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The Perfect Storm: Severe, Prolonged Stress Leads to Burnout

by Diana Price, Medially Reviewed by C.H. Weaver M.D. Updated 11/2021

About eight years ago, Rev. Roxanne Pendleton thought she was experiencing a return of symptoms of clinical depression that she had battled years before.

As pastor of a small-town congregation, Rev. Pendleton had been through a particularly challenging period professionally, while also navigating personal and family challenges. Having recently moved her newly blended family, which encompassed three boys and three girls, to a new town and new school, she was also experiencing stress around legal conflict with her ex-husband, ongoing health issues in beloved pets, a miscarriage, and her husband’s extensive travel and on-call schedule. Her congregation, and the larger community in which she lived, had been rocked by a series of deaths by suicide and violent crimes, and Rev. Pendleton was among the spiritual and mental health providers who had spent months engaged in crisis support, pastoral care, grief counseling, and community outreach.

Over time, the pace and intensity of her work became relentless. “There just wasn’t enough time, and there weren’t enough resources to meet the overwhelming needs in our community. There weren't enough people to help,” Rev. Pendleton says. In the face of what felt like constant emergency crisis response, she just pushed harder. “To try to respond to all the people who needed help, I basically stopped sleeping. I got maybe two to three hours a night.”

It was the lack of sleep that finally forced her to recognize the physical and mental symptoms she was experiencing were flapping red flags. “I started having symptoms that I thought meant a relapse of the clinical depression with anxiety disorder I had had many years before,” she says. “This included feelings of hopelessness, helplessness, pessimism, crankiness, and abiding sadness; feeling constantly under attack, restless, and “amped up”; struggling to de-escalate my reactions; being unable to “turn off” my emotions or release the stress of the day; nightmares; insomnia; chronic fatigue; brain fog; decreased motivation; a desire to isolate; gastrointestinal distress and other physical symptoms; decreased ability to tap into feelings of compassion; emotional numbness; inability to feel pride or joy at success; and loss of pleasure in daily life. Not only was it traumatic for me to experience, it was terrifying for my loved ones to witness.”

But after seeking support through therapy, Rev. Pendleton recognized that it was actually something else: “I was experiencing compassion fatigue and burnout. It was just too much for my nervous system to navigate.”

Even with a long career in pastoral ministry, training in behavioral health, and well-honed self-care practices to mitigate the impact of stress and trauma, Rev. Pendleton found herself in new territory when it came to the experience of burnout. “I had over a decade under my belt of living very intentionally to care for my mental health and well-being, but my self-care practices just couldn't match the acuity of that time.”

Rev. Pendleton made the difficult decision to leave her position as pastor and took an extended period off to recover and reset before seeking a new position in behavioral healthcare. “I was very fortunate to receive a severance package from my church, which allowed me to take six months off. It took every minute of that time to restore my health and emerge from burnout,” she says.

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What is Burnout?

The prolonged, severe stress that Rev. Pendleton experienced is the most significant cause of burnout, which the American Psychological Association defines as “physical, emotional, or mental exhaustion accompanied by decreased motivation, lowered performance, and negative attitudes toward oneself and others.”1 While we most commonly hear the term in relation to work-related chronic stress, burnout can be brought on by prolonged stress in other areas of life as well, including parenting, caretaking, and romantic relationships.2

While stress can cause burnout, it’s important to understand the difference, which is often described in terms of “too much” and “too little.”3 If you’re experiencing stress, you’re likely feeling too much pressure from a single source, or as a result of various factors, but you feel that if you can manage those stressors, you will feel better. If you’re experiencing burnout, you feel exhausted and depleted. You have too little—too few internal and external resources to manage or change your circumstances and emerge from what feels like a hopeless situation.

Rev. Pendleton, who now serves as Senior Projects Coordinator, Center for Trauma Informed Innovation at Truman Medical Centers in Kansas City, Missouri, educates others about burnout in her work to inform organizations and communities about trauma-informed care and support personal, professional, and organizational resilience. She says that to understand how this constant barrage of chronic stressors can lead to burnout, it’s helpful to be aware of what’s happening in the brain and body to bring us to this point.

