Occupational burnout

Not to be confused with Occupational burning.
Burn-out
Classification and external resources
ICD-10 Z73.0

Burnout is a type of psychological stress. Occupational burnout or job burnout is characterized by exhaustion, lack of enthusiasm and motivation, feelings of ineffectiveness, and also may have the dimension of frustration or cynicism, and as a result reduced efficacy within the workplace.[1]

The term burnout in psychology was coined by Herbert Freudenberger in his 1974 Staff burnout, presumably based on the 1960 novel A Burnt-Out Case by Graham Greene, which describes a protagonist suffering from burnout.[2][3]

More recently the term brownout[4] has been used in the business world to describe a less serious version of burnout. It refers to staff who are disengaged and demotivated in their job role.

Occupational burnout is typically and particularly found within human service professions. Professions with high levels of burnout include social workers, nurses, teachers, lawyers, engineers, medical practitioners, customer service representatives, and police officers.[5] One reason why burnout is so prevalent within the human services field is due in part to the high-stress work environment and emotional demands of the job.[1]

Maslach and her colleague, Michael Leiter, defined the antithesis of burnout as engagement.[6] Engagement is characterized by energy, involvement and efficacy, the opposites of exhaustion, cynicism and inefficacy.[6] Bakker et al. (2014) in Burnout and Work Engagement: The JD–R Approach makes the same argument as Leiter.

Diagnosis

Burnout is not recognized as a distinct disorder in the DSM-5.[7] However, it is included in the ICD-10,[8] and can be found under problems related to life-management difficulty (Z73).

Social psychologists Christina Maslach and Susan Jackson developed the most widely used instrument for assessing burnout, namely, the Maslach Burnout Inventory. The Maslach Burnout Inventory operationalizes burnout as a three-dimensional syndrome made up of exhaustion, cynicism, and inefficacy.[9] Some researchers and practitioners have argued for an "exhaustion only" model that views that symptom as the hallmark of burnout.[10][11]

A growing body of evidence suggests that burnout is clinically and nosologically similar to depression.[12][13][14][15][16] In a study that directly compared depressive symptoms in burned out workers and clinically depressed patients, no diagnostically significant differences were found between the two groups; burned out workers reported as many depressive symptoms as clinically depressed patients.[17] Moreover, a study by Bianchi, Schonfeld, and Laurent (2014) showed that about 90% of burned out workers meet diagnostic criteria for depression, suggesting that burnout may be a depressive syndrome rather than a distinct entity.[14] The view that burnout is a form of depression has found support in several recent studies.[13][15][16]

The term "responder apathy syndrome" (RAS) refers to a controversial psychological diagnosis connected to occupational burnout that is not recognized by most physicians or psychologists.[18] Originally developed to explain the apathy seen in paramedics[19] and firefighters toward those calling for their help, the definition has generally been expanded to include nurses, respiratory therapists and other health care workers involved in direct patient care. Generally diagnosticians term the symptoms as generalized burnout[20] and ignore the occupation specific burnout termed RAS.

Causes

Evidence suggests that burnout's etiology is multifactorial in nature, with dispositional factors playing an important role.[21][22] One cause of burnout includes stressors that a person is unable to cope with fully. Occupational burnout often develops slowly and may not be recognized until it has become severe. When one's expectations about a job and its reality differ, burnout can begin.[1] How pressure is dealt with determines how much stress someone feels and how close they are to burnout. One individual can experience few stressors, but be unable to handle the pressure well and thus experience burnout. Another person, however, can experience a far greater number of stressors, but effectively deal with them, and avoid burnout. How close someone is to a state of burnout can be determined through various tests.[23]

Burnout is becoming a more common result as the modern workplace changes. Being both economically and psychologically exhausting, the increasingly hostile and demanding environments in which employees work is being studied as a cause. More frequently, economic values are placed ahead of human values. The phenomenon is more likely when a mismatch is present between the nature of the job and the person doing the job. A common indication of this mismatch is work overload. It involves doing too much with too few resources, going beyond personal limits. This may occur in a situation of downsizing, which often does not reduce a company's mandate, but allocates it to present employees.[6]

