Few people would say the past year or so have been anything other than stressful. From illness, loneliness and job uncertainty, to juggling work and childcare while constantly making and remaking plans according to the latest rules.
So it’s not surprising that ‘more people are reporting burnout and chronic stress now’, says Dr Nic Hooper, a senior lecturer in psychology at the University of the West of England. ‘It’s been a hell of a year.’
But just how much should we worry about what this stressful period of history is doing to us?
It’s well known that stress can have very real, physical health consequences. And two new studies published in the same week highlighted just how wide-ranging these effects can be.
From illness, loneliness and job uncertainty, to juggling work and childcare while constantly making and remaking plans according to the latest rules
In the first, scientists at Columbia University Vagelos College of Physicians and Surgeons in the U.S. found that stress does, in fact, turn hair grey — while reducing stress levels may be able to reverse the process.
The second, published in the journal Cardiovascular Research, suggested high stress levels make it more likely someone will develop ‘broken-heart syndrome’, or takotsubo, a form of heart disease that occurs after a severe emotional shock such as a bereavement. Now, worryingly, job stress (a risk factor for heart attack and stroke) is rising at an alarming rate among working women, according to a Swiss study reported earlier this month.
‘In general terms, stress is where demand exceeds our resources and our perceived ability to cope with that demand,’ explains Dr Chetna Kang, a consultant psychiatrist at the Nightingale Hospital in London.
This may seem concerning, given that this feeling — of having to keep too many plates spinning in the air or having too few hours in the day — is one we’re all familiar with.
And yet a certain amount of stress is normal, says Dr Hooper. ‘We too easily fall into the trap of pathologising stress when, in fact, it’s a normal part of the human experience,’ he says.
‘Some of the most important and wonderful things we do in life are also stressful — if you get married, for instance.’
What’s more, our bodies are designed to cope with short bursts of stress.
Our stress response system has evolved to deal with the sorts of stressors we might have encountered in our evolutionary past, such as a predator we need to get away from, explains Dr Robin Law, a senior lecturer in psychology who is part of the psychophysiology and stress research group at the University of Westminster: ‘Once the threat has subsided, then it goes back to normal.’
Yet a certain amount of stress is normal, says Dr Hooper. ‘We too easily fall into the trap of pathologising stress when, in fact, it’s a normal part of the human experience,’ he says
But there seems to be a tipping point; and too much stress, for too long, is ‘associated with almost everything bad that you could imagine’, says Dr Law — from depression to lower immunity and cancer.
This kind of chronic stress is increasingly — and, according to some leading scientists, unhelpfully — being labelled as ‘burnout’.
So how does something stressful have a physical effect in the first place?
The body’s main stress-response system is the hypothalamic-pituitary-adrenal (HPA) axis. It consists of two areas of the brain, the hypothalamus and the pituitary gland, as well as the adrenal glands, which sit above the kidneys.
These communicate with each other to control the release of cortisol, sometimes nicknamed the ‘stress hormone’ because more of it is released when we encounter something stressful. (We also need it for functions such as regulating blood pressure and blood sugar levels.)
In response to something stressful the brain sends signals to the adrenal glands to secrete more cortisol into the bloodstream.
‘It permeates cells all over the body, promoting functions that help us escape from or overcome the perceived threat,’ explains Dr Law. For instance, it increases your heart rate and releases energy stores, while also suppressing functions that aren’t as immediately essential, such as digestion.
In the short term, this is all ‘really useful’, he says — it primes the body to be able to run faster, concentrate harder, or brace for a physical attack.
The problem in the modern world is that ‘the majority of problems we encounter are chronic stressors that don’t go away — so things like money, work or family problems’, explains Dr Law.
‘As a result, a person maintains this stress response for a longer period of time. And it’s this sustained exposure to cortisol that has very negative effects on your physical and psychological health.’
It starts to damage the stress-response system’s feedback loop, with the brain becoming less able to detect exactly how much cortisol the body needs.
‘The stress-response system damages itself,’ explains Dr Law. ‘Cells have two types of receptor for cortisol — and the effect cortisol has depends on how much cortisol is bound to the two different types. There should be a balance between them.’
If there’s too much cortisol in circulation, it upsets this balance that helps the cells work correctly.
