HEALTH AND PLACE

The previous section provided an overview of neurodiversity and how the office space can affect the health of neurodiverse people. In this section we discuss some of the biological aspects, to understand in more detail how the places we inhabit have an effect on our health. This is a crucial part of the report, as it cements the idea that spaces are not just an aesthetic experience, they are also experienced biologically.

THE BIOLOGICAL STRESS RESPONSE

The first part of this section will look at the biological stress response, and the second part will focus on burnout syndrome.

In this first part we cover the following learnings:

• Our health is dependent on the places we inhabit; this includes the office space.

• When a physical space is not designed to support health, it can be especially debilitating to neurodiverse people, to the point of developing burnout syndrome.

• Burnout syndrome can be the start of chronic or long-term unemployment.

Health is an ecological (rather than an individual) phenomenon, meaning that it is the places that we live and the experiences that we have within these places that affect our health, rather than just individual choices.28 For example, if a person lives in an area of high air pollution, it puts them more at risk of diabetes and obesity, even if they follow a good diet and take exercise.29, 30 In terms of the physical office space, it too will have an effect on the health of people. Whether it is through indoor air quality or, for those who are neurodivergent, how a space is sensorially organised.

This section explores the mechanisms by which physical elements of the physical office space can cause harm to the employees (whom it should serve and support). In particular, we explore the stress pathway as a throughline from workplace settings (and their broader socio-cultural context) to physiological and psychological harm and burnout of the individual, and how this pathway can be even more prominent for those who identify as neurodivergent.

“We are freshwater fish in a saltwater pond, put us in freshwater and we’ll function just fine, put us in saltwater and we struggle to survive.”

HOK Network31

THE STRESS RESPONSE

In order to survive and function optimally, our body must maintain steady internal conditions, such as body temperature and fluid balance, irrespective of fluctuations in the environmental conditions. The ability or propensity to remain in a steady state that is within our individual acceptable range is called homeostasis (homo = same, stasis = status). In order to maintain homeostasis, several biological and behavioural systems or ‘buffers’ can be employed that enable us to adapt to the change in environment.

For example, entering a very warm environment would typically induce physiological changes (e.g. sweating and vasodilation) as well as behavioural adaptations (e.g. fanning and seeking shade) in order to maintain a steady body temperature (and thus maintain homeostasis). This process of adaptation in response to environmental changes is called allostasis.

The change in temperature in this example is a stressor. A stressor is a chemical or biological agent, environmental condition, external stimulus or event seen as causing stress to an organism.32 Environmental stress encompasses a wide range of phenomena, but perhaps the most recognised in workplace settings are those stressors that are inherently social (e.g. unpleasant interactions with colleagues or clients) and heavy workloads. Intrinsically linked to social factors (because the physical environment influences social behaviour) are

Key terms associated with the stress response

Stressor – Any event, force or condition that results in physical or emotional stress. Stressors may be internal or external forces that require adjustment or coping strategies35 on the part of the affected individual.36

Stress – The physiological or psychological response to internal or external stressors.

37

Stability – The ability or tendency of the body or a cell to seek and maintain a condition of equilibrium – a stable internal environment – as it deals with external changes.38 (This can be thought of in two parts: homo = the same; stasis = status.)

Allostasis – The process of maintaining homeostasis through the adaptive change of the organism’s internal environment to meet perceived and anticipated demands.39

Allostatic load – The cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity, and can be identified using biomarkers and clinical criteria.40

Allostatic overload – When environmental challenges exceed the individual’s ability to adapt and cope. 40 ■

classical environmental stressors, which predominantly involve characteristics of the physical environment (e.g. temperature, and poor air quality or acoustics).33

Stress is the body’s response to exposure to stressors. It is an adaptive response that is associated with physiological changes in the body (e.g. through the activation of the HPA axis, the sympathetic nervous system and the sympathoadrenal system).34 This response, which is sometimes known as the fight-or-flight response (or fight, flight or freeze), directs the body’s resources to prepare it to do just that – to fight or to flee from the threat. This is achieved through the redirection of internal resources that contribute to the general ‘upkeep’ of the body (e.g. parasympathetic nervous system activity, otherwise known as the ‘rest and digest’ system, which controls functions such as digestion). Energy and attention are redirected from these ‘upkeep’ systems to systems that support action (e.g. the muscles).

