How to combat burnout

Yohanna Berhanu is a third-year PharmD candidate at the West Virginia University School of Pharmacy.

At one time or another, you may have experienced some form of burnout. It almost feels as though your brain is on autopilot, simply going through the motions. This aimless transit through life is brought on most commonly by an exhaustive or stressful environment. Given the grueling nature of pharmacy school, many student pharmacists experience this feeling at some point in their journey. You know the feeling—the feeling of pure dread flowing through your veins as you frantically cram for one exam after another, with assignments and quizzes sprinkled in between.

On top of school, many student pharmacists also try to be involved in pharmacy-related organizations, which may likely come with time-taking responsibilities. As a student pharmacist, I can personally attest to the chronic stress and feeling of having 20,000 things on my to-do list.

The origin of the term “burnout”

In order to truly understand what burnout is, it’s important to first uncover its etymology. The term “burnout” was first coined by psychologist and Holocaust survivor Herbert Freudenberger in the early 1970s.¹ At this time, Freudenberger had already established his life in the United States and began working as a clinician for clients dealing with substance use disorders.¹ He initially came up with the term one day after he was suddenly unable to get out of his bed and found himself completely drained of his energy and any semblance of joy.¹

Of course, being a psychologist, Freudenberger closely analyzed his feelings and came up with the syndrome of burnout, which he details in Burnout: The High Cost of Achievement, the book he wrote with Geraldine Richelson.¹ This book was ahead of its time because of the way it opened up the conversation of Freudenberger and his patients’ experiences with burnout. Of the people mentioned, Freudenberger distinctly highlights the fact that burnout appears to be most prevalent among overachievers due to their tendency to overwork themselves while not receiving the instantaneous satisfaction of a reward. For those seeking guidance, Freudenberger also mentions how to identify burnout in oneself along with a stepwise approach on how to combat this feeling. Moreover, he discusses in great depth about how burnout is the body’s response to stress and the gateway to other altered, complex emotions.³ In addition to Freudenberger’s contributions, present-day research has shown us that burnout can pose a risk for the development of other psychiatric issues including anxiety and depression.³

The scientific basis of burnout

Though not formally recognized in The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), scientists have taken various routes to explain the phenomenon of burnout. Some of the signs and symptoms of burnout include anxiety, exhaustion, poor performance, reduced motivation, irritability, isolation, altered sleep, and reduced immunity.^3–8 The two main overarching themes characterized by long-term burnout are changes in DNA methylation patterns and the dysregulation of the hypothalamus-pituitary-adrenal axis (HPA axis).⁵ At a baseline, genetics and environment closely interact with each other through the epigenetic mechanism of DNA methylation patterns.⁵ As an adaptive mechanism, DNA methylation makes certain gene loci are more or less accessible for transcriptive purposes, which can be a double-edged sword with either helpful or harmful effects.⁵

Existing research has successfully linked the changes in the integrity of DNA’s structure with the presence of various inflammatory biomarkers as well as disruptions with serotonin transport pathways. Of the biomarkers, cortisol appears to be the most influential and heavily studied.⁶ In normal human physiology, cortisol serves as a potent stress hormone that is highly regulated by the HPA axis and thus pushes the body into “fight or flight” mode.⁷ This means that cortisol alters metabolic processes that pertain to storage and rest by raising blood glucose, blood pressure, and heart and respiratory rate, as well as slowing down digestion and suppressing immune responses.⁷ Moreover, there is evidence to attest to the role chronic burnout and high cortisol levels play in impaired immunity and sleep, as well as various disease states such as cardiovascular disease and many other life-shortening comorbidities.^4,7

The effect of the COVID-19 pandemic

It would be an understatement to say that the COVID-19 pandemic has increased the number of student pharmacists with burnout. With students often isolated from their regular friend groups and confined to their homes, this left many students hyperfixated on school. As a student who entered pharmacy school during the pandemic, I quickly became burned out. Each day felt never-ending, with hours on Zoom for lectures and then the remaining hours of the day spent deciphering what was taught without even stepping out of my living room. Moreover, not having a conspicuous barrier between school and home life led me to spiral into a hyperfixated and, subsequently, detached state.

But student pharmacists are not one monolithic group, and personal learning styles can also affect the perceptions of burnout. As more and more school events return to in-person meetups again, I believe the next hurdle student pharmacists will face will be the need to become accustomed to interpersonal communication and career networking.

From one student pharmacist to another

Each student pharmacist knows firsthand the extensive workload of pharmacy school. Here are some tips I have compiled on how to combat burnout:

• Prioritize your mental and physical health.
• Take breaks—you need breaks!
• Participate in self-care (e.g., exercising, watching movies, writing, painting).
• Don’t just sleep, but rest.
• Acknowledge and celebrate wins, no matter how big or small.
• Learn how to calm your soul.
• Journal your feelings.
• Identify and avoid unnecessary stressors.
• Know that it is okay not to be perfect.
• Seek out both personal and professional connections.
• Make a daily screen time limit to avoid overworking.
• Do something you enjoy doing that is nonpharmacy-related at least once a week.

References

1. King N. When a psychologist succumbed to stress, he coined the term “burnout.” All Things Considered. www.npr.org/2016/12/08/504864961/when-a-psychologist-succumbed-to-stress-he-coined-the-term-burnout
2. Freudenberger HJ, Richelson G. Burn-Out: The High Cost of High Achievement. Bantam Books; 1981.
3. Ashraf F, Ahmad H, Shakeel M, Aftab S, Masood A. Mental health problems and psychological burnout in Medical Health Practitioners: A study of associations and triadic comorbidity. Pak J Med Sci. 2019;35(6):1558–1564. doi:10.12669/pjms.35.6.444
4. Bayes A, Tavella G, Parker G. The biology of burnout: Causes and consequences. World J Biol Psychiatry. 2021;22(9):686–698.
5. Penz M, Wekenborg MK, Pieper L, et al. The Dresden Burnout Study: Protocol of a prospective cohort study for the bio-psychological investigation of burnout. Int J Methods Psychiatr Res. 2018;27(2):e1613
6. Wendsche J, Ihle A, Wegge J, et al. Correction to: Prospective associations between burnout symptomatology and hair cortisol. Int Arch Occup Environ Health. 2020;95:779–788.
7. Jonsdottir IH, Dahlman AS. Mechanisms in: Endocrine and immunological aspects of burnout: a narrative review. Eur J Endocrinol. 2019;180(3):R147–R158.