Why Some People Get Burned Out and Others Don't

Kandi Wiens and Annie McKee
Harvard Business Review
Originally posted November 23, 2016

Here is an excerpt:

What You Can Do to Manage Stress and Avoid Burnout

People do all kinds of destructive things to deal with stress—they overeat, abuse drugs and alcohol, and push harder rather than slowing down. What we learned from our study of chief medical officers is that people can leverage their emotional intelligence to deal with stress and ward off burnout. You, too, might want to try the following:

Don’t be the source of your stress. Too many of us create our own stress, with its full bodily response, merely by thinking about or anticipating future episodes or encounters that might be stressful. People who have a high need to achieve or perfectionist tendencies may be more prone to creating their own stress. We learned from our study that leaders who are attuned to the pressures they put on themselves are better able to control their stress level. As one CMO described, “I’ve realized that much of my stress is self-inflicted from years of being hard on myself. Now that I know the problems it causes for me, I can talk myself out of the non-stop pressure.”

Recognize your limitations. Becoming more aware of your strengths and weaknesses will clue you in to where you need help. In our study, CMOs described the transition from a clinician to leadership role as being a major source of their stress. Those who recognized when the demands were outweighing their abilities, didn’t go it alone—they surrounded themselves with trusted advisors and asked for help.

The article is here.

Why are doctors plagued by depression and suicide?

By Judith Graham @judith_graham
STAT News
Originally published July 21, 2016

Here is an excerpt:

The starkest sign of the crisis gripping medicine is the number of physicians who commit suicide every year — 300 to 400, about the size of three average medical school classes. Male doctors are 1.4 times more likely to kill themselves than men in the general population; female physicians, 2.3 times more likely.

The grim tally is probably an under-count, since many suicides aren’t listed as such on death certificates. And it doesn’t include suicides among medical students, which aren’t tracked systematically in the United States.

In one study of six medical schools, nearly 1 in 4 students reported clinically significant symptoms of depression. Almost 7 percent said they had thought of ending their lives in the last two weeks.

The article is here.

Nurses Say Stress Interferes With Caring For Their Patients

By Alan Yu
NPR.org
Originally posted April 15, 2016

Here is an excerpt:

Almost 20 percent of newly registered nurses leave a hospital within the first year for the same job elsewhere, or a different job in a different organization, according to a 2014 study. Rushton says to her, that means health care organizations aren't investing enough in their nursing staff.

Nurse burnout also is linked to moral distress, Rushton says, from situations where nurses know what they should do for their patients but can't act on it. For example, nurses might have to give a patient at the end of life a treatment that causes suffering without any medical benefit. She just started a program called the Mindful Ethical Practice and Resilience Academy to try to help new nurses deal with moral distress.

It's a series of in-person workshops, some of which involve nurses using simulations to practice how to make their ethical concerns heard at work. One scenario includes a patient with a complex medical condition and a nurse has been caring for him and talking to him for days following the recommended treatment.

The article is here.

Note: There are several significant areas that apply to mental health professionals in terms of stress, moral distress, professional respect, and overwork.

The Effects of Social Context and Acute Stress on Decision Making Under Uncertainty

Oriel FeldmanHall, Candace M. Raio, J. T. Kubota, M. G. Seiler,  & E. A. Phelps
Psychological Science, November 5, 2015
doi: 10.1177/0956797615605807

Abstract

Uncertainty preferences are typically studied in neutral, nonsocial contexts. This approach, however, fails to capture the dynamic factors that influence choices under uncertainty in the real world. Our goal was twofold: to test whether uncertainty valuation is similar across social and nonsocial contexts, and to investigate the effects of acute stress on uncertainty preferences. Subjects completed matched gambling and trust games following either a control or a stress manipulation. Those who were not under stress exhibited no differences between the amount of money gambled and the amount of money entrusted to partners. In comparison, stressed subjects gambled more money but entrusted less money to partners. We further found that irrespective of stress, subjects were highly attuned to irrelevant feedback in the nonsocial, gambling context, believing that every loss led to a greater chance of winning (the gamblers’ fallacy). However, when deciding to trust a stranger, control subjects behaved rationally, treating each new interaction as independent. Stress compromised this adaptive behavior, increasing sensitivity to irrelevant social feedback.

The entire article is here.

