Herbert J. Freudenberger (Germany, 1926 – New York, 1999) was the psychologist who described the symptoms of professional burnout after conducting an extensive study on the Burnout Syndrome (from the English burn – to burn + out – to burn out completely, exhaustion or emptiness due to work).
During his work treating chronic addicts in a professional environment that lacked both staff and materials, due to the high emotional demand characterized by the type of work and the exhausting conditions (lack of materials, excessive demand, high tension, and increased difficulty), he began to notice a gradual emotional exhaustion and demotivation in his colleagues, along with physical and psychological symptoms of emotional exhaustion.
In 1980, he published a book on professional burnout with stress as a background theory and a multifactorial concept, making it a reference on the topic.
“The worker stops investing in their work and in the emotional relationship it entails, seemingly becoming incapable of engaging with it. This leads the person to realize they are without the resources to cope with stressful situations.” (Maslach, Jackson, 1981).
It is a persistent form of occupational stress that becomes a chronic disease, a depressive syndrome resulting from excessive or exhausting and stressful working conditions. It is an emotional disturbance with symptoms of extreme exhaustion, stress, and physical burnout resulting from demanding work that requires a high level of competitiveness or responsibility. Overwork is the primary cause, and this syndrome is common among professionals who work daily under pressure and with constant responsibilities, such as doctors, nurses, teachers, police officers, journalists, among others.
Burnout Syndrome can also occur when professionals plan for or are assigned to achieve difficult work goals, situations where the person may feel, for some reason, that they do not have sufficient skills to meet them. This syndrome can lead to a state of deep depression, which is why it is essential to seek professional support when the first symptoms appear. The diagnosis is primarily clinical, performed through the investigation of symptoms or standardized inventories.
It involves:
- Emotional Exhaustion: A lack or deficiency of energy accompanied by feelings of emotional exhaustion, which may manifest physically, psychologically, or as a combination of both. Workers perceive that they no longer have the energy to carry out their activities due to the depletion of their resources.
- Depersonalization: Treating clients, colleagues, and the organization as objects, becoming cold, distant, cynical, and emotionally detached. The most common manifestations are anxiety, increased irritability, loss of motivation, reduced commitment to work goals and results, reduced sense of belonging to the company or job, and alienation from the work environment, including constant criticism, reluctance to engage, and total self-exclusion from the environment leading to self-centered behavior (selfishness).
- Diminished Personal Accomplishment: Feelings of personal and professional inadequacy with a tendency toward negative self-evaluation. Constantly passing from criticism of the work, people, and environment to self-criticism and feelings of worthlessness, reducing the sense of competence, leading to frustration and a feeling of inadequacy in the work environment, culminating in general dissatisfaction with oneself and their work.
Any worker can develop it, but the highest risk and generally greater intensity are found in professionals who have direct contact with others, especially in dealing with emotional, psychological, or trauma-related demands, particularly in the classic trio of healthcare, education, and public safety professionals, who are most affected.
Causes.
Burnout Syndrome is a multidimensional syndrome, and its causes are also multifocal.
- Individual: People with high motivation, excessive dedication, and elevated idealism about their work, as well as those with rigid behavior and high perfectionism.
- Organizational: Companies that offer little organizational support and provide poor working conditions, environments lacking autonomy in oppressive companies, and inadequate salaries, as well as a lack of promotion opportunities.
- Social: Environments that promote social isolation within work and lack a sense of community or belonging to the company or environment. Difficulty or absence of group work, even in multidisciplinary teams (where people work in the same place but without a sense of teamwork or interconnection of knowledge areas, working independently).
The interaction of these factors tends to produce a perception of low professional appreciation, resulting in burnout.
Burnout Syndrome is described in the International Classification of Diseases (ICD-10) – Section XII – Group V – Mental and Behavioral Disorders Related to Work – ICD Z73.0 (Feeling of being finished (Burnout Syndrome; Professional Exhaustion Syndrome)).
Diagnosis.
- The diagnosis of Burnout Syndrome is made by a health professional, either a psychotherapist or a psychiatrist, after a clinical assessment of the patient.
- Psychiatrists and psychologists are the healthcare professionals recommended to identify the issue and guide the best treatment plan, depending on the case.
- Many people do not seek medical help because they do not know or cannot identify all the symptoms, and often neglect the situation without realizing that something more serious may be happening.
- Close friends and family can be good pillars in the beginning, helping the person recognize signs that they need assistance. Within the Unified Health System (SUS), the Psychosocial Care Network (RAPS) is able to provide comprehensive and free treatment, from diagnosis to medication treatment. The Psychosocial Care Centers, one of the services in the RAPS, are the most suitable places for this care.
Measuring Burnout Syndrome.
The most commonly used tool for diagnosis is the MBI (Maslach Burnout Inventory – Maslach, Jackson, 1978), a self-administered inventory with 22 items specifically designed to assess the syndrome based on how the worker experiences their work, without considering the antecedents and consequences of the process. It is part of an analysis of two dimensions (emotional exhaustion and depersonalization), with the third dimension (personal accomplishment) added after a study in 1993.
