When burnout comes for you, it’s not subtle. It casts an inexplicable darkness on the most mundane things: driving in traffic, showing up to work on time, filing an expense report. It feels like a weight tied to your waist, stealing any spark of energy you will into existence.
You might confuse it for depression — and it very well could be — but, by reflecting on how and when it arrived, you suspect the culprit is the unraveling of your work life. At some point, you were pushed beyond a limit — or even more than one: a new boss who gave you more to do with less resources, another year passed without a raise, a manager accused of wrongdoing who faced no consequences. Now you feel exhausted, without a clue how to revive yourself.
Memories of my own bout with burnout came rushing back when I read Anne Helen Petersen’s Buzzfeed essay on the subject in January. Based on how the piece, titled “How Millennials Became The Burnout Generation,” rapidly pinged across the internet, I know I wasn’t the only one who saw themselves in her words.
At first, I wholeheartedly agreed with Petersen’s conclusion. Burnout, she wrote, will be the “millennial condition” — the generation’s “permanent residence” — until we tear the system down, or in less revolutionary terms, fix capitalism so that it rewards quality over quantity. Yet the longer I thought about it, particularly from the perspective of someone who (obsessively) reports on mental health, the more I realized Petersen’s honest but fatalistic diagnosis might lead some down a misguided path in which they give up hope that their burnout will ever improve.
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So I decided to learn as much as possible about how providers help people recover from burnout. To my surprise, few academics study this question because burnout, at least in the U.S., is not an official medical condition. Instead, researchers have focused on the sources of job-related stress and its consequences, which is why the solutions for burnout you see online or in news coverage can feel underwhelming compared to the severity of your exhaustion. Yet while the scientific evidence on burnout treatment is far from conclusive, there’s enough research to suggest that some strategies can relieve burnout symptoms — and people’s suffering.
If you particularly loved Petersen’s warranted takedown of self-care as the fruitless work of personal “optimization,” you are not going to like what I discovered in my search, because much of what we know about treating burnout is all about self-care.
The good news is that it’s not the version of self-care you’ve come to loathe, in which treating yourself well is more about consumption and branding than it is about recovery and healing. Instead, this type of self-care is about learning and practicing skills like stress management, relaxation, and anxiety reduction. These are acts that take effort. After all, you’re forming new habits, work that can feel daunting and comes with the risk of failure.
You may also be pleased to learn that researchers who study burnout believe employers play an essential role; they’re aware that only so much will change when a company and its managers remain in denial about how their policies and behavior can physically and emotionally exhaust their employees.
So until the day when we’ve transformed capitalism — and the culture of optimization and overwork that it breeds — into a more humane force, let this be your guide to navigating recovery from burnout.
What we know about burnout
A standard Google search about getting over, treating, or dealing with burnout often leads to links with familiar suggestions: take a mental health day, get exercise, and talk to a supervisor about your concerns. The American Psychological Association offers more comprehensive advice for coping with stress at work, such as tracking your stressors, establishing clear boundaries between your personal and professional lives, and seeking help when necessary.
The research on managing chronic job stress indicates that people benefit from taking sufficient time off from work, engaging in relaxing activities, developing meaningful pursuits outside of work, and getting enough high-quality sleep, says David Ballard, senior director of the office of applied psychology at the American Psychological Association.
Still, tips like “exercise more” or “go on vacation” feel vague or too overwhelming to execute. It would be ideal if, like with depression or anxiety, we could access tested and proven treatment designed to improve our mental health; unfortunately no such evidence-based protocol exists for burnout.
What we know is that burnout is characterized by feeling exhausted as well as mentally distant from or cynical about one’s job, which leads to being less effective at work. Research on the phenomenon has found that factors like an intense workload, experiencing unfairness, and role conflict and ambiguity are associated with burnout. Meanwhile, people with traits like neuroticism, agreeableness, conscientiousness, and difficulty expressing their emotions are more likely to hit the proverbial wall.
The World Health Organization recently updated its definition of burnout to describe it as an occupational phenomenon in the International Classification of Diseases, a publication that countries, health systems, insurers, providers, and researchers use to track and make diagnoses. The resulting news coverage last month led to confusing headlines indicating that burnout is now an official medical condition. Alas, the update clarified that burnout isn’t a “medical condition,” but results from “chronic workplace stress.”
