The Extra Scoop: What is Burnout?

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0:59Welcome to The Extra Scoop, our expert-led bonus episodes, giving you the need to know on the topics everybody is talking about. That's right, from gut health to sleep, hormones to skin, we are cutting through the noise with top experts, so there is no fluff, just facts. Exactly, it's all quick, practical, evidence-based advice to fit into your busy lives. So this is The Extra Scoop, let's get started.

1:28As our listeners probably know by now, our Extra Scoop episode's all about taking those topics that everyone's talking about and just quickly breaking them down for you so that you have expert-led insights that leave you feeling informed and very empowered when it comes to your health and well-being. And with nearly 90 % of UK employees experiencing some level of burnout in the last two years, and the third reporting frequent physical and mental exhaustion due to workplace pressures, burnout just feels like this widespread issue. I know for sure both of us keep seeing it everywhere. Lots and lots of headlines.

2:02It feels incredibly relevant. Lots of us also just feeling constantly exhausted, overwhelmed, like we're running on empty. But the question Rhi and I have been having is what does burnout actually mean? Why is it gaining so much attention at the moment? And obviously, most importantly, what can we all be doing to prevent it? So to help us unpack burnout, we are joined by neuroscientist and clinician, Dr. Claire Ashley, who's got 15 years of experience helping individuals and organizations prevent and recover from burnout with evidence-based strategies. So welcome, Claire. Thank you for joining us today.

2:34Thank you so much for having me. Oh, it's our pleasure, Claire. Honestly, when we saw your impressive CV and the work you've done around this area, we were like, we have to get her on for an extra scoop. So let's break it down, Claire. What is burnout really? How do we even define this? What's the clinical difference, I guess, between just being tired and run down all the time versus actually being burned out? Yeah. So there is a key differentiator between regular stress, which everyone experiences and is something that we all go through periods of stress throughout our lives, both at home and at work.

3:10And that's not to be pathologized. It's part of the normal human experience. And it's something that we all have to learn coping strategies to manage and to get over it successfully. Right. but burnout is something completely different to regular stress and it's really important to make the distinction between the two. Burnout is, it has an official definition. It wasn't actually officially recognized until 2019 when the World Health Organization gave it an official definition and that definition is that burnout is an occupational syndrome, so they only recognize it as happening in the context of work, which is debatable, but that's the official definition that arises as the result of workplace stress that has not been successfully managed and there are three parts to it.

3:52And without these three parts, then technically you don't have a diagnosis of burnout. Those three parts are one, depersonalization. So that's kind of the posh medical term for lack of caring, feeling really detached from your work and a lot of apathy, cynicism. The second component is emotional exhaustion. And emotional exhaustion is something that I think a lot of people that experience stress identify with. So that's the fatigue of caring for too much for too long. And the third component is reduced performance at work. So to have an official diagnosis of burnout, then you have to tick all of those boxes in the context of prolonged stress at work.

4:28Now, I personally slightly disagree with this definition. I think that it ignores the fact that people that do unpaid work can get burnout. So I'm thinking about parents, I'm thinking about caregivers. And it also ignores demographics of people that are at risk of burnout, where the burnout is not necessarily being driven by the work. So particularly people that are neurodivergent, so people with ADHD and autism are also at really high risk of burnout that isn't necessarily purely fueled by work. And the thing about burnout is that it starts off as stress and you go through a process where the stress is affecting you maybe a little bit and maybe that some days are harder than others, but you're taking it in your stride and you're managing it.

5:10And then it gradually gets worse and worse and worse. You develop a whole myriad of symptoms that are emotional, that are physical before you end up in full-blown burnout. And that slide into burnout is difficult to recognize, but it's really important because if you end up in full-blown burnout, then most people need an average of three and a half months off work sick. And it's a one to three year average recovery period. And so that is very different from regular stress, which a lot of people can handle through strategies, through having some time out, having a nice weekend away or spending some time with their friends.

5:44Burnout isn't like that. It requires so much more than just taking a couple of days off. And it also carries, unfortunately, a whole raft of problems alongside the symptoms that you get along with it, including health problems such as an increased risk of cardiovascular disease, diabetes, increased risk of accidents. And actually, if you are under the age of 45, then your risk of dying from any cause goes up significantly. So burnout is very different from regular stress. That was such a helpful differentiator because I said, certainly where I sit, I feel I keep saying the word burnout everywhere.

6:20Totally guilty of overusing it as well myself when we say I have been feeling really burnt out. But actually what we mean is we feel overwhelmed for a little bit too long. we feel a bit too much stress versus what we feel we can handle over a prolonged period, but it's not that clinical diagnosis. And I think what you said, there's something I wanted to pick up on there, which I personally thought was really interesting, is this idea of stress is a normal human experience. And whereas it, again, I feel at the moment with a lot of conversations in the world of health and wellness, it's almost like we're trying to eradicate stress or eradicate difficult things, which doesn't feel like a plausible way to live life.

