When Caring Becomes Inaccessible

When Caring Becomes Inaccessible: Burnout, Apathy, and the Nervous System Intelligence Framework

J.Michelle

Abstract

Burnout is commonly characterized by exhaustion, disengagement or cynicism, and reduced professional efficacy. Yet one of the most consequential subjective experiences associated with severe exhaustion and disengagement may be described more simply:

I do not care anymore.

This apparent apathy is easily interpreted as loss of commitment, diminished work ethic, personality change, or indifference. Such interpretations may overlook an important distinction between the value an individual assigns to an outcome and their current capacity or willingness to mobilize the effort required to pursue it.

Established research in effort-based decision-making (EBDM) demonstrates that motivated behavior is influenced not only by the value of a potential outcome but also by the effort required to obtain it. Relatedly, the Expected Value of Control (EVC) framework proposes that allocation of cognitive control reflects an evaluation of expected payoff relative to the costs associated with exerting control (Shenhav et al., 2013) (Salamone & Correa, 2024; Horne et al., 2021).

Drawing upon these established frameworks, burnout research, stress physiology, and motivational neuroscience, this conceptual paper proposes an NSI-specific interpretation of burnout-related apathy: in some individuals, apparent loss of caring may instead reflect continued caring accompanied by reduced access to the effort necessary to act upon that caring.

The proposed model does not equate burnout with a particular autonomic state, nor does it suggest that all apathy arises from nervous-system dysregulation or altered effort allocation. Rather, Nervous System Intelligence (NSI) provides a framework for differentiating changes in values from changes in the conditions governing motivated action.

The central proposition is therefore not that NSI introduces a new model of effort-based decision-making. Instead, NSI applies established effort-allocation science to an interpretive problem: observable disengagement cannot, by itself, determine whether caring has disappeared or whether access to action has changed.

Keywords: burnout, apathy, motivation, nervous system intelligence, effort-based decision-making, expected value of control, chronic stress, disengagement, exhaustion, motivational access

—

Introduction

Burnout presents an apparent contradiction.

Individuals experiencing burnout are frequently those who were previously highly engaged in the environments from which they eventually withdraw. They may have invested substantial cognitive, emotional, and physical effort in their work, responsibilities, relationships, or goals before developing profound exhaustion and disengagement.

At some point, however, the internal experience can change.

The individual who once responded to increasing demands with greater effort may begin saying:

I do not care anymore.

The statement is easily interpreted literally.

Initiative decreases. Tasks that once generated urgency no longer do. Problems remain visible, but the impulse to solve them weakens. Responsibilities remain cognitively understood, yet the individual struggles to initiate the actions necessary to address them.

From the outside, this may resemble indifference.

But behavior alone cannot establish mechanism.

What if the individual's values have not changed as dramatically as their behavior suggests?

What if caring remains present while access to the effort necessary to act upon that caring has changed?

This distinction provides the central question of this paper.

Contemporary motivational neuroscience provides an established scientific foundation for asking that question. Effort-based decision-making research demonstrates that goal-directed behavior involves cost-benefit processes in which potential rewards or outcomes are evaluated in relation to the effort required to obtain them. Related work on the Expected Value of Control examines how expected payoff, efficacy, and the subjective cost of cognitive control influence whether and how strongly cognitive control is allocated.

Nervous System Intelligence does not replace these models.

It asks what their implications may be for interpretation.

Rather than asking only:

Why has this person stopped caring?

NSI encourages another question:

Has caring changed—or have the conditions governing access to motivated action changed?

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Burnout: From Sustained Demand to Disengagement

The World Health Organization conceptualizes occupational burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed. Its defining dimensions include energy depletion or exhaustion, increased mental distance from one's job or cynicism related to one's job, and reduced professional efficacy.

Burnout is classified as an occupational phenomenon rather than a medical condition, and the WHO definition specifically situates it within the occupational context; the specific WHO source citation should be confirmed and added during the publication reference audit noted at the end of this manuscript.

This boundary matters.

Experiences resembling severe exhaustion and disengagement undoubtedly occur outside employment. However, expanding the formal term burnout to encompass every form of chronic stress-related depletion risks collapsing potentially distinct phenomena into a single construct.

Accordingly, this paper uses burnout when discussing the established occupational phenomenon and uses broader language such as chronic stress-related exhaustion and disengagement when discussing potentially analogous processes outside occupational settings.

