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Dr. Carr's Corner

Managing Burnout — Part One: Personal Determinants of Health

In today’s blog, Part 1 of this Burnout series, I will share some tips that are in your control to manage — that you can do personally to improve your risk for burnout.

In subsequent blogs, I will explore the broader Social and Organizational Determinants of Burnout and share some evidence-based tips for leaders and organizations.

You’re exhausted, disinterested in work, have trouble concentrating, feeling like you’re not as effective as you used to be.

This can be any one of us on any given day — but what if you feel like that every day?

How can the chronic pressures of life without adequate recovery and recharging lead you to a state of burnout? If you’re exhausted, cynical, and feeling useless, what’s the risk that depression can set in. The WHO doesn’t classify burnout as a health condition but rather an “occupational phenomenon” that results from chronic stress which hasn’t been successfully managed or mitigated.

Researchers define burnout as a state of emotional, mental, and often physical exhaustion brought on by prolonged or repeated stress. It also involves a sense of reduced accomplishment and loss of personal identity.
The most validated measure for burnout, developed by Christina Maslach groups symptoms of burnout into three categories:

1. Emotional exhaustion:

  • Feeling chronically tired even when you’re not doing much
  • Having trouble sleeping at night or waking up tired
  • Struggling to concentrate or keep your attention on a task.

2. Depersonalization or cynicism:

  • Blaming everyone around you for the way you feel
  • Experiencing “compassion fatigue” — i.e., being emotionally unavailable for others
  • Feeling isolated and struggling to maintain relationships.

3. Reduced sense of personal accomplishments of efficacy:

  • Prolonged feelings of depression and/or anxiety
  • Loss of enjoyment in those parts of your work that used to bring you joy or energy
  • Persistent thoughts about your work being meaningless.

Burnout is not a new phenomenon; psychologists Robert Yerkes and John Dodson developed a theory of how burnout can develop with their pressure performance curve in 1908.

In the figure below, they show the relationship between stress or pressure and performance creating the Yerkes-Dodson Law.

pressure and performance

From the curve, you see that a certain level is stress or pressure is required to allow our physical, emotional, mental, and spiritual areas to adapt and grow. Just like a muscle in the gym needs resistance to grow, too much challenge without adequate time to build or recover will lead to injury. So we need a bit of challenge to grow. In fact, the right level of challenge helps us grow capacity to be our best self or ideal state where we can achieve peak performance in all areas of our life. When we are in this state, we are in flow, also known as being ‘in the zone’ — a state where one is fully immersed in a feeling of energized focus, full involvement, and enjoyment in the process of the activity. Remember a time when you were in complete absorption in what you were doing with no sense of time. Realistically though, we can’t be in this state forever. There are physiological and psychological consequences of chronic pressure without appropriate recovery.

What is recovery, then?

Simplistically, recovery is an intentional relief of stress and renewal of energy. We all know we need to rest our muscles between trainings for there to be growth likewise you need balance stress expenditure with energy recovery. With the appropriate energy recovery, we can increase our capacity to do more — physically, emotionally, mentally, and spiritually. Just like an athlete develops greater speed, strength, and endurance.

Often we pace ourselves not as a series of sprints but as a marathon. We leave out time for recovery, the most vital component for adaptation and growth.

So am I burned out?

burned out woman

How do you know if you’re burned out? How can you avoid future burnout at work?

The first step is to become aware of the potential signs of burnout, so you can address them before they get any worse. We can grow our self-awareness muscle — understanding and being tuned into our bodies’ needs, current levels of energy, and reserve.

The path to burnout almost always starts with people working too much, under too much pressure, or under adverse social, environmental, and organizational conditions (essential life needs not being met, low sense of control, feelings of being undervalued, and economic or job insecurity).

Subconsciously, when we are under pressure, our bodies are engaged in allostasis: a short-term adaptation of different body systems to maintain our critical functions and ensure survival. Yet, over longer time intervals, continued allostatic loading can exact a cost that impacts adversely mental and physical well-being.

Some indicators to look out for, especially if you’re experiencing them consistently?

  • Feeling stressed and anxious
  • Feeling exhausted and worn out
  • Lacking motivation and interest in your work
  • Feeling disconnected from your job, co-workers, and/or organization.

Psychologists Herbert Freudenberger and Gail North have outlined 12 phases of this syndrome:

  1. Excessive drive/ambition. Common for people starting a new job or undertaking a novel task, too much ambition can lead to burnout.
  2. Pushing yourself to work harder. Ambition pushes you to work harder.
  3. Neglecting your own needs. You begin to sacrifice self-care like sleep, exercise, and eating well.
  4. Displacement of conflict. Instead of acknowledging that you’re pushing yourself to the max, you blame your boss, the demands of your job, or colleagues for your troubles.
  5. No time for non-work-related needs. Values are skewed, friends and family dismissed, hobbies seen as irrelevant. Work is the only focus.
  6. Denial. Impatience with those around you mounts. Instead of taking responsibility for your behaviors, you blame others, seeing them as incompetent, lazy, and overbearing.
  7. Withdrawal. You begin to withdraw from family and friends. Social invitations to parties, movies, and dinner dates start to feel burdensome instead of enjoyable.
  8. Behavioral changes. Those on the road to burnout may become more aggressive and snap at loved ones for no reason.
  9. Depersonalization. Feeling detached from your life and your ability to control your life.
  10. Inner emptiness or anxiety. Feeling empty or anxious. To cope with this emotion, you may turn to thrill-seeking behaviors, such as substance use, gambling, or overeating.
  11. Depression. Life loses its meaning, and you begin to feel hopeless.
  12. Mental or physical collapse. This can impact your ability to cope. Mental health or medical attention may be necessary.

