The course of mental illness in patients seeking specialist care for stress-related exhaustion was not related to sex or age. The burden of mental symptoms is high and similar for men and women, and at the 18 month follow-up, one-third of the study group still showed symptoms of burnout. A long duration of symptoms before consultation was associated with a prolonged time of recovery, which underlines the importance of early detection of stress-related symptoms.
All patients were offered multimodal treatment (MMT) with similar components but adapted to their individual needs during the whole follow-up period of 18 months
Usually visiting the physician with an interval of four to six weeks
Physical activity and other lifestyle topics were repeatedly encouraged
Eight-week stress reduction group programme
Two-hour lecture, teaching basics about stress and the consequences of chronic stress exposure
Employers, working colleagues and relatives were also offered to attend a short lecture regarding stress-related mental disorders
Cognitive behavioural group therapy for insomnia and/or a recommendation to visit a psychologist for individual psychotherapy were other treatment methods.
Offered to participate in an aerobic exercise group and strength training at the clinic once a week for 18 weeks and 20% (n = 47) participated; the rest were recommended individual physical training.
Antidepressant medication was offered or adjusted when needed.
Communication with the Social Insurance Office and the employer was facilitated, and about half of the patients participated in special meetings regarding the earliest possible return to work.
The burden of mental symptoms is high and similar for female and male patients, and at the 18 month follow-up, one-third of the study group still show symptoms of burnout despite extensive MMT
Patients with exhaustion disorder appear to consult their general practitioner numerous times with stress-related complaints in the years preceding their diagnosis. The findings indicate which presenting complaints general practitioners may need to be more attentive to so that patients at risk of developing exhaustion disorder can be identified earlier and get the support they need. Addressing stress factors earlier in the course of illness and preventing the development of exhaustion disorder may contribute to a reduced burden for both individual patients and for society, with a reduction in sick leave and societal costs for mental illness.
The presenting complaint at the occasion when the exhaustion disorder is diagnosed, are:
Nausea, irritable bowl, headache, dizziness, palpitations, chest pain, back pain, musculoskeletal pain, abdominal pain, and feeling faint
Work demands are, by far, the most prevalent stressor, followed by relational problems in private life… One important practical implication of this study is that patients with stress-related exhaustion often have a long period of impaired ability at work. Successful prevention at the workplace is thus of great importance. However, it is equally important to discuss how society can support individuals such as single parents or couples with relational conflicts.
Mental Practices to Prevent or Soothe Burnout
Notice your Thinking Patterns
What are you unconsciously or repetitively saying to yourself about your situation?
What are your beliefs about your situation?
How are your thinking patterns and beliefs affecting how you feel?
Negative Self Talk Exercises
Have a conversation with this Negative Self-Talk
Thank the voice for caring about you
Listen to it fully as you can
Listen for the deeper, underlying values and needs that it’s asking for
Take an immediate and then a longer term action to meet it’s request
Request a gentler interruption next time, that’s easier for you to hear
Planning & Systems
Possibly with someone you trust – when in burnt out less able to plan
Evaluate your goals
Creating an actionable plan, with small achievable steps
In this video I share my story of how Psychedelics have supported healing a part of my life that I hadn’t been able to do with therapy. I hope this encourages conversations about psychedelics and decriminalization.
Societies desire to not go deep and address top layer issues instead of root cause, sometimes could include Solution-focused (brief) therapy (SFBT)
No Energy yet difficulty with Sleep
Sleep deprivation is being shown to increases amygdala activation.
A study showed that while both groups expressed significant amygdala activation in response to increasingly negative picture stimuli, those in the sleep-deprivation condition exhibited a remarkable +60% greater magnitude of amygdala activation, relative to the control group
A sleep deprived person may see an event as an emergencies (due to activated amygdala) that needs to be urgently addressed, when in fact those that have had more sleep interrupt what’s needed differently
Loneliness and Withdraw due to sleep deprivation
A study demonstrate that a lack of sleep leads to a neural and behavioral phenotype of social withdrawal and loneliness; one that can be perceived by other members of society, and reciprocally, makes those societal members lonelier in return. We propose a model in which sleep loss instigates a propagating, self-reinforcing cycle of social separation and withdrawal.