Burnout also remains scientifically contested in important respects. Questions remain regarding its measurement, diagnostic boundaries, biological correlates, and relationship with depression; representative scholarly reviews documenting these contested areas should be identified and cited during the publication reference audit noted at the end of this manuscript. It should therefore not be treated as a fully resolved biological entity with one established physiological mechanism.

One feature, however, is particularly relevant to the present inquiry:

disengagement.

Exhaustion describes diminishing energetic availability.

Disengagement describes increasing distance between the individual and the demand.

The relationship between those processes may contain important information about what individuals colloquially experience as apathy.

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Apathy Is Not Simply the Absence of Caring

Apathy is generally understood within clinical and research literature as involving diminished motivation, initiation, or goal-directed behavior; representative clinical definitions, diagnostic criteria, and review papers supporting this characterization should be confirmed and cited during the publication reference audit noted at the end of this manuscript.

It must be distinguished from several related phenomena. These distinctions are recognized across clinical and research literature on motivation, affect, and psychiatric assessment; specific supporting citations should be confirmed and added during the publication reference audit noted at the end of this manuscript.

Exhaustion primarily concerns depletion of physical, emotional, or cognitive resources.

Apathy concerns diminished motivation, initiation, or goal-directed action.

Anhedonia concerns diminished experience or anticipation of pleasure or reward.

Depression is a broader clinical syndrome that may include apathy, anhedonia, fatigue, impaired concentration, hopelessness, and numerous other symptoms.

These phenomena may coexist, but they are not interchangeable.

An exhausted individual may still strongly want an outcome but experience insufficient energy to pursue it.

An individual experiencing anhedonia may no longer anticipate the activity or outcome as rewarding.

An apathetic individual may experience diminished initiation or motivation toward goal-directed action.

A person experiencing burnout may exhibit elements of several of these processes simultaneously.

The observable result may look remarkably similar:

inaction.

But identical behavior does not establish an identical underlying mechanism.

That distinction becomes particularly important when interpreting the statement:

I don't care anymore.

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Effort-Based Decision-Making: The Established Scientific Foundation

Goal-directed behavior requires more than recognizing an outcome as desirable.

Organisms must also determine whether pursuing that outcome is worth the resources required to obtain it.

This problem is extensively studied within effort-based decision-making (EBDM).

EBDM research conceptualizes motivated behavior, in part, as a cost-benefit process in which potential rewards or valued outcomes are evaluated relative to the effort necessary to obtain them.

The central principle can be expressed informally as:

Potential value of outcome ↔ cost of obtaining outcome → willingness to engage

This expression is explanatory shorthand, not a new NSI equation and not a literal neural computation.

The underlying principle belongs to the established EBDM literature.

This distinction is important because motivation cannot be reduced simply to how much an individual wants something.

The activation necessary to pursue a valued outcome represents another component of motivated behavior.

Within the established EBDM literature, a consistent finding is that organisms may shift toward lower-effort alternatives when the effort required to obtain a preferred outcome increases, even when the outcome itself retains value; the specific studies supporting this principle should be confirmed and cited during the publication reference audit noted at the end of this manuscript.

Dopaminergic systems contribute importantly to behavioral activation and effort allocation, but effort-related motivation cannot be reduced to dopamine alone. Multiple neurotransmitter systems, neural networks, metabolic processes, cognitive variables, and environmental conditions contribute to motivated behavior.

The relevant scientific distinction is therefore between at least two questions:

Does the outcome still matter?

and

What is the organism currently willing or able to expend in order to pursue it?

Those questions are related.

They are not identical.

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Expected Value of Control: A Related Model

A related framework becomes particularly relevant when the effort under consideration involves cognitive control.

The Expected Value of Control (EVC) framework proposes that cognitive-control allocation reflects evaluation of several interacting factors, including expected outcomes, the probability that control will influence those outcomes, and the cost associated with exerting control.

In simplified conceptual terms:

Expected payoff and efficacy of control ↔ cost of cognitive control → allocation of control

EVC should not be treated as synonymous with EBDM.

EBDM represents the broader problem of deciding whether effort is worth expending for an outcome.

EVC addresses the more specific problem of determining whether, where, and how strongly cognitive control should be allocated.

Both are relevant to the present model.

Burnout frequently occurs in environments requiring sustained cognitive, emotional, behavioral, and sometimes physical mobilization. When continued performance requires increasingly costly control while the expected effectiveness or payoff of that control diminishes, EVC provides an additional theoretical lens through which declining engagement may be understood.

NSI does not claim either mechanism as its own.

