Hi, I'm Alicia Johnson, LMFT, a licensed therapist specializing in burnout and stress. Ask me anything!

How can we distinguish burnout from just feeling unmotivated? At what point do we go like "Yep, this is definitely burnout. I need a long break" vs "I'm just feeling unmotivated today. But I've had enough breaks already". Not sure if that makes sense

Makes sense to me!

For me I think of burnout as a long term pattern. If I am unmotivated once in a while then I am human and give myself a break those days. When I notice the motivation stays for long periods of time, like weeks or months, that is a signal from my body that something is going on such as burnout, depression, or anxiety and I have to do some reflection to see what's going on. So I would start out with just noticing what is going on and maybe see if other symptoms are showing up too such as tiredness, irritability, soreness, etc.

I would like an answer to this one as well. I experienced severe burnout during my time in academia, despite summer breaks and one semester-long fellowship.

Yes breaks often aren't enough to "fix" burnout. I could probably rant about burnout in academia but I will try to be short and sweet.

I often talk about the systems we are in that contribute to burnout. Places we work in often put high demands/expectations on us without offering much support. For those situations, boundaries become really important but it is unfair and hard because some work places/settings end up pushing back and creating more burnout when people try to set boundaries. It also may not be safe to do these. If possible, in these situations I encourage people to find one safe person to talk to so they don't feel alone and can figure out a game plan

What are some of the best things one can do for burnout? I know it’s not about taking bubble baths! Thank you!

Riight! I feel like all movies show one bubble bath and problems go away!

I will say- bubble baths can be a piece of your self-care plan but it alone won't cure burnout.

I always tell people to start with basic needs. So make sure you're drinking water, moving your body, eating snacks, etc. In order to fight burnout, you need physical and mental energy so self-care is helpful for that!

Then theres deeper steps like figuring out what you have control over, if you need to set any boundaries, if theres underlying anxiety, etc. Those are tougher to tackle and may be helpful to chat with trusted folks or professionals.

How do you handle toxic family members (sibling) who bring constant stress and anxiety? Between work, my family and parents, I feel constantly torn and inadequate. I can't seem to find a way to make everyone happy anymore. Is it as simple as cutting those toxic persons out of your life?

I wish cutting out toxic people from our lives was simple! For some people, setting boundaries, limiting contact, or no longer talking to those people is the right call but it isn't easy and may lead to them trying to put you down further (not that that should be your responsibility at all). For others, they want the people in their life still and find ways to make sure the toxic people's thoughts and emotions do not impact how they feel/think about themselves. Those folks do things like positive mantras, examining evidence of the beliefs, and creating mental boundaries.

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A book that may be helpful is adult children of emotionally immature parents.

A book that may be helpful is adult children of emotionally immature parents.

I actually picked this up on an audiobook service not long ago. You plugging it might help me get around to listening. Thanks!

I hope it can give some more tangible tips! Those situations are so complex and tricky so I wish you the best!

There's another book that my wife has bought multiple copies of because she keeps giving them away to other people. It's called Boundaries. I think it's two authors, and one of them has the surname Cloud. That should be enough to find it.

Yes Henry Cloud and John Townsend !

They say 'it gets better'. What if you don't see it getting better even after years? How do you hold on?

I think many people who say "it gets better" are well meaning it often comes across as invalidating especially when you're feeling like crap and in the deep of it. For my clients who come to me in those dark spaces, I try to not invalidate the helplessness and hopelessness that are very real. I often try to bring up balance and alternative thoughts so maybe having them list 3 things that suck from the week and 1-2 things that went okay. We often start really small with gratitude like being grateful for our pets or our favorite beverage.

Then- my personality type is to bring out the strengths in people, because if someone has been fighting for their life for years, that is some strength and their body is doing something to survive.

Hope this answered the questions!

Thank you for taking this approach. I was given similar advice during CBT, and it helped to create some ground to settle on. Another thing that helped me is keeping in mind that walking is okay - when you're down and resting, stagnant, it's okay to take a moment to relax , but then get up and walk. Doesn't have to be a sprint or overnight success, but just "moving" makes me feel like I've accomplished something, even if it meant just surviving another day.

YES! I always encourage people to start small and moving your body in a way that is authentic for you. For some people that is a full blown workout and for others it is stretching for a few minutes or walking around the block (im the latter ha)

"my personality type is to bring out the strengths in people" - this resonated with me! I am you! :D But have you noticed in therapy how our eagerness to focus on strengths might cause problems? If so?

It can for some folks, for sure. I offer free consultations which allows people to see my personality and therapy style. That way if it doesn't work for them, we can find them someone else.

I also think bringing out strengths is just one tool we use and many times we also use validation, processing stories, body and emotion awareness, etc. so i try to meet them where they are at and use the tool that they are needing in that moment.

How do you deal with burnout if you work in a high pressure environment that doesn’t have a “typical” work day? For instance, some days are extremely hectic while some might not be, which leads to a lot of difficulty in establishing any routines for engaging with your hobbies. What mechanisms would you suggest for someone in such a situation for avoiding burnout?

For the scheduling part- balance is still crucial. The balance may not be work 9-5 then relax when off work it may be like work those long hectic days then when you have pto or holidays or weekends/etc you lean heavily in the rest/recharge camp.

Also- I encourage folks with rotating/changing schedules to have options for their routines. For example- if my hobby is reading, I can have a plan A for when I have a lot of time and can read several chapters, a plan B for maybe reading a magazine or a few pages, and a plan C for not a lot of time and I check my library for new releases or text my book club what they're reading.

Also- I tell my clients- doing something is better than nothing. So eve if you can engage in your hobby for 30 seconds, that will be better than nothing.

Thank you!

