At the 38th Congress of the French Society for Rheumatology (SFR), held on December 14-16, 2025, in Paris, France, a session bringing together psychologists and rheumatologists focused on managing stress among physicians. “Stress is defined as a state of anxiety or mental tension caused by a difficult situation. This phenomenon is unique to each person and is not solely negative. It can be positive, helping to mobilize resources in the face of difficulties, fostering cohesion, vigilance, or creativity. Conversely, negative stress leads to emotional tension, reduces performance, and can cause exhaustion and loss of control. We distinguish three types of stress: hypostress, which is lack of motivation; hyperstress, which is emotional overload; and eustress, the ideal form because it stimulates and motivates better responses to challenges,” said Lisa Biale, a rheumatologist at the Bégin Military Teaching Hospital in Saint-Mandé, France. “In neuroscience, optimal performance rests on a balance among three neurotransmitters: dopamine (reward), norepinephrine (motivation via stress), and acetylcholine (focus). Maintaining this right balance is essential to remain in a state of maximal performance,” added Marie-Victoire Chopin, PhD, a clinical psychologist in Paris.

Risk Factors

Current risk factors for stress among healthcare workers fall into several categories, Biale said. First, individual factors include gender (disproportionately affecting women), mental workload, the need for recognition, a history of anxiety or depressive disorders, and difficulty setting boundaries. “In medicine, it can be complex to precisely define the boundaries of one’s role. Certain personality traits predispose individuals to detrimental chronic stress, such as perfectionism, an extreme sense of duty, high ideals of caregiving, and great empathy. Finally, difficulty in letting go is an additional factor, often raised in discussions on professional well-being,” she added.

Risk factors are also organizational, Biale said: “The main organizational risk factors are work overload, staff shortages, task shifting between professions, a frenetic pace, constant connectivity (emails outside regular working hours), lack of resources, and conflicting demands. These elements all contribute to suffering in the healthcare sector.” The culture of “holding on at all costs” is also an aggravating factor that reinforces a survival bias and prevents asking for help, said Margaux Moret, MD, a senior rheumatology clinician at the Nancy Regional and University Hospital Center, Nancy, France.

Consequences

The ultimate consequence of stress is burnout, but that state develops progressively after passing several stages: “Vulnerabilities that lead to burnout often follow an insidious process. You don’t wake up one morning suddenly exhausted; generally, it begins with stress situations sometimes described as secondary stress: an intense reaction, frequently linked to our constant exposure to suffering in the clinical environment. At this stage, it’s not yet a case of profound exhaustion, but we already observe a strong response to our patients’ traumatic accounts: hypervigilance, irritability, sleep disorders, mental overload, although recovery is still possible,” Chopin explained.

Next comes compassion fatigue that develops gradually and leads to emotional wear from prolonged exposure to distress. This fatigue shows up as growing exhaustion and a progressive loss of pleasure and meaning associated with work. “Gradually, indifference sets in, sometimes accompanied by dark humor and a feeling of powerlessness. It is then that empathy, so essential to the helping relationship, tends to diminish. Ultimately, when burnout occurs, it is a true professional exhaustion caused by chronic exposure to stress, overload, and organizational constraints. At this stage, we observe emotional withdrawal, defensive cynicism, a decrease in efficiency and commitment, until everything seems to collapse,” Chopin continued.

For preventative purposes, it is possible to assess one’s stress with practical tools such as the vulnerability barometer based on Well-Being Therapy, presented by Chopin. It evaluates six dimensions of well-being: self-acceptance, control of the environment, positive relationships, purpose in life, personal growth, and psychological safety. This barometer helps detect early warning signs and determine the need for psychological care.

Biale’s day-to-day stress management tips:

• Hygiene (physiologic, emotional, and cognitive)
• Support groups
• Learning to delegate
• Accept imperfection
• Structure recovery time
• Know your strengths and weaknesses
• Work on self-confidence
• Accept mistakes and question yourself
• Maintain professional boundaries

Prevention

“To overcome difficult periods individually, it’s essential to first take care of your lifestyle, both emotionally and cognitively,” Biale said. “Support groups, debriefing, and mentoring for younger colleagues also help manage complex situations. It is essential to learn to delegate, accept imperfection, structure recovery time, and identify strengths and weaknesses, so you can progress with tolerance,” she concluded.

This story was translated from Univadis France, part of the Medscape Professional Network.