Instead, these established models provide part of the scientific foundation upon which the present interpretation is constructed.

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Chronic Demand Changes the Context in Which Effort Is Evaluated

Consider functioning under relatively sustainable conditions:

Demand → mobilization → action → meaningful outcome → recovery

Effort carries a cost.

But recovery restores resources, while successful action may reinforce the expectation that mobilization produces meaningful outcomes.

Now consider prolonged occupational stress:

Demand → mobilization → action → additional demand → insufficient recovery → renewed mobilization → additional demand

The individual repeatedly expends resources without adequate restoration.

If persistent demand occurs alongside low control, inadequate reward, insufficient support, or repeated experiences in which greater effort produces little meaningful improvement, something beyond exhaustion may begin to change.

The context in which further effort is evaluated changes.

Continued mobilization may become increasingly costly.

Its expected return may become increasingly uncertain.

The individual may experience diminishing control over outcomes.

The perceived efficacy of additional effort may decline.

These changes map onto established questions within EBDM and EVC: What is the anticipated value of continued action? What will the action cost? How likely is additional effort or control to alter the outcome?

Burnout may therefore affect motivated behavior not only because an individual becomes exhausted but because chronic conditions alter several variables relevant to continued mobilization simultaneously.

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From Exhaustion to Apparent Apathy: A Proposed Pathway

The present model does not suggest that every individual experiencing burnout becomes apathetic.

Nor does it propose that all apathy occurring during burnout results from the same mechanism.

Instead, it identifies one plausible pathway:

Prolonged demand

↓

Repeated cognitive, emotional, and physiological mobilization

↓

Inadequate recovery and/or persistent demand-resource mismatch

↓

Increasing exhaustion and subjective effort cost

↓

Potential reduction in expected benefit, controllability, or efficacy of continued effort

↓

Reduced willingness or capacity to mobilize effort

↓

Reduced initiation and goal-directed behavior

↓

Withdrawal, detachment, cynicism, or apparent apathy

The observable endpoint may be described by the individual as:

I don't care anymore.

But that statement may represent several very different internal conditions:

I care, but I am too exhausted to respond.

I care, but responding feels overwhelmingly expensive.

I care, but I no longer believe my effort will change anything.

I care, but I cannot generate the activation necessary to begin.

Or:

This genuinely no longer matters to me.

The purpose of NSI is not to decide in advance which interpretation is correct.

Its purpose is to prevent those possibilities from being prematurely treated as equivalent.

—

The NSI Contribution: Caring and Access to Action Are Different Questions

The central theoretical contribution proposed here lies not in the cost-benefit calculation itself.

EBDM already provides an established scientific framework for understanding effort allocation.

EVC provides an established framework for understanding the allocation of cognitive control relative to expected payoff and cost.

The NSI contribution proposed here is an interpretive distinction:

The observable reduction of goal-directed behavior does not, by itself, establish a corresponding reduction in how much the underlying outcome matters to the individual.

In some cases of burnout-related apathy, caring may remain present while access to the effort necessary to express that caring through action becomes increasingly constrained.

This can be represented conceptually as:

Caring / valuation ≠ access to motivated action

This is not intended as a mathematical equation.

It represents a distinction between two questions that are easily collapsed in everyday interpretation:

Does this matter to me?

and

Can I currently mobilize sufficiently to act because it matters to me?

A person may answer yes to the first while increasingly struggling with the second.

The central proposition of this paper is therefore:

Burnout-related apathy may sometimes represent not the disappearance of caring, but the increasing inaccessibility of effort in the presence of continued caring.

This proposition extends established effort-allocation science into an NSI interpretive framework without claiming the underlying EBDM or EVC mechanisms as novel NSI constructs.

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The Nervous System and Burnout

Because burnout develops in the context of prolonged stress, autonomic and hypothalamic-pituitary-adrenal processes have understandably been investigated as possible biological contributors.

The evidence requires restraint.

As noted in the Limitations section of this manuscript, studies examining autonomic and HPA-axis function in burnout have produced heterogeneous findings, and research has not established a single physiological signature that universally defines burnout. Because the evidence is heterogeneous rather than convergent, characterizations of burnout as the nervous system becoming "stuck," "shutting down," entering a specific autonomic state, or exhausting its sympathetic capacity risk overstating what the current evidence supports.

A more defensible interpretation is that prolonged stress repeatedly recruits interacting systems involved in adaptation, including autonomic, endocrine, cognitive, emotional, metabolic, and motivational processes.