I like to give myself micro-rewards. It allows me to pause, do something I like for a moment, acknowledges that I accomplished some small goal or task. It can be as simple as a quick walk outside, a few of your favorite chips, mix and drink a non-alcoholic drink....you decide.

I was able to use COVID as leverage to change my hours at work - and they've allowed me to keep a modified schedule. I work a few long days but then have some days off. This has been a game changer in my stress and burn out levels.

An interesting product that works for me is the Lief - it monitors your heart rate variability and prompts you to do breathing exercises during the day. Sounds crazy, works really really well.

These all seem great! Thanks for sharing!

How long does it take to recover from severe burn out?

It's been over a year since I left my job due to severe burn out and I still don't feel myself or that I'm back to my best.

Any tips to help?

I have been meditating every day since which has helped a lot but im still not quite there

Ah I wish there was a number I could give you! Sadly, if it was that deep, it can take a while.

The meditating sounds so helpful though! I would look up the self-care wheel and make sure you are also attending to other areas of your wellness. Sometimes we focus on just one or two areas of our care needs, and maybe there's a piece that is missing and could help you feel like you're making forward progress!

Good luck!

It's been 3 years for me. I have to come to terms that I will never be the same person I was, though my work situation drastically improved. I'll always carry scars and have to accept the new reality.

Oh. Damn. I’m a year out from quitting the toxic job that was the cherry on top of a toxic decade. Once in a while, for a few minutes, I feel great and like I’m gonna be back to “normal” again. But I really thought I’d be fully back by now. And I’m worried that this is a permanent change in my brain chemistry or something. The experience of burnout has definitely significantly changed my approach to life. But now it’s like there’s two parts at war inside, the part that’s trying to take care of me and accept that it’s okay to do so, and the part that’s like you’re not doing enough go go go you’ll never accomplish anything like this.

I worked at a toxic place for 8 months. It took me around 1.5-2.5 years to come back to myself. I’m still not the same person I was, but I’ve rebuilt a lot of confidence and happiness in my new role. It took time to build trust and get encouragement from my new boss and her leadership team. You can do it. Just keep taking care of yourself and seeking joy.

This! It is similar to work that treatment for trauma and anxiety experience in that you are rewriting brain patterns, retraining your nervous system, creating new normals. It is work but worth it in the end.

It seems like a lot of burnout/stress advice amounts to "make more time for yourself" - ignoring the factors that lead to not having time. (Work, kids, paying rent, duty/guilt, feeling exhausted).

Do you have any tips that don't require dropping one of the balls I'm juggling? Or is it all about choosing which balls to drop?

Yes! I actually have a blog post about this because there are very real barriers to self-care. https://www.aliciajohnsononlinetherapy.com/blog-1/5-barriers-to-self-care-and-what-you-can-do-to-overcome-them

I would try to find tasks/activities that combine some of balls! Go for a walk with the kiddos, listen to your fave song at work, tell yourself 1 good things about yourself. Self-care does not have to be time consuming, draining, or expensive. Being intentional and living within your values is a strong foundation to burnout prevention.

Thank you for this AMA. As a therapist treating patients for burnout myself, how should I deal with the uncomfortable thought that I'm maybe ''helping'' a patient return to a job that is likely to result in them suffering from burnout again? A job that might have been at the individuals capacity threshold from the beginning, which now is lower than before because of the residual mental fatigue from the burnout.

Thank you for your work!

When my clients with burnout choose to stay at job, we talk about warning signs they should look out for that maybe bigger changes need to happen. We talk about their reasons for staying and make sure they are making the best choices for them.

It is hard but leaving toxic places isn't always possible so we can make sure they have tools and support and know what to do when the burnout creeps back.

What is your perspective on how having a healthy work/life balance impacts burnout?

I think for many people, burnout can happen when pulled too thin and they are too exhausted to take care of themselves. When that happens a difficult cycle can happen and we are too tired to do what makes us feel well and healthy and by us not doing those things, we then feel the burnout way harder.

A work-life balance can help prioritize people's needs so they can have a solid foundation for when things do get stressful and so they can have the energy and mindset to do the work and responsibilities they want to do.

Let's say one is fundamentally terrible at establishing work-life balance (due to deep-seated workaholism, poor self-care, other imbalanced self worth issues, etc), and thus are caught in a longer-term loop where burnout is always on the horizon. What are some suggestions to rewire those patterns in order to become less destructive?

This is some of my favorite work to do with clients.

I typically have client start by identifying where these beliefs and patterns come from. Is is family or culture or media? Then we can start seeing if we want to continue these patterns, find alternatives, and explore values.

Personally, I've got a lot of obstacles between myself and therapy. I do think it would benefit me, but at this point in my life, I don't think that it's an option. Are there other services or ways to try and improve my mental health that I just haven't thought of or aren't well known? Or alternatively, are there alternative routes that I haven't considered?

Therapy is just one tool for mental health so if now is not the time where therapy is an option, there are a lot of other things you can do for mental health journey. Without knowing your specific obstacles and goals, here are some that come to the top of my mind

- Following licensed professionals on social media.

- Texting support such as https://www.crisistextline.org/

- Mental health podcasts

- Free online support groups

-Journaling

- Creating playlists

-Reading books

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And many more. What is important is that you find tools that work for you!

I would like to add a few things in the hopes it proves to be helpful. Many areas have "peer support agencies" that are free to the community and offer drop in services like group therapy, and yoga. There are hotlines and warm lines (and online chats) available to talk out issues that may be on your mind. There may be casual meet up groups in your area where similar aged people get together to socialize. Youtube has guided meditations or mindfulness practices. Many therapy practices have sliding scale fees if finances are a barrier. Also many places of work have Employee Assistance Programs. They often have free therapy sessions or help connect employees with the resources that would help.

All great resources!

