How to Deal with Burnout on your Recovery Journey

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Transcript

Host: Tessa Lackey:

Hello and welcome to Prescribed Listening by the University of Toledo Medical Center. I'm your host, Tessa Lackey. In this episode, we look at burnout, but specifically on your recovery journey, we talked to Dr. Tanvir Singh from UTMC Psychiatry and the UTMC Recovery Center about tips to help prevent burnout, which Dr. Singh says is key to avoiding burnout in the first place. We also talked to him about how to know if you're burnt out, whether it's those physical symptoms or something emotional like an outburst, or maybe you're just struggling to get out of bed to do something you know need to do. We talk about stress on your recovery journey and how stress in general in life, whether you're on a recovery journey or not, is unavoidable and how you can work through it without turning back to habits you're trying to avoid and overall just benefit your own mental health.

Whether you're on a recovery journey or you're just someone who is working through burnout and working to try and not be burnt out, there are some great tips in this episode that you can apply to help work through some different coping skills and some tips just to overall prevent being burnt out in general and work through those things. So here's our episode with Dr. Tanvir Singh. Thanks for joining us, Dr. Singh, today on the podcast. So last time you were here, we discussed the difference between substance abuse and addiction and how loved ones can see the difference and provide support to them. So today we're going to talk about burnout and burnout on your recovery journey itself specifically.

So burnout itself, at least from what I've seen and I think in the mental health world is a huge discussion in itself, but within keeping the focus on the recovery process or even with burnout in general, whether it's your home, work, family stress, or anything that may be going on that brings up stressful emotions, whether you're on a recovery journey or not. For people who are on that recovery journey though, there is its own kind of burnout while on this journey. So just to give us a little bit of a baseline, how would you define burnout?

Guest: Dr. Tanvir Singh:

Well, thanks for having me here. So burnout is basically exhaustion. When you're exhausted, that's when you can lose control or go through a feeling of being hopeless and lose the motivation. So recovery is not just about not using a substance, it's a way of life. The concept is a better quality of life experiences, building a platform for yourself where you can explore more positivity. So burnout is more likely to happen when someone focuses just not using and just counting days they have not used.

Obviously, that's an important metric to how many days somebody has been sober, but if that becomes only a sole way of living a life, then you are more likely to burn out because apart from focusing on recovery, you still have to live a life. You still have to go through the stress of life, stress of relationships, jobs, and unfortunately people with addiction, they have more to deal with in those areas. They have burned so many bridges, so there's a lot of things which they have to work on. That's why it's so important that they look at recovery as a better quality of life, opening new doors and new opportunities. So prevention is the best way to avoid a burnout.

Host: Tessa Lackey:

So as people are on this life journey and ridding themself of the use of drugs and alcohol to cope with the stresses of life, how do you normally instruct people when these big emotions tend to come up? What are some coping skills that you normally suggest to people?

Guest: Dr. Tanvir Singh:

So part of the recovery is the focus on self-control, and you have to exercise those muscles of self-control 24 hours so it can exhaust you. What we do advise is in moments when you can be spontaneous. Now, the word spontaneous as a positive meaning to it though it is pretty similar to the word impulsive. The idea is when you can just do something without too much of planning and just enjoy the moment, it's like you go on a roller coaster and give up that control. It's always unique why people like roller coasters so much because it's supposed to be pretty horrific experience, but that's when you can just give up the control and be spontaneous in a way and live to the moment.

So you cannot run life as a marathon forever. Marathon is good to build endurance, but if you don't stop, you're going to fall flat on your face. So that's why you need those moments where you can just be, where you can have a moment to yourself and you can be spontaneous, and that's very relaxing for the muscles of self-control. Whenever we do anything deliberate, we are using muscles of the brain and like any other muscles, if you constantly stress them, you're going to exhaust them.

Host: Tessa Lackey:

So using your rollercoaster example, so let's say you're going through the ride and the rotations and the different loops of life on this rollercoaster, and you reach a point where you've been whipped around so much that you are holding the lap bar really, really hard. I guess with this, when you're at the point of burnout, what are some symptoms that you might notice with burnout while you're on this recovery journey that might be an indication like, "Oh, I'm actually really burnt out and I need to take a breath."

