Dr Florence Cotel on the Science of Burnout
About
Dr Florence Cotel is a neuroscientist, entrepreneur and endurance athlete. In this episode we talk to her about the scientific basis and real world implications of Burnout.
Host
Dr Elisabetta Burchi
Clinical Psychiatrist
Parasym/Nurosym
Guest
Dr Florence CotelNeuroscientist, author, endurance athlete
Links
Interview
Dr Elisabetta Burchi 0:05
Welcome, everybody. Welcome, today. We are here with Dr. Florence Cotel.
Thank you for being with us, Florence.
Dr Florence Cotel 0:16
Thank You
Dr Elisabetta Burchi 0:17
As you can imagine, Florence is French, but she's been working in Australia for some years now, and she's a neuroscientist.
She's an endurance athlete, and she's also a writer. She's working on a book about Burnout.
And lots of topics to talk about with her, and I would also like to mention that she launched basically a non-profit organization that is working around the innovation ecosystem trying to put together scientists with entrepreneurs and other stakeholders with the aim to basically solve the real-world problems.
I think she's the right person to be here and talk about topics that are, of course, scientific topics but are also very interesting for everybody.
So Florence, do you want to say something about yourself.
Dr Florence Cotel 1:59
Thank you very much for having me.
Say something about myself. Maybe I will talk just a little bit more about this Non-for-profit organization is called Bliss Science and Innovation Inc.
That I founded really because of my passion for neuroscience and this need that I see for putting together psychiatrists like yourself with neuroscientists like myself with people that are specialized in cognitive neuroscience and enabling different partners that come from different perspectives different views that can see different challenges and that can answer different questions together in order to tackle bigger more global and more complex problems.
So the creation of the organization really started with my passion for neuroscience which is also driven by my passion for Burnout. That might sound a bit funny to say it that way because Burnout is it's just a very negative thing, but for a neuroscientist, it's an extremely interesting syndrome to study.
And it's an extremely important topic to tackle because it affects many people. At the moment, we don't have real straightforward solutions, and that increases the importance of just going and tackling it.
Dr Elisabetta Burchi 3:27
Absolutely, Florence.
Would you like to tell us something more?
Everybody knows about Burnout occupational.
I can say from a medical perspective that Burnout is not recognized as a medical condition is not included in, for instance, in the DSM-5, which is the manual of the reference point for psychiatrists even if we have a similar syndrome which is included but we don't mention Burnout.
On the other hand, the world health organization mentions Burnout and, as I wrote it down here, as a type of non-medical life management difficulty, and it talks about chronic work-related stress.
But you're right. We don't have a specific path also for clinicians in order to help people that are affected by Burnout, and so maybe lots of work needs to be done.
Can you tell us more about Burnout from the different perspectives, more scientific and also not only on a molecular level more on a behavioural level? Can you tell us something more?
Dr Florence Cotel 4:56
Yes, absolutely. I think that very few people care about the molecular level. I do.
I think it's fascinating, but I will skip it for now maybe we can talk about it at the end. Then what you've said is absolutely true. There is no international consensus about what is Burnout.
The signs and treatments are not established. There are studies that go in many different types of directions, so I will present the one that I find convincing.
Maybe I can introduce that the reason why there is no consensus at the moment is that understanding Burnout and describing Burnout is still very recent. It started basically 50 years ago in the 70s, and in the medical world in the healthcare world, 50 years is actually very short.
To establish a disease, to really describe the foundations of understanding of the progression and develop treatments.
And so in the 70s, the first psychiatrist and psychologist that described Burnout really described it in people that were carers, people that teachers, in the medical sector, in nurses are always in staff professionals that were caring for a lot of other people and I can describe in kind of like briefly in general the difference the evolution of Burnout.
I would draw two different phases in like some people describe as mild and severe. There really is some kind of a start and a continuation, and the start is typically people that are driven by an ideal something that they really want to accomplish or something that they deeply care about.
And people that experience Burnout is typically people that are very hard-working, care a lot about what they do have very strong work ethics. And they have this internal drive of doing better and doing more.
And there's an event that happens that corresponds to a disappointment, and that makes them feel that they may never reach their ideal, or maybe then everybody around them that they saw cared about it don't care so much. This big disappointment is really what starts the process, and it triggers a decrease in motivation that people notice in themselves.
They see that they are less productive and because typically, it's very productive, very hard-working people that experience Burnout. They're going to compensate for the lack of productivity by working even harder, and that's when the really negative cycle starts. Because the harder they work.
Working hard does not bring back motivation. Motivation is never linked to how hard you work, and it can be detrimental to work too hard to push too far in people that lack motivation because then you lose the link between how bad you care, how bad you're motivated by something, and how much the effort you put into it which are usually connected.
