Posted: March 10, 2022
Author: Caitlin Brown, LMSW-Macro, E-RYT 500, Social Work Part-time Faculty

For a detailed description of what burnout and compassion fatigue are and the various perspectives on them, please see Part 1 of this blog. 

Yoga Therapy Treatment & Prevention

Utilizing the perspectives of yoga and Ayurveda, various tools can be used to address burnout and compassion fatigue. These tools can address not only the symptoms, but also some of the underlying causes. The tools are not one-size-fits-all but rather can be modified or used in various combinations depending on how burnout and compassion fatigue are manifesting in the individual. Furthermore, these tools of yoga can also be used for self-care, to help prevent BO and CF before they manifest. The tools are organized by the kosha model, but other elements (chakras, gunas, Ayurveda plus additional elements) will also be discussed.

Annamaya Kosha

To address burnout in the annamaya kosha is to address it in the physical body. Tools include food recommendations and asana (physical postures).  Ayurveda provides many helpful recommendations around eating routines. Eating warm, nourishing, grounding foods can help calm the vata-imbalanced vacillation between tamas and rajas so common in burnout. For example, this would be stews cooked with fresh vegetables, especially root vegetables and spices such as ginger. If there is a lot of anger and conflict in the burnout, one might avoid spicy or acidic foods which could cause heartburn and acid reflux and further aggravate pitta. Having a consistent routine and eating at the same times each day is also important to prevent BO and CF or help restore balance.

In terms of asana, if burnout is manifesting strongly in feeling exhausted and depleted, grounding, restorative asana may be best, especially asana facing downward to encourage calming such as bilasana (child's pose), paschimottanasa (seated forward fold), or baddha konasana (bound angle) folding forward. If one is feeling stuck, powerless, or hopeless, doing some whole body shaking at the beginning of practice with sighing out can help begin to bring movement and loosening. Also doing flowing movements but slowly, gently, and smoothly (so as to not agitate rajas more) could be helpful (Stiles, 2020). For general self-care and BO prevention, it would be important not to push too hard, to not overdo movements in intensity or speed.

 The energy-flowing series (pawanmuktasana) from Satyananda as described by Antonio Sausys can also help one find freedom from feeling stuck. Areas in this series of particular interest to burnout would be the knee releasing, elbow movements and shoulder movements. The knees are the buffers of reality (Sausys, 2019). Locked knees indicate rigidity and a need to control (common in a burntout pitta imbalance) while consistently having bent knees represents not having strong buffers, passivity, feeling unable to speak up (indicative of a burntout vata imbalance). The elbows represent attraction and rejection, push & pull, boundaries (vata burnout imbalance). When doing the elbow movements, one can visualize what they want to attract and what they want to release, want to say no to. The shoulders represent power, and the power to bear the weight of the world (or the weight of one's job and the trauma and emotions of one's clients). In burnout the shoulders might be rounding forward (feeling overwhelmed and powerless) or high up by one's ears (being rigid and controlling). The shoulder movements can help find balance with power (Sausys, 2019).

Pranamaya Kosha

When working with the pranamaya kosha, the issue with BO and CF is often of depleted energy. Pranayama can be used to circulate prana and to energize. Care must be taken not to burn out further with too vigorous pranayama. The yoga therapist can start with a foundational breath like complete breathing (mahat pranayama), wave breath, or 3-part breath (dirga pranayama), depending on which feels the most comfortable for the client. Alternate nostril breathing (nadi shodhana) can also be used to balance the tamasic and rajasic energy. Then after the client feels comfortable with the breath, adding in something a little more energizing like breath of joy. This can move energy upward, release stress during the exhale through the mouth and is balanced with grounding after. This breath can be especially helpful for depressive symptoms (Weintraub, 2004).  If burnout is manifesting as a lot of agitation and anxiety, bee breath (bhramari pranayama) could be helpful. This breath can help calm the busy mind and activate the parasympathetic nervous system (Weintraub, 2020).

