Mindful Burnout Training

Editor's note: This text-based course is a transcript of the webinar, Mindful Burnout Training, presented by Olivia Petrucci, OTR/L, OTD.

Please also use the handout with this text course to supplement the material.

Learning Outcomes

After this course, participants will be able to:

• Identify the factors contributing to burnout among occupational therapy practitioners.
• List the negative effects of burnout.
• Recognize different strategies that can be used to mitigate personal burnout levels.

Introduction

Thank you for joining me today for this presentation on the Mindful Burnout Training program I developed for occupational therapy practitioners. I want to start by sharing a bit about who I am and what brought me to this work, because I think context matters here.

I have spent the past four years working in acute inpatient psychiatry, facilitating therapeutic groups and evaluating patients. I currently work at UMass Memorial Medical Center, where I treat up to 22 patients per day using evidence-based interventions to promote strength, recovery, and independence. Just last year, I completed my post-professional doctorate in occupational therapy at Boston University. During that program, I had the opportunity to research burnout extensively, which became the foundation for my doctoral project: a proposed burnout program specifically designed for occupational therapy practitioners. Today, I have condensed and adapted that five-week program into this continuing education presentation.

I was inspired to create this program after experiencing very high levels of burnout in my first two years as an occupational therapist. During that time, I searched for resources to help me reduce burnout, but what I found was a significant gap in materials designed specifically for occupational therapy practitioners (OTPs). That gap motivated me to address the problem directly and build a program that would not only help reduce burnout but also help other practitioners know that they are not alone.

Over the course of this presentation, we will begin with an introduction to burnout and what it looks like, then move on to the factors that contribute to it and its negative effects. We will look at burnout across different practice settings, review four key standardized measures used to evaluate burnout over time, and then dive into three evidence-based frameworks that offer practical strategies you can take away and begin using right away: polyvagal theory, cognitive behavioral therapy, and mindfulness. We will work through four case examples together, and end with a summary and key takeaways.

What Is Burnout?

Defining Burnout

Burnout is defined as chronic occupational stress characterized by emotional exhaustion, depersonalization, and hopelessness. Its negative effects can impact practitioners' well-being, productivity, retention, and the quality of care they deliver to patients and clients (Bouskill et al., 2022).

Burnout is not a new concept. It was first described in 1974 by psychologist Herbert Freudenberger, who defined it as "a state of mental and physical exhaustion caused by one's professional life, often impacting highly dedicated, high-achieving individuals" (Freudenberger, 1974). Those last two qualities — high dedication and high achievement — speak directly to who we are as occupational therapists. That is part of why this work matters so much, and why the risk is so real for our profession.

What Burnout Is Not

Before going further, it is worth clarifying what burnout is not, because misconceptions can get in the way of recognizing and addressing it.

Burnout is not simply feeling stressed after a long day. Burnout develops from chronic, unmanaged work stress over time. It is also not a weakness. Research links burnout to organizational and workplace factors, not to personal shortcomings. Burnout is not the same as depression. Burnout is specifically work-related, while depression affects many areas of a person's life. And critically, burnout is not solved by a single self-care activity. Addressing it requires ongoing awareness and the use of effective strategies to manage and reduce burnout levels over time (Maslach & Leiter, 2016).

Stress Versus Burnout

It is also important to distinguish between stress and burnout, because they can be easily confused. Stress is focused on short-term responses to demands or pressures, while burnout reflects that chronic, unmanaged work stress. With stress, there are often feelings of overwhelm; with burnout, the presentation is more likely to include irritability, disengagement, or numbness. Stress symptoms can improve with rest and time off, while burnout symptoms tend to persist even after rest. With stress, a person may feel motivated but struggling to keep up. With burnout, there is often a total loss of motivation (Maslach & Leiter, 2016; World Health Organization, 2019).

Burnout Statistics

The prevalence of burnout among OTPs is striking and has only grown since the COVID-19 pandemic. Research indicates that 52.8% of OT practitioners internationally have reported burnout. Additional research conducted in Spain found that 64.9% of occupational therapists presented with burnout syndrome, and 63.4% experienced emotional fatigue (Escuder-Escudero et al., 2020; Ganesan et al., 2021). Based on these numbers, nearly half of all occupational therapists are experiencing some form of burnout in their professional lives. That is not a fringe issue — it is a field-wide reality.

Why Are OT Practitioners at Risk?

