Burn-out Recovery: What to expect and how to cope?

The day came to acknowledge your burn-out. Your doctor confirmed it. The fashionable way of saying ”Oh, I have been feeling so burned-out lately”, used to express temporary high stress and fatigue that normally goes away after some rest and a good holiday, does not apply to you. This time it is an illness. You are off from work, you are puzzled, drained, scared, chronically exhausted. You feel anxious and depressed. Your life is on stand-by and you don’t know for how long. What should you expect? What should you do? Here is a piece of advice from people who have been through it.

Sleep! Sleep! Sleep! Your chronic fatigue is a sign that you need to take a long sleep overdose. Stop denying your condition and give yourself permission to sleep: 10, 12, 15 hours a day or more. Sleep whenever your body asks you to sleep at any point in the day or night. And forget about the wake-up alarm. Your sleeping patterns may have been disrupted long time before your burnout had been confirmed. Your internal battery is empty and it will need a very long time to recharge. The more you sleep, the more chances there are that your cognitive capacities improve over time. And yes, one day you will be able again to concentrate, to pay attention, to remember things and to have a clearer mind.

See your doctor regularly. As a consequence of your burn-out, various physical functions such as digestive, cardio-vascular or immunity may have been disturbed and may need medical treatment. Depression, anxiety and suicide have occurred in burn-out cases, so it is important that you are seen regularly by your doctor. Since each burn-out is different, the symptoms and consequences vary from person to person. Your doctor may request to see you every two weeks or even weekly. Your physician will refer you to other specialists and extend your medical leave according to your state, usually every month or every two months. It is important that you feel understood and in good hands. Should you not feel well treated, change your doctor. Ask a friend or a relative to help with finding another one, as your priority may be sleeping.

Stop the guilt and try to quieten that critical voice. Easier said than done, especially when you used to be an achiever looking for perfection in everything that you did in both professional and personal life. Most people with burn-out will feel guilty for having to stop working and be on sick leave. They may question their condition and they may think that they are not « sick enough » in order « to deserve » to be on a medical leave. Or they would blame themselves for not being « strong enough ». They may carry a huge feeling of failure. If you tell to yourself that « the illness came because you were not strong enough » or even « you let others down by getting sick», remember this: Burn-out occurs to people who thought they were unbreakable and unstoppable. It usually affects people who gave too much for too long time. Every burn-out is a perfectly normal reaction to an abnormal work situation. And if your critical inside voice is still harsh, remember that thoughts are mental events. Not all of our thoughts are true.

Find a good therapist. To smoothen your painful experience and help you cope with feelings of guilt, shame, depression and anxiety, seek a psychologist specialised in cognitive behavioural therapy and preferably in burn-out. The therapist will help you accept your condition and understand why this situation occurred. The therapist will also help you understand which part from your personal story fuelled your work overcommitment to the point of forgetting your needs and crossing your physical and psychological boundaries.

In most cases, a burn-out may trigger clinical anxiety and depression. On the other hand, you may feel depressed without actually suffering from clinical depression. Burn-out has many symptoms similar to depression, which sometimes makes it difficult to diagnose. One can suffer from burnout without having a depression, whilst others can develop a depression on the background of a past burn-out. Some people that had suffered from depression in the past are more likely to develop a burn-out when working in a toxic environment.

Your therapist can be a psychologist or psychiatrist. The difference is that the latter has the status of a doctor and can prescribe medicines such as antidepressants and anxiolytics. Some psychiatrists also practice psychotherapy. Keep in mind that burn-out is a relatively new illness and there may be therapists who don’t properly understand it. Doctors/psychologists/psychiatrists are humans too with their own personalities, beliefs, knowledge and affinities. If the relation doesn’t work, change your therapist. You need to feel safe, understood, in confidence and at ease during the therapy.