“When we experience a threat, our bodies transition from a parasympathetic to a sympathetic nervous system response,” Rev. Pendleton says. Many things can happen physiologically when this occurs: digestion can shut down because energy and blood is shunted to your arm and leg muscles so you can literally fight or flee; your platelet count increases so blood can clot in case you are wounded; your heart rate will increase, and your blood pressure will rise to give you more energy. All of these responses are meant to serve us in acute, short-term situations. “Our threat response is designed to stop after about 30-45 minutes,” Rev. Pendleton says.

But prolonged, intense stress, the type that leads to burnout, means that our bodies and brains get no respite. “The factors feeding burnout are experienced as a threat to the nervous system,” she says. “When we don't have enough resources do whatever it is we need to do, when we don't have enough time or training or the environment is relentlessly acute—all of these things hit the nervous system over and over and over—that relentless pummeling leads to burnout.”

“When your body and brain are continually activated to respond to stressors, and you don’t have time to return to your baseline state of calm, you exist in a chronic state of inflammation.” At this point, Rev. Pendleton adds, your body responds by beginning to shut down. “You can experience extreme fatigue, and your organs begin to struggle to operate well. Neurological fatigue can cause us to become more and more reactive, more hyper-vigilant, until eventually we get to the point where we're so emotionally depleted that we can become cynical and numb as a protective mechanism.”

According the, physical and emotional signs and symptoms of burnout include:4

  • Feeling tired and drained most of the time
  • Lowered immunity, frequent illnesses
  • Frequent headaches or muscle pain
  • Change in appetite or sleep habits
  • Sense of failure and self-doubt
  • Feeling helpless, trapped, and defeated
  • Detachment, feeling alone in the world
  • Loss of motivation
  • Increasingly cynical and negative outlook
  • Decreased satisfaction and sense of accomplishment

Behavioral signs and symptoms of burnout include:5

  • Withdrawing from responsibilities
  • Isolating yourself from others
  • Procrastinating, taking longer to get things done
  • Using food, drugs, or alcohol to cope
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  • Taking out your frustrations on others
  • Skipping work or coming in late and leaving early
  • Burnout Today: The Perfect Storm

There’s no question that burnout is having a moment. In the wake of the COVID-19 pandemic, many women find themselves in the eye of a perfect storm: work-related (work-from-home, job loss) stress, caregiving demands (children, homeschooling, caring for aging parents), and health-related concerns create a consistent, high-pressure stream of stress. Against this backdrop, headlines around burnout and its causes are proliferating.

And the data supports the buzz. In a recent CNBC and SurveyMonkey Women at Work Survey, 53 percent of women said their mental health suffers to the point of burnout because of their jobs, all or some of the time.6 In addition to significant stress around work, women disproportionately bear the burden of caregiving and related stressors. Approximately 75 percent of all caregivers are female, and they may spend as much as 50 percent more time providing care than males.7 A recent survey of 4,100 caregivers (of children and aging parents) in the U.S. and Europe by Boston Consulting Group, found that caregivers in most countries were significantly more worried about job security and their physical and mental well-being than were non-caregivers.8

Andrea Dalton, who works alongside Rev. Pendleton as a Special Projects Coordinator at the Center for Trauma Informed Innovation, notes that this unique moment in time has added a new dimension to the stressors in women’s lives that lead to burnout. “On top of our ongoing responsibilities in our families, our jobs, and our communities, we’ve experienced ongoing stress related to politics, social justice, and climate change. We’re all just carrying so much.”

Rev. Pendleton notes that the lack of support for women across various areas of responsibility increases the potential for the chronic stress that leads to burnout. “The systems we have developed as a society around work and caregiving roles are not set up to provide rest and spaciousness in which we can recover,” she says. “In fact, despite research consistently showing that productivity decreases when people are too tired and don’t have time for rest and self-reflection, we continue in our society to just drive, drive, drive, until we literally drive ourselves into the ground. We get sick, and yet we still keep working. We tend to celebrate overwork and over engagement.”

Dalton agrees and notes, “We have become increasingly disconnected from our communities, so that while communities used to come together to support women who were caregiving and working in different capacities, our relationships have become much more transactional. We don’t share the burden in the same way.”

