Signs and Causes of Burnout and Secondary Trauma

Hey there everybody, and welcome to this presentation on mindfulness and self care to prevent burnout and secondary traumatic stress. I'm your host, Dr. Donnelly Snipes. In this video, we're going to talk about why it's important to examine burnout and trauma. Together we'll define burnout and trauma and explore who's at risk. Then we'll identify signs of and contributors to burnout, explore the relationship between burnout and primary and secondary trauma, and then explore techniques for the prevention of burnout and traumatic injury. We examine burnout and secondary traumatic stress as well as traumatic stress together because they can impact each other. Burnout impacts the way people feel about their jobs and their purpose in their jobs and can stem from feeling unsafe and powerless and at work. So when we talk about burnout prone environments, that is one of the overarching characteristics of the work environment is the person feels a sense of powerlessness and as a result a sense of a lack of safety. Trauma, on the other hand, impacts the way people feel about themselves and the world. So it's more global as a result of a traumatic event that contributes to them feeling unsafe and powerless. So here again we have people feeling unsafe and powerless. And guess what? The interventions are going to be designed to help people start feeling more safe and empowered, recognizing what they can and cannot control. People who are burned out are more susceptible to traumatic injury. When people are burned out, their HPA axis is disregulated, which means their stress response system is not reacting the way it is supposed to. When that happens, people are more susceptible to traumatic injury. They're more susceptible to when other stress is piled on. People who've experienced trauma are more susceptible to burnout. When people have experienced trauma and have not completely resolved contributes to that HPA axis staying activated. They feel unsafe and disempowered, so they're more hypervigilant, they're more on edge, they're more aware of what's going on because they don't feel safe. What that means is they're basically primed. And when more stress comes their way, when they end up in environments that compound their feeling of unsafeness and disempowerment, guess what? They're more likely to develop burnout. Now, burnout is real. It's not just a term we throw around. The ICD 11, which is a diagnostic manual that's used by the World Health Organization has burnout as code QD85. So for those of you who need to see it in a diagnostic manual to feel like it's a Legit diagnosis. Well, there you go. The ICD 11 defines burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed. Some people can work in burnout prone environments and not become burned out. It doesn't bother them. But other people have difficulty managing that stress for one or more reasons. Burnout should not be applied to experiences in other areas of life. And it's characterized by three dimensions. So someone who's burned out has feelings of energy depletion or exhaustion most of the time, not just at work. Increase mental distance from one's job, or feelings of negativity or cynicism related to one's job going to work, and you just don't even feel like you care about being there anymore. Or you get there and you're like, what's the point? Nothing I do helps. And finally, a sense of ineffectiveness and a lack of accomplishment. You got into the field with these dreams and ideas of what you'd accomplish. And people who become burned out, those dreams and ideas are getting squelched and fading to the background. So they're like, what's the point? What am I accomplishing here? I am curious and there isn't a lot of research out there about how this changes for people who work at home. They and, and what I. When I'm saying work at home, I'm not talking about people whose primary duty is homemaking and parenting and doing that kind of stuff. That's a job, no doubt. But what I'm talking about is somebody who has an office in their house and their families around them. So does that qualify as a workplace or since it doesn't directly relate to their job, maybe they're a newscaster and obviously their family doesn't affect whether what stories they're covering. But since it is tangential, since it is connected to where they work, I'm wondering how that impacts burnout. But that's somebody's dissertation somewhere. Trauma, burnout and PACER disregulation all kind of go hand in hand. And PACER stands for physical activity, affective, cognitive, environmental and relational. So let's look at that for a second. When people experience trauma or burnout, they may develop a state of HPA axis dysregulation. With trauma, it may or may not happen. With burnout, we definitely have that HPA axis or that stress response system, dysregulation, HPA disposal. HPA axis dysregulation is what results when chronic stress leads to what we call glucocorticoid resistance or tolerance to the Stress hormones. And this can in turn lead to pacer dysregulation. And the analogy I like to use for this is the door knock analogy. Think about if you're in an environment that for some reason, people are knocking on your door a lot. Initially, when people come by, they knock, you answer and, you know, handle whatever it is. But at a certain point, if people are constantly coming by and knocking on your door and interrupting you, you may start ignoring it. You're like, I got other stuff to do. I can't handle this right now. You're just, you're. You're overwhelming me. You're bothering me. So you start becoming resistant to open, opening the door. You start becoming tolerant to people's knocking. You're like, yeah, I don't even hear that anymore. So what happens if somebody needs you to open the door? They knock. You don't even pay attention. They knock louder. You're still not paying attention. They start banging on the door. Oh, okay. You open the door. And that's what happens with glucocorticoid resistance, or tolerance is the receptors don't respond to the typical amount of stress hormones anymore. Those stress hormones come and they knock at the door. And the receptors like, I ain't