The job-demands model of burnout proposes that burnout is influenced by job demands and job resources. Job demands are the physical and psychological costs of work, such as work pressure and emotional demands. Job resources are organizational aspects of the job that help employees manage job demands. A review by Demerouti et al. found that burnout can be explained by the two factors of job demands and job resources, and that exhaustion is correlated to job demands, and that job resources are negatively correlated to disengagement. Demerouti also showed that burnout is present in all types of jobs, and not just within human services.[24]

Maslach, Schaufeli and Leiter identified six risk factors for burnout: mismatch in workload, mismatch in control, lack of appropriate awards, loss of a sense of positive connection with others in the workplace, perceived lack of fairness, and conflict between values.[25]

Burnout is supposed to be a work-specific syndrome. However, this restrictive view of burnout's scope has been shown to be groundless.[26]

Phases

Psychologists Herbert Freudenberger and Gail North have theorized that the burnout process can be divided into 12 phases, which are not necessarily followed sequentially.[7]

  1. The compulsion to prove oneself
    Often found at the beginning is excessive ambition. The desire to prove oneself in the workplace turns into compulsion.[7]
  2. Working harder
    Because they have to prove themselves to others or try to fit in an organization that does not suit them, people establish high personal expectations. In order to meet these expectations, they tend to focus solely on work while they take on more work than they otherwise would. It may happen that they become obsessed with doing everything themselves to show that they are irreplaceable.[7]
  3. Neglecting their needs
    Since they have to devote everything to work, they now have no time and energy for anything else. Friends and family, eating and sleeping start to be seen as unnecessary or unimportant, as they reduce the time and energy that can be spent on work.[7]
  4. Displacement of conflicts
    They become aware that what they are doing is not right, but they are unable to see the source of the problem. This may lead to a crisis in themselves and become threatening. The first physical symptoms appear.[7]
  5. Revision of values
    While falling into a state of denial of basic physical needs, perceptions and value systems change. Work consumes all energy, leaving none for friends and hobbies. The job is the new value system and people start to become emotionally blunt.[7]
  6. Denial of emerging problems
    People may become intolerant and dislike being social. They may be seen as aggressive and sarcastic. Problems may be blamed on time pressure and all the work that they have to do.[7]
  7. Withdrawal
    Minimal social contact turns into isolation. Alcohol or drugs may be used as a release from obsessive working "by the book". These people often have feelings of being without hope or direction.[7]
  8. Obvious behavioral changes
    Coworkers, family, friends and others in their immediate social circles cannot overlook the behavioral changes in these people.[7]
  9. Depersonalization
    It is possible that they no longer see themselves or others as valuable. Their view of life narrows to only seeing the moment and life turns to a series of mechanical functions.[7]
  10. Inner emptiness
    They feel empty inside and may exaggerate activities such as overeating or sex to overcome these feelings.
  11. Depression
    Burnout may include depression. In that case, the person is exhausted, hopeless, indifferent, and believes that life has no meaning.[7]
  12. Burnout syndrome
    They collapse physically and emotionally and need immediate medical attention. In extreme cases, suicidal ideation may occur, with it being viewed as an escape from their situation. Only a few people will actually commit suicide.[7]

Effects

Symptoms of burnout include dysfunctional attitudes towards work, exhaustion, loss of motivation, distress, and feelings of ineffectiveness. Poor coping mechanisms can contribute to or result from burnout.[1]

Many theories of burnout include negative outcomes related to burnout, including measures of job function (performance, output, etc.), health related outcomes (increases in stress hormones, coronary heart disease, circulatory issues), and mental health problems such as depression. It has been found that patients with chronic burnout have specific cognitive impairments, which should be emphasized in the evaluation of symptoms and treatment regimes. Significant reductions in nonverbal memory and auditory and visual attention were found for the patient group.[27]

Usually occupational burnout is associated with increased work experience, increased workload, but also absences and time missed from work, it shows up as an impaired empathy and cynical attitudes toward clientele or colleagues, and thoughts of quitting.[28]

