Stress and Burnout


Stress and anxiety are terms that are often used interchangeably, but there are important differences between the two. Typically, stress is considered to be a short-term response to an environmental threat, such as an argument with a spouse or an important exam. It is experienced as a state of mental or emotional tension that occurs when our available resources do not meet the demands of the situation. Anxiety is often a byproduct of stress and can be one of many long-term reactions to stressful situations. It is a more sustained emotional state that persists after the threat has subsided. For more information, read about anxiety here.

Richard Lazarus, a psychologist who created the stress and cognitive appraisal theory, proposed that our experience of stress is related to our belief about our ability to cope with a stressor. For example, if I have an assignment deadline and I don’t think I have enough time or the skills to complete the task, I will likely feel stress. The stressor is the requirement to complete the project and the stress is my resulting frustration and anxiety. However, if I actually have the skills and I believe I can do it, then my stress will be less.

It is important to recognize that not all stress is bad. In fact, it can actually help us deal with life events in a more effective way. If you are feeling stressed in reaction to an important deadline, it may actually help prepare you to meet the deadline. However, if left unaddressed, stress can become chronic and lead to difficulties in concentration, insomnia, or more serious health problems like high blood pressure or a weakened immune system.

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Burnout is a response to chronic stress at work and is characterized by exhaustion, increased cynicism and detachment, and feelings of ineffectiveness. Herbert Freudenberger first described burnout in 1974 while working in a free clinic in New York City. He described burnout as “becoming exhausted by making excessive demands on energy, strength, or resources” in the workplace.

Signs of burnout include the following:

  • Emotional and physical fatigue
  • Difficulty sleeping
  • Feelings of apathy and hopelessness
  • Impaired concentration and attention
  • Dissatisfaction at work
  • Anxiety
  • Depression
  • Anger
  • Loss of enjoyment
  • Pessimism
  • Increased irritability
  • Lack of productivity and poor performance

Periodic Assessments: Periodically your therapist may have you fill out additional forms in the course of treatment to see what is changing and what still needs to change. This allows you and your therapist the opportunity to see what is really going on. You can learn if your depression, anxiety or emotional responses are changing. You may also want to set some goals for your behavior—for example, projects that you want to get done or things that you are procrastinating on.

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There are six factors that have been shown to significantly contribute to burnout:

  1. Work overload – Excessive amounts of work can reduce the capacity to meet the demands of the job, resulting in fewer opportunities to rest and recover.
  2. Lack of control – Not being able to make decisions that affect work outcomes and a lack of professional autonomy can increase the likelihood of burnout.
  3. Not enough rewards– Financial, social, and institutional recognition are important to increased job satisfaction. Not getting a raise, promotion, or other recognition can devalue the job and lead to burnout.
  4. Interpersonal Issues – Interpersonal difficulties with colleagues and bosses may lead to ongoing conflict and disagreements.
  5. Fairness – Perception of unfairness results in increased anger, hostility, and cynicism.
  6. Values – Mismatch of personal and institutional values can lead to a trade-off between the work we want to do and the work that we have to do.

The consequences of burnout can be wide ranging. Studies have shown that long-term burnout can lead to physical consequences, including high cholesterol, heart disease, headaches, gastrointestinal issues, prolonged fatigue, and respiratory issues. In addition, burnout can have psychological and professional consequences as well. Insomnia, depression, job dissatisfaction, absenteeism, and disability are possible outcomes.

How common are issues related to stress and burnout?

According to research done by the American Psychological Association, 75% of adults reported feeling moderate to high levels of stress in the past month and almost half reported that their stress has increased in the past year.

The most commonly cited issues causing stress in the United States include stress about the future of our nation, money, work, political climate, and violence and crime.

Over 50% of people reported that stress has caused them to fight with people they are close to.

The cost to employers exceeds $300 billion per year for stress related healthcare and missed work.

Burnout is highly prevalent among certain professions, with approximately 30% of teachers experiencing burnout, 31% of medical students experiencing burnout, and up to 69% of medical oncologists suffering from burnout.

There has been a significant increase in the amount of research dedicated to examining burnout. Between 1991 and 2010 the number of studies increased over sevenfold, while studies of depression increased by a factor of 3.4.

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How to Deal with Stress and Burnout

Treatment approaches for stress and burnout can focus on prevention strategies or interventions to reduce acute stress. Common recommendations include:

  • Change work patterns – Working less, taking more breaks, delegating responsibilities where appropriate, and avoiding overtime work can reduce burnout. With changes in technology, there can be pressure to be “on” at all times (responding to emails after work, being available after hours, etc.) As much as possible, try to leave work at work.
  • Get social support – It is important to remain engaged socially when dealing with chronic stress or burnout at work. Continue to strive for positive interactions with friends, family, and colleagues.
  • Practice relaxation – engaging in relaxing activities, paced breathing, or self-care strategies can be effective in reducing burnout. In particular, practicing mindfulness is one strategy to increase focus on the present moment while shifting attention away from the issues that are causing stress.
  • Focus on good health – taking time to exercise, avoiding alcohol and other drug use, getting better sleep, and controlling devices can promote better health overall and make us better prepared to deal with stress. For more information on substance use, read here.
  • Change thinking patterns – Identifying and changing problematic thinking is a common strategy recommended in cognitive behavioral therapy. Recognizing unhelpful thoughts like worries about what others think or unrealistic standards can be the first step to changing these patterns.

Challenging negative thoughts

Certain automatic thoughts can contribute to our overall levels of stress. Watch out for the following thinking traps:
  • Fortunetelling: You predict the future negatively: Things will get worse, or there is danger ahead. “I’ll fail that exam,” or “I won’t get the job.”
  • Catastrophizing: You believe that what has happened or will happen will be so awful and unbearable that you won’t be able to stand it. “It would be terrible if I failed.”
  • Labeling: You assign global negative traits to yourself and others. “I’m a failure,” or “He’s a rotten person.”
  • Discounting positives: You claim that the positive things you or others do are trivial. “That’s what wives are supposed to do—so it doesn’t count when she’s nice to me,” or “Those successes were easy, so they don’t matter.”
  • Negative filtering: You focus almost exclusively on the negatives and seldom notice the positives. “Look at all of the people who don’t like me.”
  • Overgeneralizing: You perceive a global pattern of negatives on the basis of a single incident. “This generally happens to me. I seem to fail at a lot of things.”
  • Shoulds: You interpret events in terms of how things should be, rather than simply focusing on what is. “I should do well. If I don’t, then I’m a failure.”

What We Expect From You As A Patient

The treatment of stress and burnout requires your regular attendance in therapy and your willingness to carry out self-help homework assignments that can be very effective in helping you cope in the long-term. Many patients also benefit from medication which should only be taken as prescribed by your doctor.
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