Self-understanding 

The basic argument for self-understanding is that if people have better knowledge of their personal strengths and weaknesses, in terms of personality, needs, and motives, then they will have a more realistic assessment about why they are experiencing burnout. Such self-knowledge can then be used to change their behavior and get more positive outcomes. There are many techniques that can be used to generate more self-insight, including counseling, mindfulness, and psychotherapy. 

In the following pages we will briefly discuss a few methods widely available for exploring self-understanding: 

• Individual psychotherapy
• Cognitive Behavioral Therapy (CBT) for burnout
• Mindfulness, Acceptance and Commitment Therapy for burnout
• Self development groups

Individual psychotherapy 

Definition

Psychotherapy is a therapeutic approach for helping individuals with various mental health issues (e.g., burnout). It is also known as talk therapy. Research on psychotherapy has shown positive effects on reducing troubling symptoms ¹.<br>Psychotherapy is delivered by trained professionals (e.g., psychologists, psychiatrists, mental health providers), who guide the individual via discussion, to eliminate or control troubling symptoms (e.g., anxiety, depression), so that they can function and feel better. Therapy can be conducted at an individual or group level. Depending on one’s mental health issues, psychotherapy can be short-term (a few sessions) or long-term (months or years). There are several types of psychotherapy such as CBT, interpersonal therapy, psychodynamic therapy, psychoanalysis, etc. 

How it works

• If you feel that your stress and/or anxiety levels are preventing you from functioning clearly and maintaining a healthy work-life balance, then it is important to seek help Contact your counseling center and ask to see a psychologist.
• On your first appointment you will be asked to share information about your problem and how it affects your daily The trained professional will propose a treatment plan, including the frequency and duration of therapeutic sessions, as well as the expectations for developing an active, collaborative and confidential relationship.
• It is possible that your therapist may suggest additional types of therapies for maximizing personal wellness. 
• Devoting time to performing the suggested strategies and being committed to following the treatment plan increases the possibility to get the most out of psychotherapy.

Resources for self-directed practice:

• Mayo’s clinic overview of psychotherapy;
• Effectiveness of psychotherapy;
• Understanding psychotherapy and how it

Cognitive Behavioral Therapy (CBT) for burnout 

Definition

Cognitive Behavioral Therapy refers to a class of interventions for treating individuals with mental health issues, such as anxiety, burnout, anger control problems, and general stress ². It has been studied extensively over the years and has produced strong evidence for supporting individuals³. It is based on the premise that mental health or psychological issues are maintained by negative cognitions (e.g., beliefs, thoughts), which can be treated by teaching certain strategies to individuals on how to change their cognitions and behaviors. Changing one’s negative mindset can lead to changes in emotional distress and problematic behaviors. 

How it works

• List the personal reasons potentially generating burnout, and prioritize them from the least contribution to burnout to the most contribution to burnout. For example:
  • completing homework;
  • doing grocery shopping;
  • meeting my partner for quality time;
  • dealing with my mother’s health issues;
  • studying for exams and exam results;
  • balancing school and

• Your thoughts create emotions and behaviors. These could lead to intense stress and anxiety (emotions) and avoidance or other behaviors that are not helpful. As the diagram shows, they create a circle, where each of the three components affects the other However, the easiest to ameliorate would be your thoughts.
• You will need to record the negative thoughts that are connected to a burnout reason. Start first with the most stress-provoking reasons and then continue with the least- challenging ones. When considering the example listed above “studying for exams and exam results”, we start recording any negatively related thoughts such as:

• “For sure I will not finish my studying on time for ”
• “I failed to get a good grade on my last exam, so this will happen again with the rest of my ”
• “I may not be smart enough to get good grades and then finish my ”
• “I am an I do not belong in medical school as I am failing to get good grades.” 

As you can see, the above negative statements lead to stress and burnout (emotions) and unproductive behaviors (e.g., avoiding studying or quitting or panic attacks). You may not be always aware of your thoughts, but if you start recording them when feeling overwhelmed, then you can restructure them and break the above circle.

