Don't wait for the weekend to reduce burnout; see what little things you can do on a daily basis. Key insights from the AMA with PhD and clinician Dr. Amalia Kelley on cumulative stress, nervous system regulation, and navigating neurodivergent exhaustion
We had an insightful AMA yesterday with professor, clinician, therapist, and author Dr. Amalia Kelley. It was a deeply validating conversation that shed light on why our bodies crash from accumulated stress and how trauma impacts our sleep. Dr. Kelley beautifully reminded us that true regulation isn’t about forcing calm, but gently building a more flexible, compassionate relationship with our nervous system.
About cumulative stress effect
Q. My question is about the cumulative effect of stress. Why does it build up like that? You can feel totally strong and capable of handling things, and then your body crashes.
Is it possible to regulate our nervous system when everything accumulates like that?
Dr. Amalia Kelley: When we are in a state of high stress, we often feel an intense need to push through because our body has entered fight-or-flight mode. Our nervous system is constantly tracking variables like safety, demand, and stimulation, alongside physiological factors like sleep quality and the systemic inflammation built up from chronic stress.
Because of this constant tracking, it is actually not uncommon for a major, dramatic event not to be the thing that pushes us over the edge. In fact, shutdown often occurs only after we are completely removed from the stressful situation. When the body finally senses that it can safely exit fight-or-flight mode, our baseline levels of stress hormones, such as adrenaline and cortisol, begin to drop.
The good news is that regulation is a skill that comes along for the ride as we practice it. True regulation is not about forcing the nervous system to calm down instantly; it is about maintaining and expanding the flexibility of your nervous system.
I often advise my clients not to restrict their breathing techniques only to moments of high stress. Instead, practicing them at regular intervals throughout the day teaches the nervous system how to detect the moment it begins to drift away from a homeostatic state. This consistent practice makes it far more likely that you will naturally utilize breathwork, movement, or sensory regulation tools when you need them most.
Many people only notice their stress levels once they reach a state of total collapse. By practicing regulation proactively, you will begin to notice your internal cues much sooner, which is incredibly beneficial overall.
About nightmares connected to childhood memories
Q. I struggle with 'night terrors' from childhood memories, and waking up in a state of high alert. What am I supposed to do best?
Dr. Amalia Kelley: It really is the worst experience. No one wants to wake up from a nightmare, but feeling as though you are still trapped in it is terrible, and I am truly sorry you are dealing with that. This experience is incredibly common, especially for individuals who have a history of trauma or are navigating stress in the present; it aligns directly with the standard symptom presentation for PTSD.
There is an evidence-based treatment that I train on through the National Center for PTSD (and other clinical bodies) and frequently utilize with my clients called Imagery Rehearsal Therapy, or IRT. Essentially, it is a cognitive behavioral intervention that integrates creativity through writing, though I often incorporate art therapy into it as well. While working through this with the support of a clinician can be even more comprehensive, it is absolutely something you can practice on your own if you feel safe doing so.
To practice IRT, you first identify the recurring nightmare or distressing dream you’ve been having. Then, with an attitude of self-compassion, you write down as many details of the dream as you can remember, in the best chronological order possible. Keep in mind that dreams can be jumbled and disorganized, and sometimes manifest just as a felt sense rather than a clear timeline. You simply write down whatever you know or feel.
Once the dream is recorded, you gently rewrite or change elements of the narrative to an ending that feels more empowering, safe, and regulating. You can even infuse elements of humor into the new script. The goal is not to deny that the dream or the underlying trauma occurred; rather, it is to rewrite the nightmare's script so that distress is no longer the inevitable outcome. Research shows that consistently practicing this rescripting technique significantly reduces both the intensity and frequency of nightmare responses.
