Mindfulness: Armor Against Anxiety

Anxiety Snapshot

Approximately 25% of adults in the United States will experience an anxiety disorder in their lifetime.[1] Feelings of anxiety and worry can stem from regular daily events such as taking an important exam, giving a speech, or going on a first date. Normal occurrences as such will not always point to the presence of an anxiety disorder. However, when feelings of worry and negative thought patterns are chronic and uncontrollable, they can indicate that an anxiety disorder is present.[2] Experiences of anxiety can vary from person to person, and different types of anxiety disorders can provoke various uncomfortable feelings or thought patterns. BetterHelp (2022) lists the ten most common “hallmarks” of an anxiety disorder whether it be generalized anxiety disorder (GAD), panic disorder or social anxiety disorder (i.e., social phobia):[3]

1. Excessive Worry - Experiencing a sense of dread that lasts six months or longer about regular topics such as school, work, social life, relationships, heath, and finances.

2. Difficulty Sleeping - Lying awake at night and not being able to fall asleep due to anxious or fearful thoughts about a possible upcoming event.

3. Fatigue - Feeling exhaustion throughout the day or becoming easily tired even if one gets an adequate amount of sleep.

4. Trouble Concentrating - Procrastinating either knowingly or unknowingly and struggling to complete daily tasks at school or work due to blanking out.

5. Irritability and Tension - Feeling on edge regularly or becoming easily angered when stressed out. Tension can also present itself physically in tense muscles or aches and pains.

6. Increased Heart Rate - Experiencing rapid heart rate or irregular palpitations can occur during panic attacks and episodes of social anxiety. 

7. Sweating and Hot Flashes - Feeling one’s body temperature rise can stem from increased heart rate and higher blood pressure.

8. Trembling and Shaking - Feelings of fear and anxiety can induce limb shaking, especially in the hands. A state of heightened adrenaline and a fight-or-flight response can cause shaking as well.

9. Chest Pains and Shortness of Breath - Limiting the amount of oxygen in the lungs can cause chest pains, particularly during panic attacks. One may feel a sensation of tightness in the chest.

10. Feelings of Terror or Impending Doom - Feeling like something negative is going to occur can happen suddenly and come from an unknown source. Such feelings are likely to be disproportional to the actual events causing anxiety and panic.

Mindfulness Meditation as a Modern Practice

The field of positive psychological research has a common goal of focusing on what can go right in life, also known as positive affect. Positive affect can include enjoyment, personal connection, and states of pleasant feelings.[4] Deliberate trainings of positive emotions are referred to as Positive Psychology Interventions (PPIs); mindfulness meditation (MM) is one of the most effective known PPIs (Morgan, 2021). MM recently made its way into Western culture during the last century and can be defined as, “The awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment”.[5] As a result of practicing MM, emotions can be regulated, and physiological and mental changes can occur, enhancing one’s reality.[6] 

Mindfulness meditation manifests in two forms: state mindfulness and trait mindfulness. State mindfulness is the feeling of being present in the moment after practicing MM, whereas trait mindfulness is a practice one carries throughout their life, regardless of knowing about mindfulness or not.[7] There are five approaches one can take when practicing MM:[8]

• Body Scan: Focusing on one’s bodily sensations; typically starting at the top of the head down to the toes.

• Focused Attention: Holding concentration on one object or a specific feeling.

• Open Monitoring: Allowing your mind to wander and focusing on the sensations it naturally is pulled towards while remaining present.

• Mindful Movement: Utilizing practices such as yoga and tai chi to focus on one’s bodily sensations.

• Loving Kindness: Visualizing oneself and others while cultivating feelings of gratitude, forgiveness, and love. First turning inward to oneself and progressing outward toward a cherished friend, a neutral person, a difficult person, and eventually everyone elsewhere.

Loving-Kindness Meditation and Loving-Kindness Coloring

A study conducted in the United Kingdom by Mantzios et al. (2022) found that loving-kindness meditation (LKM) and loving-kindness coloring (LKC) were both successful in decreasing feelings of anxiety.[9] Previously mentioned in the last section, LKM is one of the primary and effective practices that show up in mindfulness meditation. LKC is an alternative practice where one redirects attention to a colorful design such as a mandala and actively observes one’s thought patterns to understand which thoughts are provoking certain feelings.[10] Ultimately, both LKM and LKC showed to partially increase state mindfulness, self-compassion, and decrease anxiety.[11] Having the choice between different meditation practices allows individuals to find what works best for them. Some limitations to the study include: the results were only minimally statistically significant and only included under-graduate students as participants. In the case of such limitations, future research should replicate the same study with more of a general population to improve the external validity of the information.[12]

Coping with Anxious Thought Patterns

Additional mindfulness approaches for coping with anxious and fearful thoughts include: thinking realistically, facing one’s fears, and getting regular exercise.[13]

Think Realistically

A real-life example of coping with anxiety using realistic thinking is when one is experiencing health anxiety. For instance, if an individual feels tired most of the time and wonders, “What if I have cancer and don’t know it?” Catastrophic patterns of thought can cause one to go down roads of fearful thinking that are counterproductive to becoming healthier. 