Treatment and prevention

At the individual level

It is difficult to treat the three symptoms of exhaustion, cynicism, and inefficacy, as they react to the same preventive or treatment activities in different ways.[29] Exhaustion is more easily treated than cynicism and professional efficacy, which tend to be more resistant to treatment. Research shows that intervention actually may worsen the professional efficacy of one who originally had low professional efficacy.[30]

For the purpose of preventing occupational burnout, various stress management interventions have been shown to help improve employee health and wellbeing in the workplace and lower stress levels. Training employees in ways to manage stress in the workplace have also proven effective in prevention of burnout.[31] One study suggest that social-cognitive processes such as commitment to work, self-efficacy, learned resourcefulness and hope may insulate individuals from experiencing occupational burnout.[28] Increased job control is another intervention shown to help counteract exhaustion and cynicism in the workplace.[29]

Burnout prevention programs have traditionally focused on cognitive-behavioral therapy (CBT), cognitive restructuring, didactic stress management, and relaxation. CBT, relaxation techniques (including physical techniques and mental techniques), and schedule changes are the best-supported techniques for reducing and preventing burnout in a health-care specific setting. Combining both organizational and individual level activities may be the most beneficial approach to reduce symptoms.[1]

Employee rehabilitation is a tertiary preventive intervention which means the strategies used in rehabilitation are meant to alleviate, as well as prevent, burnout symptoms.[29] Such rehabilitation of the working population includes multidisciplinary activities with the intent of maintaining and improving employees' working ability and ensuring a supply of skilled and capable labor in society.

Additional prevention methods include: starting the day with a relaxing ritual; adopting healthy eating, exercising, and sleeping habits; setting boundaries; taking breaks from technology; nourishing one's creative side, and learning how to manage stress.[32]

At the organizational level

While individuals can cope with the symptoms of burnout, the only way to truly prevent burnout is through a combination of organizational change and education for the individual.[6]

Maslach and Leiter postulated that burnout occurs when there is a disconnection between the organization and the individual with regard to what they called the six areas of work life: workload, control, reward, community, fairness, and values.[33] Resolving these discrepancies requires integrated action on the part of both the individual and the organization.[33] A better connection on workload means assuring adequate resources to meet demands as well as work/life balances that encourage employees to revitalize their energy.[33] A better connection on values means clear organizational values to which employees can feel committed.[33] A better connection on community means supportive leadership and relationships with colleagues rather than discord.[33]

One approach for addressing these discrepancies focuses specifically on the fairness area. In one study employees met weekly to discuss and attempt to resolve perceived inequities in their job.[34] This study revealed decreases in the exhaustion component over time but did not affect cynicism or inefficacy indicating that a broader approach is required.[33]

Stemming from Mayo's Hawthorne Studies, Employee assistance programs were designed to assist employees in dealing with the primary causes of stress. Some programs included counseling and psychological services for employees. There are organizations that still utilize EAPs today, but the popularity has diminished substantially because of the advent of stress management training (SMT). SMT is employed by many organizations today as a way to get employees to either work through stress or to manage their stress levels—to maintain stress levels below that which might lead to higher instances of burnout.

See also

Stress and the workplace:

Medical:

