Are Your Tiny Traumas Building Up to Burnout?

[00:00:00] Rachel: Throughout our lives, particularly when working on the frontline with people who are hurting. we encounter little traumas that accumulate over time. Whether it’s feeling humiliated or belittled by a bully or going through a difficult breakup, these little T traumas can impact our mental and emotional wellbeing in ways we can’t always spot. And that build-up trauma can even impact our empathy and compassion, as they push us from calm into a fight or flight response.

[00:00:29] Rachel: My guest this week is Dr. Claire Plumbly, a clinical psychologist who specializes in trauma. She calls that response to the red zone. And if you’ve ever been there, you’ll know how debilitating it can be. But Claire has some practical steps that you can take right now to help move out of the red zone and back into green, as well as resources to help us beat burnout.

[00:00:50] Rachel: This isn’t just about getting through the day or ignoring those moments when you feel triggered. If you’re feeling overwhelmed, you can speak to someone like Claire, but if you just need some practical evidence-based tips to recharge your battery, when it goes into the red, then keep listening.

[00:01:04] Rachel: Welcome to You Are Not A Frog, the podcast for doctors and other busy professionals in high stress, high stakes jobs. I’m Dr Rachel Morris, a former GP, now working as a coach, trainer and speaker. Like frogs in a pan of slowly boiling water, many of us don’t notice how bad the stress and exhaustion have become until it’s too late.

[00:01:29] Rachel: But you are not a frog. Burning out or getting out are not your only options. In this podcast, I’ll I’ll be talking to friends, colleagues and experts and inviting you to make a deliberate choice about how you will live and work so that you can beat stress and work happier.

[00:01:50] Claire: I’m Claire and I’m a clinical psychologist. I specialize in trauma, anxiety, and burnout. I’m based in Taunton in Somerset. That’s where I do a day a week practice, but I do also run an online, um, therapy practice and I have associates who are all, um, trauma trained as well.

[00:02:10] Rachel: have you always been a trauma therapist or did you start off in a different way and you were sort of drawn to that in your practice?

[00:02:16] Claire: mean, all psychologists are working with trauma, really, because usually any kind of presentation has come from an elevated nervous system and bad things happening to people. But yeah, no, I started in an IAP service, Improving Access to Psychological Therapists, so more general kind of primary care. And I did that for about seven years. And then I went into a sexual assault referral centre, The Havens in London, and started specialising in sexual trauma, did that for a few years.

[00:02:46] Rachel: And so what brought you to be interested in trauma as it related to burnout?

[00:02:51] Claire: So, when I went on to social media about a year and a half ago, I was learning the skill of trying to make sure I was meeting people where they were at. So if they’re not coming and asking for one to one therapy, they’re earlier in their journey. And looking at how people were talking about their difficulties at the earlier parts. They’re using more language like burnout, exhaustion, overwhelm, overthinking. It’s us as psychologists who then maybe put other labels on that down the line, or when someone has reached a clinical either level of burnout or clinical diagnostic criteria for other things.

[00:03:26] Claire: Yeah, so I was kind of meeting people where they were at. And obviously, burnout can range from the kind of mild up to the kind of crash and burn end. And a lot of people on social media, like myself, psychologists, are trying to help people understand the importance of catching it as early as possible, because it’s having that grinding down effect on you, and you’ve just got more cognitive faculties to try and get on top of it if you catch it earlier.

[00:03:49] Rachel: A lot of our listeners, so doctors, other healthcare professionals, people in other high stress jobs, you know, often are witnessing an awful lot of stuff. Even if the trauma is not directly happening to them, it’s happening to their clients, to their patients, they may see some really, really awful stuff. And I think we’ve sort of really, really separated them. We said, well, you can get burnout due to the demands of the job, or there might be certain things that traumatize you.

[00:04:15] Rachel: And actually, it’s exactly what you’re saying, Claire. I’m noticing that a lot of people, particularly people that I’m coaching one to one or maybe talking to at events where I’m speaking or training, there isn’t one big thing that’s happened. Or maybe there’s one thing that’s tipped them over the edge. But they’re looking at it and going, well, hang on, why did that tip me over the edge?

[00:04:36] Rachel: But then you sort of look at everything they’ve coped with over the last 20 years, and yes, it is a combination of workload, maybe a pretty stressful, toxic work environment, but often there are these little traumas that we often don’t even notice anymore because they’re just part of the day job, but they must be having an effect, right?

[00:04:57] Claire: Absolutely. We’ll see that in therapy when people come for an apparently unrelated issue and they’re puzzled, why can’t I deal with this? And it’s in the context of chronic ongoing stress and, you know, our stress response was only developed to deal with a short term stressor. So if we override the signs of stress. which a lot of people in burnout are shown to tend to do, they kind of think it’s just normal to live in stress, so they can get good at ignoring and normalizing stress, then this is the kind of the impact it has later on. It’ll be a seemingly small thing that just tips the balance, and that’s the point at which, oh.

[00:05:34] Claire: But yeah, your point around, you refer to it as little traumas is exactly how we explain it to our therapy clients. For a lot of people, trauma is often synonymous with post traumatic stress disorder, PTSD, but that’s not how a lot of therapists see it. So to get a diagnosis of PTSD, the definition of trauma is that it’s extremely life threatening and a horrific event that leads to it. And we would call that a big T trauma. So everybody looking at that would agree it’s traumatic. So, you know, like an assault or a natural disaster or something like this.

