Addressing Burnout | Cognitive Behavioral Therapy Strategies

Hey there, everybody, and welcome to Today's presentation on 8 Tips to Reignite the fire and address burnout. I'm your host, Dr. Donnelly Snipes. So let's start by talking about what burnout is. Burnout is sometimes thought of as subclinical depression. It doesn't quite meet the criteria most of the time of major depressive disorder. However, people are well on their way to feeling depressed. Some people call it exhaustion. And yes, we've seen that in people who get burned out. They are just exhausted. They don't have the energy to care about anything. Sometimes burnout is grief. You get into a profession or an occupation in order to make a difference or. Or you enter into a situation with a certain expectation and it just doesn't seem to happen. And you start feeling like your efforts are futile and you start feeling hopeless and helpless. It can also come from disenfranchised grief when you are experiencing losses in your life or in your job or what have you, and people are telling you to just suck it up. So in disenfranchised grief, we're not being allowed to go through the grieving process for things that are often not your typical grief issues, not the typical loss of a loved one, but maybe getting transferred, maybe losing a program or having a client dropout. There are a lot of different issues, issues that can comprise disenfranchised grief. And I've got a video about that if you want to learn more about disenfranchised grief. HPA axis dysregulation is another characteristic of burnout. Like I said, it can be called subclinical depression or exhaustion, adrenal fatigue, HPA axis dysregulation. A lot of times these phrases that we're using often describe a core set of symptoms in HPA axis dysregulation. And I've talked about that in other videos. The person's stress response system gets wonky, for lack of a clinical term. When your body is exposed to stress hormones too often, too much, too long, the body turns down the sensitivity. It says, hey, I can't take that much stimulation when it turns down the sensitivity. Unfortunately, it also turns down the sensitivity to positive stimuli. So the person often feels very flat. And I make the analogy that sometimes it's like feeling like Eeyore from Winnie the Pooh, just kind of going along. There's no color, everything's kind of gray. But when they do get stressed out, when they do get triggered, it's an extreme reaction. They go from FL flat to furious and A lot of people with burnout will see that in their relationships and at work where, you know, they're just barely getting one foot in front of the other most of the time. And they tend to have these sort of explosive episodes, or they'll bite people's head off when they normally probably would have been more patient, or they get really, really upset about something when in other times when they weren't so exhausted, they probably wouldn't have reacted so strongly. Well, let's think about this. That is a survival mechanism of sorts. When you're starting to feel exhausted, feel tired, feel run down your body, your brain is saying, I don't have the energy to fight off invaders or the hungry lion or whatever it is. I can't deal with any more stress. So I'm going to push as much away as I possibly can because I just can't deal with anymore. I don't have the energy and learn helplessness. This is another characteristic of burnout. It's also a cause of burnout. And there were some experiments back in the 60s, I believe, and they were pretty awful experiments that hopefully would never be done again. But basically, the experimenter put a dog on one side of a fence, and both sides of the fence were able to be electrified. So the dog was just sitting there minding his own business, and all of a sudden, they electrified the fence underneath him, and he jumped over. He's like, okay, I got to get away from that. He relaxed for a minute. You know, this is our normal stress response. It's like, okay, threat's gone. I can relax. Well, he gets over to the other side, he starts to relax and chill out a little bit, and guess what happens? They electrify that one. So he jumps back over, and they do this a few times. And the dog regularly responds by getting out of the way of the threat. But then eventually they decide they leave both sides electrified. So no matter which way where the dog jumps, he's going to get electrified. And eventually the dog just gives up and lays down. And that's kind of what we're talking about with burnout. In psychology, they call that term learned helplessness. The dog learned that he was helpless to get away from the trauma. And we can experience this too in burnout environments. So this is really what we're talking about with burnout. We have physiological changes when our HPA axis starts turning down the sensitivity because we've been exposed to too much stress for too long. And we have cognitive changes when we start feeling like we don't have any More energy, and we start feeling helpless and hopeless. It's like, what's the point? So what do we do about it? Okay, so let's look at the causes of stress, and