Over the last few months, many professionals are experiencing an excessive amount of stress and fatigue, perhaps best understood in the larger context of pandemic fatigue1, compassion fatigue, burnout, vicarious trauma and what is increasingly being called Zoom Fatigue. In previous years, the scientific research base has referred to this last phenomenon as videoconferencing fatigue and was reported by a wide variety of people who are required to sit at a computer terminal for work without training in how to avoid ocular stress, fatigue or pain.2
Zoom Fatigue is not only real, but it is surfacing as a topic of many larger collegial discussions of coping techniques, self-care, and telehealth solutions as reflected in a wide variety of articles published on professional association websites, several recently published peer-reviewed, independent journal articles, such as the recently published special issue of Traumatology, called Secondary Traumatic Stress, Compassion Fatigue, and Vicarious Trauma.
Interestingly, the telehealth literature has not generally reported the phenomenon as a widespread issue until COVID-19. The primary focus of the current article then, is to consider the range of factors that can contribute to Zoom Fatigue and offer suggestions for how it can be mitigated. This blog post also introduces a new series of articles focused on how to make your telehealth experience easier, more enjoyable and more productive. Brought to you by the Telebehavioral Health Institute (TBHI) and its sister non-profit organization, the Telehealth Institute (TI), this article series is intent on helping you, the professional, equip yourself with the most easily managed technology, the strongest evidence base and a roadmap for how to use both in delivering the best possible care to the people you serve.
How do you prevent the ill effects of Zoom Fatigue in your telehealth practice? You can start by asking these questions:
- Are you spending several hours at a time in front of your computer screen, straining to connect with the people in your practice?
- Have you put effort into minimizing fatigue in your telehealth practice?
- Do you know where you can go to get more specific direction?
If you are like most practitioners, you were thrust into delivering teletherapy without adequate time and direction to develop your telehealth knowledge base and skills. You’ve been forced into using technology that you struggled to choose and operate, and all the while, providing support to very distressed people relying on you for care. You may be experiencing a constellation of reactions that include Zoom Fatigue, named (perhaps unfairly) after a popular online meeting platform. Next, we’ll review what can cause Zoom Fatigue and outline a few possible antidotes to suffering from your own telehealth practice.
What Causes Zoom Fatigue?
For many health professionals, video conferencing is essential to serving patients and clients who can’t come to the office. Virtual meetings have potential downsides, especially if we have not been trained in how to understand and use them wisely in professional contexts. A recent National Geographic article describes some causes of Zoom Fatigue:
- The inability to use the full range of non-verbal signals and cues that are typically taken for granted during in-person meetings.
- Over-reliance on limited signals and cues that come from watching other people’s faces.
- Needing to maintain a fixed posture and position to keep yourself in view of your device’s camera.
- Using equipment that is too small for the task at hand. Using mobile phones for example, requires squinting into a small screen, often no larger than the size of an index card, for long periods. Research suggests this leads to reduced eye blinking, resulting in eye irritation and strain.
- Being unable to mentally or physically escape, even briefly, because being on camera all the time compels nonstop concentration and focus.
- A feeling of self-consciousness when seeing oneself speak during a video conferenced session.
How to Prevent or Reduce Zoom Fatigue
The classic telehealth literature typically cautions practitioners about sitting too long without walking in between sessions, but does not typically mention video conferencing fatigue.3 The difference between traditional telehealth and full-time practice in front of a video screen, is that in classic telehealth models, professionals work for short bouts of clinical sessions, then engage in other work-related tasks. If a professional in an agency or hospital, for example, were to have 4 or 6 video sessions per day, those sessions would be scheduled at various times that mimic in-person scheduling. The clinician then, would walk to and from the lunchroom or restroom, interact with colleagues, engaging in office banter and other activities; perhaps see an in-person patient or client; and otherwise maintain a regular routine in a relatively controlled environment, free of distractions and interruptions. They may also benefit from perhaps years of routines related to self-care and de-stressing, reinforced by friends and family as well as co-workers. Their documentation would be developed over years of training and office work, and now, easily filed and accessed without much additional thought or effort.
Since COVID-19, professionals working from home not only have to pack their days with distraught patients and clients, but also have often been forced to concurrently contend with many other factors: their own lack of familiarity with the technology upon which they must rely; lack of familiarity with technology-enabled workflows related to documentation and office management; a self-care schedule that is difficult to manage when sheltering-at-home with friends and families; varying degrees of cooperativeness with regard to privacy and sound-control. Stacking appointments one after another under such pressured conditions can lead to approaching our home-based work stations with tension and anxiety; our bodies, brains and eyes denied the chance to recover from Zoom Fatigue.
You might not be able to control how many virtual meetings you have in a day. You may still be learning how to manage your technology or digital documentation requirements, but if you understand the causes of Zoom Fatigue, you can be better prepared to minimize its damages.