[00:06:11] Claire: But for a lot of people, they’ve experienced little T traumas. And these are the types of traumas that were personally painful or humiliating or disempowering, lack of control, all of these types of things are in there. To anybody else looking at that event, it might have been water of sucks, but they don’t even notice or remember it. But for you, it stayed with you. And so your nervous system has had to react to that in the moment.

[00:06:35] Claire: Particularly if there’s an accumulation of these little t events, and if the themes of the little T events, little T traumas were very similar, like lots of moments of humiliation or feeling like your boundaries were walked all over, then this kind of accumulative effect really does cause a big impact on your nervous system. And that’s what the definitions of trauma by people like Gabor Maté are. It’s that your nervous system, your body body, has had to make adaptations. Uh, to, to cope with what’s happened. And those adaptations are, um, emotional, behavioral, physiological.

[00:07:12] Claire: I once had it described to me, or shown to me in a training, they got a squeezey ball and squeezed it and said, you know, if you squeeze this ball, it bounces back, that’s what should happen to your nervous system. It kind of reacts and deals with the current stressor, and then it bounces back. But in trauma reactions, what’s happened is your nervous system has been squeezed, and then it kind of stays squeezed, and it doesn’t bounce back. So how you’re dealing with kind of future. Events and stressors is adaptive according to what’s happened to you in the past.

[00:07:42] Rachel: I love that analogy of the ball, but that makes so much sense to me, because yeah, people sort of say, what’s wrong with me? Why am I reacting so badly to this? And you’re like, well, look at what you’ve been putting up with. And it’s like the ball’s been squeezed and squeezed until the, I guess it’s like the elasticity breaking, isn’t it? And you can’t then bounce back.

[00:08:02] Claire: Although you can, just to say you can, so we’re not giving people no hope. Obviously, we have neuroplasticity and options of help. So we don’t want people to switch off at point think, oh,

[00:08:12] Rachel: We’re going to let you know how to do it, so don’t worry, stay tuned, stay tuned for the answers. But I do just want to address the, I guess it’s the elephant in the room? But a lot of people are thinking, okay, everybody has traumas, right? Growing up, you get trauma as you fall over in the playground, people are horrible to you at school. Certainly, if you’ve been through med school, everyone gets trauma. You all have experienced, a lot of you, teaching by humiliation, nightmare on call. You’ve all had patients being really rude to you, staff being really rude to you. You’ve all felt lack of control and, you know, everyone has it. Therefore, it’s pretty normal. So then, why are we saying it’s pathological? Or is it true that just everybody has experienced these little T traumas and we all need help?

[00:08:51] Claire: It’s interesting when I post about trauma sometimes. People get angry, exactly that, like what’s the big deal? This is normal. So I think we’ve normalized. Exactly that, overworking and accepting that stress is the norm, but it doesn’t make it okay. So people won’t reach out because they kind of, it impairs your ability to be self compassionate, that’s the problem. And to recognize that actually I can do something to make myself feel better.

[00:09:21] Claire: And I, I guess it gives organizations a get out jail free card to keep doing what they do, isn’t it? Like systems don’t need to change if we’re saying this is normal and just accepting the status quo.

[00:09:31] Rachel: Well, I think you’re saying that We’re not letting people off the hook just because lots and lots of people have it. But if everybody has it, then what hope do we have? Because with the best one in the world, there aren’t enough therapists around to deal with all of us. But is it a question of just recognizing everyone does have it to some extent, then minimizing it and doing what you can to treat yourself? What are the benefits of recognizing it, I guess is what I’m asking.

[00:09:58] Claire: Yeah. I guess. Thinking of it rather than as something like that you have and needs to be treated from a medical model perspective, just thinking of general self care as being needed in life and that that is. It’s really easy to drift off from that and that perpetuates any difficulties we’ve got and makes it hard give ourselves space, but we just, we’re so busy we don’t give ourselves space. And we’ve been taught or socialised to thinking that that’s a problem and sign of difficulties, but what if we kind of changed that idea into being like, yes, So we have all experienced these moments, and it’s part of being human to have our nervous systems activated. But what we know really helps us is connection, understanding the context, so kind of being kind of really kind to one another and providing. space to understand that these things have happened for this reason, this reason.

[00:10:50] Claire: Because often we go inside and the emotions make us withdraw, shame, anxiety, what will people think? I’m being a burden, and then it becomes something we should be dealing with on our own over here. So it’s about community and connection, I think.

[00:11:04] Rachel: I guess it’s a little bit like housekeeping really, isn’t it? So, there’s a model in general practice by Roger Naber, this is how I learned to consult where there’s the five parts of your consultation and there’s, I can’t remember what all of them are, but you’ve got the physical examination, you’ve then got safety netting, making sure that the patient’s going to come back if things get worse, that you’ve got a way of following up. But then the final one is housekeeping. And that is, how are you after the consultation, getting yourself ready for the next patient?

[00:11:33] Rachel: And that’s the only place I’ve really heard that happening. And I could be wrong and I know that many emergency departments, for example, have in house psychologists now. And they’re really, really looking particularly at people that work in the specialties that have quite traumatic stuff happening quite a lot of the time. But there is that housekeeping that we forget to do. As you said, like taking the breaks, like just connecting with colleagues over coffee that I guess if your nervous system has been squeezed, well, then just allow it to go back that then makes it more resilient and squeezable and boingy backy running out of adjectives here for next time. Does that make sense?

