January 02, 2019

Achieving Emotional Well-Being

Stress prevades the veterinary profession, but personal and profession-wide practices can change the dialogue for the better. 
By Amanda Carrozza
In recent years, the veterinary community has placed much-needed emphasis on the alarming rates of depression and suicidal thoughts that plague the profession. Results from the first mental health survey1 of US veterinarians, conducted in 2015, revealed that 24.5% of men and 36.7% of women in veterinary medicine have experienced depressive episodes since veterinary school. But identifying the problem is just part of the equation. Learning how to cope with professional stressors and creating a work environment that reflects the value of emotional wellbeing are necessary to ameliorate this increasingly concerning issue.

Some of the prevalent factors that lead to burnout and depression are shared among other professions, such as long work hours and too few vacation days. But as Jennifer Bradtke, PsyD, director of the counseling center at Ross University School of Veterinary Medicine in St. Kitts, West Indies, explained, there are mounting stressors that are very specific to the work veterinarians do, including self-imposed expectations and compassion fatigue. “Veterinarians are pretty type A and have a lot of perfectionistic tendencies, so just trying to meet the expectations they’ve set for themselves creates additional stress,” Dr. Bradtke said.

The biggest challenges facing veterinarians might be moral stressors. “Moral stress is when a veterinarian or other animal-related professional knows what the right thing to do is but can’t do it because of a factor outside of themselves, like when a client won’t euthanize an animal that is suffering,” said Elizabeth B. Strand, PhD, LCSW, founding director of veterinary social work at the University of Tennessee College of Veterinary Medicine in Knoxville. “Or a veterinarian is unable to care for a pet because a client cannot afford it, and the client takes his or her anger out on the veterinarian by saying, ‘You don’t care about animals,’ which could not be further from the truth.”

Moral stress, coupled with compassion fatigue that often results from being an emotional crutch for clients, can cause veterinarians to become overwhelmed or regret their decision to enter the profession.


IDENTIFYING SYMPTOMS OF STRESS
An optimal way to identify the onset of depression or burnout is to pay attention to personal changes. According to Dr. Bradtke, a veterinarian or veterinary student might notice changes in energy and emotions, increased irritability, or a sense of apathy or even cynicism.

Veterinarians may also experience emotional detachment from their work, which might spill over into their personal lives and manifest as isolation. “It might initially seem like a hesitancy toward getting involved in social activities, but then, little by little, it leads to more withdrawal as burnout, or perhaps even depression starts to set in,” Dr. Bradtke said. Physical symptoms such as headaches, body aches, and insomnia may arise, as well.

Because the signs vary in type and intensity—for example, anger could be a fleeting feeling or a specific reaction—veterinarians must be champions for their own mental health and admit when their emotional or mental well-being might be compromised. It is easier to intervene at the onset of symptoms rather than when they become severe, Dr. Bradtke said.


PERSONAL COPING MECHANISMS
Incorporating simple yet effective coping mechanisms into daily life can help alleviate stress and ward off burnout and compassion fatigue.

Self-Care
General self-care is a basic yet vital aspect of burnout prevention that is often cast aside when work schedules become cumbersome. Getting sufficient sleep, exercising, and eating well are the main components of a strong wellness routine. “I am also a big fan of meditation or just trying to practice mindfulness,” Dr. Bradtke said (Box).

Gratitude
Dr. Bradtke also suggests regularly practicing gratitude. “There is quite a bit of research on how gratitude can help combat depression, compassion fatigue, and job satisfaction in general,” she said. Keeping a gratitude journal can help strengthen the immune system, decrease blood pressure, increase optimism, boost resilience to trauma-induced stress, and reduce feelings of isolation, according to investigators.2

Redefining Success
Veterinarians must also take ownership of the unnecessary burdens they place on themselves—specifically, in managing expectations. “It really comes down to working to challenge some of your thoughts and redefining what success is,” Dr. Bradtke said. “One of the challenges people with perfectionistic tendencies face is that they set a goal, but once the goal is met, it’s not enough. That sense of satisfaction is never truly realized, and they’re consistently setting unrealistic expectations for themselves and perpetuating the belief that they are not doing enough.”