If you live in Sweden or the Netherlands, however, news that burnout isn’t a medical condition might surprise you. Patients there can be diagnosed with work-related exhaustion and they receive treatment from clinicians who use different approaches to help people get better. Therapists in the U.S. still see burnout but may officially treat patients for anxiety, depression, or general adjustment disorder. What we know about what treatment could look like actually comes from studies conducted in Sweden, the Netherlands, Finland, and a handful of other countries.
The potential self-care solution
Though the research is far from conclusive, a few studies suggest that cognitive behavioral therapy (CBT), a type of treatment that focuses on developing skills to change a patient’s negative or harmful thinking patterns and learning new, positive behaviors, can alleviate burnout symptoms. Such skills include building greater confidence in one’s abilities, confronting one’s fears, relaxing the body and mind, and learning how to identify and reconsider distorted thoughts like over-generalizations and inaccurate assumptions.
A critical aspect of CBT is adopting habits that can feel difficult at first, like exercising while tired or taking a break during a busy time at work. With consistent practice — and self-compassion for when it feels like you’ve failed at using your new skills — those uncomfortable feelings should ebb or become manageable over time.
Mental health providers trained in CBT can teach their patients these techniques, but there are also ways for people to explore CBT principles and practices through books. (The Association for Behavioral and Cognitive Therapies, a professional organization, offers a handy guide for what to look for in a therapist and how to find one trained in CBT.)
When Fredrik Santoft, a Swedish licensed psychologist and researcher at the Karolinska Institutet, tested CBT training in a randomized, controlled trial, he found it led to significant reductions in burnout symptoms compared to a standard return-to-work intervention designed to help people get back to their jobs. That form of treatment includes preliminary education about stress management but focuses primarily on working with a therapist to create a concrete plan for going back to work, which is then shared with the person’s employer.
“In a way, our CBT treatment is self-care, but it’s really broad and involves every aspect of life.”
All of the study participants received some exposure to basic CBT principles, but 42 of them were placed in a group given the full CBT treatment whereas 40 were treated with the return-to-work intervention. Those in the CBT group learned how to monitor their activities and moods, how to prioritize and schedule tasks, and how to evaluate the emotions surrounding their new behaviors. The researchers focused especially on the role of rejuvenating activities, with the assumption that people experiencing burnout feel guilt and anxiety when they try to take care of themselves.
The full CBT treatment improved the participants’ sleep and their sense of competence, which in turn improved their burnout. His findings, published in May in the journal Behavior Therapy, indicate that CBT can be a powerful antidote for work-related exhaustion. The challenge is understanding when, why, and for whom it’s effective, and then designing treatment around that data.
“In a way, our CBT treatment is self-care, but it’s really broad and involves every aspect of life,” says Santoft, who believes that one-off experiences or purchases like going to a yoga retreat or buying a fitness smartwatch won’t help people develop the critical, long-term skills needed to recover from clinical burnout.
A separate Swedish study, published in 2018, found that CBT, mindfulness-based CBT, and traditional yoga all equally improved quality of life for 94 participants on sick leave because of burnout. The randomized, controlled trial used the three different interventions in groups of participants for 20 weeks. The mindfulness-based CBT taught patients specifically how to note and accept distressing thoughts and feelings through increased acceptance and self-awareness.
Overall, each participant received three hours of training per week in various skills, which they also practiced on their own for an additional seven hours throughout the week. Their tasks included creating a “self-motivated day-to-day activity chart,” which they used to plan their schedules in advance. At each day’s end, they’d reflect on how emotions surfaced or changed and then rated how manageable the day had been. They also instituted a “micro-pause” wherein they focused for several minutes on physical sensations and feelings while doing a brief, practical chore. The break was designed to put the participants in touch with how they were feeling.
The various skills taught in both studies redirect people’s energy toward problem-solving and away from the kind of desperation described by Petersen. “So what now?” she asks. “Should I meditate more, negotiate for more time off, delegate tasks within my relationship, perform acts of self-care, and institute timers on my social media? How, in other words, can I optimize myself to get those mundane tasks done and theoretically cure my burnout?”