Occupational therapy practitioners are at heightened risk for burnout for several interconnected reasons. We work closely with patients who are facing serious life challenges — we are rarely meeting people at their best moment. We provide physically and emotionally demanding care. We manage high productivity expectations, and we are constantly balancing clinical work with documentation and administrative tasks (Kim et al., 2020).

Research has also identified a specific subgroup with the highest burnout risk: female therapists in their twenties working in small or medium-sized hospitals. This group demonstrated higher emotional exhaustion, higher depersonalization, and a lower sense of professional accomplishment than other groups studied (Kim et al., 2020). Whether or not you fall into this demographic, it is important to understand that risk factors for burnout can compound across individual, organizational, and systemic levels.

Factors Contributing to Burnout

Research has identified several key factors that contribute to burnout among occupational therapy practitioners. These include high perceived workload — the sense that the demands of the job are exceeding our capacity — as well as having fewer than 10 years of experience, difficulty saying "no" or setting clear boundaries, limited autonomy in one's role, lack of support from a supervisor or manager, time pressures, and conflicts between a therapist's values and those of their employer (Poulsen et al., 2014; Gupta et al., 2012; Shin et al., 2022).

Understanding these factors is the first step toward addressing them. When we can name what is contributing to our burnout, we move from feeling overwhelmed by something vague and uncontrollable to recognizing specific, addressable challenges.

Burnout Across Practice Settings

Occupational therapists work across an extraordinarily diverse range of settings, and burnout is present in all of them. Workplace factors may vary by setting, but common threads — work demands, documentation standards, and organizational or systems pressures — run through every practice context (Poulsen et al., 2014; Shin et al., 2022).

School-Based Practice

In school-based settings, practitioners frequently deal with large caseloads and high service demands. There are extensive documentation requirements, including individualized education programs and evaluations, combined with limited time actually spent with students. Many school-based OTs split their time between multiple buildings, which adds logistical stress on top of an already demanding workload (Gupta et al., 2012).

Acute Care and Hospital Settings

In acute care and hospital settings, the environment is fast-paced and the stakes are high. Practitioners face significant productivity expectations, short patient interactions, high medical acuity, and constant pressure around discharge planning and helping patients return to their home environments. Staffing shortages compound these demands, and what this can look like in practice is having seven patients back-to-back, multiple discharges on a single day, and constant interruptions due to staff coverage gaps (Salyers et al., 2016; West et al., 2018).

Inpatient Rehabilitation

Inpatient rehabilitation settings bring their own particular pressures, including high therapy intensity expectations, significant productivity and documentation demands, insurance challenges that can interfere with clinical decision-making, and discharge pressures that require close coordination with medical and social work teams (Gupta et al., 2012; Shin et al., 2022).

Mental Health Practice

Mental health practice is the setting I know best, and it carries a unique emotional weight. There is often high intensity in patient interactions, along with significant **compassion fatigue**. Practitioners are regularly managing challenging behaviors and navigating safety concerns, frequently with limited staffing and resources (Salyers et al., 2016). This combination can be especially taxing over time.

Outpatient and Community-Based Practice

Outpatient and community-based settings are marked by high productivity expectations, back-to-back patient scheduling, insurance limitations that can directly affect the quality and duration of care a practitioner can provide, limited time per session, and a heavy administrative and documentation burden (Poulsen et al., 2014; Gupta et al., 2012).

Shared Burnout Themes

Across all of these practice settings, research consistently identifies the same recurring contributors to burnout: high workload, productivity demands, documentation burden, limited autonomy, the emotional demands of care, and organizational pressures (Poulsen et al., 2014; Shin et al., 2022). Whatever setting you practice in, recognizing these shared themes can validate your experience and help you identify targeted strategies.

Negative Effects of Burnout

Understanding the negative effects of burnout matters both for individual practitioners and for the quality of care provided to patients and clients. Burnout can manifest in many ways and is often person-specific, but documented effects include poor sleep and insomnia, musculoskeletal pain and general body aches, increased alcohol or substance use, an increase in clinical errors that can compromise client outcomes, chronic fatigue, depression, and anxiety (Brown & Pranger, 1992; Salyers et al., 2016).

One way I like to think about the progression of burnout is to imagine a volcano. At the base, you have the factors that contribute to burnout: challenging workloads, lack of support from managers, limited autonomy, and time demands. As those pressures accumulate without appropriate coping tools, the stress builds. And then at the point of eruption — at full-blown burnout — the effects spill outward in all directions. For the practitioner, this can mean poor sleep, fatigue, depersonalization, and decreased self-esteem. For the workplace and patients, it can mean increased absenteeism, reduced job performance, and compromised quality of care.

