"Zoom fatigue" describes the tiredness, worry, or exhaustion associated with excessive use of virtual communication platforms. Like other experiences linked to the COVID-19 pandemic, Zoom fatigue is highly prevalent, intense, and entirely new.

In an effort to understand this new form of fatigue that can burden the more than 300 million daily Zoom participants, experts from various disciplines, including acoustics, business, and social sciences, have contributed their explanations. For instance, it has been suggested that audio is the main reason why video conferences are exhausting. It turns out that millisecond delays in virtual verbal responses negatively affect our interpersonal perceptions, even without technical or internet issues.

Other explanations attribute the fatigue to an underlying predisposition shaped by the backdrop of the pandemic, such as increased financial stress and unemployment. Cognitive factors are also likely contributing to the fatigue, as a heightened ability to multitask virtually threatens our attention span. Exploring these multifactorial etiologies has deepened our understanding of the fragile complexities that shape the precious face-to-face social interactions we had before COVID-19.

What is the psychological explanation for Zoom fatigue? We can begin the exploration by reviewing the process of mental fatigue. A central psychological component of fatigue is a trade-off between rewards and costs that occurs in our minds unconsciously. Essentially, at every behavioral level, a trade-off is made between the likely rewards and the costs of engaging in a particular activity. Even minor decisions, like pressing the "Delete" button instead of "Backspace" to erase a word, are made based on these unconscious estimates to maximize the reward (e.g., time) over the cost (e.g., effort). The link between this reward evaluation and fatigue is found here: activation of dopaminergic pathways in brain structures associated with reward (e.g., ventral striatum, anterior cingulate cortex [ACC], amygdala) increases subjective alertness, energy, and motivation — the opposite of fatigue.

Is the lack of perceived reward relative to the cost during video conferencing a primary psychological mechanism of Zoom fatigue? Indeed, social interactions are highly associated with our reward circuits, as oxytocin, the hormone involved in social bonding, modulates these same dopaminergic pathways involved in reward processing. Additionally, it seems to matter how that social interaction occurs. For example, functional magnetic resonance imaging (fMRI) data reveals that live face-to-face interactions, compared to viewing recordings, are associated with greater activation in the same brain regions involved in reward (i.e., ACC, ventral striatum, amygdala). Therefore, the more active the social connection, the greater the perceived reward, which, in turn, affects the neural pathways that modulate alertness against fatigue.

This neuropathophysiology may explain Zoom fatigue. For example, if inherent audio delays associated with technology lead to more negative perceptions and distrust between people, it is likely that a smaller reward is perceived when those people are on a video conference. Another example is direct mutual gaze. There is solid evidence on how eye contact enhances connection: faster responses, better facial recognition, and increased likability and attraction. These tools that make interactions organically rewarding are compromised with video. In video, the gaze must be directed at the camera to appear to make eye contact with an observer, and during conferences with three or more people, it may be impossible to distinguish mutual gaze between any two individuals.

Not only are rewards diminished through these social disconnections during video conferencing, but there are also elevated costs in the form of cognitive effort. Much of communication is actually unconscious and nonverbal, as emotional content is quickly processed through social cues such as touch, joint attention, and body posture. These nonverbal cues are not only used to gather information about others, but also to directly prepare an adaptive response and engage in reciprocal communication, all within milliseconds. However, in video, most of these cues are hard to visualize, as the same environment is not shared (which limits joint attention), and subtle facial expressions and gestures may not be captured. Without the help of these unconscious cues that we've relied on since childhood to socially and emotionally evaluate and bond with others, compensatory cognitive and emotional effort is required. Furthermore, this increased cost competes for people's attention with very high distractions, such as multitasking, the home environment (e.g., family, lack of privacy), and their reflected image on the screen. In short, video conferencing may be associated with a low reward and high cost.

Moreover, undoubtedly many other factors contribute to Zoom fatigue. The biopsychosocial model urges our field of psychiatry to consider comprehensively all the hidden influences that make up our experiences. Biologically, videoconferencing is muddied by a more sedentary daily rhythm experienced during the pandemic. In particular, physical activity is associated with a 40% reduction in fatigue risk. Psychologically, a filtering of our stimuli through a fundamental rewards-costs analysis may explain how our dopaminergic pathways contribute. Socially, a perfect storm of high unemployment, school closures, racial injustice, political divisions, physical distancing, and loneliness predisposes everyone in our nation vulnerably.

However, the purpose of the biopsychosocial formulation is to guide the treatment plan. Although the factors contributing to Zoom fatigue are complicated and multidimensional, closer examination may lead to hope. Contributing factors, depending on their adjustability, serve as potential therapeutic targets to alleviate fatigue and preserve the aspects of social interaction that were once unconscious and taken for granted. Exploring alternative and more explicit ways to improve perceived rewards during virtual communication may be a therapeutic approach not only for Zoom fatigue but also for the mental and physical toll it takes.

Dr. Lee is an assistant professor at the David Geffen School of Medicine at UCLA and director of the Pediatric Consultation Liaison and Pediatric Emergency Psychiatry Service at UCLA Mattel Children’s Hospital. He has nothing to disclose regarding this article.