Within the present model, the relevant question is therefore not:

Which nervous-system state is burnout?

It is:

How have prolonged demands and the individual's accumulated experience changed the conditions under which mobilization occurs?

This distinction is central to Nervous System Intelligence.

—

Nervous System Intelligence

Nervous System Intelligence is defined as:

"The ability to understand the influences that shaped how you see, interpret, and respond to the world—and to intentionally choose responses that align with the person you choose to be."

NSI does not require the assumption that every behavior is directly caused by autonomic physiology.

Responses occur within contexts shaped by prior experience, present conditions, physiological state, perceived threat, available resources, learned expectations, interpretation, and individual goals.

Applied to burnout-related apathy, NSI changes the interpretive sequence.

Instead of:

Why am I so lazy?

the individual can ask:

What is influencing my current capacity to initiate this action?

Instead of:

Why don't I care anymore?

the question becomes:

Has what I value changed, or has my access to motivated action changed?

Instead of:

What is wrong with me?

the relevant inquiry becomes:

What is this change in my response telling me about the relationship between current demands, expected outcomes, perceived control, effort costs, and available resources?

These questions do not excuse behavior or eliminate responsibility.

They improve the quality of the information available before a response is chosen.

That is the function of intelligence.

—

The NIRVA Method as an Applied Response

The NIRVA Method provides a structured process through which this information can potentially be translated into intentional behavior:

NOTICE

Recognize the change.

I am withdrawing.

Tasks I previously initiated automatically now feel disproportionately difficult.

I keep saying that I do not care.

The first intervention is observation rather than judgment.

INTERRUPT & IDENTIFY

Interrupt the automatic interpretation of the behavior and identify relevant influences.

Is the dominant experience exhaustion?

Has effort repeatedly failed to produce meaningful change?

Has perceived control decreased?

Has recovery disappeared?

Has the anticipated value associated with the activity changed?

Has the subjective cost of action increased?

Is there evidence of depression, sleep disruption, illness, medication effects, trauma-related symptoms, or another condition requiring assessment?

The purpose is differentiation rather than assumption.

REGULATE

Where excessive physiological or psychological demand contributes to the state, regulation involves changing the conditions necessary to restore an adaptive range of response.

Regulation should not be reduced to breathing exercises or relaxation techniques.

Depending upon the underlying influences, regulation may require sleep, nutrition, workload modification, boundaries, environmental change, social support, medical or psychological treatment, restoration of autonomy, meaningful recovery, or removal from an unsustainable demand.

VALIDATE

Validation recognizes that the response developed within a context.

It does not declare every response beneficial.

It asks whether the response becomes understandable when the conditions that produced it are considered.

Apathy may contain information.

Exhaustion may contain information.

Withdrawal may contain information.

The task is to determine what information the response carries before deciding what should happen next.

ALIGN

The objective is not permanent withdrawal.

It is restoration of intentional choice.

Once relevant influences have been identified and sufficient capacity becomes available, the individual can ask:

What response now aligns with the person I choose to be?

This preserves agency without requiring self-condemnation.

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Why the Distinction Matters

If apparent apathy is interpreted exclusively as insufficient motivation, the intuitive intervention is often to increase pressure:

Push harder.

Become disciplined.

Set better goals.

Increase accountability.

Try harder.

But if diminished engagement partly reflects an altered effort-cost environment produced by prolonged demand, inadequate recovery, reduced control, or declining expected efficacy, requiring still more effort may reproduce the very conditions contributing to disengagement.

The appropriate intervention therefore depends upon the mechanism.

An individual whose primary problem is exhaustion requires something different from an individual experiencing anhedonia.

A worker who no longer believes additional effort can alter an uncontrollable environment requires something different from someone whose work has genuinely lost personal meaning.

An individual with major depressive disorder requires something different from an otherwise healthy individual temporarily depleted by extreme occupational demand.

And an individual who continues to care but temporarily cannot mobilize adequately toward what they care about requires a different interpretation from an individual whose values have genuinely changed.

The outward statement may be identical:

I don't care.

The underlying condition may not be.

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Apathy as Information Rather Than Identity

This leads to an important implication of the NSI framework.

A state should not automatically be converted into an identity.

There is an enormous psychological difference between:

I am apathetic.

and:

I am experiencing reduced motivation, and I want to understand what is influencing it.

The first statement converts a current response into a characterization of the self.

The second preserves curiosity, context, and agency.

This does not mean every episode of apathy is adaptive.