First, one must identify the distorted thoughts that may be occurring on a regular basis. One way to identify a distorted thought is to change a “what-if?” question to an affirmative statement. For example, change “What if my low energy and fatigue are signs of cancer?” to “Because I have low energy and fatigue, I have cancer.” Then, question the validity of the affirmative statement. For instance, what are the actual odds that low energy and fatigue could be indicative of cancer and not something more simple and likely such as a lack of sleep, being overworked, overstressed or possibly dehydrated? Additionally, considering the results of an unrealistic outcome can bring about feelings of peace: “If the worst did happen, is it really true that I’d not find any way to cope?” Once you have assessed the validity of the statements, replace them with more realistic ones. Since there are several possible explanations for fatigue, the “worst-case” odds of having cancer in this scenario are very low.[14]

Face Your Fears

One of the most effective approaches to overcoming one’s fears is to face them head-on.[15] For individuals that experience phobia-related anxiety, facing fears can seem extremely off-putting. However, exposure should be a gradual, step-by-step process instead of immediate and sudden immersion into a fearful situation. This process, known as exposure therapy, usually involves a comprehensive plan to face one’s phobias when feasible.[16] Phobias are likely to induce avoidance behaviors, which can interfere with normal routines such as work or relationships and cause significant distress. Common phobias include: public speaking, riding in elevators, fear of flying, and fear of heights.[17] Sensitization (i.e., the process in which one becomes overly sensitive to particular stimulus) is a prime factor in the development of phobias. For example, a phobia of giving speeches in public can stem from past negative experiences with public speaking. These prior negative experiences are likely to lead to feelings of physical anxiety (e.g., sweating and shaking) as well as psychological symptoms (e.g., worry and low self-esteem). Real-life exposure allows one to unlearn the connection formed between a situation and an anxious response by re-associating feelings of calmness and confidence with that certain situation.[18] A licensed mental health professional can help direct one how to safely be exposed to stimuli they are afraid of. 

Exercise Your Fears Away 

Bourne and Garano (2016) note that getting regular exercise is one of the most powerful and effective methods to combat feelings of anxiety. The body’s natural fight-or-flight response is activated when faced with a perceived threat bringing along an influx of adrenaline. Exercise acts as a natural outlet for an overwhelming amount of adrenaline, diminishing the tendency to react with an anxious response to one’s fears.[19] Regular exercise has a direct effect on the following various physiological factors associated with anxiety:[20]

• Reduction of Muscle Tension

• Rapid Metabolism

• Discharge of Frustration

• Enhanced Oxygen of the Blood and Brain

• Increased Levels of Serotonin

In addition to physiological factors, there are also several psychological benefits that accompany increased amounts of regular exercise:[21]

• Increased Self-Esteem

• Reduced Insomnia

• Reduced Dependence on Alcohol and Drugs

• Improved Concentration and Memory

• Greater Sense of Control Over Anxiety

If feelings of anxiety are chronic and impact one’s everyday life, steps should be taken to reduce such negative experiences by contacting a licensed mental health professional for further guidance.[22]

Contributed by: Tori Steffen

Editor: Jennifer (Ghahari) Smith, Ph.D.

REFERENCES

1 Bourne, E. J, & Garano, L. (2016). Coping with Anxiety: Ten Simple Ways to Relieve Anxiety, Fear, and Worry. New Harbinger Publications. https://ezproxy.snhu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=1197205&site=eds-live&scope=site

2 BetterHelp. (n.d.) How to tell if you have anxiety: 10 signs and symptoms. (accessed 10-20-2022) https://www.betterhelp.com/advice/anxiety/how-to-tell-if-you-have-anxiety-10-signs-and-symptoms/

3 BetterHelp

4 Morgan, W. J., & Katz, J. (2021). Mindfulness meditation and foreign language classroom anxiety: Findings from a randomized control trial. Foreign Language Annals, 54(2), 389–409. https://doi-org.ezproxy.snhu.edu/10.1111/flan.12525

5 Kabat‐Zinn, J. (2003). Mindfulness‐based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156. 

https://ezproxy.snhu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edswah&AN=000182986300002&site=eds-live&scope=site

6 Morgan (2021)

7 Ibid.

8 Roeser, R. W. (2016). Mindfulness in students' motivation and learning in school. In K. Wentzel & D. Miele (Eds.), Handbook of motivation in school (pp. 385–487). Taylor and Francis. https://www.researchgate.net/publication/301813078_Mindfulness_in_students'_motivation_and_learning_in_school

9 Mantzios, M., Tariq, A., Altaf, M., & Giannou, K. (2022). Loving-kindness colouring and loving-kindness meditation: Exploring the effectiveness of non-meditative and meditative practices on state mindfulness and anxiety. Journal of Creativity in Mental Health, 17(3), 305–312. https://doi-org.ezproxy.snhu.edu/10.1080/15401383.2021.1884159

10 Mantzios et al. (2022)

11 Ibid.

12 Ibid.

13 Bourne & Garano (2016)

14 Ibid.

15 Ibid.

16 Ibid.

17 Ibid.

18 Ibid.

19 Ibid.

20 Ibid.

21 Ibid.

22 Mantzios et al. (2022)

PTSD Self-Care Tips

A Path to Healing

Post-traumatic stress disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a terrifying event. Currently experienced by approximately 3.5% of the U.S. adult population; it is estimated that 1-in-11 people will be diagnosed with PTSD in their lifetime.[1]

The most common types of events leading to the development of PTSD include:[2]

• Combat exposure

• Childhood physical abuse

• Sexual violence

• Physical assault

• Being threatened with a weapon

• A serious accident (e.g., vehicle crash)

Many other traumatic events also can lead to PTSD; these include: the sudden, unexpected loss of a loved one,[3] life-threatening medical diagnosis, natural disaster, fire, mugging, robbery, plane crash, torture, kidnapping, terrorist attack, mass shooting and other extreme or life-threatening events.[4] 

Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.[5] Most people who go through traumatic events may have temporary difficulty adjusting and coping, but with time and proper self-care, recovery can occur. If symptoms worsen, last for months or years, and interfere with your day-to-day functioning, you may have PTSD.

