How mental training can help you to personal bests

Abstract:

Winning in a sport may rely more on an individual’s ability to withstand the psychological pressures of competing than on their strength and physical talents. Psychological skills successful athletes tend to share include the ability to replace negative thoughts with positive ones and to learn from mistakes.

Full Text:

What’s the winning edge in the 1990s? Surprisingly, it may have less to do with strength and talent and more to do with what sports psychologist James Loehr calls “mental toughness“–the ability to handle (and even enjoy the psychological pressures of a competitive situation.

Many of today’s top athletes work with sports psychologists who help them train for a new kind of “inner game.” Loehr worked with speed skater Dan Jansen before the 1992 Olympics in which Jansen finally won a gold medal (after falling during two previous Olympic Games).

All athletes are different. But sports psychologists say most successful athletes share these skills:

  • They combat negative thoughts–and can even change the way they are feeling. “Tough competitors,” writes James Loehr in his book The New Toughness Training for Sports, “consistently use images of success, of fighting back, of having fun, of staying relaxed, of being strong in the face of adversity, to move their chemistry in those directions.” Loehr says all of us should practice daily to make our self-image “strong, vivid, and courageous.”sports psychologist 1
  • They know how to “see” themselves succeeding. Through techniques of “visualization” and “mental rehearsal,” (sounds made from musical instruments play a very important role in relaxation of brain and release stresses, especially music played by the best acoustic guitar, violin or other string-family instruments) many athletes go through the exact motions of a competition in their head: mentally practicing each move, noting their feelings, even the way they are breathing at a certain moment. Sports psychologists say mental rehearsal actually improves the brain-body links to help your moves come more automatically–and that studies have shown that athletes who visualize success really do better in competition.
  • They learn to see stress as a challenge, not a threat. Athletes who view stressful situations as a threat actually produce hormones and chemicals in their body that can impair physical and mental performance. Athletes who meet stress as a challenge create a rush of adrenalin and sugar inside their bodies–a natural “high” that is probably responsible for what athletes call a sense of “flow” of heightened awareness as they perform. If you can learn to encounter stress and say, “Great! I’m ready for this!” you are more likely to succeed at whatever you do.sport psychologist 2
  • They use humor to break up tension. “When you think nutty, goofy, silly, funny, off-the-wall thoughts, fear and anger vaporize,” writes Loehr.
  • They know how to learn–and move on–from mistakes. Runner Sharif Karie lost his first races in the United States, but knew he was learning from his mistakes. Sports psychologists say the ability to ask tough questions (What could I have done different? What have I learned that I can use in the future?) is critical.
  • They develop what Loehr calls a “just for today” spirit. Sometimes it seems too hard to say “l will always” do something: eat right, study hard, practice a boring drill in your sport. But successful players develop the self-discipline to commit themselves to doing it right just for today. Mentally, it’s easier to think about controlling what you do on a single day–and if you succeed today, tomorrow becomes a little easier.

Can you see how these mental training skills for athletes could help you in other parts of your life?Business executives, research scientists, high school students, parents, volunteers for a cause, and just about anyone else can put these stress-survival habits to work for them.sport psychologist 3

Think about a stressful situation in your life: in sports, at school, at home. Try making a plan to succeed “just for today”. . .or to mentally rehearse just how you’ll handle a situation without losing it.

The Terrible Triad: ALS and Parkinson’s join Alzheimer’s at the top of the list of neurodegenerative diseases

“Alzheimer’s, Parkinson’s and ALS are the triad of age-dependent neurological disorders. We’re going to see more of them as the population ages.” -Dr. Michael Strong, neurologist, London, Ont.

Introduction

Strong, one of Canada’s leading researchers into amyotrophic lateral sclerosis, commonly known as Lou Gehrig’s disease, works on what he calls one of the last frontiers of medicine. “ALS is not like cancer where there are treatments that can put a dent in the disease,” he says. “We’ve got nothing. This is dying at its worst.” While providing no comfort to ALS sufferers, the remark nicely sums up current medical understanding of a disease that kills the nerves controlling movement in the arms and legs and the muscles used in breathing, swallowing and talking. Of the dozens of degenerative neurological disorders, caused by the progressive death of specific groups of cells within the brain, ALS is at the top in terms of mortality, followed by Alzheimer’s and Parkinson’s diseases. There are no cures or even treatments to significantly slow the progress of ALS, the grim result being that patients, on average, die peacefully of respiratory failure within five years of being diagnosed.