[00:12:16] Claire: Exactly. Yeah, I think that’s, I think we can keep running with this ball metaphor, because it does work really well. Like if you’re, you’re doing your morning clinic, and your ball’s being squeezed, squeezed, squeezed, making sure you don’t then work through lunchtime, where it’s not got any capacity to go relax and back to at least some sort of resemblance to what it started off at the beginning of the day.

[00:12:38] Claire: But I think these burnout patterns where we’re not creating space, they start really young. I’ve just read a really good book, actually. I don’t know if you’ve heard of it, Can’t Even. Helen Peterson. So she links it all the way back to early patterns in your childhood, which I’m sure a lot of people listening will resonate with, where we’re being told to work hard because medical school’s competitive, how you’re going to get in if you don’t work hard?

[00:13:02] Claire: And, you know, my daughter is in year seven. And when she started school, she signed up to all of the clubs, which meant at lunchtime, she goes straight from her morning lessons into a club, and then she doesn’t even have time during a club to eat her lunch, and then she’s going into her afternoon lessons. And that’s exactly the burnout patterns that we’re teaching our our kids. And she came home so proud of herself for signing up i was like oh this is the message i’ve sent and she’s internalized. i’m like how can we just clause some of your free time to just Be silly with your friends at lunchtime? Because that’s important So, yeah, we repeat these patterns that we start early on in life where we’re just not giving ourselves any space.

[00:13:43] Rachel: Particularly in healthcare and other really high stress jobs, the constant work, the no lunch break, the no breaks, the work your arse off until finally you collapse and you’ve got to get home because of a child go or something, or that literally the cleaners are trying to lock up, that’s just normal now. It used to be the exception, but it is just normal now. And to the point where we’re even feeling guilty. If we’re not doing it like that. And so I would say the burnout pattern is the norm. The healthy, regular pattern that should be the norm is the exception and it feels self indulgent.

[00:14:20] Claire: I agree.

[00:14:22] Rachel: But what do we do about it, Claire? Because what do we do we, oh, gosh, you know, when

[00:14:27] Rachel: a lot of my work at the moment is around helping people say no. So working out what we’re going to prioritize, helping people say no. And often it’s you’ve got to prioritize so you can get to those important things that you really, really want to do. It’s very difficult to prioritize the downtime and the rest of the housekeeping stuff, when what you’re saying no to, you’re feeling guilty about, when what we’re saying no to, we’re feeling shame about, because if we say no to something and it means someone else’s inconvenience or it messes with the idea that we are perfect, that we always help, we go out of our way to help other people, it becomes really, really difficult. It’s one thing saying no to do, because I’m doing something else that’s very worthy and important. But saying no in order to avoid burnout. Yeah, really

[00:15:18] Claire: But I mean, if you think, it’s interesting,

[00:15:20] Claire: some of this training I did recently on trauma talks about the different functional levels of IQ we have when we’re in different parts of our nervous system. So when we’re in our green rest and digest, hopefully business as usual, so that’s our parasympathetic ventral vagal system, our IQ is functioning as it usually would.

[00:15:41] Claire: And then we, you know, when we get a bit kind of stressed, we’re rushing around, it’s kind of dropping down a little bit. And then, this is our fight or flight sympathetic nervous system in the go.

[00:15:52] Claire: And then when we crash and start to kind of tip into feeling just completely overwhelmed, starting to shut down on autopilot, then that’s our lowest functioning level of IQ. And that’s where we feel a bit cloudy, like struggling to find our words or remembering things, our concentrations all over the place. And I think that’s why medical burnout probably gets talked about. Often you see it in the news sometimes, don’t you? Because of course, I suppose that’s the danger then what a lot of doctors maybe worry about as well is that that’s gonna cause a big problem for one of their clients, patients. But I think it’s helpful to remember that actually you’re not functioning at the level you are when you’re coming in fresh to your shift.

[00:16:33] Rachel: Oh, totally. Yeah. I mean, my patients, gosh, my patients at 5 30, 6 o’clock in the evening got a very, very, very, very different experience to me fresh at, at 8:30. And we don’t think about that because we have just been told that the Holy Grail is to be able to keep carrying on rather than actually, rather than actually resting.

[00:16:52] Rachel: And then what we do is we, we do ignore those traumas that happen during the day, those traumatic things, and we keep going with patients, even if we’ve just had one that was very, very hard and very, very traumatic. And it feels that there is no time then if you’re in the middle of a surgery, clinic, et cetera, et cetera, to then actually do that little bit of housekeeping.

[00:17:15] Rachel: People who are listening back to this won’t have seen, but on the front of your book, Claire, there’s that battery, on red. Um, and I was talking with Dr. Dike Drummond, um, the other day. He does lots of, Burnout stuff in the US, there’s a podcast come out with him quite recently and he said he often asked doctors, you know, where are you now? Where’s your battery level? Where’s your battery level on a 10? And if you’re saying, well, probably three or four, is that good enough? Is that what you want? Is that really what you want?

[00:17:44] Rachel: And then another person who I do in a community with John Parkin, who’s written the F it books, he’s sent out this brilliant blog the other day about battery levels and the fact that when we recharge, if we find our battery’s really low, you know, 2%, so we think, oh, I’ve got to recharge. So we plug in and we recharge to. 15% and we go, right, there we are. Off I go, off I go and recharge. I mean, is this consistent with the sort of people that you see in your clinic?

