Burnout is an oft used buzzword that describes the emotional, social and physiological result of a specific, chronic stressor—typically work. Sufferers describe feeling exhausted, angry and cynical and sometimes suffering from physical symptoms such as headaches or gastrointestinal upset. Feeling better may involve a two- pronged approach in looking at self-oriented interventions while also addressing vocational stress.
What Is Burnout?
Typically, the stressor(s) leading to burnout is work-related, but the effect is understood to cut across both work and personal life with an overall experience of fatigue, identity loss and meaninglessness. While career or job burnout accounts for the majority of literature on the subject, similar experiences of exhaustion and loss of meaning may result from parenting, caretaking responsibilities or even troubled romantic relationships.
Despite the fact that burnout is not a medical diagnosis, the interest in it has increased over the last 40 years. Workplace stress accounts for a 50% increase in medical spending in high stress job environments and over 550 million missed workdays, according to the American Psychological Association.1
The responsibility for treatment is often on the worker rather than organizational mitigation strategies. Additionally, burnout is difficult to identify on an organizational level because the disengagement of the burned out worker may make them more susceptible to failing to use provided resources, such as their PTO, chain of command, Human Resources Department, or EAP.
Burnout & Covid-19
Recently, the Covid-19 pandemic has created poorer delineation between home and work as many workers have been tele-working while facilitating online school for their children. Others are essential workers and subject to fears of exposure in their workplace. Healthcare workers have been considered at increased risk of burnout in general and particularly so in the present healthcare crisis. Increasing loss of control over the work environment or workday, feelings of lack of clarity due to poor communication within workplace teams, lack of community and in many cases an increased workload are creating a situation that is ripe for work burnout for many people.
Defining, Diagnosing, & Measuring Burnout
Literature on the topic of burnout began appearing in 1978 but did not exceed 10 publications per year until 1989, with a significant rise starting in 2005. 2 Studies that attempt to define and diagnose burnout typically look at one of several categories: studies that describe psychological and somatic symptoms, psychometric studies and biomarker research.
There are a number of validated burnout measures that can be used to differentiate burnout from other types of stress, depression and anxiety. One such measure is the MBI. “The Maslach Burnout Inventory (MBI) is considered the ‘gold standard’ for measuring burnout, encompassing 3 scales: emotional exhaustion, depersonalization, and personal accomplishment.”3 In a study of Emergency Medicine residents, the MBI was compared to other wellness measures, and a high MBI score was found to correlate with reductions in quality of life, work-life balance and perceptions of satisfaction with career choice.3
What Is the Difference Between Stress & Burnout?
Work stress may be intermittent or chronic, but the person experiencing the stress mainly experiences anxiety as a result, without losing hope of being able to meet the responsibilities and find relief somewhere in the future. People who report subjective stress are generally driven to work more, not less. Burnout is a chronic condition that results in disengagement, low productivity, depersonalization and often health issues.
Given that “burnout” is not an accepted medical diagnosis, there are not clearly articulated symptoms that lead to a differential diagnosis of burnout versus generalized stress. The need for a discrete diagnosis code for burnout has been debated and currently the constellation of burnout symptoms is categorized as an occupational concern in the ICD11.
Burnout might be classified by a provider as adjustment disorder. The constellation of symptoms is similar but, without a discrete diagnostic category for burnout the diagnosis may vary depending upon the cause.
What Causes Burnout?
Burnout has been associated with the combination of high or unrealistic personal and occupational expectations over an extended period of time with low control, perceived fairness or support. primary drivers of burnout appear to be related to certain occupational factors, as demonstrated in a Gallup survey.
Gallup found the top five reasons for burnout are:
- Unfair treatment at work
- Unmanageable workload
- Lack of role clarity
- Lack of communication and support from their manager
- Unreasonable time pressure1
Personality factors may also serve as risk or protective factors. For example: Emotional stability (the opposite of Neuroticism), Extraversion, Openness to Experience and Conscientiousness are seen as protective factors and are associated with constructive coping.
