Is All-or-Nothing Thinking Pushing You to Burnout?

[00:00:00] Rachel: A few months ago, I was doing some team coaching with the senior partnership team of a practice down south. And they were experiencing some sort of disgruntledness within the team. They were experiencing some moaning and some whinging, there’d been a lot of change recently. And they were at a loss about what to do in order to just get people to do what they were required to do for their job, to help with some of the moaning and complaining.

[00:00:25] Rachel: And we were talking about the importance of conflict at work and how actually most of us don’t have enough conflict because we’re just so scared of what would happen. And so we talked about boundaries and we talked about what they could do about it and how they could possibly challenge these people a little bit more.

[00:00:41] Rachel: And one of the partners said, Well, the problem is we don’t just want to go around performance managing them and sacking them willy-nilly. And I said to them, Wow, that’s like one end of the spectrum. But has anyone even mentioned something to them? Have you even had a conversation about what they’re doing? Maybe start with that.

[00:01:01] Rachel: You see, they had got very black and white thinking that either we have to performance manage them, which is gonna be really awkward and really ruin the relationship, or we do nothing at all. It was either or. And it was causing them a whole deal of grief because they were completely stuck. And this abject fear of having these tricky conversations because they thought they were gonna be really high stakes meant that they weren’t doing anything at all.

[00:01:26] Rachel: And we see this either or black and white binary thinking a lot in healthcare. And I think that this is one of the major factors in increasing our stress and increasing our levels of burnout. But if you start to recognize that, you’ll see this binary thinking everywhere. And this is a major cause of the reason why we fail to set boundaries, we fail to look after ourselves, and we get trapped in the spiral of guilt and fear and shame. So in this quick tip, I just want to explore this a little bit and help you recognize how some of your binary thinking may be leading you into burnout. And I want to suggest that instead of the binary thinking that we all just slip into so easily, we start to embrace ’em both and thinking, actually being able to hold two truths at once.

[00:02:14] Rachel: And the problem is if we fall into this binary thinking trap all the time, we just stay stuck because we see ourselves as either strong or struggling, either objective or emotional, either selfless or selfish. It makes our burnout worse because whoever wants to be thought of as selfish? So we fail to set boundaries. We don’t get any time to look after ourselves, and we keep going down the vortex of busyness. Eventually we go into burnout, we can’t work anymore, or we leave, and then where are we for our colleagues and our patients then? But if we get this right, we actually have the power to change stuff and we can put some language around what we’re experiencing. We can give ourselves permission to hold complexity, that that isn’t always an answer, that there isn’t always a right thing or a wrong thing to do.

[00:03:01] Rachel: And this will keep us human, it will keep us acknowledging our limits so that we can embrace our limits and give ourselves what we need. It’ll also help us model healthy boundaries and healthy self-care to other people. And long-term, it’s gonna mean that you can keep going.

[00:03:18] Rachel: This is a You Are Not a Frog quick dip, a tiny taster of the kinds of things we talk about on our full podcast episodes. I’ve chosen today’s topic to give you a helpful boost in the time it takes to have a cup of tea so you can return to whatever else you’re up to feeling energized and inspired. For more tools, tips, and insights to help you thrive at work, don’t forget to subscribe to You Are Not a Frog wherever you get your podcasts.

[00:03:45] Rachel: Now firstly, I think it’s really important to understand why we are falling into this binary thinking trap. I mean, I think it’s pretty obvious we are trained like that, aren’t we? I remember when I was at medical school doing sort of 10 exams in one week, and most of them were true false questions, true or false, black and white. And what’s worse? We even had negative markings, so it was quite possible to get like minus 20% in an exam. So you had to be really sure that you were right. We were penalized for getting things wrong, and it was always seen that there was a right answer to these conundrums.

[00:04:16] Rachel: Now people always say medicine is an art just as much as a science, but I don’t see much of that in medical training, and I don’t see much of that in when we’re thinking of dealing with our complex emotions either.