opening the door for you now. I just. I'm going to tune you out. So in order to get those stress hormones to activate the stress response system, there has to be a lot of them. So they go from being flat, you know, know, not responding to much of anything to requiring a tsunami of stress hormones in order to get those receptors to activate. The other analogy is alcohol. And, and a lot of people are familiar with this. When you first start drinking, you can drink a little bit and, and get a buzz. Once you've been drinking for a while, you know, over months or years, you may start developing a tolerance to it. So it requires more alcohol to get you the same effect. So same thing is true with your stress hormones. When your tissues are regularly exposed to that hormone, eventually they, they start tuning it out. They don't respond to it until greater amounts are there. What are the signs of burnout? We already talked about the three major signs of burnout. The sense of exhaustion, the sense of detachment, and the sense of a lack of accomplishment. But there are a lot of other more insidious, if you will, signs of burnout, physical and emotional exhaustion. All right, we got that one. Sleep changes. People who are burned out may be exhausted. So they're in bed a lot, but they're not getting good quality sleep or they May have insomnia, they dread going to work the next day, or they're stressed out about everything that's going on at work that keeps them up at night. Either way, we've got sleep changes, which also means circadian rhythm changes. Both of those are stressors on the body. Both of those are going to contribute to HPA axis dysregulation. It's important when we're working with people who are starting to display signs of burnout or any of these signs, even if they're not directly related to burnout, that we address them. We don't wait until the person's burned out. We don't wait till the person's got CPTSD or ptsd. We start seeing dysregulation in their functioning. And we make sure that we provide tools and information, so information about the importance of circadian rhythms, information about sleep hygiene, information about tools that people can use to quiet their mind so they can go to sleep at night. And some of that may be journaling before they go to bed, mindfulness of what their stressors are, journaling it, getting it out on paper so then they can lay down that night. Thought stopping, guided imagery, meditation. There are a lot of things that people can use, and not everybody is going to find each one of those things helpful. But it's important that we help people recognize that they are far more susceptible to trauma, illness and burnout if they their circadian rhythms are out of whack. And if they're exhausted, impaired concentration or memory. Well, guess what? When people are stressed out, when that HPA axis is dysregulated, the hormones and neurotransmitters that are responsible for helping people concentrate and remember things are generally out of whack as well. Your norepinephrine, your dopamine tend to be out of whack. Additionally, if people are stressed out, if they're feeling unsafe and disempowered, they are at least partially in fight or flight mode. So think about it sort of on, on a, on a scale where red alert, there's a threat there and you need to do something to get the heck out of there to survive. Yellow alert, you're feeling really edgy and you don't know if something's going to happen or not. So you've got to be on, on your toes. But there's not necessarily a threat. So think, if you think of weather, red alert is a warning. Yellow alerts, a watch, and then green, you feel safe, you feel empowered, you feel calm. Well, people who are Experiencing early signs of burnout or trauma are often going to be in yellow alert. They're stressed out, they're stressed out when they wake up, they're stressed out when they're at work, they stressed out when they go to bed. And when you're stressed out, you're in fight, fight or flight. To a greater or lesser degree. The further you are down that scale, the further you are towards that red alert, the more difficult concentration and memory are going to become and the more emphasis your body is placing on fight or flee for survival. Helping people recognize what may be contributing to their concentration or memory impairments and helping them develop supports to get them through until they those things improve. So your executive functioning tasks, writing lists, eliminating distractions, those are two things that you can do in order to help people who are struggling with with memory and concentration. Physical symptoms like heart palpitations or high blood pressure can be related to burnout and panic attacks as well. So it's important to recognize that the anxiety builds. The stress from feeling powerless and and unsafe increases that sense of fear, which is fight or flight. And people can start developing panic attacks and heart palpitations. We need to help them recognize what contributes to those, what vulnerabilities contribute to those. Too much caffeine, for example, can increase the risk of heart palpitations, increased blood pressure. People who let their blood sugar get too low can actually have heart palpitations and increases in blood sugar. And because their body says hey, blood sugar's too low. So the stress response system, HPA axis, goes into high, high alert. It says we don't have enough fuel and causes the body to dump blood sugar. So during that, you know, initially the person starts feeling shaky as the blood sugar goes down. And then their stress response system kicks off and they start feeling, they may start feeling more panicky, if you will. Appetite changes are common in burnout. Some people will eat to self soothe. Some people will have no appetite at all. We want to examine that, encouraging people to notice their nutritional intake and do what they need to do in order to get the nutrients their body needs in order to make the hormones and neurotransmitters and stuff necessary to rebuild and sustain their nervous system. Increased illness. We know that increased stress leads to increased illness, increased stress leads to increased inflammation. HPA