Pandemic Burnout in Healthcare Workers: Three Ways Mindfulness Can Help

Even in the absence of a pandemic, frontline healthcare workers often find themselves having to cope with challenges such as compassion fatigue, over-working and understaffing. However, add to this the risk of contamination by Covid-19, disruption of normal supportive infrastructure, increased job retention issues, and perhaps feeling used or misused as part of government PR campaigns, then it’s easy to see why some frontline healthcare workers might be struggling to cope.

A further mental health issue caused by the Covid-19 pandemic is moral injury, which refers to the psychological impact of a frontline healthcare worker being caused to violate their moral or ethical code. This could be due to actions, inactions, feeling helpless, let down or betrayed by leaders, and concerns that work may be putting the health of family members at risk.

Failing to recognise burnout and failing to provide appropriate psychological support for this key worker group could significantly undermine the capacity for the NHS to function effectively during the pandemic.

What is Pandemic Burnout?

Pandemic burnout occurs as a result of chronic job stress due to the pandemic and is characterised by symptoms of physical and emotional exhaustion, negative attitudes toward work, and impaired professional efficacy. More specifically, some of the tell-tale signs that a frontline healthcare worker might be experiencing pandemic burnout are low energy levels, reduced ability to concentrate, insomnia, feeling anxious, low mood, becoming dispassionate, gastrointestinal pain, irritability, becoming cynical and pessimistic, absenteeism, reduced work productivity, and generally feeling detached from work.

In a paper I wrote on pandemic burnout that was recently published in the British Journal of General Practice, I summarised some of the evidence relating to burnout and mental health problems in frontline healthcare workers. For example, a survey of the UK healthcare workforce reported that one in two workers felt their psychological health had declined during the pandemic, and approximately one in five reported they were more likely to leave the sector as a result. In another survey of over 6,000 UK doctors, 44% reported experiencing mental health issues such as burnout, anxiety, depression and stress as a result of their work. This is in line with a survey in China in which rates of 44-50% were reported for healthcare workers experiencing symptoms of depression or anxiety during the pandemic.

How Mindfulness Can Help

During the last 40 years, a significant body of evidence has emerged showing that secular mindfulness interventions can help cultivate resiliency and recovery from mental illness in a range of populations, including frontline healthcare workers. More specifically, the evidence points toward improvements in burnout symptoms, stress, anxiety, depression, emotion regulation, job and life satisfaction, and patient-centred care. Mindfulness has also been shown to help foster acceptance and enhance immune system functioning via reductions in blood cortisol levels and inflammation response.

There also exists preliminary evidence indicating a role for mindfulness specifically in the context of helping individuals cope with the mental health challenges associated with the Covid-19 pandemic.

For example, a survey in Italy reported a relationship between higher levels of dispositional mindfulness and reduced pandemic-related psychological distress.This is in line with a study conducted during the outbreak in Wuhan (China), where residents who received a 10-day mindfulness intervention showed significant improvements in daily anxiety and sleep duration compared to residents who were allocated to a mind wandering control group.

Similarly, in a study of Italian female teachers impacted by the pandemic, attendance at an eight-week mindfulness course resulted in significant improvements in levels of anxiety, depression, affective empathy, emotional exhaustion, psychological well-being, interoceptive awareness and mindfulness.

Mindfulness involves using an attentional anchor, such as awareness of breathing in and out, in order to ground oneself in the present moment. In the specific context of regulating pandemic-related burnout, the following outlines three key ways that mindfulness can help:

• Frequent recuperation: Regularly taking time throughout the day to stop, consciously breathe in and out, and become aware of one’s body and mind is a way of cultivating calm and re-centring oneself. This is a useful technique for attending to and releasing bodily and psychological stress before it has a chance to accumulate
• Objectification: Relating to thoughts, feelings and situations as observable phenomena helps to create ‘perceptual space’, which reduces the likelihood of losing perspective or of holding onto situations too tightly. Without exception, all things are born, live and die – including the pandemic. Forgetting this tends to cause people to catastrophise and become overwhelmed by situations, which wastes time and emotional energy
• Acceptance: Accepting the present moment makes it easier to adjust to the situation that is unfolding now. A better future – including a way out of the pandemic – can only be created by working with what is happening here and now. It’s also important to accept and be comfortable with uncertainty. Situations such as the current pandemic serve as an abrupt reminder as to the uncertain nature of life, but the truth is that uncertainty is a characteristic of our existence and is one of few things that we can always be certain of