Burnout Is Not a Psychological Problem
Julie Aelbrecht is a meditation and RYT 500 Yoga Teacher specialising in sleep and burnout recovery and prevention.
In this article, she writes about the treatment of burnout and how we need to reframe our understanding of the condition.
Treating burnout as a purely psychological problem keeps it murky and vague - like depression - and puts the onus for prevention on the individual.
We propose instead that we start to look at burnout as a mind-body problem and carry that with us in prevention work.
It’s not all in your head
“Just meditate”, “practice mindfulness”, and “go to therapy” are all excellent pieces of advice for our mental wellbeing in general, but they are insufficient when it comes to preventing the most 21st-century ailment of them all: workplace burnout.
Burnout is becoming increasingly prevalent in our society, and prevention will be key for small and large employers.
However, most prevention measures are shallow and one-sided: they focus on the workers' minds and forget their bodies.
Burnout is neither a mental disorder by the World Health Organisation nor in the psychiatry manual DSM-5.
And yet whenever we read a newspaper article on burnout, the cited experts are psychologists and psychiatrists.
Having treated patients with burnout in a clinical setting (I developed a gentle movement and meditation protocol for in-patient burnout treatment between 2019 and 2020), I concluded that treating the mind alone is not enough.
My colleagues who analysed blood samples to prescribe supplements made nutritional recommendations, provided physical therapy and re-education, and made as much of an impact on the recovery of our patients as I did with my mindfulness or other colleagues with psychotherapy.
Treating burnout patients holistically and looking at their physical and mental well-being proved successful treatment.
So why not carry this knowledge and approach to preventing burnout in the workplace?
Let’s take a look, then, at how burnout shows up in the body.
Heart health and burnout
Our wealthy but sedentary societies pay a lot of attention to heart health.
However, burnout patients also showed higher resting heart rates than healthy controls.
A connection between high blood pressure and exhaustion has also been found by researchers, even when adjusting for age, sex, educational level and depressive symptoms.
This means that workplace exhaustion will impact your cardiovascular health regardless of whether you are depressed or not, what gender you are or how many diplomas you have.
To make matters worse, in a study on exhaustion as a predictor of myocardial infarction (commonly known as heart attacks), the authors found that many coronary patients had a history of burnout.
Participants who answered the question “Have you ever been burned out?” were at increased risk for heart attacks, whether they smoked or had high cholesterol or blood pressure.
In risk assessment studies, the individuals with high risk for burnout had poor cardiorespiratory health compared to those with low risk.
Those with higher levels of burnout also had lower oxygen consumption.
On top of that, lower oxygen efficiency was also connected with lower professional achievement. Researchers of one particular study at the University of Sao Paolo found that “cardiovascular fitness seems to be associated with decreased burnout symptoms and better able to cope with occupational stress.”
Movement as medicine
The number one way to lower blood pressure and increase oxygen efficiency and resting heart rates is to increase physical activity.
Especially ‘cardio’ exercises that temporarily increase the heart rate, have been shown to reduce the resting heart rate and blood pressure in the long run.
This does not have to involve handing your colleagues or employees Nike’s and sending them off to the park at lunch.
Temporarily raising our heart rates can be as simple as taking short breaks during the workday to walk around, stretch and do some desk exercises.
These short movement breaks can also help to relieve common “desk pain” complaints in the lower back, shoulders and neck.
Even in the mitochondria (the powerhouse of the cell!), burnout patients have been found to differ from the rest of us. Patients had significantly lower ATP levels of mitochondrial functional outcomes. ATP is the source of energy in all of our cells.
When Swiss researchers devised a physical exercise protocol to help these patients, they concluded that regular physical activity positively affected their mitochondrial activity.
Researchers have also been able to draw broader conclusions.
Men had an important connection between burnout and cardiovascular disease, while women showed higher rates of musculoskeletal disorders.
These are strain injuries on our joints, tendons, ligaments and bones. A Finnish study even found that the worse the three major symptoms of burnout were (exhaustion, cynicism and a lack of professional efficacy), the higher the rates of musculoskeletal and cardiovascular disorders.
These associations couldn’t be explained by social factors or health behaviours such as smoking or depression.
The best prevention for musculoskeletal injuries, much like cardiovascular issues, is stretching and taking frequent breaks.
