Veterinarians are experiencing a mental health crisis, with higher suicide risk, burnout and poorer well-being compared to other high-risk professions in the medical field. The mental health stigma in this field prevents treatment-seeking, resulting in an unexpected health disparity. Unfortunately, their stress has only compounded since the COVID-19 pandemic began.
The Robert Wood Johnson Foundation has selected two Kent State University College of Arts and Sciences faculty members, along with two community clinicians, for Clinical Scholars, an initiative that will provide funding and leadership training to the four team members. Their plan is to implement a project that will help veterinary professionals in Northeast Ohio address mental health stigmas they experience in their lives and provide usable techniques that can be incorporated into their veterinary practices. The three-year, $432,000 grant will support the team’s implementation of an Acceptance and Commitment Training (ACT)-based educational program tailored to reduce distress in the context of difficult client interactions.
The Project Team
The project is led by Mary Beth Spitznagel, Ph.D. and Alanna Updegraff, Ph.D., both clinical psychologists and associate professors in the Department of Psychological Sciences at Kent State.
The project partners include Meg Sislak, DVM, DAVCR, a veterinarian at MedVet Akron who has many local clinic connections and Lisa Wiborg, LISW-S, VSW, a veterinary social worker who co-owns a veterinary social work service, Healing Paws, LLC. Their advisory board consists of leaders in the field of veterinary social work and experts in burden transfer research and ACT interventions.
With specialized training in neuropsychology, Spitznagel began researching caregiver burden in family members of people with dementia, which is the primary population she serves in her clinical work through the Summa Center for Senior Health. After providing care for her dog with transitional cell carcinoma and cognitive dysfunction, she expanded her research to examine how caregiver burden affects pet owners, and transfers some of the burden to veterinarians.
“I think Mary Beth has been really cutting-edge in identifying this as an issue, naming it, measuring it, and figuring out what we can do about it,” Updegraff said.
Updegraff also serves as the Director of the Psychological Clinic at Kent State and will share her expertise in ACT delivery and development of interventions and training protocols for this project.
A New Approach is Needed
Many issues contribute to occupational stress for veterinarians including long hours, compassion fatigue, and moral stress surrounding euthanasia.
“Those issues have been separately considered and various interventions to reduce stress have been attempted without much success,” Spitznagel said.
Medicine is the main focus of training for veterinarians, but a large part of their job is the difficult daily interactions with pet owners who are in distress themselves due to a sick pet. Pet owners come into the clinic with their own burdens— like sadness, anger, indecisiveness, anxiety—so, these heightened emotions can have a cumulative effect on a veterinary professional’s own stress and burnout.
“There is growing awareness of the occupational stressors in the veterinary medicine environment, but the solutions offered aren’t evidence-based and tend to be somewhat generic, like ‘find work-life balance,’ or ‘be more mindful,” Spitznagel said. “Those are useful suggestions in their own rights, but our project aims to help people working in veterinary medicine identify ways to buffer themselves against “burden transfer” from these difficult interactions, and from resulting stress and burnout. That gives us an opportunity to help veterinary medicine in a preventive way that has not been done before. Our goal is to help them identify when these points of burden transfer are occurring and provide strategies to effectively deal with them and implement change.”
The team has already been looking at how daily interactions with pet owners impact veterinarian stress. They first ran focus groups to learn what pet owners do when they have a sick pet, when they're feeling stressed out, exhausted, financially strapped and frustrated. How do these pet owners behave? Those groups produced a long list of situations ranging from changing a pet's care plan without consulting the veterinarian to declining a recommended treatment or refusing to pay for services to blaming their veterinarian for poor outcomes, and more. They then asked over a thousand veterinarians nationwide to tell them how often they encountered these client interactions in recent weeks and to rate their own levels of stress and burnout.
“Those who experienced more situations of this nature reported higher stress and burnout, but that's not where the story ends because the veterinarians own reaction to these situations, meaning how bothered they felt by these interactions was more related to their overall stress and burnout than how often the situations occurred,” Spitznagel said. “That's great news. It gives us another angle from which to approach our problem. The veterinarians’ reactivity is more important than the frequency of these interactions, which makes it a modifiable risk factor for their distress. Initial data from our small-scale implementation suggests we can help them reduce their stress response to difficult client interactions through this ACT-based educational program.”