Personal Burnout Self-Scan

I want to invite you to take a moment here to reflect on what is contributing to your personal burnout levels. Is it a high workload? Limited autonomy or choice in your role? Lack of support from your supervisor or manager? Simply naming these factors builds self-awareness, and that self-awareness is foundational to burnout prevention. Reflection does not solve the problem on its own, but it is where the work begins (West et al., 2018).

Measuring Burnout

Just as we use standardized assessments to measure our patients' progress, it is important to consider measuring our own burnout. Burnout can be difficult to recognize and quantify — which is part of what makes it so insidious. Standardized measures have been developed to help practitioners better understand their personal burnout scores, identify levels of burnout, and monitor changes in burnout over time (Brown & Pranger, 1992; Salyers et al., 2016).

When Should Burnout Be Measured?

Burnout screening is valuable at the individual level as a personal self-screen. There are also organizational situations where systematic burnout measurement can be especially useful, including high staff turnover, increased sick days or absenteeism, staff complaints about exhaustion, and program evaluation contexts (Maslach et al., 2001).

Maslach Burnout Inventory – Human Services Survey (MBI-HSS)

The Maslach Burnout Inventory – Human Services Survey, or MBI-HSS, is the most widely used measure of burnout in occupational therapy research and is sometimes referred to as the gold standard for measuring burnout in healthcare settings. It assesses the three key components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. A high burnout score on this measure is indicated by high scores on emotional exhaustion and depersonalization and a low score on sense of personal accomplishment (Maslach et al., 2016; Rogers & Dodson, 1988; Shin et al., 2022).

To break these components down further: emotional exhaustion captures feelings of being emotionally overextended and exhausted by one's work. Depersonalization reflects unfeeling or impersonal responses toward patients. Personal accomplishment represents feelings of competence and successful achievement in the work. It is worth noting that the MBI-HSS does require a purchase and licensing, but it is available online for single use at $20. The measure will interpret and report your score, and also provide suggestions for reducing stress.

Copenhagen Burnout Inventory (CBI)

The Copenhagen Burnout Inventory is a 19-item validated self-report tool that measures burnout through three dimensions of exhaustion: personal burnout, which reflects the degree of physical and psychological fatigue experienced; work-related burnout, which is attributed specifically to work demands; and client-related burnout, which is the burnout associated with working with clients (Kristensen et al., 2005).

Sample questions from the CBI give a clear sense of what each dimension measures. For personal burnout: "How often do you feel tired?" For work-related burnout: "Do you feel worn out at the end of the working day?" For client-related burnout: "Do you find it hard to work with clients?" Respondents answer on a scale from always (100%) to never or almost never (0%). The CBI is available online as an open-access resource, meaning it is free and accessible to anyone interested in using it.

Oldenburg Burnout Inventory (OLBI)

The Oldenburg Burnout Inventory is a validated 16-item tool that was developed specifically to address some of the limitations of the MBI-HSS. One of its notable strengths is that it does not require purchasing a license, making it immediately accessible. It also includes both positively and negatively phrased items, which reduces response bias — a methodological strength that sets it apart from other measures (Demerouti et al., 2003).

The OLBI assesses two dimensions: exhaustion, encompassing physical, emotional, and cognitive fatigue, and disengagement, which reflects detachment from work. Sample items include positively framed statements like "I always find new and interesting aspects in my work" alongside more challenging ones like "There are days when I feel tired before I arrive at work" and "It happens more and more often that I talk about my work in a negative way." The contrast between these item types captures the full range of a practitioner's experience. This measure is available for open access online.

Professional Quality of Life Scale (ProQOL)

The Professional Quality of Life Scale, or ProQOL, takes a broader view by measuring how helping professionals experience their work across both positive and challenging dimensions. Its components include compassion satisfaction, compassion fatigue, burnout, and secondary traumatic stress (Stamm, 2010). With 30 items, it is the longest of the four measures reviewed here, but what distinguishes it is that it also examines the positive aspects of working in helping professions — not just the costs. The ProQOL is available free of charge and accessible online.

