Burnout in OT: 2 ACT based journaling strategies to help you before it gets bad.

DrAditiTheOT burnout in OT
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There are plenty of self care strategies out there to combat burnout in OT, but what this blog offers is a practical evidence based, tangible, to-do worksheets you can download and use today.   Why?  Because regardless of whether you are a new grad or a seasoned OT; burnout is a reality none of us can afford to ignore.

So if you went into OT because of its selfless values and empathetic traits, you may soon realize that ironically these are the same values which can lead you to one of the biggest occupational hazards: burnout in OT. 

What does the research say about Burnout?

Sadly I found numerous studies reporting that occupational therapy practitioners in the United States and around the world are experiencing a high level of burnout. ( Edwards & Dirette, 2010; Gupta et al., 2012; Katsiana et al., 2021)Another study indicated that up to 41% of healthcare workers experience symptoms of burnout at some stage.  

There is a lot of research that highlights several obvious and not so obvious factors associated with burnout in OT.  Obvious factors include : highly unmanageable caseloads, lack of resources, balancing clinical & non-clinical duties & lack of satisfaction with pay etc. 

The not so obvious factors highlighted in the literature include, i.e. the pressure to adopt a generalized approach or use non occupational practices and underrecognized value of the profession (Devry et al. 2018).  

So as you can see the statistics definitely are against us in OT.  

So many strategies and so little time…

Now, I am sure you are all fairly familiar with many of the typical and important strategies to combat Burnout in OT.  Strategies like setting a time to unplug, setting boundaries, making time for family & friends, meditating etc.  While those are all very valid strategies, my goal in this blog was to look a little deeper beyond the “surface level” of self care.  

I was seeking something that really ‘packed a punch’.  Something that was research based, highly effective and easy to incorporate into our daily lives.   And guess what?   All the research pointed to the efficacy of Acceptance Commitment Therapy and of course, journaling.

So that’s when I decided to combine these two evidence based strategies to create a unique self-care tool designed to be used across a variety of settings by patients and practitioners.

What does burnout means and what exactly it looks like?

For me it was a feeling of total exhaustion and highly irritability.   

I just remember being tired.  Tired of everything. The clients, the paperwork, the insurance reports, scheduling… and even my 10 minute commute to work !  Everything irritated me incessantly !

That was just my experience, but according to the World Health Organization, these common signs of burnout include:

  • feelings of energy depletion or exhaustion, 
  • negativity or cynicism related your job 
  • reduced professional efficacy.

In other words.. this is what burnout looks like:

DrAditiTheOT burn out comic

I also found a great diagnostic tool called the Maslach Burnout Inventory  that can tell you what stage (if any) of burn out you are at. It poses a series of questions that can help you identify your outlook on work/life.  It can also help you discover if you are suffering from mental exhaustion. Or if you are feeling fulfilled at your job.  It offers an introspective view of all the factors we typically assume are fine.  

How can ACT help combat burnout in OT?

ACT is a behavioral intervention that works by increasing psychological flexibility, fostering mindfulness and incorporating value based behavior.  These skills are not only useful on a day to day basis, but can be exceptionally useful to address chronic stress in the workplace. 

While there aren’t any studies specifically looking at ACT for burnout in OT, there are a number of studies worth reviewing that highlight the efficacy of ACT approaches for nurses and other healthcare workers. (Montaner et al. 2021; Puolakanaho et al. 2020).  

Prudenzi et al. conducted an RCT study very recently in 2022, which found that “ACT intervention led to a significant decrease in symptoms of psychological distress and a less pronounced reduction in burnout.” These effects were mediated primarily via an improvement in mindfulness skills and values-based behavior and moderated by participants’ initial levels of distress.” (Prudenzi et a/ 2022)

I have personally been using ACT in my own life for the past 2 years and teach several courses applying the principles of ACT in OT.   Mindfulness  &  Journaling with ACT in OT are some of my most popular courses designed not only to help patients, but also help us as practitioners.  

The following are 2 ACT based strategies I have successfully used to address anxiety and can also be used to combat Burnout in OT:

1. Identify and Journal your core values.

One of the major contributing factors leading to burnout is the  disconnect between company values and your values as an employee.  So, a great place to begin is by identifying your core values personally and then comparing them professionally.  

What are values?  

Well.. they are what we care about deep in our hearts.  They help us make choices based on what is important to us and what direction we want our life to go in.  They are rooted in personal beliefs of who we strive to be.

Now to be clear – values are not the same as life goals, because they cannot be checked off once completed.  They are more like a GPS of how to live your life.  They tell us about how we want to act.. Not so much how we should think or feel…. but actually act.  They can serve as a guiding compass for our day to day decisions in life personally and professionally.

By identifying values and journaling about them…. you are using 2 powerful mediums that can help you clarify and transcribe your passions.  Journaling has a long track record of being one of the most underutilized yet highly powerful self-care tools that can help you de clutter your mind.  Plus it has a plethora of other salient health benefits.   

Below is an example of a core values worksheet I have used to address anxiety with one of my middle school students.  It can help students achieve visual clarity on what is truly important to them.

