- Understand why burnout is often misdiagnosed as depression, anxiety, or fatigue—and how chronic stress and disconnection create overlapping symptoms that self-care alone can’t resolve.
- Discover how burnout impacts the body biologically, from cortisol and neurotransmitters to mitochondrial stress and oxidative damage at the cellular level.
- Learn how connection, purpose, safety, acceptance, and care form the foundation of resilience—and why restoring these is essential before true physical healing can begin.
Full Transcript
Podcast Introduction and Guest Introductions 0:00
Other people are having panic and anxiety attacks. You know, how the World Health Organization has defined it is with these, you know, under these things of cynicism, emotional exhaustion, depersonalization, and reduced professional efficacy. Which that's all fine and dandy, but how people experience that physiologically in their own body. Your health is shaped by more than symptoms. Through real stories and expert insights, we explore how your genetics, environment, and daily choices affect your wellbeing.
We uncover root causes and share practical tools to help you find the healing you need. Welcome to the Forum Health Integrative Medicine Podcast. Hi, welcome to the Forum Health Integrative Medicine podcast. I'm your host, Amanda Grabeau. I've been immersed in the functional and integrative medicine space for over a decade as a researcher, business consultant, and a certified coach. For years, I've been helping practitioners and patients decode the why behind chronic health patterns. My passion is educating people about proactive versus reactive medicine, helping people become stronger advocates for their health, especially in the areas where conventional care doesn't fully address the root causes.
Today's episode is a special one. And co-hosting with us today is Dr. Andrew Peterson, DO, a physician with more than 24 years of clinical experience and a deep commitment to unraveling complex illnesses through a holistic lens. Dr. Peterson is a nationally recognized expert in Lyme disease and tick-borne illnesses, but his work doesn't stop there. He's known for addressing conditions that often elude traditional diagnosis, from environmental toxin exposures to endocrine and autonomic dysfunction, with innovative patient-first strategies that expand what's possible in chronic care.
We're honored to welcome Erica Shepherd, a board-certified holistic family nurse practitioner and international speaker who blends traditional medical
Why Burnout Is More Than Self-Care 2:06
training with functional, integrative, and mind-body medicine to help patients go beyond survival and into thriving. Erica graduated summa cum laude from both Arizona State University and Georgetown University, earning her clinical credentials and then expanding her expertise into holistic care. With over 14 years in the medical field, she brings a rare combination of scientific expertise and human-centered wisdom to her work. helping people optimize everything from hormone balance to metabolism to mental well-being, all while honoring the mind, body, spirit, and environmental connection.
She's spoken on stages like TEDx, and today she's here to share her unique perspective on integrative care, patient empowerment, and transformative healing. Erica has a powerful framework for burnout that goes way beyond just take a vacation and it's going to give you a new lens on what recovery can actually look like. This episode is personal for me. I've lived through burnout and I learned the hard way that labeling it correctly matters because the solution changes when you finally identify the right areas of focus.
So let's get started. Hi, everybody. My name is Amanda. I'm your host, and I'm here with Dr. Peterson and Erica Shepherd. Erica Shepherd is a board certified holistic family nurse practitioner who is passionate about elevating the mental and physical well-being of patients she serves at Form Health in Denver. Hello, Erica. Hi, Dr. Peterson. Eric, it's great to be with you. I'm excited to talk to you about this topic, burnout and self-care. It's great to have you in our Denver office. You're a tremendous addition to that staff and thank you for the work that you do.
Thank you, Dr. Peterson. Love being here. Oh good. So burnout, a lot of people do all these things. They meditate, they journal, they go on vacations. We do those things to try and sort of take care of ourselves and yet it seems like we're still exhausted. Why? Why do you think self-care alone isn't enough? Or what's going on? You know, Dr. Peterson, that's a great question. I have personally and professionally dealt with burnout and so we've become intimate friends. And what I've come to learn over all these years is that we've kind of gotten burnout all wrong and just this notion of mentality that we're not doing enough.
