In 2019 the WHO described burnout as “the syndrome that results from chronic workplace stress than has not been successfully managed.” You may have heard burnout also referred to as compassion fatigue, secondary trauma, or vicarious trauma, and it is estimated that it occurs in 50% of clinicians. This is a serious issue in the health care field, and for all helping professionals, that has been intensified during last year of the covid-19 pandemic. Today we are witnessing many new clinicians experiencing burnout before they have even been in the field for very long.
So what does burnout look like, and how can it be prevented?
Thank so so much to Chris Perez and Denver Wellness Digest for the interview!
Understanding Burnout with a Trauma Lens
Many people think about trauma as one large, impactful event. Complex trauma refers to multiple traumatic events that build up and have a compounding effect over time. These events maybe be big ones (Trauma with a capital “T”), or might be smaller ones that are not recognized immediately as trauma. This includes things like ongoing emotional abuse or gaslighting, microagressions, and high stress work environments. This slow build of stress over time can be harder to notice, but can have just as big of an impact as single event traumas, and can lead to Post Traumatic Stress Disorder. Clinician burnout can be viewed as a build up of complex trauma, a high level of stress that burns the candle at both ends until the system collapses. It can be hard to see it coming, so it’s important to keep an eye on signs and symptoms of burnout before it gets out of hand.
The Problem with “Pushing Through”
Many people have a tendency to push through stress, but this is based on the idea that the period of stress is brief and that rest can be enjoyed when the stressful event ends. This might work well if you are having one intense week, but when the stress is ongoing for weeks, months, and years, you can not wait for the “other side” to arrive before you rest a recuperate. “Pushing through” doesn’t work as a long term solution. There needs to be another approach.
Signs and Symptoms of Burnout
I encountered my first experience of burnout in the last semester of my masters degree when I was working and seeing clients as an intern therapist, writing my masters paper, and navigating the sudden onset of the covid-19 pandemic. It was an intense and overwhelming time, and it was my own therapist who pointed out to me that I was experiencing burnout. Realizing that this was true, I sat down and wrote a list of all the symptoms I was experiencing so that I would have it for future reference. This was my personal experience, but many of these items align with known burnout symptoms. Today, I use this list as a personal check-in tool to assess my level of stress and how well I’m coping.
- Feeling rushed
- Feeling irritable, annoyed, angry, impatient
- Hard to wake up in the morning and tired all day
- Hard to fall asleep at night due to racing thoughts
- Waking up in the night with anxiety
- Low sex drive and low desire for any physical touch
- Feeling more introverted than usual, socializing feels like too much
- Always tired, and unable to feel rested even after days off
- Not feeling excited about anything in my day, work or otherwise
- Low motivation
- Gratitude feeling challenging
- Low appetite
- Feeling queasy or sensitive in digestion
- Inability to exercise, both due to scheduling and low energy
- Collapsing, unable to do anything but watch Netflix all weekend
- Feeling very protective of my time and energy boundaries, irritated at people asking me to do small things
- Not keeping up with household chores
- Difficulty keeping in touch with friends and family
- Cancelling plans
- Crying at unexpected events and stressors
- Thinking about work first thing in the morning
- No emotional bandwidth for supporting friends and family, no capacity for being a support person outside of work
Preventing Burnout by Tuning-in to the Body
It’s vital to pay attention to our bodies and how our bodies are responding to stress. Cultivating self-awareness of both our physical health and how emotions, stress, and trauma are impacting the body helps us recognize signs of burnout sooner as well as gives as avenues to address it. Listening to our bodies can help us create supports on day-to-day, week-to-week, and year-to-year levels.
- Back to Basics: Never underestimate the significance of sleep quality, diet, and exercise.
- Movement: Moving the body is vital for releasing stress and tension that builds up in the muscles and tissues over time. My favorite modality to move and express my experience is dance, but there are many options. Any kind of movement will help move and transform the energy that you’re likely holding in throughout the day. Physical movement helps us transform and dissipate tension and release stuck sympathetic nervous system responses.