Persistent or pervasive apathy can accompany serious psychiatric, neurological, medical, sleep-related, medication-related, and other conditions and may require professional evaluation.

Nor does NSI assume that apparent disengagement always conceals continued caring.

Sometimes values genuinely change.

Sometimes the outcome no longer matters.

The framework instead argues that interpretation should precede judgment.

The appearance of disengagement is an observation.

Its mechanism remains a question.

—

Implications for Organizations

The model also challenges organizational approaches that treat burnout primarily as an individual resilience deficit.

Burnout research has identified prolonged excessive demand, inadequate recovery, low control, insufficient support, and poor effort-reward balance as contributing workplace risk factors; the specific supporting citations should be confirmed and added during the publication reference audit noted at the end of this manuscript. To the extent that such conditions contribute to burnout, interventions directed exclusively at the worker may be insufficient.

Teaching an employee to regulate while leaving an unsustainable environment unchanged risks asking the individual to become increasingly efficient at tolerating conditions that continue producing excessive demand.

NSI therefore operates at two levels.

The individual asks:

What is influencing my response?

The organization must ask:

What conditions are repeatedly requiring this response?

Effort-allocation science adds another organizational question:

What has this environment taught the individual about the cost, efficacy, and expected return of continued effort?

All three questions matter.

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Testable Propositions

The revised model generates several empirically testable propositions.

Proposition 1: Greater burnout severity will be associated with reduced willingness to expend effort for reward in at least a subset of individuals, even when valuation of available outcomes remains relatively preserved.

Proposition 2: The relationship between burnout and apparent apathy will be partially mediated by exhaustion, subjective effort cost, perceived controllability, and perceived efficacy of continued effort.

Proposition 3: Individuals reporting burnout-related "not caring" will demonstrate heterogeneous motivational profiles, potentially including exhaustion-dominant, reward-valuation-diminished, controllability-diminished, efficacy-diminished, and effort-cost-dominant patterns.

Proposition 4: In individuals whose underlying valuation remains relatively preserved, restoration of recovery, control, or perceived efficacy will improve goal-directed initiation without requiring a corresponding increase in the subjective value assigned to the outcome.

Proposition 5: Behavioral measures of effort allocation will differentiate at least some individuals reporting continued caring with impaired initiation from individuals whose disengagement primarily reflects reduced reward valuation.

Proposition 6: Interventions that distinguish diminished valuation from diminished access to motivated action will produce different behavioral outcomes than interventions treating all disengagement as insufficient motivation.

These propositions allow the NSI interpretation to be tested rather than merely asserted.

—

Research Agenda

Future research should directly investigate the proposed distinction between caring and access to effortful action.

Participants with varying levels of occupational burnout could be assessed simultaneously for burnout severity, apathy, anhedonia, depression, sleep quality, perceived controllability, effort-reward imbalance, subjective fatigue, perceived effort cost, reward valuation, and behavioral effort allocation.

Established EBDM paradigms could test whether individuals experiencing severe burnout become less willing to expend effort despite retaining relatively preserved valuation of available rewards.

Where cognitive effort is specifically examined, EVC-derived measures could investigate whether changes in expected efficacy, expected payoff, or subjective control cost contribute to reduced allocation of cognitive control.

Longitudinal research would be particularly valuable.

If increasing occupational demand and inadequate recovery precede increasing subjective effort cost, followed by reduced effort allocation and disengagement despite relatively preserved outcome valuation, the proposed model would receive stronger support.

Conversely, if diminished reward valuation consistently precedes disengagement, if caring reliably declines alongside behavior, or if apparent effects disappear after accounting for depression or other relevant conditions, the model would require revision.

The distinction between caring and access to action must therefore remain empirically falsifiable.

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Limitations

Several limitations require explicit recognition.

First, burnout remains conceptually and diagnostically contested.

Second, burnout overlaps substantially with depression and other conditions capable of producing fatigue, apathy, anhedonia, and impaired motivation. This overlap has been noted across the burnout literature, though the precise boundaries between burnout and related clinical conditions remain an active area of investigation; specific supporting citations should be confirmed and added during the publication reference audit noted at the end of this manuscript.

Third, studies examining autonomic and HPA-axis function in burnout have produced heterogeneous findings, and evidence has not established a universal autonomic or HPA-axis signature underlying burnout; specific supporting citations should be confirmed and added during the publication reference audit noted at the end of this manuscript.

