Speaker A: Welcome to the Therapist burnout podcast, episode 63.
Hey, therapist, today I’m talking with you a little bit about why your brain is so confused, exhausted, feels like you’re floating through the week.
Believe me, you’re not the only one. So I hear repeatedly from other therapists that they just feel like I can’t think, I can’t do my work. I have no idea which way to go.
I feel like I’m spinning.
Yeah. So I wanted to do this episode. I did episode way back when I started the podcast. And it’s so funny because I feel like I was kind of in.
My brain was kind of in that state at that time. I think I recorded it, like, when I was still in practice. It’s interesting to hear myself when I was in practice and some of the things that I was struggling with at that time.
So I wanted to touch a little bit on the neuroscience of burnout, which dovetails, interestingly, with the neuroscience of trauma, like light bulb. It makes a lot of sense.
And also what I’m doing now is I feel like ideas are just connecting more like, don’t think I have a ton of new ideas. When I listen back to myself, it’s interesting because I have a lot of similar ideas from back, you know, a couple years ago when I started this podcast.
Yeah, I guess at the time of the recording, when I recorded it, it was two years ago because that’s when I started this podcast. But I didn’t put it out till later in that year.
But it’s. It’s just interesting that my ideas then came out like this big jumble, and now they’re. They’re making connections. So that’s fun to see. I’m proud of my brain.
Go, brain. Happy for you.
Good job.
And it’s March, so I want to touch base on Brain Injury Awareness Month. I am a certified brain injury specialist. I don’t work with folks who have brain injuries, but I work as a school psychologist.
And so I’ve been working with overwhelmed brains my. Pretty much my entire career. I started. When did I start my program?
Started NeuroRehab, 15 years ago, just about. Wow.
So I’ve been working with overwhelmed brains for quite some time, and I still work with them now. And I got this question from. I’m still on the email list for the Brain Injury association of America, and they gave me a couple questions.
So in the month of March, I’m just going to give you a couple of factoids. We’ll have a brain injury corner if anyone is interested in me. Doing a podcast just on brain injury.
I’ve done trainings on it forever.
So if you’re interested in hearing just some more information on that, I thought about doing some like clinical competency podcasts. If folks are interested in that, let me know, write me back.
I might do a little survey on the pen pal list or my mailing list. I’ll put that right in the link of the show notes. So if you have some ideas about the podcast, you love this podcast.
I take requests. Okay. I used to be a DJ in another life and so put in your request, folks. All right, so Brandon Dre Corner for the month of March.
Did you know? And this is US Data now giving a nod to my folks. I have a good number of listeners in the UK and in Australia.
So hello to you. Did you know that at least 64 million adults report having experienced at least one traumatic brain injury, a TBI in their lifetime? Or there are at least 2.9 million TBI related emergency department visits each year in the U.S.
would it surprise you to learn as well that 81% of adults in the U.S. do not recognize concussions as traumatic brain injuries? This was one point that I yeah, I, I think a lot of people don’t realize that a concussion is a brain injury.
When I used to post, I had a whole podcast called TBI Therapist. So I think you can still find it in podcast player. So if you look up TBI therapist, it’s linked in my website as well.
So I’ll provide links to those episodes if you’re interested. That most people don’t know that a tbi, a concussion rather is a tbi.
And it’s all so messed up that a mild TBI is a concussion essentially. Right. But it’s not mild. So I worked with folks after brain injury who had a mild TBI or a concussion, same thing who didn’t go back to work, they didn’t lost their relationships, they had big impacts from their tbi.
And so I felt like, and I did. I podcasted on this nearly a year that I wanted to help people, especially with the emotional experience of a brain injury, which is significant.
So also 53% of people who suspect that they have a concussion never get checked. So what we’re learning more with the brain injury research is that if you have symptoms two weeks post a concussion or TBI or same thing, you should be getting followed up.
And what I’d like to recommend for people to do is go to a PT who specializes with concussion because one of our most recommended treatments for Concussion is to get moderate aerobic exercise, walking.
And so I really want you to be seen by PT who understands concussion to help you get that rehab done. Also to know someone who knows what they’re talking about.
So there’s a lot of outdated concussion literature out there, and your doctor may not have the recent data or the guidelines. So in 2022, the sixth statement on concussion in sports comes out, and that really drives our guidelines for concussion.