Our Role in Addressing Burnout

As individual OT practitioners, our responsibility is threefold: to understand and educate ourselves about burnout (which you are doing right now by engaging with this course), to recognize what is contributing to our personal burnout levels, and to utilize strategies to reduce and minimize those levels. For those of us in managerial roles overseeing other OTs or OTAs, our responsibility extends further. This includes supporting practitioners in managing their burnout and providing appropriate accommodations such as charting from home or flexible scheduling, as well as actively offering employer-based resources such as wellness programs or employee assistance programs for counseling.

Polyvagal Theory

Understanding Polyvagal Theory

We are now going to move into the strategies section, and I want to start here with the polyvagal theory because it provides the neurological foundation for everything else we will discuss. The polyvagal theory explains how our nervous system responds to stress and safety — both of which are constant features of an OT workday. It gives us language for that "shut down" or "on edge" feeling that we may experience in our daily lives, and it helps us understand that our automatic responses to stress are not character flaws or weaknesses — they are our nervous system doing exactly what it is designed to do (Porges, 2007).

The key insight of polyvagal theory is that by recognizing which nervous system state we are in, we can better understand our body's reaction to stress and threat and make intentional choices about what to do to move toward a calm, regulated state. This is not about achieving perfect serenity all the time. It is about building awareness and having a toolkit.

Three Pillars of Polyvagal Theory

Polyvagal theory rests on three pillars, all of which have direct relevance to managing burnout: the three-tiered hierarchy, neuroception, and co-regulation (Porges, 2007).

The Three-Tiered Hierarchy

The polyvagal theory proposes that our nervous system follows a hierarchical response pattern to stress. At the top of this hierarchy sits the ventral vagal state — where we feel calm, grounded, connected, and able to think clearly and emotionally regulate. This is the state we are aiming for. When stress increases, the nervous system shifts down to the sympathetic state, which is the classic fight-or-flight response. In this state, a person may feel anxious, irritable, and have difficulty slowing down. If stress becomes persistent and unmanaged, the system may descend further to the dorsal vagal state — often described as "shutdown." Here, a person may feel disconnected, numb, fatigued, or unmotivated (Porges, 2011).

What does this look like in an actual OT workday? In the ventral vagal state, you are present with patients and their families, thinking flexibly, communicating openly, and collaborating effectively with your team. In the sympathetic state, you might notice yourself rushing through sessions, snapping at colleagues, or feeling a persistent sense of nervousness even when nothing acute is happening. In the dorsal vagal state, you might move more slowly than usual through and between sessions and experience a kind of emotional withdrawal — going through the motions without genuine engagement.

I want to invite you to think back to your last shift and ask yourself: which state were you in? What were your body cues? Were you calm and connected? Nervous or on edge? Withdrawn or unmotivated? This kind of reflection is the beginning of self-awareness, and self-awareness is where change starts. The ventral vagal state is the goal — and the good news is that there are concrete techniques we can use to get there.

The Vagus Nerve

Central to understanding how we move between these states is the vagus nerve. The vagus nerve helps shift the body from the sympathetic state to the ventral vagal state, lowering heart rate and stress in the process. It runs through the body and regulates heart rate, breathing, digestion, and immune function, and it is responsible for what many of us know as the "rest and digest" response. Crucially, different strategies can actively help us stimulate the vagus nerve and support this shift toward regulation (Porges, 2011).

For practitioners in a sympathetic state — that fight-or-flight response — grounding techniques, paced breathing, mindfulness, and sensory strategies can be especially helpful. For practitioners in a dorsal vagal state, gentle movement and upbeat music are often more effective starting points, because they provide the activation the nervous system needs before deeper regulation is possible (Dana, 2018).

Vagus Nerve Techniques

Many of the following techniques may already be familiar to you, but you may not have known they were vagus nerve activation techniques. These are practical tools that can help bring you back to the ventral vagal state faster.

Deep belly breathing — using a slow four-to-six-count inhale with a longer exhale — directly activates the vagus nerve. Humming, singing, and chanting all stimulate the vagus nerve through vocal cord vibration. Cold water on the wrist or face, or even a brief cold shower, can interrupt the stress response and initiate a calming shift. Slow neck rolls and gentle stretching support nervous system regulation through gentle proprioceptive input (Porges, 2011).

A few other techniques that are easy to work into a workday: chewing gum or sipping water, light self-massage of the neck, jaw, or behind the ears, and placing a hand on the chest or belly — that light pressure can genuinely signal safety to the nervous system. One that I have found particularly interesting is gargling. The vagus nerve is connected to the muscles at the back of the throat, and the act of gargling contracts the muscles of the palate, which directly stimulates the vagus nerve (Porges, 2011).

