BURNOUT

Written by Dr. Becca Graham

The concept of burnout was not one I understood quickly. Like many folks growing up in America with hustle and grind culture, I was not taught about burnout, not even when I became a therapist and experienced it within a field that has a high rate of burnout(1). The APA defines burnout as: physical, emotional, or mental exhaustion, accompanied by decreased motivation, lowered performance and negative attitudes towards oneself and others(2). It occurs when you feel overwhelmed, emotionally drained, and unable to meet constant demands(3). I read this and thought, “okay, but wait, why are there constant demands? Why is anyone expected to be able to meet constant demands?”
Burnout within America is particularly unique. As a society, America is the place where you are taught that if you work hard enough, you can be successful and make all your dreams come true(4). Well, we know that is false; with systems of oppression built around white, able bodied, cis, christian, upper class, heterosexual folks, everyone is not starting on an equal playing field(5).
Beyond this, America is incredibly capitalistic and values hard work and tenacity but does not value things like peace or joy. I remember past colleagues of mine boasting about how they did not use their sick time or vacation time, as though taking time off made one weak and not a team player. I internalized messages like this from a young age. I remember going to school with a fever at seven years old and being sent home because I thought I had to have perfect attendance. Fast forward 20 years, when my multiple chronic health issues peaked during my doctoral program, and I found myself up against a wall. I was forced to examine the shame that stemmed from comparing myself to others and not wanting to disappoint. While I am still a work in progress, I have shifted my expectations of myself and have begun to honor my humanity by taking my time and sometimes letting others down, despite how inconvenient I find it. 
You may have heard the phrase, “take care of your body or it will force you to.” I think a lot of us are actually pretty numb to even hearing when our bodies are telling us to rest, and only in moments of post trauma, grief, or immense physical pain do we take time for our needs. However, given the fact that being a human is never easy, particularly amidst ongoing local and global violence and injustices within the world, taking care of ourselves is necessary.
Stages & Symptoms of Burnout
Research on burnout is actually quite useful in that it provides tools that help us to call it out when it comes up in our lives as well as prevent it in the first place(6). There are five stages;
Stage 1.    The beginning stage, defined by behaviors such as taking on more tasks, skipping lunch, and staying late at work.
Stage 2.    Onset of stress, described as feeling overworked and overwhelmed but carrying on and putting up with it.
Stage 3.    Chronic stress, described as feeling unwell, masking feelings, not coping,  and feeling exhausted and joyless.
Stage 4.    The burnout stage, where one is physically and emotionally spent, with nothing left to give and feeling like they have hit a wall.
Stage 5.    The final stage, habitual burnout, where one only gets superficial rest and is just waiting to get back to the cycle of stress and overload. 
There are several signs of burnout that are reflected physically, emotionally, and behaviorally(7). The key three symptoms of burnout are exhaustion, cynicism or depersonalization (feeling detached from one’s thoughts, feelings, & body, and a sense of lost identity or not belonging to oneself) and reduced personal accomplishment(8). Others include headaches and muscle tension, feeling helpless and drained, neglecting self care, endless anxiety and feeling overwhelmed, negativity, irritability, unexplained tension, overly tired, inconsistent sleeping patterns, insomnia, isolation, blunted/ distant emotions, and feeling numb/ apathetic about life. 
Work based stress is a huge source of burnout for folks, especially in high demand or service oriented jobs(9), or jobs with low reward and job insecurity(10). Other factors include perfectionism, lacking a support system, past trauma, minoritizations (minority stress, micro & macro aggressions, lack of representation, etc.), health and disability related issues, and being a caretaker.
What We do About it
Ways to prevent burnout are mindfulness, self care, enforcing boundaries, saying no, and cultivating a better work-life balance (ex. engaging hobbies, living within your values).
Mindfulness 
Mindfulness often gets a bad rap. I personally despised mindfulness throughout my mental health career until I had to teach it on a weekly basis. Mindfulness does not mean the absence of movement, thoughts, or even feelings. Mindfulness is a gift and a muscle that, when flexed, allows us to be in the present moment without judgment, thus allowing ourselves to be observant, open and curious rather than judgmental or consumed by thoughts and feelings. Mindfulness has awesome side effects. It can increase one’s ability to cope with stressors & life changes, and can decrease mental health symptoms such as anxiety, depression, and panic. It can also increase emotion regulation, self compassion, and generosity towards others, while improving one’s overall quality of life(11). 
The what skills (what to do with your thoughts and self in a given moment) of mindfulness are observe, describe, and participate(12). 

1. Observe your experience, sense what is happening without labeling or getting caught in your thoughts, feelings, or physical reactions, as if you were hearing a conversation between strangers while walking by, and not sticking around to see what happens. 
2. Describe, labeling your experience or putting into words what you notice, (ex. This day is sunny; I am feeling disappointed; I am having critical thoughts about myself.)
3. Participate, be present in the moment, getting lost in the moment, and participating in life with our senses wide open. It is letting go of obsessive thoughts, letting go of expectations, and letting go of future worries. It is like going to a concert and experiencing it fully in your mind, body, and soul, versus being in your head about how you should be or what the right way to be is, or what you need to do tomorrow. 