6:57Life can't be kind of Instagram perfect. It ebbs, it flows, you have stress and it's learning to live with that and feel like that's very normal. It's normal to feel overwhelmed at times. You're not doing anything wrong. Is that something you see or agree with? Oh yeah, I completely agree with what you've just said. And I think that it comes from a number of things actually. So I think first of all, social media definitely plays a part in this. You mentioned the Instagram aesthetic, the picture perfect lifestyle. And I think it's really difficult when you're on social media to remind yourselves that actually you are just seeing someone's highlights real.

7:30And actually, even if they're sharing difficulties, then what they're sharing is very curated as well, and isn't necessarily real life. And it's difficult if you're constantly on social media, which a lot of us are to kind of have that realization, especially when things are difficult for yourself. I think that modern work is really difficult as well. And I think that people are experiencing stress more these days, and in different ways as well. And different groups are experiencing it in different ways and some groups are more at risk than others. So when we look at the scientific literature, we see that there are groups that are experiencing stress more, and you'll probably see this in your own practice as well.

8:07It's largely younger people compared to older people. It's women compared to men. And then within women that are suffering from stress, overwhelmed burnout, it's mothers in particular. And then within that group, it's black, Asian and Latina mothers. And you can understand that because at every point they're experiencing more stress and more layers of complexity when it comes to work and their home life. As a woman, you might be even in equal relationships, a cis etrosexual relationships, then you're likely to be paying the childcare bill, which as we know is very, very expensive in this country.

8:41You'll likely be taking on more of the mental and domestic load in the household. So that adds on an extra layer of stress in addition to your work stress as well. And then obviously, if you're Black, Asian, Latina, then or any other marginalized group, then you are going to be subject to microaggressions and bias and discrimination, which also adds on that extra layer of stress. And I think we lead difficult and complex lives. And I think that's why people are also struggling with it at this particular present point in time. And the world of work has changed as well. We can't forget that. We are working in very different ways now with remote working, hybrid working, the return to office culture.

9:18And we're working in a cost of living crisis and a difficult economic climate, which means that there's more pressure to perform at work, but also your money isn't going as far outside of work. And that also creates the perfect storm for stress and overwhelm and burnout. It makes perfect sense. And one thing you mentioned in the definition at the start. So first of all, I'm sure a lot of people didn't know that it was actually clinically defined in 2019. But you mentioned one of the criteria being in the workplace. So how does this impact? I can imagine you said mothers are obviously higher, but how does this impact women that perhaps their work is that they're a mother every day?

9:57You know, they have no definition. So how do they then get diagnosed with something when a stay at home mom still isn't really seen, I think, in the larger context as a job, perhaps? Yeah, I completely agree with your take on that. And that's why I personally disagree with that definition. The reason why the World Health Organization only recognizes it as a workplace problem is because they very much view it as kind of the end point of prolonged workplace stress. It's a normal physiological reaction to end up in that position when you've been subject to prolonged workplace stress. But they don't feel it's the response to the fault of the individual.

10:34And they very much feel like it's a workplace culture issue. And so with the definition, they were very clear that they wanted workplaces to be responsible for making changes so that their employees didn't burn out. They didn't feel like it was something that individuals could control particularly. And certainly within the scientific community, this is a very strong feeling as well. And I totally understand that. But you're right. It excludes people, particularly parents, mothers and other caregivers. I'm thinking about people who might look after elderly relatives, for instance, or people, children with special educational needs or disabilities or whatnot.

11:06It excludes them from that definition. And it is my personal belief as a clinician that anything that causes prolonged stress can end you up in burnout. And the difficulty for women and particularly mothers is that when it comes to managing your work stress, you can possibly potentially, if it's available to you, take some time out and have some therapy or be supported to develop new coping strategies to manage that stress and tackle the root cause of your stress. But when you're a mother, obviously, as your child grows, the stress has changed slightly. You know, my kids are slightly older now, so I don't have to worry about like a toddler running into the middle of the road and killing themselves, you know, or sticking their fingers in a plug socket.

11:49My challenges now with my children are very different and they're largely centered around emotional stresses and bodily changes in puberty and all of that sort of stuff. So that's still difficult. It's still stressful. I still have to be there for them. but that's still stress and I can't remove myself from that situation because I've chosen to be there and I and the other thing is it's complicated by the fact that you love your children but modern parenting is hard and I do feel like women are being not necessarily excluded by the official definition but I think they are still at risk and are a group that definitely need help in this area because it's hard being a working mum it's so difficult and even if you're not working being a is difficult as well.