One technique I want to highlight specifically is called physiological sighing: two quick inhales through the nose followed by one long exhale. Research has found that this technique lowers both blood pressure and heart rate (Huberman et al., 2023). It takes about five seconds. That is the kind of tool that can be used standing in a hallway between patients, and it actually works.

Intrashift Recovery

What I want to emphasize is that many of these vagus nerve techniques require very little time, which means they can genuinely be incorporated into a busy OT workday. Research with physicians found that short intrashift rest breaks — ranging from seconds to less than an hour — were associated with lower fatigue and discomfort, and importantly, they did not worsen clinical performance (O'Neill et al., 2022). As OT practitioners in a helping profession, we can draw on this evidence to justify and prioritize the use of intrashift rest breaks for ourselves. We give our patients rest breaks during therapy. We can do the same for ourselves.

Neuroception

The second pillar of polyvagal theory is neuroception — the process by which the autonomic nervous system subconsciously scans the environment for cues of safety, danger, or life threat. This happens automatically, outside of our conscious awareness, and it influences our emotional responses, body sensations, behavior, and social engagement throughout the day (Porges, 2007).

In an OT workday, examples of threat cues that can move us out of the ventral vagal state include productivity pressure and alarms — sounds and stressors that our nervous system registers as signals of danger. Examples of safety cues that can support us in maintaining the ventral vagal state include predictable routines and calming music in a staff lounge. Small environmental modifications can have a meaningful impact on where the nervous system lands throughout the day.

Co-Regulation

The third pillar is co-regulation — the process by which one person's calm, balanced, or energized nervous system helps regulate another's. Through co-regulation, our nervous system can shift toward the ventral vagal state through connection with another person who signals safety (Porges, 2011).

As practitioners, we can actively use co-regulation by identifying our supports and knowing who to turn to when we find ourselves in sympathetic or dorsal vagal states. This might be a friend, a partner, a therapist, or a trusted coworker. The key is having those relationships in place before you are in crisis, so that seeking support becomes a reflex rather than a last resort.

Key Takeaways: Polyvagal Theory

The most important things to take away from this section are first, to start recognizing which state you are in throughout your workday — and to do so without judgment. Second, to practice the vagus nerve techniques daily: deep breathing, gentle stretching, cold water on the wrist or face. Third, to lean on your supports and actively use co-regulation as part of your burnout prevention toolkit.

Cognitive Behavioral Therapy (CBT)

What Is CBT?

Cognitive behavioral therapy, or CBT, is an evidence-based, goal-oriented, highly structured approach that helps individuals challenge negative thought patterns and turn less often to unhelpful behaviors (Craske, 2017). CBT has been used extensively in burnout programs for healthcare workers, with research finding that CBT-based programs effectively reduced burnout syndrome in this population (Anclair et al., 2018; Fernandez-Arata et al., 2022). This is an area where our training as OTs gives us a built-in advantage: we already understand the connection between thoughts, behaviors, and occupational performance.

CBT techniques relevant to burnout include positive affirmations, cognitive reframing, developing positive coping mechanisms, progressive muscle relaxation, journaling, and mindful meditation (Beck, 2020).

Positive Affirmations

Positive affirmations are intentional, realistic, and supportive statements used to challenge unhelpful negative self-talk. They are typically short, grounded in self-compassion, and used to shift our internal narrative. For healthcare professionals who often turn self-critical under pressure, affirmations can serve as a counter-force to the self-criticism that fuels burnout (Anclair et al., 2018; Beck, 2020).

Some examples that feel authentic for OT practitioners include: "I am fully present throughout my day." "I am calm." "I give myself permission to rest and recharge." "I make a meaningful difference." "I am patient, compassionate, and attentive." "I take care of myself so I can care for others." "I bring calm, focus, and clarity into my work."

To make affirmations a consistent practice, I recommend keeping a list on your phone as a reminder. Some practitioners find it helpful to make a voice recording that they can listen to on the commute to and from work. Keeping a written list nearby — especially on more challenging days — gives you a quick reference point when negative thoughts start to take hold.

Cognitive Reframing

Cognitive reframing involves identifying unhelpful thoughts and replacing them with a balanced, healthier perspective. The process is straightforward: write down the negative thought as it arises, and then deliberately reframe it.