Cognitive abilities, behavior, and judgment
Multiple studies have been done to determine the effects of total sleep deprivation; more recently some have been conducted to show the effects of sleep restriction, which is a much more common occurrence, have the same effects as total sleep deprivation. Each phase of the sleep cycle restores and rejuvenates the brain for optimal function. When sleep is deprived, the active process of the glymphatic system does not have time to perform that function, so toxins can build up, and the effects will become apparent in cognitive abilities, behavior, and judgment.
Feeling tired & wired
A combination of physical exhaustion or low physical energy while simultaneously feeling anxious or wired, stressed
Being unable to feel rested even if you are getting enough sleep
Body confused about not getting enough light and enough darkness; circadian rhythm
Body and stomach pains. Gut hurting when stressed and eating
Some people experience aches and pain
When people feel emotional pain, the same areas of the brain get activated as when people feel physical pain: the anterior insula and the anterior cingulate cortex. A study on social rejection seemed to demonstrate this.
The body isn’t getting enough natural light or enough natural darkness
Mary Kuentz and Laura Wade explore their journeys through emotional burnout, some of the research about burnout symptoms.
Definition of Burnout
Mechanical – When there’s nothing left to combust, no more energy in the system
Emotional “burnout” was coined in the 1970s by the American psychologist Herbert Freudenberger. Emotional burnout describes the consequences of severe stress and high ideals in “helping” professions. Doctors, therapists, coaches, and other healers, who sacrifice themselves for others, would often end up being “burned out” – exhausted, listless, and unable to cope. It’s the shadow side of self-sacrifice. We will be looking at how to support without sacrificing and what to do when you’re already sacrificing.
Mary and I are passionate about taking Holistic views, so we will be discussing how issues affect us on an emotional, mental, physical, and spiritual levels.
Today we will be looking at the Emotional side of Burnout, and including how to know when you’ve entered the spectrum of burnout and what to do about it.
Emotional Signs of Burnout
Reduced Performance (difficulties in maintaining boundaries)
Emotional Protection/Isolation – Flat Affect Feels, nothing to look forward to, joyful things from the past no longer seem joyful in the present
Hopelessness about the state of the world and being unable to affect the issues of the world. Suffering is still happening in the world. What’s the use?
Practices to Heal Emotional Burnout: 3 practices, 2 and 1 of micro and large
Self-Empathy – begin to practice self empathy that you would give a friend client or loved one
Journaling – stream of conscious writing, to give it a place to vent
Take a Break, a day, a week – Emotional Well-being Day
May be different from a SPA DAY!
What’s the one shift, easy and doable, that would make the biggest difference?
How can you begin integrating that shift into your life, even in a small way?
Stop Blaming yourself for feeling burnt out
Many people keep pushing, internally and externally to overcome burnout in the early stages, i.e., “If I can just finish this project…” “If I can just get to Friday…” “If I can just push through this pain…”
Pushing to keep up
Punishing themselves to be who they have been in the past
Informed Health Online [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: What is burnout? 2012 Dec 5 [Updated 2017 Jan 12].Available from: https://www.ncbi.nlm.nih.gov/books/NBK279286/
Listed 3 main symptoms of Emotional Burnout:
Exhaustion: People affected feel drained and emotionally exhausted, unable to cope, tired and down, and do not have enough energy. Physical symptoms include things like pain and stomach or bowel problems.
Alienation from (work-related) activities: People who have burnout find their jobs increasingly stressful and frustrating. They may start being cynical about their working conditions and their colleagues. At the same time, they may increasingly distance themselves emotionally, and start feeling numb about their work.
Reduced performance: Burnout mainly affects everyday tasks at work, at home or when caring for family members. People with burnout are very negative about their tasks, find it hard to concentrate, are listless and lack creativity.
I come across many models that don’t seem to hold up when I compare them to different studies or how I see them working with my clients.