12:27Absolutely. I think there'll be a lot of nodding heads. But as you said, for caregivers on the whole as well. And so if you are thinking about this, you put it really brilliantly, Claire, this kind of sliding scale from normal stress, which is that that exists, that's part of life to prolonged stress that begins to overwhelm you for a period of time. And then you slide down that ramp into eventually a kind of clinical definition of burnout. what are the biggest steps when you're getting to that in my mind I think the interesting bit that people will be really relating to is that moment where you feel you can't cope with the stress where it's becoming overwhelming or it's gone on a bit too long and you're really starting to kind of feel it in your body and I think even if you most of us listening this haven't necessarily had a kind of a clinical definition or diagnosis of burnout can probably all relate to that moment where you feel that kind of depersonalization, as you said, that ability that you just can't cope with the smallest things because you're so overstimulated, so overwhelmed for a prolonged period of time.

13:29What do you do at that point? Yeah, so you're absolutely spot on. There is a stepwise slide into burnout where unfortunately there's a whole raft of things that conspire to prevent you from recognizing it until you get to that point where you realize that you're in over your head. So I'll just briefly talk you through those stages and then what you need to do when you realize that you're in over your head. So the first stage of burnout is called the honeymoon period. And this is characterized by enthusiasm for your work. I'm sure we've all experienced this when you're undertaking a new job, a new role, a new task, a new initiative, and you're full of enthusiasm.

14:04You absolutely love what you're doing. You take a lot of joy and meaning and satisfaction from your work and you're very productive. And this can feel wonderful, But the danger with this stage is that if you don't adopt strategies to wind down and be boundaried about what you take on, then you can progress to feeling stressed. And the second stage of burnout is the onset of stress. And this is when some days are more stressful than others. And this is when you start to overcommit your work. So you start to maybe neglect your hobbies and your personal needs, start to see your family and your friends less.

14:33And you feel like your job is the most important thing in your life. and what you're trying to do really with over committing to your work is trying to feel less stressed and to manage your stress. In this stage as well you might start to notice the onset of some physical symptoms so burn-up is a very physical thing to experience and the most commonly reported symptom is muscle pain in fact but there's a whole raft of things you can get with it ranging from headaches, shortness of breath, chest pains, stomach aches, palpitations and also psychological symptoms including difficulty focusing and concentrating and memory issues as well.

15:06Now, if you then progress to the next stage, which is chronic stress, and this is when more days are stressful than not, and all of the symptoms that you might have started to develop in the second stage start to become worse and more significant. So, your problem-solving skills and your performance starts to drop off, your productivity decreases, you might start to feel very guilty because you're not performing very well at your job and you realise this, and it's a profound sense of failure that comes with that, and the other symptoms might start to get worse. And one of the hallmark features actually of burnout is this thing called emotional dysregulation.

15:39So you might find yourself crying lots and bursting into tears over things that you might have been able to manage calmly and in your stride prior to feeling really stressed. And some people might even start to self-medicate with alcohol, drugs, or other substances in this particular stage. But the really sneaky thing about burnout is that you could be having really significant symptoms in that third stage of burnout, but still not really realize what's happening to you, partly because that denial is another core feature of burnout, but also because people don't necessarily have the education, the knowledge, the skills to be able to recognize it in themselves.

16:14But up until this particular point, then you've got that opportunity to avoid full-blown burnout and that one to three-year recovery period. Then the fourth stage of burnout is burnout itself. And that's where you reach critical exhaustion levels that not just affect your work, but affecting your daily life as well. and this is when you kind of tick all of those boxes of the definition of burnout and apathy really is the key emotion and characteristic of that particular stage and then there is a fifth stage which is habitual burnout which is when what you're experiencing is habitualized and you need external help to be able to get over your burnout and depression really characterizes that particular stage as well.

16:54When you realise that you're in burnout, my advice to people is actually to stop. It's actually really hard to recognise that it's happening to you. But when you're there, to stop, if you can, to take time off work because your work stress is the thing that is fueling your symptoms and it's helpful to have some time out. But I realise that sick leave isn't necessarily appropriate or accessible to everyone. So if you're not able to take sick leave, then that's fine. It might be that you could have some adjustments made at work to allow you, or if you're experiencing in the home, for instance, if you're a mother, to get some extra help so that you don't have to take on so much of the physical and the emotional workload.

17:32And then also to start thinking about the recovery process. And I would encourage anyone that identifies with being burnt out to speak to their doctor or a therapist so that they can kick start that recovery process. Wow. So it is something then that would be recognized if you went to your GP, because I think a lot of people will be thinking, well, what can I do right now to either prevent or getting to one of those first stages of recovery? And you mentioned it can take one to three years. It sounds very daunting, I think, for lots of people to think, wow, it's going to take me, you know, one to three years to recover from this.