How stress influences our morality

By Lucius Caviola & Nadira S. Faber
The Inquisitive Mind
Issues 23, 2014

Here is an excerpt:

Moral judgments seem to be affected by stress only when the situation elicits an emotional reaction strong enough to be impacted by the stress reactions such as trolley-like personal moral dilemmas. For example, Starcke, Polzer, Wolf, and Brand (2011) used everyday moral dilemmas that were less extreme compared to the trolley dilemma, for example, asking participants whether they would leave a message to the owner of a car that they had accidentally scratched. They did observe an association between people’s cortisol levels and egoistic judgments in those dilemmas considered to be most emotional. However, the researchers failed to find a significant difference in judgments between stressed and non-stressed participants, presumably because the moral vignettes used in this study did not elicit emotions that were strong enough to cause a difference compared to trolley-like personal moral dilemmas.

Nonetheless, many of us are confronted with highly emotional moral situations in real life in which our judgments could be influenced by stress. For example, people might be more prone to help a child beggar on the street if they feel stressed after an uncomfortable meeting at work. Even more worryingly, doctors who face life-and-death decisions might be influenced by the daily stress they experience.

The entire article is here.

Why Many Doctors Don't Follow 'Best Practices'

By Anders Kelto
NPR News - All Things Considered
Originally published April 22, 2015

Here is an excerpt:

Imagine, for example, that a healthy, 40-year-old woman walks into your office and asks about a mammogram.

"If that woman were to develop breast cancer or to have breast cancer, you can imagine what might happen to you if you didn't order the test," Wu says. "Maybe you'd get sued."

Doctors often hear stories like this, he says, and that can affect their judgment.

"Emotion and recent events do influence our decision-making," he says. "We are not absolutely rational, decision-making machines."

The entire article is here.

How stress influences our morality

By Lucius Caviola and Nadira Faulmüller

Academia.edu

Abstract

Several studies show that stress can influence moral judgment and behavior. In personal moral dilemmas—scenarios where someone has to be harmed by physical contact in order to save several others—participants under stress tend to make more deontological judgments than non-stressed participants, i.e. they agree less with harming someone for the greater good. Other studies demonstrate that stress can increase pro-social behavior for in-group members but decrease it for out-group members. The dual-process theory of moral judgment in combination with an evolutionary perspective on emotional reactions seems to explain these results: stress might inhibit controlled reasoning and trigger people’s automatic emotional intuitions. In other words, when it comes to morality, stress seems to make us prone to follow our gut reactions instead of our elaborate reasoning.

The entire paper is here.

Scientific faith: Belief in science increases in the face of stress and existential anxiety

Miguel Fariasa, Anna-Kaisa Newheiserb, Guy Kahanec, and Zoe de Toledo
Journal of Experimental Social Psychology
Volume 49, Issue 6, November 2013, Pages 1210–1213

Abstract

Growing evidence indicates that religious belief helps individuals to cope with stress and anxiety. But is this effect specific to supernatural beliefs, or is it a more general function of belief — including belief in science? We developed a measure of belief in science and conducted two experiments in which we manipulated stress and existential anxiety. In Experiment 1, we assessed rowers about to compete (high-stress condition) and rowers at a training session (low-stress condition). As predicted, rowers in the high-stress group reported greater belief in science. In Experiment 2, participants primed with mortality (vs. participants in a control condition) reported greater belief in science. In both experiments, belief in science was negatively correlated with religiosity. Thus, some secular individuals may use science as a form of “faith” that helps them to deal with stressful and anxiety-provoking situations.

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The suggested parallels between religious belief and belief in science may seem to be in tension with recent work emphasizing the intuitive character of religious belief. Tasks involving more analytic processing were shown to decrease religious belief (Gervais & Norenzayan, 2012), whereas the stimulation of a more intuitive mindset led to a greater belief in God (Shenhav, Rand, & Greene, 2012). Contrary to religion, scientific practice is defined by analytical thinking; rational enquiry and weighing of evidence are given precedence even when they conflict with intuition. But when it comes to believing, even if it is a belief in the scientific method as opposed to divine revelation, the underlying mechanism may be similar.

The entire article is here.