Between 1,500 and 2,000 Canadians, most of them over 50, are now coping with ALS. By comparison, 80,000 to 100,000 Canadians suffer from Parkinson’s disease, caused by the death of cells that produce the substance called dopamine that ensures smoothness of movement. ALS and Parkinson’s differ from Alzheimer’s in that they affect muscle control, not the capacity to think and reason. Parkinson’s patients often live 20 years or more with the non-fatal disorder, and die of other causes. Doctors can treat the disease with drugs or surgery, but its cause remains unknown, and there is no cure. “It’s very complicated,” says Dr. Janis Miyasaki, a neurologist at Toronto Western Hospital. “We’re talking about the brain, the seat of the soul.”eurological disorder 1

Growing numbers of those with Parkinson’s and ALS have given the conditions a higher public profile in recent years. Well-known Parkinson’s victims include Pope John Paul II, former heavyweight boxing champion Mohammad Ali and Canadian-born actor Michael J. Fox, 38, who announced he was quitting the hit TV series Spin City in mid-January. ALS sufferers include the celebrated British physicist Stephen Hawking, who, against the odds, has lived with ALS for about 30 years. Yet some doctors, particularly those studying ALS, complain that the government provides too little support — at best $500,000 to $700,000 in a year — for research. “The funding is disastrous,” says Strong. “The problem is we don’t have hundreds of people with ALS banging on Parliament’s doors.”

Most, in fact, are too preoccupied with their rapidly deteriorating health. Chris Vais, a 37-year-old Presbyterian minister living near Vankoughnet in Ontario’s Muskoka district, was diagnosed with ALS three years ago. Since then, his legs have weakened to the point where he spends most days in a wheelchair. He eats pureed food and his speech is slow and slurred. Despite his illness, Vais and his 35-year-old wife, Susan, decided to start a family, and she gave birth to a daughter, Clare, last May. “We just decided we would carry on with our plans,” says Vais. “There is so much happening in research, you never know when they will find a cure.”

Strong, who runs one of Canada’s largest ALS clinics, says researchers could well the identify the causes of some forms of the disease within five years, and may even be able to develop drug treatments to halt its progress. There are various theories about what kills the nerve cells that control movement. Many researchers believe the cells cease to function properly after becoming flooded with a substance called glutamate, which plays a role in transmitting signals from the brain to muscles. A more recent theory, now hotly debated, suggests the cause may be viruses associated with flu or the common cold.

Treatment for ALS, Parkinson’s

  • For ALS (Amyotrophic lateral sclerosis)

Until researchers find the cause of ALS and develop treatments, doctors can do little more than try to ease the symptoms. Typically, neurologists enlist the help of several specialists, including physiotherapists, nutritionists and social workers. “What we do now is rescue work,” says Montreal neurologist Angela Genge. “As for treatment of ALS, we’re at the level of cancer therapy in the early 1950s.”

  • For Parkinson’s disease

Medical science has made much greater inroads against Parkinson’s over the past three decades. A common treatments is a drug called levodopa, a dopamine substitute that can reduce common symptoms such as tremors, stiffness and lack of balance. But prolonged drug treatment almost inevitably leads to complications such as uncontrollable writhing, jerky movements or rigidity that makes movement impossible. “You can be so immobile that you become bedridden,” says Ottawa neurologist David Grimes. Several new drugs that produce fewer long-term side-effects are now available, but they are not effective on all patients.neurological disorder 2

Two surgical procedures are available for a small number of Parkinson’s patients when drug therapies fail or severe complications develop. One operation, says Dr. Andres Lozano of Toronto Western Hospital, uses a wire electrode, inserted through a hole drilled in the skull, to destroy brain cells that have become overactive due to a deficiency of dopamine. In the other, a surgeon implants an electrode in the brain, then runs a wire from it under the skin, down the neck and beneath the collarbone. There it is attached to a pacemaker implanted under the skin of the chest. Using a computer and a programming device placed on the skin above the pacemaker, the neurosurgeon can adjust the electrical current to regulate the behaviour of brain cells.

Two other experimental techniques are being tested in Canada. In 1997, Lozano became the first surgeon in the world to perform an operation that feeds protein to the surviving cells that make dopamine. Lozano says the goal is to halt the progress of the disease by preventing more cells from dying. And since 1996, neurosurgeon Ivar Mendez of the Queen Elizabeth II Health Sciences Centre in Halifax has performed an experimental and controversial transplant procedure on eight patients, giving them brain tissue from aborted fetuses to help them grow new dopamine-producing cells.