And if we did more, even of the good stuff, that we would start moving the dial a little bit. But even now, our burnout rates are getting worse and worse, even with more awareness and modalities and TikTok culture and everything. We're doing all the bubble baths. We're doing all the meditation. And what I've come to learn and what started moving the dial for me is that the problem is recognizing that it's a problem with the individual. And really it's a problem with community systems and connectivity.
And coming from this perspective has been not only life-changing for me, but also for my patients. And what happens that we experience on the individual level when we experience these grander communal dysfunctions, if you will, and I'll get more into that here in a minute, but that our internal community starts to dysfunction as well. We are made of trillions of cells and But as we know from all the studies around epigenetics and cellular biology is that cells and the body respond to the environment.
Right. And so with that, I started learning, okay, if I started focusing more on how I'm resourced from the outside, it affects how my body resources from the inside.
Burnout Symptoms and Biological Effects 5:54
So what I hear you saying is if we are not connected to other people, then we can't be connected biologically ourselves inside. Am I hearing that right? Yes, both connected and resourced through each other. Keep going. I like this. I love this. Good. So where my, my theory around burnout is in how I'm approaching it is from this understanding of both connectivity, how we're connecting and how we're being resourced. Right. Because if we're running on an empty tank, you know, the car's not going to get very far.
So. If there's no roads for the car to run on, it won't matter. Exactly. There's been a lot of organizational research around burnout and even the World Health Organization now in the ICD-11 recognizes burnout as a condition, which is, you know, it's a thing. Glad that we're recognizing it. Hang on one second. Are there other names that this goes by? The burnout? Yeah. Yeah. Are there other things that we've been calling it? Because they're fascinating to me that it's now in the ICD-11 book, right?
Like that means, is it unique from some of the other things or is it another layer of those things like adrenal fatigue? Right, right, right. I would say it's another layer. It's, you know, addressing that because people will come in, you know, with like, I'm fatigued. I am depressed. I used to care and now I don't. Right? bad apathy or some people get really angry and irritable. They're like, I'm so irritable. Um, other people aren't sleeping well. They'll be complaining of insomnia, right? Other people are having panic and anxiety attacks.
You know, how the world health organization has defined it is with these, you know, under these things of cynicism, emotional exhaustion, depersonalization and reduced professional efficacy, which that's all fine and dandy, but how people experience that physiologically. in their own bodies can be variable. So I think often when people are complaining of these different symptoms, they're all under this umbrella of the, through the phenomenon of burnout. Nice. Okay. So go back to community. I'm sorry.
I interrupted. Tell me more about the mechanism of resourcing. Yes. And so what they're realizing through the research, they're recognizing through this phenomenon of work, and so they're calling it an occupational syndrome. But what I've learned over the years is that it doesn't just manifest through dysfunctions of work or imbalances at work, although a lot of us spend a lot of time at work. If our interpersonal relationships are our home life or spiritual life, and those aspects that are very important to our health and wellbeing are also out of balance, and our communities, how we relate to each other in those spaces are out of balance too, that can also create a tremendous amount of burnout.
I'm sure, or maybe it's me, but I have been in some interpersonal relationships over the years where I'm like, this feels beyond exhausting, right? It's because I can't connect to this person and we're depending on each other, but it's not happening. And so this can happen in spaces other than work. Oh, I just, I think that's so important. I had my own personal journey with burnout this past year and I'm an open book. I took FMLA and it wasn't because I was unhappy in my career or my job. It was, and so I identified it as I must be depressed because burnout in my mind had to be because I work was disappointing to me or I was burnt out at work.
And it wasn't that I was burnt out at work. It was that it was everything else going on in my life that I lost connection that I lost. And you described me to a T last year and it was such a emotional journey, just also identifying being depressed or anxious or all these other things. And I started treating, well, I didn't start treating myself, but I started working on myself, but I worked on myself the wrong way. Cause I identified the wrong problem. Right. And what did you see it? What was the identity?
