Health Coaching as a Promising Antidote for Burnout

By Maria Carolina B. Tuma

Body and mind have never been apart. In the last 30 years, the biological interactions between them have been studied by psychoneuroimmunology, an area of research that investigates the multidirectional relationships between emotions or thoughts and physiological responses, integrated by mediators of the neurological, endocrine, and immune systems. Under this multidisciplinary approach – involving psychology, neurosciences, behavioral medicine, physiology, immunology and genetics – health and quality of life are consequences of the experiences we live.

The connection between health and perception of lived experiences makes a lot of sense. Every individual has characteristics that exist in a social, historical, cultural context, and thus is subject to psychosocial, hereditary (genetic), or resulting from learned behaviors (epigenetics). This combination between the individual and his environment shapes patterns of perception of stress and coping. These patterns, in turn, are manifested through the activation of biological pathways involving neurotransmitters (such as serotonin, whose reduced levels are associated with depression, or dopamine, associated with reward), hormones (such as cortisol and adrenaline, mediators of stress responses) and cytokines (mediators of the immune system). Simply put, a person’s health – which translates into physical health and also in psychosocial functioning and quality of life, is the result of processes that involve more than the inherited biological and behavioral baggage, social support, behaviors, and lifestyle.

In this context, burnout is a condition characterized by the response to chronic stressors associated with work, of emotional and interpersonal nature, which can lead to both emotional exhaustion and social indifference or dissatisfaction with the job.

Individual factors, such as personality traits and family life, influence who experiences professional burnout. Although not considered a medical diagnosis*, burnout has been associated with sleep disturbances, symptoms of depression, alcohol and drug consumption, which consequently favor the development of chronic conditions such as hypertension and diabetes, and an increased vulnerability to disease in general, especially heart disease. Burnout, therefore, has an impact that goes beyond mental health.

A study by Winona University (1) proposes to divide the burnout process into five stages, with the crisis actually only happening in the stage before the last. It is an alert to the need for seeking coping strategies for stressful situations since the beginning of the burnout process. The first stage is called the “honeymoon” phase, when engagement, high productivity, and commitment to work are accompanied by an excess of assumed responsibilities. Few people recognize this stage as the beginning of burnout and do not seek positive coping strategies. In the second stage, the awareness of difficulties in dealing with stress is increased and manifests itself in dissatisfaction with the work, sleep problems, depressive symptoms and compulsions. In the third stage, the symptoms that were occasional become chronic, including exhaustion, anger, and depression. In the fourth stage, characterized by crisis – burnout itself, the symptoms become not only chronic, but critical: in addition to the increase in frequency and/or severity of physical symptoms, pessimistic postures, doubts about one’s own worth and escape attitudes increase. Excessive eating, drinking, smoking, using drugs, and watching series on television are examples of the escapism that accompanies the latest stages of burnout. These postures reflect a lack of self-regulation, that is, a failure in the natural ability to monitor and modulate emotion, cognition and behavior to adapt to the demands of specific situations.

Considering that burnout involves psychological aspects such as excessive anxiety, reduced sense of accomplishment and loss of personal identity, and biological aspects such as deregulation of stress responses, it is interesting to analyze it from the point of view of psychoneuroimmunology. What behavior patterns lead to burnout? Specifically, what are the activation triggers of biological responses that cumulatively result in the state of crisis that characterizes burnout? Which are the coping mechanisms in situations of intense or lasting stress? How do these responses manifest themselves in physical, emotional, relational health?

If the response to stressful stimuli depends on the perception of stress and if coping strategies are tools to modulate the biological responses involved in the process, it is plausible that preventing burnout involves working perception and coping aspects. The challenge is knowing when to intervene. According to the five stages proposed for the burnout, the sooner the better. It is about being fully aware of the current situation in order to act in time to prevent what’s to come.

On the one hand, emotional exhaustion, indifference to others, or job dissatisfaction can be caused by a specific context, such as an inability to influence decisions, a lack of resources to do their job, or a lack of social support. On the other hand, the causes of burnout may lie in personal attitudes, such as extremes of activity, imbalance between work and personal life and perception of lack of (self) control. Assuming that it is more difficult to control the context, it is reasonable to focus on personal choices and perceptions of lived experiences. If the experience of reality takes place depending on the state of consciousness in which a person is found, that is where one must act.