Dr Aditi The OT values


If you want to identify your values professionally as an OT, you could also utilize the AOTA Core values found here as a guide.

Once you have a clear vision of  your values, you can use it as a resource to guide you in everyday decision making.  It can help you set goals for yourself while staying within your values.  You will be able to ask yourself…  “is this decision in sync with my values?”  Is it bringing me closer or moving me away from my core values?  And then act in accordance with your values.  

The core values worksheet provides a visual guide for you to literally ask yourself these questions in any given scenario and make a decision based on that.  

2. Unhooking from your negative thoughts.

The next step is to deal with your negative thoughts.  Feelings of negativity and/or cynicism towards your job is a common symptom of burnout in OT.   It is important to address these thoughts before they become problematic. 

If left unaddressed, these thoughts may dictate how your day goes or how you choose to interact with your colleagues and patients in the workplace.   It can also be difficult to shut off these thoughts especially when you are in a full blown phase of burn out. 

Now we all have a tendency to ruminate on our negative thoughts, and we may also magnify the value of these thoughts to the point where our minds start to believe these are not just thoughts, but actual ‘facts’.  This is a slippery slope on a good day, but it can be so incredibly detrimental when you are in burnout mode.   

What tends to happen is that these thoughts start to take over and not only make us miserable for days end, but they can also cloud our judgment.  Thoughts can prevent us from seeing other options and viable solutions.

It’s about accepting our thoughts for what they are… just thoughts.

ACT offers a new perspective on these thoughts.  It suggests that instead of fighting these thoughts and trying to change them or repress them…. we can simply change how we relate to them.

It is about becoming aware of the thought instead of actually believing that everything we think is true. 

For example, if you are experiencing a thought that tells you…  “ I am useless at my job” you may choose to reframe the thought by creating an awareness of the thought itself.  So you would instead say….

Oh here I go… I am having that thought again that “ I am useless at my job.”

Below is an example of how I used this Observer of your thoughts journal worksheet to help a student be an observer of his thoughts…

By reframing these negative thoughts, you are actually engaging in a concept called Cognitive Defusion.  This is achieved by creating a space between you and your negative thoughts.  It enables you to detach and separate from them, so you can make choices and decisions with less emotional reactivity and with more mental clarity.   

 According to Russ Harris in ACT Made Simple (2009), Cognitive Defusion can help us 

  • Looking at thoughts rather than from thoughts
  • Noticing thoughts rather than becoming caught up in thoughts
  • Letting thoughts flow ( come and go) rather than holding on to them.


Burnout in OT is a harsh reality that not only affects our own quality of life, it also “impacts the quality and effectiveness of the treatment we provide as OTs ”. (Park 2021)

The purpose of these ACT based journaling worksheets is to provide you with very doable actionable items that can be easily incorporated into your daily life to combat burnout in OT.  

They are designed to help you increase psychological flexibility, a skill that is generally useful in navigating the nuances of everyday life… but one that can be exceptionally useful in the face of chronic stress or a demanding work setting.

Psychological flexibility can help address burnout symptoms by helping us to

  • Be less reactive and more collected when dealing with difficult emotions.
  • Helps us detach from our thoughts so we can make decisions with clarity.
  • Stay true to our values even if we cannot change the situation.
  • Achieve the work-life balance we are all seeking.

All of these factors are not only useful when recovering from burnout, but they can also help with preventing burnout before it starts.   

I have incorporated these 2 strategies in my life to help me combat burn out and so far it seems to be working. ( Fingers crossed : )    However, along with these 2 strategies, I faithfully practice mindfulness every single day.  Even if it is for just 5 minutes during my lunch break at work.  Mindfulness is definitely an ‘on the go’ self-care strategy that works for me. 

Do you have a favorite self-care strategy?  

I wonder if you wouldn’t mind sharing in the comments below…..



Katsiana, A., Galanakis, M., Saprikis, V., Tsiamitros, D., & Stalikas, A. (2021). Psychological resilience and burnout levels in occupational therapists in Greece: An epidemiological nationwide research. Psychology, 12, 86106.

Edwards, H., & Dirette, D. (2010). The relationship between professional identity and burnout among occupational therapists. Occupational Therapy in Health Care, 24, 119129. https://doi.org/10.3109/07380570903329610

Gupta, S., Paterson, M. L., Lysaght, R. M., & von Zweck, C. M. (2012). Experiences of burnout and coping strategies utilized by occupational therapists. Canadian Journal of Occupational Therapy, 79, 8695. https://doi.org/10.2182/cjot.2012.79.2.4

Poulsen, A. A., Meredith, P., Khan, A., Henderson, J., Castrisos, V., & Khan, S. R. (2014). Burnout and Work Engagement in Occupational Therapists. British Journal of Occupational Therapy, 77(3), 156–164. https://doi.org/10.4276/030802214X13941036266621

Park E. Y. (2021). Meta-Analysis of Factors Associated with Occupational Therapist Burnout. Occupational therapy international, 2021, 1226841. https://doi.org/10.1155/2021/1226841


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