Guest: Dr. Tanvir Singh:

So like I said, burnout is exhaustion. So when you are exhausted, it is very hard to keep on going. That's when many relapses can happen. Many no-shows in the treatment appointments can happen, noncompliance with medications can happen. You can be absent in a positive relationship, you could miss work. So you do see those changes because it's harder to keep on going. So exhaustion then it's hard to even get out of bed, that kind of moment, those are the warning sign that somebody is exhausted.

Host: Tessa Lackey:

I guess in those times where when you do feel those symptoms and you are saying, "I don't want to go to a meeting or I'm just not going to work today, I can't stand it," is an answer to that to say, "I'm going to take the day off of work and I'm going to read a book, or I'm going to watch my show or do whatever I really enjoy doing and then just starting clean the next day?" Or is it to get up and go to work and then plan from there?

Guest: Dr. Tanvir Singh:

Yeah, so that's a very good question because it depends. Sometimes prolonged burnout can lead to even clinical depression, like the old term use of the mental breakdown. Then you do need a much bigger pause. You need to take some days off and you need to recollect yourself, but sometimes you haven't reached that low point and you just have to reprioritize certain things which are more valuable to you at this time, it's like you have to have a reset point. So it depends where you are with the burnout. So that's why even for the people around them, the loved ones, if they can detect it sooner, it's more likely you can avoid major complications, which comes from the burnout.

Host: Tessa Lackey:

So for specifically on your recovery journey itself, because this sounds very similar to me, recovery burnout and I guess just in general burnout sound like they're basically the same thing. Would you agree?

Guest: Dr. Tanvir Singh:

Yeah, yeah, I would agree.

Host: Tessa Lackey:

And as a human being in general, it's just not possible, at least I would say, to avoid these feelings of stress or anger or whatever you're feeling in the moment. So what are some examples that you would give on a healthy redirection to redirect from if your attention wants to go back to drugs or alcohol specifically? What are some healthy alternatives that you would say if this is where you're so burnt out, you want to go back toward those unhealthy paths? What are some examples that you would give?

Guest: Dr. Tanvir Singh:

So stress by itself mean release of stress hormones, and when you have this constant high release of stress hormones, it does affect our self-control, which is the prefrontal areas of the brain. It's harder for them to function, and they are the areas of the brain responsible for self-control. So you are more compromised and then when you are relying on that self-control to maintain the sobriety, especially in the early or mid-stage of recovery, especially first few months, that's a very, very vital area of the brain you are relying on. So part of the treatment is the better stress management techniques, which are taught in the counseling, how to avoid unnecessary stress, but basic common sense rules also play a huge role.

Actually, it's not just for the people in recovery, in general, it applies to all of us. A ton of stress hormones are released just because we are not sleeping enough, we are not eating on time, we are not decisive enough on some toxic or unhealthy relationships, and we are not balanced in our diet, nutrition, lack of exercise. So basic principles which we all are aware of, actually, if we try to follow them, that does avoid a ton of release of unnecessary stress hormones, which we can save for the time, which is inevitable, like life does throw stress, which are inevitable. So if we save some of those times and the resources for that time, it can help so much.

Host: Tessa Lackey:

One term comes to mind to me for this, when you're in therapy or when you're in some kind of a recovery or a program or something like that, going and building new tools kind of a thing is a visual that comes to mind to me for even if you're not in a stressful situation or in a place of burnout in that moment, building those tools. So if it's, for example, everyone has a care in their lives or maybe they really struggle with certain people or whatnot in their own life and they need to build boundaries around that, learning how to build boundaries before you need to put up that wall and building new tools. Would you say that that's-

Guest: Dr. Tanvir Singh:

Yeah, that's such an excellent point. So positivity, you have to constantly manufacture, negativity comes pretty naturally. So you have to put in a lot of effort and open new doors to constantly look for new positivity. The way our brain is wired, it adopts very easily to positivity and it doesn't appeal to you as much, but the negativity still hurts you as much. So you have to constantly look for opening new doors and create new positivity.

Host: Tessa Lackey:

Looking at things with that glass half full mentality versus half empty perspective.

Guest: Dr. Tanvir Singh:

Exactly.

Host: Tessa Lackey:

Okay. So in a lot of my research before this episode, I saw a lot of people use the phrase avoiding stressful situations, which that just sounds nearly impossible to me to say you can completely avoid a stressful situation. So how do you avoid stress that can trigger burnout when stress really is everywhere?

