From Burnout to Back at Work: Celia’s Journey with Occupational Therapy

Summary

This case study outlines how Celia, a 36-year-old professional with ADHD, overcame anxiety and burnout through the support of occupational therapy with Mental Health Occupational Therapist Laura Hackett

Presentation

Celia is a 36-year-old professional with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and a history of anxiety and recurrent burnout. She had always found aspects of organisation, time management, prioritisation and emotional regulation challenging, but had developed strategies that enabled her to manage these difficulties throughout her education and early working life.

As her career progressed and her responsibilities increased, Celia found that her executive functioning difficulties became more apparent. She struggled to prioritise competing demands, estimate how long tasks would take and recognise when she was taking on more than she could realistically manage. She frequently became highly focused on work and would continue working for long periods without taking adequate breaks. Celia described a pattern of “pushing through” periods of stress and fatigue, until she reached a point where she could no longer sustain her usual level of functioning. During these periods of workplace burnout, she experienced significant emotional and physical exhaustion, increased anxiety, irritability, disrupted sleep and difficulty concentrating.

Over the previous three years, Celia had experienced three significant periods of burnout, each resulting in an extended period of sick leave from work. Following each period of time off, she found return to work challenging. She would initially feel motivated to get back to her usual level of productivity, but struggled to sustain the pace required once her normal workload resumed. Celia described becoming caught in a cycle of returning to work feeling determined to “catch up”, increasing her workload and working longer hours, followed by increasing exhaustion and emotional overwhelm. She found it difficult to recognise her limits and would often only slow down once her symptoms had become significant.

At the time of referral for Mental Health Occupational Therapy, Celia was preparing to return to work following her most recent period of burnout. She was concerned about experiencing another episode and was worried that she would not be able to sustain employment in the long term.

The Mental Health Occupational Therapist completed an assessment of Celia’s occupational functioning, considering the impact of ADHD, anxiety and emotional regulation difficulties on her work, self-care, routines, relationships, sleep, leisure and overall occupational balance.

Goal

Celia identified that her main goal was not simply to return to work, but to remain in work in a sustainable way without repeatedly reaching burnout.

Together with the Mental Health Occupational Therapist, Celia identified a number of goals:

• To develop a sustainable approach to return to work.
• To improve awareness of her energy levels and personal limits.
• To develop strategies for energy management and pacing.
• To improve executive functioning skills, including planning, prioritising and task initiation.
• To develop strategies for emotional regulation when experiencing stress and workplace demands.
• To recognise early warning signs of burnout.
• To establish sustainable work and self-care routines.
• To develop strategies for managing transitions between work and home.
• To improve overall occupational balance.
• To develop a personalised burnout prevention and relapse-prevention plan.

Intervention

1) Understanding ADHD, executive functioning and the cycle of burnout

The Mental Health Occupational Therapist first worked with Celia to develop a clearer understanding of the pattern that had contributed to her previous episodes of burnout. Together, they explored what typically happened before, during and after a period of burnout and considered how Celia’s ADHD and executive functioning difficulties affected her ability to manage everyday occupations.

Celia recognised that she often responded to increased workload by working harder and for longer. She would reduce breaks, postpone meals, exercise less, spend less time with friends and gradually lose time for activities that helped her recover. She also identified that her ADHD contributed to periods of hyperfocus, during which she could become deeply absorbed in a task and lose awareness of time, hunger, fatigue and other physical or emotional signals.

The Mental Health Occupational Therapist supported Celia to recognise that burnout was not simply the result of having a busy job. It was related to the interaction between her individual needs, executive functioning, emotional responses to stress, workplace demands, routines and opportunities for recovery. This helped Celia begin to view burnout as something that could be identified and managed earlier rather than something that happened suddenly and without warning.

2) Developing emotional regulation strategies

Emotional regulation was an important component of the Mental Health Occupational Therapy intervention.

Celia described becoming increasingly overwhelmed when faced with competing demands, unexpected changes or the perception that she was falling behind. She could become frustrated with herself and would respond by increasing her effort, often working harder rather than recognising that she needed to pause or change her approach.

The Mental Health Occupational Therapist helped Celia identify her emotional and physical signs of increasing stress. These included becoming irritable, feeling mentally “stuck”, increased muscle tension, difficulty making decisions, racing thoughts, reduced concentration and a strong urge to continue working until a task was completed. Celia was supported to develop practical emotional regulation strategies that she could use before reaching a point of emotional overwhelm. These included taking planned breaks, changing environment, using brief grounding strategies, engaging in movement, using breathing techniques, reducing competing sensory demands and temporarily stepping away from a difficult task before returning to it.

The focus was on helping Celia recognise that emotional regulation was not about eliminating difficult emotions. Instead, it was about noticing changes in her emotional state and responding in a way that prevented stress from escalating and affecting her occupational functioning.

3) Energy management and pacing

A significant part of the Mental Health Occupational Therapy intervention focused on energy management and pacing.

Celia had previously tended to judge her capacity by how much she could accomplish during her most productive periods. This meant that on days when she had high levels of energy and concentration, she would often complete large amounts of work and assume that she could maintain the same pace.