References

  1. 1 2 3 4 5 Ruotsalainen JH, Verbeek JH, Mariné A, Serra C (2014). "Preventing occupational stress in healthcare workers". The Cochrane Database of Systematic Reviews. 12: CD002892. doi:10.1002/14651858.CD002892.pub4. PMID 25482522.
  2. ↑ Can’t Get No Satisfaction: In a culture where work can be a religion, burnout is its crisis of faith. by Jennifer Senior, November 26, 2006, New York Magazine
  3. ↑ Freudenberger, H. J. (1974). "Staff burnout". Journal of Social Issues. 30 (1): 159–165. doi:10.1111/j.1540-4560.1974.tb00706.x.
  4. ↑ Rigby, Rhymer. "Are you suffering from 'brownout'?". Retrieved 16 September 2015.
  5. ↑ Jackson, S.; Schwab, R.; Schuler, R. (1986). "Toward an understanding of the burnout phenomenon". Journal of Applied Psychology. 71 (4): 630–640. doi:10.1037/0021-9010.71.4.630.
  6. 1 2 3 4 Maslach, C. & Leiter, M.P. The truth about burnout. New York. Jossey-Bass, 1997.
  7. 1 2 3 4 5 6 7 8 9 10 11 12 13 Ulrich Kraft, "Burned Out", Scientific American Mind, June/July 2006 p. 28-33
  8. ↑ ICD-10: International Classification of Diseases. Geneva: World Health Organization, 2015.
  9. ↑ Maslach, C., Jackson, S.E, & Leiter, M.P. MBI: The Maslach Burnout Inventory: Manual. Palo Alto: Consulting Psychologists Press, 1996.
  10. ↑ Kristensen, T.S.; Borritz, M.; Villadsen, E.; Christensen, K.B. (2005). "The Copenhagen Burnout Inventory: A new tool for the assessment of burnout". Work & Stress. 19: 192–207. doi:10.1080/02678370500297720.
  11. ↑ Shirom, A. & Melamed, S. Does burnout affect physical health? A review of the evidence. In A. S. G. Antoniou & C. L. Cooper (Eds.), Research companion to organizational health psychology (pp. 599-622). Cheltenham, UK: Edward Elgar, 2005.
  12. ↑ Ahola, K.; Hakanen, J.; Perhoniemi, R.; Mutanen, P. (2014). "Relationship between burnout and depressive symptoms: A study using the person-centred approach". Burnout Research. 1 (1): 29–37. doi:10.1016/j.burn.2014.03.003.
  13. 1 2 Bianchi, R., & Laurent, E. (in press). Emotional information processing in depression and burnout: An eye-tracking study. European Archives of Psychiatry and Clinical Neuroscience.
  14. 1 2 Bianchi, R.; Schonfeld, I. S.; Laurent, E. (2014). "Is burnout a depressive disorder? A re-examination with special focus on atypical depression". International Journal of Stress Management. 21 (4): 307–324. doi:10.1037/a0037906.
  15. 1 2 Bianchi, R., Schonfeld, I. S., & Laurent, E. (in press). Is burnout separable from depression in cluster analysis? A longitudinal study. Social Psychiatry and Psychiatric Epidemiology.
  16. 1 2 Hintsa, T., Elovainio, M., Jokela, M., Ahola, K., Virtanen, M., & Pirkola, S. (in press). Is there an independent association between burnout and increased allostatic load? Testing the contribution of psychological distress and depression. Journal of Health Psychology.
  17. ↑ Bianchi, R.; Boffy, C.; Hingray, C.; Truchot, D.; Laurent, E. (2013). "Comparative symptomatology of burnout and depression". Journal of Health Psychology. 18 (6): 782–787. doi:10.1177/1359105313481079.
  18. ↑ 4Responder Apathy Syndrome. Retrieved November 4, 2011.
