UNDERSTANDING STRESS AND BURNOUT

The words “stress” and “burnout” are often paired together and while they share commonalities, it is important to distinguish the difference between the two and understand that they are not the same. Stress can be defined as a state of physical, mental or emotional strain caused by demanding circumstances and/or unfavourable life events. Burnout is a state of physical, mental and emotional exhaustion caused by excessive and prolonged stress. In addition, it is important to note that stress is not a disorder whereas burnout is. The World Health Organization has declared burnout to be an official medical diagnosis which is why you may experience severe symptoms when diagnosed with burnout.

STRESS

BURNOUT

Burnout typically begins with stress and once that stress accumulates, it can eventually lead to burnout. So when does stress turn into burnout?

THERE ARE FIVE STAGES OF BURNOUT:

  1. Honeymoon Phase
    Undertaking a new task, experiencing high job satisfaction, commitment, energy, and creativity
  2. Onset of Stress
    Aware that some days are more difficult than others
  3. Chronic Stress
    Going from feeling motivated, to experiencing stress on a frequent basis
  4. Burnout
    Behavioural changes, chronic headaches, chronic stomach or bowel movements, lack of motivation, feeling helpless
  5. Habitual Burnout
    Symptoms of burnout are so embedded in your life that you are likely to experience a significant physical or emotional problem

When you are working in a chaotic and high pressure environment, you can tend to feel like you have little control over anything. This may cause stress which can eventually result to burnout. However, there are many other factors that contribute to burnout including lifestyle and personality traits. If you have too many responsibilities, aren’t getting enough sleep and you are not receiving enough support from family and friends, you could feel burnt out. In addition, if you have a high-achieving, type A personality and possess perfectionist tendencies, then you may be at risk of burnout as well.

OUR APPROACH TO STRESS AND BURNOUT

We start with a Clinical Intake Interview to review background history, medical history, identify specific symptoms and their severity, review previous assessments and interventions, and identify if any other assessments are required. The next step is to complete a QEEG (Quantitative Electroencephalogram) assessment to analyze your brainwave patterns. The best way to understand brain waves is to compare them to each section of an orchestra. Every section of an orchestra needs to work together to make sure the music sounds good. Sometimes one section of the orchestra is more dominant than the other, but all sections are necessary to produce beautiful music. In the same way all brain waves are necessary to balance each other out, complement each other, and become dominant when necessary. For example, when you need to analyze and engage in higher level thinking you want your brain to be dominant in faster brain wave patterns to accomplish this task. When you are getting ready for sleep you want your brain to gradually slow down and be dominant in slower brain wave patterns.

People who are stressed usually demonstrate an excess or dominance of fast brainwave patterns such as beta or high beta. This is because a stressed person is usually stuck in a processing, analyzing, and problem solving mode. Those who are stressed usually find it difficult to relax, which is why they may have a reduction in calm and alert brain wave patterns such as alpha and sensorimotor rhythm (SMR). In contrast, those who are burnt out may demonstrate an excess or dominance of slow waves such as delta (the brainwave dominant during sleep) and theta (the brainwave associated with daydreaming and tuning out). They may also experience difficulty concentrating and can have a reduction in calm and alert brain wave patterns such as alpha and sensorimotor rhythm (SMR). Once we figure out what brain wave patterns are related to your symptoms we can design a personalized program to target and improve them. During each session we monitor your brain waves in real time and when there is greater balance of brain wave patterns we reward you with video and sound. These audio and visual rewards help train and guide your brain to have improved balance and improve your symptoms.
Sometimes clients require additional support in conjunction with neurofeedback training. Some options are psychotherapy and somatic experiencing therapy.

RESEARCH ARTICLES ON STRESS AND BURNOUT

This section is meant to highlight research that has been done in the field. The following brief summaries are resources that we have gathered for the public. For an in-depth look at each research article we recommend using the citation to find and read the original article. We hope to add additional resources when possible!

Bak, K.-J. (2010). A Study on the effects of neurofeedback training on the resistance stress of kids. Journal of the Korea Academia-Industrial Cooperation Society , 11 (3), 1066–1070. doi: 10.5762/kais.2010.11.3.1066
This study focused on the effectiveness of Neurofeedback training on 40 kindergarten students who showed resistance to stress between the months of January 2008 and December 2008. 20 subjects were placed in an experimental group and the other 20 were placed in a comparative group. The brainwaves were adjusted by time series linear analysis and after observing the pre and post brain wave measurement results, the differences between both resistance stress was confirmed. Overall, the results suggest that Neurofeedback may positively affect the subjects’ mental state.