[00:18:12] Claire: Yeah, I mean, I have people coming in, and they don’t link the dots between how much they’re working. Because you can’t think clearly, you can’t, problem solve your way out of it, because those cognitive functions are housed in the part of the brain you don’t have good access to at a point like that.

[00:18:27] Claire: We have good access to that when we are in our parasympathetic ventral vagal nervous system, the green part. And how that impacts us is we struggle to imagine a more positive future and strategies for getting out of it. And so that ability to step back and take the bigger picture in is, is impaired as well. So yeah, you can charge your batteries up for 15% and forget that there’s all that other percentage that’s still empty. And, and an imagination for what that would look like is really, I think, missing.

[00:18:57] Rachel: Absolutely, and I know I’m such a better person. I’m so much more creative when my battery is at 80% as opposed to, you know, 20%. Oh, what would it take? You know what? I don’t know what it would take to get battery to 100%. Is your battery 100%?

[00:19:11] Claire: Um, I know, I’m curious, uh, like last week I was off and I definitely, you know, felt recharged. Um, I feel like I need to rewind to go back and see what percentage I got, I

[00:19:22] Rachel: That’s a good question to ponder. I would like to ask all our listeners, what would it look like to get your battery up to 100%? What would it feel like? Can you imagine?

[00:19:31] Claire: But it, it, it’s interesting ’cause like researching for this, this burnout book, I’ve read a few people’s, you know, books on, on, I’ve got the burnout solution here and, and other burnout books. And often the authors talk about that moment of clarity they had that things couldn’t go on. And either it’s because they did completely crash and burn or it’s when they went away and they were kind of, they’ve had two weeks proper break, and they’re on their way on back or on the beach or something, and they kind of go, I can’t go on like this.

[00:19:59] Claire: And I think that’s the difference. They’re no longer in their amber or red nervous part, part of their nervous system. They’re back in their green and their ability to see and imagine this is not what I wanted for myself. These are my values. Oh, Yeah, they’re over there. I’m a million miles from them is much more possible when they have had all that proper switch off time.

[00:20:16] Rachel: Yeah, time and space is so important, which is why I think going on retreat is so important, getting away, getting into nature, all these things, just to get you away from the stuff that’s going on all the time.

[00:20:27] Rachel: I’m really interested. Is burnout then caused just by repeated little traumas? Is that what burnout actually is?

[00:20:34] Claire: I mean, as a psychologist, I would say, yes, it feels like that is. But the research talks about jobs that are either monotonous or feeling like your boundaries are completely being trampled all over. You know, when you’re really passionate about something, you can exhaust yourself. And maybe that’s not a trauma. So there are aspects like that, you know, entrepreneurs, artists, athletes, people like that who really want to do well and really passionate about their stuff and find it hard to put down. So they don’t notice the exhaustion. But I suppose as a psychologist, you’d be questioning why that kind of. of need to get to that certain level of standards. That probably does float back somewhere in your early life to some expectations that were put on you or a need to prove yourself or fearing of rejection. But we don’t want to, like I say, pathologise everything, but everybody’s got a formulation of psychology, dots that can be linked up. And that’s, you know, something in therapy you can always try and just unpick that. You don’t need to be at a clinical level of diagnosis to do that. You can absolutely do that at any point and just understand your motivations and values a little bit better and where these patterns are coming from.

[00:21:43] Rachel: Yeah, because I guess at any point somebody could stop. They could say, right, I’m not gonna carry on practicing or, you know, doing that sport, or this is where work is gonna stop for today. I’m going to say no, or this is where I call in sick, I can’t go in, or this is where I say no to that extra shift or stuff.

[00:22:01] Rachel: It is the lack of ability to set those boundaries, isn’t it? Or people trample on them and then we can’t enforce them. I’m really interested in boundaries because I think doctors really don’t have any boundaries. They really don’t. And a lot of that is from our In the past and our training.

[00:22:19] Rachel: As in, I remember when I was a junior doctor, we could just be called to do anything. People had to, they asked you to do something. Even if you couldn’t do it, you’d have to learn to do it and just do it. It almost got to the point where, you know, if the cleaners weren’t there, then the junior doctors had to clean the ward. It was just at that point where we had to do everything. We’ve grown up with this thought of I ought to do everything. I can do everything, so I should do everything. And of course, looking after everybody else is the most important thing.

[00:22:49] Rachel: And there were, I guess, I guess writing that back to lots of little micro traumas about what happens if we didn’t do it and people having a go at us or, like you said, humiliating us or only valuing us for what we did. And oh, it’s just, you know, it’s very difficult. So we’ve got this mindset that I. I cannot ever just say, no, that is enough.

[00:23:10] Claire: It’s interesting though, isn’t it? Because Psychologists don’t particularly. Boundaries comes up in different ways in the models that we, or certainly when I trained, but not as a standalone thing that you just go in and do as a kind of specific intervention necessarily. So I’ve been coming more interested in it in more recent years as well. And I think people don’t really know what boundaries are, really, or actually how they are communicating that they’ve reached their limits in ways that are non direct.

[00:23:36] Rachel: Hint and hope, as I heard yesterday.

