Stress and Burnout: Understanding the human stress response and its malignant power to impair

The neurobiology of burnout starts with high levels of stress hormones coupled with perceived lack of efficacy and fatigue

Stress is well-known to the medical community and is treated with lifestyle adaptation and management of symptoms and disease. Once stress becomes too intense, it has a measurable impact on one’s own health.  I have posted blogs about a variety of stressful circumstances, some are associated with personal behavior and lifestyle choice; others are more in line with exposure to traumatic, stressful events experienced by first responders like members of law enforcement or front line healthcare providers. 

As well as impacting professional growth, research suggests that extreme stress levels can impair social skills, overwhelm cognitive ability, and eventually lead to changes in brain functioning. People who under constant stress pay a price in being unable to fully relax. They report feeling under constant threat from forces beyond their control and being stuck running in place. “In a recent study, job satisfaction, overall there were little differences between groups in ratings after a mindfulness program. The study looked at the impact on job satisfaction among members of a university faculty using weekly mindfulness meetings. Among those who participated, there was a significant link between feeling calm and relaxed, and greater workplace wellbeing, with those reporting less stress and anxiety also noting higher levels of job satisfaction according to Dr. B. Grace Bullock reporting on an Australian study in efficacy of mindfulness training.

Burnout can leave people exhausted, unmotivated, anxious and cynical – the consequences of which can be catastrophic to business and front line workers across all sectors of society. This is especially true among healthcare workers, where the stigma associated with mental illness still enables silence among those most in need. It is the real deal and probably underlies the recent exodus of nurses, doctors, police officers, and other front line professionals who have had enough and are moving on from their jobs. At our rehabilitation hospital more and more staff nurses are opting for a shorter commute by changing jobs. Some are leaving to become stay-at-home mothers after 18 months of fighting the fight with the virus, all the while their children were home in quarantine – going to school on their laptop computers.

“In a recent study, job satisfaction, overall there were little differences between groups in ratings after a mindfulness program but there was a significant link between feeling calm and relaxed, and greater workplace wellbeing, with those reporting less stress and anxiety also noting higher levels of job satisfaction. B. Grace Bullock 2017

Stress tends to create significant reactivity within the body. This brings forth rampant chemical flooding by the adrenal cortex and other stress hormones. These chemicals can add to a decline in physical well-being.  These over active hormones are lethal for the medically infirm and physically vulnerable. Yet, for some people, stress is like a drug and creates a circular pattern of sensation seeking as described in the prototypic type A personality.

 The neurobiology of stress and PTSD is being studied and may be linked to primitive brain circuits involved in the fear conditioning response and its eventual, sometimes refractory extinction or habituation of on-going perceived threat (Do Monte, Quirk, Li, and Penzo 2016). As an example, Police work carries with it a neurobiological underpinning that is well documented in terms of the impact of repeated stress and exposure to traumatic events. Chronic exposure to traumatic scenes and a host of other factors gradually elevate the hypothalamus-pituitary-adrenal (HPA) axis in the brain and body of typical career LEO’s. “The human brain, having evolved to seek safety in numbers, registers loneliness as a threat” as reported in a recent NY Times piece. 

Stress effects all aspects of how we feel. Most physicians know that mindfulness techniques lower subjective levels of stress. However, even though paced breathing puts the brakes on sympathetic overdrive, people do not use it long enough to create habits. “Meditating”, according to Dr. Woolery-Lloyd, initiates “the relaxation response,” which activates the body’s parasympathetic nervous system and decreases cortisol and inflammation.” Yet even our primary care physicians and physicians in emergency rooms across the country are at risk from frontline stress, burnout and area at higher risk of suicide. This taken from a story written by Jessica Defino about the impact of stress on human skin in NY Times on 12/08/2020. The point being that the stress response is pervasive in human functioning and can wreak havoc on physical health including the integumentary system – our largest organ – our skin.

“Why don’t we come up with a program before bad things happen?” asked Dr. Englert. “Bad things are going to happen. When they do, the person, the individual, and their family will be more resilient, more able to recover quickly from that event.” said Alexa Liacko, ABC News interview. It is in being vulnerable that we are able to stretch our emotional experience that brings forth growth and reduces stigma. You cannot expect frontline healthcare and first responders to walk through water and not get wet.

Lloyd, C et al. (2002) Journal of Mental Health 11, 3, 255–265

3 thoughts on “Stress and Burnout: Understanding the human stress response and its malignant power to impair

  1. Many years ago, I read a definition of stress as being a mental and physical reaction to an outside stimulus. Which of course explains why mindfulness can be effective.

    More recently, I was reading Sears’ book on Gettysburg, noting the highly diverse reactions of different commanders to a common stimulus, that of being under fire. Some hid as far in the rear as possible. Some, like Union General Gibbons, on the receiving end of Pickett’s charge, rode his horse up and down the line under fire, giving orders quietly and exhibiting no excitement — a hugely calming effect on his men after receiving a bombardment lasting several hours. The book demonstrates that there are virtually an infinite number of reactions to the same stimulus. It’s a choice that we make regarding how we react that affects us internally as well as affecting those around us.

    One antidote to stress is effective training. I suspect that special forces training works in part by giving troopers the confidence that they can deal with whatever happens. That confidence minimizes stress reactions and facilitates focus. More trivially, NBA practice works the same way, The hook shot becomes an automatic motion. You don’t think about it, you just do. When you stop to think, you miss. The mental reaction to missing causes more misses.

    Parents can instill that confidence as well, but I suspect most don’t, lacking it themselves.

    • Mr. Crain, just so happens, Union General Gibbon celebrated his birthday on April 20 – his 195th. They do not permit such ranking officers to be so close to combat today. Who cannot identify with General Gibbon’s lead-by-example leadership? It was certainly a distraction to the opposing force. This helped his troops to avoid becoming overwhelmed against the insurmountable odds posed by Pickett and the Confederate forces. By doing, so his courage emboldened his troops and kept them focused on the task at hand lowering fear. This allowed for the stress of the battle to be channeled into the counter force needed to push back on the attack. I saw the monument to Gibbon in Gettysburg and have a nice photo taken in the soft light of sunset, where men clad in Union uniforms blow taps each night during the summer.

      • Another Civil War buff? Awesome. My great grandfather as a teen was a Kentuckian who enlisted in a Pennsylvania cavalry regiment and fought at Gettysburg. I’ve often thought that the way the pieces came together at Gettysburg to prevent a rebel win seems like a strong argument for the presence of some kind of higher power. I know from documents that my ancestors viewed slavery as a terrible sin.

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