[00:04:28] Rachel: We’ve also been trained in a system that glorify sacrifice. So we believe that sacrificing ourselves is the most noble thing that you can do for mankind. And in fact, there’s a brilliant book called The Status Game by Will Storr, and he talks about the fact that in some cultures, you know, the Greek culture, the ancient Greek culture, it was, it was the body that was glorified. You know, these superhuman athletes that were glorified. So we often glorify people by, by who they are, their strength, or by what they’ve got, the money that they’ve got, but also how sacrificial they are. If somebody is really altruistic, I mean, look at Mother Teresa Or Captain Tom, you know, doing those laps of his garden In Covid, we love to see people that are, are giving of themselves to other people. And we we’re told that that’s a very noble thing to do.

[00:05:18] Rachel: And of course we need to be generous. And of course that’s good for society, but we glorify it to the point where protecting oneself is seen as selfish. No matter how many times we trusts out, that quite trite phrase of self-care isn’t selfish. Deep down, it’s not self-sacrificing. Therefore, we still believe it is selfish.

[00:05:40] Rachel: So particularly in medicine where we might not be the best athletes in the world, we might not have that much money. It’s this doing good. It’s a doing good thing that we define ourselves at by, and that gives us a lot of our identity. And often that is about how much sacrifice we are making to help people.

[00:05:57] Rachel: And the amygdala love stats. So remember, the amygdala is the little bit of your brain that detects a threat. So if it takes a physical threat, are you just about to be, eaten by a lion? It sets a hierarchical threat. Are you gonna be challenged by the alpha male? But it detect a group threat. So we move away from circumstances where we’re gonna be upsetting people because when we lived in caves, if we upset the group of people didn’t like us, we’d be chucked out, we’d beaten by a lion. But it also moves towards doing things that benefit the group. We are pack animals.

[00:06:29] Rachel: So the amygdala will, will do things to try and keep us safe immediately safe, immediately safe in our environment. And it’s also worth remembering that when our amygdala detects a threat, like, oh, I might be upsetting somebody, it sends us straight into the corner, into our fight flight or free zones, into our, our adrenalized sympathetic nervous system, where you are thinking becomes even more black and white because, the blood is literally diverted from your prefrontal cortex to your big muscle so that you can run away.

[00:06:59] Rachel: So we are predisposed to black and white thinking when we are in fight, flight, or freeze, when we are triggered, when we are stressed and, we make cognitive shortcuts, we put people in boxes as good or bad, right or wrong. We judge our own behavior as good or bad, or right or wrong. To be judged, things as either helping or hurting or in or out, and we can’t think in a nuanced way.

[00:07:24] Rachel: So when the amygdala detects a threat, which might be letting other people down, letting patients down, letting colleagues down, it puts us into the corner and tries to protect us. It makes us tell ourselves stories like it’s either them or it’s me, and it will favor them ’cause that will actually keep a safe short term.

[00:07:42] Rachel: And the moment you even think about taking a step back to protect yourself for the long haul, your E will flare up and go, no, no, no, no, no, you’re probably gonna upset somebody right here, and it amplifies our guilt and our fear about what might happen.

[00:07:58] Rachel: So not only does being in your sympathetic nervous system zone increase black and white thinking, your amygdala actively promotes it. It loves it because that’s the way you can deal with threats short term. It’s that thing about trying to avoid short-term hurt.

[00:08:14] Rachel: Now obviously we all know that that then often results in this long-term harm that is caused by ignoring our needs, putting everybody in front of ourselves.

[00:08:25] Rachel: The other reason why we get stuck in this binary thinking trap is that we work in a system which just rewards self-sacrifice, doesn’t it? And it rewards overexertion and it doesn’t tend to reward sustainability. It doesn’t really reward people that put boundaries around their work and say, this is enough. Because why would it? The system wants more and more. It wants you to work harder and harder for less resources. That’s pretty much what happens in a capitalist system, even in healthcare.