Stress undermines empathic abilities in men but increases them in women

By Sissa Medialab
Science Daily
Originally published March 17, 2014

Stressed males tend to become more self-centered and less able to distinguish their own emotions and intentions from those of other people.  For women the exact opposite is true.  Stress, this problem that haunts us every day, could be undermining not only our health but also our relationships with other people, especially for men. Stressed women, however, become more “prosocial,” according to new research.

The entire review is here.

The original article is:

L. Tomova, B. von Dawans, M. Heinrichs, G. Silani, C. Lamm. Is stress affecting our ability to tune into others? Evidence for gender differences in the effects of stress on self-other distinction. Psychoneuroendocrinology, 2014; 43: 95 DOI: 10.1016/j.psyneuen.2014.02.006

Editor's Note: These findings may have importance in terms of ethical decision-making while under duress.

Dark thoughts: why mental illness is on the rise in academia

By Claire Shaw and Lucy Ward
The Guardian
Originally published March 6, 2014

Mental health problems are on the rise among UK academics amid the pressures of greater job insecurity, constant demand for results and an increasingly marketised higher education system.

University counselling staff and workplace health experts have seen a steady increase in numbers seeking help for mental health problems over the past decade, with research indicating nearly half of academics show symptoms of psychological distress.

The entire story is here.

A Pilot Study Examining Moral Distress in Nurses Working in One United States Burn Center

By Jeanie Legget and others
Journal of Burn Care & Research:
September/October 2013 - Volume 34 - Issue 5 - p 521-528
doi: 10.1097/BCR.0b013e31828c7397

Moral distress is described as the painful feelings and psychological disequilibrium when a person believes she knows the morally right action to take and is unable to carry it out because of external or internal constraints. It has been studied in intensive care unit (ICU) nurses, but to the best of our knowledge not in burn ICU nurses. A pilot study was performed to gather initial data on moral distress among nurses treating burn victims. Findings from an intervention aimed at decreasing the level of moral distress in these nurses are reported. Nurses (n = 13) were recruited from one U.S. burn ICU and were randomized into two groups. A separate sample pretest post-test design was used. Group A completed the Moral Distress Scale-Revised (MDS-R) and Self-efficacy (SE) Scale before a 4-week educational intervention involving weekly 60-minute sessions, and Group B completed both scales afterward. Participants also completed written evaluations after each session. The MDS-R and SE Scale were readministered to both groups 6 weeks after the intervention was completed. Given the size and distribution of the sample, nonparametric data analyses were used. The MDS-R median score for Group B (92.0) was significantly different statistically from Group A (40.5) with P = .032 directly after the intervention was completed. No significant difference was found in the median SE scores between Group A (34.5) and Group B (34.0; P = .616). The median for Group B was 69 and Group A was 60.5 (P = .775). At the 6-week follow up, the difference between the two groups was no longer observed. Defining and discussing moral distress may have contributed to increased awareness and higher levels of moral distress in Group B directly postintervention. The changes in moral distress levels postintervention and at the 6-week follow up highlight the need to examine the intervention in a larger sample.

The entire article is here.

Can Emotional Intelligence Be Taught?

By Jennifer Kahn
The New York Times
Originally published September 15, 2013

Here is an excerpt:

For children, Brackett notes, school is an emotional caldron: a constant stream of academic and social challenges that can generate feelings ranging from loneliness to euphoria. Educators and parents have long assumed that a child’s ability to cope with such stresses is either innate — a matter of temperament — or else acquired “along the way,” in the rough and tumble of ordinary interaction. But in practice, Brackett says, many children never develop those crucial skills. “It’s like saying that a child doesn’t need to study English because she talks with her parents at home,” Brackett told me last spring. “Emotional skills are the same. A teacher might say, ‘Calm down!’ — but how exactly do you calm down when you’re feeling anxious? Where do you learn the skills to manage those feelings?”

A growing number of educators and psychologists now believe that the answer to that question is in school. George Lucas’s Edutopia foundation has lobbied for the teaching of social and emotional skills for the past decade; the State of Illinois passed a bill in 2003 making “social and emotional learning” a part of school curriculums. Thousands of schools now use one of the several dozen programs, including Brackett’s own, that have been approved as “evidence-based” by the Collaborative for Academic, Social and Emotional Learning, a Chicago-based nonprofit. All told, there are now tens of thousands of emotional-literacy programs running in cities nationwide.