Fourth, EBDM and EVC are established research frameworks, but their relevance does not establish that burnout-related disengagement is universally produced by altered effort-based valuation or control allocation.

Fifth, the proposed relationship among prolonged demand, exhaustion, effort cost, perceived efficacy, and apparent apathy remains theoretical and requires direct empirical testing.

Sixth, the distinction between continued caring and reduced access to motivated action is proposed here as an NSI interpretive construct. Its usefulness and discriminant validity must be established empirically rather than assumed.

Seventh, individuals may genuinely change their values, priorities, or commitment during prolonged stress.

The framework must therefore never be used to insist that apparent disengagement conceals continued caring when an individual's values have actually changed.

Finally, NSI itself remains a conceptual framework requiring empirical validation rather than an established neuroscientific construct.

These limitations do not weaken the need for investigation.

They define what future research must determine.

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Conclusion

Burnout is often described through what disappears:

Energy.

Engagement.

Productivity.

Motivation.

Care.

But observable disengagement cannot reveal, by itself, what has actually been lost.

An individual who stops acting toward something may no longer value it.

Or the individual may continue to value it while lacking sufficient energy.

The anticipated reward may have diminished.

The perceived effort cost may have increased.

The person may no longer expect additional effort to change the outcome.

The perceived efficacy of cognitive control may have declined.

A psychiatric, neurological, medical, environmental, medication-related, or sleep-related factor may be contributing.

Several mechanisms may operate simultaneously.

Established effort-based decision-making research provides a scientific framework for understanding why value and effort cannot be treated as the same variable.

Expected Value of Control theory further demonstrates why the anticipated effectiveness and subjective cost of cognitive control matter when deciding whether and how strongly to mobilize.

Nervous System Intelligence adds a different contribution.

It asks that these distinctions be considered before behavior is assigned meaning.

Observe the response.

Identify its influences.

Understand the context.

Determine what has actually changed.

Restore sufficient capacity for intentional choice where possible.

Then align behavior with the person the individual chooses to be.

Within this framework, the statement:

I don't care anymore

is not automatically a conclusion.

It becomes a question:

What, exactly, has become inaccessible?

Sometimes the answer may be caring itself.

But sometimes caring remains.

What has become inaccessible is the ability or willingness to repeatedly mobilize effort on its behalf.

Caring and access to caring through action are not necessarily the same thing.

That distinction deserves empirical investigation.

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Core Scientific Grounding for the Revised Manuscript

The final reference list should explicitly include the established EBDM literature, including contemporary reviews of effort-related motivation and effort-based choice, rather than referring generically to "the broader literature."

It should also include:

Shenhav, A., Botvinick, M. M., & Cohen, J. D. (2013). The expected value of control: An integrative theory of anterior cingulate cortex function. Neuron, 79(2), 217–240.

A contemporary review of the neurobiology of effort-based decision-making and the role of dopamine in activational aspects of motivation should also be identified and included; the specific citation must be verified by the author during the publication reference audit before this manuscript is treated as publication-ready.

Additional contemporary EBDM, burnout, apathy, effort-reward, controllability, and motivational-access literature should be incorporated into the publication reference audit before the manuscript is treated as publication-ready.

Evidence and Citation Boundary

Burnout and disengagement are multifactorial. The cited literature supports effort-cost, control-allocation, motivation, and occupational-burnout components; the NSI interpretation that caring may remain while access to effort changes is a conceptual synthesis rather than an established diagnostic mechanism.

Core evidence base: (Shenhav, 2013; Salamone, 2024; Horne, 2021; Amiri, 2024).

References

Shenhav, A., Botvinick, M. M., & Cohen, J. D. (2013). The expected value of control: An integrative theory of anterior cingulate cortex function. Neuron, 79(2), 217–240. https://doi.org/10.1016/j.neuron.2013.07.007

Salamone, J. D., & Correa, M. (2024). The neurobiology of activational aspects of motivation. Annual Review of Psychology, 75, 1–32. https://doi.org/10.1146/annurev-psych-020223-012208

Horne, S. J., Topp, T. E., & Quigley, L. (2021). Depression and the willingness to expend cognitive and physical effort for rewards: A systematic review. Clinical Psychology Review, 88, 102065. https://doi.org/10.1016/j.cpr.2021.102065

Amiri, S., Mahmood, N., Mustafa, H., Javaid, S. F., & Khan, M. A. (2024). Occupational risk factors for burnout syndrome among healthcare professionals: A global systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 21(12), 1583. https://doi.org/10.3390/ijerph21121583