The how skills for developing one’s mindfulness muscle are:

1. Doing things non-judgmentally and with acceptance: notice your thoughts,  feelings, and bodily sensations without evaluation, and with a playful attitude. You might even identify 1-2 cognitive, emotional, and physiological sensations. For example, “I notice I am feeling sad & tired, I notice the tension in my shoulders and gut, I notice my thoughts are around a mistake I made. I accept this is how I think and feel at this moment. It is normal to have difficult thoughts and feelings, this does not mean I will always feel this way or that I need to be harder on myself, or obsess about it in order to get rid of my current experience. I can handle this.” Observe your experience as if you were a compassionate third party who is radically curious and open, rather than judgemental and cruel. “I see I made a mistake, all people make mistakes, how can I learn from this experience or what meaning can I make out of it?” 
2. Doing things one-mindfully: do one thing at a time versus many things at once. Often I find myself anxious while doing the easiest of activities, not because making my bed is stressful, but because making my bed while planning my day, and thinking about the next 15 tasks I need to complete is. To combat this, you can ground yourself in your activity by engaging your senses and noticing the sounds, images, and smells that accompany it. While making my bed, I may notice the softness on my hands, the smell of the fabric softener I use, and the construction noise outside my window. 
3. Doing things effectively (do what work needs to be done vs what should be done, and do things in a way that works for you and not focusing on doing it “right” or “perfectly”). Make a list of all the things you need to do (I like to include even small things like texting my friend back or checking the mail). From that list identify what is your priority (things that absolutely have to get done), and identify what is not (things that should get done, but do not need to get done in this instant). You can get as organized (or not) as you like with this list (ex. rank each activity). From a disability lens, it is important to identify what you yourself can handle in any given time, something that must get done might move to the should get done list based on your energy and pain levels. The stoplight metaphor can be useful in these circumstances, are you at a green and can do a lot easily, are you at a yellow where you can function but need to have some carefulness, or are you at a red and need to stop and prioritize immediate health needs. 

One can do any activity, whether it's scrolling on social media or brushing one’s teeth more mindfully when done with intentionality and permission from yourself to be present. For example, before scrolling on your phone you might set a 30 minute timer, engage in some slow deep breathing (taking more time to exhale then inhale), and tell yourself, “in this moment I am taking time for myself, there is nothing else I need to do, I can allow myself to be in this moment without judgment or worry.”
Self Care and Rest 
Self care is important for increasing your mood and ability to manage stress(13). From a cognitive behavioral lens, incorporating self care into one’s daily life teaches the brain and the body to expect good things to come and that one does not need a reason or excuse to engage in joy. Three self care tips are: 1. finding ways to nourish your mind, body, soul, and heart(14), 2. tending to one's rest, appetite, and physiological needs (not easy, but important for overall well being), and 3. doing one thing a day that fills up your cup, even if it is small. During my PhD program, I tried to get outside at least once a day, and I watched the sunset and the seasons change. Self care is not a one size fits all approach, and I encourage gentleness with oneself as you figure out what works best for you. Of course, one cannot self care themselves out of everything and that is where I will make a plug for therapy (with someone who is a good fit). I know a huge shocker coming from a mental health professional!
There is beautiful literature and ideology from Indigenous folks and folks from the global majority (nonwhite) who advocate for rest as a form of resistance, liberation, and anti colonization. As the incredible Tricia Hersey writes in Rest is Resistance: A Manifesto, “We must believe we are worthy of rest. We don’t have to earn it. It is our birthright. It is one of our most ancient and primal needs. [...] Release the shame you feel when resting. It does not belong to you”(15). 
Sources

1. https://www.apa.org/monitor/2023/04/psychologists-covid-burnout#:~:text=Faced%20with%20the%20increased%20workload,%25)%20and%202021%20(48%25).
2. https://dictionary.apa.org/burnout
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10010219/
4. McNamee, S. J., & Miller, R. K. (2004). The meritocracy myth. Rowman & Littlefield.
5. https://doi.org/10.1080/21604851.2019.1630203
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604257/
7. https://integrisok.com/resources/on-your-health/2021/november/what-are-the-5-stages-of-burnout
8. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642#:~:text=Job%20burnout%20risk%20factors&text=You%20have%20a%20heavy%20workload,no%20control%20over%20your%20work 
9. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4153-7
10. https://www.linkedin.com/pulse/ultimate-guide-avoiding-burnout-workplace-spruce-infotech-inc
11. https://www.betterup.com/blog/mindfulness-skills#:~:text=Mindfulness%20skills%20are%20powerful%20mental,Cognitive%20Behavioral%20Therapy%20(MBCT).
12. https://dbtselfhelp.com/dbt-skills-list/mindfulness/#:~:text=This%20set%20of%20skills%20is,to%20live%20in%20the%20moment.
13. https://www.manhattancbt.com/archives/2505/self-soothing-self-care/
14. https://ctrinstitute.com/blog/4-key-dimensions-self-care/
15. Hersey, T. (2022). Rest is resistance: A manifesto. Hachette UK.