Don’t rush into antidepressants 

In case you are diagnosed with depression too, don’t rush into taking antidepressants. Keep them as a last resort. Specialists in burn-out* actually claim that in case of burn-out and medium depression the antidepressants are not effective. Worse, the use of antidepressants may increase the level of depression by turning a medium level depression into a severe depression. And that’s bad news. Severe depression is like being “at the bottom of the bottom”, unable to actually feel any emotion, be it joy or sadness, unable to enjoy or want anything, unable even to do the slightest activity. Besides, not everyone’s body tolerates antidepressants, especially in case of a problematic liver. The side effects include distressing feelings that may worsen your depression, committing suicide, harming yourself, severe insomnia and a vast panoply of physical side-effects including digestion problems, muscles contracting by themselves, feeling of disconnection from your body, dropping things, dizziness, restlessness and feeling as if you need to move constantly, inability to sit or stand still and the list may go on.

In case the antidepressants are the only way to get better, read carefully the medicine leaflet. Ask a relative or friend to read it too and also ask to keep an eye on you. If possible do not live by yourself during the first weeks of the treatment. For some antidepressants, the dose should be increased gradually, otherwise the full dose may trigger serious side-effects. Stop the antidepressants gradually, as per the doctor’s advice, to avoid extreme withdrawal symptoms.

The antidepressants usually affect sleep, so you will be prescribed sleeping pills. If you had been previously suffering of insomnias linked to chronic stress or extreme fatigue, the sleeping pills may not be effective. Avoid taking sleeping pills more than three nights in a row, otherwise you risk becoming dependent. Driving ability may be affected and alcohol should be avoided.

For anxiety and panic attacks, your doctor may prescribe you anxiolytic medicine. As for the antidepressants, always read carefully the leaflet and inform your doctor about the experienced side effects.

Dismiss the pressure to get better

Some people will try to « plan their burn-out healing » like a project, aiming to get better fast preferably by a certain date. Although your mind wants you active, your body is on strike with an unknown end date. Your energy will fluctuate a lot. You may feel better during a few hours and then feel completely exhausted later on. Each time you start your day, be it at 10AM, 12PM or even 2PM, you will be uncertain about your available energy. Some simple activities like preparing breakfast or getting dressed may make you feel tired. Most of the days you will be feeling exhausted, somnolent and not entirely awake. You will sleep a lot and your naps may even take up to four hours. You may not be able to use your intellect. For some, reading is impossible and being a couch potato becomes a normality. My advice is not to cover yourself with guilt. You were indeed a dynamic achiever, running from one activity to other, involved in various projects and probably with a rich social life. The thought of transforming yourself into a snail is extremely frustrating. Blaming yourself and putting pressure on yourself to get better will only be counterproductive and will not allow your body to recover. Remember, you are doing the best you can given the circumstances. And you will need time.

Accept that it may be weeks, months and yes… sometimes even years until the full recovery, depending on how long you’ve been dragging your burn-out before it became an illness. During a course about stress at work and burn-out, I asked a doctor with extensive experience in burn-out how long a person needed in order to recover. He did not have a clear answer. Because there isn’t one. Each person will need different periods of time to recover, depending on his/her body, the duration of the suffered chronic stress and its physical and psychological repercussions.

Depending on your energy level, do some gentle physical activity. Once you start to feel a bit better try to engage into a gentle activity, whilst keeping in mind that your energy will fluctuate. Try doing easy yoga postures at home by making sure you are respecting your body’s needs. Watch online videos or order a yoga for beginners book. If you have a bit more energy, join a tai-chi or qigong class. Try a class or two and then choose whether to enrol or not. And in case you miss classes because you simply don’t feel well enough to go, don’t blame yourself. Accept what your body needs. Alternatively go for a walk in a park or a forest. Stop and smell the air, feel your feet on the ground, touch the trunk of a tree and carefully feel its bark. Going out in nature may appeal to your senses and reconnect with your body. You can try meditation based on visualisations or positive affirmations. Mindfulness meditation practice is a good option. However it may turn out a difficult or worse trigger negative feelings due to the inability to manage your focus. Sometimes paying attention to your aching body whilst feeling drained, somnolent and with a heavy head is not the ideal practice to increase your wellbeing. Whatever activity you choose, note that it is a step-by-step process. Keep in mind: zero pressure and forget about short-term results and productivity.