then for each cause, we'll talk about what to do. Chronic unrelenting stress leads to burnout. Burnout, remember? Is that HPA axis dysregulation? So we'll start out with that one. In order to regulate your HPA axis, you need to remove some of the stress. I know. Easier said than done. That means making a conscious choice to say, I need to create safety. I need to prioritize my own health and mental health. I need to set some boundaries here. And that is easier said than done. Don't get me wrong. And I have another video on recalibrating your HPA axis if you want to look at that. But just like anything else, like recalibrating the HPA axis or recovering from burnout, I want you to start slow and expect setbacks. In the HPA axis recalibration video, I talked about recalibrating your HPA axis like trying to tame a feral cat. And that's something I've actually done a few times, so it's a meaningful analogy for me. When you work with a feral cat, you know, you're this huge, big thing to them, and they don't know if you're going to hurt them or not. So you've got to gain their trust. And you start gaining their trust slowly but surely. You know, maybe sitting there first and then putting food out for them, but not going near them. And it takes months, a lot of times, especially for adult cats, to get to the point where you can even hand feed them, let alone pet them. And it's important to sort of recognize that in recalibrating our HPA axis, we need to expect it to take a while. But just like a feral cat, if you move too fast and break its trust or startle it, then it's a setback. You can't start the next day where you were today because you've broken that trust with the HPA axis. If you are putzing along and you're trying to follow your HPA axis reregulation plan, and then something happens and it triggers those stress hormones. Okay, well, that's gonna set you back some. So then you've got to just recoup where you're at. You know, don't feel hopeless and helpless and let yourself backslide even more. Put an anchor in and say, all right, here I am. Let's start moving forward. But let's talk about some. Some of these other causes of burnout. One of the primary causes of burnout is a lack of a sense of control, that hopelessness and helplessness. And this can be. A lot of times we talk about burnout in terms of burnout work environments. But burnout can be much more global. If we have a lack of a sense of control about things in our life, we can develop burnout. It can be at work, it can be at home, it can be in general. I know over the past two, three years, people have really been struggling to have a sense of personal control and safety and agency. So the first thing other than starting to recalibrate your HPA axis, establish a sense of safety and control. Look around at your life and take it bit by bit. Look at your family life, look at your health, look at your energy, look at your job, look, you know, one at a time and identify what things in this realm do I have control over? What things can I control? What things can I not control? You know, first let's figure out what's controllable, and then you can go back and say, okay, of the things I can control, what can I do to feel more empowered in this area? For example, my daughter a couple of years ago was diagnosed with a chronic illness. And as a mom, I really don't like that. I don't like feeling out of control. I don't like feeling helpless to make it better, so to speak. And that was a struggle, but recognizing, you know, there are only certain aspects of that that I can control. An illness is an illness, and that's, you know, the way her body is working right now. So it was important to advocate for her and with her and figure out, okay, how can I best help you? I can't make the illness go away, but how can I help? You have your highest quality of life. What can I do? How can I be of service? How can I be of use? And that gave me a sense of agency, if nothing else at work, you know, establishing a sense of control. Some things, like the YouTube algorithms, I have no clue what makes them actually tick. And nobody does. I mean, we can guess, we have some ideas, but I have no clue. So what can I do to establish a sense of control? Well, I poll my community. I find out from my community. What kind of videos would you like to watch? It may not be the ones that you YouTube algo is particularly hitting on, but at least that is helping me make sure that I am attending to the needs of my current subscribers. And if the algo picks up on it and it goes viral, then great. But that helped me reestablish a sense of control. I can't control whether it goes viral, but. But I can control whether it appeals to the people who are already subscribed. And that's important to me. So in your life, go bit by bit and identify what you can control and make a plan for how you're going to start exerting some control over that and what you can't control and how you're going to deal with that. I can't control my daughter's illness. I can't control the YouTube algos, some of which kind of go over my head. I can't control the weather. You know, there are things