Why Rest Feels Unsafe: How chronic stress and trauma make slowing down feel dangerous

For many high functioning, high achieving individuals, like physicians, rest doesn’t feel restorative.

It feels uncomfortable.
Anxiety-provoking.
Even wrong.

I see this over and over again in my coaching clients, in colleagues, and in myself. Doctors will tell me they’re exhausted, burned out, and desperate for a break. Yet when they finally get administrative time or time off, it often brings guilt, restlessness, or a sense of unease rather than relief.

This isn’t a personal failure or a lack of self-care skills.

It’s a nervous system response shaped by our medical culture and broader societal conditioning.

From the earliest days of training, medicine teaches us that usefulness equals worth. This belief mirrors broader American values that prioritize productivity, efficiency, and achievement. We learn that pushing through exhaustion is framed as sacrifice, and therefore as virtue. Productivity becomes proof of usefulness, achievement brings external validation, and validation becomes the measure of success. Over time, this turns into a powerful positive reinforcement loop. Within that framework, pausing feels unnatural: a loss of productivity, a loss of validation, and the looming fear of falling behind or failing.

Over time, this conditioning rewires the nervous system to associate constant motion with safety. Our brains learn to link doing with approval, stability, and growth. In demanding environments, like the daily life of a physician in clinic or the hospital, the nervous system adapts by staying in a chronic state of fight or flight. Constant activity becomes familiar, and familiar begins to feel safer than stillness.

This is a form of chronic stress adaptation.

For many physicians, this is further compounded by identity fusion. Achievement stops being something we do and becomes who we are. When we slow down, we stop producing, which can trigger anxiety, guilt, or even a sense of emptiness. Rest removes the structure, predictability, and illusion of control that fast-paced, high-achieving environments provide. 

For high-functioning people who rely on control to feel safe, rest can feel undeserved, like failure or loss of worth. Physicians don’t just practice medicine, they become the caretaker, the problem-solver, the responsible one who holds everything together. And when your sense of self is built around being useful, rest can feel like disappearance: If I’m not helping, producing, or fixing, who am I?

This is why guilt so often shows up during rest. Not because rest is wrong, but because stepping away can feel like losing purpose. What we experience as discomfort is often a result of identity confusion.

From a trauma-informed perspective, chronic stress in medicine keeps many physicians locked in survival states. Some push harder and become more irritable or over-controlling. Others stay constantly busy, unable to slow down. Some feel numb or stuck, while others over-accommodate and people-please. These fight, flight, freeze, and fawn responses are not character flaws, they are adaptive responses to prolonged toxic chronic stress.

Constant activity is often a sign of a nervous system stuck in fight or flight.

Rest requires a shift into safety. But if safety has only ever existed inside productivity, that shift feels unfamiliar and unsettling. This is why telling doctors to “just rest” often backfires. The body doesn’t know how.

Medicine doesn’t just reward overwork, it normalizes it. We praise resilience without questioning the conditions that require it. We frame endurance as professionalism and self-sacrifice as commitment. Over time, doctors internalize the belief that rest is indulgent, lazy, or selfish.

As a result, rest becomes something to earn rather than a basic human need.

So when high-functioning people say:

“I don’t know how to relax”

“I feel anxious when I’m not productive”

“Rest makes me uncomfortable”

They’re not being dramatic or resistant to self-care. Their nervous system is doing exactly what it was trained it to do.

This is why telling high achievers to “just rest more” rarely works. Sustainable rest requires rewiring safety, not willpower.

This also helps explain why vacations alone don’t fix burnout. Time off may bring temporary relief, but the frustration and exhaustion often return quickly once physicians return to work. The problem isn’t the vacation, it’s that the nervous system doesn’t automatically reset just because you stepped away. When your body has learned to equate worth with output, rest without internal permission can feel tense rather than restorative.

True recovery requires more than time away from work. It requires relearning safety in stillness and decoupling worth from productivity. It requires learning how to be without performing.

For many doctors, rebuilding safety doesn’t mean suddenly doing nothing. It often happens gradually. That might look like brief pauses without checking email, rest with gentle structure such as walking, stretching, or creative activities, or simply noticing guilt without immediately obeying it. For me, it has meant intentionally blocking time for rest in my calendar just as I block time for patient visits and meetings, and treating it as non-negotiable rather than optional or reserved only as a last resort. The goal isn’t forced relaxation, it’s teaching the nervous system that rest does not equal failure and loss of worth.  That rest does not require earning or justification, that rest is allowed just because we are human.

If we want to build true sustainability in medicine, it requires us to do something differently.

It means redefining professionalism to include nervous system regulation.
Redefining worth to include being, not just doing.
And recognizing that rest isn’t the opposite of care, it’s what makes good patient care possible.

The good news is this: if your nervous system learned these patterns through medical training and culture, it can also learn something new.

Practical ways to begin include slowing the breath (longer exhales signal safety to the body), grounding through the senses, orienting to the present moment, or pairing rest with predictability and routine.  Even naming, “It's ok to rest,” can help interrupt the body’s learned urgency to constantly be doing something.  Over time, these small practices teach the nervous system that rest does not equal failure or loss of worth.

With intention, repetition, and practice, rest can become safe again not because the demands of medicine disappear, but because your relationship to worth, productivity, and care begins to change. And when rest is no longer something to earn or fear, it becomes what it was always meant to be: a foundation for sustainable practice in medicine.

A version of this has been published on: https://www.psychologytoday.com/us/blog/the-other-side-of-the-white-coat/202512/why-rest-can-feel-unsafe