axis dysregulation leads to increased inflammation and increased inflammation leads to increased illness or is correlated with. So it's important to recognize that as employees, if we're talking about burnout, which is a work environment, as employees start to get burned out, they are going to experience more illnesses, more days away from work. Depersonalization is another sign of burnout. You don't even feel like you're in your own body. You're kind of numb and just going through the motions at whatever you're doing. Increases in depression, anxiety and disregulation. It's important that we help people become much more mindful of their mood and of their cognitive needs in a particular moment. Help them develop the ability to be aware in the moment of how they feel and what they need. And then implement distress tolerance, coping skills and problem solving skills as appropriate. An absence of positive emotions. So sometimes people who are burned out, they feel, but the only thing they feel is anger or anxiety. They don't feel happiness, they don't feel curiosity. It's just they're either in fight or flee, fight or flee, fight or flee. Or they may get to the point that the HPA axis is so dysregulated that they can't feel anything. They're just numb. And that kind of goes towards that depersonalization. They don't feel happy, they don't feel sad, they don't feel angry. They just don't feel anything unless there's something huge. Remember we talked about that door knock? Unless the stress hormones come and mass and start knocking on that door in order to activate the stress response system, there can be cynicism and disillusionment and moral injury. And those aren't all the same thing, but they're, they're very closely related. People start envisioning whatever they're doing as being purposeless, if you will. They become disillusioned. They got into the field for a reason or they got took this job for a reason. And it's not meeting those goals. And it doesn't seem like there's any hope that it will meet those goals. And moral injury contributes to that cynicism and disillusionment. When leaders under undermine people, when they don't have your back, when they give contradictory information, or when they tell you to do things that go against your moral values, that can contribute to burnout. And this is seen more in, for example, soldiers and law enforcement and emergency services than in some other occupations where that moral injury is seen more often in those. But it is important to recognize the impact of having to do things that you don't think are right, but you got to do them in order to keep your job. A lack of patience, very common. If you're in fight or flight. It's hard to be Patient say, okay, let's look at this. You just want to make it go away. You want to make it stop. A lack of resilience. Everything's a crisis. When something happens, it's just like you're already stressed out to your max. One more thing happens. It doesn't matter how small it is, it's the straw that broke the camel's back. And you're just like, I can't take it. I just can't take it. Relationship deterioration. Well, when you start becoming negative, pessimistic, exhausted, having difficulty with your memory and your concentration, and be becoming more depressed at anxious and emotionally dysregulating, you don't have a lot of energy to spend around people. And the people around you may not understand what's going on with you. They're seeing this metamorphosis right before their eyes, but they're not sure where it's coming from or exactly what's going on. So the relationships start to deteriorate. The person with burnout feels like the people around them don't understand, don't support them, you know, don't get it. And the people around them feel like the person with burnout is just magically changing. They're like, I, I don't know what's going on with you. I don't see the problem the same way you do, and, or I'm not understanding the impact it's having on you. So there's a communication breakdown that happens a lot. But there's also, like I said, the person with burnout just doesn't have the energy to socialize. A lot of times you may see substance abuse and foregoing important personal activities. That could be going to the gym, going, going to your kids recital, going to family reunions. Anything that requires energy above and beyond your basic activities of daily living may be too much for somebody who's burned out. They're just. And even sometimes basic activities of daily living like showering may go to the wayside. Burnout versus ptsd. Now I said, we're going to look at them together. In ptsd, the person was exposed, exposed to death, threatened death, actual or threatened, serious injury or violence in the following ways, either through direct exposure, you know, it happened to them, witnessing the trauma, learning that a relative or close friend was exposed to a trauma, so not even seeing it, just hearing about it, or indirect exposure to aversive details of the trauma. Usually in the course of professional duties like first responders or medics. I wouldn't, I. I encourage people not to get terribly hung up on. Well, does this meet the criteria of a traumatic experience? If you experience it as traumatic, all right, let's start addressing it. Let's not try to ignore it or minimize it. Complex post traumatic stress disorder may develop after exposure to an event or series of events of an extremely threatening or horrific nature, most commonly, which means not always, but most commonly, prolonged or repetitive, from which escape is difficult or impossible. In order to qualify for complex ptsd, all the diagnostic criteria for PTSD must be met. There must be severe and persistent problems in affect regulation. So you start to see that dysregulation. Because the HPA axis has been, you know, on for so long, beliefs about oneself is diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event. Now remember, with burnout, it specifically has to do with feeling defeated or worthless in your ability to accomplish your goals in your job, not life itself. But. But some people may start extrapolating and we'll talk about that and difficulties in sustaining