The Mental Health Occupational Therapist introduced the concept of pacing and supported Celia to consider her available physical, cognitive and emotional energy across the day and week. Celia began to monitor how different activities affected her energy and identified which tasks were particularly cognitively or emotionally demanding. Rather than completing demanding tasks consecutively, she began alternating higher-demand activities with lower-demand tasks and planned recovery periods. She also learned to avoid using periods of high energy to “catch up” on everything she had fallen behind on. This helped Celia understand that sustainable functioning required her to work at a pace that could be maintained consistently, rather than repeatedly exceeding her capacity and requiring extended recovery periods afterwards.

4) Supporting a sustainable return to work

As Celia was preparing for return to work, the Mental Health Occupational Therapist supported her to consider what a sustainable return would look like.

The focus was not simply on whether Celia was capable of completing her previous workload. Instead, the occupational therapist explored the conditions that would enable her to remain well while participating in work. Celia was supported to identify her priorities for the initial stages of returning to work and to consider how her workload could be gradually increased. She developed strategies for managing competing demands, including identifying the most important tasks, breaking larger projects into smaller steps and avoiding unnecessary task-switching. Where appropriate, Celia was encouraged to communicate with her workplace about workload, priorities and expectations so that she could develop a realistic and sustainable working pattern.

The Mental Health Occupational Therapist also supported Celia to develop a clear end-of-working-day routine. This included reviewing outstanding tasks, identifying priorities for the following day and creating a consistent transition from work to home. This reduced Celia’s tendency to continue thinking about unfinished work throughout the evening and helped establish healthier boundaries between her professional and personal life.

5) Establishing sustainable self-care and occupational balance

Celia had previously viewed self-care as something that could be prioritised when her workload was manageable. However, this often meant that the activities that supported her wellbeing were the first things to disappear when she became stressed.

The Mental Health Occupational Therapist worked with Celia to identify practical self-care strategies that could realistically be maintained alongside employment.

These included:

• Maintaining a consistent sleep and waking routine.
• Taking regular breaks during the working day.
• Eating regularly rather than working through meals.
• Incorporating manageable physical activity.
• Scheduling meaningful leisure activities.
• Maintaining social connection.
• Creating periods of low-demand recovery.
• Establishing boundaries around work-related communication outside working hours.
• Using calming or grounding activities when experiencing increased emotional arousal.
• Allowing adequate recovery time following periods of increased work demand.

Rather than creating an extensive self-care programme, the occupational therapist supported Celia to identify a small number of realistic habits that could become part of her normal routine.

The intervention also focused on occupational balance. Celia explored how time and energy were distributed between work, self-care, rest, relationships, leisure and other meaningful activities. This helped her recognise that maintaining mental health required more than simply reducing her workload; it also involved maintaining participation in activities that supported her identity, wellbeing and quality of life.

6) Identifying early warning signs and developing a relapse-prevention plan

Towards the end of the intervention, Celia and the Mental Health Occupational Therapist developed a personalised burnout prevention and relapse-prevention plan.

Celia identified her own early warning signs, including:

• Working increasingly long hours.
• Skipping breaks or meals.
• Difficulty switching off from work.
• Increased irritability.
• Reduced sleep.
• Withdrawing from social activities.
• Losing interest in exercise and leisure.
• Increasing difficulty making decisions.
• Feeling overwhelmed by relatively small tasks.
• Becoming dependent on urgency and pressure to complete work.

These signs were incorporated into a practical plan outlining what Celia could do when they began to appear.

Celia also identified the strategies that had been most effective during her Mental Health Occupational Therapy intervention and developed a plan for continuing to use these independently. This gave Celia a framework for responding to difficulties at an earlier stage rather than waiting until she reached a point where she required another prolonged period of sick leave.

Outcome

Following Mental Health Occupational Therapy, Celia reported a greater understanding of the relationship between her ADHD, executive functioning difficulties, emotional regulation, energy levels and occupational performance.

She developed practical strategies to support planning, prioritisation, task initiation and management of competing demands. More importantly, she developed greater awareness of her capacity and learned to recognise the early signs that she was beginning to exceed it.

Celia successfully returned to work using a more gradual and sustainable approach. She reported that she was better able to pace herself throughout the working day and was less likely to respond to periods of increased workload by immediately increasing her working hours. She also reported improvements in her ability to transition between work and home and had reintroduced regular sleep, exercise, social activities and leisure into her routine. Celia recognised that maintaining employment and protecting her mental health required a different approach from the one she had previously used. Rather than relying on periods of intense productivity followed by exhaustion and recovery, she was developing a more sustainable pattern of working, rest and meaningful activity.

The Mental Health Occupational Therapy intervention provided Celia with practical strategies for emotional regulation, executive functioning, energy management, occupational balance, pacing, self-care, sustainable work practices and burnout prevention. Most importantly, Celia left the intervention with a personalised relapse-prevention plan that she could continue to use to monitor her wellbeing, respond to early warning signs and maintain her participation in work and other meaningful occupations over the longer term.

This case demonstrates how Mental Health Occupational Therapy can provide practical and person-centred mental health support for adults experiencing ADHD, executive functioning difficulties, anxiety and burnout. An Occupational Therapist can support individuals to understand how mental health difficulties affect everyday occupations and to develop strategies that promote sustainable participation in work, self-care, relationships, leisure and other meaningful activities.

Appointments

If you would like to book an appointment with our Mental Health Occupational Therapist, Laura Hackett, you can call the clinic on 091 727777, get in touch via our contact page or email admin@ebtc.ie