Mental exhaustion [neurasthenia]

Mental exhaustion, or neurasthenia or mental breakdown, is a state of mind that results in intense emotional disturbance and mental and physical fatigue. It is generally an acute condition of temporary duration and sudden onset.

The main cause of nervous exhaustion is stress that may result from difficult situations, such as relationship problems (couple, family, etc.), health problems, financial problems, work problems, etc. The most common symptoms of nervous exhaustion are: anxiety, sense of worry, depressive disorders, low interest in life’s pleasures, and emotional fragility. Those who develop nervous exhaustion should seek the care of a psychotherapist, who will plan therapy based on factors such as causes, symptoms, and the patient’s own character.

In common speech today, “mental exhaustion” is used to refer to a general state of physical and mental fatigue and weakness that can include a wide variety of symptoms, such as: excessive feelings of tiredness after mental exertion and difficulty concentrating (resulting in reduced efficiency both at work and in other tasks of daily life), physical weakness, chronic fatigue, pain, difficulty relaxing, dizziness, racing heartbeat, headaches, difficulty sleeping, reduced ability to feel pleasurable emotions (anhedonia), irritable mood (“nervousness”).

In practice, the term “nervous breakdown” was and is widely used to refer to a difficult period that causes symptoms attributable to depressive states and anxiety disorders. Specifically, it is a condition that occurs acutely after a particularly stressful period. This can result in “mixed” problematic mental states attributable to both a mood disorder and an anxiety disorder.

Symptoms of mental exhaustion

So-called “mental exhaustion” indeed has many of the symptoms of anxiety disorders and depression. Apathy, listlessness, lack of energy, muscle weakness, lack of zest for life, sadness and melancholy are indeed typical symptoms of depression. People who suffer from depression may also suffer from panic attacks or anxiety, and vice versa.

So-called nervous exhaustion is often associated with somatization and stress symptoms. Often it is an overload of the latter that is the main cause of nervous exhaustion.

The person experiencing nervous exhaustion may manifest:

  • Feelings of anxiety, worry, or fear about something unfathomable;
  • Disorders typical of depression (depressive disorders) and a negative mental attitude toward life and its events (recurrent pessimism, distrust, etc.);
  • Feeling of lack of interest in what one usually enjoys;
  • A feeling of being lost outside one’s home. This results in a tendency to stay indoors and avoid contact with the outside world;
  • Emotional frailty. This results in an ease with crying and sadness;
  • Passivity in the face of events and a sense of lack of control over one’s life;
  • Strong insecurity;
  • Physical frailty and easy fatigue, even after minimal effort;
  • Trouble sleeping at night;
  • Confusion of thought;
  • Disinterest in personal care.

In very rare cases, nervous exhaustion may also be responsible for: mood swings, hallucinations, paranoia, and flashbacks (i.e., sudden memories of past events).

The role of excessive stress

But what does it mean to be stressed? How can stress lead to such deterioration in a person? In humans, affective and situational instability are the main sources of stress. They exert a significant blocking influence on all patterns of adaptability, which are thus destroyed. This promotes the accumulation of a large amount of tension in the system. When such tension is excessive, the stress response can become lethal and selective. If it is not mediated by the hypothalamic-pituitary-adrenal axis (the system involved in managing stress response reactions), it can lead to nervous exhaustion.

When the body is no longer able to respond and adapt to stressors, symptoms similar to those of anxiety and depression can occur. For example, initially there may be a period of hyperexcitability or weakness, irritability, hypersensitivity, and reduced functional capacity. Later there may be psychosomatic symptoms, especially vegetative ones, such as marked signs of fatigue and weakness. Later, more depressive symptoms may appear, including anhedonia, exhaustion, extreme fatigue, and depressed mood.

If this condition persists over time, it leads to a secondary negative evaluation of the person, who comes to see himself or herself as weak, unresponsive, and wrong. These thoughts further increase the symptoms described above, leading to a self-perpetuating vicious cycle. The environmental and family context may also influence the person during this time of extreme distress. Relatives, friends, and companions may accuse their loved one of being unable to cope with life. Of being incapable and unable to cope with stress, of being angry and critical. This in turn becomes a stressor, worsening an already compromised psychophysical state.

How to deal with a nervous breakdown

What to do when such a situation occurs? First of all, although stressful events were the cause of such “exhaustion”, it is not enough to get out of it to eliminate the stressors. It is necessary to start with an initial modification of behavior and physical activity, and then address more complex psychological and cognitive aspects.

Behavioral changes

In fact, in order to slowly resume normal functioning, it is usually necessary to start with simple, minimal actions that can promote recovery and counteract the inertia of depression. For example, monitoring daily activities. It allows you to recognize what and how many activities you do during the day and thus increase only the pleasant activities. Taking time for yourself, doing things you enjoy, helps to promote the apathetic unblocking of the depressed mood.

Second, it has been recognized how consistent physical activity, preferably outdoors (such as walking for about 20 minutes a day), promotes the release of mood-regulating endorphins. This is especially important during stressful times. In addition, if our nervous exhaustion has a good quota of anxiety, it is possible to do relaxation exercises and meditations that stimulate the parasympathetic system. The latter has a calming effect on our body. In particular, mindfulness meditation techniques can activate this system and promote a return to an optimal level of activation. Of course, such techniques must be learned correctly and practiced daily in order to be effective. It is like an exercise that needs to be learned first and mastered later.

