Jāņa Zālīša psihoterapijas klīnika

Burnout syndrome – Article series “How to treat the soul?” Part 6!

“There is no victory without a fight” – it is good if the work requires strength for development and motivates to move forward. It is bad if work turns into a painful daily struggle with oneself, takes away the joy of life and gives nothing except constant fatigue. This time the article is devoted to a common problem – emotional burnout.
This problem was first described in the 20th century among doctors. At the time, there was even a hypothesis that this type of fatigue was caused by an unknown virus, until this phenomenon was explained from the point of view of psychology. The term “burn -out” was first used in the early 1970s by the American psychiatrist G. Freudenberg [10]. Currently, in the International Classification of Diseases, burnout has its own diagnostic code: Z73.0 Overwork (exhaustion).
The main driving force that promotes professional development is contradictions or inconsistency between the growing complexity of professional requirements and individual experience and skills. In such conditions, an internal conflict arises – the real self (“how do I see and perceive myself?”) is in conflict with the reflective self (“how do I perceive myself when I look at myself through the eyes of another person?”). This contradiction creates a tension that motivates the search for a solution, leading to growth [1]. Emotional burnout can be considered one of the unsuccessfully resolved crises in the path of professional development: the complexity of the requirements does not correspond to the size of the internal resources. Due to the impact of the high emotional load, the psychological defense mechanism develops – complete or partial disconnection of emotions, as a response to certain stressful conditions. On the one hand, it allows you to save energy, on the other hand, it can have a bad impact on work results, relationships with colleagues or clients, as well as lead to illnesses, because stress at work does not go away by itself [2].
Yes, various types of inconsistencies between the person and the work, which are not eliminated in time, play a big role in the development of the burnout syndrome! Psychologists K. Maslača and K. Leiters emphasize the following factors [10]:
  • 1) discrepancy between the requirements for the employee and his resources (skills, strength, character);
  • 2) inconsistency between the desire to be independent in one’s work and the strict control of management, limiting people’s initiative and creative approach; the employee may feel useless;
  • 3) the inadequacy of the remuneration for the work invested is perceived as non-recognition of the work;
  • 4) non-compliance of colleagues’ relations with natural personal needs – lack of respect, recognition, support, comfort in the collective;
  • 5) there is a lack of understanding of justice at work, as a result of which the employee’s self-esteem falls;
  • 6) inconsistency between ethical personal principles and job requirements.
Emotional burnout is most often observed in employees of “altruistic” professions. For them, the implementation of professional requirements requires a great emotional return – teachers, nurses, doctors, social workers, psychologists, pastors. This syndrome can also occur in other professions whose work is not directly related to contact with other people, such as programmers. It is not uncommon for students and housewives [2].

The main signs of emotional burnout syndrome:

Emotional burnout syndrome develops gradually. In the beginning, there is a great passion for work, a person may even give up his other needs that are not related to work, and after a while, the passion is replaced by emotional and physical exhaustion. C person feels depressed and tired, which usually does not go away after a night’s sleep. Another sign is depersonalization – a cruel, impersonal attitude towards one’s profession, towards clients, patients, colleagues, does not allow compromises in one’s work. Positive and negative emotions previously evoked by work are replaced by indifference and cynicism. Personal achievements , work efficiency decrease, a person does not see opportunities for professional development [3].
Five types of symptoms characteristic of emotional burnout syndrome can be distinguished [2]:
  • 1) physical symptoms – fatigue, depression, exhaustion, weight changes, sleep disorders, poor general body condition, shortness of breath, shortness of breath, nausea, dizziness, excessive sweating, tremors, increased arterial pressure, skin diseases, diseases of the cardiovascular system ;
  • 2) emotional symptoms – lack of emotions, pessimism, cynicism and cruelty both at work and in private life, indifference, feeling of helplessness and hopelessness, aggressiveness, easy irritability, unreasonable anxiety, anxiety, weakening of attention, feeling of guilt, loss of ideals, hopes and professional perspectives ; as a result of which depersonalization occurs (it seems that you and the people around you become impersonal, a feeling of loneliness arises);
  • 3) changes in behavior – working more than 45 hours a week, fatigue occurs during work, the desire to rest, indifference to food, resistance to physical exercise decreases, the consumption of tobacco, alcohol, medication may increase, accidents occur (falls, injuries, accidents, behavior becomes impulsive);
  • 4) intellectual state – interest in new ideas in one’s professional field decreases, lack of creative approach to solving various problems, boredom, apathy, joy of life disappears, templates, routines, formal approach to work are preferred, because there is indifference to the new, there is no desire to participate in educational activities at events;
  • 5) social symptoms – social activity decreases, hobbies disappear, social contacts mostly take place only at work, feelings of isolation, misunderstanding with other people arise, lack of support from friends, relatives, colleagues, relationships deteriorate.
The symptoms of emotional burnout are very similar to the symptoms of depression. But it is important to distinguish one from the other, because it depends on how successful the treatment will be. If there is only emotional burnout syndrome, then you can improve your well-being by stopping work for a while, taking a longer vacation, and this will be enough to restore your strength. However, in the case of depression, the recommendation to rest longer is not really correct, because such patients definitely need psychotherapy or drug treatment. It is important to understand that with emotional burnout, the problems that disturb are mostly directly related to work, but with depression, gloomy thoughts and feelings affect all areas of life.
Therefore, patients with emotional burnout syndrome do not always have depression, although unresolved emotional burnout syndrome can contribute to the development of depression in the future [4], and it is also an independent risk factor for the development of coronary heart disease, as well as chronic musculoskeletal pain syndrome [5].
How to recognize

