Burnout: Recognition and Prevention
The prevalence of burnout varies between work fields. One study found physicians experience burnout at rates of 37.9% and the general population at around 30% (Shanafelt et. al, 2012). Medical students reported a 50% burnout rate, with over 10% experiencing suicidal ideation (Dyrbye et. al, 2008). Symptoms of burnout include cynicism, lack of focus, low satisfaction, low energy, irritability, headaches, increased dependency on alcohol, and others (Mayo Clinic). A review of the effects of burnout listed numerous negative health outcomes such as increased risk for diabetes, headaches, hospitalization for cardiovascular disease, and pain-related disabilities. Psychological impacts include insomnia, depressive symptoms, and hospitalization for mental disorders (Salvagioni et al., 2017).
To sum it up, burnout is a harmful, but unfortunately, common illness.
Speaking from my own personal burnout experience, across varying levels of severity, it is an experience I would not recommend. In fact, I would recommend experiencing many other things over burnout, including (but not limited to), the painful sensation of stepping barefoot on a Lego or realizing you forgot your wallet as you reach the grocery store counter to pay.
Unfortunately, during these burnouts nothing could instantly make the struggle go away. Based on my own experiences and research, I have compiled preventative tips and strategies for recognizing and addressing burnout early on in one’s work experience. As someone who has addressed burnout early on as well as ignored an instance of burnout, leaving it to spiral into what I call “the sad tornado of self-destructive habits,” it is my opinion that acknowledging and addressing burnout early on is the best strategy one can have. I will also make some suggestions if you are currently experiencing burnout.
As a disclaimer, the personal experiences I am including draw from my clinical work as a Registered Behavior Technician (RBT) for the past three years, primarily with early intervention (EI) clients. However, the suggestions I have are broad enough to be applied in any field. To be even more transparent, clinical work has never been an interest of mine or something I would want to make my career. Even now, I still don’t know how I got here. One day I was walking into my mandatory Principles of Applied Behavior Analysis (ABA) course not knowing what ABA was and a year and a half later I’m screeching praise statements at a pitch I didn’t know I could do and working on toilet training with my EI clients. Naturally, this disinterest in pursuing the field I was working in would make me more prone to burnout. I loved to see each client’s progress and excitement and found it helpful in dragging me out of my shell and making friends. (I made more friends working at a clinic for nine months than I did in three years of working on my undergraduate degree.) I just didn’t have much interest in observing a functional analysis or helping write programs. On an academic/intellectual level, it was just not for me. However, just because you may love the field you are working in does not make you invincible to burnout, and I would argue, may even leave you more open to having a worse burnout because of the confusion of “I love my job, so I shouldn’t feel this way,” resulting in someone feeling guilty and worsening the depressive effects of burnout.
I will be discussing my own feelings of burnout in this blog, including some pretty heavy emotions and experiences I had at my worst points. I find them important to discuss in some detail to clearly illustrate an example of burnout and why addressing it early on is crucial. Think of me as some spooky person you see in a movie warning the main character to avoid some cursed area, but with less foreboding riddles; though in this case, don’t ignore me like the protagonist would in a movie. I will also be referring to two types of burnouts I experienced: non-crisis and crisis. My non-crisis experiences involved more anxiety attacks than depression. Regarding the crisis-level burnout, this is a trigger warning, as I will be discussing my experience of severe depression, anxiety, mood swings, suicidal ideations, and self-destructive behaviors that occurred during my crisis burnout.
That said, if you are having feelings similar to mine, crisis or not, I encourage you to explore these numbers or websites: National Suicide Prevention Lifeline and Crisis Text Line. Texting was the method that got me into contact with a person faster than the online chat. I did not use the phone line, but I know the response rate is faster there as well.
Preventative measures against burnout
So, you aren’t currently in the midst of a burnout/job existential dilemma, but that doesn’t mean you shouldn’t be prepared.
While I may not have a hurricane emergency or zombie apocalypse stash ready, I do make sure to try and have some plan for burnout and some measures to avoid it. While the zombie takeover is inevitable, I’m more than likely going to experience burnout again before I’m ever zombified. Pro-tip though—bunker in an ABA clinic; armed guards would probably be useful.