These coping mechanisms include:
- Active problem solving
- Seeking social support (for instrumental reasons)
- Positively reinterpreting stressful situations
- Acceptance of stressors
Neuroticism, low Agreeableness and low Conscientiousness were risk factors for burnout and are associated with passive coping strategies, such as:
- Venting of emotions
- Denial
- Seeking social support for emotional reasons5
Signs & Symptoms of Burnout
Primary signs and symptoms of burnout are exhaustion, decreased productivity and feelings of powerlessness. Symptoms that may be observable to loved ones include sleep issues, sexual problems, bitterness and loss of empathy. Physical symptoms can include back pain, poor digestion, headache, or more frequent colds.
Often, a person may attempt to combat burnout by increased caffeine, alcohol or drug use. Since the issue with burnout is one of prolonged exposure, the concerns may build up over time and may not be easily recognizable as burn-out. Early warning signs may be written off as a bad mood.
Early warning signs of burnout may include:
- Doctor’s visits for vague complaints
- Irritability/Lack of sense of humor
- Escape fantasies
- Self- pity
- Mistrust of others
- Feelings of guilt
- Feeling time pressured
- Lack of initiative
As the burnout continues unaddressed, the symptoms and consequences become more pronounced.
Serious and persistent burnout may lead to:
- Heart Disease
- Anxiety
- Suicidal Ideation
- Major Depression
- Substance Use Disorder
- Relational Issues
- Poor work performance
Ways to Cope With & Prevent Burnout
Methods of intervening require noticing the signs early and taking action before they become more serious. Creating reasonable boundaries and expectations and developing cognitive strategies that support optimism and self-care are keys to sustained well being. Prevention of burnout necessitates addressing drivers of work stress on an individual and organizational level. Recovery may be complicated by self-sabotaging behaviors and require additional considerations.6
Since employees can have relatively little control on organizational factors, some research has been done to determine what employees can do to improve their approach to work-related demands. These researchers have recognized the value of job crafting: “Job crafting is an important ‘bottom-up’ approach that can be used to train employees to optimize their own work environment themselves, so that they stay engaged.7 In the training, employees who are at risk for burnout may learn to identify the demands and resources in their work environment. Consequently, they learn the principles of job crafting, and make their personal job crafting plan. This plan includes goal setting, such as seeking specific job resources (e.g., asking for feedback and social support), and reducing work pressure and role conflicts.“6
Individual Strategies for Coping With Burnout
For those experiencing burnout in their personal life or while dealing with caregiving or other stressors, these three strategies may help relieve the stress:
1. Develop an Individual Care Plan
- Reduce complexity in your home routine
- Set a “hard stop” for work related communication during family time
- Prioritize sleep and rest
- Get exercise at least 3x/week
- Engage in a hobby at least once/week
- Explore journaling as a self care practice
- Engage in a gratitude or faith based practice
- Eat healthy and stay hydrated
- Explore meditation
2. Seek Community Online or in Person
- Talk to a trusted friend at least once a week for support
- Join a support group—in-person or online
3. Call or Visit a Therapist
A licensed therapist can help you talk through and process what is causing burnout, and can then assist you in developing personalized strategies for mitigating the stress.
Job Crafting for Employee Burnout Prevention
If you are experiencing work burnout, these strategies can help you address the issues and move forward into an effective and productive mindset:
1. Address Lack of Clarity at Work
- Dust off your job description and discuss priorities with your boss
- Review your professional goals and rewrite
2. Address Workload
- Simplify–focus on no more than 3 goals or priorities at a time
- Explore the Pomodoro method of time management
- Structure your day to fit professional goals
3. Address Communication Issues
- Seek out communication at home and work
- Develop and model effective and efficient work communication
When to Get Professional Help for Burnout
You may be able to address burnout on your own with the support of friends, colleagues and loved ones. However, if the burnout you are experiencing is leading to absenteeism, fractured relationships in your work or professional life, physical impairment or suicidal thoughts you should seek professional help.
