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Monday, April 15, 2019 1:00 am

Burnout leaving us in ashes

Authors say problem not the stressors but the stress

Jenny Rough Washington Post

Extinguish the flames

How you can battle burnout:

Movement matters. Movement and deep breathing allow your body to complete its stress response cycle by releasing tension that has built up through the day, say Emily and Amelia Nagoski, authors of “Burnout: The Secret to Unlocking the Stress Cycle.” Give yourself any physical activity that doesn't require much thought. Walk, take a Zumba class or scrub the floor. “I dread the thought of women looking for information about how to deal with burnout and being told to clean their kitchens,” Emily says. But light housework can help if you're the type who loves spring cleaning. Even better, engage in physical activity with friends instead of plugging your ears with headphones. Shared laughter and togetherness help you feel safe and lower stress levels, the Nagoskis say.

Ask for tiny, noticeable things. “Look at the balance between job demands and job resources,” burnout expert Paula Davis-Laack says. A job demand is “anything in your work that takes consistent effort or energy,” she says, such as meetings, emails or finding new clients. Job resources are “motivational, energy-giving aspect of your work.” That list includes high-quality relationships with colleagues, autonomy, the opportunity to work on new things, having a mentor and receiving clear feedback. If demands are high and resources are low, ask your boss for small changes to shift the balance. Davis-Laack calls these smalls shifts TNT: tiny noticeable things.

Create a corporate culture. Employers influence burnout, too. “Organizations should enforce reasonable work hours,” says Dan Schawbel, author of “Back to Human: How Great Leaders Create Connection in the Age of Isolation.” Companies can prevent employee burnout by developing a culture that encourages vacations and breaks. In France, for example, the Right to Disconnect law gives employees time away from email and phone calls after work hours. Promoting flexibility programs also helps prevent burnout because it allows employees control over when, where and how they work, Schawbel says. Think 30-hour workweeks, telecommuting or job sharing.

Care for your body, mind – and soul. In our mobile society with families often far apart, and in a day and age where religion is on the downturn, many don't have a community to turn to for help. “When bad things happen, who do you go to?” psychologist Sheryl Ziegler asks. “It used to be the leader of the church. I'm not saying you must go to the church you went to when you grew up, but that spirituality piece is valuable, no matter your beliefs. If you don't have a community, make one. It's that important.”

A common ailment is going around, and you probably know someone plagued by it. Caused in part by social media, the 24-hour news cycle and the pressure to check work email outside of office hours, it could hit you, too – especially if you don't know how to nip it in the bud.

Burnout is everywhere. Books are being published about it, high-powered medical groups are raising alarms and ordinary people are feeling it. A recent report from Harvard and Massachusetts medical organizations declared physician burnout a public health crisis. It pointed out the problem harms not only doctors but also patients.

“Burnout is associated with increasing medical errors,” the paper said.

Of human resource leaders, 95% say burnout is sabotaging workplace retention, often because of overly heavy workloads, one survey found. Poor management contributes to the burnout epidemic.

“Organizations typically reward employees who are putting in longer hours and replace workers who aren't taking on an increased workload, which is a systematic problem that causes burnout in the first place,” says Dan Schawbel, research director of Future Workplace, the firm that conducted the survey along with Kronos.

“Mommy Burnout,” a book published last year by psychologist Sheryl Ziegler, resonated with women who had run themselves into the ground trying to be super mom (and dads made it clear they were burned out, too).

A new book, “Burnout: The Secret to Unlocking the Stress Cycle,” by sisters Emily Nagoski (a health educator) and Amelia Nagoski (a choral conductor who was hospitalized for burnout) aims to help women, in particular, live a more balanced life.

Amelia Nagoski was juggling the demands of a doctoral program when she experienced such severe abdominal pain she was hospitalized. Doctors concluded it was “just stress” and told her to relax. Turns out, she had stress-induced inflammation.

Ziegler defines burnout as “chronic stress gone awry.” The big three symptoms are emotional exhaustion, cynicism and feeling ineffective, according to the Maslach Burnout Inventory, a survey designed to measure employee burnout in the workforce.

Other symptoms can include frequent colds or sicknesses, insomnia and a tendency to alleviate stress in unhealthy ways, such as with too much alcohol or online shopping.

Part of the difficulty of pinpointing true burnout may be because burnout is a nonmedical term – at least in the United States. But other countries, including France, Denmark and Sweden, do recognize burnout syndrome and consider it to be a legitimate reason to take a sick day from work.

“Everybody intuitively recognizes what burnout feels like in their bodies and their feelings and their thoughts,” Emily Nagoski says. “It's like art: You know it when you see it.”

