At Both Ends

 By David Malone, August 1, 2023

"I'm feeling burned out."

There’s a good chance all of us have either said these words or heard them said from someone we know at some point in our lives. But what exactly does it mean to be burned out? Although burnout is not an official medical diagnosis, the American Psychological Association’s Dictionary of Psychology does offer some defining characteristics of the condition, including “physical, emotional or mental exhaustion, decreased motivation, lower performance and negative attitudes toward oneself and others.”

There are numerous causes of burnout, with some of the most prevalent being heavy and unmanageable workloads, lack of communication or support, a high-pressure work environment, lack of work/life balance, and/or working in a helping profession, such as massage therapy.

“Burnout is very common in the health fields, as you are expected to constantly give energy away to others,” says Eric Deegear, LMT.

Burnout Predictors, Causes and Risk Factors

Although burnout can be caused by a variety of things, there are three common types massage therapists should be aware of:

1. Overload Burnout: This type of burnout occurs when people start spending more time working in search of success.
2. Under-challenged Burnout: When a person feels under-appreciated or bored with their work, the risk of this type of burnout increases.
3. Neglect Burnout: Some experts say this type of burnout is closely related to imposter syndrome, and is marked by feelings of helplessness and hopelessness at work.

Massage therapists may be at risk for any of the three primary types of burnout, though overload burnout may be the most prevalent. According to Mary Beth Braun, a professional coach and massage therapist, risk factors for overload burnout include “scheduling appointments too close together, working too many hours, and not getting enough rest and recovery.”

Compounding the problem of overscheduling and working too many hours is the idea that many massage therapists self-identify as empaths, which often means saying no to clients can be difficult.

Knowing how burnout can manifest is a great first step, but combine that with an understanding of some of the predictors of burnout and you have a real chance of catching this condition early. A 2022 study¹ evaluating the predictors of burnout in female nurses during the first wave of COVID-19 found “symptoms of depression are a common predictor variable to all the dimensions of burnout, whereas symptoms of anxiety predict emotional exhaustion and depersonalization.”

Similarly, another recent study² looked at predictors of occupational burnout among health care workers in Poland during COVID-19 and found escalating depression to be the top predictor of burnout. Other predictors of occupational burnout included quality of life domains, which include physical, psychological and social parameters, as well as age and marital status.

How Can Massage Therapists Protect Against Burnout?

Because overload burnout is so common in the massage profession, one of the best prevention strategies for massage therapists is understanding their limits and prioritizing self-care. “Engage in regular physical activities such as stretching, yoga or exercise to maintain physical health and reduce muscle tension,” says Tammer Malaty, MS LPC-S. “Make time for hobbies and activities that bring joy and relaxation.”

Staying active is a common theme, as both Braun and Deegear also mention yoga and stretching as some of the best things massage therapists can do to help prevent burnout. “You must stay active to avoid injury and exhaustion. I do hot yoga five times a week to increase my endurance, stamina, strength and flexibility,” Deegear says.

Emotional self-care is just as important. Massage therapists might find practicing meditation and mindfulness helpful, as well as just making time to do things they enjoy.

Under-challenged burnout is a little unique and often requires a different approach, one that focuses on mental stimulation and offers opportunities for more personal growth. Deegear suggests playing to your strengths and interests. “Find a mentor or business coach in your field who can help you construct a career path that uses your strengths and protects against your weaknesses,” Deegear says. Focusing on work you find interesting and challenging can help protect against the pitfalls of boredom.

Additionally, look for ways to grow alongside the massage therapy profession. Keep up on trends in research and look for continuing education that helps you build your knowledge instead of simply reinforcing what you already know, like a class that will help you deepen your understanding of a condition research is showing massage therapy can benefit, like fibromyalgia or arthritis, or education that will add to your skillset.

A 2022 study³ evaluating the efficacy of coping strategies used to reduce burnout syndrome in health care worker teams found the most effective and efficient coping strategies were social and emotional support, physical activity, physical self-care, and emotional and physical distancing from work. Other coping mechanisms associated with less burnout were physical well-being, clinical variety, setting boundaries, passion for one’s work and realistic expectations.

The key to keeping any type of burnout at bay is to make sure the work never overtakes or overshadows your personal life. “Develop a sustainable self-care plan and stick to it,” says Braun. “A sustainable self-care plan is essential for well-being, career longevity, and burnout prevention.”

When Prevention Isn’t Possible: How to Identify Burnout Symptoms

As much as we focus on self-care though, as much as we talk about and engage with techniques and strategies aimed to protect against burnout, understanding when burnout may still be creeping in is imperative.

And Malaty offers five common signs and symptoms of burnout massage therapists should be on the lookout for, including:

1. Emotional exhaustion: Check in with yourself. Are you feeling drained, overwhelmed or unable to cope with the emotional and physical demands of your job?
2. Irritability and mood swings: Where you once felt generally happy, do you now feel quick to anger? Do you find your moods are hard to predict and less stable. If all else in your life is the same, consider if burnout might be the root cause of these changes.
3. Detachment and cynicism: Do you notice that you’re not feeling as motivated at work? If you find that you’re not sure if you see the point in your work any longer or are continually wondering if you’re making any real difference, burnout may be the culprit.
4. Fatigue: If you feel like you’re sleeping well but even small tasks are taking longer or you just can’t seem to get yourself going, check in with yourself and see if something bigger—like burnout—might be the cause.
5. Changes in sleep patterns or diet: Changes in diet and sleep can be the first signs that something is amiss. If you find you’re sleeping at different times during the day or eating differently (more or less, healthy or unhealthy), then investigating whether something deeper and more holistic is happing, like burnout, is a good idea.

Once these signs and symptoms have been identified, the same self-care practices that can be used to try and avoid burnout can also be used to help alleviate symptoms. “Take some time off for vacation and rest,” suggests Braun. “Once energy, emotional and physical health feel more balanced, come up with a self-care plan and reorganize your work schedule to ensure you can sustain it.”

It can be difficult for massage therapists to force themselves to take time off because, as the old saying goes, time is money. But forcing yourself to continue working through a period of burnout can quickly end up being a short-term gain but long-term loss.

“Take a break. Cut down on your hours and try something that will complement your massage license,” says Deegear. “Then, when you feel ready, come back in with excitement and feel that joy again. There’s no need to force it.”

What Is the Difference Between Burnout and Depression?

Burnout and depression can mirror each other in many ways, sharing signs and symptoms. However, there are key differences between the two.

According to the Cleveland Clinic, the biggest difference is that depression is a diagnosable mental health condition, but, at least according to the American Psychiatric Association’s DSM-5, burnout is not.

However, the World Health Organization’s International Classification of Diseases (ICD-11) has recognized burnout as a medical diagnosis (still separate from depression) since January 2022.

The ICD-11 defines burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and 3) a sense of ineffectiveness and lack of accomplishment. Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”

The key difference here is that burnout refers specifically to workplace. For example, if someone is experiencing burnout, taking time off work to go on a vacation, spending time with friends and family, or just relaxing, will most often help alleviate the symptoms. A depressive episode, however, is more generalized, and often not significantly helped by just a change of scenery or a break from work.

Here’s something else to keep in mind: Burnout and depression are not mutually exclusive and can occur at the same time. If someone is suffering from burnout or depression, the signs and symptoms being experienced should not be ignored.

5 Self-Care Ideas You Can Do in 5 Minutes

1. Go outside and take a walk around the block.
2. Reach out to a friend and have a quick five-minute catch-up.
3. Ask yourself: “How am I feeling today?” Then, listen to your answer.
4. Give yourself a quick head massage.
5. Roll your feet on a tennis ball.

References