This is to avoid sitting in one particular position for too long.
Sleep to lower your stress levels
Looking at the blood results of burnout patients in a bit more detail, we can learn many things.
Subjects with burnout have higher levels of pre-diabetic factors such as glycaemia and HbA1C in their blood, a factor that indicates the amount of glucose attached to our haemoglobin.
The French researchers who conducted this study found no strong models for the levels of strain, job satisfaction, anxiety and insomnia to predict burnout, but if they factored in HbA1C, they could predict burnout much more accurately.
Finally, burnout patients had higher total cholesterol. These researchers advocated for including sleep and biological parameters in the study of burnout.
Burnt-out individuals also produce higher anti-inflammatory cells, altering their immune system. It is heightened, fighting off infections that may not be there. On a hormonal level, patients show higher cortisol levels during the first hour after waking up.
Cortisol, as you may know, is one of our stress hormones. It regulates our muscle tone and function when stressed and gives our body the signal to start converting more protein into glucose in the liver.
Achieving high-quality sleep is very important in lowering one’s overall cortisol level. When we are in our deepest sleep phases, the cortisol faucet in our adrenal glands is almost completely turned off.
In other studies, burnout was associated with various somatic symptoms, including sleep disturbances, recurrent headaches, and digestive problems.
In my private practice, I have started to focus on sleep education, even for those clients who come to me complaining only of stress or tension in the body. Getting a good night’s sleep is essential to maintaining a well-balanced life.
Sleep education has its place in the workplace.
We don’t all have to install nap-pods in the office as at the Facebook headquarters, but providing workers with some basic education on sleep hygiene and habits can go a long way to compensating for the everyday stress levels they experience.
Burnout influences what and how much you eat
Burnout has, in some studies, been associated with an almost two-fold risk of diabetes. The risk of diabetes after burnout was worse, irrespective of age, sex, body mass index and even smoking or alcohol use.
If we think about the twin issues of gastrointestinal problems and higher risk for diabetes, a peek at our food habits in the workplace may also be a good idea.
One study of diet as a risk factor for burnout has shown that chronic stress influences the amounts and types of food individuals eat.
Scientists have advocated developing dietary strategies to mitigate burnout and promoting healthy eating among professionals.
They support the Mediterranean diet, cognitive behavioural theory, and mindful eating interventions.
A Finnish study from 2021 finally concluded that eating healthy food items had an inverse relationship with the severity of burnout symptoms independently of age, education years, physical activity, and depressive symptoms.
Meaning that the worse these individuals ate, the more severe their burnout symptoms were.
The subjects with mild burnout ate low-fat dairy, vegetables, fruit, berries and white meat.
These studies emphasise the importance of a diverse and balanced healthy diet to promote work well-being.
What our colleagues and employees eat at home is their choice, but it might be a good idea to support the availability of healthy food at work and employer-sponsored events.
And more than one workplace welcomed people back after the pandemic with Snickers and chocolates.
Some dietary education in the workplace and providing healthy options for morning and afternoon breaks can go a long way to supporting healthy, happy employees.
Eat, sleep, move, repeat
When looking at the most recent scientific evidence of burnout's physical symptoms and ramifications, we have to conclude that focusing on psychological treatments and prevention is not enough.
Instead, we propose a more holistic view, considering physical activity, diet and sleep for more efficient prevention of workplace burnout.
Scientists worldwide have done an incredibly detailed job of studying burnout in all its facets.
They have found strong correlations between physical fitness, diet and sleep.
While we shouldn’t throw the mental well-being out with the bathwater, it is time to recognise that focusing on mindfulness, meditation, and psychological treatment alone is not enough to prevent burnout.
If burnout presents physical symptoms and has been correlated with poor diet, lack of activity and sleep, would it not make sense then to take this knowledge with us in the preventative work?
Burnout prevention advice, like general health advice, is deceptively simple: eat, sleep, move, repeat. Putting it into practice and integrating the most recent scientific knowledge into our workplaces will be an interesting challenge.
Interested to know more about how we can support burnout prevention in your organisation?
We’ve developed a Yoga based programme that helps you prevent burnout and support your staff to find balance in their lives. Fill in the form below to learn more.
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