The emergence of COVID-19 resulted in a sudden, unprecedented change in context that impacted the way behavior analysts live and work worldwide. Any rapidly shifting context requires behavioral flexibility, in addition to the acquisition of new skills and access to resources that foster resilience in the face of practical challenges and uncertainty about the future. Behavior analysts (particularly novice practitioners) may already be vulnerable to burnout (Plantiveau, Dounavi, & Virués-Ortega, 2018) and in need of greater support to adopt protective self-care practices. Such practices will enable them to continue providing effective services to distressed families, while navigating their own challenges. This article seeks to offer behavior analysts some tools and practices drawn from the work of contextual behavior scientists that can promote well-being and resilience. This includes strategies for clarifying and committing to an overarching value of self-care, acting congruently with personal and professional values across many domains of living, and practicing self-compassion in the process.
There is something in every one of you that waits and listens for the sound of the genuine in yourself. It is the only true guide you will ever have. And if you cannot hear it, you will all of your life spend your days on the ends of strings that somebody else pulls. (Thurman, 1980, pp. 2–3)
Whatever your journey to becoming a behavior analyst has been, it seems safe to assume that a value we share is to help others. The behavioral science community has a longstanding tradition of valuing behavior change of social significance (Baer, Wolf, & Risley, 1968). This often translates into reducing aversive conditions that contribute to suffering, and establishing conditions that result in contacting reinforcement of some kind. However, in the process of helping others, behavior analysts are at risk of experiencing burnout. Burnout is a well-known phenomenon among helping professionals and involves emotional exhaustion, depersonalization, and negative perceptions and evaluations of one’s accomplishments at work (Maslach, Jackson, & Leiter, 1996). In this article, we suggest that if we are to help and care for others, we must also prioritize taking care of ourselves. We contend that such self-care is particularly important in this time of global crisis, which has presented many challenges that increase our risk of burnout.
One predictor of burnout relevant to the present circumstances is feeling ineffective. Furthermore, levels of emotional exhaustion are compounded by an individual’s ability to cope in such circumstances (Bottoni et al., 2020; Griffith, Barbakou, & Hastings, 2014). Skaalvik and Skaalvik (2010) discussed core individual factors that advance feelings of burnout and noted that the belief that one cannot successfully accomplish a task and a lack of effective coping skills impact people the most. It is fair to say, in these current times, many of you reading this will be experiencing an increase in both these risk factors. Recent data already suggest that over 60% of early career Board Certified Behavior Analysts (BCBAs) are experiencing burnout (Plantiveau, Dounavi, & Virués-Ortega, 2018), and in particular, providers working with individuals with autism spectrum disorder (ASD) have high levels of emotional exhaustion (Bottoni et al., 2020). These findings are even more concerning given that newly certified BCBAs (i.e., certified for 5 years or less) amount to nearly 50% of the total BCBAs in the world, and approximately 88% of BCBAs serve ASD and related populations (Behavior Analyst Certification Board, n.d.).
The cost of burnout at both the individual and organizational levels is high; having preventative and remediation strategies in our repertoire is of utmost importance. BCBAs need more than technical skills to thrive and deliver optimal services, particularly in contexts, such as the COVID-19 pandemic, that affect all parts of society. As the number of new applied behavior analysis (ABA) practitioners continues to increase exponentially, concerns have already been raised regarding the almost sole focus of graduate programs and training sites on building technical skills (Leaf et al., 2016). Behavior-analytic practitioners have extremely limited exposure to training and education in “soft skills” that could buffer clinicians against the effects of burnout (e.g., perspective taking, compassion, active listening skills; LeBlanc et al., 2019).
As we will discuss throughout this article, we view self-care from several perspectives. Self-care can be seen as a value in and of itself: an overarching purpose for many acts that improve our health and well-being. However, self-care acts in our culture are often viewed only from this isolated perspective—exercising, eating well, and doing the small things that make us feel better. To truly engage in self-care, we must also consider how congruent our values are with our actions in all the other areas of our lives; a lack of congruence between personal and work values can be tied to burnout, while living according to one’s personal values has clear implications for well-being (Veage et al., 2014). Thus, self-care can also be seen as a repertoire of practices that includes values-directed action across many valued life domains. As we will discuss more extensively in the following sections, self-care also includes the practice of self-compassion. And so, self-care requires (a) clarifying and committing to an overarching value of self-care, (b) committing to act congruently with personal and professional values across many domains of living, and (c) practicing self-compassion in the process. These actions combined move us forward on a path of building resilience.