relationships and feeling close to others. So we see a lot of overlap between ptsd, CPTSD and burnout. It's important to recognize, as I stated earlier, people can have both. They can have burnout and they can have ptsd. Matter of fact, if they have one, they're more likely to develop the other. Therefore, we need to do our best to screen for and prevent and provide early intervention for signs and symptoms of burnout or trauma in our workplaces. Burnout and trauma exposure happen in three concentric circles. And I thought this was really interesting. And you can think of it in terms of violence or illness or natural disasters. We've had all three recently, so you can probably apply it. The inner circle, the smallest circle, contains those who are directly injured or experiencing symptoms and traumatic treatment. So this is the patient or the victim. And if it's violence, you know it's the victim. If it is an illness, it may be somebody going through invasive surgeries or cancer treatments or something. The next larger circle contains those who are witnessing the suffering of patients or victims. So this is the significant others, the family members and the care and the service providers. People who are, are witnessing this. And that doesn't just mean the doctor or the nurse. This also means the housekeeping staff that comes in to empty the waste baskets and stuff. The person in the hospital is still there suffering, and their loved ones may be there suffering with them. And this person walks in and they're seeing this, and it can be traumatic. Now, the largest circle, which encompasses everybody, the largest circle would be those experiencing realistic or, or unrealistic fear of harm, social isolation or financial hardships. So this is sort of the community at large. The people who have, who, who know about the incident or know about what happened and they start becoming afraid, they start feeling unsafe in their, in their environments, wherever they are. People exposed to traumatic events are at greater risk of primary or vicarious trauma or burnout. If you are exposed to traumatic events and, and we need to define for ourselves what exposure is and because does that mean seeing it over and over and over again 24,7 on TV? Does that mean seeing it streaming live? Does that mean only seeing it in person? Remember, with PTSD you can hear about the event. So a attorney, a prosecuting attorney who hears the very graphic details, or even a defense attorney who hears the graphic details of a crime, they are hearing about it in the course of their job, which can cause trauma. Now if they feel like they're ineffective in their job, then we can also see the development of burnout. It is very common to see people present with both trauma and burnout. Trauma or burnout triage the 4s's similarity to the victim, patient or person served. If you can see yourself in that position and just think to yourself, oh, there, but by the grace of God go I, then it's something that you can empathize with. If you can see that happening to a family member, then you're at greater risk. And we see, for example, law enforcement officers who respond to the scene of a child drowning may be more impacted than if they have children, especially of a similar age to that child, than law enforcement officers who don't have kids. It doesn't mean that cops who don't have kids don't have a similar level of empathy. It just impacts them differently. Because your mind does really weird things and your mind may suddenly impose the image of your child there down at the bottom of the pool. And in order to tell you, I guess you know, you need to prevent this from happening to your kid. So the similarity to the victim can contribute to the likelihood that you are going to impact, experience more significant impact from the trauma or the environment. In a burnout environment, you're like working in a drug treatment center, for example. If you are somebody in recovery or if you have a family member who's in recovery and you're seeing people you're working with going out and relapsing repeatedly, then that may contribute to your sense of burnout. Number of stressors in the prior six months or, and this can include unresolved stressors that happened a long time ago that are continuing to drain your energy. Did it happen in your safe zone, which is an area where you're supposed to be able to prevent bad things from happening, whether it's your home or, for example, with doctors and counselors and teachers at work? You're supposed to be able to keep the people in your care safe. And if that doesn't happen, then it can feel more traumatic, there can be more guilt associated with it and the availability of social support, people who actually understand and get it. And we're going to talk about those a little bit more in depth, but just keep that in mind when you are in situations. What's their similarity? Prior stressors, safe zone and availability of supports, preferably within 24 hours of whatever the traumatic event was. Or when we're talking about burnout work environments, pretty consistently, is there a supervisor that the person can go decompress with who is at risk of burnout, secondary traumatic stress, or cptsd? Well, a lot of people, health care, your doctors or your counselors, all the way out to housekeeping. So they aren't directly, you know, talking to or doing things with the patient, but they may talk to them, you know, in passing as they're coming in to change bed sheets or empty. Empty garbage or clean the bathroom or whatever they're doing. I know at the facilities I worked at, the sanitation staff was always very chatty. You know, they were very friendly people, but they would also hear things from clients and they would see clients struggling and they would hurt for the clients. Emergency services. And this includes responders like cops and firefighters as well as the 911 call centers. People overlook the incredible amount of stress that 911 dispatchers experience on the daily vets and animal control. You may not think, well, you know, you're not very similar to a dog or to a horse or whatever. But for people who get into animal services, a lot of times they empathize with those