Cognitive interventions

When one’s activities and emotional and physiological stability are restored, it is helpful to understand which thoughts led to the breakdown and which ones maintain the stress load. Errors in reasoning, duty, self-blame, and over/under-responsibility need to be identified. This helps to understand and modify the cognitive distortions that promote depressed mood or anxious states. Recognizing and interrupting rumination or brooding, which are ways of thinking that perpetuate the vicious cycle in the first place, is crucial to getting rid of it. To do this kind of work, however, it is advisable to seek the help of a good cognitive-behavioral psychotherapist. We are not always able to independently observe our own thoughts or the processes we carry out at the cognitive level.

Problem solving

Finally, learning a structured method of problem solving helps to reduce, where possible, the symptoms that are aggravated by the presence of unresolved problems. In fact, this method helps to understand the connection between the symptoms and the problems that plague the person, in that if the problems are solved, the symptoms will also improve. Someone who has experienced a nervous breakdown feels overwhelmed by the problems, so it is necessary to “break down” the larger problems into smaller, more manageable sub-problems and find alternative solutions to deal with them.

Treatment of nervous exhaustion

Several components can be addressed in the treatment of nervous exhaustion through cognitive-behavioral psychotherapy, the use of relaxation techniques, mindfulness, and assertiveness training.

Cognitive techniques for emotional exhaustion

Even in the most stressful and chaotic situations, there is always a component of discursive thinking, explicit or otherwise, that tends to guide our reactions in terms of thoughts, emotions, and behaviors. This discursive thinking would derive from maladaptive patterns that distort the processing of information from the environment in a dysfunctional way in relation to the individual’s goals (Beck et al., 1979).
When this dialogue with ourselves occurs in a way that challenges our self-esteem, our ability to act, and our positive expectations about what we are experiencing, our ability to act may be impaired, and we may even experience very intense unpleasant emotions, resulting in an inability to express ourselves fully or pursue our goals optimally (Wann, Brennen & Holte, 2006). Internal dialogue can be a powerful tool for self-regulation of behavior, thought, and emotion, functional in keeping us focused on the goals we want to achieve, as well as enabling us to remain calm (or motivated) in competitive or stressful situations (Malouff & Murphy, 2006).

Therefore, it is important to identify which affirmations seem to be most effective in relation to the stressful situation we are about to face. Once we have identified our own, we can, through practice and repetition (cognitive rehearsal), create our own repertoire of affirmations to say to ourselves when we find ourselves in stressful situations, which we will arrange to keep in our minds, even writing them down somewhere to take with us. The use of these affirmations in real situations will then enable us to incorporate them permanently into our thinking habits, so that they can be used in new situations as well.

Relaxation techniques for nervous exhaustion

Several techniques can be used to effectively manage what we have called nervous exhaustion, including square breathing and progressive muscle relaxation (Jacobson, 1938). Both are relaxation techniques that are useful in reducing the state of activation generated by the stressful event so that the ability to control bodily responses can be improved.

Progressive Relaxation is a technique that reduces muscle tension and allows for improved muscle tone, counteracting the chronic state of stress and anxiety. It consists of techniques that involve different muscle groups; learning is based on a series of exercises that teach how to recognize the tension in the muscle itself and, finally, to train awareness of one’s own body.

Square breathing, on the other hand, is an effective technique for stress reactions. In fact, it can be used both before and during a stressful situation. In particular, it works on the rhythm of breathing, slowing it down and regularizing it. This technique is relatively easy to learn and can be used in any context. It is particularly useful in stressful and tense situations, when breathing becomes irregular and shallow, causing a reduction in the body’s vitality, increased fatigue and tiredness.

Nervous exhaustion and mindfulness

Meditation, particularly mindfulness, is a widely used practice to counteract the effects of frustrating thoughts and emotions that we may experience in what is known as nervous exhaustion. The goal is to eliminate unnecessary suffering by cultivating a deep understanding and acceptance of whatever is happening through active work with one’s mental states. According to the original tradition, the practice of mindfulness is intended to enable one to move from a state of imbalance and suffering to a state of greater subjective perception of well-being through a deep understanding of mental states and processes.

Mindfulness proposes to experience the modality of being, which is not a special state in which all activity ceases, but rather a decentralized perspective that allows one to free oneself from the usual automatic and involuntary modes of response that attempt to push away the unpleasant and hold back the pleasant. Mindfulness-Based Cognitive Therapy, like Mindfulness-Based Stress Reduction, cultivates a particular use of attention and mindfulness, suggesting a focus on thought processes rather than content. The intent is not to eliminate all negative states from the mind, but to prevent them from becoming stable when they arise.

Nervous exhaustion and burnout

Much of the stress in our daily lives comes from work. The ever-increasing pace and demands of business, as well as the growing tendency to identify with one’s job, often result in a large investment of resources that, over time, can seriously affect our well-being. Various mental illnesses, such as stress, anxiety and panic, can be generated in an unhealthy work environment and compromise individual resources.

Excessive and prolonged demands in the workplace can lead to burnout syndrome, a true form of exhaustion resulting from the nature of some professional tasks. The person in burnout manifests certain symptoms such as nervousness, insomnia, depression, sense of failure, low self-esteem, indifference, isolation, anger and resentment.

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