Mental Health

Burnout & Recovery, Part 2: The Marathoners Model

[Part 1 of this post is here.]

I made the mistake of Googling “How to recover from burnout.”

Seriously, don’t do it. No, really, I —
Well, okay. Don’t say I didn’t warn you.

Now that you’ve done what I did and maybe scrolled through some of the amazing tripe that’s out there as advice, lemme tell you: ignore 98% of it.

One of the reasons I no longer practice something called “Solution-focused Brief Therapy” (SFBT) in spite of it being a highly-touted, evidence-based therapeutic intervention, is because it is at best a bandage solution, meant to deal quickly and (IMO) superficially with potentially significant client issues… all for the purpose of returning them to the workforce as Productive Members of Society as fast as possible, thus minimizing impact to the EMPLOYERS and their INSURERS. I’m not going to call it a scam outright, because it does provide some real, albeit temporary, relief to those who seek it. But it’s not an approach I respect for the simple reason that it’s predominantly used to tape up psychic injuries and send internally-wounded folks often right back into the very teeth of the stressors that are grinding them down in the first place.

And you know what that leads to? Burnout. Bandaids ain’t gonna hold jack-shit when we’re talking about the psychological equivalent of disembowelment. (Why yes, I *DO* have Very Strong Opinions on this topic, why do you ask??)

Workplace burnout is fast becoming the primary reason why employees take stress leave, even though what is likely covered by their insurance (assuming they have the luxury of coverage in the first place) is far below what’s actually required for recovery. From an American Institute of Stress 2022 study:

Workplace stress is one of the largest hurdles you can experience on the job. Stress at work comes in all shapes and sizes, across all types of industries and careers. After extensive research, our data analysis team concluded:

  • 83% of US workers suffer from work-related stress, with 25% saying their job is the number one stressor in their lives.
  • About one million Americans miss work each day because of stress.
  • 76% of US workers report that workplace stress affects their personal relationships.
  • Depression-induced absenteeism costs US businesses $51 billion a year, as well as an additional $26 billion in treatment costs.
  • Middle-aged participants had a 27% increase in the belief that their financial status would be affected by stress in the 2010s compared to the 1990s.
  • More than 50% of workers are not engaged at work as a result of stress, leading to a loss of productivity.
  • Companies spend around 75% of a worker’s annual salary to cover lost productivity or to replace workers.
  • The main causes of workplace stress are workload (39% of workers), interpersonal issues (31%), juggling work and personal life (19%), and job security (6%).

That’s a pretty bleak picture, and I suspect the Canadian numbers correlate relatively closely. Under Canadian employment law, “if you are a full-time employee with a work week of 37.5 hours, you earn sick leave at the rate of 9.375 hours each month for which you receive 75 hours pay. Sick leave is prorated if you are a part-time employee.” Under the Ontario Employment Standards Act, “Most employees have the right to take up to three days of unpaid job-protected leave each calendar year due to a personal illness, injury or medical emergency. This is known as sick leave.” Good to see in print that even our federal and provincial governance can’t agree on how to effectively manage sick leave, which is what employees are requesting when they are asking for stress leave. THREE DAYS??? Oy.

Unsurprisingly, many people start with the same assumptions about a stress leave that they might take into a vacation break: it’s time away from work, I’ll feel so invigorated, I’ll get so many non-work projects accomplished, I’ll make such great use of my now-free time! I’ll find a new job! But even a couple of weeks into a leave, they find they often Just Can’t Even, and that’s when they often wind up in my office, or offices like mine. They’re wondering where their motivation went, and why can’t they seem to feel any better even with the time they’ve already taken off.

Burnout is a state that affects us on every level: physically, emotionally, mentally, and relationally. That means recovering from burnout needs targeted recovery processes (note the multiple there) aimed at each and every one of those aspects. And because burnout is often the product of long exposure to the stressORS that have ground us down to mush, it operates very much like a long-term illness. We’ve been “sick” for a very long time, even if we didn’t realize it until that sickness brought our functionality to a crashing, crushing halt. Ergo, we’re not going to “fix” it with a weekend of sleep, a two-week vacation, or even a two-month stress leave. We just can’t. THAT’S NOT HOW BURNOUT WORKS. (And yet, that’s what employers and insurers want us to believe because it benefits them, or they believe it does, to have their employees back in the trenches as fast as possible, recovered or not. They want the bandaids, because then they don’t have to fix their own destructive, systemic issues that create the stressors in the first place.)

So then, how DOES one recover from burnout, if at all??

The first step is recognizing the difference between the stressors, and the stress. Stress is what you experience as a result of a variety of factors (the stressors) having an ugly, corrosive impact on your quality of life.

Stressors are what activate the stress response in your body. They can be anything you see, hear, smell, touch, taste, or imagine could do you harm. There are external stressors: work, money, family, time, cultural norms and expectations, experiences of discrimination, and so on. And there are less tangible, internal stressors: self-criticism, body image, identity, memories, and The Future. In different ways and to different degrees, all of these things may be interpreted by your body as potential threats.
Stress is the neurological and physiological shift that happens in your body when you encounter one of these threats. It’s an evolutionarily adaptive response that helps us cope with things […] [I]t activates a generic “stress response,” a cascade of neurological and hormonal activity that initiates physiological changes to help you survive[.] Your entire body and mind change in response to the perceived threat.”
(Nagoski & Nagoski, “Burnout: The Secret to Unlocking the Stress Cycle,” Ballantine Books, 2019)

Burnout, therefore, is the result of living within the cascading effects of that threat-response pattern over the long term. And as a long-term issue, the recovery is also going to be a long-term process. How long? Well, that depends on too many factors to have a standard formula, but from my perspective, what I’m seeing is that the deeper the burnout, the longer the recovery will take.