The good news is there are concrete, proactive steps you can take to help avoid or bounce back from burnout.

Expanding Capacity Begins By Expanding Awareness

Be aware of your personal battery

All things going on in your life right now can contribute to this allostatic load, including the stress of living under COVID, your role, finances, relationships, health, etc. Ninety percent of what drives our health throughout a lifetime is based on our social, work, and physical environment.

I use three large groupings to understand better the factors that put one at risk and then choose an approach to address the risk. These are :

PDOH: Personal Determinants of Health;
SDOH: Social / Environmental) Determinants of Health;
ODOH: Organizational Determinants (of Health):

Personal: No matter how driven and dedicated you may be, none of us are superheroes; we all need time to rest and recharge, whether we’re in the workplace or working from home. When we don’t give ourselves time and space to recover, our stress and exhaustion escalate — a sure-fire recipe for burnout. But when we do allow ourselves to recharge, we’re able to sustain our energy, focus, and purpose — to thrive.

Some easy-to-do tips for reducing your risk of burnout and improving energy renewal throughout your day.

Recharge your battery — Refuel your tank! What things re-energize you? Make a list and categorize it into things you can do in 10 minutes or less and things that take more time.

Schedule recovery time. Step away from your desk and hold off on checking emails or calls to feel truly refreshed. Make rest a priority by scheduling 15 minutes of “recovery time” on your calendar between each of your significant commitments during the day, wherever possible.

Reconnect to your purpose. Find a quiet place to sit with a pen and paper. Jot down what you think your current purposes in life are — who and what matters most to you, who relies on you, which goals are you pursuing? Does your time and energy allocation help you achieve these? Do they still fit who you are? If not, you’re free to rewrite your story and use your purpose to refocus your intention to a new path and improve health and well-being. Listen to this podcast on Purpose and Burnout.

Go for a walk. Simply going for a brief walk — through a park or just down the block — can do wonders, boosting your blood flow and increasing your alertness and focus.

Take a break from a challenge. If you’re facing a challenging problem, your impulse may be to just keep at it until you solve it. However, this can lead to debilitating stress. Give yourself a little time away from the task — run an errand, have a healthy snack, chat with a friend or colleague — and come back with a clear, calm head.

Connect with someone. Reach out and connect with someone you care about — a call, text, email, or face-to-face meeting. Research shows that social connection and meaningful relationships positively impact our overall health and can re-energize our spirit.

Spend time outside. Research shows that even 20 minutes spent outdoors — preferably in the sunlight — can lower anxiety and boost your mood. Eat lunch in the park, take a stroll, or sit on a bench and soak up the sun.

Take a moment to breathe. When you’re feeling stressed, breathing can help rebalance your body’s systems allowing you to reset your mind and body, so you’re better able to thrive. Find a quiet and give yourself a few minutes.. Make sure you’re sitting as comfortably as possible, with a lifted torso and relaxed shoulders. And practice this exercise:

 

Get out of the comfort zone. Try out a new challenge to push yourself to grow and feel successful in that growth. Take a one-day class on a skill you’ve never tried.
  • Meet someone new at a speed-dating or social event
  • Try out social support, or begin training for an event (e.g., a fun run)
  • Go somewhere in your town you’ve heard about but never been before.
Reframe obstacles or failures. Obstacles and previous failures are a natural part of moving beyond our comfort zones, tackling new challenges and achieving growth. Reflect on a challenge you have overcome in the past. You then can bring this reflection of success to the next obstacle you attempt.
 
Acknowledge your feelings. Research suggests that by acknowledging certain emotions (such as fatigue, cynicism, detachment, etc ) you can lessen self-imposed stress. Self-compassion exercises may help you accept whatever feelings arise at that moment.

 

Being exposed to continual stress without appropriate recovery can cause us to burnout. Feelings of exhaustion, anxiety, and isolating from friends and family members can be some of the signs. By tuning in more to your body’s energy levels, feelings and emotions, you can begin to shift your response to stress and apply positive self-care habits that will reduce the risk of burnout and allow you to thrive, adapt and grow from life’s pressures.

About the Author

Bob Carr Leadership Photo

Robert Carr, MD, MPH, FACPM

Chief Medical Officer

Robert Carr was most recently Senior Vice President & Corporate Medical Director at GlaxoSmithKline and on the faculty at Georgetown University. He received his Doctor of Medicine from the University of Miami School of Medicine and his Masters of Public Health and Preventive Medicine Residency from the John Hopkins Bloomberg School of Hygiene and Public Health. Bob also served as the President of the American College of Preventive Medicine

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