For many people with Parkinson’s, surgery represents the last hope of relief. Keith Kennedy, 48, a former forest ranger from Middle Stewiacke, N.S., 75 km northeast of Halifax, who received a fetal-tissue transplant a little over a year ago, has cut back on his use of prescription drugs by more than 60 per cent. Kennedy says he has less stiffness and muscle pain, and the tremors that plagued him have almost disappeared. Similarly, Lynda McKenzie, 47, of Milton, Ont., 40 km northwest of Toronto, says a similar transplant, performed in Denver in December, 1998, has alleviated a painful rigidity that often left her flat on her back on the couch. “It’s been a slow change rather than a miracle,” she says. “But I feel like I’ve had my life handed back.”

Mental health often overlooked

Some facts of mental disorder/illness

In 2001, the World Health Organization (WHO) estimated that 450 million people worldwide had a mental or neurological disorder. Twenty-five percent of the population can expect to experience one or more disorders within their lifetime. Mental illness is universal, affecting people in all nations and from every background, but poor people in developing countries lack access to many of the most basic resources for effective treatment.

WHO’s definition of mental health disorders is broad, encompassing a wide range of problems of both the mind and brain. It includes autism, Alzheimer’s disease, schizophrenia, depression, sleep disorders, addiction and substance abuse, bipolar affective disorder, panic and anxiety disorders, mental retardation, and epilepsy. (Although epilepsy occurs because of an electrical mix-up in the brain, and retardation and autism are developmental problems, people with these conditions are often discriminated against and prevented from fully participating in normal social activities.)mental illness 1

Overall, mental disorders account for almost a third of global disability (the number of healthy life years lost to a disability) from all diseases. Depression is by far the most debilitating–more than 120 million people are affected worldwide. Currently, depression represents 12 percent of the global disability burden, and by 2020 its share is expected to rise to 15 percent, second only to heart disease.

Although the incidence of depression is highest during middle age, experts recognize that the elderly and children aren’t immune to mental health problems. The prevalence of some disorders–dementia and Alzheimer’s–rises with age. In the United States, one in ten young people suffers from impairment of psychological development or from behavioral, emotional, and depressive disorders. Roughly 18 percent of children and adolescents in Ethiopia have a mental disorder, while in India the figure is 13 percent. More than 20 percent of young people in Germany, Spain, and Switzerland are afflicted with depression, anxiety, or other mental problems.

Rural isolation and poverty can make things worse. In remote regions, mental and general health care facilities and counselors are nonexistent or too expensive. Rural women–who also suffer from economic hardship–are more than twice as likely to suffer from depression than the general population. Often the mentally ill, who carry the extra burden of being poor, wind up incarcerated. In the United States, there are five times as many prisoners with mental illness as there are patients in state mental hospitals.

Changing societal norms can also bring out psychological problems as people are separated from their traditional social safety nets of family and community. For instance, eating disorders–an increasingly common problem among girls (and more and more boys) in affluent nations–have spread to developing countries as cultural definitions of female beauty change. Dependence on a cash economy, overcrowding, pollution, and increased violence in cities can also exacerbate mental disorders.

Mental illness strikes men and women differently. Almost 10 percent of women have a depressive episode every year, compared with fewer than 6 percent of men. Men, however, are more likely to have substance abuse problems and antisocial personality disorders. Severe mental disorders, such as schizophrenia, show no clear gender preference.

Mental illness often exacerbates and in some cases leads to other health problems. Patients with untreated mental disorders who also suffer from other chronic conditions–such as cancer, HIV/AIDS, heart disease, or diabetes–are less likely to experience an improvement in their overall health. And addictions to drugs, tobacco, or alcohol–which WHO also classifies as mental health disorders–can increase the severity and duration of mental illness. Studies show that the mentally ill are about twice as likely as others to smoke. Alcohol abuse is on the increase in many of the world’s developing regions, especially among indigenous groups which previously had little exposure to intoxicants.