MALADAPTATION TO MODERN LIFE STRESSORS

Stress is a predictive adaptive response that is crucial to sustaining our stability and healing. However, repeated exposure to stress, and thus activation of the associated physiological pathway, can have harmful consequences. This is because the body remains in a constant state of physiological arousal and does not have an adequate chance to be in a state of restoration (i.e. activation of the parasympathetic nervous system activity). Over time, this results in allostatic load, or ‘wear and tear’, on the body and a dysregulation of several systems that are crucial to optimal functioning.40 Furthermore, this phenomenon can present as part of a negative feedback loop, wherein repeated exposure to stress leads to a depletion of internal resources with which to mitigate any new stressors, meaning that the impact of these new stressors is more pronounced and thus more likely to elicit the stress response; and so it continues.

The problem we have is that the modern environment is likely to trigger the stress response at times when it is inappropriate. The modern environment is markedly different to that in which we, as humans, evolved and adapted, and change has occurred in a very short period of time relative to a human life span. This can lead to a mismatch between our environment and our response to it. The stressors that our ancestors experienced included, for example, coming across a sabre-toothed tiger as they went about their day. While, thankfully, situations such as this are much less likely to occur nowadays, capitalist systems are associated with a whole new range of stressors to which the stress response is not appropriate or adaptive. For example, a fight-or-flight reaction is not a useful response to being stuck in traffic, being late for a meeting or forgetting your homework. Another output of modern life is the continual and acute exposure to environmental pollutants in urban spaces, such as air, noise and light pollution; this too can cause the stress response to be continually engaged.41

Considerations for neurodiversity

• Those who are neurodivergent may have different thresholds for particular stressors or occupy a specific range that lies closer to allostatic load.42

• For those who are neurodivergent, social situations can be more stressful because of socio-communicative variances, causing a repeated activation of the stress response.

• The sensorial experience can produce a range of stressors depending on the sensory modulation of a person. This is another opportunity for the stress response to be overused, leading to allostatic load.

• For socio-economic reasons, a person who is neurodivergent may live in a place with high environmental stressors, which, again, can cause further engagement of the stress response. ■

Allostatic load and disease

There is now a huge amount of evidence linking allostatic load to various non-communicable diseases such as depression, anxiety and PTSD. As we have learned, these conditions are often comorbid with conditions that fall under the umbrella of neurodiversity. It is important to point out that some of the places that neurodiverse people come into contact with can amplify their comorbidities. Therefore, it is of paramount importance to create environments that do not harm people. ■

Finally, we must also consider how our environment has changed through industrialisation and the development of digital technologies. A significant number of people now live in an environment that is characterised by a constant onslaught of stimuli that compete for our attention, such as a dense city with constant changes, activities and demands. This constant barrage of incoming information is very far removed from what we would have experienced even a century ago, and so we are constantly having to filter the information we are receiving. For people who are neurodivergent, this can present a constant source of stress, especially for those who live with ADHD or autism (Figure 1). This is important, as the places where people live and their commute impacts the mental state a person brings to the office. If a person lives in a neighbourhood that does not provide them with the ability to get restful sleep, this can impact their ability to cope with new stressors during the day, such as a complex commute. In turn, this person could arrive at the office with elevated stress levels, potentially making them take longer to settle into the office space. Office design has to consider the various aspects of modern life and the role that design needs to play to help support people through it.

Stressors

Changes in the environment due to industrialisation and modern life that require adaptation

Environmental pollution

Air, noise, light

Density

Intense industrial and human activity in a small amount of space

Long working hours

Shift work, multiple jobs, housework, family organisation

Stress adaptation

Mitigated by APA axis

Financial anxiety

Loss of job, cost of living rises, poverty, dependants

Increased adaptability

Due to adequate resources: adequate housing, reliable social support, access to rest, economic security

Reduced adaptability

Due to reduced resources: inadequate housing, poor social support, lack of rest, poor economic security

Stability

Regular allostatic process

Maladaptation

Allostatic load

Healing, being able to participate in society, dignity, health justice Can make symptoms of conditions under the neurodiversity umbrella more acute and lead to increased exposure to stressors. This can increase risk of conditions such as depression and anxiety

Figure 1 How stressors can put neurodiverse people at risk of poor health as well as make their symptoms more acute if they do not get adequate support. It is important to note that this process would be the same for neurotypical people.