But if you work very hard for something that you care very little about, the connection is broken.
And those are the very first stages of Burnout; people start being may be working, even more, putting their own needs if not last at the beginning, maybe not first, and they start isolating themselves a bit more because they want more time to work.
They stop going for their leisure. They if they're not going to attend a sports club. They're going to attend fewer session training sessions if they're very used to seeing their friends they're going to see their friends less often. They're putting more and more energy into this need to prove that they can become productive as they used to be before.
They become very frustrated because, as I said, working more does not improve your productivity when it doesn't change your motivation, and as they progress and they start becoming more tired. It's like their values change. They become very frustrated, sometimes aggressive and cynical, and that's when they start to be emotional, if not exhausted, disengaged.
It's really the motivation that lowers and lowers and the frustration that increases of not being as productive. There's something that the experience that is called depersonalization the personality changes they change the value, so they don't act upon their values anymore and then they really and now we're entering a kind of the late advanced stages that will inevitably trigger severe Burnout when people totally isolate themselves to work more.
They start totally lacking empathy, and they start feeling empty. At that stage, they describe a very strong sense of exhaustion that is not just physical exhaustion but also emotional exhaustion. Every very simple task that they used to be doing very quickly becomes extremely difficult to do.
That's when they start realizing that they're losing attention, that they're losing the capacity to concentrate that they don't have a memory anymore. If they stay in the cycle of still wanting to remain productive, then they inevitably reach some kind of collapse that let's say a very famous author has described Ariana Huffington that is the founder of The Huffington Post described in a book called "Thrive" how she one day just literally collapsed.
She was working in her office. She stood up. She walked two meters, and she vertically collapsed on the floor and had to be taken to the hospital, and it took her a long time to realize everything that had happened before for her to reach that stage, so that's the kind of the continuum of Burnout.
Natural history.
Dr Elisabetta Burchi 11:51
Yes, it's like reaching a climax, negative climax but yes, absolutely.
This is one type you know because so definitely probably it's like as every syndrome especially in the mental field you know in a mental arena, we give different expressions to the same syndrome dependently on the characteristics of the person or the individual clearly you know and so probably the more perfectionists are gonna starting the cycle from struggling more and arriving at exhaustion as you said because they spend all the energy they have. Right.
What about the other kind of individuals? Probably I suppose they are going to withdraw probably in front of the incapability of being able to be at the height of their expectations. I don't know.
Dr Florence Cotel 12:55
Actually, in Burnout, it's very obvious people work the exhaustion not just comes from stress. It comes from working intense hours.
Dr Elisabetta Burchi 13:06
So everybody goes through this stage of trying to push.
Dr Florence Cotel 13:12
Working very hard, so the word burnout is itself a daily expression is used by a lot of people and in a lot of cases.
For example, if you just type hashtag burnout on Instagram, you're going to see a lot of pictures of motorbikes and cars that have pumped up pinned up. It's because they burn out the engine.
So it's it now it's becoming very commonly used in our vocabulary by people that feel very tired because I'm very tired and burned out, which does not correspond to the syndrome itself. So this is making everything a lot more confusing because now there are some studies of scientists and psychiatrists that base the study on people self-diagnosing their Burnout.
You end up having a lot of studies that collect signs of people that are very tired. They're not in Burnout because typically, Burnout takes a long time to recover, and there are people that are tired. They feel very drained they've worked in long hours but they go on holiday for two weeks, and they come back, and they feel better. People that are experiencing Burnout.
Two weeks is not going to change anything. Two months is not going to change much either. There really is, it's a physical phenomenon, and it's very difficult to hear the suffering of everybody and to classify it to be able to define treatments for everyone. They are people that really suffer from caring for their surroundings.
There's a type of syndrome that is really observed typically for women but also for men that care for their fam for their own family, and that that describes a type of exhaustion that is very similar to the exhaustion that we described in Burnout. I think that we should come up with a different vocabulary for that condition, and maybe some treatments overlap, but the causes are different and typically for anything that has a mental aspect.
Understanding the causes is extremely important in defining the appropriate treatment what I would say is similar in kind of all conditions or all the situations. And then the symptoms that people report is that they've reached a point where they kind of disconnect from their body. They all, at some point, push themselves.
There's a lot they have lots of signs being tired is one of them but being regularly sick. It's okay to have a cold here and then but a person that catches a cold every week, every two weeks and four months there's something everybody's trying to say something yes and feeling tired at times when there are external factors that justify it is healthy but feeling tired constantly over weeks and over months isn't.