Suicide is the most tragic outcome of mental illness. Nearly one million people end their lives each year, and an estimated ten million to twenty million people try to kill themselves. Suicide–usually preceded by severe depression or schizophrenia–is a leading cause of death in young adults (fifteen to thirty-four years of age) in China and most of Europe. in the United States, farmers in the upper Midwest–a region plagued by economic hardship and loss of small farms–are 1.5 to two times likelier than other groups of men to commit suicide. There is a strong correlation between violence against women and contemplation of suicide. WHO found that Japanese victims of domestic violence were more than thirty times as likely to commit suicide as women who were not abused. Battered women in the United States are five times more likely to commit suicide.mental illness 2

Treatment methods for mental illness

Available treatment methods for mental illness vary regionally and among socioeconomic classes. Use of psychotropic drugs–mostly in industrial nations–is rapidly increasing. Antidepressants are the third most often prescribed drug, with sales of over $13 billion worldwide. The number of Americans taking medicines to treat their depression has risen by more than two-thirds over the last decade. Unfortunately, many are not supplementing their drug therapy with counseling or other interactions with mental health professionals.

In developing nations, however, therapeutic drugs for mental illness are usually unavailable to the general population. As a result, many people end up hospitalized–often in crowded, unsanitary asylums where they are neglected and abused–for conditions that could be treated with drugs, therapy, or both. Human rights commissions in India and Central America found that at least one-third of the “inmates” in these hospitals were people with epilepsy or retardation, who need not be hospitalized.

Few nations have adequate mental health programs, and many lack even the most basic or rudimentary services. WHO recommends that all nations provide treatment for mental illness as part of primary health care, launch public awareness campaigns to break stereotypes about mental illness, support community care of affected individuals, develop the human resources necessary to provide mental health care, and support research on mental illness.

Selected mental health problems:

  • Depression

Twenty percent of cases never go into remission; recurrence rate after first episode is as high as 60 percent.

  • Schizophrenia

Found equally in women and men; affects twenty-four million people worldwide.

  • Substance abuse

Dependence on tobacco, alcohol, and illicit drugs affects millions of people and is a rising problem in developing nations.

  • Epilepsy

Caused by excessive electrical activity in the brain–not dementia–it affects about fifty million people worldwide.

  • Obsessive compulsive disorder

Characterized by uncontrollable anxious thoughts or rituals; more common than schizophrenia, bipolar disorder, or panic disorder and affects about 2 percent of the U.S. population.

  • Eating disorders

Between 5 percent and 20 percent of people with anorexia nervosa, a disease characterized by an intense fear of weight gain, die as a result of complications. Other disorders, including bulimia nervosa and binge-eating, are becoming more common among young women and girls in non-Western nations, such as Japan, Brazil, and South Africa.

Unbound: mentally ill people can end up shackled in rural Ghana. Releasing them also involves liberating entire communities from their prejudice

A story of a metally ill teacher in rural Ghana

When Francis, a 48-year-old teacher, had the misfortune of becoming mentally ill, his aggressive behaviour as he increasingly lost touch with reality drew him into conflict with his neighbours. Francis’s brother sought help from traditional healers, who performed numerous rituals to try to appease family ancestors for any wrong-doing the family might have committed. When nothing worked, one of the healers pinned Francis’s foot through a heavy length of tree trunk to restrain him.

For two long years Francis remained thus restrained, in an empty windowless room, naked on a bare concrete floor upon which he ate, slept and relieved himself. People lost sight of the intelligent and articulate man who had taught at the local school and saw only his mental imbalance. As Francis remembers: ‘Even though I did not know or care where I was, I really felt I should not be kept in this room. I protested angrily and shouted to be allowed out but that did not help. Either I would be ignored, or they would guard me even more firmly as they feared I may do something untoward.’

Situations like this remain a reality in rural Ghana for many people like Francis whose families are unable to think how else to deal with erratic behaviour. Often, families will have spent considerable sums of money asking local healers to help, and restraining by force may well be a last resort.unbound

For families living in poor rural communities, life is tough and they need to maximize their own productive time in the field, at market, or working at a trade. Caring for another family member, especially an adult, constitutes considerable responsibility and a heavy burden. But this practical aspect of the problem is far from the worst of it. It is actually much harder to contend with the stigma and fear surrounding mental illness. ‘What is wrong with him?’ ‘Will I catch it?’ ‘I am frightened of him.’ Fellow villagers start to shun the whole family, blaming them for other troubles in the area and urging them to move out. Such social exclusion starts a cyclical relationship with the mental illness, with one exacerbating the other.

Francis’s wife could not bear the terrible situation he was going through and left. She had little say in the treatment he received as that was considered the preserve of Francis’s brothers. The family had heard there was a hospital for people with mental illness in Accra, the capital, but they did not have the money to travel that far and, anyway, felt there were spiritual forces at work. So sticking to traditional treatment was the best solution for them.