So before people thought you should just be in a cocoon and not look at your screens and do screen deprivation. Don’t move, don’t walk. That doesn’t work at all.
Don’t, you know, go out and do anything. So it’s really like, you know, 24 to 48 hours of immediate rest and then slowly back to activity. I mean, if you can just remember that, that that’s helpful, I can link all that stuff.
And if you guys want a little podcast on that stuff, I am happy to do it because it still remains a passion of mine. I still see students who have suffered a concussion and just having this knowledge is really important.
So if you’re still seeing people, if you know someone has had a concussion in your life. People approach me all the time, like when I’m playing tennis and I know you know about concussions, so can you help me?
And I’m like, hey, go to this person, that person, that person. And a lot of times what I found when I saw folks after a brain injury, they would come to me like a year or two later and they were still experiencing symptoms and they had developed anxiety and depression because they’d been isolated,
they hadn’t been moving, and, you know, all the things break down. So the Brain Injury association of America has a lot of great resources for professionals, certainly mad math. There’s also a Understanding Concussion certificate course.
And that’s, that’s about $100. So that’s interesting. There’s also a lot of free resources on understanding concussion. So at the time of this recording, the CDC still has their heads up online training courses for healthcare providers.
And that is 100%.
And I recommend therapists if you’re going to stay in the field, if you’re not quitting to grab one of these trainings because it really has that, that just state information that you need to know to make those referrals and to understand potentially what your clients or patients need.
And it gives you the CDC pediatric MTBI guideline as well as a guide to healthcare professionals. And it has one for school professionals. So if you happen to be A school psychologist.
Grab that one. It’s great information.
I will also link that stuff in the show notes. That’s the heads up. CDC training for mild TBI and concussion.
That is your brain injury corner for March. And I’ll be doing those on the podcast for the month of March because it’s Brain Injury Awareness Month. So check out those resources.
I might refine this a little bit for you guys to give yourself, give you a little guide on that and we’ll go from there. Okay. Back to your regular scheduled programming.
I tell you these stories and I’m like, everyone is going to know all the details from my. But when you write me in, you tell me. Thank you for being authentic and real and telling us what you really struggled with and what I continue to struggle with.
In 2020.
I got to the point where I was so overwhelmed that I was in this place where I was just spinning that. I think I’ve talked about this a number of times in the podcast.
It was a number of things. It was having children who were,
had a kid. Yeah. So I had a kindergartner and a preschooler in the pandemic in 2020. Yeah. My son was finishing up kindergarten in 2020 at the, in the spring and my younger one was in preschool.
So,
you know, March hits. I have a practice. We have no access to childcare and I’m still working, my partner’s still working. The school that he worked for didn’t require him to be at school, but he was required to do work.
It was like, just figure it out, you know, come to all these meetings and you still have to care for your preschooler. I remember being on online,
in online school for the kindergartner.
And,
you know, some of the teachers would have, you know, people in the background, their kids in the background, and they’re like, I just, just trying to get it done. Oh my gosh.
What we, what we did. But I just remember the state of my brain and like that person I quoted from the top from that research article. Did I quote them?
So I’m accessing a couple articles today. So one of these is by Marco Vivola. I think I’m saying that correctly. Joel Owen, Paul Fisher. And that’s Psychological Therapist Experiences of Burnout, A Qualitative Systemic Review and Meta Synthesis.
This is from 20,
this is from 24. So pretty recent. They’re saying that no qualitative systemic reviews on therapists permanent have been carried out. Which I was, I, I find that in the research that they’re.
I just find it’s different for us. And how can it not be, right? The work that we do, I feel like it’s different. It’s weird. Therapist work is weird. So of course the research should be different.
And so doing this qualitative work to understand what. What are we actually saying, what are we experiencing? Is important. All right, I just want to scroll down to some of these statements.
Cause I was like, I hear this all the time. But I don’t necessarily quote to people I’m on consult calls with. But it’s quoted in a public study, so I can do that.
So I just want to read some of this to you. So the Experience and Impact of Burnout in their discussion, therapists talked about feeling fatigued and struggling to focus at work, describing a sense of being there, but not being there.
So many people have said that statement to me, like, I’m just kind of going through the motions. I feel like I don’t even know what happened during the day. I don’t know how I got through this.