While trauma-focused psychotherapies are the most highly-recommended type of treatment for PTSD and provide the greatest evidence for recovery, you may wish to include some supportive self-care strategies. These include:

1. Journaling

   Writing (including expressive, transactional, poetic, affirmative, legacy, and mindful writing) can increase resilience, and decrease depressive symptoms, perceived stress, and rumination.[6] Specifically, when people write and translate their emotional experiences into words, they may be changing the way their experiences are organized in the brain, resulting in more positive outcomes.[7] Guided, detailed writing can help people process what they’ve been through and help envision a path forward. Additionally, it can lower blood pressure, strengthen immune systems, and increase one’s general well-being. Resulting in a reduction in stress, anxiety, and depression, expressive writing can additionally improve the quality of sleep, leading to better focus, clarity and performance.[8]

   Research has found that the most healing of writing must contain concrete, authentic, explicit detail. Linking feelings to events, such writing allows a person to tell a complete, complex, coherent story, with a beginning, middle, and end. In this retelling, the writer is transformed from a victim into something more powerful: a narrator with the power to observe. In the written expression of what occurred, people can reclaim some measure of agency and control over what happened.[9]

   The following tips may help getting started with journaling:[10]

   • Make it a habit – try to stick to a routine.

   • Keep it simple – journal only for a few minutes; consider setting a timer. ‌

   • Do what feels right – find what’s best for you and go with it.

   • Write about anything, with any type of pen/pencil, in any type of book – there are no rules, this journal is yours.

   • Get creative – write lists, make poetry, draft a letter to someone, doodle or draw art.

   • Aim small, win big – keep in mind that journaling isn’t a “magic fix”, but it will help and provide benefit, and will give back the effort you put in.

2. Grounding and 4-7-8 Breathing Techniques

   Grounding strategies can help a person who is dissociating or overwhelmed by memories or strong emotions and help them become aware of the “here and now”. Examples of grounding techniques include:[11]

   • Stating what you observe around you (e.g., what time is it, what pictures are on the wall, how many books are on the table, etc.)

   • Decreasing the intensity of affect - clenching fists can move the energy of an emotion into fists, which can then be released; visualize a safe place; remember how you survived and what strengths you possess that helped you to survive the trauma.

   • Distract from unbearable emotional states - focus on the external environment (e.g., name red objects in the room or count objects nearby). Somatosensory techniques (e.g., toe-wiggling, touching a chair) can remind people of their current reality.

   4-7-8 breathing techniques - controlled breathing is one way to move our systems out of a state of panic. Inhaling activates the sympathetic nervous system (fight-or-flight), while exhaling activates the parasympathetic nervous system (rest and digest).[12] To employ the 4-7-8 breathing relaxing technique:

   • breathe in for 4 counts

   • hold the breath for 7 counts

   • exhale for 8 counts

   Note that any variation on these numbers should still elicit a calming response as long as the exhale is noticeably longer than the inhale.

3. Peer Support Groups

   Within a peer support group, a person can discuss day-to-day problems with other people who have also been through trauma. While support groups have not been shown to directly reduce PTSD symptoms, they can help you feel better by giving a sense of connection to other people with similar, shared experiences. Further, peer support groups can help people cope with memories of a trauma or other parts of their life they are having difficulty dealing with as a result of the event. Dealing with and processing emotions such as anger, shame, guilt, and fear becomes easier when talking with others who understand.[13]

   Similarly, group therapy may be another outlet one can employ to receive support as they recover from trauma.

4. Meditation & Mindfulness

   Meditation practices can combat symptoms of PTSD as they have elements of exposure, cognitive change, attentional control, self-management, relaxation, and acceptance.[14] Specifically, mindful meditation orients one’s attention to the present with curiosity, openness, and acceptance. Experiencing the present moment non-judgmentally and openly may lead to the approach of (and not avoidance of) distressing thoughts and feelings, thus potentially leading to the reduction of one’s cognitive distortions.[15]

5. Healthy Diet & Exercise

   A healthy neuro-nutritional diet is beneficial for both your mind and body. Good neuro-nutrition, based on a holistic and healthy diet of fresh fruits and vegetables, lean proteins, whole grains, nuts and seeds and spices and herbs, can improve moods and cognitive function, help reduce the risks of cognitive decline due to ageing as well as provide healthy nutrients to the rest of your body. Further, healthy neuro-nutrition can help improve the brain’s neuroplasticity (i.e., its ability to change) as well as neurogenesis (i.e., its ability to create new neurons.) Additionally, healthy neuro-nutrition helps to mitigate inflammation, which has been linked to a myriad of health deficits. Animal meats, hydrogenated oils, and many of the chemical and preservatives in processed foods have inflammatory qualities.[16] A healthy diet can also help address physical health conditions associated with PTSD, including diabetes, hypertension, and metabolic syndrome.[17]