animals. A lot of times they see animals as creatures with, who feel emotionally and physically and creatures who, whether you believe it or not, may have a soul. So there are a lot of similarities that we see, and a lot of us refer to our animals as part of the family. So. And most vets and animal control officers also have, guess what? Animals. So it's important to recognize that they see similarities there, and it hurts their heart. They got into the field in order to help animals have the highest quality of life. And that's not always what they see. Lawyers, teachers, students, these are all people who may see or experience either directly or indirectly traumatic events or feel the conditions of burnout. Burnout environments and for students, school is a work environment that is their job is to be at school. Caregivers, both relative and non relative, they're at risk of burnout, secondary traumatic stress and potentially ptsd. So you don't have to be a home care nurse. You can be a relative caregiver and experience burnout and secondary traumatic stress when it feels. Feels like nothing you do makes a difference. Retail food service, both of those have to deal with a lot of changing requirements, a lot of backlash. Some, you know, and I say here, think Master Chef. I've only seen a few snippets of that show, but I can't imagine working for that man. And, and so there's a lot of stress involved in those environments. But also engineers and performers, they are susceptible to burnout especially. And the ones that have the asterisk are more susceptible to all three. The ones without the asterisks at this point seem to be more susceptible to burnout, but not necessarily trauma work related. Contributors to burnout. You knew we'd get here. Excessive workload. Anybody who has more work than they can figure out how to do and they're expected to get it all done may start feeling overwhelmed and exhausted and frustrated at a, at a point in time. Now, excessive workload by itself, none of these things by themselves usually causes burnout. It's a culmination of factors. Emotionally draining work when you are a, and I didn't even include back there clergy if you're a pastor who's regularly doing hospital visits and last rights and those sorts of things, that can be emotionally exhausting. And even though you do it because you're called to help people in their time of need, it doesn't erase the fact that it is, it's exhausting. High volume of high risk or difficult cases. Those are the ones that have a high risk of failure. And that can, that can mean death, that can mean relapse, that can mean going to prison instead of like an innocent person going to prison instead of getting off or in the case of a prosecutor, a guilty person not getting convicted when they feel they should have similarity to victims. We already talked about that. Lack of work support and we're going to talk about the difference here because these come up again when we get to personal contributors to burnout. But if you don't have support for from your colleagues, if you don't have support from your supervisors, it can feel very scary. You can Feel like you're out there like a fish out of water, flapping on your own. A lack of work resources. If you don't have the tools you need to get the jobs done, then that can also contribute to burnout. A lack of work rewards. You do what you do partly because you're called to do it for some reason or another. Now, some people aren't in a career that they have a passion for. They're in a job because they need money to pay their rent. And if they're not, they're working their butt off and they still aren't making enough money to pay their rent. It's going to start feeling very demoralizing very quickly and very exhausting. And they may start developing symptoms of burnout. A lack of a sense of control, or say in the work environment, about your schedule, about your duties, about how you respond to things. If people feel like something's going on in their environment and they're not safe, whether they're being told to do things that are illegal or they're being told that they have no control over all of these OSHA violations and, you know, they just need to suck it up and deal with it or whatever it is. If they don't feel like they have a sense of control or say, over their safety, over their ability to achieve their goals in this job, then they're often going to feel unsafe and disempowered. Unclear or ever changing requirements, those goals. Constantly moving that goalpost at the end of the field, constantly moving, and that's exhausting. Your boss tells you, one day, this is what we got to do this week, and then the next day is like, yeah, no, let's, let's switch it over here. And you're like, well, which is it? You told me we had to get this done and. And then you're switching gears on me. I don't know what to expect. And that can be really difficult for those of us who are planners. Severe consequences of mistakes. Everybody makes mistakes. But if you're in an environment in which mistakes are extremely strongly punished, that can be traumatizing. Now, in some situations, like if you're a surgeon and you make a mistake and somebody dies, you know, that's, that's significant and there can be significant consequences. But a lot of times, you know, as long as it was, you're doing best practices and stuff, there's a root cause analysis. The chances of you be losing your license for a mistake is unlikely. It can be really unpleasant for a while, but it's unlikely. But There are in, in those situations, in those really high stress jobs, mistakes, failures can have pretty significant consequences. And that can make every move you make feel like a life or death option. Work life imbalance by choice or necessity. Work life imbalance by choice. That's the, the person who is what we'll call a workaholic for lack of a clinical term. They have enough stress in the rest of their life. They, they just, they want to be there or they want to try to get it perfect and do it right, even though perfection is not something that's probably achievable. Or work life imbalance by necessity and that goes to that. Excessive workload. Poor work person fit is another