Connecting the Dots, A Series on Burnout
Burnout, the Nervous System & You
Welcome to my new series called "Connecting the Dots" which intends to connect the different pieces of information floating around that could actually help you stop being burned out if they were put together so you understand how they all interconnect. This series is created because when I was in my chronic cycles of burnout, I feel that if these dots of information had been connected for me, it would have changed my belief that I couldn't work like this for another 20 years as I was turning 45. That was the big realization for me that I needed to quit, not just where I was working but wanting to leave the whole system so I quit my career after 20 years of working as a nurse. But I believe you don’t have to do this radical thing. You can stay engaged and regulated in your life and not feel chronically exhausted and overwhelmed and that life happens to you. Or that you are missing out on life, the years fly by and you don’t know where they’ve gone. It all interconnects.
In 2017 or so, I attended an all day workshop hosted by the hospital I worked for at the time on burnout. They had facilitators who took us through deep breathing exercises and talked about mindfulness, all who worked for the hospital. The impression I had when I left was that the problem of being burned out was mine, but do these deep breathing techniques to be more mindful to see if that would help. The hospital acknowledged that burnout was an issue but did not know what to do about it and wasn't going to do anything more than this workshop. So I went back to reading my self-help books, drinking wine most night in my pj's that I put on as soon as I got home and really struggling to get through each day.
After I started my own practice working with nurses in burnout, I had a friend push back on my belief and talk about how to get out of burnout. It was definitely more fluffy at the time. I am grateful to my friend Sara B. for doing this as it made me dig deeper as to what keeps people in cycles of burnout and then what to do about it in an effective and sustainable (as in you can keep doing it) way. Now you get the benefit of these dots of information that have been connected.
Sit down with your favorite bevy, take three deep breaths to clear your mind and enjoy
When Chaos Feels Everywhere
Whether it's home, work or the world, chaos feels like it's in every facet of life. This can make you feel like you're spiraling, as if you've internalized all the chaos. Leaving you feeling angry, depressed and overwhelmed. When you are already hanging on by a thread, it adds and increases the overwhelm you may already live in daily. How can you begin, or continue, to function?
Quick tip because I know you need it now…
Create space within your nervous system. I use this verbiage because it brings the sensation of being able to take a deep breath, to feel a minute or a microsecond of time to feel calm & comforted. It may be fleeting but if it happened once, it can happen again and again. When we are chronically stressed we breath mostly with our chest and don’t actually take deep breaths to our full lung capacity. When you create space within your nervous system, you feel more centered and able to breathe. It’s the pause.
Hold onto the first moment it happened and then recreate it until you can feel your jaw unclench, your shoulders and neck loosen. Maybe you can sit for a moment and not feel the overwhelming urge to constantly be doing (a sign of a hyperactive or hyperaroused nervous system, also known as fight or flight) or not be doom scrolling or lay in bed for hours shut off from the real world (a sign of a hypoactive or hypoaroused nervous system, also known as a freeze response). My go-to response is functional freeze. There was a time, when I was still working as a staff nurse, when my therapist asked me if I ever felt triggered. The answer was no but it was because I was so disassociated and disengaged from my inner landscape of emotions, I didn’t have many. It took a lot to get me activated.
Remember, our nervous systems are complex and have been trying to keep us safe for decades and these responses have been what has worked and what is familiar. Which means it will take time, awareness and continued effort to create change. I see so many people who have negative self-talk, shame and guilt for being burned out or not being able to get themselves out of burnout but our brains and nervous system goes back to what is familiar, which may have been helpful at one time (learned in childhood) but is not any longer as adults. This keeps us feeling stuck. Be gentle with yourself.
Let’s talk the nervous system
(Short A&P review but without the test)
The nervous system is the body’s command center. It’s made up of the brain, spinal cord and nerves and works by sending electrical signals between the brain and all the other parts of the body. These signals tell the body to breathe, speak, see etc. There are two main parts, the Central Nervous System (CNS) and the Peripheral Nervous System (PNS). The CNS is the brain & spinal cord. The PNS is made up of the network of nerves that branch out from your spinal cord. This system relays information from the brain and spinal cord to the organs, arms, legs, fingers and toes. There are two parts to the PNS, the somatic nervous system and the autonomic nervous system. The autonomic nervous system is what we will focus on today in this article but just so you know the definition of both...
Somatic Nervous System-includes the muscles you can control, plus all the nerves throughout your body that carry information from your senses to the brain (sound, taste, touch, smell).
Autonomic Nervous System-network of nerves from the brain that goes throughout your body that controls your internal organs and your unconscious processes (heart beat, breathing, etc). This is separated into two parts:
Sympathetic nervous system- Activates body processes that help you in times of stress or danger. This system controls your body’s “fight-or-flight” response. You are in danger and this is what kicks in.
