|Home | About | Journals | Submit | Contact Us | Français|
Euthanasia-related stress is a workplace hazard for animal shelter workers. A simple but powerful stress reduction technique is outlined and results from a small demonstration sample of 5 animal shelter workers are discussed. Based on the literature and these preliminary findings, some conclusions are presented for implementing the technique.
Animal shelter workers who conduct euthanasia are under a particular and increasing type of stress that may lead to significant health problems (1) and high job turnover (2). Indeed, a recent study reported higher suicide rates among Australian veterinarians than amongst the general population (3). Furthermore, high stress in those carrying out euthanasia may have detrimental effects on the animal’s welfare. It is imperative, therefore, that stress management be considered. Traditional stress management programs, however, are cost- and time-intensive. Expressive writing is a stress management technique that appears particularly well-suited to employees who have euthanasia responsibilities. Illustrative case study data are presented from 5 shelter workers and veterinarians who have used this technique.
Since 1986, over 200 articles have been published on expressive writing (4). The essence of the technique is that participants spend a period of time (usually between 10 to 20 min) writing about a stressful topic. This is repeated over a number of days. While researchers were initially skeptical, work has repeatedly shown that expressive writing has strong effects including improvement in physical health symptoms (5), reduction in visits to a doctor (6), and increased immune functioning (7). Expressive writing also helps students to get better grades (8) and the unemployed to get jobs more quickly (9). Indeed, 2 meta-analyses have shown that disclosure has a significant effect on health outcomes (10,11) regardless of the age, ethnicity, or education level of the participants.
Expressive writing aids in a cathartic “release” and a relaxation of the inhibiting processes (6). More importantly, it helps people to change the way they think about the traumatic event and to develop confidence from gaining control over their emotions (12). When people see that they are able to control their emotions through expressive writing, they become more confident in actually dealing with stressors (12). Finally, depth of analysis and positivity developed through the writing is linked to better outcomes (13).
Guiding participants of expressive writing towards greater cognitive processing and greater positivity, therefore, would appear to be a powerful tool in alleviating stress. Expressive writing, unlike traditional stress management training, can be successfully implemented at low cost using minimal materials, without an external consultant (14). Moreover, this technique takes significantly less time for participants than traditional stress management (15 to 20 min per session compared with 1 or 2 h per session).
Interestingly, one study (15) found that just two, 2-minute sessions of writing were enough to affect physical health symptoms 4 to 6 wk after the sessions. However, it is likely that this is a minimum condition that will provide some, but not the greatest possible effect. A meta-analysis (11) found that the effects were greatest when the expressive writing was conducted over at least 3 sessions and that the period of writing lasted at least 15 min. The length of each session and the number of sessions undertaken, therefore, could be determined by the workers themselves with potentially greater benefits ensuing from longer and more frequent sessions. Finally, including information on dysfunctional thinking patterns and positive self-leadership may help participants to gain insight and a positive orientation.
The shelter director at a mid-sized shelter in western Canada was approached in January 2009 to test the effectiveness of expressive writing. In this shelter, euthanasia of animals is a daily occurrence, mostly for health and behavior reasons. The director asked employees to volunteer, and 5 workers participated in the trial and agreed to be interviewed afterwards. Given the richness of the data and convergence of thematic information, additional data were not collected. All participants were provided with a template diary with instructions to write about their feelings on euthanasia or related areas of work every 3 days for 2 weeks. Participants were asked to write for at least 15 minutes in each session and were informed that nobody would read their journal unless they agreed to share it. All participants were then interviewed by the researchers about the effects of the diaries and the diaries’ feasibility for animal shelter workers. At this point, the researchers also asked if the participants would share parts of their journal with them for evaluation and publication purposes.
Participant 1 reported that writing helped her remember and better understand why euthanasia occurs: “I found that I started writing about the basis on how we decide when to euthanize an animal and saw the ethics in it…I found that writing out all the reasons helped it (euthanasia) go over better sometimes.” She further suggested it was particularly suited for new employees who are struggling to understand the ethics behind euthanasia. “It may be useful for new staff when they are first getting used to seeing it…they might be worried about the reasoning behind it. There is a lot of curiosity as to why an animal is being put down.”
Participant 1 is an example of the cognitive reevaluation that writing can induce. “It helped me dissect it more in my head. After euthanizing an animal I usually take a break, have a cigarette and think about it. I found that I was thinking about it in ways that were different from my break.” By writing about stressful events, she was able to break them down, see why they affected her, and put them to rest. “During the time that I was writing [about] it, I was emotional. Afterwards there was less of an effect.”