A more realistic view of restructured statements of an overwhelmed medical student is shown below: 

• After restructuring your thoughts, the next part is to activate yourself, by emitting observable behaviors that could lead to meaningful and healthy changes in your daily

For example, some good healthy behavioral habits that could reinforce the restructured thoughts are:

• get out of bed even if you feel that your mood is not great;
• schedule your work and at least make a start Procrastination will not help you!
• try to cook a quick meal or take regular walks, so you can do something else for a few minutes instead of continuously studying;
• set some fun goals for the near future (e.g., “when I am done with my exams, I will go to the beach with my partner”);
• take good care of yourself by getting out of bed, taking your shower, dressing up, even if you will be studying all day, eating healthy and keeping your social 

If you are at the point where you feel that your everyday functioning is significantly and negatively affected by feelings of being overwhelmed and burnout, then you should not hesitate to contact a mental health provider (e.g., counselor, psychologist, psychiatrist) at your institution’s counseling center and set up an appointment. You may also consider discussing your situation with others near you (e.g., friends, teachers, heads of department, family, etc.).

Resources for self-directed practice:

• Work Stress: 5 Tension-Busting Tricks From Cognitive Behavioral Therapy;
• Scientific article on interventions to alleviate burnout symptoms;
• Scientific article on mediators of change in CBT for clinical burnout;
• Scientific article on CBT and mindfulness for stress and burnout

Mindfulness and Acceptance and Commitment Therapy for burnout 

Definition

Acceptance and Commitment Therapy (ACT) includes mindfulness. ACT is the third wave of behavioral therapy, with CBT being the second wave. ACT also helps in improving your cognitive flexibility, which is a vehicle of success in your way to overcome burnout. Finally, ACT helps you set your values, which can guide your steps and motivation toward wellbeing. 

How it works

• You will need to set your values and your goals towards a life that you For example, a plan like “I would like to finish nursing school and become a philanthropist in a country that needs my services” is too schematic and somehow extreme. You need to define first your path. So, alternatively, you could say to yourself “What is the path? I need to finish nursing school, no matter hard it is. Before doing this, however, I need to focus on my semester work and doing well on my exams. I will do the best I can to study for each exam, and I will find the good part for each step that I take”.
• With mindfulness you pay attention to your thoughts, feelings, You become aware on how your body feels when overwhelmed, and what thoughts you get, when you are watching your favorite show. Meditations could help you here.
• Don’t struggle to accept yourself and try to act towards your goals and values, even if the result is not guaranteed (e.g., doing well on your exams and getting your degree);
• Acknowledge your situation and where you are now (“I am in the exam session and I need to work towards my goal”);
• Take actions! Study as best as you can, take your exams and don’t avoid them! 

Resources for self-directed practice:

To get a sense of mindfulness meditation, you can try one of the guided recordings by Dr. Ronald Siegel, an Assistant Clinical Professor of Psychology at Harvard Medical School. They are available for free here.

Other resources:

• sciencedirect.com
• ncbi.nlm.nih.gov
• amazon.co.uk
• verywellmind.com
• medschool.ucsd.edu
• ncbi.nlm.nih.gov
• headspace.com
• evergreenhealth.com
• youtube.com

Self-development groups (based on the model of group therapy) 

Definition

Self-development groups are regular meetings of 8-12 students, who often focus on their positive resources and personal lives. They aim to enhance and maintain the participant’s self -esteem and personal insight. The self-development group sessions are often led by psychiatrists or psychologists trained in group therapy. 

How it works

Participating in a self-development group can help you identify patterns of relationships that are restricting your capacity to relate to other people and it can impact on potential stressors, such as lack of thriving in the study situation, a sense of opposition towards teachers and the curriculum, a feeling of being controlled too much, of having too little space for personal interests, and not being seen as a personality. 

The self-development groups can give you an experience of feeling openness about personal problems, as well as the abilities needed to build a network among your peers. Being part of a self-development group can help you feel closer to other group members and can generate a feeling of having a safety net that would help you solve different kind of problems.

For example, it can help you to talk to colleagues about personal or professional problems, and in this way, you can learn that it is acceptable to have problems, since other will disclose their own problems ⁴. 

The group participation might also help you to tolerate insecurity and ambiguity, which is an aspect many health professionals may confront with.

Resources for self-directed practice:

An example of a structured course for experiential learning in small groups