Do you have any tips for people who think they are on the path to burning out for ways to combat it or more subtle signs that you might be burning out?

I always find symptoms of burnout are listed as things that when you notice them you're already there.

And another question out of curiosity do find more people with things like ADHD or similar mental health things are more prone to burnout in your experience?

Great question!

When I talk about being aware of symptoms there are often early warning signs of stress before it turns to burnout. For example, if stress is stored in my neck and tense after a day of work, I can attend to that symptom before it spirals into full burnout.

As for other tips- I am a big believer in building up a strong foundation and habits so that when stress does happen, you're prepared. So creating meaningful routines, having positive self-worth, self-compassion, coping tools, support systems, etc.

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As for the second question- I don't specialize in ADHD and am not aware of any current studies that examine that specific question but I do think burnout awareness is increasing and I wouldn't be surprised if we learn more about it the next few years. For my clients, many of them have anxiety and depression and if you think about common symptoms in those diagnoses you can see a lot of overlap with burnout AND things that make burnout prevention difficult, so my guess would be yes that ADHD can add some fuel to the fire for some folks.

Is there any particular job that a lot of your clients have in common?

I specialize in helping other helpers so my caseload may be a little skewed that way. My clients are case managers, therapists, doctors, etc who are passionate about serving others and sometimes forget to care for themselves or feel guilty or silly for feeling burned out.

I don’t suffer from any stress or burnout, but some of my closest friends do. Do you have any advice for how best to support them/potentially help them see that they’re slowly driving themselves mad? Or would you suggest not getting involved? I guess specifically if they’re not ready to seek help themselves

Listening and offering support is so helpful! A tool I tell my clients who want to help their pals is to ask their friends if they want "support or solutions" so maybe those friends just need to vent and let it out and you can listen and tell them how crappy stuff is. Other friends may say hey yeah actually I want some advice and you can then give them suggestions such as looking for jobs or practicing coping tools, etc.

Say when it comes to support, a lot of the times I realise I only say the few same things.

"I'm sorry that happened to you"

"That sucks but I hope things will get better"

"Let me know if I can do anything to help"

I notice I don't tend do say, things will get better/fixed because I'm not the sort to white lie. But is it better to? Sometimes? I do want to support my friends but I often feel like I don't know what I can say or do beyond my limited few phrases.

I personally love the phrases you currently use. If you feel comfortable, I would ask your friends what they prefer. Some people in my family like hearing that things will get better even though for me I just want someone to tell me it sucks. Sometimes I will say something like "I know you've been through hard stuff before and I think you will get through this, but right now this is really hard and it sucks."

Do you have thoughts on how technology use can either add to burnout or help it?

Very good question! What comes to mind for me is how technology is used. Everything has pros and cons.

For pros- it can provide community, it can provide access to information, it can be used for virtual support groups or therapy, etc.

For cons- it can add to the comparison game if we are comparing ourselves to others, if used too much it can pull us away from the other areas in our life, and it can also have not nice or supportive people on there that can bring you down.

I have an incredibly high-trauma-exposure career and am pretty consistently worried about the burnout which often comes from working in my field. I'm lucky to have access to therapy and a supportive workplace where mental health is valued. But I'm kind of feeling like... I don't know. I talk to a therapist virtually once a week. It feels open-ended and kind of aimless sometimes.

Should there be therapy "goals" in a situation like this? The work I do certainly never stops churning, and I feel like the therapy is prophylactic as much as anything, but...

Two main thoughts. With your exposure to trauma at work it also could lead to what's called vicarious trauma or secondary trauma which has a lot of overlap with burnout but also overlaps with ptsd so that's a whole other beast. Good news is that therapy can be helpful for both.

Everyone's therapy journey is different but I would say trust your gut. About half of my clients like being able to come in and chat and see what their brains are telling them they want to discuss while the other half is very goal oriented and we stick to our treatment plan. I would say having loose goals can be helpful for either camp.

If you don't feel like therapy isn't super helpful and you aren't noticing any burnout yet, you could decrease sessions amounts.

If you want to stay in therapy and maybe get more out of it, you could chat with the therapist about possible goals or even switch up therapists and see if another style brings anything else out.

How do you get over burnout - when it’s coming from multiple directions? It’s not just the work environment, it’s the constant uphill battle of dealing with different aspects. I really want to take a sabbatical for 6 months but part of the stress is also dealing with medical professionals that won’t assist with putting together paperwork for my employer. If you’re here to help me and I’m saying I need a break, why are they also giving roadblocks? I don’t even want to ask anymore cause I’m exhausted. I can’t move past and get to a point of healing and trying to put together a road map, when what should be a simple request turns into questions and invalidation

This is so common in workplaces where they don't really practice what they preach.

If you need a break and the sabbatical isn't working out, I would try taking a week off if you have the PTO. Use that time to focus on the basics and rest. Then when you are at work, finding small ways to take care of yourself, making sure your boundaries aren't being crossed, your workplace is in line with your values, and you get support for the stress (whether that is bosses supporting you, friends, or even professionals).

A trick I use when I am super stuck and in the thick of burnout is to find what I can control and focus on those small things.

That makes sense. I was doing small crafts in my personal time because that feeling of control and completion helps. But i have chronic migraine that eats up all my pto. So it’s a catch 22 - I need the extended time off to reduce that reaction but have to fight to get validation to do so which just triggers the reaction-that triggers the response from the office and over and over again. Outside of quitting all together - what’s the process of finding a therapist that offers the support needed? Too often they’re glad to assist up until the point of actually filling out paperwork - can’t do anything without that. I feel like when I’ve asked it upon first meeting - I’m treated like I’m faking or trying to get out of work - which makes no sense since none of that time off is paid time. There’s no benefit besides having a much needed break

Do you need a therapist to fill out the paperwork for a sabbatical? Most therapists should be able to do this. I have filled out FMLA paperwork for clients before. Many therapists have local facebook groups to ask for referrals so if you reach out to one in a consult and they wont do it, maybe ask if they can find someone who would. That is odd!

