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Even subtle forms of workplace abuse are a serious threat to heart and brain health.

Most recognize the harm from a leader who yells, berates, and humiliates.

Few realize the harm from the stress of expectations, little control, and lack of rewards.

Evidence accumulating over decades documents that our brain and heart health are vulnerable to abusive workplace environments. Yet few of us are taught how to recognize obvious, let alone subtle, toxic behaviours before they have begun to erode our mental and cardiovascular health.

Recently published research examines the impact of “job strain” on heart health. This subtle form of abuse occurs when employees have high job demands and expectations but little control over their work. An example would be a teacher who is expected to cover an extensive curriculum, with a large class, including students who suffer from trauma, as well as those with learning disabilities. The teacher has little control over all of these challenges and yet is expected to ensure students’ educational success.

Another example would be an engineer being told there aren’t enough resources and there isn’t enough time to do proper safety checks, or a physician who must put in seven to eight hours a week doing administrative paperwork while a backlog of patients isn’t being diagnosed or treated. In both cases, the worker doesn’t have control over the high demands of the workload and has little control over resource or time allocation. Both are aware of what could go wrong.

Effort and reward imbalance

Another subtle form of abuse occurs when leaders deny rewards to workers. Effort is ignored. Success is dismissed. Dedication is simply expected and not acknowledged. If anything, opportunities are blocked. No matter how hard they try, these workers are set up for failure and burnout.

Research identifies this discrepancy at work as “ERI,” which is an imbalance between the effort given and reward received. It’s when an employee goes the extra mile, puts in the time and practice to excel, has demonstrable success, but is not rewarded. There isn’t a pay increase. There isn’t a promotion. In short, ERI is defined as “effort-reward imbalance.”

Examples of a gap between efforts and rewards

A camera operator in the film industry agrees to work through the night, but not only does he not receive a pay increase for overtime, but he is also expected to show up to work the next morning at the same time as the others. It’s subtle, but the ERI assessment reveals an imbalance between the effort and the reward received.

Another example: A chef isn’t fast enough for the head chef, who is frustrated to the point of shoving the chef aside and doing the work herself. Despite the praise the chef’s carefully crafted dishes repeatedly earn, she is relegated to prep and is penalized with a notable salary drop.

Impact of job strain and ERI on the heart

Research conducted at Université Laval from 2000 to 2018 on 6,400 white-collar workers, led by Mathilde Lavigne-Robichaud, revealed that targets without any heart disease initially, but who were exposed to job strain or ERI, suffered an almost 50 percent increase in coronary heart disease (CHD) when compared to those who were in non-toxic workplaces.

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Published in 2025, this study confirms decades of research into the vulnerability of our hearts to psychological maltreatment at work. An article in CityNews Montreal by Jean-Benoit Legault quotes the lead researcher, Mathilde Lavigne-Robichaud: “There is more than 30 years of epidemiological evidence on the harmful effects of psychosocial stressors at work on cardiovascular health.”

Lavigne-Robichaud’s study revealed that men who had both job strain and ERI had twice the risk of CHD. Women’s outcomes were not as conclusive as they tend to manifest heart issues later in life, after retirement. The researchers also exposed the normalizing of these hazards in the workplace, where almost one in four workers reports job strain or ERI. Ten percent of employees experience both. While workers are protected from physical harm by law, the law has not caught up to protecting their hearts from psychosocial harms.

It's not just hearts, and it’s not just targets who are at risk

Psychosocial hazards and the stress they cause do not just negatively harm the heart. These hazards physically harm brains. Recent research shows that not only are the targets’ brains activated, but so are the brains of observers. This is an important step in acknowledging and assessing the psychosocial harms to the brains of witnesses, along with targets.

A recent study at Rutgers University—with the findings presented at a conference in Denmark—examined the brains of observers who watched video of leaders verbally abusing employees. MRIs of the observers’ brains were examined in terms of emotional and ethical reactions. “The findings show that witnessing abusive leadership first activates motivational brain regions, including the insula and cingulate cortex, associated with emotional salience, anger, and alarm.”

Lead researchers Danni Wang and Chao Chen explain that activation then shifts “toward regions linked to empathy, social cognition and moral reasoning.” While this occurs when watching a video simulation, it is less likely to mirror an abuse scenario when it is one’s actual leader abusing a colleague. A key factor—which we saw foregrounded in the heart study—is how much control a worker has, which is usually little to none. The lack of control faced with an abusive leader impacts the brain as well as the act of witnessing.

When leaders apply the command and control model

In measuring the impact on the brain in abuse cultures, it’s vital to factor in the leader’s application of the command and control model. As noted in the heart study, in actual employment scenarios, the leader can increase expectations and demands, hold back resources and time, and limit rewards, as well as fire the observer, harm their reputation, and derail their career. Decades of research document how this harms brain health.

As documented in The Bullied Brain and The Gaslit Brain, the harm to brains actually experiencing or observing abuse is physically harmful and leaves neurological scars. In an environment where safety is denied and threat is omnipresent, the amygdala can be enlarged, the corpus callosum can be demyelinated, and the hippocampus can be shrivelled. Hearts and brains suffer in toxic workplaces, and recognizing the obvious as well as the subtle signs is key to protecting one’s health and the health of others.

Devi, L. (2026). “MRI Scans Reveal How the Brain Processes Toxic Workplace Abuse.” Rutgers News.

Fraser, J. (2022). The Bullied Brain. Guilford, CT: Globe & Pequot.

Fraser, J. (2025). The Gaslit Brain. Guilford, CT: Globe & Pequot.

Lavigne-Robichaud, M., Trudel, X., Talbot, D., Milot, A., Pena-Gralle, A., et al. (2025). "Coronary Heart Disease Attributable to Psychosocial Stressors at Work." Advances: Journal of the American College of Cardiology.

Legault, J. (2025). Stress & lack of recognition at work can cause coronary heart disease: Université Laval research. The Canadian Press.

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