[00:23:39] Rachel: Gosh, I mean, this happened to me literally the other day. I had been in London doing some training. I got, I’d left the house at 6am. I got back at half 7am. I walked in and people were sitting around and I said, what, have you done tea? No, I walked straight to the fridge, got out and started cooking in a very grumpy manner. Rather than saying, I’m really tired. And I just like to feel really sorry for myself for thinking. But then there was a voice going, I can’t ask other people to do this because they’ve had long days. This is my job. They’re stressed. They’ve got exactly, you know, it was just all those sort of things yet I was annoyed about it. And in the end, I was going, you know, I’ve been up since 6am, blah, blah, blah. And I said, my son, he looked at me and went, Mum, would you like a beer?

[00:24:26] Rachel: It was so sweet. It was just the right thing. I was like, I don’t want a beer but actually, I would love a glass of wine. But it was just funny. It was like, He obviously recognized it, but it was so funny. His boundaries were like, well, I’m not gonna I’m in the of revising, but I’ll show you some empathy. But yeah, it was that hint and hope and feel guilty and passive aggressive. And all I could have done was gone in and gone would anyone be willing to cook instead of me? Because I’m really, really tired. And I’m sure probably someone would have said yes, or we could have gone, no, but you know what? Let’s get a takeaway. You know, there are different things, but we are totally our own worst enemies when it comes to this, I think.

[00:25:05]

[00:25:05] Rachel: mean, what do you define as a boundary? Because we always talk about setting boundaries, but I think it’s a bit of a weird word, isn’t it? What do you define as that?

[00:25:14] Claire: I think of it as imagining there’s like a fence around your wall, and this is your time and energy and space. And where does that wall go, like how far out is it? Because if you’re willing to give more of your time and energy versus, like, less. And so it’s kind of recognizing, yeah, how much you’ve got to give and that these are finite resources. And sometimes I talk to my clients about how they talk about this wall. People are like, there is no wall. I don’t know where the wall should go.

[00:25:42] Rachel: But the thing about your wall is, that’s totally up to you. And I think that’s the, the thing that we try and talk to people about is that you’re in charge of your wall and your boundaries. You know, no one can force you to put your boundary down, can they? That is your, that’s your ch, that’s your choice. They can request and they can bang against your boundary.

[00:25:59] Claire: I think it can feel like they are, but that’s where the skill learning comes in. Because what you get when you try and enforce a boundary is pushback. And it’s really obvious if someone gets angry. It’s almost easier to stand up for your boundaries when someone’s angry, because that’s the role of anger is to make us kind of feel like, oh, hang on, our boundary’s here. But questioning your judgment, for example, or checking, are you sure you can’t just do that? Or, oh, you’d be really good, you’re the right person, this. Persuasion, or emotional blackmail, I just won’t cope without you, you’re the person for this job. And all of that is harder to be firm against.

[00:26:36] Claire: But it is all the same thing. It’s all designed to push emotional buttons so that you drop your boundaries.

[00:26:42] Claire: Yeah, I made a video on social media on this. had an attempt to stop motion using Lego Man. But it was like a Lego man on a little island. And I cut out a piece of paper and put him on the island. And I put the sharks around. And how I described it was every time you give into a boundary or, or kind of give a bit of this time and space where this, this island gets smaller. And so in the end of this video, this little Lego man’s on a tiny island.

[00:27:07] Claire: The thing is on that island without that time and space and energy, they’re the things that fill you up and keep you resourced and safe from, from burnout. Because without that you don’t have any resilience for, you know, that moment that will tip you over, um, be the straw that breaks the camel’s back. So when island’s bigger, um, because we’re giving ourselves some downtime or permission to say no so that we can spend time with our kids or doing the things we wanted to enjoy, yeah, we’re, we’re, it’s safe, safer

[00:27:35] Rachel: That is what happens to us. People take bites out of our island. The bricks go and we’re closer and closer to that shark infested sea. And then we’ve got no buffer. No buffer at all, because then suddenly there’s a complaint, a really nasty complaint, or something goes wrong with a patient, you know, that it happens, or someone’s really irritated with this, or, you know, or there’s a health crisis yourself or something. And because you haven’t got that buffer of an island, all the blocks disappear and you’re suddenly, you’re suddenly in the sea, aren’t you? And whereas if you’ve just got that emotional buffer, then you’re gonna cope.

[00:28:14] Rachel: And you give away your time and energy. It’s like you said, yes, people can push back at you and they can be passive aggressive and they can try and persuade you and stuff. But at the end of the day, it’s up to you. That is in your control. But I think over the years, we have been led to feel that it’s just totally not in our control.

[00:28:33] Rachel: I was talking to someone in one of our communities last night and talked about emails. So emails is one thing that I think is this sort of creeping burnout waiting to happen really with emails. Because we feel beholden to emails because other people send them and they land in our inbox. Therefore, we feel we haven’t got any control at all and we feel beholden to answer them. But we wouldn’t feel if the phone was ringing all the time, we could ignore it. We decide not to answer it. We send it, you know, so why is it with emails? As soon as someone puts in a request with email, we ought to answer, we’ve got to answer, we have no boundaries. Because we think, because it’s in an email. If someone said to me, oh, Rachel, can you just do this? And I’m like, actually, sorry, I can’t, I’m too busy. But if they put it on an email, it’s like, well, it’s an email, it’s a task now.

[00:29:20] Rachel: And this person was having real problems recognizing that how she dealt with her emails or even if she did any of those tasks was in her control as opposed to anybody else’s control.

[00:29:31] Claire: maybe just to link it back to a psychology theory, like if you are verbally communicating that or can see someone, you can give off those friendly vibes with your eye contact, your tone of voice, that this isn’t a threat, it’s just a kind of like, really sorry, not today, I can’t do that, or. But in email, you lose all those cues. So, you know, that social engagement system that maintains a sense of safety and kind of niceness kind of isn’t there. That’s probably something to do with it.

