Understanding Why Your Brain Does What It Does When You Struggle with Anxiety and Depression

By Carissa Weber, MA, LPC, CSAC

No different than toxic positivity, burnout is one of those words I’m hearing more and more in my private practice. When you look at all the stress going on in the world, it is no wonder the phrase, “feeling burnt to a crisp” is one I hear at least once a day.

But what does it mean to be burnt out? Many of you in the human service field (like teachers, nurses, police, firefighters, social workers, you know, the people that help others) may have heard it, done trainings on it, and have heard management talk about ways to prevent burnout. In this post, we are going to cover the science of burnout and ways to heal from it. I hope you are ready for it!

What is burnout? Probably the best place to start is to define it, am I right? When I looked up the official diagnosis, several answers come up. The very first one (courtesy of the Oxford Dictionary) is “the reduction of a fuel or substance to nothing through use or combustion.” For all you gear heads out there, this makes sense. How on Earth does this relate to a human being?

Having enough working knowledge of engines to make sense of this definition, let me explain. An engine needs a fuel source to work. For example, if your car doesn’t have fuel (whether it is gas, diesel, spent vegetable oil, electric, I could go on), you’re car isn’t going to go anywhere. Sometimes, the engine looses fuel because we are busy using it. Other times (and in stressful situations), the engine can loose fuel from a leak somewhere in the system.

When an engine looses fuel from a source outside of running it dry, a trusty mechanic has to search through many things. Maybe a gasket (which is used to support moving parts of an engine) has dried up and that is the source of the leak. Perhaps the float in the carburetor (which is responsible for metering how much fuel enters the carb), sank in the float bowl, so gas is spewing everywhere (ask me why I know about this). Yet, another issue could be the fuel line busted somewhere along the way.

I think I gave enough examples from an engine not having enough fuel to tie it back into the science of burnout. When we talk about burnout in humans, we talk about how prolonged exposure to stress can “drain the tank.” Personally, I think the above example lends itself well to the science behind burnout.

When we talk about burnout, we have to talk about where it starts in the brain. Can you guess where burnout starts? If you said “it starts in that darn amygdala,” you would be incorrect. Wait, what?! You got it! We start to experience burnout first in our prefrontal cortex.

I bet you are asking “but Carissa, the stress response starts in that darn amygdala, what gives?” Well, you are partially right. If you recall from my post, Fight-Flight-Freeze: The Ultimate Coping Skill, the stress response does start in that darn amygdala. When we experience a long-term stressor (oh, like working short-handed during a pandemic for the last year or so), our prefrontal cortex chimes in. The prefrontal cortex takes a lot of cues from what is going on inside of the brain.

Time to reference my awesome engine analogy! The prefrontal cortex is like the engine’s diagnostic computer. It checks in with the system (the hippocampus, hypothalamus, that darn amygdala, the insula, and all the neurotransmitters), on a regular basis. Typically, it calls bullshit on that darn amygdala’s check engine light. When it starts to notice other symptoms, it starts to panic a bit.

Some of these diagnostic symptoms can come from a poor air sensor (which would be the prolonged release of acetylcholine and norepinephrine). This could come as symptoms of tight muscles, racing heart all the time, and being stuck in the Triple-F response. It could also be that that darn gasket (being the hippocampus) dried up. We can tell that is the case when we struggle to remember things or only remember the bad things. Another diagnostic symptoms that computer recognizes is a stuck float (in this case, the thalamus). We know that is the case because adrenaline is dumping into our system, which leaves us feeling like we have nothing left to give.

With all of this happening, the prefrontal cortex starts to acknowledge that there indeed is a problem. It starts to push aside any sort of positive feedback it is taking in, focusing on the facts the rest of the brain is throwing at it. As this starts to happen, we notice some of the typical symptoms of a stress response:

Once these symptoms hang around for a while, the prefrontal cortex struggles with motivation (thanks to the lack or rest and restorative sleep), the ability to keep the brain focused (because the brain has been flooded with cortisol, norepinephrine, and adrenaline for an extended period of time), and even the ability to remain positive (dare I say, even boarder on the line of toxic positivity).