One model that seems to keep proving it’s worth is Dr. Saj Ravzi’s Stress Response Hill, shown below. Check out his entire video, it’s worth the investment of time. The one point of his I want to highlight, is that most of us are operating at the “1”, we are slightly activated most of the time, and when we try to do mindfulness or relaxation exercises to get to the “0”, we may actually fell more agitated. It’s common to then think the exercise must not work, when actually the agitation in the body increases before it fully relaxes, so the increase in agitation means it’s working. I find this model extremely helpful to explain to clients prior to beginning relaxation exercises, as it helps them understand the increase in anxiety is part of the process.
New experiences can bring up opportunities to examine childhood wounds and begin healing them. A common new experience I see people having is their first child or their first child that’s the same gender they identify with. Seeing the child grow to be ages the parent was when different traumas happened can bring up old childhood pains. While it can be very challanging, the experiences can also be a blessing allowing us to see parts of ourselves that need love, understanding, and forgiveness.
If you or a client is going through a new experience and has a response that exceeds the circumstance or seems like it belongs to a younger self, take the time to examine that response. What’s its’ message? What is it needing to heal? Provide the piece of the self that responded in this way with compassion.
What new and challanging experience can you try this week? Be mindful while doing it and see what emotions or sensations arise. If any parts of yourself are uncomfortable, take the time to comfort them, and be thankful to the new experience for showing you this piece of yourself to heal.
Inspiring our mental health providers to provide their sharpest game and supporting people in healing their trauma to live their best lives. I provide training programs for counseling graduate students and, a few months each year, I act as the lead therapist and interim director for a holistic rehab in Hawaii.
My focus is…
Creation, Connection, and Contribution, especially around methods for healing. More than anything, I want to support others in accessing internal peace. I want to contribute workshops, community spaces, a wiki group therapy platform – that can continue to grow without becoming stagnant on the creator, articles, systems, apps, and especially new ideas. This shapes most of my life decisions. Saying no to a lot, so I can have the time for creation, connection, and contribution.
I also love learning lots of stuff, especially different approaches to healing, thinking and living. That’s why I absorb so much from a multitude of fields, explore the world, and want to keep absorbing and growing. I connect with those who stretch, strive, and grow, and love having meaningful conversations with others about their view of how things work. I’m optimizing my life for learning and connecting.
I will be releasing a podcast soon about burnout, and we did a great job about speaking about the internal factors.
I did not cover the external factors though. Sometimes the systems that we work in are not conducive to our health. You are not broken, the system is. It’s okay to walk away from moral injury. Each of our decisions of what systems we choose to work in are valid.
It is not your fault if you are feeling exhausted and ineffective in a convoluted system. It is your responsibility to choose how you want to handle the circumstance you are in. You may decide to stay and work on your boundaries and adding emotional fitness skills. You may decide to leave and work for a smaller practice, where more of your energy can go to serving clients instead of working to change the system. All choices are valid, worthy, and acceptable. Listen to yourself. Take action on your wisdom.
For more information on Moral Injury, see Dr. Z’s video on how it’s effecting the healthcare system.
Arianna Huffington spoke on Masters of Scale about how her organization is using AI to monitor call centers. After an operator hangs up with a difficult caller, the AI detects the intensity in the call, and instead of patching through another caller, the operator will get a Thrive call. This Thrive call is a 30-60 second guided call, which could be on mindfulness, gratitude, breathing, etc. Arianna’s company Thrive understands that these small investments in emotional fitness pay for themselves. Emotional fitness supports the operators and the callers both have better experiences. What emotional fitness practice can you begin incorporating today?
FYI – A recent meta study on breath work comparing 8 types of breathing showed that all types of breathing were effective for a portion of the participants. There wasn’t one style that was effective for everyone. So explore different emotional fitness practices, what seems most supportive for you? The exercises that seem the most supportive may also change over time. Try keeping a list in your phone of what works and even what doesn’t work for you, so you know where to turn after a more intense moment, since most of us don’t have Thrive calls coming in to remind us what there is to be grateful for.
Shine on and have the day that’s best for you.
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