About the Acceptance and Commitment Training (ACTraining) Approach
“Acceptance and Commitment Training involves asking people to think about their values and what matters to them,” Updegraff explained. “The goal is not to change people’s thoughts or emotions but rather to help them distance themselves from some of the thoughts and emotions that they get hooked on that keep them from behaving in a way that is consistent with their values. When a value is unfulfilled or when they are not able to live out a value, the training helps the veterinarians and veterinary staff find another value that they can fulfill in that moment in that setting.”
Rather than try to fight against or try to get rid of their unhelpful thoughts, emotions, and urges they ask them to accept them and ‘let them be’.
“People don’t have to stop thinking or feeling things,” Updegraff said. “We help them figure out ways to get a little bit of space, to separate from their thoughts and emotions, and that then enables them to choose to behave in ways that are consistent with their values. When they do, their life is more fulfilling and meaningful, and even when those difficult emotions and stressors are still there, there is something to balance that out. Therapy using this focus has a lot of empirical research support in treating a lot of mental health conditions, including depression and anxiety, but more recently, workplace training using similar methods has been shown useful as well.”
The team will use strategies from ACTraining to focus specifically on the burden transfer that is happening in veterinary medicine.
“Our research has shown that burden transfer can affect anyone working in veterinary medicine, so we will work with not only veterinarians, but with veterinary nurses/technicians, veterinary assistants, managers, and customer service representatives,” Spitznagel said.
In addition to running the program in veterinary clinics throughout Northeast Ohio, the team will create a sustainable training module to train future allied mental health providers in the delivery of this educational program both locally through training at Kent State as well as veterinary social work programs to allow future veterinary social workers nationwide to implement the program on a larger scale.
COVID-19 Impact
The team hopes to be in the veterinary community very soon, but had to adapt their original program plan, which included a lot of face-to-face interaction, to include an online version that can be delivered remotely due to the COVID-19 pandemic.
“Veterinary providers are ‘essential personnel’ and have remained open throughout the pandemic,” Spitznagel said. “They dealt with the stressors everyone else faced but have worked throughout all of it. Unlike many other essential employees, they never really got the same recognition and appreciation—they have not been hailed as heroes like human medicine workers. Early in the pandemic, when everyone was afraid of this huge wave that was going to happen, veterinarians were actually asked to stop using the typical level of personal protective equipment (PPE) to save masks for human healthcare. So, veterinarians across the country and the world were being asked to ‘do that surgery that you normally do with a surgical mask…with a cloth mask instead’. So, I think they’ve had a rough go. The pandemic has been especially difficult for this field.”
Most veterinary hospitals have also moved to curbside service to reduce close contact between people -- usually, the animal is taken inside by an assistant, and the owner waits outside in the car until the veterinarian calls them. A necessary precaution these days, but it hampers a key element of establishing the veterinary-client-patient relationship—the ability to build rapport with the client.
“This means there is greater potential for mistrust, or misunderstandings,” Spitznagel said. “Particularly with heightened stress levels in the world in general right now, that can make veterinary jobs even more difficult.”
To learn more about becoming a participating veterinary clinic, please contact KSUpetsnvets@gmail.com.
About the Robert Wood Johnson Foundation’s Clinical Scholars Program
The Robert Wood Johnson Foundation’s programs connect changemakers across the country—from every profession and field—to learn from and work with one another in creating more just and thriving communities. The Clinical Scholars program is designed for teams of experienced health care providers from any discipline. In the program, fellows sharpen their leadership skills and collaborate on a project to address complex health problems, allowing them to gain new perspectives and expertise while extending their impact as professionals and as trusted community members.
“The leadership training will be an integral step in communicating with people in the field about the importance of bringing tailored strategies, including our program, to promote wellbeing in veterinary medicine,” Spitznagel said. “I think it’s a little bit of an insular community and so being the outsiders as psychologists, we say ‘Hi, we want to help’, but getting people in the field excited about what we are doing is something I think the leadership training can help with.
“It’s going to give us the skills to be really effective in creating change,” Updegraff added. “That’s part of what I’m really excited about.”
To learn more about Clinical Scholars and RWJF’s other leadership programs, and to meet other participants, visit www.clinical-scholars.org.
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Media Contacts:
Jim Maxwell, jmaxwel2@kent.edu, 330.672.8028
Mary Beth Spitznagel, Ph.D., mspitzna@kent.edu, 330.672.2399