Lynda Holt, Honorary Professor of Social Leadership and CEO of Health Service 360 shares her thoughts on how to improve mental health support for CEOs.

High-performing CEOs know they have to look after their mental and physical wellbeing to show up at their best. Yet what we know and what we do can sometimes be more like distant relations rather than close friends.

As a busy leader, there is often a temptation or even an expectation, you’ll push through, tough it out, and get the job done. It doesn’t matter if this pressure is self-imposed or external, its impact on your physical and mental health is the same. Next time you are trying to convince yourself you’ll rest or take a break at some mythical future time when you are less busy, remember burnout is brutal. It affects your physical, mental, and emotional wellbeing, and probably that of those around you.

The effects on the body of burnout and stress

Burnout, stress, and prolonged anxiety change your brain physiology and the regulation of your body’s neuroendocrine systems which maintain homeostasis by titrating hormone production in response to stimulus. Our survival depends on responsiveness, and the right hormones at the right time for rest, repair, reproduction, as well as flight/fight.

There is a small part of your brain called the amygdala which is responsible for emotional regulation and determining the threat level. When a threat is perceived, it triggers a response through your hypothalamic–pituitary–adrenal (HPA) axis, a complex neuroendocrine system of pathways and feedback loops that control your stress response, releasing cortisol in response to physical or emotional threats.

The cortisol release creates reactions throughout your body affecting most systems including your cardiovascular and immune systems, your digestion, and your memory formation. Once the threat passes your cortisol levels fall and you go back to ‘resting’ function.

The devastating effects of longterm stress 

When stress doesn’t ease, for example in burnout or prolonged anxiety, your HPA is constantly triggered and cortisol levels remain high, leading to a range of other physical problems.

When cortisol levels remain elevated for an extended period your body eventually reduces cortisol production, almost as if it has been burned out, causing abnormally low levels associated with fatigue, poor immunity, and low-grade inflammation, which can cause plaque deposits in your arteries increasing your risk of heart attack, stroke, and even early cognitive decline.

One of the immediate results of your elevated stress response is a reduction in the executive function of your pre-fontal cortex – or your logical processing. Elevated stress hormones literally make you less capable, making it harder for you to ‘think straight’ or problem-solve. Memory, judgement, and impulse control decrease – or go out the window in some cases. And if that wasn’t enough the areas of your brain responsible for anxiety and anger are amplified.

We can build our ability to manage stress 

The good news is that we all process stress in broadly the same way, physiologically speaking, so in theory we can all build our ability to manage it.

Looking after your own mental health and preventing burnout demands self-awareness, self-regulation, and good planning. Your brain hates uncertainty. It spends most of its time predicting and course adjusting to maintain some level of homeostasis. The more uncertainty you can remove by understanding what you need to function well, and what your day, your next meeting, or even a difficult conversation might demand of you, the better you can plan.

Recognising symptoms and triggers early, learning to modify your reaction, and even planning for those reactions, will help you to reduce uncertainty and regulate your stress response ahead of time. With practice this trains your amygdala to differentiate better between threat and non-threat.

This is about preparedness, or training yourself to be ready, then you are much less likely to be blindsided by your neurochemistry.

There are three elements to this:

  1. Sorting – prioritising repetitive tasks, situations, and pressures
  2. Simplifying – using routines and rituals, reducing decisions, and removing choice
  3. Story – getting out of your head and away from the unhelpful things you may tell yourself.

In the shorter term, being really aware of what triggers stress, anxiety and overwhelm, and what reduces it, will help you. If you don’t know try this simple exercise: put a line down the middle of your page and write ‘what energises me’ on one side and ‘what drains me’ on the other, then spend a bit of time capturing the people, things, and situations that fall either side of that line.

Mental health is like a bank balance – you have to replenish it!

Your mental wellbeing is a bit like a bank balance, you have to put enough in to keep taking out, take too much out you’ll start to feel uncomfortable or even unwell. If you need a quick deposit, remember the things that ground you, smells, pictures, movement, sounds and know where you can grab them if you need to, sensory stimulus and physical activity are the quickest ways of regulating your nervous system or burning up a bit of unwanted cortisol.

If you are already experiencing some of the symptoms of burnout or poor mental health, create mental respite if you need it, and use your biology to help you. Instead of battening down the hatches, withdrawing, and thinking you need to do everything yourself try to connect, help, and be helped.

Connection and compassion release hormones that help counter your stress response, expand your mental bandwidth and help you feel more at ease, and they also make you a great leader. Make them your closest friends, and not distant relatives.


Linda HoltAbout Professor Lynda Holt MA, RGN, DipHE, CPBP, FinstLM, FRSA

Linda Holt is CEO of Health Service 360 and a prominent leadership voice, author and change activist in the healthcare sector. She established Health Service 360, an award-winning development consultancy, back in 2001 and spends her time helping leaders and health professionals to lead courageously, make tangible change, value themselves, and empower their people.

She believes it is each of us, not big organisations, religions, or governments, that change the world, – little action by little action, and as a Professor of Social Leadership at the University of Salford, Lynda helps to equip people with the skills and mindset needed to act and create social change.