  19. ↑ Rubin M (2011). "Get a clue: It can be all too easy to make assessment errors in the field; here's some tips to prevent you from making mistakes.". EMS World. 40 (9): 57–64. PMID 21961428.
  20. ↑ Dickinson T, Wright KM (2008). "Stress and burnout in forensic mental health nursing: a literature review.". Br J Nurs. 17 (2): 82–7. doi:10.12968/bjon.2008.17.2.28133. PMID 18414278.
  21. ↑ Alarcon, G.; Eschleman, K. J.; Bowling, N. A. (2009). "Relationships between personality variables and burnout: A meta-analysis". Work & Stress. 23 (3): 244–263. doi:10.1080/02678370903282600.
  22. ↑ Swider, B. W.; Zimmerman, R. D. (2010). "Born to burnout: A meta-analytic path model of personality, job burnout, and work outcomes". Journal of Vocational Behavior. 76 (3): 487–506. doi:10.1016/j.jvb.2010.01.003.
  23. ↑ Truby, B. (2009)
  24. ↑ Demerouti, Evangelia; Bakker, Arnold B.; Nachreiner, Friedhelm; Schaufeli, Wilmar B. (2001). "The job demands-resources model of burnout.". Journal of Applied Psychology. 86 (3): 499–512. doi:10.1037/0021-9010.86.3.499.
  25. ↑ Maslach, C.; Schaufeli, W.; Leiter, M. (2001). "Job burnout". Annu. Rev. Psychol. (52): 397–422. See p. 413–416.
  26. ↑ Bianchi, R.; Truchot, D.; Laurent, E.; Brisson, R.; Schonfeld, I. S. (2014). "Is burnout solely job-related? A critical comment". Scandinavian Journal of Psychology. 55 (4): 357–361. doi:10.1111/sjop.12119.
  27. ↑ Sandstrom, A; Rhodin IN; Lundberg M; Olsson T; Nyberg L. (2005). "Impaired cognitive performance in patients with chronic burnout sysndrome.". Biological Psychology. 69 (3): 271–279. doi:10.1016/j.biopsycho.2004.08.003. Retrieved December 5, 2012.
  28. 1 2 Elliott, T.; Shewchuk, R.; Hagglund, K.; Rybarczyk, B.; Harkins, S. (1996). "Occupational burnout, tolerance for stress, and coping among nurses in rehabilitation units". Rehabilitation Psychology. 41 (4): 267–284. doi:10.1037/0090-5550.41.4.267.
  29. 1 2 3 Hätinen, M.; Kinnunen, U.; Pekkonen, M.; Kalimo, R. (2007). "Comparing two burnout interventions: Perceived job control mediates decreases in burnout". International Journal of Stress Management. 14 (3): 227–248. doi:10.1037/1072-5245.14.3.227.
  30. ↑ Van Dierendonck, D.; Schaufeli, W. B.; Buunk, B. P. (1998). "The evaluation of an individual burnout intervention program: The role of inequity and social support". Journal of Applied Psychology. 83: 392–407. doi:10.1037/0021-9010.83.3.392.
  31. ↑ William D. McLaurine, A correlational study of job burnout and organizational commitment among correctional officers, Capella University. School of Psychology, pp. 92
  32. ↑ Smith M. M.A., Segal J. Ph.D., & Segal R. M.A.
  33. 1 2 3 4 5 6 Maslach, C.; Schaufeli, W. B.; Leiter, M. P. (2001). S. T. Fiske; D. L. Schacter; C. Zahn-Waxler, eds. "Job burnout". Annual Review of Psychology. 52: 397–422. doi:10.1146/annurev.psych.52.1.397.
  34. ↑ van Dierendonck, D.; Schaufeli, W. B.; Buunk, B. P. (1998). "The evaluation of an individual burnout intervention program: the role of in- equity and social support". J. Appl. Psychol. 83: 392–407. doi:10.1037/0021-9010.83.3.392.

