Burnout

"Burnout" is an English term and means burnt out, completely exhausted. There is still no clear definition of burnout, which is why the exact number of people affected is still unclear.

The term was coined in the 1970s by the American psychologist Herbert Freudenberger. Burnout was first described in social professions (healing and nursing professions, voluntary workers). The idealism of most people in this occupational group and the constant working at the emotional and physical stress limit with a low level of recognition can cause them to burn out.

Currently, burnout syndrome is described as complete physical, mental and emotional exhaustion. In addition, there is restlessness, tension, lack of motivation, drop in performance and psychosomatic complaints.

In most cases, these symptoms follow a strong frustration, the cause of which often lies in the job. Reasons for this are excessive demands, lack of recognition (praise, promotion opportunities, salary increase) or bureaucratic hurdles that make it difficult to achieve personal goals.

It can also be frustrating not to achieve a life goal or to achieve it without feeling the expected satisfaction.

Today, it is generally agreed that burnout can affect all occupational groups and also senior citizens or the unemployed. Burnout does not necessarily have to be preceded by "burn" in the sense of excessive commitment; it can also be triggered by mobbing.

Phases

Researchers divide burnout into different phases (usually occurring one after the other). The following model refers to the expert Prof. Martin Burisch (University of Hamburg).

Phase 1: Overstrain, overcommitment

Idealistic, over-commitment causes "burning" people to throw themselves into a project. At this stage, burnout can only very rarely be predicted. As soon as the hoped-for recognition (reward, professional advancement) lags behind the expectation over a longer period of time, the actual burnout syndrome begins.

The pressure from which those affected suffer can also be externally motivated. Exhaustion, frustration and irritation follow. The body also reacts to the overstrain. Headaches, stomachaches and sleep disturbances are the result.

Phase 2: Reduced commitment

A typical characteristic of the burnout syndrome is a strong frustration. Sufferers have to accept that the set goal will not be reached. The previous idealism fades and the commitment decreases.

Since a lot of time and diligence was invested in setting goals, demands are raised sharply. Those affected feel exploited and treated with too little appreciation.

At the same time an inner dismissal takes place. From this point on, only the most necessary things are done and even then generous breaks are taken, mistakes accumulate. For some, this attitude spreads to leisure time, while others flourish as soon as they leave their workplace.

Burnout sufferers distance themselves from their social environment. Compassion and sympathy (empathy) give way to emotional coldness, and cynicism is not uncommon. The normally positive feeling towards fellow human beings (work colleagues, friends, family) decreases.

Phase 3: Depression, aggression and apportionment of blame

A culprit must now be found for the personal failure. It can affect the sick person himself, but also people from his environment.

If the blame is sought and found in oneself, depression threatens. Feelings of failure, inability, powerlessness and helplessness take over and cause all self-esteem to dwindle.

Characteristic symptoms of depression (nervousness, emptiness, pessimism, anxiety, even suicidal thoughts) become noticeable.

A different picture emerges when the blame is found with colleagues or "the system". The own part in the failure is denied, aggression spreads. It comes to numerous conflicts with fellow men, against whom the whole anger is directed. Affected persons are moody, constantly irritated and feel attacked very quickly.

Phase 4: Degradation and dwindling performance

Errors of carelessness increase, appointments are forgotten. Decision-making difficulties, a lack of creativity and an inability to cope with complex problems are the result of constant tension.

Professionally, people work according to the principle of "duty by the book". Initiative, motivation and productivity steadily decrease.

The mental attitude also gradually changes. The "pigeonhole" and "black and white" thinking sets in, changes and break with routine are rejected, as it would require an additional expenditure of energy.

Phase 5: Disinterest, flattening

Affected persons also withdraw emotionally because of their declining performance. Indifference and boredom increase. Hobbies, family and friends are reduced to a minimum, loneliness spreads.

Phase 6: Despair

In the last phase, complete despair prevails. The meaning and value of life is questioned, suicidal thoughts accumulate and are sometimes put into practice.

Burnout is influenced by internal (personal) and external (environmental) factors.

Depending on personality and skills in dealing with obstacles and pressure, the risk for this syndrome varies from person to person.

However, individual situations can be so stressful and hopeless that very few can get through them without leaving a mark. Experts call this "wearout" or passive burnout.

The causes are as variable as the people affected. Since every life situation is different, the factors that lead to burnout can only be roughly divided into internal and external factors.

Internal factors

There are two types of people. Both have in common the pronounced striving for recognition.

Type 1:People with low self-esteem. They are oversensitive, conformist, passive and very needy of love.

Type 2:Very dynamic, determined and ambitious people with a high degree of idealism and commitment.

In addition, there are other risk factors:

• Self-image is built on the successful performance of a single role (e.g. successful manager).
• Meaningfulness of one's own actions is questioned
• unrealistically high goals, unequal relationship between required effort and outcome
• Goals are set according to the expectations of others
• high expectations of recognition after goal achievement
• lack of sense and acceptance of own weaknesses, helplessness
• Inability to say no (to others or to one's own striving for perfection)
• Achievement of goals at any cost, because one's self or the project is exceptional and justifies all means

External factors

Burnout often begins with a drastic change in one's life situation (starting university, starting a career, changing jobs). Through such changes the self-image is shaken and questioned. Expectations can be disappointed and life goals destroyed.