VARIANCES IN SENSORIAL PERCEPTION

There are also indirect health pathways to consider, such as sensorial perception. This is especially significant for those who are neurodivergent, as their sensorial perceptive variations, if not well supported through place design, can be a source of stress. This highlights how the sensorial experience of a place can relate to health.

Those who we interviewed for this report all defined neurodiversity as having sensorial or perceptive variations; in other words, being able to see and feel the world in a different way from those considered neurotypical. These variations in a past world with normative amounts of stressors may not have led to maladaptive responses like allostatic load. However, in our current world, where there is a constant exposure to stressors, we have to consider the sensorial processing variations as potential drivers for stress. Table 2 describes two processes that have an impact on the sensorial and perception experiences in some neurodiverse people: sensory gating and habituation.

Sensory or perception mechanisms

Sensory gating

The neural processes of filtering and separating redundant or irrelevant stimuli from meaningful stimuli. It is an adaptive process in that it maximises our limited cognitive capacity and we can choose where best to focus on or use our energy.43

For example, if you are at a cocktail party, whomever you are speaking to has your attention and you have the ability to tune out the rest of the room.

Habituation

Another way in which we mitigate the incoming of several stimuli is through habituation. Habituation is defined as ‘a decrease in response as a result of repeated stimulation, not due to peripheral processes like receptor adaptation or muscular fatigue’.46, 47 Simply, you get used to something happening, and therefore respond to it less. This phenomenon can be observed in brain activity measured using tools such as electroencephalography (EEG). The brain shows a large neuronal response to a stimulus when it is first perceived, and there is a gradual reduction in neuronal activity in response to the stimulus the more times it is repeated. Eventually, brain activity is nearly undetectable. Relation to neurodiversity and stress

If there are variances in sensory gating and a person with ADHD or autism is in a space where there are multiple unorganised stimuli (e.g. a co-working space), they may find it difficult to isolate which stimuli to attend to. In turn, this can require a lot of mental energy and create sensory overload.43, 44

Another point to consider is that this type of office environment can make it difficult to concentrate and pick up social cues, as the attention is not able to focus, but also the brain may not be able to coordinate interactions across different specialised regions, making it difficult to make sense of the stimuli, including social cues.

This is an interesting intersection between space and social cues, which can affect how a person bonds socially with their colleagues.45 This, in turn, can create feelings of loneliness and stress.

The sensorial experience in autism is still being explored scientifically, but it is hypothesised that autism may be linked to sensory habituation variations. On the one hand, the reduction in habituation may contribute to an inability to detect novel stimuli in the presence of ongoing ones, leading to a lessened sensitivity to changes in the environment. Conversely, it could compromise the ability to habituate, which can reduce stimulus suppression and may lead to an oversensitivity to stimuli.48

For those with ADHD, there could be difficulty in habituation to visual stimuli.49

Habituation is an important part of attention processes; therefore, if a person is in an environment where they cannot habituate due to the organisation and intensity of the stimuli, they can have challenges in sustaining attention.50 This has two-fold consequences: first, not being able to mitigate the stimulation can cause stress; and, second, making up for lost time can lead to longer work hours.

Table 2 The impact of sensory gating and habituation on the sensorial and perception experiences in some neurodiverse people

SOOTHING STRESS

Part of stress adaptation is how a person self-soothes or is able to bring themselves back to stability. Those who are neurodiverse have some specific behaviours and physicalities they engage in to help soothe stress and bring back a sense of comfort. These activities are a normal part of life; unfortunately, due to the way society is organised, neurodiverse people may have to engage in these mechanisms more often to fit into prototypical societal practices.

It is important to note that, while people can use these mechanisms to create comfort and an equilibrium in their physical systems, society should not expect this as part of ‘coping’. In other words, we should normalise removing the harm, rather than expect people either to cope, mitigate or adapt to it.

Two strategies that neurodiverse people may use to mitigate stress

Stimming

‘Stimming’ is short for ‘self-stimulating behaviours’. These can be repetitive motor movements or sounds, such as pacing, rocking or chewing on a pen. Stimming is a universal behaviour that exists on a continuum – everybody does it to some degree. However, it is typically much more pronounced in those who are neurodivergent. It is typically associated with ASD but is also often present in ADHD. Stimming can also be a healthy, instinctive, natural behaviour that can have benefits; for example, it can serve to help with concentration or to let out excess energy. When neurotypical people see stimming, they may be judgemental. This, in turn, can lead people who identify as neurodiverse to try to hide their behaviours to avoid being socially ostracised or even fired. This is associated with an incredible amount of stress.51

Masking

Masking can be a conscious or unconscious suppression of a range of domains; it is a social survival strategy to appear more neurotypical.52 Masking can be used on a daily and regular basis to be able to lead a meeting, hold down an interview process, or to try to fit in within a physical space.