[00:30:00] Rachel: Yeah, and then you get more resentful, don’t you? Feel out of control? And linking back, you told me that list of things that cause trauma with a little t are things where you lack control, right?

[00:30:10] Claire: I think I see that as chronic stress, but it would be always in the context, wouldn’t it of an overflowing email box means you have inescapable levels of work, so, and you feel, like, beholden to that level of work and you can’t just say to a boss, this is too much, or, like, there’s something there, isn’t it, that feels really difficult for your nervous system to manage.

[00:30:33] Rachel: You’ve got the overwhelm with work and the lack of boundaries, which is definitely associated with burnout we know. Then we’ve got these sort of traumas with the little T that come at us probably most of us throughout our careers, which if we just did a bit of self maintenance after they had happened, our squeegee ball would be able to sort of spring back, but we often don’t.

[00:30:54] Rachel: And then I think mixed in with that we have the sort of Big T traumas, which hopefully most people don’t ever experience a really massive thing, you know, like an assault or something where they may be prone to PTSD. But there is other stuff that happens that I don’t think we recognize and deal with quick enough.

[00:31:14] Rachel: I mean, have you seen that with clients that they are so used to dealing with little traumas that they don’t recognize when a big one has come along that they need to actually do something different?

[00:31:23] Claire: Yeah, we call it kind of minimizing in therapy. We might use a word like that. But I think what can happen is if people have got learned behaviors for coping with difficult emotions, they just immediately kick in. So keeping really busy, because who wants to sit with the distress of a trauma? I mean, that’s a classic, and that leads to further burnout.

[00:31:42] Claire: And often you’ll, how, how it might present in therapy, for example, it’s like somebody then has something else that happens and it’s like, all, hang on a minute, I’m, I’m suddenly getting all these intrusive thoughts of this other thing that happened a few years ago and it’s all kind of crashing in at me at once.

[00:31:58] Claire: Or we can get, even if it’s not explicit, intrusions and, and flashbacks, we get. Implicit memories can come up. So this is where we get these emotional kind of flashbacks, where we get excessive levels of emotions that don’t really warrant the level needed for the situation. This is always a bit of a hint that there’s something maybe in the past that might be worthwhile going back and trying to deal with.

[00:32:21] Claire: And that can be relevant to the boundaries as well, that level of guilt and anxiety. You know, just a, a simple question you ask yourself is, is this level of anxiety and guilt warranted for this?

[00:32:31] Rachel: And then, I mean, what can we do about it? We talked about a bit of self care, connection, giving yourself time, getting a proper rest for the little T stuff. What about the, I mean, is there like a middle, a middle sized T stuff that needs dealing with a little bit differently?

[00:32:46] Claire: I mean, like I said, um, earlier, like cognitive strategies that are often recommended is trying to give yourself the space by using tools like journaling, um, to try and. Just get it out of you and try and order your thoughts a little bit. That kind of thing can be really helpful as a self help strategy.

[00:33:05] Claire: And, you know, reading books that are written by psychologists who have these strategies and actually doing the tasks in them rather than just reading the book. Those are really good starting points.

[00:33:15] Claire: But if you’ve got to the point where you can’t get into those types of cognitive strategies, what’s important is not to start blaming yourself and putting yourself down and kind of adding these things to your to do list and going, well, I failed at that, and I can’t do it. I always say to my clients, it’s not a sign that you failed, it’s just a sign of where your nervous system is at the moment, and your nervous system needs something different to that right now. It needs something much more basic, back to kind of connection and regulation, and so it depends. If you’re more in that kind of rushy, fight, flight part of your sympathetic nervous system, or if you’ve dipped more into your red dorsal nervous system. But if you’re in your rushy, then it’s remembering that you’ve probably got a lot of adrenaline, oxygen, and too much of the kind of stress hormones that need to just be discharged, because we get an urge to kind of pace and do things like this. So doing something that releases that can be really helpful.

[00:34:09] Claire: There’s another burnout book by the Nagoski sisters called Solving a Stress Cycle, and they talk about like kitchen discos and going for a jog and having a laugh with friends. These are all really good for kind of discharging.

[00:34:20] Claire: Um, and I, I teach my clients, all therapists teach you their clients breathing exercises. ’cause it’s like the quickest way that to bring the part of your nervous system that you need to under your conscious control to, to slow your heart rate down. So soothing breathing rhythms. And the other technique I always really like is some slow kind of bilateral tapping, which I use in my EMDR. And the research shows that slow bilateral tapping or eye movements dampens down the amygdala and sets off the reward circuitry. So you move from being in that kind of fight or frozen state, wanting to retreat and withdraw and flee, into that kind of calm but able to approach state. You’re not overwhelmed anymore. Andrew Hubeman’s a good neuropsychiatrist who’s got lots written on that. And he’s got some good YouTube talks, if anyone wants to just search for him.

[00:35:15] Rachel: Can you just tell us what the, the bilateral slow tapping is?

[00:35:18] Claire: So put your hands out in front of you. So your palms are facing you about shoulder length, shoulder height. Now, cross them across your middle. And so your thumbs are kind of then hooked. And so it looks like a butterfly. And then place them on your chest. So your kind of palms are now over your heart and your fingers are up by your collarbone. And then you just gently tap at a pace like this. Tap, tap. The bilateral is so you’re tapping one hand at a time, not both hands.