What was the wrong identification at first for you? The wrong identification was I'm depressed. I like I'm having a deep depressive episode was what I identified. But it sounds like what was really going on is that you were disconnected. Yes, 100%. And that was your body's way of telling you. Yeah, that's what's so beautiful about what you said at the very beginning, Erica, is if we can be connected to our spouse, to our children, to our church group, to our employers or employees, right? I could work with somebody, but not feel connected to them.
And that's partly on me, right? Like, get to know them. And then as I become connected, now that improves. And biologically, it changes how my body is functioning, right? Right. 100%. And you bring up a good point, Dr. Peterson, that it is on us to take accountability for recognizing what our body is telling us and then paying attention to that data and seeing, okay, where can I fill those gaps? And I know in my own experience that there's been times where it's like, okay, I need to reach out or build more bridges in those ways or be able to recognize what I need.
and what my life needs to be resourced, right, within this community and within myself. And then there's times where you're in the wrong place, where no matter what you're gonna do, that it's not gonna be the right fit. And a lot of people get stuck in that trap, where you are in the wrong place, whether it's the wrong job, the wrong relationship, you're not setting enough boundaries with your family of origin, God bless you, you love them. But like, you may need a little more protection around your space.
And so, These things lead to burnout in the biggest way possible and so I can't emphasize enough that the problem with more self-care is it's not a self-issue. Like if you keep focusing on yourself, you keep hitting this dead-end road and wondering why is the more I'm doing on myself not working because it's about your ecosystem. It also speaks to sort of the balance that exists in life that if we exclusively focus on others and their needs, we're going to have burnout. And if we exclusively focus on ourselves and just read a bunch of self-help books, we're going to still feel just as disconnected and have burnout.
Community Needs: Care, Acceptance, Purpose, Safety 12:36
And so we've got to find that balance with, it's like exercise, right? If you over exercise, it's bad for you. If you don't exercise, it's bad for you. And then it goes back to also where we have this responsibility, and that doesn't mean it's easy, and it doesn't mean it's our fault entirely, but it's like exercise. It's comfortable to not exercise. It's uncomfortable to start. Once you do start, you feel better, right? Similarly, it's probably uncomfortable to spark up a conversation with someone that you don't really feel all that connected to.
But it's worse if you don't in the long run. Exactly. Totally. And what I want to also clarify too is that all these self-care measures that we have are absolutely very important. You know, I've done interviews on burnout before from this perspective and I've had people say, well, you're saying self-care is bad. I'm like, no, I'm not. Self-care is amazing. It's just, again, we don't want to limit ourselves when we're talking about this phenomenon burnout that it's like you need to do more of those things.
Because again, the majority of people who come to see me are doing all those things. They've already done all those things and they're so confused why they still feel the way they feel. If you're on one side of the balance versus the other instead of in the middle, they don't admit it. Go ahead, Amanda. I was in this place at the beginning of this year and kind of mislabeled. And it wasn't until I got really honest and I had some of our providers that I leaned into, but I was taking the time and doing all of the stuff for myself, and I wasn't feeling better.
I wasn't feeling the relief. That's when I realized that all these signs and symptoms that I have, they could point to depression, they could point to all these different areas, but in reality, it was burnout. And although the signs and symptoms can look a lot different for a lot of people, Right. The healing part of it and like the connection is a big piece of it, but what is actually happening biologically in the body for people who are experiencing burnout? Like we get all these different signs and symptoms, but what's happening on the biological level?
Yeah. So when we're in these spaces, and again, we're connecting to our external environment and whether it's the people at our work, the work itself, our interpersonal relationships, our body responds. And so if this is stressful and again, the dynamics are out of balance, then the body's going to go into a stress response where it starts dumping more cortisol, you know, which is stress hormones. It can increase the activity in the HPA access. It can change how the neurotransmitters are being fired, which again, when we feel depressed, it's because our neurotransmitters are firing differently.
We're not firing as much serotonin. All that to be said is it goes down to the cellular level. It affects how our neurotransmitters are firing. It affects what hormones are being dumped. Some are dumping more. Some are dumping less. And it can cause this cascade. And then what happens over time is that if this stress response is prolonged, Our body, the little individual cells each have an engine called the mitochondria, which is the little engine of every cell. And you remember maybe that from high school biology, but they're working hard every day.