We currently think that masking includes things such as making eye contact even if it makes you feel uncomfortable, or not talking about your interests too much for fear of being labelled 'weird'.

Pearson and Rose (2021)52

While this phenomenon is more linked to autism, in our interviews, those who had ADHD also expressed that there are times when they mask. Masking takes up energy and depletes internal resources, leading to prolonged stress, which can be both fatiguing and contribute to allostatic load.53 ■

BURNOUT SYNDROME

The accumulation of acute and prolonged stress can result in burnout syndrome. It is the apex of where poor office design, health and access to employment intersect. Crucially, burnout syndrome is highly prevalent among the neurodiversity community, and it can lead to poor health outcomes and chronic unemployment.

This section is about understanding the significance of making offices that support the neurodiversity community. It explores the various pathways in which physical aspects of the office space can contribute to burnout syndrome. Starting with an introduction to the syndrome, it then moves towards understanding how the syndrome manifests, and it ends with how the office space can contribute to it and what happens when burnout syndrome is not curtailed.

AN INTRODUCTION TO BURNOUT SYNDROME

Burnout syndrome (often shortened to ‘burnout’) does not have a diagnostic category, for various reasons. For example, burnout syndrome is currently identified as occurring through only a single pathway – a person’s employment and its ecosystem, such as the physical space, culture and tasks.54 The study of burnout is still quite new, and further information is needed about its ecological aetiology: for example, does it make a difference where a person lives, whether they have other neurodevelopmental conditions, or whether they are exposed to toxins at work? Also, how is it related to allostatic load? Despite science still needing more time to understand ‘burnout’, it is a phenomenon that is experienced by one in five people.55 Therefore, it is worth discussing burnout syndrome in relation to the physical spaces people work in, which are likely to contribute to the phenomenon. Another reason we need to talk about burnout is its high prevalence in many people in the neurodiverse community. According to the UK National Autistic Society, autism can make it more likely for a person to experience burnout.56 In addition, in a study of 62 people who had been identified as taking long-term sick leave due to burnout, 52% had PTSD and 24% had ADHD.57

Burnout syndrome as a systemic (not individual) problem

From a systemic perspective, a researcher within the medical field describes burnout syndrome as ‘the failure of a system to adequately support an individual’s employment process’. The point of this statement is to shift the attention from the individual to the ecosystem, both in understanding the pathways to and the solutions to burnout.

Many medical professions and human resources departments will focus on personal interventions, such as doing more yoga, exercise or meditation, or taking time off.69–71 However, as we know, burnout can affect the ability to engage in self-care or physical activity due to muscle pains, headaches and diminished self-esteem. Therefore, these points of advice may not be realistic, and, in addition, essential workers may simply not have the time to engage in these activities. More poignantly, if a person has to go back to work in an environment that glorifies the ableism of working long hours, has ineffective management that does not understand neurodiversity, or creates unachievable work demands due to perpetuated myths related to neurodiverse people having an ability to provide a ‘competitive advantage’, they will continue down the burnout path (despite the personal mitigations they engage with).71–73 It is also worth considering that the various methods of personal mitigation or ‘coping’ can also exhaust mental and physical resources, which further depletes the neurodivergent person. ■

HOW DOES BURNOUT SYNDROME PRESENT AND FEEL?

Burnout syndrome has a long list of symptoms, and its presentation is unique to a person’s employment type, work culture and environment. Furthermore, as it is not a diagnosable disorder, it can be difficult for those experiencing the syndrome to articulate it in medical terms. In turn, this can leave room for being ignored by their employer or even prevent them seeking timely medical advice. Therefore, it is important for this report to explore some of the ways in which burnout syndrome can manifest and some of the feelings attached to it. This is to create more awareness and learn how to spot the syndrome before it spirals.

Table 3 lists some of the symptoms of burnout and the potential ways in which they can present. These symptoms can cluster and can amplify each other. Due to its wide-ranging symptomatology, it would be best practice to conduct periodic surveys that help monitor burnout syndrome within the office environment. This is to both adjust the work culture and the physical workspace.