The theory that kids need to learn to manage their emotions in order to reach their potential grew out of the research of a pair of psychology professors — John Mayer, at the University of New Hampshire, and Peter Salovey, at Yale.

The entire story is here.

Fewer Hours for Doctors-in-Training Leading To More Mistakes

By Alexandra Sifferlin
Time
Originally published March 26, 2013

Giving residents less time on duty and more time to sleep was supposed to lead to fewer medical errors. But the latest research shows that’s not the case. What’s going on?

Since 2011, new regulations restricting the number of continuous hours first-year residents spend on-call cut the time that trainees spend at the hospital during a typical duty session from 24 hours to 16 hours. Excessively long shifts, studies showed, were leading to fatigue and stress that hampered not just the learning process, but the care these doctors provided to patients.

And there were tragic examples of the high cost of this exhausting schedule. In 1984, 18-year old Libby Zion, who was admitted to a New York City hospital with a fever and convulsions, was treated by residents who ordered opiates and restraints when she became agitated and uncooperative. Busy overseeing other patients, the residents didn’t evaluate Zion again until hours later, by which time her fever has soared to 107 degrees and she went into cardiac arrest, and died. The case highlighted the enormous pressures on doctors-in-training, and the need for reform in the way residents were taught. In 1987, a New York state commission limited the number of hours that doctors could train in the hospital to 80 each week, which was less than the 100 hour a week shifts with 36 hour “call” times that were the norm at the time. In 2003, the Accreditation Council for Graduate Medical Education followed suit with rules for all programs that mandated that trainees could work no more than 24 consecutive hours.

The entire article is here.

Physician Suicide Linked to Work Stress

By Crystal Phend, Senior Staff Writer
MedPage Today
Originally published November 14, 2012

Suicide among physicians appears to follow a different profile than in the general population, with a greater role played by job stress and mental health problems, a national analysis showed.

Problems with work were three times more likely to have contributed to a physician's suicide than a nonphysician's, Katherine J. Gold, MD, MSW, of the University of Michigan in Ann Arbor, and colleagues found.

Their analysis of the National Violent Death Reporting System also showed that known mental illness prior to suicide was 34% more common among physicians than nonphysicians.

"The results of this study paint a picture of the typical physician suicide victim that is substantially different from that of the nonphysician suicide victim in several important ways," the group wrote online in General Hospital Psychiatry.

The entire story is here.

The original article is here.

Here is the conclusion from the abstract:

Mental illness is an important comorbidity for physicians who complete a suicide but postmortem toxicology data shows low rates of medication treatment. Inadequate treatment and increased problems related to job stress may be potentially modifiable risk factors to reduce suicidal death among physicians.

Psychologist's death blamed on sex case worries

BBC News
Originally published July 23, 2012

A clinical psychologist who blamed herself for a decision to release a known sex offender was "visibly upset" before her death, an inquest has heard.

Lisa Derriscott, 33, of Long Eaton, Derbyshire, was found dead in a burned out car near her home on 3 August 2011.

She worked on a Nottinghamshire mental health team that sanctioned the release of sex offender Shaun Tudor, 44, who went on to reoffend.

In a narrative verdict, the Derby coroner said she took her own life.

The entire story is here.

Thanks to Ken Pope for this information.

Stressed physicians reluctant to seek support

They cite lack of time and fear of hurting their careers as reasons to avoid employee-assistance programs.

By KEVIN B. O'REILLY, amednews staff

Nearly 80% of physicians at an academic medical center said they experienced a personal crisis within the past year, yet most said they would not seek support from physician-health services or employee-assistance programs.

The 108 surgeons, anesthesiologists and emergency physicians surveyed said they experienced a wide range of stressful events, such as serious illnesses or deaths in their families and severe adverse events in their patients. But most they said they were unlikely to turn to institutional sources of support, with 40% saying they would be willing to consult physician-health services and 29% open to using employee-assistance programs. About a third of the doctors had never even heard of these services, said an Archives of Surgery study published in March.

The reason offered most frequently for not getting help was lack of time, with 90% of the physicians surveyed at Brigham and Women’s Hospital in Boston citing it. About 70% feared a lack of confidentiality, negative impact on their careers or the stigma of mental illness. Nearly half feared legal consequences or thought “using services means I am weak.”

The entire story is here.

The original abstract is here.