18:07What would be something now we can actively do? And then the second caveat was the GPs, are they receptive to this conversation? Yeah, it is daunting actually to think when you're in the pit of burnout and I understand this because I've been there myself and I understand how vulnerable you're in emotionally when you're in that position and how just the state of despair and disillusionment that people experience when they're in the full blown pit of burnout. it's not a great place to be and it's really hard to help yourself when you're in that situation I actually found it helpful because to know that it's a one to three year recovery period when I started doing a deep dive into the scientific literature around it because what it did is because that recovery was so hard and I really berated myself because I was like why aren't I getting better quicker this should be easy you know I'm a doctor I can do this I should be able to do this really easily.

19:02I know what I need to do to get myself better. Why isn't it happening? But actually, when I understood the pathology of it and how your body and your brain changes with burnout and that it wasn't in my head and it wasn't my fault, it actually took a weight off my shoulders to know, actually, this is completely normal. And it gave me that permission to be kind to myself and to be compassionate to myself. And so, yes, it does feel daunting and overwhelming, but actually it's a reminder to be kind to yourself and to make sure that your recovery is done slowly and not to rush yourself too much because then you'll just end up risking going back to where you were in the first place.

19:38But that conversation about GPs is a really interesting one because obviously I'm a GP myself. And when I burnt out, I didn't know what burnout was. My colleagues didn't know what burnout was. It was never something that we talked about in medical school. We'd never been taught it at all in medical school, in my postgraduate training. I remember having in my GP training, one conversation, one teaching session on how to manage your workload if you're feeling overwhelmed. And it was basically come in earlier and go home late. That was it. So it wasn't really on the agenda, but things are definitely changing.

20:11I know that there is now changes that are happening at medical schools to help medical students to have these conversations with patients, but also themselves and their colleagues, their peers, which is great. And I also know that doctors now are talking about it more openly because doctors are burning out at a crazy rate. And there is actually now, people might not be aware of this, there is actually a healthcare service for doctors who are struggling with their mental health. It's called NHS Practitioner Health. I've been a patient of theirs during my own burnout and they saved my life and they're overwhelmed with doctors needing help.

20:44So this is a conversation that more and more doctors are having amongst themselves. And as a result, they are helping patients, I think, to recognise burnout. And someone messaged me on Instagram the other day and they said, my GP actually recommended your book to me. I've written a book called The Burnout Doctor that explains how to effectively prevent burnout, how to recover from it. It's all evidence-based. And I just thought, oh my goodness, the fact that GPs are now recommending this book, I was like, it means they understand, they get it and they're having those conversations with patients.

21:15I was absolutely made up. That's brilliant. Well, congratulations on that. And Claire, for people listening, I think exactly what you just said is so important because everyone has stress in their life. Everyone has overwhelm. Well, I think most people, probably everyone listening because they're all looking for these kind of simple tools. What are those day to day tools that we can all start to try and implement in our lives to just better manage the reality of stress? And I almost I quite like the idea that better acknowledging that stress is part of our life, as you said at the beginning, like it's part of human nature, it's part of our lifestyles, there's no way of getting around it.

21:52But what should we all be trying to do to have better mechanisms, tools in place to deal with the reality of life stresses more effectively? I mean, my answer to that, and I realise it's not accessible to everyone, is that everyone should be having therapy and or coaching, because those things teach you the skills to be able to manage your stress really effectively. but I know it's not accessible to everyone and not everyone is able to access a therapist. So I think in lieu of that, I think it's about implementing small, achievable, realistic changes into your daily life that allow you to manage your work stress, in particular, if we're thinking about workplace burnout, more effectively.

22:34And when you look at the evidence around effective burnout prevention and effective burnout recovery, there are some common themes. and I think these are the things that people really need to concentrate on when it comes to handling stress effectively. So the first thing is that control over your work stress and control over your well-being is really crucial when it comes to managing your stress effectively and actually what's really interesting in the literature when it comes to burnout is that it doesn't matter what you have control over because it might not be that you can control the big things that are causing you to feel stress.

23:11It's okay to have control over smaller things because the people that have control over the smaller things, or even that they believe that they have control over them, this mindset shift allows them to then go and make changes to how they cope at work that then basically help them to be buffered and protected against burnout. So those things really matter. So how do you identify what you can reasonably control and where you can't. So there is an exercise called the circle of control exercise that was developed by someone called Stephen Covey. Feel free to go and Google it, or it's all detailed in the book as well.

23:45And what it does is it allows you to work through what it is that you can realistically control in work or in your life. And you basically put that in a small circle. And then in a bigger circle, you write down all the things that you can't control. So to give an example, for instance, When I was burning out as a GP, I couldn't control the fact that I had to see 50 plus patients a day. I couldn't control what they were coming in and seeing me about and the fact that they were really complicated and had huge need. There was nothing I could do about that. What I could control is how I organized my day, how much time I spent with those patients and how I looked after myself during my working day.