The field of behavior analysis still has room to grow regarding the attention paid and resources devoted to the individual well-being of our practitioners. Although we wait for others to conduct conceptual analyses and peer-reviewed studies on self-care within the field of ABA, we offer readers some strategies and resources derived from the huge body of literature already established outside the field of behavior analysis. Our main intention is to offer a few tools and practices that come from the work of contextual behavior scientists that we have used in our work, and in our own self-care, to answer questions like “What kind of behavior analyst do I want to be?” and “What is important to me in my life?” It is not exhaustive, but it is a start for all of us unfamiliar with these tools, as well as a gentle reminder to those of us who are familiar to take care of our own well-being. We will begin with an exploration of the components of self-care as described previously and examine how the current pandemic context has likely shifted our priorities and may present conflicts in terms of both personal/professional boundaries and ethical decision making. We close with a discussion of how values can transform the functions of aversive events. In addition, throughout this article you will find a series of invitations to start developing your own self-care practices and values-based actions to build resilience and self-compassion in the present. We hope these help you in some small way and that you return to them when needed.
We invite you to put this article down and take a few moments to reflect on this past week. See if you can bring to mind a moment where you “met your limits.” Perhaps it was with a client who is struggling, or a parent, or your child, or a staff member. See if you can notice some kind of difficulty that brought about an emotional challenge for you. As you think about that situation, what is it that your client, or parent, or child, or colleague was doing? What are three things about that situation that posed a personal obstacle for you? Perhaps you can notice what you were experiencing in that moment, what you were thinking, and what you were feeling. Take note of these things that were hard for you, and give yourself permission to not do anything with them yet. Just notice what showed up for you, and sit with it for a little while. You will want to come back to this experience later.
Self-Care, Self-Compassion, and Valuing
Living a life according to your values means, “. . . being in motion, using your feet . . . Values cannot be lived from a ‘still’ position. We are carried into and through our values with our actions.” (Walser, 2019, p. 35)
We have presented self-care as a value and also as a pattern of acting in congruence with values—but what do we mean by “values”? Values can be defined as freely chosen, verbally constructed, desired life consequences (Hayes, Strosahl, & Wilson, 1999). Put another way, values as verbal statements establish long-term, complex reinforcers for ongoing activities, much like motivating operations establish the value of stimuli as reinforcers in the moment. More simply, they are our chosen life directions, as opposed to the goals or benchmarks along the way. For example, we might value self-care and in the service of that value set goals related to establishing healthy routines, such as going to yoga class twice a week with a friend. The action of going to yoga with your friend is just one example of a response that falls within a broader functional self-care class of behaviors. The ongoing pattern of engaging in self-care actions represents valuing. Behavior analysts attending to their own well-being in all areas of life can be supported through the ongoing pursuit of clarifying their own values and identifying values-congruent actions. If we value our own well-being and self-care, this can only be made visible through the actions by which we choose to demonstrate our commitment.
The importance of valuing self-care has not changed in light of the COVID-19 pandemic, but the ways in which we engage with that value may need to change. The current crisis highlights our shared humanity; the suffering we are all experiencing reaches across borders to impact everyone in some way, in some form. The conditions that predict burnout—emotional exhaustion and feelings of ineffectiveness—show up in nearly every sphere we operate in. No matter your work or home situation, it is likely that few of us are feeling like we are doing a “good job” right now, either personally or professionally. In such situations, it is common to criticize ourselves, to tell ourselves that if only we tried harder, we would be able to do it all, more effectively—and we may compare ourselves to others who seem to be doing everything better than we are. However, in times such as these, it is not self-criticism, but self-compassion that will allow us to move forward more effectively.
We believe that the science and practice of behavior analysis itself are compassionate—from this perspective, all behavior makes sense given a person’s history and current context. We are no different from our clients (we are all subject to the same behavioral principles), and everyone can grow and change. All humans struggle. All humans experience vulnerability and pain. All humans make mistakes. We know as clinicians it can take time to change a behavior that has been practiced and reinforced for a very long time, and it takes time to learn new skills. As behavior analysts, we often ask clients (e.g., parents) to do things that feel difficult and uncomfortable (e.g., implementing an extinction procedure with their child), with the knowledge that these new ways of behaving will result in positive outcomes in the long run. It is important that as behavior analysts we recognize the discomfort that comes with doing something new (perhaps you even notice some discomfort reading this here now) and see it as a cue or information that tells us not that something is wrong but that growth and change are coming.