Working with mudras is another tool that works on the pranamaya kosha. Mudras are hand gestures which aid in moving prana in various ways in the body and can help remove energy blockages (LePage & LePage, 2014). If there is a sense of depleted energy, first using mudras that balance and nourish energy, such as hakini mudra (LePage & LePage, 2014; Weintraub, 2020). Then using mudras that gently activate prana vayu, the upward current of energy can be helpful, such as vajrapradama mudra. This mudra can help restore optimism, energy, and enthusiasm; open the heart, and lift depression, all helpful for burnout (LePage & LePage, 2014). Mudras are also very portable; a client could use them during their workday if they need balance, more energy, more calm, etc.

Mudras can also be used when working with the chakras. Using the Lifeforce Yoga chakra clearing meditations, both the energizing and calming versions, depending on how burnout is manifesting, can help one find more balance in the chakras and prana in the body. This meditation uses mudras and bija mantras (seed sounds) for each chakra. Regular chakra balancing can also be used for self-care and prevention.

In BO and CF, the manipura chakra and anahatha chakra are particular focus points based on discussion in part 1. If one feels powerless, gradually assert power through strengthening asana such as warriors, plank, and chair and using the bija mantra "ram". However if there is a controlling, workaholic nature to the burnout or lots of anger, use the soothing sound of "aaah" and gentle, flowing movements rather than a hold which could increase heat (and control and anger). Gentle supported backbends such as supta baddha konasana (reclined bound angle) could help soften and open the heart, where compassion is fatigued and empathy is burntout, and using either the seed sound of "yam" or "A" (Devi, 2020; Weintraub, 2020).

To help deal with the exhaustion and fatigue of burnout, yoga nidra can be used in the evening before bed. This can help the client transition from the external to the internal sensations of the body, helping both body and mind to soften and relax. Using the iRest protocol for yoga nidra could be particularly helpful. It can introduce one to the idea of an inner resource or sanctuary, a comfortable place they can go to at anytime (even outside of the nidra practice, such as while they're at work) and a nondualist practice, where they can practice holding both uncomfortable and comfortable sensations at the same time (in both the nidra practice and translatable to when they're at work) (Weintraub, 2012). This can also be used preventatively, helping the client diffuse potentially difficult situations before they worsen.

Manomaya Kosha

One helpful tool for BO and CF in the mental and emotional layer is meditation. For example meditation to encourage self-awareness of thoughts and emotions, self-compassion meditations, and loving kindness meditation. The yoga therapist could use themes specific to the needs of the client such as meditations that help enhance self-awareness during the client's workday, meditations to do after a difficult work situation, meditations for setting boundaries, ending the workday, and creating a sense of community, all important for someone experiencing BO or CF.  Meditations tailored to the person's profession could be particularly helpful as they help the person feel understood in their particular situation.

 If the burntout person is experiencing a lot of self-doubt and negative self-talk, self-compassion meditations could be helpful. For example, one meditation is called "The Self-Compassion Break". It helps the person bring mindfulness to a current difficult situation, recognize that others have also been in similar situations and to treat themselves kindly during the experience (Neff, 2020). Loving Kindness meditation can be used when one is experiencing interpersonal conflict, gradually building up to directing the LKM phrases to people they're in conflict with. There are also LKM variations that strongly encourage self-compassion (Neff, 2020). These types of meditations could also help encourage compassion satisfaction, as well as a sense of community at work, helping with engagement. These practices could also be done in a group setting at an organization, as part of a self-care series.

The concepts of abhyasa and vairagya can be helpful for examining thoughts and emotions related to BO and CF. Abhyasa is effort, persevering practice. Vairagya is surrender, letting go. If out of balance, these show up in BO and CF as the vacillation between rajasic and tamasic states. In treatment, the yoga therapist could give the client journaling prompts to examine when there is need for effort and when there is need for surrender and how to balance them. Having a greater understanding of these concepts can also help one with proactively balancing abhyasa and vairagya before there is BO and CF.