An approach that promotes an increase in self-awareness, using presence and attention, is Health and Wellness Coaching.

By establishing a partnership centered on the person rather than the problem, the process facilitates development of autonomy to manage their own health effectively. Without prescribing, health coaching facilitates self-knowledge that results in self-care: it brings to light the recognition of established patterns of behavior, identifies own skills and resources, and encourages change towards better health and well-being. The transformation happens when intrinsic motivation grows, based on the individual’s values, and extrinsic motivation decreases, based on external reward and punishment. This seesaw is essential in the context of burnout.

As a result-oriented and stigma-free method, health and wellness coaching is a promising strategy.

to deal with burnout. With techniques of sensitive listening and reflective questioning, supported by Positive Psychology, emphasizing individual strengths, questioning limiting beliefs and investigating new perspectives. As a result, it increases self-awareness and the capacity for self-regulation, along with a sense of accomplishment, purpose, and engagement, all of which are critical to tame the exhaustion typical of burnout.

In the health coaching process, sources of motivation for the desired behaviors are identified and the pros and cons for unwanted behaviors, installed as “bad” habits. In the case of burnout, the unwanted includes compulsivity, perfectionism, guilt, self-denial, and denial of one’s vulnerability. What you want is balance between work and personal life, the ability to prioritize yourself and make appropriate choices for your physical and mental health. As the positive aspects associated with the desired condition are favored, priorities change and the person starts to “take charge” of their health in a competent and self-determined way. This perception of competence to deal with a given situation, according to specific demands and using skills that the individual already has is what defines self-efficacy, one of the main goals of health coaching. In burnout, self-efficacy is limited.

Emotional intelligence, self-efficacy and perceived social support factors, as well as low levels of mindfulness and coping, were observed in health professionals with burnout (2). In contrast, individuals with lower levels of burnout reported greater perception of self-efficacy and social support. No surprisingly, coaching interventions for physician burnout prevention and recovery have generated positive results, such as improved quality of life and reduced exhaustion (3,4). As a result, it is feasible to think that self-efficacy, anchored in stress management strategies and coping mechanisms based on self-awareness, acts as a protective factor against burnout.

Another protective factor against burnout is empathy. Allied to the presence and suspension of judgment, the empathetic posture is one of the premises of the health coach for the process of change to flow. At a recent event, Margareth Moore described coaching as the space where neuroplasticity occurs, that is, where new neural connections will replace the old ones (5). In this construction of new habits, the individual naturally develops empathy and reduces self-judgment. As a result, self-compassion is enhanced – the ability to nurture compassion for oneself when feeling inadequacy, failure or general suffering. In fact, empathy and self-compassion have been linked to reducing high levels of anxiety inherent in burnout.

How to put all this together in practice? It is attractive to think of health coaching as a prevention tool against burnout. As a person connects with the vision of who and how they want to be, their self-awareness increases along with the motivations to take care of oneself. The self-perception and the context become more harmonious. Strategies for coping and self-regulation are strengthened, favoring the modulation of psycho-neurobiological responses involved in burnout. They increase self-efficacy and self-compassion, both of which benefit from the practice of presence. If low self-efficacy and burnout are related, it is likely that by increasing the former, the latter can be reduced. The same goes for self-compassion and anxiety, the bigger that one, the smaller this one. In this scenario, health and wellness coaching can be a good antidote to prevention and recovery for burnout.

Finally, if burnout is the result not only of working too hard, but also of doing too little what really matters, it makes sense to bet on a strategy that seeks to raise awareness of what makes one’s eyes shine, what really matters, what is in harmony with the person’s essence, what makes them vibrate in their best version.

*Since the original article was published in 2021, burnout has been assigned a specific ICD.

Article published on the Coaching Brazil Magazine from August, 2021 (originally in Portuguese: Coaching de saúde como um promissor antídoto para Burnout, Maria Carolina B. Tuma

References

https://www.winona.edu/stress/bntstages.htm
Jurado, M et al. 2018. Int J Environ Res Public Health. 30;15(6):1116.
Gazelle, G et al., 2015. J Gen Intern Med. 30(4):508-13.
Dyrbye, LN et al., 2019. JAMA Intern Med. 179(10):1406-1414.
Margaret Moore “Science in Coaching”, I Internacional Symposium on Health Coaching and Wellbeing. Março, 2021.