Symptoms.
Burnout Syndrome involves nervousness, psychological suffering, and physical issues such as stomach pain, excessive fatigue, and dizziness. Stress and a lack of desire to get out of bed or leave the house, when persistent, can indicate the onset of the disease.
The main signs and symptoms that may indicate Burnout Syndrome include:
- Excessive physical and mental fatigue;
- Frequent headaches;
- Appetite changes;
- Insomnia;
- Difficulty concentrating;
- Feelings of failure and insecurity;
- Constant negativity;
- Feelings of defeat and hopelessness;
- Feelings of incompetence;
- Sudden mood changes;
- Isolation;
- Fatigue;
- High blood pressure;
- Muscle pain;
- Gastrointestinal problems;
- Altered heart rate.
These symptoms usually appear mildly but tend to worsen over time. For this reason, many people believe it is something temporary. To avoid more serious problems and complications, it is essential to seek professional support as soon as any sign is noticed. It could be something temporary, or it could be the onset of Burnout Syndrome.
Coping with Burnout.
Objectives and multifactorial change focuses for coping:
- Individual: The most common intervention, focused on the individual and their behavioral and cognitive skills through experimentation and expanding their behavioral repertoire to cope with burnout. This involves working on personal characteristics and emotional responses to stressful situations, health support, quality of life, and social support. Referrals to healthcare professionals, treatment, development of healthy habits, and social support networks (family and professional) are recommended.
- Individual-Organization Relationship: Improves communication, as communication in work environments is often poor and full of noise, which affects productivity, work quality, and consequently the health of workers and teamwork. The focus will be on correcting these dysfunctions within teams.
- Organization: Focuses on organizational management tools, such as training, and promoting changes to physical and environmental conditions in the workplace. Modifying the situations in which activities and work processes are carried out, seeking and promoting more organizational support to make the work environment less harmful to employees’ mental health.
- Combined Interventions: Interventions combining both individual and organizational aspects aim to address each person’s needs and especially promote environmental adjustments to reduce stressors or desensitize them. Environments with a high variability of stressors can cause issues for many people and should be managed to reduce these stressors through prevention, promotion, and treatment actions, especially in preventive coping strategies by involving everyone in discussions and reflections on the problems and structuring changes. Companies with better adjustment and less stressful environments tend to be more productive, and as a result, have higher and more sincere employee commitment, leading to better outcomes.
Treatment.
The treatment for Burnout Syndrome is mainly psychotherapy but may also include medication (antidepressants and/or anxiolytics). Generally, in the early stages, psychotherapy can directly address stressors and how to cope with them, alleviating the symptoms. In more advanced stages, medication will be necessary, but only if the stress-inducing stimuli are removed, otherwise the client may become dependent on the medication and develop the syndrome again once they return to their activities. Treatment typically takes between one and three months, but can last longer depending on the case. Changes in work conditions and, especially, lifestyle habits are essential.
Regular physical activity and relaxation exercises should be routine to relieve stress and control the symptoms of the disease. After a medical diagnosis, it is strongly recommended that the person take a break and engage in leisure activities with close friends, family, spouses, etc.
Detachment from the stress-inducing environment: many people end up taking psychiatric leave from work, which makes them feel better. This is an important window of opportunity for psychotherapy and the development of more resilient behavioral repertoires to return to handling stressful situations and environments, and, most importantly, to act on them or have the conditions to change the environment.
Signs of worsening: Signs of worsening Burnout Syndrome appear when the person does not follow the proper treatment and remains exposed to the stressful environment and situations. Symptoms worsen, including complete loss of motivation and gastrointestinal disturbances. In more severe cases, the person may develop depression, which often indicates the need for hospitalization for detailed evaluation and possible medical interventions.
Prevention.
The best way to prevent Burnout Syndrome is through strategies that reduce stress and pressure at work. Healthy behaviors prevent the disease from developing and also help address signs and symptoms in the early stages.
The main ways to prevent Burnout Syndrome include:
- Set small goals in both professional and personal life;
- Engage in leisure activities with friends and family;
- Do activities that “escape” from the daily routine, such as going for a walk, dining out, or going to the movies;
- Avoid contact with “negative” people, especially those who complain about work or others;
- Talk to someone you trust about what you’re feeling;
- Regular physical activities. This can include going to the gym, walking, running, cycling, rowing, swimming, etc.;
- Avoid alcohol, tobacco, or other drugs as they will only worsen mental confusion;
- Do not self-medicate or take medications without a prescription;
- Reflect on your relationship with work;
- Pay attention to your physical and mental health, undergo regular check-ups, and pursue self-awareness;
Another important prevention tip is getting adequate rest, with at least 8 hours of sleep per night. It’s crucial to maintain a balance between work, leisure, family, social life, and physical activity.
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