Boiling the frog: How tech intensifies burnout and how ‘flexibility’ can help

Last year a report by Microsoft Work Trend Index showed that Australian workers were the most burnout of those surveyed, with 62% reporting that they felt ‘burnt out’ during 2022. Extensive research across multiple countries has shown work intensity has been steadily rising over the last two decades. Heavy workload is a major cause of work-related stress, depression, and anxiety, which are all key indicators and symptoms of burnout . In the UK, an alarming report at the end of last year showed that 1 in 6 of the workforce was sick with more than 50% of those illnesses being work-related mental health issues. The term burnout is now ubiquitous, and it could be argued that almost everyone has now experienced this syndrome at one point or another over the last few years. Journalist Sarah O’Connor in the Financial Times last year, referenced statistics showing that whilst work has become physically safer. It has become psychologically more dangerous as workloads and expectations become unmanageable.

Graph showing muscoskeletal disorders and psychological disorders occuring as a result of work — Source: Health & Safety Executive. Originally published in Financial Times December 15, 2022

The key components of burnout include exhaustion, detachment from work and inefficacy, the sense that you can’t accomplish what you need to with the resources you have. Christine Maslach and Michael Leiter, psychologists, and leaders in the research of Burnout, define it as a syndrome “emerging from chronic interpersonal stressors at work”. It is these interpersonal stressors that have been accelerating over the last two decades, so what is driving the acceleration?

Computers, clients, and colleagues

The constant use of technology is a key component in the increasing intensification of work over the last two decades. In a recent article titled “Working Still Harder”, Professor Francis Green of University College London and his colleagues found that the rising complexity of computers and related technology was the key factor for this rising intensity.

Similar findings were also found in a 2021 paper by the Institute for the Future of Work, who found that the next two biggest factors in work intensity were demands from clients and colleagues (including managers). We can understand work intensification as being driven by the accelerating intensity of client, colleague and manager demands, the engine of this acceleration being our digital technology.

Demands from clients and colleagues now pervade our homes, and what used to be our personal time. No wonder that people feel as though the intensity of work has increased. We are always on. This constant ‘always on’ state meaning that there is little time to rest and reflect on the work being completed and to generate the new ideas and approaches that are critical for creativity. Not only do these demands feed into exhaustion, but they can drive a sense of inefficacy and the resulting cynicism that was captured in the “quiet quitting” movement of 2022.

A corrosive contagion

Burnout is a contagious syndrome and as such it can be a toxin that poisons the culture of a workplace. However, according to research by the McKinsey Health Institute last year, organisations underestimate the role that they play in creating this syndrome. What tends to happen as a result is that wellness programs are rolled out, which whilst well intentioned, put the responsibility of managing and dealing with this syndrome back on the individual. It becomes another thing for them to do or complete or succeed at whilst the same issues creating the problem remain. Without meaningful organisational change, individual efforts to cope with burnout are likely to fail, feeding into those feelings of inefficacy and cynicism, or worse.

What can be done? ‘Psychological Flexibility’ and ‘Self-Efficacy’

Research by Jacqueline Brassey and colleagues from McKinsey Health Institute state that the starting point for change is with leadership teams. The effective role modelling of behaviours by leaders can help to alleviate their own symptoms of burnout whilst adapting behaviours that change how team’s function. Without positive examples of leaders tackling these problems for themselves and their teams, broader organisational change is impossible.

Brassey and her colleagues found that teaching the skills of what is known as “psychological flexibility” has a significant impact on a leaders sense of efficacy. Remember that efficacy or its lack of, is a key component in the development of burnout. In fact, Michael Leiter, one of the leading researchers in the field refers to burnout as a “crisis in self-efficacy”.

Psychological flexibility is the capacity to remain in the present moment despite unpleasant thought, emotions, and bodily sensations; whilst choosing to act based on the situation and one’s values. Psychological flexibility has been found to be highly effective in the treatment of mental health issues in clinical and workplace settings.

The 3 core pillars and six sub processes of Psychological Flexibility

No alt text provided for this image — Image: The 3 Pillars and Six Core Process of Psychological Flexibility. Reference: Harris, 2009

1. Being Open to Experience, with Acceptance and De-fusion

Being open to experience, is being aware of the different thoughts, emotions and sensations taking place. Opening to experience involves acceptance, something often misunderstood as passivity. What acceptance means is an act of will based on what is here now, what is available. Defusion, relates to identifying internal experiences such as thoughts as being just that, experiences, not fixed truth. In fact, it is easy to think of defusion in context of its opposite, fusion. Psychological flexibility is about ‘de-fusing’ or creating some space between our thoughts and emotions, not being caught up in them.