contributor to burnout temperaments. A big one. If you are somebody like me, who's a planner who likes to know what to expect, who does not react to spontaneity well at all, then being in an emergency room or emergency services or somewhere where you've got to be spontaneous most of the time is probably going to add a whole lot of stress. Likewise, if you're an environment, if you're a spontaneous person and you're in an environment that is mundane and routine, like working on an assembly line or even accounting or something, where you're doing the same thing day after day after day, it may feel, it may feel oppressive, it may be very stressful because you're like, why am I doing this? This is, this is awful. And poor work person fit because of a lack of adequate skills. Some people get into a job and they're kind of thrown in the deep end, as my boss used to say, and expected to figure out how to swim. And that contributes to burnout. People need to be trained. People need to feel confident and competent in doing what they're doing. And frequent schedule changes. We, we've talked a little bit already about how circadian rhythms are so incredibly important. And if somebody is on eight to four for three weeks and then all of a sudden their schedule switched and they're working midnight to 8am that is really hard on the body, really hard on other areas of their life, and contributes a lot to physical as well as mental ill health. Pacer contributors to burnout I already mentioned multiple times sleep and circadian rhythm disruption. Gotta make sure that we're helping people recognize the importance there. And I've got videos on all of the things on circadian rhythms and all of the things that the circadian rhythms have. Their grimy little mitts in pain is another thing. When people are in pain, their HPA axis is already activated, which means they are primed. They are more prone to be distressed by stressors in their environment. We need to help people figure out how to manage their pain. They may not be able to get rid of it, but what can they do to manage it? What triggers it? What are their vulnerabilities that contribute to them having more pain and helping them figure out how to live their highest quality, rich and meaningful life and have pain. Nutrition is essential to keep blood sugar up so you don't start getting shaky to as well as to provide the building blocks for making the neurotransmitters and everything necessary to be happy and healthy. Now that doesn't mean that somebody has to eat this like radically healthy Mediterranean diet all the time, but it's important that they do get the required nutrients, however that happens. And that's between them, their doctor and their dietitian and substance use. Substance use monkeys with the stress response system as well as the neurotransmitters creates inflammation in the body. It does a lot of bad things in the long run, even if in the short run it may help the person sort of numb out the distress. So the long term, long tail effects of substance use makes people more vulnerable to distress the following hours, days and weeks. Affectively, people who have mood disorders or ADHD are more at risk of burnout. Mood disorders, you know, if you're have high levels of anxiety, you're already primed and more susceptible to stressors that come your way. Depression, you may feel hopeless and helpless already. So when things come your way, you're like, I just, I don't have the gas, I don't have it in me. With adhd, the energy required for those executive functioning tasks and doing your job can be exhausting for people and, and so that can contribute to burnout. People with ADHD also often have difficulty with sensory gating. And that means it's difficult to fact filter out what's important to focus on and what is what is not important to focus on. So they're just constantly being bombarded and that's exhausting cognitively. People who tend to be perfectionists are more likely to get burned out because as I said, perfection is generally an illusion. People who have a lot of cognitive distortions like personalization and mind reading and jumping to conclusions and emotion based reasoning are often going to be more susceptible to, to distress and burnout. And those who have a pessimistic view of self and the world are more prone to burnout. And a lot of these things like pessimistic view of self and world, sleep disruption, changes in nutrition, substance use, mood disorders, those can accompany or be consequences of trauma. We need to look and say is there underlying trauma that also needs to be addressed? Or remember, burnout has to do with work. We can improve the work environment until the cows come home. But if the person has this underlying trauma, they are going to have a lot of difficulty recovering because that HPA axis is still just kind of spinning its wheels in the mud environmentally a person. Remember I said this was going to come up in the personal life too. A lack of resources in personal life, finances, support, whatever, a lack of rewards and rewarding experiences in personal life, a lack of a consent, sense of control or say in their personal life and a lack of safety. If you live, maybe you live in an environment where you're worried about drive by shootings. A lack of safety in their personal environment contributes to burnout. And I know earlier I said that burnout only has to do with work and that's true. But if you have somebody who's not sleeping well, who's in pain, who's poorly nourished, who isn't getting much pleasure from their, you know, home life, if you will, who is stressed out about stuff going on in their home life, it's going to be infinitely more difficult for them to deal with the stressors at work. They're already depleted, they're already exhausted. And relationally, a lack of support and secure attachment and a reluctance to delegate to other people, both are symptoms, can be symptoms of trauma, but both of those things are necessary in order to manage time and manage stress and recover from trauma or burnout. So it's important to help people identify, know when it comes to resources, what do they need and where can they get it, what services are available that