“My self-esteem suffers, I am not able to communicate or engage with other people.” “I can’t step into the world with other people, because I feel so overwhelmed.” “Everything goes fragile – like everything is going to break.”

Interviewees

THE ROLE OF THE OFFICE IN BURNOUT SYNDROME

The physical office space can have direct and systemic effects that can lead to burnout through the stress response. A direct effect could be lack of regulation of glare leading to stress in real time as well as to stress due to the longer working hours required to make up for loss of concentration. A systemic effect could be a person not being able to concentrate for days due to increased noise levels and not being given any support, which, in turn, could impact interactions with people. This potential change in interaction could bring about stress from loneliness, feelings of social isolation or feeling misunderstood. It is also important to note that there is a link between the physical office space and social outputs.

Here is a list of potential factors or scenarios that may occur in the office space and contribute to burnout syndrome.

• A person does not experience ‘feelings of fairness or support’ because they are: – not given the right digital tools to complete their work

– not provided with a type of work area that suits their mental, physical and psychological needs – not listened to and are gaslighted when they express feelings of discomfort.

Symptom

Emotional exhaustion Possible presentations

A state where emotional regulation is no longer possible.58

It can feel like anxiety, panic, mental exhaustion, irritability, lack of control or complete disconnection.

It can also change appetite and sleep patterns, and cause headaches, nausea and physical pain.58

Depersonalisation The experience of feeling unreal, detached and, often, unable to feel emotion.59

Panic attacks ‘A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you’re losing control, having a heart attack or even dying.’60

Diminished self-esteem A state of mind where a person loses the mental ability to see themselves in a favourable light, is self-critical, and has trouble making social connections and engaging in self-care.61

Headaches Pain in various regions of the head that ranges in intensity. Headaches can be mild or severe, and can include nausea and vision problems.

Muscle aches Pain in muscle tissues.

Changes in digestion

Changes in immune function Through the biological stress response, burnout syndrome can lead to gastro-intestinal problems, such as irritable bowel syndrome.62

Through the biological stress response, burnout syndrome can lead to systemic inflammation in the body, which can make people more susceptible to various illnesses.63

Table 3 Some of the symptoms of burnout and how they may present

This can affect the way in which they perceive themselves, as well as their self-worth and self-esteem.

• A person experiences sensorial overload due to:74

– a space that is perceived as too loud

– a space that creates many visual distractions due to the movement of people, patterns or cluttered sight lines – a space that does not offer thermal comfort (i.e. either too cold or too hot).

It is important to note that some people with autism or ADHD may need more sensorial stimulation, so they might prefer background noise. This is something that should be negotiated at an individual level, as the sounds will still need to be orchestrated (i.e. it is not just about ‘noise’).

• A person perceives marginalisation and social exclusion due to:

– a space not having adequate physical amenities (e.g. ramps, railings or lifts) to allow for safe movement, isolating people with mobility variances – there not being adequate spaces for various activities (an interviewee mentioned that they were given a break space for themselves, but it was cluttered, poorly lit and not fit for purpose).

Burnout syndrome among essential workers

The office space is not only used by desk workers. There are also essential workers such as cafeteria staff, hygiene specialists, security guards and receptionists.64 These types of workers should also be considered in office design. This is especially important for essential workers who are also neurodiverse, who are faced with navigating at least two types of marginalisation – classism and ableism – increasing their risk of burnout syndrome.

Here we highlight some of the pathways of how neurodiverse essential workers can be more at risk of burnout syndrome, and the consequent necessary considerations for the office space.

• Essential workers who do shift work are especially vulnerable to burnout, as their working pattern can dysregulate the sleep–wake cycle, leading to fatigue and challenges with emotional regulation. Both of these effects can lead to burnout. This disruption to the sleep–wake cycle is in addition to sleep disturbances already experienced in many conditions in the neurodiversity spectrum.65, 66

• A person is not being allowed to self-express or self-soothe.

– Some people may need to do stimming as part of their self-soothing practices, which may require them to have their own designated work area. Not being able to do stimming can lead to burnout syndrome.74

– If a person is in a space that does not allow them to adapt their sensorial experience to their needs, they can experience sustained stress and, eventually, burnout.

• A person is not being given dignity or autonomy.