- And More Movement: Big chunks of exercise or longer movement practices are great, but don’t wait until the end of the day to move your body. Shift your weight in your chair and stretch your spine often. Roll your shoulders and other joints in the body. Stand and shake in between appointments. Frequent movement will help to release stress throughout the day before it builds up into chronic tension.
- Embedded Self-Care: Embedded self-care refers to self-care that happens in session, while you are working and while you are with clients or patients. You don’t have to wait for a break to take care of yourself. This might look like leaning back in your chair, grounding through your feet or your pelvis, mindfully noticing your senses, taking a drink of water, using a stress ball or fidget toy, or taking a deep breath. These are small but important ways to stay connected to yourself while you are serving others.
- Allow Emotional Impact: Helping professionals need to contain their own experience in order to care for their clients and patients, but it’s important to not completely cut off your own emotions. If a client’s experience impacts you, notice the sensation in the body, notice the emotion or the stress that is present, and acknowledge that internally for yourself before moving on. Feeling this and breathing with it in the moment will help you to metabolize the experience a little bit immediately rather than suppressing it, which can increase the compounding effect of these events over time. As much as is possible an appropriate, let the experience move through you rather than blocking it and trapping it inside. When you’re actively working, you may only be able to allow a small amount of space for this, and that’s ok. Feel what you feel, and then contain the rest for a later time when you can come back to it and process it more fully. The key here is that you have to come back! Create an intentional time, on your own or with a therapist, to return and process these impactful moments.
- Ground Yourself After An Emotional Experience: Intentionally use grounding and regulating practices during and after stressful and emotional events to help you rebalance your nervous system.
- Explore How Positive and Negative Mindsets Impact the Body: Cynicism, jadedness, and complaining can be signs of burnout that lead contagious downward spirals. Everyone has a negativity bias that makes it easier to focus on things that are difficult or not going well. However, focusing on successes and joys in the work is more likely to uplift you and keep you engaged and energized. This isn’t only a mental exercise. Notice how negative thought patterns impact your body – how are your carrying yourself, breathing, and feeling when you have those thoughts? Compare this to when you remember a success story – how does that impact your body, posture, breath, sensations, and mood? Combining body awareness with positive thinking helps to pave and solidify those neural pathways and build that type of patterning in the mind.
Burnout is a Systemic Problem
The truth is self-care and burnout is not all on you as an individual. No amount of self-care is going to rejuvenate you if you are working 80 hour weeks with high intensity clients every week of the year. Our health care system is fundamentally set up in a way that is not supportive for providers. It’s important to examine what stressors are happening in your work environment, your hours, and the demands placed on you by external forces. Be realistic about what is in your control and what is not in your control. You are not going to change the whole system in a day, but you might be able to identify some places for advocacy. Ask yourself: what are the wiggly pieces in this system that might be changeable and would improve things for me and my co-workers?
Build Your Social Support System
The difference between trauma survivors who develop PTSD and those who don’t is a matter of support. It’s not about inner strength, and it’s not about the intensity of the trauma. Research shows that having support while working through a traumatic experience makes all the difference. As helpers, we must also have social support. Family, friends, and colleagues will all play difference and vital roles in our well being. Mentors and supervisors are important for support in work and career path. Friends who in you field can be beautiful connections who will understand your struggles intimately. Friends who are not in your field can be beautiful connections who will keep you alive to other aspects of life. I also highly recommend therapy for all care providers so that you have a professional to turn to and support you through stress and vicarious trauma.
Seek Out Support Before You Need It
Working with a trauma therapist to address stress, vicarious trauma, and burnout is an often under utilized resource for providers. Often when people come to therapy, they are already far along the path to burnout. But like any health issue, it is much easier to address and correct if it is caught earlier in the process. Remember that an ounce of prevention is worth a pound of cure.
If you are experiencing the signs of burnout, or want to prevent those signs from appearing, working with a trauma therapist can be a vital part of your plan for resilience building. If you would like support in this process, please reach out for a free consultation.
