Stress Resilience and the Brain in Burnout

Burnout is a condition affecting many people, resulting in loss of
productivity, exhaustion, and depersonalization. A lot of overlap between
burnout and depression exists however, making the understanding of burnout
unclear. One possible distinguishing feature can be dysfunctions in
glucocorticoid systems. Indeed there exists evidence supporting this
conclusion, with a suppressed glucocorticoid system being a prominent feature
of burnout, but not depression. This evidence comes from studies examining the
cortisol awakening response, and using the dexamethasone suppression test.
However, this evidence is not entirely conclusive, as there are also studies
showing the opposite effects. One possible explanation behind these findings
could be the influence of childhood trauma, socioeconomic factors, and possibly
daily life stress reactivity. Furthermore, these glucocorticoid deficits may
have specific neural underpinnings, as reflected by the brains reactivity to
stress. Studies examining the neural circuitry that may be behind burnout are
limited to a handful of studies, and only one study using MRI. None of these
studies however examine the effects of stress on the brain in burnout, which
may be the underlying driving force behind this condition.

The main objective of this study is to examine the neural underpinnings of
stress reactivity in people with burnout. In turn, we aim to link this stress
reactivity to real life stress activity, and in turn to glucocorticoid
deficits. We also aim to examine the potential confounding variables that may
also be coming into play such as experiences of trauma.

This is a case-control study examining difference between people with burnout
and controls. Subjects will perform an intake procedure where they will sign
the consent form. Following consent, subject will complete the Utrecht Burnout
Schaal which measures burnout. Controls who score too high will be excluded at
this point. Subject will then proceed to fill in a survey on trauma experience.
On another day, subjects will return to retrieve watches that collect
physiological data that will be used to measure subjective stress reactivity.
Subjects will use these watches in tandem with surveys that are sent over a
period of 7 days to measure stress reactivity. These surveys are delivered 10
times a day, and require 3 minutes to fill. This method is known as experience
sampling, and is commonly used in many studies with clinical populations. On
three of these days, subjects will also collect saliva samples upon waking, and
at 15 min intervals during the first hour of waking. An additionally four more
samples are collected throughout the day. These allow us to measure potential
glucocorticoid differences in subjects with burnout.

Upon completion of this week, subject return to the study site, where they
engage in tasks that measure effort-reward trade offs, and will also collect a
dexamethasone tablet on this day to use in the evening. Upon returning home
subjects are expected to take the pill orally before bed time, and collect
saliva samples as they did on previous days during the testing week.
Finally, each subject will complete two scans on separate days. The purpose of
the first scan is to acquire structural images, and to get subjects accustomed
to being in a scanner. The second scan day will be a functional MRI scan
examining brain activity under stress. This will be the last testing period of
this study, and after completion subject will be debriefed.

This study require a significant time investment. While it is a minimal risk
study, there may be a potential psychological burden associated with filling in
surveys throughout the day, and possible negative emotions elicited from the
questionnaires used. MRI is generally safe when taking into account the strict
exclusion criteria adhered to. Potential discomfort from laying in the scanner
may arise, and from being in confined spaces. This is accounted for by ensuring
subjects are laying comfortably in the scanner, and with the addition of
support cushions where necessary. Subjects are also screened for feelings of
claustrophobia, no rule out discomfort associated with small spaces. Subjects
themselves will not receive direct benefit from participation beyond monitory
compensation. This study will benefit burnout by attempting to further
elaborating on mechanisms behind this condition, and potentially paving the way
to new studies examining targeted treatments that focus of the glucocorticoid
system.