After a few weeks of noticing the signs that there may be a system failure, the prefrontal cortex does something out of character: it goes offline. Just like a computer chip in your car, it just stops working. Now, if this was an engine, you may notice the car not turning over when you try to start it, or maybe it just comes to a stop for no reason. The same thing goes for your brain. You will notice emotional regulation goes right out the window. The connection your prefrontal cortex had with any other part of your brain just seems to be gone. Heck, your thalamus starts to feel bad for you and starts releasing dopamine randomly. It may help, but ultimately, it is like oil flooding an engine: not helpful.

As the prefrontal cortex goes down, that darn amygdala tries to get this ol’ engine of a brain to restart. That’s right, it takes control. It makes impulsive decisions about reactions. Prime example: being super cynical about things changing. We’ve been there before, but that isn’t quite the top of burnout, engine exploding we’re gearing up for (see what I did there?).

A few more weeks go by. The prefrontal cortex’s check engine light is still on. At this stage of the game, we have entered the stage of denial. Just like with our car, we ignore the check engine light, thinking it isn’t that big of a deal. As this is going on, sleep deprivation kicks in. We start to experience our emotions in a more intense way. This is because the hippocampus has started to shrink under all the pressure. Even that darn amygdala is shrinking. It might be firing on all cylinders, but the walls are closing in on it.

By this stage of stress and burnout, many people start to report chronic headaches (I wonder why), constant muscle tension, and an overall sense of helplessness. Studies have shown at this stage of the game, people’s immune system starts to shut down, making you more susceptible to getting sick. The depression symptoms are really starting to kick in and kick your butt. You may even notice you are isolating yourself more and more.

“You cannot pour from an empty cup. Take care of yourself first.”

– Norm Kelly

Now, a few more weeks pass and your prefrontal cortex decides it is no longer playing games. With cortisol levels higher than ever, a nonstop flow of adrenaline and norepinephrine, the prefrontal cortex says it is done. That darn amygdala panics, and tries to rally the rest of the brain. Unfortunately, the limbic system is drained. This collapse of the limbic system tells your body there is no hope. Nothing left to give. Your brain forgets it’s coping skills, your body goes into “survival” mode, and that’s it. Mental health reigns supreme and lets the depression and anxiety dictate your life.

Now that we know the signs and symptoms of burnout, and a general timeline of how it happens, we now have to look at what do we do to prevent it.

Coping Skills Alert

Before I get started on the list of things in your control to prevent burnout, I need to preface something. There are things within our control to help prevent burnout, and there are things outside of our control. Things outside of our control (like work, medical concerns, family stress), play a role in developing burnout. Unfortunately, we cannot force our employers to change their policies (don’t get me wrong, we need to), or tell our body to stop being sick. This portion is about what WE can control.

Preventing burnout comes down to a few things:

• A realistic and healthy routine
• Taking time to doing something you love
• Evoking healthy communication skills

Now, this is all easier said than done. If you are like me (a busy full-time parent that also holds down a full-time career, a fun side gig, a small farm, a marriage, and a partridge in a pear tree), you’re probably wondering “How on Earth do I make a routine when I work 80 hours a week?” I get it. You’re exhausted. Your motivation goes out the window the moment you finally sit. You feel defeated before you even get started. But there is something to be said about practice (there I go again with that P word). By starting small, and allowing yourself to reward yourself for the routine you are implementing, your brain starts to get it.

The prefrontal cortex starts to light up. It tells the thalamus to turn that routine into a habit and reminds the hippocampus to release dopamine when you do it. It helps that darn amygdala to know what to expect from your day, letting it free up some more serotonin. It allows the insula to use the GABA in your brain to relax those tense muscles and decrease those tension headaches. Dare I say it, you start to feel life is kinda enjoyable.

What about if you are currently burnt to the level of the frozen pizza you forgot about in the oven? Recovering from burnout is a timely process that must be done. The sooner you are able to recognize burnout is happening, the easier it is to recover from it.