   Glucose is a critical nutrient to fuel a healthy mind and brain, with the healthiest sources of glucose found in unprocessed plant-based complex carbohydrates. By incorporating a steady, balanced supply of these vegetables, fruit, beans, nuts, seeds and whole-grain products, one can additionally achieve better mood regulation. The PTSD Association of Canada notes: blood sugar is balanced by having meals spaced fairly evenly, and eating every three to four hours. Choosing unrefined carbs and balancing those meals with protein and fat help delay the absorption of the glucose into the bloodstream. This can help keep your blood sugar level even, for both mood stability and appetite control.[18]

   Exercise and other physical activity has been found to lessen the symptoms associated with PTSD. A 2022 meta-analysis by McKeon et. al., found that physical activity and structured exercise are inversely associated with PTSD and its symptoms. Moreover, exercise interventions may lead to a reduction in symptoms among individuals with, or at risk of PTSD.[19] Additionally, a 2021 meta-analysis by McGranahan and O'Connor notes that exercise training has promise for improving overall sleep quality, anxiety, and depression symptoms among those with PTSD.[20] The duration of exercise does not need to be significant in order to be effective. In fact, Pontifex et al., (2021) report that just twenty minutes of moderate intensity aerobic exercise has been shown to improve inhibitory control, attention and action monitoring.[21] To get the most out of one’s exercise, physical activity enjoyed outdoors has been shown to boost these beneficial effects.

It is important to keep in mind that the benefits of the afore-mentioned self-care tips will likely develop over time, following a consistent approach. Try not to get discouraged in the process and remember that some self-care tips will be more effective than others. Everyone’s path to recovery and healing will be different.

To learn more about PTSD, click here to access our interviews with experts on the subject; click here to access a multitude of articles including additional ways to recovery.

Contributed by: Jennifer (Ghahari) Smith, Ph.D.

Editor: Jennifer (Ghahari) Smith, Ph.D.

REFERENCES

1 “What is Post-traumatic Stress Disorder (PTSD)?” American Psychiatric Association (accessed 7-5-22) psychiatry.org/patients-families/ptsd/what-is-ptsd

2 Ibid.

3  “Post-traumatic Stress Disorder,” National Institute of Mental Health (accessed 6-22-20) www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

4 “Post-traumatic Stress Disorder (PTSD),” Mayo Clinic (accessed 6-22-20) www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

5 Ibid.

6 Glass, O., Dreusicke, M., Evans, J., Bechard, E., & Wolever, R. Q. (2019). Expressive writing to improve resilience to trauma: A clinical feasibility trial. Complementary therapies in clinical practice, 34, 240–246. https://doi.org/10.1016/j.ctcp.2018.12.005

7 “Writing Can Help Us Heal from Trauma,” Harvard Business Review (accessed 7-6-22) hbr.org/2021/07/writing-can-help-us-heal-from-trauma

8 Ibid.

9 Ibid.

10 “The Benefits of Journaling for Mental Health,” Diversified Rehabilitation Group (accessed 7-6-22) ptsdrecovery.ca/the-benefits-of-journaling-for-mental-health/

11 Melnick SM, Bassuk EL. Identifying and responding to violence among poor and homeless women. Nashville, TN: National Healthcare for the Homeless Council; 2000.

12 “Proper Breathing Brings Better Health,” Scientific American (accessed 2-16-22) www.scientificamerican.com/article/proper-breathing-brings-better-health/

13 “PTSD: Peer Support Groups,” U.S. Department of Veterans Affairs (accessed 7-6-22) www.ptsd.va.gov/gethelp/peer_support.asp

14 Baer RA. Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice. 2003;10:125–143. doi: 10.1093/clipsy.bpg015.

15 Gallegos AM, Cross W, Pigeon WR. Mindfulness-based stress reduction for veterans exposed to military sexual trauma: Rationale and implementation considerations. Military Medicine. 2015;180:684–689.

16 “Neuro-Nutrition for a Healthier Brain,” PTSD Association of Canada (accessed 7-6-22) www.ptsdassociation.com/nutritional

17 McKeon, Grace; Steel, Zachary; Wells, Ruth; Fitzpatrick, Alice; Vancampfort, Davy; Rosenbaum, Simon. Exercise and PTSD Symptoms in Emergency Service and Frontline Medical Workers: A Systematic Review, Translational Journal of the ACSM: Winter 2022 - Volume 7 - Issue 1 - e000189 doi: 10.1249/TJX.0000000000000189

18 PTSD Association of Canada

19 McKeon, et. al.

20 McGranahan, M. J., & O’Connor, P. J. (2021). Exercise training effects on sleep quality and symptoms of anxiety and depression in post-traumatic stress disorder: A systematic review and meta-analysis of randomized control trials. Mental Health and Physical Activity, 20, 100385. doi:10.1016/j.mhpa.2021.100385

21 Pontifex, M. B., Parks, A. C., Delli Paoli, A. G., Schroder, H. S., & Moser, J. S. (2021). The effect of acute exercise for reducing cognitive alterations associated with individuals high in anxiety. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 167, 47–56. https://doi.org/10.1016/j.ijpsycho.2021.06.008

Understanding Burnout: Does Zoom Make It Worse?