Establish a social support system
This is a common suggestion across any article on mental wellness, so naturally it applies here, too. Whether it is biological family, family you created, friends, or coworkers, a support system is important to have in establishing people to talk to, engaging in activities with (discussed in the next section), and creating healthy coping strategies.
For those of us who have difficulty vocalizing our emotions and feelings to others, reaching out is uncomfortable. For me, I cannot even tell my cat I am sad, and she is my emotional-support animal. I found it a little easier to express my emotions during my non-crisis burnouts, as I was actively concerned about my well-being and wanted to fix myself. However, when at my crisis level, I felt numb and lacked a strong desire to help myself. I was waiting for the day I would break down and do something to hurt myself. A small part of me wanted to reach out to someone and say, “I am a danger to myself; help me,” but I never could, even when someone who could provide me the assistance I needed, like my psychiatrist and therapist, asked if I was having thoughts of suicide.
To address this, I suggest a code word or phrase to your friends. Instead of having to draft a message of “Hey, I’m having a panic attack and/or having harmful thoughts. Please talk to me,” which is easier to write now when I don’t have to send it to a friend or in the midst of a crisis, I use a code phrase. For me, whenever I’m in crisis, I text someone, “Tell me a joke.” I call this my S.O.S, waving-the-white-flag signal. I could easily just Google a joke, but I’m not sure if jokes on Google are a thing anymore; I assume memes have replaced them. I’m very out of touch with social media. Plus, Google does not offer much in the form of social interactions. In times of particularly dark thoughts or low points (beyond burnout), I have found my text-message code to be helpful in initiating a conversation and distracting me. I know some people reading this may call it unhealthy to try and avoid the feeling, but in the moment, it was better for me to distract myself. Particularly in a crisis, I was never sure if I was going to follow through with a plan or engage in impulsive self-destructive behaviors. This method also allows for an easier way for a support person to reach out and talk to you. That suicidal message is very heavy and if I got it, I would not know where to start in terms of conversation. By having a phrase that prompts a specific response, such as “Let’s have a contest of who can find the best cat pictures” or “Who can make/edit the cheesiest meme,” you can have a light-hearted conversation that does not weigh as heavily on the other person.
Do activities outside of work (Turn it off)
The above is another cliché piece of advice, but also important. One of the negatives of cellphones (beyond the complete removal of privacy) is that a job can contact you in multiple ways at any time. Texts, emails, phone calls, Facetime, Zoom, Whatsapp, Facebook Messenger, virtual carrier pigeons, and more make you open to being contacted by your job whenever and wherever (in bed, on the toilet, at a funeral). Unfortunately, with this ease of communication, there can be an expectation that you should, in a way, always be on-the-clock. 
While you may not be doing your typical job activities at nine at night (unless you work night shifts) you still have access to your email and could respond to messages sent by others. Sometimes, people expect you to work off the clock (damn you, capitalism) and either comment or give you a look on why you did not respond sooner even THOUGH IT WAS A WEEKEND, KAREN!
I advise people to set aside time to do something they enjoy, planned or unplanned, where they focus on doing something other than work. Plan to have a weekly lunch with friends, go to a theme park with a friend, explore abandoned places that you hope are not haunted or hiding a body. If you are not great with planning events, be open to attending spur-of-the- moment invitations to meet with friends. I have a variety of friends, some who need to plan to socialize while others text me randomly on Tuesday night at 9 p.m. to come over and discuss whether that zombie apocalypse will include vampires or not.
Schedule time-off
This suggestion can be difficult for those who do not receive time-off benefits, who are heavily dependent on their income, and live paycheck to paycheck. (With the cost of living increasing but not the pay, I’m not bitter at all.) However, if you are able to, I highly recommend taking some time off every once in a while, if you can plan ahead for stressful work deadlines. As mentioned previously, taking some time away from work or to hang out with your social support group is important to have a more balanced life and avoid being weighed down by work.
Am I already experiencing burnout?
If this is your first time reading or skimming this, then maybe you are not experiencing burnout, but if you are 
referring back to this section, then you probably are, especially if it is accompanied by late-night Internet searches such as “what burnout feels like” or “why have I been so anxious at work lately?” The following section discusses methods of identifying burnout, and recommendations of what to do about it.