Self-Care Practices and Perceived Stress Levels Among Psychology Graduate Students

By Shannon B. Myers , Alison C. Sweeney, Victoria Popick, Kimberly Wesley, Amanda Bordfeld, & Randy Fingerhut
Training and Education in Professional Psychology, Vol 6(1), February 2012, pp 55-66.

Stress has been defined as the perception that the demands of an external situation are beyond one's perceived ability to cope (Lazarus, 1966).

DeAngelis (2002) suggests that psychologists are particularly vulnerable to stress and that, while they promote self-care practice and stress management with clients, psychologists rarely heed their own advice.

Psychology graduate students are also vulnerable to stress because of the multiple demands of graduate school including academic coursework, research, clinical training, and financial constraints.

Stress related to performance anxiety, competition, institutional demands, lack of experience, and interpersonal/professional relationships has been noted in this population (Badali & Habra, 2003).

Furthermore, psychology graduate students represent a unique population who must navigate these stressors and their new roles, while simultaneously developing the knowledge and skills necessary to provide clinical and therapeutic services to others.

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Discussion

The current study suggests that self-care practices are related to perceived stress levels among psychology graduate students across the United States. There were also some differences based on demographic factors. Age, relationship status, and sufficiency of income to cost of living were significantly related to perceived stress levels. Psychology graduate students who indicated that their household income was insufficient compared with their cost of living perceived more stress, which is consistent with previous research suggesting a reciprocal relationship between perceived stress and financial satisfaction in adult students (Sandler, 2000). Married students also reported significantly less stress than their nonmarried counterparts. This pattern has emerged in previous research in which psychology graduate students who were not in a committed relationship reported the highest levels of stress (Hudson & O'Regan, 1994). Marriage can provide a strong source of relational support, which has been linked to lower levels of stress in students (Craddock, 1996). Finally, age significantly predicted perceived stress levels, in that the older students reported less perceived stress. Previous research has suggested that older individuals report fewer daily hassles than their younger counterparts possibly as a result of the development of alternative coping strategies (Folkman, Lazarus, Pimley, & Novacek, 1987). Older students may have developed more effective ways to cope with the competing demands of graduate school and therefore perceive less stress.

The entire article is here.

The author note provides the following contact information for reprint requests, questions, and comments: Shannon B. Myers, The Cancer Institute of New Jersey-UMDNJ, 195 Little Albany Avenue, New Brunswick, NJ 08901; Email: shmyers1@hotmail.com.

Thanks to Ken Pope for this information.

Dr. Fingerhut is a member of the Ethics Committee.

Student Voice: My Match Experience

By Jesse Matthews
PPA Member

Jesse Matthews

My graduate school philosophy has always been to take things one semester at a time.  I thought about the future, but usually in a “four more years until I graduate” kind of way.  I figured that if I concentrated on my courses, my work (always a full-time job and sometimes part-time jobs), and my family life, I wouldn’t get too overwhelmed and things would work out fine.  I attribute this approach to a lack of knowledge, but probably also to not wanting to know everything that was ahead. 

This approach served me well until around my fourth year when I was mid-way through practicum.  It probably was not until then that I began hearing about the internship crisis and just how many students were affected by it.  I convinced myself then that this only happened to “bottom of the barrel” students, i.e. those who didn’t have the best grades or who weren’t willing to work hard enough.  I continued focusing on my grades; getting my practicum hours; doing extra things like more research, volunteering, and getting more involved in professional organizations, and just getting through it one semester at a time, trying to set myself apart from the rest.

In 2010, when I was finishing my second year of practicum, I attended the annual Internship Workshop at the APA Convention in San Diego.   I can’t tell you I’ve ever seen so many anxious people in one place!  I had been part of the APAGS Convention Committee, so through my involvement with APA I became more aware of the internship crisis and the specifics of the issue. 

It was around this time that I became aware of my false beliefs about the Match, and learned that it could happen to anyone.  Certainly some students were likely to be at a disadvantage, but with the many confounding variables involved in the process, these were not the only factors at work.  This is when I began to feel really anxious, but I told myself that if I did all that I could do to have the best application possible, then that would be all that I could do, so I shouldn’t worry about things that are beyond my control.  I had a 4.0 GPA, a good number of practicum hours, I was on an APA committee, and I had a lot of other good experience under my belt.  Having a family and also working full-time to pay bills I felt I had a disadvantage, but I knew I had to just do the best I could.  And not only did I have less time available, but relocation was not an option for me.  I felt a lot of anxiety at this point, and as though there were so many things out of my control.  At this point, as I was writing and rewriting essays, studying for my comprehensive exams, and working on my dissertation, my goal became to “match, or else”.

