Burnout

Last spring, I was driving to meet a friend for dinner while listening to Brene Brown's podcast. She was interviewing two sisters who wrote a book on "Burnout." I was so captivated by the information, or maybe so in need of it, that when my friend pulled into the parking lot, I beckoned her to come sit in my car and listen. The book is "Burnout: The Secret to Unlocking the Stress Cycle" by Emily and Amelia Nagoski. I don't think I fully appreciated why I was so enveloped in the interview until I started to apply some of the tools they recommended to my own life, and then later brought the information to leaders and clinicians in my healthcare organization. I needed it, others needed it-and we still do. 

So what is 'burnout'? Turns out it's not just 'stress' – it's a state of emotional and physical exhaustion brought upon by long periods of 'constant unrelenting stress'. I don't know that I could describe the aftermath of the global pandemic any better, particularly for those of us supporting the mental health crisis that has ensued in the last year. Psychologist Herbert Freudenberger, who coined the phrase back in the 1970s, characterized burnout as a set of symptoms including exhaustion from work's demands, physical symptoms (including headaches and sleeplessness), 'quickness to anger,' and closed thinking. The term also includes a decreased sense of accomplishment leading to a sense of futility--"nothing I do matters." other symptoms might consist of 'depersonalization' or lack of empathy and compassion.  

In summary, it looks and feels a lot like depression. Therefore, common symptoms associated with depression are also potential signs of burnout. These overlapping symptoms include alcohol or drug use, disconnecting from loved ones, overworking, feeling numb or seeking ways to numb out, sleeplessness or excessive sleeping to avoid, unhealthy eating habits and mood shifts (irritability or sadness). 

If any of the above are hitting home for you, know you are far from alone. In a recent study by Indeed, over 52% of survey responders experienced burnout in 2021, up from 43% pre-COVID-19, with millennials noted as the most affected population (59%). It should also be noted that in a new annual Women in the Workplace report by McKinsey and Lean-In.org, 42% of the 65,000 employees surveyed said they 'often' or 'almost always' feel burned out. That is up from 32% last year and seven points higher than their male peers. Women noted that the responsibilities outside and within the home are part of the burden, including taking on more work in the office around employee well-being and advancing diversity, equity and inclusion (DEI) efforts – increasing their work twofold. The Women in the Workplace report found women of color are particularly at risk, still experiencing many micro-aggressions, despite the initiatives companies have deployed.

While white employees are more likely now than two years ago to say they are BIPOC allies, only a fraction regularly advocate for better opportunities for women of color. Additionally, according to the Bureau of Labor Statistics, more than 590,000 healthcare and social workers quit their jobs in July – the highest number since December 2020. These resignations directly affect employees within those organizations who are subsequently spread thin. Also affected are those seeking healthcare and mental health services, which has significantly increased in the face of the pandemic.

So now what? All is not lost; we will rise out of this season – but we need to redirect some of our energy and focus to creating that change within ourselves, our communities, and organizations.  

First, let's take a closer look at the stress cycle that can contribute to burnout. In their book, Emily and Amelia Nagoski state:

To be 'well' is not to live in a state of perpetual safety and calm, but to move fluidly from a state of adversity, risk, adventure, or excitement, back to safety and calm, and out again. Stress is not bad for you; being stuck is bad for you."

 

The question then remains: What do we do to get 'unstuck' in order to 'increase fluidity' between stressed and calm?  

Consider:

• What are your stressors?
• What does 'stress' feel like in your body?
• What does 'calm' feel like in your body?

Awareness is key, especially noted what it feels like 'complete the stress cycle.' What does that mean? Our 'fight, flight, or freeze' physiological stress response aids in our survival – it triggers a sophisticated but primal process of physical and mental reactions that prepare us to engage with the stress trigger. So once that trigger is gone, the stress response is complete, right? 

The Nagoski sisters discuss the importance of signaling to your body that the trigger is no longer a threat. 

Until the body knows it can return to a calm and safe state, it will stay activated in small ways. These activation indicators might include increased heart and respiratory rates or muscle tension, which can have significant physical effects later (i.e., high blood pressure, etc.)

So how do you signal the 'all clear' to the body? Well, as discussed in the book, "Stress is a physiological cycle activated by stressors – and what works to complete that cycle generally have nothing to do with what works to manage those stressors. The most efficient way to complete the cycle is any kind of physical movement; other effective strategies include deep, slow breathing, positive social interaction, laughter, affection, cathartic crying, and creative self-expression."

Did you read that correctly? It's not necessarily resolving the issue with the 'jerk' at work or finding dependable childcare coverage for the unpredictable illnesses (although that can help in the long run); it's the in-the-moment self-care actions that close out the body's response to the stressor. These actions don't need to be extensive, time-consuming, or costly.  

Could you:

• Take a few slow and deep 'belly breaths' in through the nose
• Text a friend or colleague to say hi or let them know you are thinking of them
• Take a minute or two to outside – even better, a two-minute walk
• Look at a funny Instagram post (yes, even social media could be positive in the right dosage)
• Doodle on your notebook during a meeting to release some of the energy and engage something soothing

When you do these things with purpose, with the intent of closing the stress cycle, they can be supportive. Like any new behavioral response, you need to repeatedly practice a different way of engaging with stress until it becomes second nature.

Lastly, as Emily and Amelia point out, burnout can be combated by re-engaging in the sense of 'meaning' and 'connection.' Why do you get out of bed in the morning? Who and what is important to you? They refer to this as your 'Something Larger':

"But no matter what forces oppose you, whether it's natural disasters or personal loss, nothing can stand between you and your Something Larger. Your Something Larger lives inside you."

Consider:

• In what ways do you engage with your Something Larger?
• Is work, or part of your work, one way to do it?
• What does it feel like to lose connection with your Something Larger?

Loss of connection was particularly notable in the last 18 months. We had to be more intentional and creative in finding ways to connect with others. We all have different thresholds for social interaction, whether at work or within our personal lives. Nevertheless, connection is essential. We need connection to thrive and to heal. Just like they described our need to be fluid in our movement between stressed and calm, Emily and Amelia talked noted:

"We need both connection and autonomy. That's not a contradiction.
Humans are built to oscillate from connection to autonomy and back again."

As someone who needs time alone to recharge, and frankly struggled a bit as my social calendar started to fill back up, I recognize the deep importance of engaging with others – family, friends, co-workers…even a kind woman at the grocery check-out. It's so important to find trustworthy and nourishing people in your life and expend energy on meaningfully connecting.  

Last, a quick word on 'joy.' I am not sure I fully identified with this word two years ago. Sure, I felt joy along with a host of other 'positive' emotions. But it's been helpful to fully look at the meaning and identify where I truly experience it.  

Brittney Cooper writes in the book "Eloquent Rage":

"Happiness is predicated on 'happenings,' on what's occurring, on whether your life is going right, and whether all is well. Joy arises from an internal clarity about our purpose."

Emily and Amelia write:

"Joy doesn't just come "from within." Because a sense of "enoughness" comes from our connection with others, we access joy when we connect with others through shared meaning."

So what have I done to predicate 'joy' in my life? Well, first, I am a therapist who has a therapist. It's kind of cliché, but it has helped me examine so much of the above in the last year, re-connect to my Something Larger, and put things into action…as well as examine what gets in the way with me staying consistent with those actions. I try to be kind to my body – help it close the stress cycle with purposeful calming. 

I spend a moment or two longer in every hug I can give and receive, especially after knowing what it's like not being able to connect that way for so long. I practice gratitude – for my health, relationships, work, and the ability to support others even just by writing some thoughts down in a blog.