Hi Alicia, thank you for this AMA!

Would you be able to give an estimate on how many people’s condition you think needs therapy and other tools but not necessarily a substantial change in their context (ie quitting their job) and how often instead these people are first and foremost in a bad life/work environment and getting out of it would actually be the primary action towards healing?

I’m getting more and more interested in how self help is gaining so much momentum currently while we seem to neglect how western societies are leveraging on principles that indeed trigger stress and burn out

Love this question and your thoughts!

I have a hard time giving number answers since context really matters but I will try to still give a good answer. I agree that for many people leaving or changing the context can have positive healing change! Where I think therapy comes into play is that that isn't always easy for people. In my work with clients we go over the anxiety and intrusive thoughts that come up when thinking about setting boundaries or quitting, we go over the pressures and guilt of leaving, we process their values and needs. Also- some people financially cannot leave jobs so therapy can help in those situations.

But I agree that tools and therapy doesn't have to be the first tool or the only tool and if people are able to make those changes in their context on their own then I would for sure start there!

Thank you for doing this. I've been in a very dark place the last 6 months. So much of this has been very enlightening and I appreciate your efforts here.

What makes you want to take the time out of your day to do something like this?

Thank you for the kind words.

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Honestly, I enjoy sharing awareness for burnout. I think those with burnout can feel alone and like its just them so if other people can read this and get some hope or tips and it helps them, I feel like my job is done!

How would you help burnout for a stay at home parent?

This may depend on the age and context of the family but I still encourage people to find ways to take breaks even if just 30 seconds in the bathroom telling yourself you're amazing. I also think routines are really helpful and can help limit the mental load so the energy goes towards caring for the kiddos and random stuff that pops up. And if possible asking for help. We dont have to do it all by ourselves all the time.

What industry do you see most clients seeking assistance from? I work in IT, and suspect we are a measurable percentage.

I flirt with burnout on at the very least a weekly basis.

I specialize in burnout in the helping field so most of my caseload is that but I was very surprised that the other half of my burnout caseload is IT folks.

I think we have known about burnout in the helping field for a while but in my perspective there has been a shift recently about work-life balance and now we are seeing folks in corporate jobs, finances, tech, etc start realizing the stress and burnout impact

As someone trying to figure out the best approach to deciding what to do "next" in my life/career... do you see therapy as a route to figuring that out, or is that something best figured out prior to finding a more specific therapist to help with goal setting and managing the challenges of a career shift? Sometimes a career path sounds really great until you get into the day-to-day, and at 41 I don't feel like a lot of people want to give me the room to get my foot in the door if I don't have prior experience. Maybe there are specific types of approaches to this or some other resources that I'm not aware of, so I figured I'd ask.

Backstory for ref: I have already done some therapy after getting a Dx of ADHD in my 30s, which led me to go to college, get a BS in psych, but I experienced severe burnout by the end of that experience which left me stuck in the same career path, but somehow making less money, and VERY unhappy with the current sustainability probability. My insurance changed which left me without a therapist since my last year of school in '18.. and so my current goal is to figure out the best route to a more fulfilling career... just not sure how that works anymore.

I think therapy can be super helpful with this- with the right therapist!

I have several clients who come to me for career guidance and we walk through options together and they feel more confident in those decisions. I would also likely try to find someone who is trained in working with ADHD since that may impact decision making around career choices.

If you wanted to do some work on your own- I am a big fan of vision board, brainstorms, and brain dumps- that may help you narrow down some options that you can bring into the therapy sessions then.

How do we prevent burnout from happening? (asking for a friend...LMBO)

Build a strong foundation for yourself. Create meaningful routines and habits that fill your cup and give you passion and joy. Practice coping tools before you need them. Reflect on your purpose and values. Those will help you long term!

What would you suggest to a person burnt out from there career and in desperate need of change?

If you have the energy to figure out what needs to change then go for it. Whether that is changing jobs, making changes at work, making changes at home, etc.

If you don't have the energy for that yet- I would start small with making sure basic needs are met. Refuel your energy so you can have physical and mental energy to do the hard work of battling burnout.

Also- if you have PTO, use that!

anacdote alert...

looking back its pretty obvious I burned out during my PhD. It took me about 6 years and a change of career to land a job I was able to perform in. Note I didn't recover. Just found a niche. Which turned out to be a very high stress workload job. Literally 10 times more work than you would ever be able to achieve. Needless to say when I left that role, it was still hard to perform to any level. Again I found myself stumbling from high performance job to job. During this whole 2 decades, depression and anxiety (probably longer back TBH)

A few months ago, I was diagnosed with ADHD.

now, everything makes sense. I still have chronic executive dysfunction but I am working on that.

I just wish I had found out earlier. I suspect my life would have been very different.

I don't know what advice to give other than to seek help. I was trapped into believing that I was incompetent and that mental illness was a weakness that one didn't admit to.

On the plus side I'm still here. Still moving forward.

I saw a meme recently that struck a cord

Therapist: Well you definitely have burnout Me: Oh. How long will that take to fix? I have so much to do...

Thank you for sharing!

I think this story will relate to a lot of people. One thing about burnout is the imposter syndrome that can accompany it and make us feel like we are bad at things or that stuff is our fault when it isn't. Glad you were able to figure out that patterns and do what ou gotta do!

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Lol at the meme. I love when clients share memes so I may have to tell them this one.

Is there cause for concern if you’ve been redlining with work for nearly seven years but still don’t feel burnout? I’ve heard it can catch up with you later in life. Any truth to this?

yes and no.

