Burnout and the Brain is the cover story by Alexandra Michel for the February 2016 for Association for Psychological Science publication, “Observer.” A psychologist, Herbert Freudenberger, brought burnout into the research lexicon in 1974. He defined is as the loss of motivation, a growing sense of emotional depletion,, and cynicism. He found these symptoms among formally idealistic mental health workers who depleted and weary, resenting patients and the clinic.
Burnout is recognized as a legitimate medical disorder and has been given its own ICD-10 code(Z73.0—Burn-out state of vital exhaustion). Many of the symptoms of burnout overlap with depression including extreme fatigue, loss of passion, and intensifying cynicism and negativity. A 2013 survey of human resource directors in the United Kingdom found that nearly 30% reported that burnout was widespread in their organization. Christina Maslach and Susan E. Jackson collaborated on the most influential framework for defining and assessing burnout, the Maslach Burnout Inventory.
Burnout emerges when the demands of a job outstrip a person’s ability to cope with the stress. People in careers focused on caregiving report the most prevalent rates of burnout, but the condition does not discriminate among call center representatives, professional athletes or CEOs. Eventually jobs that require too much of employees will cultivate feelings of negativity and hopelessness as people struggle to meet unrealistic deadlines, rude customers, and cope with the emotional tolls of their jobs.
Maslach and her collaborators have identified the following six key components of the workplace environment that contribute to burnout: workload, control, reward, community, fairness, and values. The physician Richard Underman describe he incremental onset of burnout as “the accumulation of hundreds or thousands of tiny disappointments, each one hardly noticeable on its own.”
Research from psychological scientists at the Karolinska Institute in Sweden ha shown that workplace burnout can alter neural circuits leading to a vicious cycle of neurological dysfunction. They recruited 40 research participants with formal diagnosed burnout symptoms from the Stress Research Institute at Stockholm University. They also recruited a control group of 70 health volunteers with no history of chronic street or other illnesses. All participants completed two test sessions: a task designed to measure their ability to regulate their negative emotions and an evaluation of their brain’s connectivity using resting state functional MRI (fMRI).
Researchers showed all participants standardized series of neutral and negative emotional images to assess reactions to stress. After a participant had looked at an image for 5 seconds, a se of instructions appeared on the screen that directed each participant to either suppress (down-regulate), intensify (up-regulate), or maintain her emotional response to the picture. Immediately following this instruction cue, the same image was presented again for 5 seconds. As the participant focused on the picture. a loud, startling burst of sound played. An electrode taped to the participant’s cheek recorded the reflex reactions to this stressful stimulus.
The two groups showed similar startle responses when they were instructed to maintain or intensify their emotional reactions. But when groups were asked to down-regulate their emotional responses to negative images. clear differences emerged. Participants diagnosed with burnout reported more difficulty modulating their strong negative emotional responses compared with the healthy controls, which was confirmed by their physical responses. They had much stronger reactions to the startling noise than did the healthy control group.
On another day a subset of the participants came into the lab where they were scanned while lying quietly. Activity among several brain areas involved in processing and regulating emotions were examined. Participants in the burnout group had relatively enlarged amygdalae, and also appeared to have significantly weaker connections between the amygdala and brain areas linked to emotional distress, especially the anterior cingulate cortex (ACC). The more stressed an individual reported feeling, the weaker the connectivity between these brain regions appeared on the R-fMRI.
Compared with the control group, the overworked group also showed weaker correlations between activity in the amygdala and the medial prefrontal cortex (mPFC), a structure important to executive function. Weaker connections between these to brain structures could help explain why participants in the burnout group had more difficulty controlling their negative emotions.
Another researcher at the Karolinska Institute, Ivanka Savic, confirmed that brains of individuals suffering from burnout don’t just function differently—their very structure might change. He took MRI-based measurements of cortical thickness and amygdala, ACC, and mPFC volumes to gauge the physical toll of stress. A brain area essential to cognitive functioning, the frontal cortex, begins to think as part of the normal aging process, but patients suffering from burnout showed more pronounced thinning in the mPFC compared to the controls as well as the effects of aging being more prominent in the scans of the burnout group. Burnout patients appeared to have larger amygdalae and shrinking of the caudate which correlated with their perceptions of workplace stress.
Savic theorizes that over activation of the amygdalae leads to impaired modulation of the mPFC regions, which trigger further stimulation of the amygdalae, which leads to even more activation of the mPFC. As the cycle spirals further out of control over time, neural structures being to show signs of wear and tear, which lead to cortical thinning as well as memory, attentional, and emotional difficulties.
A team of Greek psychological scientists led by Pavlos Deligkaris have examined the cognitive costs of burnout. In 13 of the 15 studies he examined he found that executive attentional and memory systems appear to suffer in association with burnout, and cognitive functioning is impaired in burned-out individuals. Of the seven studies assessing sustained or controlled attention, five indicated that individuals with burnout were more prone to attentional lapses. Of the seven studies that included assessments of memory, six showed an association between burnout and memory impairments.
So burnout is a serious problem that goes beyond its symptoms and results in damage not only to cognitive processes, burt also to the brain. Can it be treated? It is both unfortunate and surprising that little research has been done in this area. The little research that has been done suggests that the answer is positive, but much more research needs to be done. It strikes me that meditation might prove beneficial both in prevent burnout and in treating burnout once it has occurred.
Of course, if burnout is caught early, then perhaps treatments will not be necessary. The costs of burnout are severe. Jobs need to be modified, and individuals need to understand that there is no glory in destroying their brains. Although the damage from Chronic Traumatic Encephalopathy might be more severe, the effects of burnout are likely more prevalent. A new philosophy is needed. Where is all the leisure time that was supposed to result from technology? When I was in elementary school in the fifties I was promised that by the turn of the century, leisure time would be greatly increased. Why are we all working more in this age of technology? (Put “Labor Day” in the healthy memory blog search). Also see the healthy memory blog post “The Wellbeing of Nations: Meaning, Motive, and Measurement”.
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