In contrast, the disappointment of an expectation can also trigger Burnout (failure to get a promotion).

• Overload at work
• too little control
• too little autonomy
• Lack of success and recognition
• injustice
• bureaucratic hurdles
• unsatisfactory rewards
• own values and convictions contradict requirements
• lack of social support
• unresolved conflicts at work

Inner attitude and perception of the situation have a greater influence on the development of burnout than the actual stress. If input and outcome or positive and negative are perceived as at least approximately equal, high demands can be sustained over a longer period of time.

Burnout affects emotions, psyche, cognitive abilities and the body. In which constellation of symptoms the syndrome presents, varies from patient to patient. Complaints can be roughly classified according to phases and psychosomatics.

Ad Phase 1: Warning symptoms

Excessive use of energy for a project is manifested by:

• Hyperactivity
• voluntary unpaid extra work
• Feeling of own indispensability
• Perception of permanent lack of time
• Suppression of personal needs
• Denial of failure and disappointment
• Restricting social contacts to objectives (customers, patients, etc.)

Soon exhaustion becomes noticeable:

• Restlessness, inability to relax
• Lack of energy
• sleeplessness
• above-average susceptibility to infections
• Increasing risk of accidents

Ad phase 2:

• Idealism decreases
• Commitment is limited
• disproportionately increasing demands
• Inner resignation
• Conviction of being exploited and not valued enough
• inner rebellion against work
• decreasing working hours (more breaks, coming later, leaving earlier)
• increasing distance and negative feelings towards work contacts (patients, colleagues)
• blooming during free time
• lack of empathy
• emotional coldness, cynicism

Ad Phase 3:

Depression:

• Helplessness, powerlessness
• inner emptiness
• sinking self-esteem
• Pessimism
• fear
• dejection
• Lack of motivation

Aggression:

• Blame is sought externally (colleagues, "the system")
• Irritability
• impatience
• frequent social conflicts
• Intolerance
• Aggression

Ad Phase 4:

• Careless mistakes
• decreasing creativity
• Difficulties in solving complex problems
• Difficulty making decisions
• lack of motivation
• decreasing productivity
• unwillingness to take the initiative
• "Duty according to the rules
• pigeonhole and black-and-white thinking
• Rejection of change

Ad phase 5:

• emotional withdrawal
• Boredom
• Indifference
• Loneliness
• Giving up hobbies
• Alienation

Ad phase 6:

• complete despair
• hopelessness
• everything seems pointless
• Doubt about the meaning of life
• Suicidal thoughts

Psychomatic symptoms

• Nightmares, sleep disorders
• Headache and backache, tension
• High blood pressure, palpitations, tightness in the chest
• Nausea, vomiting, diarrhea
• sexual problems
• noticeable weight loss or gain (change in eating habits)
• increased consumption of nicotine, alcohol or caffeine
• high susceptibility to infections

The ICD10 catalogue includes Burnout only as a sub-digit with the description "state of total exhaustion". Since there is no official independent diagnosis, it is difficult to clearly identify the syndrome in practice.

The symptoms of listlessness etc. are not only very similar to depression, but burnout usually ends in depression if left untreated.

Symptoms such as exhaustion also apply to the chronic fatigue syndrome, CFS for short.

For these reasons it is essential to exclude similar diseases first. For this purpose a detailed anamnesis (medical history, complaints) is necessary.

MBI

Many questionnaires try to make Burnout measurable. The most commonly used is the MBI - Maslach Burnout Inventory. It was developed in 1976 by psychologist Christina Maslach and contains 22 questions and 3 dimensions:

1. Emotional and persistent physical exhaustion.
2. depersonalisation (negative, distanced to cynical attitude towards clients, colleagues, superiors)
3. reduced performance capacity

Furthermore, statements have to be assessed according to their accuracy.

In other tests, the focus is on further criteria. The questionnaire Work-Related Behavioural and Experiential Patterns (AVEM) assesses work engagement, ability to cope with stress, emotional state and describes "coping types".

The most important tool for establishing a diagnosis is undoubtedly the doctor-patient interview. This identifies triggering factors and mechanisms.

The later Burnout is treated, the worse the chances of recovery. Therefore, it is important to start treatment quickly and professionally.

In the initial phase

If the syndrome is just emerging, crisis intervention or short-term therapy (a few hours) may be sufficient. Improved strategies for solving problems and conflicts are developed and the feeling for stress limits is sharpened. Autogenic training and progressive muscle relaxation can support the treatment.

Advanced burnout

If the illness is already more advanced, a more intensive therapy (outpatient or inpatient) becomes necessary. Due to the different causes, there is no universal treatment strategy.

Through cognitive behavioral therapy, erroneous ideas and behavioral patterns can be identified and gradually corrected. Paradigms (world views) such as compulsive perfectionism in order to be valuable are overturned and the patient is thus freed from his pathogenic, inner motivators.