The way out

  • Providing chemical drug: Simply providing a chemical drug to treat an illness can only ever address a part of the problem–if, indeed, it helps at all. Drugs only help a percentage of people with mental illnesses.
  • Tackling the issue holistically: It is vital to tackle the issue holistically, to tackle: the illness; the ignorance and negative attitudes; the exclusion; and the poverty. Though it sounds like a large task, it is possible–even in the most resource-poor areas.

When BasicNeeds Ghana, the mental health charity I work for, chanced on Francis, we were shooting photos of the living conditions and experiences of people with mental illness or epilepsy, as part of documenting the lives of people with psychosocial illnesses. After a short meeting with Francis, it was clear he could easily be helped clinically. A Community Psychiatric Nurse was called in, diagnosed Francis with psychosis and administered medication. On the next visit, four weeks after the first treatment, Francis was a changed man. We then persuaded his brother that the medication had stabilized Francis’s condition sufficiently and he should be released from the log. Now it was time to persuade the healer, who had the final say. He agreed, provided some rituals were performed, which Francis’s brother carried out.

Had Francis been set free from the log by a well-meaning community worker instead, the chances are he would have been pinned back into position very soon afterwards. But because we took time to demonstrate his stabilized condition to those who had put him there, the healer was able to share the credit for releasing Francis and so save face. Moreover, by passing on basic information about common symptoms to traditional and faith-based healers, the attitudes of a large number of people in a community can be properly shifted.

The clincher for the wider community is, of course, when they see a person with previously erratic behaviour doing productive work again. When someone transforms from being a burden to being a burden-sharer, it counts for a great deal.

For that reason, contact was made with the education authorities, who were glad to know Francis was still interested in teaching and reinstated him in his job. His wife, Yaa, returned with hopes of rebuilding their family.unbound 2

Conclusion

Francis himself is hopeful. ‘I feel great that my family easily interact with me. I relate with my neighbours and members of the community quite well, even though a few times I have noticed one or two people look at me in a queer manner. [Now that I am working again] I should soon regain my rightful place as one of the educated members of the village, with an opinion on its affairs.’

But what about the others still shackled and chained? There is a vital need for stories like this to be told and passed on to address deeply held stigma and fear. Community plays and radio drama are making an impact, as are newspaper articles produced by self-help groups of people who have been directly affected.

These small local groups have together created a national membership association of users–MEHSOG (Mental Health Society of Ghana)–that’s taking their stories to a much higher level. They were instrumental in campaigning for the Mental Health Bill of Ghana which became an act this March. The new law will ensure the integration of mental health in all health services and policy initiatives, so that it is not just an afterthought. It will encourage civil society organizations that have shied away from mental health to come on board. It provides the legal and moral backing for people dealing with mental illness to pursue their basic rights. I now dare to be hopeful of truly significant social change in the future.

Companion fatigue: also known as ‘the cost of caring,’ compassion fatigue is real in the veterinary industry

Over time, veterinarians have been trusted and respected professionals in society; however, the toll on humans that comes from providing veterinary care to animals has only recently received attention. The deaths of Dr. Sophia Yin and Dr. Shirley Koshi by suicide were widely discussed in the profession. However, recent studies suggest that their deaths are not isolated events.

Research has shown that the prevalence of death by suicide in veterinarians is significantly higher than in the general population. The number of veterinarians who have contemplated suicide is alarmingly high, with two independent studies reporting that more than 1 in 5 veterinarians had seriously considered suicide.suicide 1

What is leading to the high rates of death by suicide and suicidal thoughts?

Research has demonstrated that veterinarians experience higher levels of anxiety, depression, burnout and stress than the general population, and it has been reported that one in 10 veterinarians experiences psychological distress.

The increased rates of mental illness and stress in veterinarians is worrying on its own; this concern increases when one considers the findings of a 2012 study that suggested that veterinarians are unaware of the mental health vulnerability of those in the veterinary profession. One area of mental health in which research is sorely lacking is in “compassion fatigue.”

It has garnered attention recently in the veterinary and shelter blog-sphere and is increasingly being recognized as an issue requiring more attention.

What is Compassion Fatigue?