Prepare your meeting space
Zoom Fatigue environmental distractions come in three forms: external, ergonomic, and technical.
- External distractions include children, pets, phone calls, app notifications and poor lighting. They can occur not only in your space, but also in your patient’s or client’s space. Knowing how to control such factors is part of understanding telehealth clinical issues.
- Ergonomic distractions include uncomfortable or unsuitable chairs, awkward screen positioning, and poor lighting.
- Technical distractions include issues with the meeting software, such as audio and video connection problems.
Minimize environmental distractions by considering the following:
- If others are in the same location you are, make sure they know you will be in a session, and teach them to respect the privacy requirements that you must maintain.
- Put an “In Session: Do Not Disturb” sticky note on your kitchen counter and on your home office door.
- If you have pets, keep them where they won’t disturb (this includes sound distractions). If you introduce them to your sessions, document why.
- Avoid multitasking. Put your phone on silent, close your email browser and turn off any social media apps.
- Use the biggest video screen, with the best picture resolution, that you can. Use an old TV if you have one. Even relatively outdated television screens have very high resolution. You can purchase a simple little cable to connect your laptop to your TV to have your TV serve as a large video monitor.
- Arrange your background to reflect your professionalism. Remove all clutter.
- Adjust your lighting to reduce eye strain from too much contrast between the screen and the room lighting. Adjust the brightness coming from your own monitor to reduce your eye strain. Do eye exercises by closing your eyes and rotating your eyes in their sockets. Slowly make a circle with your eyes closed, first circle to the right, then to the left. Breathe.
- Invest in comfortable furniture. Adjust the chair and screen position to hold a comfortable posture. Consider a quality orthopedic chair, or a standing desk.
- Familiarize yourself with the meeting software’s interface. Give yourself peace of mind by thoroughly training yourself for technical problems and document your procedures for them.
- Take an online course on how to maximize your video effectiveness as well as how to prevent and handle advanced clinical issues through a video practice.
Zoom Fatigue is a mental and physical challenge. Don’t forget to put at least a few minutes into your own body and spirit.
Minimize fatigue during the meeting
Here are some things to consider doing during your video sessions:
- Shift. You might not be able to walk away, but you can make small adjustments to how you are seated or standing to help you keep your blood pumping while not being a distraction. If you use a standing desk, you can shift your weight from one foot to another in small ways.
- Look up. Take your eyes off the screen for a moment. Focus on an object further away. Your clients and patients are not likely to complain if you look away in thought, as you would in your in-person practice. One technique you can try is the “Triple-Twenty”: Every twenty minutes, spend twenty seconds looking at something at least twenty feet away. Look out the window, if you can. If you are concerned that you may appear disinterested, explain to your patient or client that you are practicing self-care techniques and are trying to make your video-practice mimic real life, where you don’t typically stare at them the entire time they are seated in front of you.
- Move. If you have the chance to take a break, get out of your chair and move. If you live in a two-story home and are meeting downstairs, use the upstairs bathroom. Step outside if you can. Walk briskly, sprint a few times. If you can’t easily step outdoors, do some light stretching, deep breathing exercises, or take a few minutes for meditation before your next session.
- Filter. In a couple or group session, change your view from gallery to single, and back again as needed.
- If you feel self-conscious seeing your own face on your video screen, use a sticky note to cover your image.
After the meeting
There are a few things that you may want to consider after spending time on video to manage your practice more easily:
- Take planned breaks. Avoid stacking your appointments if you can. Take an occasional half-hour in between sessions. Even having a full ten minutes in between sessions will help.
- Optimize your documentation requirements by taking a class on how to most easily document your telehealth practice.
- Schedule daily or weekly collegial time with your office-mates. Such meetings can be by phone or video, depending on the groups’ preferences.
Learn More About How to Reduce Zoom Fatigue
If you want to learn more about what Zoom Fatigue is and how to fight it, attend the live and also recorded September 16, 2020 TBHI webinar, “7 Effective Strategies for Managing Zoom Fatigue Symptoms.”
Participants of this 1-hour event will be able to:
- Answer the question: What is Zoom Fatigue?
- Name at least 7 strategies for combating Zoom Fatigue
- Describe how one’s desk arrangement can be changed to reduce Zoom Fatigue
- Name which hardware and software combinations reduce Zoom Fatigue
- Describe a few quick and easy ways to simplify the stress of documentation
- Name at least one function that can easily be managed by an administrative assistant to reduce the stress of dealing with technology experienced as a clinician
1 Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network Open. 2020;3(3):e203976.
2 Krystal, J. H., & McNeil, R. L. (2020). Responding to the hidden pandemic for healthcare workers: stress. Nature Medicine, 26(5), 639-639.
3 Luxton, D., Nelson, E., & Maheu, M. (2016). Telemental health best practices. Washington, DC: American Psychological Association.