In addition to IRT, we can look to Cognitive Behavioral Therapy for Insomnia (CBT-I), which is the gold standard treatment for chronic sleep issues. A few key principles from CBT-I are incredibly helpful for middle-of-the-night awakenings. First, you do not have to force yourself to stay in bed if you are feeling highly dysregulated. It is often far more helpful to physically get out of bed and engage in a low-stimulation, calming activity until you feel sleepy again — such as taking a warm shower, sitting in a comfortable chair, journaling, or reading.
There is much more to explore within CBT-I, including specific supplements and advanced regulation protocols, but I will leave you with one final, encouraging insight regarding IRT: interesting comparative studies conducted with veterans showed that IRT was significantly more effective at reducing PTSD-related nightmares than practicing meditation and breathwork alone before sleep. I truly hope this protocol brings you some well-deserved relief.
About the brain that feels like 50 open tabs
Q. My brain feels like a browser with 50 tabs open and half of them are frozen. What’s a 30-second trick to hit 'refresh' when I’m spiraling?
Dr. Amalia Kelley: I love this "50 tabs open" metaphor because I can definitely relate to it. I don’t even know how many tabs I have open on my own computer right now in real time!
The interesting thing is that the hyper-curiosity and divergent thinking characteristic of individuals with ADHD makes them much more likely to open all these tabs and leave them open as placeholders or reminders. It reminds me of how folks with ADHD feel the need to write down every single thing on a to-do list, only for the list to become so overwhelming that nothing gets done.
To organize this internally, the very first step is to recognize that you are not alone, and to practice letting go of the pressure. I love using a diffused approach inspired by Acceptance and Commitment Therapy (ACT), where you remind yourself: "I am not the overwhelm, and I am not the 50 tabs, but I can observe that the 50 tabs are open." Separating yourself from the clutter creates immediate cognitive space. You can even use a playful mantra when you catch yourself hitting that limit, like, "Whoops, 50 tabs are open."
While you can always use external tools to organize the actual digital tabs, it sounds like you are really asking how to refresh your brain and body when your mind feels overloaded. To do that, we have to shift into sensory and physical modes.
Here are some simple, highly effective sensory tools you can try:
Temperature Shifts: I love using cold. Holding an ice cube (without hurting your skin) or splashing your face with cold water is highly regulating.
Olfactory Regulation: Use scent to ground yourself. In my office, I keep a sensory bin with aromatic essential oils or sinus-clearing inhalers, like eucalyptus or peppermint, to immediately wake up the senses and clear the mental fog.
Environmental Transitions: Physically move to a different room. Changing your environment completely alters your sensory input.
Somatic Movement: Shake out your body. Put on music, move your arms, shake your hands, shift your feet, or gently twist your spine. You don't need to organize the tabs in your mind right now, but you do need to organize your body.
The Balance Challenge: Try practicing a classic yoga tree pose. The demand for physical balance forces your brain back into the present moment.
Unmasked Connection: Talk to someone you trust. Go tell a safe person, "Oh my gosh, I have 50 tabs open right now. Help me get back to the present."
Extended Exhalation Breathwork: While many people utilize box breathing, I highly recommend the 4-6-8 breath technique (inhaling for 4 seconds, holding for 6, and exhaling for 8).
If you try these tricks and pick the ones that resonate most with your nervous system, I bet you anything that some of those overwhelming internal tabs will just melt away.
On ADHD paralysis
Q. I struggle with ADHD paralysis, standing in the middle of the room wanting to do things but being unable to move. How do I 'trick' my nervous system into starting?
Dr. Amalia Kelley: So many people with ADHD struggle with paralysis. Whether it is referred to as task paralysis or ADHD paralysis, the outcome is exactly the same. It can easily make you feel as though you are struggling with laziness or a lack of motivation, but that is actually not what is happening. Instead, your nervous system has essentially entered a freeze response due to overwhelming demands placed on your executive functions.
When you need to initiate a task, instead of focusing on the end goal — such as cleaning the entire kitchen — focus strictly on tiny micro-steps, like putting away just three dishes. The ADHD brain requires motion to kickstart momentum.
