Running on Empty: Understanding Stress & Burnout

a Virtual Health Talk with Ella Markland, PMHNP

For many of us, stress has become background noise. It's woven into our workdays, our schedules, our relationships, and even our downtime. We move from one responsibility to the next without stopping long enough to realize just how much we're carrying. We tell ourselves, “I’ll slow down after this project,” or “Things will calm down after the holidays.” But for many of us, that quieter season never seems to arrive.

That's one reason stress and burnout have become such important topics of conversation. During a recent UNC Health Appalachian Health Talk, Ella Markland, PMHNP, discussed why so many people feel overwhelmed, exhausted, and stretched thin – and why understanding the difference between stress and burnout matters.

The Rocket Ship

To help us understand the difference between stress and burnout, Ella compares stress to a rocket ship. “When you are first blasting off from the launch pad and your rocket ship is full of fuel, you have direction, you have motivation, you have a goal,” she explained. This is what Ella describes as healthy stress. It's the excitement of starting a new job, training for a race, planning a wedding, or working toward a goal that matters to you. The pressure is real, but so is the sense of purpose behind it. You're challenged, but you're also energized! The stress is helping move you forward rather than holding you back. In this stage, the rocket is moving exactly as it should.

The problem begins when the demands placed on us start to outweigh our ability to recover. This is the middle ground Ella describes as distress. We may still be showing up to work, taking care of our families, and checking things off our to-do lists, but something starts to feel different. As Ella puts it, "Your rocket ship is still headed in a direction, but now that gravitational force is starting to put more pressure on your rocket. Maybe the bolts and the nuts are starting to become a little bit loose, and things are starting to rattle."

And if that pressure continues long enough without relief, burnout can follow.

“This is when your rocket ship has no more fuel,” Ella said. “There is nothing left in the tank.” Unlike stress, which can still leave room for motivation and purpose, burnout often feels like emotional exhaustion. The things that once energized you no longer do. Work feels heavier. Relationships feel harder. Even activities you normally enjoy can begin to feel like just one more thing on the list. The rocket hasn't simply slowed down – it's run out of fuel.

The Warning Signs We Often Ignore

One reason burnout can sneak up on us is that the warning signs rarely appear all at once. Burnout doesn't happen overnight, but develops gradually, often after months or even years of carrying more than we can realistically sustain.

According to Ella, stress can show up in ways that many of us don't immediately connect to our mental well-being. It may start with headaches, muscle tension, digestive issues, or difficulty sleeping. For others, it looks more emotional, like feeling anxious, irritable, overwhelmed, or finding it harder to concentrate throughout the day. Some people notice they're getting sick more often, while others simply feel exhausted no matter how much rest they get.

The challenge is that many of these symptoms are easy to dismiss. We tell ourselves we're tired because we've been busy or we assume we're irritable because we've had a stressful week. But sometimes those symptoms are our body's way of asking us to pay attention. Before burnout ever arrives, the rocket ship usually gives us warning signs that fuel is running low.

We were built to Escape Bears, not Emails

One of the most relatable parts of the conversation centered around why stress feels so overwhelming in today's world. Our bodies were designed with a built-in alarm system. Thousands of years ago, that system helped humans survive real, immediate threats. If a bear appeared in front of you, your body would respond instantly. Your heart rate would increase, adrenaline would surge, and your body would prepare to fight, flee, or protect itself. Once the danger passed, your system would settle back down.

The problem is that today's threats often look very different. Instead of bears, many of us are facing overflowing inboxes, looming deadlines, financial pressures, family responsibilities, constant notifications, and an endless stream of information competing for our attention. While these challenges aren't physically chasing us, our bodies often respond as if they are.

As Ella explained, "In today's world, those perceived threats could potentially never turn off. And so, our alarm systems are always on." It's no wonder so many people feel exhausted!

Many of us aren't running from bears anymore, but our minds and bodies are still reacting as though we're constantly under threat, so how do we quiet the alarm system? According to Ella, the answer isn't always something complicated. Sometimes it's as simple as slowing down long enough to reconnect with the present moment. One technique she frequently teaches is called box breathing. The exercise involves slowly inhaling for four seconds, holding for four seconds, exhaling for four seconds, and repeating the pattern while imagining the four sides of a box.

"When we get anxious and stressed, our breathing automatically gets shallower and more rapid," Ella explained. "When you start to deep breathe and concentrate on your breathing, you're actually tapping into your parasympathetic nervous system, which is responsible for slowing down and regulating all of your systems."

She also recommends grounding exercises, which help bring your attention back to the here and now. One simple approach is to pause and notice three things you can see, three things you can hear, and three things you can touch. These techniques may seem small, but they can help interrupt the cycle of stress and remind your body that the bear isn't standing in front of you.

Learning to Navigate Stress Differently

As the conversation wrapped up, Ella shared one final reminder that “Well-being is not the absence of stress. It is the ability to navigate through it.”

Stress is probably always going to be part of life. But maybe part of caring for ourselves is learning to recognize when our own rocket ship is running low on fuel. Maybe it is setting boundaries. Maybe it is taking a real lunch break. Maybe it is turning our phones off for an hour. Maybe it is finally admitting we are tired.

For some people, that next step may include talking with a behavioral health professional like Ella or another mental health provider. Whether you're struggling with stress, anxiety, burnout, depression, or simply feeling overwhelmed, having someone to talk to can make a difference. At UNC Health Appalachian, our Behavioral Health team provides care and support for individuals facing a wide range of mental health concerns.

So, if your rocket ship is starting to rattle, pay attention. If the fuel gauge is running low, take time to refuel. And if you've already run out of fuel, know that help is available. Visit https://www.unchealthappalachian.org/services/behavioral-health/ to learn more.

Watch Ella Markland's Health Talk here

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