Healing and preventing burnout by creating conditions for health
The daily, grinding stress so often experienced by people in the helping professions is what causes the psychological injury we know as burnout. Burnout is a state of depletion – mental, emotional, and physical exhaustion – that leaves us feeling drained and overwhelmed, unable to meet the constant demands that created the problem in the first place. Like any other injury, burnout is best prevented. The good self-care that helps us heal from psychological injury also helps us prevent it.
Healing is an inside job. Create the right conditions and healing happens from the inside out. If I cut my finger, I don’t have to tell my skin cells how to knit themselves back together and I don’t have to tell my immune system to send infection-fighting cells to the scene. The body is wise. It knows what to do. What I do have to do is to create and maintain conditions for healing – keep the area clean and protected, for example, maybe get professional help in the form of a few stitches if the wound is deep. Perhaps I need a special diet or medicine or physical therapy. Whatever the necessary conditions, to help myself heal, I must put them in place and maintain them for however long it takes-maybe a few days, maybe forever, depending on the injury. Mind and spirit heal similarly. Create the right conditions for healing and you will heal. Maintain these conditions and you will stay well. Yes, there may be scars. Sure, there are things we don’t foresee or can’t control. We have setbacks. Stuff happens. That’s life. But the principle holds. We create conditions for healing and wellness by taking good care of ourselves.
Condition One: Safety first.
“First do no harm” is doctor rule number one, the first part of the oath I took at my medical school graduation. Without basic safety, nothing good happens. If I bruise my arm, it won’t heal if I keep banging on it. Psychological injuries, too, only heal in safety. You need a sense of sanctuary when you’re burnt out, and there’s no sanctuary without safety. Creating and maintaining safe physical, mental, and spiritual spaces for yourself is a top priority. Healthy routines are essential-regular times for waking up, sleep, exercise, meals, etc. Good self-care says NO to both internal predators (e.g., negative self-talk) and external ones (people who disrespect or abuse you). This might mean limiting your contact with certain people, places, or things. It might mean being more assertive or substituting healthy behaviors for unhealthy ones. Self-protection can take many forms. For example, I run a near-total media blackout in my personal life when I feel burnt out and I’m careful to take regular breaks and vacations. These things help me stay open and responsive to my patients and to the people in my life, which helps keep me emotionally safe.
Condition Two: Get grounded.
High stress, overwork, and burnout sometimes result in a kind of mental checking out we sometimes call brain fog. The technical term is dissociation. Your thinking self, the part that knows you’re miserable or in danger, disconnects from your action self, the part in charge of what you do. Your feeling self shuts down and you get a little emotional anesthesia, but it’s temporary. When the brain fog clears, you haven’t fixed anything so you return to the same problems, or worse, and you may end up feeling worse than you did before. In dissociation, we can’t think clearly enough to do what we need to do to protect and take care of ourselves. We’re not in touch with real feelings so we can’t use to guide our actions. When body, mind, and spirit aren’t on the same page, everyday life is hard. Our minds try to protect us but staying dissociated is costly. We can’t afford to live there long-term.
Being grounded is a condition for health. Getting grounded is an antidote for dissociation. Grounding connects you with real, healthy things in your real, current life, which helps you feel steady and present. When you find yourself getting lost in your head, you need simple, immediate strategies. That isn’t the time for anything complicated, so it’s helpful to practice before you get to that point. When you start feeling checked out, slow down and simplify. Drive the speed limit and wear your seatbelt. Maintain healthy routines. Avoid drugs, alcohol, and excessive television or computer use, which increases dissociation. When your stress level rises, try a simple breathing exercise: Breathe in slowly through your nose, as if you’re about to sing or shout, allowing your lower abdomen to rise and imagining yourself taking in peace with your breath. Hold for a second, then breathe out slowly through your nose, make a quiet, continuous breath sound in your throat, like the “ocean” sound you hear when you put a seashell to your ear. Repeat as needed!
Other grounding strategies:
- Put a piece of ice in your mouth and focus on the sensations-cold, smooth, sharp, etc.
- Light a candle and focus on the flame-the flicker, the scent, the way the light changes.
- Hold a marble or a rock in your hand and concentrate on its contours, the feel of it, how it looks.
- Take a slow, quiet “noticing” walk. Focus on colors, wind, sky, earth, scents, etc.
- Do some gentle stretches or take a yoga class.
- Garden, pray, paint, cook, color, draw, make something, or listen to music.
Condition Three: Take care of the basics.
Once safe and grounded, you need comfort and nourishment. Eat simple, nutritious meals. Drink plenty of water. Postpone major projects if you can and get plenty of rest. Go outside, focus your eyes on the horizon, and feel your spirit lift. The little things are the big things. Taking care of the basics sends a message of calming normalcy in times of trouble.
Overworked, burnt-out people often struggle with a basic life skill I call pacing. A pace can be a step, the length of a step, or the speed of stepping. Pacing yourself in everyday life lets you meet its demands without hurting yourself. To live healthfully in the moment means that you watch where you’re going and pay attention to how you’re getting there-how much, how fast, how far, how many, how often, etc. We need rest and exercise, treats and discipline, time with others and time to ourselves, responsibility and freedom, the capacity to commit and to let go. The life pace you need in order to stay healthy and well is unique to you and may vary in accordance with what’s happening in your life. For example, if you’re grieving a big loss, you need to be gentle with yourself, maybe slow the pace, and focus on quiet, comforting things. If you’re angry or stressed, maybe you need to pick up the pace, perhaps exercise vigorously to release tension. If you’re anxious or depressed, an easy-going walk in a pretty place might be best – to help you keep moving and remind you that the world is bigger than that one moment.
Condition Four: Feel, name, accept, and express your real feelings.