Compassion fatigue is a concept that has been recognized in those that have care-providing professions, such as veterinarians, veterinary technicians, animal rescue workers, nurses and physicians. While there is no widely accepted definition, one that is used in nursing transfers well to the veterinary profession: Compassion fatigue is “the final result of a progressive and cumulative process that is caused by prolonged, continuous and intense contact with patients, the use of self and exposure to stress.”

This definition highlights the consequences of the ongoing provision of care to clients and patients, the cost of having who you are impact the care you provide, and the result of a stressful job. You might be wondering whether enjoying being a compassionate practitioner and feeling like that is a strength will protect you from compassion fatigue. Despite its name, compassion fatigue is not simply exhaustion that results from caring about one’s patients. There is a dynamic balance between compassion satisfaction (the pleasure derived from helping others), the exhaustion that results from doing so (compassion fatigue) and having trouble performing one’s job effectively. Compassion fatigue results when there is an imbalance between these things.

Signs of Compassion Fatigue

Individuals tend to respond to the types of continuous stressors that lead to compassion fatigue in one of two ways: One can conserve energy or one can remain overcharged. As such, the manifestations of compassion fatigue differ in each individual. Compassion fatigue can result in changes in a variety of aspects, including the physical, spiritual, behavioral, emotional and cognitive. The following is an abbreviated list of symptoms and signs that have been recognized as occurring in individuals suffering from compassion fatigue:

  • avoiding work
  •  feelings of inadequacy or low self-esteem
  • dissociation and numbness
  • difficulty sleeping
  • tearfulness
  • anger and frustration toward coworkers and colleaguesteen suicide

Most of us can likely relate to experiencing at least one, if not more, of those signs at some point in our careers. After all, who hasn’t stayed up worrying about a case, or questioned whether that last client was happy with the care he or she received? It is when these behaviors or signs are present in combination or for more than a couple of days that reflection about what is going on is warranted. If you wonder whether you are experiencing compassion fatigue, there is a self-test accessible from proqol.org/ProQol_Test.html.

What Can Be Done?

Whether you are currently experiencing compassion fatigue, recovering from a previous bout or hoping to prevent it, here are some techniques to try.

  • Set limits: Does work run your life, or do you exert control over how work influences your life? Consider setting boundaries to your work, whether it be the number of scheduled euthanasias in a day, the hours you work, the number of annoying clients you’ll see in a day, etc. By advocating for what you want and can handle in the work day, you will set yourself up to be healthier and happier at home and work.
  • Practice mindfulness: Mindfulness is a concept that centers upon attending fully to the activity that one is doing and immersing oneself in the experience while withholding judgment. In today’s society, multi-tasking is ubiquitous. We eat while writing records, check our email while watching television, and so on. By purposefully choosing to be aware of what you are doing as you are doing it, you will become more connected with your surroundings, which can help mitigate stress.
  • Embrace social connection: Whether it be through your informal social circle or a more formal support group, seek out others and connect with them. This can help you establish your life and identity away from work, which can help you become more resilient to the pressures faced when working with clients and patients.
  • Attend to your body’s needs: Sleeping, eating and exercising often take a back seat to those that come to us for help, whether they be clients, patients or family. By ignoring what your body needs, you are adding to the stress and strain it must cope with. Without adding more to your to-do list, try to ensure you are getting an adequate amount of sleep, eating nourishing foods and getting daily exercise.

Additional resources can be found on compassionfatigue.org and vetlife.org.uk. Complete references are available in the archived article on EquiManagement.com.

Partial References

(1.) Bartram, D.J. A cross-sectional study of mental health and well-being and their associations in the UK veterinary profession. Diploma of Fellowship Thesis, Royal College of Veterinary Surgeons, 2009.

(2.) Jones-Fairnie, H., Ferroni, P, Silburn, S., et al. Suicide in Australian veterinarians. Aust Vet J 2008;86(4):114-116.

(3.) Study: 1 in 6 veterinarians have considered suicide. JAVMA News. April 1, 2015. http://www.avma.org/News/ JAVMANews/Pages/150401d.aspx

(4.) Skipper, G.E., Williams, J.B. Failure to acknowledge high suicide risk among veterinarians. / Vet Med Educ 2012;39(l):79-82.

(5.) Miller, L. Wellness of veterinarians: CVM A National Survey Results. Can Vet J 2012;53:1159-60.

(6.) Hatch, P.H., Winefield, H.R., Christie, B.A., et al. Workplace stress, mental health, and burnout of veterinarians in Australia. Aust Vet J 2011;89(11):460-468.