Support and Solutions

In the face of such widespread prevalence of burnout among women—and the reality that, pandemic or not, women are going to continue to experience this debilitating syndrome—there is hope in the many tools and strategies to prevent and recover from burnout.

Be Aware. If you are feeling any of the symptoms of burnout described above, be aware that these may be red flags, indicating that you need to assess the stressors in your life and make changes to address what factors you can. Because burnout can build slowly over time, paying attention to subtle signs and symptoms can be an important step in getting the support you need.

Take Practical First Steps. If you do recognize that you’re experiencing signs of burnout, consider how you can make changes in your daily routine or at work that can reduce the burden of stress right away. Can you ask for help with specific caregiving or work tasks? Can you cancel one weekly appointment or meeting? Sometimes making seemingly small changes to reduce the pressure of daily responsibilities—even small ones—can go a long way toward alleviating chronic stress.

Reach out for Professional Help. Dalton notes that “working with a therapist, a counselor or a life coach, someone who's not in the thick of it, can be really helpful in devising creative ways to make space for yourself to get restored.” This person may help you chart a course to a less stressful job, provide tips for navigating conversations with your boss to help you stay in your current job, or provide insight into redesigning caregiving patterns and family communication to help relieve stress at home.

Remember Your Purpose. “Often, when we experience burnout, we're not in a position to be able to change the systemic pressures that are contributing to our stress,” Dalton says. “We can’t always leave a job or spend time away from family caregiving. But if we can reconnect with and reignite our purpose and passion—that reason we started working in our field or the deep love we have for family or our passion for activism—that can provide a reset for the brain and help us process and move forward.”

Develop a Self-Care Plan to Build Resilience. Rev. Pendleton notes that building resilience is a powerful step toward emerging from and preventing burnout. Resilience is “the capacity to prepare for, cope with, and grow through adversity,” she says. “While it’s inherent in some, all of us can cultivate resilience through intentional, relentless self-care, which really means doing what you need to do for yourself to be present and to thrive whether at work, at home, or in your community.”

There’s no universal prescription for self-care, but there are strategies and practices that can provide structure for a sustainable approach. Rev. Pendleton says that these include:

  • Creating daily morning and evening rituals. Set yourself up for success by developing a routine that starts your day right and another evening ritual that allows you to metabolize your stress response at the end of the day.
  • Spending time in nature. Whether you sit in your backyard, visit a local park, or venture further afield, taking time to enjoy the sensory experiences of the natural world can offer valuable respite and space to reflect.
  • Scheduling breaks for yourself between meetings, phone calls, and tasks. Give yourself the gift of time—even five minutes between scheduled events will offer you time to breathe, move, and reset.
  • Setting boundaries. Taking care of yourself can mean learning to say “no,” whether to work, social commitments, or family requests so that you can create a margin of space for yourself to rest and recover.
  • Practicing Self-Compassion. Acknowledging to yourself that you are tired, that life is stressful, and that you are doing hard things, can open up space in your mind and your heart. Offering yourself the kindness and acceptance you would offer others experiencing stress and hardship will activate the parasympathetic nervous system, release the feel-good brain chemical dopamine, and engage the vagus nerve to tell the body it’s time to relax. 

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Additional Resources from AWomansHealth


Stress and Heart Health

Stop Stress in its Tracks

Signs and Symptoms of Stress


Imagine Your Way to Peace

Use Your Head to Soothe Your Body


  1. Dictionary of Psychology. American Psychological Association website. Available at: . Accessed May 7, 2021
  2. Burnout Page. Psychology Today website. Available at: Accessed May 7, 2021.
  3. Burnout Prevention and Treatment. Website. Available at: Accessed May 7, 2021.
  4. Burnout Prevention and Treatment. Website. Available at: Accessed May 7, 2021.
  5. Burnout Prevention and Treatment. Website. Available at: Accessed May 7, 2021.
  6. Fox, M. Brain fog, fatigue and chronic stress — 53% of U.S. women are burned out. Here’s how to cope. CNBC website. Available at: Accessed May 7, 2021.
  7. Caregiver Statistics: Demographics. Family Caregiver Alliance website. Available at: Accessed May 7, 2021.
  8. Green A, Kos E, Krentz M. Take Care of the Caregivers at Your Company. Boston Consulting Group website. Available at: Accessed May 7, 2021.