Guest: Dr. Tanvir Singh:

Yeah, so again, that's a really good point. There are some exceptions, like I was giving an example of... You also mentioned a unhealthy relationship, a toxic person. If you can be decisive, you can avoid prolonging the stress. So there are certain choices, but majority of the time, yeah, we cannot avoid stress, we can just deal with it in a better way. So avoidance doesn't usually work. It actually backfires on you. There are tons of studies which support it. So if just decide to contain your reaction to a high emotion, though you're feeling that high emotion inside, you avoid that behavior response, but it doesn't help you. Like I said, there are studies which support, there's more risk of anxiety, depression, substance use with people who barely internalize their emotions and their reactions. What does work is the technique, which we say cognitive reappraisal, where you make sense of the reason you are not reacting in your behavior.

If you can rationalize it, make sense of it, why it is better for you, and it serves you better to react in a different way. So the cognitive reappraisal is the, and there again, tons of studies which support that it's a very healthy way to cope, and it actually builds a lot of resilience and better emotional regulation. Now, sometimes you can use distraction when the emotions are just too high because if your emotions are too high, then you can have a mind which goes blank. So it's very hard to do a cognitive reappraisal, like looking at the situation and approaching it in a different way. So to buy time, you can walk away, listen to music, even punch a pillow sometimes, whatever you do if it buys you time. But again, what the studies show is so vital that you again come back to the stressful reason that the situation you were in and try to look at it in a different way. So distraction is the only way to buy some more time, but you still have to look at that stressful situation face on. Otherwise, it is just unhealthy for you.

Host: Tessa Lackey:

Is there any maybe examples of phrases maybe you could give so that you can go have that distraction? For example, if you were in... Let's say someone at work wants you to do this project or wants you to attend this meeting that you absolutely want nothing to do with or don't have the time for, but you don't know how to say, "No, I don't have time to do this, or I can't go to that," but I don't want to tell you no or something and you need a minute to step away, or you're so upset about them even asking that you need to step away. What are some... So whether it's an example like that or just an example of how to step away, what are some kind of things people can say so that they can go have that moment and then come back?

Guest: Dr. Tanvir Singh:

Yeah, you can take a break for a couple of minutes. Usually, no matter how crazy your boss is, you can find a couple of minutes, but stepping back is a actually very psychological term to look at it too. Stepping back is then when you have a wider vision of what's going on, stepping back is you're giving it a wider, so you're making sense of it. So it's not only, "Okay, I hate to be in that meeting," but there are probably other things going on too, which makes sense to be in the meeting, or maybe it does make sense to be really not be in the meeting. So it's like stepping back is looking at all the other aspects and not getting hyper-focused on just one thing. And then when you are able to make sense of it, you can usually find peace in whatever decision you go with. And that is much easier on your psych, not only for that moment, but in general. And for even your physical health.

Host: Tessa Lackey:

Yeah. Oh my gosh, yes, we can dig into the impact of stress on your body, but while we're on this as well, so for example, sometimes for me, I will tell people, "Let me look at my calendar and I'll get back to you," and then I can walk away for a minute, look at my calendar and say, "Can I actually do this or not kind of a thing." Or would you say maybe something like if it's not something that involves you checking a calendar or maybe something like, "Yeah, give me a minute or I'll get back to you or let me give you a full answer tomorrow," or something like that, would you say-

Guest: Dr. Tanvir Singh:

Exactly. That's what I would say, just buying enough time for yourself so you are more at peace. Because one thing we got to understand is if we just go with, "Okay, I hate it, but I just have to do it." That's suppression of your natural reactivity and emotions, and that will linger on forever. So if you got to do this thing on Monday and today's Friday, your whole weekend is gone ruminating about... So it has a much, much higher negative impact on you. It's like a burning rod you'll be holding onto. So that's just not healthy for you and would have a lot of consequences on your health.

Host: Tessa Lackey:

So talking about the impacts of stress on your body, from my own experiences, I mean, I feel like there's crazy amount of things that stress does to your body. I know for me, I get stress migraines, I mean your gut stress is a trigger for it. What are some examples that you would give for how stress itself can impact your body?

Guest: Dr. Tanvir Singh:

So the stress means release a much more cortisol, the stress hormone and constant stress, which means constant release of this excessive stress hormones does put you at risk for many illnesses, which usually start much later in life. So degenerative changes is a kind of natural process too because most of us, as we get older, we deal with arthritis and all the other degenerative changes, but excessive stress hormone release does put you at risk for onset of those illnesses at a much younger age. And there are studies which show the loss of immunity, so you're more prone to even infections. And when you do have infections, the complication risk is much higher too. You can be even more resistant to the treatment with consistent, high elevated stress hormones and mentally we have discussed before and anxiety, depression, more prone to PTSD and trauma related complications, even psychosis and some cancer have been linked with higher stress levels.