Parasympathetic nervous system- De-activates the body processes from stress or danger. Responsible for “rest-and-digest” periods. You feel safe and secure and this is a period of relaxation.
The balance & communication between the Sympathetic and Parasympathetic is key to your body’s well-being
mindmypeelings.com
The key to effectively regulating your nervous system is knowing these three autonomic nervous system states:
Window of Tolerance
Optimal zone where you can deal with stress from every day life
You feel safe, calm, clear thinking, are able to engage socially & with your life
This window is very narrow when you are in burnout
Hyper-arousal (Sympathetic Dominant)
Excessive activation/energy in the form of fight/flight responses
You’re body is ready to react to danger, is tense & alert
You are always busy and irritable or easy to anger
Hypo-arousal (Parasympathetic Dominant)
Freeze response, emotionally flat, lack of energy & response
The tiger is going to eat you and your body shuts down to numb the pain
You are chronically exhausted, have brain fog, decision fatigue
Chronic stress and overwhelm leads to being stuck in fight, flight or freeze
Your nervous system was designed to deal with acute stress. You walk upon a bear with cubs, the moose lowers its head to charge, there’s a large spider on the wall. THOSE situations. Modern society has created chronic acute stress. And then has told us this is “normal”. It’s actually…not normal (just reiterating that for us all). When you walk into work and you always have to be “on”, multi-tasking, getting interrupted, don’t feel valued, seen & heard by your manager and/or coworkers. It’s harsh and creates stress everyday when you are AT work and when you are GOING TO work and it’s hard to LET GO of work if you are always thinking about what could-a or should-a happened or what can happen next time. Your mind is constantly “on” without relief to turn “off”. This means you release constant cortisol (the stress hormone), which keeps your body activated as it’s watching out for danger. This in turn, interferes with your sleep and makes you crave sugar & carbs & relief (somehow with something) because you are trying to soothe your nervous system in any way you possible. And how many of you have chaos at home too? Your parents need you, your partner can’t figure something out, the kids are crying…the dogs barking…your house is a mess because you don’t have time to clean. All the things. For many years this was my life. I would wake up MORE TIRED than when I went to bed. Married on my way to divorce and then single parenting it and working full time. It is fucking hard. What we do is truly hard.
This chronic acute stress leads us to be in constant states of hyperarousal and/or hypoarousal. It’s not “either/or” as many times you will cycle through both but tend to have one response as the most common or dominant as it’s the most comfortable to your nervous system. Also, these are habits and behaviors you learned in childhood and as an adolescent. You can look at how your parents/caregivers dealt with, or didn’t deal with stress, and many times, that’s what we do too. I am very hypoarousal dominant, feel that I’ve been in functional freeze most of my adult life; now that I know what it is and understand these nervous system states. My sister on the other hand, is very much in a hyperarousal state chronically and has always had the candle burning at both ends and many projects going at once.
To learn more about which state your nervous system dominates, take this Burnout Assessment Quiz.
HYPERarousal Symptoms
feeling chronic panic
anxiety (chronic)
sleeping issues or disturbance
chronically angry & defensive
hyper vigilance
irritability
easily startles
self-destructive behaviour
chasing chaos
high energy
aggression
fast heart beat
shallow and quick breaths
high blood pressure
high levels of cortisol and adrenaline
muscle tension
HYPOarousal Symptoms
depression
low energy/exhaustion/fatigue
brain fog/lack of focus
feeling disconnected, disassociated or disengaged
numbing or checking out frequently
tech addiction (doom scrolling)
craving for substances (addiction)
irregular heart beat
shallow/irregular breathing
digestive issues
over & under active immune system
sensitivities to cold
What does this mean for you?
Having a better understanding of where your nervous system response is most dominant, will help you use the most effective tools to soothe yourself. Knowing this will also make these tools more sustainable because when they work, you will be more likely to continue using them. It becomes a positive feedback loop. The more you are in your Window of Tolerance, the more you are building resiliency against the effects of stress. I realize resiliency is getting used a lot in this system of capitalism as it has been twisted to make you more productive and focused at work. The very same reason many nurses get a bad taste in their mouth when they are told to do “self care” as if that makes everything better. I know there’s more to it than that after spending much of a decade reading self-help books and not actually feeling differently & better. Or just like when I left the all day workshop on burnout feeling like this is something I have to deal with on my own and this self-care is just a bunch of bullshit because it’s not enough to truly make a difference. But what I don’t hear people talking about enough, unless they are in a trauma-trained and informed profession, is how these nervous system states, or responses, effects what we need to be doing to manage ourselves differently. And let’s be honest, we all have trauma. If you didn’t have it before you went into healthcare, you certainly have it now.