I have come to liken what’s actually required for recovery as being akin to what happens when a serious athlete, like a marathon runner, breaks a leg.

At the point of the break, the marathoner does NOT think, “Hey! Now I can go and run all those OTHER races I’ve been meaning to get to for months/years!” No, the marathoner is going to be KEENLY aware of the damage and the pain… something burnout victims are notoriously bad at acknowledging (something, something, frogs in pots of slowly-heating water, something…). In a best-case scenario, the marathoner can get off the course and into help and safety immediately. Sometimes the break happens and the marathoner is going to have to continue on for a while before escape to treatment can happen, which means the pain will be inescapable once realized, and the damage might get worse before it has a chance to get better. Obviously, we want systems that support the former, but all too often we’re trapped in systems that enforce the latter.

Once the marathoner is off the course, then we’re into a healing process that looks a lot like this, and this model is what I’m now using with my burnout clients:

  1. First things first, the break needs a chance to actually heal: knitting bone and soft tissue back together, sometimes with professional intervention, but mostly just letting the brain and body do what they need to do to put broken pieces back together. THERE IS ABSOLUTELY ZERO LOAD-BEARING ACTIVITY AT THIS POINT. There can’t be; the broken bones won’t tolerate it. There’s a lot of rest. This stage usually takes several weeks for both bone breaks and for burnout.
  2. Then, once the bone has knit and the soft-tissue damage or inflammation has largely receded, THEN AND ONLY THEN will a doctor give the okay to start physiotherapy and rehabilitation. This is the stage in which the marathoner is trying to teach new tissue how to do basic things like move and flex, and integrate with the existing tissue. Agin, not a lot of load-bearing activity here. In burnout terms, this is the stage in which people start to do basic functions in their own lives, like tend to personal care or basic relational interactions. They might start THINKING about whether or not to update their resume, but they’re generally in no great energetic state to put their best selves forward in interviews. This stage can take literally MONTHS for both the marathoner and the burnout client.
  3. After that, and only once the medical and phsyio supports sign off, can the marathoner even THINK about starting to move like normal. They’re certainly not in a state to go back to running, but they might be able to take a walk to the end of the block and back. They’ll eventually work up to making it a sloppy shuffling runwalk, and be constantly monitoring the new tissue for pain or other signs of damage. THIS is also a stage that can take months to progress through, and this is the stage where both athletes and burnouts are likely to push too hard too fast, and experience inevitable setbacks when the recovery process proves unequal to the desire to just get on with things.
  4. When there’s a generally-consistent ABSENCE OF SYMPTOMS related the break/burnout for period of time approved by the support system (NOT the recovering individual), THEN AND ONLY THEN is the individual at the state where they can BEGIN to start retraining their body to work back up to a level of pre-break functional capacity. This is NOT the stage at which the marathoner goes and runs a 26-mile race. This is when they start actually running to see how far they can get, or they start for endurance but take it at a quarter-speed. This is when the burnout client MIGHT return to work one or two days a week on light duty.
  5. From there we collectively eyeball a “return to full-function” target but maintain a consistent and careful watch on how the recovering individual does with resumption of the load-bearing factors.

Throughout this, the burnout client, like the marathoner, is hopefully working on adaptive skills to better balance the stressors that created the state of collapse in the first place. This may involve being honest with themselves about what they can and can’t handle; this may involve needing to do different work on managing stressful relationships. This may require changing jobs, or dealing differently with health issues. Some of these factors CANNOT be addressed by quick-fix bandaid solutions, and the entire recovery process is NOT a short-term affair. Burnout can literally take YEARS to recover fully; that part is defined mostly by the client’s ability to adopt and sustain more effective capacity-management strategies, not just “coping” strategies.

Clients don’t like hearing that they could be recovering from burnout for a long time; most people don’t like the notion of being compromised, because it will mean having to change how they live, how they behave, and how they view their own capability, differently for the duration. Employers don’t want to hear that they may be paying full or partial salaries for absent employees for months on end, and insurers put out so many hoops and challenges to those applying for stress leave that it makes it hard to onside medical and mental health professionals who are required to provide corroborating evidence of the client’s mental state for the duration.

I get it. It’s hard. So is being laid up with a broken leg when you’d rather be out running the Boston Marathon or through-hiking the Appalachian Trail. But the point at which you’re willing to acknowledge that something is broken is NOT the point to simply switch gears/stressors and keep applying load to something that has been broken down by bearing too MUCH load for too long.

Heal first. Then start to retrain or add adaptive skills. THEN start to work back up to load-bearing functionality. THEN re-assess that capacity, and make whatever changes will be necessary to maintain yourself at non-breaking levels.

It’s a slow process, but so far, it’s the only one I have seen work, and I’ve been looking at the issues of burnout for a really, really long time.

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