Although you may recognize and act on the importance of compassion for your clients, to apply compassion to yourself can be one of the most challenging skills to develop. For behavior analysts, who generally hold themselves to very high standards and often have established rules about not making mistakes or being vulnerable, it is probably even more difficult. Developing self-compassion will take time. It is hard to let go of what is familiar—if we are used to responding to ourselves in a harsh, punishing way, it will feel uncomfortable and difficult to respond in a kind, gentle, compassionate way.
Self-compassion consists of three main elements: kindness, common humanity, and mindfulness (Neff & Dahm, 2015). In other words, self-compassion allows us to relate to our own experiences, and those of others, with kindness, present-moment awareness, and openness to the inadequacies of the self through shared humanity (we are all imperfect; Neff & McGehee, 2010). In doing so, we move toward the development of flexible responses to life circumstances. Even small acts of self-compassion can have a significant impact on our ability to cope and adapt, as well as remain resilient through each challenge we are faced with.
We invite you to notice your responses to trying something new (e.g., attempting to teach a parent a new skill via videoconference). Notice your responses with curiosity, and try practicing self-compassion, even when it feels weird, uncomfortable, wrong, or difficult—be curious, and see what happens. Be gentle with the discomfort you are feeling, and keep going. And if your mind continues to respond in a harsh and punishing way, we invite you to say, “I know you are criticizing me because you are suffering.” Then see if you can be just a little kinder to yourself, like you would to a friend or child who was struggling. We invite you to continue reading this article holding yourself gently, with kindness, acknowledging that we are all on this journey together, and we are all doing the best we can.
Context Matters: Weathering Change
You can’t stop the waves, but you can learn how to surf. (Kabat-Zinn, 1994 p. 30)
No matter what role we play, a new context has been forced upon us. Such uncontrollable life happenings inevitably evoke aversive private events—difficult thoughts and feelings that we wish we could escape from. For example, each of us has experienced the anxiety, fear, frustration, and anger that accompany a loss of income, uncertainty about the future, valued medical treatments being deemed nonessential, disruption to family routines and custody arrangements, remote schooling, social isolation, contamination fears, and other difficult choices that have to be made. We can all agree that we do not want these problems, including the psychological distress that comes with them.
As we noted earlier, self-care also requires that we live congruently with our values across many domains. Work and education, leisure, personal growth and health, and our relationships with others are broad areas in which we all can identify ways of living that are important to us (see Fig. 1). Throughout our lives, what is of most importance, and what activities we prioritize, is continually changing in accordance with small and large shifts in our personal and professional contexts. There may be times where certain life domains take priority—when we have a child, or start a new business, or start a new relationship, priorities shift. More difficult life changes create a shift as well—the loss of a job, the end of a relationship, or the death of a loved one. Under typical conditions, although it may be necessary to spend some time clarifying our values, it is often not terribly difficult to identify what areas of life are most important to us or notice where we may wish to spend more of our energy. However, in this time of global crisis, we have experienced radical change. The broad importance of our values may not have changed, but the ways in which we engage with those values, and the priorities we place in different domains, likely have.
In an attempt to hold on to our old routines and habits, many of us will have rigid or inflexible reactions initially in resistance to the new context. This mismatch between our behavior and the change in contingencies can contribute to an increased risk of burnout. We are essentially scrambling to fit “square pegs into round holes” and wondering why we are not feeling any better. We can make sense of this in terms of the human tendency to avoid uncertainty, by sticking with what is familiar, even when that is not helpful. Ambiguity is often experienced by humans as aversive: Our history and evolutionary process have made it valuable to believe that “what’s bad is bad and what’s ambiguous is bad too” (Wilson & Dufrene, 2008, p. 10). Humans are sense makers and certainty seekers. We typically prefer aversives that are predictable and in our control over those that are unpredictable and uncontrollable, even when the controllable aversives result in worse outcomes for the organism (Abbot, 1985; Badia, Harsh, & Abbot, 1979). This may explain why it is so difficult for us to adapt to sudden, uncontrollable changes in circumstances, such as the many uncertainties and unpredictable forces at play during COVID-19.
The sudden change in our physical environment and living circumstances may present conflicts in other ways as well. For those of us working from home now, formerly clear boundaries between our lives at work and our lives at home have become blurred. Even if you normally worked from home, now perhaps your partner is also home, or your children, and it is not the same anymore. We see ourselves, our students, our clients, and our colleagues struggle to meet deadlines and make it to virtual meetings on time and to try to maintain productivity and look “professional.” In contrast, if you are working as an essential service provider, you likely find it hard to focus on home priorities and relationships in the same way you did before—you are carrying more stress and fear, and you may not even physically be staying in your home if you are trying to quarantine yourself from others in your family. There is always an interplay between the personal and the professional. Work is a part of life, and life contains multitudes.
