Occupational burnout

Not to be confused with Occupational burning.

Occupational burn-out
Other names	Burn-out
Specialty	Psychology

Occupational burnout is a syndrome (group of symptoms) linked to long-term, unresolved, work-related stress. Since May 2019, the World Health Organization (WHO) has stipulated that burnout must be understood as being specifically work-related. According to the current WHO classification (ICD-11), burnout can arise from unsuccessful management of chronic work-related stress, resulting in an occupational syndrome characterised by 1) feelings of exhaustion; 2) negativity or cynicism; and 3) reduced efficacy. While burnout influences health and may be a reason for people contacting health services, it is not itself classified by the WHO as a medical condition.

In 1974, Herbert Freudenberger became the first researcher to publish in a psychology-related journal a paper that used the term 'burnout'. The paper was based on his observations of the volunteer staff (including himself) at a free clinic for drug addicts. He characterized burnout by a set of symptoms that includes exhaustion resulting from work's excessive demands as well as physical symptoms such as headaches and sleeplessness, "quickness to anger" and closed thinking. He observed that the burned-out worker "looks, acts, and seems depressed". After the publication of Freudenberger's original paper, interest in occupational burnout grew. Because the phrase "burnt-out" was part of the title of a 1961 Graham Greene novel, A Burnt-Out Case, which dealt with a doctor working in the Belgian Congo with patients who had leprosy, the phrase may have been in use outside the psychology literature before Freudenberger employed it.

In 1981, Christina Maslach and Susan Jackson developed the first widely used instrument for assessing burnout, the Maslach Burnout Inventory. Originally focused on the human service professions (e.g., teachers, social workers), its application broadened to many other occupations. Researchers have developed more focused conceptualizations of burnout. It has been described in terms of emotional exhaustion, depersonalization (treating clients/students and colleagues in a cynical way), and reduced feelings of work-related personal accomplishment. It has also been seen to comprise emotional exhaustion, physical fatigue, and cognitive weariness. Another view involves a combination of exhaustion and disengagement. The core of these three conceptualizations, as well as Freudenberger's, is exhaustion. Burnout is now also seen as involving the full array of depressive symptoms (e.g., low mood, cognitive alterations, sleep disturbance). Marked differences in understanding of what constitutes burnout have highlighted the need for consensus definition.

Diagnosis

Classification

Burnout is an occupational health issue involving multiple symptoms linked to chronic work-related stress. While such a syndrome is known to affect a person's health (as can occur with all forms of stress), burnout has not in itself been classified as a medical condition.

Burnout is not recognized as a distinct disorder in the current revision (dating from 2013) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). As regards the International Statistical Classification of Diseases and Related Health Problems (ICD), burnout had been classified in the ICD-10 edition as a type of non-medical life-management difficulty. In May 2019, the World Health Organization clarified that burnout is specifically connected to employment, rather than similar experiences caused by non-occupational life-management difficulties. In the most recent version (ICD-11), burnout is classified under 'Problems associated with employment or unemployment', in the section on 'Factors influencing health status or contact with health services', dedicated to reasons for which people contact health services other than recognized diseases or health conditions. According to ICD-11:

Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and 3) reduced professional efficacy. Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.

Criteria

In 1981, Christina Maslach and Susan Jackson developed the first widely used instrument for assessing burnout, namely, the Maslach Burnout Inventory (MBI). Consistent with Maslach's conceptualization, the MBI operationalizes burnout as a three-dimensional syndrome consisting of emotional exhaustion, depersonalization, and reduced personal accomplishment. Other researchers have argued that burnout should be limited to fatigue and exhaustion.

A growing body of evidence suggests that burnout is etiologically, clinically, and nosologically similar to depression. 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. Moreover, a study by Bianchi, Schonfeld, and Laurent (2014) showed that about 90% of workers with full-blown burnout meet diagnostic criteria for depression. The view that burnout is a form of depression has found support in several recent studies. Some authors have recommended that the nosological concept of burnout be revised or even abandoned entirely given that it is not a distinct disorder and that there is no agreement on burnout diagnostic criteria.

Liu and van Liew wrote that "the term burnout is used so frequently that it has lost much of its original meaning. As originally used, burnout meant a mild degree of stress-induced unhappiness. The solutions ranged from a vacation to a sabbatical. Ultimately, it was used to describe everything from fatigue to a major depression and now seems to have become an alternative word for depression, but with a less serious significance" (p. 434).

Risk factors

Evidence suggests that the etiology of burnout is multifactorial, with dispositional factors playing an important, long-overlooked role. Cognitive dispositional factors implicated in depression have also been found to be implicated in burnout. 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.

Burnout is thought to occur 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, which sometimes involves a worker who survives a round of layoffs, but after the layoffs the worker finds that he or she is doing too much with too few resources. Overload may occur in the context of downsizing, which often does not narrow an organization's goals, but requires fewer employees to meet those goals.

