Work Stress (Part 2): Burnout and Coping Strategies

Stress is the body’s response to pressure and demanding situations. While stress is common, and can even be helpful in certain occasions, it also causes mental, physical, and emotional strain that affects health and wellbeing. This is an issue for many people at the workplace, especially.

Following on from the first part on the effects of stress, Dr Nicky Kimber-Rogal offers a comprehensive insight into the health problems that can develop due to stress, the relationship between stress and burnout, and the effective management of stress at work, in this conclusion of a two-part series on work stress.

When does work stress become a serious medical problem?

Medical problems can occur when stress is prolonged without any respite or rest. It is also dependent on the natural, innate resilience of the individual. Some people (called ‘hardy personalities’ - a term first coined by a psychologist called Kobasa) are naturally predisposed to enduring more stress than others. This is when the nature/nurture debate is important. For example, if an individual has a genetic history of anxiety or high arousal states, this can be either diminished or exacerbated by the environment in which they are brought up.

Returning to the issue of prolonged stress, historical studies with animals (now unethical and prohibited) showed that whilst some stress is good and can be motivating, prolonged stress can result in ulceration, heightened blood pressure, potential heart problems, and more. At a human level, the effects are very clear to see: if you startle someone, they will feel their stomach churn, and they may freeze in their tracks or opt for hyperactivity (which in itself, can lead to burnout).

Psychiatric diagnostic manuals classify disorders when it affects one’s ability to function; for example, many people are obsessive, particular, compulsive, hyper-focused, but would not have a diagnosis of obsessive compulsive disorder. This type of behaviour would be considered a disorder when it interferes with everyday life or when it is having an adverse effect on family, friends, and health. For example, checking to see if a door is locked is not obsessive, but if the individual spends so much time checking and re-checking the door that they cannot leave the house to work and feed their family, then it is clearly a disorder.

Work stress can also manifest in many ways, one of which is discrimination. Many psychologists treat workers who have become involved in litigation with their companies, whether it be bullying, undermining, marginalising, or other unpleasant behaviours. They may feel de-skilled, or over or under-used, and the effects of this may become apparent on both the body and the mind. Social life diminishes, exercise routines are reduced, and perhaps weight loss or weight gain may occur, causing the individual to become physically and emotionally compromised.

What is the relationship between stress and burnout?

The relationship between stress and burnout can be complicated, because symptoms of stress and burnout overlap. For example, burnout is described in the ICD-11 (the US diagnostic manual) as ‘energy depletion or exhaustion, growing mental distance, or negativism or cynicism related to one's job’. This could also be indicative of reactive depression caused by stress, whether or not it is job-related.

The issue is therefore complex, and depends to some extent on the perspective of different practitioners. A psychiatrist, for example, may use the UK Diagnostic and Statistical Manual of Mental Disorders (DSM) or the American equivalent manual (ICD-11). However, the DSM does not include the term ‘burnout’ as an illness whereas the US version includes ‘burnout’ as a section on problems related to employment or unemployment.

Broadly speaking, with stress, there is often an end in sight (for example, the stressors may be lifted or the individuals finds coping mechanisms to combat the stressors). Although it may be difficult, it appears possible and hopeful. Burnout, on the other hand, is a state of physical, intellectual, and emotional exhaustion caused by investing too much into something without the help or hope of self-restoration, leading to a cycle of negative emotions and withdrawal (and this is where it is similar to depression).

In summary, it is important to use terms like stress and burnout correctly, and to recognise when they may overlap with feelings of depression or anxiety. In addition, practitioners may distinguish between feeling depressed, feeling demoralised, or feeling sad.

Practitioners may ask themselves the following questions:

• Does an individual’s low mood fluctuate?
• Is an individual’s anxiety a normal or a typical response to events in the workplace, such as bullying?
• Is an individual’s persistent low mood and sense of helplessness or hopelessness a normal or a typical response to being given too much responsibility and information, and not enough control?

Moreover, practitioners may also make distinctions between an endogenous and a reactive depression; with the former, depression may come from organic or physical/biochemical sources whereas, with the latter, reactions may be caused by prolonged bullying or work overload.

How can work stress be avoided? How is it treated?

Stress cannot be avoided. As mentioned before, some stress in life is good. Stress, however, can be reduced by communication and delegation. For example, communicating to colleagues and managers about the pressure an individual is under must be emphasised, and encouraged by the work ethos and principles.

People often make assumptions about how others are coping. Many people assume a position of ‘strength’ (that is, appearing invincible and being able to cope with any amount of workload), causing others to believe that they are not suffering in any way. They may then pile on more work until the individual is visibly stressed or symptomatic.

Many companies publicly announce a focus on mental health at work prevention, but employees may feel incapable of approaching the Human Resources or the Occupational Health departments because they fear they may be stigmatised or even lose their jobs.

Setting boundaries is also a very important aspect to combat stress at work. People often find it difficult to say ‘no’ when they are asked to do something, even when they are overloaded, for fear of the response they will get. In some work situations, an employee may feel that they do not have the right to refuse a task as it may break their contract. However, they can still state, assertively, the problems that the request could cause. Negotiation, mutual self-disclosure and compromise are all tools which can be used to reduce stress.

In terms of treatment of stress, again, the biopsychosocial model is relevant. Talking through issues to someone who both listens and can implement change is important, and regular exercise which reduces the stress hormone cortisol and increases endorphins is also invaluable.

Lastly, a medical doctor may prescribe beta blockers, anxiolytics, or anti-depressants for symptoms, whereas a psychotherapist may look at the compulsive repetition of attachment patterns learnt in early life. Social support is always advocated. People who stay alone - or feel alone - with high stress levels, need to share their situation with others, and be supported and encouraged.

If you are dealing with stress, do not hesitate to visit Dr Nicky Kimber-Rogal’s Top Doctors profile today.