Source: Canva

What, Exactly, is Burnout?

Burnout is a psychological symptom that results from chronic work-related stress (Melamed et al., 2006). Melamed et al. define burnout simply as “emotional exhaustion, physical fatigue, and cognitive weariness.”[1] Specifically, Maslach et al. find that burnout can be conceptualized along three dimensions:[2,3] 

1. Exhaustion - stress and chronic fatigue due to overwhelming demands.

2. Cynicism - apathy, loss of interest in work, and a sense of futility and meaninglessness toward one’s job.

3. A decrease in quality of work performance - the manifestation of reduced feelings of performance-effectiveness or accomplishment

The multivariate impact of burnout is quantifiable. Burnout negatively impacts productivity and can be measured by: quantity of sick leave days, job retention, and the intention to change jobs.[4] Studies have also found higher levels of burnout have correlated with increased inflammation biomarkers, risk of cardiovascular disease, sleep disturbances, fatigue, and mood disturbances.[5-8]

How Does Burnout Arise?

In addition to more obvious factors like an overwhelming workload, two decades of research on burnout have illuminated some lesser known factors that influence one’s likelihood of burning out. If people perceive that they have the capacity to influence decisions within their workplace and believe they have access to resources necessary to perform well, job engagement is likely to increase. When people feel insufficient recognition or reward (i.e. financial, social, institutional) for their work, both they (as individuals) and their work can feel devalued; this is found to be closely related to feelings of inefficacy and decreased satisfaction. Interpersonal dynamics within the workplace also affect one’s experience of burnout; relationships characterized by support and trust protect against burnout, while unresolved conflict and a lack of trust between peers or coworkers are correlated with greater burnout risk. Fair and equitable policies are also important, as people who feel that they are not being appropriately respected can become chronically cynical, angry, or hostile. Finally, a conflict of values between an individual and their organization can increase one’s likelihood of developing burnout, as the continual pressure to make trade-offs between their values and obligations can affect stress and exhaustion levels.[9]

Figure 1: List of possible burnout symptoms

Image based on a list produced by Schaufeli & Enzmann (1998) [10]

Who Burns Out the Quickest?

Different individuals working under the same job conditions will not necessarily feel burned out at the same time or to the same degree. This is because burnout is a response to stress and individuals evaluate, cope with, and respond to stressors differently. One study by Ghorpade et al. (2007) finds that differences in personality can influence whether one conserves resources (consequently protecting themselves) or becomes susceptible to stressors. Further, extroversion and emotional stability have been found to be negatively related to emotional exhaustion.[11] Openness and agreeableness are also negatively correlated with burnout, while conscientiousness and neuroticism appear to be positively associated.[12,13] 

Something that researchers have struggled to account for is how often burnout might be mislabeled as depression or anxiety, and how such misdiagnoses can lead to ineffective treatment interventions. People suffering from burnout might appear to be depressed, as the symptoms of burnout resemble those of depression (e.g. loss of interest, fatigue, impaired concentration, depressed mood).[14] As there are no diagnostic criteria for burnout and it is not mentioned in the DSM-5, one cannot be formally diagnosed with the condition. One major distinction between depression and burnout is that burnout arises specifically in work-related contexts whereas depression is pervasive across different contexts.[15]

Burnout from Online and Telecommunication-Based Environments

It is often contended that screen time is associated with copious amounts of stress-related symptoms, including psychological, cognitive, and muscular impairments.[16,17] Mheidly et al. (2020) write that pandemics “are often associated with a state of stress and panic. Accordingly, strain resulting from telecommunication can accumulate with other stressors to lead to exhaustion, anxiety, and burnout.”[18] They note that imposed lockdowns, quarantines, and the inability to socialize as a result of the COVID-19 pandemic have led to considerable disruptions in lives, often accompanied by increased tension, anxiety, boredom, and disturbed sleep cycles. Within workplaces, promotions have been delayed and wages have been cut; these negative changes can create adverse levels of pressure and anxiety within people.

Mheidly et al. (2020) recommend promoting awareness regarding stress and burnout as a result of increased telecommunication. They note the following measures are likely to combat this type of burnout: increasing the frequency of breaks between virtual lectures and teleconferences to both reduce eye strain and prevent attention loss, increasing podcast-based communication as a substitute for visual screen time, and implementing healthy practices throughout the work or school day. Yoga, in particular, has received growing research attention, with evidence indicating it can be an effective intervention to reduce stress, increase physical activity, and improve well-being.[19-21]

How to Recover from Burnout

Just as the onset and development of burnout change depending on the individual, so too does the recovery. While Heng & Schabram (2021) believe that the best cure for burnout is prevention altogether, that isn’t always realistic. Therefore, they emphasize the importance of agency in the restoration process. Their research finds that to “effectively overcome burnout, employees must feel empowered to take control over their own lives and decisions.” Rather than expect or request a manager to intervene and improve coworker relations, they note that it is more effective for employees to reaffirm their own social networks. In a subsequent study where they surveyed social service workers (people prone to chronic burnout), Heng & Schabram found “those who were already suffering from burnout had a harder time engaging in acts of self- or other-care, [while] those who were able to muster the energy to practice compassion showed significant reductions in burnout.”[22] Other research has found that mindfulness practices such as breathing exercises, gratitude exercises, yoga, and movement can be effective at cultivating compassion, and that compassion meditation training can rewire neural circuitry in the brain.[23,24]

Self-care and healthy practices are crucial to implement for burnout recovery. Such practices can include: 

• reducing screen time

• increasing time in nature

• stretching to mitigate tension brought on by extended sitting

• practicing agency and taking control in areas of work or school where one can make changes for themselves

• reflecting on one’s support system and building relationships where trust and respect are foundational

• engaging in self-compassion

It’s also important to be aware that the symptoms of burnout can resemble those of depression; if one’s cynicism and exhaustion begin to pervade other areas of life besides work, then different approaches (e.g., therapy or medication) may be more effective or necessary for healing to occur. 

