Can focusing on burnout cause more burnout?

It may sound counterintuitive to suggest focusing on burnout could, in fact, cause more burnout. After all, there is no shortage of research studies, journal articles, and other media reminding us of the epidemic of stressed out, overburdened, and disengaged physicians, nurses, and other healthcare professionals.^1,2,3,4

While most of the literature centers on clinician burnout, it’s increasingly clear that administrative leaders are not immune. A study by the consulting firm WittKieffer⁵ revealed that more than 40% of healthcare executives said that burnout was interfering with their job performance, and more than 60% felt overwhelmed at work. An MGMA Stat poll showed that fewer than 50% of the 834 responding healthcare leaders had taken steps to support their own resiliency.⁶ Moreover, many hospitals and health systems have increased efforts supporting clinicians and other workers to mitigate burnout. These efforts include reducing workloads, implementing flexible schedules, resiliency training, and a host of other wellness programs.⁷ These initiatives are certainly important and should continue to be rolled out and expanded when possible.

However, there is often more to the story when it comes to what holds us back from improving our mental outlook and alleviating feelings of burnout. Namely, our thought patterns and where we focus our attention can profoundly influence how we interpret circumstances — and, in turn, significantly impact our emotional and physical health.

The following sections explore the role of repetitive negative thinking and, by contrast, the benefits of reframing thoughts and broadening our awareness toward a balanced — and often more realistic — mindset. While these themes are largely absent from much of the burnout literature, the information provided here can prompt reflection on how a negativity bias can affect us and inspire a shift toward a more uplifting way of thinking. As you will learn in the following sections, how we think plays a powerful role in improving our emotional well-being — and that shift alone can go a long way toward easing the weight of burnout.

What psychology and neurosciences teach us

Research from psychology, neuroscience, and other related disciplines has shown that obsessing over what’s not going well in our lives can trigger a downward spiral of negativity, worsening symptoms of depression, anxiety, and hopelessness.^8,9 When left unchecked, this negativity bias can also narrow our thinking, reduce motivation, and impair our ability to solve problems.¹⁰

An example of this is the concept of depressive rumination, which refers to habitual focus on the fact that one is depressed. This persistent mental loop not only prolongs depressive symptoms but often deepens them.¹¹ In a similar vein, fixating on being burned out — rather than addressing its causes or reframing our perspective — can create a self-fulling cycle of feeling more overwhelmed, disengaged, and exhausted.

Adding to the equation, functional imaging and other tests have shown that our brains have a certain amount of neuroplasticity, meaning they can actually change in response to our experiences and thought patterns.¹²

Shifting away from a negativity-focused mindset can be quite complex and is not instantaneous. For many, especially those stuck in toxic environments or chronically frustrating circumstances, it can feel nearly impossible. Unfortunately, the tendency to dwell on what’s not working — or what could go wrong in the future — is an all-too-common phenomenon, one that can have lasting emotional and physical consequences.

The perils of repetitive negative thinking

Repetitive negative thinking (RNT) refers to frequent, prolonged bouts of excessive worry and rumination.¹³ Worry refers to fearful and anxious thoughts about future happenings, while rumination involves obsessing about past adverse events or current circumstances.¹⁴ While these traits are woven into the human condition — and it can be helpful for learning from past experiences or anticipating future pitfalls — when excessive, RNT is a major contributor to emotional distress and crisis.¹⁵

Worry and rumination become dysfunctional, and even pathological, when they occur too often and become intrusive and uncontrollable.¹⁶ When our thoughts are caught in a cycle of negativity, we are much less inclined to seek solutions or engage in effective problem-solving. In other words, when we are using our brains to worry and ruminate, we aren’t thinking about how to make things better.

Adding to the dysfunction of RNT is the fact that our experiences and related thought patterns can change our neurobiological responses and cognitive abilities.¹⁷ Frequent or intense adverse events — including persistent RNT — can strengthen the neural pathways associated with fear, anxiety, and other adverse reactions. These pathways are further amplified by stress hormones, compounding our negative responses.

For example, when we face ongoing negative experiences at work, the amygdala — the brain region associated with the fight or flight reflex — can become more easily triggered. It releases higher levels of norepinephrine, which, in excess, inhibits the functioning of the prefrontal cortex, the part of the brain responsible for rational thinking.^18,19

Put simply, when we engage in RNT, our brains become faster at reacting negatively and slower at responding positively.