Consider these two examples. The first thought: "I shouldn't feel exhausted — I love my job." The reframe: "Feeling exhausted is not a flaw. It means I need rest and time to relax in order to sustain the work I care about." The second thought: "I feel guilty for taking time off while my unit is short-staffed." I can absolutely relate to this one. The reframe: "Taking care of my health allows me to show up and be more present when I return." These reframes do not deny the reality of the situation — they shift the meaning, and that shift has measurable effects on stress and emotional exhaustion (Beck, 2020).

Cognitive Distortions

Related to cognitive reframing is the concept of cognitive distortions — inaccurate or unhelpful thinking patterns that influence how we interpret situations. Recognizing these patterns matters because distorted thinking increases self-criticism, stress, and emotional exhaustion and can keep us locked in cycles that deepen burnout (Beck, 2020).

Three of the most common cognitive distortions in healthcare professionals are all-or-nothing thinking, personalization, and catastrophizing. All-or-nothing thinking involves viewing situations as entirely good or bad with no middle ground — for example, "If I didn't finish everything today, I failed." Personalization involves blaming yourself for outcomes outside your control — for example, "My patient didn't progress, so I must be a bad therapist." Catastrophizing means expecting the worst possible outcome — for example, "If I make one mistake, I could lose my license." When you notice yourself falling into one of these patterns, that recognition itself is the intervention. Naming the distortion interrupts the automatic cycle.

Positive Coping Skills

Positive coping skills are activities that channel time and energy toward something meaningful and restorative. They differ from person to person, and I encourage you to identify what genuinely restores you. Some common examples include listening to music, making a gratitude list, taking a walk in nature, journaling, watching television or a movie, spending time with pets, reading, and working on art projects. Two of my personal favorites are spending time with my dog Frankie and working on art — the combination of sensory engagement and creative flow genuinely shifts my nervous system in a way that other activities do not. The key is building these activities into your routine consistently, not just in moments of crisis.

Progressive Muscle Relaxation (PMR)

Progressive muscle relaxation, or PMR, is a stress-reduction technique that involves systematically tensing and releasing different muscle groups to increase awareness of physical tension and promote relaxation. It encourages practitioners to notice the difference between tension and relaxation in the body — an awareness that then has a calming effect on the nervous system as a whole (Jacobson, 1938; Varvogli & Darviri, 2011). I use PMR regularly in my clinical practice and teach it to patients, but it is equally valuable as a self-care tool for OTPs.

To incorporate PMR into your routine, consider practicing a short session between breaks at work, using it before or after your shift to decompress, or pairing it with deep breathing or mindfulness for a more comprehensive relaxation practice (Jacobson, 1938; Varvogli & Darviri, 2011).

Psychological Flexibility and Third-Wave CBT

Recent research on CBT and burnout has focused on what is called third-wave CBT, which emphasizes mindfulness, acceptance of internal experiences, values-based action, and psychological flexibility. A recent study found that third-wave CBT significantly reduced emotional exhaustion and depersonalization in healthcare workers (Han et al., 2025).

Psychological flexibility — one of the core skills of third-wave CBT — is the ability to notice thoughts and emotions without becoming fused with them, to stay present under stress, and to choose actions aligned with one's professional values. Here is how to apply it in practice: first, pause and label the thought. "I'm noticing that I'm feeling overwhelmed." Next, separate your identity from the thought. "This is a stress response, not a fact." And then take one values-based action — something small and concrete that reflects who you want to be as a practitioner. This three-step sequence can interrupt an escalating stress response and reconnect you to your sense of purpose (Han et al., 2025).

Key Takeaways: CBT

Burnout is significantly influenced by negative thought patterns like self-criticism and cognitive distortions. Reframing those thoughts does not change the external circumstances, but it does change our relationship to them, and that matters enormously for our ability to cope. Positive affirmations can counter negative self-talk and support self-compassion over time. And developing a personal repertoire of healthy coping skills — and actually using them — helps us manage stress before it accumulates to the point of burnout.

Mindfulness

Mindfulness and Burnout

Mindfulness involves focusing on the present moment, acknowledging and accepting one's feelings, and cultivating awareness of one's surroundings without judgment (Pollak et al., 2014). It ties naturally back to the polyvagal theory framework: mindfulness practices are, in many ways, tools for supporting the shift into and maintenance of the ventral vagal state.

From the evidence, mindfulness interventions have demonstrated clear effectiveness for burnout reduction. Online mindfulness programs were found to reduce emotional exhaustion and depersonalization among healthcare workers during the COVID-19 pandemic, a period when stress and burnout were at their highest levels in recent memory (Kim & Hunter, 2023).