Recognizing burnout
It can be difficult to identify whether you are experiencing burnout. People can attribute negative emotions with having a bad day or week, brushing off the early signs of burnout and allowing it to continue and worsen. I think culture has some influence on this. American culture can often have a “Get over it!” or “Power through!” mentality, especially when it comes to un-wellness that is not overt. People may feel inclined to assist someone in a wheelchair (sometimes to an unnecessary and insulting level as discussed by this article) but when it comes to illnesses not outwardly obvious, such as mental struggles (or even physical ones not apparent like nerve or pain disorders), they can be brushed off. Even if you are noticeably anxious or upset, it can often be attributed to having a bad day or something personal happened, but you will be fine after the weekend.
For those of us who struggle with additional mental struggles, like anxiety, mood (depression, bipolar), or personality disorders, you can feel even worse than usual. From my own experiences, beyond risk factors, identifying the burnout alone was its own problem. I’m no stranger to anxiety.
I have had full panic attacks at loud noises (and butterflies) and have even awakened with one. (What a way to start the day!) When I drove to work and had a panic attack, I brushed it off as my usual anxiety. Yet, consistent anxiety or negative emotions toward work, especially the aspects you typically love about it, is not something to ignore. While I never wanted to be a clinician, I did develop strong relationships with my clients. I enjoyed seeing them develop new skills, however large or small the gain was, and enjoyed bouncing up and down and being overall ridiculous with them. (It was the perfect location to be loud and weird, because I always had the “but I’m being FUN AND EXCITING” excuse.) Sometimes I had off days where I felt more anxious than usual, especially when I had an assignment or task I was new to or a client I was unfamiliar with. When I was having both my crisis and non-crisis burnout periods, going to work every day resulted in anxiety and when I came home I had a panic attack or an episode in which I had a breakdown (tears, shaking, screaming into the abyss/pillow, the whole nine yards). That was not everyday anxiety or mood swings. It’s okay to hate Mondays, but if you hate and are anxious every workday, then you are probably experiencing burnout.
Acknowledgement/affirmations
If you are currently experiencing burnout, regardless of severity level, it is important to know your emotions are valid and you are not wrong to feel this way. Others at work could have experienced, or may be currently experiencing, burnout. Just because you are experiencing burnout does not make you a bad employee or person.
Part of my experience in burnout, and why it would often take weeks to work through, is the cycle of guilt I felt. As a therapist for EI clients who prided myself on being whacky and exciting (or weird and loud, if you asked the other therapist in the room) with the client, during burnout, I found it hard to be as fun or focused. That often created a cyclical process involving me experiencing the negative burnout emotions, that would then manifest into guilt because I was not performing as well as I thought I should or that I was not doing justice to my client, that would then feed the negative emotions I already had. This resulted in quick snowballing from not fine to breakdown, and crisis-level burnout in one instance. While I struggled to affirm myself then, I now know I was not a bad therapist, employee, or person for experiencing this.
Ways to reduce
Mental health day
As mentioned above, stepping away from work can be a preventative measure against burnout. Sometimes, you need a day to relax or do something other than work. Ideally, you could plan for this and take days off ahead of time with a notation on your calendar: “On, February 10, 2021, I’ll probably start experiencing burnout. Schedule some vacation time for that week.” That isn’t the case, but what a superpower that would be! You wouldn’t be a great member of the Avengers, but it’s a great power for yourself. On days you feel especially bad, or you can feel the stress growing, try and take a mental health day. I plan to do a follow-up to this on how organizations can support their employees, one of which is allowing workers to have days off without needing a doctor’s note or accepting “I need a day to collect myself” as a reason for taking time off. It can be uncomfortable to take a “mental health day,” so what I did in the two instances I needed a mental health day was state that I had food poisoning. I’d rather have just said “I need a mental health day.” I find burnout to be, especially in ABA, a problem that affects everyone, but no one actually talks about it. I know my excuse-making is not helping that issue. I am also hiding the burnout, and that makes me a hypocrite, but who isn’t? I think a change in organizational values (allowing a certain number of days a year for an employee to take off without needing a doctor’s note) could help and also provide data on the actual frequency of people who are experiencing burnout or something similar.