For example,
If you run hyperaroused and use the gym and exercise to help manage your stress but don’t create time for you to “relax & do nothing” (whatever this looks like for you), you’re keeping your nervous system in an activated state. Are you actually ever in your Window of Tolerance? Probably not. Or not for long. Do activities that bring you DOWN into a relaxed state, and work on your brain not constantly going. Squirrel brain is always not in the present moment.
If you run hypoaroused (like me!) and come home from work and go to sleep immediately and isolate yourself from friends & family on a regular occurrence but don’t create time for gentle movement to bring you up into your Window of Tolerance, you stay in this frozen response state. Do gentle activities to bring you UP into your Window of Tolerance. Make sure you get some nice social time so you can co-regulate with other people who aren’t in a frozen state. This also brings you UP. Maybe you and your hyperaroused friend can get together and regulate each other into your Windows of Tolerance. Be creative.
What you can do today
Before we get into the nitty-gritty of what you can do, let’s talk about the WHY. Like I mentioned in the section above, we live in a system of capitalism that wants to extract our labor. In my workshop on burnout (Getting Beyond Burnout: A Workshop for Everyone in Healthcare) the WHO definition of burnout is all related to work. You are not engaged and you are not productive. But we are more than our work, more than our profession. We have lives and interests and hobbies outside of work (or we used to, maybe not now, but we will get back into having hobbies, my friends). So do this for you. I don’t know a nurse that doesn’t have a chronic illness or autoimmune disease. I have one and was headed into chronic fatigue syndrome too. For the last decade, I had been trying to pursue how to get more energy; I just never had enough and was chronically exhausted.
So on to ways you can shift out of your dominant nervous system state…
If you are hyper-aroused, anxious or activated, you want to calm your nervous system and bring yourself back into your Window of Tolerance. You are regulating DOWN.
use the energy, or the need to be constantly active, and go for walk outside, in nature, no matter the weather. There are numerous studies about the benefits of being out in nature and if you are stuck inside for long shifts (anything beyond 4 hours is long, let's be real) this study from the NIH says that even viewing pictures of nature can relax the body (that is why I use a lot of nature scenes on my website and marketing) so having a picture on your phone screen to look at or a picture at your desk.
put your hands in ice cold water for 10-30 seconds. Dr Nicole LePera has a reel about this. While your hands are in a bowl of ice water, take deep breaths from the belly. The uncomfortable sensation brings your focus back into your body. I frequently turn my morning shower to very cold water at the end (well maybe not VERY cold but it’s cool). It wakes me up more than any caffeine and I feel more relaxed and focused throughout the day. Here's more information on cold plunges but be aware that if you're already in burnout, you may not tolerate being immersed or surrounded by cold water as it's too stimulating or overwhelming to your nervous system, hence the hands in the cold water instead.
If you are hypo-aroused, chronically exhausted and feel shut down or overwhelmed, the key is to gently soothe your nervous system back into the Window of Tolerance. You are regulating yourself UP.
Even though you are exhausted and this may be the last thing you want to do but connecting with others co-regulates your nervous system (I know I know, I've spent many years in my pajamas scrolling social media, I truly get it). Choose wisely who you spend your precious time with but many people feel better and more energetic with time spent with the right people. For one, you have to get dressed and out of the house and movement moves you up towards the Window of Tolerance. Secondly, we are social animals, we crave connection with others. This soothes your nervous system and moves you into the Window of Tolerance (or closer to it). Think of how you feel after spending time with some wonderful friends, laughing and talking and connecting. Do that more frequently, you may have to initiate and text them. Just do it. If you want an easy community to plug into, there is a burnout support group that I host every 2nd and 4th Thursday evening of the month at 7p PST via Zoom. You can stay in your pj's and bring your fav bevy.
Use gentle movement to stimulate and get your nervous system out of functional freeze and towards the Window of Tolerance. See above friend group to get a BURNOUT BUDDY and go for a walk every week, do a yoga class together, hit the gym. I say gentle because we aren’t running marathons here.
There are many more ideas on my burnout resources page for you to check out and if you are not already, sign up for my newsletter to get more in-depth articles on burnout and regulating your nervous system differently plus get the next part of Connecting the Dots series in your inbox!
When the nervous system is regulated and can manage the stress of everyday life, THAT is being in the Window of Tolerance. This is the optimal zone where every day stress does not throw off your day, week or month. You feel the stress (you are not ignoring the stress or having toxic positivity) but are able to access your frontal lobe to problem solve even with an acute stress incident. It doesn’t mean you won’t get activated but you are able to think through the issue/stress and able to soothe yourself and come back into the Window of Tolerance.
Remember...
Your nervous system has spent decades trying to keep you safe. How you currently self soothe when you are stressed and overwhelmed feels very familiar and these can be hard coping habits to change. But it CAN change. Our brains have neuro-plasticity and new neuropathways can and will be created. It takes time and coming back to the supportive ways you soothe your nervous system.
Pick one action and do it consistently
Written by Doris Taylor, RN BSN