2. Being Present, via contact with the present moment and ‘Self-as-context’

Being present means maintaining a non-judgmental awareness of what is happening now, without trying to change it. It is otherwise popularly known as mindfulness. Self-as-context can be understood in comparison to its opposite which is ‘self-as-content’ i.e. you are the content of your thoughts and feelings. Self-as-context refers to the sense that you are the one experiencing the content of your mind, rather than being the content itself. An example of ‘self-as-context’ is when a mistake is made at work, or a conflict arises, the individual sees this in context of the bigger picture, rather than catastrophising this event into their downfall.

3. Do what matters, informed by Values and through Committed Action

Doing what matters implies that you need to know what is important before committing to action. This commitment requires the understanding or discovery of your values so that your goals align with them. Values are the compass pointing in a certain direction, whilst goals are the destination. To reach this destination, committed actions are required to follow through, action that persists even when unpleasant bodily sensations, feelings and thoughts arise.

Self-Efficacy and the benefit of social support

Through two 4.5 workshops and one 2.5 hour ‘booster’ workshop, Brassey and her colleagues from Maastricht University and the McKinsey Health Institute demonstrated that the psychological flexibility skills listed above could be cultivated and that this had a positive effect on self-efficacy, one of the key factors in burnout.

One of the benefits of developing these kinds of skills in a group setting relates to the social context and support inherent in the training. Extensive research has shown that one of the best treatments for burnout is providing social support for those struggling. Group settings remove the isolation and misplaced sense of personal failing and provide social reinforcement and support for learning new skills.

Caveat and conclusion

What is important to note here is that psychological flexibility doesn’t mean happiness. The aim of developing these skills isn’t to promote a grin-and-bear-it attitude, but to help people navigate the shoals of shifting circumstance.

Maslach and Leiter make clear in their research that Burnout, is syndrome fundamentally caused by organisations and as such requires an organisational response. One of these organisational responses is equipping leaders to role model the right behaviours so they cultivate a culture of support. Psychological flexibility is a mindset and set of behaviours that can be a pillar of this support. The development of these psychological skills is an evidenced based way of alleviating one of the key factors in burnout, self-efficacy. However, without additional changes to organisational elements like workload, employee autonomy, rewards and quality performance reviews, these efforts will be in vain.

Burnout: The long shadow of idealism?

In order to burn out, a person needs to have been on fire at one time
Ayala Pines

COVID-19 has shone an overdue light on the indispensability of workers that we often take for granted. Nurses, doctors, social workers, taxi drivers, cashiers, cleaners and many others. Whilst many of us have had to adjust to the comparatively mild inconveniences of working from home, these workers are often putting their health at risk to deliver essential services and care. As this emergency and lockdown continues, these workers will need access to comprehensive support to stave off and manage the effects from burnout. The term burnout is most commonly used with reference to those who exert significant “emotional labour” in their work, which refers to the requirement of managing emotions and feelings whilst dealing with people (i.e patients or customers) with the term becoming ubiquitous across not just healthcare but also professional services occupations.

Burnout, more than just exhaustion

A recent definition by Christina Maslach of the University of California, who originally coined the term and Michael Leiter, currently at Deakin University, provided a concept of burnout as:

“…the index of dislocation between what people are and what they do. It represents an erosion of value, dignity, spirit and will – an erosion of the human soul. It is a malady that spreads gradually and continuously over time, pulling people into a downward spiral from which it is hard to recover.”

For Maslach and Leiter there is a dislocation of what people are and what they do, causing a split where actions no longer reflect values. This split leads to a chasm of meaningless that in turn can become a downward spiral of rumination, self-doubt and eventually depression. The dislocation means that the underlying values that supported an initial devotion or idealism have shifted or dissolved, usually as the result of some perceived or actual failure or a head-on collision with a difficult occupational reality.

What is interesting about the above is the inclusion of words such as values, spirit and soul. This definition by Maslach and Leiter alludes to the fact that burnout syndrome, cannot be viewed simply as exhaustion but as something related to existential loss of meaning and purpose. Viktor Frankl, the late psychiatrist, holocaust survivor and founder of Logotherapy could have the key to understanding why burnout is becoming more common. Frankl’s overarching philosophy of the “will to meaning” suggested that to avoid depression and existential despair, one had to authentically live out one’s underlying values by paying attention to what is meaningful. These values are not necessarily moral, but are related to a deeper sense of what attracts your attention, focus and sustained, conscious action; an integrated embodiment of an individual’s orientation toward and action within their framework of meaning.