It may be that you are working in line with your values, taking care of yourself, and having a balance and life that works for you. In that case- I wouldn't be worried and just keep doing what you're doing!

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It can "sneak up" on folks. I think for many people, when this happens, it is often starting a lot earlier than we think but our brains and bodies minimize it so we can keep going. Then one day it cracks and we feel overwhelmed. So if you think this is the camp you're in, I would do a lot of check ins with yourself and see if you're doing well and if theres anything you need!

How do you define burnout?

I define burnout as the mental/physical/emotional exhaustion that happens when we feel stuck, hopeless, helpless, or overwhelmed with situations.

Thank you. Lots of discussion around these terms, but defining the terms seems important to discussion.

I agree!

For those wanting to go to therapy to talk about suicide ideation, I think there's a fear of being locked up/loss of secret clearance/etc because it's one of the "required reporting" topics. Do you have any advice for anyone who might not want to talk to a therapist for these reasons?

My advice may depend on the state since each reporting law/duty to protect laws are different (also depends on age) but heres how I handle those situations.

In my state, Michigan, if you're over 18, having suicidal thoughts are likely not going to be enough to involuntarily send someone inpatient. I go over this in my consultations with clients who are concerned about this and I remind them that they have full control over what they tell me. I encourage them to be honest with me but at the end of the day if they don't disclose that, that is their right. We often go over a safety plan and other safe people to contact such as crisis lines, family, friends, etc.

Other ideas that aren't therapy is a crisis line where you can text such as https://www.crisistextline.org/

support groups or classes where it is less about sharing stories and more about learning tools.

Thank you for the reply. It's a shame that it can't be discussed freely :(. Especially if someone wants to go specifically to talk about suicidal thoughts. Sounds like a don't ask, don't tell kind of situation, which is exactly not what some people need. I really dislike the idea of skirting around an issue so important.

Was kind of hoping there would be some clause allowing discussion in a clinical context.

This one is tough because each state is different so I dont wanna give bad advice. I would ask a therapist in the consultation how they handle those situations.

For me- my clients are able to talk about the thoughts and there are certain things they know I assess for which I am upfront with them about. So I would say most places could have a space where you can talk about it but I would def ask potentional therapists how they handle it and how they assess for it.

It is for sure lacking in this field though!

How do you navigate a "tough conversation" with a client who you suspect has a mental illness in addition to being burnt out? Or vice versa--someone who thinks they need a diagnosis but you think it's burnout and not necessarily something permanent.

As someone who has experienced both, I always wonder how someone could exhibit signs of burnout and not be diagnosed with depression, or how to be taken seriously when I tell someone the difference between situational things that are making me miserable vs. the shitty chemical makeup of my brain lol. Like "I dread going to work every day where I'm constantly stressed and pissed off and then when I get home I cry all night and can't stop thinking about how much I hate it there" "Have you been taking your meds?" Ugh.

I am sure each therapist would answer differently but I will share my take.

I personally dont diagnose in my practice unless a client requests an assessment. I don't bill insurance so a diagnosis is not needed for billing. I let clients decide if they want a diagnosis on file or not.

But when diagnosis questions or convos come up, I am pretty open and honest with clients. We chat about how proper labels can be helpful in finding the most effective treatment and I ask them what they think about the labels/diagnoses. Then we chat about how there is a lot of overlap with burnout and various diagnoses so if they wanted a diagnosis for whatever reason we could do an assessment or if they'd prefer to not have a diagnosis we can work on symptoms. If stuff gets to the point where medication could be helpful, I may bring that up in a conversation and ask if that is something they have thought of.

I try to provide collaborative care as much as possible so if I was worried about depression or even health stuff, I encourage people to get an eval or meet with a doctor to rule out underlying stuff.

I think that there is an unfortunate overlap between chemical depression, and circumstantial depression.

The sad reality is that it’s easier to tell someone to take a pill everyday than it is to help them become financially stable, learn to cope with family trauma on a healthy way, or otherwise make long term lifestyle changes.

Ideally, the medication is a stepping stone to help make those longer term changes. Sometimes though, for both patients and caregivers, it turns into a crutch that allows the larger societal factors to be pushed to the wayside.

I’ve found that there are some issues that therapists are great for, and others where close friends are much better. Neither form of support comes close to meeting the full spectrum of what a human brain needs to stay healthy, but in combination hopefully you can work out who is best at coaching you on which issues to get you to the real solutions.

Thank you for sharing! I completely agree and love when people can have multiple tools in their toolkit that can work for different situations.

Is the answer to burnout to switch jobs frequently?

Not necessarily. Part of our identity and passion can come from our work so some people value career advancement and if that fits their needs then they should stay there.

Switching jobs can be helpful if you notice your needs are no longer being met, you want new challenges, your life/family changes, etc.

If you are in a good fit work place, then people can work there forever and not get burned out.

I am super unmotivated at my job right now (programmer). Don't get me wrong, I love it, it gives me a great work life balance, and I'm really good at it. But it requires a lot of time spent thinking and coming up with solutions to problems.

I haven't had a proper holiday in like 3years, so figuring that is a driving factor.

Is the best way to reset to just take time away, and then come back with a new zeal for work?

I am bias and think breaks are helpful for most people. So if you have the time off, I would say go for it.

Some people though, can work nonstop and as long as theyre intentional about mini breaks, self-care, staying connected, happy in other areas- they may never get burnout.

Most people aren't in that camp though so I would say take a proper break, do hobbies you enjoy, and find some fun outside work!

I work 5-6 days a week 40+ hours (short staffed), come home, cook dinner (family of 3), get things ready for the next day (kid and myself), finally sit down/relax around 10pm or later, then have a hard time falling and staying asleep. I have little to no help when I get home and I’m completely exhausted when I do get a day off. What can be incorporated into my day to help with burn out, stress, and anxiety? I want to seek counseling/therapy but have no idea where to start.