I can't control. And I have. I have had to develop an attitude of acceptance of those things. And Linehan calls it radical acceptance. It is what it is. Now. What am I going to do about it? I can continue to stay mad about it. I can decide to let it go. I can embrace it. I can figure out other ways. In acceptance and commitment therapy, Hayes talks about it as living in the and I can experience this and have a rich and meaningful life. I've got a neck injury right now, which is keeping me from doing the gardening that I love to do, that I want to do to the degree that I want to do it, which, you know, frustrates me because I want to be in control of my own body, and it's kind of rebelling against me, and that irritates me. So that's one of those irritants that can add up and contribute to feeling helpless and hopeless and burned out. Sometimes you look around and it's like it doesn't seem like anything's going right. I give up. But in terms of my neck, you know, I can recognize what I can control and. And live in the. And, you know, I can have this neck injury and garden. I just have to limit what I do and how long I do it. I can't be out in the field for seven hours. You know, I have to limit myself to an hour and a half or two hours. Unclear expectations are another cause of chronic unrelenting stress. And that is, again, not just at work. What are your expectations for you start out by defining your rich and meaningful life. Who's important in it, what's important in it, what activities, what experiences? What defines a rich and meaningful life for you? That gives you some clarity of where you want to invest your energy. So then when something comes up. You can ask yourself, okay, I can use energy to get upset about this, or I can let this go. And I can use this energy and invest it in something that will help me move toward my rich and meaningful life. So you need to get clarity for yourself about what you want, where you're going, clarity in your relationships. What expectations does each person have? And a lot of times we get in the bad habit of mind reading, and we assume that we know what other people's expectations are for us, and we may be very, very wrong about that. And then when we do what we think we're expected to do and we don't get the response we think we're expecting to get, then we feel helpless and hopeless. So get some clarity on those expectations. In your relationships at work, what is it specifically that you want me to do? And when we talk about goals and expectations, it's important for them to be observable and measurable. If I tell my kids I want to come home to a clean house every day, I'm working 10 hours. There's no reason I should have to come home and sweep and mop and do all that stuff. So I want to come home to a clean house every day. Well, their definition of clean and my definition of clean may be very different. So observable and measurable. What do I mean by clean? Or if you tell somebody that they're being really annoying, well, how do you expect them to behave? Well, what are your expectations in that situation? Don't just say, don't be annoying, because they may not know what annoying looks like to you or how they're expected to behave. Especially children, how they're expected to behave in a certain situation. So children may get really antsy and stressed out going to new environments because of unclear expectations. Get clarity and give clarity about expectations in relationships, at work, in chores, everything you do. And that plays on assertive communication. Dysfunctional dynamics. And I left out the word work because, again, this can be everywhere. And people who experience the most burnout often have these issues not only at work, but also at home. So dysfunctional dynamics would be being in relationships or being in environments where there is a lack of assertive communication. It's either aggressive or passive or passive aggressive, but definitely not assertive, and that can be really problematic. Or being in environments where people are lying and manipulating, and you can kind of look at that as aggressive behavior. So enhance your boundaries. It's really important to learn how to develop and maintain those boundaries. Your mind, your body, is your house, and you can choose who you let into your house, how long you let them stay, if you let them stay, and exactly where, where you allow them to go in your house. Some people you're just going to let in the foyer. You know, you're going to keep it on a really superficial level. Other people you may let all the way in, your best friend probably has a key and free roam of your house and they take care of your house when you're on vacation. You wouldn't do that with a stranger. So setting those boundaries and yes, there's a video on setting and maintaining boundaries on the YouTube channel. Lack of support can also contribute to burnout. We are not meant to handle the weight of the world by ourself. We are meant to synergize with other people. None of us has all the tools or all the answers. So support can be practical support. Somebody helping you move or cleaning the house so you