can help them access the resources they need, how can they develop a sense of control or say in their personal life with whom or in what situations do they feel like they don't have that right now? And how can they start to feel more empowered and trauma related contributors to burnout and I know trauma is part of pacer, but trauma impacts every aspect of pacer, physical, affective, cognitive environment and relational. So people that have a currently what I call uncontrolled trauma history, they've got trauma that they haven't dealt with and it's still impacting them in the present. They're already feeling unsafe and disempowered pretty much 24,7. So they're going to be at greater risk of responding more strongly or being Negatively impacted by burnout work environments. People who have currently controlled trauma, that is, they experience trauma, they've processed it, they feel most of the time safe and empowered, well, that's great. But if they're triggered for some reason, if there's something going on at work that is triggering that trauma, that triggers a trauma memory for them, then it can contribute to them being more susceptible to burnout, stressors and secondary trauma. Even if a person hasn't had a primary trauma themselves, highly sensitive people have difficulty when they're surrounded by a lot of really stressed out, negative, pessimistic, burned out people. They have difficult difficulty maintaining those emotional boundaries. So they can start feeling burned out themselves just by being around burned out people. If you're working with patients or clients and they die or they relapse, that can contribute to burnout. That can cause secondary trauma. When you see that happening, that that can be cause PTSD or cptsd. And it can also contribute, can also contribute to feelings of burnout and purposelessness at work. And empathy and powerlessness can contribute to that secondary trauma. When you are empathizing with the person who's gone through this horrible experience and you know that there's nothing you could have done to prevent it, and then you start looking around and going, oh my gosh, how awful that is that one person could do that to another person, or how awful that is that, you know, a tornado could do that to a family. That can lead to a sense of powerlessness and secondary trauma. So let's talk about a few more interventions. Sleep and circadian rhythms. We already talked about nutrition. Focus on nutrients, blood sugar stabilization and hydration. Go easy on stimulants, manage pain and ideally encourage people to exercise. Low intensity exercise has been found to reduce cortisol levels as well as provide a whole bunch of other benefits and increase serotonin and other stuff. We're not talking about going out and running a marathon. We're talking about going out and walking the dog. Set smart goals for work. Specific, measurable, achievable, relevant and time limited. That means sit down with your supervisor or sit down with your employee if you are the supervisor and set very specific goals that this person can accomplish. They're not going to change, they're not going to move. So the person knows, this is what I've got to do and they're achievable and relevant to that person's purpose and mission in their occupation. Brainstorm ways to work smarter, not harder. Because sometimes regulations change and all of a sudden it seems like, you've got to do 20 times more work in order to get the same job done. Okay, well, how can we do this as efficiently as possible? Encourage people to practice the squeegee breath. And this is a little bit different than square breathing. And I really like this because I love squeegees. But I can envision, when I take that breath in, it's like raising the squeegee to the top of the window. And when I exhale that breath, it's like using that squeegee and squeegeeing, if that's a word, squeegeeing out all the stress out of my body. It's like, so I love that imagery. Take time to add in the positive on a daily basis. And if you're a supervisor, I encourage you to do this with your staff during the day. Encourage them to do something positive for themselves during the day, during their lunch break, whatever. It can be 30 seconds. It can be five minutes. It doesn't have to be, you know, 30 minutes or an hour, but something that makes them smile, something that makes them laugh each day. Identify three to five things that actually went well, that you were actually empowered to do, that you made progress on, that went well. Keep a scrapbook or journal of your positive experiences. And you're a clinician. No phi. You can also do, like, a perennial garden, where, if you're a gardener, where you plant a plant, a perennial comes back every year, and each plant represents a success that you've had, so you can start to see those successes multiply and grow and bloom. You can create ornaments, wind chimes, stepping stones, a Lego wall, or even black back splash tile on your wall and on each tile, write a little success or on each ornament. Or you can just journal if you're not not into gardening or arts and crafts. Use psychological flexibility. Think to yourself. To me, a rich and meaningful life is who is important in it? What is important in it? What things, experiences, thought, people, places, you know, all that. If you were living your rich and meaningful life, what would that be like? Once you've got that in your mind, ask yourself, is what I'm doing, thinking, or feeling right now helping me move toward those things? And if not, what can I do to improve the next moment? How can I adjust so I'm using my energy to address this situation or maybe just ignore it because there's nothing I can do to change it. But what can I do to use my energy more purposefully to help me move toward my rich and meaningful life? And that can include perspective taking, decision making. And sometimes it means making the decision to get a different job. Problem solving, observing what's going on, describing what's going on, exploring the different solutions and, and choosing one in order to address what's going on. Coping and emotion regulation. Maybe developing some more tools to add to your toolbox. Assertiveness. Sometimes