Or else, what?  What would I do if I didn’t match?  What would that be like?

As I began my doctoral program, and even a few years in, I had no idea of what I would soon be facing.  Sure, I would finish- however things turned out, but I just didn’t see any other option but for it to work out the first time.  I had invested too much time and money and have made too many sacrifices to come this far and to have my career stalled.  I had a pretty good master’s level job with a nice schedule and was paying the bills, but I had been in school for over ten years and just wanted to get done.  I was tired.  I could have stayed at my job if needed, though I had no idea how I would begin to pay student loans during my extra, unplanned year off.

I had also been promising my wife for however many years that “I’ll be done soon”.  She’s not in psychology or a graduate program, so she probably only vaguely understood when I tried to explain it.  And I had to explain it many times- to my wife, other family members, friends, coworkers, and so on.

If I didn’t match I would have to continue to work for another year- more than that, actually, but I would reapply and hope it worked out the second time.  To be honest I really couldn’t stomach that option.  I also couldn’t bear the thought of graduation- and a better life for my family, being put on hold for some undefined period of time.

What if I didn’t match the second time around?

There was no way I could begin to think about that.  Despite my anxiety I was determined to apply to all of the local sites which would be a good fit, to do my homework on them, and to ace the interviews.  I literally lost a lot of sleep, but I followed every recommendation and piece of advice I was given, and though I continued to feel anxious, I tried my best to focus on my other responsibilities.  So around that time I passed my comps, applied to internships, and continued with my dissertation.  Though I had so much going on at once, it helped me to focus on one thing at a time, again not looking too far into the future.

I applied to 22 internship sites, including a number which were in my program’s consortium.  Luckily I live in the Philadelphia area and there are a lot of sites close by, though I heard it’s also a competitive area.  I applied to a range of sites- some I knew were competitive (relatively speaking, since they’re ALL competitive!), and others that I perceived as less so.

I waited until the notification date and then I began to hear about interviews.  My first response was a “yes” (interview), which was quickly followed by something like 15 “no’s”.  I was discouraged, but ended up being invited for seven interviews.  I can’t say this wasn’t a blow to my self-confidence though, as I didn’t get interviews at any APA-accredited sites.  I had a lot of negative self-talk at this time, but convinced myself that I was a good candidate and things would turn out just fine.  I knew this wouldn’t affect me too much for where I saw myself in the future- but since I always want to have options available, I saw it as limiting, and I was upset.  By interview time I was over it though, and again determined to do my best in the interviews.

I ended up going on six interviews, as one site called before my scheduled date to say that they would be closing and there would be no internship for that year.  I felt more badly for the employees losing their jobs, so I wasn’t too bothered by this- particularly since it would have been a distance for me to travel and it wasn’t my top choice at that point.

I had two weeks off from my job every year for winter break, so I did my best to schedule interviews during that time.  Inevitably, however, I had to take time off to attend interviews.  And although my employer knew what I was going through, I caught flack for taking that time off.  This, of course, was another source of stress that I didn’t need, but had to manage.

I went to all of my interviews, including three in one day, and tried to “knock ‘em dead”.  Afterward I went over each site with my wife, weighing the pros and cons, as well as my overall feeling about each, and then I did my rankings.  After that I waited until Match day, trying my best to focus on the other things I had going on at the time, such as my dissertation.  This was a period of about a month, and it was out of my hands at that point and I did all that I could do.  I refused to think that I might not match, while maintaining confidence that I had a lot to offer and that it had to have been noticed by someone.

The night before Match day I remember getting very little sleep.  It was like when I was a kid and we were going on vacation the next day- except much different.  It wasn’t a feeling of pure excitement, but more of uneasiness, as I hoped for the best but feared the worst.  Match day was either going to be a great day- the culmination (at that point) of a lot of time, effort, and sacrifice, and proof that I would in fact graduate on time- OR, it was going to be a terrible day, indicating that I had stalled in my quest to graduate and to have a career, and it was back to the drawing board for at least one more year.