First- you're kicking butt for doing all the things. Now it is time to slow down and rest in small ways.

One- I highly recommend the book How to Keep House While Drowning by KC Davis. She talks a lot about parenting struggles and how to find ways to schedule things, prioritize things, and find time for rest/caring for self.

Second- as for counseling, it can be a confusing process to start so I have a blog that may help https://www.aliciajohnsononlinetherapy.com/blog-1/i-think-im-ready-for-counseling-now-what

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Now for the actual tips on what can be incorporated in your day.

- at work: make sure you are taking SMALL breaks. drink water. have snacks. walk around the office. make sure not ALL of your energy is getting depleated at work.

- think about are there areas you can simplify or where you can do the bare minimim. can dinner be frozen or premade meals once in a while? can you sign up for food delivery? are there people you can ask for help?

- lastly, incorporate your kiddos in self care tasks. Do family game nights, go for walks with them, watch movies together.

Ok, I'm not sure if this is burnout, but i feel a strong urge to cry, dizziness, i feel hot, cant eat and all that every time i need to work on my final paper and its really taking a toll on my mental health. How do i know if it might be a burn out or something more serious? (Ps: i have ADHD so that might influence things).

Probs not the most popular answer but to really figure out if there is a mental health diagnosis going on, that would require an assessment with a therapist or psychiatrist. Since on paper so many symptoms overlap and can look similar, a trained professional would be able to assess for timelines, functions, etc and could tell you if a normal reaction to stress, ADHD, or something else

Are there any free / affordable curriculums or classes you would recommend for community leaders? Particularly those which could be offered by school districts, churches, community orgs, etc? I am thinking something like Mental Health First Aid, but more geared to this end.

I have a course about burnout I can share if you would like. It is $50 or there's a deal right now that a bunch of therapists put together and there are a total of 40 trainings and 4 of them are burnout related. plus some focus on parenting, first responder care, etc. I am not trying to be salsey so I will only share those if people are interested.

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As for free resources, I know there are podcasts around burnout but I don't listen to podcasts so I wouldn't be able to recommend a good one.

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If you wanted to search for local people or courses, I would make sure they are taught by licensed professionals. Burnout is a hot topic right now and a lot of people are making stuff that may not actually be helpful.

What can cause a burnout? The common thing you hear is a stressful job or family situation, but could you run into a burnout without an obvious stressor? Like with depression, where there does not have to be a specific trigger?

I think anything can cause burnout. For me, I view burnout as emotional and mental exhaustion around larger things in our life such as family or work but it can be cultural or we can get burned out if we think about stuff we can't change or are helpless/hopeless about stuff. I probably would want to do some further reflection to see if the symptoms are coming from anxiety or depression, etc but yeah burnout can happen over anything.

What's your take on imposter syndrome and burnout? Do you think there's a causal relationship? Or rather just not mutually exclusive? Because feeling like a fraud makes you want to work harder, but working harder burns you out. Interested to hear your thoughts

I don't know if we know enough to say if theres a casual relationship but I do think think they go hand in hand. If I am burned out, that is less energy I have to use my positive tools and those imposter syndrome doubts creep in. Also, I may be performing less than I am used to so the imposter syndrome is going to want to make me feel bad for that. Or I may even be questioning if I am cut out for the field.

I think you're onto something though because I could see how for some people, maybe those with anxiety or perfectionists may use that doubt as a driving force and could lead to burnout.

How do you tell the difference between grief and burnout? I lost my 12 yo stepson after a prolonged and horrifying terminal illness about a year ago and the household fell completely on my shoulders. Partner still can't work and I have 4 living children to support. I'm drowning and I can't tell if it's burnout, grief, or ptsd.

So sorry for your loss. I don't specialize in grief but just based on the short info I hear, it sounds more like grief. Grief can overlap and have other stuff join it, but my guess would be grief is the core of it. Theres also a term called complex grief/traumatic grief and I would be curious if that is more fitting for you.

As a leader at my job, what signs can I look for in my employees that suggest stress or burnout?

Thank you for your work in supporting your team!

Some people internalize and those folks may be tricky to spot. But for those who show it on the outside, is there work performance decreasing? Are they irritable? Are they pulling away from coworkers? Are you noticing changes in their behaviors?

Those are all signs something could be going on.

Also- creating a safe environment where people can share honestly when they are overwhelmed and need support.

I'm 36 and have struggled with anxiety and depression for a majority of my life. I'm currently not being medicated or receiving therapy of any kind because for the past 2-3 years my social anxiety has hit an all time high. I shake uncontrollably, can't write or speak correctly while my heart rate shoots past the 140s and 150s. My question: what do you recommend for people like me who can't get themselves to a place to receive therapy/treatment? Any suggestions or tips would be greatly appreciated. I'm desperate. I want my life back.

If possible, maybe an online doctor where you can fill out stuff at your own pace before hand. I have had clients do virtual doctor appointments and they only last a few minutes because they filled out paperwork before hand.

If thats not an option, there are support groups. Whether that is online and you remain anonymous or through zoom.

Lastly, I would look into grounding tools. They may help with the heart rate and shaking. They can be odd at first so go at your own pace and trust yourself and your comfort level.

When the patient gets to the point where they no longer have the desire to improve because they believe it’s futile and the majority of their emotions are negative, even without stimulus. What’s the next step without medication?

Building a solid trusting relationship with them. I have had clients hate therapy and medications but I met them where they were at, validated their perspective, and worked on a genuine relationship. Then they could trust me when I pointed out patterns or gave them tips.

Although it can be a symptoms of generalised anxiety disorder, do you have any thoughts disassociation actually being used as a coping mechanism for trauma/anxiety?