In order to heal, you need to be able to address your emotions properly, which means to identify, acknowledge without judgment, validate, and express whatever your real feelings are, without harm to self or others. You must face and feel what troubles you before you can move on. You don’t say to your crying child, “Shut up. That doesn’t hurt. You’re not hungry. I can’t believe you’re such a baby.” If you wouldn’t say it to your child, don’t say it to yourself.
Trying to push away emotional realities is pointless. Even if you manage it momentarily, the feelings don’t go away. They go underground and make you depressed, anxious, or irritable, or they come out sideways at yourself or others. Catharsis–getting your feelings out of your head and into the open by talking to someone-often brings relief and greater clarity, which improves problem solving. Journaling is proven to be helpful as well. Writing accesses different parts of your brain and improves focus. You can ask yourself, “What do I feel right now?” and not worry about the reactions of others. Here’s a little pacing work sneaking into the feeling stuff: Slowing down allows you to feel your real feelings more easily. Take a little time, and if you need to cry, cry. If you’re mad, be mad directly, safely, and with an awareness of the real cause. Dealing with strong feelings in a healthy way is self-respectful and validating.
Condition Five: Gather together.
Be with people you love. Detachment and isolation are risky, especially if you’re getting burnt out. Take the solitary time you need to breathe and get grounded, of course, but also stay open and connected with safe people in your life.
Condition Six: Manage anger.
Where there are stress and burnout, there is often anger. Some people are more comfortable with anger than others, but it cannot be avoided in life and it’s important to be able to experience, recognize, and express it safely. Anger serves a purpose. It’s an energizing, signal emotion that can function somewhat like a warning light on your car-letting you know that something needs to be addressed. Pushing anger underground or trying to avoid it can cause depression. If it flies out unmanaged, you could hurt yourself or someone else. Sometimes people are surprised to learn that anger management programs are more about recognizing (sooner) and releasing (safely) anger than about suppressing it. Anger lives in the body, so some form of activity is generally the most efficient way to release it-vigorous exercise or ripping up old magazines, for example. You can also talk it out with someone or write it out in your journal or in an unsent letter. The important thing is to get it out, calm yourself, and clear your mind so that you can sort out what’s really going on and what you might need to do about it.
Condition Seven: Create psychologically clean conditions.
Creating psychologically clean conditions means establishing the conditions for healing and prevention outlined in this article. It also means not doing things that don’t work or are hurtful.
If you keep finding yourself in the same problematic situation or relationship over and over, you may be recreating an old painful experience or relationship in an attempt to master it in the present. Unfortunately, this doesn’t work. If nothing changes, nothing changes. If you keep doing the same thing-like chronically overworking-you will keep getting the same result, such as worsening burnout. We need our whole, real selves fully engaged-body, mind, and spirit – to deal with pain and problems appropriately. Healing from psychological injuries such as burnout or trauma requires attention to biology (physical health), psychology (mental and emotional health), and sociology (social, cultural, and relational environments and interactions). During my psychiatric training, the biopsychosocial model of healthcare was coming to the forefront. The spiritual element didn’t get much airtime, which brings us to Condition Eight.
Condition Eight: Tend to your spirit.
Body, mind, and spirit make up a whole, healthy person. We describe a happy person as being “in good spirits” for a reason. Religion has its detractors, but religion and spirituality are not the same thing, and the spiritual part of the self is different from either of those. I like what Duke Ellington once said about music, “If it sounds good, it is good.” If what we do when we develop our spiritual selves is good and helpful, then it’s good and helpful. The sheer tenacity and power of healthy spiritual experience in human life says something about our need for it. It has been used in dark ways, yes, but it can also be a potent solace, inspiration, and source of strength. Electricity can be dangerous, but we don’t stop using it, right? If you have a formal spiritual practice that helps you, use it. Meditate or pray. Sing. Write your own prayer for healing and health. Meditative prayer connects powerfully to our sense of something larger than ourselves, a force beyond the everyday. If you don’t have a formal practice, that’s fine, too. Spend a quiet moment and a few deep breaths to consider the meaning of your life in a larger context. Are you living in accord with your beliefs and priorities?
Creative work is a spiritual act, to my mind-both a manifestation of health and a way of getting there. The first art known to humankind (cave paintings in France) was related to spirituality. Spiritual practice and creative work fill a need most of us seem to have as members of the human tribe. Write a poem, paint a picture, sing a song. Listen to music, look at art, or take a walk specifically to admire the loveliness of our miraculous world. Though it may seem odd, spiritual and creative practice can be quite grounding, especially in traumatic situations. Remember the outpouring of prayer, church, songs, and creative work in every genre in the wake of 9/11? That’s us at our best-human beings joining together, doing what we do to deal with pain. Find that part of yourself and use it.
Condition Nine: Give it time.
There are stages of grief, stages of psychotherapy, and stages of healing. Everyone is a little different and it takes however long it takes. Go gently, pace yourself, and don’t try to rush the process. Nurture yourself and those you love. Help others. Let others help you. Find your center and balance your life. The opposite of burnout or any other psychological injury is living with authenticity, self-respect, and purpose.
Condition Ten: Get professional help if you need it.
If you have serious symptoms of depression, anxiety, addiction, trauma, or unfinished business with your past, please consider professional help. The pain will remain until you work it through to whatever resolution you need. Some things are just too hard to do by yourself. Getting help is the smart thing to do.
By Deborah Gross, MD. From Jackson, MS, Dr. Gross is a Life Fellow in the American Psychiatric Association, a Diplomate in the American Board of Addiction Medicine, and a Fellow in the American Society of Addiction Medicine. This article was adapted from the author’s forthcoming book, 90 Ways in 90 Days: A Personal Workshop for Women with Disordered Eating and was printed in the October 30 issue of the Professionals Health Network newsletter.
Posted November 6, 2020