Dupee, Margaret & Werthner, Penny (2011) Managing the Stress Response: The Use of Biofeedback and Neurofeedback with Olympic Athletes. Biofeedback: Fall 2011, Vol. 39, No. 3, pp. 92-94. https://doi.org/10.5298/1081-5937-39.3.02
Athletic performance can be threatened by excessive tension and stress which is why the goal of this study was to help athletes manage their stress response through self-regulation of the autonomic and central nervous systems’ activation levels. This study involved 15 elite athletes who were preparing for the Vancouver 2010 Olympics. These athletes underwent a psychophysiological stress assessment, EEG, and bio-neurofeedback training. Athletes and coaches reported that the bio-neurofeedback training helped athletes manage the stress of training and competing. As a result, bio-neurofeedback helped produce better athletic performance.

Fedotchev, Alexander & Oh, S.J. & Semikin, G.I.. (2014). Combination of Neurofeedback Technique with Music Therapy for Effective Correction of Stress-Induced Disorders. Sovremennye Tehnologii v Medicine. 6. 60-62.
Neurofeedback was conducted on 18 volunteers suffering from stress-induced disorders and it was revealed that there was a dominant narrow-band (0.4 – 0.6 Hz) oscillators in theta (4-8 Hz) and alpha (8-13 Hz) EEG bands. During two examinations, the volunteers were presented with classical music. The music would be interrupted for approximately three seconds if the amplitude of the volunteer’s theta (slow wave) exceeded the initial level, or if the amplitude of the volunteer’s alpha (middle wave) did not reach the initial level. Volunteers were then asked to maintain the functional state where the music would play continuously. The authors found that there was marked EEG normalization and evidence pointing towards the reduction of stress. The volunteers also had positive shifts in their mental and emotional states as early as the end of the first neurofeedback treatment.

Hafeez, Yasir & Ali, Syed Saad & Malik, Aamir. (2016). Neurofeedback training content for treatment of stress. 133-137. 10.1109/IECBES.2016.7843429.
This paper provides a comprehensive summary of critical information for neurofeedback training and describes the need for the development of content. This content acts as a stimulus which trains the client to control their brain activity in stressful conditions. The developed content involves audio and game. The audio is used to enhance the amplitude of alpha brainwaves in the left-prefrontal lobe, whereas the game is used to reduce the power of high-beta activity. The results indicate significant improvement in reducing stress levels.

Hoffmann, Erik Brain Training Against Stress , 2005, [online] Available: http://completebraincare.comlpdfsBrain%20Training%20A-gainst%20Stress%20PTSD.pd
This study involved 10-20 sessions of Alpha Neurofeedback training on 20 individuals who suffered from several stress symptoms. The subjects were clinically evaluated and their QEEG’s were recorded. 15 of the 20 subjects who showed clinical improvement had an 89% increase of their mean Alpha activity, whereas 5 subjects with little improvement didn’t show an increase of alpha at all.The difference of Alpha enhancement between both groups was statistically significant as it indicates that Alpha enhancement is a predictor of clinical outcome. As a result, this study had a 75% success rate after about 12 hours of treatment which means that Alpha wave neurofeedback training may be an effective method to treat stress.

Ossebaard, H.C. Appl Psychophysiol Biofeedback (2000) 25: 93. https://doi.org/10.1023/A:1009514824951
Stress and burnout have been recognized as major causes for individual and societal issues in the West. Neuropsychological findings have allowed the authors to explore alternative methods to induce relaxation. One method being the application of so-called brainwave synchronizers or neurofeedback, which is said to induce a relaxation response by entraining alpha brain-wave activity through audiovisual stimulation. In this study, a double blind, quasi-experiment was conducted on employees at a Dutch addiction care center to look into the possible effects of two brain machine programs on anxiety and burnout. Subjects experiencing both conditions showed a significant, immediate decrease in an anxious state as assessed by Spielberger’s State-Trait Anxiety Inventory (STAI).

Weon, H. W., Yi, S. G., & Kang, H. G. (2008). Effects of a Neurofeedback Program on Brain Function and Stress in High School Students. Journal of Korean Academy of Child Health Nursing , 14 (3), 315–324.
The purpose of this study was to determine the effects of neurofeedback on stress and brain function in high school students. There were 62 students who participated in this nonequivalent control group study and the subjects underwent neurofeedback training for 30 minutes at a time, 3 times per week, for a total of 12 weeks. Brain function was measured by the brain waves in the subjects’ frontal lobes and analyzed by 8 brain quotients which distinguished patterns of EEG rhythms. A stress scale from regular daily life was then used to measure stress experienced by the students. After neurofeedback training, the level of brain quotients in students from the experimental group increased (t=2.36, p<.05) and the level of stress decreased (t=-3.59, p<.001). These results suggest that neurofeedback is an effective treatment modality for stress reduction in high school students.

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