It used to be important, maybe even fun, definitely something at which you were doing pretty well. But along the way, it somehow got spoiled. Instead of looking forward to it, now you dread going into work. Whenever the phone rings or an email arrives, your heart sinks. Tasks that used to be a matter of minutes can stretch out for hours, even days. You feel your performance dropping and every workday is a struggle. It sounds awful, doesn’t it? Unfortunately, according to statistics, approximately two-thirds of full-time workers deal with the burnout syndrome at least once in their lives. But is burnout even a real mental health issue or is it just stress? And if it is real, is there any way to treat it or should you just quit your job, pack your bags and run to Hawaii?

What is burnout?

In clinical terms, burnout is defined as a chronic work-related syndrome which manifests through physical and emotional exhaustion, depersonalization, cynicism, and feelings of reduced accomplishment. Traditionally, burnout was exclusively associated with paid work, however, in recent years, the definition has been expanded to include all mandatory effortful activities, such as studying or caring for an aging relative.

Burnout syndrome can not only leave individuals feeling exhausted, detached from their coworkers and surroundings, and poorly performing in the workplace, but it also has significant health consequences, as well as a negative long-lasting impact on brain structure and functioning. Some common physical symptoms include headaches, gastrointestinal problems, more frequent colds, chest pains, muscle pain, and sleep disturbances. Additionally, people with burnout tend to experience memory problems, as well as poor concentration. In terms of brain activity, they show decreased signals in areas associated with empathy and emotion regulation, as well as a decrease in resting-state alpha waves, a typical brain rhythm normally associated with cortical inhibition (this term refers to decreased excitability of the brain and it’s important because it gives your brain time to relax, so to say). At the same time, brain structure in burnout individuals is also altered. In particular, burnout has been linked to decreased volume in the medial prefrontal cortex, a brain structure associated, among others, with emotion regulation.

What causes burnout?

What makes burnout wreak so much havoc on the body? The key player in these negative consequences is chronic stress and more specifically, its effects on something called the hypothalamic-pituitary-adrenal axis, otherwise known as the HPA axis. This is one of the major neuroendocrine systems in the body and it controls reactions to stress, as well as many other bodily processes, such as digestion, the immune system, emotions, and energy storage. To put it in simple terms, messing with the HPA axis will ruin a lot of normal bodily functions. Before we talk about how stress manages to do that, however, we need a general understanding of how the HPA axis works.

We can imagine the hypothalamus as someone trying to send a super-important message to a receiver which must fulfill an action, in this case, the adrenal glands, and we can consider the pituitary to be an intermediary. Each message is written in “hormone code”, and because it is so important, both the hypothalamus and the pituitary will keep blasting the same message until the adrenal signals “message received”. The hypothalamic hormone code is called corticotropin-releasing hormone (CRH). Once this message arrives at the pituitary, it is converted in a different code called adenocorticotropin-releasing hormones (ACTH). Finally, as soon as the message encoded via ACTH arrives at the adrenal glands, the action begins: the adrenals start to produce cortisol, a hormone message which prepares the body to fight (kind of like adrenaline, but for a longer time), and at the same time, it signals back to the hypothalamus and the pituitary that they no longer need to blast the message. We call this a negative feedback loop: the more cortisol we have, the less we need to produce, and consequently, the less CRH and ACTH as well.

However, in a chronic stress situation, this negative feedback becomes disrupted. The specific molecular mechanisms of this process are complicated and not fully mapped out, but the general idea is as follows: the HPA axis continuously receives signals from brain regions associated with stress responses, which leads to higher levels of cortisol over longer periods of time. These high levels, in turn, cause the hypothalamus to become less responsive to cortisol, further disrupting the negative feedback loop. In short, chronic stress = high cortisol levels.

The effects of cortisol include mobilization of energetic resources, decreased inflammatory response, as well as stimulation of stomach acid release. You can then imagine why increased cortisol levels can lead to fatigue (energy is constantly burned, so it can’t be replenished fast enough), more chances of getting sick (the immune system is suppressed, so it can’t fight that well anymore), or stomach problems (excess production of gastric acid isn’t great).

As you can see, burnout is very much a real disorder, with far-reaching and devastating effects on the body. And while the symptoms are both physical and psychological, the cause is psychological chronic stress, which makes burnout be treated like a mental issue rather than a physical one. Importantly, being burnt out is more than just being stressed, it is being chronically stressed. Usually, when people talk about stress, they refer to a short time period: something which comes and goes as soon as the external stressor disappears and which, although unpleasant, doesn’t have long-lasting effects. But in the context of burnout, we talk about stress that lasts for much longer and which persists and affects us even after any external stressor has been removed.

Can burnout be treated?

By now I think that we all understand that burnout is pretty bad. But is there any hope for recovery and if so, what should one do? Well, there are good news and bad news. Let’s start with the bad news: burnout has become the focus of intense research only in recent years, therefore, not enough is known about the disorder mechanisms themselves, let alone about successful and established treatment options. The good news is that due to this newly-generated interest in burnout research, there is some hope in terms of recovery help.

For example, a study published by German researchers in 2016 showed that a multimodal treatment applied over five weeks significantly reduced burnout symptoms for the study participants. Treatment methods included psychotherapy, mindfulness meditation, group therapy, and movement therapy, and focused on goals such as increasing the distance from work, teaching the participants how to manage their stress, reducing perfectionism, and improving interpersonal skills, together with the perception of social support. Other studies also suggest that helping people develop healthy coping strategies, as well as helping them feel well-integrated in a support group is useful in reducing burnout symptoms. Furthermore, it seems that the most effective strategy in tackling burnout is to use a combined approach instead of a single method.

What’s the take-home message?

To sum up, burnout is a psychological problem which goes beyond feeling somewhat stressed. It has devastating mental and physical effects and it appears as a consequence of prolonged, unresolved stress. Furthermore, while there are some treatment options, burnout doesn’t go away on its own, no matter how hard you wish for it. If you or someone you know is experiencing burnout symptoms, it is important to seek professional help. Finally, the most effective burnout treatment appears to be a combination of various strategies.

What did you think about this article? Is burnout something that has affected you? If so, how did you cope with it? Let us know in the comments. And don’t forget to follow us on Instagram in order to stay up to date with our most recent posts.

References*:

1. Savic, I. (2015). Structural changes of the brain in relation to occupational stress. Cerebral Cortex, 25(6), 1554-1564.

2. Meyer, L. K., Lange, S., Behringer, J., & Söllner, W. (2016). Inpatient and day hospital treatment of patients with depression and job-related burnout. Zeitschrift für Psychosomatische Medizin und Psychotherapie, 62(2), 134-149.

3. Ulrich-Lai, Y. M., & Herman, J. P. (2009). Neural regulation of endocrine and autonomic stress responses. Nature reviews neuroscience, 10(6), 397-409.

4. Morera, L. P., Gallea, J. I., Trógolo, M. A., Guido, M. E., & Medrano, L. A. (2020). From work well-being to burnout: a hypothetical phase model. Frontiers in Neuroscience, 14.

5. Ezeudu, F. O., Attah, F. O., Onah, A. E., Nwangwu, T. L., & Nnadi, E. M. (2020). Intervention for burnout among postgraduate chemistry education students. Journal of International Medical Research, 48(1), 0300060519866279.

* In order to keep the list short, I’m only citing a couple of studies here, but please don’t forget that reliable scientific results are always replicated across multiple studies before they gain the trust of the scientific community.