The job demands-resources model has implications for burnout, as measured by the Oldenburg Burnout Inventory (OLBI). Physical and psychological job demands were concurrently associated with the exhaustion, as measured by the OLBI. Lack of job resources was associated with the disengagement component of the OLBI.

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.

Burnout is supposed to be a work-specific syndrome. However, this restrictive view of burnout's scope has been shown to be groundless. In other words, burnout could apply to nonwork roles such as that of caregiver or student.

Effects

Some research indicates that burnout is associated with reduced job performance, coronary heart disease, and mental health problems (although note the abovementioned research that suggests it is a depressive syndrome, e.g., Ahola et al., 2005). Chronic burnout is also associated with cognitive impairments such as memory and attention. Occupational burnout is also associated with absences, time missed from work, and thoughts of quitting.

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. Exhaustion is more easily treated than cynicism and professional inefficacy, 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.

For the purpose of preventing occupational burnout, various stress management interventions have been shown to help improve employee health and well-being 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. 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. Increased job control is another intervention shown to help counteract exhaustion and cynicism in the workplace.

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. A Cochrane review reported that evidence for the efficacy of CBT in healthcare workers is of low quality, indicating that it is no better than alternative interventions.

Employee rehabilitation is a tertiary preventive intervention which means the strategies used in rehabilitation are meant to alleviate, as well as prevent, burnout symptoms. 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.

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.

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. Resolving these discrepancies requires integrated action on the part of both the individual and the organization. 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. A better connection on values means clear organizational values to which employees can feel committed. A better connection on community means supportive leadership and relationships with colleagues rather than discord.

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. The intervention was associated with decreases in exhaustion over time but not cynicism or inefficacy, suggesting that a broader approach is required.

See also

• Compassion fatigue
• Counterproductive work behavior
• Employee engagement
• Spoon theory
• Writer's block
• Meditation

Stress and the workplace:

• Industrial and organizational psychology
• Occupational health psychology
• Perceived organizational support
• Perceived psychological contract violation
• Work–life balance

Medical:

• Depression (mood)
• Stress (medicine)

Further reading

• Bianchi, R.; Schonfeld, I.S.; Laurent, E. (2014). "Is burnout a depressive disorder? A reexamination with special focus on atypical depression". International Journal of Stress Management. 21 (4): 307–324. doi:10.1037/a0037906.
• Caputo, Janette S. (1991). Stress and Burnout in Library Service, Phoenix, AZ: Oryx Press.
• Cordes, C.; Dougherty, T. (1996). "A review and integration of research on job burnout". Academy of Management Review. 18 (4): 621–656. doi:10.5465/AMR.1993.9402210153.
• Freudenberger, Herbert J (1974). "Staff burnout". Journal of Social Issues. 30: 159–165. doi:10.1111/j.1540-4560.1974.tb00706.x.
• Freudenberger, Herbert J. (1980). Burn-Out: The High Cost of High Achievement. Anchor Press
• Freudenberger, Herbert J. and North, Gail. (1985). Women’s Burnout: How to Spot It, How to Reverse It, and How to Prevent It, Doubleday
• Heinemann, L.V.; Heinemann, T. (2017). "Burnout Research: Emergence and Scientific Investigation of a Contested Diagnosis". Sage Open. doi:10.1177/2158244017697154.
• 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 (3): 192–207. doi:10.1080/02678370500297720.
• Maslach, C., Jackson, S. E, & Leiter, M. P. MBI: The Maslach Burnout Inventory: Manual. Palo Alto: Consulting Psychologists Press, 1996.
• Maslach, C.; Leiter, M. P. (2008). "Early predictors of job burnout and engagement". Journal of Applied Psychology. 93 (3): 498–512. CiteSeerX 10.1.1.607.4751. doi:10.1037/0021-9010.93.3.498. PMID 18457483.
• Maslach, C. & Leiter, M. P. (1997). The truth about burnout. San Francisco: Jossey Bass.
• 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. PMID 11148311.
• Ray, Bernice (2002). An assessment of burnout in academic librarians in America using the Maslach Burnout Inventor. New Brunswick, NJ: Rutgers University Press.
• Shaufeli, W. B.; Leiter, M. P.; Maslach, C. (2009). "Burnout: Thirty-five years of research and practice". Career Development International. 14 (3): 204–220. doi:10.1108/13620430910966406.
• Shaw, Craig S. (1992). A Scientific Solution To Librarian Burnout. In New Library World Year, 93(5).
• Shirom, A. & Melamed, S. (2005). 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.
• 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 (3): 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
• Warr, Peter. (1999). Psychology at Work, 4th ed. London: Penguin.