TEST - Maslach burnout survey: The Maslach Burnout Inventory [6; 7].

Please rate how often you experience the following feelings. You have to respond quickly based on the first impression.
  • 0 points – “Never”;
  • 1 point – “Very rare”;
  • 2 points – “Rare”;
  • 3 points – “Sometimes”;
  • 4 points – “Often”;
  • 5 points – “Very often”;
  • 6 points – “Every day”.
  • 1. I feel emotionally drained.
  • 2. I feel like a “squeezed lemon” after work.
  • 3. I feel tired in the morning and don’t want to go to work.
  • 4. I clearly understand what my colleagues feel and try to take it into account in business interests.
  • 5. I feel that I talk to some colleagues as if they were inanimate objects.
  • 6. After work, I want to distance myself from everyone and be alone for a while.
  • 7. I manage to find the right solution in conflict situations at work.
  • 8. I feel depressed and weak.
  • 9. I am sure that people need my work.
  • 10. I feel that I am becoming insensitive towards clients and colleagues.
  • 11. I noticed that my job is turning me into a cruel person.
  • 12. I have many plans for the future, I believe that everything will work out.
  • 13. My dissatisfaction with work is increasing.
  • 14. I feel like I work too much.
  • 15. It has happened that I really don’t care what happens to some of my colleagues.
  • 16. I want to spend time alone and rest from everyone and everything.
  • 17. It is easy for me to create a favorable atmosphere in the team.
  • 18. During work, I feel a pleasant uplifted mood and excitement.
  • 19. Thanks to my work, I have already done really valuable things in life.
  • 20. I feel that there is a feeling of indifference towards what I used to like and was interested in.
  • 21. I easily deal with emotional problems at work.
  • 22. Lately, I feel that colleagues more often transfer their responsibilities and problems to me.
Add up the scores for the answers to questions 1, 2, 3, 6, 8, 13, 14, 16, 20. The total indicates emotional exhaustion: 0-15 – low, 16-24 – medium, 25 and above – high level of emotional exhaustion.
Answers to questions 5, 10, 11, 15, 22 determine depersonalization: 0-5 low level of depersonalization, 6-10 – medium, 11 and more – high.
Answers to questions 4, 7, 9, 12, 17, 18, 19, 21 give an idea of ​​the decrease in personal achievements. If the total is 37 or more, it shows that working capacity and professional achievements are at a good level, 31-36 points – average level, if 30 and below – you have reduced working capacity, which is evidenced by a low level of personal achievements.

Panacea for emotional burnout syndrome!

The risk of developing emotional burnout syndrome directly depends on working conditions, relationships in the collective, the health of the person himself and emotional reactions to stressful situations. Successively improving all the above mentioned areas can significantly reduce the risk of emotional burnout syndrome.
If the emotional burnout syndrome has already developed, it is recommended [11]:
  • 1) psychotherapy – cognitive-behavioral therapy, learning to use relaxation techniques, integrative psychotherapy;
  • 2) changes in working conditions;
  • 3) drug treatment in average therapeutic doses depending on the symptoms – antidepressants, anti-anxiety drugs, sleep aids.
Time management plays a big role: it is important to set short-term and long-term goals, to forecast and moderately distribute the workload, to follow the daily schedule and to organize work breaks during the day.
Reduce stress factors as much as possible: avoid unnecessary competition, learn to switch from one activity to another, perceive conflicts at work more easily, do not strive to be better always and everywhere.
Expand your professional competence: participate in professional development activities and share information. It helps to have a wider perception of the world and to learn other people’s opinions about current problems.
Seek help from other people: analyze your feelings and talk about them with those around you.
Keeping yourself in good physical shape – “a healthy mind in a healthy body”.

