Burnout: signs, causes and how CBT can help

Burnout is often described as extreme tiredness, or as a problem a good holiday will fix. In reality, it is something more fundamental: a shift in how you relate to your work, your sense of effectiveness and, sometimes, your sense of who you are. It tends to build slowly, which is why many people only recognise it once it is well established.

Therapy can help you understand what is driving the burnout, break patterns that keep you operating beyond your limits, and develop more sustainable ways of managing pressure without losing the standards or ambition that matter to you.

This article covers the signs of burnout, what causes it, how it differs from depression and anxiety, and how CBT can help.

Signs of burnout

The World Health Organization describes burnout as resulting from chronic workplace stress that hasn't been successfully managed. It has three main features:

• Exhaustion. Feeling drained in a way that rest doesn't seem to touch. Waking up tired, dreading the day before it has started, running on adrenaline and caffeine.
• Detachment and cynicism. Feeling distant from your work or the people you work with, becoming irritable or cynical about things you used to care about, going through the motions.
• Reduced effectiveness. Finding it harder to concentrate, make decisions or get things done, and feeling less capable than you used to be, even when others don't notice a difference.

Other common signs include poor sleep, frequent minor illnesses, difficulty switching off in the evenings or at weekends, losing interest in things outside work, and a growing sense that you can't keep going like this.

What causes burnout

Burnout is partly about the work itself. Research has consistently linked it to a handful of workplace factors: excessive workload, little control over how the work is done, insufficient recognition, poor relationships at work, a sense of unfairness, and a mismatch between your values and what the job asks of you.

But two people in the same job don't always burn out in the same way. Personal patterns play a large part too, and these are often what therapy can change:

• Perfectionism: standards that can never quite be met, and a sense that anything less than your best is failure
• Difficulty saying no, delegating or setting limits
• A sense of self-worth that depends heavily on achievement or on being needed, which often connects to low self-esteem
• Fear of being seen as inadequate, which makes it hard to admit you are struggling
• A habit of pushing through rather than stopping, which works well until it doesn't

Why rest alone doesn't fix it

The reason people struggle to break the cycle of burnout is rarely a lack of willpower or insight. It is usually because the conditions that created the burnout, both at work and within themselves, have not changed. Rest helps, but it doesn't address the underlying pattern. When you return to the same environment with the same responses, the cycle resumes.

Chronic stress also affects the capacity for rest, decision-making and perspective. What looks like laziness or weakness from the outside is often a system running on empty, doing its best to protect itself.

Burnout, depression and anxiety

Burnout overlaps with both depression and anxiety, and they often occur together. The difference matters because it affects what treatment should focus on.

Burnout is specifically tied to work: the exhaustion and detachment centre on your job, and other areas of life may still bring some enjoyment, at least at first. Depression tends to be more pervasive, affecting mood, interest and self-worth across all areas of life. Anxiety often drives the overworking that leads to burnout in the first place, through worry about performance, fear of letting people down, or a constant sense of needing to stay ahead.

Part of a careful assessment is working out which of these is in the foreground for you, and how they fit together. If anxiety is a large part of the picture, my anxiety therapy page may also be useful.

How CBT can help

CBT for burnout is not about learning to tolerate more pressure or becoming more resilient so you can keep going as before. It is about understanding what led you here and changing the patterns that keep you there.

Treatment typically involves building a clear picture of what has contributed to the burnout, including both the demands you face and the way you respond to them; working on the beliefs that drive overwork, such as "I can't let anyone down" or "Resting is a waste of time"; and gradually rebuilding recovery, limits and the parts of life that work has crowded out.

People in burnout often try to fix it the same way they approach everything else: by working harder at it. Having someone alongside who can see the pattern helps you avoid turning recovery into another performance target.

When to seek help

It may be time to speak to someone if exhaustion has lasted for months rather than weeks, if time off no longer helps, if you are dreading work most days, or if the strain is affecting your health, your relationships or your sense of yourself. Many people wait until they are close to stopping altogether. It is usually easier to address burnout earlier.

In my practice

Burnout is one of the areas I see most often, particularly in senior professionals and high achievers who have managed extraordinarily well for a long time and are now finding that the strategies that served them are no longer enough. What I find, again and again, is that the problem is rarely what it appears to be on the surface. Burnout that looks like exhaustion often has perfectionism or a fear of failure at its core. My aim is to understand both, and to help you build a more sustainable way of working and living from there.

Guy Klein

BABCP-accredited CBT therapist and EMDR Europe accredited practitioner, in clinical practice since 2015. Guy works with adults online and in Queen's Park, North West London, with a particular focus on OCD, anxiety and trauma. More about Guy