researched inventory. It’s just something I put together that I thought would be helpful for people to consider, and think about, and apply it to their own situation. Again, it goes back to what we’re talking about with your work in coaching and my work in therapy is, number one, I think, with recovery is that people have to feel safe again. They have to reestablish a sense of connection. This is where coaching and therapy come in. The biggest danger with trauma is becoming isolated. The more isolated you become, you cut yourself off from all the resources you need to heal and to gain better coping skills. Once you’re able to connect with someone else who is not drowning in a sea of stress, they can throw out some life preservers to you. You can start to see things in a more realistic way.

 

We have different parts of our brain and we have these fear centers, the limbic system, the amygdala. Once that becomes activated, our ability to problem solve and reason through things becomes compromised, because now we’re just being driven by stress on neuro chemicals, cortisol, and adrenaline. Our mental vision becomes more and more narrow and distorted, and it can really reach a point of being out of contact with reality. The old saying, “A problem shared is a problem halved.” It gets into something I hope we would talk about is the wonderful curative and healing potential of working in groups. I know you talked about doing coaching groups, I do psychotherapy groups particularly with auto accident survivors and it’s so powerful. I think one of the most powerful things people can do is to get connected with a group, where you see that you’re not alone, you’re dealing with the same kinds of issues and stressors that everybody else is in the group. It just makes all the difference, I think.

 

Jen: Yeah, absolutely. Everything that we’ve designed at DocWorking does evolve around coaching and peer support combined and we really have seen people make great strides in small group coaching, and even just in the ability to relate to other peers on the platform, just a place where we can communicate and see that we’re not as isolated as we feel. Because as you say, I think you can get that into your mind and it just amplifies when you’re not sharing it with other people. You think that you have a problem that other people don’t share and you’re embarrassed to share it, when you then go to a group coaching type of scenario where someone is willing to step forward and say, “I have this problem,” then everyone else chimes in and says, “Oh, I have that problem, too” or “Maybe you don’t say that. Maybe you’re just thinking it.” But it’s still very helpful to see that other people are dealing with this, and to see someone move through it.

 

One of the things that I’ve seen happen is someone who starts out saying, “I think I’m going to have to leave medicine.” I’ve seen that more than once now, and our coaches have seen it multiple times, because they’ve been working with physicians for years. But once the person is saying that, they start to realize everything is not black and white. There are a lot of choices in between, then they can make a choice to stay. At least that’s what I’ve seen so far is that people often do make the choice to stay once they realize that they can have more control than they thought. I think a lot of it is feeling isolated and feeling like you don’t have any control over your own schedule in your own life. So, once you realize that you can take it back, that can make a huge difference.

 

Dr. Zender: It gets into the huge issue of preventing suicide also. We know from research and suicidology that the people who attempt suicide or commit suicide, their thinking has become bifurcated in the sense that they see there’s only two options, either A happens or I’m going to have to kill myself. It’s such a cognitive distortion that comes from, again, these stress hormones taking over your mental functioning. As soon as the person sees that– No, there’s not just two options, there’s a third option.

 

Well, and we know that there’s obviously many options if you can only think about them. That’s where the group comes in handy, because now, you have a whole group of people offering you options that you didn’t think of before or maybe you thought about it, but you forgot them. Now, you can remember them again, and you can start to work with it. The issue of isolation and this bifurcated thinking that people fall into when they’re under high levels of stress is something that is really amenable to, I think coaching and psychotherapy.

 

Jen: Yeah, absolutely. Having trusted thinking partners to even just brainstorm can make such a huge difference. You bring up another great point, which I’m very interested in hearing your thoughts about which is the difference between psychotherapy and coaching.

 

Dr. Zender: I’m not a professional coach, but I am certainly a very experienced psychotherapist. I think that my idea is that acting as a coach is one component of being a psychotherapist. You’re encouraging your patient or client to do things that you think would be helpful, you’re giving feedback, you’re sort of a cheerleader for them, you’re a safe person, you’re a benign person, you’re somebody that they feel confident in their ability to trust. I think those are probably aspects of coaching as well. Differences, I suppose involve lots and lots of training, and actual techniques of psychotherapy, and models of psychotherapy, and theories of mental disorder and mental illness, and neuroscience, and all those kinds of things. But I imagine particularly coaches get pretty heavily involved in neuroscience issues, too. So, yeah, I think there’s probably just a lot of overlap. What do you think?

 

Jen: I think there definitely is overlap in the ways that you mentioned. But also, I tend to think of coaching as looking forward, helping someone to identify their values, and see what it is that’s important to them to focus on, and move forward where that could be leadership, that could be work-life balance, it could be all of these things, there could be many things that each individual can sort out as they begin to work with trusted thinking partners as opposed to dealing with something like posttraumatic stress disorder, where you really need a professional mental health expert to help you unravel and treat.