Me Time
Even when the demands of the profession tug in a million different directions, it’s vital that veterinarians carve out personal time. Long work hours coupled with an inability to turn off the day’s events can strain personal relationships outside the office. To combat this, Dr. Bradtke encourages her students, as well as experienced professionals, to make a concerted effort to spend time with family and friends doing activities unrelated to the profession. “I often hear of veterinarians using their vacations and free time to volunteer within the field, which is incredibly noble and necessary, but it doesn’t provide a break from workrelated stress,” she said.

Reconnecting
It’s also important to remember that the veterinary profession is worthwhile and rewarding. In fact, Dr. Strand spends a significant portion of her class time teaching the skills needed to reconnect with the passion that led to pursuing the profession in the first place. “Veterinarians deserve to be well,” she said. “There is no reason that becoming a veterinarian should be associated with anything but enjoyment of their work.”


PROMOTING WELLNESS THROUGHOUT THE PROFESSION
At the Collegiate Level
Drs. Strand and Bradtke are motivated by what they see happening within veterinary medicine programs. “I think most, if not all, veterinary colleges in the United States have a mental health professional who is dedicated to promoting the well-being of veterinary students,” Dr. Strand said. “And there is more and more education within veterinary medicine institutions about the importance of maintaining wellness.”

Still, more must be done to prepare novice veterinarians for unavoidable tribulations. “I think veterinary medicine programs should incorporate realistic expectations about what the work is really going to look like,” Dr. Bradtke said. “It might also be helpful to have faculty members talk about their own experiences and how they cope with stressors.”

Despite the progress made, Dr. Bradtke sees resistance toward changing the culture of perfectionism and really valuing work–life balance. “These programs are incredibly demanding, with a lot of information to learn in a very short period of time,” she said. “But perhaps there is a way to incorporate greater flexibility and encourage self-care within the programs.”

In the Workplace
People tend to emulate the behaviors of professionals they respect, so it’s important that experienced veterinarians and practice owners set the standard for selfcare within the workplace.

Veterinarians should share their own coping mechanisms for certain practice situations, according to Dr. Bradtke. “I am a huge proponent of sharing your struggle with others. You’re not alone in finding work difficult,” she said. “Creating a greater sense of community and destigmatizing help-seeking behaviors can be incredibly helpful in decreasing burnout.”

Not only should practice owners encourage staff to take advantage of vacation opportunities, they also need to take time off themselves. “New professionals often want to put their best foot forward, which may result in working longer hours,” Dr.  Bradtke said. “But it could be beneficial for an experienced veterinarian to say, ‘Why don’t you go home and enjoy your weekend?’”

It’s essential that veterinarians celebrate each other’s efforts toward wellness, Dr. Strand said: “When one of your colleagues says, ‘I am leaving at 5 today to go for a run,’ everyone around that colleague should say, ‘That’s awesome—do it!’”

Most important, Dr. Bradtke encourages veterinarians to speak up if they notice a colleague struggling. Just opening the dialogue could help change the work culture and that individual’s self-perception, leading to healthier decisions.

“Have the courage to stand up for your own wellness even if others are not celebrating it,” Dr. Strand advised. “You’re worth it.”


References
  1. Larkin M. Study: 1 in 6 veterinarians have considered suicide. American Veterinary Medical Association website. www.avma.org/News/JAVMANews/Pages/150401d.aspx. Published March 18, 2015. Accessed July 27, 2018.
  2. Emmons RA, McCullough ME. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol. 2003;84(2):377-389. doi: 10.1037/0022-3514.84.2.377.
  3. Guendelman S, Medeiros S, Rampes H. Mindfulness and emotion regulation: insights from neurobiological, psychological, and clinical studies. Front Psychol. 2017;8:220. doi: 10.3389/fpsyg.2017.00220.


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