[00:08:54] Rachel: And so saying no just feels like this act of rebellion against your workplace, act of rebellion against your leaders and your managers, maybe even an act of rebellion against your patients. Because in healthcare, your boundaries aren’t baked in.

[00:09:06] Rachel: Now there are some systems where the boundaries are baked in, because the impact of overstepping those boundaries is just so high. So for example, pilots have boundaries baked in. They’re not allowed to fly for more than a certain amount of hours because the impact of them going over that amount of time, or the impacts of them breaking those boundaries is that they might crash, they might kill a whole load of people. So the system doesn’t want that to happen. So they bake the boundaries in to protect everybody else.

[00:09:36] Rachel: But for some reason we haven’t yet baked in those boundaries in healthcare to protect the patients. ’cause it’s not only protects you, it protects the patients long term, because you can’t perform as well when you’re knackered, when you’re not setting the boundaries or saying no. So there’s a long way to go before we get these baked in boundaries in our healthcare system.

[00:09:54] Rachel: And finally, I think we don’t really have any language that we can use around the middle ground. We are not taught how to use this nuanced language. And some of us who are neurodivergent actually prefer these sort of black and white types of thinking. And I know that I am particularly prone to exaggeration, and when I’m feeling annoyed, pissed off, I can really go, you know, oh, it’s either brilliant or it’s really bad. And there’s often, in my mind, no room for any middle ground.

[00:10:21] Rachel: So binary thinking causes us to be overextended. It causes us to feel more stressed. It causes us to feel ashamed of setting boundaries because we start to see ourselves as weak, selfish.

[00:10:33] Rachel: So what do we do about this? How do we address it? Well, there’s three things that we can do. Firstly, is to name it, secondly unlearn it and reframe it and replace with something that’s much more helpful.

[00:10:45] Rachel: So I’m gonna name for you six binary traps. I think all of us fall into sometimes.

[00:10:49] Rachel: So the first one is caring for others versus protecting myself, caring versus protecting. And the thinking behind that is that saying no is really selfish and it feels like I’m not caring for anybody apart from myself. And if I take a break or meet my own needs, it feels like I’m abandoning my patients. The reframe for that is you can care deeply and have protective boundaries allow you to thrive and protect your ability to care long term.

[00:11:18] Rachel: The second binary trap, competence versus vulnerability. I distinctly remember I was doing a training session about leadership for a load of surgical trainees and, uh, some consultants came into the room at the end of the session and I was just in the middle of talking about Brene Brown and some of the work she’s done around vulnerability trust and vulnerable leadership, which means we admit the mistakes we’ve made.

[00:11:39] Rachel: And one of the consultants that came in who was about my age, put his hand up and said, I’m sorry. I don’t agree with that at all. That just shows weakness. My jaw fell to the ground. I thought, oh my goodness, if that’s what he believes, he must be having such a hard time in his work because you cannot get to my age and never have made a mistake or never have done anything wrong or never had a complaint.

[00:12:04] Rachel: And if I’m trying not to project vulnerability, if I’m trying to project competence all the time, yet these things are happening, then I’ve got so much cognitive dissonance going around. That must be incredibly stressful. And what on earth is that? Modeling for everybody else and for my trainees? That is just like hotline of burnout.

[00:12:25] Rachel: But I’m sure the things that are going round in his mind were, well, if I ask for help, people will think I can’t cope. And that’s so often what we thought. You know, if I say that I can’t complete everything, people will think I can’t cope and that I’m weak. If I make a mistake, people will think I’m just completely incompetent.

[00:12:43] Rachel: We know that you can’t learn anything without failing and you know, has anyone ever played a game of tennis and every single shot being totally perfect? No, of course not. Even the professionals, right?

[00:12:53] Rachel: But when we have that binary thinking of competence versus vulnerability, we get very isolated, particularly when we’re in high stress, high stakes situations, and it leads us to suffering, but very silent suffering. And when you squinch down your emotions, they will come out somewhere else and have a look at the book, uh, the body keeps the score, if you wanna know more about that.