Vijnyanamaya Kosha

When working with the wisdom or personality layer, setting a sankalpa can be particularly helpful. Sankalpa is a resolve, also translated as "your heart's desire". This sankalpa can be all encompassing and connect to the deeper meaning of one's life, or it can be more of an intention for the moment, for the day. A more specific, short-term intention can be helpful in the extreme exhaustion phase of burnout. "What do I need just in this moment?" or to break down a larger resolve into smaller, more manageable steps. The deeper resolve helps one connect more to their dharma, their purpose for their lives (McGonigal, 2020). Contemplating this type of sankalpa can be helpful when one feels ready to begin to make deep changes, perhaps changing jobs or careers, to be able to connect again with the True Self.

Working with sankalpa is one way to begin to practice svadhyaya, self-reflection. Another way is through self- inquiry. The yoga therapist can lead the client through a self-inquiry meditation, such as one found in "The Secret Power of Yoga" (Devi, 2007) or give the client journaling prompts such as "What is my gift that means the most to me?" and " What am I doing when I am the happiest/most absorbed/most expansive? And how does this align with my gift that means the most to me?" (Weintraub, 2020). If the client already has some knowledge of yoga, the therapist might recommend they read "The Great work of Your Life" by Stephen Cope, which explores the "Bhagavad Gita" and gives examples in modern life of how people find their dharma. Other books, perhaps profession specific, could also be used to help the client examine their calling or purpose. These types of questions or readings could also be introduced during professional education and in continuing education workshops. Introducing them early can help people examine if the profession is a fit with their values and dharma and help encourage engagement and compassion satisfaction while preventing BO and CF.  On an organizational level, a yoga therapist could work with a group at their place of employment and pose these questions.

Anandamaya Kosha

The bliss body, the deepest layer of our being, might initially seem very abstract or difficult to access for someone who's burnout, and they may feel very disconnected from others and themselves. First it would be important to work with the other koshas and gradually begin to explore deeper layers. After exploring dharma in the wisdom body, the client could use this in meditation or prayer. They may also use their sankalpa as a mantra to repeat. Surrendering through chanting can help one begin to access the bliss body. Creating rituals using sankalpa and dharma exploration is another way to connect to the bliss body. These types of deeply nourishing self-care practices can also help cultivate engagement and compassion satisfaction.

Building on the self-inquiry questions, it would be important to encourage the client to spend time doing what makes them happy, what brings them joy. In BO and CF, there is a sense of joy being drained, so it is important to reintroduce it. The controlling, overworking aspect of burnout can be softened through encouraging unstructured self-care time to play, to be silly, to laugh. Mindfulness practices can help one begin to find wonder and joy in everyday occurrences.

Seva or service, can be another tool to connect more deeply with community and with a higher sense of Self. As the person with BF or CF may already feel extremely fatigued by their job, asking them to volunteer on top of that may be counterproductive. Instead the yoga therapist would implement this intervention at an organizational level, encouraging the administration to create days of service where employees can serve others and bond with one another. These types of programs, if implemented successfully with employee buy-in, can help build shared values, work engagement, and compassion satisfaction, thus helping to prevent BO and CF.

Conclusion

 As a social worker who has worked with a variety of organizations, I saw the negative effects of burnout and compassion fatigue in myself and my colleagues. I did not have a good understanding of these terms until I was years out of my social work master's program. Similarly with self-care. Self-care is a buzz word and is often associated with indulgent things you buy or do for yourself: A massage, a pedicure, a bubble bath with wine. However it is very different to think of self-care as an act that is self-reflective and deeply nourishes sense of Self. This type of self-care is not always easy. Self-care is not solely the responsibility of the individual during their personal time. It can also happen individually in the workplace and collectively in the workplace. As a manager for many years, I began to understand how it was important that I modeled self-care and implemented it while at work. For example, having discussions about boundaries with email, that I did not respond on the weekend or after a certain hour in the evening, and nor did I expect them to. It was taking a lunch break away from my desk, encouraging afternoon walks, offering lunchtime yoga asana, and group meditation breaks.

Yoga has been such an important tool for me in addressing BO and CF as well as preventing it in the future. Yoga is holistic in that it can provide self-care on many levels of our being (all of the koshas) and at both the individual and group levels. It helps us connect to the important people in our lives and create a sense of community, as well as connect with our inner divinity, our true nature. I look forward to continuing to share these tools with other social workers and social workers in training, and anyone who is feeling depleted and devalued in their work.