don't have to, you know, sharing the chores. It can be emotional support and it can be knowledge support. Maybe they have a skill that you don't have. We had the, the freezer and the furnace break down this weekend at the house and those are not my skills, not my skill set. Now could I go to go onto YouTube and prior to probably figure out how to do it? Yes, probably. But my husband is much better at those things and he was able to diagnose what was going on and figure out how to address it. So that goes with cognitive, practical support maybe, but also sort of emotional support because he's like, you know what? You've already got enough that you're stressed about. Let me handle this. I got this. Don't worry about it. Nurture those relationships that can provide support. Figure out, you know, who they are. Who in your life is supportive of you emotionally. Who in your life is supportive, supportive of you practically, and how can you nurture those relationships? Lack of reward is another cause of burnout. When you keep doing stuff and you keep giving your all and you keep, you know, hoping you're going to achieve the goal and either the goal posts keep moving or you cross the finish line and there's just, there's no reward. And that contributes to what behaviorists call extinction burst and behavior strain. But the rest of us often call it burnout and lack of motivation if we keep doing something. You went to school to learn how to do whatever it is, and you get into your job and with all these idealistic expectations and three years in, you realize, this ain't as rosy as I expected it to be. Then you may be experiencing a lack of rewards. So you may have to put some rewards in there. What can you do? In what ways is continuing to do this rewarding? Continuing to go to your job? Look at the bigger picture. A lot of times we focus on the bad things and the failures instead of the good things. I encourage my supervisees and I do it as well to keep a journal. Not with names, obviously, you know, not with any protected health information, but noting each case that they have so they can go back and they can see their successes in addition to the ones that didn't go so well and they can see where they actually have helped people, not just the ones that didn't go right. So it's important to embrace those dialectics. Recognize you're never going to do everything perfectly. There's never going to be a situation or almost never going to be a situation where you're getting a reward every single time. So embracing those dialectics, really embrace the successes and maybe even look at the failures as opportunities to learn. How can I grow from this and turn this into a lesson if not a future success? Excessive workload is another cause of burnout. You may get into situations. At the place I used to work, they called it podos. They actually developed a mnemonic for it, performing other duties as assigned podos. And that usually ended up being like 80% of your job. And the other 20% was what they told you about. And that could get exhausting. This excessive workload, it kind of goes back up to unclear expectations because, you know, all of a sudden you're getting these curve balls thrown at you. It's essential to develop time management skills. And excessive workload can happen everywhere, not just at work, but also in life. You know, you can get overwhelmed and burned out. Going to work every day, trying to fight the good fight. You come home, you've got a toddler running around, refusing to get into the bathtub. You've got your five year old who doesn't want to eat whatever you cook for dinner. You've got, you know, whatever going on. There's just kind of chaos in a variety of different places. And it's important to manage your time and step back and go, okay, what has to get done? You know, if little Johnny doesn't get a bath tonight, is the world going to end? No, you know, ideally gets a bath tomorrow night, but if it doesn't happen tonight, okay, you know, maybe you had to work late, you picked him up, you got, instead of cooking dinner, you got takeout and then you spent some Quality family time. Then it was time for bed. And you know, you, you made the decision, the time management decision. Do I want to try to squeeze in a bath that I know is going to be challenging because little Johnny's already tired, or do I want to just let it pass for tonight? Time management. Make a list of the things that you think you have to do. Just make a list of all of them. Then go back through and cross out any that you don't have to get done this week. If it's not going to be a crisis, it doesn't have to be done this week. Cross it out, anything that's left. Figure out ways that you can simplify it. Maybe making casseroles instead of making a five course meal, or getting takeout instead of cooking every single night. And then prioritize of the things that are left. You know, prioritize, figure out how it's going to get done and look to see, go back to that support. How can I delegate some of these things? Is there anybody in my life that can help me out with this? We only have so many hours in the day and you