For Frankl, he believed that the decline in spiritual and religious life, what he referred to as the noetic dimension, had led to a vacuum of meaning which had been filled by a new kind of devotion to work and it is this devotion, which can sew the seed for burnout. In research published last year by Norbert Riethof and Petr Bob, in Frontiers of Psychiatry, the initial stage of burnout actually involves very intense experiences of meaningful life and work, a kind of idealism or devotion that by the end of the burnout process has been lost following a perceived failure to live up to impossibly high expectations.

A bright burning candle casts a long shadow and the shadow of idealism appears to be burnout.

There is a counterintuitive element here, which is that burnout appears more likely to affect those that demonstrate a higher level of idealism in their work. Idealism can be a valuable trait for an individual and the organisation they work for as it motivates people to make a difference and go beyond what is asked of them. However, the resulting excitement elicited by this acute sense of meaning, can lead to excessive dedication (perfectionism), a lack of clinical or personal detachment and an obscuring of insight into the knowledge of one’s own limitations. A bright burning candle casts a long shadow and the shadow of idealism appears to be burnout.

Excitement and stress are two sides of the same coin with both of these emotions releasing the stress hormone cortisol, which the body uses to prepare for action. The secretions of these hormones build up over time and if behaviours and work practices aren’t changed, they can have a serious effect on physical and mental health leading to a potential breakdown and in the most extreme cases, suicide. In the United Kingdom a 2018 study found that the probability of doctor’s committing suicide was five times higher than the general population, with a significant factor being the pressure that doctor’s are under due to a lack of resources.

The difficulty with the term “Burnout”

The trouble with managing burnout partly comes from the difficulty in its definition and diagnosis. In a recent survey of intensive care health professionals the overall number of those categorised as suffering from burnout ranged from 3% to 40% depending on how the syndrome was defined. Part of the difficulty of “diagnosing” burnout is due to its interaction with other mental health issues like depression, begging the question, how much is the term ‘burnout’ simply a socially acceptable label for someone actually suffering from depression? Some of the key descriptions of burnout; loss of enjoyment in things you used to find enjoyable (such as work), persistent fatigue, apathy and cynicism are actually key diagnostic criteria of the American Psychological Association for major depressive disorder. In addition to this, 2017 research in the Journal of Neuroscience and Biobehavioral Reviews, found that there was no distinction between the biological markers in the brain of those diagnosed with burnout compared to those diagnosed with major depressive disorder.

The ubiquity of the term ‘burnout’ leads to a number of issues. Overdiagnosis of the syndrome leads to a perceived normalisation of this as a necessary occupational hazard, resulting in acceptance and no urgency in developing the appropriate support frameworks. This resulting lack of support can lead to declining levels of work productivity, job satisfaction, employee engagement and increasing levels of stress and depression. Finally, it appears as though using the term is becoming a euphemistic veil for what is actually depression, something which could prevent someone seeking help due to a normalisation of this as a facet of professional life.

Beyond burnout

Mindfulness training has recently received a lot of attention from researchers and organisations as a technique for reducing physical and mental stress. Mindfulness meditation, leveraging present moment awareness, can help to create space between thoughts, emotions and actions. This “space” can help to improve cognitive empathy, otherwise known as detached concern, whilst learning to manage and not get caught up in emotional empathy, or taking on the emotional states of other people (patients, customers). This awareness can also provide an insight into an individual’s limits, informing them of when to take a step back and some time out, whilst also providing a positive perspective on purpose and achievements. The practice can act as a kind of ‘reset’ of the mind, a process that un-conceals values and brings awareness of actions, allowing a restoration of meaning through integration of both.

Beyond personal practices, a broader shift in how workplace mental health is dealt with, including the communication and support for those with occupationally specific depression could also have a significant impact. A comprehensive review of burnout treatments in 2010 found that a combination of personal and group interventions provided by organisations had the largest effect on managing burnout in individuals. This was partially due to a greater level of acknowledgement about burnout and its potential as an occupational hazard, in turn providing people with support and also an implied understanding that those suffering weren’t alone in how they were feeling.

Bringing it all together

The after-effects from the strain of this crisis are likely to be felt most acutely when the lives of most of us go back to normal. The present moment is a critical opportunity for us to re-evaluate the importance of these individuals, putting in place the proper resources and support to ensure that we protect those that are under so much strain at this time. By developing the adequate support structures for those in critical care industries, organisations can reduce the number of workers lost to burnout and workplace depression, in turn maintaining continuity of standards, care and service for those that rely on them.