We invite you over the next few days to observe yourself and those you are interacting with as whole people. Take a moment to appreciate that every person you encounter is also bringing the collision of his or her worlds to the table. When your student attends a virtual class with her baby on her lap, you might be reminded of the times you taught a class with your own baby on your lap. Cats run across keyboards, dogs snore, and children need stuff right now in the middle of trainings, and in the background, we hear the noise of someone cooking in the kitchen (or a cowbell; Batten, 2020). If we maintain rigid rules about “online etiquette” for classes and meetings or require the same levels of productivity from our clinicians and students as if they were working under ideal circumstances, we add to our own and everyone’s stress, and we may lose sight of our common humanity. Instead we invite you to be open, flexible, and compassionate with each other.
Values, Ethics, and Moral Decision Making
When we are no longer able to change a situation . . . we are challenged to change ourselves. (Frankl, 1959, p.135)
Another significant challenge during times of crisis is the possibility that certain values may seemingly come into conflict with moral and professional codes. Situations may present where we are asked to choose between personally and professionally held values. For example, initially it may feel like our value of helping others is in conflict with the value of health and safety. In fact, on closer examination, this apparent conflict can be resolved by rethinking how we engage in “helping behavior.” We might ask whether an outward action of helping in the community could be more harmful than helpful. Staying home, sheltering in place, or examining new ways of providing services remotely may be the best new way we can act toward our value of “helping others.”
Similarly, frontline workers in hospitals have been asked to make choices that place in conflict their value of “doing no harm” and deciding who gets to have a ventilator. As behavior analysts, we must also make decisions as we attempt to provide continued services to clients, while we personally adjust to adverse circumstances. If you provide behavior support in a residential care home or an in-patient hospital unit, you may find yourself having to make decisions about who continues to support clients in those settings and under what conditions. For example, you might find yourself asking which support staff may need to stay home and which can continue coming to work, or which clients can be safely discharged to their homes and which must stay on the unit. The internal struggle between your previous standard of care and what you are now able to provide may be compromised in the current context, leaving your moral code potentially fractured (Smith, 2020).
We invite you to offer acknowledgment to your own and others’ feelings of guilt and shame that commonly arise as a result of “moral injury”—these feelings are frequently experienced by those practicing in such challenging times (Nieuwsma et al., 2015). You might ask yourself, “Of all that I am carrying with me, what internal struggles could I put down?” We invite you to soften around those struggles, set them gently down, and stay open to your own and others’ suffering. We invite you to share the burden of moral decision making and have discussions around these topics with each other to promote greater flexibility and assurance within these shifting contexts.
Let’s Do This: Bring Your Values to Life
There’s more to the world than the hard things we sometimes find in it. (Wilson & Dufrene, 2008, p. 92)
Whether you are working from home, not working but at home, or doing a critical job outside your home, this is a moment for us all to reexamine and clarify our values. And this is a moment for us all to recognize that there is meaning to be found across many life domains. Perhaps when we show back up at work in the future, we can bring our whole selves with us, and we will have greater and deeper compassion for our colleagues, staff, and clients as whole people themselves.
Most of us devote far too much time to things that ultimately do not matter (e.g., what our hair looks like today) or that we do not have control over (e.g., worrying about the future). We have the choice in every moment to choose where we put our energy and attention—we get to choose what we want every moment to be about and how we want to live our lives, moment by moment. With our feet, we choose what we care about. This also means that we have the opportunity to bring ourselves back—to change direction in any moment, when we notice we have gotten off track. You might ask yourself, “What do I want this crisis to be about? Who do I want to be at this moment? What matters most to me?” The struggle we are all experiencing during the COVID-19 pandemic can be about fear and suffering, or it can be about something really important and meaningful to us, like resiliency, compassion, persistence, and love.
Transforming Adversity Through Valuing
If you can’t find a way to make peace with what you suffer, it will keep on taking your life away from you. (Jeffery, 2016)
By practicing openness with our experiences and focusing on values, we have the opportunity to transform the function of adversity from a context that is purely aversive to a context that offers opportunities to contact rich sources of reinforcement. When we “white-knuckle” through our experience, we are solely focused on bracing ourselves against the “threat”—we experience only suffering. When we mindfully choose to focus our attention on what we care about most, we open ourselves up to the possibility of contacting new sources of reinforcement that were not available to us before. The painful aspects of our experience do not disappear, but they are no longer the sole focus of our attention. For example, a behavior analyst might notice that moving services to her home allows her to work more directly with families and requires her to be more creative and flexible in terms of her work. In tracking these aspects of her experience (as opposed to struggling against the change), she remembers how much she values contact with families and the creativity and freedom that comes with clinical work. She notices how disconnected she had previously become from what is most rewarding to her about being a behavior analyst, and she decides she does not want to return to the rigid, legal mandates of school-system work.
