Healing the Healer: Helping Frontliners Get Back Online
I couldn’t believe it. The morning after I decided to write this blog, I received an email from one of my clients, an attending physician, stating he learned that a former resident died by suicide. He said he wasn’t sure what to think or how to feel. It was confirmation that this is an important topic that people may not know enough about.
Emergency physicians, like other first responders, are repeatedly exposed to traumatic events as part of their job. Shift work, poor sleep, inadequate staffing/support, and constant high stress situations contribute to developing symptoms of Post-Traumatic Stress Disorder (PTSD).
The physicians who come to work with me are seeking support because they are burned out, anxious, and sometimes apathetic or depressed. They don’t know why they can’t perform how they want to. They report they’ve started feeling cynical or negative toward their patients. They say they got into medicine to help people and are dismayed when they find themselves frustrated with the population they initially enjoyed helping.
They report they’ve tried “self-care,” like sitting on the couch and bingeing shows on their days off, in an effort to not feel so fatigued. They go on vacations but have sets of too many shifts before and after their time off. They rarely have consistent schedules, going from night to morning shifts with only one day in between, to prepare.
I’m sort of their last-ditch effort, sometimes -- the person they don’t really want to have to see.
They’re reluctant to seek treatment because they fear it will be used against them by their peers, licensing board, malpractice insurance, or life insurance down the road.
There’s a stigma that exists within this population that you “should” be able to handle the cases, that “you knew what you were getting into,” that you’re “weak” if you’re experiencing negative symptoms as a result of the job. So, few talk about it amongst themselves, or seek therapeutic support.
Startling statistics
A 2017 article in The Annals of Emergency Medicine reported that “the prevalence of PTSD is approximately two times greater in physicians, at 14.8%, than in the general population, with emergency medicine resident physicians’ incidence falling in the range of 11.9% to 21.5%.” (Vanyo, et al)
These stats were taken prior to the pandemic.
The story of a New York City physician, Dr. Lorna Breen, who died by suicide in 2020, several months into the pandemic, shone a light on this very real problem that existed prior to, and was likely exacerbated by, the pandemic (Moutier, et al). Dr. Breen, like many emergency physicians, didn’t know how to cope with the sheer amount of illness, death, and powerlessness that persisted during the pandemic. She was fearful of repercussions of seeking mental health treatment or taking time off to recover from the burn out experienced in the pandemic. Her family helped pass a law providing grants to make it easier for health professionals to access strategies to address burn out and mental health (Zarefky, 2022).
According to an article in The Annals of Emergency Medicine, emergency physicians experience rates of burnout higher than the general population, at 65% during a career, and ranging from 49% to 65% amongst emergency medicine resident physicians (Vanyo, et al).
Further, they noted that PTSD is associated with higher rates of suicide, a risk that prior to the pandemic was already at “concerning levels among the physician population, with male and female physicians at a 40% and 130% higher risk, respectively, than the general population.” (Vanyo, et al)
The people who tirelessly learn to override their fight or flight response to the point of running toward things the rest of us run from, are paying the price in depression, anxiety, panic attacks, irritability, nervous system activation, and relational problems.
One of my clients told me that self-care help suggested in the workplace “usually ends up with some silly ‘wellness’ recommendations, such as trying to maintain a balanced life, maybe doing some wellness modules. Never is it mentioned that seeing a therapist, or just reaching out for help, might be a good thing.”
The Benefits of Relational EMDR Therapy℠
In addition to the symptom relief that can come with improving self-care skills and habits, relational EMDR psychotherapy can be an effective way to treat the underlying symptoms of trauma, to heal on a deeper level—beyond symptom relief.
An article by Perri et al found that after seven (7) sessions of EMDR therapy with healthcare providers during the pandemic, “anxiety was reduced by 30% and traumatic and depressive symptoms by 55%,” and these results were sustained at a one month follow up (Perri, et al). In some instances, symptoms were further reduced by up to 11% at the one month follow up (Perri, et al).
This is a population for whom relational EMDR therapy can be invaluable or “career-extending,” as some first responders call it.
By helping emergency physicians reprocess challenging cases, things that they experienced during the pandemic or other difficult rotations or shifts, they can oftentimes resume patient care from the compassionate and caring place they initially got into this line of work to do. It can help them find their power in the sometimes powerless-feeling situations, events, or systems in which they work.
Why EMDR Therapy is a Powerful Tool for Healing Trauma
As a therapist, it’s an incredibly powerful experience to have a skeptical client say, “I don’t know how it [EMDR] works, but it does!” It’s important to celebrate the changes they notice--that the target we desensitized during EMDR therapy no longer bothers them, they aren’t triggered in the same way, and they don’t have the same level of anxiety about it that they previously had. We share moments of triumph, and build upon those, to increase resiliency and reduce symptoms of burn out.
It’s important we bring public awareness to the population of emergency physicians who both experience trauma daily and encounter barriers and stigma for seeking help. We count on these folks being there for us and our loved ones, in emergency situations.
We need to increase education and awareness, while also reducing barriers to care, to help emergency physicians perform optimally in stressful situations that are inherently part of the job.
The population of emergency residents and physicians is one that I greatly enjoy working with and would be happy to consult with you to share my experiences about the benefits of EMDR therapy; Megan Gittins, LPC, www.cohesive-counseling.com
Please note: The previous title of this blog, "Trauma is a Part of Life. But the Good News is We Can Heal," is an excerpt from the book, Every Memory Deserves Respect, by Deborah Korn and David Baldwin. We sincerely apologize for the error.
REFERENCES:
- Hooper JJ, Saulsman L, Hall T, Waters F. Addressing the psychological impact of COVID-19 on healthcare workers: learning from a systematic review of early interventions for frontline responders. BMJ Open. 2021 May 21;11(5):e044134. doi: 10.1136/bmjopen-2020-044134. PMID: 34020974; PMCID: PMC8142676.
- Moutier CY, Myers MF, Feist JB, Feist JC, Zisook S. Preventing Clinician Suicide: A Call to Action During the COVID-19 Pandemic and Beyond. Acad Med. 2021 May 1;96(5):624-628. doi: 10.1097/ACM.0000000000003972. PMID: 33570850.
- Perri RL, Castelli P, La Rosa C, Zucchi T, Onofri A. COVID-19, Isolation, Quarantine: On the Efficacy of Internet-Based Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive-Behavioral Therapy (CBT) for Ongoing Trauma. Brain Sciences. 2021; 11(5):579. https://doi.org/10.3390/brainsci11050579
- Tortes Saint-Jammes, Juliane, Sorel, Olivier, Zara-Jouillat, Eugénie, Martin, Charles-Henry, Gil-Jardiné, Cédric, Lavandier, Alix. Journal of EMDR Practice and Research Vol 16 Issue 3, May 2022, DOI: 10.1891/EMDR-2022-0006
- Vanyo, L, Sorge, R, Chen, A, Lakoff, D. Posttraumatic Stress Disorder in Emergency Medicine Residents. Ann Emerg Med. 2017;70:898-903. Doi: https://doi.org/10.1016/j.annemergmed.2017.07.010
- Zarefsky, M. (2022, March 10). Dr. Breen’s family on what new law bearing her name will do. https://www.ama-assn.org/practice-management/physician-health/dr-breen-…