need time to breathe, you need time to decompress, you need time to sleep. If you're not getting adequate quality sleep, it's going to contribute to burnout. Going along with this, kind of somewhat related, is what I call the tsunami of life. And when I was younger, my mother used to say the bad things happen in threes. And I've heard that over and over again. And unfortunately that doesn't necessarily always seem to hold true. Sometimes you keep getting stuff even after you've hit three. You get four, five and six. And it's just like, when will it stop? And you can feel exhausted and overwhelmed. That's when support is really helpful. That's when time management is helpful, when all of a sudden life is just pouring down on you. Some things may have to go. And being willing to say for my own sanity and mental health, I am going to recognize how much more energy and effort life is taking right now because of all of this strange stuff that's going on. And I will get back to normal at some point, but during this period, I'm going to be compassionate with myself. A lot of us have a life tsunami around the holidays. You know, we're juggling finances, trying to figure out how to buy presents, trying to figure out whose house we're going to visit for what holiday. And you know, there's lots of stuff and holiday parties that we're expected to go to. But life Tsunamis happen during other times. Being compassionate with yourself during this time so you don't drown in the tsunami is really important. And finally, last but not least, unresolved trauma. And you might be going, how does that cause burnout? Well, unresolved trauma means your amygdala is on high alert, means you're hypervigilant, you're kind of scanning because you don't feel safe, you don't feel empowered. And there are these triggers, and they may be sights, smell, sounds, times of day, whatever that may make you remember or have a feeling like that trauma is happening again. A lot of times we remember our traumas through bodily reactions, not necessarily memories. So you have that sinking feeling in the pit of your stomach, or you have that stress response, and that can be the result of unresolved trauma. And people with CPTSD often struggle with this a lot because life itself is exhausting and can lead to burnout for them, because everywhere they look, there's something that's triggering an intrusive memory. So it's important to, to explore ways to resolve that trauma, whether it's through counseling, cognitive behavioral therapy, emdr, whatever method or process that works for you. Getting to the point where you can be in environments and those trauma memories aren't being triggered, your HPA axis is not being triggered is really important to, to helping you prevent burnout. Burnout means ultimately your body has kind of fizzled out. Loss of energy. When we talk about the stress response, we talk about fight, flee, fawn, you know, try whatever. It is. Just, you know, I will do whatever I can. Just make the stressor stop, flight, fight, flee, fawn, freeze, and forget about it. And burnout is forget about it. You just, you don't have energy. Things that you would normally care about. You just, you don't even have energy to care about at this point. You're exhausted, you're feeling depressed, you may be feeling guilty because you feel exhausted, and you can't do the things that you want to do. Burnout is a common phenomenon that is too often minimized until it becomes like, officially major depression. Burnout involves dysregulation of the HPA axis. It can lead to clinical depression, guilt, health, and relationship issues. When our HPA axis gets dysregulated, when we start experiencing this much chronic stress, and it increases inflammation, it increases pain, it increases your risk for cardiovascular disease and cancer and diabetes. So there are health consequences to also generally triggers autoimmune issues. Burnout can be addressed to an extent, but sometimes change is needed. If you are in a totally dysfunctional environment, you may not be able to do enough boundary setting where it is functional. It's important to recognize when you need a change, when you need to say, this is this just I can't. I'm not going to be able to make this a safe and empowering environment. Recovery from burnout is a lot like trying to recover from a sprint, but by jogging it takes a while. You know, if you go out and you sprint 400 yards and then you slow down to a really slow walk, your heart rate just really quickly decelerates. But if you go out and you sprint for 400 yards and then you slow down to a jog, you know, it takes a lot longer to recover. When you're trying to go on with life, you can't just take two weeks and go to Tahiti or something. That's that jog. You're having to use a certain amount of energy while you're also trying to conserve energy at the same time. Be compassionate with yourself, use good time management and figure out what is it that's important for me to invest my energy in. What is it in my life that I have the power to control and I want to invest my energy in. I hope this has been helpful. I'll see you next time.