Benefits of Mindfulness

The benefits of mindfulness for OT practitioners are multifaceted. Mindfulness builds resilience to stress and burnout over time. It improves emotional regulation and self-awareness. It can enhance patient care by increasing the presence and empathy a practitioner brings to clinical interactions. And it is easily adaptable into daily routines — which matters enormously when time is the most limited resource most OTs have (Luken & Sammons, 2016).

Micro Mindfulness Practices

One of the most important findings in the research on mindfulness and burnout is that brief practices can be genuinely effective. I call these micro mindfulness practices — interventions that take one to five minutes and can be integrated into almost any workday, no matter how busy.

The first is one-minute breathing: inhale for a count of four, hold for four, and exhale for a count of six. This can be used between sessions, on the commute to and from work, or before beginning documentation. The simple act of slowing down the breath shifts the nervous system toward regulation. The second micro-practice is the 5-4-3-2-1 grounding technique: during any moment of downtime, identify five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste. This technique brings attention back to the present moment and interrupts the thought spirals that often accompany a sympathetic stress response (Kabat-Zinn et al., 1994; Treleaven et al., 2018).

Why Micro-Practices Are Effective

Micro-practices are effective for several interconnected reasons. They fit easily into a workday, which directly reduces the most commonly cited barrier to mindfulness practice: lack of time. By requiring only a small commitment, they make consistency achievable, and consistency is what produces lasting change in the nervous system. Research on virtual mindfulness programs has specifically supported the effectiveness of brief micro-practices, finding that even very short interventions can produce measurable reductions in burnout indicators.

Meditation

For practitioners who want to build a deeper mindfulness practice, **meditation** — the practice of focused attention to increase awareness and support nervous system regulation — is a valuable tool (Goyal et al., 2014; Creswell, 2017). Free resources are widely available. Spotify and YouTube both offer a broad range of guided meditations, and free-to-use apps include Insight Timer, UCLA Mindful, and Smiling Mind. There is no need for a subscription or significant investment to get started.

Key Takeaways: Mindfulness

The most important things to carry forward from this section are to focus on the present moment without judgment, to use mindfulness as a tool for emotional regulation and stress reduction, and to recognize that one to five minutes of intentional practice can make a real difference. Mindfulness does not need to be a major production — it just needs to be consistent.

Additional Strategies

Beyond the three primary frameworks, there are several additional strategies that can meaningfully reduce burnout.

Energy conservation in the professional context means being intentional about where time and energy go. Writing or typing a to-do list and prioritizing tasks by urgency can prevent the diffuse overwhelm that comes from holding too many demands in mind simultaneously. It is also helpful to ask yourself whether you are spending time and energy on things within or outside of your control — and to consciously redirect your attention toward what is actionable. Lightening your workload by delaying, delegating, or asking for help is a skill, not a weakness. Being flexible and adaptable — and knowing when to say no and enforce your boundaries — are equally essential.

Evidence-based practice is also directly connected to burnout. Research has found that implementing evidence-based practice was associated with higher self-efficacy in occupational therapists, which was in turn associated with lower levels of burnout (Bar-Nizan et al., 2024). When we practice with confidence rooted in evidence, we are also protecting our professional well-being.

Case Examples

The following four case examples are designed to help you apply what we have covered. As you read each one, consider which polyvagal state the practitioner is in, and which strategies would be most helpful for them.

Case Example 1: Kristy

Kristy is an occupational therapy assistant working in an acute rehabilitation unit. She has been practicing for about five years and frequently stays late to finish her notes. Toward the end of her shift and when she gets home, she finds herself feeling irritable with the people around her and persistently "on edge."

Kristy is most likely in a sympathetic state. She is experiencing heightened irritability and remains in fight-or-flight mode even after her shift has technically ended — her nervous system has not had the opportunity to shift out of that alert, activated state. The demands of staying late and the residual pressure of an unfinished workday keep her sympathetic nervous system running.

To support Kristy, the most helpful strategies would include meditation and paced breathing to help lower her heart rate and begin shifting her nervous system toward regulation. Cognitive reframing would also be valuable — Kristy likely has negative thoughts about her work performance and productivity that are keeping her in a state of chronic low-level stress. Reframing thoughts like "I should be able to finish everything on time" into something more compassionate — "I do meaningful work, and sometimes that takes more time than expected" — could meaningfully reduce her sympathetic activation over time.