For more information, click here to access an interview with SAS Therapist, Jim McDonnell, on high-stress employment.

Contributed by: Maya Hsu

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

1 Melamed, S., Shirom, A., Toker, S., Berliner, S., & Shapira, I. (2006). Burnout and risk of cardiovascular disease: Evidence, possible causal paths, and promising research directions. Psychological Bulletin, 132(3), 327–353. https://doi.org/10.1037/0033-2909.132.3.327 

2 Maslach, C., Jackson, S. E., & Leiter, M. P. (1997). Maslach Burnout Inventory: Third edition. In C. P. Zalaquett & R. J. Wood (Eds.), Evaluating stress: A book of resources (pp. 191–218). Scarecrow Education.

3 Koutsimani, P., Montgomery, A., & Georganta, K. (2019). The Relationship Between Burnout, Depression, and Anxiety: A Systematic Review and Meta-Analysis. Frontiers in psychology, 10, 284. https://doi.org/10.3389/fpsyg.2019.00284

4 Storm, K., & Rothmann, S. (2003). The relationship between burnout, personality traits and coping strategies in a corporate pharmaceutical group. South African Journal of Industrial Psychology, 29(4), 35-42. Retrieved from https://www.researchgate.net/publication/47739448_The_relationship_between_b urnout_personality_traits_and_coping_strategies_in_a_corporate_pharmaceutical _group

5 Toker, S., Shirom, A., Shapira, I., Berliner, S., & Melamed, S. (2005). The association between burnout, depression, anxiety, and inflammation biomarkers: C-reactive protein and fibrinogen in men and women. Journal of Occupational Health Psychology, 10(4), 344-362. http://dx.doi.org/10.1037/1076-8998.10.4.344

6 Toppinen-Tanner, S., Ahola, K., Koskinen, A., & Vaananen, A. (2009). Burnout predicts hospitalization for mental and cardiovascular disorders: 10 - year prospective results from industrial sector. Stress and Health, 25(4), 287-296. http://dx.doi.org/10.1002/smi.1282

7 Rosen, I. M., Gimotty, P. A., Shea, J. A., & Bellini, L. M. (2006). Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout 39 among interns. Academic Medicine, 81(1), 82-85. Retrieved from http://journals.lww.com/academicmedicine/Fulltext/2006/01000/Evolution_of_Sl eep_Quantity,_Sleep_Deprivation,.20.aspx

8 Ahola, K., Honkonen, T., Kivimäki, M., Virtanen, M., Isometsä, E., Aromaa, A., & Lönnqvist, J. (2006). Contribution of burnout to the association between job strain and depression: The Health 2000 Study. Journal of Occupational and Environmental Medicine, 48(10), 1023-1030. http://dx.doi.org/10.1097/01.jom.0000237437.84513.92

9 Maslach, C., & Leiter, M. P. (2016). Understanding the burnout experience: Recent research and its implications for psychiatry. World psychiatry : official journal of the World Psychiatric Association (WPA). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911781/#wps20311-bib-0024 

10 Schaufeli, W., & Enzmann, D. (1998). The burnout companion to study and practice: A critical analysis. Taylor & Francis. 

11 Ghorpade, J., Lackritz, J., & Singh, G. (2007). Burnout and personality. Journal of Career Assessment, 15(2), 240–256. https://doi.org/10.1177/1069072706298156 

12 Anvari, M. R., Kalali, N. S., & Gholipour, A. (2011). How does personality affect on job burnout? International Journal of Trade, Economics and Finance, 2(2), 115-119. Retrieved from http://www.ijtef.org/papers/88-F00068.pdf

13 Dargah, H. G., & Estalkhbijari, Z. P. (2012). The relationship between the Big Five Personality Factors and job burnout. International Journal of Asian Social Science, 2(11), 1842-1850. Retrieved from http://www.aessweb.com/pdffiles/ijass%20pp.1842-1850.pdf

14 American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Washington, DC: American Psychiatric Pub.

15 Iacovides, A., et al. (2003). The relationship between job stress, burnout and clinical depression. Journal of Affective Disorders, 75(3), 209-221. https://doi.org/10.1016/S0165-0327(02)00101-5

16 Lemola, S., Perkinson-Gloor, N., Brand, S., Dewald-Kaufmann, J. F., & Grob, A. (2014). Adolescents' electronic media use at night, sleep disturbance, and depressive symptoms in the smartphone age - Journal of Youth and adolescence. SpringerLink. Retrieved January from https://link.springer.com/article/10.1007/s10964-014-0176-x?r=1&l=ri&fst=0&error=cookies_not_supported&code=20def7ff-647e-4b3f-923a-66c0a437f01b 