And people tend to keep on going when you're taking care of your own children; you're not going to stop taking care of your children. You keep on going even though you're exhausted, even though you would like to sit and relax, and so there's this trend of a large amount of people that are in different situations but that have pushed their body beyond the signals that the body was giving.
And for that reason, they share one need in recovery that is reconnecting with their body and with with the science that their body is giving them.
Dr Elisabetta Burchi 17:36
So Florence, basically, you are telling us that there are signs, and we should pay attention to them before this vicious cycle becomes in a certain way only one direction you know and then in order to recover, it's gonna take much more, I suppose then if you know if you proactively recognize certain symptoms certain signs and you do something to break this cycle earlier.
So we have talked about tiredness, we have talked about losing motivation for something that instead now people were interested in what they were doing because this was the start of everything.
When you have high expectations and a high motivation to be effective and then seeing probably that you are not as effective as is requested or as you request from yourself and then it starts not this maybe run behind the goal.
Dr Florence Cotel 18:51
Yes, you can really imagine the hamster wheel and people working very, very hard but staying, remaining, or at least having the feeling that they remain exactly at the same spot that they remain immobile. This is where treatment can start enabling people to see that maybe they're not perfect. Maybe they are not reaching their goal, but they are moving forward.
This really helps people start to feel better, and it can kind of defuse this need of pushing themselves even further and working even harder, and being even more productive when they have this sensation that they are moving forward closer to what they want to reach a reward that is important to go on.
And intermediate reward because a lot of people that are a perfectionist. As long as they haven't reached the end goal, they don't feel any reward, and that's when educating managers comes into play because it's the role of managers, or at least the managers can provide that to employees.
This ability, to see that they have reached milestones, that they have achieved something, that their work is paying. They may not have finished the project yet, but they have they are going forward in the right direction.
Dr Elisabetta Burchi 20:24
So we are also talking about culture, not that we have to build in in companies, managers and so that this can be a preventive intervention, Right. It's changing the culture of working places, so it's not just about medicine and treatment. It's about prevention. It's about culture. Right.
I believe on a personal level, even psychotherapy is known for this. If we recognize ourselves as being particularly perfectionist and we may think that we are at risk of living in a world that actually is very requiring and we all know that 100 years ago it was different and not even 100 years ago even less but so the environment is already a risk factor and if you also put on top of it our personal characteristics of being particularly professionalists and probably we may think we are at risk of developing Burnout and probably we can take some preventive.
Dr Florence Cotel 21:35
Yes, absolutely, people have extremely high expectations for themselves, and it's really good to build a system for yourself, for themselves to see that they are achieving something all along the way. One example is the medical sector for medical doctors.
There are some interesting studies where some doctors were really feeling intense Burnout because they felt that they had started studying medicine to help patients, and they didn't have time to help patients because they had to be doing all...The practical stuff.
Yeah, exactly, and all the and that they had so many patients that they didn't have time just to sit with a patient and talk to a patient or that in some situations when they had to announce a very difficult diagnostic or prognostic that they didn't know how to do it and they felt that they were clumsy and in this studies what they did was teaching medical doctors how to talk to patients, how to renounce very difficult giving them tools to perform even better and to feel that they were doing a job that corresponded to why they had started this difficult journey in the first place and they have decreased the prevalence of Burnout by your strong percentage by giving the tools. If you just consider the concept, it's giving them tools to individuals to feel to perform better and to feel that they are fulfilling their initial goals.
What they're doing is meaningful, basically.
Dr Elisabetta Burchi 23:26
Yes exactly.
So this is very important and we should also maybe as we are doing now with this interview, right, to educate people about the importance of alignment between actions and goals and believing what we do now and so everything even in the working place needs to take into account the importance for your means about .......
So, I think this is very relevant it goes beyond the cellular level the cellular molecular mechanisms that underpin. I believe, as you mentioned, chronic fatigue and Burnout. You have studied this as a neuroscientist, so we had not touched upon that, but if you want to say something about the molecular level, we can.
So we have talked about the warning signs what we can do for preventing on a more institutional level uh what about the individuals, for instance, sport can be because we are endurance athletes and endurance, you know enduring this kind of sign of fatigue can be related to these two topics.
What do you suggest on an individual level? What can the individual do? And then, but I will ask you later, we have also talked about the body now, the science of the body reconnecting with the body.
Dr Florence Cotel 25:15
I think I will start by saying that at different stages it's different things that people should be doing.
At early stages when the most prevalent sign is the lack of motivation, and usually, people start having this kind of disconnection between how much their work, how much effort they put into something, and how little they care about it. It's about providing yourself with something that excites you that makes you feel good, and because of that, we talk a lot about work-life balance.