Once you are able to recognize and label burnout is happening, you are on the path to heal. I tell all my clients that are experiencing burnout to:

• Rest
• Identify stressors you can change or eliminate for a short period of time
• Engage in activities that give you energy
• Vocalize what you may need help with

Rest is the hardest thing for people to follow through on because their brain is in autopilot, trying to accomplish everything. Rest isn’t just taking a few days away from life. Rest is allowing yourself to slow down and not feel guilty about it (feeling a bit called out? Good!). Rest can look like allowing yourself an extra hour of sleep, taking some of your hard earned paid time off and make a long weekend, participating in activities that give you energy (see the list below). Yes, you may feel guilty or ashamed that you cannot be Superman right now, but resting allows your brain (and body) a chance to start to heal.

Next, we need to look at what is in our control to get that ol’ engine running again. That means, exploring what stress we can remove from our lives. In the moment, we may not be able to identify anything that can be taken off. That is where we need to look at the whole picture. Something as small as someone else doing the grocery shopping or asking for an extension on a project can offer a little bit of relief. That little bit of relief can go a long way. It is like putting enough gas in the tank until we can get to the next gas station.

Now, on to everyone’s favorite burnout preventer: activities that give us energy. This isn’t just the hobbies we used to enjoy, but activities of daily living. You know, brushing your teeth, taking a shower, putting on something besides sweatpants. Another activity that gives us energy is eating food. If you recall from my post, The Feel Good Neurotransmitters and How to Release Them, we need nutrition from our diet to create serotonin. Even if we don’t feel like eating, if we choose to eat something that turns into serotonin, we are helping heal from burnout.

As we move on in this burnout adventure, we need to talk about asking for help. As much as your darn amygdala might say you don’t need the help, we know it is lying to you. Asking for help helps heal burnout in a couple different ways. First, it allows you to connect with someone (yippee for oxytocin!). Next, it helps you use interpersonal effectiveness skills to prevent feeling alone. Finally, it helps reduce your stress level by delegating things to other people so you can heal.

Big question time: what if you see someone clearly struggling from burnout? How do I help them? That is a great question. When reaching out to someone who is not acting like their normal self, it is important to first listen to what they are saying. Don’t try to solve their problem right away, just listen.

Next, offer them some external validation. This can be in the form of words (like “you’ve been working so hard, no wonder you feel so run down”), the form of gifts (to show them that you care and are here for them), or offer to help in a way they need it. I remember struggling with burnout early in my career. I was a toddler mom with a brand new baby at home. Between studying for board exams, getting in my licensure hours, and working full-time, I was more burnt than overcooked bacon. When my friend simply offered to drop off dinner once a week, it did so much good. Not only did I get a chance to talk to someone, but the responsibility for that night was so much lighter. It was a small gesture, but it was something that really helped me heal my burnout.

Holy cow Batman! This post got super long! I want to thank you for sticking with me until the end of it. Burnout is something ALL people can experience, no matter what job they have, how much money they make, or their gender. Hopefully this article has helped you understand the importance of scheduling in your own self-care so you can continue to be you.

To recap this post:

– Burnout is when you experience prolonged stress

– Burnout occurs over time

– It takes time to heal from burnout

– Don’t forget to practice self-care and to check in on your friends

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References

• Arnsten, A, and Shanfelt, T (March, 2021). Physician Distress and Burnout: The Neurobiological Perspective. 96(3):763-769 n https://doi.org/10.1016/j.mayocp.2020.12.027. Retrieved from www.mayoclinicproceedings.org
• InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: What is burnout? [Updated 2020 Jun 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279286/
• Michel, A (2016). Burnout and the Brain. Retrieved from https://www.psychologicalscience.org/observer/burnout-and-the-brain
• Simpson, J. A., Weiner, E. S. C., & Oxford University Press. (1989). The Oxford English Dictionary. Oxford: Clarendon Press. Retrieved from https://languages.oup.com/google-dictionary-en/
• Chow, YeeKong & Jolanta, Masiak & Mikołajewska, Emilia & Mikołajewski, Dariusz & Wójcik, Grzegorz & Wallace, Brian & Eugene, Andy & Olajossy,. (2018). Limbic brain structures and burnout – A systematic review. Advances in medical sciences. 63. 192-198. 10.1016/j.advms.2017.11.004.

Image Source

• Megan Kelly at https://www.instagram.com/mentalstatuspod/
• Carissa Weber at www.thatdarnamygdala.com
• www.pexels.com
• https://tommyht.com/free-check-engine-light-scan