[00:35:54] Claire: We do this slowly and we connect it to positive resources, which are positive imagery like a calm place or figures in our lives that have given us a sense of calm or peace or wisdom or nurturing. But even on its own, the research shows that just the tapping on its own will help your nervous system to settle.

[00:36:16] Claire: So this is a good alternative if someone listening to this doesn’t get on with breathing. But I would always try starting with breathing because it is the quickest way. So a good experiment with this is just to find your heart rate and just notice how it speeds up when you breathe in and slows down on the way out. Just do a few breaths like that. If anyone’s driving at home, please don’t do this and make yourself

[00:36:41] Rachel: Don’t do this in the

[00:36:42] Claire: Yes.

[00:36:43] Rachel: or if you’re operating,

[00:36:45] Claire: What you’re noticing then is the vagal break, the ability to regulate your heart rate through the breath. And so the longer slow out breaths is when the heart rate’s slowing down. But either way, if you can make sure the breath is even, So if you’re counting, say, you want it to be even on the in and then even on the out. So some people might have in for four, out for five, in for four, out for five. That’s an even regular breathing rhythm. And this will help your heart rate know that the fuel coming at it is consistent and it’s out of the danger zone, essentially. So everything starts to function more in the green kind of rest and digest mode.

[00:37:26] Claire: And if you take a look at the App Store, you can get biofeedback tools as well, which sometimes, if you’re someone who just wants to see it’s working, it’s very clever what you can get now. You put your thumb over the, The camera and the flash and it picks up your heart rate and you can just do that for three or four minutes. You can see it then starting to regulate and then you know it’s kind of doing its job. It will be doing its job, but I think if you’re struggling to sit and do it, something like that can really help you stay motivated to actually do the slow breathing.

[00:38:02] Rachel: Great, and we all like a bit of evidence to back all this up so we can actually see it ourselves.

[00:38:08] Rachel: I’m just also interested in, so I get the green zone, the parasympathetic zone, and you’ve got that listed, I’m presuming it’s the AMA zone, the fight or flight, which is your sympathetic loss of adrenaline. Can you just tell me a little bit more about the red zone?

[00:38:21] Claire: so we are drawing on polyvagal theory here, which was developed by a chap called Stephen Porge. And he recognised from some work with babies, actually newborns, that actually the parasympathetic nervous system was a bit more complicated than we first thought. So we tend to think of a parasympathetic nervous system as more where we are when we are calm and in our rest and digest mode, which is true, but there’s actually two branches of that. And he’s mapped it onto, in terms of the evolution of our systems. And the oldest part of that is this dorsal vagal nervous part of our nervous system, which is responsible for the basic functioning of kind of a lot of nervous system that happens on autopilot.

[00:39:10] Claire: And so actually then the sympathetic nervous system And then the green rest and digest part is the ventral vagus nervous system, the social engagement system that I referred to earlier, which is also part of that. And that came much later, it’s the youngest part of our nervous system.

[00:39:31] Rachel: so we’re using that bit of the red of the nervous system when we’re in the red zone. Is that just because nothing else is working because we’ve literally burnt out our hypothalamic pituitary axis or?

[00:39:41] Claire: So yeah, so all of these systems are useful in our ordinary functioning, but we also have a threat mode attached to them. And so our threat mode will activate initially to try and keep ourselves safe from danger, and that’s the sympathetic nervous system, the fight or flight. But if we can’t escape from the danger, so if our boundaries are constantly kind of ignored, or if we can’t mobilize ourselves out of danger’s way, then this is where we’ve got our Get Out of Jail Free card with the red zone, which will kind of go into the flop. And that’s where you know, in the an Auckland you see the prey kind of literally flopping down and everything seems to stop. The breathing, the ribcages will stop and it’s kind of means the predator loses interest and disappears off. And then when the animal comes out of this, you’ll see it vigorously shaking and that closes that cycle because everything kind of re engages then.

[00:40:41] Claire: And so what that looks like in humans, you know, sometimes people will just zone out. I get that in the therapy world where sometimes just clearly aren’t able to, to take on board what I’m saying, they just look a little bit vacant and lost and um, like they can’t list, they’re not listening anymore. But, you know, we can have different levels of that as well so, you know, feeling detached. Compassion fatigue, you know, blunted emotions, this would also fit more here.

[00:41:08] Rachel: So redstone is, is burnout, isn’t it? I mean that the, it’s the symptoms of burnout. The depersonalization, the lack of empathy, the exhaustion, the feeling of poor performance, of blunted emotion. I mean, that makes so much sense. It really does. And that’s why, yeah, you often get, you get the stress, stress, stress, stress, and then you, then you get into that red of not caring, but you’re still sort of vaguely functioning and Oh, that makes a lot of sense. And treatment for that red zone, again, I presume it’s all the stuff that we’ve already talked about, and then some.

[00:41:40] Claire: Yeah. Yeah. It’s just, it’s going really gently and thawing back out that. It’s, like I said, it’s the connection. That’s where touching, knowing where your body begins and ends, remembering that, like, because when you’re dissociated, that disconnection from your body and your surroundings just goes. So it’s kind coming back to safety. Trying to be where there are cues of safety, and we get that from our surroundings and people. So seeking those places of safety out. So, you know, is there a place in your home that you can make feel safe?