Or is this just kicking the can down the road 😅

Dissociation is actually one of the common symptoms of trauma as well so that makes stuff tricky because many symptoms are in a variety of diagnoses!

I would also argue it can be a coping tool for burnout as well when our brains have had enough and need a break!

I chew the hell out of my fingers, is that stress?

Often, yes! It can be a coping tool and self-soothing. There is a diagnoses under the body-focused repetitive behavior category that you could see if any of that material relates because it could be a variety of functions. https://www.bfrb.org/your-journey/what-is-a-bfrb

Hi Alicia! I'm a therapist working with high-acuity clients in a co-occurring residential treatment program. I've been feeling very burnt out for a few months now, but I don't know what to do to alleviate that feeling. I've tried changing my work schedule to shorter days, taking a bit of time off, and setting boundaries. But I feel incredibly guilty that I am not able to give my best to my clients because of how exhausted I am. Any tips?

Thank you for your work!

Yeah your work is tough and stressful so make sure you're recharging regularly. Great first steps btw!

The first thing that stands out to me is the guilt. If we feel guilty when we are caring for ourselves, it is hard to be fully present in those moments and let the recharging happen.

I would check out some self-compassion tools by Kristin Neff. Her website has some easy to follow exercises to build up the self-compassion and minimize the guilt.

You deserve to care for yourself!

Thanks for doing this!

My question is: What are things people not suffering from burnout can do to help those who are?

For more personal context: My older brother is currently suffering from burnout so severe it's very scary being near him. I live with him currently so I've seen all of this happen and he's progressing to a state where he can't think, he can't move, he can't do the basic things to keep himself healthy. Keeping fed is a constant struggle.

On the other hand, I'm really really high energy and do 5 million things at once. I want to help him. I have been helping in the ways I can. I will drop everything to help him, but he's so burned out he doesn't know what will help and can't make many decisions without lots of pain. So I do what I can.

I'm wondering if there's some things I can do that might help that I don't see. I've been going about this kinda alone (I have a complicated family life and it's kinda risky for me to collaborate with family on these things).

Thats so kind of you supporting your brother.

For starters- always remember to care for yourself too. Caregiving and supporting loved ones is an amazing act but we need you to be strong so you can do that work.

As for tangible items- if he isn;t sure what he needs, it may take some trial and error. I like to start with basic needs since that's a foundation he would need to do the harder work. So maybe bringing him snacks, filling up a water/beverage glass, checking if needs refills on soaps/hygiene products. Then just being there for him. Letting him know you care for him and once he figures out what he needs youll be happy to help when you can.

What's your best tip for how to become stressed and burn out?

If this isn't a typo- the best tip to get stressed and burned out is to work in a place that sucks the soul from you. For me it was community mental health.

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If it is a typo and you're looking at best tip to avoid being stressed and burned out- finding what you have control over

Do personal circumstances influence Burnout? I feel like I was already burnt out at work and a recent breakup is adding more burnt out feelings. Is this common?

Oh yeah! The stuff in our lives are all interconnected so your mental health, physical health, relationships, etc are all going to influence each other.

As a US resident…how can I get help without going bankrupt and destroying my life trying to mold it around when I can get help?

There are lots of free resources here in the U.S. I would check out local community centers, community mental health agencies, free support groups (locally, online), national organization such as https://www.samhsa.gov/find-help/national-helpline

Hey Alicia! Love this interesting AMA! What states are you able to work with clients in? And where can I find more info about you? Thanks!

So glad it is connecting with folks! I am having a blast! I have an online therapy practice that serves Michigan, Oklahoma, and Florida and I have a ton of info on my website and blog for folks to learn more if we would be a good fit

www.aliciajohnsononlinetherapy.com

What motivates you to keep doing your work?

Have you ever felt something like burnout listening to so many burnout stories from your clients?

How have you managed to cope with your work?

LOVE THESE QUESTIONS!

I get motivated when I see injustice and unfairness happening to clients. I get amped up hearing places aren't respectful of boundaries or people mistreating people. I love to empower others and when I see client's making boundaries and noticing their worth- theres no greater feeling.

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I haven't experienced burnout from listening to client stories. Thankfully I have really good support systems, consultation groups, and have done internal work to keep going. I HAVE gotten burned out working therapy jobs because of management, paperwork, unfair practices, etc.

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I cope by having self-care routines before, during, and after my work day. Before work, I try to do 15 minutes of yoga and wash my face. During the day, I go for a midday walk. And after work I watch an episode of tv with my partner and we eat dinner. The routine helps my brain know what to expect and to leave stress at work

Hi Alicia!

I read in other comments that you specialize in burnout in the helping field so I'm sure you have a lot of instances of clients dealing with a lot of loss. What kind of advice do you have for people in careers like healthcare and vet med?

Those are two of my fave populations! My advice is to find people who support you. When burnout happens in those fields, there is a lot of guilt and imposter syndrome so having safe supports help lift you up would be great. My other advice is to practice self-compassion and work on setting boundaries. People in the helping fields dont have to sacrifice their mental health to help others.

What resources would you recommend for an autistic adult with C-PTSD, who's suffering the first burnout they've been able to recognize as such?

(Preferably those with a minimal cost if any, I can't get employment to save my life and don't qualify for SSI anymore.)

I want to say community health agencies since they often offer free services BUT i am worried that they could also do harm with the C-PTSD so maybe do some research in your area for good community agencies (they do exist but sadly so do some awful ones)

I would also see if there are any online or in person free support groups. I know there are online communities for both Autistic Adults and for PTSD so I would imagine with some digging you may be able to find something like Autistic Adults with PTSD support group.

Other free go to resources I share are- finding blogs or podcasts online, social media accounts by licensed professionals with specific training in things relevant to you.