The difficulty in making this determination is that, in later stages of burnout, you may feel too detached to accurately judge your condition, and you may also undermine your work situation and wellness. “Exhausted employees show self-undermining behaviors, on a daily basis. Additionally, we argue that chronically burned- out employees are less able to manage their own emotions, and more likely to encounter conflicts at work. These self-undermining daily behaviors all contribute to higher daily job demands.”6
Self-Evaluation of Burnout
If you answer “yes” to more than two of the questions in this self evaluation you should at least consider a consultation with a therapist to address burnout:
- Have I missed an increasing number of days of work over the past 3-6 months?
- Have I gotten into more conflicts with my colleagues and/or supervisor lately?
- Have I had to “make up” for my lack of engagement at work by doing an increasing amount of work outside of regular work hours?
- Have I been engaging in escape fantasies while at work more frequently?
- Have I noticed symptoms of depression or anxiety that are impairing my work performance?
- Has my physical health been declining and I have either failed to address it or been given suggestions by my doctor about self-care that I have failed to follow up on?
- Have I stopped caring about my work performance?
Who Should I Consult for Help in Overcoming Burnout?
A licensed mental health professional can help determine whether the issue you are experiencing is burnout or whether there is also depression, anxiety or possibly another concern. They can offer supportive and skill-building therapeutic interventions that can help increase your sense of self efficacy in recovery from burnout. They can also make referrals to a Psychiatrist if a medication evaluation might be indicated, or recommend a Family or Marriage counselor if relational issues are caused by or making burnout worse.
Therapists with a background in integrated/holistic counseling, mindfulness-based counseling, cognitive behavioral therapy and/or career counseling expertise will be able to help with skills and strategies that can help address issues typical in burnout.
Your employer may offer a free Employee Assistance Program which could provide a set number of counseling sessions each year to employees and/or their family members. These sessions are typically provided on the phone or by video. During Covid-19 there has been an expansion of telehealth services which allow you to schedule therapy and Psychiatry services in the comfort of your own home and without the need to travel to an office.
How to Find a Therapist
Therapists can be found through an online directory, a referral from a healthcare provider or through your insurance company. The greatest consideration is whether you feel as though the therapist that you are working with is supportive, empathetic and able to hear your concerns.
Timeline for Treatment
The length of therapy can depend upon the severity of your presenting issue and also the speed of progress. Most therapy is conducted on a weekly basis with an expectation of at least some relief within a 6-12 week timeframe. Sufferers of severe burnout may find that they need to work with a therapist over a more extended period of time, especially if there are also significant work performance or family functioning issues resulting from the burnout.
Cost
Typical costs of therapy range from $60-200 per session, while highly specialized therapists or those in major metropolitan areas may charge more.
How to Support a Loved One Who Is Experiencing Burnout
Loved ones can be instrumental in helping address burnout.
If you loved one is experiencing burnout, consider these actions:
- Encourage your loved one to talk about disconnection and discouragement
- Encourage boundaries around tele-work versus family time
- Help plan healthy meals and activities
- Choose a gratitude or faith practice
- Encourage and plan breaks and social activities
- Actively support therapy
- Explore options for an extended work break or job change
Avoid these well-meaning but harmful behaviors:
- Micro-managing or getting irritated by slow progress
- Taking a stance for or against medication
- Toxic positivity (minimizing the issue) or giving advice
Resources for Dealing With Stress & Burnout
If you or a loved one are dealing with burnout, these resources may be helpful:
- Take a Burnout Assessment
- Find a therapist through an online directory
- Explore healthy living with Blue Zones
- Consider mindfulness apps, like Calm and Headspace
- Figure out your work values for more vocational satisfaction
- Start journaling