[00:13:13] Rachel: So the reframe for that could be competence includes knowing when to collaborate, knowing when to ask for help, and knowing when to rest, knowing when to stop pushing myself. That is a definition of competence.

[00:13:28] Rachel: And side note, I do like how we are starting to reframe sort of this looking after yourself and asking for help as a professional responsibility. That should, in my mind, be part of our competency frameworks.

[00:13:42] Rachel: The next binary trap that we fall into is clinical and objective versus emotional. So either I can be very objective about something, look at it clinically, or I can be thinking with my emotions and just be all over the place.

[00:13:57] Rachel: So either I’m a calm, objective, professional, or I’m a complete emotional wreck, and I dunno about you, but in my training, I was never taught that being emotional was very helpful. And of course, being over emotional isn’t particularly helpful, particularly when you’re making hard decisions in high stress roles. And you do need a bit of detachment, but not all the time. Because if you have that binary thinking, then your emotional reactions just get suppressed. You’re not allowed to express those things and you feel shame if you do.

[00:14:29] Rachel: And at its worst, it can even lead to things like moral distress and burnout when we are just pushing it all down, even though we are feeling really upset about something that we can see happening. So how about this reframe? Emotional awareness enhances not weakens. Clinical judgment, empathy and competency. I like that one.

[00:14:48] Rachel: Here’s another one, and I’m sure lots of you have thought this. I’m either strong or I’m struggling either or it It can’t be both and. And then we think, well, if I’m struggling, I’m not strong enough for this job, and I have lost count of the amount of very, very competent, strong healthcare professionals that have come to me saying, I’m burning out. Why can’t I cope? What’s wrong with me?

[00:15:08] Rachel: That feeling of shame, like I’m not good enough. And your struggle just gets hidden and the shame builds and builds, particularly around your performance, around your mental health.

[00:15:19] Rachel: And if you think like that, then if you burn out, you’re gonna feel a lot of shame. And so you’ll probably do everything you can to ignore signs and symptoms of burnout. So you won’t be treating it in time, and you’ll probably end up with much worse burnout that’ll take a lot longer to recover from.

[00:15:35] Rachel: So the reframe for this one could be strength includes acknowledging your limits and seeking support.

[00:15:43] Rachel: I think there’s a line in that lovely book, the Horse, the Mole, the Badger, the Fox, or whatever it is, but the little boy asked the horse, what’s the bravest thing you’ve ever done? And the horse says, ask for help.

[00:15:55] Rachel: Right, two more to go

[00:15:59] Rachel: The next one, you are either a team player or you’re setting boundaries. Either or. You can’t be both. And I see this thinking all the time. If I say no to that shift or no to that task, I’m letting my team down. If I say no to that thing, I’m just passing the stress to everybody else. I must be a bad person. Again, shame and the amygdala is hating this, saying, oh my goodness, you can’t possibly let other people down. What if you get kicked out the tribe? So it’s amplifying all these thoughts.

[00:16:26] Rachel: But this is like, everyone then starts over-functioning, ’cause no one can let anybody else down. And so being busy, being overwhelmed, being burnt out, that just becomes normalized. And the reframe for this could be, well actually setting boundaries models really good practice for the rest of the team. And it models much healthier norms. It gives other people permission.

[00:16:48] Rachel: Because if you’ve been working in healthcare for longer than a couple of years, you will be a leader, a manager. You will be supervising somebody or another, and people will look and see what you are doing and then they will copy it. Unless you give yourself permission to set boundaries, no one else will be able to give themselves permission.

[00:17:05] Rachel: And finally, and I really love the reframe on this one, and I think this one gets a lot of people, particularly when they’re on the slide into burnout, is I’m either all in or I’m out.