PS Science Experiment/Example:

Long-term overload caused by work causes changes in the functioning of the brain, due to which the ability to manage one’s negative emotions deteriorates.
A study was conducted at the University of Stockholm comparing the ability to control emotions according to the presence of burnout syndrome in different participants. And with the method of magnetic resonance examination, the anatomically visible differences in brain function were compared. Attention was drawn to the structures directly responsible for anxiety – a subcortical structure called the amygdala and the area of ​​the brain’s cortex located in the forehead, or the prefrontal cortex. The amygdala is the part of the brain where anxiety and fear primarily occur in response to any potentially dangerous irritant. It does not evaluate to what extent the created emotions correspond to reality. The prefrontal cortex, on the other hand, is like a filter, with which a person is able to consciously assess whether anxiety and fear really have an appropriate basis, whether these negative emotions correspond to the situation, and if not, the signals of anxiety and fear in the amygdala are normally deleted.
During the study, participants were shown pictures with unpleasant content. They were given the task to deliberately increase or decrease their negative emotions, which were shown while looking at the pictures. It turned out that the participants with diagnosed burnout syndrome were significantly worse at managing their anxiety and fear emotions than the relatively healthy study participants. Magnetic resonance imaging also showed that people with burnout have a larger amygdala, which has less connectivity with the prefrontal cortex and other areas responsible for the conscious regulation of feelings of anxiety. From the above, it can be concluded that with burnout syndrome, the normal functioning of the brain has broken down and it is not so easy to restore it. The treatment course takes 6 months on average. Therefore, it is very important not to allow burnout syndrome to develop, but if it has already happened, to notice and change the circumstances that lead to emotional burnout in time to prevent further changes in the functioning of the brain [9].

Sources of information:

  • [1] Психологическое сопровождение оборудование профессии/ Под ред. Л.М. Митиной. M.,
  • 1998. С.6-8.
  • [2] Vodopyanova, N. E. Burnout syndrome. Diagnostics and prevention: practice.
  • пособие / Н. E. Vodopyanova, Е. С. Starchenkova. — 3-е изд., ispr. и доп. — M. :
  • Издательство Юрайт, 2018. — 343 с. — (Series : Professional practice). — ISBN
  • 978-5-534-03082-2.
  • [3] Maslach C. Burnout: A multidimensional perspective. In: Professional burnout: Recent
  • developments in the theory and research [Ed. WB Shaufeli, Cr. Maslach and T. Marek]
  • Washington DC: Taylor & Trancis, 1993. P. 19‒32.
  • [4] Depression: What is burnout? Last update: January 12, 2017. Source: PubMed Health, online
  • acces https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072470/
  • [5] Maria Avot, Anna Miller. Burnout syndrome for medical practitioners in Latvia. Riga
  • Stradin University.
  • Scientific articles. Riga: RSU, 2015, 204-211. p.
  • [https://www.rsu.lv/sites/default/files/imce/Dokumenti/zinatniskie_raksti_medicina/2015/2015_i
  • zdegsanas_sindromes_arstiem_latvija.pdf]
  • [6] Maslach C., Jackson SE The measurement of experienced burnout. Journal of
  • Occupational Behavior, 1981; 3: 99–113.
  • [http://onlinelibrary.wiley.com/doi/10.1002/job.4030020205/epdf]
  • [7] http://psylab.info/Опросник_выгорания_Маслач
  • [8] http://www.psi-test.ru/pub/1/Sidorov-Sindrom-vygoraniy.html
  • [9] Golkar, Armita et al. “The Influence of Work-Related Chronic Stress on the Regulation of
  • Emotion and on Functional Connectivity in the Brain.” Ed. Daniel Margulies. PLoS ONE 9.9
  • (2014): e104550. PMC. Web. 9 Feb. 2018
  • [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153588/]
  • [10] Professional burnout of employees. Yelena Horoshkina, Mag. psych., personnel selection
  • consultant, executive director of SIA «HR Eksperts», \”Psychological World\”
  • [http://www.tvnet.lv/saimniece/brivbridis/753564-darbinieku_profesionala_izdegsana]
  • [11] Boeva, A.V. Syndrome of emotional burnout in doctors and psychiatrists / A. V. Boeva, B.
  • A. Ruzhenkov, У. С. Москвитина // Научные ведомости БелГУ. Ser. Medicine. Pharmacy. –
  • 2013. – №11(154), вып.22.-С. 6-12. – Библиогр.: с. 10-12.