Try any alternative therapy that you feel is suitable for you: Homeopathy, foot reflexology, aroma therapy, full body massages with essential oils, relaxation techniques, breathing techniques, EMDR (Eye movement desensitisation and reprocessing), EFT (Emotional Freedom Technique), Bach floral water and the list may go on. Try anything that appeals to you as a way to ease-up your painful journey but don’t overdo it. Choose a method or two but don’t fill your weekly calendar with endless appointments. Otherwise you risk dispersing your energy even more. Resting is your main focus. Remind yourself that your battery has gone flat and can’t charge itself effectively.

Seek social contact. Reconnect with an old friend and go for a meal from time to time. Keep in mind that you are entitled to cancel in case you feel unwell without blaming yourself. Look for support groups but don’t make yourself attend meetings if you are feel lacking energy. Try online support groups on social media. Getting in contact with other people experiencing the same illness may reassure you and diminish your loneliness and isolation.

Engage in activities that you love or you would have loved to do in the past. It may help you feel happier and more satisfied. It may put a smile on your face and help you shift your focus from the daily sick person routine, isolation, and distress to something that possibly brings you joy. These kind of activities are particularly important especially if you struggle with depression. However, don’t expect to feel instantly happy. Sometimes you may even experience sadness or frustration in case your physical and psychological state prevent you from participating or enjoying these activities. Your experience may improve over time.

Social Insurance & Control Doctor: In case you live in Belgium, your first month of medical leave will be paid by your employer. As your sick leave will likely exceed a month, your next social benefits will be paid by the local social insurance, called Mutualité in French. Your employer will be requested to provide salary information to the social insurer to allow your monthly benefits to be calculated. Sometimes there may be a delay in the first payment by your social insurer. In case you have a different type of insurance via your employer, contact the HR. Ask your spouse/ partner/friend for help in case you physically and mentally cannot deal with this. After a period of time (usually six months of medical leave), you may be requested to be consulted by a Control Doctor (“Médecin Conseil” in French) from the social insurance that will confirm the diagnosis given by your doctor. The « Médecin Conseil » will  approve your medical leave and consequently you will continue to receive benefits. Your doctor will need to provide detailed information about your symptoms, treatment used and its evolution. It is also helpful to have the written opinion of a psychiatrist, as some Social Insurance Control Doctors do not throughly understand burn-out. There is always the risk that the Control Doctor refuses your medical certificate and demands you to return to work, despite your illness. In this case, proof of ongoing psychological therapy and sometimes psychiatric treatment may come in handy.

Conclusion. Recovering from a burn-out which is sometimes accompanied by depression and anxiety is a long and painful process. And even though it may sound strange and completely out of place, a burn-out can be a good thing in the sense that it obliges you to reconsider your lifestyle, your health & life choices, your overall wellbeing and your relation with work. For a company or an institution, employees with burn-out is an alarm signalling that something is completely abnormal and that preventive measures should be put in place. It is an invitation to review the corporate practices in terms of leadership, workload, work organisation, expectations, work conditions, internal communication and the way people are valued. A company is nothing without people.

 

Photo Source: Pinterest, Scott Maxwell

 

 

 

References:

  • Specialists in burn-out*: Doctors, Psychologists and Psychiatrists that contributed to the course “Stress au Travail et Burnout”, organised by the ULB University, Formation Continue in Brussels, October 2017
  • Burn-out et après, Aude Selly
  • Positive Depression: The 8 stages of Depression, Payen, Dr Etienne
  • Guide du burn-out : Comment l’éviter, comment en sortir, Anne Everard

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