So you have trillions of mitochondria. And then what can happen is that those get taxed, they can back up and then think of a car that's not like you know, running its oil and gas properly. And it's that car on the side of the highway that's pumping out all that smoke. And it's just like polluting everything. And that's what happens on the cellular level. And it's called oxidative stress and that can back up and then it affects your DNA and the telomeres and all that gets shorter. So it's the long-term effects that when this builds up, builds up, builds up the body, essentially their functions back up and on the cellular level.
it creates a lot of prolonged stress responses. So it's not pretty and everybody's different. So I can't say like, you know, some people end up like with hair loss or feeling depressed and other people might end up like a ball of anxiety and they're up for days on end, right? It's just everybody's an individual, but how that stress response manifests on the cellular level causes this cascade to happen. I assume that's why you have to look for a lot of things because it might be cortisol, it might be progesterone, it might be thyroid, it might be the level of, you know, any number of different things because of the individual responses.
Exactly. And I think the most under-talked about phenomenon in medicine that is causing the most health issues to this day is prolonged stress. Like without question. And so people are like, well, you know, I just want to fix my hormones. And I'm like, well, how are your relationships? And they're like, I'm sorry, what? I couldn't agree with you more. I take care of chronically ill patients that have Lyme and mold. And if it's not the first thing we talk about, it's the second because it makes all the difference in the world.
So I want to, for our listeners, I want you to go through if you can, just to, you know, maybe make it a little more succinct for them. What would you characterize as the specific signs and symptoms of burnout? I know we've talked about them, but just give me the top five. Yeah. I would say the top five symptoms of burnout are one apathy where you used to care, you have no capacity to care anymore, but you know you're a caring person and you used to care about it. I would say the next is fatigue, fatigue, fatigue, fatigue.
It's like, I cannot keep up with anything like how I used to. I love CrossFit and there was, I was so burned out for a long time there that I couldn't even do it. It's not cause I didn't want to. It's because I couldn't. Um, and I just was like so tired. I think the next one is brain fog and also not being able to focus. And some people are like, maybe I have ADHD. Well, maybe you're just burned out and you need a whole reset on your body. And that can. be a possibility the other can be a lot of people get disturbed sleep it doesn't mean you're not sleeping you could have yes you could have trouble falling asleep you could have trouble staying asleep or you could get not restful sleep it's like i just slept for eight or nine hours that's me uh i just slept for eight or nine hours and it felt like a bust and so it's that that's impaired sleep and repair cycle so i went was that four i think that was four do i have five I don't have to have five.
I just wanted listeners at home to be able to say, does this sound like me? Does this sound like me? And just overall, you know what your capacity could be for it to do work, to be passionate. And it's like, basically the fire has gone out. Okay, so we've talked about sort of the medical perspective of this is now identified as an ICD-10 or ICD-11 coded diagnosis. And it's a little bit more than what we would call adrenal fatigue or chronic fatigue because what you're describing is that it requires this connectedness.
And that's probably foundationally part of what contributes to someone's other symptoms of depression or chronic fatigue or what have you. What about, and you talked about, you know, what happens at a cellular level. So what are these things that at a community level, environmentally, what's actually happening that causes the burnout? Can you help me understand that? So my theory, so let me take a step back. I spent years doing mind-body medicine with people, and it were these sessions that were usually an hour long that people would tell me their most intimate
Assessing Relationships and Environment 20:30
pain points that was causing suffering in their life. And it took years, but I started recognizing a pattern. And the pattern that I recognized is that they were always talking about one of four things. Okay. And I say it's my CAPS theory of, of human needs and the most foundational needs for human connection. And you read this down, but it's care. It's the first one is care. People need to feel cared about. Right. The second one is acceptance. People feel need to feel accepted for who they are.