I woke up and checked my e-mail and there was nothing there yet, though I didn’t expect anything to be there.  I think you were supposed to find out if you matched (and where) by 11am EST.  I had to be at work by 8:00, so I tried to keep to my regular routine as much as possible, got ready, and drove to work.  I had no smart phone yet, so I would have to wait until I got to work to check again.  So I got to work, powered up my computer, checked my e-mail- and there it was- an e-mail from APPIC with my Match status.  I opened it up and found that I had matched with my first choice internship site.

WWWHHHHHHHHOOOOOOOO!!! (the sound of relief and excitement at the same time)

I called my wife and told her about it.  Again, she was excited, but didn’t really get the whole gravity of the matter or understand just how much was on the line.  I updated my Facebook status, sat back and smiled, and then went to work.  It was a very good day.

I have been on internship since September 1^st of last year and am reaching the end of my graduate school career.  To be honest I feel somewhat traumatized from the whole Match experience, as well as slightly jaded about my decision to become a psychologist.  I do feel positive about my future, but the continued internship crisis is no doubt doing a significant amount of harm to the profession.

I felt for everyone applying for internship this year and going through the process.  I wouldn’t wish the anxiety I felt about the whole process on anyone, and as it is now, I would have chosen a different path if I could go back and do it again.  It would have been such a different experience if there were just enough internships to go around.  I might have been concerned about where I would go and all of that, but I would know that something would work and I would graduate on time.

It’s different for people of different experiences and at different points in life I’m sure, but as a husband and father to three young boys, struggling just to make it- and someone who has been in school for now 13 years, I am still so thankful that I matched.

You hear about the numbers each year, and I think most people recognize that this process is tough, but that honestly doesn’t even begin to describe it.  The anxiety and stress I felt at times was almost unbearable- to feel so little control over your future and what happens to you- and in some cases, your family.

Sure, we would have made it had I not matched, but I am really glad that I didn’t have to resort to a plan B.  It’s not fair for anyone to have to go through that, and clearly something needs to be done to resolve this internship crisis.  I have been fortunate to be a part of the APAGS Committee, and APAGS is very dedicated to bringing attention to the internship crisis and to working to find answers to alleviate it.

It is a very complicated issue as I have found, but most agree that the involved stakeholders need to take responsibility for their contribution to the issue, and become part of the solution instead of the problem.  Although I successfully made it through the whole process, I remain very committed to helping others to get through it, as well as to brightening the future of our field of psychology.

Risk and Reward Are Processed Differently in Decisions Made Under Stress

By Mara Mather and Nichole R. Lighthall

Current Directions in Psychological Science

February 2012, vol. 21, no. 1, pp 36-41.

Abstract

Years of research have shown that stress influences cognition. Most of this research has focused on how stress affects memory and the hippocampus. However, stress also affects other regions involved in cognitive and emotional processing, including the prefrontal cortex, striatum, and insula. New research examining the impact of stress on decision processes reveals two consistent findings. First, acute stress enhances selection of previously rewarding outcomes but impairs avoidance of previously negative outcomes, possibly due to stress-induced changes in dopamine in reward-processing brain regions. Second, stress amplifies gender differences in strategies used during risky decisions, as males take more risk and females take less risk under stress. These gender differences in behavior are associated with differences in activity in the insula and dorsal striatum, brain regions involved in computing risk and preparing to take action.

Beginning of the article:

The word stress describes experiences that are emotionally or physiologically challenging (McEwen, 2007). Stressful experiences elicit sympathetic-nervous-system responses and stimulate the release of stress hormones (e.g., cortisol in humans; Sapolsky, 2004) that mobilize the body's resources to respond to a challenge. The physiological effects of a stressful experience such as making a speech are evident not only during the event, but also in the next hour or so (Dickerson & Kemeny, 2004). When stressors are constantly present or anxiety about potential stressors is high, stress levels may become chronically elevated. Beyond the physiological effects of stress, a substantial literature indicates that both acute and chronic stress affect cognitive function.

Until recently, most studies examining stress and cognition have focused on stress effects on memory; effects on other aspects of cognition, including decision making, have received less attention. However, it is crucial to understand whether and how stress may alter decision making, as important decisions are often made under stress. For example, decisions about finances, health care, and social relationships are frequently accompanied by stress or cause stress. Early work on stress and decision making determined that stressors like time pressure and noise impaired decision making, resulting in decision making that is hurried, unsystematic, and lacking full consideration of options (Janis & Mann, 1977).

