The magic formula for burnout recovery isn't a magic formula at all
Did you know that burnout is largely considered a medical condition, with its very own Z code, and symptoms that overlap heavily with depression? And that these symptoms are basically the result of chronic, intense workplace stress (and that it’s different from compassion fatigue or secondary trauma), which can create similar changes in the structure and functioning of the brain as, say, a traumatic event?
Burnout causes symptoms like low mood, low motivation, fatigue, and negativity/cynicism. It can also cause feelings of detachment from self, others and work; decreased feelings of effectiveness on the job; and overall absence of passion that was once bursting from every seam. It zaps you of your creativity, playfulness, and stress tolerance. It makes everything feel like it’s on fire.
It needs to be said that burnout is technically not considered a mental health condition by the APA overlords (so if you’re a provider via insurance, you won’t get reimbursed for the Z-code for a client presenting with burnout as their primary concern), but that’s not to imply that it isn’t a massive problem in much of the industrialized world that causes huge disruptions to people’s personal and professional lives.
To illustrate, I want to share an interesting (and honestly, terrifying) bit I read in an article from Psychological Science about the potential effects of burnout on our brain:
“Savic . . .measure[d] participants’ degree of burnout and took MRI-based measurements of cortical thickness and amygdala, ACC, and mPFC volumes to gauge the physical toll of stress.
The results suggest that the emotional turmoil of burnout leaves a signature mark in these brain structures. The frontal cortex, a brain area essential to cognitive functioning, begins to thin as part of the normal aging process, but patients suffering from burnout showed more pronounced thinning in the mPFC compared with the controls. The normal effects of aging were also more prominent in the scans of the burnout group.
Other brain structures also showed signs of wear and tear: Burnout patients appeared to have larger amygdalae and shrinking in the caudate, which correlated with their perceptions of workplace stress.
. . . Neuroimaging studies of people who have experienced severe early-life trauma have revealed that their brains show similar patterns to the brains of people suffering from clinical burnout. Regardless of the underlying cause, evidence is accumulating to suggest that the neuronal circuits can be damaged by both situations of extreme trauma and by accumulated everyday stress.”
Basically, the effects of clinical burnout can cause actual physical changes in the brain which appear to be similar to the kinds of changes that occur in people who have experienced severe early-life trauma. These changes can have countless effects on how we manage surprises or change, how we respond to cognitive demands, how well we’re able to access our executive functioning skills, our ability to access and maintain positive mood states, our ability to be present with ourselves and others (i.e. detachment, dissociation, etc.), and more.
Y’all. Burnout can fuck. you. up.
But if you’ve ever experienced burnout, you don’t need me to tell you that. Chances are if you work in an industry where you’re routinely exposed to dangerous or traumatic situations and content, high conflict, strict deadlines, unrealistic expectations, or pressure to succeed, you’re at much higher risk of burning out. And since most of you reading here are probably in the mental health field in some capacity, none of this comes as a surprise to you. Like, at all.
You might even be thinking, “Well gee, thanks for another ‘Professional Dev 101’ lecture, Meg. You’re not teaching me anything I don’t already know.’”
And I get it. I do. Because at every point in my journey when I’ve encountered my own burnout, I’ve scoured the internet looking for validation, help, instructions—ANYTHING that could help me pull myself out of the pit of despair that is burnout.
I’d come across information like this and go through the mental checklist to confirm what I knew all along, and then I’d get back to staring into the abyss above my bed with the lights off and the covers on. Reading about it didn’t help. Not really. It kinda-sorta helped me understand what was going on, but it didn’t give me any real sense of direction in healing my burnout.
This would typically be the place where I tell you that I have the magic formula to get over burnout, and that I’m finally ready to give it to you, my dearest readers.
But, no. I’m sorry.
I don’t have the magic formula. Because there isn’t one. There really isn’t. I could recommend chair yoga, the Wim Hof method (I’m not actually endorsing that, idk what it is), and eating a low-inflammation diet (I’m also not actually recommending that), but that “advice” would be vapid at best, or contraindicated at worst.
Just like most generic “trauma healing” advice on the internet is vapid at best, and contraindicated at worst, the solution to your burnout isn’t necessarily going to be a set of breathing exercises that some internet therapist promises will work.
When you’re clinically burnt out, you’re dealing with chronic (and likely traumatic, in terms of how it affects the brain) stress. The conditions and circumstances that produce your burnout will be as unique as the way it presents in your life, and so too should the treatment be unique to you.
But one thing I can offer that will provide a sense of structure to this fucking goose chase that is burnout recovery, is an understanding of the similarities between traumatic events and chronic, intense stress.
When thinking about traumatic events and why things are experienced as traumatic, it usually comes down to a few core issues. These core issues can cause any number of traumatic reactions and symptoms, long after the event has ended:
The event, circumstance, person, or situation presented as dangerous, with the threat of actual or perceived harm to the person experiencing it
The event, as it occurred, was experienced as being out of the control of the person experiencing it
The person experiencing the traumatic event may have experienced feelings of being trapped, overwhelmed with emotion, and unable to protect themselves
Similarly, people in high stress workplaces may experience similar feelings, though they tend to be drawn out over longer periods of time, in ways that are less acutely traumatic, however more chronically traumatic.
The workload, workplace culture, expectations, obligations, or demands from employers may be experienced as emotionally/mentally dangerous or unsafe (e.g., “When things don’t get done on time, my boss turns into a total dick and yells at everyone within earshot”). In some cases, the work is actually physically dangerous (working as a first responder, working with people with a history of violence toward providers, exposure to toxins or pathogens, running into burning buildings, etc).
The workload, workplace culture, expectations, etc. may feel like things that are entirely out of the worker’s control (e.g., “I have to be at this meeting, I have no choice.” or, “I have to take on these 6 extra clients even though my schedule is full, I have no choice.”) Workers feel even further out of control because so many of them literally need the work to provide for themselves financially, and would not be able to sustain a hit to their bank account without further trauma (losing health insurance, not being able to afford food, losing a home, etc).
The worker may end up feeling trapped, overwhelmed, or unable to take care of themselves because of the level of stress placed upon them, the level of expectation, and the lack of perceived control over their work life.
When I work with clients who are clinically burnt out (or well on their way), these are the first big areas that I try to address:
What about your work is literally or figuratively dangerous/unsafe for you?
How much control, independence, and autonomy do you feel you have?
Do you feel trapped and unable to leave, for whatever reason?
From there, the conversation and clinical direction morphs into one where we are working together to increase safety, re-establish a sense of autonomy and control, and explore all the ways in which they are able to leave, if they so choose.
For someone deeply entrenched in burnout, similar to those who have experienced trauma, those things can feel entirely out of reach at first. This is why we go slow—as slow as we can—without bum-rushing our way through breathing exercises, extra self care to-do list items, and prescribing a 6am vinyasa class every morning.
Those things can be helpful. Let me repeat: those things can be helpful. But they are, in large part, ways of bypassing the slow and often grinding work of healing from chronic, intense stress. It takes time. Right? Just like with our folks who come to us to heal their trauma, we don’t rush through it and give them a bunch of congitive tasks to complete, and send them on their way.
No. We sit with them, we explore the roots, we validate, we help them indentify their autonomy and power, and we use a combination of interventions that we specifically choose for their unique situation and trauma history as vehicles for sustainable change.
So, there it is: the magic formula for burnout recovery isn’t a magic formula at all. In fact, it's kinda slow and kind boring sometimes.
Just like it should be.
Originally posted on the Antiwork Therapist substack page on 6/4/2022.