[00:42:11] Claire: If you work from home, for example, it might be your home office or making sure your things linked to work aren’t spread around the house.

[00:42:18] Claire: These might be little things. And making sure at work there’s somewhere you can go that feels like this is like I’m safe from patient’s getting at me or the phone ringing or emails like maybe not taking a phone because phones don’t feel safe when the emails are

[00:42:33] Rachel: Definitely not. So, Clare, we’re nearly out of time, so in a minute, I’m going to ask you for your top three tips for people that feel like they might be sort of starting to go down that from green to amber into red, or maybe who found that they’ve been experiencing lots of maybe traumas with a small T.

[00:42:51] Rachel: My final question is, so can we summarize from all this that burnout could be caused by stress and difficult workplace. It can also be caused by multiple traumas with a little T and most times it’s caused by a mixture of the two.

[00:43:08] Claire: Yes, absolutely. And, and difficult work environments as well and organizational factors and, and all of that. And so I don’t want people to go away thinking it’s something about just me. I think we are in a culture and systems that perpetuate it and, you know, value commercialism and capitalism and all these

[00:43:27] Rachel: Yeah, as Gabor Mate says, we’re not in an environment where anyone can thrive at the moment. Because we weren’t built to live like this, to connect like this, to yeah, all those different things.

[00:43:39] Rachel: So, if someone was struggling a bit at the moment, what would your three top tips be?

[00:43:44] Claire: I mean, I think one is that if you are just chaotic rushing, you’re getting constant urge just to rush, that that is actually a sign that you are in the amber part of your nervous system. And so actually continuing to rush is going to maintain that. So, that’s the sign that you need to pause. Don’t wait for the pause to be given to you or to feel like it, that’s the wrong way round. You’re not going to feel like it when you’re there. You need to recognise that the rushing feeling and not being able to make any time is the sign.

[00:44:21] Claire: I mean, so self care, things that I’ve talked about. If you’ve been trying those, just and they’re not going anywhere, just get some support with a therapist or like the kind of communities that you’ve got because I think accountability and connection on some level, any level will help. So I’ve run a group recently and everybody just finds, you know, just hearing that they’re not alone makes such a big difference. So, you know, humans work. We were made to be independent, we were made to be interdependent and, you know, whenever we’re working in therapy with someone, we’re always trying to find out where are those opportunities to connect because we just know how good it is for nervous system. So don’t try to do it on your own. Find a community or go and speak to a therapist.

[00:45:06] Claire: Yeah, and I would say, just going back to the boundaries, just work on boundaries and know it’s something that can change, because it’s a skill. And some of the skill in that will be around learning how to manage intense emotions, but not give in to them. Because a lot of people come to me, I don’t know if they say the same for you, Rachel, with boundaries, wanting to now do something without feeling guilty or anxious. But actually, what we’re always teaching is that actually… Actually, those emotions will show up, and we’re going to take them along for the ride. And they might get less intense because you get practiced at it and recognizing, you know, where your little island is and begins and ends, which helps. But Don’t wait to not feel guilty or anxious before putting in the boundary because again it doesn’t come, it doesn’t, that’s not the way it works. The emotions will start to change when you change your interactions with them.

[00:45:56] Rachel: Such good advice because yeah I spent a lot of my life trying to say to people don’t feel guilty or myself don’t feel guilty but you that’s just it’s hard right into us because we’re good people aren’t we but it’s just actually guilt oh hello guilt hello guilt my old friend. Yeah, that’s why you’re there you’re protecting me and that doesn’t mean I need to do anything different so really important.

[00:46:16] Rachel: You know for me I’m just listening to you that My top tips would be, yeah, give yourself permission for that self care, even if you’re really, really busy, even if you can’t afford the time, that’s probably the time when you need to, because you’re never, ever going to have got everything done. And that, I love that idea of the regular housekeeping after, you know, all the time. Where’s my housekeeping to get that battery back up, back up to? 80, 90 or even 100%.

[00:46:42] Rachel: And what you said about the minimizing we do when we do have quite significant trauma that comes at us all the time, actually, that she recognizing it and thinking, right, this has actually been more significant than usual. What am I need to access health and connection?

[00:47:02] Rachel: Wow. We’ve talked about so much, Claire. Thank you so much. We’re going to have to get you back on the podcast, particularly as you keep writing your book. And you can come and share all your revelations to us, your learnings. If people want to get a hold of you, how can they find you?

[00:47:16] Claire: Uh, yeah, so I’m on a lot of the socials. Instagram, I do short form videos on TikTok, which a lot of people cringe at, I cringe at, but that’s where we go when we zone out, we scroll on our phones. So that’s why I went on there to meet people where they’re at. Um, and I’ve got a new YouTube channel and my website is drclareplumlee.com. And you can download there my free pathway out of trauma and burnout, if you want the steps, the steps that I would be doing as a trauma trained therapist.

[00:47:47] Rachel: Brilliant. Oh, thank you so much for being here. And hopefully we’ll speak to you again soon.

[00:47:51] Claire: Thanks, Rachel.

[00:47:52] Rachel: Thanks for listening. Don’t forget, we provide a self coaching CPD workbook for every episode. You can sign up for it via the link in the show notes. And if this episode was helpful, then please share it with a friend. Get in touch with any comments or suggestions at hello at youarenotafrog. com. I love to hear from you.

[00:48:14] Rachel: And finally, if you’re enjoying the podcast, please rate it and leave a review wherever you’re listening. It really helps. Bye for now.