17 Hossmann, K.-A., & Hermann, D. M. (2002). Effects of electromagnetic radiation of mobile phones on the Central Nervous System. Bioelectromagnetics, 24(1), 49–62. https://doi.org/10.1002/bem.10068 

18 Mheidly, N., Fares, M. Y., & Fares, J. (2020). Coping with stress and burnout associated with telecommunication and online learning. Frontiers in public health. Retrieved from https://www.frontiersin.org/articles/10.3389/fpubh.2020.574969/full 

19 Pascoe, M. C., & Bauer, I. E. (2015). A systematic review of randomised control trials on the effects of yoga on stress measures and mood. Journal of Psychiatric Research, 68, 270–282. https://doi.org/10.1016/j.jpsychires.2015.07.013 

20 Büssing, A., Michalsen, A., Khalsa, S. B., Telles, S., & Sherman, K. J. (2012). Effects of yoga on mental and physical health: A short summary of reviews. Evidence-Based Complementary and Alternative Medicine, 2012, 1–7. https://doi.org/10.1155/2012/165410 

21 Fares, J., & Fares, Y. (2016). The role of yoga in relieving medical student anxiety and stress. North American Journal of Medical Sciences, 8(4), 202. https://doi.org/10.4103/1947-2714.179963 

22 Heng, Y. T., & Schabram, K. (2021). Your Burnout is unique. your recovery will be, too. Harvard Business Review. Retrieved from https://hbr.org/2021/04/your-burnout-is-unique-your-recovery-will-be-too 

23 Kirby, J. N. (2016). Compassion interventions: The programmes, the evidence, and implications for research and Practice. British Psychological Society. Retrieved from https://bpspsychub.onlinelibrary.wiley.com/doi/abs/10.1111/papt.12104 

24 Weng, H., Fox, A., Shackman, A., Stodola, D., Caldwell, J., Olson, M., Rogers, G., & Davidson, R. (2013). Compassion training alters altruism and neural responses to suffering - journals.sagepub.com. Psychological Science. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/0956797612469537?cited-by=yesl0956797612469537v1p0956797612469537v1r0956797612469537v1 

The Myths of Self-Compassion and How to Build it Into One’s Life

Understanding Self-Compassion

Research has found that increased self-compassion is linked to increased feelings of social connectedness, as well as decreased feelings of self-criticism, depression, rumination, thought suppression, and anxiety.[1] Those who are self-compassionate tend to possess psychological strengths such as happiness, optimism, wisdom, curiosity, initiative, and positive affect.[2] Additionally, self-compassion can improve emotional resilience when facing challenges or personal flaws, such as failing a test or social situation. 

Self-compassion is not “positive thinking,” but rather the ability “to hold difficult negative emotions in non-judgmental awareness without having to suppress or deny negative aspects of one’s experience”.[3] This type of non-judgmental awareness has a multitude of potential applications, and studies have found that self-compassion can reduce harmful effects of disordered eating, improve interpersonal relationships, and promote healing in clinical settings.[4,5] In an interview with Dr. Mark Leary, a professor emeritus of psychology and neuroscience at Duke University, he notes that self-compassion is not only the effort of “reducing meanness toward oneself,” but also involves “the addition of kindness.”[6] Self-compassion also must not be confused with self-esteem, which instead of kindness, is a system of hierarchical ranking in which one derives pride from a sense of superiority.

While the benefits of self-compassion correlate with those of self-esteem, the two are distinct, as self-esteem rests on external evaluations and outcomes. Self-esteem is vulnerable to fluctuations and can be associated with perfectionism, anxiety, and self-judgment, since the elevated esteem toward oneself is conditional upon success. Research by Gilbert and Irons (2005) explores the divergence of these two qualities, finding that self-compassion deactivates the threat system and activates feelings of security, safety, and relaxation, whereas self-esteem alerts and energizes the body through dopamine when one perceives the self to be “better” in some way than others.[7]

Certain myths hold people back from letting go of judgmental self-talk and embracing a stance of warmth and understanding. Some don’t believe they are worthy of gentle affection, while others are afraid to let go of self-criticism out of fear that all their motivation for success will disappear along with it. Self-criticism is a habit that people can come to depend on as a galvanizer for change and progress. In conversation with Leary he explains how negative self-assessment is absolutely important and necessary for accurate and honest self-awareness and reflection. However, the reality that people occasionally fall short of their goals is not mutually exclusive with self-compassion. One can acknowledge failure while making sure not to add unnecessary cruelty and subjective, global judgments of themselves. Furthermore, research conducted by Leary et al., (2007) suggests that “highly self-compassionate [people] have more accurate perceptions of themselves than less self-compassionate participants.”[8] Maintaining a factual account of one’s shortcomings helps prevent self-talk that may be based in extrapolative, subjective, and global judgments such as “I am a failure.” By abstaining from derision and overwhelming self-criticism, the self remains in a state of safety, which is essential for growth to occur.

