171: Ask David: "Burn Out," Physical Pain, and more

Описание: Today, Rhonda rejoins us as host after a three week hiatus! My neighbor, Dave Fribush, joins us as well, as we answer two thought-provoking questions!

Is it possible to treat “burnout?” Can negative feelings can make physical pain worse? 1. Does "burnout" exist? How do you treat it?

Comment: Hi!

I have been listening to your podcast for a while now and it has helped, and has encouraged me and made me feel less alone. Thank for your work and sharing your podcast with us!

My situation now is very much defined by my burnout syndrome (a medical diagnosis in Sweden, not sure about the US) and/or depression. From what I’ve learnt there is no evidence of CBT as a treatment for burnout - really nothing other than adaptations at your workplace. What triggered me to ”hit the wall” was studying too hard and not giving my body and mind time to recover.

Do you have any thoughts on burnout and effective treatment of it? I feel I have made huge progress in the underlying reasons to my burnout like perfectionism, performance-based self-esteem, figuring out how I want my life to be, who I am etc (although the last one is a big one!). All this with the help of CBT and other sorts of therapy. What remains is mental fatigue, on and off anxiety, not being able to focus and hardly any mental or emotional resilience.

Through healthcare, you are basically treated for depression, the treatment being anti-depressants. I’ve been on sick leave full time for over four years now, am in my late twenties and am constantly frustrated, sad and feeling stuck. I want to get going towards this life I now know that I want but I don’t seem to get any better. I eat and sleep well and exercise. I realize this could be a complete medical question but nobody REALLY seems to know anything about burnout. A long question but hey ho :) Would be grateful for any thoughts you might have, thanks again!

Sincerely,

Elisabeth

Hi Elisabeth,

I’m sorry to hear that you’ve been struggling for some time, but I'm glad you've been making progress, and I'm so glad you wrote to me.

To my way of thinking, there is really no such “thing” as burnout. Depression, anxiety, anger, and other negative feelings do exist. Burnout is just a vague buzzword for feeling upset when something upsetting has happened.

When I was in clinical practice, I saw as many as 17 depressed and anxious patients in one day, and as the day went on, I just got higher and higher and more energetic. That's because I loved what I was doing and felt I had something to offer, a lot, actually. I only got "burned out," or unhappy, if I felt I had said something that hurt someone's feelings, or if I had not done a good job for someone. Then I got really upset, but it was my thoughts, and not what I was doing, that caused my feelings. That, of course, is the cognitive model.

I found it helpful to zero in on one moment when I was feeling depressed, anxious, or “burned out,” and to do a Daily Mood Log focusing on that moment. I’ll attach one to this email in case you are interested. I’ve also included a completed one so you can see how it works. This is not a similar case, just something I grabbed by way of illustration.

Thanks,

David (a fellow Swede)

On the show, I describe one of the most stressful experiences of my career, when I appeared on a Philadelphia TV show with Maury Povich, and a patient of mine threatened to commit suicide. Fortunately, the story had a surprise ending that was very positive.

So my message is one of hope. The idea is to focus on some specific thing you are upset about, as opposed to getting overly focused on a concept like "burnout."

I think we all feel pretty exhausted at times, and if you've been studying or working too hard, it definitely makes sense to take a break to take care of yourself. When I transferred from my residency training program at Highland Hospital in Oakland, California, to the residency program at the University of Pennsylvania, in Philadelphia, one of my supervisors gave me this advice--he told me to make sure I set aside at least one half a day a week to stare at walls.

What he meant was that I was working intensely, 24/7, during the first two years of my residency, and he wanted to make sure I gave myself a break to rest from time to time. So every Sunday afternoon I just watched football games on TV, often with a cat on my lap. This was refreshing and helpful, and my supervisor's advice helped me avoid feeling guilty for not working 24/7!

2. More on physical pain. Is it really true that negative feelings can make physical pain worse?

We recently did a podcast with Dr. David Hanscom, a back surgeon who emphasized non-surgical treatments for back pain that can be surprisingly helpful. In that podcast, I described my research indicating that 50% of the pain we experience can the result of negative feelings, such as depression, anxiety, and...