If you’re skeptical, even for legitimate reasons, that burnout can improve or go away entirely, recovery will most certainly seem like a fraud sold to you by our work-obsessed culture and the wellness industry. It doesn’t help that mental health providers have imprecise tools to aid recovery, or that mental health help is so hard to come by in the U.S. But what if getting through burnout is actually a learning process over which you have a decent amount of control?
If we view burnout as a manifestation of stress, then it makes sense that CBT could help patients, says Raphael Rose, associate director of the Anxiety and Depression Research Center at UCLA and a clinical psychologist who practices CBT. Research shows the technique is effective at improving well-being when it comes to stress and exhaustion by giving people tools to ensure better sleep, healthier habits, and behavior changes, all of which can direct someone toward more fulfilling pursuits, making them feel enriched rather than wiped out.
“You can start to see how CBT skills all sort of help your body refocus, recenter, regroup, re-energize,” he says. “It’s a physiological way of saying, ‘Let’s take a break from stressors and get back to a point where we’re better able to think about solutions.’”
Such skills require consistent emotional and psychological work that simply can’t be replaced by buying luxurious things or indulging in relaxing but fleeting experiences. Developing the capacity for mindfulness, stress management, and anxiety reduction isn’t an act of optimization but instead a commitment to personal growth wherein cultivating resilience is your goal.
Santoft understands that some patients (ironically) may tire of trying so earnestly to get better, which is why he recommends learning skills and habits in a “stepwise manner.” That means smaller changes come first, along with fresh confidence and motivation. He also encourages curiosity about the “change process” so that patients feel empowered to experiment with their behavior, noting any revelations that come with replacing old patterns with new ones.
“I understand that worry,” he says, acknowledging how the recovery process itself might feel exhausting. “However, an important question in that context is: What is the potential cost of not doing it?”
Santoft continues to use CBT to treat clinical burnout. “No other treatment has shown results like this, to the best of my knowledge,” Santoft says. “And my clinical experience is that it works well for many patients.”
Given this recent research, it’s tempting to consider CBT as effective for treating burnout, but the science is more complicated. Prior to the publication of these two studies, a 2017 meta-analysis that evaluated 14 studies on burnout treatment — most of them conducted in Sweden, Finland, and the Netherlands — showed disappointing results. The most common intervention featured in the review was CBT in both individual and group settings. In one case, a CBT program was combined with career counseling sessions. In another, the researchers taught some participants CBT and Qigong, the Chinese meditative physical exercise.
“If there are adverse conditions at work, those skills can help you only so far.”
One study showed that CBT-based stress management training led to decreased exhaustion and cynicism, but a control group saw the same outcome after following up in three and six months. Something similar happened in two other CBT studies, where burnout scores initially decreased and then, after several months, the difference between the intervention and control groups disappeared. The meta-analysis authors wrote that the inconsistent findings made it “impossible to draw guidelines regarding how to treat burnout.”
“The mixed results … suggest that there are other factors than the intervention affecting the outcome,” Kirsi Ahola, director of international affairs for the Finnish Institute of Occupational Health and lead author of the meta-analysis, wrote in an email to Mashable. Those factors could include flawed study design or lack of statistical power to detect meaningful effects.
To better understand CBT’s potential as a treatment for burnout, we need more well-designed studies that shed light on whether it works and, if so, why it’s effective.
And while Ahola believes stress management skills can be immensely helpful for burned-out employees, she also insists that they’re not enough.
“If there are adverse conditions at work, those skills can help you only so far,” she wrote, noting the importance of reasonable work conditions and hours as well as the ability to discuss expectations, demands, and problems at work with supervisors and colleagues. “It is not a good long-term plan to teach people to manage impossible situations when you can also make the situations a little less impossible.”
Why employers must embrace self-care
This relentless tension, created by a system that values employers but not employees, is exactly what Petersen got right in her essay, and why a real solution seems like nothing more than fantasy.
Ballard, of the APA, believes that too much emphasis has been placed exclusively on employees developing better coping skills, effectively letting employers off the hook for their toxic culture and practices.
“You can’t really put the onus on the individual,” he says. “It’s important to monitor work levels and design jobs that provide enough variety and tasks, where people are engaged in worthwhile and meaningful activities.”
