With women at greater risk of burnout and the health implications that accompany it, medical researcher and female health advocate, Dr. Emily Handley asks how we recognise when it’s time to say no.

What is burnout?

Burnout is a slow, progressive loss of motivation and focus that occurs after long periods of sustained stress. Women are at a greater risk of developing burnout, leading to many feeling an overwhelming sense of exhaustion that they can’t shake off. So how do you recognise when it’s time to start saying no?

Burnout is defined as a psychological state of mental, physical, and emotional exhaustion, caused by prolonged high levels of stress. Constant demands from various spheres of life lead to a feeling of being overwhelmed and drained, with a loss of interest and motivation for everyday tasks. Burnout can reduce energy, create feelings of resentment and hopelessness, and even make you more vulnerable to illness.  With new scientific technologies, we now know that burnout isn’t just an emotional or psychological response, nor is it a fleeting feeling of fatigue or being ‘unwell’. Burnout can change the structure and function of our brains, altering how our bodies function overall.

Rather than a sudden onset of symptoms, burnout is an insidious progression of thoughts, feelings and actions moving through a series of stages. Initially, these changes may not seem worth taking note of, but they can lead to chronic phases that impact your quality of life. The five main stages of burnout are:  

The honeymoon phase – This stage is full of energy and optimism – you take on a new task or start a new role, feeling only satisfaction from periods of high productivity and prolonged focus.

The onset of stress – As the honeymoon phase fades, stress beings to permeate much of the day. It is now that mental and physical signs may start to appear; you begin to lose focus easily or lose productivity during the day. Fatigue sets in, which makes it increasingly difficult to enjoy your hobbies, spend time with loved ones, or sleep at night.

Chronic stress – This is when stress becomes a constant companion and consistently affects your work and your quality of life. You may be late for work, procrastinate more than usual, and experience feelings of apathy, as well as withdraw from your social life. In more extreme cases, this can be accompanied by bursts of anger or frustration, causing you to lash out at co-workers and family, impacting these relationships.

Burnout – You’ve now crossed the threshold into burnout. You can no longer function as you normally would, and typically minor problems become overwhelming. Feelings of self-doubt and numbness appear, and physical symptoms include headaches and gastrointestinal issue. At this stage, friends and family may be noticing these changes.

Habitual burnout – When left untreated, burnout becomes a part of everyday life, potentially leading to a depressive episode. Chronic and mental fatigue prevents you from working or enjoying your normal life, putting your relationships and career in jeopardy.

What causes burnout?

People who have poor self-esteem or unrealistic expectations of themselves are often more likely to develop burnout. It’s exacerbated by unmanageable workloads; unfair treatment at home or in the workplace; conflicting or confusing responsibilities; lack of communication or support from managers or loved ones; and intense pressure for deadlines to be met.

Studies from the workplace now show that women are more likely to burnout faster than men, due to a feeling of time stress. This refers to the reluctance of women to delegate; the likelihood of putting the needs of others over their own; and the socialisation of being seen as ‘agreeable’. On top of this, working women are more likely to take on responsibilities in the home. Being more sensitive to the emotions of others, women are even more likely to minimise their own feelings, making it difficult to have insight to potential signs of burnout.

Significant challenges in avoiding burnout have also emerged with the onset of the COVID pandemic. Women experience significantly greater fatigue from online meetings, with studies suggesting video calls may exacerbate gender dynamics in group settings. Women have reported being far more aware of their nonverbal cues, adding to the mental load, as well as carrying higher levels of emotional labour during the meetings themselves.

Most conversations about burnout focus on emotional responses or functioning; yet the condition has a profound toll on our physical wellbeing. Burnout can overwhelm our cognitive functions neuroendocrine system, leading to stark changes in the structure of our brains. The kicker? The changes induced by burnout in the brain are even structurally similar to those who have suffered severe early-life trauma.

