009 Mental burnout and Recovery Practices

This episode will cover Mental Burnout and Recovery Practices

Symptoms

  • Rumination
  • Inability to Focus
  • Cynicism or Negative Attitude
  • Connection between Mental Burnout and Self-Sabotage

When you’re burnt out your lack of mental energy may lead to:

  • Procrastination
    • I’ll do it when I feel better when I’m less exhausted
    • I’ll do it tomorrow
    • I’ll get to it later
  • Poor Systems and Routines
    • No energy for creating efficient ways of doing things
    • Inefficient actions mean you spend more energy doing tasks
    • Task may get done but you are more exhausted after doing them
  • Poor Planning and Chaos
    • Flying by the seat of your pants
    • Doing it when you “feel” like it rather than planning for it
    • Doing what comes “naturally” to you rather than what’s best for you
  • Vicious Cycle
    • Every day is a bad day
    • You wake up with the right intention but lose energy and momentum, fall behind, get disorganized and discouraged
  • Negative Self Talk – occurring both at times of growth and when regressing into old patterns – difference in the voice

Hope – There is hope for things to change

Studies – prevention is best, early multi-model intervention next best

Course of mental symptoms in patients with stress-related exhaustion: does sex or age make a difference?

  • 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

Symptoms that may be stress-related and lead to exhaustion disorder: a retrospective medical chart review in Swedish primary care

  • 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

Self-reported stressors among patients with Exhaustion Disorder: an exploratory study of patient records

  • 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
  • Ask for Help and Support
  • Take Care of yourself now
  • Do the restorative activities sooner
  • Sleep – Oura Ring

008 Physical Burnout & Restorative Activities

This podcast looks at the Burnout and how it affects us physically. Below are the show notes:

  • Moral Injury and Burnout
    • 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
    • Chronic exhaustion
    • 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
      • We live in man-made boxes of artificial light
  • To go deeper into the sleep studies, please see Rhonda Patrick, PhD & Matthew Walker PdD
  • Practices – Physical
    • Breathing – Breath of Fire
    • Eating well-balanced meals
    • Sleep – 7-9 hours, before 10:00 pm; sleep hygiene and artificial lights
    • Exercise, gentle
    • Sex
    • Touch, Massage, Self-Massage, Cuddle – serotonin and oxytocin
    • Play, Dancing, Coloring, Drawing – engaging a younger or more carefree part of yourself
    • Get outdoors and touch the ground
  • What is it you need? And how are you going to implement this?

007 Therapeutic Use of Psychedelics

  • This podcast discusses common questions about Psychedelic Assisted Psychotherapy and Therapeutic Use of Psychedelics.
  • Some questions answered includes:
    • How many treatments?
    • What does it look like?
    • What’s being worked on?
    • How does it support connection to one’s body?
    • What are the advantages or disadvantages?
    • Who is this not for?
    • What kind of training and preparation should a therapist have in order to do this?
    • What advice do you have for someone considering this therapy?
    • What are the preconceptions and which ones aren’t true?

Please note – there was a recording issue that made this episode more tin sounding. This error has been fixed for all moving forward. Thank you for your understanding. We wanted to share this content.

006 Emotional Burnout & Support

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.

Moral Injury & Burnout

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.

Thrive Moments

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.

Hero’s Journey

Joseph Campbell, renown for unifying concepts from literature across many different cultures, developed the philosophy of The Hero’s Journey. The Hero’s Journey seems to identifiable and meet warmly in many different contexts. When I see clients, especially those re-entering their life after a residential stay for substance abuse, able to structure their story similarly to the Hero’s Journey, they seem to be welcomed back and offered support.

What are ways you identify with the Hero’s Journey?

What are ways you can support your clients in identifying with the Hero’s Journey?

Confidentiality vs Secret Keeping in Group Therapy

Without guidance it’s easy for members of group therapy to do old patterns of secret keeping when trying to maintain confidentiality. Clients, especially those with parents that experienced trauma and/or addiction, may have been instructed as a child to not speak about what goes on at home. Without a clear explanation of what is okay to speak about in regards to group therapy, it’s easy to repeat historic patterns. When asked about a group, and a client says “I’m not allowed to talk about it”, that’s actually not true. So what can clients speak about while maintaining confidentiality of other group members?

General Topic

It’s important for clients to be able to speak about the topics covered in group therapy. Speaking about general topics, such as childhood trauma and the long term impacts, can support the client in educating their support network about what they are working on and ways others can offer them support.

Their Experiences

Clients may speak about their personal experience in group therapy. It’s important for clients to be able to speak about their insights, challenges, hopes, and practices to others in their life.

The Therapist

While the therapist must maintain confidentiality of all group members, and group members must maintain confidentiality of all other group members. Anything the therapist says or does may be talked about to others. Clients are encouraged to bring up concerns or disagreements to the therapist and practice direct communication. The clients may relate lessons or stories shared by the therapist to others. 

Finally, it’s also important to speak to and have a written agreement about the consequence of not maintaining confidentiality.

Who goes first?


There’s many ways to choose which person to lead with in a group session, and I will cover some other options on how to choose llater on. The choice I repeatedly make is by choosing a group member who has been vulnerable in check-ins and warm ups. This member can role model to others in the group and in turn support the releasing of overly protective parts in other group members so deeper work may be done.

Questioning Ourselves

What did you believe in five years ago that you no longer believe in today?

This is a question Peter Attia, MD, frequently asks his podcast interviewees. 

I believe this question is vital to ask ourselves on a regular basis. 

The scientific method never proves a belief, we can only see it as not yet wrong. As our understanding of the world grows, both individually and within the research communities, it’s valuable to recognize the changes and incorporate them into our world views. 

Some things I believed five years ago that have changed include…

  • Previously I believed: SSRIs are unlikely to have negative effects and may be helpful. 
    • Now I believe: SSRI’s are likely to have negative effects for most people. While they may still be beneficial for some people, it’s important to support clients in treatment methods with minimal risk first. 
  • Previously: CBT is highly effective and can be used in many circumstances. 
    • Now: CBT may have been subjected to an amplification of benefit and overgeneralization in usefulness. It’s still useful in some areas, yet not as many as I used to believe in.
  • Previously: Clients in emotional distress need psychological counseling interventions, and if not improving a referral to a psychiatrist. 
    • Now: Clients in emotional distress may be due to cause that’s not physiological. Wellbeing may be found though a combination of interventions including psychological, nutritional, medical, lifestyle, spiritual, physical, social, or another area.

What are things you believed in five years ago that you now have new beliefs around?