The emotional impact of these difficulties was evidenced by participants experiences of feeling numb and demotivated. Similarly, their professional efficacy and emotional availability were also affected. As a result, therapists reported experiencing decreased personal accomplishment, which led to being unable to work.
And I want to read this quote. And this is not from their study. This is from another study. They quoted Norman Harling et al. 2020. I’ve had these setbacks with burnout.
I was sitting in my car after an intense week where I’ve done lots of travel and done things and other places in my job. And afterwards I had to stop the car and sort of let it spin for a while and get out.
And I got so scared I thought, **** it, my brain is whacked now. Another participant talked about the lack of motivation and sense of dread experienced when feeling burnout. One of the main things I remember is driving to work and wishing I felt sick that day or, you know,
that I get a flat tire or something just so I didn’t have to go. They also mentioned that studies highlighted the lack of emotional availability experienced by therapists when feeling depleted in burnout seemed to permeate their personal relationships with family and friends, leading to reduced social contact, isolation, and loneliness.
This one participant in another study, Clark et al. 2020, said, I’m just like a zombie at the end of the day and then kind of have that blunt, you know, when other people tell you stuff, you’re just kind of like, I want to have that emotion and I want to show you that.
But I’ve Literally got nothing left in the tank. And so it feels like infinite. Some of those levels of empathy are in the room and therapy and the more finite they become out there in personal relationships.
So we wanted to read you those experiences of what people say it feels like to them.
And one of those, I think that is really salient to me is the brain fog is the feeling of overwhelmed is the numbing which we can liken as well to folks who struggle with trauma.
So diving into little neuroscience. So on a previous episode I had this manic episode where I read you some research when I was burned out.
Lord help me. So in the Wayback Machine. We’ll go in the Wayback machine. And that was episode five where therapists on the edge how burnout rewires your brain. I was stumbling over my words.
I didn’t even think I should publish this episode. And. And still I feel proud of that person that put out that episode because I was doing the thing I believed I needed to get this information out.
And so I’m proud of that therapist. I’m proud of that, that person. I’m proud of her, the self that I was that got this information out. And it’s just interesting to, to see yourself in that way in a podcast episode.
So I talked about the study where. Let me go over it. So Goker et al. The influence of work related chronic stress on the regulation of emotion on functional connectivity in the brain.
So what they did is they looked at structural MRI to raise the question whether limbic networks and impaired modulation of emotional stress. They essentially wanted to see the differences in 40 people who were experiencing burnout symptoms from occupational chronic occupational stress and 70 controls.
What they looked at is they were looking at the participants ability to upregulate, downregulate and maintain emotion as evaluated by recording their startle response. So what they did is they showed pictures of people who were showing, you know, really happy emotions and really depleting or quote I don’t like to use negative or positive emotions depleting,
let’s say depleting emotions like scared, sad, fearful. And they ask them to, if they, let’s say they saw the happy image.
Can you upregulate? So can you yourself experience and intensify that emotions? So they found that the folks struggling with burnout were able to upregulate like they were able to intensify their emotional, emotional response when they ask them to downregulate, however to reduce the intensity.
So if I showed you a, an image of someone scared and I wanted you not to feel that emotion. So you felt, you saw that, and I want you to downregulate the intensity of feeling that similar emotion.
People who were burnt out were less likely to be able to do that. And so they looked at this from a functional MRI perspective, and they found these stressed subjects were less capable of downregulating negative emotion, but had a normal acoustic startle response when asked to upregulate or maintain emotion.
And when no regulation was required. What they found was a functional connectivity between the amygdala and the anterior cingulate cortex correlated with the ability to downregulate negative emotion. This connectivity was significantly weaker in the burnout group, as was the amygdala connectivity with the dorsolateral prefrontal cortex and the motor cortex.
So what does that tell us? Basically, that tells us the amygdala is implicated more in this burnout group, which would likely lead to increased emotional reactivity. There’s stronger connections to those areas of the brain that we know are implicated with emotional distress.
And this is possibly why burnout intensifies. When we therapists experience the negative emotions or the depleting emotions of our clients, we might have a reduced ability after our sessions to be able to hear all the stuff we’re hearing and then regulate ourselves.