Host: Tessa Lackey:

Yeah, it's so interesting. So essentially, would you say the better you can manage your stress, the healthier in the long run you're really going to be?

Guest: Dr. Tanvir Singh:

Yeah, it's the other accumulative effect which breaks us because we have discussed before life comes with stress. We all go through [inaudible 00:20:02] incidents which are horrific for us, which are difficult to adjust to. Even life transitions, which is part of growing up, going to high school, going to college, relationships, loss of people who are dear to you, these are stresses which none of us can avoid. So it is a part of our life, so we are going to be subjected to stress, but it is the excessive, unavoidable stress, which where we don't have a choice, but we do have a choice with the avoidable stress.

Host: Tessa Lackey:

Okay. So what would your thoughts be on stuffing, ignoring or silencing your emotions as they come up when it comes to burnout and your recovery journey?

Guest: Dr. Tanvir Singh:

Yeah, that's again, not a healthy way to cope because you are suppressing your emotions. So yeah, others don't see what's going on inside you because you can contain your response, but it's not a healthy process, which happens for you, for your mental health and also for your physical health. So that's not a healthy response.

Host: Tessa Lackey:

So for people who that kind of gravitate toward stuffing their own emotions, what would be your suggestion to them?

Guest: Dr. Tanvir Singh:

So like I had mentioned before, the cognitive reappraisal, looking at situation, looking at the emotion, and then we discussed before, taking a step back, trying to have a broader vision of the situation and using distraction, "I'll call you in a few minutes, I'll get back to you as soon as possible," or even if you have to go for a small walk or buying some time distraction. So trying to have your mental balance enough and then trying to make sense of the situation, that's the healthy way to deal with those situations and suppression will burn you inside.

Host: Tessa Lackey:

Well, it would be like, to me, I would visualize suppression as you're putting too many cookies in a cookie jar and then the cookie jar is expanding because it has so many cookies in it and you can't fit anymore in it. So it only has so much space to fit whatever you're putting in it. So I guess with stuffing or silencing your emotions in those moments where you need to follow through and to see that feeling out or the thing that's bothering you is it seems like it's almost maybe, depending on the situation, obviously, it's a conversation within yourself, especially if the emotion is something you are suppressing and you're just trying to get rid of when it exists and lives there.

Guest: Dr. Tanvir Singh:

Exactly. Yeah. The cookie jar is such a perfect example. So first thing is you got to have less cookies in the jar to start with, so you have more room to regulate and deal. That's when we are talking about the stress management, the way you live your life, your quality of life, exercise, healthy relationships, all that good stuff, so you have less cookies, so there's more room to regulate your emotions when you do face a stressful situation. And if those cookies they keep on coming, you're using unhealthy ways, the spillover is lack of behavior control. When you have those cookies spilling over, that's when bad things happen. You can lash out, something comes from your mouth or your actions which have much serious consequences, or you feel so helpless that you use substances, drugs, alcohol, excessive drinking to deal with that excessive spillover. So it's so important that you take care. We all have a cookie jar in us and we take care of it. That's so important.

Host: Tessa Lackey:

Your mental health is just important to taking care of your physical health.

Guest: Dr. Tanvir Singh:

Exactly.

Host: Tessa Lackey:

So at what point is it time to take that next step and get extra help, when your cookie jar flow with over, at what point is it time to do something different?

Guest: Dr. Tanvir Singh:

Yeah, so as you said, when the cookie jar is spilling over, so when you are losing your control or you are clinically depressed or you feel so hopeless, you can't even show up to work. Like I said, you are absent in relationship and when you cannot do it on your own, yeah, that's the time when you get professional help. And one of the key areas where it does help is your baseline stress levels can be less. So whatever happens happens at that time that when you try to have a reset point, you have a reset point with like we are going with a cookie jar, so with less cookies in the jar, so you have more room to maneuver. That's such a vital piece is where is the stress level. Unfortunately, people with trauma issues, especially with childhood traumatic experiences, they come with, they grow up with the higher stress reactivity, and that's why they're so prone to the spillover effect.