Work-life balance is wonderful in order to prevent letting yourself grow in the hamster wheel and going on and only working, which is why people that have a family are less at risk of Burnout than singles because their family at some point will have them stop working.
But not everybody strives in their … not everybody has a direct family that they live with and not everybody strives in activities that they do outside work. So it's not just a work-life balance that matters. It's a difficulty versus the excitement.
You have to imagine the kind of a bucket that typically stress will empty, and you need to fill it in with more good things, and you have to provide that to yourself if your surroundings don't.
This is why there are a lot of people that in the first what could be called mild Burnout or Burnout that is progressing start a side hustle. They start volunteering for a non-profit organization, or they create a business.
They start participating in something that they care about, and that gives them a reward that excites them, and this seems to be actually the most effective way of fighting against excitement and joy. So it's not just work-life balance. It's really something that fills your bucket with joy.
Dr Elisabetta Burchi 27:30
That's really, really interesting and amazing. It's another perspective. You know it's not just about okay we have to balance things because it's good to be, you know.
Dr Florence Cotel 27:42
It's not going to help you to leave work so that you go and you sit on your couch if you don't like what you if you're watching on tv, doesn't provide you joy.
Dr Elisabetta Burchi 27:51
Excitement, joy, and pleasure. So we are talking about it interestingly on a scientific level talking about opioids, parasympathetic activation, and endorphins, you know, and that's why maybe sport is gonna be something really powerful.
Dr Florence Cotel 28:13
Absolutely sport in the first place is going to take time, and so it's going to prevent you from going too much in the hamster wheel. The second thing is sport is going to enable you to reconnect with your body. It's much harder not to listen to your body when you've done a lot of sport.
If there are some particular pains if you feel tired of this and then your body will be going to tell you louder than what you're interested in.
It's an amplifier.
It amplifies it, and if you set yourself for joining a team and you participate in matches or if you register for some races, there's a finish line. And this enables you to feel that you accomplished something you're achieving; going through a finish line does make you feel in a very easy way that you're moving forward that you've filled your life with things that are positive, and you went from a place A to a place maybe at least further.
And then, on top of that, exercising will enable your body to release endorphins. Still, it will also enable your body to activate your parasympathetic systems, which typically calms down your body, and all of it together, every effect of sport is positive. It's a really good way not to go too far in Burnout or to start or to ignite a recovery.
That said, if it to just bounce back on what I said just before, do not just go and do any kind of sport. You need to pick a sport that you enjoy doing. Because it's not about adding something to your list that you dislike that you work hard towards but that you do not care about and so it's very important to choose a sport that gives back to you that you enjoy doing I do you know I do track, and there are lots of people that wouldn't enjoy doing tracks.
There are other sports in one while we do. I would never go play soccer but lots of people that love playing soccer, it's really if we are in an era where we define we go for personalized medicine and every individual is kind of response of himself herself for finding what corresponds to them and that's true for sport and don't tell me I've tried all the sports, and you have not tried all of them. Keep on trying. There will be one that ignites something in you.
Dr Elisabetta Burchi 30:58
Florence, I think this is revolutionary nothing in a way because everybody talks about this is good for you and we know-how this approach doesn't work. Let's look at smoking. You know everybody knows that it's bad for your health everybody.
Maybe that wasn't true 40 years ago, but now we have no doubts that everybody knows despite that many people go on smoking, so the approach don't do it because it's not good for you is not enough. No, we have to maybe really turn it up, you know, and saying, do that because you prefer doing this other thing.
So we have to leverage a pleasure. We have to leverage motivation, and so I think this is really, really important. So it's not just a matter of feeling, you know, yes, I like doing this. It's a pleasure, but really the neurotransmitters, the hormones that travel around in our body across our systems.
They are different when we like something. They are different, and they contribute not only to the physical well-being of the cardiovascular system of the immunological system but also to the well-being of the brain and consequently of our mind, so I think this is absolutely important to understand.
Dr Florence Cotel 32:40
Absolutely, at some point, your brain needs a break.
If you go on working very, very hard for many, many hours every day, your brain also deserves a break, and when you're exercising the body simply in a very simple way which I may say is going to redirect the energy that usually goes to the brain is going to redirect it for the physical body for your muscles so that they can contract and they can enable you to go on, and that enables your brain to have a break, and that's also good.