Further reading

  • Cooper, C. L.; Cartwright, S. (1997). "An intervention strategy for workplace stress". Journal of Psychosomatic Research. 43: 7–16. doi:10.1016/s0022-3999(96)00392-3. 
  • Clanton, L. D.; Rude, S.; Taylor, C. (1992). "Learned resourcefulness as a moderator of burnout in a sample of rehabilitation providers". Rehabilitation Psychology. 37: 131–140. doi:10.1037/0090-5550.37.2.131. 
  • "A review and integration of research on job burnout", Cordes, C. and Dougherty, T. (1993). Academy of Management Review, 18, 621-656. Cited in O'Driscoll, M. P. and Cooper, C.L. (1996).
  • "Sources of Management of Excessive Job Stress and Burnout", In P. Warr (Ed.), Psychology at Work Fourth Edition. Penguin.
  • "Tailoring treatment strategies for different types of burnout" Farber, B. A. (1998). Paper presented at the Annual Convention of the American Psychological Association, 106th, San Francisco California, August 14–18. ED 424 517
  • Freudenberger, H. J. (1974). "Staff burnout". Journal of Social Issues. 30 (1): 159–165. doi:10.1111/j.1540-4560.1974.tb00706.x. 
  • "Authentic leaders creating healthy work environments for nursing practice", Shirey M. R. American Journal of Critical Care May 2006. Vol. 15, Iss. 3; p. 256
  • "Taming burnout's flame", Krista Gregoria Lussier, Nursing Management Chicago: April 2006. Vol. 37, Iss. 4; p. 14
  • "A Scientific Solution To Librarian Burnout", Craig S. Shaw New Library World Year 1992 Volume: 93 Number: 5
  • Stress and Burnout in Library Service, Caputo, Janette S. Phoenix, AZ: Oryx Press, 1991.
  • An assessment of burnout in academic librarians in America using the Maslach Burnout Inventor (the MBI) Ray, Bernice, Ph.D., Rutgers University - New Brunswick, 2002, 90 pages; AAT 3066762
  • Bakker, A., Demerouti, E., & Sanz-Vergel, A. I. (2014). Burnout and Work Engagement: The JD–R Approach. Annual Review of Organizational Psychology and Organizational Behavior, 1(1), 140114155134003. http://doi.org/10.1146/annurev-orgpsych-031413-091235
  • Tracy, S (2000). "Becoming a Character for Commerce Emotion". Management Communication Quarterly. 14: 90–128. doi:10.1177/0893318900141004. 
  • Newton, T. (1995). Managing stress: Emotion and power at work. Thousand Oaks, CA: Sage.
  • Herbert J. Freudenberger (1980), Burn-Out: The High Cost of High Achievement. Anchor Press
  • Herbert J. Freudenberger and Gail North (1985). Women’s Burnout: How to Spot It, How to Reverse It, and How to Prevent It, Doubleday
  • Maslach, C.; Schaufeli, W. B.; Leiter, M. P. (2001). "Job burnout". Annual Review of Psychology. 52: 397–422. doi:10.1146/annurev.psych.52.1.397. 
  • Maslach, C.; Leiter, M. P. (2008). "Early predictors of job burnout and engagement". Journal of Applied Psychology. 93: 498–512. doi:10.1037/0021-9010.93.3.498. 
  • Maslach, C. & Leiter, M. P. (1997). The truth about burnout. San Francisco: Jossey Bass.
  • Shaufeli, W. B.; Leiter, M. P.; Maslach, C. (2009). "Burnout: Thirty-five years of research and practice". Career Development International. 14: 204–220. 
  • Maslach, C., Jackson, S. E, & Leiter, M. P. MBI: The Maslach Burnout Inventory: Manual. Palo Alto: Consulting Psychologists Press, 1996.
  • Kristensen, T.S.; Borritz, M.; Villadsen, E.; Christensen, K.B. (2005). "The Copenhagen Burnout Inventory: A new tool for the assessment of burnout". Work & Stress. 19: 192–207. doi:10.1080/02678370500297720. 
  • Shirom, A. & Melamed, S. Does burnout affect physical health? A review of the evidence. In A.S.G. Antoniou & C.L. Cooper (Eds.), Research companion to organizational health psychology (pp. 599–622). Cheltenham, UK: Edward Elgar, 2005.
  • Sanders, Marc. (2013) "Existential Depression. How to recognize and cure life-related sadness in gifted people", Self-Help Manual.
  • van Dierendonck, D.; Schaufeli, W. B.; Buunk, B. P. (1998). "The evaluation of an individual burnout intervention program: the role of in- equity and social support". J. Appl. Psychol. 83: 392–407. doi:10.1037/0021-9010.83.3.392. 
  • * Wang, Yang; Ramos, Aaron; Wu, Hui; Liu, Li; Yang, Xiaoshi; Wang, Jiana; Wang, Lie (2014-09-26)."Relationship between occupational stress and burnout among Chinese teachers: a cross-sectional survey in Liaoning, China". ''International Archives of Occupational and Environmental Health'' '''88''' (5): 589–597. doi:10.1007/s00420-014-0987-9. ISSN 0340-0131
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