Petersen’s view is much bleaker: “Until or in lieu of a revolutionary overthrow of the capitalist system, how can we hope to lessen or prevent — instead of just temporarily stanch — burnout?Change might come from legislation, or collective action, or continued feminist advocacy, but it’s folly to imagine it will come from companies themselves. Our capacity to burn out and keep working is our greatest value.”
While Petersen’s incredulity is understandable — and relatable — there is a different way to think about solving the problem of burnout. J. Jay Miller, associate dean for research and director of the Self-Care Lab in the College of Social Work at the University of Kentucky, rejects the argument that we must first overhaul capitalism before we can successfully tackle work-related exhaustion.
“When we think about burnout, folks say we should start all over, and that’s not just a realistic place.”
“When we think about burnout, folks say we should start all over, and that’s not just a realistic place,” Miller says. “And we don’t have to do that.”
Miller believes that self-care must become a “professional practice skill” that every employee develops and that every employer invests in as a vital and valuable trait. For this to happen, we’d have to admit that the very qualities employers look for in desirable workers (come early, stay late, never say no), typically lead to burnout.
Miller is also acutely aware of the generational divide when it comes to self-care. Millennials, he says, are seen as selfish for wanting a fulfilling personal life instead of sacrificing themselves at the altar of a nine-hour work day. Yet, while it’s become a sport to mock millennials, it’s clear that employers have gotten greedy.
Meaningfully changing companies’ incentives to wring every bit of energy from workers requires making the business case that if an employer wants high productivity and output, they must invest in self-care as a skill, going beyond the average workforce wellness programs.
Miller, who supervises several university employees, recently began implementing his own version of this. Deciding on effective self-care strategies is a formal process that now happens as part of a person’s annual evaluation, because Miller views it as an integral part of their work. (It is not a factor in whether they receive a raise or promotion.)
In these discussions, employees are encouraged to design a reasonable self-care plan for themselves that reflects their physical, emotional, and social interests and needs. Miller says plans have included regular structured family time, evenings set aside for connecting with friends, and fitness-related goals. While Miller says he offers guidance to help employees settle on goals that are within their reach, he tries to avoid making judgments on the types of self-care people choose.
“What I’m always careful about is to not push my notion of what they should be doing for their own self-care,” he says. “I’m not a yoga person. I’m a scotch and cigar guy. The irony of telling folks what they should do for their own self care is just that — it’s an irony.”
Once self-care plans are in place, colleagues meet with each other in groups to keep each other accountable and share struggles and successes. In a corporate setting, outside of academia, it’s easy to see this approach going haywire, with employees wanting privacy and employers turning self-care into another soulless metric by which performance is optimized and measured. These more general self-care tactics also don’t employ the precise stress management skills offered by a technique like CBT.
Miller’s strategy, however, does two important things: It can create a dialogue between employees, managers, and colleagues about the effects of workplace demands — like Ahola recommends — while making it clear that self-care is a workplace value. Miller, meanwhile, doesn’t want people to confuse this version of self-care, which requires sustained reflection and accountability, with the popular definition, which typically creates only superficial change.
“Some days you’re going to be good at it, some days you’re going to be bad at it.”
“Some days you’re going to be good at it, some days you’re going to be bad at it,” he says. “It’s a continuum — you work toward it. It’s not just some cute, nice thing we do; it’s a necessary part of skillful practice.”
It will be hard to convince some employees and employers that self-care, both personal and institutional, could be the answer to the problem of burnout. Doing so will require more research in addition to a broader cultural and political shift away from overwork. Millennials who view their identity and self-worth through the lens of work will need to create firm boundaries between their life and job while learning new self-care skills that might be challenging or uncomfortable. Workplaces accustomed to taking everything they can from employees will need to own their culpability and turn self-care into a company priority.
Petersen is right that capitalism will refuse to give any of this to workers without a fight. And yet, the suffering that comes with burnout need not be inevitable or permanent. With effective skill-based self-care, workers might just forge their own path to recovery. Meanwhile, a persuasive business case that burnout is counter to a company’s best interests could lead to structural changes we urgently need. If that knowledge can empower millennials to help themselves and fight for a more humane work culture, then we all win.
Source: https://mashable.com/article/burnout-treatment/?europe=true
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