– Sometimes a person is given support, but this support is not fully adequate. For example, one interviewee expressed how they had to spend time in the toilet because they had no other place to go to try to mitigate the stress that they experienced in the office environment. This lack of dignity and support can contribute to burnout. It also communicates that you are not cared for.

– This is especially important for essential workers, who may not be given the autonomy to take breaks when they need to or may not be able to access physical spaces due to the cultural organisation of the job.67

• A person is engaging in masking.

– Masking can be part of many conditions that fall under the neurodiversity umbrella, but it is more prevalent and pronounced in people with autism.75 In order to engage in masking, a person has to be in a constant state of self-monitoring or vigilance, which requires sustained attention. In turn, this can exhaust brain and body resources, and may lead to fatigue.76 Fatigue can lead to sleep disturbance, which in turn can lead to burnout syndrome.77, 78 • Essential workers have less access to financial resources to mitigate stress after work, and less time for self-care.

Those living with ADHD or autism can already experience periods where self-care is difficult; therefore, these factors of essential work can only increase the risk of burnout.

• Due to social hierarchy, essential workers have less access to quality restorative spaces, such as rooftops, green spaces or breakrooms. Furthermore, this hierarchy can also mean these workers have less agency over when they take their breaks. When this is paired with various social and communication differences in neurodiverse people, obtaining adequate restorative breaks will be extremely challenging. All these factors can contribute to prolonged stress and, eventually, burnout syndrome.67, 68

• From the office-space perspective, there should be design considerations that can increase equity. These could be creating outdoor rest areas close to essential work areas, designing essential work areas with the same principles of dignity as desk work areas, or providing indoor rest facilities that are especially for essential workers. ■

POTENTIAL CONSEQUENCES OF BURNOUT

In this section we look at the consequences of burnout syndrome. This is important, as it exemplifies the relationship between health and place, and its potential long-term consequences.

Among those we interviewed, burnout syndrome was mentioned as a pathway to unemployment. One person experienced a long road of recovery after burnout, from engaging in selfmedication to experiencing long bouts of depression, which left them unable to work for a long period of time. Others expressed that feeling stressed and fatigued had led to them taking sick leave, which their employers were not able to justify financially, and left them without a job. Burnout can require a long period of recovery, depending on how acute it is. Therefore, unless a person is within a financial ecosystem that enables them to pay for both time off work and the resources required for recovery, they may spiral into poverty. Poverty is a big concern for neurodiverse people due to the high rates of unemployment in this community.79 In addition, ‘one-third of autistic adults in the UK have neither employment nor access to benefits’, leaving them in a very dangerous financial situation.80

A great deal of research is still needed in this area to understand the link between burnout, long-term unemployment and how it leads to poverty. However, we can understand that most people will not have adequate resources to sustain long periods of rest, as many employers do not offer this cover. Furthermore, it can be very difficult for a person who is neurodivergent to start writing their CV and to engage in the interview process all over again, as this can require high levels of masking.

The role of the physical space is to help create an employment ecosystem that is not only enabling but also helps nourish people. In turn, this could lessen the risk of burnout and play a role in achieving health justice for neurodivergent people.

Figure 2 shows an example of how a stressor (due to a physical office element) leads to burnout syndrome. This is only one example; in an office setting there will be multiple stressors at the same time. This cycle from stressor(s) to burnout can happen quickly or over a long period of time. At every stage, there is potential for intervention, prevention and stopping the burnout spiral. ■

Ethics

We should question what type of society we want to create. Are we OK with a culture that makes people sick to the point of causing a medical phenomenon like burnout? What is the responsibility of everyone who creates offices in providing adequate spaces that support people? How do the people who create offices work together with human resources departments to create a nourishing environment and culture that prevents burnout? ■

Stressor

Poor visual orchestration

Emotionality

Sense of frustration Feelings of anxiety

Potential consequences

Potential work consequences

Potential health consequences

Potential long-term consequences

Physical

Stimming Sweating Shallow breathing Circulation changes

Cognitive

Lower concentration Lower attention Lower information retention

Longer work hours Less time for breaks/rest Isolation from coworkers Lowered work motivation

Disrupted sleep Change in appetite Lowered self-esteem Loneliness Anxiety

Burnout syndrome

Unemployment, hospitalisation risk of long-term unemployment

Figure 2 From a stressor – poor visual orchestration – to burnout syndrome.