[00:17:17] Rachel: ‘ Cause at all our lives, we have given 110% to our jobs. But we get to the point of overwhelm where we know it’s not sustainable anymore, and we think, well, I cannot carry on like this for another six months. And then we end up with a binary thinking that goes well, if I’m not in a hundred percent, then I probably have to be out, but it’s not okay to drop some sessions or do something else for a little bit, or even for part of the week. And maybe I’m in the wrong profession.

[00:17:43] Rachel: And this is very perfectionistic thinking, isn’t it? And what happens? It then pushes people towards just giving up altogether and leaving, rather than managing their expectations of themselves or thinking, okay, where’s the zone of genius that I can really pursue and work there?

[00:17:59] Rachel: And the reframe here is you can show up in a sustainable and human way and still do excellent work and you can see why people have been filled into thinking that the only way to do excellent work is to give their all and work 15 sessions a week if, if that’s even possible. And let’s face it, until quite recently, all the Clinical Excellence Awards, but only given to full-time workers. We need to start recognizing the contribution that people working less than full-time make, that people with a portfolio career make, that people who are not doing it a hundred percent of the time are making. And if that’s you realize you can be absolutely excellent even if you are not giving a hundred percent of your time and energy to it.

[00:18:46] Rachel: So I’ve named several binary thinking traps that we can fall into. When we’re in those traps, it just worsens our slide down into burnout, because these traps are set for us by our amygdalas that are annoyingly trying to keep us safe, but we don’t live in caves anymore. We are not gonna die if we can’t please everybody all of the time, even though it feels like it.

[00:19:10] Rachel: And these binary traps cause us to do everything we can to avoid setting boundaries or saying no, to avoid asking for what we really need, which in the short term, yeah, okay. It avoids some difficult conversations, but long term it means that we cannot work in a sustainable way.

[00:19:28] Rachel: And once you start to look for this binary thinking, you can sort of spot it everywhere. In fact, recent podcast I did with Graham Allcott, we talked about his new book Kind, and he said that most of us think that being kind is just being really, really supportive. But he thinks being kind is being supportive and challenging. Most of us think you can be supportive or challenging and that being challenging isn’t very kind. But actually this is a, an amazing example of an both and situation. You can be competent and you can make mistakes. You can care for other people and care for yourself.

[00:20:04] Rachel: And I’ve noticed that whenever we do, uh, training and we talk about what you can control, what you can’t control, and some of these thoughts that, that we have, when we worry about setting boundaries, saying there, and the consequences, all the objections are this binary thinking, if I don’t do it, nobody else will. If I don’t do it, it will cause patient harm. If I say no, it means I’m selfish, i’m dumping on colleagues, all this sort of stuff.

[00:20:29] Rachel: But it’s only by using language of nuance, that we’re gonna be able to put this protective wall around our time and energy and be in it for the long run. This binary thinking makes us feel safe, but it’s not true. And so it’s this invisible stressor that we have just normalized in our medical culture. It’s not true, but we just believe it. And when we think it’s true, it just fuels our fear, our guilt, and our shame about our basic human needs.

[00:21:00] Rachel: So over the next few days, why don’t you try this? Just think to yourself, where do I get stuck in an either or mindset? And then practice using a both and mindset. Try saying things like I care and I need rest. Not I care, but I need rest. Or there’s I care, or I can rest, but I care and I need rest.

[00:21:23] Rachel: And just notice which of these binary thinking traps are you finding particularly hard to reframe? And what advice would you give somebody that you cared really, really deeply about? For example, yes, you care deeply and you are exhausted, or yeah, you are amazing and you are human and you make mistakes.

[00:21:44] Rachel: I had love to hear what reframes you have and what traps you find yourself falling into regularly. Just drop us an email.

[00:21:52] Rachel: So we need to name some of these thinking patterns we’ve got into. Recognize that we work in an emotionally complex and nuanced world. And that self-care and setting boundaries well, this is a professional responsibility, this is the way that we are competent and let’s all practice using language of nuance, not language of extremes.