Learning to incorporate self-compassion into one’s life is no small feat. As Sonya Jendoubi, a therapist at Seattle Anxiety Specialists believes, “it’s a continuous process that involves commitment to the self through a willingness to face, explore, and understand the current way in which one relates to oneself.” Jendoubi finds self-compassion integral to her work with clients, and unremittingly relevant to the work that occurs in therapy. If one notices a dearth of self-compassion and wishes to change this, beginning therapy might be the next step. One can also begin to implement the components on their own. Kristin Neff, a pioneer in the field of self-compassion, has proposed three main components to achieving well-being via self-compassion: 1) self-kindness, 2) a sense of common humanity, and 3) mindfulness.[9] 

Self-kindness - Flaws are noticed and treated gently, and the overall emotional tone when talking to the self is soft and supportive, like one would use to talk to a small child. When life proves challenging and painful, self-kindness looks like taking the time to turn inward and offer oneself soothing and comfort.

Common humanity - A shared sense of humanity involves recognizing that all humans are imperfect, fail, make mistakes, and engage in unhealthy behaviors. Life’s difficulties are framed in the light of commonality, inclusivity, and universality, such that one feels connected to others through their personal pain. When considering one’s flaws it is important to not cut oneself off from others, in the misbelief that one has failed unforgivably. Shaming oneself is the antithesis of self-compassion. 

Mindfulness - Mindfulness includes awareness of the present moment in a clear manner. The first step to mindful self-compassion is recognizing the fact that one is suffering. Pausing to acknowledge one’s pain may seem rudimentary and overly-simple, but it can also be an immense challenge; it is crucial to pull oneself away from their current process of self-judgment or rumination to validate one’s own suffering. Neither ignoring nor ruminating is mindful. 

Examples of what self-compassion can sound like:

• “My date told me she ‘just wasn’t feeling it,’ and left early. I’m sad and feel insecure about a joke I said. Even though she didn’t particularly like me, I’m not defined by her opinion of me. Plenty of people appreciate my humor and find me attractive, and no one is liked by everyone. I will just let myself feel this sadness tonight though, because it always hurts to experience a form of rejection.”

• “The job I wanted turned me down. This is extremely disappointing and I’m scared that no one will ever hire me. I have to remember that timing and other random external circumstances are always at play, and that I just wasn’t the best fit. Thinking about remaining unemployed is making my stomach and jaw tense. I am sending awareness to these areas in my body and taking a few deep breaths. This is not personal and I am still a hard-working, disciplined, and focused individual with lots of potential. Everything will be ok.”

• “Everybody is awkward at one time or another. Just because I froze during that meeting and didn’t know what to say does not mean that I am exceptionally awkward or socially inept. I felt some shame and embarrassment afterward, but that is completely normal. I may have even reassured someone else who froze up during their last meeting that it is not the end of the world to not know what to say all the time.”

The biggest barrier to implementing more self-compassion into one’s life may be the challenge of just remembering to spend time focusing on self-kindness, common humanity, and mindfulness. Therefore, setting aside a few minutes each day or week to journal self-compassionately may jumpstart the routine of this mental response, moving oneself and closer to automatic self-compassion. For specific journaling prompts and other exercises targeting self-compassion, Neff provides several of these on her website. 

As with all things healing, lasting, and good, this process of reworking your internal self-talk will take time. One should expect countless moments of recognizing the need for self-compassion only after the fact. Additionally, there will always be a part of the self that offers some criticism or judgment, so it’s important not to become defeated when perfection isn’t attained. And, one should remember to celebrate the moments in which they can smile at themselves, where they previously might have criticized. 

For more information, click here to access an interview with Psychologist Milla Titova on happiness & well-being.

Additionally, you may click here to access an interview with Psychologist Mark Leary on self-compassion.

Contributed by: Maya Hsu

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

1 Neff, K. D. (2009). Self-Compassion. In M. R. Leary & R. H. Hoyle (Eds.), Handbook of Individual Differences in Social Behavior (pp. 561-573). New York: Guilford Press.

2 Neff, K. D., Kirkpatrick, K. L., & Rude, S. S. (2007). Self-compassion and adaptive psychological functioning. Journal of Research in Personality, 41(1), 139–154. https://doi.org/10.1016/j.jrp.2006.03.004

3 Neff, K.D. (2009).

4 Adams, C. E., & Leary, M. R. (2007). Promoting self–compassionate attitudes toward eating among restrictive and Guilty Eaters. Journal of Social and Clinical Psychology, 26(10), 1120–1144. https://doi.org/10.1521/jscp.2007.26.10.1120

5 Williamson, J.R.  (2014), Addressing Self-Reported Depression, Anxiety, and Stress in College Students via Web-Based Self-Compassionate Journaling

6 Leary, M., & Hsu, M. (2021, October 4). Psychologist Mark Leary on Self-Compassion. Seattle Psychiatrist Magazine. Retrieved October 5, 2021, from https://seattleanxiety.com/psychology-psychiatry-interview-series/2021/10/4/psychologist-mark-leary-on-self-compassion

7 Gilbert, P. & Irons, C. (2005). Therapies for shame and self-attacking, using cognitive, behavioural, emotional imagery and compassionate mind training. In P Gilbert (Ed.) Compassion: Conceptualisations, research and use in psychotherapy (pp. 263 – 325). London: Routledge. 

8 Leary, M. R. et al., (2007). Self-compassion and reactions to unpleasant self-relevant events: The implications of treating oneself kindly. Journal of Personality and Social Psychology, 92(5), 887–904. https://doi.org/10.1037/0022-3514.92.5.887

9 Neff, K.D. (2009).