For most sufferers, building a healthy sense of self-worth is paramount. This reduces the dependence on external recognition. Often, however, this requires a profound psychological restructuring. This can take place through time and energy intensive procedures such as depth psychological procedures or psychoanalysis.

Some sufferers have lost the sense of their own needs. In order to restore this, body therapies can help in a complementary way. They learn to listen to the body, to dissolve physical tensions and thus to alleviate the psychological ones.

If depression is added to the symptoms, medication (antidepressants, high-dose St. John's wort) can be used as a therapy supplement.

The earlier burnout is recognized and treated, the better the prognosis looks. The prerequisite for healing is nevertheless the insight of a problem. Affected people should discuss these 4 questions with therapeutic support:

1. How am I contributing to my burnout myself?
2. Where do I exceed my limits?
3. Which environmental factors play a role?
4. Which can be changed and which cannot?

If you don't admit your problem, you can't treat the cause.

At the onset of burnout, a change of job, crisis intervention or a stay at a health resort may be sufficient. With therapeutic support it is important to learn a better way of dealing with stress. A stable social network, financial security and hobbies can have a positive effect on the prognosis.

If burnout is not recognized over a longer period of time, permanent damage cannot be ruled out. Even normal stress (professional or social) is a hurdle even after years of therapy.

Because partial or complete disability is not uncommon, burnout must be taken seriously and treated.

What you can do yourself

Burnout is influenced by external (environmental) and internal (personal) factors. Changing internal attitudes slowly is usually easier than changing the environment (e.g. job) from scratch. Companies can support their employees through a variety of measures and help prevent employees from falling ill with burnout syndrome.

Tips for individuals

Identify basic needs

Burnout develops from frustration. Identify tasks that satisfy your basic needs. To do this, it is important to know exactly the daily life of the social role or job you are striving for.

Get to know your needs and wants. What is really important to you? Social recognition, opportunities for advancement, freedoms or influence in job design?

Managing stress and relaxation

Stress plays a large part in the development of burnout. Use stress management and relaxation techniques to counteract it.

Self-awareness

Burnout usually develops in secret. Take time regularly to ask yourself how stressed or satisfied you are. A stress diary can help with this. It can help you identify triggers and also detect creeping increases in stress. Another option is to ask friends and family for help. You can approach them directly if you are more irritable or less motivated than usual.

Take the power away from inner drivers

Those at risk are driven to overextend themselves by inner drivers. Such drivers can be maxims like perfection. If you expose your drivers, you can take away their power. Try to understand that perfection is something utopian and their own needs are on the same level as others.

Define your goal in life

You can ask yourself the following question: What do I actually want out of life? Pursue your goals consciously, this is the only way to get closer to lasting satisfaction. Say goodbye to goals that are not actually your own.

Accept yourself

If you build your self-esteem largely on professional success, you may be especially at risk for burnout. When you accept yourself, you develop a sense of self that is independent of success. This limits the risk of overcommitment and exploitation.

Healthy lifestyle

Eating a balanced mixed diet and exercising regularly can help reduce stress. Keep nicotine, caffeine and stimulants (sugar, alcohol) to a minimum.

Tips for individuals as part of an organisation

Time management

In a demanding job, well-structured time management is especially important.

Say no

In order not to overdo it, learn to be able to say "no" to a task or challenge that has been offered or that you have set yourself.

Unrealistic expectations

If you expect too much from a task, you are more likely to be disappointed.

Life and work balance

Work-life balance refers to an important basic human need. If you don't schedule enough time for open spaces and downtime, you may be heading for burnout.

Career planning

Career goals keep you from falling into a monotonous boredom. Continuing education also creates a new perspective to see the daily work life and inspires.

Strategies in the company

Burnout can be prevented through employee satisfaction. A corporate culture that strengthens employees in their autonomy, promotes further development and makes positive use of available resources contributes to this.

Employee survey

In the course of strictly anonymous, written surveys, signs of burnout and possible dissatisfaction can be identified. Only when problems are consciously identified can they be remedied.

Flexible work design

Employees who can actively influence their work content or help determine the way in which tasks are carried out have more room for initiative and self-determination.

Flexible working hours

Managers should keep an eye on the working hours of their employees. The accumulation of overtime and imbalances between work and free time should be avoided. Offering part-time work can also contribute to this.

Training for a burnout-preventive management style

Management training is a good tool to prevent burnout among employees. People with management responsibility learn what influences burnout and how they can contribute to prevention through appreciation, support and openness.

Further education

Burnout can also be caused by a monotonous working day. Continuing education can provide new perspectives and bring new energy into the daily work routine.

Fitness and wellness

Employees can reduce stress and recharge their batteries. In addition, the feeling of appreciation by the company is promoted, which counteracts dissatisfaction.

Conflict management, decision-making, information flow

The autonomy of the individual is strengthened by flat hierarchies and an open corporate philosophy that allows scope for decision-making.

Removing the taboo

The open discussion of burnout creates a working atmosphere that protects the limits and resources of the individual.