Okay. The P is purpose. People need to feel purposeful and that they are part of a bigger picture. And the last one is safety. And people need to feel safe. They need to feel physically, emotionally, and spiritually safe. And so when I realized, oh my gosh, it always boiled, it seemed to always boil down to one of those four things, why people were exhausted or suffering in some way, right? And so I kind of approach things through that lens that if we're not having a lived experience of those four things in our community, it becomes disconnected and exhausting.
Okay. So I'm going to ask a question. Where, where do we say, oh, well, I need to change. something about me so that I can be accepted by the larger community. What goes on with that? Because acceptance is a very interesting thing. I like to think that I accept and love my children for who they are, and yet I want them to be better. There's this strange struggle with acceptance. Yeah. Isn't that the truth? So I've worked on psych wards also for years in my previous RN life. And so I've had some really gnarly conversations over the years.
And what I've come to find is like, we can put boundaries around people's behavior and that doesn't necessarily, um, connect to their identity of who they are. And so I think it's one thing. to say, hey, we want you to be the potential of who you fully are. But if we're trying to change people and they know who they are, that's a behavior that was developed because they don't feel safe in some way that they feel they have to steal to feel safer, right? So really, I think acceptance, it sounds like what you're saying comes down to being able to identify the most important characteristics of who we are.
Exactly. Acceptance can be confusing, especially in the world today. But if we know who we are, if we say, oh, okay, I have this divine potential. Exactly. That changes things differently. Right. It drastically does. And I think one of the most important conversations we can have with people, whether it's our children or our spouses or community members, is getting curious and asking really curious questions. What do you like most about yourself? When do you feel most alive? What makes you feel most like you?
And maybe that's not how I identify or how I would do those things or how I would identify myself. It's getting curious about what makes people feel most at home in themselves and being able to foster that in those people. Because when people start abandoning what they know is true about themselves, a lot of problems come from that. Right. Yeah. I can see how any of those four things people would say, Oh, I can't survive like this. So. Right. And they do, these are things that are not in somebody's direct control, which makes it challenging, right?
Like I can control a lot of things or I'm in the middle of Mel Robbins book. Let, let me. I love it. Love it. but let them thank you let them and it gives you your power back right but there is in like the cared for in the purpose in the acceptance you can't really just say let them and like but you also can if you have the energy and this is what i ran into when i was going through burnout was i could identify what it was but i was so burned out that i didn't have the energy at the time to really take corrective actions to be able to shift the area that was affecting me the most.
But looking back at it now, for those who are listening to this and haven't reached that pivotal point of burnout where you're so exhausted, but you're seeing the signs and symptoms and you have the energy to take control. You are an accumulation of the five people that you're closest to. Who are those people? Do they accept you? Do they care about you? Do they believe in your purpose? Do you know what your purpose is? But, and that like, when I looked at like, okay, who are the people who are influencing me the most right now?
Do they care about me? Do I feel safe around them? I didn't feel safe around three out of the five people I surrounded myself with. Bingo. I think that's a really good point, Amanda. It's not, I don't need to feel safe from everyone. Correct. I need to feel safe from the people that I am connected to. I don't need to feel accepted by everybody. Maybe not everybody likes me. That's fine. But I do need to feel accepted by this core group of connection and my purpose, right? I don't need my purpose to be important to someone else.
Right. So, so I do think it's really important for us to recognize that these, these things that we need, we don't need it from the world. We don't need everybody to agree. We just need it from the people that are, that are, we're surrounded by. And I want to say that we're closest to, but it's more than that. Like if you, if you're physically close or emotionally close to someone that isn't doing this for you, then look inside first, see if there's something that maybe is there something that I need to do differently, but then don't spend too long there and say, maybe this relationship isn't the one for me.
Exactly. I think, you know, in my own burnout journey, because I don't just have one burnout episode. I have multiple. There's a collection of repeated patterns there. But what started getting to me was that when I experienced my last burnout episode, I was just like, I have literally done all the right things. I have taken immaculate care of myself. And, but at that point I recognized the whole communal aspect and the whole CAPS model of understanding my relationships and the things. And I had to come to be really honest with myself of do, am I feeling cared for here?