 

It’s gotten to a point where you have a mental health illness, which is not at all uncommon as you mentioned before. I think that’s one thing that has been a positive silver lining of the pandemic for us to realize. I think it’s more common than not [laughs] probably at this point to have some type of anxiety or trauma-related illness, very common and there’s, of course, a wide spectrum of illnesses that mental health professionals, who are clinicians can help people to treat. Whereas coaching is about staying on the path, and helping you to just maximize your life, and maximize your time. That’s how I would see some of the differences.

 

Dr. Zender: Yeah, I think more and more as psychology has evolved into areas that we now call positive psychology, there may be even more overlap. But I think there certainly would be a lot of potential for coaches and psychotherapists to communicate, and probably, it could enrich both professions to do that.

 

Jen: Yeah. As you mentioned in a previous conversation, everyone on the planet could benefit from therapy and I think everyone on the planet could benefit from coaching as well and they definitely can work hand in hand.

 

Dr. Zender: I think we all need loving support from other people and often it’s hard to get that, especially when you’ve dedicated your life to helping other people and you’ve thrown yourself into years and years of training, study, and research. It’s really easy to just get cut off from the loving support that we all need and deserve.

 

Jen: Right. I think carving out the time to take care of yourself. As you said before, “You can’t fill someone else’s glass when your own glass is empty.” So, figuring out how to carve out the time to support yourself in the context of everything else you’re trying to do, I think can be very difficult. But having some trusted thinking partners to help you see different ways to do that can be transformational.

 

Dr. Zender: Yes. One of the problems that you mentioned about the time issue is that we start to look for quick and easy ways to destress and that can fall into some very unhealthy patterns with alcohol, or drugs, or eating disorders, and then sleep gets disturbed, and it’s a downward spiral from there. So, time management is a big issue and I imagine that’s something you talk about a lot.

 

Jen: Yeah, absolutely. In fact, our lead coach, Jill Farmer is really, nationally known as a time management expert. She has really some wonderful quick tips and tools that you can use to manage time that are extremely helpful. I think just understanding her perspective has certainly helped me tremendously and I think she’s helped thousands of other people.

 

Dr. Zender: It’s interesting how sometimes just a little change can make a big difference. Sometimes, just taking a little step can make a big difference. But when we get swamped with stress, we lose our way. Often, it takes someone to just give you a little push to take that step and then it can make all the difference. I was thinking that I’ve been strictly transitioned to telehealth and for probably, the first year, I had my windows covered, because I had this glare on my computer, and it made it hard for people to see me, and it was so depressing. My office was just like a tomb that I came to every day. And then I had the thought, “Why don’t I just switch my desk to where the couch was and then I can have the windows open, I won’t get that glare.” It made a huge difference. My whole outlook improved. So, yeah, it’s amazing how sometimes, we can’t see the forest for the trees and that’s where someone outside of us can be a great help.

 

Jen: Yeah, I love that example because you’re right. It can be something that’s so simple that can make such a huge difference in your life. And just having a partner to brainstorm solutions with can make such a difference, because somehow, I don’t know, it seems difficult to come up with the solutions yourself. But when you’re talking it through with someone or with a group of people, if you look just slightly in this other direction, you can see new solutions that you couldn’t see on your own.

 

Dr. Zender: There’s this great movie, I forget the name of it, but Catherine Zeta-Jones is in it. She plays this chef and she has anger management issues. So, she goes to a therapist and it ends up with her sister being killed in a car accident and her niece comes to live with her. She’s fixing all these fancy chef dishes for her to eat. She won’t eat anything. She’s talking to the therapist about it. She’s like, “Beside herself.” And the therapist says, “Fish sticks.” And she said, “What do you mean fish sticks?” He said, “Why don’t you give her fish sticks?” See if she likes those.” And she loved them. That made a huge difference. That’s the kind of thing where a therapist or coaches can offer something that is so simple, but yeah, it can make a big difference.

 

Jen: Fantastic. I love the examples, and I really would love to just keep talking with you all day, and we have barely scratched the surface. I hope you’ll come back and talk with me again.

 

Dr. Zender: I’d love to.

 

Jen: And Dr. Zender, before we go, please tell me how people can reach you, if they want to learn more about what you do, your work with motor vehicle accident survivors and recovery, as well as your physician burnout inventory, and trauma course.

 

Dr. Zender: Sure. I have a lot of information on my website, which is drjameszender.com. You can find the burnout inventory and information about the Trauma Toolkit Course there. And then I also blog for Psychology Today on a blog called The New Normal that addresses a lot of what we talked about today.

 

Jen: Thank you so much. That’s wonderful. I’m sure a lot of our listeners will be very interested in learning more. Thank you for joining me here today, Dr. James Zender, on DocWorking: The Whole Physician Podcast.

 

Dr. Zender: My pleasure.

 

[music]

 

Amanda: I’m Amanda Taran, producer of DocWorking: The Whole Physician Podcast. Thank you so much for listening. Please don’t forget to like and subscribe, and head over to docworking.com to see all we have to offer.

 

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