Physical effects on the brain

People with burnout have much greater difficulty in regulating negative emotional responses when compared to those without burnout, leading to more intense reactions to negative stimuli – such as startle responses. Other studies have shown that those with burnout, when asked to lie down quietly, have key differences in the brain area responsible for emotions such as fear and aggression – known as the amygdala. The amygdala is enlarged in those with burnout, with weaker connections between it and the anterior cingulate cortex, responsible for emotional processing. The greater the stress a person experienced, the weaker the connections between these brain regions.

Connections are also weakened between the amygdala and the prefrontal cortex. The prefrontal cortex is the ‘control centre’ of our brains, where we execute complex functions. In those with burnout, this may explain why it becomes increasingly difficult to regulate negative feelings.

It’s not just our brain functions that change with burnout: the structure of these regions is altered. The frontal cortex, essential for overall cognitive function, shows greater thinning over time with those with burnout compared to others, similar to an accelerated form of aging. Additionally, burnout can result in an enlarged amygdala in tandem with shrinkage of related regions, overall altering how we perceive ourselves in the workplace and the home.

These changes results in a vicious cycle, where the overactivity of the amygdala impairs the modulation of prefrontal and frontal brain regions, further triggering amygdala activity, and leading to greater activation of frontal regions. As this cycle continues, these regions continue to wear down, leading to difficulties in attention and memory.

Burnout has a profound effect on the regions of our brain responsible for emotional regulation and stress responses; so, accordingly, the condition creates chaos in our neuroendocrine system. In people with burnout, the body can no longer produce higher levels of cortisol – our stress response hormone – in response to stimuli. Chronic low levels of cortisol are linked to stress and trauma, and can induce consistent, low-grade inflammation throughout the body. Burnout is also a significant risk for conditions such as heart disease, with some studies suggesting chronic stress is as bad for the body as smoking.

Yet not all hope is lost; while research is ongoing, it is thought that if dealt with in time, the effects of burnout can be reversed.

How can you recover from burnout?

First of all – be honest with yourself. If you continue ignoring the issue and trying to push through burnout symptoms, you’ll only cement yourself even more firmly in the habitual burnout phase. Once you’ve acknowledged you are experiencing the first phases of burnout, find someone you trust to confide in; be it a loved one, your GP, or even a work colleague if your burnout symptoms are work-related. Try to identify which parts of your life are causing you the most stress – can you ask others to help you more often? Are you still shouldering the mental load at home? Take a day or two to yourself to step back and clearly assess your situation.

Once you know which factors may be overwhelmingly contributing to burnout, try to mitigate how much time you dedicate to these tasks. Importantly, schedule time every day that is just for you. Self-care is often associated with massages and wine, but it can also look like a walk at lunch time, turning off your emails over the weekend, or carving out 15 minutes to exercise in the morning.

Be strict with your limitations; women in particular are socialised to say ‘yes’ to everything, feeling that this dictates your value. This is a double-edged sword, where you begin to drown in your roles. It’s easy to tell someone to ‘just say no’ but much more difficult to implement it after a lifetime of doing the opposite. To help with this, make sure those around you are aware that you are trying to step back from taking on too many tasks. It’s not just on you to help yourself; you need your network to be with you on this, and to support you stepping back from taking on too much.

Be clear with your daily schedule, and the separation between work, chores, home and leisure. It’s easy to slip into bad habits, such as replying to texts immediately, checking emails later at night or feeling obliged to spend time with acquaintances you quite frankly don’t care all that much about. All of these in and of themselves appear innocuous, but precipitate forming habits that can lead to the phases of burnout once more.

Finally, if burnout is hampering your quality of life, speak to your GP. They can refer you to a mental health provider, as well as advise coping strategies. Ultimately, burnout occurs when the balance between the demands of work and other stressors outweighs that of relaxation, control and recognition. Burnout impacts all spheres of our lives, and there’s no one-stop-cure for the condition. If you feel you may be at risk of burnout, you can already begin discussions with a GP or mental health professional to make sure are fully aware of what symptoms you may be experiencing. You can turn the tide on burnout, but it’s not an easy task – so it’s critical to be honest with yourself, strict with your limitations, and clear with those around you that you need their support.