What is burnout?

Dr Amrita Sen Mukherjee, wellbeing expert and portfolio GP, looks at the causes of burnout and the steps we can take to tackle it.

Burnout is an ever-increasing predicament that faces many professional environments: it is an occupational phenomenon that has a significant impact on organisations and individuals. Burnout can lead to poor work performance, reduced productivity and high sickness absence in organisations, whilst simultaneously causing a deterioration in the physical, psychological and mental health of individuals. 

The World Health Organisation (2019) defines burnout as “a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed”. This definition highlights the importance of the relationship between occupation and workplace with burnout. As such, burnout is differentiated from depression and other ailments, as being specifically related to occupational stress. The phenomenon of burnout has long been recognised in healthcare professionals and was first researched by Freudenberger in the mid-70s.

Building awareness – stress

Stress occurs when we are unable to cope with imposed demands, or when resources are depleted to manage potential threats. Increased stress activates the adrenergic system; increasing heart rate and blood pressure causing a characteristic and recognisable physiological and psychological response. Wellbeing is negatively impacted if the capacity to manage stress is exceeded; for example, if there are increased demands and/or reduced resources. When stress becomes chronic and sustained, it can lead to burnout - thus, stress is a precursor to burnout.

Recognition

There are three main characteristics of burnout which include:

- Exhaustion
- Cynicism
- Inefficacy

The presentation of these characteristics can often be confused with depression or anxiety, but in fact the relationship of burnout to occupation supports recognition of this problem. Burnout can manifest in several ways and may present differently in different people. Those affected may exhibit a combination of behavioural, physiological and psychological changes as displayed in the table below. 

Behavioural	Psychological	Physiological
Compulsive behaviours	Overwhelm	Heart disease
Relationship difficulties	Depression	Headaches
Change in mood	Anxiety	Chronic pain
Reduced inhibitions	Loneliness	Fatigue
	Boredom	Exhaustion
		Reduced libido

Prevention is better than cure

Burnout is a modifiable condition. Through recognition of the signs and symptoms of burnout, it is possible to reduce and reverse its impact.  Investing in self-exploratory activities improves personal wellbeing, enhances coping mechanisms and bolsters resilience. Developing a toolkit of wellbeing practices can prevent burnout, supporting us in times of adversity.  

Toolkit

Developing habits around healthy practices is key. The following offers evidence-based suggestions that may be utilised to prevent burnout.

Physical activity
Regular exercises can improve mental and physical health, reducing burnout. Building exercise regularly into your weekly routine can reap significant rewards.

Sleep
Most adults need approximately eight hours of sleep each night. Poor sleep has been related to brain atrophy, therefore having a healthy plan and bedtime routine may be the key to improved rest and reduced fatigue.  

Box breathing
Box breathing (repeated inhalation and exhalation for four seconds) increases vagal tone, stimulating the parasympathetic nervous system and thus reducing blood pressure and heart rate. This practice helps to reduce stress and anxiety.

Gratitude diary
Studies have shown that keeping a gratitude journal or recognising three good things that happen in the day before sleep raises levels of gratitude, which have been found to improve overall health, happiness and sleep quality. The practice of gratitude has supported individuals to become more engaged and connected with their environments, which also increases the levels of positive emotions.

Journaling
Effective journaling brings countless benefits. Journaling allows the conscious and unconscious mind to work together through a stream of consciousness, thus allowing individuals to explore patterns and themes that may exist in thoughts and behaviours. Journaling offers a shift in mindset from the negative to the positive through the development of alternative perspectives.

Summary

In developing supportive mechanisms that allow enhanced control of emotions, behaviours and habits, potential negative occupational stressors may be mitigated. This may support the cultivation of healthier, consistent and more sustainable work-life boundaries.

References

Baikie, K.A. and Wilhelm, K. Emotional and Physical Health Benefits of Expressive Writing. Advances in Psychiatric Treatment, 11, 338-346, 2005.

The Science of Gratitude. Greater Good Science Center, UC Berkeley, 2018.

C. Keyes, "The mental health continuum: from languishing to flourishing in life," Journal of Health and Social Research, vol. 3, June, pp. 207-222, 2002.

Lazarus, R.S., & Folkman, S. (1984). Stress, appraisal, and coping. New York, NY: Springer Publishing Company.

New Economics Foundation, "Five ways to wellbeing: new applications, new ways of thinking," NEF, London, 2011.

World Health Organization, "Constitution of the World Health Organization," WHO, 1948.

Yerkes R.M. & Dodson J.D. (1908). The relation of strength of stimulus to rapidity of habit-formation. Journal of Comparative Neurology and Psychology. 18(5), 459–482.

 

Dr Amrita Sen Mukherjee BSc (Hons) MBBS DRCOG MRCGP DOccMed MAcadMEd MSc (Dist) is a wellbeing expert and portfolio GP with an interest in Occupational Medicine and Physician Health. She can be followed on social media at:

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