Mindfulness-based approaches to reduce stress and burnout
Paul Mohapel, PhD
As the COVID-19 pandemic rages on, physicians are facing increasing risk of stress and burnout, including physical and emotional exhaustion, compassion fatigue that leads to depersonalization, and a loss of meaning and efficacy in their work.1
Mindfulness initially gained popularity as treatment for patients, but, more recently, it’s been shown to have numerous personal benefits for clinicians. Studies have shown that it reduces psychological distress and burnout, while increasing emotional stability, well-being, psychosocial orientation, and empathy among practising physicians.2
Mindfulness is a form of mental training that enables one to pay attention to aspects of one’s experience in a non-judgemental and nonreactive way. The goal is to maintain awareness in a way that generates a greater sense of emotional balance and well-being. Through mindfulness practice, unhelpful habitual thoughts and behaviours can be recognized, allowing for new and creative ways of responding. Top
One of the main contributors to stress is over-identifying with our strong, negative emotional states. Once strong emotions are triggered, we invariably engage in distorted thinking that manifests as “stories” we tell ourselves. If these stories are sufficiently repeated, they begin to be perceived as truth. The issue is not with the content of the stories, per se — sometimes they can be accurate and many other times they are distortions — but rather with the emotional attachments we form with them.
Mindfulness can be an effective way to break our emotional attachment to our stories. It can help us create a space between a strong emotion and our actions, allowing us to learn how to deal with negative and stressful experiences more calmly. The acronym RAIN, coined by mindfulness teacher Michele McDonald, is a technique that can help us deal more effectively with strong emotions when they seem to be too much to handle.
Here are the four steps in the process:
R — Recognize what is happening
A — Allow life to be just as it is
I — Investigate inner experience
N — Non-identification
How to use the RAIN method in a difficult time
When you feel a strong emotion, take a moment to recognize it. Gently turn toward what you’re experiencing in an open and non-judgemental way. Tune in to the direct experience of what is happening in your body and mind. Notice your emotions, thoughts, and sensations. It can be helpful to name these in your mind; for example, “I am feeling stressed” or “I am feeling overwhelmed.” This recognition of what you are feeling opens up inner space and brings you into full contact with yourself and the actuality of the present moment. Top
Allowing means letting the experience be what it is. It is the acknowledgement and acceptance of the reality of your present moment. Allowing doesn’t mean you have to like the situation. It means “softening” your mental resistance to what is currently happening. The reason this is so important is because we often have the unconscious impulse to push away, suppress, or ignore difficult emotions. This kind of inner struggle creates more suffering and tension. In this unconscious struggle, we tend to get “caught up” in our thoughts and emotions and are more likely to simply react. By “allowing,” we’re able to make a more conscious choice as to how we want to orient ourselves to the current experience.
Sometimes just recognition and acceptance of an emotion is enough. At other times, you may choose to proceed further by investigating the emotion to help resolve it. Investigation requires open mindedness and a state of curiosity. In this step, mentally ask such questions as “Why do I feel the way I do?” “What events happened ahead of the emotion that might have influenced it?” “What do I really need right now?” “What actions could I take to nurture and support myself (and/or others) in this difficult time?” These questions can help you form a wiser relationship with emotions and thoughts. They can also help you choose a better conscious response in the moment. Top
In the final step, RAIN requires simple acknowledgement that you are not your emotions or your thoughts. Non-identification is the ability to step out of and stand beside your emotions and thoughts and simply observe them for what they are rather than becoming entangled with them. It is a state of pure awareness that is always there under every thought, emotion, and perception. This can bring about a natural sense of freedom and ease, even in the midst of a challenging emotion. No matter how intense and painful the emotional storm, there is always a part of you that is still, silent, and untouched.
Use the RAIN method any time you are feeling stressed, overwhelmed, or triggered. It’s a powerful way to centre yourself in a challenging time and a powerful technique for breaking the downward spiral of intensifying emotions. Try practising it at least once a day. It only takes a few minutes and it can make a significant difference in breaking your attachment to unhelpful emotional stress and its accompanying distorted stories.
1.Patel RS, Bachu R, Adikey A, Malik M, Shah M. Factors related to physician burnout and its consequences: a review. Behav Sci 2018; 8(11):98.
2.Scheepers RA, Emke H, Epstein RM, Lombarts KMJMH. The impact of mindfulness-based interventions on doctors’ well-being and performance: a systematic review. Med Ed 2020;54:138-49. https://doi.org/10.1111/medu.14020
Paul Mohapel, MSc, PhD, owns Mohapel Consulting Ltd., and is a Faculty Member at Royal Roads University as well as President of Mohapel Mindful Leadership.
This article has been peer reviewed.