Stress vs. stressors

Burnout is caused by chronic stress, not stressors, the Nagoskis say in their book. It's important to differentiate the two. Stressors are external: to-do lists, financial problems or anxiety about the future. Stress, on the other hand, “is the neurological and physiological shift that happens in your body when you encounter (stressors),” the Nagoskis write.

To fix burnout, people need to address the stress itself. They must allow their body to complete its stress response cycle. Instead, people tend to focus on stressors.

“They assume their stress will go away if they're on top of things, if they're accomplishing things and constantly checking things off their to-do list,” Emily Nagoski says.

That's a lesson Paula Davis-Laack learned the hard way.

Davis-Laack practiced commercial real estate law before the Great Recession of the late 2000s. The fast-paced environment gave her a constant adrenaline high as she closed deals and kept so busy that she barely left time to grab a handful of peanuts for lunch. Her frequent headaches, stomachaches and colds threatened to drag her down, but no doctor could give her a diagnosis.

One day, drafting a document in her office, she says she felt like she couldn't breathe. She bolted out of her chair and raced to a nearby health clinic. “Help me!” she gasped. She was having a panic attack. After two more medical crises landed her in the emergency room, she feared a mental or physical collapse if she kept going. She decided to walk away from the job.

“It was like a 50,000-pound weight lifted off my shoulders,” she says.

Still unsure of what was wrong, she poked around the internet doing research of her own when she came across information on burnout. “I was like, 'Oh my God, this is exactly what happened to me!'”

A doctor's story

Gender might play a role in burnout, too. Researchers from the University of Montreal questioned 2,026 people, half women, in 63 workplaces. Their work, published in the Annals of Work Exposure and Health, found that women reported higher levels of burnout.

One reason was that women have more work-and-family conflicts. The women's rights movement was “supposed to give women choices,” Ziegler says. “Sounds awesome, but it became 'You need to do it all. You need to run your house and be the perfect wife and mom and work.' The stress on women got higher.”

A study published in BMC Public Health showed that female physicians are susceptible to burnout from emotional exhaustion while male physicians to burnout because of cynicism.

Steven Manning remembers the night he realized he had become pessimistic about practicing medicine. One day at his family care practice in Williamston, North Carolina, he worked on electronic medical records well past 9 p.m. He had seen about 30 patients that day but felt he hadn't given a single one the highest level of care because the appointment times were too short. Yet the hospital and insurance companies kept pressuring him to see more patients a day.

“I began to think, 'I'm burned out. How did I get to this point? I don't enjoy coming into work.'”

Within a year, Manning started a direct primary care practice, a model where patients pay a membership fee, negating the need for insurance billing. Without mounds of paperwork, he had time to do what he truly wanted: help patients.

“It brought back the joy of medicine I felt I was missing,” he says. “Before, I barely had time to address my patients' diabetes, hypertension and heart failure, let alone spend time taking a mental and spiritual inventory.”

Now, he talks with patients about depression, anxiety and stress and notices many patients are burned out, especially mothers of young kids.

Shift in mindset

For those who suspect they might be on the road to burnout, there are practical tools to mitigate it. Among others: physical exercise, sleep and positive social connection (the real kind, not the Facebook kind). The importance of balance and self-care to prevent burnout likely isn't surprising to most.

“There's nothing fancy about what it would take to turn things around,” says Ziegler, the “Mommy Burnout” author. “But it's a huge shift in the cultural mindset. That's the challenge.”

Plus, fixing burnout can feel like adding more stressors. An employee who takes a lunch break in a park (time in nature reduces stress) might feel pressured to stay late at the end of the day. A yoga class or walk is another item to squeeze into the calendar. A mom can't quit her parenting job.

To address time-management issues, the Nagoskis provide work sheets in their book to help readers reprioritize activities. Ziegler suggests setting boundaries with social media. Use the internet for help, such as ordering groceries, but limit scrolling to 10 minutes a day. Also, it's OK to remove activities from the calendar (or quit them completely) so you can exercise.

The Nagoskis say daydreaming during low-demand tasks, having a creative outlet and engaging with something larger are three more keys to preventing burnout. They suggest writing your own obituary to find out what is meaningful to you.

“It sounds dark,” Amelia Nagoski says. “But it makes you think about who you are and what's important to you.”

Making space in our lives so we're not so hurried and harried isn't easy, especially in a culture that shames slow living, Amelia Nagoski says. Preventing burnout requires hard decisions. Everyone has the same amount of time in a day: 24 hours. To rest – whether with a walk, an extra hour of sleep or a talk with a friend – means something else drops off the schedule.

At first, you might panic that you're not “accomplishing” something. But before long, you may notice you've moved farther away from a breaking point. Your downward spiral will change directions.