‘Additionally, the effect of cortisol on the receptor itself is toxic,’ he says. ‘So if you have sustained high levels of cortisol, it essentially prevents the receptors from working properly.’
Normally, once you have the right level of cortisol, the brain receives a signal to shut down the whole system and stop secreting extra cortisol. ‘The problem is, once those receptors aren’t working properly, it’s no longer sensitive to that and you end up with higher levels than would be optimal,’ says Dr Law.
But how do we know when normal, day-to-day stress has become something more unhealthy? According to Dr Kang, signs that we’re stressed can be psychological (such as feeling less enthusiastic or socially withdrawn), physical (such as stomach aches, more colds, and a general feeling you’re coming down with something) or behavioural (sleeping too much or not enough).
‘But different people are vulnerable to different signs and symptoms,’ she says.
‘And what can be experienced as stressful is very broad.’
Dr Hooper concurs: ‘Some people can work 70-hour weeks and not feel stressed if there are other things going on in that context.’
For example, if they get meaning from their work, feel appreciated and have good supportive family relationships.
‘Whereas somebody else could be work a 35-hour week and be under a lot of stress,’ he says.
Not feeling in control is something that researchers have identified as being universally stressful, adds Dr Law.
This may be why, contrary to what we might expect, it’s not the people at the top of the work pyramid who suffer most with stress and its potential ill-health consequences, it’s the lower and middle ranks (as identified in a landmark research project which tracked health data from 10,000 British civil servants from the 1960s). This project found a lack of control at work was linked with an increased risk of heart disease, for instance.
During the pandemic there has arguably been even less opportunity to escape or recover from our everyday stresses.
In recognition of the peculiar stresses of the past 18 months, two weeks ago Nike shut down its global headquarters to give staff a chance to ‘de-stress’.
Similarly, earlier this summer, the dating app company Bumble also closed for a week of company-wide paid leave to allow its staff to recover from ‘collective burnout’.
‘Burnout’ is a word being used more and more to describe our mental health. But while it may sound like a good description for how many of us feel, it is not a recognised psychological condition.
In March, the social psychologist Christina Maslach wrote that the label burnout was becoming increasingly popular, but was being ‘misused and misunderstood’.
Maslach is one of the pioneering researchers into burnout. In the 1980s she developed a now widely used questionnaire tool, the Maslach-Burnout Inventory, to assess levels of it.
But, writing in the Harvard Business Review earlier this year, she explained that while this tool was designed to define and measure burnout in a scientific way, it was never intended to ‘diagnose an individual health problem. Indeed, from the beginning, burnout was not considered some type of personal illness or disease.’ Instead, its purpose was to spot workplace organisational problems — such as a workload that is too heavy.
She went on to explain that this misuse is a problem because it can lead to people being labelled as burnt out, when really they are over-tired or even depressed.
It also implies that ‘burnout’ is a condition that can be fixed with individual treatment, such as therapy or relaxation techniques, yet there’s ‘no evidence for established treatments for it’, she wrote.
Allen Frances, an emeritus professor of psychiatry at Duke University, in the U.S., who helped put together the diagnostic manual used by psychiatrists around the world, has also recently pointed out that burnout is ‘not a psychiatric disorder’, which is why it was not included in the manual.
‘The history of psychiatry is filled with fad diagnoses that lead to fake epidemics,’ he said.
Yet, adding confusion to the picture, in 2019 the World Health Organisation (WHO) included burnout in its International Classification of Diseases.
Under its definition, someone has to have all three of the following — over-tiredness, cynicism and lack of productivity — to qualify as truly burnt out.
Crucially, as Christina Maslach has also pointed out, the WHO said responsibility for preventing burnout shouldn’t be placed on an individual: their suffering doesn’t stem from some kind of a flaw or lack of a skill, it’s really a problem that workplaces need to fix.
Yet Dr Hooper says too often ‘tokenistic’ mindfulness or well-being programmes are put in place by workplaces with high levels of staff ‘burnout’.
‘This essentially sends a message to people that they are not someone who manages stress well; that they are somehow abnormal,’ he says. ‘When, in fact, what usually contributes to burnout in the workplace is the way its systems — whether it’s the expectation to work long hours, shift patterns, or poor feedback from management — have been set up, and it’s this that needs changing.’
Unlike burnout in its strictest, scientific sense, chronic stress is something we may individually have more power to remedy.