Case Example 2: Cynthia

Cynthia has been a practicing occupational therapist for 22 years in the school system. Every day she feels emotionally exhausted and disconnected from her work, and she experiences low energy and motivation. When she gets home, she typically isolates from others and has not been able to engage in hobbies she previously enjoyed.

Cynthia's profile — fatigue, reduced engagement, feelings of disconnection, and loss of interest in previously enjoyed activities — aligns with the dorsal vagal state. She has moved into shutdown, and the interventions that help in a sympathetic state may not be the most effective starting point for her.

Cynthia would benefit most from activities that introduce gentle activation. This could include gentle movement, which can help shift the nervous system out of the shutdown state, and upbeat music, which can provide alerting sensory input. CBT strategies would also be important for Cynthia: using positive affirmations to counter the internalized negative narrative that often accompanies chronic burnout, and working on recognizing cognitive distortions — particularly the all-or-nothing thinking and personalization that can settle in after years of high-stakes, high-demand work. Co-regulation would also support Cynthia by reconnecting her to social engagement, which has clearly been a casualty of her burnout.

Case Example 3: Giovanni

Giovanni is an occupational therapist working on an acute inpatient psychiatric unit. He has been practicing for three years. Over the past year, staffing shortages have led to an increased caseload. He has experienced increased irritability with others, difficulty sleeping, and a persistent sense of feeling rushed throughout his day.

Giovanni is in a sympathetic state. The staffing shortages have created a situation where his workday demands consistently exceed his capacity, and his nervous system is responding accordingly — with the hallmarks of the fight-or-flight response, including sleep disruption, irritability, and a chronic sense of urgency.

The most practical strategies for Giovanni, given his demanding and fast-paced setting, are the micro-mindfulness practices we discussed earlier. Between patient sessions and groups, even a one-minute breathing exercise or a quick 5-4-3-2-1 grounding practice can help interrupt the stress response and support re-regulation before the next demand arrives. After work, gentle movement — a walk, light stretching — could help him complete the transition from the high-activation state of the psychiatric unit to a calmer home environment. Over time, adding cognitive reframing around the limits of what he can control in a short-staffed environment would also be valuable.

Case Example 4: Kate

Kate is the manager of an occupational therapy department overseeing seven practitioners. She assists with patient care, collaborates with her staff and interdisciplinary team, and approaches her work with flexible thinking. Kate feels calm throughout the day, follows a predictable schedule, and maintains a consistent routine of taking a short walk during her lunch break.

Kate is where all of us are working toward: she is in the ventral vagal state. She has, whether intentionally or not, built into her daily routine many of the elements that support nervous system regulation: predictability, movement, flexibility, and connection with her team. Her predictable work schedule supports neuroception's preference for safety cues, and her daily walk provides both physical movement and a structured break from work demands.

For Kate, the goal is maintenance. She would benefit from continuing her consistent routines and could add simple mindfulness intrashift rest breaks throughout her day — even brief ones — to deepen her regulation and build additional resilience. She is also in a powerful position as a manager to model these practices and make them culturally normative for the practitioners on her team.

Summary

As we close today, I want to return to something I said at the start: you are not alone. Burnout is common among occupational therapy practitioners, and the numbers make that clear. What I hope you take from this course is not just information, but a set of practical tools that you can begin using right away.

The polyvagal theory gives us a framework for understanding our responses to stress — not as failures or weaknesses, but as automatic, physiological states that we can learn to recognize and move through with intention. When you know which state you are in, you can choose the right strategy to shift toward the ventral vagal state. Cognitive behavioral therapy provides evidence-based tools for addressing the cognitive dimension of burnout — challenging the negative thought patterns, cognitive distortions, and self-critical internal narratives that can deepen and sustain exhaustion. And mindfulness gives us daily practices, even micro-practices of just one to five minutes, that build resilience and keep the nervous system grounded over time.

These approaches are not separate tools but interconnected ones. A practitioner using paced breathing is also activating the vagus nerve and practicing mindfulness simultaneously. A practitioner who reframes a cognitive distortion is also demonstrating psychological flexibility. The more we integrate these strategies into the rhythms of our workday, the more we build a practice of proactive self-care rather than reactive recovery.

One final message I want to offer is this: it is so important that we take the time to pour into our own cups. We can only continue to show up for our patients, our colleagues, and our families when we are caring for ourselves with the same intentionality that we bring to caring for others. That is not a luxury — it is the foundation of sustainable practice.

References

See additional handout.