Biological Considerations of Burnout, Part 3
The understanding of the biological basis of burnout provided by the polyvagal informed paradigm can be applied towards implementing strategies to address this important issue.
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The previous articles in this series explored the importance of consideration of the polyvagal informed, biological understanding of burnout. With these factors in mind, the next step in this discussion is application of these elements in conjunction with polyvagal informed tools specifically towards burnout. It is important, once again, to emphasize that this discussion does not imply or place blame upon the individual, nor does it seek to exclude considerations of the social and/or cultural aspects of the healthcare system. As will, hopefully, become apparent within this discussion these important considerations are better explained and appreciated through the polyvagal informed exploration of the issue of burnout.
Applying the polyvagal informed paradigm within the management of burnout begins with the concept of acknowledging our biological state. In previous articles, this important aspect within the process of embodying a polyvagal informed perspective has been described. Michael Allison illustrates this concept of meeting the body where it is as a core tenet within his polyvagal informed paradigm. Through the explanation of this important principle, he describes that prior to implementing polyvagal informed skills and strategies, it is first necessary to utilize our awareness and attention to identify our current biological state and to do so without judgement, criticism, or blame. This is what he indicates through the principle of meeting the body where it is in conjunction with an acceptance of our current biological state. From this starting point, it then becomes possible to implement various polyvagal informed skills and strategies to shift our biological state as necessary.
This concept of acknowledging and accepting our biological state without judgement or criticism can, and should, be extended to include those around us and our surrounding environment and context. In essence this relates to the three pathways for cues and stimuli, specifically internal, external, and relational. By recognizing and accepting the current biological state and situation and doing so without criticism, blame, or judgement, we avoid providing additional potential cues of uncertainty, risk, or threat to our nervous system. The importance of this is readily apparent when we consider the previous discussion of biological state as an intervening variable. Specifically, whether the cues of uncertainty, risk, or threat emerge from our internal, external, or relational experiences, the result for our neuroception is similar, namely shifts towards sympathetic and dorsal vagal states.
Returning to the application of Michael Allison’s principle of meeting the body where it is, specifically within the larger context of burnout and its impact on healthcare professional in particular, it can be appreciated that this perspective avoids placing blame on the individual and includes consideration of the external factors impacting the situation. Not only does this perspective provide an important and foundational starting point in addressing the issue of burnout, it does so by considering all pertinent factors without providing additional cues of uncertainty, risk, and threat through placement of blame.
The polyvagal informed paradigm further provides an actionable framework through which skills and strategies which are both in alignment with our biology and consistent with it can be implemented. The previous article illustrated how symptoms of burnout are consistent with sympathetic states initially and progress to becoming consistent with dorsal vagal states. As has been described in past articles, once we have identified our biological state, we are able to implement appropriate polyvagal informed skills and strategies to shift our biological state. This strategy can equally be applied within the context of burnout.
At the individual level, by developing and embodying the polyvagal informed toolbox, we are able to increase the flexibility of our nervous system. This allows us to respond to various demands with less likelihood of shifting into sympathetic and dorsal vagal states. Inevitably, we will all experience biological state shifts on account of being human and, when this occurs, we are better equipped to identify and shift out of these states through advanced training in these skills and strategies. When considered from a larger perspective, the more individuals who are able to embody this paradigm, the greater number of people there will be who will be able to self-regulate and, importantly, within the setting of the healthcare system, be present to co-regulate others.
The discussion to this point leads to a recognition of the benefits of the polyvagal informed consideration of burnout at the individual level. It is now important to expand this understanding to the larger culture of the healthcare system. It is evident that changes are needed within the healthcare system as it pertains to its structure and culture. In order to have the desired impact, however, it is important that these changes are in alignment with our biology in order to be optimally beneficial and sustainable.
From my perspective, the polyvagal informed paradigm discussed in this article series is ideally suited to accomplish these two goals related to cultural change. As discussed above, by first empowering individuals to leverage their biology and increase their degree of nervous system flexibility and self-regulation, there will be more individuals present to co-regulate others. This will naturally lead to improvements in the culture of the healthcare system by virtue of progressively greater degrees of co-regulation amongst individuals within the system. This will also positively impact all those within the system, including co-workers and patients, as well as these individuals’ contacts outside of professional domains, such as family and friends.
Once a critical mass number of individuals within the system are embodying this philosophy, a natural cultural change will emerge. As the number of individuals within this framework increases, it will become unavoidable for the system and culture to evolve in support of this paradigm. This will lead to sustainable culture change on account of it being expressed and lived by those within the system, as opposed to imposed from above.
The culture which will emerge is one in which support will be provided to all individuals to promote the preferred biological states and to regain regulation when biological shifts inevitably occur towards sympathetic and dorsal vagal states. Without empowering individuals to leverage their biology it is unlikely that any degree of culture change would be sufficient or durable given the inherent high demand nature of the profession.
In order to develop a truly sustainable change in culture and one that is consistent with our biological needs as humans, the polyvagal informed perspective is essential. The understanding provided by this paradigm informs that more than removal of cues of uncertainty, risk, and threat is needed in order to truly and completely support our biological needs. Provision of cues of safety and connection are also essential if the culture is to provide sufficient support. This ideally occurs through the polyvagal informed paradigm outlined throughout this series.
It is hoped that this article mini-series will provide a more in-depth understanding of the importance and application of the biologically based framework provided by the polyvagal informed paradigm. This understanding provides greater compassion for the individuals within the system and, while it may consider the individual aspects, also informs as to why blame and fault should not be placed upon impacted healthcare professionals. This perspective also provides a greater understanding not only of the manner in which the system and culture contribute towards the issue, but how to bring about a shift and evolution within the healthcare system and its culture that will endure.
The polyvagal informed perspective provides for the development of mind-based and body-based skills and strategies within a robust toolbox that can be implemented to promote health, wellbeing, and sustainable high performance. This is the foundational framework of the Practices of the Healthcare Athlete. To learn more, including about polyvagal informed coaching for healthcare professionals, visit www.darindavidson.com.
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REFERENCES
Allison, M. The Play Zone: A Neurophysiological Approach to our Highest Performance. https://theplayzone.com.
Gervais, M; Carroll, P. Compete to Create: An Approach to Living and Leading Authentically. Audible Original; 2020.
Porges, SW. Polyvagal Safety: Attachment, Communication, Self-Regulation. New York: W.W. Norton & Company; 2021.
Porges SW, Porges S. Our Polyvagal World: How Safety and Trauma Change Us. New York: W.W. Norton & Company; 2023.