Another highly effective strategy is to externalize the task. ADHD brains thrive on visual anchors because they provide necessary stimulation and serve as working memory reminders. This could be a digital notification on your phone or a physical sticky note placed directly on your desk chair.
It is also crucial to actively work through perfectionism. For the ADHD brain, a deep-seated fear of failure couples with initiation struggles to create total stagnation. Instead of placing yourself in a high-pressure situation by demanding a perfect result, focus on lower stakes: give yourself permission to create a "messy first draft" or complete a task poorly just to get it done. Completing even a fraction of a task provides micro-doses of dopamine, which naturally fuels further momentum.
Finally, one of the most research-supported interventions for ADHD paralysis is body doubling. This involves having another person physically or virtually present while you work. This way, you are essentially borrowing their regulated nervous system to help ground your own. Simply texting a friend to say, "I am going to complete this specific task by the end of the day," increases the positive urgency and stimulation your brain needs.
Instead of waiting for motivation, we bypass those sluggish motivation centers entirely and use physical, environmental, and social cues to get into motion.
On inner work exhaustion
Q. Is it normal to feel totally exhausted after doing inner work? It feels like I’ve run a marathon just by talking for an hour.
Dr. Amalia Kelley: First of all, well done on doing the deep work that has brought you to this space; it truly takes a massive amount of effort.
When we look at the principles behind decision fatigue, every single choice we make requires a measurable glucose hit for the brain. As you are consciously choosing to process your emotions, reorganize your thoughts, or become more in tune with yourself — especially if you are highly sensitive, neurodivergent, or impacted by trauma — that metabolic drain can leave you feeling foggy, fatigued, and hyper-sensitive. It can trigger a strong need to temporarily withdraw and rest.
The most important thing you can do is truly listen to your body. If you are planning to engage in deep emotional work, ensure you build in a buffer of time afterward to allow your nervous system to settle. Even 20 to 30 minutes of intentional downtime can be incredibly helpful. Use grounding techniques right after the session, and attend to basic physiological needs by drinking water, eating protein, stretching, or moving gently.
On burnout
Q. So many of us experience severe burnout. Of course each person is different with varying capacity and resources, but I’ll still ask: What might recovery from severe neurodivergent and trauma burnout look like in terms of tools, how we spend our time, how long it takes, etc?
Dr. Amalia Kelley: It's important to start with the fact that burnout is not just being tired. If anything, burnout can present as a nervous system injury. This can stem from chronic over-compensation, unprocessed trauma, or a lack of support.
Recognizing how it shows up is key. For example, when I'm trying to help a client figure out whether they're experiencing burnout versus major depressive disorder, one unique marker of burnout is that you could actually feel okay in some areas of life, but experience specified burnout in another. If your marriage has been exceptionally stressful or unrewarding, if parenthood has posed a lot of chronic stress, or if your job has felt like it's completely out of your control, you might start doubting your abilities or experiencing executive functioning issues specifically in those areas while feeling fine elsewhere. This can be incredibly confusing. Of course, there is also universal burnout that many people experience overall.
It's great to have your go-to's, but it's also nice to have variation. For me, exercise and the piano are my two anchors. If I'm doing them on a daily basis — even just 10 minutes of movement and 15 minutes at the piano — it helps recalibrate my nervous system.
Sometimes, you simply need more. You might need to take a leave of absence, take a sabbatical, or completely remove yourself from a situation — and that is entirely okay. It's about being deeply attuned to what your nervous system needs and understanding that this is not a "one-and-done" fix. It is a lifestyle and a culture within your own life. We wouldn't brush our teeth just once a week, so why would we only take care of our nervous system once a week?
Don't wait for the weekend to reduce burnout; see what little things you can do on a daily basis.
If you feel like you're struggling to master all the self-regulation skills, you can take a free quiz and get your personalized plan for a calmer mind, beat procrastination, move forward with ADHD.