How long do episodes of burnout typically last?

I wish I had an exact number but it varies depending on the person and the context.

True burnout often lasts for long periods of time. If you catch it early, then the healing process can be shorter or easier.

Some factors that may impact the length of burnout:

- if you're still in the place that is causing it versus out of it

- if you have supportive people in life

- if you know what your body and brain needs to recharge and release emotions

- other mental health stuff going on

- and how long the burnout has been building.

Thank you for doing this AMA! What impact of being in the wrong career do you see on a person when it comes to burnout? I have a set of skills I’ve always been told is great, but time and time again leads me to work I can barely stand doing 40 hours a week. After doing this for years I feel a deep tired, even though I have a great boss, good compensation, enjoyable coworkers.

I think it plays a huge part. I talk a lot about value alignment with my clients. A job can be great, but it still may not be great for you. And if those mismatched roles/values/etc are there over long periods of time, that can impact our mental health.

I’m burning out living w my partner, co-counseling is difficult given both our stress and work levels, and relationship / intimacy therapists are expensive or don’t seem the best match. Suggestions?

If therapy is still an option- I would keep trying to find a good couple's therapist. I would look for someone who is specifically trained in couples such as an LMFT. I would ask if they bill insurance or have sliding scales. Many universities also offer reduced fee services for masters level counselors! Open path is a website that offers counseling for under 60 dollars (I think the range may be 20-60 but it has been a minute since I checked).

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If couples therapy isnt an option, maybe you each can have individual therapy and work on yourselves before doing couples. A good fit therapist is so important for therapy to be helpful.

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Lastly, I would focus on taking care of self and managing your own stress levels and give some patience for the couple's work. You need to care for yourself if you want the energy to care for your partner and do the hard couples work.

I also struggle with feelings of “not showing up enough”, which have been exploited in the past, making it sometimes difficult to establish boundaries. Thanks for listening! :)

So sorry that was taken advantage of in the past. A good trauma informed therapist could be helpful in building up that trust in yourself and learning to safely set boundaries that work for you

Why have I heard from many friends that LMFT's can be beneficial for individuals?

great question! LMFTs are licensed marriage and family therapists BUT most of them actually see clients individually. I am a trained LMFT but I only see individuals. My training was using "systems theory" which helps me with my individual clients because we are able to look at the lens of how culture, family, and more impact a client's thoughts, feelings, and behaviors. It is confusing with all the types of therapists but LMFTs dont only see couples and families.

I used to push myself very hard and strived for the best, but since I developed my generalised anxiety and accompanying chronic pain from numerous cycles of burnout, I’ve had to try and re-orient my self-expectations for the sake of my mental and physical health. I’ve however felt like along with that, I have lost my drive and motivation; I am growing okay with not succeeding; etc. How does one balance their personal growth and recovery from past cycles of burnout damage without feeling like they are “growing lazy”?

Something I would look into is what's called black and white thinking or all or nothing thinking. We often like to think in the extremes and it sounds like in this journey, finding the balance or "finding the gray" can be helpful. I also recommend checking out self-compassion tools by Kristin Neff in learning to practice forgiveness and kindness when there are labels such as lazy in our heads.

How would you respond to someone exhausted from the eternal Reincarnation cycle of life and death forced into rebirth against their will and the veil of forgetting misses them in which they overly process reality and remember too much about what it is?

I would encourage them to seek out support from a spiritual provider or someone with training who can incorporate spirituality into sessions.

If they felt comfortable with me- I would explore their thoughts and feelings about it. Help them find grounding tools. And validate their powerlessness.

Everything is mostly fine for me, except when our daycare requires us to keep our kids at home for days on end because of a COVID scare. I understand why they are cautious, but it is extremely stressful to have to work and also care for a 2-year old and a 4-year old. I wind up falling way behind, because at their age either me or my wife need to devote most of our attention to them when they aren't napping. My wife and I try to plan out our days so that we ideally do not have any times in which we are both in meetings. But regardless, we fall behind. We try and set expectations with colleagues, but work matters still need to be attended to. Either I do more work in the evenings to try and keep my head above water, or I give myself some personal time, which inevitably leads to me being more behind. Both options suck, frankly.

Should I just expect this to be the norm until they are both in school (which is less stringent on sending kids home for suspected COVID in the class) and grin and bear it for a few more years? Or are there strategies that might help make.my life less nightmarish when kids have to be kept home?

Those are the tricky situations that are hard to plan for!

On those days I would see if it was possible to ask for extra help. Maybe that means a family member watches kiddos or a coworker helps out with a project. or even ordering take out. Also- good communication with your wife so that you guys can remain a team and make sure the priorities are getting done. Also- seeing what areas you can give yourself a break in. If dinner is normally made or emails are normally written, can good enough be good enough those days.

Thanks! My wife's father has been a big help, often taking the kids for a few hours here or there, but he doesn't have the capacity to completely take over.

I do push for take-out, which my wife sometimes agrees to.

We do our best!

Y'all are kicking butt! Sometimes there are survive not thrive days so make sure to care for yourself and each other and it will be.

Antthing? What do you think about AMLO?

Not sure what that is, sorry!

How do you pass pyc files through conan? They are there though the package step but on push they do not go to the server because of security concerns.

HOW DO YOU GET ALL THE FILES!!!! WHY HAVE A FILE UTILITY THAT DISCRIMINATES BY FILE TYPE? WHY DOES NO ONE CARE? WHY DO I ALWAYS HAVE TO ANSWER THE HARD QUESTIONS MYSELF!

Or do you just tell people to feel better. There there Mr GroundhogCow I am sure you will find a solution that works. I feel so much better. (Gonna write a preprocessor and a postprocessor and lie about their names. Because dah. lie.)

Not sure I can help with this one! Good luck!