I think it's very intuitive to understand that everything in your body needs to rest at some point, and that includes your brain, so that's one more thing about the sport that is positive but again, because I run marathons. There's kind of like something a bit mystical about it or something that people really love saying I run a marathon. I meet a lot of people that time "oh, that's so cool. I want to do it too." and I said, "oh, you like running" "oh, I hate it, but I want to be able to say I ran a marathon." Don't. Find something that you want to do that you're going to enjoy doing.
Typically when I run, I have a smile on. This is the type of sport that corresponds to me. Find the sport that corresponds to you.
You won't get a reward out of telling people that you have achieved something. You'll get a reward out of feeling that you achieve something that you do care about and that makes you feel good.
This is extremely important. This really changes the deal also for any type of recovery because, again, you're trying to provide yourself with joy and excitement, not with torture.
Dr Elisabetta Burchi 34:33
I think that's a very strong message, a powerful message.
We could close here, but I would like before wrapping up, I would like to ask you something if you want to say something also about endurance. We have mentioned it but, Do you want to say something more? What's endurance?
So endurance, it seems not something okay goes on be strong go on even if you suffer right to suppose it's not about suffering.
Dr Florence Cotel 34:59
No, endurance typically means that your reward but your finish line is going to be postponed. It's going to take you a very long time to reach it. So this is what endurance has in common with resilience is that while you're going on, you need to be mentally strong and remember constantly remember that the reward will come, but it's going to be delayed that's really what endurance is about, and that's why a lot of people say that it's mental training and I would very much agree about it.
I do iron man, which is a long-distance drastic, really long distance and, for years not to damage your body, for months if you're already experienced.
And you're already going some serious distances, but for years if you're a beginner. In the beginning, you know it's going to take a long time, and you build up this capacity of seeing your progression, observing your progression, and getting excited at the idea that you are progressing and that in the long run, you're going to reach your goal. It's in that sense that resilience can be compared because people that go through very hard life events and are able to remember that this is temporary and if they keep on going, something good will happen down the track. They keep ongoing, and that's really what resilience is about.
Going through difficulties rising when something very difficult has happened to you, and that's the type of endurance and typically people that reach severe advanced stages of Burnout, they need to know, and they need to accept that this is becoming an endurance game. Their body has changed along with the evolution of the burnout stages, and they are not going to recover in two weeks.
They're not going to recover in two months; typically, for what is described at the moment, it takes years. And that's because there are deep, profound changes in the body that can be reversed, but it requires patience and changing some habits, and a lot of them, there's something that it's still unclear the difference between burnout depression, but in depression, there's something that is very obvious is the hopelessness of people.
They lose hope. They don't believe that anything is possible anymore, and in Burnout, some people feel helpless. They don't feel that they get the right help, and they don't feel that they have the solution on how to find the exit.
What is very important is not to lose hope because that's when they fall into depression and knowing that it's normal if you do not recover in three months or six months that you are on the path of recovery and that it's an endurance game and that you need and you need to be resilient that you need to keep ongoing. That's also helping not to fall into hopelessness and
That's what you need all along the way.
Dr Elisabetta Burchi 38:28
So we need the endurance to recover from Burnout and also from other mental disorders, I would say. We need resilience in order not to fall into Burnout, so the sport can be a preventive behavior for building up our resilience and also probably a way to recover faster once we have unfortunately been cocked by Burnout.
Dr Florence Cotel 39:15
A book is also an endurance project in my case. I'm typically a challenge hunter.
And I grew up thinking that I was somebody that could handle numbers, but there was really not good at words. One day, I decided to write a book to prove to myself that I can actually write, I can handle numbers, I can handle words, so it's taking a long time because I'm not only shaping a message and a book that I really want to help people but also shaping myself as a writer, I will say. Scientific writing is different than the type of writing creative writing that I do at the moment. I hope next year is honestly making big progress.
Dr Elisabetta Burchi 40:02
Yes. We need it, and we are clearly enjoying endurance training.
Dr Florence Cotel 40:09
Yes, you need to set yourself a milestone, and you have to find enjoyment along the way even though writing is an extremely difficult process, and every writer will say that its writing is suffering except you have to accept to suffer but once you've each time that you finish your chapter.
And you've you can feel the sweat, you can see on paper the result of all the hard work that fills you with a lot of joy, so you need to celebrate almost every chapter milestone. Don't wait until the very end to celebrate milestones for yourself.
To have those intermediate rewards, we were talking about.
But even if my book is not finished, I do give inspirational talks, and that's easier for me. I'm an experienced speaker, but it takes less time to prepare, and I use personal experience to inspire people that recovery is possible. It takes some time. It is difficult, but nothing good is ever easy.
Dr Elisabetta Burchi 41:23
Absolutely that's another rule, the law of life.
Florence, thank you very much, and we hope to see you again in our media series soon.