We invite you to consider that perhaps the most radical act of self-care you can engage in is to allow yourself to be a whole person, living in alignment with your values in all that you do. We invite you to get really curious about what else might be possible for you and those around you. Look beyond the roles you have adopted, amid the reality of this pandemic, with all the thoughts, feelings, desires, and fears that come along with that. What if there were more possibilities and ways to act in accordance with your values than you have imagined? We invite you to look beyond what is, and what is familiar. Find something that surprises you, then move with intention. Choose with your feet and your heart, not with your head.
Summary and Well Wishes
Life is brief, even at its longest. Whatever you are going to do with your life, get at it . . . In all areas of the human existence, what we put into this world, we get back from it. (Rohn, 2019)
It is not an easy time that we are living through. As we come to the end of this article, take a moment to look up from the page. Let your eyes look around the room and rest on something or someone who brings you joy. Close your eyes and listen to the sounds around you. What do you hear? Take a deep breath in and inhale the fragrances around you. Perhaps you hear a plane overhead or your children laughing (or screaming), or you notice the smell of coffee brewing in your kitchen. Taking these small moments can be a source of reinforcement when schedules of reinforcement are thin. When we spend even just a few moments with what we value and take a break from our busy (often critical) minds, we offer ourselves a small act of self-care. Even in small amounts, acts of self-care contribute to our overall sense of well-being and resiliency over time. In this unprecedented time, every action of self-care you take is a commitment to yourself, a step honoring the person you want to be (for yourself and those around you). These behaviors are evidence of who we are, what we want our lives to be about, and how we choose to live in alignment with the values we hold deeply as a whole person—a behavior analyst, family member, community member, and global citizen.
The collaboration and shared writing process of this article have been, for each of us, an act of self-care in itself, to be able to offer something to a community that is precious, while we go forth and do what the current circumstances require and as we navigate the work ahead. We hope that this article and the tools within it help you in some way as you get reacquainted with what matters to you. Table 1 contains some additional tools we have compiled that might help you continue your journey of self-care and self-compassion. We all need reminders to attend to our own well-being while still meeting the needs of our clients and colleagues. During this time, there have been extraordinary examples of the care we have for each other. Just a few of these examples include sharing resources, webinars, and videoblogs to support fellow practitioners; inquiring about each other’s well-being; displaying gratitude; and countless other quiet acts of care, all while we navigate a new way of working and living. There have been many silver linings. Our fortitude as a whole behavior analysis community cannot be separated from our personal resilience.
Thank you for joining us on this journey. We wish you nourishment and vitality to flourish. Keep offering good to the world, and remember to be good to yourself. Be well. Keep going. No matter what.
A Final Invitation
We invite you to go back to the beginning and think again about the difficult situation that pushed you to your limit. Take a moment to really sit inside what was difficult for you about that situation. We know that there is a value at stake because it challenged you. We gently invite you to think about what this experience might have to teach you about what you care about. See if you can connect with what really matters in that moment—find the value hidden amid whatever you are struggling with. In this way, you might create an opportunity to transform that difficult experience, and the suffering that comes with it, into something more important that could nurture and guide you forward. You might then ask yourself, “What is the next right thing—the smallest, tiniest step that I could take that will move me toward the things I care most about?” Let your values guide your actions, taking strength from the small acts that bring you in contact with reinforcement and carry you forward.
Today and in the days ahead, you might gently notice your process of thinking and responses to certain situations. Make efforts to allow the struggle to ride with you, rather than drive you. This is not to say that you will not get off track. You will. Your mind is an expert in getting off track, but you can always find your way back. Give yourself the space and the compassion to embrace getting off track as part of the process. This is the opportunity to practice finding your way back. In those moments, hear the genuine in yourself, your whole self, and recognize your ability to pull your own strings to create a life that is deeply meaningful.
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Conflict of Interest
The authors declare they have no conflict of interest.
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Julia H. Fiebig, Ball State University; Evelyn R. Gould, Harvard Medical School; Siri Ming, Private Practice, Baltimore, Maryland; Rebecca A. Watson, Private Practice, Camden, Maine.
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Fiebig, J.H., Gould, E.R., Ming, S. et al. An Invitation to Act on the Value of Self-Care: Being a Whole Person in All That You Do. Behav Analysis Practice 13, 559–567 (2020). https://doi.org/10.1007/s40617-020-00442-x