There’s actually cortical evidence of this from MRI research, and these aren’t even therapists that I’m talking about from this research study. And then weaker connections to the prefrontal cortex, which leads to impaired emotional regulation and executive functioning.
So in my work with overwhelmed brains, we see a lot of decreased connectivity or coordination to the prefrontal cortex, which allows us to calm our emotional centers of our brain down.
Also, this heightened startle response makes the nervous system more relaxed, more reactive to stress. If we have an overactive amygdala, that’s our threat center is like running the show. It’s,
it’s,
you know, large and in charge and our ability to say, like, hey, brain, nope, you’re actually not in threat. Actually, we’re, we’re doing okay. And going back to my story, so what scared the living **** out of me was nearly getting into an accident with my, at the time,
five year old, maybe he was almost six, my five and three year old at the time. I was in the car and I was, I was at my, I was going out of the street of my house.
So somewhere I’m. All the time, I’m there all the time, and I’m at the stop sign and I almost go into oncoming traffic. With my children and my body is reacting,
I’m crying, my kids are freaking out and my neighbor is behind me. And so someone saw it. So then I’m like, they have this like wave of shame come over me.
And, and it still wasn’t enough at that time for me to make the significant changes I need to make. But I was scared that my brain was in this state of being constantly on, that I didn’t read the cues correctly in my nervous system.
Because we need our nervous system to be functioning adequately for things like driving. Right. So if I need to be able to see, hey, there’s a car coming in, I’m, I’m aware of everything that’s going on, but I think I don’t know what was happening.
It’s hard to remember now, nearly five years later what I was experiencing at that time. But I just remember feeling like my brain was constantly spinning and that everything just felt like I was just reacting to it.
And I know I’m not the only one who’s experienced this, who’s experienced feeling like you are constantly on edge. So I also want to bring up a little bit of the research on trauma.
So according to research,
your brain goes through biological changes it wouldn’t have experienced if there was no trauma. So these are the three main brain function dysregulations that we experience. What’s number one?
Overstimulated amygdala. So the almond shaped mass located deep in our brains, the amygdala is responsible for survival related threat identification plus tagging memories with emotion. So after trauma, the amygdala gets caught up in a highly alert and activated loop during which it looks for and perceives threat everywhere.
Another memory that I have of that time, and this was probably maybe a year after my body reacting to the sound of the door in my office. So when I had people coming in I would physically react and I would be like, I don’t know if I’m going to be able to hold what this person is bringing in today.
Secondly, an underactive hippocampus. So there’s and I read lots of research on different hippocampal volumes for folks after trauma. They say an increase in the stressed hormone glucoc corticoid. I’m going to google pronounce that one kills cells in the hippocampus which renders it less effective for making synaptic connections necessary for memory consolidation.
This interruption keeps both body and mind stimulated in reactive mode as neither element receives the message or threat has transformed into the past tense. So it’s essentially like as an EMDR therapist and if you’ve done trauma work, you know this in the body, trauma feels like it’s happening right now.
And I think if we haven’t consolidated the experiences that we have felt, and we feel our experiences of our clients, right? If we haven’t consolidated those memories, sensations,
it can feel like in our body, it’s happening right now. And I introduced this when I would do EMDR therapy with my clients. The goal of EMDR therapy, the goal of trauma therapy, the goal of trauma work, is to have that memory or that experience open and not feel like it’s happening right now.
That is the whole goal. Also, ineffective variability, the constant elevation of stress hormones interferes with the body’s ability to regulate itself. The sympathetic nervous system remains highly activated, leading to fatigue of the body and its many systems, most notably the adrenal.
So we have all those stress hormones coursing through our bodies constantly. They have not been reabsorbed, and they are constantly running. So I think it makes a lot of sense to me that for people in burnout and people who’ve experienced trauma, the amygdala is implicated because we are not able to accurately downregulate difficult emotions,
depleting emotions. And so if we have a reduced ability to downregulate when that happens, it probably takes us longer to do so. So I, listening back to that episode from two years ago, I talked about that.
I talked about seeing clients because I, at that time,
I think I. I said there was like a snow day and I had to fit clients in. And I know that therapists have to do this. I know that sometimes there’s days where you see seven, eight clients, and maybe that’s not your goal to do that, but the pressure to get people in sometimes is there.