improving the next moment means being assertive. Setting an appointment with your boss and going in and talking to him and going, look, this, this is what's going on. I, I need some clarity. Relaxation skills and cognitive restructuring. It's important to encourage people, to encourage people to identify the strengths and resources that they do have. They may not have all that they need, but in identifying the ones they do have, may help them feel less powerless, may help them feel a little bit more empowered. If you want to say it differently, developmental agility or the ability to look at situations from multiple perspectives and to think creatively and flexibly. One tool that I used to do this with my kids was to have them argue the other person's point of view. If they got into a disagreement. I'm like, okay, I want you to argue the other po person's point of view or if they had a difference of opinion about something. So, you know, early debate training. Practice mindfulness. How do you feel emotionally right now? Where's it coming from? How do you feel physically right now, and what does that mean to you? If you're feeling tired, if you're feeling, you know, pressure in your chest, if you're feeling tension in your muscles, what does that mean to you? What are your current thoughts and where are they coming from? Encourage people to be aware of their trauma triggers and, and address them if there are. If they know there are trauma triggers in their environment or there could be, what can they do to protect themselves as much as possible so they're not excessively triggered. You may not be able to prevent it completely, but so they're not excessively triggered. Develop resiliency, which happens with vulnerability prevention and mitigation. And we talk about vulnerabilities a lot on this channel. Things that make you more susceptible to reacting to stressors. Whether it is a lack of sleep or being in pain or getting in an argument with your significant other. Those can all make you more vulnerable to having difficulty coping with life on life's terms the rest of the day. Develop awareness of what you can and cannot control. Develop distress tolerance. So you start to realize that you can tolerate this distress. Just like the elephant on the beach ball, it can tolerate the weight of that elephant without popping it may not like it. I don't know how the beach ball feels, but it can tolerate it. Nurture optimism and hope. The things that you can be optimistic about. Yeah, there's going to be crappy things in life. You're not going to be toxically optimistic, but nurture that hope that things can get better, that you can move toward a rich and meaningful life, and that you can endure the moment. Practice gratitude and an optimistic explanatory style. And that means noticing and expecting the positive. Now again, that doesn't mean toxic positivity. If I do this, then everything's going to be fine. No, not necessarily. But noticing what you can do and expecting that if you do everything in your control, then the best possible outcome is going to occur. It may not be the one you want, it may not be the perfect outcome, but you expect that if you, if you put in the hard work that you're going to benefit from from it. Focusing on what you can control and taking purposeful action, which means using your energy to move towards what's important to you and focusing on character strengths. Using your top strengths to engage, authentically, overcome challenges and create a life aligned with your values. That means first figuring out what your character strengths are and how they help you do these things. You can describe why you got into the field and visualize that intention, whether it's to earn money, to help people, because you're an adrenaline junkie for status or power or whatever it is. And then you need to evaluate on a regular basis, is this helping me move toward my intentions? And if not, what would help me move toward that? Or is it even possible in this situation? Check that need for perfectionism and control. Recognizing that perfectionism is an illusion. All we can work toward is progress. And you can't control everything, no matter how much you would like to develop support at work and at home. So at work, your co workers, your peers, at least one supervisor, and then also at home. So when you get home, you've got somebody who can say, wow, it seems like you had a really bad day. What can I do to support you right now? Know and ask for what you need in terms of resources. And this is at home as well as at work. Create work, life balance, developing and nurturing relationships in both areas. Try to leave work at work. And that's why I have sorta, I mean, there's always that occasional thought, but don't bring a briefcase home full of work or bring all your troubles of the day home and talk about them all evening long. If you need 30 minutes to decompress when you get home, okay, that's fine. But then switch into home mode and take time for self care and relaxation. Limit your contact with negative people. Connect with a cause or a community group that's personally meaningful to you. Advocate for yourself and others with your supervisor or human resources. If you're in a burnout work environment, sometimes it means you need to stand up and say something and assertiveness, talking about whether you need more resources, more consistency, more transparency, an ability to admit mistakes. You need support and celebration of successes instead of just criticism. There need to be better boundaries like your boss not calling you at 10 o' clock at night and a sense of control over your job and or your schedule. Those are things that come up really frequently in burnout prone environments. Burnout work environments are a reality. Burnout does not have to be Burnout causes problems in health, mental health, relationships, the work environment and employee retention and the ability to provide good services. Developing resilience and identifying the sources and interventions for your burnout is important in not only addressing it once it happens, but hopefully you know, either preventing it from ever happening or preventing it from happening again.