Participant 2 is a euthanasia trainer for the shelter and was involved in euthanasia quite often (“up to 2 or 3 times a week”). Due to her unique position, participant 2 often saw the intense reactions of new employees to the euthanasia process. “It’s very hard to watch people break down. It’s sad and it’s hard…It was harder to watch the people and their emotions [than the animal being euthanized].” She found the diary writing useful because she could categorize and differentiate her own and others’ feelings. “It helped me sort through the feelings I got off of others versus my own. I could separate myself from what new employees were feeling and myself.”
Participant 2 carried these feelings with her throughout the day until she could separate them on paper in her diary. “Being able to differentiate between what other people were feeling and coming up with some coping mechanisms for them and for me.” She found a sense of relief when she finally wrote what she was feeling. “When I look back it’s the clarity of my emotions and getting it off my chest [that helped]. Putting stuff down on paper gets it off my mind.”
Participant 2 suggests expressive writing for all her animal shelter colleagues. “The whole shelter environment is generally a high stress environment.” Euthanasia can indirectly affect many shelter employees. “Euthanasia and cremation happens on people’s good and bad days…there are not a lot of really happy bubbly days.”
Participant 3 had a very different experience from all the other participants in this study. She found that writing about her feelings was quite bothersome. “But I don’t have time to just sit and write about my day. I don’t keep a journal. It was quite unnatural to do.” Interestingly, she felt that the writing had some negative effects on her euthanasia-related stress: “I found some entries got me more upset about certain cases of euthanasia. I would rather just focus on the happy side. So mixed feelings about it.” The writing process engendered more thought about the euthanasia process, “It made me more reflective about each case, or each animal, that we have to euthanize,” but this had a negative effect for her, “It made me take longer in terms of making the euthanasia decisions and sometimes even more indecisive.”
It is likely that individual differences moderate the effectiveness of expressive writing. As she reflects, “I think it really depends on the individual…I just feel I’m not a journal writer. I just don’t enjoy the daily reflection in a journal. I think a lot of people might though.”
Participant 4 had a very positive experience for both cognitive and affective reasons (similar to participants 1 and 2): “I have kept diaries and journals before and I think they are good ways to organize your thoughts. Once you get your thoughts down on paper you can make connections you didn’t see before.” She found that writing was better than talking for her. “I’m not the best communicator, so I found it helpful.”
However, she found the forced writing times to be a bit of a constraint. Participant 4 would rather have written at her convenience or when she felt it was necessary. “One thing that doesn’t work is saying you have to write in it today. You should write when you have something to write.”
Participant 4 found that one benefit of the diary writing process was coming to an understanding of the motives and emotions of others. “I find that in my particular place of work, there is really bad communication. By writing stuff down it helps you see other peoples’ side of things.” The writing process therefore may potentially aid in conflict resolution at work, thus reducing a variety of stressors, not just those related to euthanasia.
Participant 4 also suggested that diary writing may not be as effective for all people. “It has to be a personal thing you want to do. Some people do better by talking to people, others by writing stuff down.”
Participant 5 found the writing effective for a reason not explicitly cited by others: reducing the stress levels of her family. “It was a good way to vent without having to get someone else involved. I didn’t have to get family involved.” Often, open communication with another person as a form of coping has positive effects for the speaker, but negative effects for the listener. “I guess I sort of have a tendency to vent to my husband, so maybe it helped his stress.”
Like others, she reflected more deeply due to the writing process; this can be seen by a diary excerpt:
“We are in a downturn at this point — Cat Adoptions is just about empty so if anything is at all suitable it has a chance now. Unfortunately, that means lots of cats that are really unsuitable are being held hoping they will still go up. It’s harder making a euthanasia decision when space isn’t a factor. Still, there are going to be plenty of cats and if we clog up adoptions with cats that either aren’t going to get adopted or will cause problems if they go out we aren’t doing anybody any favors.”
Participant 5 would suggest expressive writing to others dealing with any type of stress. “I would suggest it as an option, especially if they don’t have somebody else to talk to.” This suggestion came with the now common caveat, “but it depends on your personality…some people will find that thing very useful.”
The purpose of this paper was to introduce a powerful, yet easily implemented, stress reduction strategy to the animal welfare community. To better position the technique within this community, we examined the experiences of a small group of shelter employees. While we cannot draw solid conclusions from this small sample, participants had a generally positive evaluation of the writing process, save one. Most of the benefits cited from the writing process involved making connections about feelings that were not obvious before. Others cited the ability to make sense of their feelings due to the journal.
Our key recommendations are:
Overall, given the unfortunate necessity of euthanasia and the concomitant stress of the animal shelter workers who must perform those acts, the availability of a simple and cost-effective stress management tool like expressive writing is likely to be highly beneficial to the sheltering and animal welfare community.
Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ( gro.vmca-amvc@nothguorbh) for additional copies or permission to use this material elsewhere.