Shifting toward a more positive approach

Since the late 1990s, there has been a growing movement in the field of psychology to study and promote the elements that support more fulfilling lives. Largely credited to psychologist Martin Seligman, PhD, at the University of Pennsylvania, the field of positive psychology has broadened the attention of scholars and practitioners beyond the treatment of mental illness and other ailments to also explore what drives emotional well-being and human flourishing.²⁰

Grounded in both empirical and correlational research, this approach led to the development of a foundational theory that synthesizes complex components into a framework for thriving. Specifically, the elements of experiencing positive emotions, engaging in fulfilling activities, fostering supportive relationships, having a sense of meaning, and acknowledging accomplishments make up the PERMA (positive emotion, engagement, relationships, meaning, and accomplishment) theory in positive psychology.²¹

While a full discussion on the PERMA theory is beyond the scope of this article, note that cultivating positive emotions is considered a pivotal first step in counterbalancing the perils of RNT. In particular, the Broaden-and-Build Theory of Positive Emotions has been well-established as a means for enhancing psychological well-being, building resources, and living a more rewarding life.

The Broaden-and-Build Theory of Positive Emotions

In 1998, Barbara Fredrickson, PhD, developed the Broaden and Build Theory of Positive Emotions. The core tenet of this theory is that having positive experiences broadens our awareness and opens our minds to new ideas, ultimately helping us build emotional, social, and physical resources.²² These strengthened resources are then available as needed to help navigate and overcome life’s challenges.

This broadening effect of positive emotions has been described as creating an upward spiral — fueling creative thinking, stronger social connections, and enhanced physical health.²³ As such, this upward spiral of positive emotions directly counters the downward spiral of distress associated with RNT.²⁴

The first step in activating this upward spiral is to intentionally reflect on and pursue activities that evoke emotions such as joy, purpose, and gratitude. When we experience these positive feelings, our awareness expands, enhancing creative thinking, motivation, and our ability to form wider social networks. For example, with a more positive mindset, we are more open to reframing negative experiences, leading to more effective problem-solving and stress management. From a social perspective, people are also more likely to lend a helping hand and other support when we approach challenges with a positive demeanor. Combined, these enhanced resources reinforce further positive experiences, sustaining the upward spiral of well-being.²⁵

As one might expect, more frequent and enduring positive experiences can also change our neurological and biological responses. In contrast to RNT, a more optimistic outlook builds neural pathways associated with positive feelings — and enhances the release of beneficial neurotransmitters such as dopamine.^26,27 Imaging studies have shown that while chronic, uncontrolled stress can shrink the synaptic connections to the prefrontal cortex, this brain region can regenerate when stress is reduced and positive experiences increase.²⁸

Striking a healthy balance and closing thoughts

It’s important to point out that a healthy balance between negative and positive experiences — and our related responses — is both natural and necessary. Nothing in this article is intended to suggest that simply thinking happy thoughts will magically change our circumstances or solve all our problems. In fact, much like RNT, the tendency to fixate on being happy all the time or to deny the natural ebb and flow of life can become its own dysfunctional and ultimately detrimental way of thinking.²⁹

Instead, and returning to the notion that focusing on burnout can sometimes perpetuate it, the key is to become more in tune with our thought patterns. By recognizing when we slip into the cycles of excessive worry and rumination, we can develop our ability to pause, shift our focus, and respond in more realistic and productive ways.

With intention and consistent practice, it is possible to train our minds to notice what is going well in our lives, reconnect with joy and other positive emotions, and take proactive steps toward living a more content and fulfilling life.

Notes:

1. Alderton M. (2022, March). “The secret to safer patients: Workforce wellness.” Healthcare Executive, 37(2), 16–23.
2. American Medical Association & Berg S. (2024, July 2). “Physician burnout rate drops below 50% for first time in 4 years.” AMA. Available from: https://bit.ly/4gzifb2 .
3. Galanis P, Vraka I, Fragkou D, Bilali A, Kaitelidou D. (2021). “Nurses’ burnout and associated risk factors during the covid-19 pandemic: A systematic review and meta-analysis.” Journal of Advanced Nursing. https://doi.org/10.1111/jan.14839
4. Swensen S, Shanafelt T. (2020). Mayo clinic strategies to reduce burnout. Oxford University Press. https://doi.org/10.1093/med/9780190848965.001.0001
5. WittKieffer. (2020). The impact of burnout on healthcare executives [Research Brief]. Available from: https://bit.ly/42Ajp0Q .
6. Williams D. “Building resilient leadership in healthcare for better well-being.” MGMA. April 8, 2021. Available from: https://bit.ly/42uDQfL .
7. Cohen C, Pignata S, Bezak E, Tie M, Childs J. (2023). “Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: A systematic review.” BMJ Open, 13(6), e071203. https://doi.org/10.1136/bmjopen-2022-071203
8. Gorday JY, Rogers ML, Joiner TE. (2018). “Examining characteristics of worry in relation to depression, anxiety, and suicidal ideation and attempts.” Journal of Psychiatric Research, 107, 97–103. https://doi.org/10.1016/j.jpsychires.2018.10.004
9. McLaughlin KA, Nolen-Hoeksema S. (2011). “Rumination as a transdiagnostic factor in depression and anxiety.” Behaviour Research and Therapy, 49(3), 186–193. https://doi.org/10.1016/j.brat.2010.12.006
10. Carr A. (2022). Positive psychology: The science of wellbeing and human strengths (3rd ed.). Routledge.
11. Averill LA, Averill CL, Kelmendi B, Abdallah CG, Southwick SM. (2018). “Stress response modulation underlying the psychobiology of resilience.” Current Psychiatry Reports, 20(4). https://doi.org/10.1007/s11920-018-0887-x
12. Scarlett H. (2019). Neuroscience for organizational change: An evidence-based practical guide to managing change (2nd ed.). Kogan Page.
13. Spinhoven P, van Hemert AM, Penninx BW. (2018). “Repetitive negative thinking as a predictor of depression and anxiety: A longitudinal cohort study.” Journal of Affective Disorders, 241, 216–225. https://doi.org/10.1016/j.jad.2018.08.037
14. Parmentier FR, García-Toro M, García-Campayo J, Yañez AM, Andrés P, Gili M. (2019). “Mindfulness and symptoms of depression and anxiety in the general population: The mediating roles of worry, rumination, reappraisal and suppression.” Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.00506
15. Lewis EJ, Blanco I, Raila H, Joormann J. (2019). “Does repetitive negative thinking affect attention? differential effects of worry and rumination on attention to emotional stimuli.” Emotion, 19(8), 1450–1462. https://doi.org/10.1037/emo0000535
16. Bell IH, Marx W, Nguyen K, Grace S, Gleeson J, Alvarez-Jimenez M. (2022). “The effect of psychological treatment on repetitive negative thinking in youth depression and anxiety: A meta-analysis and meta-regression.” Psychological Medicine, 53(1), 6–16. https://doi.org/10.1017/s0033291722003373
17. Averill, et al. “Stress Response Modulation.”
18. Amen M. (2022). You, happier. Tyndale House Publishers.
19. Averill, et al. “Stress Response Modulation.”
20. Carr, et al. “Positive psychology.”
21. Cheavens JS, Feldman DB. (2022). The Science and Application of Positive Psychology. Cambridge University Press.
22. Fredrickson BL. (2001). “The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions.” American Psychologist, 56(3), 218–226. 10.1037//0003-066x.56.3.218
23. Lopez SL, Snyder CR. (Eds.). (2011). The Oxford Handbook of Positive Psychology (Oxford Library of Psychology) (2nd ed.). Oxford University Press, USA.
24. Garland EL, Fredrickson B, Kring AM, Johnson DP, Meyer PS, Penn DL. (2010). “Upward spirals of positive emotions counter downward spirals of negativity: Insights from the broaden-and-build theory and affective neuroscience on the treatment of emotion dysfunctions and deficits in psychopathology.” Clinical Psychology Review, 30(7), 849–864. https://doi.org/10.1016/j.cpr.2010.03.002
25. Fredrickson BL. (2009). Positivity: discover the upward spiral that will change your life. Crown Publishing Group.
26. Garland, et al. “Upward spirals of positive emotions.”
27. Rosenfeld AJ. (2019). “The neuroscience of happiness and well-being.” Child and Adolescent Psychiatric Clinics of North America, 28(2), 137–146. https://doi.org/10.1016/j.chc.2018.11.002
28. Arnsten AF, Shanafelt T. (2021). “Physician distress and burnout: The neurobiological perspective.” Mayo Clinic Proceedings, 96(3), 763–769. https://doi.org/10.1016/j.mayocp.2020.12.027
29. Lyubomirsky S. (2008). The how of happiness. Penguin Group USA, Inc.