Perhaps unsurprisingly, Covid has been a huge boost for all manner of ‘stress-busting’ products.
There were two million more downloads of the ten most popular meditation and ‘mental wellness’ apps in April 2020 compared with January, according to the analyst Sensor Tower.
Meanwhile, many companies selling CBD products (containing cannabidiol, said to have calming effects) reported sharp increases in sales.
Britons spent £150million on CBD products in the first four months of 2020 alone, data from Alphagreen shows.
But there are no universal stress-busters, warns Dr Hooper, author of The Unbreakable Student: Six Rules For Stay-ing Sane At University.
‘We’re looking for easy answers to reduce stress,’ he says. ‘But what if the thing we think is a problem is actually just a normal part of life?’
He believes a drive to eliminate stress from our lives can actually backfire. Often, he says, a vicious cycle arises when we do things to try to not feel stressed or get rid of certain feelings, such as drinking a bottle of wine or eating lots.
He points to recent Australian research that identified six key traits of psychologically healthy people as a good blueprint for coping with stress effectively.
‘Psychologically healthy people tend to exercise, they tend to challenge themselves, they connect with others, they give to others, they tend to embrace the moment and they tend to self-care,’ he says.
‘Of course, these are exactly the behaviours that go out of the window when you’re stressed. Often, the last thing you want to do is exercise or meet other people — but those might be the very things that will reduce stress and anxiety.’
Dr Law’s research has demonstrated the powerful effect exercise in particular can have on cortisol.
We’ve found that people who are physically fitter have a smaller stress response to a public speaking task,’ he says. (Public speaking tasks are often used to measure stress responses.)
But even in people who weren’t regular exercisers, ‘physical activity itself also seemed to reduce the stress response’, he adds.
And while familiar advice such as ‘take a walk in nature’ might sound wishy-washy, the corrective effects on cortisol have been shown to work very quickly in people who are chronically stressed, says Dr Law.
‘Taking a walk, doing some gardening, or looking around an art gallery can reduce cortisol levels really rapidly — it can take just ten to 15 minutes.’
Under the microscope
Fashion and textile designer, Dame Zandra Rhodes, 80, answers our health quiz.
Can you run up the stairs?
I don’t run. I walk around the Tower Bridge area [in London] before work every morning. I am also working on conditioning exercises to get my health back up after battling cancer. I find tai chi and yoga really help.
Get your five a day?
Yes, I do. I tend to make quite a lot of soups. I’ve been doing some fantastic recipes with aubergines, either cooking them Japanese style or putting them in ratatouille.
Ever dieted?
The last time I dieted was when I left the Royal College of Art in 1963. I haven’t dieted since, I just design clothes around the problems. I’m 5ft and weigh about 10st 5lb (67kg).
How has the pandemic affected you?
During the very first part of the lockdown last year I was having chemo for bile duct cancer, and in a way it was very helpful — I wouldn’t have felt like going out much. I was extremely lucky in that I’ve had constant work.
Any vices?
I like chocolate — any kind.
Any family ailments?
My mother got lung cancer, but she smoked so much that it wasn’t a surprise. She died in her late 40s.
Worst illness?
Bile duct cancer. When it was diagnosed last year they said I had six months to live. I had three months of chemo. Now I have immunotherapy: they plug you into a drip every three weeks and then X-ray you to check that the tumour hasn’t grown.
Pop any pills?
I’ve been on medication since chemo and I have heart medication. I just take what the doctor tells me to.
Had anything removed?
Tonsils when I was about 12.
Ever have plastic surgery?
No. I lived in the U.S. and saw what it did to people’s faces.
Is sex important?
My partner Salah died [in 2019]. He was the love of my life, so I don’t really need to fill up the space.
Cope well with pain?
Well, if it comes.
Tried alternative remedies?
My partner used to try that one with needles [acupuncture]. I did it a couple of times and couldn’t feel the difference.
Ever been depressed?
As I’m a workaholic, I can get myself out of depression by either boring my friends or working.
What keeps you awake?
The more worried I am about my work, the more my body makes me want to sleep. I’d say that I get about seven hours a night.
Like to live forever?
No.
Dame Zandra is working with Goldster, for over-50s to lead a more active, healthy life (goldster.co.uk).