I talked about just needing a whole day to literally recover from that. I think that’s normal. And if your brain has reduced capacity to see threat and is more reactive, is less able to get back to homeostasis after taking in that difficult and depleting emotion, then it’s going to take you longer.
And I think instead of, hopefully, what I want you to take out of this is instead of feeling shame for not being able to, quote, unquote, hack it, I would like you to know that this is likely normal.
That as humans, if we take in depleting emotions into our nervous system, if we have had a chronic level of stress and burnout for quite some time, our bodies are less able to do it, are less able to regulate.
And so what I’d like to do over the next couple weeks is talk about how do I help my brain. Okay, so I know. Thanks, Jen.
You told me what I already know. But what I find is this knowledge can be helpful in reducing your shame and then knowing, okay, if it’s going to take me longer than most people to regulate from experiencing these emotions, bringing this into my nervous system, I need to think about,
okay, there. I likely haven’t been impacted from the traumatic experiences of my clients. That’s one thing. So some therapists may need trauma therapy. I needed trauma therapy several times in my career from the impact of what I had brought into my nervous system over the years that developed acutely into panic attacks in the pandemic.
I think it was really jarring to feel like I couldn’t hold it anymore this week. I recently had a one of my consulting clients write me and I know what this feels like.
What if tears come up? What if I can’t hold it? What if I can’t get through it? I understand being in that place and what you might need is a break.
What you might need is support for someone to see you and say, hey, I get that. Can you give yourself more breaks that day? So whatever you need to do, you can do.
And then what’s on the other side of that? How can you essentially downregulate so that your body get back, get back to homeostasis and then it’s going to take longer for your body to the like.
Essentially, we need your amygdala to relax. Your hippocampus can work again. With proper memory consolidation, your nervous system can recommence an easy flow between reactive and restorative states. That’s the long term brain injury recovery that you likely need.
But it’s going to be small moves. I wish there was like a simple fix. People are like, how do I, how do we like, get out of burnout? I’m like, well, just like brain injury recovery, when people came in after they had had a brain injury, they were looking for,
like the one thing to do, it usually is not one thing. It is not one thing for anyone. And I think similarly, like, we can conceptualize this with clients. You know, that’s why I think CBT research,
you know, for depression, it’s compelling. But, you know, if you work with someone who’s depressed, that’s not the whole answer. So it’s going to be small moves, little by little, getting your humanity back, feeling more alive.
So this month on the newsletter, I’m Talking with you about feeling more alive. I’m giving you a song from my life. I teach fitness classes and that’s where I feel alive.
I feel alive teaching and moving and sharing the space with mostly other women who come to my fitness classes. And it’s such a gift for me to be able to share that space with someone else.
I’m thinking about, where is that? Where do you feel alive? Where do you feel more human in your week? Typically that’s going to be with another human. Yes, I love rest, I love mindfulness based practices, but we need people to help us feel alive.
Okay? So if you want my little songs and tips on on alive and feeling alive and other tips on burnout that I provide from the podcast, then grab the link in the show notes I’m putting at the top.
Because I feel like people don’t read.
You’re overwhelmed. I’m like, click the link in the show notes and then you’re like scrolling all this. So anyway, I’m putting it right at the top. It’s my pen pal list.
I do write back. So write me. I mean, I’m weird and squirrely today.
That is your episode. Join me in the pen palace. And I’m going to be talking more about how do we help ourselves? How do we help our amygdala learn to relax, how do we help our nervous system?
And so I’m going to be talking through my four pillars of brain health, which I feel like have they stayed the same? So listening to my four pillars of brain health, it’s the same pillars, but how I think about them has changed.
I think I’m thinking more about, like, these 1% changes in the four pillars can be really, really helpful. And the biggest one at the top of this year has been in connection and understanding research on friendships.
So if you haven’t heard that episode that I put out, please check it out. That is episode 60, therapist, you need a friend. And then also 61 antidotes for loneliness, friendship and therapist burnout part two.
And by the way, am I Burned out or Depressed? Has been one of my top downloaded episodes. So that’s resonating with you guys. So maybe I need to do some more on that stuff.
All right, well, I hope to talk with you soon. I’m on LinkedIn, so find me there. I post all this stuff and if you message me there, I’ll send you voice DMs too.
So find me Jennifer Blanchett. Have a good one. Bye.