No, not really. Am I feeling, and this was in a job place before Forum, it's like, I don't feel my fellow employees care about me, but administration does not. Employees accept me and my administration does enough. Am I being fed in my purpose of how I know I can be the most optimal provider? No. And then do I feel safe? I feel safe around my fellow employees. Do I feel safe to come and talk to leadership about how we can make this better and make it the best place? No, I do not. And so I had to go through this checklist and what can I change?
It's a very valid question. And I tried, you know, to test the waters and things like that, but then had to come to what you're saying, Amanda, is like, this is where I spend five days a week, right? And so this is part of my inner circle of life, right? And I then get to be empowered and make a choice that I can find somewhere that does meet those needs, that I can get and believe that I can have those needs met. And what's interesting is that since I've started working in an aligned place. I am working, you know, longer hours.
Hope, Recovery, and Closing Remarks 28:30
I have longer commute times and this and that, but I am so fulfilled in my soul. And it's naturally on the cellular level, like just doing its natural healing thing, which is amazing. Yeah, it should be causing you to sleep better and feel better and have more energy and be able to do that workout that you want to do. All right, well, we're going to have to have another episode with you to talk about because the listeners are going to say, hey, well, OK, what do I do? So before we wrap up, tell me what are the first steps or one or two steps that they could take.
And then step three, I'll be come back and listen to you give us the answers here. But what are the first things that you would do to say, oh, I've got burnout? I've been able to identify it. Right, right. So yeah, the first step is always awareness. And then the next step is that you really do have to decide that you want to do something about it because this is not going to fix itself. And I would say then the next step after that is doing an assessment on your environment. And doing an assessment on your environment between the places you spend the most intimate time, your inner circle, between job, between home life, and the people you spend the most time with, what is fulfilling in those needs and where are the gaps?
And then from an assessment, you can make an informed decision. I think- Mark, that it sounds like to me is going to be an assessment of these relationships, this connectedness. How much of any of it is an assessment of the environment? Say, you know, am I drinking filtered water or am I, you know, breathing in too much air pollution? Is that part of the assessment as well? Absolutely. Absolutely. Like, that's the environment. Physical and psychological environment assessment. Right. The psychological environment assessment, but also again, that stress isn't just emotional, psychological too.
For some people, and this is a whole other episode, which is why we're going to talk about it, are the stressors of chronic disease and chronic toxicity on the body that will cause that cellular buildup and burnout from that perspective as well. All right. Well, we're going to wrap up, but I want you to leave our listeners with something hopeful more than just come back and listen to the next episode, but something that they can hang onto and say, okay, I can get better. Absolutely. And that really is, is that this is not forever.
Like, you know, Amanda was talking about, like, is this going to be how it's going to be from now on? And I'm here to tell you, no, it is not. There is hope. And if you are feeling so exhausted and so, you know, either depressed or anxious or just so apathetic, I promise you there is hope and that you too can heal and that you can get back to or even better than how you felt before like I can tell you right now like I've been focusing on my burnout recovery and my Cellular health and this is the most energy I've had in 10 years.
So there is hope it's okay I love it. And I love that you say you can feel even better than before because a lot of people, they just have this baseline of they said, that's how I felt when I was 15 or 18 or whatever. That's what I'm shooting for. No, you can be better. You can be better. I mean, I grew up a very sick kid with autoimmune and gut issues. And this is before functional medicine out in the Midwest. And so it's like, I feel better right now at 39 than I did at nine. That's awesome. Amanda, do you have any parting words for our listeners?
Tune in for our next episode to learn more about how to address burnout on a more cellular level and partner with your functional and integrative providers. Awesome. All right, we'll see you guys then. See you then. Thank you for joining us on the Forum Health Integrative Medicine podcast. Each episode, we help you understand your health from every angle and inspire your lifelong wellness journey. Follow the show, share it with someone who needs hope, leave a review, and take the next step toward feeling your best at forumhealth.com.
Comments