Host: Tessa Lackey:

Yeah. If you reach that point where you need extra help and maybe in that process of things you also used, how do you not feel like a failure in that moment as well?

Guest: Dr. Tanvir Singh:

Yeah, when we seek help, it's the way... Again, it's a kind of situation where if you take a step back and look at the wider vision of what the situation is, when we are willing to seek help, it's a sign of humility. It's a sign of humbleness, which is a very positive emotion, and actually it takes the pressure away from us, but it's the way you approach it if you look at it as a more of a sign of a failure and a sign of weakness, but actually it's more of a sign of a strength when we can let our ego not come in the way of trying to have a better life. Life is a experience from point A to point B, and when we get stuck, we are wasting time, which we are never going to get back. So the humility, humbleness, that's why it has always increased forever. It's so vital for us to go back on the road of experience of life, otherwise, we're going to be stuck.

Host: Tessa Lackey:

Yeah, I love how you phrased that, especially with how it's a humble and [inaudible 00:26:33] humility to go and get help because you're doing something for yourself. That's a positive thing. It's only going to get better from there. We all stumble because we're not perfect people.

Guest: Dr. Tanvir Singh:

And it's all physics. It's all physics and physical. So suppose my feet is stuck somewhere and I cannot move it, and if I decide not to take help, then I'm going to be stuck there forever. So that's how the mental world also goes. So if I do seek help, then it gives me an opportunity to be unstuck and move on with where I want to move on. So it's a simple choice, but we make it complicated because we look at it in an emotional and a mental way.

Host: Tessa Lackey:

Yeah, it gets hard, especially I would think on a recovery journey when you're working towards something and you're trying so hard to not be where you were.

Guest: Dr. Tanvir Singh:

Yeah, exactly.

Host: Tessa Lackey:

Yeah. So I guess any final advice for burnout on your recovery journey itself that you would give people?

Guest: Dr. Tanvir Singh:

Yeah, it's the prevention. It's the prevention, which is the key, because if you're talking a moment of exhaustion, that means it's going on for a while and you are not able to have a reset point or reassess your priorities. So the prevention is the key. That's why we always advise journaling, looking at your stress levels and if you feel the stress levels are staying high, trying to change things, trying to approach it in a different way and if needed, talking to your treatment team. So it's a prevention, which is the key, not letting you go to the point of exhaustion.

Host: Tessa Lackey:

So would you say with prevention, should you be taking steps toward prevention every day, every week, or is it just kind of depend on you and where you're at and when you realize you're thinking a certain way?

Guest: Dr. Tanvir Singh:

It should be every day. There are certain deescalation activities which do help, like mindfulness, yoga, physical exercise, spending time with your loved ones, building positive relationships, like I said, moments of spontaneity, giving yourself moments of some spontaneity where you are not trying to control everything. So if those are part of your day-to-day life, it deescalates all the stress, which you are subjected to because of the self-control you're working on.

Host: Tessa Lackey:

And you don't have to do everything all at once, if you're trying to exercise and then also trying to journal, you're also trying to do five other things. Would you say focusing on one thing toward prevention is a good place to start, or is it just kind of whatever works for you?

Guest: Dr. Tanvir Singh:

Yeah, it's a very individual thing, so not everyone is going to do everything but things which can become part of your routine. It's much easier to do it on a day-to-day basis, and then you are deescalating yourself on a pretty consistent basis.

Host: Tessa Lackey:

Yeah. Okay. Awesome. Well, how can someone schedule an appointment with the recovery center if that's what they think their next step is?

Guest: Dr. Tanvir Singh:

Yeah, so you just have to call the Department of Psychiatry, (419) 383-3815. That's the generic number. You can even call through the operator, (419) 383-4000, and they'll direct your call to the Department of Psychiatry, and they will direct you to the recovery services intake, and you could be seen pretty, pretty soon.

Host: Tessa Lackey:

Awesome. Awesome. Well, thank you, Dr. Singh, for joining us today and for talking about burnout on your recovery journey, and then really burnout in general, just managing that in your life.

Guest: Dr. Tanvir Singh:

Yeah. Thanks. Thanks for having me here.

Host: Tessa Lackey:

Thanks for listening to this episode. If you took a lot away from this conversation, whether it was related to burnout, your mental health, your recovery journey, or your overall health in general, don't forget to hit subscribe. If you're looking to schedule an appointment with a recovery center or Dr. Singh, that number can be found in our show notes. We'll see you next time.