Use the support system
Time to break out the support system! As noted before, this is when I use my codeword/phrase of wanting a joke. Particularly in my non-crisis burnouts, I found meeting with friends or just talking to them over text was incredibly helpful. 
It offered me an opportunity to be away from my apartment, where I frequently had intrusive thoughts of self-harm. I think it is important to discuss how you feel with your social group, and take in the advice they offer, but sometimes you need to calm yourself first. If I went straight into talking about my feelings, without allowing myself to calm down and reduce my feelings of anxiety (even temporarily), my description would likely be a mishmash of sad things that made no sense.
Even in crisis situations, it is important to reach out. Sometimes fear of being judged or being a burden to a friend prevented me from reaching out in my most vulnerable moments. Yet, doing so may have offered me some distraction from more harmful thoughts or prevent me from doing harm to myself. At one point, I wanted to tell someone at my job whom I was comfortable with and could implement a Baker Act (mandatory psychiatric evaluation for those in danger to themselves or others) because I felt so out of control. While that can seem scary, it ultimately may have helped get me the help I needed and get a medication that would help me more than the one I was currently on sooner.
Therapy
Jobs and universities typically have Employee Assistance Programs (EAP) or programs to help students get counseling services. Naturally, you are also able to use those provided by your insurance, but those services can get backed up and have longer wait times. To this day, I am still on the waitlist for a therapist under my insurance that I applied for nearly two years ago. I have since relied on EAP and university programs.
Some people may read this and see it as extreme, and I sometimes fall into this pit as well. Looking back on my burnouts, I find myself thinking maybe it was not as bad as I thought, and I did not need to use those services. However, reading back on some of the texts I sent to people, when I would briefly describe my feelings, it is obvious I was not doing well. During my crisis burnout, I did not reach out to my social group early on, and it spiraled out of control to the point where I felt unable to reach out, even if some part of me wanted to. I also found text messages I sent to crisis hotlines. While I did not divulge the fullest extent of my problems, namely in lying when asked if I was having thoughts of suicide, those texts do act as a prompt for me now and I can remember a bit more clearly of how I was feeling. Recalling the plans I had to harm myself also serves as a clear reminder of how bad I was. It was not until after two months of feeling better (as in, I began feeling better on February 15th and I was thinking about my burnout feelings April 15th) that I realized how serious my burnout was. I could tell you in those two months that I had made plans of how and where I would make an attempt to kill myself, but the reality of how severe and concerning that statement is did not process until two months later. Looking back at my therapy appointments, in the four weeks I was in it (which aligned to when I was experiencing my burnout) my appointments went from the following:
Therapist: “Abby, what is your coping strategy?”
Me: “Repression”
Therapist: “Not a coping mechanism”
Me: “Darn!”
To the following:
Therapist: “Let’s work on some basic needs like drinking water.”
Therapist: “Here is the contact information for a psychiatric nurse.”
My final appointment, after also getting a medication change, went more smoothly and we were back to working on developing hobbies and leaving the house more. (The joke’s on you therapist, my hermit habits are super helpful in quarantine.)
Overall, you may think therapy and seeing a psychiatrist are extreme measures, but they can be so helpful and even necessary to overcome burnout. Personally, I think everyone needs to see a therapist (even the therapist) but I know not everyone agrees with that and we don’t want to burn out the therapists. Seeing a therapist at your low points (even if they are not your lowest) can help you develop helpful coping strategies or just vent to a stranger. (I find it easier than venting to a friend, to be honest, but I also hate talking about feelings.)
Conclusion
So, in conclusion, burnout is awful, but we established that already. Also, it is important to take action steps before you start getting burned out, because it is likely to happen. The preventative steps may assist in avoiding or at least weakening the experience of burnout, and the suggestions I made may be helpful in getting through that burnout. Finally, it is important to individualize these methods to yourself; I don’t know you, but you probably do, so use these as a general guideline.
YOU GOT THIS. YOU WILL GET THROUGH THIS.
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