More recent work focuses on how stress influences how people respond to the risks and rewards of decisions. Acute stress potentiates dopaminergic reward pathways in the brain (Ungless, Argilli, & Bonci, 2010), which may intensify the allure of potential gains associated with decision options. The core brain-body feedback loops involved in the stress response also are involved in assessing risk and reward (Bechara & Damasio, 2005). As part of this brain-body feedback system, the insula helps represent somatic states and signals the probability of aversive outcomes during risky decisions (Clark et al., 2008). Both physical and psychological stress activate the insula, but differently for males and females (Naliboff et al., 2003; Wang et al., 2007).

In the following sections, we review recent evidence for two distinct effects of stress. First, stress enhances learning about positive choice outcomes and impairs learning about negative choice outcomes. This effect appears to be similar across gender and age groups. Second, stress affects decision strategies differently for males and females, with behavior diverging under stress when decision making involves immediate risk taking.

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The article and abstract are here.

This article is pertinent to ethical decision-making while experiencing stress and anxiety.

Special thanks to Ken Pope for this information.

Burnout, Dissatisfaction Seem Rampant Among Medical Residents

By Kathleen Doheny

HealthDay Reporter

Latest Mental Health News

MedicineNet.com

TUESDAY, Sept. 6 (HealthDay News) -- The medical resident of today -- possibly your doctor in the future -- is exhausted, emotionally spent and likely stressed out about debt, a new study indicates.

"About 50% of our trainees are burned out," said study leader Dr. Colin P. West, an associate professor of medicine and biostatistics at the Mayo Clinic in Rochester, Minn.

Higher levels of stress translated into lower scores on tests that gauge medical knowledge and more emotional detachment, among other fallout.

The study is published in the Sept. 7 issue of the Journal of the American Medical Association, a themed issue devoted to doctors' training.

West and his team evaluated results of surveys and exams given to nearly 17,000 internal medicine residents, who were said to represent about 75% of all U.S. internal medicine residents in the 2008-9 academic year. The participants included 7,743 graduates of U.S. medical schools. They were asked about quality of life, work-life balance, burnout and their educational debt.

Among the findings:

• Nearly 15% said their overall quality of life was "somewhat bad" or "as bad as it can be."
• One-third said they were somewhat or very dissatisfied with work-life balance.
• Forty-six percent said they were feeling emotionally exhausted at least once a week.
• Nearly 29% said they felt detached or unable to feel emotion at least once a week.
• More than half said they had at least one symptom of burnout.

 The more educational debt the residents had incurred, the greater their emotional distress, the researchers found. Those with more than $200,000 of debt had a 59% higher chance of reporting emotional exhaustion, 72% greater likelihood of suffering burnout, and an 80% higher chance of feeling depersonalization.

Perhaps more alarming is the finding that greater stress was associated with lower test scores, and those students who were academically hurt by stress never caught up with their peers.

West said he can't explain why those more laden with debt are more stressed out. One possibility is that they may be more prone to stress to begin with.

Medical residents' stress has made news for years, and efforts are under way to improve their working conditions. However, West said, "to our knowledge, this is the first national study of residents' distress issues. And it's also the first national study to connect those issues to other important outcomes like medical knowledge."

As for solutions, he said "we have not yet identified the best ways to reduce burnout and promote well-being for residents, or for physicians in general."

He hopes that this new data, now gathered nationally, will help lead to solutions.

The findings come as no surprise to Dr. Peter Cronholm, an assistant professor of family medicine and community health and also a senior fellow at the Center for Public Health Initiatives of the University of Pennsylvania.

Cronholm, who published a study on resident burnout in 2008, said the residents of today may put more emphasis on work-life balance than previous generations.

One disturbing finding, he said, is that a stressed-out resident has less empathy over time. Already, close to one-third said they felt detached emotionally at least weekly.

However, he said, it's difficult to balance obligations to patients and get sufficient sleep and personal time. "Those two things sort of continue to compete with each other," he said.

Solutions aren't available yet, as "the problem is not yet totally understood. This is part of the conversation about health care reform," he said.